Histological parameters and stromal desmoplastic status affecting accurate diagnosis of extraprostatic extension of prostate cancer using multi-parametric magnetic resonance imaging

OBJECTIVE

To investigate the clinicopathological factors affecting discrepancies between multi-parametric magnetic resonance imaging (mpMRI) and histopathological evaluation for diagnosis of extraprostatic extension (EPE) of prostate cancer.

METHODS

One hundred-and-three lesions from 96 cases with suspected EPE on preoperative mpMRI, of which 60 and 43 showed bulging and frank capsular breach, respectively, were grouped according to pathological (p)EPE in radical prostatectomy specimens. Additionally, clinicopathological/immunohistochemical findings for periostin reflecting a desmoplastic stromal reaction were compared between these groups.

RESULTS

pEPE was detected in 49 (48%) of the 103 lesions. Of these, 25 (42%) showed bulging and 24 (56%) showed frank capsular breach on MRI. In the total cohort, the absence of pEPE was significantly associated with a lower Gleason Grade Group (GG) (p < 0.0001), anterior location (p = 0.003), absence of intraductal carcinoma of the prostate (IDC-P) (p = 0.026), and high stromal periostin expression (p < 0.0001). These trends were preserved in subgroups defined by MRI findings, except for anterior location/IDC-P in the bulging subgroup.

CONCLUSIONS

GG, anterior location, and periostin expression may cause mpMRI-pathological discrepancies regarding EPE. Periostin expression was a significant pEPE-negative factor in all subgroup analyses. Our results indicate that patients with suspected EPE on MRI, regardless of their pEPE results, should be followed as carefully as those with definite pEPE.

A case of low-grade endometrial stromal sarcoma presented as an intramyometrial mass mimicking uterine leiomyoma on MRI

A low-grade endometrial stromal sarcoma (ESS) has a pattern of presenting as an intramyometrial mass and is often misdiagnosed as cellular leiomyoma or degenerative uterine leiomyoma. A low-grade ESS is a malignant tumour that requires total hysterectomy with bilateral salpingo-oophorectomy; while a leiomyoma is a benign tumour and could be acceptable for enucleation. As the treatment strategies differ between a low-grade ESS and leiomyoma, radiologists should be familiar with the characteristic MRI findings of a low-grade ESS. A 51-year-old woman with abnormal uterine bleeding had been observed for 2 years at a previous hospital for a uterine leiomyoma based on MRI findings. A contrast-enhanced MRI demonstrated an intramyometrial mass composed of three components with the hypointense rim on T2-weighted images (T2WI): the first component was a homogeneous solid structure with mild hyperintensity on T2WI with a low apparent diffusion coefficient value; the second component was cystic; the third component was a structure of low signal intensity on T2WI similar to the muscle. Although a degenerative uterine leiomyoma was a differential diagnosis, these MRI findings were suggestive of a low-grade ESS. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and partial omentectomy were performed. The pathological diagnosis was a low-grade ESS. In a low-grade ESS, there are three major patterns of MRI findings: one of these patterns is the less popular but clinically important intramyometrial mass pattern, which can be misdiagnosed as a leiomyoma, and this case conformed to this pattern.

Ultra-short Echo-time MR Angiography Combined with a Modified Signal Targeting Alternating Radio Frequency with Asymmetric Inversion Slabs Technique to Assess Visceral Artery Aneurysm after Coil Embolization

Contrast-enhanced CT and MR angiography are widely used for follow-up of visceral artery aneurysms after coil embolization. However, potential adverse reactions to contrast agents and image deterioration due to susceptibility artifacts from the coils are major drawbacks of these modalities. Herein, we introduced a novel non-contrast-enhanced MR angiography technique using ultra-short TE combined with a modified signal targeting alternating radio frequency with asymmetric inversion slabs, which could provide a serial hemodynamic vascular image with fewer susceptibility artifacts for follow-up after coil embolization.

Idiopathic myointimal hyperplasia of mesenteric veins: radiological evaluation using CT angiography

A 44-year-old man presented with a chief complaint of constipation. Initial contrast-enhanced CT showed extensive bowel wall thickening, mainly in the left colon, with a thin cord-like inferior mesenteric vein (IMV), in contrast to ectatic mesenteric venous branches, suggesting bowel ischaemia owing to venous stasis. One month later, at the time of symptom exacerbation, CT angiography showed a cord-like IMV and ectatic mesenteric venous branches with early enhancement, suggesting the presence of an arteriovenous fistula (AVF). Owing to the progression of bowel ischaemia and necrosis with peritonitis, emergency surgery was performed. Surgical specimens showed focal myointimal hyperplasia of the proximal mesenteric veins in both ischaemic and non-ischaemic lesions of the resected colon, thus leading to the diagnosis of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) when combined with the clinical and imaging findings. IMHMV is a bowel ischaemic disease caused by non-thrombotic venous obstruction that requires bowel resection and has been suggested to be associated with AVF. Cord-like IMV and AVF in the mesentery are important CT findings that characterize IMHMV. CT angiography is useful in diagnosing IMHMV.

Use of Imaging and Biopsy in Prostate Cancer Diagnosis: A Survey From the Asian Prostate Imaging Working Group

OBJECTIVE

To elucidate the use of radiological studies, including nuclear medicine, and biopsy for the diagnosis and staging of prostate cancer (PCA) in clinical practice and understand the current status of PCA in Asian countries via an international survey.

MATERIALS AND METHODS

The Asian Prostate Imaging Working Group designed a survey questionnaire with four domains focused on prostate magnetic resonance imaging (MRI), other prostate imaging, prostate biopsy, and PCA backgrounds. The questionnaire was sent to 111 members of professional affiliations in Korea, Japan, Singapore, and Taiwan who were representatives of their working hospitals, and their responses were analyzed.

RESULTS

This survey had a response rate of 97.3% (108/111). The rates of using 3T scanners, antispasmodic agents, laxative drugs, and prostate imaging-reporting and data system reporting for prostate MRI were 21.6%-78.9%, 22.2%-84.2%, 2.3%-26.3%, and 59.5%-100%, respectively. Respondents reported using the highest b-values of 800-2000 sec/mm² and fields of view of 9-30 cm. The prostate MRI examinations per month ranged from 1 to 600, and they were most commonly indicated for biopsy-naïve patients suspected of PCA in Japan and Singapore and staging of proven PCA in Korea and Taiwan. The most commonly used radiotracers for prostate positron emission tomography are prostate-specific membrane antigen in Singapore and fluorodeoxyglucose in three other countries. The most common timing for prostate MRI was before biopsy (29.9%). Prostate-targeted biopsies were performed in 63.8% of hospitals, usually by MRI-ultrasound fusion approach. The most common presentation was localized PCA in all four countries, and it was usually treated with radical prostatectomy.

