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第 27 回日本骨軟部放射線研究会
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期 ： 2016 年 1 月 29 日 （金） 13 ： 55 － 18 ： 20
1 月 30 日 （土） 9 ： 00 － 14 ： 50
場 ： 東京コンファレンスセンター ・ 品川 大ホール
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東京都港区港南 1-9-36 アレア品川 5F
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会◆ 当番世話人： 相澤 義房
鎌倉 史郎

国立循環器病研究センター

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１． 研究会参加者へのご案内
１） 研究会受付は、 会場にて 2016 年 1 月 29 日 （金） 13 ： 00 より行います。
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３． 世話人会
日時 ： 2016 年 1 月 29 日 （金） 18 ： 30 － 19 ： 00
会場 ： 研究会会場にて

事務局 ：〒 105-8461 東京都港区西新橋 3-25-8
東京慈恵会医科大学 放射線医学講座内
E-mail ： nihon-kotsunanbu@jikei.ac.jp
電話 ： 03-3433-1111 （内線 3360） FAX ： 03-3431-1775-2-

第 27 回日本骨軟部放射線研究会 プログラム
第 1 日目 2016 年 1 月 29 日（金）13 ： 55 － 14 ： 00 開会の挨拶

大友 邦

14 ： 00 － 14 ： 54 Session 1 外傷その他

座長 川原 康弘 （長崎労災病院）

1. Spontaneous healing of a bucket-handle lateral meniscal tear in a young boy
		Department of Radiology, Nagasaki University School of Medicine

		

Hirofumi Koike 他

2. MR imaging findings of pathologic mediopatellar plicae (medial patellar plica syndrome): arthroscopic
correlation
		

Department of Radiology, Nagasaki University Hospital		

Tetsuji Yamaguchi 他

3. Clinical interpretation of the MR findings acquired by low-field dedicated machine for adolescentbaseball players
		

Department of Radiology, University of Tsukuba		Yoshikazu Okamoto 他

4. Anterior iliac lesion in three young male athlete		

Departments of Radiology and Orthopedic surgery, Osaka University Graduate School of Medicine

		Hisashi Tanaka 他

5. Post-traumatic permanent dislocation of the patella in the left knee joint		Department of Radiology, Toho University Sakura Medical Center		

Masayuki Odashima 他

6. A case of chronic expanding hematoma after total hip arthroplasty; Angiographic findings at preoperative
embolization
		

Department of Diagnostic Radiology, Kitasato University School of Medicine

		Haruto Sugawara 他

14 ： 54 － 15 ： 48 Session 2 関節疾患その他

座長 橘川 薫 （聖マリアンナ医科大学）

7. MR findings of polymyalgia rheumatica; a case report		Department of Radiology, The Jikei University School of Medicine

		Shinjiro Tojo 他

8. CT and MRI demonstration of myopathic change in polyarteritis nodosa		Department of Radiology, St. Marianna University School of Medicine

		Kaoru Kitsukawa 他

9. Dual-energy CT evaluation of psoriatic arthritis: initial experience		Department of Radiology, The Jikei University School of Medicine

		

Takeshi Fukuda 他

10. Calcific periarthritis involving the left iliacus muscle: a case with “wandering calcification”
		Department of Radiology, Numazu City Hospital		

Hajime Fujimoto 他-3-11. Bone marrow lesions, subchondral bone cysts and subchondral bone attrition are associated withhistological synovitis in patients with end-stage knee osteoarthritis: a cross-sectional study		

Department of Radiology, Juntendo University Graduate School of Medicine

		Akifumi Hagiwara 他

12. Aiming of a shorter psoriatic arthritis MRI protocol: can contrast-enhanced MRI replace STIR for thedetection of synovitis?
		

Department of Radiology, The Jikei University School of Medicine

		Takenori Yonenaga 他

15 ： 48 － 16 ： 00 休憩

16 ： 00 － 17 ： 03 Session 3 脊椎 ・ 脊髄疾患

座長 國松 聡 （東京大学）

13. A case of idiopathic spinal cord herniation with characteristic imaging findings
		
Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital		

Masanori Ishida 他

14. Stickler syndrome with cervical cord compression caused by dens deformity: a case report		Department of Radiology, University of Tsukuba Hospital		

Masafumi Sakai 他

15. A morphological classification for thoracolumbar transitional vertebrae
		Department of Radiology, Research Hospital, The Institute of Medical Science, The University of Tokyo		

Yoshiyasu Nakano 他

16. Anomaly of the atlas and axis causing cervical myelopathy		

Department of Pediatric Medical Imaging, Jichi Children's Medical Center Tochigi		Waka Nakata 他

17. Arachnoid divertula with scalloping of the posterior aspect of the vertebral bodies
		

Department of Radiology, Jichi Medical School		Atsushi Ugajin 他

18. A case report of calcium pyrophosphate dihydrate crystal deposition disease (CPPD) similar to
Osteosarcoma
		

Department of Radiology, Tokyo Dental College, Ichikawa General Hospital		Yuko Kobashi 他

19. Two cases of Melanotic Schwannoma of the Lumbar Spine
		Department of Radiology, Graduate School of Medical Science, University of the Ryukyus

		

Maho Tsubakimoto 他

17 ： 03 － 17 ： 20 休憩

17 ： 20 － 18 ： 20 片山記念講演

座長 ： 大友 邦 （東京大学）

MDM2 status in osteosarcoma: diagnostic implications
国立がん研究センター中央病院 病理科
吉田 朗彦 先生
-4-

第 2 日目

2016 年 1 月 30 日（土）9 ： 00 － 10 ： 03 Session 4 軟部腫瘍その他１

座長 渡谷 岳行 （東京大学）

20. A case of sinonasal inverted papilloma with ossification
		

Department of Radiology, Kyoto City Hospital		

Hirotsugu Nakai 他

21. Bizarre parosteal osteochondromatous proliferation of the sternum		

Department of Radiology, Kinki University School of Medicine

		

Hideyuki Fukui 他

22. MR imaging findings of pilomatricomas: a radiological-pathological correlation
		

Department of Radiology, Gifu University Hospital		

Hiroki Kato 他

23. A case of solitary synovial chondromatosis arising in the gluteus maximus bursa
		

Department of Radiology, Teikyo University Mizonokuchi Hospital		

Department of Radiology, National Center Hospital of Neurology and Psychiatry		

Kaoru Sumida 他

24. A case of fibroma of tendon sheath with bone invasion in the wrist		

Department of Radiology, Faculty of Medicine, Kagawa University

		Yuko Ono 他

25. Desmoplastic fibroblastoma of the hand; mimicking fibroma of tendon sheath		Department of Radiology, Faculty of Medicine, Kagawa University

		Yuko Fukuda 他

26. A case of retroperitoneal schwannoma with ossification
		

Department of Radiology, Nihon University School of Medicine

		Yusuke Toda 他

10 ： 03 － 10 ： 57 Session 5 軟部腫瘍その他２座長 山本 麻子 （帝京大学）

27. A case of calcifying fibrous tumor arising in a scrotum		

Department of Radiology, Tokyo-kita Medical center		Tetsuya Kosaka 他

28. Transcompartmental spread of lipomatous tumors		

Department of Radiology, Iwate Medical University		Michiko Suzuki 他

29. Extraskeletal osteosarcoma of the lower leg in a young woman: A case report		Department of Radiology, Yamaguchi University Graduate School of Medicine

