Yoshiko Kanasaki

Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging

The aim of this study is to evaluate the usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging in detecting peritoneal dissemination in cases of gynecological malignancy. We retrospectively analyzed MR images obtained from 26 consecutive patients with gynecological malignancy. Peritoneal dissemination was histologically diagnosed in 15 of the 26 patients after surgery. We obtained DW images and half-Fourier single-shot turbo-spin-echo images in the abdomen and pelvis, and then generated fusion images. Coronal maximum-intensity-projection images were reconstructed from the axial source images. Reader interpretations were compared with the laparotomy findings in the surgical records. Receiver-operating characteristic (ROC) curves were used to represent the presence of peritoneal dissemination. In addition, the sensitivity and specificity were calculated. DW imaging depicted the tumors in 14 of 15 patients with peritoneal dissemination as abnormal signal intensity. ROC analysis yielded Az values of 0.974 and 0.932 for the two reviewers. The mean sensitivity and specificity were 90 and 95.5%. DW imaging plays an important role in the diagnosis and therapeutic management of patients with gynecological malignancy.

Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions.

To clarify the diagnostic accuracy of diffusion‐weighted imaging (DWI) in differentiating benign from malignant ovarian lesions.

Significance of apparent diffusion coefficient measurement for the differential diagnosis of multiple system atrophy, progressive supranuclear palsy, and Parkinson's disease: evaluation by 3.0-T MR imaging

IntroductionThe clinical differentiation of Parkinson’s disease (PD) from multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) may be challenging, especially in their early stages. The aim of this study was to evaluate the utility of apparent diffusion coefficient (ADC) measurement to distinguish among these degenerative disorders.MethodsTwenty-five MSA, 20 PSP, and 17 PD patients and 18 healthy controls were retrospectively studied. Axial diffusion-weighted and T2-weighted images were obtained using a 3-T MR system. Regions of interest (ROIs) were precisely placed in the midbrain, pons, putamen, globus pallidus, caudate nucleus, thalamus, superior cerebellar peduncle, middle cerebellar peduncle, cerebellar white matter, and cerebellar dentate nucleus, and the regional ADC (rADC) value was calculated in each ROI.ResultsIn MSA, rADC values in the pons, middle cerebellar peduncle, cerebellar white matter, and cerebellar dentate nucleus were significantly higher than in PSP, PD, and controls. Furthermore, rADC values in the posterior putamen were significantly higher in MSA than in PSP and controls. In PSP, rADC values were significantly higher in the globus pallidus and midbrain than in MSA, PD, and controls. Furthermore, rADC values in the caudate nucleus and superior cerebellar peduncle were significantly higher in PSP than in MSA and controls. In PD, there were no significant differences in the rADC values compared to in MSA, PSP, and controls in all regions.ConclusionEvaluation of rADC values in characteristic lesions in MSA, PSP, and PD by placing ROIs using 3-T systems can provide useful additional information for differentiating these disorders.

Putaminal lesion in multiple system atrophy: postmortem MR-pathological correlations

IntroductionPosterior putaminal atrophy, putaminal T2-hyper and/or hyposignal changes have been observed in patients with multiple system atrophy (MSA) with parkinsonism.MethodsPostmortem T2-weighted images were compared with histological findings in seven autopsy-proven cases of putaminal lesions of MSA. All cases were evaluated on 1.5T magnetic resonance imaging (MRI) scanners and three cases were evaluated on 3T scanners.ResultsThere were three types of putaminal changes: Type 1, mild putaminal atrophy and isointensity; Type 2, putaminal atrophy and diffuse hyperintensity with a hyperintense putaminal rim (HPR); Type 3, putaminal atrophy and iso-or-hypointensity with HPR. The signal intensities of the putamen in Types 1 and 3 were more hypointense on 3T images than on 1.5T images. In Type 1, mild putaminal atrophy showed mild neuronal loss and gliosis and diffuse ferritin deposition. In Types 2 and 3, the areas of putaminal atrophy, severe in the posterior region, showed severe neuronal loss and gliosis, many pigments that were positive for ferritin and Fe 3+ and diffuse ferritin deposition. Although, tissue rarefaction was more severe in Type 2 than in Type 3, pigment deposition was more severe in Type 3. The HPR showed a severe loss of myelin and axons with tissue rarefaction of the external capsule or putaminal rim in Types 2 and 3.ConclusionPosterior putaminal atrophy reflects neuronal loss and gliosis. While putaminal iso-or -hypointensity reflects diffuse ferritin and Fe3+ deposition, hyperintensity reflects tissue rarefaction. The HPR reflects degeneration of the putaminal lateral margin and/or external capsule. These findings reflect characteristic histological findings of MSA with parkinsonism.

