Long-term follow-up of neoadjuvant intraarterial chemotherapy using an original four-lumen double-balloon (4L-DB) catheter for locally advanced uterine cervical cancer.

BACKGROUND: We report the therapeutic potential, longterm survival, and toxicity of neoadjuvant intraarterial chemotherapy (NAIC) using an original four-lumen double-balloon (4L-DB) catheter followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer. METHODS: Sixty patients with stage IIB-IVA cervical squamous cell cancer were treated with NAIC which included cisplatin (60-70 mg/m(2), day 1), mitomycin-C (10-20 mg/m(2), day 1), and pirarubicin hydrochloride (THP; 10-20 mg/m(2), day 1) for two courses every 21 days. RESULTS: The median follow up among surviving patients was 93.7 months. Among 60 eligible patients, 22 had a complete response (CR; 36.7%) including 12 with a pathologic CR (20.0%). Thirty-six patients had a partial response (60.0%), and stable disease was observed in only 2 patients (3.3%). Moreover, we found that the platinum concentration in the cervix was correlated with the clinical response (P < 0.001). The 10-year progression-free survival (PFS) and 10-year survival were 90.9% and 90.9%, respectively, in patients with stage IIB disease and 66.0% and 70.7%, respectively, in patients with stage III disease. Leukopenia occurred in 86.7% of patients, but it was not very severe (grade 3, 4 in 13.3% of patients). CONCLUSION: Our results with NAIC using the 4L-DB catheter in locally advanced cervical cancer demonstrate that a high platinum concentration has beneficial effects on primary lesions and improves long-term progression-free and overall survival.

Body diffusion-weighted MR imaging of uterine endometrial cancer: is it helpful in the detection of cancer in nonenhanced MR imaging?

OBJECTIVE: In this study, the authors discussed the feasibility and value of diffusion-weighted (DW) MR imaging in the detection of uterine endometrial cancer in addition to conventional nonenhanced MR images. METHODS AND MATERIALS: DW images of endometrial cancer in 23 patients were examined by using a 1.5-T MR scanner. This study investigated whether or not DW images offer additional incremental value to conventional nonenhanced MR imaging in comparison with histopathological results. Moreover, the apparent diffusion coefficient (ADC) values were measured in the regions of interest within the endometrial cancer and compared with those of normal endometrium and myometrium in 31 volunteers, leiomyoma in 14 patients and adenomyosis in 10 patients. The Wilcoxon rank sum test was used, with a p<0.05 considered statistically significant. RESULTS: In 19 of 23 patients, endometrial cancers were detected only on T2-weighted images. In the remaining 4 patients, of whom two had coexisting leiomyoma, no cancer was detected on T2-weighted images. This corresponds to an 83% detection sensitivity for the carcinomas. When DW images and fused DW images/T2-weighted images were used in addition to the T2-weighted images, cancers were identified in 3 of the remaining 4 patients in addition to the 19 patients (overall detection sensitivity of 96%). The mean ADC value of endometrial cancer (n=22) was (0.97+/-0.19)x10(-3)mm(2)/s, which was significantly lower than those of the normal endometrium, myometrium, leiomyoma and adenomyosis (p<0.05). CONCLUSION: DW imaging can be helpful in the detection of uterine endometrial cancer in nonenhanced MR imaging.

Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging.

BACKGROUND: In this study, the potential in detecting and evaluating pelvic lymph node metastases on body diffusion-weighted (DW) images was evaluated in patients with gynecologic malignancies. METHODS: This study included 18 patients with gynecologic malignancy who underwent magnetic resonance imaging in the pelvis using a 1.5-T superconductive magnet. The identification of pelvic nodes on only T2-weighted (T2W) axial images and on DW axial images in addition to T2W axial images was examined and compared. Moreover, we measured and calculated a short-axis diameter, a long-axis diameter, and a ratio of short- and long-axis diameter of nodes on the T2W images and the apparent diffusion coefficient (ADC) values of the nodes on the DW images. These results were compared with histopathologic results. RESULTS: First, 136 (40%) of 340 dissected nodes were identified on T2W images, and 249 (73%) of 340 dissected nodes were identified on DW images in addition to T2W images. Second, the differences in the short-axis diameter, the long-axis diameter, and the ratio of short- and long-axis diameter on T2W images between metastatic and nonmetastatic nodes were not significant. The differences in the ADC values between metastatic and nonmetastatic nodes were not significant. CONCLUSIONS: Body DW images are useful in detection of pelvic lymph nodes in patients with gynecologic malignancy. However, the measurement of ADC values does not contribute to a diagnosis of metastatic nodes.