		Yuko Harada 他

30. Bednar tumor (pigmented dermatofibrosarcoma protuberans): a case report		Department of Radiology, Toho University Omori Medical Center		

M. Kobayashi 他

31. Pleomorphic hyalinizing angiectatic tumor in the right popliteal space with high FDG uptake
		Department of Radiology, Teikyo University School of Medicine

		Yudai Nakai 他

32. Kaposiform hemangioendothelioma of the neck in a neonate
		Department of Interventional Radiology, Kawasaki Saiwai Hospital of Radiology

		Soichiro Hase 他-5-10 ： 57 － 11 ： 10 休憩

11 ： 10 － 12 ： 13 Session 6 骨腫瘍その他

座長 常陸 真 （東北大学）

33. A case of primary Kaposiform hemangioendothelioma of bone: effectiveness of everolimus treatment
		Department of Radiology, National Center for Child Health and Development

		

Masaya Ishii 他

34. A case of epithelioid hemangioma in the triquetrum		

Department of Radiology, Faculty of Medicine, Kagawa University

		Hanae Okuda 他

35. Fibrocartilaginous Dysplasia: A case report		Department of Radiology, Kanazawa University		Miho Okuda 他

36. A case of osteoid osteoma of the distal phalanx: painful enlargement of the toe		Department of Radiology, Saitama Medical University

		

Mamoru Niitsu 他

37. Imaging of Giant Cell Tumor of Bone after Denosumab Injection		

Department of Radiology, School of Medicine, Keio University

		

Sota Oguro 他

38. Ewing sarcoma in phalanx: a case report		Department of Radiology, Iwate Medical University		Tomohiro Suzuki 他

39. Bone metastases from Head & Neck cancer. Retrospective analysis of Whole Body MRI (WB-MRI),
FDG-PET and CT		

Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases

		

Katsuyuki Nakanishi 他

12 ： 13 － 12 ： 25 休憩 ・ 弁当配布
12 ： 25 － 12 ： 35 事務局報告

事務局 福田 国彦

12 ： 35 － 12 ： 45 フェローシップ報告

湘南医療大学 保健医療学部 須山 淳平

12 ： 45 － 14 ： 45 フィルムリーディングセッション

司会

NTT 東日本関東病院 赤羽 正章

14 ： 45 － 14 ： 50 閉会の挨拶

当番世話人 大友 邦

病理コメンテータ
野島 孝之 （金沢医科大学）
蛭田 啓之 （東邦大学医療センター佐倉病院）
元井 亨（がん ・ 感染症センター都立駒込病院）

山口 岳彦 （獨協医科大学越谷病院）-6-

抄 録 集第１日目

1 月 29 日 （金）14 ： 00 － 14 ： 54 Session 1 外傷その他

座長 川原 康弘

1. Spontaneous healing of a bucket-handle lateral meniscal tear in a young boy〇 Hirofumi Koike1) Tetsuji Yamaguchi1) Masataka Uetani1) Akihiko Yonekura2) Makoto Osaki2)
1) Department of Radiology2) Department of Orthopedic Surgery
Nagasaki University School of Medicine

We report a rare case of an isolated displaced bucket-handle tear of the lateral meniscus in a 14-year-old boy that
healed spontaneously without surgical intervention. The patient acutely injured his left knee while playing soccer
and complained of painful swelling and locking of the knee. MRI performed at an orthopedic clinic showed abucket-handle tear of the lateral meniscus. However, when he visited our hospital for an arthroscopic surgery at
two weeks after the injury, he was free of knee pain and regained full range of motion. The follow-up magnetic
resonance imaging showed reduction of the torn meniscal fragment without any signal changes suggestive ofa meniscal tear. Arthoscopy showed a healed longitudinal tear involving the peripheral (red) zone of the lateralmeniscus. This is one of the few reports of spontaneous healing and further studies are necessary to establish theprognosis of non-operative treatment of bucket handle tears.

2. MR imaging findings of pathologic mediopatellar plicae (medial patellar plica syndrome):
arthroscopic correlation〇 Tetsuji Yamaguchi1) Masataka Uetani1) Yasuhiro Kawahara2)

Kazuhiro Yamaguchi3)1) Department of Radiology, Nagasaki University Hospital2) Department of Radiology, Nagasaki Rosai Hospital 3) Yamaguchi orthopedic clinic【Objective】 To evaluate diagnostic value of MRI in medial patellar plica (MPP) syndrome.
【Materials and methods】 MRI findings of 22 subjects who underwent arthroscopic resection of medial patellar
plica were evaluated. MPPs were characterized by Sakakibara classification, cartilage damage and inflammation ofmedial retropatellar fat pad on both arthroscopy and MRI.
【Results】 Sakakibara classification of MPPs on MRI was matched with arthroscopic observation in 21/22 cases.
Arthroscopy showed cartilage damage in 7/22 and inflammation of medial retropatellar fat pad in 9/22. MRI
showed cartilage damage in 1/22 and high signal of medial retropatellar fat pad on FS-PDWI in 12/22.
【Conclusion】 Although arthroscopic correlation was not obtained in all the cases, abnormal signal of medial
retropatellar fat pad on MRI can be a finding indicating inflammation due to impingement of the fat pad. Further
studies with control subjects are required to clarify the diagnostic value of MRI in MPP syndrome.

-7-3. Clinical interpretation of the MR findings acquired by low-field dedicated machine foradolescent baseball players〇 Yoshikazu Okamoto1) Manabu Minami1) Kenta Tanaka2) Takeshi Makihara2)
Tetsuya Kanahori3) Takashi Kawamura3)

Kiyoshi Maehara4) Tomoko Tonoe4)

1) Department of Radiology 2) Department of Orthopedics
3) Faculty of Health and Sport Sciences 4) Doctoral Program in Sports Medicine
University of Tsukuba

The screening test for elbow injuries induced by baseball is performed by palpation and ultrasonography (US). The
results on avulsion fracture of medial epicondyle show an approximately 20-30% positive rate, and osteochondritis
dissecans (OCD) has a 1-2% positive rate.
In the previous conference, we reported on the preliminary results of the MRI screening used by a low-field
extremity dedicated machine.
Although the subjects were from 9 to 12 years old, they were all (100%) successfully completed the exam.
The result were 0% on both avulsion fracture of medial epicondyle and OCD. However, injury of medial collateral
ligament (MCL) reached 41.9%, which was markedly different from the previous reports using US and palpation.
We presented and compared the results of an advanced screening test including MRI, US, and palpation in 52
subjects.
In addition, we propose our original hypothesis “injury - adaptation group” theory observed only by MRI.