CONCLUSION

This survey showed the diverse technical details and the availability of imaging and biopsy in the evaluation of PCA. This suggests the need for an educational program for Asian radiologists to promote standardized evidence-based imaging approaches for the diagnosis and staging of PCA.

A case of emphysematous intrascrotal abscess secondary to sigmoid coloseminal fistula

A 54-year-old male patient presented with pneumaturia. Right scrotal swelling was observed. CT showed an intrascrotal abscess with gas formation. MRI showed a fistula extending from the sigmoid colon to the seminal vesicles. Since there are many diverticula in the sigmoid colon, an abscess caused by diverticulitis may have formed a fistula. The scrotal abscess was drained; however, the pus discharge did not decrease. A colostomy was then performed, and the scrotal infection rapidly improved. Sigmoidectomy and fistula transection were performed 11 months after the colostomy. Prompt diagnosis of a sigmoid coloseminal fistula using imaging has led to optimal treatment.

Invasive candidiasis presenting bronchiectatic cavity as chest radiological findings: A case report

Invasive candidiasis is rare but is associated with high mortality in immunocompromised or critically ill patients. Here, we present a case of a 55-year-old man with untreated diabetes who was diagnosed with coronavirus disease 2019 and subsequently developed invasive candidiasis. The patient presented with fever, tachycardia, and tachypnea. Chest computed tomography revealed multiple consolidations mainly distributed around the bronchovascular bundles with bronchiectatic cavity formation, which initially raised suspicion for invasive pulmonary aspergillosis. However, subsequent testing confirmed Candida albicans infection; hence, we changed the antifungal agents effective for invasive candidiasis. This improved the patient's respiratory status, and he was then successfully weaned from mechanical ventilation. This case report highlights the importance of considering invasive candidiasis in the differential diagnosis of patients with bronchiectatic cavities on chest computed tomography, particularly in immunocompromised or critically ill patients with risk factors for invasive candidiasis.

Longitudinal changes in radiographic features of pulmonary Mycobacterium avium complex diseases

Background

The radiographic features of Mycobacterium avium complex pulmonary disease (MAC-PD), a major component of nontuberculous mycobacteria, consist of a variety of lesions; however, the responsiveness of each type of radiographic factor to treatment is unclear. Thus, we evaluated the longitudinal changes of each factor in serial computed tomography (CT) images using a mixed-effects model, and investigated the radiographic transition in patients with MAC-PD whose progress could be followed.

Methods

In this retrospective study, eighty-four patients diagnosed with MAC-PD and with yearly CT records were recruited after a review of 328 medical records with culture-positive MAC in respiratory specimens. The study participants were divided into two groups: treatment (n = 43) and no-treatment (n = 41) groups. Radiographic images were scored using the nodule (N), infiltration (I), cavity (C), ectasis (E) scoring system. Longitudinal changes in each radiographic lesion factor were analyzed using a mixed-effects model in treated and untreated patients.

Results

All factors tended to progress without treatment, and significant longitudinal changes were observed in the N, I, and E factors (N: p = 0.010, I: p = 0.004, E: p < 0.001). Although treatment tended to improve N and I in radiographic images (N: p = 0.006, I: p = 0.203), cavities and ectasis progressed, regardless of treatment (C: p = 0.057 and E: p = 0.033).

Conclusion

Radiographic changes of MAC-PD can be categorized into reversible (nodules and infiltrations) and irreversible (cavities and ectasis) lesions. Early treatment may prevent the accumulation of irreversible factors.

Initial experience of coaxial percutaneous liver biopsy with tract embolization using N-Butyl cyanoacrylate

OBJECTIVE

Bleeding occurs after liver biopsy in up to 10.9% cases, and patients with impaired hemostasis or ascites are considered to have absolute or relative contraindications. N-butyl cyanoacrylate enables immediate hemostasis, even in lethal situations. Therefore, percutaneous liver biopsy combined with tract embolization using N-butyl cyanoacrylate is expected to enable safe biopsy, even in patients for whom conventional biopsy is contraindicated. Here we describe our initial experience with coaxial percutaneous biopsy with tract embolization using N-butyl cyanoacrylate.

MATERIALS AND METHODS

Eighty-six patients who underwent tract embolization using N-butyl cyanoacrylate between October 2014 and July 2020, including 21 patients who had absolute or relative contraindications for liver biopsy, were retrospectively analyzed. Tract embolization using N-butyl cyanoacrylate comprised two steps: (1) liver biopsy with a biopsy needle inserted via a coaxial introducer needle and (2) embolization of the puncture route by injecting N-butyl cyanoacrylate via the coaxial needle.

RESULTS

No complications occurred in any patient. The mean number of biopsies per patient was 3.30 (range, 1-7). Histologically adequate samples were acquired in all cases, and pathological diagnoses were obtained. The mean time required for tract embolization was 52.8 s (range, 6-132 s). The mean peak skin dose was 9.97 mGy (range, 2-68 mGy), which is far below the 3-Gy threshold dose for temporary erythema.

CONCLUSIONS

This proposed technique may be a promising and straightforward alternative to improve the management of patients with severe liver disease by allowing safer biopsy, including patients for whom conventional liver biopsy is contraindicated.

Embolization of Deep Femoral Artery Aneurysm with a Ligated Proximal Artery Using the Direct Percutaneous Puncture Technique

We report a case of a deep femoral artery aneurysm with a ligated proximal artery that was successfully managed with endovascular therapy. An 84-year-old male was referred to our institute with a history of surgical resection of a left ruptured deep femoral artery aneurysm wherein another aneurysm was found on the peripheral side. Proximal artery ligation of the peripheral lesion was performed. The residual aneurysm had gradually enlarged after surgery, and contrast-enhanced computed tomography showed contrast effects in the aneurysm that extended to the distal artery. The aneurysm was successfully treated by direct percutaneous puncture embolization with N-butyl-cyanoacrylate.

Composite pheochromocytoma–ganglioneuroma: a case with two distinct components radiographically

Composite pheochromocytoma is an extremely rare tumor that comprises a pheochromocytoma and an embryologically related neurogenic tumor, such as ganglioneuroma, ganglioneuroblastoma, neuroblastoma, or peripheral nerve sheath tumor.

A 46-year-old male with hypertension, elevated plasma catecholamine levels, and suspected pheochromocytoma presented to the National Defense Medical College Hospital. CT and MRI showed two adjacent masses in the left adrenal gland; one was a 6 cm cephalic lesion and the other was a 1.5 cm caudal lesion. Only the 1.5 cm caudal mass showed uptake on ¹²³I-metaiodobenzylguanisine single photon emission CT/CT. Pheochromocytoma was suspected and a left adrenalectomy was performed. Pathology confirmed that the 6 cm mass was a ganglioneuroma and the 1.5 cm mass a pheochromocytoma, with cellular intermingling at their border. The two masses were diagnosed as a composite pheochromocytoma–ganglioneuroma. This is the first report in which the two components of a composite pheochromocytoma can be clearly distinguished in the pre-operative images. If a patient with clinically suspected pheochromocytoma has different components from a typical pheochromocytoma, composite pheochromocytoma should be considered.

