Distribution of liver stiffness in non-alcoholic fatty liver disease with higher fibrosis-4 index than low cut-off index.

BACKGROUND AND AIM: In the condition of high prevalence of non-alcoholic fatty liver disease (NAFLD), a new diagnostic algorithm to efficiently identify NAFLD patients with significant fibrosis is urgently required. We evaluated the predictive ability of the fibrosis-4 index (FIB-4 index) for significant liver fibrosis (F ≥ 2) in a cohort of Japanese patients with NAFLD. METHODS: We prospectively calculated the FIB-4 index in patients who were incidentally diagnosed as fatty liver in medical checkups and then conducted liver stiffness measurement by vibration-controlled transient elastography (VCTE) only in patients in whom the FIB-4 index was more than the low cut-off index (> 1.45). RESULTS: Of the 5929 people who underwent medical checkups, a total of 1374 people were identified as having fatty liver. Among these, we performed VCTE in 106 patients in whom the FIB-4 index was higher than 1.45. The distribution of the fibrosis stage as estimated by VCTE in the patients was as follows: F0, 52.8%; F1, 10.3%; F2, 21.6%; F3, 11.3%; and F4, 3.7%. The positive predictive value of the FIB-4 index for detecting NAFLD with significant fibrosis was 36.6%. The minimum value of the FIB-4 index was constant for each estimated fibrosis stage. CONCLUSIONS: This is the first prospective study to evaluate the usefulness of the FIB-4 index as the first step to screen NAFLD patients with significant fibrosis. In Japan, addition of one further step that combined with the FIB-4 index is necessary to meaningfully reduce the number of patients needing liver stiffness measurement or liver biopsy.

Risk Factors for Predicting Occult Lymph Node Metastasis in Patients with Clinical Stage I Non-small Cell Lung Cancer Staged by Integrated Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

BACKGROUND: Lymph nodes in patients with non-small cell lung cancer (NSCLC) are often staged using integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). However, this modality has limited ability to detect micrometastases. We aimed to define risk factors for occult lymph node metastasis in patients with clinical stage I NSCLC diagnosed by preoperative integrated FDG-PET/CT. METHODS: We retrospectively reviewed the records of 246 patients diagnosed with clinical stage I NSCLC based on integrated FDG-PET/CT between April 2007 and May 2015. All patients were treated by complete surgical resection. The prevalence of occult lymph node metastasis in patients with clinical stage I NSCLC was analysed according to clinicopathological factors. Risk factors for occult lymph node metastasis were defined using univariate and multivariate analyses. RESULTS: Occult lymph node metastasis was detected in 31 patients (12.6 %). Univariate analysis revealed CEA (P = 0.04), SUVmax of the primary tumour (P = 0.031), adenocarcinoma (P = 0.023), tumour size (P = 0.002) and pleural invasion (P = 0.046) as significant predictors of occult lymph node metastasis. Multivariate analysis selected SUVmax of the primary tumour (P = 0.049), adenocarcinoma (P = 0.003) and tumour size (P = 0.019) as independent predictors of occult lymph node metastasis. CONCLUSIONS: The SUVmax of the primary tumour, adenocarcinoma and tumour size were risk factors for occult lymph node metastasis in patients with NSCLC diagnosed as clinical stage I by preoperative integrated FDG-PET/CT. These findings would be helpful in selecting candidates for mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.

Correction to: Prognostic significance of preoperative plasma D-dimer level in patients with surgically resected clinical stage I non-small cell lung cancer: a retrospective cohort study.

The original version of this article [1] did not cite the following sources [2-5], which were used to write the article.

Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting pathological response to preoperative super-selective intra-arterial chemoradiotherapy for advanced squamous cell carcinoma of the mandible.

INTRODUCTION: Although chemoradiotherapy (CRT) for oral squamous cell carcinoma (SCC) has been shown to preserve organ function and improve cosmetic results, site-specific data, especially mandible, are limited. The aim of this study was to evaluate the predictability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) on response to super-selective intra-arterial CRT for advanced SCC of the mandible. METHODS: Fifteen patients with advanced SCC of the mandible underwent super-selective intra-arterial CRT followed by radical resection. Maximum standardized uptake value (SUVmax) of the mandibular lesion was evaluated with FDG-PET/CT before and after CRT. The SUVmax before and after CRT was defined as pre-SUVmax and post-SUVmax, respectively. The difference between pre- and post-SUVmax was calculated as SUVmax reduction rate to evaluate treatment response of the mandibular lesion. Each SUVmax reduction rate and surgical specimen of the corresponding lesion was analyzed to evaluate an accuracy of the modality for predicting pathological response. RESULTS: The median of pre-SUVmax was significantly lower than that of post-SUVmax (p = 0.001). Of the 15 patients, 6 had a pathological complete response (pCR) and 9 had a non-pCR. Neither pCR patients nor non-pCR patients showed significant difference of the median of SUVmax between pre- and post-CRT (pre-CRT p = 0.099 post-CRT p =0.074). The SUVmax reduction rate in patients with pCR was significantly higher than that with non-pCR (p = 0.002). Receiver operating characteristic analysis revealed that the optimal cut-off point of the reduction rate was 64.7%, with 83% sensitivity and 100% specificity. CONCLUSIONS: These results concluded that SUVmax reduction rate can predict pathological complete response of preoperative super-selective intra-arterial CRT for advanced SCC of the mandible.

