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The reliable preoperative estimation of brain hemispheric asymmetry may be achieved through multiple lateralization indices using functional magnetic resonance imaging. Adding to our previously developed AveLI, we devised a novel threshold-free lateralization index, HomotopicLI, which computes a basic formula, (Left - Right) / (Left + Right), using voxel values of pairs located symmetrically in relation to the midsagittal line as the terms Left and Right, and averages them within the regions-of-interest. The study aimed to evaluate HomotopicLI before clinical applications. Data were collected from 56 healthy participants who performed four language tasks. We compared seven index types, including HomotopicLI, AveLI, and BaseLI; BaseLI was calculated using the sums of voxel values as the terms. Contrary to our expectations, HomotopicLI performed similarly to AveLI but better than BaseLI in detecting right dominance. A detailed analysis of unilaterally activated voxels of the homotopic pairs revealed that unilateral activation occurred more frequently on the right than on the left when HomotopicLI indicated right dominance. The voxel values during right unilateral activation were smaller than those in the left, causing right dominances in the homotopic pairs by HomotopicLI. These unique features provide an advantage in detecting residual, compensative functions spreading weakly in the non-dominant hemisphere.

視床下部過誤腫は抗てんかん薬治療の反応性が乏しい難治性てんかんとして知られており，外科的加療を検討する上でこれを早期に診断する意義は高い．症例は3歳男児．6か月間の抗てんかん薬治療への反応性が乏しかったため，笑い発作の原因精査としてMRIを撮像した．左視床下部・乳頭体が腫瘤状に腫脹しT1及びT2強調像で大脳皮質と等信号を呈しており，視床下部過誤腫と診断した．視床下部過誤腫は発生部位により症状が異なると言われている．本症例の腫瘍は1cm 程度であり，発生部位を意識して撮像し，読影することで早期診断，治療が可能である．, Hypothalamic hamartoma（HH）is known to present with intractable epilepsy or central precocious puberty, which emphasizes the significance of proper diagnosis. Herein, we describe a case of HH associated with gelastic seizures. The patient was a 3-year-old boy who presented with gelastic seizures that poorly responded to antiepileptic drugs for more than 6 months. Magnetic resonance（MR） imaging revealed a hypothalamic mass within the floor of his third ventricle. The lesion appeared isointense to gray matter on both the T1- and T2-weighted images, concordant with the diagnosis of HH. Intrahypothalamic HH often presents with typical gelastic seizures. It is visualized in the coronal plane, whereas parahypothamlamic type is more visible on the sagittal imaging, which leads to precocious puberty. This case demonstrates that obtaining the precise clinical information of the patient before imaging and using the suitable MR plane are key to choosing the appropriate diagnosis and treatment of intrahypothalamic HH.

Background: There are pros and cons regarding the benefit of extended pelvic lymph node dissection (PLND) during surgery for prostate cancer (PCa). A randomized controlled trial failed to demonstrate any survival benefits, and the therapeutic role of PLND remains unclear. We evaluated early survival outcome using a propensity score (PS)-matched analysis. Methods: Three hundred ninety-nine patients with intermediate- to high-risk PCa were enrolled. They were determined to have a lymph node (LN) invasion probability of greater than 7% on the established nomogram. The National Comprehensive Cancer Network classification was used as risk stratification. Biochemical recurrence (BCR)-free survival was compared between the two groups divided by the threshold of the LN yield set at 15. Results: The mean LN yield was 23.7 and 3.4 in the sufficient (n = 217) and insufficient (n = 182) LN yield groups, respectively. In the unmatched cohort, the advantage of the 3-year BCR-free survival for sufficient LN yield remained at 10.0% (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.43-1.07; p = 0.098). In the PS-matched cohort with 133 patients in each group, the difference in the 3-year BCR-free survival rate widened to 15.8% (HR 0.54, 95% CI 0.31-0.93; p = 0.027). A Cox regression multivariate analysis performed on the model with postoperative pathological factors showed an independent predictive value of LN yield. Conclusions: The results demonstrate the therapeutic role of PLND in intermediate- to high-risk PCa. The benefit of PLND depends on the surgeon adhering to the template and removing a sufficient number of LNs in patients with an optimal risk-range.

Background: The current study investigated the relationship between maximum standardized uptake values (SUVmax) on Fluorine-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the plasma cell proliferation percentage in the bone marrow as well as hematological and biochemical test results of patients with multiple myeloma (MM). Moreover, we identified if differences exist in parameters across different types of paraproteins and stages. Material and methods: Patients clinically and pathologically diagnosed with MM between 2012 and 2019 were selected from the database of the Dokkyo Medical University Hospital, Japan. Unsuitable patients were excluded from the current study to avoid false uptake. We examined 60 patients and hematological and biochemical tests were recorded and evaluated. The percentage of plasma cells in bone marrow aspiration samples was calculated. In PET/CT images, the SUVmax of the region of interest of the right posterior ilium (aspiration area) was measured. Relationships were examined using Spearman’s correlation coefficient, and differences were identified using the Kruskal-Wallis test with SPSS. Results: A positive correlation was observed between FDG uptake and the percentage of plasma cells (r = 0.672, P < 0.0001). Conclusion: Increased FDG uptake by bone marrow correlated with the percentage of plasma cells. Somebiochemical and hematological parameters were statistically different according to the stage and types ofparaproteins. PET/CT is suitable for evaluating the condition of a patient and the activity of the MM lesion.

