Gakuto Tomizawa

Intracranial dural arteriovenous fistula with retrograde cortical venous drainage: use of susceptibility-weighted imaging in combination with dynamic susceptibility contrast imaging.

BACKGROUND AND PURPOSE: SWI is a new MR imaging method that maximizes sensitivity to magnetic susceptibility effects with phase information for visualizing small cerebral veins. The purpose of this study was to report the use of SWI in combination with DSC in examining related RCVD in patients with intracranial DAVFs. MATERIALS AND METHODS: Ten patients with angiographically confirmed DAVFs with RCVD underwent conventional MR imaging, SWI, and DSC. The ability of SWI to depict dilated cerebral veins was evaluated and then compared with DSC. The hemispheres of patients with DAVFs were grouped into affected (with RCVD) or nonaffected (without RCVD) categories by angiography. Four patients had bilaterally affected hemispheres. A total of 14 affected hemispheres in patients with DAVFs with RCVD were evaluated. RESULTS: SWI showed dilated cerebral veins on the surface of the brain in all (100%) of the 14 affected hemispheres in patients with DAVFs with RCVD and deep in the brain in 9 (64%). T2-weighted imaging showed prominent flow-voids on the surface of the brain in 10 (71%) of the 14 affected hemispheres in patients with DAVFs with RCVD and deep in the brain in 5 (36%). DSC showed increased cerebral blood volume in all of the 14 affected hemispheres. The SWI findings regarding dilated veins on the surface of the brain corresponded well with the areas of increased cerebral blood volume. CONCLUSIONS: SWI in combination with DSC could be used to characterize the presence of RCVD in patients with DAVFs.

Dural arteriovenous fistula involving the transverse sigmoid sinus after treatment: assessment with magnetic resonance digital subtraction angiography

IntroductionThe purpose of this study was to evaluate the utility of magnetic resonance digital subtraction angiography (MRDSA) in showing the presence or absence of retrograde venous drainage (RVD) in patients with intracranial dural arteriovenous fistula (DAVF) involving the transverse sigmoid sinus (TSS) after treatment.MethodsOf 16 patients with DAVF involving the TSS, 13 underwent digital subtraction angiography (DSA) and MRDSA before and after treatment, and 3 underwent DSA before treatment and DSA and MRDSA after treatment. Five patients underwent these procedures twice after treatment. A total of 21 examinations after treatment were evaluated retrospectively. The presence or absence of DAVF and RVD was decided on the basis of the DSA findings. Two neuroradiologists reviewed the MRDSA findings concerning the presence or absence of DAVF and RVD.ResultsDSA showed residual DAVF in 9 and residual RVD in 5 of 21 examinations. MRDSA revealed residual DAVF in 8 of 21 examinations. MRDSA did not show residual DAVF in one examination because of a very small (low-flow) residual DAVF without RVD. MRDSA identified residual RVD in 5 of 21 examinations. MRDSA was completely consistent with DSA concerning the presence or absence of residual RVD.ConclusionMRDSA could evaluate the presence or absence of RVD in patients with DAVF involving TSS after treatment. MRDSA may give reliable information as to whether patients with DAVF involving the TSS should undergo additional DSA after treatment.

Extensive soft-tissue involvement of dermatomyositis detected by whole-body scintigraphy with99mTc-MDP and201Tl-chloride

The authors present a case of extensive soft-tissue radioactivity visualized on both99mTc-MDP and201Tl-chloride scintigrams in a patient with dermatomyositis and colon cancer. Incidentally, diffuse and intense uptake of99mTc-MDP was observed in the shoulder girdles, anterior chest wall, psoas muscles, both proximal thighs and right lower limb, corresponding to the sites of symptomatic muscles, even though skin lesions were limited and no calcification was detected on radiographs. Moreover,201Tl-chloride was also intensely accumulated in nearly the same sites as the symptomatic muscles as shown on the99mTc-MDP bone scintigrams.Whole-body scintigraphy with99mTc-MDP and201Tl-chloride is a useful tool to detect occult muscle lesions with dystrophic calcification and hyperemia in dermatomyositis.

Predictive value of optimal morphologic response to first-line chemotherapy in patients with colorectal liver metastases.

