Cardiovascular imaging can be divided into 2 groups: non-invasive imaging, such as echocardiography, multi-slice CT, and MRI, and invasive imaging, such as coronary angiography (CAG), intravascular ultrasound (IVUS), coronary angioscopy and optical coherence tomography (OCT). Although CAG has been widely used to diagnose ischemic heart disease, there are limitations to its utility, because CAG reveals only the lumen of coronary arteries. IVUS directly visualizes three-dimensional coronary vessels and precisely measures the plaque area, lumen area, and vessel area, as well as plaque volume, lumen volume and vessel volume. Recently, novel IVUS images have been generated using radiofrequency analysis of ultrasound signals to evaluate the tissue characteristics of the plaque components. Coronary angioscopy is another method to visualize plaque surface and evaluate yellow plaques and various kinds of thrombi. There are numerous yellow plaques in addition to culprit lesion in patients with previous myocardial infarction, and these findings are helpful in the management of coronary risk factors. This modality is also useful to evaluate neointimal coverage after stent implantation, because neointimal coverage after application of a drug-eluting stent is usually delayed compared to that with a bare metal stent. OCT provides very high-resolution images. Because the axial resolution is 10 μm, OCT is able to measure the precise thickness of the fibrous cap above the lipid core within the plaque. The information obtained based on the findings of these images is very useful to applying optimal antiplatelet therapy to patients after stent implantation as secondary prevention during long-term statin treatment.

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For the diagnostic imaging of lung cancer, chest X-rays and chest CT were used historically. Recently, high-resolution Multi Detector-row CT (MDCT) including helical CT that can be rebuilt in Multi Planar Reconstoruction (MPR) has become useful for diagnosis. PET or PET /CT has also been used for the determination of lung cancer disease stage. However, the imaging abilities of both CT and PET have their limitations. Therefore, we examined the recent diagnostic imaging and treatment results in lung cancer cases that exhibited negative PET findings. As a result, follow-up of lung tumor patients must focus on false-negative PET/CT findings. Depending on each case, we must conduct radical operation within an appropriate timeframe after thoracoscopic lung biopsy.

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The authors have demonstrated three-dimensional computed tomography imaging of soft tissues, such as the labrum and the anterior inferior glenohumeral ligament (AIGHL). We have called this imaging method 3DCT shoulder virtual arthroscopy (3DCTSVA). The aim of this study was to investigate whether 3DCTSVA can be used to visualize the internal architecture of anterior shoulder instability in comparison to surgical arthroscopy. This study involved twentytwo patients. There were 17 males and 5 females, with a mean age of 23.8 years. All patients had suspected anterior shoulder instability, as determined by patient history and physical examination, and underwent 3DCTSVA before arthroscopy. Each of the joints was injected with 20 cc air, and was then scanned immediately with a helical CT (Toshiba helical CT Aquilion slice thickness: 1 mm, slice pitch: 0.5 mm, WL: 40, WW: 250). The data obtained was entered into a workstation, and commercially available software was used to create a three-dimensional simulation of a lesion in the shoulder. Reconstruction images were then obtained. The findings of 3DCTSVA were compared with arthroscopy findings. In all 22 cases, Bankart lesion was correctly identified on 3DCTSVA. In 20 of 22 cases, AIGHL was correctly identified. In 20 of 22 cases, middle glenohumeral ligament (MGHL) was correctly identified. The sensitivity, specificity and accuracy predictive values for Bankart lesion were 100%, 100% and 100%, respectively. The sensitivity, specificity and accuracy for AIGHL were 100%, 77% and 90%. The sensitivity, specificity and accuracy for MGHL were 100%, 84% and 90%, respectively. 3DCTSVA offers fine images of the anterior labrum capsule complex of the shoulder with Bankart lesion, AIGHL and MGHL. The use of 3DCTSVA will enable us to determine the state of an anterior lesion of the shoulder before actually performing arthroscopy. 3DCTSVA is a promising method for detecting the sources of derangement of the shoulder.

