We report three cases of cystic islet cell tumors, two caused by gastrinomas and the other by an islet cell carcinoma. All three patients underwent computed tomography (CT) and angiography and two also had magnetic resonance (MR) imaging. Several common radiographic findings were present as follows: thickening of the cyst wall and irregularity of the inner surface on postcontrast CT and MR images, neovascularity and a densely staining hypervascular rim on angiography, and moderately increased signal intensity of the cyst content on T1-weighted MR images, which indicated fluid containing blood and/or necrotic tissue. These findings are helpful in defining the nature of these lesions and strongly suggest that cystic islet cell tumor should be included in the differential diagnosis.

Angiography↗

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Gastrointestinal fistulas: treatment with covered stents.

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Biliary Fistula↗

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Successful transcatheter embolization of penetrating aortic ulcer using interlocking detachable coils.

A 54-year-old man with persistent chest pain was hospitalized for hypertension and DeBakey type IIIb aortic dissection. The false lumen of the dissection was almost completely thrombosed; however, a penetrating atherosclerotic ulcer (PAU) was observed 5 weeks later. At that time, we successfully embolized the PAU with a microcatheter and interlocking detachable coils (IDCs). The patient is well with no episodes of relapse in 20 months of follow-up. This case suggests the utility of the microcatheter and IDC system as an alternative to surgery.

Aortic Dissection↗

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Emergent Z stent placement for treatment of cor pulmonale due to pulmonary emboli after failed lytic treatment: technical considerations.

A patient with a pulmonary embolism due to deep vein thrombosis of a lower extremity developed hypotension and cor pulmonale despite prior placement of an inferior vena caval filter and treatment with a thrombolytic agent. After failure of percutaneous guidewire fragmentation and thrombosuction, self-expandable bilateral Z stents were positioned into the lower branches through the pulmonary arterial trunks. The patient experienced immediate relief of her cor pulmonale and successful recovery from hypotension.

Aged↗

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Independent double reading system. Application of digital image management database.

The most important role in a radiologist's work is communicating his findings to the attending physician. This is difficult when the radiologic examinations are performed with portable X-ray units because the attending physician wishes to read the images as soon as possible. To resolve this problem, we have developed an independent double reading system. The hardware consists of a magnetic card reader, a display station, a personal computer and a mouse, all linked with the digital image database and a communication network between HIS and RIS. We also present the software of this system and evaluate the results of the implementation to establish the accuracy of the technique. It was concluded that this system could expand the contribution of the radiologist to portable radiographic examinations and to improve the quality of the RIS database.

Computer Systems↗

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Measurement of human hepatic and splenic perfusion using dynamic computed tomography: a preliminary report.

The purpose of the study was evaluate hepatic (portal and arterial) and splenic perfusion at parenchymal level using dynamic computed tomography (CT) in patients with diffuse liver disease and controls. Nineteen patients and 30 normal controls underwent dynamic CT of the liver. Single-location dynamic sequences were carried out after intravenous administration of a 40 ml bolus of contrast medium (Ioversol: 5 cc/s). Hepatic arterial perfusion, hepatic portal perfusion and splenic perfusion were calculated from time-attenuation curves. Hepatic portal perfusion was significantly lower in patients (0.63 +/- 0.33 ml/min/ml (mean +/- SD); P = 0.003) compared with that in controls (1.03 +/- 0.43), although hepatic arterial perfusion did not differ (0.090 +/- 0.044 versus 0.102 +/- 0.114). Splenic arterial perfusion was significantly lower in patients (0.92 +/- 0.31; P = 0.0009) than in controls (1.35 +/- 0.44). The decreased hepatic portal perfusion in patients with diffuse liver disease was not supplemented by an increase in hepatic arterial perfusion. The decreased splenic perfusion in patients may be due to increased portal pressure. Dynamic CT enables quantification of hepatic and splenic perfusion.

Evaluation Studies as Topic↗

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Percutaneous treatment of brachiocephalic ischemic complications of a Stanford type A aortic dissection with use of endovascular stents.

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Aortic Dissection↗

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Retrievable IVC filter: preliminary in vitro and in vivo evaluation.

PURPOSE: To develop an inferior vena cava (IVC) filter that is retrievable even after neointimal formation and incorporation into the caval wall. MATERIALS AND METHODS: Eight filters were placed percutaneously in the infrarenal IVC of eight dogs. Four weeks after placement, percutaneous retrieval of the filters was attempted. Vena cavograms were obtained before and immediately after retrieval. Three dogs were killed immediately after the retrieval procedure was completed. In the other five dogs, follow-up vena cavography was performed 4-14 weeks after retrieval, and autopsy was performed. RESULTS: The filters were placed and retrieved successfully in all eight dogs. No migration, caval penetration, or tilting occurred. The IVCs were completely patent both before and immediately after retrieval in all eight dogs. In the three dogs killed immediately after retrieval, neointimal hyperplasia was seen around the struts, but there was no detachment. Delayed stenosis was not seen in any of the five dogs that were followed up, and the inner surface of the caval wall was smooth. CONCLUSION: This IVC filter can be easily placed and safely retrieved percutaneously, even after neointimal formation.

Animals↗

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Sentinel lymph node identification for patients with breast cancer using large-size radiotracer particles: technetium-99m-labeled tin colloids produced excellent results.

