Abstract: Our aim was to prospectively investigate the contrast agent concentration and the infusion rate to obtain optimal images of the Adamkiewicz artery by 64-row MDCT. Eighty patients were divided into four groups based on the following protocol: A, 100 mL of 300 mg I/mL at 5.0 mL/s; B, 100 mL of 350 mg I/mL at 5.0 mL/s; C, 100 mL of 300 mg I/mL at 3.5 mL/s; D, 100 mL of 350 mg I/mL at 3.5 mL/s. Quantitative evaluation was performed by calculating mean aortic attenuation value from T5 to L3 level. Visual evaluation of the Adamkiewicz artery was also performed. In a quantitative evaluation, the rapid injection (A, 473.4 +/- 82.6 HU; B, 506.7 +/- 71.9 HU) was significantly superior to the slow injection (C, 371.3 +/- 65.1 HU; D, 391.5 +/- 60.8 HU). In a visual evaluation, the Adamkiewicz artery was assessable in 15 of 20 (75%), 16 of 20 (80%), 9 of 20 (45%), and 10 of 20 (50%) patients in groups A, B, C, and D, respectively. The injection protocol of 1.75 g iodine/s provides both the adequate aortic attenuation of more than 450 HU to assess the Adamkiewicz artery and the best visualization of the Adamkiewicz artery in 64-row MDCT.
Abstract: BACKGROUND: The association between a gadolinium-based contrast material and nephrogenic systemic fibrosis has been discussed. The purpose of our study was to evaluate whether non-contrast enhanced magnetic resonance angiography (MRA) might provide sufficient information of renal artery stenosis. METHODS AND RESULTS: The non-contrast MRA of 26 patients with hypertension was retrospectively reviewed in the present study. The significant renal artery stenosis was visually evaluated by comparing non-contrast MRA with computed tomography or conventional angiographic finding. Difference of the intensities between the proximal and distal aorta was quantitatively evaluated. The sensitivity, specificity, positive predictive value and negative predictive value of non-contrast MRA in the evaluation of the renal artery stenosis was 78%, 91%, 64% and 96%, respectively. The distal abdominal aorta showed less signal intensity than the proximal aorta by 16.9+/-12.2%. CONCLUSIONS: Non-contrast MRA is a non-invasive and effective method that allows evaluation of the renal artery stenosis.
Abstract: A single coronary artery is a rare and potentially serious anomaly. We present the case of a 54-year-old woman with chest pain predominantly at rest. A single coronary artery was demonstrated by 64-row multidetector computed tomography (CT) imaging, which is useful for the diagnosis and classification of coronary anomaly. In our case, no coronary artery stenosis was demonstrated on CT angiographic images, and totally occlusive coronary spasm was confirmed by intracoronary infusion of acetylcholine.
Abstract: We present a case of a 19-year-old male patient complaining of right leg pain, which appeared after exercise and abated with rest. Computed tomography (CT) and magnetic resonance angiography (MRA) showed occlusion of right popliteal artery. Volume rendering CT image showed not only occlusion of right popliteal artery but also abnormal course of the medial head of the gastrocnemius muscle (MHG). CT and MR images of right popliteal fossa showed the abnormal anatomy that MHG coursed between popliteal artery with thrombus and popliteal vein. Popliteal artery entrapment syndrome was diagnosed non-invasively by multidetector CT and MRI. Sectional radiological and three-dimensional images are useful for not only depiction of the arterial changes but also identification of the abnormal anatomic structures responsible for the entrapment.
Abstract: Malignant fibrous histiocytoma of the thoracic aorta associated with ulcer-like projection has not been reported previously. The hypovascular tumor of the thoracic aorta involved the mural layer, which showed intra- and extra-mural growth patterns and no significant filling defect within the aortic lumen, and mimicked ulcer-like projection with secondary pseudoaneurysm formation. Aortic tumor, although rare, should be included among the causes of an ulcer-like projection.
Abstract: Coronary computed tomography (CT) angiography (CTA) and myocardial perfusion single photon emission CT (SPECT, or MPS) provide complementary information on vascular structure and myocardial perfusion. In patients with coronary artery disease (CAD), the combination of both methods is helpful for disease detection and therapeutic strategy planning. This article addresses the utility of coronary CTA with current 64-row multidetector CT instruments, MPS, and the combination of these methods in the evaluation of CAD.
