45-year-old man with vertigo. 45才男性 めまい

45-year-old man with vertigo.
45才男性 めまい

解答:  Ecchordosis physaliphora   (EP)  ,  泡状外脊索腫

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問題を見ていない先生はこちら

Key words: Ecchordosisphysaliphora, EP,  泡状外脊索症,  異所性 脊索の遺残

Key images:

T2WI 3D axial 3

通常のT2WI だとわかりにくい 上記の様に3DT2WI (今回は内耳道撮像目的)でないと難しい

T2WI axialT2WI 3D axi reconstruction sagi, coro ADCT1WI T2WI MPR3T1WI T2WI MPRT1WI T2WI MPR2

References:

1)MehnertF, Beschorner, KukerW,et al.

Retroclivalecchordosisphysaliphora: MR imaging and review of the literature. AJNR. 2004, 25: 1851-1855

2)   ChiharaC, Korogi Y, Kakeda S, et al.

Ecchordosis physaliphora and its variants: proposed new classification based on high-resolution fast MR imaging employing steady-state acquisition. EurRadiol. 2013 Oct;23(10):2854-60.

3) Srinivasan A, Goyal M, KingstoneM.

Case 133:

Ecchordosis physaliphora. Radiology. 2008 May;247(2):585-8. No abstract available.

4) Golden LD, Small JE Benign notochordal lesions of the posterior clivus:      retrospective review of prevalence and imaging characteristics. J Neuroimaging.2014 May-Jun;24(3):245-9.

5) KaulS, Khan OH, Edem I, et al.

Transclivalpseudomeningocele secondary to ecchordosisphysaliphora: case report and literature review. J NeurolSurg Rep. 2013 Dec;74(2):92-5.

6)  KrishtKM, Palmer CA, Osborn AG, et al.

Giant ecchordosis physaliphora in an adolescent girl: case report. J NeurosurgPediatr. 2013 Oct;12(4):328-33. doi: 10.3171/2013.5.PEDS1395. Epub 2013 Aug 2.

7)Yamamoto T, Yano S, Hide T, et al.

A case of ecchordosis physaliphora presenting with an abducens nerve palsy: A rare symptomatic case managed with endoscopic endonasaltranssphenoidalsurgery. SurgNeurol Int. 2013;4:13.

8)AlkanO, Yildirim T, Kizilkiliç O, et al.

A case of ecchordosis physaliphora presenting with an intratumoral hemorrhage. Turk Neurosurg. 2009 Jul;19(3):293-6.

9)CiarpagliniR, Pasquini E, Mazzatenta D, et al.

Intraduralclivalchordoma and ecchordosis physaliphora: a challenging differential diagnosis: case report. Neurosurgery. 2009 Feb;64(2):E387-8; discussion E388.

10) Toda H, Kondo A, Iwasaki K.

Neuroradiologicalcharacteristics of ecchordosis physaliphora. Case report and review of the literature. J Neurosurg. 1998 Nov;89(5):830-4. Review.

74-year-old man with tumor in pancreatic tail on screening US. Answer

74才男性
超音波スクリーニングにて
膵尾部腫瘍を指摘

74-year-old man with tumor in pancreatic tail on screening US.

解答編

問題を見ていない先生はこちら

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WMV version

Key words: Pancreatic metastases, 膵転移、Renal cell carcinoma, RCC, 腎細胞癌、腎癌、腎癌膵転移、RCC, diffusion, ADC map

Key images:

Plain CT1Dynamic CT early 1Dynamic CT delay 1MRCP1T2WI 1T2WI coronal 1T1WI FS1MRI dynamic early 1MRI dynamic portal 1DWI ADCADC mapPET CT1

Referrences:

Clinical features, Prognosis

1. Song SW, Cheng JF, Liu N, Zhao TH.

Diagnosis and treatment of pancreatic metastases in 22 patients: a retrospective study.WorldJ SurgOncol. 2014 Sep 25;12:299.

2. SellnerF, Tykalsky N, De Santis M, et al.

Solitary and multiple isolated metastases of clear cell renal carcinoma to thepancreas: an indication for pancreatic surgery.

Ann SurgOncol. 2006 Jan;13(1):75-85. Epub 2006 Jan 1.

3. ZerbiA, Ortolano E, Balzano G, et al.

Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection?Ann SurgOncol. 2008 Apr;15(4):1161-8.

4. Law CH, Wei AC, Hanna SS,  et al.

Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment, and outcome. Ann Surg Oncol.2003 Oct;10(8):922-6.

5. Sohn TA, Yeo CJ, Cameron JL, et al.

Renal cell carcinoma metastatic to the pancreas: results of surgical management.J GastrointestSurg.2001 Jul-Aug;5(4):346-51.

