A 60-year-old woman with a history of neurofibromatosis type 1, who was admitted with pulmonary hypertension, developed buttock pain and anemia, and contrast-enhanced computed tomography showed a large subcutaneous hematoma with minimal active extravasation. Angiography of the bilateral internal iliac arteries revealed diffuse, irregular blood vessels without extravasation. As the exact bleeding site could not be identified, the patient was managed conservatively. However, the patient's symptoms and anemia worsened the following day. Repeat angiography revealed two pseudoaneurysms in the right inferior gluteal artery, which were embolized using n-butyl-2-cyanoacrylate. Nonetheless, the patient's anemia further worsened the following day. Repeat contrast-enhanced CT revealed another site of extravasation in the enlarging hematoma, but no extravasation was observed on the subsequent angiography. Owing to the worsening anemia and enlarging hematoma, proximal embolization of the irregular bilateral inferior gluteal arteries was performed using gelatin sponge particles. The patient's anemia and symptoms improved. Vasculopathy associated with neurofibromatosis type 1 is rare, with an incidence of approximately 3%. In patients with neurofibromatosis type 1, the blood vessels become fragile because of tunica media thinning and elastic-lamina rupture. Histopathologically, neurofibromatosis type 1-associated vasculopathy is characterized by a mixture of normal and abnormal vessels. Abnormally fragile blood vessels may repeatedly rupture followed by physiological hemostasis, which may explain the diagnostic and therapeutic challenges during angiography in this case. In patients with neurofibromatosis type 1 with acute bleeding, irregular vessels without active extravasation on angiography may be indicated for embolization.

ABSTRACT:Radiation exposure of a practitioner's fingers is a problem in interventional radiology, and radiation protection gloves (protective gloves) can help reduce such exposure. Several types of protective gloves are commercially available from various manufacturers. In the present study, we compared the protective effects and usability of four types of protective gloves. To investigate the radiation protection effect, we placed normal surgical gloves and the four types of protective gloves on phantom hands with thermoluminescent dosimeters (TLD) attached to the fingertips and the dorsum and palms of the hands. Next, they were irradiated with x rays, and the radiation dose was measured and compared using the TLDs. In terms of usability, 42 medical staff members completed a questionnaire that included seven items, such as finger movability, tactile sensation, grip, and overall satisfaction, which were scored on a 5-point scale. Consequently, the protective effects differed between the gloves, and radiation exposure was lower by 30% to 60% with these gloves compared with surgical gloves. In terms of usability, a difference of 2 to 4 points was noted between the gloves for each questionnaire item. These results suggest that radiation protective gloves can protect the surgeon's fingers from radiation exposure without reducing work efficiency by selecting gloves according to the surgical procedure.

To evaluate the usefulness of computed tomographic (CT) features for identifying acute torsion of uterine subserosal leiomyoma (USL).

PURPOSE:To evaluate morphological and signal intensity (SI) changes of placental insufficiency on magnetic resonance imaging (MRI) and to assess morphological changes and decreased flow voids (FVs) on T2-weighted rapid acquisition with relaxation enhancement (RARE) images for diagnosing placental insufficiency.METHODS:Fifty singleton fetuses underwent MRI using a 1.5-T MR scanner. Placental thickness, area, volume, SI, amniotic fluid SI, and size of FVs between the uterus and the placenta were measured on MR images. Two radiologists reviewed T2-weighted RARE images for globular appearance of the placenta and FVs between the uterus and the placenta. Data were analyzed using t-tests, McNemar's tests, and areas under the receiver operating characteristic curve (AUCs) at 5% level of significance.RESULTS:Twenty-five of the 50 pregnancies were categorized as having an insufficient placenta. Significant differences were observed between insufficient and normal placentas in mean placental thickness, area, volume, placenta to amniotic fluid SI ratio, and size of FVs (49.0 mm vs. 36.9 mm, 1.62 × 10(4) mm(2) vs. 2.67 × 10(4) mm(2), 5.13 × 10(5) mm(3) vs. 6.56 × 10(5) mm(3), 0.549 vs. 0.685, and 3.4 mm vs. 4.3 mm, respectively). The sensitivity and accuracy using globular appearance plus decreased FVs were greater than those using decreased FVs (P < 0.01). There was no significant difference among AUCs using globular appearance and decreased FVs, and globular appearance plus decreased FVs.CONCLUSIONS:Placental insufficiency was associated with placental thickness, area, volume, placenta to amniotic fluid SI ratio, and size of FVs. Evaluating FVs on T2-weighted RARE images can be useful for detecting placental insufficiency, particularly in placentas without globular appearance on MR images.