Successful Closure of External Iliac Artery Perforation with Super-selective Transcatheter Coil Embolization

We present two cases of external iliac artery perforation occurring after endovascular interventions successfully treated with direct closure using super-selective transcatheter coil embolization. Two patients, one 78-year-old man and one 78-year-old woman, underwent cardiac catheterization via the right femoral approach for coronary artery disease and atrial fibrillation. Following the procedures, both patients suffered severe acute hypotension, and contrast-enhanced computed tomography revealed a massive retroperitoneal hematoma due to perforation of the right external iliac artery. We attempted direct perforation site closure with super-selective transcatheter embolization using microcoils and achieved complete hemostasis in both cases. Our technique could be an alternative treatment option for external iliac artery perforations associated with the endovascular intervention.

Successful Treatment of Subcapsular Hepatic Hemorrhage Concomitant with Diffuse Arterioportal Shunt by Transcatheter Arterial Embolization

We present a case of subcapsular hepatic hemorrhage with a concomitant diffuse arterioportal shunt successfully treated with transcatheter arterial embolization. An 85-year-old man with duodenal carcinoma developed hemorrhagic shock three days after pancreaticoduodenectomy. Contrast-enhanced computed tomography revealed an extensive subcapsular hepatic hematoma with extravasation. At the same time, diagnostic angiography showed innumerable foci of petechial extravasation from disrupted isolated arteries and the right inferior phrenic artery. In addition, a comorbid diffuse arterioportal shunt in the hematoma area was detected. We performed transcatheter arterial embolization on the peripheral side of the hepatic artery while preserving the proximal portion. Subsequently, the transcatheter arterial embolization for the right inferior phrenic artery was also performed. Complete hemostasis and occlusion of the arterioportal shunt were successful without fulminant liver failure.

Magnetic resonance imaging findings of pure prostatic ductal adenocarcinomas: a case series

PURPOSE

This study aimed to investigate the characteristics of magnetic resonance imaging (MRI) findings in pure prostatic ductal adenocarcinoma.

METHODS

From January 2009 to February 2020, seven patients who were diagnosed with pure prostatic ductal adenocarcinoma and had a referable preoperative MRI scan were included in the study. We evaluated the following MRI findings for each tumor: size, location, presence of multi-cystic component, and apparent diffusion coefficient (ADC) value.

RESULTS

The median maximum diameter of the tumors was 22 mm (range 19-70 mm). Regarding transverse distribution, five tumors were located in the periurethral area and two were located peripherally apart from the urethra. Two of the seven tumors had cystic components. The median ADC value of the tumors was 0.754 × 10^-3 mm²/s (range 0.570-0.963 × 10^-3 mm²/s). Based on the transverse distribution and components of the tumors on MRI, ductal adenocarcinomas were classified into three types: type I as a non-cystic tumor located peripherally apart from the urethra (29%, two cases); type II as a non-cystic tumor located in the periurethral area (43%, three cases); and type III as a tumor with a multi-cystic component (29%, two cases).

CONCLUSION

The non-cystic mass with periurethral distribution (type II) and multi-cystic mass (type III) may be characteristic features that differentiate pure ductal adenocarcinoma from ordinary acinar adenocarcinoma on MRI.

Angioleiomyoma of the extremities: correlation of magnetic resonance imaging with histopathological findings in 25 cases

OBJECTIVE

To identify the characteristic magnetic resonance imaging (MRI) findings in angioleiomyoma and to clarify its relationship with histopathological findings.

MATERIALS AND METHODS

We retrospectively analyzed the MRI findings and pathological subtypes in 25 patients with subcutaneous angioleiomyoma of the extremities. Based on the previous reports, MRI findings that could be characteristic of angioleiomyoma were extracted. According to the World Health Organization classification, all cases were classified into three pathological subtypes: solid, venous, and cavernous. The relationship between MRI findings and pathological subtypes was analyzed.

RESULTS

The pathological subtypes were solid (n = 10), venous (n = 11), and cavernous (n = 4). The following MRI findings were observed: (a) hypo- or iso-intense linear and/or branching structures on a T2-weighted image (positive total/solid/venous/cavernous: 19/5/10/4, respectively), which we defined as "dark reticular sign"; (b) peripheral hypointense rim on a T2-weighted image (positive total/solid/venous/cavernous: 19/7/8/4, respectively); and (c) presence of any adjacent vascular structures (positive total/solid/venous/cavernous: 6/3/3/0, respectively). Chi-square test showed a significant relationship between dark reticular sign and pathological subtypes (p = 0.0426). The dark reticular sign was found more frequently in the venous and cavernous types than in the solid type. The other MRI findings did not reveal a significant relationship between pathological subtypes.

CONCLUSION

We present the largest case series exploring MRI findings in angioleiomyoma. The dark reticular sign was a characteristic MRI finding of angioleiomyoma and was seen in most of the venous and cavernous types, which may facilitate preoperative diagnosis.

Treatment of massive hemoptysis after thoracic aortic aneurysm repair

Background

Massive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.

Case presentation

An 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged.

Conclusions

Here we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.

MRI-detectability and histological factors of prostate cancer including intraductal carcinoma and cribriform pattern

BACKGROUND

Histopathological characteristics affecting the detectability of clinically significant prostate cancer (csPCa) on magnetic resonance imaging (MRI) remain unclear. This study aimed to compare the histopathology between MRI-detectable and MRI-undetectable cancers, emphasizing intraductal carcinoma of the prostate (IDC-P) and predominant Gleason pattern 4 subtype.

METHODS

This single-center retrospective study enrolled 153 consecutive patients with 191 lesions who underwent preoperative multiparametric MRI and subsequent radical prostatectomy. MRI/histopathological findings and area fractions of histological components (cancer cells, stroma, and luminal spaces) of MRI-detectable and MRI-undetectable cancers were compared. Data were analyzed using Fisher's exact, independent t, or Mann-Whitney U tests.

RESULTS

Overall, 148 (77%) and 43 (23%) cancers were MRI-detectable and MRI-undetectable, respectively. MRI-detectable cancers were significantly larger than MRI-undetectable cancers (p = 0.03). The percentage of lesions in Grade Group 3 or higher was significantly higher among MRI-detectable cancers than among MRI-undetectable cancers (p = 0.02). MRI detectability of csPCa was associated with increases in relative area fractions of cancer cells (p < 0.001) and decreases in those of stroma (p < 0.001) and luminal spaces (p < 0.001) in prostate cancer (PCa) than the percentage of Gleason pattern 4 (p = 0.09). The percentage of lesions containing IDC-P was similar for MRI-detectable and MRI-undetectable cancers (40% vs. 33%; p = 0.48). The distribution of cribriform gland subtypes was not significantly different between MRI-detectable and MRI-undetectable Gleason pattern 4 subtype cancers (p > 0.99). Contrarily, the ratio of fused gland subtype was significantly higher in MRI-detectable than in MRI-undetectable cancers (p = 0.03). Furthermore, the ratio of poorly-formed gland subtype was significantly higher in MRI-undetectable than in MRI-detectable cancers (p = 0.01).