4. Anterior iliac lesion in three young male athlete〇 Hisashi Tanaka Norifumi Naka Kenichiro Hamada Satoshi Takenaka Yoshinori Imura,
Yoshiyuki Watanabe Hiroto Takahashi Noriyuki Tomiyama
Departments of Radiology and Orthopedic surgery, Osaka University Graduate School of Medicine

Three cases fulfilled retrospective survey using key words “anterior part of iliac bone” and “under 20 years old”
in MRI findings from around 95000 reports in ten years. All of these three cases are male with vigorous sports
activity. In all three patients, band or mass like lesions exist at the anterior surface of iliac bone. On T2-weighted
images, they showed high signal intensity. Two lesions showed high and the other lesion showed same intensity
to muscle on T1-weighted images. Two patients have been observed for four years or three months without any
change in imaging findings. No one underwent biopsy or treatment. Because of sex, age, and sports activity,
authors believe avulsion mechanism of the iliacus muscle is the cause of these lesions.

-8-5. Post-traumatic permanent dislocation of the patella in the left knee joint〇 Masayuki Odashima1) Tsutomu Inaoka1) Tomoya Nakatsuka1) Rumiko Ishikawa1) Shusuke Kasuya1)
Noriko Kitamura1)

Hideyasu Kudo1) Koichi Isobe1)

Koichi Nakagawa2) Nobuyuki Hiruta3)

Hitoshi Terada1)
1) Department of Radiology 2) Department of Orthopedic Surgery

3) Division of Surgical Pathology

Toho University Sakura Medical Center[Background] Permanent dislocation of the patella is a rare condition that is usually congenital in origin. However,permanent patellar dislocation may be acquired and this is usually secondary to knee trauma with subsequentmalunion or growth arrest. Actually, traumatic patellar dislocation is treated early and appropriately and its
occurrence of post-traumatic permanent dislocation of the patella may be low.
[Case report] A 42-year-old male who presented with muscle weakness and fatigue of the left leg was referredto our hospital. He had a traumatic event of the left knee in childhood. Clinical examination revealed a valgus
deformity of the left leg and that the patella lay lateral to the lateral femoral condyle. Radiographs, CT, and
MRI revealed patellar dislocation. CT revealed atrophic change of the left quadriceps femoris muscle and lateraldislocation of the tibial tuberosity.

6. A case of chronic expanding hematoma after total hip arthroplasty; Angiographic findings
at preoperative embolization〇 Haruto Sugawara1) Reiko Woodhams1) Kaoru Fujii1) Katsufumi Uchiyama2) Yusuke Inoue1)
1) Department of Diagnostic Radiology, Kitasato University School of Medicine
2) Department of Orthopaedic Surgery, School of Medicine, Kitasato University

A 72-year-old female had been suffering from swelling around the femoral head prosthesis for a year. Aspirate
presented bloody fluid. Dynamic CT images showed a capsulated high density cavity with a gradual enhancementfrom the arteries around the hip joint into the cavity. Chronic expanding hematoma (CEH) was suspected basedon the clinical and CT findings. TAE was requested to reduce intraoperative hemorrhage on revision arthroplasty.
Angiograms from the internal iliac artery and the deep femoral artery showed proliferated arteries distributing on
the capsule of the cavity. A carbon dioxide angiogram indicated extravasation into the cavity. TAE was performed
using gelatin sponge and Microsphere. The total amount of intraoperative bleeding was 4000 cc. There were a few
reports presenting angiographic findings of CEH. A preoperative angiography and TAE may be useful to assure thediagnosis of CEH, predict and reduce bleeding during operation.

-9-

1 月 29 日 （金）14 ： 54 － 15 ： 48 Session 2 関節疾患その他

座長 橘川 薫

7. MR findings of polymyalgia rheumatica; a case report〇 Shinjiro Tojo Takeshi Fukuda Akari Sadaoka Takenori Yonenaga Kunihiko Fukuda
Department of Radiology, The Jikei University School of Medicine

Abstract: Polymyalgia rheumatica (PMR) is a chronic inflammatory disease that causes muscle pain and stiffness,
especially in the shoulders and the hips, in elderly persons.
We present a case of PMR with literature review. The case is an 81 years old male patient who complained ofmyalgia of the both proximal femur. Blood exams revealed an increase of C-reactive protein (CRP) and erythrocyte
sedimentation rate (ESR).
On MR images, symmetrical synovitis in both hip joints were seen on gadolinium-enhanced T1-weighted image.
High intensity of obturator externus muscle, adductor magnus muscle, and gluteus medius muscle were seen on
STIR image, which were considered as extracapsular muscle edema and similar to enthesitis.
The clinical manifestations were not seen in both shoulders. However, clinical and laboratory findings were notcompatible with other rheumatic diseases, including rheumatoid arthritis and spondyloarthritis. Steroid therapy wasprovided under a diagnosis of PMR, and clinical improvement was obtained.

8. CT and MRI demonstration of myopathic change in polyarteritis nodosa〇 Kaoru Kitsukawa1) Keisuke Chihaya1) Yuki Saito1) Yasuo Nakajima1)
Hironari Hanaoka2)

Harunobu Iida2)

Masatomo Doi3)

1) Department of Radiology
2) Division of Rheumatology and Allergology, Department of Internal Medicine
3) Department of Pathology
St. Marianna University School of Medicine

Polyarteritis nodosa (PN) is a necrotizing vasculitis that involves medium- to small-sized vessels and typicallyaffects multiple organs. We demonstrate a patient with PN who developed multiple muscle involvement that was
identified using CT and MRI. A 70-year-old male presented with a two-week history of progressive pain andmuscle weakness in both lower extremities. Physical examination showed grasp tenderness of the thigh and calfmuscles and weakness of the quadriceps femoris, tibialis anterior, soleus, and gastrocnemius muscles bilaterally.
Blood tests showed elevation of C-reactive protein (19.45mg/dl), creatinine phosphokinase (419U/L), andmyoglobin (424ng/ml). CT demonstrated scattered low attenuation foci in muscles of the thigh and calf, and theiliopsoas muscle. MRI of the lower extremities showed multiple increased signal intensity lesions in the muscles
on T2-weighted images and STIR images, suggestive of inflammatory changes. A muscle biopsy was performed on
the thigh. The biopsy specimen revealed vasculitis with fibrinoid necrosis compatible with PN.

- 10 -

9. Dual-energy CT evaluation of psoriatic arthritis: initial experience〇 Takeshi Fukuda1) Shinjiro Tojo1) Takenori Yonenaga1) Akari Sadaoka1) Kiyofumi Hagiwara2)
Kunihiko Fukuda1)
1) Department of Radiology, The Jikei University School of Medicine
2) Department of Rheumatology, Tokyo General Hospital of East Japan Railway Company

Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis associated with psoriasis, and has a tendency toresult in irreversible joint damage.
We performed dual energy CT with iodine mapping in four cases with PsA, one foot and 3 hands.
Abnormal contrast enhancement was present in the symptomatic joints in all four cases.
In two cases, follow up study was performed after treatment with biological agent.
In these two cases apparent improvement of contrast enhancement was present, which was in accordance with thesymptom improvement.
Therefore, iodine mapping of dual energy CT can be used as an alternative imaging in patients where MRI iscontraindicated.

