Changes In Imaging Findings Research Articles

Metastasis infiltrating tumor to meningioma: a case report

BackgroundThere have been many reports of tumor-to-tumor metastasis, in which cancer metastasizes directly into meningiomas. However, metastasis infiltrating tumors in which cancer metastasizes around meningiomas are rare. Therefore, we report a case of metastasis originating from lung cancer that infiltrated meningioma.Case presentationA 79-year-old Japanese woman underwent head magnetic resonance imaging for brain metastasis screening before lung cancer surgery. At that time, asymptomatic meningioma of the left frontal region was accidentally found. Magnetic resonance imaging 6 months later revealed a lesion suspected to be a metastatic brain tumor close to the meningioma. Brain tumor resection was performed, and histopathological diagnosis was meningioma and metastatic brain tumor. Metastatic cancer had invaded the meningioma at the boundary between the brain tumor and metastasis.ConclusionsA sudden change in imaging findings on routine examination of meningiomas in patients with lung carcinoma may indicate a metastatic brain tumor. The form of cancer metastasis to meningioma is not limited to tumor-to-tumor metastasis, but also includes metastasis infiltrating tumors near the meningioma.

Changes in imaging findings of hereditary hemorrhagic telangiectasia with focal nodular hyperplasia during long-term follow-up: a case study

遺伝性出血性末梢血管拡張症（hereditary hemorrhagic telangiectasia：HHT）は常染色体優性遺伝の全身性血管疾患である．今回，限局性結節性過形成（focal nodular hyperplasia：FNH）を伴ったHHTの長期経過観察をしえた1例を報告する．60歳代女性．主訴はなし．幼少期より鼻出血を繰り返しており，他院にて肝内腫瘤が疑われ，2006年に当院紹介となった．家族鼻出血歴あり．入院時血液検査は肝炎ウイルスマーカー，腫瘍マーカー陰性であった．腹部超音波（ultrasonography：US）は，肝全域に著明な門脈，肝静脈の拡張，コイル状肝動脈管拡張，多発シャント像，および境界不明瞭な不整形腫瘤を多数認めた． 最大径腫瘤（S8）は，カラードプラにてspoke-wheel-pattern様シグナルを示した．ダイナミックCTでも同様の血管異常を認め，腫瘤は早期相で不均一に造影され，Wash outは認めなかった．腫瘍生検を実施しFNHの診断であった．2007年に最大腫瘤に対し，ペルフルブタン（ソナゾイド）造影検査（contrast-enhanced ultrasonography：CEUS検査）を実施し，早期相で内部不均一濃染を示し，後血管相defectを認めなかった．その後，1年ごとの画像検査では，血管病変に著変は認めなかったが，最大腫瘤はUSとGd-EOB-DTPA造影MRI（EOB-MRI）にて，徐々に縮小し，2015年に消失した．その後，EOB-MRIでは新規出現や縮小等，腫瘤の全体像を把握しえたが，USでは検出できなかった．しかし，2022年のUSで新たに腫瘤が確認され，Full focus機種でCEUS検査を行ったところ，Bモードで指摘できなかった腫瘤も観察しえた．多発FNHを伴うHHTの長期経過を観察しえた．CEUS検査，EOB-MRIは病態全体像の把握に有用である．

Natural history of spontaneous intracranial hypotension: a clinical and imaging study

BackgroundAlthough spontaneous intracranial hypotension (SIH) is well studied, there are few studies of the clinical and imaging history of SIH without interventional treatments. For example, what is the natural history...

Natural history of acute unruptured vertebral basilar artery dissection: Temporal changes in imaging findings and contributory factors