Background/aim 18F-fluorodeoxyglucose (FDG) uptake measurement on positron emission tomography/computed tomography (PET/CT) is difficult in renal tumors because of the nearby renal parenchyma and urinary tract, which excrete FDG. We carefully examined the maximum standardized uptake value (SUVmax) on FDG-PET/CT and investigated the relationship between major glucose transporters in the kidney and clear cell renal cell carcinoma (ccRCC) progression. Patients and methods Forty-five patients with ccRCC underwent FDG-PET/CT for staging and nephrectomy. Glucose transporter mRNA expression was examined in the removed kidney. Results SUVmax was increased in high-stage and high-grade tumors. Glucose transporter 1 (GLUT1) mRNA expression was higher in tumor tissues, in contrast to other glucose transporters. SUVmax was not correlated with GLUT1 mRNA expression. Kaplan-Meier analysis showed reduced overall and recurrence-free survival in the high SUVmax group. Conclusion Primary ccRCC lesions show a high SUVmax and GLUT1 mRNA over-expression. SUVmax increases with tumor upstaging and upgrading.

Objectives: To avoid misunderstandings based on the failure to demonstrate oncological benefit from extended pelvic lymph node dissection (PLND) during radical prostatectomy in a recent randomized controlled trial. We evaluated early survival outcome in contemporary patients with limited to high-risk prostate cancer (PCa) using propensity score (PS)-matched analysis.Materials and Methods: Three-hundred and forty-seven patients with high-risk PCa were enrolled. They were determined to have a lymph node (LN) involvement probability of greater than 5%. Biochemical recurrence (BCR)-free survival was compared between two groups divided by adherence with extended template and timeframe related to improving PLND procedure.Results: The mean LN yield was 23.4 and 2.7, and the positive LN rate was 19.3 and 2.0% in the extended PLND and other groups, respectively. In the entire unmatched cohort, the estimated curve was 13.1% superior in 3-year BCR-free survival for the extended PLND group. The PS-matched cohort was converged in each LN yield group to 99 patients, and the difference in the 3-year BCR-free survival widened to 22.2% (hazard ratio 0.46, 95% confidence interval 0.27-0.80; p=0.005). The statistical difference was consistent in standard high-risk PCa, and was a significant trend in very high-risk PCa. In the analysis of two groups divided by timeframe, the difference in the BCR-free survival was a significant trend.Conclusion: The results possibly demonstrate the therapeutic role of extended PLND in high-risk PCa. Statistical demonstration of benefits depends on the quality of extended PLND and whether the study cohort is the optimal composition of cancer risk.

We present a case of a 35-year-old woman with breast cancer in lactation 3 months after childbirth, in which a lactation inhibitor was useful for 18F-FDG PET/CT examination. Via ultrasonography and biopsy with histopathology, we diagnosed the lesion in the upper region of the left breast as invasive ductal carcinoma. She stopped breastfeeding and was administered cabergoline to suppress lactation. Two days after the administration, 18F-FDG PET/CT revealed segmental uptake (10 cm in diameter) and no lactation-related uptakes. Dynamic MRI also revealed a segmental enhancement of the same size as 18F-FDG PET/CT. The lactation inhibitor was useful to delineate the extent of the lesion during the 18F-FDG PET/CT examination.

Background: A recent randomized controlled trial failed to demonstrate oncological benefit from extended pelvic lymph node dissection (PLND) during radical prostatectomy, while subgroup analysis suggested a potential benefit in high grade prostate cancer (PCa). We evaluated early survival outcome in contemporary PCa patients using propensity score (PS)-matched analysis.Methods: Three hundred and seventy-eight patients with high-risk PCa were enrolled. They were determined to have a lymph node (LN) involvement probability of greater than 5%. The National Comprehensive Cancer Network classification and Johns Hopkins University criteria were used as risk stratification. Clinical stage was determined by assessing digital rectal examination and multiparametric magnetic resonance imaging. Biochemical recurrence (BCR)-free survival was compared between the two groups divided by the threshold of LN yield, which was set at 15.Results: The mean LN yield was 23.9 and 3.4, and the positive LN rate was 20.1% and 2.0% in the sufficient and insufficient LN yield groups, respectively. In the entire unmatched cohort, the estimated curve was 15.6% superior in 3-year BCR-free survival for sufficient LN yield (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.40-0.94; p=0.025). The PS-matched cohort was converged in each LN yield group to 117 patients, and the difference in the 3-year BCR-free survival widened to 24.8% (HR 0.43, 95% CI 0.26-0.74; p=0.002). In the PS-matched analyses of subgroups, the statistical difference was consistent in both standard high-risk PCa (HR 0.43, 95% CI 0.20-0.93; p=0.033) and very high-risk PCa (HR 0.45, 95% CI 0.21-0.96; p=0.040). Conclusions: Our results possibly demonstrate the therapeutic role of PLND in high-risk PCa. The benefit of PLND depends on the surgeon complying with the extended template and removing a sufficient number of LNs in selected patients with an optimal risk-range.