Abstract: The aim of this experimental study was to investigate visualization of various coronary artery stents with sub-millimeter multi-slice spiral computed tomography (MSCT) using a cardiac physical phantom. Four 3-mm stents of various designs were implanted in tubes with an inner diameter of 3 mm to simulate coronary artery. Stents were placed on a cardiac phantom and scanned at different heart rates. Retrospective ECG-gated adaptive segmental reconstruction technique was employed. Profile curves across longitudinal curved planar reconstruction images of the stents were generated. From the profile curve, the full width at half maximum was defined as the stent lumen index. The effect of heart rate and stent type on the stent lumen index was evaluated. Visual evaluation for each stent at various heart rates was also performed. The heart rate had no significant effect on in-stent visualization. However, in-stent visualization differed significantly for the various stent types for both profile curve analysis and visual evaluation (the Tukey-Kramer multiple comparisons test). Multiple regression analysis indicated that strut thickness, especially minimal strut thickness, was the significant influencing factor for the in-stent visualization. On the basis of four stent models examined it would appear that visualization of the coronary stent lumen varies depending on the stent type, but not on the heart rate. Stents with slim struts are preferable for in-stent evaluation with multi-slice spiral computed tomography.
Abstract: PURPOSE: To evaluate retrospectively if there is additional diagnostic value of fused single photon emission computed tomographic (SPECT) and computed tomographic (CT) images in assessing possible bone metastases. MATERIALS AND METHODS: Institutional review board approval was obtained, and each patient provided written informed consent. Bone scintigraphy--including planar and SPECT imaging-and CT were performed with a combined SPECT/CT system in 45 oncologic patients (24 men, 21 women; mean age, 64.7 years +/- 8.7), with a total of 42 metastatic bone foci and 40 benign foci. The reference standard was follow-up radiologic imaging. Two independent readers first analyzed only bone scintigraphic images and next analyzed two separate sets of bone scintigraphic and CT images. They then analyzed bone scintigraphic, CT, and fused images and focused on the additional value of fused images. Diagnostic confidence for each lesion was scored. The three analyses were performed 7 days apart, and the images were presented in random order at each session. The value of additional fused images was assessed by using receiver operating characteristic analysis. RESULTS: After review of fused images to classify indeterminate lesions, reviewer 1 became more confident in diagnosis of the 15 benign lesions and two metastases, and reviewer 2 became more confident in diagnosis of the seven benign lesions and one metastasis. The area under the receiver operating characteristic curve for reviewer 1 was 0.589 for scintigraphic images, 0.831 for separate data sets of scintigraphic and CT images, and 0.947 for fused images. The corresponding areas under the receiver operating characteristic curve for reviewer 2 were 0.771, 0.885, and 0.968, respectively. CONCLUSION: Results demonstrate the increased diagnostic confidence obtained with fused SPECT/CT images compared with separate sets of scintigraphic and CT images in differentiating malignant from benign bone lesions.
Abstract: OBJECTIVE: The objective of our study was to evaluate whether a low-dose contrast material (CM) protocol with a saline flush might provide sufficient contrast enhancement in aortoiliac 16-MDCT angiography. SUBJECTS AND METHODS: Forty-five patients were divided into two groups on the basis of the CM (300 mg I/mL) administration protocol: group 1 (23 patients) received 100 mL of CM at 3.0 mL/sec; and group 2 (22 patients), 50 mL of CM at 3.0 mL/sec followed by a 20-mL saline flush at 3.0 mL/sec. All patients underwent 16-MDCT angiography of the entire aortoiliac region. Seven regions of interest (ROIs) were drawn from the ascending aorta (ROI 1) to the external iliac artery (ROI 7). Quantitative analysis was performed by calculating the mean aortoiliac attenuation and the mean difference between the maximum and minimum attenuation values. Vascular enhancement of the renal arteries was visually assessed using 2D and 3D postprocessing techniques. RESULTS: The mean aortoiliac attenuation in group 1 was 314.3 +/- 45.9 H and that in group 2 was 306.1 +/- 35.0 H. The difference was not statistically significant. Adequate mean aortoiliac attenuation was achieved in 95.7% (22/23) and 95.5% (21/22) of patients in groups 1 and 2, respectively. The difference was not statistically significant. The mean difference between the maximum and minimum attenuation values was significantly smaller in group 1 (41.3 +/- 16.8 H) than in group 2 (57.2 +/- 25.3 H). The renal arteries were assessable in all patients in both groups. CONCLUSION: This protocol of 50 mL of CM with a saline flush provides attenuation comparable to that obtained with the 100 mL of CM in aortoiliac 16-MDCT angiography.
