Atsuko Heshiki

Magnetic resonance imaging patterns in patients with multiple myeloma

Sixty‐one consecutive patients with multiple myeloma were studied with magnetic resonance (MR) imaging of the spine. Sagittal T1‐weighted and short inversion time (TI) inversion recovery (STIR) images were obtained. The MR patterns of the bone marrow were classified as diffuse (D) (nu2003=u200326), nodular (N) (nu2003=u200311), Du2003+u2003N (nu2003=u200313) or normal (n) (nu2003=u200311). Abnormal patterns were seen in 50 (82%) of the 61 patients. Correlations were found between the MR imaging patterns and some laboratory findings (WBC, haematocrit, platelet count, serum albumin, and percentage of marrow plasmacytosis). The survival of the patients with abnormal MRI patterns was significantly poorer than that of the patients with normal patterns. However, the survival of patients with a nodular pattern did not differ from those with a normal pattern. The MR imaging pattern of the bone marrow in patients with multiple myeloma is a useful factor in the assessment of prognosis.

Chorioangioma: antenatal diagnosis with fast MR imaging

We report a case of chorioangioma of the placenta, in which fast magnetic resonance imaging (MRI) was useful adjunct to ultrasonography for the antenatal diagnosis. MRI allowed clear demonstration of 6.8 x 6.0 cm solid placental mass along with hydramnios and anatomically normal fetus. On T(1)-weighted breath-hold spoiled gradient-echo (fast low-angle shot [FLASH]) images, chorioangioma was mostly isointense to the placenta, but had an area of high signal intensity near the base and at the periphery, suggestive of hemorrhage. On T(2)-weighted half-Fourier single-shot fast spin echo (HASTE) images, the mass showed heterogeneous high signal intensity, but had an area of low signal intensity near the surface.

Histopathological analysis of a bladder cancer stalk observed on MRI

Papillary transitional cell carcinoma of the bladder has a loose connective tissue stalk. For staging of bladder cancer on magnetic resonance imaging (MRI), it is important to clearly separate the cancer from the bladder wall. It is possible to distinguish a stalk from the cancer by the difference of intensity on the using MRI. Sixteen stalks of 20 polypoid bladder tumors on any of the T(2)W(I), dynamic images and delayed enhanced images were demonstrated. Most of the stalks show lower signal intensity than the tumors on T(2)W(I), less enhancement on dynamic images and stronger enhancement on delayed enhanced images. The stalk consisted of fibrous connective tissue, capillary blood vessels, inflammatory cell infiltration and edema. This stalk extended from the bladder wall to the center of the tumor. Some of the superficial muscular bundles were pulled into the stalk. These histopathological findings were compatible with the patterns of signal intensities on MRI. The identification of the stalk of a polypoid tumor may be an important observation to exclude bladder wall invasion by tumor.

Bone marrow patterns in patients with aplastic anaemia and myelodysplastic syndrome: observations with magnetic resonance imaging

Abstract: Bone marrow magnetic resonance imaging (MRI) was obtained in 48 patients with myelodysplastic syndrome (MDS) (35 cases) or aplastic anaemia (AA) (13 cases). The lower thoracic and lumbar spine were evaluated on sagittal plane using a 1.5 Tesla superconducting MR unit with a surface coil. Pulse sequence of STIRs (TR 2000 msec, TI 160 msec, TE 20 msec) were applied. Four distinct patterns of signal intensity (SI) on the STIR images were classified as follows: pattern 1, homogeneously low SI; 2, marginally high SI; 3, heterogeneously high SI; 4, homogeneously high SI. In all 13 patients with AA, STIR images initially revealed pattern 1. In 25 of 35 cases with MDS patients, the STIR images were initially classified as pattern 3. The STIR images of 6 AA and 5 MDS patients with a clinical response to treatment showed pattern 2 similar to that of normal marrow distribution. The STIR images of MDS patients showed an abnormal distribution of SI. Significant signal changes in the STIR images can be observed in successive examinations of the patients, thus facilitating follow‐up of the disease and treatment. MRI of the bone marrow provides a noninvasive means of grossly examining a large fraction and is a useful technique in patients with aplastic anaemia or myelodysplastic syndrome.

Teleradiology at Gunma University Hospital

Using NEC MediFile 1000 and the public telephone system, the Department of Radiology of Gunma University Hospital and Saitama Medical School deliver image diagnosis to fellow clinicians and affiliated hospitals. The system consists of digitizing, filing, processing, retrieving and archiving units for radiographs and documents. Images were digitized by CCD and filed in 2 Gbyte double sided optical disk, which can accommodate 500 sheets of 14 x 17 films on 1500 of the smallest size slats without data compression. Image resolution was evaluated by ROC curve using multiple pulmonary nodules. The time taken for image transfer over 24 km was tested with various film sizes, image varieties and data compression rates.

Preoperative Transarterial Embolization Enhances the Surgical Management of Diffuse Plexiform Neurofibroma: A Case Report

A 15-year-old boy with neurofibromatosis type-1 (NF-1) presented for management of plexiform neurofibromas in his right arm (Fig. 1). The results of arteriography are shown in Figure 2. Venous return from the tumor was abundant, suggesting ample blood flow. A 3-F microcatheter was super-selectively advanced to the right deep brachial artery and embolization was performed by injecting approximately 20 cubes of 1mm gelatin sponge. Arteriography after embolization demonstrated an obvious decrease in venous return, in addition to a reduction of vascularity in the tumor. The redness of the tumor decreased, and an approximately 15% reduction in tumor volume was observed after embolization. Tumor reduction and suturing were performed under general anesthesia without using an air-tourniquet or xylocaine containing epinephrine. The entire bleeding volume throughout the surgical procedures was less than 10 ml. The excised sample and the local status 4 months after the operation are shown in Figure 3.

Bone Marrow MRI in Prostate Cancer

Normal bone marrow MRI has a distinct pattern with STIR pulse sequence MRI. The central low signal intensity area corresponds to fatty marrow. The red marrow is distributed in the peripheral portion of the vertebrae and shows a high signal intensity. Prostatic cancer metastases to the bone marrow revealed a high signal intensity with STIR. Prior to the appearance of an abnormal scintigram and radiograph, MRI was able to depict an abnormality.

Magnetic resonance imaging findings of vulvar epithelioid sarcoma

We describe here a case of vulvar epithelioid sarcoma. Epithelioid sarcoma is a malignant appendicular skin tumor that is rarely of vulvar origin. Magnetic resonance imaging (MRI) revealed a solid mass with an ulcer-like lesion and multilobulated contour. To our knowledge, this is the first case of vulvar epithelioid sarcoma described in the MRI literature.

Clinical Perspective on IMAC ---Radiologist's view ---

A bstracL Radiologists perspective on IMAC is summarized through t eleradiology experiences. I take IMAC affirmatively and foresee its value. To face IMAC, radiologists have to reassure their identity. The radiologists needs and roles in IMAC will soon be evaluated by fcllow clinicians, patients, and society objectively. Solid identity and high quality of radiologists have to be revisited.