[show abstract][hide abstract] ABSTRACT: MR imaging is a noninvasive and a useful modality for depicting a wide variety of uterine tumors with excellent tissue contrast. In case malignant uterine neoplasms are suspected, contrast-enhanced image is useful to delineate the tumor extent and internal architecture of the tumor. In cases of endometrial carcinomas, dynamic enhanced imaging is utilized for evaluating the depth of myometrial invasion. In differentiating malignant uterine tumors from benign conditions, in addition to filtration into the surrounding tissues, the presence of necrosis that is usually better demonstrated on postcontrast images is important imaging finding. Diffusion-weighted imaging is an emerging technique that depicts tissue contrast based on restricted diffusion of water molecules and demonstrates increased intensity in the malignant tumors. The recognition of typical MR imaging features in a wide variety of endometrial tumors may facilitate differentiation, thus better determining appropriate patient management.
Current Obstetrics and Gynecology Reports. 08/2013; 2(1).
[show abstract][hide abstract] ABSTRACT: This study describes the first case of biliary peritonitis after radiofrequency ablation diagnosed by magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific MR imaging contrast agent. The image acquired 300 minutes after the administration of Gd-EOB-DTPA was useful to make a definite diagnosis and to identify the pathway of bile leakage. It is important to decide on the acquisition timing with consideration of the predicted location of bile duct injury.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(6):914-917. · 1.32 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To retrospectively assess a new CT finding of esophageal cancer, "early esophageal rim enhancement". MATERIALS AND METHODS: Sixty-two patients with pathological proven esophageal squamous cell carcinoma who underwent dual phase CT imaging (arterial and venous phases) were enrolled. Two blinded observes independently evaluated presence of partial or circumferential enhancement of the esophageal periphery on arterial (early esophageal rim enhancement) and venous phase CT images. The radiological assessment was compared with the pathological T-stages. Agreement between the observers was also evaluated with a Cohen' kappa value. RESULTS: Pathologic results found 19, 12, 30 and 1 lesions, respectively for T1, T2, T3 and T4 stages. Agreement between two readers was substantial (κ=0.71). Esophageal rim enhancement was observed in 0, 4, 24 and 1 lesions respectively for T1, T2, T3 and T4 stages at the arterial phase, whereas no esophageal rim enhancement could be detected at the venous phase. Early esophageal rim enhancement was more frequently observed in T3/T4 lesions than T1/T2 lesions with statistical significance (p<0.0001). The sensitivity, specificity and accuracy for the diagnosis of T3 or T4 lesion were 80.6%, 87.1% and 83.9%, respectively. CONCLUSION: Early esophageal rim enhancement may be helpful for assessing invasion into the adventitia.
European journal of radiology 11/2012; · 2.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of this study was to investigate changes in magnetic resonance findings of the normal ovary during menstrual cycle on diffusion-weighted image (DWI).
Magnetic resonance imaging was performed in 9 healthy females at the menstrual, periovulatory, and luteal phases using a 1.5-T unit. Signal intensity (SI) of the ovary on DWI with a b value of 1000 s/mm was visually scored. The ovary-to-muscle contrast ratios on DWI and apparent diffusion coefficient (ADC) values were also evaluated.
All the ovaries were identified, and higher SI than the nerve root was identified in 70% (38/54) of the ovaries, although visual scores did not show significant difference among menstrual phases. The mean ADC values (10 mm/s) were 1.71 (SD, 0.27), 1.71 (SD, 0.22), and 1.67 (SD, 0.19) in menstrual, periovulatory, and luteal phases, respectively. No phase-dependent change was observed in contrast ratios and ADC values.
The normal ovary in fertile period shows high SI enough to be identified on DWI, and observed values are independent of the menstrual cycle.
[show abstract][hide abstract] ABSTRACT: The plicae palmatae are normal endocervical folds on the anterior and posterior walls. The median longitudinal ridges of the plicae palmatae have been considered to represent a remnant of fused Müllerian ducts. We present a case of uterus didelphys in which the longitudinal ridge of the plicae palmatae were obviously demonstrated on both of the uterine cervices on axial T2-weighted image. The observation of the plicae palmatae on the duplicated uterine cervices indicates the plicae palmatae is an inherent structure of the cervical canal, not a remnant of fused Müllerian duct.
[show abstract][hide abstract] ABSTRACT: To investigate feasibility of the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER or BLADE) T2-weighted imaging (T2WI) of the female pelvis by comparing it with standard fast spin-echo T2WI (STD-T2WI).