CONCLUSIONS

MRI detectability of csPCa is strongly associated with the relative area fractions of cancer cells, stroma, and luminal spaces in PCa rather than conventional histopathological parameters. Neither the presence nor the percentage of IDC-P affected MRI detectability.

Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury

The management of male pelvic fracture urethral injury remains a urological challenge. Pelvic fracture urethral injury can be associated with sequelae, such as urethral gap, erectile dysfunction and urinary incontinence. Delayed anastomotic urethroplasty, the gold standard treatment for urethral gaps caused by pelvic fracture urethral injuries, is technically demanding, and reconstructive urologists should preoperatively obtain as much detailed anatomical information as possible. A combination of antegrade and retrograde urethrography is the fundamental preoperative evaluation, but it cannot accurately assess the urethral gap length, the degree of lateral prostatic displacement, the anatomical relationship of the urethra with its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation). To make up for these limitations of urethrography, magnetic resonance imaging has emerged as a non-invasive, multiplanar and high-resolution modality for the evaluation of pelvic fracture urethral injury. Magnetic resonance imaging has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus enabling clinicians to anticipate the required ancillary techniques for delayed anastomotic urethroplasty and to predict functional outcomes, such as erectile function and urinary continence, after delayed anastomotic urethroplasty. This review discusses the role of magnetic resonance imaging in the evaluation of pelvic fracture urethral injury and its impact on patient management.

Assessment of pulmonary arteriovenous malformation with ultra-short echo time magnetic resonance imaging

PURPOSE

The purpose of this study was to evaluate the diagnostic performance of ultra-short echo time magnetic resonance imaging (UTE MRI) in the assessment of pulmonary arteriovenous malformation (PAVM).

METHODS

Eighteen consecutive patients (mean [± standard deviation] age, 48.6 ± 16.8 years) with 46 untreated PAVMs who underwent and thin-section computed tomography (CT) and UTE MRI with a 1.5-Tesla and 3-Tesla unit were retrospectively assessed. Two radiologists evaluated the diagnostic capabilities of UTE MRI for the detection and classification of PAVMs with reference to CT. Sensitivity, specificity, and kappa statistics were calculated with reference to CT. We also compared the differences in PAVM measurements between CT and MRI.

RESULTS

The sensitivity and specificity of UTE-MRI for the detection of PAVMs were 89.1% and 100%, respectively, for reader 1 and 87.0% and 100%, respectively, for reader 2. In the classification of PAVMs, inter-modality agreement in reader 1 and 2 were both substantial (κ = 0.78 and 0.69, respectively). The measurements of the PAVM feeding artery and sac on CT and MRI were strongly correlated in both readers 1 and 2 (R² = 0.981 and 0.983, respectively). Both readers 1 and 2 slightly underestimated the diameter of the PAVM feeding artery and sac on UTE MRI (p < 0.001).

CONCLUSION

This study indicates that UTE MRI is a feasible and promising modality for noninvasive assessment of PAVMs.

Ultra-short echo time magnetic resonance angiography using a modified signal targeting with alternative radio frequency spin labeling technique for detecting recanalized pulmonary arteriovenous malformation after coil embolization

Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly, for which transcatheter embolization with metallic coils is the standard of care. Although detecting recanalization after embolotherapy is crucial, direct visualization of residual flow with computed tomography or magnetic resonance (MR) imaging is generally difficult due to metal artifacts. We present a case of recanalized PAVM after coil embolization detected by ultra-short echo time MR angiography using a modified signal targeting with an alternative radio frequency spin labeling technique.

Laryngeal schwannoma with extralaryngeal extension mimicking a thyroid tumour

Objective:

A schwannoma is a common benign tumour that can arise anywhere in the body. When it occurs in an unusual location such as the larynx, its differentiation from other tumours can be challenging. Herein, we report a case of a laryngeal schwannoma with extralaryngeal extension that mimicked a thyroid tumour, focusing on its characteristic features on MRI.

Methods:

A 19-year-old male presented with a mass in the left side of the neck and hoarseness for 2 years. Endoscopy showed a submucosal mass in the laryngeal region. MRI found a well-defined solid mass in the thyroid gland, extending to the larynx through the lower edge of the thyroid cartilage. T₂ weighted MRI showed slightly low signal intensity at the central part of the tumour and high signal intensity at the peripheral part of the tumour. Pre-operative imaging suggested that the tumour originated in the thyroid gland. Left thyroidectomy with tumour excision was performed; the tumour was diagnosed as a laryngeal schwannoma with extralaryngeal extension, compressing the thyroid gland. In retrospect, features such as the dumbbell-shape and known as ‘target sign’ on T₂ weighted MRI were typical features of schwannoma. Additionally, the tumour’s extension pattern was similar to previous reports of laryngeal schwannomas with extralaryngeal extension.

Conclusion:

A large laryngeal schwannoma may extend outside the larynx with significant compression of the thyroid gland. Understanding the pattern of extension and familiarity with the features on MRI can improve the preoperative diagnosis accuracy.

Membranous urethral length on magnetic resonance imaging as a novel predictor of urinary continence after delayed anastomotic urethroplasty for pelvic fracture urethral injury

PURPOSE

We studied the impact of membranous urethral length (MUL) on magnetic resonance imaging (MRI) on post-urethroplasty continence in male patients with pelvic fracture urethral injury (PFUI).

METHODS

Of 169 male patients with PFUI who underwent delayed anastomotic urethroplasty between 2008 and 2020, 85 who underwent preoperative MRI, had no recurrent stenosis on cystoscopy, and underwent a 1-h pad test 1 year after surgery were included. MUL was defined as the distance from the distal end of the disrupted proximal urethra to the apex of the prostate, as measured using T2-weighted MRI. Urinary incontinence (UI) was defined as a 1-h pad test weight > 2.0 g.

RESULTS

None of the patients had UI before a pelvic fracture. Eighty-two patients (96.5%) had a measurable MUL, and the median length was 8.1 (interquartile range [IQR], 5.2-10.8) mm. The median weight of the 1-h pad test was 1.0 (IQR, 0.0-4.0) g, and 26 (30.6%) patients had UI. An open bladder neck (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.0-22.0; p = 0.04) and a short measurable membranous urethra (for every extra mm: OR, 1.2; 95% CI, 1.0-1.3; p = 0.04) were significant UI predictors on multivariate analysis.