10. Calcific periarthritis involving the left iliacus muscle: a case with “wandering
calcification”〇 Hajime Fujimoto1) Shinya Hattori1) Yoshihiro Kubota1) Katsuhito Shimoyama2) Masanobu Eguchi3)1) Department of Radiology2) Department of Orthopedic Surgery3) Department of Pathology
Numazu City HospitalA 68-year-old woman presented with left coxalgia of 6-months’ duration. Conventional radiograph of the pelvis
showed a well-defined, oval-shaped calcification on the lateral aspect of the left femoral head. This finding wasinterpreted as calcific periarthritis. She underwent a conservative treatment, which failed to improve her symptom.
The patient was referred to our hospital a month later. On the second radiograph, the calcification migrated
caudally and overlapped with the lesser trochanter. CT revealed a tubular-shaped calcified structure along theleft iliacus muscle. The lesion was surgically resected, and the specimen revealed a calcified mass in the muscle.
Histopathological study demonstrated a conglomerated calcified structure with infiltration of lymphocytes andforeign-body giant cells and some fibrosis. These findings are consistent with calcific periarthritis.

- 11 -

11. Bone marrow lesions, subchondral bone cysts and subchondral bone attrition areassociated with histological synovitis in patients with end-stage knee osteoarthritis: across-sectional study〇 Akifumi Hagiwara1, 2) Anwarjan Yusup3, 4) Koji Kamagata1) Muneaki Ishijima3, 5) Haruka Kaneko3)
Lizu Liu3, 5) Liang Ning4) Ryo Sadatsuki3) Shinnosuke Hada3) M. Kinoshita3) Ippei Futami3)
Kazuo Kaneko3, 5) Shigeki Aoki1)
1) Department of Radiology, Juntendo University Graduate School of Medicine
2) Department of Radiology, Graduate School of Medicine, The University of Tokyo
3) Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine
4) Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine5) Sportology Center, Juntendo University Graduate School of Medicine[Objective] The aim of this study was to examine the osteoarthritis (OA)-related structural changes associated withhistological synovitis in patients with end-stage knee OA.
[Methods] Forty patients with end-stage knee OA (female: 88%, mean age: 71.8y) were enrolled. All participants
underwent 3.0-T MRI. The structural changes including cartilage morphology, subchondral bone marrow lesion(BML), subchondral bone cyst (SBC), subchondral bone attrition (SBA), osteophytes, meniscal lesion andsynovitis, were scored using the whole-organ MRI scoring (WORMS) method. Synovial samples were obtained
during joint replacement surgery. The association between the histological synovitis score (HSS) and WORMS was
examined using Spearman’s correlation coefficient.
[Results] Among the seven OA-related structural changes, the BML, SBC, SBA and synovitis were significantly
associated with the HSS (r = 0.33, 0.35, 0.48 and 0.36, respectively), while others were not.
[Conclusion] The presence of BML, SBC and SBA was associated with histological synovitis in patients with endstage knee OA.

12. Aiming for a shorter psoriatic arthritis MRI protocol: can contrast-enhanced MRI replace
STIR for the detection of synovitis?
〇 Takenori Yonenaga1) Yasuyo Teramura2)

Masato Matsushima3) Shinjiro Tojyo1) Akari Sadaoka1)

Takeshi Fukuda1) Kunihiko Fukud1)1) Department of Radiology, The Jikei University School of Medicine
2) Department of Radiology, National Defense Medical College
3) Division of Clinical Epidemiology, The Jikei University School of Medicine

Purpose To evaluate whether intravenous gadolinium contrast MRI (Gd MRI) can be eliminated by STIR whenevaluating synovitis of psoriatic arthritis patients.
Materials and methods Finger joints MRIs of 12 psoriatic arthritis patients were evaluated by two readers forsynovitis of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints, according to the
Psoriatic Arthritis Magnetic Resonance Imaging Scoring System (PsAMRIS). Scores of STIR were compared toscores of Gd MRI as gold standard.
Result Sensitivity to detect synovitis of STIR was 41%, specificity was 96%. Weighted kappa statistic was 0.43.
Conclusion Eliminating Gd contrast administration resulted in low sensitivity for synovitis and the weighted kappa
statistic was low, indicating that Gd contrast administration remains essential for an optimal assessment.

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1 月 29 日 （金）16 ： 00 － 17 ： 03 Session 3 脊椎 ・ 脊髄疾患

座長 國松 聡13. A case of idiopathic spinal cord herniation with characteristic imaging findings〇 Masanori Ishida1) Yusuke Sato2)
Shigeo Sano2)

Junko Nakamura1) Yo Fujimoto2) Jiro Morii2) Yusuke Nakao2)

Makoto Watanabe1)

1) Department of Radiology 2) Department of Orthopedic Surgery
Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital

We present a case of a man in his 60’s with a 6-year history of progressive numbness of the legs and walking
disorder. MR images showed a focal anterior kink of the spinal cord at the T5-6 level, including focal thinningof the spinal cord and widening of the dorsal subarachnoid space. Adherence of the cord to the ventral dura andanterior epidural fluid collection were also observed. Consecutive CT myelograms depicted herniation of the left
anterior portion of the cord. Spinal cord herniation (SCH) was suspected from these findings, and then defined asa final diagnosis after an operation. This case is thought to be idiopathic because of no past operative or traumatic
history. SCH is a relatively rare disease characterized by herniation of the thoracic spinal cord through an anterior
or lateral dural defect. We discuss the SCH mechanism and imaging findings with some literatures.

14. Stickler syndrome with cervical cord compression caused by dens deformity: a casereport〇 Sakai Masafumi1)

Okamoto Yoshikazu1)

Kamada Hiroshi2) Minami Manabu1)

1) Department of Radiology2) Department of Orthopaedic Surgery
University of Tsukuba Hospital

A 2.5 year-old girl presented with limbs shortening, microglossia, cleft palate and bilateral hearing loss since birth.
Radiography of the upper and lower extremities showed epiphyseal dysplasia with flattening. Based on the clinicalfindings and mutation in COL2A1 gene, she was diagnosed as Stickler syndrome. She also showedmusclehypotonia in the whole body and developmental delay of motor function. Head control was delayed.
Cervical radiography was performed on suspicion of cervical myelopathy. It suggested slight atlanto-axial
dislocation. In cervical MRI, deformation of the dens was also seen with slight atlanto-axial dislocation. It caused
canal stenosis and slight cervical cord compression at the level of the foramen magnum.
The prognosis of Stickler syndrome is generally favorable. However, we hypothesized that dens deformity could
cause lethal condition because the dens with Stickler syndrome is associated with insufficient endochondral
ossification, especially in the childhood.

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15. A morphological classification for thoracolumbar transitional vertebrae.
〇 Yoshiyasu Nakano1) Shouhei Hanaoka2)
Hiroyuki Akai1)

Naoto Hayashi3) Takeharu Yoshikawa3)

Shigeru Kiryu1) Kuni Ohtomo2)

1) Department of Radiology, Research Hospital, The Institute of Medical Science, The University of Tokyo
2) Department of Radiology, University of Tokyo Hospital3) Department of Computational Diagnostic Radiology and Preventive Medicine, University of Tokyo Hospital

Both thoracolumbar and lumbosacral transitional vertebrae (TLTVs and LSTVs) pose a risk of significant clinicalerror. Prevailing morphological classifications for TLTVs are lacking, in contrast to those for LSTVs. Here we
propose a TLTVs morphological classification consisting of eight models—“Type 1” to “Type 8"—. To build thisclassification, we defined four types of costal elements—“short-rib type”, “lumbar-rib type”, “normal-length rib”,
and “normal-transverse process”—. Eight models of TLTVs were determined according to their combinations. We
verified our classification reviewing 300 whole-spine CT datasets. There were in total 49 (16.3 %) TLTVs. Abouthalf of them were “Type 4—bilateral lumbar-rib-type costal elements—”, followed by “Type 3”, “Type 2”, “Type 1”
and “Type 5”. None of “Type 6”, “Type 7”, or “Type 8” was observed. Our first five models may suffice tocategorize all the TLTVs.