ObjectivesTo investigate temporal changes in imaging findings of conservatively treated acute unruptured vertebral basilar artery dissection (VBAD) and its contributing factors. MethodsFifty-three patients who underwent conservative treatment for 64 cases of acute VBAD diagnosed between January 2006 and March 2019 with follow-up of at least 12 months after onset were retrospectively investigated. Statistical analyses of age, sex, medical history, pattern of onset, lesion site, imaging findings and changes over time, regular medication, and outcomes were performed. ResultsChanges in the vascular morphology of the lesion site during the follow-up period were observed in only 23 (43 %) patients (median time until change: 19 days). Univariate analysis of factors contributing to morphological changes at the dissection site showed that changes were significantly more likely in younger patients (p = 0.011). Patients taking antiplatelet drugs had a significantly greater rate of deterioration at the dissection site (p = 0.028) than others. On multivariate analysis, age was an independent factor contributing to changes at the dissection site, and taking antiplatelet drugs, particularly clopidogrel, was an independent factor contributing to deterioration. No patient developed intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during follow-up. ConclusionsMorphological changes at the dissection site are more likely in younger patients with acute unruptured VBAD and those taking antiplatelet drugs. However, chances of intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during conservative therapy are low; therefore, acute unruptured VBAD may be considered a benign condition.

The Effects of Combined Vitamin E and C for Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD): A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Antioxidant therapy is a promising treatment option for non-alcoholic fatty liver disease (NAFLD) after failure of lifestyle modification. We aimed to explore the efficacy of combined vitamin E and C therapy compared to no treatment for NAFLD. A literature search was performed in Ovid Embase, Ovid Medline, PubMed, Cochrane Library, Scopus, and Web of Science from inception to 28th April 2020. A systematic review and meta-analysis were conducted on randomized controlled trials that assessed vitamin E and C co-treatment in NAFLD. Quality of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Assessed outcomes were changes in imaging findings, histological features, and serum transaminases. Subgroup analyses that compared adult versus children were further explored. Four studies (n=260) satisfied our eligibility criteria. Vitamin co-treatment did not improve ultrasonographic liver brightness, histological parameters of hepatocyte injury (steatosis, lobular inflammation, and ballooning), fibrosis grading (standardized mean difference [SMD ]: 0.02, 95% CI: -0.40 to 0.45, I2=13%), serum aspartate transaminase (mean difference [MD]: -0.05, 95% CI: -2.59 to 2.50, I2=0%), and serum alanine transaminase (MD: 2.82, 95% CI: -2.11 to 7.76, I2=57%). Subgroup stratifications illustrated similar findings. Vitamin co-treatment may have limited efficacy in NAFLD. However, we have little confidence in our effect estimates due to bias and other major constraints.

Evaluation of tyrosine kinase inhibitors combined with antiprogrammed cell death protein 1 antibody in tyrosine kinase inhibitor-responsive patients with microsatellite stable/proficient mismatch repair metastatic colorectal adenocarcinoma: protocol for open-label, single-arm trial

IntroductionThe prognosis of patients with advanced metastatic colorectal adenocarcinoma (mCRC) after multiple-line therapy remains poor due to the high tumour load, high level of malignancy and strong drug resistance. The...

Intracholecystic papillary neoplasm associated with invasive carcinoma of the remnant gallbladder after subtotal cholecystectomy: a case report

BackgroundIntracholecystic papillary neoplasm (ICPN) of the gallbladder is a rare tumor and a relatively new concept. Therefore, the natural history and imaging characteristics of ICPN have not yet been fully documented. Moreover, cases who underwent curative resection for remnant gallbladder cancer, including ICPN with associated invasive carcinoma, have been rarely reported. We report a resected case of ICPN of the remnant gallbladder with associated invasive carcinoma for which we could observe a temporal change in imaging findings until malignant transformation.Case presentationA 79-year-old female patient with a surgical history of subtotal cholecystectomy for acute cholecystitis was an ambulatory patient of our institution because of postoperative surveillance for colon cancer. Ultrasonography and computed tomography incidentally detected a small nodule in the cystic remnant gallbladder. The nodule had increased in size 3 months later; thus, additional investigations were performed. Magnetic resonance imaging revealed a 10-mm enhanced nodule without evidence of extraluminal invasion. Diffusion-weighted magnetic resonance imaging revealed restricted diffusion of the lesion, and positron emission tomography revealed marked accumulation in the lesion. The lesion was diagnosed as suspicious for a malignant remnant gallbladder tumor. Therefore, remnant cholecystectomy with gallbladder bed resection was performed. Because preoperative endoscopic retrograde cholangiography revealed a relatively long intact cystic duct, extrahepatic bile duct resection was planned to be omitted. Intraoperatively, the hepatic and duodenal side bile duct where the cystic duct diverged was taped. Using these tapes, which permitted pulling the bile duct, the cystic duct located behind the bile duct could be safely exposed. The lesion was pathologically diagnosed as biliary morphologic ICPN with associated invasive carcinoma.ConclusionsBecause remnant cholecystectomy is an uncommon procedure and technically difficult, accurate preoperative investigation and surgical planning are important to prevent bile duct injury and omit extrahepatic bile duct resection. In the present case, intracystic change could be detected incidentally at an early stage because of previous remnant gallbladder producing (reconstituting) subtotal cholecystectomy and surveillance for other disease. This case suggests the existence of ICPN that can progress to invasive carcinoma during a short period.

