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ABSTRACT: Isolated tuberculous liver parenchymal and subcapsular abscesses are unusual,^but an abdominal wall abscess secondary to a tubercular liver abscess is extremely rare. To our knowledge, there is only one reported case of an abdominal wall abscess occurring secondary to a subcapsular liver abscess. We report the first documented case of direct invasion of the abdominal wall from an isolated tuberculous liver parenchymal abscess, diagnosed by imaging, surgical, and pathological findings. Although ultrasonography and computed tomography showed nonspecific hypoechoic and hypodense findings with peripheral contrast enhancement, T2-weighted magnetic resonance imaging (MRI) revealed a heterogeneous mass with characteristic hypointensity, suggesting the presence of free radicals produced by macrophages during active phagocytosis in tuberculosis. Although our case is extremely unusual, when hypointensity on T2-weighted MRI is seen, the possibility of tuberculosis should be considered and the results of polymerase chain reaction, culture, and histopathological diagnosis must be taken into account to avoid needless invasive surgery.
Surgery Today 05/2011; 41(5):741-4. · 1.22 Impact Factor
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ABSTRACT: Pilomyxoid astrocytoma (PMA) is a rare disease that is now a recognized variant of pilocytic astrocytoma (PA). Differentiation of PMA from PA is important in patient management because it is more aggressive than PA. However, there have been few reports on image findings for differentiating the 2. This report of a rare case of pathologically proven PMA in a 9-month-old boy addresses the difficulties of differentiation from PA even when magnetic resonance imaging (MRI) findings are typical. The reported image findings typical of PMA raise the possibility of hyperintensity in the T2-weighted MRI, and homogeneous contrast enhancement may reflect the characteristic histopathologic findings in the prominently myxoid background and in the angiocentric arrangement of tumor cells. However, there may be similar MRI findings in PA that are reflected by pathologic features of the compacted tumor cells on the background of a loosely structured tumor matrix. Although, because of a much broader imaging spectrum, no definitive pathognomonic image findings to distinguish PMA from PA have been reported, we confirmed that, even when MRI findings are typical, PMA is difficult to differentiate from PA.
Neurosurgery Quarterly 11/2009; 19(4):295-297. · 0.10 Impact Factor
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Takashi Yoshinobu,
Katsumi Abe,
Yasuo Sasaki,
Makiko Tabei,
Seiji Tanaka,
Motoichiro Takahashi,
Satoru Furuhashi,
Ikue Tanaka,
Takashi Shizukuishi,
Takuya Aizawa,
Toshiya Maebayashi, Masakuni Sakaguchi,
Yoshitaka Okuhata,
Junko Kikuta,
Naoya Ishibashi
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ABSTRACT: Multidetector row computed tomography (MDCT) creates massive amounts of data, which can overload a picture archiving and communication system (PACS). To solve this problem, we designed a new data storage and image interpretation system in an existing PACS. Two MDCT image datasets, a thick- and a thin-section dataset, and a single-detector CT thick-section dataset were reconstructed. The thin-section dataset was archived in existing PACS disk space reserved for temporary storage, and the system overwrote the source data to preserve available disk space. The thick-section datasets were archived permanently. Multiplanar reformation (MPR) images were reconstructed from the stored thin-section datasets on the PACS workstation. In regular interpretations by eight radiologists during the same week, the volume of images and the times taken for interpretation of thick-section images with (246 CT examinations) or without (170 CT examinations) thin-section images were recorded, and the diagnostic usefulness of the thin-section images was evaluated. Thin-section datasets and MPR images were used in 79% and 18% of cases, respectively. The radiologists' assessments of this system were useful, though the volume of images and times taken to archive, retrieve, and interpret thick-section images together with thin-section images were significantly greater than the times taken without thin-section images. The limitations were compensated for by the usefulness of thin-section images. This data storage and image interpretation system improves the storage and availability of the thin-section datasets of MDCT and can prevent overloading problems in an existing PACS for the moment.
Journal of Digital Imaging 11/2009; 24(1):107-13. · 1.25 Impact Factor
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ABSTRACT: Primary pleural synovial sarcoma is a rare disease with poor outcomes. Although hyperthermia therapy as part of a combined treatment regimen can offer improved local tumor control, only two reports of hyperthermia therapy for synovial sarcoma have appeared in the literature, and these sarcomas were not of pleuropulmonary origin. This report of an advanced inoperable primary pleural synovial sarcoma is the first to address the use of hyperthermia therapy in combination with chemoradiotherapy for this disease, together with radiological assessment following that therapy. Computed tomography performed after thermoradiation showed a decrease in tumor size and a characteristic unenhanced low-density area in the tumor suggesting that tumor necrosis resulted from the therapy. These image findings were helpful in assessing the tumor response to thermoradiation. We believe that hyperthermia therapy combined with chemoradiotherapy should be regarded as an option for advanced primary pleural synovial sarcoma. This would give computed tomography important role in evaluating this approach.
Medical Oncology 10/2009; 27(3):1027-30. · 2.14 Impact Factor
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Nephrology 05/2009; 14(2):263. · 1.31 Impact Factor
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Nephrology 03/2009; 14(2):263 - 263. · 1.31 Impact Factor
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ABSTRACT: Although accurate information on thoracolumbar bone structure is essential when computed tomography (CT) images are examined, there is no automated method of labeling all the vertebrae and ribs on a CT scan. We are developing a computer-aided diagnosis system that labels ribs and thoracolumbar vertebrae automatically and have evaluated its accuracy. A candidate bone was extracted from the CT image volume data by pixel thresholding and connectivity analysis. All non-bony anatomical structures were removed using a linear discriminate of distribution of CT values and anatomical characteristics. The vertebrae were separated from the ribs on the basis of their distances from the centers of the vertebral bodies. Finally, the thoracic cage and lumbar vertebrae were extracted, and each vertebra was labeled with its own anatomical number by histogram analysis along the craniocaudal midline. The ribs were labeled in a similar manner, based on location data. Twenty-three cases were used for accuracy comparison between our method and the radiologist's. The automated labeling of the thoracolumbar vertebrae was concordant with the judgments of the radiologist in all cases, and all but the first and second ribs were labeled correctly. These two ribs were frequently misidentified, presumably because of pericostal anatomical clutter or high densities of contrast material in the injected veins. We are confident that this system can contribute usefully as part of a picture archiving and communication system workstation, though further technical improvement is required for identification of the upper ribs.
Journal of Digital Imaging 11/2008; 22(6):689-95. · 1.25 Impact Factor