Sagittal STD-T2WI and BLADE-T2WI of the female pelvis were performed with (36 patients) or without (15 patients) administration of butylscopolamine on a 1.5 T MR unit. Two radiologists independently rated depiction of the uterus, ovary, intestines, bladder, gynecological lesions, overall quality, and artifacts using a four-point scale. Results were compared between STD-T2WI vs. BLADE-T2WI either with (B+) or without (B-) administration of butylscopolamine, BLADE-T2WI (B-) vs. BLADE-T2WI (B+), and STD-T2WI (B+) vs. BLADE-T2WI (B-).
When butylscopolamine was administrated, depiction of the uterus, ovary, intestines, gynecological lesions, and overall image quality was rated higher and artifacts were rated fewer for BLADE-T2WI with significance compared with STD-T2WI. When the drug was not administrated, significant difference was observed in depiction of the lesion, overall quality, and artifacts. Depiction of the uterus, gynecological lesion, and overall quality was rated significantly higher and artifacts were fewer in BLADE-T2WI (B+) than in BLADE-T2WI (B-).
BLADE method was feasible for female pelvic MRI, with best image quality in BLADE-T2WI (B+).
European journal of radiology 12/2011; 80(3):796-801. · 2.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study is to investigate radiologic findings of struma ovarii, and to correlate both CT and MR findings.
MR images of 26 cases were retrospectively reviewed. Post-contrast enhanced T1-weighted images were available in 17 patients. CT images, including seven non-contrast and eleven post-contrast studies, were available for review in 13 cases.
All 26 tumors appeared as well-defined cystic tumors with solid components, which were multilobulated surfaces in 19 and smooth surfaces in seven. Twenty-four was multicystic, whereas two were unilocular. The solid components were recognized as thickened septi or walls in 23 and a mass in three tumors. On T2-weighted images, loculi of prominent low intensity were recognized in 16 tumors. On T1-weighted images, the punctuate foci of high intensity were recognized in 24 tumors in or adjacent to the solid components. Ascites was present in only one lesion. In six of seven cases with non-contrast CT images, high attenuation areas were recognized. In five of these six tumors, high attenuation areas corresponded to the areas of prominent low intensity and the solid components on T2-weighted images. In seven cases with CT, curvilinear calcifications were recognized in the solid components.
Struma ovarii typically presents as a lobulated multicystic lesion with solid components. The tumors frequently include loculi of low intensity on T2-weighted images and punctuate foci of high intensity on T1-weighted images. On CT, high attenuation areas and calcifications in the solid components are common findings.
[show abstract][hide abstract] ABSTRACT: To clarify the preoperative differential diagnosis and management of minimal deviation adenocarcinoma (MDA) and lobular endocervical glandular hyperplasia (LEGH), a multicenter study was performed.
A total of 112 patients who underwent conization or a hysterectomy for suspected MDA were collected from 24 hospitals. The pathological diagnosis in each case was determined by a central pathological review board. The diagnostic significance of clinicopathologic findings including results of magnetic resonance imaging (MRI), Papanicolaou (Pap) smears, and testing for gastric mucin was analyzed.
The central pathological review identified 37 cases of Nabothian cyst or tunnel cluster, 54 cases of LEGH, 6 cases of MDA, 11 cases of adenocarcinoma, and 4 cases of benign disease. Lobular endocervical glandular hyperplasia was often associated with adenocarcinoma in situ, MDA, and mucinous adenocarcinoma. Three MDA patients had a recurrence, whereas none of LEGH patients had a recurrence irrespective of the type of surgery. On MRI, LEGH appeared as a characteristic multicystic lesion with an inner solid component, whereas MDA showed a predominantly solid pattern. A Pap smear or gastric mucin alone had limited diagnostic power. However, a combination of these findings is useful; that is, a cystic structure with inner solid components on MRI associated with mild glandular atypia and gastric mucin strongly suggested LEGH (24/26, 92%). A solid structure with atypical glandular cells was indicative of MDA or adenocarcinoma (5/5, 100%).
The combination of MRI, Pap smears, and gastric mucin will improve the accuracy of the preoperative diagnosis of MDA and LEGH. Patients suspected of having LEGH may need to be treated with less aggressive methods.
International Journal of Gynecological Cancer 06/2011; 21(7):1287-96. · 1.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Diffusion tensor imaging (DTI) at 3 T provides information on the microstructure and pathophysiology of tissues that is not available from conventional imaging with an advantage of high signal to noise ratio (SNR).
To evaluate the feasibility of DTI of the normal kidney at 3.0 T compared to results obtained at 1.5 T.