Objective：Transcatheter arterial embolization（TAE）, including uterine artery embolization（UAE）, is effective for the management of obstetric and gynecologic hemorrhage. Some adverse effects have been reported with TAE, such as amenorrhea, endometrial trauma, and subsequent infertility. Herein we report the efficacy and complications of emergent TAE for the management of severe intractable uterine bleeding at our institute.Methods：From 2010 to 2019, thirty-eight patients underwent emergent TAE for intractable uterine bleeding. We evaluated the efficacy and complications of TAE, including a change in menstruation, fertility, and pregnancy outcomes in perinatal patients（group A；n＝23）, and in patients with gynecologic hemorrhage（group B；n＝15）.Results：In group A, 7 cases of retained placenta, 4 cases of postpartum hemorrhage, 2 cases of placenta accrete, 2 cases of uterine artery pseudoaneurysm, 2 cases of cervical pregnancy, 1 case of cesarean scar pregnancy, and 5 cases of unexplained hemorrhage were included. The median age of the group A was 37. In group B, 4 cases of uterine artery pseudoaneurysm, 2 cases of uterine arteriovenous malformation, 3 cases of uterine fibroids, 1case of adenomyosis, and 5 cases of unexplained hemorrhage were included. The median age of the group B was 39. The first attempt at TAE successfully controlled hemorrhage in 33 of 38 patients （86.8％）without major complications, and the remaining 5 patients required an additional attempt at TAE to control hemorrhage. One patient（2.6％）had transient buttock pain and foot ischemia. Among the 33 patients who had adequate follow-up care, all patients resumed regular menstruation. The median time to resume regular menstruation after TAE was 3 months （range, 1-13 months）in group A（n＝20）and 1 month（range, 1-6 months）in group B（n＝13）. Four of patients had 6 pregnancies in total：3 full-term live births, 2 missed abortions, and 1 artificial abortion. Among the 13 patients who desired pregnancy, 3（23％）conceived spontaneously.Conclusions：This retrospective study showed that emergent TAE may be effective and safe in treating intractable uterine bleeding with a high success rate. Ovarian and endometrial function were preserved based on the relatively early return of menstruation. Further prospective investigations with large number of patients are needed to confirm the preservation of ovarian function, fertility, and pregnancy outcome in reproductive-aged women.

Aim：To assess the index lesions（the largest and clinically significant ones）in cases of surgically confirmed prostate cancer（PCa）using a multi-parametric MRI at 3 tesla and to evaluate the relationships between the clinical-pathological features of index PCas and cancer visualization. Materials and Methods：This retrospective study included 67 patients who had undergone roboticassisted radical prostatectomy. Two radiologists reviewed the MRIs（axial and coronal T2-weighted imaging, diffusion-weighted imaging（DWI）with apparent diffusion coefficient mapping and dynamic contrast enhancement MRI（DCEI））. The patients were divided into 4 groups as follows：detected on all 3 sequences（A）, on 2 of 3 sequences（B）, on 1 of 3 sequences（C）, and on none of them（D）. In all groups, all PCa characteristics were assessed, including the PSA level, Grade Group（GG）based on the Gleason score（GS）, the D’Amico criteria, and the maximum tumour length（TL）of the biopsy specimen. Results：Of the 67 patients, 16 were high-risk according to the D’Amico criteria, and 15 of these 16 high-risk patients（94％）belonged to either Group A or Group B. In addition, the mean TL and GG were longer and higher, respectively, in Group A than in the other groups（p＜0.05）. Furthermore, in Group B, 3 of the 4 high-risk patients（75％）were detected using DWI and DCEI. The lesions detected using DWI and DCEI had higher GSs and were in a higher GG. Conclusion：PCas of pathologically higher grades and clinically higher risk were more readily detectableusing multiple parameters.

Forty-five patients with ccRCC underwent FDG-PET/CT for staging and nephrectomy. Glucose transporter mRNA expression was examined in the removed kidney.SUVPrimary ccRCC lesions show a high SUV

Objective This multicenter, phase II clinical trial evaluated the diagnostic performance of 18F-fluciclovine, a novel amino acid for positron-emission tomography (PET), for detection of small lymph node metastases with short-axis diameters of 5-10 mm in patients with prostate cancer. Methods Patients with prostate cancer were eligible after screening of laboratory tests and pelvic contrast-enhanced computed tomography (CT). Pelvic region 18F-fluciclovine PET/CT was then acquired within 28 days and dissection of regional lymph nodes was performed within 60 days of pelvic contrast-enhanced CT. Diagnostic performance of 18F-fluciclovine-PET/CT was evaluated by comparison with standard histopathology of lymph nodes. Results In a total of 28 patients, 40 regional lymph nodes with short-axis diameters of 5-10 mm were eligible for efficacy evaluation; seven of these showed metastases confirmed by histopathology. The sensitivity of 18F-fluciclovine PET/CT was 57.1% (4/7). All four true positive lymph nodes detected by 18F-fluciclovine PET/CT had a metastatic lesion with a long-axis diameter of ≥7 mm and a high proportion of cancer volume (60-100%) according to pathology evaluation. The specificity, diagnostic accuracy, positive predictive value, and negative predictive value of 18F-fluciclovine PET/CT in lymph node-based analysis were 84.8% (28/33), 80.0% (32/40), 44.4% (4/9), and 90.3% (28/31), respectively. No clinically significant adverse events occurred. Conclusions 18F-fluciclovine PET/CT detected small lymph node metastases; however it also showed positive findings in benign lymph nodes. Refinement of the image assessment criteria may improve the diagnostic performance of 18F-fluciclovine PET/CT for small lymph node metastases in patients with prostate cancer.

