Izumi Togami

Endometrial carcinoma: Dynamic MRI with turbo-FLASH technique

PURPOSE Our goal was to investigate the usefulness of dynamic MRI with the turbo-FLASH technique in estimating myometrial invasion by endometrial carcinoma. METHOD Forty-six patients with endometrial carcinomas were evaluated with pathologic correlation. Dynamic MRI was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique. RESULTS The inner muscle layer showed more rapid contrast enhancement effects than the outer muscle layer even after menopause. Contrast-to-noise ratio between the inner muscle layer and endometrial carcinoma was maximum at approximately 50 s after administration of Gd-DTPA. In postmenopausal women, the accuracy in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MRI was 66.7, 77.8, and 92.6%, respectively. CONCLUSION Dynamic MRI with the turbo-FLASH technique is considered to be a useful imaging method for the estimation of myometrial invasion by endometrial carcinoma, especially in postmenopausal patients.

Bilateral Lung Volume Reduction Surgery via Median Sternotomy for Severe Pulmonary Emphysema

BACKGROUND Lung volume reduction surgery either via sternotomy or by thoracoscopy has been demonstrated to be effective for selected emphysema patients in North America and Europe. The present study summarizes short-term results of bilateral lung volume reduction performed via median sternotomy for the first consecutive 39 patients with severe diffuse emphysema in Okayama, Japan, from July 1995 to February 1997. METHODS There were 35 men and 4 women, and the age range was 54 to 74 years with a mean age of 65 years. All were former heavy smokers and none of them had alpha1-antitrypsin deficiency. Only 9 patients (23%) showed a bilateral upper lobe pattern of emphysema. The operation was done through a median sternotomy, and the most emphysematous portions were excised bilaterally with a linear stapling device fitted with strips of bovine pericardium to prevent air leakage. RESULTS No operative death was encountered. The first 33 patients completed 3-month follow-up assessment, and their mean forced expiratory volume in 1 second had improved by 41% from 735 mL to 1,037 mL. Other parameters of pulmonary function tests, arterial blood gas analysis, 6-minute walking distance, and dyspnea scale also had improved significantly. These improvements lasted for at least a year. CONCLUSIONS Bilateral lung volume reduction surgery via median sternotomy is a safe and effective procedure for selected severe emphysema patients. Although the pattern of emphysema might be different between countries, the results in Japanese patients were similar to those previously reported in North American and European patients.

Uterine cirsoid aneurysm : MRI and MRA

Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm.

Bile duct stenosis due to portal cavernomas: MR portography and MR cholangiopancreatography demonstration.

We report two cases of bile duct stenosis due to portal cavernomas. Smooth stenoses were seen arising from both walls of the common bile duct on magnetic resonance (MR) cholangiopancreatography. On contrast-enhanced MR portography, peribiliary tortuous vessels were evident, indicating portal cavernomas. MR imaging can evaluate the biliary tree and portal systems noninvasively and was useful for evaluating this condition.

Nontumorous decrease in Tc-99m GSA accumulation

Nontumorous decrease in99mTc-GSA accumulation has not been well covered in the literature. Understanding of this phenomenon is, however, essential for accurate evaluation of regional hepatic function. Scintigrams (transaxial SPECT) of 269 patients who underwent99mTc-GSA liver scintigraphy were reviewed for the presence of nontumorous decreases in99mTc-GSA accumulation. Nontumorous decreases in99mTc-GSA accumulation were seen in 32 of 269 patients (12%). In 16 of the 32 patients (6%), nontumorous decreases in99mTc-GSA accumulation corresponded to regional decrease in portal venous flow. The causes of such decrease in portal venous flow were portal thrombus of hepatocellular carcinomas in eight patients, portal venous stenosis or occlusion by hilar cholangiocarcinomas in five patients, inter alia. In eight patients (3%), the regions with decreased99mTc-GSA accumulation correlated with massive hepatic necrosis in fulminant hepatitis, scar in hepatitis, or confluent fibrosis in cirrhotic liver. In two patients (0.7%) with hilar cholangiocarcinomas, the possible causes of lobar decrease in99mTc-GSA accumulation were thought to be lobar decrease in portal venous flow, lobar biliary stasis, or both. In four patients (1.5%), the exact causes of nontumorous decrease in99mTc-GSA accumulation could not be determined.

Asymptomatic membranous obstruction of the inferior vena cava due to large intrahepatic collaterals

This paper presents a case of asymptomatic membranous obstruction of the inferior vena cava with a rare hemodynamic pattern consisting of large intrahepatic venous connections between the right inframembranous and the middle supramembranous hepatic vein. These remarkably large collaterals obviated significant enlargement of the azygous venous system and the development of a Budd-Chiari syndrome.

Three different areas of decreased hepatic radioactivity secondary to a hilar mass.

A 68-year-old woman with hilar cholangiocarcinoma underwent technetium-99m galactosyl human albumin (Tc-99m GSA) liver scintigraphy for the preoperative evaluation of functional liver reserve. Normal radionuclide uptake was evident in the right anterior segment of the right lobe but there was none in the left lobe. In the right posterior segment, uptake was incomplete. Contrast portography via the superior mesenteric artery showed complete occlusion of the left portal vein. The right anterior segment was well perfused with portal venous flow, whereas there was less perfusion to the right posterior segment. These differences of hepatic parenchymal radioactivity are probably a result of varying degrees of decrease in portal venous flow secondary to the hilar mass.

Iodine-131 MIBG uptake in hydronephrosis due to compression by a large adrenal mass

A 74-year-old woman underwent 1-131 MIBG imaging to rule out or confirm a left adrenal pheochromocytoma. Significant uptake was seen in the left side of the abdomen. Postcontrast coronal MRI revealed that this agent did not accumulate in the mass but rather in the kidney. The left kidney was compressed by the mass and developed hydronephrosis. Accumulation of I-131 MIBG in the left kidney was considered to be due to urinary stasis.

Distribution of protein-bound zinc in serum of analbuminemic rat.

The distribution of protein-bound zinc in serum of rat with analbuminemia was analyzed with gel filtration and affinity chromatography. From the profiles of chromatography, the zinc present in analbuminemic rat serum is composed of two principal species in similar to that of Sprague-Dawley rat: one fraction is firmly bound to alpha 2-macroglobulin, and a second fraction is more loosely bound to various proteins.