Shunji Arikawa

Kurume University, Куруме, Fukuoka, Japan

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Publications (21)16.67 Total impact

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    ABSTRACT: Primary pancreatic lymphoma (PPL) is a rare disease with <1%of extranodal non-Hodgkin's lymphoma arising in the pancreas. This report provides immunocytochemical information on PPL that would be valuable for making differential diagnoses between PPL, pancreatic neuroendocine tumor, acinar cell carcinoma, and pancreatic ductal cancer. A 68-year-old woman had a chief complaint of abdominal pain. Fine needle aspiration cytology (FNAC)was performed. The FNAC smear showed moderate cellularity,with a small to moderate number of irregular cells and lymphocytes.No epithelial tumor clusters or abundant mucoid background were seen. The cells were scattered with pleomorphism and showed irregular nuclear shapes with finely granular chromatin,an increased nuclei–cytoplasm ratio, and prominent nucleoli.Cytologically, PPL was suspected with Papanicolaou staining but definite diagnosis was not made. Therefore, the specimen was destained, immunocytochemically examined for leukocyte common antigen (LCA), and PPL was suspected again. Numerous tumor cells were found in the surgical sample and tumor cells were positive for CD20 and negative for CD45RO. Based on these findings,the tumor was diagnosed as PPL, B-cell type. The preoperative FNAC smear that was examined for LCA was then reexamined for CD20, CEA, and Synaptophysin. As a result, the tumor cells were positive for LCA and CD20, whereas they were negative for CEA and Synaptophysin. Taking these findings together with the cytopathologic findings, this specimen was reconfirmed as PPL. Immunocytochemical examination for LCA and CD20 is useful in the identification of malignant pancreatic lymphoma, B-cell type.
    Diagnostic Cytopathology 08/2012; 40(8):732-6. DOI:10.1002/dc.21662 · 1.12 Impact Factor
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    ABSTRACT: The aim of this study was to compare endoscopic macroscopic classification with fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake in gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to investigate the usefulness of F-18 FDG positron emission tomography (PET) for diagnosing gastric MALT lymphoma. Sixteen patients with gastric MALT lymphoma who underwent F-18 FDG PET and gastrointestinal imaging modalities were included in this study. Sixteen healthy asymptomatic participants undergoing both F-18 FDG PET and endoscopy for cancer screening were in the control group. We investigated the difference of F-18 FDG uptake between the gastric MALT lymphoma and the control group and compared the uptake pattern in gastric MALT lymphoma with our macroscopic classification. The endoscopic findings of 16 gastric MALT lymphoma patients were classified macroscopically as chronic gastritis-like tumors (n = 6), depressed tumors (n = 5), and protruding tumors (n = 5). Abnormal gastric F-18 FDG uptake was observed in 63% of tumors in the gastric MALT lymphoma group and 50% of cases in the control group. The median maximum standardized uptake values for gastric MALT lymphoma patients and control group were 4.0 and 2.6, respectively, the difference of which was statistically significant (P = 0.003). F-18 FDG uptake results were positive for all protruding tumors but only 50% for chronic gastritis-like tumors and 40% for depressed-type tumors. F-18 FDG PET may be a useful method for evaluating protrusion-type gastric MALT lymphoma. When strong focal or diffuse F-18 FDG uptake is detected in the stomach, endoscopic biopsy should be performed, even if the endoscopic finding is chronic gastritis.
