Diffusion tensor imaging of peripheral nerve in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a feasibility study.

INTRODUCTION: The purpose of this study was to assess the clinical feasibility of diffusion tensor imaging (DTI) for the evaluation of peripheral nerves in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS: Using a 3-T magnetic resonance imaging scanner, we obtained DTI scans of the tibial nerves of 10 CIDP patients and 10 sex- and age-matched healthy volunteers. We prepared fractional anisotropy (FA) maps, measured the FA values of tibial nerves, and compared these values in the two study groups. In nine patients, we also performed tibial nerve conduction studies and analyzed the correlation between the FA values and parameters of the nerve conduction study. RESULTS: The tibial nerve FA values in CIDP patients (median 0.401, range 0.312-0.510) were significantly lower than those in healthy volunteers (median 0.530, range 0.469-0.647) (Mann-Whitney test, p < 0.01). They were significantly correlated with the amplitude of action potential (Spearman correlation coefficient, p = 0.04, r = 0.86) but not with nerve conduction velocity (p = 0.79, r = 0.11). CONCLUSION: Our preliminary data suggest that the noninvasive DTI assessment of peripheral nerves may provide useful information in patients with CIDP.

Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on long-term follow up.

BACKGROUND AND AIMS: We evaluated the prognosis and associated factors in patients with small hepatocellular carcinoma (HCC; up to 3 nodules, each up to 3 cm in diameter) treated with percutaneous radiofrequency ablation (RFA) as first-line treatment. METHODS: Eighty-eight consecutive patients who underwent percutaneous RFA as first-line treatment were enrolled, among whom 70 who had hypervascular HCC nodules which were treated by a combination of transcatheter arterial chemoembolization and RFA. RFA was repeated until an ablative margin was obtained. RESULTS: The rate of local tumor progression at 1 and 3 years was 4.8% and 4.8%, respectively. The rate of overall survival at 3 and 5 years was 83.0% and 70.0%, and the rate of disease-free survival at 3 and 5 years was 34.0% and 24.0%, respectively. On multivariate analysis, age (< 70 years; hazard ratio [HR] = 2.341, 95% confidence interval [CI] = 1.101-4.977, P = 0.027) and indocyanine green retention rate at 15 min (< 15%; HR = 3.621, 95% CI = 1.086-12.079, P = 0.036) were statistically significant determinants of overall survival, while tumor number (solitary, HR = 2.465, 95% CI = 1.170-5.191, P = 0.018) was identified for disease-free survival. Overall survival of patients with early recurrence after RFA was significantly worse than that of patients with late recurrence. Tumor size was the only independent risk factor of early recurrence after RFA of HCC (tumor size > 2 cm; risk ratio [RR] = 4.629, 95% CI = 1.241-17.241, P = 0.023). CONCLUSION: Percutaneous RFA under the protocol reported here has the potential to provide local tumor control for small HCC. In addition to host factors, time interval from RFA to recurrence was an important determinant of prognosis.

Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices.

OBJECTIVE: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. METHODS: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n=24) and no-change (n=25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. RESULTS: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P=0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P=0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P=0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P=0.435). CONCLUSION: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method.

The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.

Effects of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid on T2-weighted MRCP.

PURPOSE: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a recently developed liver-specific contrast agent for magnetic resonance (MR) imaging that is excreted equally via the kidneys and the biliary system. To our knowledge, its effects on T(2)-weighted MR cholangiopancreatography (MRCP) images have not been explored. Acquisition of the hepatobiliary phase is recommended 20 min after administration of Gd-EOB-DTPA. Examination time cannot be extended if the contrast does not take effect on T(2)-weighted MRCP within 20 min after administration. We attempted to assess the change in signal of T(2)-weighted MRCP by excretion of Gd-EOB-DTPA. METHODS: Between March and July 2008, 40 patients (15 women, 25 men; mean age 70.8 years) were examined with abdominal MR imaging. T(2)-weighted MRCP was performed before and 10 and 20 min after administration of Gd-EOB-DTPA. We analyzed signal intensity of the bile duct, gallbladder, cystic duct, and pancreatic duct on MRCP for changes in intensity. RESULTS: T(2)-weighted MRCP 20 min after contrast administration showed loss of signal of the bile duct (intrahepatic bile duct in all cases, upper extrahepatic duct in 36 [90%], middle extrahepatic duct in 33 [85%], and lower extrahepatic duct in 26 [67%]), the gallbladder in 23 cases (72%), and the cystic duct in 25 (64%). This signal change increased with time. We observed no change in signal of the pancreatic duct. CONCLUSION: T(2)-weighted MRCP sequences should not be obtained after administration of Gd-EOB-DTPA because this contrast agent decreases signal intensity of the biliary structure on these images.

Results of a preliminary study using hypofractionated involved-field radiation therapy and concurrent carboplatin/paclitaxel in the treatment of locally advanced non-small-cell lung cancer.

BACKGROUND: We aimed to evaluate the feasibility and efficacy of hypofractionated involved-field radiation therapy (IFRT) omitting elective nodal irradiation (ENI) with concurrent chemotherapy for locally advanced non-small-cell lung cancer (NSCLC). METHODS: Between July 2004 and July 2006, ten patients with locally advanced NSCLC were included in this study. One had stage IIIA and 9 had stage IIIB disease. The treatment consisted of IFRT in fractions of 2.5 Gy and weekly carboplatin (CBDCA)/paclitaxel (PTX). Hypofractionated IFRT with a median total dose of 65 Gy with median percent total lung volume exceeding 20 Gy (V20) of 20.2%, and a median of five courses of chemotherapy with weekly CBDCA (area under the curve, 1.5-2.0)/PTX (30-35 mg/m(2)) were given to all patients. RESULTS: The median survival time and the 1-, 2-, and 3-year overall survival rates were 29.5 months and 90.0%, 58.3%, and 43.8%, respectively. No elective nodal failure was encountered during the median follow up of 18.2 months. No acute or late toxicities of grade 3 or worse were observed. No in-field recurrence occurred in the group with a total dose of 67.5 Gy or more, but there was such recurrence in 83.3% of those in the group with less than 67.5 Gy. CONCLUSION: Hypofractionated IFRT with weekly CBDCA/PTX was a feasible treatment regimen. Hypofractionated IFRT with a total dose of 67.5 Gy or more could be a promising modality to improve the treatment results in patients with locally advanced NSCLC.

Intra-arterial infusion chemotherapy using cisplatin with radiotherapy for Stage III squamous cell carcinoma of the cervix.

PURPOSE: To examine the effectiveness of concomitant intra-arterial infusion chemotherapy (IAIC) using cisplatin (CDDP) with radiotherapy for Stage III squamous cell carcinoma of the cervix. MATERIALS AND METHODS: We analyzed 29 cases of Stage III squamous cell carcinoma of the uterine cervix treated with radiotherapy and IAIC of CDDP from 1991 to 2006. External-beam therapy was given to the whole pelvis using four opposing parallel fields with an 18-MV linear accelerator unit. A central shield was used after 30-40 Gy with external whole-pelvic irradiation, and the total dose was 50 Gy. High-dose-rate brachytherapy was given with (192)Ir microSelectron. The dose at Point A was 6 Gy per fraction, 2 fractions per week, and the total number of fractions was either 3 or 4. Two or three courses of IAIC were given concomitantly with CDDP 120 mg or carboplatin 300 mg. RESULTS: We confirmed excellent medicine distribution directly by using computed tomographic angiography. The 5-year overall survival rate for Stage III patients was 62%, the cause-specific survival rate was 70%, and the local relapse-free survival rate was 89%. Local recurrence, distant metastasis, and occurrences of both were 7%, 38%, and 3%, respectively. The incidence of severe acute hematologic adverse reactions (Grade > or =3) was 27% for all patients; however, all recovered without interruption of radiotherapy. Severe nonhematologic effects (Grade > or =3) were 3%, including nausea and ileus. Only 1 patient's radiotherapy was interrupted for a period of 1 week because of ileus. Severe late complication rates (Grade > or =3) for the bladder, rectum, and intestine were 3%, 3%, and 10%, respectively. CONCLUSION: A combination of IAIC and systemic chemotherapy should be considered to improve the prognosis of patients with Stage III squamous cell carcinoma of the cervix.

Effect of heart rate and body mass index on the interscan and interobserver variability of coronary artery calcium scoring at prospective ECG-triggered 64-slice CT.

OBJECTIVE: To test the effects of heart rate, body mass index (BMI) and noise level on interscan and interobserver variability of coronary artery calcium (CAC) scoring on a prospective electrocardiogram (ECG)-triggered 64-slice CT. MATERIALS AND METHODS: One hundred and ten patients (76 patients with CAC) were scanned twice on prospective ECG-triggered scans. The scan parameters included 120 kV, 82 mAs, a 2.5 mm thickness, and an acquisition center at 45% of the RR interval. The interscan and interobserver variability on the CAC scores (Agatston, volume, and mass) was calculated. The factors affecting the variability were determined by plotting it against heart rate, BMI, and noise level (defined as the standard deviation: SD). RESULTS: The estimated effective dose was 1.5 +/- 0.2 mSv. The mean heart rate was 63 +/- 12 bpm (range, 44-101 bpm). The patient BMIs were 24.5 +/- 4.5 kg/m(2) (range, 15.5-42.3 kg/m(2)). The mean and median interscan variabilities were 11% and 6%, respectively by volume, and 11% and 6%, respectively, by mass. Moreover, the mean and median of the algorithms were lower than the Agatston algorithm (16% and 9%, respectively). The mean and median interobserver variability was 10% and 4%, respectively (average of algorithms). The mean noise levels were 15 +/- 4 Hounsfield unit (HU) (range, 8-25 HU). The interscan and interobserver variability was not correlated with heart rate, BMI, or noise level. CONCLUSION: The interscan and interobserver variability of CAC on a prospective ECG-triggered 64-slice CT with high image quality and 45% of RR acquisition is not significantly affected by heart rate, BMI, or noise level. The volume or mass algorithms show reduced interscan variability compared to the Agatston scoring (p < 0.05).

Evaluation of attenuation-based tube current control in coronary artery calcium scoring on prospective ECG-triggered 64-detector CT.

RATIONALE AND OBJECTIVES: The aims of this study were to investigate image noise (standard deviation of computed tomographic value) and to assess variability in repeated coronary artery calcium (CAC) scoring on prospective electrocardiographically triggered 64-detctor computed tomography. MATERIALS AND METHODS: Patients (n = 428) suspected of having coronary artery disease were scanned twice using three protocols: with tube current modified by body mass index (BMI; group A), by BMI and body height (group B), and by attenuation at the maximal heart diameter (group C). Image noise was plotted against BMI. Interscan variability of CAC scores was determined. The effective dose was estimated by computed tomographic dose index. RESULTS: The mean effective dose and image noise, respectively, were 0.9 +/- 0.2 mSv (range, 0.6-1.5 mSv) and 19 +/- 4 Hounsfield units (HU) (range, 10-32 HU) for group A; 0.8 +/- 0.2 mSv (range, 0.5-1.4 mSv) and 18 +/- 4 HU (range, 10-31 HU) for group B; and 0.8 +/- 0.4 mSv (range, 0.3-2.2 mSv) and 20 +/- 2 HU (range, 16-26 HU) for group C. Group C used a wide dose range and controlled noise within a small range. The positive slopes of image noise versus BMI, 0.81 HU/(kg/m(2)) in group A and 0.62 HU/(kg/m(2)) in group B, suggested insufficient control of the tube current. In contrast, the nearly flat slope in group C, 0.091 HU/(kg/m(2)), indicated optimal control. The interscan variability for Agatston score, volume, and mass in patients with CAC (n = 300) was 13% (median, 8%), 12% (median, 7%), and 11% (median, 6%), respectively. CONCLUSIONS: CAC scoring on prospective electrocardiographically triggered 64-detector computed tomography using attenuation-based tube current control has the potential to favorably control image noise with low dose and low interscan variability.

Survey of aorta and coronary arteries with prospective ECG-triggered 100-kV 64-MDCT angiography.

OBJECTIVE: The purpose of this study was to investigate the feasibility of prospective ECG-triggered axial 64-MDCT angiography of the aorta and coronary arteries performed at a tube voltage of 100 kV. SUBJECTS AND METHODS: Thirty patients with a heart rate less than 75 beats/min who were referred for aortic CT angiography were enrolled. The image quality of the ascending aorta, aortic valve, and coronary arteries was evaluated for motion artifacts. Contrast enhancement (mean attenuation) was measured in the ascending aorta, descending aorta, and bifurcation of the aorta. Aortic valve and coronary artery lesions were surveyed. RESULTS: Acceptable image quality was achieved in 100% (30/30) of cases for the ascending aorta, 97% (29/30) of cases for the aortic valve, and 98% (442/452) of coronary arterial segments. Contrast enhancement was greater than 200 HU and was satisfactory (ascending aorta, 379 +/- 80 HU; descending aorta, 354 +/- 72 HU; bifurcation, 355 +/- 96 HU). Lesions found in the aortic valve were plaque (n = 16) and bicuspid valve (n = 1) and in the coronary arteries were > or = 50% luminal stenosis (n = 5), plaque (n = 21), myocardial bridge (n = 12), and anomalous origin (n = 1). The effective radiation dose was estimated to be 7.5 +/- 1.7 mSv. CONCLUSION: For patients with a heart rate less than 75 beats/min, prospective ECG-triggered axial CT angiography at a tube voltage of 100 kV has the potential to provide clinically relevant information about the aorta and coronary arteries with low radiation exposure.

Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT.

The purpose of this study was to compare coronary 64-slice CT angiography (CTA) protocols, specifically prospective electrocardiograph (ECG)-triggered and retrospective ECG-gated CT acquisition performed using a tube voltage of 140 kV and 120 kV, regarding intracoronary stent imaging. Coronary artery stents (n = 12) with artificial in-stent restenosis (50% luminal reduction, 40 HU) on a cardiac phantom were examined by CT at heart rates of 50-75 beats per minute (bpm). The subjective visibility of in-stent restenosis was evaluated with a three-point scale (1 clearly visible, 2 visible, and 3 not visible), and artificial lumen narrowing [(inner stent diameter - measured lumen diameter)/inner stent diameter], lumen attenuation increase ratio [(in-stent attenuation - coronary lumen attenuation)/coronary lumen attenuation], and signal-to-noise ratio of in-stent lumen were determined. The effective dose was estimated. The artificial lumen narrowing (mean 43%), the increase of lumen attenuation (mean 46%), and signal-to-noise ratio (mean 7.8) were not different between CT acquisitions (p = 0.12-0.91). However, the visibility scores of in-stent restenosis were different (p < 0.05) between ECG-gated CTA techniques: (a) 140-kV prospective (effective dose 4.6 mSv), 1.6; (b) 120-kV prospective (3.3 mSv), 1.8; (c) 140-kV retrospective (16.4-18.8 mSv), 1.9; and (d) 120-kV retrospective (11.0-13.4 mSv), 1.9. Thus, 140-kV prospective ECG-triggered CTA improves coronary in-stent restenosis visibility at a lower radiation dose compared with retrospective ECG-gated CTA.

Transarterial infusion chemotherapy using cisplatin-lipiodol suspension with or without embolization for unresectable hepatocellular carcinoma.

We evaluate the long-term prognosis and prognostic factors in patients treated with transarterial infusion chemotherapy using cisplatin-lipiodol (CDDP/LPD) suspension with or without embolization for unresectable hepatocellular carcinoma (HCC). Study subjects were 107 patients with HCC treated with repeated transarterial infusion chemotherapy alone using CDDP/LPD (adjusted as CDDP 10 mg/LPD 1 ml). The median number of transarterial infusion procedures was two (range, one to nine), the mean dose of CDDP per transarterial infusion chemotherapy session was 30 mg (range, 5.0-67.5 mg), and the median total dose of transarterial infusion chemotherapy per patient was 60 mg (range, 10-390 mg). Survival rates were 86% at 1 year, 40% at 3 years, 20% at 5 years, and 16% at 7 years. For patients with >90% LPD accumulation after the first transarterial infusion chemotherapy, rates were 98% at 1 year, 60% at 3 years, and 22% at 5 years. Multivariate analysis identified >90% LPD accumulation after the first transarterial infusion chemotherapy (p = 0.001), absence of portal vein tumor thrombosis (PVTT; p < 0.001), and Child-Pugh class A (p = 0.012) as independent determinants of survival. Anaphylactic shock was observed in two patients, at the fifth transarterial infusion chemotherapy session in one and the ninth in the other. In conclusion, transarterial infusion chemotherapy with CDDP/LPD appears to be a useful treatment option for patients with unresectable HCC without PVTT and in Child-Pugh class A. LPD accumulation after the first transarterial infusion chemotherapy is an important prognostic factor. Careful consideration should be given to the possibility of anaphylactic shock upon repeat infusion with CDDP/LPD.

Differential diagnosis of hepatic tumor-like lesions in dog by using dynamic CT scanning.

Dynamic liver CT scanning is used to observe the hemodynamics of hepatic tumor-like lesions by taking images sequentially after administration of contrast media. In this study in dogs, we compared the hemodynamic patterns of hepatocellular carcinoma (HCC), one of the malignant tumors, and nodular hyperplasia (NH), a benign tumor that is more common in older dogs. Thirty-six dogs with HCC and 40 dogs with NH, which were histopathologically diagnosed at Taniura Animal Hospital, were used as subjects. Dynamic CT scanning was performed and the data of each scanning phase were collected. Dilated blood vessels, septum formation, and capsule formation were noted in the tumors from 25, 17, and 25 animals with HCC, respectively. In the arterial phase, high density and low contrast were noted in 8 and 23 dogs, respectively. Low density was noted in 34 dogs in the equilibrium phase. In contrast, no dilated blood vessels, septum formation, or capsule formation was noted in the dogs with NH. High density, low contrast, and low density were noted in 8, 9, and 23 dogs, respectively, in the arterial phase. In the equilibrium phase, the enhancement level was equal to the surrounding liver tissues in all animals. The CT values of HCC in the plain, the arterial phase, portal venous phase and equilibrium phase after the administration of contrast media, were significantly (p < 0.05 to 0.001) lower than those of the surrounding liver tissues. In the arterial phase, the percent incidence of low density was significantly less in HCC than NH, while that of low contrast was significantly greater (p < 0.001) in HCC than NH. Dynamic CT scanning identified differences between the hemodynamics and internal structures of HCC and NH in dogs. Dynamic liver CT scanning can therefore be considered a useful technique in the differential diagnosis of hepatic tumor-like lesions in dogs.

[Concurrent chemoradiation experience of the local relapse of rectal cancer patients].

We have reported the concurrent chemoradiation experience of local relapse of rectal cancer patients. From October 2004 to January 2007 we have treated consecutive 10 patients with radiation and the concurrent chemotherapy by CPT-11+S-1. Of 10 lesions, 5(50%)had a complete response, 2(20%)a partial response, 3(30%)a stable disease, yielding an overall response rate of 70%. Three year survival and relapse free survival was 64% and 22 months, respectively. Four patients live without cancers, 3 patients died with cancers and 2 patients live with cancers. Three patients had acute complication(more than Grade 2)including 3 appetite losses. The concurrent chemoradiation is feasible for out-patients and seems to offer good results for the local relapse of rectal cancer patients.

Intra-arterial 5-fluorouracil/interferon combination therapy for advanced hepatocellular carcinoma with or without three-dimensional conformal radiotherapy for portal vein tumor thrombosis.

BACKGROUND: The aim of this study was to elucidate the efficacy of intra-arterial 5-fluorouracil (5-FU) and interferon (IFN) alpha combined with three-dimensional conformal radiotherapy (3D-CRT) for portal vein tumor thrombosis (PVTT). METHODS: The study groups were 16 HCC patients with PVTT treated with 5-FU/IFN combined with 3D-CRT (RT group) and 16 matched controls treated with 5-FU/IFN alone (non-RT group). We compared the survival rate, response, time to progression (TTP), portal hypertension-related events (PREs) and safety. RESULT: Complete response (CR) of PVTT, partial response (PR), stable disease (SD) and progressive disease (PR) were noted in three (19%), nine (56%), four (25%) and zero patients of the RT group, one (6%), three (19%), seven (44%) and five (31%) patients of the non-RT group, respectively. The objective response rate of PVTT was higher in the RT group (P = 0.012). The rate of PREs (variceal rupture, worsening of esophagogastric varices and emerging of uncontrollable ascites) was lower in the RT group than in the non-RT group (P = 0.0195). The median survival time of the RT group (7.5 months) was not significantly different from that of the non-RT group (7.9 months). RT-induced liver disease was not observed. CONCLUSION: 5-FU/IFN combination with 3D-CRT for PVTT improved the response rate of PVTT and reduced the incidence of portal hypertension-related events.

Decrease of renal function due to warm ischemia after laparoscopic partial nephrectomy: evaluation using 99mTc-DMSA renal scintigraphy.

INTRODUCTION: The purpose of this study is, using technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA), to evaluate the decrease of renal function caused by warm ischemia. PATIENTS AND METHODS: The (99m)Tc-DMSA scan was performed before and 1, 3 and 6 months after the operation for 19 consecutive patients. The patients were divided into three groups by warm ischemic time (group A: 40 min intersection 60 min). Renal function of the unresected part was defined as the uptake to unresected part relative to the uptake to the contralateral kidney. The reduction of renal function was expressed as a ratio of the function after the surgery divided by function before the surgery and was compared between the three groups. RESULTS: The reduction in group C after 1 and 3 months tended to be greater than that in group A or B, although not reaching statistical significance (one-way ANOVA test, 1 month: p = 0.15 and 3 months: p = 0.13). There was a significant difference in reduction of renal function between the three groups after 6 months (one-way ANOVA test, p = 0.02). The Scheffé test showed a statistical significance between groups A and C (p < 0.05). CONCLUSION: Renal function calculated by (99m)Tc-DMSA shows that prolonged ischemic time causes significant damage to the kidney.

Distribution of platinum in the female genital tract and efficacy of radiotherapy combined with transcatheter arterial infusion of cisplatin for locally advanced stage IIIb carcinoma of the uterine cervix.

The current main treatment for locally advanced stage III/IV cervical cancer involves chemoradiotherapy. In this study, we investigated the distribution of platinum in the female genital tract by intra-arterial infusion of platinum (carboplatin 150 mg) during surgery and examined the therapeutic effects of radiotherapy with transcatheter arterial infusion (TAI) of cisplatin for locally advanced carcinoma of the uterine cervix. From January 1991, we randomly selected 26 patients with locally advanced stage IIIb cervical cancer to receive radiotherapy combined with TAI of 120 mg/body cisplatin twice a month at an interval of 4 weeks. Radiotherapy routinely involved 50 Gy of external beam irradiation to the whole pelvis and 12-24 Gy (point A dose) of intracavitary irradiation using a remote afterloading system. The mean platinum concentration in the cervical cancer was 1.77 microg/g wet tissue (wt) and high value, but the genital tract also contained the same platinum concentration. The platinum concentration in each regional lymph node was 1.10-1.48 microg/g wt, and its level of platinum was equal to that in the female genital tract. The effective histologic response rate was 88.5% (23/26). The median follow-up period was 38 months. The cumulative survival rate was 74.0%. Serious acute adverse reactions interfering with treatment were not observed. Based on these results, intra-arterial infusion of platinum produced a therapeutic effect on the primary cervical cancer site and the other parts of the female genital tract. We concluded that radiotherapy with TAI of cisplatin achieved superior therapeutic efficacy in locally advanced stage IIIb cervical cancer.

FDG positron emission tomography/computed tomography for the detection of extrahepatic metastases from hepatocellular carcinoma.

AIMS: To compare the efficacy of positron emission tomography (PET) computed tomography (CT), multi-detector helical computed tomography (MDCT) and bone scintigraphy for the detection of extrahepatic metastases in patients with hepatocellular carcinoma (HCC). METHODS: Thirty-four patients diagnosed with metastatic HCC were enrolled in this study. The lesions included lung (n = 18), bone (n = 12) and lymph node (n = 16) metastases. For receiver operating characteristic (ROC) analysis, lesions were diagnosed as metastatic HCC by two experienced abdominal radiologists. Another three physicians independently reviewed both positive and negative images. Each physician read three sets of images of MDCT, PET-CT and bone scintigraphy for bone metastasis. RESULTS: The mean sensitivity and specificity for diagnosis of lung metastasis were 85.2 and 88.9% for MDCT, and 59.2 and 92.6% for PET-CT, respectively. For lymph node metastasis, these values were 62.5 and 79.2% for MDCT, and 66.7 and 91.7% for PET-CT, respectively; and for bone metastasis 41.6 and 94.5% for MDCT, 83.3 and 86.1% for PET-CT, and 52.7 and 83.3% for bone scintigraphy, respectively. The mean Az values were 0.95 and 0.77 for MDCT and PET-CT in lung metastasis, respectively, 0.75 and 0.80 for MDCT and PET-CT for lymph node metastasis, respectively, and 0.59, 0.88 and 0.62 for MDCT, PET-CT and bone scintigraphy for bone metastasis, respectively. CONCLUSION: PET-CT has high sensitivity and is more suitable for the detection of bone metastases from primary HCC, relative to MDCT and bone scintigraphy.

Coronary artery calcium scoring on low-dose prospective electrocardiographically-triggered 64-slice CT.

RATIONALE AND OBJECTIVES: The purpose of this prospective study was to assess image noise and variability in repeated coronary artery calcium (CAC) scoring on low-dose prospective electrocardiographically-triggered 64-slice multidetector computed tomography. MATERIALS AND METHODS: Patients (n = 115) suspected of having coronary artery disease were scanned twice, using a tube current of 10 x body mass index mA. The standard deviation (SD) of the computed tomographic value in the ascending aorta and (mean + 2 x SD) were obtained. Repeated CAC scores (Agatston, volume, and mass) were measured by two observers, and the interscan and interobserver variability were determined. RESULTS: The mean tube current used was 246 +/- 36 mA. The mean tube current-time product and mean estimated effective dose were 57 +/- 8 mA and 0.9 +/- 0.2 mSv, respectively. The SD and (mean + 2 x SD) computed tomographic values in the ascending aorta were 16 +/- 3 and 75 +/- 10 Hounsfield units, respectively. Repeated CAC scores were correlated (r(2) = 0.995-0.998). The interscan variability for observer 1 and observer 2, respectively, were 13% and 13% for Agatston score, 12% and 11% for volume, and 11% and 11% for mass. The interobserver variability for scan 1 and scan 2, respectively, were 3% and 3% for Agatston score, 5% and 3% for volume, and 3% and 3% for mass. CONCLUSION: Low-dose prospective electrocardiographically-triggered 64-slice multidetector computed tomography shows low interscan and interobserver variability on CAC scoring while maintaining low image noise.

Significant correlation between spleen volume and thrombocytopenia in liver transplant patients: a concept for predicting persistent thrombocytopenia.

Interferon (IFN) therapy with or without ribavirin treatment is well established as a standard antiviral treatment for hepatitis C virus (HCV)-infected patients. However, susceptibility to thrombocytopenia is a major obstacle for initiating or continuing this therapy, particularly in liver transplant (LTx) recipients with HCV. Studies have reported that splenectomy performed concurrently with LTx is a feasible strategy for conditioning patients for anti-HCV IFN therapy. However, the relationship between the severity of splenomegaly and alterations in the blood cytopenia in LTx recipients remains to be clarified. Here, we analyzed the relationship between spleen volume (SV) and thrombocytopenia in 45 patients who underwent LTx at Hiroshima University Hospital. The extent of pre-LTx splenomegaly [the SV to body surface area (BSA) ratio in an individual] was inversely correlated with both the post-LTx white blood cell count and platelet (PLT) count (P < 0.001). Furthermore, the PLT count of patients with thrombocytopenia (PLT count or= 400), persistent thrombocytopenia is predictable after LTx.