Abstract: We present a case of a 57-year-old woman with an unremarkable medical history except for a continuous cardiac murmur at the left second and third interspaces. Transthoracic echocardiography revealed an unusual chamber in front of the heart. To evaluate the precise anatomy of this abnormality, multi-slice computed tomographic (MSCT) imaging was performed. MSCT angiography with retrospective ECG gating showed a coronary arterial malformation with fistulous communications to the coronary artery, pulmonary artery and the root of aorta. Images from MSCT coronary angiography can be helpful in understanding the tortuous configuration of the coronary arterial malformation.
Abstract: OBJECTIVE: The purpose of this study was to determine the optimal contrast injection protocol for clear delineation of the endocardial and epicardial contours and coronary vessels in anatomic and functional imaging with cardiac 16-MDCT. SUBJECTS AND METHODS: Thirty-eight patients were allocated to three groups according to contrast injection protocol: a long-duration biphasic protocol in which diluted contrast material was used in the latter phase (protocol A, 13 patients); a uniphasic protocol with saline flush (protocol B, 12 patients); a uniphasic protocol without a flush (protocol C, 13 patients). Six regions of interest were drawn within the left ventricle (LV), right ventricle (RV), and interventricular septum along the z-axis. Mean ventricular attenuation, mean difference between maximum and minimum ventricular attenuation, and ventricular-myocardial contrast-to-noise ratio (CNR) were calculated. Attenuation and visualization of the coronary vessels also were compared. RESULTS: The difference between maximum and minimum RV attenuation was significantly smaller in group A (58.1 H) than in groups B (179.5 H) and C (157.0 H). RV-myocardial CNR was significantly higher in group A (9.0) than in group B (5.5). The mean LV attenuation, difference between maximum and minimum LV attenuation, and LV-myocardial CNR were not significantly different among three groups. In protocol A, both endocardial and epicardial contours were clearly delineated, and cardiac functional analysis was feasible in all cases. Average attenuation and visualization of the coronary vessels were not significantly different among groups. The diagnostic accuracies in detection of coronary stenosis were 92%, 93%, and 91%, respectively, for protocols A, B, and C. CONCLUSION: The long-duration contrast injection protocol with diluted contrast material is optimal for assessing the coronary vessels and cardiac function.
Abstract: OBJECTIVE: The purpose of our study was to assess quantitative indexes and the effect of attenuation correction on the evaluation of lymph node metastasis in the staging of non-small cell lung cancer (NSCLC) using fused thallium-201 SPECT/CT images. MATERIALS AND METHODS: We evaluated 156 lymph nodes (66 metastatic, 90 nonmetastatic) from 29 patients with NSCLC. Using our combined SPECT/CT system, all patients underwent 201Tl SPECT and CT examinations immediately (early images) and 3 hr after (delayed images) the injection of 201Tl. SPECT images were reconstructed with and without attenuation correction. For the quantitative evaluation of lymph node metastasis, we calculated the early ratio, the delayed ratio, and the washout ratio for SPECT images and the short-axis diameter for CT images. Receiver operating characteristic (ROC) analysis was performed in each index for the differentiation between metastatic and nonmetastatic lymph nodes. Visual analysis was also performed by two experienced radiologists. RESULTS: The area under the ROC curve (A(z)) showed that early ratio and delayed ratio were superior to short-axis diameter for the assessment of lymph node metastasis. In addition, early and delayed ratios on attenuation-corrected images were superior to those ratios on images without attenuation correction. However, the A(z) value for washout ratio was smaller than that for short-axis diameter. Early ratio on attenuation-corrected images was the most useful index (A(z) = 0.94). The sensitivity, specificity, and accuracy for early ratio on attenuation-corrected images were 78.8%, 94.4%, and 87.8% for the diagnosis of lymph node metastasis and 84.6%, 100%, and 93.1% for clinical staging (N0-N1 vs N2-N3), respectively. Fused images showed significantly higher diagnostic accuracy than CT images on visual analysis. CONCLUSION: Quantitative assessment using fused SPECT/CT images is useful for the diagnosis of lymph node metastasis in patients with NSCLC.