    Clinical nuclear medicine 02/2012; 37(2):152-7. DOI:10.1097/RLU.0b013e3182393580 · 3.93 Impact Factor
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    ABSTRACT: OBJECTIVE: We aimed to compare perfusion computed tomography (CTP) characteristics of the normal pancreas with those of chronic pancreatitis (CP) and to examine the possibility of evaluating pancreatic exocrine function with CTP. METHODS: Thirty-two patients (control group, n = 18; CP group, n = 14) who completed the whole pancreas CT perfusion examination with 256-slice CT were studied. Four parameters, including perfusion (PF), peak enhancement intensity (PEI), time-to-peak (TTP), and blood volume (BV), were measured and compared between the control and CP groups, and between patients with and without exocrine pancreatic insufficiency (EPI) in the CP group. Pancreatic exocrine function was determined via serum trypsinogen. RESULTS: There was no significant difference between the distribution of PF, PEI, and BV in different pancreas regions, namely, the head, body, and tail (P > 0.05). PF, PEI, and BV of the CP group were significantly decreased, and TTP was significantly increased compared with the control group (P < 0.05). A significant decrease of PF, PEI, and BV and increase of TTP were observed in patients with EPI than in patients without EPI (P < 0.05). CONCLUSIONS: Perfusion CT is an appropriate imaging technique to diagnose CP and may be useful as a screening test to rule out early EPI.
    Pancreas 01/2012; 41(4). DOI:10.1097/MPA.0b013e3182374fe0 · 2.96 Impact Factor
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    ABSTRACT: PURPOSE The purpose of this study was to evaluate the utility of whole pancreatic perfusion computed tomography (PPCT) for predicting the response of pancreatic cancer to combined chemotherapy and radiotherapy. METHOD AND MATERIALS Eighteen patients with confirmed pancreatic cancer underwent PPCT before therapy. PPCT was performed using a 256-slice scanner (acquisition time, 45 sec) after intravenous injection of contrast medium (35 ml, 350 mg/I, 4 ml/sec). Perfusion parameters including perfusion (PF), peak enhancement (PE), time to peak (TTP), and blood volume (BV) were measured in the tumor and tail of the pancreas. Tumor microvessel density and immunohistochemistry of surgical specimens were compared between patients who partially or completely responded to treatment (responders) and those who did not (non-responders; stable or progressive disease), as determined by the Response Evaluation Criteria in Solid Tumors from 3-month post-therapeutic follow-up CT examination. Statistical analysis was performed with the two-sample t test. RESULTS Eight of 18 patients examined at follow-up responded to therapy. Pretreatment PF (16.5±9.8 mL/min/100 mL), PE (31.6±8.5 HU), and BV (14.1±1.1 mL/100 g) were significantly higher in responders than in non-responders (7.0±2.4 mL/min/100 mL, 31.6±8.5 HU, 14.1±1.1 mL/100 g) (P<0.05). Although not significant, responders had lower TTP values and higher MVD values. All perfusion parameters in the tail of the pancreas were not significantly different between responders and non-responders, but were lower and more prolonged than in the normal pancreas. CONCLUSION Whole PPCT using a 256-slice scanner has the potential to predict the response of pancreatic cancer to combined chemotherapy and radiotherapy, and can be used to simultaneously evaluate residual pancreas function. It is anticipated that this technique can be further adapted for management of pancreatic cancer. CLINICAL RELEVANCE/APPLICATION Whole PPCT improves the functional image of pancreatic cancer for combined chemotherapy and radiotherapy.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: This study aimed to compare the usefulness of multidetector row CT (MDCT), MR cholangiopancreatography (MRCP), and endoscopic ultrasonography (EUS) in diagnosing branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Imaging and pathological findings were retrospectively evaluated for 25 patients with branch duct IPMNs of the pancreas who underwent surgical resection (13 adenomas, 4 borderline lesions, and 8 carcinomas). MDCT and MRCP were performed on all 25 patients, whereas EUS was performed on 22 patients. MDCT and MRCP were used to identify features predictive of malignancy, including carcinoma, borderline lesions, and the presence of thickened irregular walls/septa or a solid mass. EUS was used to identify the presence of intramural nodules or a solid mass. Correlations between histopathology and maximum diameter of the main pancreatic duct (MPD) or cyst size detected by MDCT and MRCP were also examined. Presence of a solid mass was highly correlated with malignancy with all imaging methods (MDCT; P=0.001, MRCP; P=0.008, EUS; P<0.001, respectively). Presence of thickened irregular walls/septa on MDCT correlated well with malignancy (P=0.019). In contrast, presence of thickened irregular walls/septa on MRCP and intramural nodules on EUS did not correlate with malignancy. No significant correlation was found between malignancy and average maximum MPD diameter or cyst size (P>0.05), though values tended to be larger in malignant tumors. Our results suggest that the presence of thickened irregular walls/septa or a solid mass on MDCT are highly correlated with malignancy, and that MDCT is useful for diagnosis of branch duct IPMNs of the pancreas.
