Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema.

Diabetic retinopathy is a form of diabetic microangiopathy, and vascular hyperpermeability in the macula leads to retinal thickening and concomitant reduction of visual acuity in diabetic macular edema (DME). In this review, we discuss multimodal fundus imaging, comparing the pathogenesis and interventions. Clinicians diagnose DME using two major criteria, clinically significant macular edema by fundus examination and center-involving diabetic macular edema using optical coherence tomography (OCT), to determine the appropriate treatment. In addition to fundus photography, fluorescein angiography (FA) is a classical modality to evaluate morphological and functional changes in retinal capillaries, e.g., microaneurysms, capillary nonperfusion, and fluorescein leakage. Recently, optical coherence tomography angiography (OCTA) has allowed us to evaluate the three-dimensional structure of the retinal vasculature and newly demonstrated that lamellar capillary nonperfusion in the deep layer is associated with retinal edema. The clinical application of OCT has accelerated our understanding of various neuronal damages in DME. Retinal thickness measured by OCT enables us to quantitatively assess therapeutic effects. Sectional OCT images depict the deformation of neural tissues, e.g., cystoid macular edema, serous retinal detachment, and sponge-like retinal swelling. The disorganization of retinal inner layers (DRIL) and foveal photoreceptor damage, biomarkers of neurodegeneration, are associated with visual impairment. Fundus autofluorescence derives from the retinal pigment epithelium (RPE) and its qualitative and quantitative changes suggest that the RPE damage contributes to the neuronal changes in DME. These clinical findings on multimodal imaging help to elucidate the pathology in the neurovascular units and lead to the next generation of clinical and translational research in DME.

Radiopacity Measurement of Restorative Resins Using Film and Three Digital Systems for Comparison with ISO 4049: International Standard.

This study compared Ultra Speed Occlusal Film (USOF) and 3 digital systems in determining the radiopacity of 5 different restorative resins in terms of equivalents of aluminum thickness. Whether those digital systems could be used to determine whether radiopacity was in line with International Organization for Standardization (ISO) recommendations was also investigated. Disks of each of 5 restorative resins and an aluminum step wedge were exposed at 65 kVp and 10 mA on USOF and imaged with each digital system. Optical density on the film was measured with a transmission densitometer and the gray values on the digital images using Image J software. Graphs showing gray value/optical density to step wedge thickness were constructed. The aluminum equivalent was then calculated for all the resins using a regression equation. All the resins were more radiopaque than 1 mm of aluminum, and therefore met the ISO 4049 recommendations for restorative resins. Some resins showed statistically higher aluminum equivalents with digital imaging. The use of traditional X-ray films is declining, and digital systems offer many advantages, including an easy, fast, and reliable means of determining the radiopacity of dental materials.

Optimization of parameter settings in cine-MR imaging for diagnosis of swallowing.

Videofluorography is frequently used to evaluate swallowing and is considered the "gold standard" among imaging modalities. This modality, however, has several disadvantages, including radiation exposure and limitations in the detection of soft tissues. Conversely, magnetic resonance imaging (MRI) offers excellent contrast resolution in soft tissue without radiation exposure. A major drawback of MRI in evaluating swallowing, however, is that temporal resolution is poor. The aim of this study was to investigate a new cine-MRI modality. Imaging parameters were optimized and the efficacy of this new technique is discussed. Three techniques for speeding up MRI were combined: true fast imaging with steady state precession, generalized auto-calibrating partially parallel acquisition, and key-hole imaging. The effects of the receiver coils used, receiving bandwidth, slice thickness, and flip angle on each image were determined. The optimal imaging parameters obtained comprised a reduction factor of 2, receiving bandwidth of 1,000 Hz/pixel (repetition time of 151.7 milliseconds and echo time of 1.4 milliseconds), flip angle of 50°, and slice thickness of 6 mm. Neck and spine coils were used. Under these conditions, the new cine-MR imaging technique investigated showed a temporal resolution of 0.1 sec/slice (10 frames/sec). Even with optimized parameter settings, this technique did not allow a true temporal resolution of 30 frames/sec by a large margin. Motion artifacts persisted. Further study is needed on how to speed up this technique.