Establishment and characterization of a cell line (OMC-9) originating from a human endometrial stromal sarcoma.

Cell lines are very useful for clinical and basic research. The establishment of uterine malignant tumor cell lines with unusual histology is especially important. We describe the establishment and characterization of a new human endometrial stromal sarcoma cell line of the uterus. The cell line OMC-9 was established from a tumor mass in the uterine body of a 55-year-old woman. Characteristics of the cell line studied include morphology, chromosome analysis, heterotransplantation, tumor markers and chemosensitivity. This cell line has grown well for 196 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, appear to be spindle-shaped or multipolar and have a tendency to pile up without contact inhibition. The cells exhibit a human karyotype with a modal chromosomal number in the diploid range. The cells were able to be transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. OMC-9 cells produced tissue polypeptide antigen. Both CD10, a sensitive and diagnostically useful marker of endometrial stromal neoplasms, and vimentin were identified immunohistochemically in the original tumor and the heterotransplanted tumor. The cells were sensitive to actinomycin D, doxorubicin, carboplatin, cisplatin and etoposide, drugs used commonly in the treatment of gynecologic cancer. Only three reports of uterine endometrial stromal sarcoma cell lines have thus far been reported in the literature. OMC-9 is the first endometrial stromal sarcoma cell line in which CD10 expression and chemosensitivity have been identified.

Patients' subjective evaluation of early and late sequelae in patients with breast cancer irradiated with short fractionation for breast conservation therapy: comparison with conventional fractionation.

BACKGROUND: To compare the frequency of "subjective" complications and their severity between conventional and short fractionation and to analyze the differences between the two groups. METHODS: Data from 350 patients with breast cancer who received breast conservation therapy between 1992 and 2003 were retrospectively analyzed. One hundred and ninety-six patients and 154 patients received 50 Gy in 25 fractions over 35 days (group C) and 44 Gy in 16 fractions over 22 days (group S), respectively. Early sequelae were evaluated at the end of radiation therapy (point A) and 7-10 days after the treatment (point B). Late sequelae were assessed at least 6 months after the end of radiation therapy (point C). RESULTS: The most commonly observed toxicity at point A was erythema, followed by heat sensation, sense of discomfort, and pain. There were no significant differences in these symptoms between the two groups. The frequency of these symptoms hardly changed between points A and B. At point C a sense of hardness more frequently appeared in group S than in group C with a significant difference. Other commonly noted symptoms had no significant difference between the two groups. CONCLUSIONS: Short fractionation results in acceptable patient "subjective" sequelae comparable to the sequelae experienced following conventional fractionation.

Evaluation of lymph node metastases in gastric cancer using magnetic resonance imaging with ultrasmall superparamagnetic iron oxide (USPIO): diagnostic performance in post-contrast images using new diagnostic criteria.

BACKGROUND: We assessed the value of magnetic resonance imaging (MRI), using ultrasmall superparamagnetic iron oxide (USPIO) with new diagnostic criteria, in the evaluation of regional lymph node metastases in gastric cancer. METHODS: Thirty-one patients with gastric cancer were enrolled. 1000 lymph nodes were dissected during surgery, and of these, 519 nodes (51.9%) were identified by currently used MRI imaging analysis. We evaluated lymph nodes on USPIO-post-contrast T2*-weighted images using the following two criteria: (1) we diagnosed the nodes on T2*-weighted images according to conventional criteria, where a node having an overall low signal intensity (pattern A) was nonmetastatic, while a node having partial (pattern B) or overall (pattern C) high signal intensity was metastatic; (2) we subdivided pattern B nodes on T1-weighted images using the new criteria, in which a node for which the high-intensity area on T2*-weighted images was not defined as adipose tissue on T1-weighted images (pattern B1) was metastatic, while a node for which the high-intensity area was defined as adipose tissue (pattern B2) was nonmetastatic. RESULTS: (1) The results using the conventional criteria were 96.2% sensitivity, 92.5% specificity, 76.3% positive predictive value (PPV), 99.0% negative predictive value (NPV), and 93.3% accuracy. (2) The results using the new criteria were 96.2% sensitivity, 98.3% specificity, 90.1% PPV, 99.0% NPV, and 97.1% accuracy. CONCLUSION: The assessment of lymph node metastases from USPIO-post-contrast MRI alone using the new criteria was useful in the diagnosis of regional lymph node metastases in gastric cancer.