Tapering of TNF inhibitors in axial spondyloarthritis in routine care - 2-year clinical and MRI outcomes and predictors of successful tapering.

In a 2-year follow-up study of patients with axial spondyloarthritis (axSpA) in clinical remission who tapered TNF inhibitor (TNFi) treatment according to a clinical guideline, we aimed to investigate the proportion who successfully tapered/discontinued therapy and baseline predictors thereof. The proportion regaining clinical remission after flare and the progression on MRI/radiography were also assessed. One-hundred-and-nine patients (78 [72%]/31 [28%] receiving standard and reduced dose, respectively) in clinical remission (BASDAI < 40, physician global score < 40) and no signs of disease activity the previous year tapered TNFi as follows: to two-thirds of standard dose at baseline, half at week 16, one-third at week 32 and discontinuation at week 48. Patients experiencing clinical, BASDAI or MRI flare (predefined criteria) stopped tapering and escalated to previous dose. Prediction analyses were performed by multivariable regression. One hundred and six patients (97%) completed 2 years' follow-up; 55 patients (52%) had successfully tapered: 23 (22%) receiving two-thirds, 15 (14%) half, 16 (15%) one-third dose and 1 (1%) discontinued. In patients at standard dose at baseline (n = 78), lower physician global score was the only independent predictor of successful tapering (odds ratio [OR] = 0.79 [95% CI: 0.64, 0.93]; P = 0.003). In the entire patient group lower physician global score (OR = 0.86 [0.75, 0.98]; P = 0.017), lower Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Erosion score (OR = 0.78 [0.57, 0.98]; P = 0.029) and current smoker (OR = 3.28 [1.15, 10.57]; P = 0.026) were independent predictors of successful tapering. At 2 years, 97% of patients were in clinical remission. Minimal changes in imaging findings were observed. After 2 years following a clinical guideline, 52% of patients with axSpA in clinical remission had successfully tapered TNFi, only 1% discontinued. Baseline physician global score was an independent predictor of successful tapering.

Can regular follow-up imaging contribute to the determination of appropriate timing of surgery in patients with undiagnosed mucinous cystic neoplasm? A multicenter retrospective study.

Guidelines suggest that patients with undiagnosed pancreatic cystic lesions should be monitored despite a lack of evidence supporting surveillance for undiagnosed mucinous cystic neoplasms (MCNs). We aimed to investigate the pre- and post-operative clinical course of patients with MCN and the utility of follow-up for patients who were not diagnosed with MCN at initial examination. This multicenter retrospective study enrolled 28 patients with resected pathology-proven MCN; 12 and 16 patients underwent surgery within and after 6months from the initial examination (Groups A and B, respectively). Outcome measures included changes in imaging findings until surgery in Group B, pathological findings between both groups and differences in pathological findings between patients with and without regular follow-up imaging in Group B. In Group B, the median cyst size was 30 and 48mm at the initial examination and immediately before surgery, respectively. The incidence of mural cysts, thickened walls and mural nodules were 25, 19 and 0%, respectively, at the initial examination and 69, 56 and 31%, respectively, immediately before surgery. There were no significant differences in the invasive carcinoma rates between Groups A and B (13 vs. 17%). Regular follow-up imaging was offered to Group B. Among these, invasive carcinoma was found in one patient exhibiting no recurrence. One patient without follow-up imaging had invasive carcinoma recurrence post-operatively. MCNs increased in size, and typical imaging findings appeared over time. For undiagnosed MCN, regular follow-up examination contributed to the determination of the appropriate surgical timing.