Abstract: Aneurysms of the sinus of Valsalva are rare. We report here the case of a 56-year-old man with a ruptured aneurysm of sinus of Valsalva with flow into the right ventricle which was diagnosed non-invasively by 64-row multi-slice computed tomographic (CT) imaging. The right sinus of Valsalva aneurysm rupturing into the right ventricular outflow region might be silent or symptomless in many cases. The patient also had mild symptom. For anatomical demonstration, contrast-enhanced CT was performed. Although the ruptured sinus of Valsalva was initially diagnosed by echocardiography, CT images did give our surgeons a better three-dimensional appreciation when surgical repair was performed. Multi-slice CT imaging should be considered the technique of choice for both diagnosis and follow-up examination of the aneurysm of sinus of Valsalva and its rupture.
Abstract: PURPOSE: To determine whether quantitative diffusion-weighted imaging (DWI) is useful for characterizing poorly contrast-enhanced and T2-prolonged bone masses. MATERIALS AND METHODS: We studied 20 bone masses that showed high signal intensity on T2-weighted images and poor enhancement on contrast-enhanced T1-weighted images. These included eight solitary bone cysts, five fibrous dysplasias, and seven chondrosarcomas. To analyze diffusion changes we calculated the apparent diffusion coefficient (ADC) for each lesion. RESULTS: The ADC values of the two types of benign lesions and chondrosarcomas were not significantly different. However, the mean ADC value of solitary bone cysts (mean +/-SD, 2.57 +/- 0.13 x 10(-3) mm(2)/second) was significantly higher than that of fibrous dysplasias and chondrosarcomas (2.0 +/- 0.21 x 10(-3) mm(2)/second and 2.29 +/- 0.14 x 10(-3) mm(2)/second, respectively, P < 0.05). None of the lesions with ADC values lower than 2.0 x 10(-3) mm(2)/second were chondrosarcomas. CONCLUSION: Although there was some overlapping in the ADC values of chondrosarcomas, solitary bone cyst, and fibrous dysplasia, quantitative DWI may aid in the differential diagnosis of poorly contrast-enhanced and T2-prolonged bone masses.
Abstract: The aim of this study was to compare results of left ventricular (LV) function obtained by quantitative gated single-photon emission tomography (QGS) and multidetector-row spiral computed tomography (MDCT) with reference parameters using an electrocardiogram-gated cardiac physical phantom. The phantom study was performed using a combined SPECT/CT system. Flexible membranes formed the inner and outer walls of the simulated LV. The stroke volume was adjusted (45 mL or 58 mL) and the fixed 42-mL end-systolic volume (ESV) produced two different volume combinations. The LV function parameters were estimated by means of MDCT and QGS. Differences in true and measured volumes were compared among CT with a reconstructed image thickness of 2.5 mm and 5.0 mm and QGS volumetric values. Each scan was repeated three-times. The estimation of LV volumes using both QGS and MDCT analyses were reproducible very well. QGS overestimated ejection fraction (EF) by approximately 20%; MDCT volumetry overestimated EF by approximately 5% in each volume setting. The differences in true and measured values for EF and ESV obtained with QGS were significantly greater than obtained with MDCT. Conclusion: MDCT provides a reliable estimation of functional LV parameters, whereas QGS tends to significantly overestimate the EF in small hearts.
