Objective: We investigated the characteristic findings of regenerative nodules (RNs) for differentiating early hepatocellular carcinoma (HCC) from high-grade dysplastic nodules (HGDNs) using magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA, EOB-MRI) and contrast enhanced ultrasonography (CEUS) in patients with chronic liver disease. Subjects and methods: Pathologically confirmed lesions (100 early HCCs, 7 HGDNs, and 20 RNs with a maximum diameter of more than 1 cm and mean maximal diameters of 15.5, 15.1, and 14.8 mm, respectively) were enrolled in this retrospective study. The signal intensities of these lesions during the hepatobiliary phase of EOB-MRI were investigated, and findings characteristic of RNs using this modality were also evaluated using CEUS. Results: Ninety-eight of the 100 early HCCs that were hypo-intense (n＝95), iso-intense (n＝2), or hyper-intense (n＝1) and the seven HGDNs that were hypo-intense (n＝6) or hyper-intense (n＝1) during the hepatobiliary phase of EOB-MRI exhibited centripetal vessels during the arterial dominant phase of CEUS, although one early HCC that was hypo-intense exhibited both centrifugal and centripetal vessels. Eighteen of the 20 RNs and one early HCC that were hyper-intense with a small central hypo-intensity and the remaining two RNs that were hyper-intense on EOB-MRI exhibited centrifugal vessels during the arterial dominant phase of CEUS. The small central hypo-intense area corresponded to central vascular structures in the lesion, such as the hepatic artery and portal vein running from the center to the periphery, when viewed using CEUS. Conclusion: Central vascular structures may be a characteristic finding of RNs when observed during the hepatobiliary phase of EOB-MRI and the arterial dominant phase of CEUS.

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Purpose: The authors had the impression that the vaginal wall was thickened in patients with pelvic organ prolapse or stress urinary incontinence on abdominal ultrasonography. Therefore, we tried to measure the thickness of the vaginal wall by transabdominal ultrasonography in urological outpatients with or without pelvic organ prolapse or stress urinary incontinence. Subjects and Methods: Among female patients who visited our urology outpatient clinics, patients whose anterior and posterior vaginal wall thickness (vaginal thickness) could be retrospectively measured from median longitudinal section photogram of transabdominal ultrasonography in the supine position were included in the study. Overactive bladder patients and patients with cystitis were assigned to the control group, and the relationship between vaginal thickness and age was compared. Vaginal thickness was also compared among the control group, the pelvic organ prolapse group, and the stress urinary incontinence group. Results: There were 178 cases in the control group, with an age of 64.6±18.4 years (mean±standard deviation) and mean vaginal thickness of 9.2±2.7 mm. There was no relation between age and vaginal thickness. There were 76 cases (65.1±9.2 years old) in the pelvic organ prolapse group, and their mean vaginal thickness (14.7±4.4 mm) was significantly higher than that of the control group. Three months after surgery using a mesh sheet for pelvic organ prolapse, the mean vaginal thickness decreased. There were 12 cases (65.1±12.0 years old) in the stress urinary incontinence group, and their mean vaginal thickness (14.7±4.4 mm) was significantly higher than that of the control group, but it did not differ before and 3 months after surgery using mesh tape. Conclusion: Vaginal thickening indicates loading in the vagina, suggesting that there is pelvic organ prolapse or stress urinary incontinence, which may be useful for diagnosis of these diseases.

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Although an ectopic intrathoracic kidney can be complicated by congenital diaphragmatic hernia (CDH), prenatal diagnosis of this condition is rare. We report a rare case of prenatally diagnosed ectopic intrathoracic kidney with CDH presenting as fetal mesocardia. A 32-year-old gravida 1, para 0 showed fetal mesocardia on ultrasonographic screening performed at 18 weeks’ gestation. No additional ultrasonographic anomalies were identified at the time. Detailed examination using magnetic resonance imaging at 30 weeks’ gestation showed that the fetal right kidney and a part of the liver were intrathoracic in location, and we diagnosed right CDH. She underwent cesarean section at 37 weeks’ gestation and delivered a female infant weighing 2,812 g with Apgar scores of 5-7. The infant was intubated immediately after birth, and mechanical ventilation was initiated. Although mild pulmonary hypertension was observed, her cardiorespiratory status stabilized smoothly. Computed tomography confirmed the diagnosis of right CDH, and we performed surgical repair on day 2 of birth. The posterior segment of the hepatic lobe and the right kidney were herniated through a right diaphragmatic defect and were covered by a hernia sac. The right kidney was located retroperitoneally and could not be replaced under the diaphragm. We diagnosed right CDH and concomitant ectopic intrathoracic kidney. We performed plication of the hernia sac with the transversus abdominis and Gerota’s fascia. In this case, fetal mesocardia led to the prenatal diagnosis. Our case suggests that CDH can cause an ipsilateral mediastinal shift by complication with ectopic intrathoracic kidney.

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Complicated cysts are frequently seen in US findings. We experienced a woman in her 40s with a left breast mass with an atypical B-mode image with score 4 on elastography (according to the Tsukuba elasticity score). Core needle biopsy (CNB) and US-guided vacuum-assisted biopsy (US-VAB) were performed, and the mass turned out to be a complicated cyst, not cancer. A malignancy was suspected on B-mode. A surrounding slight color Doppler signal was detected. The elasticity score was 4, and the fat-lesion-ratio (FLR) was 17.2. The mass was evaluated as category 5 (The Japan Association of Breast and Thyroid Sonology categorization¹⁾). The pathology of the lesion was consistent with complicated cyst. Follow-up US about 1 year later detected no abnormality. Elastography is useful for differentiation of benign from malignant breast masses. In that case, an elasticity false-positive finding may support malignancy. It is important to be aware of the possibility of false-positive cases determined to be on the malignant side on elastography when diagnosing complicated cysts.

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It has been reported that contrast-enhanced ultrasonography (CEUS) can detect minute blood flows in breast tumors. As such, CEUS is a useful modality for diagnosing breast tumors. Although there are some CEUS studies of breast cancer in the literature, there are few reports of mucinous carcinoma of the breast. Between October 2014 and December 2016, we retrospectively enrolled four mucinous breast cancer patients who underwent CEUS examinations in this study. We used a LOGIQ E9 (GE Healthcare) with a ML6-15-D linear transducer. We acquired CEUS images for about 1 minute after intravenous injection of Sonazoid (0.015 ml/kg). Pathological findings in three cases revealed mixed types of mucinous carcinoma, and one case had a pure type. The mixed-type mucinous carcinomas showed ring-like enhancement or heterogeneous enhancement. And the pure-type mucinous carcinoma exhibited no apparent enhancement. The results in this study implied that CEUS findings of mixed-type mucinous carcinomas were different from those of pure-type ones. We conjectured that the contrast-enhanced appearance of mucinous breast carcinomas was dependent on the volume of invasive components.

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