CONCLUSIONS

A long MUL is significantly positively associated with urinary continence in male patients with PFUI. This could be of potential value to reconstructive urologists when counseling patients regarding post-urethroplasty continence before urethroplasty.

Lower limb lymphedema staging based on magnetic resonance lymphangiography

OBJECTIVE

Dermal backflow (DBF) and reduced lymphatic visualization are common findings of lymphedema on various imaging modalities. However, there is a lack of knowledge about how these findings vary with the anatomic location and severity of lymphedema, and previous reports using indocyanine green lymphography or lymphoscintigraphy show variable results. Magnetic resonance lymphangiography (MRL) is expected to clarify this clinical question due to its superior ability for lymphatic visualization. This retrospective study aimed to investigate the following: (1) Are there any characteristic patterns for DBF and lymphatics' visualization, depending on the anatomic location within lower limbs and severity of lymphedema? (2) Is it possible to classify the severity of lymphedema based on MRL findings?

METHODS

Two radiologists performed consensus readings of MRL of 56 patients (112 limbs) with lower-limb lymphedema. The frequency of visualized DBF and lymphatics was analyzed in six regions in each lower limb. The results were compared with the International Society of Lymphology clinical stages and etiology of lymphedema. Characteristic findings were categorized and compared with the clinical stage and duration of lymphedema.

RESULTS

DBF and lymphatics were observed more frequently in the distal regions than the proximal regions of lower limbs. DBF appeared more frequently as the clinical stage increased, reaching statistical significance (P < 10^-3) between stages 0 or I and II. DBF above the knee joint was rarely observed (0.48%) in early stages (0 and I) but appeared more frequently (13.5%, P < 10^-5) in stage II. Lymphatics appeared less frequently as the stage progressed, with significant differences (P < .05) between stages I and II and between II and III. The frequency of lymphatics above the knee joint decreased significantly (P < .05) between stages I and II and between II and III as the stage progressed, reaching 0% in stage III. An MRL staging was proposed and showed significant positive correlations with the clinical stage (r = 0.79, P < .01) and the duration of lymphedema (r = 0.57, P < .01).

CONCLUSIONS

MRL-specific patterns of DBF and lymphatics that depended on the site within the lower limb and clinical stage were shown. The DBF pattern differed from those observed in previous studies with other imaging techniques. The proposed MRL staging based on these characteristic findings allows new stratification of patients with lymphedema. Combined with its excellent ability to visualize lymphatic anatomy, MRL could enable a more detailed understanding of individual patient's pathology, useful for determining the most appropriate treatment.

Diffuse Alveolar Hemorrhage Associated with Dilated Cardiomyopathy and Sleep Apnea Syndrome

We herein report a case of diffuse alveolar hemorrhage (DAH) associated with dilated cardiomyopathy (DCM) and sleep apnea syndrome (SAS) in a 47-year-old man. The patient exhibited recurring dyspnea and bloody sputum. Chest radiography showed bilateral diffuse infiltrative opacities without pleural effusion. A bronchoscopic analysis of bronchoalveolar lavage fluid revealed hemosiderin-laden macrophages. Based on these findings, he was diagnosed with DAH. Laboratory and pathological findings ruled out the possibility of collagen diseases and vasculitis. Overnight polysomnography revealed concomitant severe obstructive SAS. Treatment with continuous positive-pressure ventilation and pharmacological therapy for DCM prevented recurrence of DAH.

Combining the Tumor Contact Length and Apparent Diffusion Coefficient Better Predicts Extraprostatic Extension of Prostate Cancer with Capsular Abutment: A 3 Tesla MR Imaging Study

Purpose: To assess the diagnostic performance of the tumor contact length (TCL) and apparent diffusion coefficient (ADC) for predicting extraprostatic extension (EPE) of prostate cancer with capsular abutment (CA).

Methods: Ninety-three patients with biopsy-proven prostate cancer underwent 3-Tesla MRI, including diffusion-weighted imaging (b value = 0, 2000 s/mm²) and radical prostatectomy. Two experienced radiologists, blinded to the clinicopathological data, retrospectively assessed the presence of CA on T2-weighted imaging (T2WI). TCL on T2WI and ADC values were measured on detecting CA in prostate cancer. We used the receiver operating characteristic curves to assess the diagnostic performance of TCL and ADC values for predicting EPE.

Results: CA was present in 58 prostate cancers among 93 patients. The cut-off value for TCL was 6.9 mm, which yielded an area under the curve (AUC) of 0.75. This corresponded to a sensitivity, specificity, and accuracy of 84.2%, 61.5%, and 69.0%, respectively. The cut-off value for ADC was 0.63 × 10^–3 mm²/s, which yielded an AUC of 0.76. This, in turn, corresponded to a sensitivity, specificity, and accuracy of 84.2%, 59.0%, and 67.2%, respectively. The combined cut-off value of TCL and ADC yielded an AUC of 0.82. The specificity (84.6%) and accuracy (81.0%) of the combined value were superior to their individual values (P < 0.05).

Conclusion: A combination of TCL and ADC values provided high specificity and accuracy for detecting EPE of prostatic cancer with CA.

Applicability of ultrasonography for detection of marginal sinus placenta previa

This study aimed to examine whether marginal sinus placenta previa, defined as when the marginal sinus just reaches the internal cervical os and placental parenchyma might be >2 cm from the internal cervical os, can be diagnosed using ultrasonography (US). We identified the placenta previa cases that underwent both US and magnetic resonance imaging (MRI) between April 2010 and December 2018 at our institution. The diagnostic discrepancies for marginal sinus placenta previa between US and MRI were examined retrospectively. Of the 183 cases of placenta previa, 28 (15.3%) cases were diagnosed as marginal sinus placenta previa using MRI. Among them, 18 cases (64.3%) could also be diagnosed using US. The sensitivity and specificity of the diagnosis of marginal sinus placenta previa using US were 64.3% and 92.9%, respectively. A change in US diagnosis occurred in 10 (35.7%) cases, all of which were diagnosed with low-lying placenta previa or marginal placenta previa and did not develop any serious miserable obstetrical outcomes. In conclusion, the diagnostic accuracy of US for detecting marginal sinus placenta previa was not significant. MRI examination may be required to accurately categorize the types of placenta previa.