DTI of the normal kidney of 15 healthy volunteers obtained with 3.0 and 1.5 T scanners using respiration-triggered acquisition was examined. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of both the renal cortex and the medulla and SNRs were measured (b-values 0 and 400 s/mm², diffusion direction of 6). The image quality of FA and ADC maps was also compared subjectively.
The FA values of the renal cortex were 0.15 ± 0.03 at 3.0 T and 0.14± 0.03 at 1.5 T on average. This difference was not significant. The FA values of the renal medulla were 0.49 ±0.04 at 3.0 T and 0.42 ± 0.05 at 1.5 T. ADC values of the renal cortex were 2.46 x 10⁻³± 0.09 mm<²/s at 3.0 T and 2.20 x 10⁻³±0.11 mm²/s at 1.5 T. The ADC values of the renal medulla were 2.08 x 10⁻³ ± 0.08 mm²/s at 3.0 T and 1.90 x 10⁻³± 0.11 mm²/s at 1.5 T. These FA and ADC values were consistent with previous publications. The difference was significant for the FA value of the medulla (P< 0.01) and ADC values in both cortex and medulla (P < 0.01). The subjective image quality of the FA map with the 3.0 T scanner was significantly superior to that with the 1.5 T scanner (P< 0.01), but not significant for the ADC map (P = 0.18). There was a significant difference in SNR between 3.0 T (48.8 ± 6.6) and 1.5 T images (32.8 ± 5.0).
The feasibility of renal DTI with a 3.0 T magnet resulting in improved SNR was demonstrated.
[show abstract][hide abstract] ABSTRACT: We describe a case of congenital segmental giant megaureter in a boy that presented as a fetal abdominal mass. He also had bilateral undescended testes, bilateral vesicoureteral reflux, and segmental aniridia. He presented with hypoglycemia in the neonatal period that resolved. Postnatal magnetic resonance imaging, voiding cystourethrography and radionuclide imaging established the diagnosis, and a ureteroureterostomy was performed at 12 months.
Journal of Pediatric Surgery 01/2010; 45(1):269-71. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: Primary mucinous adenocarcinomas of the uterine corpus are typically low grade and frequently associated with endometrial hyperplasia and/or ordinary endometrioid adenocarcinoma, but may appear as a heterogeneous group of neoplasms. A case is described of a 56-year-old postmenopausal woman who presented with mucinous vaginal discharge. Imaging demonstrated thickened myometrium due to adenomyosis. Serum CA19-9 levels were elevated to 486 U/mL. Microscopic examination of hysterectomy specimens indicated highly differentiated mucinous adenocarcinoma diffusely infiltrating the portion of adenomyosis of the corpus. In some areas endometrial glands of adenomyosis were replaced by benign-looking mucinous metaplasia. The uterine cervix showed no abnormalities. HIK1083 and MUC6 immunohistochemistry indicated a gastric phenotype of the tumor, as seen in cases of prototypical minimal deviation adenocarcinoma (MDA) of the cervix. In summary, mucinous endometrial adenocarcinoma rarely shows features similar to MDA of the cervix. This case provokes a discussion on diagnostic and management strategy, and histogenesis of mucinous neoplasm of the endometrium.
Pathology International 01/2010; 60(1):42-7. · 1.72 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate whether the accuracy of local extension (T-staging) of esophageal carcinoma could be improved with addition of arterial phase images by use of multi-detector row computed tomography.
The institutional review board approved this study, and all the subjects provided informed consent. Dual-phase (the arterial and venous phases) contrast-enhanced computed tomography was performed in 45 consecutive patients (39 men and 6 women; age range, 47-84 years) with 47 lesions of esophageal carcinoma who underwent surgical intervention. Two radiologists independently evaluated the T-staging of esophageal carcinoma on both phases. The T-staging on both the arterial and venous phase images was compared with the T-staging at histologic evaluation by means of a resected specimen (as the reference standard). Differences in the overall accuracy and sensitivity for the T-staging between the 2 phases were analyzed with the McNemar test.
The analysis of the interobserver agreement for T-staging showed almost perfect agreement (kappa = 0.85 on the arterial phase and kappa = 0.93 on the venous phase). The overall accuracy in the arterial phase was significantly better than that in the venous phase (68% vs 51%, P < 0.01). The sensitivity values of the T-staging in the arterial phase were 0% in T1a, 71.4% in T1b, 12.5% in T2, 89.5% in T3, and 100% in T4. The sensitivity values in the venous phase were 0% in T1a, 14.3% in T1b, 0% in T2, 94.7% in T3, and 100% in T4. Statistical significance was apparent in the sensitivity of the T1b lesions.