Background: The present study investigated the relationship between maximum standardized uptake values (SUVmax) on Fluorine-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the plasma cell (PC) proliferation percentage in the bone marrow (BM) of patients with multiple myeloma (MM).Material and methods: Patients clinically and pathologically diagnosed with MM between January 2012 and October 2019 were selected from the database of Dokkyo Medical University Hospital (DMU Hospital), Japan. Patients with other malignancies and those who received chemotherapy and radiation therapy or hematopoietic treatments in the previous 4 weeks and 2-3 months prior to PET/CT scans were excluded from the present study to avoid false uptake. We examined 60 patients (female: male; 27:33; 1:1.22) aged between 37 and 91 years; mean ± SD; 67.3 ± 10.2 years. Hematological and biochemical tests with results on hemoglobin (Hb), hematocrit (Ht), C reactive protein (CRP), beta-2 microglobulin (b2m), creatinine (Cre), albumin (Alb), calcium (Ca), white blood cells (WBC), and red blood cells (RBC) were recorded and evaluated. The percentage of PC in BM biopsy samples was calculated. On PET/CT images, the SUVmax of the region of interest (ROI) of the right anterior iliac crest, the biopsy site, was measured. Relationships were examined using Pearson’s correlation coefficient with SPSS.Results: The types of MM diagnosed were IgGk in 31 patients (51.6%), IgGλ in 19 (31.6%), IgAλ in 5 (8.3%), IgAk in 2 (3.3%), IgDλ in 2 (3.3%), and IgDk in 1 (1.6%). According to the Durie-Salmon staging system, 4 patients had stage I, 6 stage II, and 33 stage III, while stages were not recorded in the remaining 17 patients. A positive correlation was observed between FDG uptake and the percentage of PC (r=0.7, pConclusion: Increased FDG uptake by BM correlated with the percentage of PC. PET/CT is crucial for the diagnosis, treatment evaluation, and follow-up of MM patients.

Liposarcoma of the uterine corpus is extremely rare. We performed a laparotomy on a 55-year-old woman with the complaints of abdominal distension and genital bleeding who was found to have a uterine tumor, 17 × 16 cm in diameter. The preoperative diagnosis was a lipoma or lipoleiomyoma of the uterine corpus. However, pathological examination revealed proliferation of mature adipocytes and lipoblast-like atypical cells with small, weakly pleomorphic nuclei and foamy or vacuolated cytoplasm present within a fibrous septum. Immunohistochemistry showed that the tumor cells were focally positive for mouse double minute 2 homolog (MDM2). The final pathological diagnosis was a well-differentiated liposarcoma of International Federation of Gynecology and Obstetrics (FIGO) stage IB (pT1bNxM0). On magnetic resonance imaging (MRI), T1 -weighted and fat-saturated images showed high and low intensity in the tumor, respectively, suggesting that this tumor contained a fat component. The septum inside the tumor had a contrast enhancement on T1-weighted, gadolinium-enhanced imaging. The septum was nonuniformly thickened and partially nodular. In hindsight, these findings may have suggested a well-differentiated liposarcoma in the uterine corpus rather than a lipoma or lipoleiomyoma. Clinicians should be aware of the possibility of a liposarcoma of the uterine corpus when a neoplasm contains adipose tissue and a nonuniformly thickened or partially nodular septum on MRI., Highlights • A rare case with a well-differentiated liposarcoma originating from uterine corpus. • The tumor cells were positive for MDM2 and S-100 protein. • On MRI, T1WI and T2WI showed high intensity in the tumor with fat- suppression. • The septum inside the tumor had a low signal on T1WI with contrast enhancement. • The septum was nonuniformly thickened and partially nodular.

To analyse the quantitative changes of the prostate and seminal vesicles (SV) on magnetic resonance imaging (MRI) after ejaculation. Ten healthy young males were enrolled for T2-weighted and T2 mapping MRI before and after two consecutive ejaculations. T2 values of the peripheral zone (PZ) and the central gland (CG) at the midgland of the prostate were compared before and after ejaculation, respectively. T2 values of the PZ at the apex and base were also compared before and after, respectively. Pre- and post-ejaculation SV volumes were compared. The Wilcoxon’s signed rank test with Bonferroni adjustment was used for comparison. After ejaculation, T2 values of the PZ significantly decreased (mean, 119±20 vs. 105±21, p=0.002) while those of the CG did not significantly change at the midgland. At the apex, T2 values of the PZ also decreased significantly (mean, 114±9 vs. 94±7, p=0.002). On the other hand, T2 values of the PZ did not change at the base. SV volumes were significantly reduced after ejaculation (mean, 11.1±7.7mL vs. 7.2±6.7mL, p=0.002). Ejaculation decreases T2 values of the PZ at the midgland and apex, and reduces SV volumes. Abstinence periods should be considered in evaluating the prostate and SV on MRI. • T2 values decrease after ejaculation in the apical-mid peripheral zone. • Ejaculation does not affect T2 values of the central gland. • Volume of the seminal vesicles decreases after ejaculation. • An abstinence period should be considered before pelvic MRI in men.

