The ratio of the number of patients with non-alcoholic steatohepatitis (NASH) to the total number of patients with liver dysfunction has increased in many countries around the world. Liver dysfunction is also caused by multiple blood transfusions in patients with leukemia and other hematological diseases, with liver dysfunction often accompanied by secondary hemochromatosis. This study describes a 25-year-old man with secondary hemochromatosis combined with NASH. Magnetic resonance imaging was useful for visualizing the distributions of both iron and fat in the liver of this patient in order to make a differential diagnosis and to evaluate the effect of treatment.

Hepatic necrosis after transcatheter arterial embolization (TAE) is rare because of the dual blood supply to the hepatic parenchyma via the portal vein and hepatic artery.We describe a patient with blunt hepatic injury who had a portal-systemic venous shunt in the right posterior segment of the liver and who suffered a fatal hepatic necrosis after TAE.A 74-year-old female with blunt hepatic injury was treated by TAE: both the right hepatic artery and middle hepatic artery were embolized using gelatin sponge particles.She developed multiple organ failure and died four days after the TAE.Autopsy revealed massive necrosis in the right lobe and left medial segment of the liver.To the best of our knowledge, this is the first report of hepatic necrosis after TAE for blunt liver trauma related to a portal-systemic venous shunt.

We describe the case of a 60-year-old man suffering from an advanced thymic neuroendocrine tumor with left supraclavicular lymph node and multiple bone metastases. The patient initially underwent systemic therapy with somatostatin analogues. Thereafter, peptide receptor radionuclide therapy (PRRT) was considered because the lesions had remained stable despite the pharmacological therapy. PRRT was performed 10 months after the initial treatment in a European hospital. Eighteen months after the treatment, cranial nerve palsy arising from skull base metastases and Horner's syndrome induced by left supraclavicular lymph node metastases became exacerbated. Therefore, a course of external radiotherapy was performed with palliative intent in our hospital. During the radiotherapy planning, the biodistribution of 111In-octreotide was examined to determine whether the absorbed dose of the previous PRRT was acceptable. As a result, external radiotherapy was performed, and an acute radiation reaction was observed; the severity of the reaction was typical of reactions to neck radio-therapy. The treatment course of the present case was considered to be instructive because PRRT cannot be performed in Japan at present.

We investigated the diagnostic usefulness of brain magnetic resonance imaging (MRI) screening in HIV-1-infected patients without neurological symptoms in detecting intracranial diseases at early stages. In this retrospective analysis, the study patients were HIV-1-infected patients who underwent brain MRI scan in clinical practice between 2001 and 2013. We excluded patients with MRI for (1) follow-up examination for prediagnosed intracranial diseases, (2) cancer staging, (3) screening mycobacterium/bacteria/fungi disease proliferation in the brain, and (4) evaluation for meningitis/encephalitis. The study patients (n=485) were classified into two groups: those who underwent brain MRI scan without any neurological symptoms/signs (asymptomatic patients, n=158) and those who underwent MRI due to such symptoms (symptomatic patients, n=327). Asymptomatic patients had lower CD4 counts than symptomatic patients (median 78 versus 241/μl). Intracranial diseases were detected in three (2%) of the asymptomatic patients [two toxoplasmosis and one progressive multifocal leukoencephalopathy (PML)] compared to 58 (19%) of the symptomatic patients (the χ2 test, p<0.01). The latter included toxoplasmosis (n=10), PML (n=7), cytomegalovirus encephalitis (n=3), primary central nervous system lymphoma (n=3), cryptococcoma/meningitis (n=3), and HIV-associated dementia (n=17). Among symptomatic patients, intracranial diseases were common in those with slurred speech (3/6, 50%), seizure (4/10, 40%), eyesight/vision abnormality (5/16, 31%), altered mental status (8/31, 26%), and hemiplegia/numbness (13/50, 26%). For patients with CD4 count <200/μl, intracranial diseases were detected in only 3 (3%) of 144 asymptomatic patients, compared with 46 (32%) of 113 symptomatic patients (p<0.01). Brain MRI screening for HIV-1-infected patients without neurological symptoms is of little value.