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The diagnosis of prostate cancer has increased with the widespread utilization of prostate specific antigen (PSA) screening. Imaging diagnosis is important in prostate cancer for making treatment decisions. Tumor staging directly affects treatment decision when curative treatment, such as radical prostatectomy, is an option. The tumor lesions in most prostate cancer cases are not feasible to detect on computed tomography (CT) scan. However, over the last decade imaging technologies have developed in many medical fields, in addition to urology, and imaging diagnostic equipment such as transrectal ultrasound (TRUS) power Doppler and contrast-enhanced, and magnetic resonance imaging (MRI) involving diffusion-weighted MRI and proton magnetic resonance spectroscopy, have shown promise for improving the detection and characterization of prostate cancer. This paper describes the recent improvements and future perspectives of prostate cancer imaging diagnosis with TRUS and MRI.

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Three decades ago, X-ray was the main procedure for imaging diagnosis. However, it was difficult to diagnose spinal disorders based on X-ray alone because it could not obtain sufficient information from the surrounding bony spinal column. With the advent of magnetic resonance imaging (MRI) and computed tomography (CT), the diagnostic accuracy of spinal disorders has improved significantly regarding their localization and pathological conditions. In this paper, we review the progress in the diagnostic imaging and describe the future prospects. MRI provides a morphological diagnosis based on a range of more invasive to less-invasive techniques, and the production of two-dimensional to three-dimensional images. For example, MR myelography is comparable or superior to conventional myelography and MR cisternography clearly demonstrates the nerves and roots in the spinal canal. In addition, multi-row detector CT (MDCT) systems provide details of bone and soft tissue with multiplanar reconstruction. CT myelography together with MDCT significantly improves image quality and has an advantage for dynamic investigation. CT angiography with 3D reconstruction depicts cervical vascular information. In the near future, functional and metabolic imaging will play an important role in the diagnosis of spinal cord disorders. Duc to the large volume of data obtained with MDCT, it will be necessary to organize the systems for the management of data. To take advantage of these data, it is important to learn about the precise anatomy of the spinal lesion and pathological conditions.

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Multiple modalities, such as X-ray, ultrasound, computed tomography, magnetic resonance imaging, angiography, endoscopy, are used for diagnostic imaging of the abdomen. Recent advances and advantages in imaging technology make these techniques more reliable for diagnosis. This article discusses imaging techniques and the clinical efficacy of abdominal diagnostic imaging.

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We describe the recent use of Optical Coherence Tomography (OCT) for ocular fundus imaging diagnoses. OCT is a device for imaging the ocular fundus which previously could only be obtained non-invasively, as planar, sectional images similar to tissue slices observed under a light microscope. OCT is similar to ultrasonographic devices, except for the fact that low-interference waves at a near-infrared wavelength are used as to image the tissue, instead of ultrasound wave forms. Since its initial development, improvements, from the use of time domain OCT to spectral domain OCT, have now made it possible to obtain images more quickly and at a higher resolution. The latest Spectralis HRA+OCT is able to obtain OCT images, together with ocular fundus angiography images, which represent the standard approach for imaging diagnoses. OCT is useful for ascertaining and diagnosing the pathological conditions of ocular fundus diseases.

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The development of medical engineering (ME) has made remarkable progress, it is now possible to make a definitive diagnosis, because we can obtain an accurate image by combining an ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), etc. Especially, ultrasonography has been necessary to the development of obstetrics and gynecology because of it,s advantage of being non-invasive and simple in nature and so, ultrasonography has been used from an early stage to usual clinical medicine for screening and management of the fetal abnormalities and the diagnosis of a female pelvis internal-organs structural disease. We discuss the basic matters and the clinical usefulness of three-dimensional ultrasonography which is coming in use in obstetrics and gynecology.

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¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) has repidly entered into widespread use throughout Japan. Over 200 PET centers are currently in use. FDG-PET can be used to detect many malignant tumors and has become the gold standard for oncologic imaging. However, many false-negative cases have been reported. Many new radiopharmaceuticals have been developed as post-FDG agents. One of these radiopharmaceuticals, ¹¹C- acetate (AC), has been used to detect tumors for which FDG gives poor results. The usefulness of AC-PET remains to be established, but many reports have suggested its utility for tumors, such as prostate cancer, lung cancer, hepatocellular carcinoma, brain glioma. etc.