Background: It has been reported that morphologic response to preoperative chemotherapy is an independent prognostic factor in patients who undergo hepatic resection of colorectal liver metastases (CLM). The aim of this study was to evaluate the predictive value of morphologic response to first-line chemotherapy in patients with CLM. Methods: We assessed 41 patients with CLM who received fluorouracil-based chemotherapy with or without bevacizumab as the first-line chemotherapy between April 2006 and June 2012. Three blinded radiologists evaluated computed tomography images and classified them as optimal, incomplete or no response according to the morphologic criteria. Response to systemic chemotherapy was also evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). Predictive factors associated with progression-free survival (PFS) were identified in multivariate analysis. Results: Twenty-three patients (56%) received chemotherapy with bevacizumab, while 18 patients (44%) received chemotherapy without bevacizumab. Optimal morphologic response was observed in 11 patients (48%) treated with bevacizumab and in 5 patients (28%) treated without bevacizumab (p = 0.19). Eight patients (20%) underwent hepatic resection after chemotherapy. The median follow-up period was 31.3 months. The median PFS was 13.3 months for patients with optical morphologic response and 8.7 months in those with incomplete/no morphologic response (p = 0.0026). On multivariate analysis, performance status and morphologic response were significant independent predictors of PFS. Conclusion: Optimal morphologic response was significantly associated with PFS in patients with CLM who were treated with fluorouracil-based chemotherapy as the first-line chemotherapy.

Neutrophil/lymphocyte ratio as a prognostic indicator of hepatic arterial infusion chemotherapy with arterial cisplatin plus continuous 5-fluorouracil.

Hepatic arterial infusion (HAIC) therapy may be a therapeutic option for advanced hepatocellular carcinoma (HCC) in addition to administration of sorafenib, which is the only currently established standard regimen for this disease. Survival benefit of HAIC has been reported in patients positive for antitumor response. Therefore, the prediction of antitumor response is important in decision‐making for HAIC treatment.

Flow-sensitive alternating inversion recovery (fair) imaging for retrograde cortical venous drainage related to intracranial dural arteriovenous fistula

IntroductionTo evaluate the hypothesis that flow-sensitive alternating inversion recovery (FAIR) magnetic resonance (MR) imaging can detect retrograde cortical venous drainage (RCVD) in patients with intracranial dural arteriovenous fistula (DAVF).MethodsSeven patients with angiographically confirmed DAVF with RCVD and two DAVF patients without RCVD underwent examinations with conventional MR imaging and FAIR, five of these seven patients with RCVD also underwent examination with dynamic susceptibility contrast (DSC) MR imaging. The ability of FAIR to depict prominent cerebral veins was evaluated, and FAIR was compared with the relative cerebral blood volume (rCBV) maps created with DSC.ResultsIn all DAVF patients with RCVD, FAIR clearly showed prominent veins on the surface of the brain in affected hemisphere, and FAIR corresponded well with the areas of increased rCBV. In all DAVF patients without RCVD, FAIR showed no prominent veins.ConclusionFAIR can detect RCVD in patients with DAVF.

Response to intra‐arterial cisplatin and concurrent radiotherapy in a patient with primary mucosal malignant melanoma of the nasal cavity

The prognosis for patients with mucosal malignant melanoma (MMM) of the nasal cavity is very poor because of the radioresistance of melanoma cells.

Malignant Melanoma Imaging with Tl-201

Two patients with malignant melanoma were evaluated using Tl-201 scintigraphy. Planar scintigraphy showed tumor accumulation, and SPECT Tl-201 imaging revealed exact tumor localization. The findings indicate the utility of Tl-201 to detect the primary lesion and to identify postoperative recurrence in malignant melanoma.

Extrarenal adult nephroblastoma.

Ga-67 scintigraphy, abdominal computed tomography (CT), and pelvic magnetic resonance imaging (MRI) were performed in a patient with extrarenal adult nephroblastoma. CT showed a large intra-abdominal cystic tumor displacing the liver and the right kidney. MRI revealed a pelvic tumor with cystic changes. Ga-67 scintigraphy revealed multiple sites of tumor localization in the abdomen. These results suggest that Ga-67 scintigraphy may be a useful imaging method in the detection of primary and metastatic lesions in the setting of extrarenal adult nephroblastoma.