Combined multi-kernel head computed tomography images optimized for depicting both brain parenchyma and bone.

BACKGROUND: The hybrid convolution kernel technique for computed tomography (CT) is known to enable the depiction of an image set using different window settings. OBJECTIVE: Our purpose was to decrease the number of artifacts in the hybrid convolution kernel technique for head CT and to determine whether our improved combined multi-kernel head CT images enabled diagnosis as a substitute for both brain (low-pass kernel-reconstructed) and bone (high-pass kernel-reconstructed) images. METHODS: Forty-four patients with nondisplaced skull fractures were included. Our improved multi-kernel images were generated so that pixels of >100 Hounsfield unit in both brain and bone images were composed of CT values of bone images and other pixels were composed of CT values of brain images. Three radiologists compared the improved multi-kernel images with bone images. RESULTS: The improved multi-kernel images and brain images were identically displayed on the brain window settings. All three radiologists agreed that the improved multi-kernel images on the bone window settings were sufficient for diagnosing skull fractures in all patients. CONCLUSIONS: This improved multi-kernel technique has a simple algorithm and is practical for clinical use. Thus, simplified head CT examinations and fewer images that need to be stored can be expected.

18F-FDG-PET/CT as an indicator for resection of pulmonary epithelioid hemangioendothelioma.

A 60-year-old man with a 7-year history of multiple pulmonary nodules presented to our hospital because the nodules were seen to have increased in size on review of films on a regular medical checkup 1 week earlier. Computed tomography (CT) revealed multiple pulmonary nodules with calcification in the lungs. The largest nodule measuring 2.5 cm in the maximum dimension was lobulated and ill-defined. The patient underwent 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) to evaluate the multiple nodules and to search for a primary lesion. 18F-FDG-PET/CT revealed increased uptake in only two nodules with a standardized uptake value of 4.61 and 2.10, respectively. The two foci with increased 18F-FDG uptake were resected and pathologically proven to be pulmonary epithelioid hemangioendothelioma (PEH). PEH can transform into malignancy with metastasis. An 18F-FDG-PET/CT finding may be an indicator to decide on PEH resection.

[Chronological change in the national health insurance reimbursement based on the DPC package payment system regarding 131I internal therapy].

The national health reimbursement in 131I internal therapy for thyroid cancer and Graves' disease has increased by introducing the DPC package payment system. The thyroid cancer administration fee for shield room should be increased because of the strict regulation for 131I internal therapy, expensive equipments, confinement of radiopharmaceutical supply, and low efficiency in admission to shield rooms. In addition, the Graves' disease administration fee for shield room should be introduced since the inpatients undergo the same administration and care as the thyroid cancer inpatients.

[Statistical study on the self-selection bias in FDG-PET cancer screening by a questionnaire survey].

A questionnaire survey was performed to investigate the possible presence of self-selection bias in 18F-FDG PET cancer screening (PET cancer screening). Responders to the questionnaires survey consisted of 80 healthy persons, who answered whether they undergo PET cancer screening, health consciousness, age, sex, and smoking history. The univariate and multivariate analyses on the four parameters were performed between the responders who were to undergo PET cancer screening and the responders who were not. Statistically significant difference was found in health consciousness between the above-mentioned two groups by both univariate and multivariate analysis with the odds ratio of 2.088. The study indicated that self-selection bias should exist in PET cancer screening.

Clinical significance of the serum IL-2R level and Ga-67 scan findings in making a differential diagnosis between sarcoidosis and non-Hodgkin's lymphoma.

OBJECTIVE: To compare the serum-soluble interleukin-2 receptor (sIL-2R) levels of non-Hodgkin's lymphoma patients and active sarcoidosis patients in relation to the (67)Ga scan findings. METHODS: A total of 29 adenopathy patients suspected of having non-Hodgkin's lymphoma or sarcoidosis were enrolled in the study. All patients underwent a whole-body (67)Ga scan and single-photon emission computed tomography studies 48 h after intravenous injection of (67)Ga citrate. The sIL-2R levels were compared between the sarcoidosis patients and non-Hodgkin's lymphoma patients, the patients with and without the panda and/or lambda sign, the lymphoma patients with stage I/II disease and with stage III/IV disease, and the sarcoidosis patients and non-Hodgkin's lymphoma patients with stage III/IV disease. RESULTS: The range of the sIL-2R levels was 195-3750 U/ml in sarcoidosis and 240-62 300 U/ml in non-Hodgkin's lymphoma. The sIL-2R levels of the six non-Hodgkin's lymphoma patients with stage III/IV disease were significantly higher than those of the 15 sarcoidosis patients (P < 0.001). The sIL-2R levels of the sarcoidosis patients with the panda and/or lambda sign were significantly higher than those with neither sign (P < 0.005). The sIL-2R levels of the non-Hodgkin's lymphoma patients with stage III/IV disease were significantly higher than those of the patients with stage I/II disease (P < 0.005). CONCLUSIONS: Measurement of sIL-2R levels was sometimes useful in differentiating between sarcoidosis and stage III/IV non-Hodgkin's lymphoma, staging non-Hodgkin's lymphoma, and predicting the presence of the panda and/or lambda sign in sarcoidosis patients.