16. Anomaly of the atlas and axis causing cervical myelopathy〇 Waka Nakata1) Hideharu Sugimoto2) Takehiko Yamaguchi3)1) Department of Pediatric Medical Imaging, Jichi Children’s Medical Center Tochigi2) Department of Radiology, Jichi Medical University3) Department of Pathology, Dokkyo Medical University Koshigaya Hospital

We present two rare cases of cervical canal stenosis caused by an anomalous articulation between posterior archof the atlas and the hypertrophied lamina of the axis. The radiological characteristics, and histologic findings ofsurgical specimen will be discussed.
Case 1: 59 year old female complained of left neck pain and numbness of 2 months duration. A tumor of thecervical spine was suspected at the local hospital.
Case 2: 59 year old female presented with one month history of headache. CT scan obtained at local hospital
revealed occlusion of left middle cerebral artery. She was scheduled for surgical treatment. She graduallydeveloped bilateral hand and lower leg numbness and abnormality of cervical spine was suspected.

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17. Arachnoid divertula with scalloping of the posterior aspect of the vertebral bodies.
〇 Atsushi Ugajin1)

Hideharu Sugimoto1)

Hiroyuki Hujii1) Koichi ito1)

Miho Terauchi1)

Yuichiro Kawahara1) Yohei Koyashiki1) Mizuho Suzuki1) Teruaki Endo2)
1) Department of Radiology2) Department of Orthopaedics
Jichi Medical School

A 80’s man presented with left leg weakness. MRI showed dural ectasia-like lesion with scalloping of the posterior
aspect of the vertebral bodies from Th12 to L1. CT myelography and CSF flow imaging revealed CSF inflow to
expanded dural sac.
Spine X-ray and CT showed diffuse ossification of the anterior longitudinal ligament, sclelosis of sacroiliitis joints,
and osseous fusion of vertebral bodies and facet joints. Arachnoid divertula is a rare manifestation in patients withankylosing spondylitis. Bony erosion in ankylosing spondylitis involved the posterior elements more often thanthe posterior aspect of the vertebral bodies.
Our case is suggestive of considering the mechanism of arachnoid divertula by visualizing CSF inflow.

18. A case report of calcium pyrophosphate dihydrate crystal deposition disease (CPPD)
similar to Osteosarcoma〇 Yuko Kobashi Yosuke Nozawa Akira Baba

Shinji Yamazoe Takuji Mogami

Department of Radiology, Tokyo Dental College, Ichikawa General Hospital

Forty-two year old male presented with severe neck pain, numbness of left fingers and dizziness. On physicalexamination, there was not muscle weakness or atrophy of the left upper extremity. X rays of cervical spine
showed radiolucent area with calcification in the lateral mass at level of C4 to C6. Furthermore, C6 vertebral bodywas collapsed. On CT examination, questionable calcification was present around left C5/6 facet joint and madeleft neural foramen narrow. C6 vertebral body showed collapse with osteolytic change. From these findings, we
suspected osteosarcoma or crystal deposition disease such as CPPD. Open biopsy was conducted and pathologicalresults were consisted with CPPD. CPPD occurs when crystals form deposits in the joint and surrounding tissues
with unknown etiology. In cervical spine, Crowned dens syndrome is known well. Our case would be rare because
CPPD mainly occurred at left C5/6 facet joint and involved C6 vertebral body.

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19. Two Cases of Melanotic Schwannoma of the Lumbar Spine〇 Maho Tsubakimoto Tsuneo Yamashiro

Masahiro Okada

Sadayuki Murayama

Department of Radiology, Graduate School of Medical Science, University of the Ryukyus

A melanotic schwannoma (MS) is a rare variant of nerve sheath neoplasm which is categorized as a benign tumor
according to the WHO classification. Approximately 10% of MSs have malignant potential with distant metastasis
or local recurrence after resection.
We managed two patients with MS in our institution. The patients had well-defined epidural masses in the lumber
vertebral canal which had high intensity on T1WI and low-to-intermediate intensity on T2WI. Although the preoperative diagnosis was uncertain, local tumor resections were performed for presumptive benign lesions. The
lesions were histologically diagnosed as MSs post-operatively. One patient had a local recurrence and multiple
lung metastases 5 years later, and the other patient had no recurrences for 1 year.
Although MS is regarded as a benign neoplasm, radical surgical resection with wide margins is recommended. To
avoid recurrences, a pre-operative radiologic diagnosis is essential when encountering this rare and unique tumor.

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抄 録 集第 2 日目1 月 30 日 （土）9 ： 00 － 10 ： 03 Session 4 軟部腫瘍その他１

座長 渡谷 岳行

20. A case of sinonasal inverted papilloma with ossification○ Hirotsugu Nakai Ryota Fujimoto Naoe Satogami
Department of Radiology, Kyoto City Hospital

A 65-year-old man was refered to our hospital complaining of nasal congestion and rhinorrhea lasting for a year.
Nasal endoscopy revealed a mass in the left nasal cavity. Computed tomography images showed soft tissue mass
with ossification in the left nasal cavity expanding into the ethmoid and maxillary sinuses. Destructive change inthe surrounding tissue was minimal.
Endoscopic tumor resection was performed.
Pathological examination showed islands of epitherial cells infolding into the stroma with ossification. Cytologicalatypia was absent.
Thus inverted papilloma with ossification was diagnosed.
Here we pesent an exremely rare case of inverted papilloma with ossification, whereas inverted papilloma in itself
is basically a common benign tumor.

21. Bizarre parosteal osteochondromatous proliferation of the sternum○ Hideyuki Fukui Nobuo Kashiwagi

Eisuke Enoki Yasuaki Nakajima Isao Numoto

Yuichi Wakabayashi Masashi Toguchi

Nobuyuki Asato

Tomoko Hyodo Yukinobu Yagyu Masashi Kumano
Mitsuru Matsuki

Miho Yamakawa Sung-woon Im

Masakatsu Tsurusaki

Izumi Imaoka

Kazunari Ishii Takamichi Murakami

Department of Radiology, Kinki University School of Medicine

Bizarre parosteal osteochondromatous proliferation (BPOP), so-called “Nora’s lesion” is benign reactive, but
locally aggressive lesion which has high recurrence rate. This rare lesion usually occurs in the small tubular
bones of the hands and the feet, our report of a 17-years-old man is the first case affecting the sternum. CT and
MR findings were consistent with intricate internal content including chondromatous stroma and ossification, but
unusual location made a preoperative diagnosis difficult.