Preoperative evaluation of local invasion and metastatic lymph nodes of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography before laparoscopic surgery.

OBJECTIVE: To evaluate local invasion and lymph nodes metastasis of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography (MDCT) before laparoscopic colorectal surgery. METHODS: Fifty-one patients with colorectal cancer underwent MDCT. The evaluation items were as follows: (1) local invasion; (2) detected lymph nodes evaluated by short-axis diameter, long-axis diameter, short/long axis diameter ratio, and computed tomography (CT) attenuation; and (3) visualization of mesenteric artery and vein by 3-dimensional-CT angiography. RESULTS: First, in the evaluation of local invasion, overall accuracy was 94.1%. Second, the point of 0.8 or greater in short/long-axis diameter ratio was best index for the diagnosis of metastatic lymph nodes. Using this index, the accuracy of the diagnosis per node was 80.5%. Third, 3-dimensional-CT angiography correctly demonstrated variations of the mesenteric artery and vein. CONCLUSIONS: The MDCT was effective for evaluation of local invasion and lymph nodes metastasis of colorectal cancer and mesenteric vascular variations before laparoscopic surgery.

Effects of sivelestat sodium hydrate on the reduction of radiation pneumonitis.

In this study, we irradiated the murine lung and analyzed the inhibitory effects of sivelestat sodium hydrate, a neutrophil elastase (NE) inhibitor, on lung injury in mice. Sivelestat sodium hydrate (3 mg/kg) was administered by intraperitoneal injection immediately, 3, 6, and 12 h after irradiation in groups RE-0, RE-3, RE-6, and RE-12, respectively. A control group and a group receiving radiation without sivelestat (group R) were also used. NE activity was measured 24 and 48 h after irradiation. The lungs were simultaneously extirpated and stained with hematoxylin and eosin and a naphthol AS-D chloroacetate esterase stain (N-ASDCLA). NE activity increased in the groups in which the murine lungs were irradiated. There was no increase in NE activity in the control group. Among the sivelestat-administered groups, NE activity was slightly elevated in group RE-0 and was suppressed, compared to group R, in groups RE-3, RE-6, and RE-12 at 24 h after irradiation. In the irradiated groups, intra-alveolar neutrophil infiltration, perivascular edema, and alveolar wall thickness were observed, but these changes were mild in the sivelestat-administered groups. The number of N-ASDCLA-positive cells increased in the sivelestat-administered groups, while group R had low values. This indicated that sivelestat sodium hydrate blocked the release of NE from the neutrophils in the irradiated lungs. NE plays an important role in the development of radiation-induced lung injury. Sivelestat is thus expected to decrease radiation-induced lung toxicity by suppressing NE release from neutrophils.

Hepatic computed tomography for simultaneous depiction of hepatocellular carcinoma, intrahepatic portal veins, and hepatic veins in real-time virtual sonography: initial experience.

OBJECTIVE: The aim of this study was to examine a double-step injection of contrast material in hepatic computed tomography (CT) for the simultaneous depiction of hepatocellular carcinoma (HCC), intrahepatic portal veins, and hepatic veins in real-time virtual sonography. METHODS: This study consisted of 6 patients with solitary HCC nodules with early enhancement on dynamic contrast-enhanced CT. Computed tomographic scanning was performed in a combined late arterial/hepatic phase after 2 sequential contrast material injections. RESULTS: In all 6 patients, the solitary HCC nodule, intrahepatic portal veins, and hepatic veins were simultaneously visualized with enhancement, for which CT values were appreciably higher than that of the liver parenchyma. In virtual sonography, HCC nodules and intrahepatic vessels were simultaneously shown, and the HCC lesions were treated by radio frequency ablation without vascular injury. CONCLUSIONS: A double-step injection of contrast material in hepatic CT was helpful in the identification of the relationship between the HCC nodule and intrahepatic vessels under virtual sonography and contributed to the accurate and safe performance of radio frequency ablation for HCC.

2-[Fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience.