Does supplementation of contrast MR imaging with thallium-201 brain SPECT improve differentiation between benign and malignant ring-like contrast-enhanced cerebral lesions?

OBJECTIVE: To determine whether thallium-201 ((201)Tl) brain single photon emission computed tomography (SPECT) could supplement magnetic resonance (MR) imaging diagnostic information by visual comparison of two separate data sets from patients with ring-like contrast-enhanced cerebral lesions. METHODS: A combination of MR imaging and (201)Tl brain SPECT sets obtained from 13 patients (10 men, 3 women) ranging in age from 26 years to 86 years (mean 61.0 years) were retrospectively reviewed. A total of 12 patients had a solitary lesion, and the others had multiple lesions. All but two intracranial foci were pathologically confirmed. The final diagnoses were six glioblastomas, two cerebral metastases from lung cancer, and one each of abscess, resolving hematoma, primary central nervous system lymphoma, toxoplasmosis, and radiation necrosis. The two separate image formats (MR images and SPECT) were shown to ten readers with practical experience. All of the MR images for each patient were shown to each reader first. After interpreting them, the readers were shown the SPECT images. Images were scored in terms of how benign or malignant the foci were on a 5-point scale from "definitely benign" to "definitely malignant." RESULTS: The improvement in the performance of all ten readers was from 67.7% to 93.8% in mean accuracy (P = 0.0028) and from 0.730 to 0.971 in mean Az value (P = 0.0069) after they were shown the (201)Tl brain SPECT images. CONCLUSIONS: (201)Tl brain SPECT should substantially increase confidence in the diagnosis of intracranial lesions with ring-like contrast enhancement when MR imaging does not permit differentiation between benign and malignant disease.

Pulmonary spread of laryngeal papillomatosis: radiological findings.

Laryngeal papillomatosis is a rare benign disease seen in children and young adults. The spread of laryngeal papillomas throughout the respiratory tract occurs rarely; and involvement of the distal bronchi, bronchioles, and lung parenchyma is very rare. We report a case of pulmonary spread of laryngeal papillomatosis in a 34-year-old man, focusing on the radiological evidence. Chest radiographs showed pulmonary nodules, but computed tomography scans more clearly demonstrated multiple small nodules showing cavitations and distributed centrilobularly. Pulmonary nodules and cavitations progressed gradually through the 6-year follow-up. The combination of clinical and characteristic radiological features suggests a diagnosis of pulmonary spread of laryngeal papillomatosis.

Single dose planning for radioiodine-131 therapy of Graves' disease.

OBJECTIVE: Patients with Graves' disease were studied one year after radioiodine-131 therapy to assess the relationship between the effectiveness of the therapy and the radioiodine doses used. METHODS: Patients were classified into three groups according to thyroid function as hyperthyroidism, euthyroidism and hypothyroidism at one year after I-131 therapy. In these groups we compared the mean values of dose, dose per thyroid weight calculated with I-123 uptake before the therapy (pre D/W), dose per thyroid weight calculated with therapeutic I-131 uptake (post D/W), and absorbed dose. RESULTS: No significant differences were found between the three groups in terms of dose or pre D/W. The mean values of post D/W and absorbed dose in the non-hyperthyroid (euthyroid and hypothyroid) group were significantly greater than those in the hyperthyroid group. Post D/W of 6.3 MBq/g was a threshold separating the non-hyperthyroid group from the hyperthyroid group. There was no correlation between pre D/W and post D/W; however, the mean post D/W was significantly greater than the mean pre D/W. All patients with pre D/W above 6.3 MBq/g showed non-hyperthyroidism at one year after the radioiodine treatment. CONCLUSIONS: No indicators before the radioiodine therapy had significant relationships with the effectiveness of the therapy at one year after the treatment. However, the single therapy planned for setting the pre D/W above 6.3 MBq/g will certainly make the patients non-hyperthyroid. As this proposal of dose planning is based on a small number of patients, further study is needed.

Multifactorial analysis on the short-term side effects occurring within 96 hours after radioiodine-131 therapy for differentiated thyroid carcinoma.