    The Kurume Medical Journal 01/2011; 57(4):91-100. DOI:10.2739/kurumemedj.57.91
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    ABSTRACT: We report a case of drug eruption (erythema multiforme type) in a 54-year-old woman, following concurrent chemoradiotherapy for squamous cell carcinoma of the anal canal. Chemotherapy comprised one cycle of mitomycin C 10 mg/m2/day (intravenous bolus injection)on day 1 and 5-fluorouracil(5-FU)1, 000 mg/m 2/day (continuous intravenous infusion) on days 1-4 of radiotherapy. External irradiation of the pelvic space was performed, using daily fractions of 1. 5 Gy(total dose, 33 Gy). From day 4 after chemoradiotherapy, erythema appeared proximal to the forearm site used for drug administration. On day 6, erythema was noted on the trunk, hip and thigh. We suspected erythema multiforme based on the appearance of wheals and target lesions of the skin and a patient history of chemoradiotherapy. Steroids were administered orally, which resolved systemic eruption at week 2. The patient also experienced grade 3 leukocytopenia, neutropenia, thrombopenia, diarrhea, and anorexia. Although we could not provide sufficient chemotherapy and radiation therapy due to severe side effects, squamous cell carcinoma of the anal canal responded extremely well with a marked decrease in complete response. We surmise that the drug eruption was associated with 5-FU. Concurrent chemoradiotherapy is safe and effective for squamous cell carcinoma of the anal canal, but care is required to prevent drug eruption during treatment.
    Gan to kagaku ryoho. Cancer & chemotherapy 04/2010; 37(4):727-30.
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    ABSTRACT: The aim of this study was to compare multidetector-row computed tomography (MDCT) findings between cases of sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and infiltrative extrahepatic cholangiocarcinoma (IEC). We retrospectively assessed MDCT findings from 16 IEC cases and 13 SC-AIP cases. MDCT findings were analyzed with regard to location, length, wall thickness, contour, stricture wall enhancement pattern, proximal duct diameter, and the presence of diffuse concentric thickening in the proximal duct and gallbladder wall thickness. Stricture length, stricture wall thickness, and proximal duct diameter were significantly smaller for SC-AIP than for IEC: 19.3 +/- 8.7 vs. 31.8 +/- 12.0 mm (P = 0.004), 2.1 +/- 1.3 vs. 4.1 +/- 1.3 mm (P < 0.001), and 9.2 +/- 3.9 vs. 13.3 +/- 5.0 mm (P = 0.012), respectively. SC-AIP was correlated with stricture location in both the intrapancreatic and hilar hepatic bile ducts, concentric stricture contour (P < 0.001), and diffuse concentric thickening of the proximal bile duct (P = 0.010). Overall values of sensitivity, specificity, and accuracy used to distinguish between SC-AIP and IEC for stricture wall thickness of <3.0 mm and concentric contour were 76.9%, 93.8%, and 86.2%, respectively, and 100%, 87.5%, 93.1%, respectively. Concentric contour and stricture wall thicknesses of <3.0 mm may help distinguish between SC-AIP and IEC.