OBJECTIVES: The new magnetic resonance whole body diffusion-weighted imaging with background body signal suppression (DWIBS) uses short tau inversion recovery-echo planar imaging sequence under normal respiration. DWIBS is different from 2-[fluorine-18]-fluoro-2-deoxy-D: -glucose positron emission tomography ((18)F-FDG PET) imaging in technology, but their images are similar. We compared the two modalities regarding the detection and characterization of malignant tumors. METHODS: DWIBS and (18)F-FDG PET/computed tomography (CT) were performed on 16 cancer patients on the same day. The diagnoses were the following: lung cancer (n = 12), colon cancer (n = 2), breast cancer (n = 1), and pulmonary metastasis (n = 1). A total of 27 malignant tumors (15 lung cancer, 5 pulmonary metastases of parathyroid cancer, 3 pulmonary metastases of lung cancer, 3 colon cancer, 1 breast cancer) and seven reference organs around malignant lesions (two liver regions, four normal lymph nodes, one muscle region) were evaluated visually and quantitatively using the apparent diffusion coefficient (ADC) (x10(-3) mm(2)/s) and standardized uptake value (SUV). RESULTS: Twenty-five (92.6%) of the 27 malignant lesions were detected visually with DWIBS imaging in contrast to 22 malignant tumors (81.5%) with (18)F-FDG PET/CT imaging. The quantitative evaluation showed that there was a significant difference between the mean SUVs of the reference organs (n = 7, 1.48 +/- 0.62) and the malignant (n = 22, 5.36 +/- 2.80) lesions (P < 0.01). However, there was no significant difference between the mean ADCs of the reference organs (n = 7, 1.54 +/- 0.24) and the malignant (n = 25, 1.18 +/- 0.70) lesions. CONCLUSIONS: DWIBS can be used for the detection of malignant tumors or benign tumors; however, it may be difficult to differentiate between benign and malignant lesions by ADC.

Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging.

BACKGROUND: We assessed the utility of enhanced magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide (USPIO) in the evaluation of axillary lymph node metastases in patients with breast cancer. STUDY DESIGN: MR examination of the axilla was performed before and 24-36 h after USPIO administration for patients with stage II or III breast cancer. Diagnostic performance was compared using size criteria (metastasis was defined when short axis diameter >5 or >10mm) or morphologic criteria on conventional MRI, the combined study of USPIO precontrast and postcontrast images, and USPIO postcontrast study alone. RESULTS: A total of 622 nodes (503 metastatic and 119 nonmetastatic nodes) were dissected from 33 patients. The results of conventional MRI for nodes >5mm were 59.1% sensitivity, 86.7% specificity, and 80.4% overall accuracy. Results for nodes >10mm were 15.7% sensitivity, 99.2% specificity, and 80.2% overall accuracy. Results based on morphology were 36.5% sensitivity, 94.1% specificity, and 81.0% overall accuracy. The results of the combined study of USPIO precontrast and postcontrast images were 86.4% sensitivity, 97.5% specificity, 91.1% positive predictive value, 96.1% negative predictive value, and 95.0% overall accuracy. The results of USPIO postcontrast images alone were 84.7% sensitivity, 96.8% specificity, and 94.0% overall accuracy. Patient-based results of postcontrast USPIO study alone were 100.0% sensitivity, 80.0% specificity, and 93.9% overall accuracy. CONCLUSIONS: USPIO postcontrast study alone was useful in the assessment of axillary lymph node metastases in patients with breast cancer.

Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results.

The aim of this study was to demonstrate the feasibility of using diffusion-weighted (DW) magnetic resonance (MR) imaging under free breathing for the detection of a urinary bladder carcinoma. In 15 patients with 17 urinary bladder carcinomas, DW images were obtained in the axial plane under free breathing scanning with a multisection spin-echo type single-shot echo planar sequence with a body coil. DW images were evaluated based on cystoscopic findings. Moreover, the apparent diffusion coefficient (ADC) value was measured in a circular region of interest (ROI) within the carcinoma, urine, normal bladder wall, prostate and seminal vesicle. In the results, on the DW images, all 17 carcinomas were clearly shown as high signal intensity relative to the surrounding structure. The ADC value (x10(-3) mm(2)/s) in the carcinoma was 1.18+/-0.19, which was significantly lower compared with that of urine (3.28+/-0.20), the normal bladder wall (2.27+/-0.24), prostate (transition zone: 1.57+/-0.09, peripheral zone:1.85+/-0.22) and seminal vesicle (2.01+/-0.22). In conclusion, DW images under free breathing enabled the clear detection of the urinary bladder carcinoma, whose ADC values were lower compared with those of the surrounding structure. The DW images may be useful in evaluating tumors invading to the surrounding structures.