A major challenge in computing the lateralization index (LI) of functional magnetic resonance imaging (fMRI) is the change in the index value according to the threshold applied and the task employed. To address this problem, we previously developed a threshold-free index called AveLI. AveLI is the average of the sub-LIs that are computed at all positive intensity values as the threshold. Thus, the algorithm has an intrinsic weighting on higher values due to the repeated involvement of the sub-LIs, and simultaneously also includes the lower intensities. While our previous study suggested the adequate reproducibility of AveLI between two tasks, we herein aimed to further investigate it using four different language tasks. We endeavored to include left-handed people to obtain a greater proportion of right hemisphere dominance in the 47 healthy participants analyzed. To characterize AveLI, we compared a total of six LI types including an index with a threshold and one with no threshold or weighting. We confirmed that AveLI had the highest reproducibility among all LI types examined. This was due to the use of the algorithm with weighting. A conventional LI with a threshold exhibited less reproducibility than AveLI, despite its ability to detect the left and right dominances to a similar extent as AveLI. This discrepancy suggested that AveLI encompassed an intrinsic lateralization that was hidden in the lower intensities, whereas the LI with the threshold omitted it to provide a task-specific lateralization.

Diagnostic imaging is undoubtedly important in modern medicine, and final clinical decisions are often made based on it. Fortunately, Japan has the highest numbers of diagnostic imaging instruments, such as CT and MRI devices, and boasts easy access to them as well as a high level of diagnostic accuracy. In consequence, a very large number of imaging examinations are performed, but diagnostic instruments are installed in so many medical facilities that expert management of these examinations tends to be insufficient. Particularly, in order to avoid risks, clinicians have recently become indifferent to indications of imaging modalities and tend to rely on CT or MRI resulting in increasing the number of imaging examinations in Japan. This is a serious problem from the viewpoints of avoidance of unnecessary exposure and medical economy. Under these circumstances, the Japan Radiological Society and Japanese College of Radiology jointly initiated the preparation of new guidelines for diagnostic imaging. However, the field of diagnostic imaging is extremely wide, and it is impossible to cover all diseases. Therefore, in drafting the guidelines, we selected important diseases and focused on "showing evidence and suggestions in the form of clinical questions (CQs)" concerning clinically encountered questions and "describing routine imaging techniques presently considered to be standards to guarantee the quality of imaging examinations". In so doing, we adhered to the basic principles of assuming the readers to be "radiologists specializing in diagnostic imaging", "simultaneously respecting the global standards and attending to the situation in Japan", and "making the guidelines consistent with those of other scientific societies related to imaging". As a result, the guidelines became the largest ever, consisting of 152 CQs, nine areas of imaging techniques, and seven reviews, but no other guidelines in the world summarize problems concerning diagnostic imaging in the form of CQs. In this sense, the guidelines are considered to reflect the abilities of diagnostic radiologists in Japan. The contents of the guidelines are essential knowledge for radiologists, but we believe that they are also of use to general clinicians and clinical radiological technicians. While the number and contents of CQs are still insufficient, and while chapters such as those on imaging in children and emergency imaging need to be supplemented, the guidelines will be serially improved through future revisions. Lastly, we would like to extend our sincere thanks to the 153 members of the drafting committee who authored the guidelines, 12 committee chairpersons who coordinated their efforts, six members of the secretariat, and affiliates of related scientific societies who performed external evaluation.

A 26-year-old woman presented to our hospital with right costovertebral angle (CVA) pain. Ultrasonographyand computed tomography(CT) scan indicated right hydronephrosis, and MAG3 renogram showed an obstructed pattern in the right kidney. Enhanced CT scan revealed an ureteropelvic junction obstruction (UPJO) with an aberrant vessel. To clarifythe ureteropelvic junction (UPJ) structure in detail, we utilized 3D-CT with retrograde pyelography (RP), which further revealed the true pinhole ureteral stricture of UPJ unaffected bythe aberrant vessel.

Background Many urologic surgeons refer to biopsy core details for decision making in cases of localized prostate cancer (PCa) to determine whether an extended resection and/or lymph node dissection should be performed. Furthermore, recent reports emphasize the predictive value of prostate-specific antigen density (PSAD) for further risk stratification, not only for low-risk PCa, but also for intermediate- and high-risk PCa. This study focused on these parameters and compared respective predictive impact on oncologic outcomes in Japanese PCa patients. Methods Two-hundred and fifty patients with intermediate- and high-risk PCa according to the National Comprehensive Cancer Network (NCCN) classification, that underwent robot-assisted radical prostatectomy at a single institution, and with observation periods of longer than 6 months were enrolled. None of the patients received hormonal treatments including antiandrogens, luteinizing hormone-releasing hormone analogues, or 5-alpha reductase inhibitors preoperatively. PSAD and biopsy core details, including the percentage of positive cores and the maximum percentage of cancer extent in each positive core, were analyzed in association with unfavorable pathologic results of prostatectomy specimens, and further with biochemical recurrence. The cut-off values of potential predictive factors were set through receiver-operating characteristic curve analyses. Results In the entire cohort, a higher PSAD, the percentage of positive cores, and maximum percentage of cancer extent in each positive core were independently associated with advanced tumor stage ≥ pT3 and an increased index tumor volume > 0.718 ml. NCCN classification showed an association with a tumor stage ≥ pT3 and a Gleason score ≥8, and the attribution of biochemical recurrence was also sustained. In each NCCN risk group, these preoperative factors showed various associations with unfavorable pathological results. In the intermediate-risk group, the percentage of positive cores showed an independent predictive value for biochemical recurrence. In the high-risk group, PSAD showed an independent predictive value. Conclusions PSAD and biopsy core details have different performance characteristics for the prediction of oncologic outcomes in each NCCN risk group. Despite the need for further confirmation of the results with a larger cohort and longer observation, these factors are important as preoperative predictors in addition to the NCCN classification for a urologic surgeon to choose a surgical strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0238-y) contains supplementary material, which is available to authorized users.