A rare case of isolated splenic sarcoidosis: A case report and literature review

Sarcoidosis is a multisystemic granulomatous disease. It is rarely isolated in the spleen. The present report describes a case of isolated splenic sarcoidosis that was diagnosed histologically following laparoscopic splenectomy. A 76-year-old woman, who underwent radical nephroureterectomy 7 years earlier for left renal pelvic cancer and mastectomy 6 years earlier for left breast cancer in another facility, was referred to our hospital for assessment of splenic tumors that were identified during a follow-up examination. The computed tomography scans revealed multiple nodules in the spleen, which had increased in size over 2 years. Positron emission tomography revealed accumulation of [18F]-fluorodeoxyglucose in the spleen. Laparoscopic splenectomy was performed and the diagnosis of sarcoidosis was confirmed histologically. A review of previous reports and the present case suggested that diagnosis of splenic sarcoidosis should be considered when the CT scans show multinodular splenic tumors, and sarcoidosis might be associated with malignant tumors.

Mild metatropic dysplasia: emphasis on the magnetic resonance imaging of articular cartilage thickening

Metatropic dysplasia (MD) is a rare skeletal disorder characterized by short stature due to epiphyseal cartilage and growth plate abnormalities. The severity of MD varies from mild to lethal. This disorder is caused by mutations in the transient receptor potential vanilloid 4 (TRPV4) that encodes calcium-permeable, nonselective cation channels.

A 33-year-old female presented at our hospital with a history of worsening knee pain diagnosed at the previous institution as a case of osteoarthritis. Radiographs of the knee showed epiphyseal irregularity without joint space narrowing. On MRI, fat-suppressed proton density-weighted imaging revealed thickened articular cartilage with a smooth surface and an abnormal signal intensity of the subchondral bone; T₁ weighted imaging demonstrated irregularity of the epiphysis. These findings and the familial history (both her children had TRPV4 mutations) led to the suspicion that her condition could be due to mosaicism for TRPV4 mutation. To the best of our knowledge, this is the first report of MRI findings focusing on articular cartilage thickening in a patient with mild MD. Bone dysplasia including MD should be considered in young patients with articular cartilage thickening and subchondral bone irregularities on MRI.

Acquired Cystic Disease-Associated Renal Cell Carcinoma Extending to the Renal Pelvis Mimicking Urothelial Carcinoma on Computed Tomography (CT): Two Case Reports

Case series

Patients: Male, 66-year-old • Male, 67-year-old

Final Diagnosis: Acquired cystic disease-associated renal cell carcinoma

Symptoms: Hematuria

Medication: —

Clinical Procedure: —

Specialty: Oncology • Radiology

COVID-19 in older adults: Retrospective cohort study in a tertiary hospital in Japan

AIM

We aimed to describe the clinical characteristics, treatment and outcomes of patients with COVID-19 pneumonia, in particular older patients, admitted to tertiary and partner hospitals in Saitama, Japan.

METHODS

We retrospectively reviewed the medical records of patients with COVID-19 pneumonia admitted to tertiary and partner hospitals in Saitama, Japan. Twenty-six patients with COVID-19 were categorized into two groups, i.e., older (≥75 years) and younger adults (≤74 years). We evaluated the clinical characteristics, comorbidities, symptoms, laboratory test results, treatments and outcomes of the patients.

RESULTS

The majority of the older patients had comorbidities, such as dementia, cardiovascular disease and bone fractures. Comorbidities were significantly more frequent in older patients than younger patients. No association was found between age and body temperature or the incidence of respiratory failure. White blood cell count was significantly lower in older patients (P = 0.018) and the decrease in lymphocytes was greater in younger patients (P = 0.009). Computed tomography (CT) of all patients showed non-segmental, peripherally dominant ground-glass opacities consistent with COVID-19 pneumonia. In older patients, antiviral drugs, anticoagulants and anti-inflammatory drugs were administered on a compassionate use basis. The difference in mortality between the older and the younger patients was not statistically significant.

CONCLUSIONS

In older patients, typical clinical symptoms and blood test changes were often absent; however, CT always contained typical findings of COVID-19, suggesting that CT may be a useful diagnostic tool. Our report illustrates that appropriate treatment, taking patient background into consideration, may improve their condition regardless of age. Geriatr Gerontol Int 2020; 20: 1044-1049.

Postoperative pneumonia causes the loss of skeletal muscle volume and poor prognosis in patients undergoing esophagectomy for esophageal cancer

PURPOSES

This retrospective study investigated the effect of postoperative pneumonia on the loss of skeletal muscle volume after esophagectomy for esophageal cancer.

METHODS

A total of 123 patients who had undergone esophagectomy for esophageal cancer and had (30 patients) or did not have (93 patients) postoperative pneumonia were included in the analysis. The association of clinicopathological characteristics with loss of skeletal muscle volume and long-term survival were evaluated in patients with or without postoperative pneumonia.

RESULTS

There were no differences in the psoas muscle volume index (PI), lymphocyte count, serum albumin level, or prognostic nutritional index between the two groups both preoperatively and at 6 months after surgery. The decrease in PI at 6 months after surgery was significant in patients with postoperative pneumonia (- 9.9 ± 2.5%) but not in those without pneumonia (- 2.6 ± 1.6%). Patients with postoperative pneumonia had a significantly increased frequency of asymptomatic pneumonia at 6 months after surgery compared with those who did not have postoperative pneumonia (36.7% vs. 19.4%). Overall survival was significantly poorer in patients with postoperative pneumonia than in those without pneumonia (p < 0.05).

CONCLUSIONS

Postoperative pneumonia was associated with the loss of skeletal muscle volume and asymptomatic pneumonia within 6 months of surgery as well as poorer overall survival.

The use of magnetic resonance imaging to predict placenta previa with placenta accreta spectrum

INTRODUCTION

Massive hemorrhage due to placenta previa with placenta accreta spectrum is associated with high maternal mortality and morbidity. Therefore, accurate prediction of placenta previa with placenta accreta spectrum is essential; magnetic resonance imaging (MRI) is a useful tool for this purpose. This study investigated novel predictors of anterior and posterior placenta previa with placenta accreta spectrum using MRI.

MATERIAL AND METHODS

This was a retrospective study at a tertiary obstetrics hospital in Japan. The singleton patients with placenta previa who were scanned with MRI prenatally and had a cesarean section at our institution between 2007 and 2018 were included. The prediction of anterior and posterior placenta previa with placenta accreta spectrum was evaluated using four MRI findings: heterogeneous signals in the placenta, dark T2-weighted intraplacental bands, myometrial thinning or interruption, and focal uterine bulging. The prediction of posterior placenta previa with placenta accreta spectrum was performed using the quantification of cervical varicosities, which were defined as the ratio of the distance between the minimum distance from the most dorsal cervical varicosities (a) to the deciduous and amniotic placenta (b) on a sagittal image.