CT and MR features of sclerosing mesenteritis mimicking a mesenteric metastasis from the carcinoid tumor.

Sclerosing mesenteritis is a rare and benign inflammatory entity characterized by fibrofatty thickening of the mesentery. To our knowledge, there are only a few reports on the features of sclerosing mesenteritis on magnetic resonance (MR) imaging and computed tomography (CT). In this present case, MR imaging demonstrated tissue characterization of fibrosis, and partial maximum intensity projection (MIP) and three-dimensional angiography images obtained using multislice CT clearly revealed the extent of the tumor and the vascular appearance affected by the mass. However, a mesenteric metastasis from the carcinoid tumor may show such imaging features. Therefore, when encountering such a case, we suggest that a tentative diagnosis of sclerosing mesenteritis be made, followed by a biopsy for intraoperative histopathologic analysis to avoid aggressive surgery.

Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10.

BACKGROUND: Knowledge regarding the presence and location of lymph node metastasis in gastric cancer is essential in deciding on the operative approach. Lymph node metastases have been diagnosed with imaging tests such as computed tomography (CT) and ultrasonography (US); however, the accuracy of such diagnoses, based on size and shape criteria, has not been adequate. Ferumoxtran-10 (Combidex; Advanced Magnetics) is a lymphotropic contrast agent for magnetic resonance imaging (MRI) whose efficacy for the detection of metastatic lymph nodes in various cancers has been reported by several investigators; however, its efficacy for this purpose has not been reported for gastric cancer. We investigated the efficacy of ferumoxtran-10-enhanced MRI for the diagnosis of metastases to lymph nodes in gastric cancer. METHODS: Seventeen consecutive patients who were diagnosed with a nonearly stage of gastric cancer were enrolled in the study. All the patients were examined by MRI (Signa Horizon 1.5 T; GE Medical; T2*-weighted images) before and 24 h after the intravenous administration of ultrasmall particles of superparamagnetic iron oxide--ferumoxtran-10 (2.6 mg Fe/kg of body weight)--and the presence or absence of metastasis was determined from the enhancement patterns. The imaging results were compared with the corresponding histopathological findings following surgery. RESULTS: Of 781 lymph nodes dissected during surgery, the imaging results of 194 nodes could be correlated with their histopathological findings. Fifty-nine lymph nodes from 11 patients had histopathological metastases. In nonaffected normal lymph nodes, we observed dark signal intensity on MRI caused by the diffuse uptake of the contrast medium by macrophages resident in the lymph nodes, which phagocytose the iron oxide particles of ferumoxtran-10. The number of phagocytic macrophages was decreased in metastatic lymph nodes, and they showed various patterns of decreased uptake of ferumoxtran-10. Three enhancement patterns were observed in lymph nodes: (A) lymph nodes with overall dark signal intensity due to the diffuse uptake of ferumoxtran-10; (B) lymph nodes with partial high signal intensity due to partial uptake; and (C) no blackening of lymph nodes due to no uptake of ferumoxtran-10. Patterns (B) and (C) were defined as metastatic. The sensitivity, specificity, positive predictive value, negative predictive value, and overall predictive accuracy of postcontrast MRI were 100% (59/59), 92.6% (125/135), 85.5% (59/69), 100% (125/125), and 94.8% (184/194), respectively. These parameters for predictive accuracy were much superior to these parameters previously evaluated by CT or US. Nodes in the retroperitoneal and paraaortic regions were more readily identified and diagnosed on the MR images than those in the perigastric region. CONCLUSION: The present study confirmed that ferumoxtran-10-enhanced MRI is useful in the diagnosis of metastatic lymph nodes and that the use of this modality will be helpful in treatment decision-making for gastric cancer patients.

Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy.

OBJECTIVE: In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy. MATERIALS AND METHODS: The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings. RESULTS: In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein. CONCLUSION: Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.

Preoperative esophageal cancer staging: magnetic resonance imaging of lymph node with ferumoxtran-10, an ultrasmall superparamagnetic iron oxide.