6. Faure JP, Tuech JJ, Richer JP, et al.

Pancreatic metastasis of renal cell carcinoma: presentation, treatment and survival. J Urol. 2001 Jan;165(1):20-2.

7. AkatsuT, Shimazu M, Aiura K, et al.

Clinicopathological features and surgical outcome of isolated metastasis of renal cell carcinoma. Hepatogastroenterology. 2007 Sep;54(78):1836-40.

Imaging features

1. Ng CS, Loyer EM, Iyer RB, David CL, DuBrow RA, Charnsangavej C.

Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJRAm J Roentgenol. 1999 Jun;172(6):1555-9.

2. Klein KA, Stephens DH, Welch TJ.

CT characteristics of metastatic disease of the pancreas. Radiographics. 1998 Mar-Apr;18(2):369-78.

3. VincenziM, Pasquotti G, Polverosi R, et al.
Imaging of pancreatic metastases from renal cell carcinoma. Cancer Imaging. 2014 Apr 22;14:5.

4. PalmowskiM, Hacke N, Satzl S, et al.

Metastasis to the pancreas: characterization by morphology and contrast enhancement features on CT and MRI. Pancreatology. 2008;8(2):199-203.

5. AscentiG, Visalli C,  Genitori A, et al.

Multiple hypervascular pancreatic metastases from renal cell carcinoma: dynamic MR and spiral CT in three cases. Clin Imaging. 2004 Sep-Oct;28(5):349-52.

6. Tsitouridis I, Diamantopoulou A, Michaelides M, et al.

Pancreatic metastases: CT and MRI findings. DiagnIntervRadiol. 2010 Mar;16(1):45-51.

RCC and ADC value

1. Choi YA, Kim CK, Park SY, et al.

Subtype differentiation of renal cell carcinoma using diffusion-weighted and blood oxygenation level-dependent MRI.AJR Am J Roentgenol. 2014 Jul;203(1):W78-84.

2. SasamoriH, Saiki M, Suyama J, et al.

Utility of apparent diffusion coefficients in the evaluation of solid renal tumors at 3T. MagnReson Med Sci. 2014;13(2):89-95.

3. Sevcenco S, Heinz-Peer G, Ponhold L, et al.

Utility and limitations of 3-Tesla diffusion-weighted magnetic resonance imaging for differentiation of renal tumors. EurJ Radiol. 2014 Jun;83(6):909-13.

4. Yu X, Lin M, Ouyang H, et al.

Application of ADC measurement in characterization of renal cell carcinomas with different pathological types and grades by 3.0T diffusion-weighted MRI.

EurJ Radiol. 2012 Nov;81(11):3061-6.

5. PaudyalB, Paudyal P, Tsushima Y, et al.

The role of the ADC value in the characterisation of renal carcinoma by diffusion-weighted MRI. Br J Radiol. 2010 Apr;83(988):336-43.

RCC and PET-CT

1. Win AZ, Aparici CM.

Clinical effectiveness of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography in management of renal cell carcinoma: a single institution experience. World J Nucl Med. 2015 Jan-Apr;14(1):36-40.

2. Sharma P, Karunanithi S, Chakraborty PS, et al.

18F-Fluoride PET/CT for detection of bone metastasis in patients with renal cell carcinoma: a pilot study. NuclMed Commun. 2014 Dec;35(12):1247-53.

3. Lee H, Hwang KH, Kim SG, et al.

Can Initial (18)F-FDG PET-CT Imaging Give Information on Metastasis in Patients with Primary Renal Cell Carcinoma? NuclMed Mol Imaging. 2014 Jun;48(2):144-52.

4. Fuccio C, Ceci F, Castellucci P, et al.

Restaging clear cell renal carcinoma with 18F-FDG PET/CT. ClinNucl Med. 2014 Jun;39(6):e320-4.

5. Chen JL, Appelbaum DE, Kocherginsky M, et al.

FDG-PET as a predictive biomarker for therapy with everolimus in metastatic renal cell cancer. Cancer Med. 2013 Aug;2(4):545-52.

6. Nakhoda Z, Torigian DA, Saboury B, et al.

Assessment of the diagnostic performance of (18)F-FDG-PET/CT for detection and characterization of solid renal malignancies. Hell J Nucl Med. 2013 Jan-Apr;16(1):19-24.

7. Wang HY, Ding HJ, Chen JH, et al.

Meta-analysis of the diagnostic performance of [18F]FDG-PETand PET/CT in renal cell carcinoma. Cancer Imaging. 2012 Oct 26;12:464-74.