Abstract: OBJECTIVE: Attenuation artifacts adversely affect the diagnostic accuracy of myocardial perfusion imaging. We assessed the clinical usefulness of X-ray CT based attenuation correction (AC) in patients undergoing myocardial perfusion imaging by comparing their myocardial AC- and non-corrected (NC) SPECT images with the coronary angiography (CAG). METHODS: We retrospectively reviewed the myocardial SPECT images of 30 patients (18 men, 12 women; mean age 68 years). Thirteen of 30 patients with coronary artery disease (CAD) and 17 without CAD were confirmed by CAG. They underwent sequential CT and myocardial SPECT imaging with thallium-201 (111 MBq) under an exercise or pharmacological stress protocol using our combined SPECT/ CT system. Two readers reviewed the myocardial SPECT images for the presence of CAD on a 4-point scale where 1 = normal, 2 = probably normal, 3 = probably abnormal, and 4 = abnormal. Two reading sessions were held. First, non-corrected (NC)-SPECT and second, AC-SPECT images using X-ray CT images were interpreted. Interobserver variability was assessed with kappa statistics. Diagnostic performance (accuracy) of coronary arterial stenosis was compared between AC- and NC-images. RESULTS: Interobserver agreement for visual assessment was substantial or almost perfect. For AC-images, the observer consensus for analysis was 0.84 for the LAD-, 0.87 for the LCX-, and 0.71 for the RCA-territory. For NC-images, it was 0.91, 0.71, and 0.78. AC resulted in statistically significant improvements in overall diagnostic accuracy (sensitivity/ specificity/accuracy = 76%/93%/89%, 67%/86%/81%, respectively, for AC- and NC-images). CONCLUSIONS: Because of an increase in the specificity, diagnostic accuracy was significantly increased on AC-images. These preliminary data suggest that X-ray CT based AC in myocardial SPECT imaging has the potential to develop into a reliable clinical technique.
Abstract: OBJECTIVE: The purpose of this study was to develop a method of fused images of coronary CT angiography and myocardial perfusion SPECT. CONCLUSION: Four patients with ischemic heart disease underwent 3D volume-rendering fused images using a conversion program and volume-rendering fusion function of a computer workstation. The fusion images clearly showed the relationship of relevant coronary arteries and the abnormal perfusion territory in all patients and were useful for the evaluation of coronary artery disease.
Abstract: Institutional review board approval was obtained for multiple imaging examinations in healthy volunteers and patients and for the analysis of images. The purpose of the study, and the risks associated with radiation exposure with regard to stochastic effects that might result in cancer and/or genetic mutations, were explained to all subjects, and all questions from subjects were answered. Each subject provided written informed consent. The purpose of the study was to prospectively determine the respiratory protocol at computed tomography (CT) that results in the best registration of CT images with images acquired at single photon emission computed tomography (SPECT) in the thorax. Errors of registration between myocardial SPECT images and CT images obtained with different respiratory protocols (postinhalation breath hold, postexhalation breath hold, and free breathing) in 13 healthy subjects were compared. CT scans obtained with free breathing and postexhalation breath hold better matched SPECT images than did those obtained with postinhalation breath hold (one-way analysis of variance, P < .01). Fewer SPECT/CT images showed artifacts with registration performed by using internal landmarks (four, two, and one of 13 images with postinhalation breath-hold, postexhalation breath-hold, and free-breathing protocols, respectively) than with registration performed by using external markers (nine, four, and two of 13 images). CT data acquisition with a free-breathing or postexhalation breath-hold protocol and image registration by using internal landmarks are recommended for attenuation correction.
Abstract: OBJECTIVE: To investigate which is more suitable for whole-body screening with multidetector row CT (MDCT) during one breathhold, a uniphasic or biphasic injection protocol for contrast material. SUBJECTS AND METHODS: Sixty patients received a volume of 1.7 mL x weight (kg) with iopamidol 300 mg iodine/mL. The patients were randomized into two injection protocols: A) a fixed injection rate of 2.0 mL/sec with a 70 sec delay, B) administration of 80% of the contrast material in 40 sec, then administration of the remaining 20% in 20 sec with an 80 sec delay. A helical scan from the apex of the lung to the base of the pelvic cavity was performed during one breathhold. CT attenuation values of the thoracic aorta, pulmonary artery, abdominal aorta, portal vein, superior vena cava (SVC), suprarenal and infrarenal inferior vena cava (IVC), liver, and pancreas were measured. Two radiologists visually assessed the degree enhancement of the IVC. In addition, the two radiologists visually assessed artifacts caused by contrast material in the subclavian vein and SVC using a four-point scale. RESULTS: Enhancement of the SVC in protocol A was significantly better than that in protocol B (p=0.04). Enhancement of the infrarenal IVC and liver in protocol B was significantly better than that in protocol A (p<0.01, p<0.01). Renal enhancement in protocol B was significantly better than that in protocol A (p=0.02). In all patients with both protocols A and B, enhancement of the suprarenal IVC was visually graded as acceptable or good. In all patients with protocol B, enhancement of the infrarenal IVC was graded as acceptable or good. In only 2/3 of patients with protocol A, enhancement of the infrarenal IVC was graded as acceptable or good. There was no significant difference in artifacts in the subclavian vein between the two protocols (p=0.77). Artifacts in the SVC in protocol B were significantly fewer than those in protocol A (p<0.01). CONCLUSION: Protocol B was more suitable for whole-body screening than protocol A, because of better enhancement of the liver and infrarenal IVC and fewer artifacts in the SVC.