Effect of Liver Transplant on Neurologic Manifestations and Brain Magnetic Resonance Imaging Findings in Wilson Disease.

Wilson disease is an autosomal recessive disorder of copper metabolism. It leads to copper accumulation in various organs (liver, eye, brain) and deteriorates their functions. Symptoms usually appear in the second and third decades of life. Neurologic symptoms and manifestations may appear 2 to 5 years after liver involvement, and neurologic symptoms are usually movement disorders. The main treatment objective is to decrease accumulation of copper by increasing urinary copper excretion. With early diagnosis and treatment, the quality of life of patients with Wilson disease evolves. In this study, we aimed to evaluate the effects of liver transplant on neurologic manifestations and radiologic findings in patients with Wilson disease. Since 1988, our center has performed 642 liver transplant procedures. Fifty-three patients with Wilson disease received a liver transplant during this period, with 15 adults patients included in our study. All study patients were evaluated by the same neurologist and radiologist. Tremor was scored by the glass scale test. Radiologic evaluations were made by cranial magnetic resonance imaging. Before liver transplant, 4/15 study patients had tremor. In 1 patient, tremor was accompanied by dystonia; the patient's imaging findings and neurologic manifestations had regressed posttransplant. In the other 3 study patients with tremor, tremor decreased without any change in imaging findings. New-onset tremor was seen in 1 patient after liver transplant, but this patient had no observed imaging changes. This situation was correlated with immunosuppressive therapy. Neurologic recovery can be achieved in patients with Wilson disease with early diagnosis and treatment. Radiologic findings can be improved after therapy.

68Ga]Ga-PSMA-11 PET/CT for monitoring response to treatment in metastatic prostate cancer: is there any added value over standard follow-up?

BackgroundThe aim of the current study was to assess whether and to what extent monitoring response to treatment using prostate-specific membrane antigen (PSMA)-based positron-emitting tomography/computerized tomography (PET/CT) studies contribute clinically relevant data to routine clinical follow-up during treatment of patients with metastatic prostate cancer (PCa).ResultsFifty-two patients with metastatic PCa who underwent [68Ga]Ga-PSMA-11 PET/CT imaging and serum prostate-specific antigen (PSA) level measurements before and during treatment were investigated. Response was categorized by serum PSA dynamics according to improvement, stable disease, and disease progression and compared to change in imaging findings on pre- and post-treatment PET/CTs. McNemar’s test was used to assess agreement between PET/CT- and PSA-based responses to treatment.Thirty-four patients (65.4%) had compatible biochemical- and imaging-based response to treatment. However, the imaging and biochemical responses were discrepant in 18/52 patients (34.6%). PET/CT showed progressive disease in 5/52 patients (9.6%) and improvement/stable disease in 13/52 (25%) compared to biochemical assessment results. Discrepancy between imaging and biochemical response was most prominent in biochemically stable patients (90.9%), followed by patients with biochemical progression (33.3%), and in only few (8.7%) patients with biochemical improvement. The imaging-based response was suitable for choosing subsequent treatment in 22 of 30 patients (73.3%) with longer follow-up (median time of 10.3 months (IQR 6.3–18.2)). The relevance of the imaging methodology was reflected by its ability to assess individual lesions in cases of heterogeneous lesion responses, reveal the appearance of new lesions, and identify lesions that required specific consideration, such as targeted radiotherapy.ConclusionsResults of this retrospective analysis showed that biochemical responses to treatment and [68Ga]Ga-PSMA-11 PET/CT-based responses to treatment differ in one third of metastatic PCa patients. The latter additionally enabled lesion-based and not solely patient-based analysis. Monitoring response during treatment by [68Ga]Ga-PSMA-11 PET/CT is suitable for decision-making in patient management and choice of treatment in the majority of patients.

