Anti-inflammatory and morphologic effects of pitavastatin on carotid arteries and thoracic aorta evaluated by integrated backscatter trans-esophageal ultrasound and PET/CT: a prospective randomized comparative study with pravastatin (EPICENTRE study).

BACKGROUND: We sought to evaluate the effects of a strong lipophilic statin (pitavastatin) on plaque components and morphology assessed by transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE), as well as plaque inflammation assessed by 18F-fluorodeoxyglucose (FDG) PET/CT in the thoracic aorta and the carotid artery. Furthermore, we compared the effects of pitavastatin with those of mild hydrophilic statin (pravastatin). METHODS: We examined atherosclerotic plaques in the thoracic aorta by TEE and those in the carotid artery by integrated backscatter (IBS)-TTE and PET/CT. We identified the target plaque, where there was macrophage infiltration and inflammation, by strong FDG uptake in the thoracic aorta and carotid arteries and measured maximum standard uptake values (max SUV) by PET/CT. We measured the intima-media thickness (IMT) and the corrected IBS (cIBS) values in the intima-media complex by TEE and TTE at the same site of FDG accumulation by PET/CT. RESULTS: Patients were randomly divided into two treatment groups: a pitavastatin group (PI group: n =10, 68.4 ± 5.1 years) and a pravastatin group (PR group: n =10, 63.9 ± 11.2 years). The same examinations were performed after six months at the same site in each patient. We used calculated target-to-background ratio (TBR) to measure max SUV of plaques and evaluated percent change of TBR. There was no significant difference in low density lipoprotein-cholesterol, TBR, IMT and cIBS values in plaques at baseline between the PI and PR groups. After treatment, there was greater improvement in TBR, cIBS values and IMT in the PI group than the PR group. CONCLUSIONS: The pravastatin treatment was less effective on plaque inflammation than pitavastatin treatment. This trend was the same in the carotid arteries and the thoracic aorta. Pitavastatin not only improved the atherosis as measured by IMT and cIBS values but also attenuated inflammation of plaques as measured by max SUV at the same site. The present study indicated that pitavastatin has stronger effects on the regression and stabilization of plaques in the thoracic aorta and carotid arteries compared with pravastatin.

Preoperative detection of prostate cancer: a comparison with 11C-choline PET, 18F-fluorodeoxyglucose PET and MR imaging.

PURPOSE: To compare (11)C-choline positron emission tomography (C-PET), (18)F-fluorodeoxyglucose PET (FDG-PET), and MR imaging in the preoperative detection of prostate cancer. MATERIALS AND METHODS: C-PET, FDG-PET, and MR images were obtained in 43 consecutive patients with suspected prostate cancer, and prostate cancers were histopathologically confirmed in 26 patients. Unenhanced T1-weighted, T2-weighted, and gadolinium-enhanced MR images were obtained. C-PET and FDG-PET were conducted 1.5 and 60 minutes after injection of 5.5 and 5.0 MBq/kg tracers, respectively. A nuclear and a genitourinary radiologist retrospectively reviewed PET and MR images at random, respectively, and assigned a confidence level for the presence of prostate cancer using a four-point scale. Diagnostic performance was tested using the McNemar test and receiver operating characteristic curve analysis. RESULTS: The sensitivity was greater (P < 0.05) with MR (88%) and C-PET (73%) images than with FDG-PET images (31%). The accuracy was greater (P < 0.05) with MR images (88%) than with C-PET (67%) and FDG-PET (53%) images. The area-under-curve value with MR (0.90) was greater than those with C-PET (0.53) and FDG-PET (0.54) images (P < 0.01). CONCLUSION: MR imaging should be primarily performed in the preoperative detection of prostate cancer. C-PET and FDG-PET did not improve the detection.

Mediastinal lymph node staging in potentially resectable non-small cell lung cancer: a prospective comparison of CT and EUS/EUS-FNA.