    Japanese journal of radiology 04/2010; 28(3):205-13. DOI:10.1007/s11604-009-0410-8 · 0.84 Impact Factor
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    ABSTRACT: By the time undifferentiated carcinoma is detected, it has formed a large mass, and it is reportedly difficult to pathologically observe its relationship with the pancreatic duct. In this study, we examined the pancreatic ducts of seven patients of surgical samples, and pathomorphologically investigated the relationship between the adenocarcinomatous and sarcomatous components and the pattern of tumor extension. In addition, we evaluated the usefulness of pancreatic juice cytology by comparison with the findings of the main pancreatic duct (MPD). Seven primary undifferentiated carcinomas of the pancreas (from three male and four female patients with a mean age of 59 years) were analyzed. Histopathological evaluation was based on the WHO diagnostic criteria. Pancreatic juice cytology was performed and evaluated in two patients. All the undifferentiated carcinomas contained adenocarcinomatous and sarcomatous components, and two had a distinct glandular structure. However, we could not pathomorphologically confirm the continuity of the adenomatous with the sarcomatous components in any of the patients. Three undifferentiated carcinomas contained osteoclast-like giant cells. Pathological observation of the tumor and MPD was possible in three of the seven undifferentiated carcinomas. PanIN-3 was observed in the MPD of three patients, suggesting extension into the MPD. In one of these three, the tumor presented intraductal growth in the MPD, and preoperative pancreatic juice cytology revealed atypical cells with osteoclast-like giant cells. In the remaining two, the tumor extraductally compressed the MPD upward. Undifferentiated carcinoma showed two patterns of cancer extension: (1) invasion and expansive growth during the sarcomatous transformation of adenocarcinoma, and (2) intraductal extension. In addition, some undifferentiated carcinomas showed extension in the MPD. Of note, postoperative pancreatic juice cytology may be useful for the diagnosis.
    Journal of Hepato-Biliary-Pancreatic Surgery 05/2009; 16(4):478-84. DOI:10.1007/s00534-009-0078-6 · 1.60 Impact Factor
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    ABSTRACT: To compare contrast material-enhanced three-dimensional (3D) magnetic resonance imaging (MRI) at 3.0T and multidetector row computed tomography (MDCT) in the same patient with regard to image quality of pancreatobiliary disease and hepatic vascular conspicuity. This study enrolled 32 patients with pancreatobiliary disease who underwent both gadolinium-enhanced 3D dynamic MRI and multiphasic CT using 16-MDCT. Data analysis of image quality was performed by two radiologists based on source images, multiplanar reconstruction (MPR), curved planar reconstruction (CPR), and maximum intensity projection (MIP) reconstruction. Determination of image quality was based on a 4-point image quality rating scale. The overall image quality of the MRI axial images was superior to that of the axial MDCT images. The MRI protocol yielded an average score of 3.8 points versus 3.5 for the CT imaging. No significant difference was found between 3.0T MRI and MDCT images in MPR or CPR image quality. Image quality for visualization of the distal intrahepatic segmental arteries was significantly improved using MDCT imaging. No significant difference was found between the MDCT and 3.0T MR in portal vein branch image quality. High-resolution dynamic contrast-enhanced MR imaging at 3.0T is a comprehensive technique which provides high image quality in pancreatobiliary disease.
    Journal of Magnetic Resonance Imaging 04/2009; 29(4):846-52. DOI:10.1002/jmri.21701 · 3.21 Impact Factor
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    ABSTRACT: The patient was a 67-year-old man under follow-up after gastric cancer surgery. An abdominal CT scan performed 1 year earlier had shown an approximately 14-mm hypovascular mass in the pancreatic body; however, he did not consent to treatment and was followed up for 1 year. A blood workup showed that the fasting blood glucose level, which had been within normal limits, was elevated to 174 mg/dl (normal, 70-109 mg/dl), and the HbA1c level was 12.0% (normal, 4.3-5.8%). Abdominal CT revealed an approximately 20-mm mass in the pancreatic body and an approximately 12-mm mass in the pancreatic tail, and magnetic resonance imaging cholangiopancreatography (MRCP) showed discontinuity of the main pancreatic duct (MPD). Since these findings led to the suspicion of invasive ductal carcinoma (IDC) of the pancreas developing in the pancreatic body and tail, we performed distal pancreatectomy with splenectomy. Histologically, IDCs were observed in the pancreatic body and tail. However, PanIN was not observed in the MPD between the two carcinomas. They were diagnosed as independent invasive ductal carcinomas of the pancreas.