BACKGROUND: Accurate detection of metastasis to lymph nodes is an essential component of the approach to treatment. The purpose of this study was to evaluate the utility of magnetic resonance imaging with ferumoxtran-10 in diagnosing lymph node metastasis in esophageal cancer. STUDY DESIGN: Sixteen patients with esophageal cancer who were scheduled for surgical lymph node dissection were enrolled. All patients underwent MRI scanning before and 24 hours after intravenous administration of ferumoxtran-10, an ultrasmall, superparamagnetic iron oxide. The presence or absence of metastasis was identified in lymph nodes by their enhancement patterns. Nonmalignant nodes contained macrophages that phagocytosed ferumoxtran-10. Metastatic nodes exhibited a decrease in phagocytic activity, and consequently showed little or no uptake of ferumoxtran-10. So we subdivided the enhancement patterns into the following three patterns: (A) node having an overall low signal intensity, (B) node having an area of high signal intensity, and (C) node having an overall high signal intensity. We identified that patterns (B) and (C) were metastatic patterns. The imaging results were compared with histopathologic findings. RESULTS: Of the 408 resected lymph nodes, imaging results of 133 nodes could be compared with histopathologic findings. Twenty-four lymph nodes had histopathologic metastases. Using our enhancement criteria, sensitivity was 100%, specificity was 95.4%, and accuracy was 96.2% for diagnosis of metastatic nodes. CONCLUSIONS: Ferumoxtran-10 is useful for characterizing benign or malignant lymph nodes in esophageal cancer patients based on the defined enhancement criteria.

[A case of iatrogenic pseudoaneurysm of the pulmonary artery induced by a Swan-Ganz catheter].

We report a case of iatrogenic pseudoaneurysm of the right pulmonary artery induced by a Swan-Ganz (SG) catheter. An SG catheter was inserted to the pulmonary artery before the esophageal surgery. Chest radiograph after the surgery showed a nodule in the right lower lung field. Based on the retrospective review of serial chest radiographies after SG catheter placement, we suspected iatrogenic pseudoaneurysm of the pulmonary artery caused by over-insertion of the catheter tip. Contrast-enhanced CT showed the nodular shadow with eccentric and marked enhancement continuing right A4b. We diagnosed a pseudoaneurysm of the pulmonary artery. The nodular shadow resolved spontaneously over a 2-month period.

[A case of giant fibrovascular polyp of the esophagus: MR findings].

We report a case of giant fibrovascular polyp of the esophagus. The patient was a 69-year-old man who complained of hematemesis. Barium swallowing revealed a long, expansile lesion within the esophagus. Endoscopy demonstrated a pedunculated lesion covered with normal esophageal epithelium. On MRI, the sagittal image showed the characteristic sausage-like shape of the lesion. On T2-weighted images, the lesion demonstrated predominantly low signal intensity, which reflected a fibrous tumor. Opposed-phase imaging showed the area of decreased intensity within the mass, which reflected adipose tissue. MRI was useful for the differential diagnosis of fibrovascular polyp.

Evaluation of breath-hold 201Tl SPECT in the differential diagnosis of solitary pulmonary nodules.

UNLABELLED: The aim of this study was to evaluate the usefulness of deep inspiration breath-hold SPECT (BrST, a method for 201Tl SPECT) in the diagnosis of solitary pulmonary nodules (SPN). METHODS: Ten patients with malignant lesions and five with benign lesions were enrolled in this study. Early SPECT acquisition was performed 15 min after injection of 201Tl, while delayed SPECT images were acquired 3 h after injection. The first 15-sec acquisition was done using the BrST technique, and the second with the conventional free breathing (FB) method. We performed this technique alternately, and therefore, the odd data were from BrST and the even data were from FB. We referred to the T/N ratio of the early images as the ER and to the T/N ratio of the delayed images as the DR. To semi-quantitatively evaluate the degree of retention in the lesion, the retention index (RI) was calculated. RESULTS: The RI of BrST indicated greater accuracy than that of FB in the differential diagnosis of SPN. For the benign and malignant lesions, the RI of BrST was -3.07 +/- 31.51 and 29.86 +/- 25.01, respectively (p < 0.05). The sensitivity, specificity, and accuracy of BrST (80%, 80%, and 80%, respectively) were significantly higher than those of FB (p < 0.05). CONCLUSION: The BrST method is more accurate than that of the conventional FB method in the differential diagnosis of SPN.