Correlation of 3-T MRI and CT findings with patient symptoms and treatment outcome in radiofrequency ablation of osteoid osteoma

ObjectiveThe aim of this prospective study was to evaluate pre- and post-treatment MRI and CT findings of osteoid osteoma (OO) patients treated with radiofrequency thermo-ablation (RFTA) and to compare these findings with visual analog scale (VAS) scores. MethodsSixteen patients (4 females and 12 males; mean age of 18.87 ± 8.75 years (range: 8–37)) with OO were examined with CT and MRI, at baseline and at an average of 3 months following the procedure. On pre- and post-procedural CT and MRIs, OO-related findings were recorded. Treatment success was evaluated with VAS scores. ResultsBaseline VAS scores were 8 or 9 and follow-up scores were 0 or 1, indicating no early recurrences.Nidus diameters decreased significantly after the procedure (p = 0.027, p = 0.002, and p = 0.002; and p = 0.001, p = 0.001, p = 0.001 for AP, ML and CC nidus diameters for CT and MRI, respectively).The mean nidus volume were significantly decreased after the procedure (p = 0.001, for CT and MRI).On post-procedural images, cortical thickening, the signal intensity and contrast enhancement of the nidus and the extent of periostitis were significantly decreased (p = 0.019, p = 0.001, p = 0.001 and p = 0.034, respectively). There was no significant change in nidus calcification, perinidal cortical and intramedullary sclerosis, periosteal reaction, bone deformity, bone marrow and soft tissue edema, joint effusion and synovitis after the procedure (p = 0.253, p = 0.062, p = 0.245, p = 1, p = 1, p = 0.429, p = 0.371, p = 0.625, p = 1). ConclusionAlthough the changes in imaging findings may be helpful in early follow-up of OO patients treated with RFTA, these changes alone cannot be used with accuracy in predicting treatment response. Level of EvidenceLevel IV, Therapeutic Study.

Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture.

Background:There are no reports analyzing imaging findings of arteries embolized with N-butyl cyanoacrylate (NBCA)-Lipiodol. To evaluate the time course of changes in the imaging findings of small arteries embolized with NBCA-Lipiodol.Materials and Methods:Selective transcatheter arterial embolization procedures via the inferior phrenic artery (right IPA, n = 25; left IPA, n = 5) were performed in 30 patients (25 males, 5 females; mean age 63 years, range: 45–78) at our institution. The NBCA-Lipiodol mixture was used as an embolic agent. The ratio of NBCA to Lipiodol was 1:4 (Group-A, n = 16) or 1:8 (Group-B, n = 14).We retrospectively reviewed the computed tomography (CT) findings and outcomes of small arteries embolized with the NBCA-Lipiodol mixture. The residual lipiodol was compared between Group-A and Group-B. The Student's t-test and Chi-square test were used for statistical analyses. In addition, the residual lipiodol rate was calculated using the Kaplan–Meier method and compared using the log-rank test.Results:The mean observation period was 264 ± 84 days (range: 104–425). Lipiodol completely disappeared in 20 arteries (66%) during follow-up. Recanalization of arterial flow was not seen in CT images, even when Lipiodol disappeared. Group-B showed a shorter period of progression to disappearance of Lipiodol than Group-A (P < 0.05). On follow up, the rate of residual Lipiodol in Group-A was higher than that in Group-B (P < 0.05).Conclusion:Residual Lipiodol was expected to gradually disappear. Lipiodol disappeared early when the density of NBCA was low in the NBCA-Lipiodol mixture. Further evaluations of various arteries and ratios of NBCA to Lipiodol are needed.

Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma.

To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE). Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated. Among 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1mm in diameter; p=0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor. Tumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.

Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results.