BACKGROUND: Mediastinal lymph node staging (N-staging) is essential to optimize the treatment in non-small cell lung cancer (NSCLC). Transesophageal endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has recently been introduced as a complementary method. However, in most reports, EUS-FNA has been performed in patients who have demonstrated enlarged lymph nodes (LNs) on CT findings. The yield of EUS/EUS-FNA in patients without enlarged mediastinal LNs by CT has so far only been evaluated in a few reports. AIMS: Our aim was to compare the diagnostic accuracy of CT and EUS with or without EUS-FNA (EUS/EUS-FNA) prospectively, for N-stage in all patients with potentially resectable NSCLC, including patients with and without mediastinal LN enlargement based on CT findings. METHODS: Eighty consecutive patients with potentially resectable NSCLC based on CT findings were enrolled in this prospective comparative study, and underwent EUS/EUS-FNA. RESULTS: Pathological N-stage was established in 78 patients, while in another 2 cases, malignant pleural effusion was proven by EUS-FNA, and we avoided further N-staging. In the 78 patients, the prevalence of malignant mediastinal LNs was 21%. The accuracy of EUS/EUS-FNA (91%) was significantly higher than that of CT (71%). The negative predictive value of EUS/EUS-FNA was 90%. In addition, EUS-FNA identified 2 patients as N3 disease in 56 patients without mediastinal LN involvement on CT. CONCLUSIONS: EUS/EUS-FNA gave more accurate N-staging in patients with possibly resectable NSCLC than CT, and is thus considered to be useful to determine the optimal treatment strategy.

Detection of malignant hepatic tumors with ferumoxide-enhanced MR imaging: usefulness of multishot and single-shot fast spin echo sequences.

The purpose of our study was to assess whether respiratory-triggered multishot fast spin echo (MS-FSE) and breath-hold half-Fourier single-shot fast spin echo (SS-FSE) images, in addition to breath-hold T(2)*-weighted gradient recalled echo (GRE) images, increase observer performance in the detection of malignant hepatic tumors with ferumoxide-enhanced magnetic resonance (MR) imaging. Ferumoxide-enhanced MR images obtained from 48 patients with 83 malignant hepatic tumors were retrospectively reviewed by three independent off-site readers. In the first image review, GRE images alone were reviewed. Then, MS-FSE images were added for the first combination review. Finally, SS-FSE images were added for the second combination review. Observer performances were tested by McNemar's test and receiver-operating-characteristic analysis for the clustered data. Sensitivity for hepatocellular carcinomas, metastases, and malignant hepatic tumors overall was significantly (p < 0.05) higher with GRE and MS-FSE combined and GRE, MS-FSE and SS-FSE combined than with GRE alone. For metastases, the Az value was significantly (p < 0.05) higher with GRE and MS-FSE combined, and GRE, MS-FSE and SS-FSE combined than with GRE alone. We confirmed the incremental value of ferumoxide-enhanced MR imaging by obtaining MS-FSE and SS-FSE images in addition to GRE images in the detection of malignant hepatic tumors.

Target definition by C11-methionine-PET for the radiotherapy of brain metastases.

PURPOSE: To evaluate the ability of 11C-methionine positron emission tomography (MET-PET) to delineate target volumes for brain metastases and to investigate to what extent tumor growth is presented by magnetic resonance imaging (MRI) and MET-PET. MATERIALS AND METHODS: Three observers undertook target definition in 19 patients with 95 brain metastases by MRI and MET-PET images. MRI gross target volume (GTV) (GTV-MRI) was defined as the contrast-enhanced area on gadolinium-enhanced T1-weighted MRI. MET-PET GTV (GTV-PET) was defined as the area of an accumulation of MET-PET apparently higher than that of normal tissue on MET-PET images. The size of occupation ratio was determined using the following equation: SOR (%) of MET are within x mm margin outside GTV-MRI = the volume of the GTV-PET within x mm outside the GTV-MRI/the volume of the GTV-PET. RESULTS: For GTV-MRI volumes of 0.5 mL, GTV-PET volumes were larger than GTV-MRI volumes and a significant correlation was found between these variables by linear regression. For all tumor sizes and tumor characteristics, a 2-mm margin outside the GTV-MRI significantly improved the coverage of the GTV-PET. CONCLUSIONS: Although there were some limitations in our study associated with spatial resolution, blurring effect, and image registrations with PET images, MET-PET was supposed to have a potential as a promising tool for the precise delineation of target volumes in radiotherapy planning for brain metastases.