Sentinel lymph node (SLN) biopsies using radioactive tracers have been reported to detect the metastatic status of the axillary lymph nodes in breast cancer patients. However, the optimal radioactive tracer particle sizes remain to be determined. In this study, identification of SLNs with large radiolabeled tin colloid particles was evaluated. Seventy-five patients with T1-2, N0 breast cancer were enrolled. Two hours prior to surgery, 1 to 2.5 mL technetium-99m-labeled tin colloid particles were injected around the tumor under ultrasonographic guidance. Immediately before the operation, dye fluids were also injected around the tumor to increase the interstitial pressure. After axillary dissection, lymph nodes with x100 or more uptake of radioactivity than the mean of the other lymph nodes are considered to be SLN. All lymph nodes from the axillary dissections were pathologically investigated, and the characteristics of SLNs were evaluated. SLNs were clearly identified in 74 of 75 patients (98.7%). Of 37 patients without SLN metastasis, pathological investigation revealed no further involvement of the remaining non-SLNs. The SLNs tended to be larger in size, and more than 50% were located in the lower medial site of the axilla. This is the first study to show that SLNs could successfully be identified with radiolabeled tin colloid particles. When SLNs were negative for metastases, non-SLNs were always negative.

Breast Neoplasms↗

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Assessment of left ventricular volume by an ambulatory radionuclide monitoring system during head-up tilt in patients with unexplained syncope: relation to autonomic activity assessed by heart rate variability.

BACKGROUND: Decreased left ventricular volume during head-up tilt plays an important role in triggering syncope in patients with neurally mediated syncope. However, precise changes in left ventricular volume during head-up tilt have not been well investigated. This study was conducted to test the hypothesis that the decline in left ventricular volume during tilt could trigger ventricular mechanoreceptor activation. METHODS AND RESULTS: To investigate the mechanisms of tilt-induced syncope, we measured the temporal changes in left ventricular volume, ejection fraction, cardiac output, and heart rate variability indices during head-up tilt in 25 patients with syncope of undetermined etiology. Eleven patients had a cardioinhibitory response (CI group), 7 patients showed a vasodepressor response (VD group), and 7 patients demonstrated a negative response (NG group). Before syncope, ejection fraction increased most in the CI group, the left ventricular end-diastolic volume declined most in the VD group (VD group, -11.0% +/- 3.3%; CI group, -2.8% +/- 4.8%; NG group, -3.4% +/- 2.2%; P <.005), and the high-frequency spectra increased most in the CI group (CI group, 25.0% +/- 21.0%; VD group, -4.1% +/- 11.7%; NG group, -5.3% +/- 12.7%; P <.01). The vasodepressor response was dependent on left ventricular volume, whereas the cardioinhibitory response was related to the vagal activity reflected by high-frequency spectra. CONCLUSIONS: The precise evaluation of left ventricular volume by an ambulatory radionuclide monitoring system combined with a heart rate variability analysis is considered useful for clarifying the pathophysiology of neurally mediated syncope.

Adult↗

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Contrast-enhanced spiral CT of the liver: effect of injection time on time to peak hepatic enhancement.

PURPOSE: On contrast-enhanced hepatic CT, maximum tumor detection of liver metastases from colorectal cancer is achieved at peak hepatic enhancement. We investigated the relationship between injection time of contrast medium and time to peak hepatic enhancement (TPHE) after the end of injection. METHOD: One hundred nineteen patients without a cardiovascular disorder were enrolled in this study. Before the spiral CT was performed, a small amount of contrast medium was injected and a single level dynamic CT was performed to evaluate aortic enhancement and to determine the scan start time of the spiral examination. Patients were divided into three groups; contrast medium was injected over 30 s in 40 patients (Group A), 45 s in 39 patients (Group B), and 60 s in 40 patients (Group C). The TPHE after the end of injection was measured, and the difference among the groups was compared using one-way analysis of variance. A p value of <0.05 was considered a statistically significant difference. RESULTS: The TPHEs of the groups were 25.3 +/- 4.6 s (Group A), 27.0 +/- 5.8 s (Group B), and 24.4 +/- 4.6 s (Group C) and were similar in value. No statistically significant difference was observed (p = 0.067). CONCLUSION: Hepatic enhancement reaches its peak at approximately 25 s after the end of contrast medium injection irrespective of injection time.

Adult↗

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Influence of liver cirrhosis on pseudolesions in liver at CT during arterial portography.

PURPOSE: Pseudolesions are sometimes seen around the falciform ligament, around the gallbladder, or at the posterior edge of the medical segment on CT during arterial portography. The purpose of this study was to investigate the influence of liver cirrhosis on these pseudolesions. METHOD: The basis of this study was 33 patients with liver cirrhosis or hepatitis (group A) and 43 with neither (group B). The standard for diagnosis was surgical findings. We investigated whether there was a difference in the frequency of each pseudolesion between groups A and B. When tumors were seen in each location, they were excluded from statistical analysis. RESULTS: Pseudolesion around the falciform ligament was seen in none of 32 patients in group A and in 18 of 40 in group B (4 cases were excluded), around the gallbladder in 14 of 30 in group A and 16 of 42 in group B (4 cases were excluded), and at the posterior edge of the medial segment in 13 of 33 in group A and 16 of 42 in group B (1 case was excluded). There was a statistically significant difference in the frequency of pseudolesion around the falciform ligament (p < 0.001, Fisher test), but not around the gallbladder or posterior edge of the medial segment. CONCLUSION: Liver cirrhosis decreases the frequency of pseudolesions around the falciform ligament, but not around the gallbladder or posterior edge of the medial segment.

Adult↗