8. Namura K, Minamimoto R, Yao M, et al.

Impact of maximum standardized uptake value (SUVmax) evaluated by 18-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) on survival for patients with advanced renal cell carcinoma: a preliminary report. BMC Cancer. 2010 Dec 3;10:667.

9. Mueller-Lisse UG, Mueller-Lisse UL.

Imaging of advanced renal cell carcinoma. World J Urol. 2010 Jun;28(3):253-61.

10. Rodríguez Martínez de Llano S, Jiménez-Vicioso A, et al.

Clinical impact of (18)F-FDG PET in management of patients with renal cell carcinoma.

Rev Esp Med Nucl. 2010 Jan-Feb;29(1):12-9.

11. Staging of renal cell carcinoma.

Mueller-Lisse UG, Mueller-Lisse UL, Meindl T, et al. EurRadiol. 2007 Sep;17(9):2268-77.

12. Ak I, Can C.

F-18 FDG PET in detecting renal cell carcinoma. ActaRadiol. 2005 Dec;46(8):895-9.

 

Thymoma teaching, 胸腺腫 まとめ

Thymoma teaching, 胸腺腫 まとめ

*動画の題名が縦隔腫瘍になっていますが、実際は胸腺腫のまとめです。

問題を見ていない先生はこちら

縦隔解剖について確認はこちら

解答編 前篇はこちら

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Key words: Thymoma, 胸腺腫、anterior mediastinal tumor, 前縦隔腫瘍, WHO classification, WHO分類、Masaoka classification, 正岡分類、胸腺癌, thymic cancer, Diffusion weighted image, DWI, 拡散強調画像

まとめ:黒色は非浸潤性胸腺腫、赤色はより浸潤性、紫色はより癌を示唆

  • 大きい
  • 被膜(より完全)、隔壁
  • 境界明瞭、不明瞭
  • 分葉状、不整
  • 出血、壊死、嚢胞性変化
  • 石灰化
  • 不均一造影効果
  • 造影効果が高いか否か
  • T2WI上不均一
  • T2WI上腫瘍内の低信号
  • 胸膜播種
  • 縦隔脂肪浸潤
  • 大血管浸潤
  • LN腫大
  • 線維性隔壁:AB、B
  • MRIは被膜、隔壁、出血の検出でCTより優れる
  • ADC値はWHO分類、正岡分類と相関:ADC値低いとより悪性度高い

References:

1. Priola AM, Priola SM, Di Franco M, et al.Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence.

RadiolMed. 2010 Feb;115(1):1-21.

2. Tomiyama N, Müller NL, Ellis SJ, et al.

Invasive and noninvasive thymoma: distinctive CT features.

J Comput Assist Tomogr. 2001 May-Jun;25(3):388-93.

3. Jeong YJ, Lee KS, Kim J, et al.

Does CT of thymic epithelial tumors enable us to differentiate histologic subtypes and predict prognosis?

Am J Roentgenol. 2004 Aug;183(2):283-9.

4. Harris K, Elsayegh D, Azab B, et al.10.1186/1477-7819-9-95.

Thymoma calcification: is it clinically meaningful?

World J SurgOncol. 2011 Aug 23;9:95.

5. Hu YC, Wu L, Yan LF, et al.

Predicting subtypes of thymic epithelial tumors using CT: new perspective based on a comprehensive analysis of 216 patients.

Sci Rep. 2014 Nov 10;4:6984.

6. Sadohara J, Fujimoto K, Müller NL, et al.

Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas.

Eur J Radiol. 2006 Oct;60(1):70-9.

7. Inoue A, Tomiyama N, Fujimoto K, et al.

MR imaging of thymic epithelial tumors: correlation with World Health Organization classification.

Radiat Med.2006 Apr;24(3):171-81.

8. Han J, Lee KS, Yi CA, et al.

Thymic epithelial tumors classified according to a newly established WHO scheme: CT and MR findings.

Korean J Radiol. 2003 Jan-Mar;4(1):46-53.

Diffusion-weighted images in thymomas.

1. Abdel Razek AA, Khairy M Nada N.

Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging.

Radiology. 2014 Oct;273(1):268-75.

2. Priola AM, Priola SM, Giraudo MT, et al.

Chemical-shift and diffusion-weighted magnetic resonance imaging of thymus in myasthenia gravis: usefulness of quantitative assessment.

Invest Radiol. 2015 Apr;50(4):228-38

3. Seki S, Koyama H, Ohno Y, et al.

Diffusion-weighted MR imaging vs. multi-detector row CT: Direct comparison of capability for assessment of management needs for anterior mediastinal solitary tumors

Eur J Radiol. 2014 May;83(5):835-42.