A 39 years old woman was admitted to our hospital with a status epilepticus, with high fever of 41°C. Magnetic resonance Imaging (MRI) revealed high signal intensities of both sides of thalami and hypothalami in T2 weighted and fluid attenuated inversion recovery (FLAIR) images. A needle biopsy of the thalamic lesion was consistent with neuromyelitis optica spectrum disorder although her serum antibody to aquaporin-4 was negative. The level of orexin in celebrospinal fluid (CSF) was reduced. She presented hypersomnia, which didn't improve even after intravenous methylprednisolone 1 g daily for 3 days. Administration of oral modafinil extended her waking time. There is a number of reports about neuromyelitis optica (NMO) with hypothalamic lesions. We report this case as important suggestion of treatment of these cases.

Background: We report herein a case of cavernous sinus (CS)-dural arteriovenous fistula (DAVF) with brainstem venous congestion that was successfully treated by transarterial embolization, followed by radiotherapy. Case Description: An 80-year-old woman presented with right eye chemosis and left hemiparesis. T2-weighted magnetic resonance imaging showed hyperintensity of the pons. Diagnostic cerebral angiography demonstrated CS-DAVF draining into the right superior orbital vein and petrosal vein, and fed by bilateral internal and external carotid arteries. Transarterial embolization was performed and followed by radiotherapy, resulting in resolution of the pontine lesion and neurological and ophthalmological symptoms within 5 months. Conclusions: We also review the literature regarding therapy for CS-DAVF with brainstem venous congestion. Once CS-DAVF with venous congestion of the brainstem has been definitively diagnosed, immediate therapy is warranted. Treatment with transarterial embolization followed by radiation may be an important option for elderly patients when transvenous or transarterial embolization is not an option.

We report a case of a large condyloma on the upper side of the penis that exhibited a high FDG uptake on PET/CT images, mimicking urine contamination. The patient was a 30-year-old, HIV-infected homosexual man, and his CD4 cell count was 163/mu L. FDG PET/CT imaging was performed for a survey of occult cancer. A whole-body FDG PET/CT examination showed an intense FDG uptake on the upper side of the penis. The CT portion confirmed that the lesion was not urine contamination but a tumor with a cauliflower-like shape. The tumor was excised and a histopathological examination revealed a condyloma.

We present the F-18 FDG and ¹¹C-choline PET/CT images obtained in 2 cases of hemangioblastoma. Hemangioblastoma is a highly vascular benign tumor that typically arises in the cerebellum or spine. The characteristic findings of a hemangioblastoma on both CT and MR include a peripherally located cerebellar lesion with a central cystic region and a peripherally enhanced nodule. In both patients, the uptake in the lesion was relatively low on the F-18 FDG PET/CT images and relatively high on the ¹¹C-choline PET/CT images.

ObjectiveThe aim of this study was to evaluate the impact of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) on the management of patients with infectious spondylitis. Materials and methodsTwenty-nine patients with infectious spondylitis (9 with tuberculous spondylitis and 20 with pyogenic spondylitis) who had undergone an 18F-FDG PET/CT examination were retrospectively evaluated; 42 lesions were detected. A useful impact on the clinical management of infection therapy (start or longer duration of antibiotic therapy, or surgical intervention, etc) was defined as a strong impact, whereas gaining new information not affecting the clinical management of infection therapy from 18F-FDG PET/CT was defined as a weak impact. No impact was defined as not obtaining any new information influencing infection therapy. Results18F-FDG PET/CT had a strong impact on the clinical management of 52% (15 of 29) of the patients. 18F-FDG PET/CT detected 10 cases of spondylitis and one artificial graft infection that the clinician had not recognized, and the therapeutic period was extended in these patients. In five patients with tuberculous spondylitis, the 18F-FDG PET/CT images were used to decide the biopsy sites in three patients and to determine which lesions required surgery in two patients. Conclusion18F-FDG PET/CT is useful for detecting infectious spondylitis.

1042 Learning Objectives 1. Describe the complicated definition of IgG4 related diseases. 2. Review 18F-FDG PET/CT images of IgG4 related diseases, focusing on the autoimmune pancreatitis and extrapancreatic lesions. The idea of IgG4 related diseases have been proposed as characteristic pathology of massive IgG4-bearing plasma cell infiltration of the affected organs and elevated serum IgG4 level. They range spatially and temporally; the diseases are autoimmune pancreatitis, sclerosing cholangitis, hilar lymphadenopathy, sialoadenitis, retroperitoneal fibrosis, interstitial pneumonia, prostatitis, and so on, and the 30-40% of them has relapsed, although steroid therapy is effective. 18F-FDG PET/CT can detect lesions sensitively because of abundant of inflammatory cells. [Content organization] We present variety of 18F-FDG PET/CT images of IgG4 related autoimmune pancreatitis and extrapancreatic lesions. Although steroid therapy is effective, the relapse is an important problem, FDG PET/CT is useful to detect and monitor lesions of IgG4 related diseases temporally and spatially

OBJECTIVE:It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions.MATERIALS AND METHODS:We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed.RESULTS:At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05).CONCLUSION:Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.