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22. MR imaging findings of pilomatricomas: a radiological–pathological correlation○ Hiroki Kato

Haruo Watanabe Masayuki Matsuo

Department of Radiology, Gifu University Hospital

Purpose: To assess the correlation between MR imaging and pathological findings of pilomatricomas.
Material and Methods: MR images were obtained consecutive patients with histologically proven pilomatricomas.
Images were retrospectively reviewed for size, signal intensity compared with skeletal muscles, enhancement
patterns, and imaging findings.
Results: We included 11 consecutive patients with 12 histologically proven pilomatricomas. The maximum tumor
diameter ranged from 7 to 32 mm (mean, 16.5 mm). On T2-weighted images, five tumors showed homogeneous
hypointensity, whereas six showed reticular hyperintensity and one showed cystic hyperintensity. On fat-suppressed
T2-weighted images, nine tumors showed reticular hyperintensity, eight showed ring-like hyperintensity, and five
showed peritumoral fat stranding. On fat-suppressed gadolinium-enhanced T1-weighted images, one tumor showedno enhancement, whereas three showed reticular enhancement and five showed ring-like enhancement.
Conclusion: MR imaging features of pilomatricomas included reticular and ring-like hyperintensities on fatsuppressed T2-weighted images and reticular and ring-like enhancement on fat-suppressed gadolinium-enhanced
T1-weighted images.

23. A case of solitary synovial chondromatosis arising in the gluteus maximus bursa○ Kaoru Sumida1, 2) Atsushi Nambu1) Ayumi Saito1) Yoshie Sato1) Noriko kobayashi1)

Masao Tago1)

Isao Shibuya3) Masashi Kawamoto4)
1) Departments of Radiology 3) Department of Orthopedics 4) Department of Diagnostic Pathology
Teikyo University Mizonokuchi Hospital2) Department of Radiology, National Center Hospital of Neurology and Psychiatry

Chondral tumors in soft tissue are referred to as soft-tissue chondromas or extraskeletal chondromas, or as
synovial chondromatosis if they arise in synovial tissue. We report the case of a 29-year-old man with synovial
chondromatosis, also called synovial osteochondromatosis, which appeared in a solitary and extra-articular form.
On magnetic resonance imaging (MRI) and computed tomography, the central portion of the tumor showed similar
characteristics to bone marrow, despite the absence of any connection to adjacent bone. T2-weighted imaging
displayed marked peripheral hyperintensity consistent with a cartilaginous area. These findings suggested thepresence of enchondral ossification and were similar to those of skeletal osteochondroma, with the exception of
the absence of attachment to bone. MRI is useful for distinguishing solitary synovial chondromatosis from otherlesions, such as myositis ossificans, extraskeletal chondrosarcoma and parosteal osteosarcoma.

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24. A case of fibroma of tendon sheath with bone invasion in the wrist○ Yuko Ono Yuko Fukuda Hanae Okuda Yoshihiro Nishiyama
Department of Radiology, Faculty of Medicine, Kagawa Universtity

Case: 40s female
CC: right ulnar side wrist pain
Present history: She had the right ulnar side wrist pain since 7 years. The pain and swelling had been getting worse
for the past 3 years. Radiograph showed a soft tissue mass with bone destruction of the distal ulna and erosion of
the triquetrum. MRI showed a well-defined mass, measuring 46 × 30 × 48 mm, surrounding extensor carpi ulnaris
tendon that infiltrated ulna, triquetrum, slightly radius and lunate. The mass demonstrated low-iso signal intensity
on T1WI, heterogeneous high signal intensity on T2WI/STIR and there was diffuse enhancement on gadoliniumenhanced image. FDG-PET/CT showed intense FDG uptake in the mass (SUVmax:7.99). Preoperative radiologic
impression was tenosynovial giant cell tumor. Following surgical resection, histopathological examination revealed
closely aggregated spindle cells in a collagenous matrix. Finally, the tumor confirmed as fibroma of tendon sheath.

25. Desmoplastic fibroblastoma of the hand; mimicking fibroma of tendon sheath.
○ Yuko Fukuda Yuko Ono

Hanae Okuda Yoshihiro Nishiyama

Departments of Radiology, Faculty of Medicine, Kagawa University

A 70s female presented with progressive right hand swelling over 2 years duration and complained of tenderness.
At MRI showed right palm mass, measuring 4 × 3cm, iso intensity on both T1WI and T2WI. There was mildheterogeneous enhancement on post contrast imaging. FDG PET/CT image showed mild accumulation. Tendon
sheath fibroma was suspected before the surgery. Surgical resection was performed. Macroscopically, it appears as
whitish cut surfaces. Microscopically, the tumor presented a dense proliferation of collagenous fibers and sparsely
distributed spindle-to stellate-shaped cells. The histopathology was characteristic of a desmoplastic fibroblastoma.
Desmoplastic fibroblastoma is a rare fibrous soft tissue tumor, benign but locally aggressive.
We present a rare case of desmoplastic fibroblastoma of the soft tissue of the hand.

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26. A case of retroperitoneal schwannoma with ossification○ Yusuke Toda Yusuke Watanabe

Jin Hirakata Noriko Kinukawa

Osamu Abe

Department of Radiology, Nihon University School of Medicine

A man in his 20s was noted to have an abdominal mass on health checkup and referred to our hospital. Abdominal
CT revealed a large hypodense tumor containing scattered areas of calcification-like hyperdensity in the right
retroperitoneal space. On MRI, the tumor was oval shaped and well encapsulated. It was hypointense on T1WI andheterogeneously hyperintense on T2WI, and showed heterogeneous enhancement on gadolinium-enhanced MRI.
On opposed phase images, there were scattered punctate foci with signal loss corresponding to hyperdense areas on
CT. Surgical resection was performed, and histopathological diagnosis was benign schwannoma with ossification
containing fatty marrow.
Schwannomas often contain calcification, but ossification is an extremely rare degenerative change and there havebeen few reports that demonstrated ossification on diagnostic imaging. Here we report a case of retroperitoneal
schwannoma with ossification containing fatty marrow demonstrated on CT and MRI.

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1 月 30 日 （土）10 ： 03 － 10 ： 57 Session 5 軟部腫瘍その他２座長 山本 麻子

27. A case of calcifying fibrous tumor arising in a scrotum○ Tetsuya Kosaka1) Hisao Koga1) Ayako Tamura1) Mizuki Onozawa2) Hiroshi Shiraiwa2)
Tomonari Amano3)
1) Department of Radiology 2) Department of Urology 3) Department of Pathology
Tokyo-kita Medical center

A case of calcifying fibrous tumor (CFT) arising in a scrotum of a 42-years old male who presented with a painlessleft scrotal mass of 15 years duration. Ultrasound revealed a well-circumscribed low echoic mass of 2cm indiameter. The tumor was clearly separated from the testis and epididymis on CT. It had scattered calcification andscanty enhancement. On MRI, it showed very low signal intensity on T2WI and intermediate signal intensity on
T1WI. Contrast enhanced imaging revealed a low uptake of gadolinium. Local excision was performed. The cut
surface was white, there was no bleeding or necrosis. Microscopically, the tumor was composed of hyalinizedfibrotic tissue with scattered calcifications and a low cell density of interspersed spindle-like cells. We would
like to report a rare case of CFT arising in a scrotum including reported CT and MRI findings and the differential
diagnosis.