Nationwide survey on the current situation of quality control of diagnostic displays in Japan.

The Japan Association of Radiological Technologists (JART) and the Japan Medical Imaging and Radiological Systems Industries Association jointly conducted a nationwide survey to reveal the current situation of diagnostic displays in Japan using a questionnaire on the performance and quality control (QC) of diagnostic displays for mammography and common use. The questionnaire for radiological technologists (RTs) was distributed via email to 4519 medical facilities throughout Japan, where RTs affiliated with JART were employed; 613 (13.6%) facilities responded. Diagnostic displays with suitable maximal luminance (500 cd/m2 or higher for mammography and 350 cd/m2 or higher for common use) and resolution (5 megapixels for mammography) have been widely used. However, while 99% of the facilities recognized the necessity of QC, only approximately 60% implemented it. This situation arose due to several barriers to QC implementation, such as insufficient devices, time, staff, knowledge, and the recognition of QC as a duty. The implementation of QC can lead to the avoidance of incidents or accidents caused by a decrease in luminance, variation in luminance response, and the influence of ambient light. Moreover, the barriers discouraging the implementation of QC are mainly related to a lack of human resources and budgets. Therefore, to popularize the QC of diagnostic displays in all facilities, it is crucial to identify countermeasures to eliminate these barriers and to continue positive actions for popularization.

Quantification of dilated deep capillaries in diabetic retinopathy on optical coherence tomography angiography.

Morphological changes in capillaries are one of major clinical signs in diabetic retinopathy (DR). In this study, we quantified the dilated deep capillaries on optical coherence tomography angiography (OCTA) images. Central 3 × 3 mm en face images were obtained using a swept source OCTA device in 105 eyes of 99 patients with DR. Capillaries with a greater diameter in the deep layers were defined as the dilated deep capillaries, using stepwise image processing. The relative areas of automatically selected capillaries with a great diameter were calculated as the index of the dilated deep capillaries. Most eyes with DR had string-like or dot-like dilated deep capillaries in the OCTA images, which appeared to be dilated capillary segments or microaneurysms histologically. They were distributed more densely in the parafovea than in the central sector, while there were no differences between individual quadrants. The index of the dilated deep capillaries was higher in eyes with DR than in nondiabetic eyes. The index in the central subfield was modestly associated with visual acuity, diabetic macular edema, and proliferative diabetic retinopathy. The quantitative dilated deep capillaries are designated as a biomarker of vision-threatening DR.

Inference of Capillary Nonperfusion Progression on Widefield OCT Angiography in Diabetic Retinopathy.

Purpose: The purpose of this study was to explore the spatial patterns of the nonperfusion areas (NPAs) on widefield optical coherence tomography angiography (OCTA) images in diabetic retinopathy (DR) and to investigate their associations with NPA progression and DR severity. Methods: We prospectively enrolled 201 eyes from 158 patients with DR. Widefield images were obtained using a swept-source OCTA device (Xephilio OCT-S1), followed by the creation of 20-mm (1614 pixels) en face images. Nonperfusion squares (NPSs) were defined as 10 × 10-pixel squares without retinal vessels. Eyes with high-dimensional spatial data were mapped onto a two-dimensional space using the uniform manifold approximation and projection algorithm and divided by clustering. The patterns of NPA distribution were statistically compared between clusters. Results: All eyes were mapped onto a two-dimensional space and divided into six clusters based on the similarity of NPA distribution. Eyes in clusters 1 and 2 had minimal and small NPAs, respectively. Eyes in clusters 3 and 4 exhibited NPAs in the temporal and inferotemporal regions, respectively. Eyes in cluster 5 displayed NPAs in both superonasal and inferonasal areas. The unique NPA distributions in each cluster encouraged us to propose eight possible pathways of NPA progression. DR severity was not equal between clusters (P < 0.001), for example, 8 (15.7%) of 51 eyes and 15 (65.2%) of 23 eyes had PDR in clusters 1 and 5, respectively. Conclusions: Dimensionality reduction and subsequent clustering based on the NPA distribution on widefield OCTA enabled the inference of possible NPA progression in DR.