Diffusion-weighted imaging findings of adnexal torsion: Initial results

Our purpose is to clarify the diffusion-weighted (DW) imaging findings of adnexal torsion. We retrospectively analyzed the DW imaging findings in 11 consecutive patients with surgical confirmation of adnexal torsion. We assessed signal intensity of the adnexal mass and fallopian tube thickening, and the location of abnormal signal intensity within the adnexal mass. On DW imaging, thickening of the fallopian tube was apparent as abnormal signal intensity in 8 of 11 patients. Abnormal signal intensity was inhomogeneous in 7 of 8 patients. Abnormal signal intensity on DW imaging was observed in 10 of 11 adnexal masses, and in the walls of 7 out of 8 adnexal cystic lesions. In adnexal torsion, DW imaging showed abnormal signal intensity in the thickened fallopian tube and in the wall of cystic ovarian lesions. These findings would be feasible to diagnose adnexal torsion.

Three-dimensional gradient echo versus spin echo sequence in contrast-enhanced imaging of the pituitary gland at 3 T

INTRODUCTION To clarify whether a three-dimensional-gradient echo (3D-GRE) or spin echo (SE) sequence is more useful for evaluating sellar lesions on contrast-enhanced T1-weighted MR imaging at 3.0Tesla (T). METHODS We retrospectively assessed contrast-enhanced T1-weighted images using 3D-GRE and SE sequences at 3.0T obtained from 33 consecutive patients with clinically suspected sellar lesions. Two experienced neuroradiologists evaluated the images qualitatively in terms of the following criteria: boundary edge of the cavernous sinus and pituitary gland, border of sellar lesions, delineation of the optic nerve and cranial nerves within the cavernous sinus, susceptibility and flow artifacts, and overall image quality. RESULTS At 3.0T, 3D-GRE provided significantly better images than the SE sequence in terms of the border of sellar lesions, delineation of cranial nerves, and overall image quality; there was no significant difference regarding the boundary edge of the cavernous sinus and pituitary gland. In addition, the 3D-GRE sequence showed fewer pulsation artifacts but more susceptibility artifacts. CONCLUSION Our results indicate that 3D-GRE is the more suitable sequence for evaluating sellar lesions on contrast-enhanced T1-weighted imaging at 3.0T.

Diffusion-weighted Imaging of Uterine Endometrial Stromal Sarcoma: A Report of 2 Cases

We demonstrated 2 cases of uterine endometrial stromal sarcoma with emphasis on diffusion-weighted imaging. The tumors showed high signal intensity, and their tumor venous thrombi were clearly depicted on diffusion-weighted imaging. Diffusion-weighted imaging is a useful method not only for diagnosis of endometrial stromal sarcoma but also for preoperative planning.

Comparison of increased venous contrast in ischemic stroke using phase-sensitive MR imaging with perfusion changes on flow-sensitive alternating inversion recovery at 3 Tesla:

Background Increased venous contrast in ischemic stroke using susceptibility-weighted imaging has been widely reported, although few reports have compared increased venous contrast areas with perfusion change areas. Purpose To compare venous contrast on phase-sensitive MR images (PSI) with perfusion change on flow-sensitive alternating inversion recovery (FAIR) images, and to discuss the clinical use of PSI in ischemic stroke. Material and Methods Thirty patients with clinically suspected acute infarction of the middle cerebral artery (MCA) territory within 7 days of onset were evaluated. Phase-sensitive imaging (PSI), flow-sensitive alternating inversion recovery (FAIR), diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) were obtained using 3 Tesla scanner. Two neuroradiologists independently reviewed the MR images, as well as the PSI, DWI, and FAIR images. They were blinded to the clinical data and to each others findings. The abnormal area of each image was ultimately identified after both neuroradiologists reached consensus. We analyzed areas of increased venous contrast on PSI, perfusion changes on FAIR images and signal changes on DWI for each case. Results Venous contrast increased on PSI and hypoperfusion was evident on FAIR images from 22 of the 30 patients (73%). The distribution of the increased venous contrast was the same as that of the hypoperfused areas on FAIR images in 16 of these 22. The extent of these lesions was larger than that of lesions visualized by on DWI in 18 of the 22 patients. Hypointense signals reflecting hemorrhage and no increased venous contrast on PSI and hyperperfusion on FAIR images were found in six of the remaining eight patients (20%). Findings on PSI were normal and hypoperfusion areas were absent on FAIR images of two patients (7%). Conclusion Increased venous contrast on PSI might serve as an index of misery perfusion and provide useful information.

Usefulness of administration of SPIO prior to RF ablation for evaluation of the therapeutic effect: An experimental study using miniature pigs

OBJECTIVES To evaluate the usefulness of administration of superparamagnetic iron oxide (SPIO) and magnetic resonance (MR) imaging for assessing the efficacy of radiofrequency (RF) liver ablation. MATERIAL AND METHODS Using a protocol approved by the animal research committee of our university, nine RF liver ablations were performed in three miniature pigs. Six ablations were performed after administration of SPIO in two pigs (group A). Three ablations were performed in the other pig without administration of SPIO (group B). All pigs were sacrificed 4 days after the procedure. Harvested livers were scanned with a 1.5T MR system before and after fixation with 10% buffered formalin, and MR images were precisely compared with histological specimens. RESULTS There were no histological differences between the two groups. All ablated liver lesions showed coagulation necrosis at the external layer. There were no viable cells inside the coagulation necrosis. All ablated lesions had a hypointense rim on fast low angle shot (FLASH) images. The rims of group A were thicker than those of group B. The rims of group B corresponded histologically to congestion and hemorrhagic necrosis area. The rims of the group A corresponded to hemorrhagic necrosis and coagulation necrosis areas. In group A, the hypointense rim reflected necrotic Kupffer cells that took up SPIO before RF liver ablation. CONCLUSION Administration of SPIO made it possible to precisely evaluate ablated liver parenchyma by hypointense rim on FLASH images. This method is helpful for the evaluation of safety margin after RF ablation for liver tumors.

Significance of combined use of MRI and perfusion SPECT for evaluation of multiple system atrophy, cerebellar type

Background Multiple system atrophy, cerebellar type (MSA-C) sometimes shows asymmetrical findings on magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). Purpose To assess the frequency and clinical significance of asymmetrical MRI and 99mTc-ethyl cysteinate dimer perfusion (ECD) SPECT findings of the cerebellum, middle cerebellar peduncle (MCP), and pons in MSA-C patients. Material and Methods We retrospectively reviewed 28 patients with MSA-C who underwent MRI and 99mTc-ECD SPECT and evaluated laterality of atrophy and signal changes on MRI, and laterality of perfusion on 99mTc-ECD SPECT transversely and longitudinally. Results Laterality was identified for 64%, 61%, and 21% of atrophy in the cerebellum, MCP, and pons, respectively, on MRI and for 71% of atrophy in the cerebellum on perfusion SPECT. Concerning comparisons between the latest MRI and SPECT findings, laterality of cerebellar/MCP atrophy on MRI and decreased cerebellar perfusion on SPECT was matched in 57%, mismatched in 11%, and absent in 25% of patients. On past images, MRI and SPECT showed matched laterality in 33%, mismatched laterality in 27%, no laterality in 13%, and SPECT precedent laterality in 27% of patients. Including the latest and past images, asymmetrical changes were observed in 75% of patients. We could not identify any correlation between laterality of image findings and cerebellar symptoms in most patients. Conclusion Asymmetrical changes on MRI and perfusion SPECT are common in MSA-C patients. Perfusion SPECT is useful for diagnosing MSA-C in the early stages from a functional perspective.