    Journal of Hepato-Biliary-Pancreatic Surgery 04/2009; 16(5):699-703. DOI:10.1007/s00534-009-0065-y · 1.60 Impact Factor
  • Suizo 01/2009; 24(1):108-115. DOI:10.2958/suizo.24.108
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    ABSTRACT: Thirty patients with intraductal papillary-mucinous tumor (IPMT) of the pancreas underwent multidetector-row CT (MD-CT) in addition to endoscopic retrograde pancreatography (ERP), and, in 27 cases magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS). The usefulness of MD-CT was investigated by comparing various imaging methods of the communication from the main pancreatic duct (MPD) to patulous/bulging papilla in addition to the indices for benign or malignant disease, the degree of dilation of the MPD, localization and size of cystic lesions, and presence or absence of neoplastic lesions, such as thickened walls and septa, intramural nodule, solid mass. With MD-CT, dilation of the MPD and localization and size of cystic lesions were accurately assessed, even in patients with obstruction of the main pancreatic duct in whom ERP was difficult to perform regardless of the presence or absence of massive amount of mucus. MD-CT with reconstructive imaging, such as MPR imaging and CPR imaging, allowed us to assess communication with the MPD and patulous/bulging papilla easier than MRCP. In our study, MD-CT was useful in the evaluation of thickened walls and septa that are predictive factors of malignancy in IPMT.
    Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 04/2007; 104(3):373-80.
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    ABSTRACT: The 3-dimensional image was excellent as a result of the fast scanning and narrow collimation using multidetector computed tomography (CT); and the parallel escalation in the capabilities of the workstation allow the use of CT angiography/CT cholangiography image fusion. We demonstrated the feasibility of fusion images of the hepatobiliary system. We believe that fusion images are extremely valuable for applications such as preoperative planning for hepatic and bile duct resection.
    Journal of Computer Assisted Tomography 11/2006; 30(6):913-6. DOI:10.1097/ · 1.41 Impact Factor
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    ABSTRACT: Expression of CD56, also known as the neural cell adhesion molecule (NCAM), in the pancreatic ducts of chronic pancreatitis is considered to represent a regenerative process of the pancreatic duct system. CD56 expression was analyzed in 25 tissue samples of invasive ductal carcinoma without mixed ductal-endocrine carcinoma of the pancreas, and in the surrounding non-cancerous pancreatic tissue. CD56 expression was detected in intercalated ducts (ICDs) of lobules in the pancreatic parenchyma showing chronic inflammation close to the carcinoma, but not in the carcinoma itself, in all cases. CD56 showed strong, diffuse expression in the areas with severe inflammation, but expression was weak in ICDs where the inflammation was mild. We suggested that CD56 expression is degenerative process in pancreatic tissue with chronic inflammation, and that examination of CD56 expression may be helpful in the differentiation of atypical degenerative ducts from cancerous ducts.
    The Kurume Medical Journal 02/2006; 53(3-4):59-62. DOI:10.2739/kurumemedj.53.59
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    ABSTRACT: A case of uterine lipoleiomyoma in a 72-year-old woman is presented. Although a series of imaging studies suggested a lipomatous tumor, diagnosis was difficult because the tumor appeared as a pedunculated mass extending from the uterine body. To distinguish the tumor from an ovarian lipomatous tumor, the "beak sign" in a magnetic resonance imaging study was diagnostic in this case. The purpose of this paper is to review lipomatous masses of the female pelvis, to discuss the differential diagnosis of the unusual imaging features, and to discuss imaging techniques to optimize pelvic mass characterization.
    The Kurume Medical Journal 02/2006; 53(1-2):37-40.