There are reports that fusion is the standard treatment of choice for cases of lumbar degenerative spondylolisthesis (LDS) associated with lumbar spinal canal stenosis with a large degree of slippage. The reasons why, however, have not been clarified. On the other hand, it is known that the progress of slippage decreases and restabilization occurs over the natural course of LDS. Therefore, if minimally invasive decompression could be performed, there would be little possibility of it influencing the natural course of LDS, so it would not be necessary to include preoperative percentage slip in the criteria for the selection of fusion. This study examined the course of LDS cases more than 5 years after treatment with minimally invasive decompression to determine whether pre- and postoperative slippage and disc changes influence the clinical results. A total of 51 intervertebral segments in 51 cases with the chief complaint of radicular or cauda equina symptoms due to lumbar spinal canal stenosis were examined after prospective treatment with minimally invasive decompression for LDS. The mean age of the patients at the time of surgery was 66.7 years and the mean follow-up period was 7 years 4 months. Minimally invasive decompression was performed regardless of the degree of low-back pain or percentage slip. The outcome variables were clinical results and changes in imaging findings. Over the follow-up period, postoperative percentage slip increased and disc height decreased, but the Japanese Orthopaedic Association score improved. Regardless of the preoperative percentage slip, disc height, or degree of intervertebral disc degeneration or segmental instability, the clinical results were favorable. In the high preoperative percentage slip group, low disc height group, and progressive disc degeneration group, there was little postoperative progress of slippage. In the group with a postoperative slippage increase of more than 5%, slippage increased significantly at postoperative year 2, but no significant difference was observed at the final follow-up. When minimally invasive decompression was performed to treat LDS, the postoperative change in slippage was no different from that during the natural course. Furthermore, regardless of the degree of preoperative slippage or intervertebral disc degeneration, the clinical results were favorable. Also, the higher the preoperative percentage slip and the more that disc degeneration progressed, the more the progress of postoperative slippage decreased. Because the postoperative progress of slippage decreased, it is believed that even after minimally invasive decompression, restabilization occurs as it would during the natural course. If minimally invasive decompression can be performed to treat LDS, it is believed that preoperative percentage slip and intervertebral disc degeneration do not have to be included in the appropriateness criteria for fusion.

Adhesive Small Bowel Obstruction: Early Operative versus Observational Management

We assessed the nonoperative and operative management of adhesive small bowel obstruction (ASBO) and compared complication rates and surgical outcomes. ASBO is a common complication of abdominopelvic surgery. Although patients may respond to nonoperative management, many require surgery. We retrospectively studied patients admitted to Mount Sinai Hospital with a diagnosis of complete ASBO to determine outcomes of nonoperative management. Patients admitted with complete ASBO from 2001 to 2011 were included. Patients with no previous abdominopelvic surgery, surgery within the six weeks preceding admission and obstruction due to other identifiable causes, such as incarcerated hernia, were excluded. Complication rates and outcomes were compared between patients managed with immediate surgery and those managed initially with nonoperative strategies. Of 460 patients admitted with complete ASBO, 106 (23.0%) had surgery within 24 hours of admission. At surgery, 20 (18.9%) had ischemic bowel and 8 (7.5%) had perforations. The remaining 354 patients had a trial of nonoperative management lasting at least 24 hours. Of 354 patients managed initially without surgery, 100 (28.2%) patients were discharged without operative intervention during their index admissions. Among the patients having surgery more than 24 hours after admission, indications for surgery were generally failure to resolve, worsening clinical status, and change in imaging findings. Of those patients observed for at least 24 hours, 40 (15.7%) were found to have ischemic bowel and 5 (2.0%) had perforation at surgery. Rates of bowel resection, stoma creation and postoperative complications were similar for the immediate and delayed surgery groups. Among the delayed surgery group, 71 (28.0%) required a bowel resection and 11 (4.3%) stoma creation. Twenty one per cent had postoperative complications, most commonly ileus. There were no statistically significant differences in the outcomes between immediate and delayed groups regardless of duration of delay. Among patients observed with complete ASBO, 24.6 per cent of patients with adhesive obstruction resolved without surgery or readmission. Delaying operative management did not affect surgical findings or complication rates.

