A 77-year-old woman was admitted to our Hospital for a mass lesion in the plantar area of the left foot.The patient referred that the mass was present for about 30 years but it had never been treated before because asymptomatic.Foot Magnetic Resonance Imaging (MRI) reviewed a low-signal-intensity tumor on both T1 weighted and T2 weighted images.Based on clinical and diagnostic imaging findings we initially suspected a fibroproliferative neoplasm like an aggressive fibromatosis.Histologically the lesion was benign fibroblastic spindle cell lesion with dense or loose collagen fibers.Cellularity was low and no mitotic figures were found.The tumor cells were positive for CD34, whereas they were negative for α smooth muscle actin, desmin, HHF35 and S100 protein.These pathological findings were consistent with an Extrapleural Solitary Fibrous Tumor (Extrapleural SFT).The Extrapleural SFT should be included in the differential diagnosis of extrapleural lesions in which MRI suggests fibrous content.These entities exhibit a dense fibrocollagenous matrix that can produce low signal intensity on T2-weighted MRI images, similar to Extrapleural SFT.However, in order to reach a proper diagnosis and treatment is essential to integrate a detailed patients' clinical history and to perform a biopsy to collect cells for closer examination.
Antiresorptive agent-related osteonecrosis of the jaw (ARONJ)/medication-related osteonecrosis of the jaw (MRONJ) include both bisphosphonate-related osteonecrosis of jaw (BRONJ) and denosumab-related osteonecrosis of jaw (DRONJ). The purpose of this study is to study radiological characteristics of ARONJ/MRONJ. These imaging features may serve as one useful aid for assessing ARONJ/MRONJ.CT scans of 74 Japanese patients, who were clinically diagnosed by inclusion criteria of ARONJ/MRONJ, obtained between April 1, 2011 and September 30, 2016, were evaluated. We investigated the CT imaging features of ARONJ/MRONJ, and clarified radiological differentiation between BRONJ and DRONJ, BRONJ due to oral bisphosphonate administration and due to intravenous bisphosphonate administration, BRONJ with respective kinds of medication, BRONJ with long-term administration and short-term administration, BRONJ with each clinical staging respectively. Fisher's exact test, χ2 test, Student's t-test and analysis of variance were performed in the statistical analyses.Unilateral maxillary sinusitis was detected in all patients with upper ARONJ/MRONJ (100%). DRONJ showed large sequestrum more frequently than BRONJ (3/4, 75 vs 3/35, 8.6%, p < 0.05). DRONJ showed periosteal reaction more frequently than BRONJ (4/10, 40 vs 7/65, 10.1%, p < 0.05). Patients of BRONJ resulting from intravenous bisphosphonate administration showed larger and more frequent buccolingual cortical bone perforations than BRONJ resulting from oral bisphosphonate administration (7/8, 87.5 vs 11/30, 36.7%, p < 0.05). There was no significant correlation between CT findings and respective kinds of medication, long/short-term administration, clinical stages of BRONJ.ARONJ/MRONJ has characteristic CT image findings which could be useful for its assessment.
Abstract Objective To investigate the predictability of ophthalmic artery involvement in maxillary sinus cancer using preprocedural contrast enhanced CT and MRI. Methods We analyzed advanced (T3, T4a, and T4b) primary maxillary sinus squamous cell carcinoma treated with super-selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) from Oct 2016 to Mar 2020. Two diagnostic radiologists evaluated the tumor invasion site around the maxillary sinus using preprocedural imaging. These results were compared with the angiographic involvement of the ophthalmic artery using statistical analyses. We also evaluated our RADPLAT quality using complication rate, response to treatment, local progressive free survival (LPFS), and overall survival (OS). Results Twenty patients were included in this study. There were ten cases of ophthalmic artery tumor stain and there was a correlation between ophthalmic artery involvement and invasion for ethmoid sinus with statistically significant differences. Other imaging findings were not associated with ophthalmic artery involvement. Conclusions Ethmoid sinus invasion on preprocedural imaging could suggest ophthalmic artery involvement in maxillary sinus cancer. It may be useful in predicting prognosis and treatment selection.