A final diagnosis of bladder cancer is made based on a pathological assessment using cystoscopy and biopsy. Recently, computed tomography (CT) and magnetic resonance imaging (MRI) have become widely used as screening tests for hematuria, and there are scattered reports of new imaging modalities such as CT urography (CTU) and diffusion-weighted MRI being useful in the detection of bladder cancer. However, there are no reports comparing CTU and MRI in this context. In the present study, we compared the bladder cancer detection abilities of CTU and MRI. We analyzed 58 cases of bladder cancer that had been examined by both CTU and bladder MRI. The objects of comparison were T2-weighted images and diffusion-weighted images for MRI and contrast CT images of the renal parenchyma and excretory phases for CTU. Bladder cancer was confirmed histopathologically via either biopsy or surgery for all cases. For patients with multiple bladder cancer, up to three lesions per case were included in the analysis. Two independent readers assessed all cases. Out of 91 lesions from 58 cases, Reader 1 detected 72 (79.1%) and 65 cases (71.4%), and Reader 2 detected 69 (75.8%) and 70 (76.9%), using MRI and CTU, respectively. The κ-values for Reader 1 versus Reader 2 were 0.780 for MRI and 0.857 for CT, showing high diagnostic consistency. MRI showed a higher lesion detection rate than CTU, but this difference was not statistically significant. This study showed no significant difference in bladder cancer detection rate between CTU and MRI, confirming the value of MRI in the clinical diagnosis of bladder cancer.

Abdominal visceral pseudoaneurysms are rare, but rapid diagnosis is clinically important because of the associated conditions that are often fatal. Multidetector-row computed tomography (MDCT) is important in the diagnosis and treatment of many human conditions. This study thus sought to investigate the usefulness of MDCT for diagnosing abdominal visceral pseudoaneurysms. We retrospectively assessed the MDCT diagnosis of pseudoaneurysms and identification of the responsible vessels or cases diagnosed with an abdominal visceral pseudoaneurysm via angiography. The study comprised 35 patients who underwent MDCT preoperatively and in whom angiography detected an abdominal visceral pseudoaneurysm over a 7-year period. Using the angiography findings as the gold standard, we investigated whether a pseudoaneurysm and the responsible vessel could be diagnosed using preoperatively imaged MDCT findings. For angiography and MDCT, diagnosis was reached on the basis of two radiologists' agreement. Of 35 patients (28 males and 7 females), the median subject age was 67 years (range: 22–84 years). We found that MDCT could preoperatively detect abnormal findings such as hematomas in all patients. MDCT detected the presence of a pseudoaneurysm in 88.6% (31/35) of patients and identified the responsible vessel in 71% (25/35) of patients. In 6 patients, MDCT findings could successfully reveal both the pseudoaneurysm and the extravasation. MDCT was effective for diagnosing abdominal visceral pseudoaneurysms and it could be useful for determining treatment strategies and aiding treatment techniques in such patients.