OBJECTIVE: This study was performed to clarify factors that might influence short-term side effects occurring within 96 hours after administration of 131I for patients with thyroid carcinoma. METHODS: In 71 patients with differentiated thyroid carcinoma, short-term side effects including gastrointestinal complaints, salivary gland swelling with pain, change in taste and headache were retrospectively analyzed. All patients were given domperidone for prevention of gastrointestinal complaints and advised to consume sour foods to promote discharge of radioiodine from the salivary glands. Selected factors possibly affecting the incidence of side effects were dose per body weight, TSH, effective half-life of 131I, sex, age, 131I accumulation into the stomach and salivary glands, and edema prior to radioiodine administration. The factors were evaluated by multivariate analyses. RESULTS: Incidence of gastrointestinal complaints, salivary gland swelling with pain, change in taste and headache was 65.2%, 50.0%, 9.8% and 4.4%, respectively. In gastrointestinal complaints, the incidence of appetite loss, nausea and vomiting was 60.9%, 40.2% and 7.6%, respectively. The gastrointestinal complaints increased significantly in the patients dosed above 55.5 MBq/kg and with TSH elevation. For salivary gland swelling with pain, female patients displayed a significantly higher incidence than males. No statistically significant factors were detected for change in taste or headache. CONCLUSIONS: Significant factors influencing short-term side effects were dose per body weight and TSH values for gastrointestinal complaints, and female sex for salivary gland swelling with pain. Our preliminary experience suggests that the most frequent gastrointestinal complaints can be prevented with ramosetron.

Combined multi-kernel chest computed tomography images optimized for depicting both lung and soft tissue.

PURPOSE: To evaluate the quality of our improved multi-kernel chest computed tomography (CT) images. METHODS: A random sample of 50 normal patients was retrospectively selected from those who underwent chest CT scans between January 2010 and July 2010. Normal lung structures were divided into six categories, and two radiologists independently compared with lung images. RESULTS: The improved multi-kernel images were displayed identically to soft tissue images on soft tissue window settings and were evaluated as equal to lung images on lung window settings. CONCLUSIONS: This improved multi-kernel technique required fewer stored images and simplified examinations of chest CT.

Radiation-induced myositis mimicking chest wall tumor invasion in two patients with lung cancer: a PET/CT study.

Two patients with lung cancer who had undergone stereotactic body radiation therapy (SBRT) exhibited increased F-18 FDG uptake in the chest wall after 6 months and 18 months, respectively, after SBRT. The prescribed dose of 50 Gy to the planning target volume was delivered on 4 consecutive days in each patient. It is important for nuclear medicine physicians to be familiar with F-18 FDG PET/CT findings ascribed to radiation-induced myositis in lung cancer patients treated with SBRT so that an appropriate differential diagnosis can be established.

Questionnaire survey of hospitals in Saitama Prefecture regarding the shortage of 99mTc-labeled radiopharmaceuticals and 99Mo/99mTc generators.

OBJECTIVE AND METHODS: A questionnaire survey was conducted at all 32 hospitals in Saitama Prefecture to investigate the current difficult situation in terms of nuclear medicine management in the face of the (99m)Tc shortage due to insufficient supply, and 29 hospitals (90.6%) replied. RESULTS: Of the 29, 15 (51.7%) reported a reduction in the number of nuclear medicine studies performed due to the shortage of supply, although the reduction was small. The decrease per month was less than 20 studies in 73% of the institutions. Of the nuclear medicine studies that involve the use of (99m)Tc, the studies whose reduction in number most seriously affected patient management were, in decreasing order: (99m)Tc-MAA lung perfusion scans, (99m)Tc-MAG(3), (99m)Tc-DTPA, or (99m)Tc-DMSA renoscans, (99m)Tc-MDP bone scans, (99m)Tc-HMPAO or ECD brain SPECT studies, (99m)Tc-MIBI or tetrofosmin myocardial SPECT studies, (99m)Tc-radiocolloid sentinel lymphoscintigraphy, (99m)Tc-HSA-D or pyrophosphate bleeding scans, (99m)Tc-GSA hepatic function reserve scans, and (99m)Tc-MIBI parathyroid scans. The reduction is probably ascribable to factors such as cancellations of emergency studies, absence of substitute studies, sequential studies using the same radiopharmaceutical, and higher cost of the syringe-type products than the vial-type products. Substitutes for (99m)Tc studies were performed at 52% (15/29) of the institutions. Myocardial perfusion imaging with (201)Tl chloride was the most common substitute study. CONCLUSIONS: The results of this survey suggested the several procedures to resolve the issues related to the shortage. The staffs at all institutions except one gave the impression that their nuclear medicine ordering systems had been greatly affected by the shortage of supply. This adverse circumstance, however, may provide a good opportunity to educate the public about nuclear medicine studies that use (99m)Tc and SPECT, with which citizen are now unfamiliar.