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Indocyanine green (ICG) fluorescence angiography has been used in the assessment of vascular flow. ICG emits nearinfrared fluorescence when it is excited with near-infrared light. Thus, ICG fluorescence is highly transmittable through biological tissues compared with visible light fluorescence. ICG fluorescence was first applied to retinal angiography. In the field of neurosurgery, ICG fluorescence angiography has been used to confirm successful aneurysm clipping during surgery. ICG angiography has also been used for the intraoperative assessment of bypass patency in EC-IC bypass surgery. In the present study, we used ICG angiography to evaluate patency of the bypass graft, as well as blood supply via the bypass to the cortex during superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in moyamoya disease and non-moyamoya ischemic diseases. We compared changes in cortical perfusion by bypass blood flow between these patients. We compared the cortical areas that were fed by the bypass moyamoya disease and non-moyamoya ischemic diseases. ICG angiography clearly demonstrated bypass blood flow from the anastomosed STA to the cortical vessels, including the arteries, capillaries, and veins in both moyamoya disease and non-moyamoya ischemic diseases. Interestingly, the anastomosed STA supplied blood flow to a larger cortical area in moyamoya disease than non-moyamoya ischemic diseases. The bypass supplied a greater extent of blood flow to the ischemic brain in moyamoya disease than in non-moyamoya ischemic diseases. This difference might be due to the fact that the perfusion pressure was lower in moyamoya disease than that in non-moyamoya ischemic diseases.

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症例は 85 歳，男性．便秘，腹痛，嘔吐を主訴に受診した．初診時身体所見では，下腹部に強い腹膜刺激症状を認めた．腹部 CT 検査所見では肝臓周囲，ダグラス窩にまで及ぶ腹水が認められた．大腸穿孔による汎発性腹膜炎を疑い，緊急手術を施行した．術中所見では，胆汁性腹水を多量に認め，胆嚢底部に約 2mm の小穿孔を認めた．病理所見では，慢性胆嚢炎が背景にあり，穿孔部は強い炎症所見，壊死を認め，慢性胆嚢炎を背景とした胆嚢穿孔と診断された．胆嚢穿孔は比較的稀な疾患であるが，急性腹症の鑑別疾患として念頭に置く必要があると考えられた．

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症例は 72 歳の男性．慢性腎不全で透析を受けていた．胸部違和感と労作時の呼吸苦を主訴に胸部 X 線写真を行い，右肺の虚脱を認めため，直ちに胸腔ドレナージを行った．ドレナージ直後より肺の膨張は良好で気漏も認めなかったが，3 日後より著明な皮下気腫が出現した．ドレナージチューブからの空気の流出を認めなかったため，ドレーンの閉塞を考えドレナージを入れ替えたが気漏は認めなかった．胸部 CT 上，皮下気腫，縦隔気腫を認め，ドレーンからの気漏は認めないことから，自然気胸に続発した特発性縦隔気腫と診断した．肺の気腫化や透析患者などの肺の脆弱化した症例では，特発性縦隔気腫を併発することも考慮して治療にあたる必要がある．

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86 歳，女性．平成 19 年 6 月に近医で胃幽門部癌と診断され，他院で精密検査を行い，腹壁および大網への浸潤が認められ，stage IV のため緩和医療を勧められ当院緩和ケア科へ紹介受診となった．しかし，疼痛，嘔気などの自覚症状は認めないため，当科へ転科となり，外来経過観察を行っていた．10 月頃より，嘔吐頻回となり入院．上部内視鏡を施行し幽門部狭窄を認めたため，十分なインフォームドコンセントのもと，Expandable metallic stent (以下 EMS) を留置した．以後，摂取量は少ないものの通常の食事摂取が可能で，EMS 挿入後 1 年 4 ヶ月たった現在でも外来通院中である．癌緩和医療における内視鏡の役割として，EMS は食道用ではあるが，胃幽門部や十二指腸狭窄に対し応用でき，QOL の改善に有用であると思われた．

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