Background: Thymoma exhibits a range of histological and biological features and their imaging findings varies. Purpose: To evaluate the associations between CT findings of thymomas and their classification according to the Masaoka staging system and World Health Organization (WHO) classification. Material and Methods: Eighty-four patients with thymoma were evaluated. Comparisons between the CT findings of Masaoka stage I/II and III/IV lesions, and the WHO type A-B1 (low risk) and B2/B3 (high risk) lesions were performed. Results: Stage III/IV thymomas (mean size, 60 mm) were significantly larger than stage I/II (45 mm) lesions and had more irregular shape and contour. Necrosis and calcification were observed in 16 (59%) and nine (33%) stage III/IV thymomas, and 16 (28%) and seven (12%) stage I/II lesions, respectively. Regarding the WHO classification, the high-risk thymomas displayed irregular shape and contour more often than low-risk lesions. There were significant differences between the patterns of mediastinal invasion seen in high- and low-risk groups; 21 (68%) vs. six (12%) lesions demonstrated mediastinal fat invasion, seven (23%) vs. two (4%) lesions exhibited great vessel invasion, five (16%) vs. 0 (0%) lesions displayed pericardial invasion, and 18 (58%) vs. 10 (20%) lesions invaded the lungs, respectively. Conclusion: Masaoka stage III/IV thymomas were larger in size, had more irregular shape and contour, and exhibited necrosis and calcification more often than the stage I/II lesions. In the WHO classification, high-risk thymomas demonstrated more irregular shape and contour than low-risk thymomas.

To evaluate the depictability of pericardiacophrenic veins (PCPV) as landmarks for the location of the phrenic nerves on multi-detector-row computed tomography (MDCT), and to investigate the usefulness of depicting the PCPV to aid differential diagnosis of anterior mediastinal lesions. Fifty-six patients with anterior mediastinal lesions (Fifty lesions originated from the thymus, six were of non-thymic origin) were evaluated. Contrast-enhanced CT scans of the chest were performed in all cases before diagnosis, and 22 of these scans were performed with electrocardiographic (ECG) gating. Two chest radiologists assessed the depictability of the PCPV and the positional relationship between the center of each anterior mediastinal lesion and the ipsilateral PCPV. The use of ECG gating increased the PCPV depiction rate in the lower left part of the mediastinum. The depiction rate of the left PCPV was significantly higher than that of the right PCPV. All 50 tumors of thymic origin and 3 of the 6 tumors of non-thymic origin were located on the medial side of the ipsilateral PCPV. The 3 lesions located on the lateral side of the ipsilateral PCPV were of non-thymic origin (p = 0.0007). The use of ECG gating during MDCT may improve the depictability of the PCPV in the lower left section of the anterior mediastinum. Solitary anterior mediastinal lesions located on the lateral side of the ipsilateral PCPV are likely to be of non-thymic origin.

Objective:The application of bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for haemoptysis was recently reported to be useful. A triple co-axial (triaxial) system consisting of a 4-Fr catheter, 2.7-Fr microcatheter and 1.9-Fr no-taper microcatheter has been developed. The aim of the present study was to evaluate the usefulness of the triaxial system in BAE using NBCA.Methods:12 patients with haemoptysis, 8 males and 4 females with a median age of 64 years (range, 49–88 years), underwent BAE between August 2012 and October 2014. Medical records and images were reviewed, and the technical success rate, clinical success rate, haemoptysis-free rate and complications were evaluated. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography, whereas clinical success was defined as the cessation of haemoptysis within 24 h of BAE. Recurrent haemoptysis was defined as a total of >30 ml of bleeding per day.Results:The targ...

Laparoscopic transverse colectomy is challenging due to the technical difficulties in identifying an adequate dissection plane, ligating, and dissecting lymph nodes around the middle colic vessels. One of the reasons for the technical difficulties is the complex relationship between the middle colic vein (MCV) and its tributary. So, defining the venous anatomy around the MCV before laparoscopic surgery seems important to avoid massive bleeding. The purpose of this study was to evaluate the depiction rate and variation of the MCV and its tributaries on three-dimensional computed tomography angiography (3DCTA). This study included 331 patients (203 men and 128 women) scheduled for laparoscopic surgery between June 2010 and April 2012. Most of the patients had gastric or colorectal cancer. Patients who needed emergency surgeries for obstruction or perforation were excluded. 3DCTA with an intravenous contrast medium was performed immediately following administration of effervescent granules or room-air insufflation. We assessed variations of the MCV tributaries using trans-axial, multi-planer reconstructed images and volume-rendering images. The MCV could be identified in all patients. The MCVs drained into the superior mesenteric vein in 62.5% of patients, gastrocolic trunk of Henle in 29.3%, inferior mesenteric vein in 4.8%, splenic vein in 2.7%, and jejunal vein in 0.6%. 3DCTA is useful to evaluate anatomic variants of the MCV in preoperative planning for laparoscopic surgery. Use of 3DCTA for recognition of the anatomic complexity around the MCV and its tributary plays an important role in preoperative planning for optimal patient outcome.

To evaluate the frequency of insufficient contrast enhancement of the pulmonary artery (PA) during chest computed tomography (CT) and its improvement by an increased injection rate. Two hundred and eighty-eight (group A) and 278 (group B) consecutive patients underwent chest CT with the administration of 100 mL of a 300-mgI/mL nonionized contrast material through the antecubital vein using a power injector. The flow rate was 2 mL/s in group A and 3 mL/s in group B, and 50 mL saline was administered simultaneously using a dual injector. The scan delay was 30 s in both groups. The CT numbers in the pulmonary trunk, bilateral main PA, left atrium, and ascending and descending aortas were measured. Insufficient enhancement of the PA was defined as a CT number of the pulmonary trunk ≤180 HU. Insufficient enhancement of the PA was observed in 21 of 288 patients (7.3%) in group A, whereas it was seen in only 9 of 278 patients (3.2%) in group B (P=0.038). The use of a flow rate of 3 mL/s is associated with a significantly lower frequency of insufficient contrast enhancement of the PA, compared with the use of a lower flow rate of 2 mL/s with the same total volume of contrast.

Since the Radiology Diagnostic Oncology Group (RDOG) report had been published in 1991, magnetic resonance (MR) imaging had limited clinical availability for thoracic malignancy, as well as pulmonary diseases. However, technical advancements in MR systems, such as sequence and reconstruction methods, and adjustments in the clinical protocol for gadolinium contrast media administration have provided fruitful results and validated the utility of MR imaging (MRI) for lung cancer evaluations. These techniques include: (1) contrast-enhanced MR angiography for T-factor evaluation, (2) short-time inversion recovery turbo spin-echo sequences as well as diffusion-weighted imaging (DWI) for N-factor assessment, and (3) whole-body MRI with and without DWI and with positron emission tomography fused with MRI for M-factor or TNM stage evaluation as well as for postoperative recurrence assessment of lung cancer or other thoracic tumors using 1.5 tesla (T) or 3T systems. According to these fruitful results, the Fleischner Society has changed its position to approve of MRI for lung or thoracic diseases. The purpose of this review is to analyze recent advances in lung MRI with a particular focus on lung cancer evaluation, clinical staging, and recurrence assessment evaluation.