Clinically Significant Nonperfusion Areas on Widefield OCT Angiography in Diabetic Retinopathy.

Purpose: To investigate the distribution of clinically significant nonperfusion areas (NPAs) on widefield OCT angiography (OCTA) images in patients with diabetes. Design: Prospective, cross-sectional, observational study. Participants: One hundred and forty-four eyes of 114 patients with diabetes. Methods: Nominal 20 × 23 mm OCTA images were obtained using a swept-source OCTA device (Xephilio OCT-S1), followed by the creation of en face images 20-mm (1614 pixels) in diameter centering on the fovea. The nonperfusion squares (NPSs) were defined as the 10 × 10 pixel squares without retinal vessels, and the ratio of eyes with the NPSs to all eyes in each square was referred to as the NPS ratio. The areas with probabilistic differences (APD) for proliferative diabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR) (APD[PDR] and APD[NPDR]) were defined as sets of squares with higher NPS ratios in eyes with PDR and NPDR, respectively. The P ratio (NPSs within APD[PDR] but not APD[NPDR]/all NPSs) was also calculated. Main Outcome Measures: The probabilistic distribution of the NPSs and the association with diabetic retinopathy (DR) severity. Results: The NPSs developed randomly in eyes with mild and moderate NPDR and were more prevalent in the extramacular areas and the temporal quadrant in eyes with severe NPDR and PDR. The APD(PDR) was distributed mainly in the extramacular areas, sparing the areas around the vascular arcades and radially peripapillary capillaries. The APD(PDR) contained retinal neovascularization more frequently than the non-APD(PDR) (P = 0.023). The P ratio was higher in eyes with PDR than in those with NPDR (P < 0.001). The multivariate analysis designated the P ratio (odds ratio, 8.293 × 107; 95% confidence interval, 6.529 × 102-1.053 × 1013; P = 0.002) and the total NPSs (odds ratio, 1.002; 95% confidence interval, 1.001-1.003; P < 0.001) as independent risk factors of PDR. Most eyes with NPDR and 4-2-1 rule findings of DR severity had higher P ratios but not necessarily greater NPS numbers. Conclusions: The APD(PDR) is uniquely distributed on widefield OCTA images, and the NPA location patterns are associated with DR severity, independent of the entire area of NPAs. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Macular hole closure at seven years after surgery.

PURPOSE: To report a case of macular hole (MH) closure at seven years after internal limiting membrane (ILM) peeling. OBSERVATIONS: A 66-year-old woman developed a MH in her left eye. Pars plana vitrectomy with ILM peeling and SF6 gas injection followed by face-down position for a week slightly improved the visual acuity from 20/400 to 20/200 but did not close the MH. During subsequent three years of follow-up without any treatment, the MH did not close. Seven years after the surgery, she visited us for cataract surgery in her right eye, and the optical coherence tomography (OCT) examination coincidentally found closure of the MH in her left eye. The visual acuity of her left eye remained 20/200 despite the MH closure. CONCLUSIONS AND IMPORTANCE: ILM peeling might indirectly contribute to the closure of MH at seven years after the surgery although the mechanism is unclear. Sharing the serial OCT images until the MH closure would help us explore the mechanisms of ILM peeling to close MH and develop rational surgery technique manipulating ILM for MH.

Factors predicting the treatment frequency of ranibizumab injections during the second year in diabetic macular edema.