The arterial phase can improve the accuracy of T-staging of esophageal carcinomas, especially early-staged lesions.
[show abstract][hide abstract] ABSTRACT: Knowing the normal imaging appearance of the pituitary stalk is important for the diagnosis of pituitary infundibular lesions, and more accurate assessment of the stalk may be possible at 3T than at 1.5T. Our purpose was to evaluate the normal pituitary stalk by use of high-resolution MR imaging at 3T.
Sagittal MPRAGE images and high-resolution oblique-axial T2-weighted images of the pituitary stalk were acquired in 29 healthy volunteers (16 men and 13 women; mean age, 28 years; age range, 21-43 years) at 3T. The diameter and length of the pituitary stalk and the depth of the infundibular recess were measured. Signal intensity of the stalk was visually evaluated on T2-weighted images.
The AP and transverse diameters of the pituitary stalk were 2.32 +/- 0.39 mm and 2.16 +/- 0.37 mm at the pituitary insertion, respectively, and 3.25 +/- 0.43 mm and 3.35 +/- 0.44 mm at the level of the optic chiasm. No significant differences were observed between the AP and transverse diameters at each level. The length of the stalk was 5.91 +/- 1.24 mm, and the depth of the infundibular recess was 4.69 +/- 0.87 mm. The stalk showed central hyperintensity with a peripheral rim of isointensity in 20 subjects (69%) and homogeneous isointensity in 9 subjects (31%).
The data of the current study can serve as standard measurements of the normal pituitary stalk. The central hyperintensity and peripheral rim may represent the infundibular stem and pars tuberalis, respectively.
American Journal of Neuroradiology 10/2009; 31(2):355-9. · 3.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate visibility of the external carotid artery (ECA) and its branches using three-dimensional (3D) balanced steady-state free-precession (SSFP) MR angiography with a time-spatial labeling inversion pulse (Time-SLIP), and to provide an optimal value of the inversion time (TI).
Peripheral-pulse-wave-gated 3D balanced SSFP images were obtained in 20 healthy volunteers. Images with a Time-SLIP using four different TIs (600, 900, 1200, and 1500 ms) and without a Time-SLIP, referred to as sequence A to E, were acquired for each subject and compared for visibility scores of ECA system and relative signal intensity (SI) of ECA.
Average Friedman rank for overall visibility was 1.63, 3.01, 3.59, 3.58, and 3.20 for sequence A to E, respectively. Sequence C and D yielded significantly higher visibility than sequence A, B, and E. The mean relative SI value was 0.97, 0.87, 0.81, 0.76, and 0.67 for sequence A to E, respectively.
Balanced SSFP MR angiography with a Time-SLIP is superior to that without a Time-SLIP, showing excellent visualization of ECA system in approximately 3 min in average with sufficient background suppression including veins and salivary ducts. A TI of 1200 ms was considered to be optimal for this purpose.
Journal of Magnetic Resonance Imaging 09/2009; 30(3):678-83. · 2.57 Impact Factor
[show abstract][hide abstract] ABSTRACT: To demonstrate the feasibility of diffusion tensor imaging (DTI) of kidneys with respiratory triggering, and determine the optimal imaging parameters for fraction anisotropy (FA) maps.
DTI of kidneys from 16 healthy volunteers was performed using a 1.5T scanner. Five different sequences with different parameters including respiration-triggered acquisition or multiple breath-holding, slice thicknesses of 3 or 5 mm, and different numbers of signal averaging and b values were compared. FA and apparent diffusion coefficients (ADCs) of the cortex and medulla were measured. Measurement error within the same and repeated examination was examined using within-individual standard deviation (Sw).
FAs of the renal cortex were lower than the medulla (mean value of a sequence ranging 0.148-0.224, 0.433-0.476) and the ADCs of the cortex were higher than the medulla (2.26-2.69x10(-3) mm2/s, 1.77-2.19x10(-3) mm2/s) in all sequences (P<0.001). The renal cortex-medulla difference was the largest, with respiratory trigger- ing including a 3-mm slice thickness, three signal averages,and a b-value=0, 200, or 400 s/mm2 (P<0.001). Sw tended to be smaller in the sequence with a b-value of 400 s/mm2.
DTI of kidneys with respiratory triggering is feasible with excellent cortex-medulla differentiation.