Although prostate cancer MR imaging (MRI) has advanced as a result of the improvement in hardware technology and the development of software for clinical use, including multi-parametric MRI(MP-MRI), which has been recognized as a useful tool, the ability of MP-MRI to diagnose prostate cancer has not been improved dramatically. To standardize the reporting system of MP-MRI of the prostate, the European Society of Urogenital Radiology published a prostate imaging reporting and data system (PI-RADS) in 2012. Objective evaluation is very important, but inter-reader agreement of PI-RADS scoring is not so high. In 2014, it was revised as the PI-RADS version 2. This new system is being assessed now. Prostate MRI has great potential to optimize clinical practice in patients with this type of cancer, not only in terms of cancer detection but also cancer localization before biopsy or operation, monitoring active surveillance patients, etc.

A 69-year-old man with lung cancer underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for staging. FDG PET/CT showed high uptakes in the prostate gland with calcification, and magnetic resonance imaging was recommended to check the prostatic malignancy. T2-weighted images revealed midline cystic lesion at the base to midgland level and cystic lesion in right apical peripheral zone. We suspected urine reflux conditions. Voiding cystourethrography demonstrated those cystic lesions were communicating with the urethra. Therefore these lesions were diagnosed as the prostatic utricle cyst and the dilated prostatic duct in peripheral zone. We conclude that the urine reflux condition should be recognized as a prostate benign lesion with FDG accumulation.

We present a case of renal metanephric adenoma (MA) mimicking papillary renal cell carcinoma (PRCC) on computed tomography (CT). In the present case, double-phase enhanced CT showed a hypovascular right renal tumor with gradual and prolonged enhancement. The renal tumor was surgically removed. Histological examination of the resected specimen showed renal MA. Although the radiological features of renal MA have been described by some authors, only a few reports have mentioned the pattern of enhancement on multiphase enhanced CT. The pattern of enhancement of a renal tumor is likely to be correlated with its pathological features. Since renal MA is thought to be genetically related to PRCC, these two tumors are likely to demonstrate similar radiological features, so that differentiating between them becomes difficult. In patients with a hypovascular renal mass that shows gradual and prolonged enhancement on multiphase enhanced CT, the diagnosis of renal MA should be considered.

We investigated whether intraoperative radiotherapy (IORT) during curative surgery for esophageal carcinoma is useful or not. The cases of 117 patients diagnosed with thoracoabdominal esophageal carcinoma who underwent curative surgery between 1986 and 2007 were reviewed: 72 patients received IORT (IORT group) and 45 did not (non-IORT group). Upper abdominal lymphadenectomy was performed in 115 patients (98.5%). Seventy patients (59.8%) received chemotherapy and 80 patients (68.4%) received external radiotherapy. IORT encompassed the upper abdominal lymph node area. A single-fraction dose of 20–30 Gy was delivered using high-energy electrons. Median follow-up duration for patients was 7.4 years. The 5-year overall survival rate did not significantly differ between the IORT and non-IORT groups. However, the 5-year abdominal control rate was significantly higher in the IORT group (89.2%) than in the non-IORT group (72.9%; P = 0.022). We next focused on a patient subgroup with a primary lesion in the lower thoracic or abdominal esophagus or measuring >6 cm in length since this subgroup is probably at high risk of upper abdominal lymph node metastasis. Of the 117 patients, 75 belonged to this subgroup, and among them 45 received IORT. Both univariate and multivariate analysis revealed the survival rate was significantly higher in patients who received IORT than in those who did not (P = 0.033 univariate; 0.026 multivariate). There were no obvious perioperative complications solely attributed to IORT. IORT for esophageal carcinoma will likely be effective for patients with a primary lesion in the lower thoracic or abdominal esophagus, or with a long lesion.

The purpose of this study was to use serial CT observations to characterize early-stage lung cancer in patients with chronic interstitial pneumonia.We found 23 lung cancers in 22 patients during routine follow-up of chronic interstitial pneumonia between 1999 and 2010. Patients with lung cancer found at initial CT were excluded. Two radiologists independently reviewed serial CT scans, determined the earliest scan showing lung cancer, and evaluated the tumor shape, size, density, and location. Delay in diagnosis was measured from the time of the earliest scan showing lung cancer and the subsequent clinical diagnosis.During the mean follow-up period of 4.1 years, CT scans were obtained eight times on average. The median tumor size at presentation was 11 mm, and at clinical diagnosis was 22 mm. The median delay in diagnosis was 409 days. Fifteen tumors (65.2%) were in the interface between normal and fibrotic lung cysts (honeycomb cysts, paraseptal emphysema, and traction bronchiolectasis), four were in the area of ground-glass opacity, and one was in the midst of honeycomb cysts. Twelve tumors were round or oval, eight tumors had an ill-defined stellate shape, and two had a bandlike shape. One tumor appeared as an area of ill-defined increased lung attenuation.Nearly one half of the tumors had a stellate or bandlike shape and were difficult to recognize as tumors initially. Most of the tumors were located at the interface between normal lung and fibrotic cysts; only rarely were tumors located in the midst of honeycomb cysts.