RESULTS

Among 202 patients, 14 (6.9%) patients were pathologically diagnosed as having placenta accreta spectrum. Further, 38 (18.8%) patients had anterior placenta previa and 164 (81.2%) patients had posterior placenta previa. When anterior placenta previa with placenta accreta spectrum was predicted using at least one of the four MRI findings, the sensitivity and specificity of the anterior placenta previa with placenta accreta spectrum were 87.5% and 86.7%, respectively. In contrast, the sensitivity and specificity of posterior placenta previa with placenta accreta spectrum were 42.9% and 96.2%, respectively. But when the A/B ratio was set at 0.20, the sensitivity and specificity of the prediction for posterior placenta previa with placenta accreta spectrum using cervical varicosities were 100.0% and 89.2%, respectively.

CONCLUSIONS

The findings of MRI to predict the anterior placenta previa with placenta accreta spectrum were different from posterior placenta previa. The cervical varicosities may be useful in predicting posterior placenta previa with placenta accreta spectrum.

Quantitative analysis of the anatomical changes in the scalp and hair follicles in androgenetic alopecia using magnetic resonance imaging

BACKGROUND

Although the structural changes of the scalp in androgenetic alopecia (AGA) have been reported, these changes have been poorly understood. It is expected that modern MRI would visualize the scalp anatomy in vivo. This study aimed to explore whether AGA causes (a) changes in the thickness of the scalp, (b) anatomical changes in the hair follicles, and (c) changes in the signal intensity of MRI.

MATERIALS AND METHODS

Twenty-seven volunteers underwent MRI for hair and scalp (MRH) and were categorized into two according to the Hamilton-Norwood Scale: the "AGA group" and the "normal group." Two radiologists analyzed the thickness and signal intensity of the scalp, and the depth of hair follicles. These measurements were compared between the two groups.

RESULTS

The thickness of the hypodermis and the entire scalp was significantly thinner in the AGA group than in the control group. The AGA group had significantly shallower depth of hair follicles and relative depth of the hair follicles to that of the entire scalp than the normal group. The hypodermis showed higher signal intensity in the AGA group than the normal group.

CONCLUSION

MRH allowed noninvasive visualization of the scalp anatomy and demonstrated the thinner nature of the entire scalp and hypodermis, along with the shallower depth of the hair follicles in the AGA group in comparison to the normal group. Additionally, MRH demonstrated the increased MR signal intensity in the scalp associated with AGA. MRH may be a promising new method for quantitative and objective analyses of AGA.

MR Imaging of Hair and Scalp for the Evaluation of Androgenetic Alopecia

Purpose:

Although androgenetic alopecia (AGA) is a common cause of hair loss, little is known regarding the magnetic resonance imaging (MRI) of the AGA or scalp. This study aimed to analyze whether MRI for hair and scalp (MRH) can evaluate anatomical changes in the scalp caused by AGA.

Methods:

Twenty-seven volunteers were graded for the severity of AGA using the Hamilton–Norwood Scale (HNS), commonly used classification system. All subjects underwent MRH; two radiologists independently analyzed the images. As a quantitative measurement, the number of hair follicles was analyzed and compared with the HNS. As a qualitative analysis, each MRH scan was visually graded in terms of the severity of alopecia, using a 4-point MR severity score. The scores were compared with the HNS.

Results:

The volunteers were divided into two groups of 12 and 15 males without and with AGA at their vertex, respectively. Inter-observer agreements for the hair count and the MR severity score were excellent. The mean hair count on MRI in the normal group was significantly higher than that in the AGA group (P < 10⁻⁴). The MR severity score in the AGA group was significantly more severe than that in the control group (P < 10⁻⁴). In terms of the presence or absence of thinning hair, the MR severity score was consistent with the HNS determined by a plastic surgeon in 96% of cases. MR severity scores of clinically moderate AGA cases were significantly lower than those of severe cases (P = 0.022).

Conclusion:

MRH could depict scalp anatomy showing a clear difference between AGA and normal scalps, in both hair count and subjective visual assessment. The MR severity score was in good agreement with the clinical stages by HNS. The results support the potential of MRH as a promising imaging technique for analyzing healthy and pathological scalps.

Balloon-occluded retrograde glue embolization for intractable lymphorrhea from bilateral iliac lymphatics following surgery for rectal cancer

Lymphorrhea is a rare complication of rectal surgery. Although percutaneous embolization of thoracic or lymphatic ducts is now increasingly being reported for various types of lymphatic leakage, there are only sparse data on lymphatic interventions for lymphorrhea following rectal surgery. A novel balloon-occluded retrograde lymphatic embolization (BRLE) technique can be a simple and effective option for intractable lymphorrhea. We report a case of a man with infected lymphorrhea after rectal resection. Transperineal drainage was performed; however, lymphatic leakage persisted after 1 month of conservative treatment. Lymphangiography revealed multifocal leaks from bilateral iliac lymphatics. The proposed BRLE technique was performed via a balloon catheter inserted through the transperineal drainage. The balloon allowed occlusion of lymphatic outflow and forceful retrograde injection to achieve denser accumulation of n-butyl cyanoacrylate. Tight embolization of bilateral iliac lymphatics and drastic improvement of the leakage was achieved. To the best of our knowledge, this is the first report of percutaneous embolization for lymphorrhea after rectal surgery. This case supports the efficacy of the BRLE as a simple and effective therapeutic option for such persistent multifocal lymphatic leaks.

Histological differences in cancer cells, stroma, and luminal spaces strongly correlate with in vivo MRI-detectability of prostate cancer

The current study aimed to investigate the plausible histopathological factors that affect the detectability of prostate cancers on multiparametric magnetic resonance imaging (MP-MRI). This retrospective study included 59 consecutive patients who had undergone MP-MRI and subsequent radical prostatectomy. The cases were standardized according to the tumor size ranging from 10 to 20 mm on the final pathological diagnosis. Histopathological review and semi-automated imaging analysis were performed to evaluate the relative area fractions of the histological components, including cancer cells, stroma, and luminal spaces. Among the 59 prostatectomy specimens, no case showed two or more foci of cancer that matched the size criteria. Of the 59 lesions, 35 were MRI-detectable [Prostate Imaging Reporting and Data System (PIRADS) score of 3 or greater] and 24 were MRI-undetectable (PIRADS score of 2 or less). No significant differences were observed in Gleason Grade Group, percentage of Gleason pattern 4, and predominant subtype of Gleason pattern 4 between MRI-detectable and MRI-undetectable cancers. On the other hand, significantly higher mean area fraction of cancer cells (60.9% vs. 42.7%, P < 0.0001) and lower mean area fractions of stroma (33.8% vs. 45.1%, P = 0.00089) and luminal spaces (5.2% vs. 12.2%, P < 0.0001) were observed in MRI-detectable cancers than in MRI-undetectable cancers. In a multivariable analysis performed upon exclusion of area fraction of stroma due to its multicollinearity with that of cancer cells, area fractions of cancer cells (P = 0.0031) and luminal space (P = 0.0035) demonstrated strong positive and negative correlation with MRI-detectability, respectively. Changes in cancer cells, stroma, and luminal spaces, rather than conventional histological parameters, could be considered one of the best predictors to clinical, in vivo MRI-detectability of prostate cancer.

