Purpose:To evaluate the usefulness of the wash-in rate based on dynamic contrast-enhanced (DCE) MRI for the detection and localization of prostate cancer. Materials and Methods:In 53 patients, the wash-in rate was measured in the cancer area and in three normal areas (the peripheral zone, inner portion of the transitional zone, and outer portion of the transitional zone). On the basis of these data, parametric imaging was generated and then its accuracy for cancer detection and location was evaluated compared to that of T2-weighted imaging without the use of an endorectal coil. For that purpose the entire prostate was divided into 18 segments. Results:The wash-in rate value was greater in cancer tissue (9.2/second) than in three normal tissues (3.3/second, 6.7/second, and 3.2/second, respectively; P Ͻ 0.001). The sensitivity and specificity were greater on parametric imaging of the wash-in rate compared to T2-weighted imaging in the entire prostate (96% and 82% vs. 65% and 60%, respectively) and the peripheral zone (96% and 97% vs. 75% and 53%; P Ͻ 0.05). In the transitional zone, the sensitivity was greater on parametric imaging (96%) than on T2-weighted imaging (45%; P ϭ 0.016), but the specificity was similar (51% vs. 73%; P ϭ 0.102). Conclusion:The wash-in rate based on DCE-MRI is a useful parameter for prostate cancer detection and localization.

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Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.

Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.

Meckel's diverticulum is the most frequent congenital malformation of the gastrointestinal tract, occurring in 2% of the general population. Meckel's diverticulum is usually asymptomatic and found incidentally. However, the lifetime risk of complications is 4-40%. In this essay, we describe the clinical and imaging findings in 12 cases of Meckel's diverticula with complications over a 5-year period, which were confirmed pathologically. The major complications of Meckel's diverticulum include gastrointestinal bleeding, bowel obstruction, perforation and inflammation. Small bowel follow-through (SBFT), computed tomography (CT) including CT enterography and RI scintigraphy can be used to show typical imaging features of Meckel's diverticulum and its complications. Knowledge of the clinical and radiologic findings of Meckel's diverticulum can aid in the early and accurate diagnosis of this anomaly and its complications.

Virtual gastroscopy showed excellent results with a good interobserver reliability for the detection of EGC compared with 2D axial CT.

ObjectiveTo evaluate the safety and technical success rate of an ultrasound-guided fiducial marker implantation in preparation for CyberKnife radiation therapy.Materials and MethodsWe retrospectively reviewed 270 percutaneous ultrasound-guided fiducial marker implantations in 77 patients, which were performed from June 2008 through March 2011. Of 270 implantations, 104 were implanted in metastatic lymph nodes, 96 were in the liver, 39 were in the pancreas, and 31 were in the prostate. During and after the implantation, major and minor procedure-related complications were documented. We defined technical success as the implantation enabling adequate treatment planning and CT simulation.ResultsThe major and minor complication rates were 1% and 21%, respectively. One patient who had an implantation in the liver suffered severe abdominal pain, biloma, and pleural effusion, which were considered as major complication. Abdominal pain was the most common complication in 11 patients (14%). Among nine patients who had markers inserted in the prostate, one had transient hematuria for less than 24 hours, and the other experienced transient voiding difficulty. Of the 270 implantations, 261 were successful (97%). The reasons for unsuccessful implantations included migration of fiducial markers (five implantations, 2%) and failure to discriminate the fiducial markers (three implantations, 1%). Among the unsuccessful implantation cases, six patients required additional procedures (8%).ConclusionThe symptomatic complications following ultrasound-guided percutaneous implantation of fiducial markers are relatively low. However, careful consideration of the relatively higher rate of migration and discrimination failure is needed when performing ultrasound-guided percutaneous implantations of fiducial markers.

Although extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon, it can be found anywhere in the body. Most extrahepatic metastases of HCC occur in patients with advanced-stage intrahepatic tumor, but incidental extrahepatic lesions have also occasionally been found in patients with earlystage intrahepatic HCC. The detection of extrahepatic metastatic disease is crucial when planning therapy for patients with HCC and should be used to avoid unnecessary surgical intervention. In this study we illustrate the radiologic findings of ex-trahepatic metastases of HCC involving various sites. The presumed mechanism of extrahepatic extension of HCC is also discussed.