Journal of Magnetic Resonance Imaging 03/2009; 29(3):736-44. · 2.57 Impact Factor
[show abstract][hide abstract] ABSTRACT: Recent developments in MR imaging techniques have enabled the functional assessment of the uterus. Cine MR imaging is a useful tool for evaluating uterine kinematic functions derived from myometrial contractility, and for investigating the alteration of uterine contractility in a variety of conditions and gynecologic disorders. Diffusion-weighted imaging can demonstrate abnormal signal in pathologic foci based on differences in molecular diffusion, and could provide useful information in evaluating malignant conditions. Dynamic contrast-enhanced MR imaging has the potential to improve tumor detection and local staging, and quantitative information may be useful for both monitoring therapeutic effects and predicting outcome. These state-of-the-art functional MR imaging techniques are beneficial for elucidating various uterine conditions when used appropriately, and the findings further provide the basis of future MR imaging investigations.
Magnetic Resonance Imaging Clinics of North America 12/2008; 16(4):673-84, ix. · 1.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report a rare case of schwannoma of the brachial plexus presenting as an enlarging cystic mass. A 52-year-old woman was found to have a rapidly enlarging cystic lesion in the left pectoralis minor space. Surgical exploration finally found that the lesion was schwannoma originating from the fascicles of the brachial plexus. Partial removal of the fluid enabled us to dissect the mass without difficulty. The patient showed no sign of neurological disorders postoperatively. Although schwannoma sometimes accompanies the cystic lesion in part, schwannoma of the brachial plexus manifesting as a cystic lesion is very rare.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 11/2008; 14(5):311-3.
[show abstract][hide abstract] ABSTRACT: This study aimed to evaluate the clinical value of image fusion from magnetic resonance (MR) combined with positron emission tomography (PET) imaging, using 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) in head and neck cancer.
Sixty-five consecutive patients underwent MR and FDG-PET scans before or after the treatment of known or suspected head and neck cancer. T1-weighted and T2-weighted images were first assessed by MR interpretation, and then, the fused images of T2-weighted images from MR and PET were evaluated in a blind manner. Diagnostic performance was compared.
For initial staging, in 48 patients, malignant tumors were histologically confirmed in 45 patients. The interpretation sensitivities of MR alone and fused images for primary tumors were 98% and 100%, respectively. For lymph node metastasis, the sensitivity and specificity of both methods were 85% and 92%, respectively. Of 15 patients with suspected recurrence, ten patients had recurrent tumors, three patients developed second malignant tumors, and two patients had no recurrence. For these patients, the overall sensitivity of MR alone was 67%, whereas that of the fused images was 92%. Eight additional lesions were accurately diagnosed by image fusion only. In two patients with lymph node metastasis from unknown origin, the primary site was not detected in one patient, while tonsilar cancer was identified only by image fusion interpretation.
Image fusion from MR with PET might be useful in evaluating head and neck cancer, especially in suspected recurrent cases rather than in fresh cases.
[show abstract][hide abstract] ABSTRACT: Tuberous sclerosis is a rare autosomal dominant neurocutaneous syndrome characterized by the presence of benign congenital tumors in multiple organs. The diagnosis is usually established on the basis of diagnostic criteria applied to physical or radiologic findings. Because the classical triad of epilepsy, mental retardation, and adenoma sebaceum is uncommonly seen at clinical examination, radiologic examinations can play an important role in the diagnosis of tuberous sclerosis and in treatment. Cardiac rhabdomyoma, renal angiomyolipoma, and neurologic involvement encompassing cortical or subependymal tubers and white matter abnormalities are the common radiologic findings. Detection of these entities can be strong evidence for suspecting tuberous sclerosis. The presence of pulmonary lymphangioleiomyomatosis, multifocal micronodular pneumocyte hyperplasia, or multiple renal cysts also raises suspicion of tuberous sclerosis. Moreover, tuberous sclerosis can involve bone, liver, and the alimentary tract. The clinical course and patient prognosis depend on the sites of manifestations. Familiarity with the clinical and radiologic findings in various organs is crucial in diagnosis and treatment.
[show abstract][hide abstract] ABSTRACT: We present a case of Sertoli-Leydig cell tumour of the ovary in a 14-year-old girl who presented with abdominal distension. Ultrasonography showed a multilocular cystic lesion filled with finely echogenic fluid. Contrast-enhanced CT demonstrated a huge multilocular cystic mass with thickened septa. At MR imaging, the capsule of the cyst was focally thickened, showing intermediate signal intensity on T2-W images. Although extensive cyst formation of Sertoli-Leydig cell tumour is rare, this tumour should be considered in the differential diagnosis of a multilocular cystic ovarian tumour in a young female.