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BACKGROUND: Transcatheter arterial embolization (TAE) of the hepatic artery is a common treatment method for hepatocellular carcinoma (HCC), but it often induces gastric mucosal injury. We examined whether or not rebamipide administration, beginning 1 week before and ending 2 weeks afterTAE, can prevent worsening of gastric mucosal disorders. METHODS: The subjects were 73 chronic hepatitis C or type C liver cirrhosis patients who concomitantly had HCC and received TAE in our hospital. The patients were randomly allocated to the rebamipide group (oral, 300 mg/day for 3 weeks starting 1 week before TAE) or the non-rebamipide group. Gastric endoscopy was performed 1 week before and 2 weeks afterTAE and the presence of erythema, erosion and/or submucosal haemorrhagic spots was monitored. Based on the findings, gastric mucosal disorder before and after TAE was quantitatively evaluated using the modified Lanza score (MLS). RESULTS: Overall, MLS after TAE increased significantly (P< 0.05). However, in the rebamipide group, MLS did not change. The MLS after TAE increased significantly in patients who had either liver cirrhosis, oesophageal varices or gastropathy (P< 0.01 or < 0.05). In the non-rebamipide group, a significant increase in MLS after TAE was observed in patients who had one of the above-mentioned three diseases (P< 0.01 or < 0.05). CONCLUSIONS: Gastric lesions which were present before TAE were significantly worsened after TAE. Rebamipide administration prevents TAE-induced aggravation of gastric lesions.

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OBJECTIVE: Our goal was to elucidate the CT and MRI findings of inflammatory pseudotumors of the spleen. METHODS: The CT and MRI findings of three patients with inflammatory pseudotumors of the spleen were reviewed and compared with the pathologic findings. RESULTS: On the early phase of CT, the masses were hypodense to the normal spleen, and on the delayed phase, they demonstrated delayed enhancement. On T1-weighted MR images, the masses were isointense to the normal spleen, and on T2-weighted images, the masses had heterogeneous low signal intensities. After administration of Gd-DTPA, the masses showed delayed enhancement. CONCLUSION: Inflammatory pseudotumors of the spleen were characterized by low signal intensity on T2-weighted MR images and delayed enhancement after contrast material administration on CT and MRI. The fibrous stroma may contribute to these unusual findings.

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Percutaneous transcatheter embolization of the testicular vein was performed on 28 patients with angiographically proven varicocele testis. In 2 patients bilateral and in 26 only the left vein was embolized using 3-, 5-, or 8-mm stainless steel coils. All patients had clinically palpable varicoceles and male infertility. The grade of varicoceles improved after embolization in 23 of 28 cases (82%). Effective sperm count increased significantly from 34.5 +/- 44.6 to 65.1 +/- 71.0 following embolization. However, pregnancy was achieved only in one of 28 cases. Technically, the basilic vein approach was felt to be superior to the femoral vein or jugular vein approach for this procedure.

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Two cases of massive gastrointestinal haemorrhage caused by arterioenteric fistulae are presented. In both cases, bleeding was controlled by interventional angiography. In the first case, a fistula between an aberrant right subclavian artery and a reconstructed oesophagus was temporarily occluded with a balloon catheter as a pre-surgical measure. In the second case a communication between the external iliac artery and the colon in a patient with invasive cervical cancer was treated by embolization. An arterioenteric fistula should be considered as a possible cause of acute gastrointestinal haemorrhage in post-operative or cancer patients and aortography or pelvic arteriography may be required to make the diagnosis.

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Magnetic resonance imaging in a 54-year-old Japanese man showed a huge low-intensity abdominal mass on T1 WI and a high-intensity tumoral structure with low-intensity bundles on T2 WI. The histologic diagnosis was intra-abdominal mesenteric fibromatosis. As the levels of tissue estrogen and progesterone receptors were not elevated (both less than 5 FMOL/mg), tamoxifen treatment was not indicated.

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Clinical charts, radiologic features, macroscopic and microscopic findings, and clinical follow-up data in seven patients with serous cystadenoma of the pancreas (SCAP) were retrospectively reviewed. The seven patients with SCAP consisted of six women and one man, and their ages ranged from 52 to 76 years with a mean age of 64.9. The most common symptoms were abdominal mass or pain. The greatest diameter of the seven tumors ranged from 2cm to 10cm with a mean diameter of 6.6cm. On ultrasonograms and/or computed tomograms, the tumors were visualized as lobulated masses containing numerous small cysts. Three tumors angiographically examined were all characteristic hypervascular masses with neovascularity. Macroscopically, the tumors were well-defined lobulated masses containing many cysts with a central scar. Microscopically the cysts were lined with a layer of cuboidal epithelium with centrally placed round nuclei and clear cytoplasms containing abundant glycogen. One patient had undergone a cystojejunostomy five years before the complete resection and the tumor increased in size necessitating a pancreatoduodenectomy. The seven patients with SCAP were doing well without any signs of local recurrence or distant metastasis during the period from 2 months to 120 months after a complete resection. Despite its enormous size at the time of diagnosis, SCAP should be resected with aggressive intent because the complete resection produces a favorable clinical course.