Abstract: Attenuation correction is very important for quantitative SPECT imaging. We designed an uncollimated non-uniform line array source (non-uniform LAS) for attenuation correction based on transmission computed tomography (TCT) using Tc-99m and compared its performance with an uncollimated uniform line array source (uniform LAS) in a thorax phantom study. This non-uniform LAS was attached to one camera head of a dual-head gamma camera, and transmission data were acquired with another camera head with a low-energy, general purpose, parallel-hole collimator at 50 cm-distance apart from the source. The modified TEW using a subtraction factor of 1.0 was employed to correct scattered Tc-99m photons for transmission data. In the phantom experiment, eight TCT data were acquired with the scanning time changed from 2 minutes to 20 minutes for each LAS. The Tc-99m attenuation coefficient (mu) maps with the non-uniform LAS and uniform LAS improved the statistical count variation in the mediastinum filled with water as the scanning time got longer. The Tc-99m mu-map with the non-uniform LAS and 6 minutes of scanning time had equal quality at the center of the thorax phantom to that with the uniform LAS and 16 minutes of scanning time. In conclusion, for the TCT imaging with combination of the parallel hole collimator and uncollimated Tc-99m external source the non-uniform LAS can reduce the Tc-99m radioactivity or the TCT scanning time compared with the uniform LAS.
Abstract: For transmission computed tomography (TCT) systems using a centered transmission source with a fan-beam collimator, the transmission projection data are truncated. To achieve sufficiently large imaging field of view (FOV), we have designed the combination of an asymmetric fan-beam (AsF) collimator and a small uncollimated sheet-source for TCT, and implemented AsF sampling on a two-head SPECT system. The purpose of this study is to evaluate the feasibility of our TCT method for quantitative emission computed tomography (ECT) in clinical application. Sequential Tc-99m transmission and Tl-201 emission data acquisition were performed in a cardiac phantom (30 cm in width) with a myocardial chamber and a patient study. Tc-99m of 185 MBq was used as the transmission source. Both the ECT and TCT images were reconstructed with the filtered back-projection method after scatter correction with the triple energy window (TEW) method. The attenuation corrected transaxial images were iteratively reconstructed with the Chang algorithm utilizing the attenuation coefficient map computed from the TCT data. In this AsF sampling geometry, an imaging FOV of 50 cm was yielded. The attenuated regions appeared normal on the scatter and attenuation corrected (SAC) images in the phantom and patient study. The good quantitative accuracy on the SAC images was also confirmed by the measurement of the Tl-201 radioactivity in the myocardial chamber in the phantom study. The AsF collimation geometry that we have proposed in this study makes it easy to realize TCT data acquisition on the two-head SPECT system and to perform quantification on Tl-201 myocardial SPECT.