Kaposi sarcoma is an acquired immunodeficiency syndrome-related disease that mainly involves the skin, gastrointestinal gut, and lungs. Whole-body 18F-fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT) scanning is useful for simultaneous detection of multiple lesions of Kaposi sarcoma. We present a 67-year-old man with a history of infection with human immunodeficiency virus who presented with numerous cutaneous lesions. FDG-PET/CT images showed lesions in the skin, lung, and lymph nodes. The gastrointestinal lesions were detected using gastric fiberscopy (GF) and colon fiberscopy (CF). After Kaposi sarcoma therapy, the uptake in the lesions of the skin, lung, and lymph nodes decreased, but new lesions were detected in the pancreas and lumbar spine. He had pancreatitis and Candida spondilitis. Whole-body FDG-PET/CT is useful for detecting lesions and determining the extension to which the disease has spread, adding the gastrointestinal lesions by GF and CF. After therapy, FDG-PET/CT can be used to demonstrate which lesions remain active and to determine the overall response to treatment. In this case, we show how useful FDG-PET/CT is and how difficult it is to treat Kaposi sarcoma.

The purpose of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiating pulmonary artery sarcoma from pulmonary embolism.

A 61-year-old woman with progressive gait disturbance underwent Tc-99m ECD SPECT. Regional cerebral blood flow (rCBF) was analyzed by an easy Z-score imaging system (eZIS). The SPECT and eZIS showed decreased rCBF in the bilateral occipital cortex. The T1WI of magnetic resonance imaging (MRI) showed severe atrophy of the medulla oblongata. However, the abnormality of white matter in the whole brain was not evident in the T2WI. The medulla finding was specific for adult-onset Alexander disease (AOAD). AOAD had been diagnosed based on a mutation in the glial fibrillary acid protein (GFAP) gene. The finding of a decreased rCBF on SPECT and eZIS might precede the leukoencephalopathy in AOAD.

A 55-year-old Japanese man was admitted to our hospital with severe weakness. Without measurement of serum electrolyte concentrations, diuretic therapy for hypertension was started 2 weeks prior to admission. Laboratory findings showed profound hypokalemia (1.4 mEq/L), and extreme elevation of the serum creatinine phosphokinase levels (15,760 IU/L), suggesting that the patient had hypokalemic paralysis and hypokalemia-induced rhabdomyolysis. Further evaluations, including adrenal venous sampling strongly suggested that he had primary aldosteronism. He was treated successfully by laparoscopic adrenalectomy. This case provides an important lesson that serum electrolyte concentrations should be measured in hypertensive patients before the administration of antihypertensive agents.

Radioactive seed implantation for the treatment of early-stage prostate cancer has become popular. Implanted I-125 seeds for brachytherapy are vulnerable to migration away from the prostate gland during dose delivery. It may result in altered dose distribution or unexpected seed embolization. Because of its small size (0.5 X 4.4 mm), the detection rate of migrated seeds using conventional x-rays is not satisfactory. We have developed a new scintigraphic method with 100% sensitivity, covering all low I-125 seed photopeaks. It may become the mainstream of monitoring seed migration instead of x-ray. We present some interesting cases, which were never expected without using scintigraphic detection.

We report three cases of percutaneous osteoplasty for the treatment of hypervascular bone metastasis. Four hypervascular bone metastases were treated in three consecutive patients by percutaneous osteoplasty under fluoroscopic or computed tomographic guidance. Primary malignant tumors included pheochromocytoma and renal cell carcinoma. Pain relief after osteoplasty was achieved in all three patients. There was no major complication. Projectile bleeding and subcutaneous hematoma were noted during or after osteoplasty but were easily controlled conservatively. Percutaneous osteoplasty for hypervascular bone metastases is not only a highly effective but also a minimally invasive technique that provides immediate pain relief without major complication.