A 40-year-old female, who underwent transcatheter arterial embolization due to acute bleeding from an iliolumbar artery, was subsequently genetically diagnosed with vascular Ehlers-Danlos syndrome. She experienced chronic anemia for many years due to the easy bruising of her whole body. The bruising improved with oral administration of celiprolol hydrochloride. There were no cardiac or vascular events during the 7 years following the transcatheter arterial embolization. Vascular Ehlers-Danlos syndrome requires specialized treatment that is scientifically proven to prevent a major vascular event. Proactive genetic diagnosis is recommended in patients suspected of having vascular Ehlers-Danlos syndrome after careful patient interview.
To our knowledge, this is the first study to investigate the thickness of the normal epiglottis on computed tomography (CT) in a Japanese population. The focus was on determining the thickness of a normal epiglottis, which could then serve as a reference in detecting abnormalities. We believe that this would facilitate diagnosing and determining the extent of cancerous invasion of the supraglottis and secondary invasion of the epiglottis. This retrospective study was based on a review of radiographic data in patient charts. Cervical CT scans obtained from 79 Japanese patients (44 men [55.7%] and 35 women [44.3%]; age range, 28–85 years; mean, 58.9 years) showing a normal epiglottis under laryngoscopy were evaluated. The thickness of the epiglottis was measured on CT scans and the results analyzed with the Student's t-test, an analysis of variance, and the Tukey-Kramer test. The epiglottis in men was significantly thicker than that in women (p<0.05). A statistically significant difference was observed in thickness depending on longitudinal height (p=<0.001). The thickness at the median was larger than that bilaterally in all patients (p=<0.001). No statistically significant difference was observed in thickness depending on side or age. The thickness of the normal epiglottis was established at each level. We believe that these data could serve as a reference in diagnosing and detecting abnormalities of the epiglottis.
Angioleiomyoma represents a benign stromal tumor, which usually occurs in the subcutaneous tissue of the extremities.The angioleiomyoma in the finger is rare.We report 2 rare cases of an angioleiomyoma in finger.Case one, was a 72-year-old man with a mass on the radial side of distal phalanx of the left third finger.Case two, was a 70-year-old man with a mass on the ulnar side of interphalangeal joint of the left thumb.Both cases showed isointense to hypointense mass lesion on both T1 and T2-weighted images and were pathologically diagnosed with an angioleiomyoma.Heterogeneously isointense to hypointense on T2-weighted MR image showed two components: smooth muscle tissue punctuated with thick-walled vessles and/or hyalization on pathological finding.When much hyalization is included, it will not be enhanced on gadolinium-enhanced fat suppressed T1-weighted magnetic resonance (MR) image.Both T2-weighted and gadolinium-enhanced fat suppressed T1-weighted MR image findings should considered to predict tumor composition.
Background: Cervical ossification of posterior longitudinal ligament (OPLL) is a common disease among the elderly population of East Asian countries.Cervical OPLL is often misdiagnosed in lateral radiography or magnetic resonance imaging (MRI).The present study analyzes the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to computed tomography (CT).Methods and Materials: A total of 60 Japanese patients who were clinically diagnosed with cervical OPLL by CT imagining were considered in this study.Firstly, a lateral radiograph was checked identifying a high-density structure along the posterior aspect of vertebral bodies as OPLL.Secondly, a T2 weighted MRI sagittal image was obtained which delineated a thick low-signal posterior longitudinal ligament as OPLL.Thirdly, a cervical CT investigated vertebral bodies in which OPLL was present.Subsequently, lateral radiographs and MRIs were compared to the CT scans.The diagnostic accuracy in lateral radiograph and MRI were evaluated and causes of misdiagnosis were postulated.Results: Diagnostic accuracy utilizing lateral radiograph and MRI were 20% (12/60) and 25% (15/60), respectively.Only 5 out of the 60 cases displayed evidence of OPLL in all three modalities.Regarding each vertebral level, accuracy using lateral radiograph and MRI of each C2-C7 was C2 (88.8% and 100%), C3 (88.8% and 100%), C4 (79.5% and 97.9%), C5 (95.5% and 110.6%),C6 (42.5% and 70.2%) and C7 (23.8% and 66.6%).Conclusions: Diagnosing cervical OPLL using lateral radiograph is prone to underestimation; whereas, diagnosis via MRI is prone to overestimation.If severe spondylosis, facet joints, and pedicle shadows occur, they can hinder the detection of OPLL in the lateral radiograph.Regarding the MRI-based diagnosis, it would be difficult to distinguish ossifications from ligament hypertrophy.However, the use of X-ray and MRI present an accurate diagnostic tool for cervical OPLL at the levels of C2, C3, C4 and C5.