PURPOSE: To investigate the predictors of annual treatment frequency in the second year of pro re nata (PRN) intravitreal ranibizumab (IVR) injections for diabetic macular edema (DME). STUDY DESIGN: A retrospective study. METHODS: We reviewed 65 eyes of 60 patients with center-involved DME who received PRN IVR injections after 3 monthly loading doses. The central subfield thickness (CST) and qualitative findings were assessed on the spectral domain optical coherence tomography (SD-OCT) images. We then investigated whether the parameters at the baseline or at the 12-month visit were associated with treatment frequency in the second year. RESULTS: The number of ranibizumab injections decreased from 6 (4-8) during the first year to 2 (0-3) during the second year (P < .001). The injection numbers during the first year (ρ = 0.259, P = .037) but not during the second year (ρ = 0.152, P = .226) were modestly related to the logarithm of the minimum angle of resolution (logMAR) improvement at 24 months. Multivariate analyses revealed that the CST (ß = 0.336, P = .005) and hyperreflective walls in the foveal cystoid spaces (ß = 0.273, P = .020) at baseline were associated with the number of IVR injections during the second year. The treatment frequency during the second year was also related to the CST (ß = 0.266, P = .012), hyperreflective walls (ß = 0.394, P = .002), and cumulative doses of ranibizumab injections (ß = 0.294, P = .006) at the 12-month visit. CONCLUSIONS: The cumulative doses of ranibizumab injections, CST, and hyperreflective walls in the foveal cystoid spaces at the 12-month visit are designated predictors of the treatment frequency of ranibizumab injections during the second year in DME.

The intercapillary space spectrum as a marker of diabetic retinopathy severity on optical coherence tomography angiography.

Microcirculatory disturbance plays a pivotal role in the pathogenesis in diabetic retinopathy (DR). We retrospectively quantified the total counts and morphological features of intercapillary spaces, i.e., intercapillary areas and nonperfusion areas (NPAs), on swept-source optical coherence tomography angiography (SS-OCTA) images and to evaluate their associations with DR severity grades. We acquired 3 × 3 mm OCTA images in 75 eyes of 62 diabetic patients and 22 eyes of 22 nondiabetic subjects. In the en-face superficial images within the central 2 mm, the areas enclosed by retinal vessels were automatically detected. Their total numbers decreased in some eyes with no apparent retinopathy and most eyes with DR, which allowed us to discriminate diabetic subjects from nondiabetic subjects [area under the receiver operating characteristic curve (AUC) = 0.907]. The areas and area/perimeter ratios continuously increased in DR, indicating a continuum between healthy intercapillary areas and NPAs. The number of intercapillary spaces with a high area/perimeter ratio increased according to DR severity, which showed modest performance in discriminating moderate NPDR or higher grades (AUC = 0.868). These quantified parameters of intercapillary spaces can feasibly be used for the early detection of microcirculatory impairment and the diagnosis of referable DR.

Clinical Relevance of Parafoveal Intercapillary Spaces and Foveal Avascular Zone in Diabetic Retinopathy Without Macular Edema.

Purpose: To investigate the clinical significance of intercapillary spaces on swept source optical coherence tomography angiography images in diabetic retinopathy. Methods: We retrospectively reviewed 110 eyes of 110 patients suffering from diabetic retinopathy without macular edema for whom 3 × 3 mm swept source optical coherence tomography angiography images centered on the fovea were obtained. Automatic image processing of the superficial slab images allowed us to define the areas encircled by retinal vessels as intercapillary spaces within the central 2-mm circle. We evaluated how the quantitative parameters of intercapillary spaces are associated with logMAR and feasible to diagnose diabetic macular ischemia. Results: Total counts (ρ = -0.419; P < 0.001) rather than morphologic parameters of the intercapillary spaces showed a significant correlation with logMAR. There were individual levels of correlations between logMAR and counts of intercapillary spaces in individual sectors. In particular, the summed numbers of the spaces in three highly significant sectors were more significantly associated with logMAR (ρ = -0.515; P < 0.001). Multivariate analyses confirmed that the number of the intercapillary spaces (ß = -0.266; P = 0.016) and foveal avascular zone area (ß = 0.227; P = 0.042) were related to logMAR. The clustering using the foveal avascular zone area and the number of intercapillary spaces revealed two major clusters; one had fewer intercapillary spaces (P < 0.001) and poorer logMAR (P < 0.001) than the other, with a wide range of the foveal avascular zone area. Conclusions: Decreased intercapillary spaces contribute to visual impairment in diabetic retinopathy and suggest one possible criterion of objective diagnosis of diabetic macular ischemia.