The purpose of this study was to identify independent CT findings that correlated with pulmonary function tests (PFTs) in patients with obstructive airway diseases.Sixty-eight patients with obstructive airway disease and 29 normal subjects (mean age, 52 years; 36 men and 61 women) underwent inspiratory and expiratory thin-section CT and PFTs. Patient with obvious emphysema was excluded. Two radiologists independently reviewed the images and semi-quantitatively evaluated lung attenuation (mosaic perfusion, air trapping) and airway abnormalities (extent and severity of bronchial wall thickening and bronchiectasis, bronchiolectasis or centrilobular nodules, mucous plugging). Univariate, multivariate and receiver operating characteristic (ROC) analyses were performed with CT findings and PFTs.Forty-two patients showed obstructive PFTs, 26 symptomatic patients showed near-normal PFTs. On univariate analysis, air trapping and bronchial wall thickening showed highest correlation with obstructive PFTs such as FEV1.0/FVC, MMEF and FEF75 (r ranged from -0.712 to -0.782; p0.001), while mosaic perfusion and mucous plugging showed moderate correlation, and bronchiectasis, bronchiolectasis and nodules showed the least, but significant, correlation. Multiple logistic analyses revealed air trapping and bronchial wall thickening as the only significant independent determinants of obstructive PFTs. ROC analysis revealed the cut-off value of air trapping for obstructive PFTs to be one-third of whole lung (area under curve, 0.847).Our study confirmed air trapping and bronchial wall thickening are the most important observations when imaging obstructive PFTs. The cut-off value of air trapping for identifying obstructive PFTs was one-third of lung irrespective of inspiratory CT findings.

The purpose of this article is to review fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) findings in a variety of benign, malignant, and borderline malignant ovarian tumors. It is advantageous to become familiar with the wide variety of FDG-PET/CT findings of this entity. Benign ovarian tumors generally have faint uptake, whereas endometriomas, fibromas, and teratomas show mild to moderate uptake. Malignant ovarian tumors generally have intense uptake, whereas tumors with a small solid component often show minimal uptake.

To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) with iodinated contrast agent and (18)F-fluorodeoxyglucose (FDG) in the diagnosis of suspected uterine cancer recurrence and to assess the impact of PET/CT findings on clinical management, compared with PET alone and enhanced CT alone.Of 103 women who had undergone treatment for histopathologically proven uterine cervical or endometrial cancer, 90 underwent FDG-PET/contrast-enhanced CT examination for suspected recurrence. PET-alone, CT-alone, and fused PET/CT images were interpreted by two radiologists by consensus for each investigation. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months. Differences among the three modalities were tested using the Cochran Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment.Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET alone were 79.5% (35/44), 73.9% (34/46), and 76.7% (69/90), respectively, whereas those of CT alone were 68.2% (30/44), 87.0% (40/46), and 77.8% (70/90), respectively, and those of PET/CT were 90.9% (40/44), 93.5% (43/46), and 92.2% (83/90), respectively. PET/CT findings resulted in a change of management in 38 of the 90 patients (42%) with an additional effect on patient management in 13 patients (14%) diagnosed by CT alone and 14 patients (16%) diagnosed by PET alone.FDG-PET/contrast-enhanced CT is a more accurate modality for assessing recurrence of uterine cancer, and led to more appropriate subsequent clinical management than that resulting from PET alone or enhanced CT alone.

The objective of our study was to evaluate serial CT changes from normal or near-normal lungs to honeycomb lungs in dust-exposed patients who developed chronic interstitial pneumonia.From the records of the national hospital for pneumoconiosis, we retrospectively identified patients with chronic interstitial pneumonia who were under surveillance between 1986 and 2006. All patients occasionally underwent chest CT for evaluation of silicosis or exclusion of possible complications. Patients were included in this study only if the initial CT examination did not show obvious chronic interstitial pneumonia. Fourteen patients (all men; median age at initial CT, 58 years) were identified as meeting the inclusion criterion. Two independent reviewers randomly reviewed the CT scans of the study patients to score the extent of ground-glass opacity, reticulation, and honeycombing; to provide a summation of all interstitial opacities (fibrosis score); and to assess coarseness.Autopsy findings were available for eight of the 14 patients and confirmed the usual interstitial pneumonia (UIP) pattern seen on CT. The median follow-up period was 15.4 years, and none of the patients experienced acute exacerbation. One hundred two CT scans were reviewed. The earliest CT abnormalities included faint ground-glass opacity limited to the lung bases (n = 13) or only coarse reticular opacity (n = 1). In 13 patients, fibrosis and coarseness progressed linearly, whereas the other opacities did not. The annual increase of the fibrosis score and coarseness ranged from 0.306% to 4.633% and 0.179 to 0.479, respectively. Honeycombing developed in all patients over a median period of 12.1 years (range, 3.7-19.1 years).The coarseness best represented the progression of chronic interstitial pneumonia in dust-exposed patients. The earliest CT finding of a UIP pattern in dust-exposed patients was indistinguishable from other types of chronic interstitial pneumonia.