Mobile Spinal Schwannoma with a Completely Cystic Appearance

Patient: Female, 48

Final Diagnosis: Spinal schawnnoma

Symptoms: Dysuria • leg pain

Medication: —

Clinical Procedure: —

Specialty: Orthopedics and Traumatology

Magnetic Resonance Imaging Findings of Penile Abscess

A 72-year-old man presented with pain and swelling in the penis, indicating penile infection or abscess. An ultrasound was performed but unable to lead to a diagnosis of abscess. Magnetic resonance imaging with diffusion-weighted imaging was strongly suggestive of penile abscess. The puncture of the abscess was unsuccessful. However, pus was drained spontaneously via the urethra, and the symptoms disappeared eventually. Although ultrasound can be useful, sometimes it might be difficult to distinguish between inflammatory tissue and abscess containing necrotic tissue. Magnetic resonance imaging, especially diffusion-weighted imaging, can be a powerful tool for diagnosing abscess in the penis.

Analysis of Diffusion-weighted MR Images Based on a Gamma Distribution Model to Differentiate Prostate Cancers with Different Gleason Score

Purpose:

Prostate cancer management includes identification of clinically significant cancers that may require curative treatment. Statistical models based on gamma distribution can describe diffusion signal decay curves of prostate cancer. The purpose of this study was to evaluate the ability of parameters obtained with the gamma model in differentiating prostate cancers with different Gleason score values.

Methods:

This study included 155 patients with prostate cancer who underwent multiparametric magnetic resonance imaging prior to prostate biopsy (127 patients) or radical prostatectomy (28 patients) between January 2015 and June 2017; 159 foci of prostate cancer were included in our study. We compared cases scored as Gleason score (GS) 3 + 3 and GS ≥ 3 + 4, and analyzed cases scored as GS ≤ 3+ 4 and GS ≥ 4 + 3 based on the gamma model (Frac < 1.0, Frac < 0.8, Frac < 0.5, Frac < 0.3, and Frac > 3.0), and apparent diffusion coefficient (ADC).

Results:

Among 159 cancerous lesions in 155 patients, 13 (8.2%) were GS 3 + 3 prostate cancers, 51 (32.0%) were GS 3 + 4 prostate cancers, 30 (18.2%) were GS 4 + 3 cancers, and 65 (40.9%) were GS ≥ 4 + 4 cancers. Frac < 0.3, Frac < 0.5, Frac < 0.8, and Frac < 1.0 were significantly higher and ADC values were significantly lower in GS ≥ 4 + 3 cancers than in GS ≤ 3 + 4 cancers (P < 0.01, P < 0.01, P < 0.01, P = 0.01, and P < 0.01, respectively). With receiver operating characteristic (ROC) analysis, Frac < 0.3 and Frac < 0.5 had significantly greater area under the ROC curve for discriminating GS ≥ 4 + 3 cancers from GS ≤ 3 + 4 cancers than ADC (P = 0.03, P < 0.01, respectively).

Conclusion:

Frac < 0.3 and Frac < 0.5 showed higher diagnostic performance than ADC for differentiating GS ≥ 4 + 3 from GS ≤ 3 + 4 cancers. The gamma model may add additional value in discrimination of tumor grades.

Tomato endo beta-mannanase: A candidate of potential tomato allergen protein detected with human monoclonal antibody established from a patient suffered from Japanese cedar pollinosis

Peripheral blood lymphocytes from a patient allergic to Japanese cedar pollens were transformed by Epstein-Barr virus infection. Some transformed B-lymphoblastoid cells (BLCs) secreted IgM class antibodies to cedar pollen extracts and tomato fruit extracts. One stable human-mouse hybridoma clone Y-22-3-3 secreting IgM class monoclonal antibody to tomato fruit extracts was established by cell fusion of BLCs with mouse myeloma cells. Western blot analysis of tomato extracts showed Y-22-3-3 monoclonal antibody recognized a tomato protein with a molecular weight of 40 kDa. The CBB-stained 40 kDa protein from antibody-affinity chromatography was analyzed by MALDI-TOF/TOF, and identified as tomato endo-beta-mannanase, which was previously reported as one of the potential candidates for tomato allergens.

Bosniak Category III Renal Cysts Caused by Crizotinib in an Anaplastic Lymphoma Kinase Gene-Rearranged Non-Small Cell Lung Cancer Patient

Bosniak category III renal cystic masses are often treated with surgical resection because of high risk of malignancy. Crizotinib is an anaplastic lymphoma kinase (ALK) inhibitor used to treat ALK gene-rearranged non-small cell lung cancer and reported to be associated with complex renal cyst formation. We herein report a case of Bosniak category III renal cysts occurred in a crizotinib-treated ALK gene-rearranged non-small cell lung cancer patients. The cysts regressed spontaneously after cessation of crizotinib and we could thus avoid unnecessary surgical resection.

The added value of tomosynthesis in endoscopic retrograde cholangiography with radiography for the detection of choledocholithiasis

OBJECTIVE

The diagnostic performance of endoscopic retrograde cholangiography (ERC) with radiography is imperfect. We assessed the value of adding tomosynthesis to ERC with radiography for the detection of choledocholithiasis.

METHODS

This study included 102 consecutive patients (choledocholithiasis/non-choledocholithiasis, n = 57/45), who underwent both radiography and tomosynthesis for ERC in the same examination and were not diagnosed with malignancy. The reference standard for the existence of choledocholithiasis was confirmed by endoscopic stone extraction during ERC, intraoperative cholangiography, or follow up with magnetic resonance cholangiopancreatography (n = 78, 11, and 13, respectively). A gastroenterologist and a radiologist independently evaluated the radiographs and the combination of tomosynthesis and radiographic images in a blinded and randomised manner. Receiver operating characteristic analysis was used for statistical analysis.

RESULTS

The areas under the receiver operating characteristic curve for combined tomosynthesis and radiography were significantly higher than those for radiography alone for both readers: Reader 1/Reader 2, 0.929/0.956 [95% confidence interval (CI), 0.861-0.965/0.890-0.983) vs 0.803/0.769 (95% confidence interval, 0.707-0.873/0.668-0.846), respectively (p = 0.0047/< 0.0001).

CONCLUSION

Adding tomosynthesis to radiography improved the diagnostic performance of ERC for detection of choledocholithiasis. Advances in knowledge: Adding tomosynthesis to radiography improves detection of choledocholithiasis and tomosynthesis images can be obtained easily after radiographs and repeated immediately.

A Case of Hemorrhagic Adrenal Pseudocyst Mimicking Solid Tumor

Patient: Female, 78

Final Diagnosis: Adrenal pseudocyst

Symptoms: None

Medication: —

Clinical Procedure: Operation

Specialty: Urology