Purpose: To investigate the diagnostic accuracy of 3.0-T diffusion-weighted imaging (DWI) for detection of prostate cancer by using different b-values. Methods: Seventy-three patients underwent magnetic resonance imaging (MRI) at 3.0 T. Three MRI sets were reviewed by two radiologists: MRI and DWI (b=500s/mm(2)) (protocol A), MRI and DWI (b=1000s/mm(2)) (protocol B), and MRI and DWI (b=2000s/mm(2)) (protocol C). Areas under the receiver operating characteristic curve (AUCs) were calculated. Results: The mean of the AUCs in protocol C was larger than those in protocol A and in protocol B (P<.05). Conclusion: DWI (b=2000s/mm(2)) at 3.0 T can improve the diagnostic accuracy for detection of prostate cancer. (C) 2012 Elsevier Inc. All rights reserved.

Herein we report our experience with a C-arm cone beam computed tomography (CBCT)-guided abscess drainage procedure. We retrospectively examined the medical records and imaging results of patients whose abscesses were drained between 2005 and 2010 employing this system. We analyzed the technical success rate and incidence of procedure-related complications. Percutaneous abscess drainage using C-arm CBCT was performed using a flat-panel detector digital subtraction angiography (DSA) system on 104 lesions in 97 patients (55 men, 42 women) with a mean age of 64.7 (30-88) years. The drainage procedure was performed twice in 6 patients and 3 times in 2 patients, and 6 patients received 2 or more punctures at the same time. The technical success rate with this procedure was 98.1% (102 of 104 lesions). Placement of the drainage tube was abandoned in 2 patients due to difficulty in inserting a wire into the abscess cavity in 1 case and difficulty looping the wire in the other. The incidence of procedure-related complications was 3.85% (4 of 104 lesions). Our retrospective study and review of the relevant literature revealed that the C-arm CBCT-guided abscess drainage procedure examined was generally safe for patient use, showed a high technical success rate and low incidence of procedure-related complications, and was useful for abscesses that were inaccessible using other instruments. Although C-arm CBCT has limited contrast resolution, this disadvantage is easily overcome by comparing images with those obtained using other modalities.

INTRODUCTION: Clinical management of urinary bladder cancer is determined primarily on the basis of distinguishing superficial tumors (stage T1 or lower) from invasive ones (stage T2 or higher) because the treatment options differ considerably. Therefore, preoperative imaging studies would play an important diagnostic role if they could be used to precisely differentiate between the two categories of bladder cancer. Several previous studies have suggested that diffusion-weighted (DW) MR imaging at 1.5 T was useful for diagnosing T stage (1-4). However, to our knowledge, there have been no previous reports to evaluate the ability of DW MR imaging at 3.0T for diagnosing T stage. The purpose of this study was to evaluate the ability of DW MR imaging at 3.0T for diagnosing T stage in bladder cancer. MATERIALS AND METHODS: Thirty-nine consecutive patients known to have or suspected of having urinary bladder cancer underwent MRI that included T2WI (TR/TEeff, 4,500/82) and DWI (TR/TE, 3,800/70; b-values, 50, 500, and 1,000 s/mm2) using a 3 T whole body scanner (MAGNETOM Trio, A Tim 3.0T; Siemens Medical System, Erlagen, Germany) with a body-matrix coil and a spine-matrix coil. Urinary bladder cancer was pathologically proven in all patients. Two radiologists interpreted T2-weighted images alone and T2-weighted plus DW images. Conventional criteria were used for interpreting T2-weighted images. For DW images, the criteria proposed by Takeuchi et al. were applied (2). A thin, flat, high signal intensity (SI) area corresponding to the tumor with a low SI submucosal stalk or thickened submucosa, which resembles an inchworm (inchworm sign), was diagnosed as T1 or less. A high SI tumor without submucosal componets and with a smooth tumor margin was diagnosed as T2. A high SI tumor extended into the perivesical fat with an irregular margin was diagnosed as T3, and extended into adjacent organs was diagnosed as T4. We used pathologic stages documented in the official pathologic reports as the standard of reference. The McNemar test was used to examine differences in accuracy, sensitivity, and specificity. RESULTS: The pathologic stages were T1 or lower in 24 patients, T2 in nine, T3 in three, and T4 in three. Sensitivity, specificity, and accuracy for differentiating T1 tumors from T2 to T4 tumors are summarized in Table 1. Sensitivity and accuracy obtained by using T2-weighted plus DW images were significantly better than those obtained by using T2-weighted images alone (P = 0.02). Sensitivity, specificity, and accuracy for differentiating T2 or lower tumors from T3 or higher tumors are summarized in Table 2. Overall accuracies for diagnosing tumor stage are summarized in Table 3. The overall accuracy for diagnosing tumor stage with T2-weighted plus DW images was significantly better than that obtained by using T2-weighted images alone (P = 0.02). CONCLUSION: DW images at 3.0 T can provide useful information for evaluating the T stage of bladder cancer, particularly in differentiating T1 or lower tumors from T2 or higher tumors.