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    ABSTRACT: LEARNING OBJECTIVES 1)To show the indications, usefulness and radiological findings of the hepatobiliary disease using multi-detector CT 2)To review state-of-the-art techniques of high-resolution CT angiography/CT cholangiography image fusion 3)To evaluate the impact of high-resolution CT angiography/CT cholangiography image fusion on selected clinical cases ABSTRACT Recently, the quality of the 3D images was excellent as a result of the fast scanning and narrow collimation using multi-detector CT. The parallel escalation in the capabilities of the workstation allows the use of CT angiography/CT cholangiography image fusion. In the hepatobiliary system, the choice of therapy for an individual patient requires complete preoperative staging to determine the resectability. We demonstrate high-resolution CT angiography/CT cholangiography image fusion in patients with various hepatobiliary pathology. This protocol included acquisition of two different scans and allowed accurate assessment of the hepatic parenchymal morphology and volumetrics and a detailed analysis of the biliary and vascular anatomies. We believe that our high-resolution fusion images are extremely valuable for applications such as preoperative planning for hepatic and bile duct resection, preoperative evaluation and planning for liver transplantation.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: PURPOSE/AIM 1. Assess the diagnostic performance of recent advances in 4D imaging techniques. 2. Review state-of-the-art 4D-CT portography (3D-CT portography with time axis) techniques for evaluation of the portal venous system. 3. Define the clinical utility of 4D-CT portography for abnormalities of the portal venous system. CONTENT ORGANIZATION 1. Theoretical background of 4D-CT imaging 2. Protocol for 4D imaging of the portal venous system 3. Diagnostic imaging using 4D-CT portography 4. Review of 4D-CT portography imaging findings - Normal portal vein anatomy and flow direction with time axis - Abnormalities of the portal venous system and flow direction 5. Comparison of 3D and 4D images of the portal venous system with respect to clinical utility SUMMARY Detection of the portal venous system is clinically important in the diagnosis of digestive disease. Although doppler ultrasonography is completely noninvasive, it does not allow imaging over a wide range, or of the deeper parts of the portal venous system. 4D-CT portography is volumetric cine imaging which provides wider coverage of the portal venous system. This imaging technique allows observation of the whole portal venous system and can detect dynamic blood flow and flow direction.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM The purpose of this exhibit is: 1. To review state-of-the-art techniques of three-dimensional imaging of hepatic hilum. 2. To understand the new CT fusion technique and evaluate the potential benefits of new technology in evaluation of hepatobiliary lesions. 3. To illustrate CT image fusion of various hepatobiliary abnormalities CONTENT ORGANIZATION 1. Three-dimensional anatomy of hepatic hilum (artery, portal vein, bile duct, liver parenchyma and other organs) 2. Technique of CT image fusion 3. Diagnostic imaging (CT) 4. CT fusion image of hepatic hilum - Anatomical variations of vascular and biliary structures - Adenomyomatosis of gallbladder - Gallbladder cancer - Cholangiocarcinoma - Liver tumor - Others 5. Future directions and summary SUMMARY The major teaching points of this exhibit are: 1: Accurate knowledge of the three-dimensional anatomy in hepatic hilum is essential for successful liver surgeries, including liver transplantation, tumor resection, and laparoscopic hepatobiliary surgery. 2: The escalation in the capabilities of the workstation allows the use of CT image fusion. 3: Our technique suggests that the results of CT image fusion have a near one-to-one correlation with surgical findings.
    Radiological Society of North America 2006 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM The purpose of this exhibit is: 1. To present the radiologic findings of liver, biliary tract, and pancreatic disease obtained with 3T dynamic 3D MRI. 2. To demonstrate the feasibility of multiplanar reformation (MPR), curved planar reformation(CPR), and 3D images for the depiction and characterization of hepatobiliary pancreatic lesions. CONTENT ORGANIZATION 1. Technique and scanning protocol of 3T dynamic 3D MRI. 2. MPR, CPR, MIP, and volume rendering technique for diagnostic imaging using high resolution 3T dynamic 3D MRI source data (tumor, artery, portal vein, bile duct, and other organs). 3. Review of imaging findings with 3D reconstruction - Liver tumor (hepatocellular carcinoma, metastasis) - Gallbladder cancer - Cholangiocarcinoma - Pancreatic tumor (ductal adenocarcinoma) - Others 4. Future directions and summary SUMMARY MDCT is the most widely used imaging technique for the detection and characterization of liver, biliary, and pancreatic disease. The z-axis spatial resolution was recently improved, however, with the introduction of 3D T1-weighted imaging and parallel acquisition techniques using 3Tesla MRI. High-resolution T1-weighted 3D gadolinium-enhanced MR technique allows for the detection of small lesions and visualization of their relationship to neighboring vessels and structures.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting;