Iatrogenic venous air embolism caused by CT injector--from a risk management point of view.

An iatrogenic venous air embolism caused by computed tomography (CT) injector occurred in a 74-year-old man undergoing abdominal-pelvic CT for evaluation of an abdominal aortic aneurysm (AAA). During the initial inspection scan of the thoracic part, a large amount of air was detected in the right ventricle, but no contrast medium was noted in the aorta. Surface oxygen was given immediately, and the patient was placed in the left lateral decubitus position on the CT bed. During that time he had no symptoms except coughing. CT revealed no air in the brain or pulmonary vein, and he was returned to his room 55 minutes after the incident. There were no complications during a six-month follow-up period. The importance of daily risk management and immediate proper after care to prevent such accidents was reconfirmed.

[A case of thymic carcinoma responded to intra-arterial chemotherapy combined with radiation therapy].

A 70-year-old male complained of pain in the left neck. A tumor of about 8 cm in diameter was detected by contrast CT in the region extending from the anterior to upper mediastinum. For definitive diagnosis, biopsy was performed under CT guidance, and the patient was diagnosed as having anaplastic carcinoma in the thymus (T4, N1, M0, stage IVb). Since surgical treatment was judged to be impossible because of infiltration into large blood vessels, the patient underwent chemotherapy by intra-arterial injection (CDDP, ADM) and radiotherapy (45 Gy), and obtained a CR. Metastasis to the spleen was detected during the follow-up period, but a CR was obtained by chemotherapy by intra-arterial injection (CDDP) and systemic chemotherapy (TXL). Generally, the prognosis for carcinoma in the thymus is poor, and the prognosis for anaplastic carcinoma in the thymus is considered especially poor. However, chemotherapy by intra-arterial injection of carcinostatics such as CDDP can be applied to patients in whom surgical treatment is impossible.

[A case of advanced hypopharyngeal carcinoma successfully treated with superselective intra-arterial infusion of docetaxel].

Docetaxel is an excellent agent with a high antitumor effect for advanced/recurrent head and neck cancer. A 67-year-old male with advanced hypopharyngeal cancer (T3N2bM1: Stage IV) underwent two courses of superselective intra-arterial infusion of docetaxel and intravenous administration of CDDP and 5-FU. Using a coaxial technique, a microcatheter was placed in the feeding artery. Using imaging techniques docetaxel (60 mg/body and 30 mg/body) was infused into the vessels. During chemotherapy the patient received concomitant radiotherapy (50 Gy). MRI after chemoradiation showed a complete response for the primary tumor and a partial response for the neck metastasis. Grade 4 leukopenia and neutropenia and grade 3 pharyngitis/esophagitis were observed during chemoradiotherapy, but these adverse effects abated immediately and were not critical. We conclude that this superselective intra-arterial infusion of docetaxel will be useful and safe for head and neck cancer.

Three-dimensional trabecular bone architecture of the lumbar spine in bone metastasis from prostate cancer: comparison with degenerative sclerosis.

OBJECTIVE: Prostate cancer frequently metastasizes to bone, inducing osteosclerotic lesions. The objective of this study was to clarify the three-dimensional (3D) trabecular bone microstructure in bone metastasis from prostate cancer by comparison with normal and degenerative sclerotic bone lesions, using microcomputed tomography (micro-CT). DESIGN AND MATERIALS: A total of 32 cancellous bone samples were excised from the lumbar spine of six autopsy patients: 15 metastatic samples (one patient), eight degenerative sclerotic samples (four patients) and the rest from normal sites (three patients). The samples were serially scanned cross-sectionally by micro-CT with a pixel size of 23.20 microm, slice thickness of 18.56 microm, and image matrix of 512 x 512. Each image data set consisted of 250 consecutive slices. The volumes of interest (96 x 96 x 120 voxels) were defined in the original image sets and 3D indices of the trabecular microstructure were determined. RESULTS: The trabecular thickness (Tb.Th) in degenerative sclerotic lesions was significantly higher than that in normal sites, whereas no significant difference was observed in trabecular number (Tb.N). By contrast, in metastatic lesions, the Tb.N was significantly higher with increased bone volume fraction (BV/TV) than in normal sites, and no significant difference was found in Tb.Th. The characteristics of the trabecular surface in the metastatic samples showed concave structural elements with an increase in BV/TV, indicating osteolysis of the trabecular bone. In 3D reconstructed images, increased trabecular bone with an irregular surface was observed in samples from metastatic sites, which were uniformly sclerotic on soft X-ray radiographs. CONCLUSION: These results support, through 3D morphological features, the strong bone resorption effect in bone metastasis from prostate cancer.

Evaluation of serum KL-6 as a predictive marker of radiation pneumonitis in patients with breast-conservation therapy.

BACKGROUND: Although radiation pneumonitis in radiotherapy following breast-conservation surgery is rare, it may lead to severe pneumonitis as well as to other types of pulmonary dysfunction. This study examined the usefulness of the serum KL-6 level as a new marker for the early detection of radiation pneumonitis. METHODS: Twenty-nine consenting patients served as subjects (age range, 32-78 years; mean age, 51 years) between 2001 and 2002. A total tangential irradiation dose of 50 Gy/25 fractions (fr) was administered for 5 weeks, using a 4-MV X-ray, and an additional 10 Gy/5 fr for 1 week of 6-MeV electron-beam irradiation was performed for patients with pathological tumor cell findings in the excised tumor margins. Levels of serum KL-6 were measured before and after radiotherapy. RESULTS: Four patients developed radiation pneumonitis, all of whom had elevated post-therapy KL-6 levels. Patients with lower or unchanged KL-6 levels did not develop radiation pneumonitis. There was a significant difference in serum KL-6 levels between patients with and without radiation pneumonitis (P = 0.0421). KL-6 levels remained below the threshold value of 465 U/ml in all patients. CONCLUSION: For the early detection of radiation pneumonitis following breast-conservation surgery, and to assess the efficacy of therapy, the monitoring and measuring of changes in KL-6 levels before and after radiotherapy is more important than comparing KL-6 levels against the threshold value. Measuring KL-6 serum levels is also useful in assessing the efficacy of therapy for radiation pneumonitis.

A long-term survivor of leiomyosarcoma around the right side of the base of the skull: effective radiotherapy combined with intra-arterial chemotherapy.

We report a rare case of a leiomyosarcoma that developed around the right side of the base of the skull in a 51-year-old woman. The patient consulted our hospital complaining of pain in the right side of her neck and upper right arm in August 1994. A leiomyosarcoma, originating around the right side of the neck and base of the skull was diagnosed. Initially, surgery was planned, but invasion into the spinal canal was discovered. Curative resection of the leiomyosarcoma around the right side of the base of the skull was not possible. Therefore, external beam radiotherapy (EBRT) combined with intra-arterial chemotherapy and hyperthermia was employed. After the treatment, the tumor decreased in size to 45% of its initial volume, and, simultaneously, her symptoms completely disappeared. The patient initially remained clinically free of the disease, but showed reaggravations at the primary tumor site 3 years and 3 months, and 4 years and 11 months, after the first treatment. The reaggravations were treated with EBRT combined with intra-arterial chemotherapy. As a result, she survived for 5 years and 7 months after the first treatment.

T2-weighted MR imaging of prostate cancer: multishot echo-planar imaging vs fast spin-echo imaging.

The aim of the present study was to assess the performance of pre-biopsy T2-weighted MR imaging using multishot echo-planar imaging (EPI) sequence for visualization of prostate cancer and to compare image quality with that of fast spin-echo (FSE) sequence. Thirty-nine patients with suspected prostate cancer and one healthy male volunteer were examined on a 1.5-T MR scanner equipped with a pelvic phased-array coil. Axial MR images were obtained using multishot EPI sequence with a multishot number of 16 and FSE sequence without fat suppression. Paired EPI and FSE images were independently evaluated by three radiologists. Furthermore, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between EPI and FSE images of 12 pathologically proven lesions of prostate cancer. Delineation of the periprostatic venous plexus, prostate zonal anatomy, and seminal vesicle on EPI was graded to be superior/inferior to FSE in 15.8/0, 14.6/0, and 21.5/4.3% of cases, respectively. On the other hand, delineation of the neurovascular bundle was superior/inferior to FSE in 2.6/13.2% of cases. The SNR and CNR of prostate cancer on EPI were significantly higher than those on FSE (7.99 +/- 2.51 vs 3.36 +/- 0.58, p<0.0001, and 5.51 +/- 2.02 vs 2.21 +/- 0.79, p<0.0001, respectively). In conclusion, multishot EPI has higher quality of contrast resolution for imaging of prostate cancer compared with FSE and would have the potential usefulness in the detection of prostate cancer, although these results obtained with a phased-array coil cannot be extrapolated to examinations performed with an endorectal coil.

Detection of bone marrow and extramedullary involvement in patients with non-Hodgkin's lymphoma by whole-body MRI: comparison with bone and 67Ga scintigraphies.

The aim of this study was to evaluate the diagnostic potential of whole-body MRI (WB-MRI) for the detection of bone marrow and extramedullary involvement in patients with non-Hodgkin's lymphoma. WB-MRI, which was performed on 34 patients, consisted of the recording of T1-weighted spin-echo images and a fast STIR sequence covering the entire skeleton. The WB-MRI findings for bone marrow and extramedullary involvement were compared with those from (67)Ga and bone scintigraphies and bone marrow biopsy results. Two MRI specialists reviewed the WB-MRI results and two expert radiologists in the field of nuclear medicine reviewed the bone and (67)Ga scintigraphy findings. Bone marrow and extramedullary involvement of non-Hodgkin's lymphoma were confirmed by follow-up radiographs and CT and/or a histological biopsy. The detection rate of WB-MRI was high. More bone marrow involvement was detected by biopsy, and more lesions were detected by scintigraphies. In total, 89 lesions were detected by WB-MRI, whereas 15 were found by biopsy, 5 by (67)Ga scintigraphy, and 14 by bone scintigraphy. WB-MRI could also detect more extramedullary lesions than (67)Ga scintigraphy; i.e., 72 lesions were detected by WB-MRI, whereas 54 were discovered by (67)Ga scintigraphy. WB-MRI is useful for evaluating the involvement of bone marrow and extramedullary lesions throughout the skeleton in patients with non-Hodgkin's lymphoma.