We evaluated clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices in patients with portal hypertension. Of 50 patients with gastric varices who underwent B-RTO, 46 (94.0%) patients in whom B-RTO was technically successful were reviewed retrospectively. Gastric and esophageal varices after B-RTO were evaluated by contrast-enhanced computer tomography and endoscopy, respectively. Liver function parameters and Child-Pugh scores were estimated before and at 1 year after B-RTO. The cumulative survival rate was calculated, and univariate and multivariate analyses were used to assess the prognostic factors. No major complications occurred in any of the patients following B-RTO and no recurrence or bleeding of gastric varices was noted. Of the 42 patients who were followed up for the progression of esophageal varices, 13 (31.0%) had worsened varices and of these, 6 (14.3%) showed bleeding. Prothrombin activity had significantly improved at 1 year after B-RTO, although there were no changes in other liver function parameters. The overall cumulative survival rates at 1, 3, and 5 years after B-RTO were 91.6%, 70.9%, and 53.6%, respectively. Multivariate analysis identified the occurrence of advanced hepatocellular carcinoma (HCC) during the observation period as a prognostic factor for survival (hazard ratio = 4.1497, 95% CI = 1.32314-13.0319, P = 0.0148). B-RTO of gastric varices is an effective treatment ensuring lower recurrence and bleeding rates; however, these patients require careful observation for progression of esophageal varices. The management of HCC is crucial for achieving long-term survival after B-RTO.

We successfully created a percutaneous transhepatic portacaval shunt under ultrasonography (US) guidance in a 46-year-old man with refractory ascites. The shunt was created to salvage an attempt to create a transjugular intrahepatic portosystemic shunt (TIPS) that failed because of the elevated level of portal vein bifurcation due to alcoholic liver cirrhosis. Under US guidance, we simultaneously punctured the right branch of the portal vein and the inferior vena cava (IVC) using a two-step biliary drainage set. An Amplatz gooseneck snare was introduced transjugularly to retrieve the percutaneously inserted guidewire. The intrahepatic tract between the portal vein and the IVC was dilated using a balloon catheter, and a stent was placed in the tract. The patient showed complete resolution of ascites at discharge. We assume that our method is an alternative method for TIPS creation in patients with inadequate anatomical relations between the portal vein branches and the hepatic veins. This approach is thought to be feasible for patients with occluded or small hepatic veins.

To evaluate motion artifacts, tissue contrasts, and lesion detectability in the neck with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (BLADE) technique.