Fat suppression with short inversion time inversion-recovery and chemical-shift selective saturation: a dual STIR-CHESS combination prepulse for turbo spin echo pulse sequences.

PURPOSE: To test a newly developed fat suppression magnetic resonance imaging (MRI) prepulse that synergistically uses the principles of fat suppression via inversion recovery (STIR) and spectral fat saturation (CHESS), relative to pure CHESS and STIR. This new technique is termed dual fat suppression (Dual-FS). MATERIALS AND METHODS: To determine if Dual-FS could be chemically specific for fat, the phantom consisted of the fat-mimicking NiCl(2) aqueous solution, porcine fat, porcine muscle, and water was imaged with the three fat-suppression techniques. For Dual-FS and STIR, several inversion times were used. Signal intensities of each image obtained with each technique were compared. To determine if Dual-FS could be robust to magnetic field inhomogeneities, the phantom consisting of different NiCl(2) aqueous solutions, porcine fat, porcine muscle, and water was imaged with Dual-FS and CHESS at the several off-resonance frequencies. To compare fat suppression efficiency in vivo, 10 volunteer subjects were also imaged with the three fat-suppression techniques. RESULTS: Dual-FS could suppress fat sufficiently within the inversion time of 110-140 msec, thus enabling differentiation between fat and fat-mimicking aqueous structures. Dual-FS was as robust to magnetic field inhomogeneities as STIR and less vulnerable than CHESS. The same results for fat suppression were obtained in volunteers. CONCLUSION: The Dual-FS-STIR-CHESS is an alternative and promising fat suppression technique for turbo spin echo MRI.

Automatic segmentation of teeth from dentomaxillofacial 3D-CT images.

CT is an effective tool for image diagnosis because it enables noninvasive observation of internal organs. In the course of CT, 3D-CT, such as a helical scanning CT and a multi-detector row CT, has been developed. With the use of 3D-CT, organs can be observed from several viewing directions. Even now, however, 3D-CT images are generated by manual procedures to extract objective organs using the threshold method. These procedures waste time and effort. Therefore, development of highly automated and effective extracting techniques has been desired. The region growing (RG) method is one of the effective techniques of extracting internal organs. The conventional RG method, however, has some defects. Extracted regions are strongly affected by the threshold value for segmentation. A break point on a region contour yields a leakage of region. To overcome these defects, we formulated a modified region growing method with edge detection (MRGWED) which combines a three-dimensional region growing technique and an edge detection technique. Using the MRGWED, we tried to extract teeth from dentomaxillofacial 3D-CT image data.

Relationship between maximum standardized uptake value (SUVmax) of lung cancer and lymph node metastasis on FDG-PET.

