We set out to retrospectively review the clinical and imaging features of patients with post-radiation sarcoma, especially in the head and neck region. We reviewed the records of 4194 patients with carcinoma of the head and neck region who had a history of radiation. They had undergone CT and/or MRI. Medical records were reviewed for the primary diagnosis, radiation history and latency period to the development of sarcoma. The patients included four men and two women with a mean age of 64.5 years. The mean latency period for the development of sarcoma was 11.5 years. Primary diagnoses were maxillary carcinoma, nasopharyngeal carcinoma, adenoid cystic carcinoma of the oral floor, tonsilar carcinoma, soft palate carcinoma and tongue carcinoma. Histopathological examinations revealed osteosarcoma, spindle cell sarcoma, chondrosarcoma, malignant peripheral nerve sheath tumour, spindle cell carcinoma and malignant fibrous histiocytoma, respectively. Common findings were a heterogeneous and well-enhanced soft tissue mass and bone destruction. There is at present little or no prospect for the effective prevention of radiation-induced sarcoma of the head and neck. This emphasizes the importance of the earliest possible diagnosis for such patients. The imaging findings are not diagnosis specific, but strict follow-up within the radiation field by CT and MRI and an appreciation of the expected latency period may help to provide the diagnosis. When radiotherapy is performed for head and neck neoplasms, periodic follow-up observations may be necessary for many years.

Purpose: To evaluate diffusion-weighted magnetic resonance (DW) imaging as an adjunct to mammography for the detection of small invasive breast cancer. Materials and Methods:Institutional review board standards were followed for this retrospective study. We performed both breast DW imaging and mammography on 25 women under 50 years of age with pathologically proven T1 breast cancer and on 21 healthy women under 50 years of age. Four offsite radiologists blind to the clinical information independently interpreted the mammograms and DW images and then classified their confidence level regarding the presence of breast cancer. The composite area under receiver operating characteristic curve (AUC), of mammography alone, DW imaging alone, and the combination of DW imaging and mammography (DWI/Cal) were calculated.Results: The AUC of composite ROC curves of mammography, DW imaging, DWI/Cal combination, was 0.79 (95% CI, 0.86 (95% CI,, and 0.96 (95% CI, 0.92-1.00), respectively.Conclusion: DW imaging may be a useful adjunct to mammography in the detection of small invasive breast cancer in women under 50 years of age.

Lymph nodes may occasionally become apparent in the free jejunal flap. There was no suggestion of metastatic lymph nodes when examined retrospectively. We speculate that this reaction was the result of environmental changes attributable to surgery.

BACKGROUND: Breast conserving therapy is being established as a standard therapeutic procedure for early breast cancer in Japan. However, the indications of radiotherapy and a standardized therapeutic procedure have not been established yet. In this study, complications following radiotherapy were evaluated in patients who had previously undergone breast conserving therapy at Tokushima University Hospital. METHODS From October 1989 to March 1996, 60 women with stage I or II breast cancer underwent radiation therapy after breast conserving surgery, and all patients were followed-up for a median of 27 months. Radiation morbidity scoring of the breast and adjacent organs was performed using the toxity criteria of the Radiation Therapy Oncology Group (RTOG) and European Organization for Research andTreatment of Cancer (EORTC). RESULTS: Only 1 patient developed local recurrence, and no distant metastasisor death was observed. The cause of recurrence in 1 case was considered to be due to extended intraductal component. Although transient dermal reaction was induced by irradiation of the breast, no side effects that may cause cosmetic problems were found. No serious radiation complications were found in the lungs, ribs, heart or other adjacent organs. CONCLUSION: The adverse reactions caused by irradiation does not reduce the merit of combined use of radiation therapy in breast conserving therapy, and therefore, are not the hesitation factor in application of radiotherapy.

A N X-RAY ROTATIONAL projection system (SF-VA100, Hitachi Medical Co., Tokyo, Japan) provides three dimensional reconstructed images with minimal 0.8 millimeter spatial resolution in each direction. In this system, a cone-beam X-ray unit with an image intensifier, which is placed 180 degree opposite to X-ray tube, rotates around the patient at a speed of 4.8 seconds per one rotation. The advantage of this system is higher spatial resolution in the direction of the body axis comparing with the helical CT scan. Instant volume scan at one rotation, with twenty centimeter field of view, could reduce both total scanning time and X-ray exposure. On the other hand, slow rotation time as compared with the conventional CT scan may be one of the causes of motion artifacts, and inferior image quality in radiographic contrast limits its use to structures with high radiographic contrast, such as angiography, lung fields, or bony structures. As far as we know, there is no report of applications of this system to the lung fields and bony structures, although almost all previous studies reported the 3-D angiography by using this system.l-' We evaluated the feasibility of this system for the clinical use. MATERIALS AND METHODSWe evaluated this system on three different clinical fields as follows. First, demonstration of the pulmonary lesions for the surgical or interventional approach and evaluation of radiotherapeutic effect. Second, demonstration of bony structures with skull base or sellar lesions for the neurosurgical approach. Third, demonstration of vertebral structures comparing with conventional X-ray tomography. RESULTSIn the pulmonary lesions, the multiplanar reconstruction (MPR) method made it possible to choose any view directions, such as a plane along the vessels from the pulmonary hilum to the lesion. In primary lung cancers, the involved vessels were easily identified by confirming the continuity from the hilum, which is occasionally difficult on axial CT images. In an arteriovenous malformation, a feeding artery and a draining vein were clearly demonstrated and gave great information for preembolization planning (Fig 1). Comparing of the pre-and post-radiation images of lung cancer was useful for the evaluation of therapeutic effect because exact measurement of the tumor size in any direction, especially in the direction of body axis, was possible. Peripheral pulmonary lesions were demonstrated clearly with breath holding, but central lesions were tend to be suboptimal in appearance due to motion artifacts caused by the cardiac cycle.In the skull base and sellar lesions, the reconstructed images corresponding to the magnetic resonance images were useful for the evaluation of tumor extension. Intracranial invasion of the head and neck tumors through the skull base with bone destruction were demonstrated in any direction. Sagittal images were excellent for the demonstration of pterygopalatine fossa and communicating pathways such as Vidian canal, foramen rotundum, superior orbital fissure and so on (Fig 2) and use...