In this study, we retrospectively compared the usefulness of cone beam CT (CBCT) with that of digital subtraction angiography (DSA) in the identification of the origin of the cystic artery during arterial embolization for hepatocellular carcinoma. Subjects were sixty-four patients who underwent transcatheter arterial embolization (TAE) for hepatocellular carcinoma, in whom both CBCT and DSA were performed. Two radiologists independently examined CBCT and DSA images, and attempted to identify the origin of the cystic artery in each image. For DSA, en face views were reviewed on the monitor. For CBCT, 5 mm thick horizontal sections were generated using Workstation software, and the MPR method was used for coronary sections. These were then investigated with OsiriX. Of the sixty-four patients, the cystic arterial origin could be identified using DSA in 21 (32.8%) and CBCT in 62 (96.8%). The cystic artery was shown to originate in the proper, right, middle, and left hepatic artery in one, 58, two, and one patient, respectively. These results show that CBCT was more useful than DSA for identifying cystic arterial origin. Therefore CBCT should be positively applied during TAE.

Yasushi Akutsu,MD, PhD, FACP,∗ TakehikoGokan,MD, PhD,† Noritaka Seino,MD, PhD,† Kyouichi Kaneko,MD,∗ Yusuke Kodama, MD, PhD,∗ Youichi Kobayashi, MD, PhD∗ ∗Division of Cardiology, Department of Medicine, Showa University School of Medicine, Shinagawaku, Tokyo, Japan; †Department of Radiology, Showa University School of Medicine, Shinagawaku, Tokyo, Japan Address for correspondence: Yasushi Akutsu, MD, PhD Division of Cardiology Department of Medicine Showa University School of Medicine 1-5-8 Hatanodai, Shinagawaku Tokyo 142–8666, Japan hzn01233@s02.itscom.net

This study compared steady-state free precession (SSFP) with Fast Low Angle Shot (FLASH) at 3.0 T cardiac Cine MRI with respect to contrast to noise ratio (CNR) and visual image quality assessment. All images were acquired on a 3.0-T Siemens MAGNETOM trio. Seven healthy volunteers (all males, mean age 32.5±7.1 years) underwent magnetic resonance imaging using SSFP and FLASH sequence on the same day. For both SSFP and FLASH imaging, 8-mm thick short axis and long axis views were acquired with equal matrix size (192×192). CNR calculations were performed on the short axis images acquired at end systole time points. Three radiologists independently assessed image quality. SSFP images were superior to FLASH images with respect to CNR (SSFP : 7.14±2.16, FLASH : 3.57±1.83, P < 0.001). In image quality, SSFP images were superior to FLASH in both short and long axis views (P< 0.01). Although SSFP images contained dark blood artifacts in 3 cases, these images were improved by frequency offset. SSFP sequences provided higher quality images than FLASH sequences, and would be available for cardiac cine MRI at 3.0 T.

This study investigated the method and clinical value of percutaneous needle biopsy of the thoracic region using a combination of cone-beam computed tomography (CBCT) equipped with a flat panel detector for digital subtraction angiography (DSA) and fluoroscopy. In 77 patients with a total of 79 lesions in the thoracic region (67 in the lung field, 6 in the mediastinum, and 6 in the chest wall), CT-like images of the lesions were acquired by CBCT, and needle biopsy was performed with fluoroscopic guidance. Puncture of the mass via the planned route was possible in all cases, and specimens of a sufficient size for pathological diagnosis could be biopsied. Only slight adjustments of the puncture site and angle were made under fluoroscopy. The final diagnosis of the biopsied specimen was malignant disease in 70 of the 77 patients (90.9%) ; 54 of the 77 patients (70.1%) had primary lung cancer and in 4 of the 77 patients (5.2%) had metastatic tumor. The histological type of the primary lung cancer was adenocarcinoma in 26 of the 77 patients (33.8%), squamous cell carcinoma in 22 of the 77 patients (28.6%), and small cell carcinoma in 6 of the 77 patients (7.8%). Complications occurred in 31 of the 77 patients (40.3%), comprising pneumothorax and pulmonary hemorrhage, but no fatal complications such as air embolism or the dissemination of malignant cells eventuated. In addition, unlike CT-guided biopsy, the described procedure requires only an angiography room. This method enables reliable biopsy using 3-dimensional data, and is a promising percutaneous biopsy method.