PURPOSE: To evaluate the relationship between SUVmax of primary lung cancers on FDG-PET and lymph node metastasis. METHOD AND MATERIALS: The subjects were a total of consecutive 66 patients with lung cancer who were examined by FDG-PET and subsequently underwent surgery between October 2004 and January 2008. There were 41 males and 25 females, ranging in age from 45 to 83 years with an average of 68 years. The pathological subtypes of the lung cancers consisted of 49 adenocarcinomas, 11 squamous cell carcinomas, 2 adenosquamous carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, 1 pleomorphic carcinoma and 1 mucoepidermoid carcinoma. We statistically compared (1) the mean SUVmax of lung cancer between the groups with and without lymph node metastasis (2) the frequency of lymph node metastasis between higher and lower SUVmax of lung cancer groups that were classified by using the median SUVmax of lung cancer, and (3) evaluated the relationship between the SUVmax of lung cancer and frequency of lymph node metastases, and (4) correlations between the SUVmax of lung cancer and number of the metastatic lymph nodes and pathological n stages. RESULTS: The difference in the average of the SUVmax of lung cancer between the cases with and without lymph node metastases was statistically significant (p = 0.00513). Lymph node metastasis was more frequently seen in the higher SUVmax of lung cancer group (17/33, 52%) than in the lower SUVmax of lung cancer group (7/33, 21%) with a statistically significant difference. There was no lymph node metastasis in lung cancers with an SUVmax of lung cancer less than 2.5, and lung cancers with an SUVmax of lung cancer more than 12 had a 70% frequency of lymph node metastasis. There were moderate correlations between SUVmax of lung cancer, and the number of the metastatic lymph nodes (gamma = 0.404, p = 0.001) and pathological n stage (gamma = 0.411, p = 0.001). CONCLUSIONS: The likelihood of lymph node metastasis increases with an increase of the SUV of a primary lung cancer.

Four-Year Outcome of Aflibercept for Neovascular Age-Related Macular Degeneration and polypoidal choroidal vasculopathy.

Intravitreal injections of anti-vascular endothelial growth factor agents such as ranibizumab and aflibercept are the first-line treatment for neovascular age-related macular degeneration (AMD). However, data about long-term outcome in real-world clinical practice is scarce. We recruited 98 AMD patients and investigated four-year visual outcome. During the four years, 25 patients dropped out. The survivors received 7.0 ± 0.1 injections during the first year and 8.0 ± 7.4 injections in the following three years. The logarithm of minimum angle of resolution (logMAR) at baseline, year one, and year four was 0.28, 0.14 (P = 0.033), and 0.22 (P = 0.697), respectively. The gain of vision was not different among AMD subtypes (typical AMD, polypoidal choroidal vasculopathy, and retinal angiomatous proliferation; P = 0.513) Among the investigated factors, the presence of external limiting membrane (ELM), the absence of vitreoretinal adhesion, and thicker choroid at baseline were associated with better logMAR values at year four (coefficient beta = -0.388, 0.201, and -0.001; P = 7.34 × 10-6; 0.01, and 0.028, respectively). In the present study, vision was retained at baseline level after the four-year treatment with aflibercept. The status of ELM, vitreoretinal adhesion, and choroidal thickness were predictive factors for final vision.

A potential reference point for assessment of condylar bone marrow of the temporomandibular joint on proton density weighted images.

The purpose of this research was to determine a potential reference point for measurement of signal intensity of bone marrow of the condyle on proton density-weighted images (PDW) prior to analysis of bone marrow abnormality related to symptomatic osteoarthritis of the temporomandibular joint (TMJ). The study was based on 79 joints in 41 patients. The regions of interest (ROI) were placed over the bone marrow of the condyle and four other structures, It was hypothesized that a correlation between signal intensity of ROI over bone marrow and that of another structure would provide a potential reference point4or measurement of signal intensity of bone marrow. A significant positive linear correlation was found in the group for gray matter-1 and bone marrow. The correlation coefficient was 0.3 (Pearson correlation coefficient; p < 0.05). It was determined that gray matter is a potential reference point in evaluating the signal intensity of bone marrow in the mandibular condyle.

Static MR images for diagnosis of swallowing.

Evaluation of swallowing has been made possible by cine-Magnetic resonance (MR) imaging with high time resolution. However, the spatial resolution in cine-MR imaging remains inadequate for the detection of anatomical structures. Therefore, it is necessary to refer to static MR images in conjunction with cine-MR imaging. The aim of this study was to determine which MR parameters were appropriate for static imaging of the anatomical structures involved in swallowing. MR imaging was carried out, and T1-weighted, T2-weighted and proton-density-weighted MR images were obtained in the sagittal plane in 5 healthy volunteers. Each image was evaluated for anatomic landmark clarity by 3 oral radiologists. The anatomic landmarks selected were the lip, tip of tongue, center of tongue, tongue base, soft palate and epiglottis. Differences in clarity among 3 imaging modalities were evaluated. A 3-point score rating system was used. The results showed that lower TE sequences, i.e., either T1-weighted or proton-density-weighted images, were the most suitable for use in conjunction with cine-MR imaging in diagnosing swallowing disorders.