Abstract: OBJECTIVE: The aim of our study was to compare T2-weighted and contrast-enhanced dynamic T1-weighted images with histologic findings in assessing the depth of myometrial invasion by endometrial carcinoma in adenomyosis. MATERIALS AND METHODS: We retrospectively reviewed the MRIs of 11 patients who had a total of 12 lesions of endometrial carcinoma within adenomyosis. T2-weighted and contrast-enhanced dynamic T1-weighted images were compared with the histologic findings separately. We assessed the extent of myometrial invasion by endometrial carcinomas. The depth of myometrial invasion seen on MRI was classified as stage S (superficial invasion), stage D (deep invasion), or undetectable. The staging accuracies of each sequence were assessed. The tumor-myometrium contrast-to-noise ratios were calculated for each sequence. RESULTS: The histologic specimens revealed that myometrial invasion was deep in seven of 12 lesions and superficial in five. On T2-weighted images the depth of invasion was underestimated in two lesions and impossible to determine in five lesions. On dynamic T1-weighted images the depth of invasion was overestimated in one lesion and underestimated in one lesion. The staging accuracy on dynamic T1-weighted images (83%) was significantly higher than that on T2-weighted images (42%). The contrast-to-noise ratio was significantly higher on dynamic T1-weighted studies during the early phase (mean +/- SD, 2.68 +/- 0.94) than it was on T2-weighted studies (1.74 +/- 1.05) and during the delayed phase (2.01 +/- 0.86). CONCLUSION: When adenomyosis coexists with endometrial cancer at the same site on T2-weighted images, contrast-enhanced dynamic T1-weighted imaging improves the accuracy of staging.
Abstract: The authors describe a case of struma ovarii coexisting with mucinous cystadenoma. Ultrasonography and magnetic resonance imaging showed a multilocular cystic mass with a solid component. The ovarian tumor demonstrated uptake of I-123 sodium iodide, allowing a preoperative diagnosis of struma ovarii. In women with an unexplained increase in thyroid function and low I-123 uptake in the cervical thyroid gland, scintigraphy of the pelvis should be considered.
Abstract: PURPOSE: To assess the value of multidetector CT portography in visualizing varices and portosystemic collaterals in comparison with conventional portography, and to compare the visualizations obtained by three rendering models (volume rendering, VR; minimum intensity projection, MIP; and shaded surface display, SSD). METHODS: A total of 46 patients with portal hypertension were examined by CT and conventional portography for evaluation of portosystemic collaterals. CT portography was performed by multidetector CT (MD-CT) scanner with a slice thickness of 2.5 mm and table feed of 7.5 mm. Three types of CT portographic models were generated and compared with transarterial portography. RESULTS: Among the 46 patients, 48 collaterals were identified on CT transverse images, while 38 collaterals were detected on transarterial portography. Forty-four of 48 collaterals identified on CT transverse images were visualized with the MIP model, while 34 and 29 collaterals were visualized by the VR and SSD methods, respectively. The average CT value for the portal vein and varices was 198 HU with data acquisition of 50 sec after contrast material injection. CONCLUSIONS: CT portography by multidetector CT provides excellent images in the visualization of portosystemic collaterals. The images of collaterals produced by MD-CT are superior to those of transarterial portography. Among the three rendering techniques, MIP provides the best visualization of portosystemic collaterals.
Abstract: We successfully performed embolization therapy for a pelvic arteriovenous malformation by the retrograde transvenous approach using a liquid embolic material. This malformation was unique in that it had a single draining vein, which allowed this technique employing an occlusion balloon.
Abstract: PURPOSE: The purpose of this study was to evaluate the temporal changes of MR imaging in the denervated tongue after a radical neck dissection. METHODS: One hundred seventy-four consecutive MR studies in 116 patients with radical neck dissections for malignant tumors of the head and neck were evaluated retrospectively. Patients with tumors involving the tongue or hypoglossal nerve were not included in this study. RESULTS: Abnormal signal intensity and/or hemiatrophy on the side of the tongue operated on was seen in 22 patients who had hypoglossal paralysis after radical neck dissection. The denervated side of the tongue appeared hypointense to hyperintense relative to the normal side on T1-weighted images and hyperintense on T2-weighted images. Signal intensity ratios of the abnormal to normal muscles were 0.9-1.6 on T1-weighted images and 1.3-2.8 on T2-weighted images. High signal intensity on T1-weighted images appeared 5 months or more after the dissection, whereas on T2-weighted images, the most prominent increases in signal intensity appeared in the first several months after denervation. Hemiatrophy of the tongue was observed on MR images obtained more than 6 months after surgery. CONCLUSION: MR findings in the denervated tongue are compatible with histologic changes and are characterized by an enlarged extracellular fluid space or fatty infiltration. The pattern of signal intensity and the degree of hemiatrophy suggest the duration of denervation.