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Clinical charts, radiological features, macroscopic and microscopic findings, and clinical follow-up data were retrospectively reviewed in 11 patients with papillary cystic neoplasm of the pancreas (PCNP). The patients were nine women and two men, aged from 13 to 51 years with a mean age of 25 years. The greatest diameter of the PCNPs ranged from 2.5 cm to 14.0 cm with a mean size of 7.5 cm. Six tumours were located in the tail of the pancreas, two in the body and three in the head. Most patients complained of abdominal pain or a mass. Ultrasonographic and/or computed tomography findings showed five solid, four mixed (solid and cystic) and two cystic types of tumour. Angiographically, PCNP was either a hypovascular or mild hypervascular mass with a displacement of the surrounding vessels. No vascular encasement was seen. Macroscopically all 11 tumours consisted of a well defined solid mass with degenerative change of various widths, including haemorrhage, necrosis or dystrophic calcification, and were represented by three radiological types of PCNP. The 11 patients with PCNP survived for from 3 to 253 months after curative resection without any signs of local recurrence or remote metastasis. PCNP usually affects the distal portion of the pancreas of young women. Despite its huge size, PCNP should be explored with aggressive surgical intent because of the inherently good prognosis.

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The results of diagnostic imaging procedures, macroscopic and microscopic findings and clinical follow up data of 20 mucinous cystic neoplasms of the pancreas were retrospectively reviewed to determine the grade of malignancy and its surgical implications. The largest mean diameter was 8.9 cm for 10 malignant cases, 5.0 cm for two premalignant cases, and 3.1 cm for eight benign tumours. Ultrasonography or computed tomography or both, corresponded well with macroscopy. The 10 malignant and two premalignant lesions had intracystic mural nodules or extracystic solid components, while the eight benign specimens had neither nodules nor solid portions. Structural complexity seen on ultrasonography or computed tomography, which reflected the irregularity in size and shape of the cysts, internal septa, walls, and solid components, was severe in the 10 malignant and two borderline tumours and mild or moderate in the eight benign lesions. Angiography showed that five of the nine malignant tumours were hypervascular, while the two premalignant and four benign lesions were all avascular. Five of 10 patients with malignant tumours died of local recurrence or remote hematogenous metastases, and one with malignant disease was still alive with liver metastases at the time of writing. We propose that a careful preoperative estimate of the malignant potential of such cysts should be made based on the size of the tumour, the presence of mural nodules and solid areas, and the structural complexity on ultrasonography or computed tomography, as well as the amount of vascularity seen on angiography. Attention should be paid at follow up to the presence of local recurrence and haematogenous metastases in cases of malignant disease.

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Three patients with Tolosa-Hunt syndrome (THS) were examined using computed tomography (CT), orbital venography and magnetic resonance imaging (MRI). CT of the brain showed no definite abnormality in two patients, right optic nerve enlargement and an abnormal area around the orbital apex in one patient. Orbital venography showed an occlusion of the superior ophthalmic vein in one of three patients. MRI showed an abnormal soft tissue area in the cavernous sinus, with intermediate to high signal intensity on T1- or intermediate weighted images. There was clinical improvement following corticosteroid therapy and the abnormal soft tissue on MRI decreased in volume and in signal intensity, although this was equivocal in one patient. Thus MRI proved to be useful in demonstrating lesions in the cavernous sinus in patients with THS.

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Magnetic resonance (MR) imaging performed in 13 patients with moyamoya disease was reviewed and compared with computed tomography (CT) and angiography. The MR findings consisted of occlusion of arteries, collateral vessels and parenchymal changes. Narrowing or occlusion of the middle cerebral artery and the supraclinoid portion of the internal carotid artery were seen in all hemispheres but one. Collateral vessels, cerebral infarcts and atrophy with dilatation of the ventricles were observed on MR imaging. In general, the MR findings correlated well with angiography regarding occlusive changes and moyamoya vessels but was less sensitive in a few cases. Because of its higher sensitivity in detecting occlusive changes and collateral vessels, MR imaging was superior to CT in the diagnosis of this disease.

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Magnetic resonance (MR) images of 13 intracranial mass lesions taken with the intravenous administration of gadolinium-DTPA were evaluated in comparison with precontrast computed tomography (CT), postcontrast CT, and precontrast MR. In the MR images taken with Gd-DTPA, tumor delineation improved in eight of 13 cases (62%) in comparison with precontrast MR images, and in seven of 13 cases (54%) in comparison with the overall evaluation of precontrast CT, postcontrast CT, and precontrast MR images. Tumor demarcation was unchanged in the remaining cases; no deterioration was observed with Gd-DTPA administration. MR imaging with Gd-DTPA should be performed to better evaluate the extent of intracranial mass lesions and to provide additional information.

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Four cases of jugular foramen neurinoma, extending from the posterior fossa into the temporal bone through the jugular foramen, are reported. The information provided by magnetic resonance imaging was compared with that by computed tomography. Due to the excellent sensitivity, the absence of bone artifacts, and the ease of imaging in any plane, magnetic resonance imaging gave better information particularly about the location of the tumour than X-CT scan did. It included the dumb-bell shaped tumour through the jugular foramen, the extra-axial nature of the tumour, and the precise anatomical relationships between the tumour and the facial and acoustic nerves or the internal carotid artery. Sagittal and coronal views clearly demonstrated the superior and inferior margins of the tumour. The information is very useful not only for preoperative diagnosis but also for planning the surgical approaches and postoperative follow-up.

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