4. Shin KE, Yi CA, Kim TS, et al.

Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT. EurRadiol. 2014 Mar;24(3):677-84.

EurRadiol. 2014 Mar;24(3):677-84.

62-year-old man with abnormal shadow in right lower lung field during follow up of brain infarction.

62才男性
脳梗塞フォロー中右下肺野に異常陰影指摘

まだ問題を見ていない先生はこちら

Case 1

62-year-old man with abnormal shadow in right lower lung fieldduring follow up of brain infarction.

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今回は解答編 バージョン1です。症例の解説が主体です。

解答編バージョン2で胸腺腫総まとめしています。

胸腺腫の総まとめビデオはこちら 10分余った時間で勉強してください。

Key words: Mediastinal tumor, Thymoma, thymoma, thymic tumor, 縦隔腫瘍、胸腺腫、胸腺腫瘍、WHO classification, WHO分類

Key images:

Case 1  62M Type A

Type A thymoma 62M Chest plain 1Type A thymoma 62M CT plain 1Type A thymoma 62M MRI 1Type A thymoma 62M MRI 2Type A thymoma 62M MRI 3Type A thymoma 62M MRI 4

Case 2  69MType B3 Thymoma 69M Chest plain1 Type B3 Thymoma 69M CT1Type B3 Thymoma 69M CT2Type B3 Thymoma 69M MRI1Type B3 Thymoma 69M MRI 2.6

胸腺腫: ADCとWHO分類との対比論文はこちら

1.

Abdel RazekAA, KhairyM Nada N.

Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology. 2014 Oct;273(1):268-75.

2.

Priola AM, Priola SM.

Usefulness of Diffusion-weighted MR Imaging in Predicting Masaoka-Koga Clinical Staging of Thymic Epithelial Tumors by Using the Apparent Diffusion Coefficient.  Radiology. 2015 Mar;274(3):936-7.

 

 

えっ大動脈の近傍は後縦隔じゃない?

縦隔解剖について確認しましょう!

iPad version はこちら

 

You tube version についてはこちら

Key words: 縦隔解剖、縦隔、縦隔上部、前縦隔、中縦隔、後縦隔、Superior portion of mediastinum, anterior mediastinum, middle mediastinum, posterior mediastinum

縦隔腫瘍の問題はこちら

その解答はこちら

解答 ②は3/30 アップ予定

39-year-old woman with dyspnea. answer verion.

39才女性の呼吸困難  解答編
左肺の無気肺

まだ、問題を見ていない先生はこちら

iPad version

You tube version

 

key word: カルチノイド、気管支カルチノイド、Bronchial carcinoid tumor, Neuroendocrine neoplasm

Reference:

Jeung MY, Gasser B, Gangi A, et al.

Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings.

Radiographics. 2002 Mar-Apr;22(2):351-65.

Meisinger QC, Klein JS, Butnor KJ, et al.
CT features of peripheral pulmonary carcinoid tumors.
AJR Am J Roentgenol.2011 Nov;197(5):
1073-80

Gomez A, Zalacain R, CabriadaV,e t al.
Bronchial carcinoid tumors. Analysis of 41 cases.
Rev
Clin Esp. 2004;204:202-5

Paillas W, Moro-Sibilot D, Lantuejoul S, et
carcinoid tumors: role of imaging for diagnosis and local staging.
J
Radiol. 2004 Oct;85(10 Pt 1):1711-9.

Zidi A, Douira W, Hantous-Zannad S, et al.
Imaging of bronchial carcinoid tumors: 20 cases.
Rev
PneumolClin. 2006 Dec;62(6 Pt 1):380-5. [Article in French]

Davini F, Gonfiotti A, Comin C, et al.
Typical and atypical carcinoid
tumours: 20-year experience with 89 patients.
J
CardiovascSurg (Torino).2009 Dec;50(6):807-11

Bueno Palomino A, ZureraTendero L, Espejo Herrero JJ, et al.
Multidetector computed tomography assessment of the degree of differentiation of bronchial carcinoid
Radiologia. 2013 Jul-Aug;55(4):323-30. [Article in Spanish]

Magid D, Siegelman SS, Eggleston JC, et al.
Pulmonary carcinoid tumors: CT assessment.
J
Comput Assist Tomogr. 1989 Mar-Apr;13(2):244-7.

ZwiebelBR, Austin JH, Grimes MM
Bronchial carcinoid tumors: assessment with CT of location and
intratumoral calcification in 31 patients.
Radiology. 1991 May;179(2):
483-6

Squerzanti A, Basteri V, Antinolfi G, et al.
Bronchial carcinoid tumors: clinical and radiological correlation.
Radiol Med. 2002 Oct;104(4):273-84. [Article in English, Italian]