A failed case to diagnose cardiac sarcoidosis presenting advanced atrioventricular block.

A 53-year-old-male developed atrioventricular block in January 2001. A chest X-ray and laboratory tests, including serum angiotensin converting enzyme, were normal. The patient underwent permanent pacemaker implantation and attended for semiannual follow-up after discharge since the etiology of advanced atrioventricular block remains unknown. One year later, the patient was diagnosed with uveitis related to sarcoidosis. No clinical finding specific to cardiac sarcoidosis was notable at that time. Four years after onset, the patient developed congestive heart failure. An echocardiogram revealed diffuse LV hypokinesis, but no asymmetric interventricular septal thinning. Laboratory tests showed normal angiotensin converting enzyme. Noncaseating granuloma was not confirmed by transbronchial biopsy. Despite normal myocardial uptake of gallium-67, uptake of (18)F-Fluorodeoxyglucose increased in the myocardium. Nevertheless, clinical manifestations did not match the criteria for cardiac sarcoidosis. Prednisolone was administered daily. Two months after tapering dosage, the patient developed multiple organ failure and died. Post mortem histological findings were consistent with cardiac sarcoidosis. We experienced great difficulty in detecting cardiac involvement in the early stage of sarcoidosis. A specific method with greater sensitivity is required to diagnose cardiac involvement in the early stages of sarcoidosis.

Embolization for massive urethral hemorrhage.

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.

A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography.

UNLABELLED: AIMS; Our study aims to investigate the pathophysiologic mechanism underlying tako-tsubo cardiomyopathy using F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). METHODS AND RESULTS: Fifteen patients with tako-tsubo cardiomyopathy were enrolled in this study. Plasma catecholamines, cardiac troponin T (cTnT), and D-dimer were serially evaluated in all patients. Thallium-201 ((201)Tl) single-photon emission computed tomography (SPECT) and F-18 FDG PET were performed in 10 and eight patients, respectively. Emotional or physical stress occurred in 12 (80.0%) patients. ST-T segment abnormalities existed in all patients. Thirteen patients exhibited mildly elevated cTnT, although coronary angiography did not reveal significant stenosis in any patient. Endomyocardial biopsy specimens (n = 9) demonstrated contraction-band necrosis (n = 4) and mononuclear cell infiltration (n = 3). The levels of norepinephrine and epinephrine peaked on admission (744 +/- 452 and 140 +/- 166 pg/mL, respectively). There was severely reduced uptake at the apex on F-18 FDG PET image, despite slightly reduced uptake of (201)Tl. Elevation of D-dimer was observed in nine patients. CONCLUSION: The extent of metabolic defect involving apical akinetic area was more severe than perfusion abnormality. Our data suggest that sudden emotional or physical stress may cause a catecholamine-induced metabolic disorder in the myocardium, which is probably central to this syndrome.

Malignant hepatic tumor detection with ferumoxide-enhanced magnetic resonance imaging: is chemical-shift-selective fat suppression necessary for fast spin-echo sequence?