Digital subtraction technique for evaluation of peri-implant bone change in digital dental imaging.

The purpose of this study was to investigate digital subtraction technique in digital dental imaging for implant performance, used to quantitatively evaluate bone change around dental implants. For longitudinal assessment of peri-implant bone change, we applied subtraction technique to digital peri-apical radiographs using a digital dental imaging system in two cases at the upper canine and premolar regions. In both cases, we found two peaks of bone change at the crestal region; we also quantitatively demonstrated a marked change over the first one-month period and approximately three-month period spanning the fourth month to the end of the sixth month following implantation. Digital peri-apical radiography accommodating the digital subtraction program should be re-acknowledged as a reliable modality for assessing amount of bone change at local implantation sites.

[A case of intratracheal osteoma].

A 75-year-old woman who complained of cough at night and stridor on exertion was admitted for examination of a possible tracheal tumor. Chest radiography and CT showed an intratracheal calcification. Bronchoscopic examination revealed a lobulated tumor on the anterior wall of the trachea, 6 cm below the vocal cord. The tumor was covered with tracheal epithelium. Microscopic findings of the transtracheal biopsy specimen revealed the tumor to be composed of bone tissues covered with normal tracheal epithelium. No cartilage, smooth muscle, or fats tissue were detected, and so a diagnosis of intratracheal osteoma was made. After Nd-YAG laser therapy, the size of the tumor decreased, and clinical findings improved. During periodical follow up after discharge, the residual tumor was expectorated at home on coughing. Histological examination confirmed the tumor to be osteoma. An intratracheal osteoma is very rare, and this case is the first case reported in Japan.

Concurrent two-dimensional radiotherapy and weekly docetaxel in the treatment of stage III non-small cell lung cancer: a good local response but no good survival due to radiation pneumonitis.

Docetaxel is a novel, potentially highly beneficial drug for the treatment of lung cancer, and has shown remarkable radio-sensitizing effects in vitro. In the present study, we evaluated whether weekly docetaxel (20 mg/m(2)) and conventionally fractionated radiotherapy with the two-dimensional (2D) technique could be tolerated and effective in the treatment of locally advanced non-small-cell lung cancer (NSCLC). Thirty-two stage III (IIIA:13, IIIB:19) NSCLC patients were treated with weekly administration of docetaxel (20 mg/m(2)) on days 1, 8, 15, 22, 29 and 36 in addition to concurrent radiation therapy. The total tumor dose was 60-66 Gy given with a 2D technique in 6-7 weeks. Complete response was observed in 9/32 (28%) patients and partial response in 20/32 (63%). Three (9%) patients died of chemoradiation-induced pneumonitis after completion of therapy. In total, grade >3 toxicities included pneumonitis (47%) and esophagitis (16%). The median overall survival duration was 12 months. The dimensions of the radiotherapy port were larger in patients who produced severe (grade >3) chemoradiation pneumonitis than in patients who did not (P<0.05). The median survival time was 12.4 months and 2-year overall survival were 35%. The survival was better in patients whose first radiotherapy port dimensions were less than 150 cm(2) compared to patients whose first radiation port dimensions were >==150 cm(2) (P<0.05). In conclusion, concurrent weekly administration of docetaxel (20 mg/m(2)) with 2D radiotherapy for NSCLC, had good local response, but survival rate was not completely satisfactory due to chemoradiation pneumonitis, which was the principal toxicity that adversely affected prognosis in elderly patients whose radiotherapy port was large.