脳動脈瘤コイル塞栓2年以後の塞栓状態の画像上変化

In this study, we evaluated the embolic state based on imaging findings two years after embolization, and divided our patients into groups to examine postoperative changes in imaging findings. We studied 61 patients with cerebral aneurysms who underwent embolization in our hospital. There were 23 males and 38 females (mean age 60.6 y) with 66 aneurysms (16 ruptured and 50 unruptured). Embolic state was evaluated two years after treatment, and subsequent imaging-based follow-up with MR angiography was continued for six months or more. The follow-up period ranged from 30 to 146 months after embolization (median: 49, mean: 63). Based on the embolic state two years after coil embolization, the aneurysms were divided into three groups: complete occlusion (C group), neck remnant (N group), and body filling (B group) groups. Changes in the embolic state at the final evaluation point were investigated. Two years after embolization, 39 aneurysms were assigned to C group, 21 to N group, and six to B group. According to the final results, complete occlusion was noted in 37 aneurysms (94.8%) in C group, neck remnants in 18 (85.7%) in N group, and body filling in six (100%, additional treatment: 1) in B group; there were no changes in comparison with the results two years after embolization. We compared the results between ruptured and unruptured groups. In the former, there were no changes in 13 aneurysms, improvement was achieved in one, and deterioration was noted in two. In the latter, there were no changes in 47 aneurysms, improvement was achieved in two, and deterioration was noted in one (additional treatment: one aneurysm); there were no differences. With respect to the aneurysmal size, there were no differences in the results among three groups with a capacity of ＜100 mm3 (41 aneurysms), 100 to 200 mm3 (nine aneurysms), and ≧200 mm3 (nine aneurysms). With respect to the volume embolic ratio (VER), there were also no differences among three groups with a VER of ＜20% (14 aneurysms), 20 to 30% (25 aneurysms), and ≧30% (21 aneurysms). There were no changes in imaging findings two years or more after the coil embolization of cerebral aneurysms. The long-term result was very favorable regardless of the presence or absence of rupture, aneurysmal capacity, and VER. However, long-term follow-up was possible in only a small number of patients in specific groups, consisting of body filling or ruptured aneurysms; a larger number of patients should be investigated in the future.

Hyperplastic hepatic nodules in a case of idiopathic portal hypertension: Changes in imaging findings during a 6-year follow-up

Hyperplastic hepatic nodules in a case of idiopathic portal hypertension: Changes in imaging findings during a 6-year follow-up

Correlation of MR Imaging Findings and Clinical Manifestations in Neurosarcoidosis

MR imaging is widely used for the diagnosis and follow-up of neurosarcoidosis lesions. However, the temporal evolution of imaging abnormalities and the prognostic significance of imaging features is not well understood. We undertook a retrospective study of patients with biopsy-proved or clinically diagnosed neurosarcoidosis for the following reasons: 1) to assess concordance between abnormalities noted on MR imaging with neurologic symptoms at presentation; 2) to correlate changes in imaging findings during follow-up with clinical improvement or worsening; and 3) to identify imaging features that may have prognostic significance. We reviewed radiologic records from 1999 to 2008 of patients with biopsy-proved or clinically diagnosed neurosarcoidosis and correlated MR imaging findings in these patients with their demographic characteristics, clinical features, and symptomatic responses during follow-up. Thirty-two patients were included in the study. Cranial nerve lesions and leptomeningeal disease identified on MR imaging were symptomatic in 64% patients, dural lesions were associated with symptoms in 28% patients, but nonenhancing white matter lesions did not have correlating symptoms. During follow-up, MR imaging findings generally changed in concordance with the change in clinical symptoms (80% patients). Cranial nerve enhancement (9/11) and spinal lesions (5/8) were most likely to resolve with clinical improvement, whereas dural lesions (6/11), enhancing parenchymal lesions (3/7), and non-enhancing parenchymal lesions (0/4) were less likely to change during therapy. Patients with > or =1 enhancing T2-hypointense lesion (4/7, 57%) were less likely to show clinical improvement than those without such lesions (12/13, 92%). Although many sarcoid-related MR imaging abnormalities were not associated with correlating symptoms at presentation, there was a high degree of concordance between changes in clinical symptoms and MR imaging abnormalities during follow-up. Enhancing T2-hypointense dural and parenchymal lesions were associated with suboptimal imaging and clinical response to immunosuppressive therapy.

Imaging of multistep human hepatocarcinogenesis

In Japan, there are approximately 32 000 deaths ( approximately 30 deaths per 100 000) per year due to hepatocellular carcinoma (HCC), and it is the third most common cancer in men and fifth in women. Approximately 90% of them are associated with chronic liver diseases due to hepatitis C or B virus infection. Therefore, it has become possible to detect small early stage HCC by the periodic screening in these high-risk patients group. During the screening imaging diagnosis of HCC, various kinds of hepatocellular nodules are also frequentlydetected. To characterize them is very important for the early diagnosis and treatment of HCC. For this purpose, it is necessary to understand the concept of multistep hepatocarcinogenesis and the sequential changes of imaging findings.