28. Transcompartmental spread of lipomatous tumors○ Michiko Suzuki1) Ehara Shigeru1) Tomohiro Suzuki1)

Hiroshi Tada2) Yoshikuni Mimata2)

Takashi Satoh3)
1) Department of radiology 2) Department of orthopedic surgery3) Department of pathology

Iwate Medical University

Soft tissue tumors usually localized in one compartment, but it may be spread into other compartment particularly
in large malignant neoplasms. The objective of this study is to describe unusual extensive non-malignant tumors.
This is a retrospective review of such cases in relatively low grade or benign lipomatous soft tissue neoplasms
with transcompartmental spread. The imaging studies include CT and MR imaging in 3 cases: well-diffentiatedliposarcoma involving pelvic cavity and muscle layer around the hip, lipoma involving the upper arm and axilla,
and lipoma involving Haffa’s fat pad and suncutaneous tissue around the knee. In conclusion, relatively low grade
lipomatous tumors may spread over compartments.

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29. Extraskeletal osteosarcoma of the lower leg in a young woman: A case report○ Yuko Harada Masako Oosaki

Naofumi Matsunaga

Department of Radiology, Yamaguchi University Graduate School of Medicine

We report an instructive case of extraskeletal osteosarcoma of the lower leg in a 28-year-old woman with aprogressive pain for six months. On unenhanced CT, an oval-shaped mass measuring 4cm in diameter was seenin the left soleus muscle. Marked calcification was not evident, and the mass was obviously separated from thetibia. On T2-weighted imaging, the tumor was well-defined and moderately hyperintense with a hyperintense
foci. Edema-like hyperintense areas were seen around the mass. On post-contrast T1-VIBE imaging, relatively
homogeneous and moderate enhancement was shown with peripheral hypointense rim and foci. The tumor was
pathologically diagnosed as extraskeletal osteosarcoma on open biopsy. We also present follow-up imagings after
chemotherapy with literature reviews.

30. Bednar tumor (pigmented dermatofibrosarcoma protuberans): a case report〇 M. Kobayashi1)

N. Shiraga1) K. Matsumoto1)

K. Suzuki1) H. Suzuki1)

J. Kodera1) T. Akashiba2)

A. Ishiko2) Y. Akasaka3) K. Shibuya3)
1) Department of Radiology 2) Department of Dermatology 3) Department of Surgical Pathology
Toho University Omori Medical Center

A woman in her 40s was referred to our hospital because of her back tumor.
Physical examination revealed a firm, round mass of 35 mm in diameter.
MRI scans showed a well-defined subcutaneous tumor in her back. Most of the lesion appeared hypointense on
T1WI, mixed intensity on T2WI, and hyperintensity on DWI. Localized hyperintense area on T1WI was noted andwhich was not suppressed by fat-suppressed T1WI. The MRI findings were not specific and the tumorectomy was
performed. On histopathological examinations, tumor was composed of oval to spindle shaped cells arranged ingroups, fascicles storiform pattern. Macrophages with melanin were also seen. Pathological diagnosis was Bednar
tumor (pigmented dermatofibrosarcoma protuberans).
Bednar tumor is a rare skin neoplasm, considered to be a pigmented variant of dermatofibrosarcoma protuberans.
In this case, hyperintensity on T1WI might reflect the melanin and could be the key of correct diagnosis.

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31. Pleomorphic hyalinizing angiectatic tumor in the right popliteal space with high FDG
uptake.
○ Yudai Nakai1) Asako Yamamoto1) Yuichi Ishikawa1) Tomonori Kanda1)

Hiroshi Oba1)

Tatsuro Kaminaga1) Kenji Sato2) Satoshi Abe2) Yoshinao Kikuchi3, 4) Tsuyoshi Ishida5)
Shigeru Furui1)
1) Department of Radiology 2) Department of Orthopaedic Surgery3) Department of Pathology

Teikyo University School of Medicine
4) Department of Pathology, Teikyo University Hospital5) Department of Pathology and Laboratory Medicine, Kohnodai Hospital, National Center for Global
Health and Medicine
A 74-year-old woman was referred for evaluation of a right popliteal mass enlarging for 1 year. It did not cause
discomfort. MRI revealed an irregular-shaped intermuscular mass which measured 18.2 cm in diameter. T1weighted images showed low signal intensity. T2-weighted images demonstrated a heterogeneous pattern with
mixed areas of high and low signal intensity. Dynamic contrast-enhanced MRI revealed an early peripheral anddelayed central enhancement which were heterogeneous. The maximum standardized uptake value (SUVmax)
on 18F-FDG-PET was 23.05. Malignant tumor was suspected and marginal resection was done. The tumor wascharacterized by clusters of dilated blood vessels and invasive growth of spindle cells including pleomorphic cells.
Regional necrosis and mixoid changes were existed. Immunohistochemically, the specific differentiation was notdetected. Pathological final diagnosis was Pleomorphic hyalinizing angiectatic tumor (PHAT). PHAT is a rare soft
tissue tumor of low malignant potential. We discuss the imaging findings of PHAT.

32. Kaposiform hemangioendothelioma of the neck in a neonate〇 Soichiro Hase1, 2) Sokun Fuwa1) Tassei Nakagawa1) Jun-ichi Nishimura1) Yuichi Okata3)
Makiko Yoshida4)1) Department of Interventional Radiology, Kawasaki Saiwai Hospital of Radiology2) Department of Radiology, Japanese Red Cross Society Himeji Hospital3) Department of Pediatric Surgery, Hyogo Prefectural Kobe Children’s Hospital4) Department of Pathology, Hyogo Prefectural Kobe Children’s Hospital

Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive vascular tumor of infancy and childhood.
It is mostly located in the retroperitoneum and skin. We present the case of a newborn girl with a KHE occurringin the left neck. She was delivered through the vagina at 40 weeks’ gestation and noticed left facial nerve palsy atbirth. 22 days after giving birth, she was admitted with left neck swelling and thrombocytopenia. CT revealed anenhancing lobular soft-tissue mass measuring 41×32×30 mm in the left neck. The mass extended both intra- andextra-cranially with destruction of left temporal bone. MRI revealed a strongly enhancing mass with intratumoral
hemorrhage. An open skull base biopsy was performed and proved a histological diagnosis of a KHE.

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1 月 30 日 （土）11 ： 10 － 12 ： 13 Session 6 骨腫瘍その他

座長 常陸 真33. A case of primary Kaposiform hemangioendothelioma of bone: effectiveness of
everolimus treatment○ Masaya Ishii1) Osamu Miyazaki1) Keita Terashima2) Atsuko Nakazawa3) Takako Yoshioka3)
Ayako Muto1) Reiko Okamoto1)
Mikiko Miyasaka1)

Masayuki Kitamura1) Yoshiyuki Tsutsumi1)

Syunsuke Nosaka1)

1) Department of Radiology 2) Division of Neuro-Oncology, Children’s Cancer Center3) Department of Pathology
National Center for Child Health and Development

A seven-year-old boy without skin change, who had suffered from a prolonged pain of right leg since elevenmonth-old, had been followed in the other hospital as chronic recurrent multifocal osteomyelitis (CRMO).
Contrast-enhanced MRI showed abnormal map-like enhancement in metaphysis and epiphysis of the right distal
femur, which extended to extraosseous soft tissue. This lesion progressed gradually. Biopsy of the right femur
proved this lesion to be kaposiform hemangioendothelioma (KHE).
Everolimus, which is an inhibitor of mTOR and structurally similar to sirolimus, successfully decreased the tumor
size and controlled the symptom.
Primary KHE of bone without cutaneous lesion is extremely rare and only some cases have been reported. Use of
everolimus for KHE has not been reported although sirolimus, which is not approved in Japan, is known to be aneffective drug for KHE.