The purpose of the study is to evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) with (18)F-fluorodeoxyglucose (FDG) with IV contrast for preoperative staging of ovarian cancer, in comparison with enhanced CT, using surgical and histopathological findings as the reference standard.Forty patients with ovarian cancer underwent FDG-PET/contrast-enhanced CT scans for staging before primary debulking surgery. PET/CT and the CT component separately, were interpreted by two experienced radiologists by consensus for each investigation. Status with regard to lesion inside and outside the pelvis was determined on the basis of histopathology. The significance of differences between the two imaging modalities was determined using the McNemar test.Staging revealed stage I in 18 patients (IA, n=9; IB, n=3; IC, n=6), stage II in seven (IIA, n=2; IIB, n=3; IIC, n=2), stage III in 14 (IIIA, n=1; IIIB, n=3; IIIC, n=10), and stage IV in one. The results of CT and PET/CT were concordant with the final pathological staging in 22 out of 40 (55%) and 30 out of 40 (75%) cases, respectively. The overall lesion-based sensitivity improved from 37.6% (32 out of 85) to 69.4% (59 out of 85), specificity from 97.1% (578 out of 595) to 97.5% (580 out of 595), and accuracy from 89.7% (610 out of 680) to 94.0% (639 out of 680) between CT and PET/CT. There were significant differences in sensitivity and accuracy, with p values of 5.6 x 10(-7) and 1.2 x 10(-7), respectively.Integrated FDG-PET/contrast-enhanced CT is a more accurate imaging modality for staging ovarian cancer and useful for selecting appropriate treatment than enhanced CT.

To assess the effect of age, size, the degree of degeneration, and contrast enhancement on magnetic resonance imaging (MRI) on 18F-fluoro-2-deoxyglucose (18F-FDG) uptake in uterine leiomyomas using quantitative standardized uptake values (SUVs).A total of 61 leiomyomas of 41 patients, who underwent combined positron emission tomography/computed tomography (PET/CT) using 18F-FDG and contrast-enhanced MRI were included in this study. Sixty-one leiomyomas were divided into two groups: "non-degenerated" leiomyomas showing distinct low signal intensity on T2-weighted images and intermediate signal intensity on T1-weighted images, and "degenerated" leiomyomas showing other types of signal intensity. Sixty-one leiomyomas were also divided into two groups of "strongly enhancing" leiomyomas and "weakly enhancing" leiomyomas in terms of their degree of contrast enhancement on MRI.The mean values of the maximum and average SUVs for the total of 61 leiomyomas were 2.34 +/- 0.75 (range 1.59-5.15) and 1.74 +/- 0.50 (0.66-3.95), respectively. There was a moderate negative correlation between the maximum and average SUVs and age (r = -0.43 and P = 0.00016, r = -0.31 and P = 0.029, respectively). Although there was a mild positive correlation between maximum SUV and size (r = 0.35 and P = 0.011), there was no significant difference between average SUV and size. Although there was no significant difference in average SUV between "degenerated" and "non-degenerated" leiomyomas, the maximum SUV of "degenerated" leiomyomas was significantly higher than that of "non-degenerated" leiomyomas (P = 0.0012). The degree of contrast enhancement on MRI was not significantly correlated with 18F-FDG uptake.Mild or moderate uptake of 18F-FDG is often observed in uterine leiomyoma and declines with age, and should not be confused with malignant accumulation.

We report a case of colitic cancer detected by target biopsies at surveillance colonoscopy in a patient with long-standing and extensive ulcerative colitis. At first, the detected colitic cancer was removed by endoscopic mucosal resection as the patient refused surgical resection. However, total proctocolectomy with an ileal-J-pouch anal anastomosis was performed additionally after informed consent had been obtained from the patient, as the resected specimen included invasive cancer histologically. Surprisingly, histologic examination of the surgical specimens revealed another flat invasive colitic cancer and 2 microcarcinoids, which were not detectable by preoperative colonoscopy or by macroscopic investigation of the surgically resected specimen. The occurrence of carcinoid in patients with ulcerative colitis has been reported only sporadically. In addition, coexistence of colitic cancer and carcinoids is extremely rare. Cases of this rare combination reported previously in the English literature are summarized and discussed.

The purpose is to evaluate the accuracy of integrated FDG-PET/CT, compared with PET alone, for diagnosis of suspected recurrence of uterine cervical cancer. Fifty-two women who had undergone treatment for histopathologically proven cervical cancer received PET/CT with suspected recurrence. PET-alone and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each investigation. A final diagnosis was confirmed by histopathology, radiological imaging, and clinical follow-up for over 1 year. Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 92.0% (23/25), 92.6% (25/27), and 92.3% (48/52), respectively, while for PET, the corresponding figures were 80.0% (20/25), 77.8% (21/27), and 78.8% (41/52), respectively. PET/CT resolved the false-positive PET results due to hypermetabolic activity of benign/inflammatory lesions and physiological variants, and was able to detect lung metastasis, local recurrence, peritoneal dissemination, para-aortic lymph node metastasis, and pelvic lymph node metastasis missed by PET alone. However, tiny local recurrence and lymph node metastasis could not be detected even by PET/CT. FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with cervical cancer.