PURPOSE: To determine whether chemical-shift-selective (CSS) fat suppression is necessary for ferumoxide-enhanced T2-weighted fast spin-echo (FSE) imaging in the detection of malignant hepatic tumors. MATERIALS AND METHODS: Ferumoxide-enhanced magnetic resonance (MR) images obtained in 38 patients with surgically confirmed 61 malignant hepatic tumors (36 hepatocellular carcinomas (HCCs), 25 metastases) were retrospectively reviewed by three independent readers. Three sequences of MR images with CSS fat-suppressed T2-weighted FSE, non-fat-suppressed T2-weighted FSE, and T2*-weighted gradient-recalled-echo (GRE) sequences were randomly reviewed on a segment-by-segment basis in a blind fashion. Observer performance was tested using the McNemar's test and receiver-operating-characteristic (ROC) analysis for the clustered data. Lesion-to-liver contrast-to-noise ratio (C/N) was also assessed. RESULTS: The mean C/N with the CSS fat-suppressed FSE sequence was highest in HCCs, metastases, and tumors overall. Sensitivity was highest with the CSS fat-suppressed FSE sequence in HCC, was highest with the non-fat-suppressed FSE sequence in metastases, and was comparable in tumors overall. Specificity was comparable between the sequences. The area under ROC curve (Az) value was greatest with the CSS fat-suppressed FSE sequence in HCCs, was greatest with the non-fat- suppressed FSE sequence in metastases, and was comparable in tumors overall. The sensitivities and Az values were lower with the GRE sequence than the FSE sequence. CONCLUSION: The CSS fat-suppressed FSE sequence was superior to the GRE sequence in the detection of HCCs, but the non-fat-suppressed FSE sequence was comparable to the GRE sequence. The non-fat-suppressed FSE sequence was superior to the CSS fat-suppressed FSE and GRE sequences in the detection of metastases. Optimal FSE imaging with CSS fat suppression or without aiming for the detection of HCCs or metastases, respectively, outperforms GRE imaging in ferumoxide-enhanced MRI.

Detection of malignant hepatic tumors with ferumoxides-enhanced MRI: comparison of five gradient-recalled echo sequences with different TEs.

OBJECTIVE: The purpose of our study was to compare the detectability of malignant hepatic tumors on ferumoxides-enhanced MRI using five gradient-recalled echo sequences at different TEs. MATERIALS AND METHODS: Ferumoxides-enhanced MRIs obtained in 31 patients with 50 malignant hepatic tumors (33 hepatocellular carcinomas, 17 metastases) were reviewed retrospectively by three independent offsite radiologists. T1-weighted gradient-recalled echo images with TEs of 1.4 and 4.2 msec; T2*-weighted gradient-recalled echo images with TEs of 6, 8, and 10 msec; and T2-weighted fast spin-echo images of livers were randomly reviewed on a segment-by-segment basis. Observer performance was tested using the McNemar test and receiver operating characteristic analysis for the clustered data. Lesion-to-liver contrast-to-noise ratio was also assessed. RESULTS: Mean lesion-to-liver contrast-to-noise ratios were negative and lower with gradient-recalled echo at 1.4 msec than with the other sequences. Sensitivity was higher (p < 0.05) with gradient-recalled echo at 6, 8, and 10 msec and fast spin-echo sequences (75-83%) than with gradient-recalled echo sequences at 1.4 and 4.2 msec (46-48%), and was higher (p < 0.05) with gradient-recalled echo sequence at 8 msec (83%) than with gradient-recalled echo at 6 msec and fast spin-echo sequences (75-78%). Specificity was comparably high with all sequences (95-98%). The area under the receiver operating characteristic curve (A(z)) was greater (p < 0.05) with gradient-recalled echo at 6, 8, and 10 msec and fast spin-echo sequences (A(z) = 0.91-0.93) than with gradient-recalled echo sequences at 1.4 and 4.2 msec (A(z) = 0.82-0.85). CONCLUSION: In the detection of malignant hepatic tumors, gradient-recalled echo sequences at 8 msec showed the highest sensitivity and had an A(z) value and lesion-to-liver contrast-to-noise ratio comparable with values from gradient-recalled echo sequences at 6 and 10 msec and fast spin-echo sequences.