34. A case of epithelioid hemangioma in the triquetrum○ Hanae Okuda Yuko Ono Yuko Fukuda Yoshihiro Nishiyama
Department of Radiology, Faculty of Medicine, Kagawa University

A 40s woman presents to the hospital complaining of worsening of left wrist pain for one year. Plain radiographand CT showed expansive osteolytic mass in the triquetrum, measuring 15 × 15 mm. MR showed low SI on T1WI,
iso-high SI on T2WI, high SI on T2WFS and multilocular enhancement. FDG-PET/CT showed mild accumulation.
Curettage was performed with bone graft packing. Microscopically, the tumor was composed of accumulationof epithelioid endothelial cells and increasing vessels with the expansion. Immunohistochemical staining
revealed factor Ⅷ and CD31 positivity, and Ki-67 positive rate was less than 1%. It was diagnosed as epithelioid
hemangioma. According to the 2013 WHO classification, epithelioid hemangioma of bone is recognized as anintermediate-grade vascular tumor. We report a case of epithelioid hemangioma in the triquetrum with someliterature review.

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35. Fibrocartilaginous Dysplasia: A case report○ Miho Okuda1) Hiroshi Ikeno1) Toshifumi Gabata1) Hiroyuki Inatani2) Yoshitomo Kajino2)
Hiroyuki Tsuchiya2) Hiroko Ikeda3)
1) Department of Radiology, Kanazawa University2) Department of Orthopaedic Surgery, Kanazawa University3) Department of diagnostic pathology, Kanazawa University Hospital

Fibrocartilaginous dysplasia is a rare variant of fibrous dysplasia in which extensive cartilaginous differentiation isobserved. We present a case of a 10-year-old boy with right hip pain. Initial radiographs of the right femur reve
aled an expanded large lucent lesion, which was histologically confirmed as fibrous dysplasia. Over the course of 8
years, the patient underwent several osteotomies and screw fixation because of progression of femur deformity. At
that time, the fibrous dysplasia involved the right pelvis, whole femur, tibia, and talus.
At the age of 18 years, the patient showed extensive right femur deformity. On T2-weighted MRI, the lesion
appeared heterogeneous and well defined, with a relatively high signal intensity area inside the lesion. CT showedamorphous calcification in this area, which was suspected as a cartilage component. Curettage with fixation
surgery of the lesion was performed, and presence of cartilage inside the fibrous dysplasia lesion was confirmed
histologically.

36. A case of osteoid osteoma of the distal phalanx: painful enlargement of the toe○ Mamoru Niitsu1) Taisei Kurihara2) Eiichi Arai3) Mayuko Haraikawa1) Yasuo Yazawa2)
1) Department of Radiology, Saitama Medical University2) Department of Orthopedic Surgery, Saitama Medical University International Medical Center3) Department of Pathology, Saitama Medical University International Medical Center

Osteoid osteomas (OO) involving the phalanges are a rare occurrence. We report a case of OO of the distal phalanxof the toe. A 17-year-old boy presented with progressive, localized pain at the tip of the 4th toe of the left footover one month. There was always pain, not especially at night. The distal segment of the toe showed a bulbous
enlargement and the nail and soft tissue were hypertrophied. There was accompanying erythema and localized
severe tenderness. There was no history of trauma.
Plain radiographs demonstrated a lytic bone lesion with a sclerotic rim, and MRI showed low-intensity core withbone marrow and soft tissue edema in the distal phalanx. Surgical resection was performed and the patient's pain
resolved immediately after the operation. Histological examination revealed vascular fibrous tissue with spongious
bone formation in the center, which was interpreted as an OO.

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37. Imaging of Giant Cell Tumor of Bone after Denosumab Injection○ Sota Oguro1) Shigeo Okuda1) Michiro Susa2) Hideo Morioka2)Masahiro Jinzaki1)

1) Radiology department 2) Orthopedic department
School of Medicine, Keio University[Purpose]
To evaluate a change on the imaging of GCTB after the denosumab injection.
[Materials and Methods]
This retrospective study conducted 15 patients who have GCTB and treated using denosumab from November
2011 to August 2014. The patients comprised 9 men and 6 women with a mean age of 42 ± 14 years. All patientswere diagnosed by a biopsy.
[Results]
Partial remission which showed more than 30% decrease in size was obtained in 2 cases and the other cases wasevaluated as stable disease. All the tumor decreased in size. The size of the secondary cystic change decreased in 5
cases. Bone formation in the tumor was appeared in 6 cases.
[Discussion]
The GCTB decreased in size in all cases after the denosumab injection. However, how long the denosumab should
be continued is still unknown.

38. Ewing sarcoma in phalanx: a case report○ Tomohiro Suzuki1)

Michiko Suzuki1) Hiroshi Tada2) Yoshikuni Mimata2) Takashi Satoh3)

Shigeru Ehara1)
1) Department of radiology 2) Department of orthopedic surgery3) Department of pathology

Iwate medical university

We report a case of Ewing sarcoma of finger, which is a rare location. The patient was initially 9-year-old, andinitial radiograph revealed only soft tissue swelling with no localized bone lesions. The patient was followed up
with no biopsy, but, two years later, high grade osteolytic lesion of the phalanx was evident. Biopsy of the lesion atthat time revealed Ewing sarcoma. The patient was performed chemotherapy, surgical resection of the tumor andreconstruction. Imaging features of high-grade tumor of uncommon location are presented.

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39. Bone metastases from Head & Neck cancer. Retrospective analysis of Whole Body
MRI (WB-MRI), FDG-PET and CT○ Katsuyuki Nakanishi1) Akio Tsukabe1)

Nobuhito Araki2) Noriyuki Tomiyama3)

1) Department of Diagnostic Radiology 2) Department of Orthopedic Surgery
Osaka Medical Center for Cancer and Cardiovascular Diseases
3) Department of Diagnostic Radiology, Osaka University Graduate School of Medicine

Bone metastases from Head & Neck Cancer (HNC) are rare condition and the radiological findings have not been
well analyzed. We assessed ten cases of bone metastases from HNC (3 oropharynx, 2 salivary gland, one each of
larynx, nasopharynx, hypopharynx, nasal cavity and primary unknown) retrospectively using whole body MRI,
FDG-PET and CT. Six of our ten cases, either intratrabecular or subtle osteoblastic pattern are recognized diffusely
in CT. In these 6 cases, these lesions are shown as high intensity on DWI and ADC values are less than 1.2 mm2/sec.
All six cases are squamous cell carcinoma (SCC). In the other four cases, osteolytic lesions are included. Two ofthem are adenoid cystic carcinoma of salivary gland.
Bone metastases from HNC, especially SCC, either intratrabecular or subtle osteoblastic pattern tend to be shownon CT and these lesions are shown as high signal on DWI and low ADC value.

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