Prognostic significance of preoperative plasma D-dimer level in patients with surgically resected clinical stage I non-small cell lung cancer: a retrospective cohort study.

BACKGROUND: Plasma D-dimer level, a marker of hypercoagulation, has been reported to be associated with survival in several types of cancers. The present study aimed to evaluate the prognostic significance of preoperative D-dimer levels in patients with surgically resected clinical stage I non-small cell lung cancer (NSCLC). METHODS: Participants comprised 237 patients with surgically resected clinical stage I NSCLC. In addition to factors such as age, sex, and smoking status, the association between preoperative D-dimer level and survival was explored. RESULTS: Patients were divided into two groups according to D-dimer level: Group A, ≤ 1.0 µg/ml (n = 170); and Group B, > 1.0 µg/ml (n = 67). The 5-year recurrence-free survival rate was 81.6% for Group A and 66.6% for Group B (p < 0.001). The 5-year overall survival rate was 93.6% for Group A and 84.7% for Group B (p = 0.002). Multivariate survival analysis identified D-dimer level as an independent prognostic factor, along with age, maximum standardized uptake value of the primary tumor, and pathological stage. CONCLUSIONS: Preoperative D-dimer level is an independent prognostic factor in patients with surgically resected clinical stage I NSCLC.

Clinicopathological and prognostic features of surgically resected pathological stage I lung adenocarcinoma harboring epidermal growth factor receptor and K-ras mutation.

BACKGROUND: This study aimed to evaluate mutations of the epidermal growth factor receptor (EGFR) and K-ras genes and their clinicopathological and prognostic features in patients with resected pathological stage I adenocarcinoma. METHODS: We examined 224 patients with surgically resected lung adenocarcinoma and analyzed the prognostic and predictive value of these mutations in 162 patients with pathological stage I adenocarcinoma. RESULTS: Mutations of the EGFR and K-ras genes were detected in 100 (44.6%) and 19 (8.5%) of all tumors, and in 81 (50.0%) and 17 (10.5%) of the pathological stage I tumors, respectively. EGFR mutations were significantly associated with female gender, smoking habit (never smoker), and low grade. By contrast, K-ras mutations were significantly associated with male gender, smoking habit (ever smoker), and the presence of mucinous components. No significant differences were observed in recurrence-free or overall survival between the EGFR-mutant, K-ras-mutant, and wild-type groups (five-year recurrence-free survival 77.8% vs. 87.8% vs. 79.5%; five-year overall survival 82.8% vs. 82.4% vs. 79.2%, respectively). Multivariate analysis showed that neither EGFR nor K-ras mutation was an independent prognostic factor. CONCLUSIONS: The present study demonstrated that pathological stage I adenocarcinoma harboring EGFR and K-ras gene mutations have distinct clinicopathological features. The presence of these mutations alone were not prognostic factors in patients with resected pathological stage I adenocarcinoma.

Identification of false-negative and false-positive diagnoses of lymph node metastases in non-small cell lung cancer patients staged by integrated (18F-)fluorodeoxyglucose-positron emission tomography/computed tomography: A retrospective cohort study.

BACKGROUND: The aim of this study was to evaluate the diagnostic accuracy of integrated (18) F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC), and to investigate potential risk factors for false-negative and false-positive HMLN metastases. METHODS: We examined the data of 388 surgically resected NSCLC patients preoperatively staged by integrated FDG-PET/CT. Risk factors for false-negative and false-positive HMLN metastases were analyzed using univariate and multivariate analyses of clinicopathological factors. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated FDG-PET/CT in detecting HMLN metastases were 47.4%, 91.0%, 56.3%, 87.7%, and 82.5%, respectively. On multivariate analysis, the maximum standardized uptake value (SUVmax) of the tumor (P = 0.042), adenocarcinoma (P = 0.003), and tumor size (P = 0.017) were risk factors for false-negative HMLN metastases, and history of lung disease (P = 0.006) and tumor location (central; P = 0.025) were risk factors for false-positive HMLN metastases. CONCLUSIONS: The present study identified risk factors for false-negative and false-positive HMLN metastases in NSCLC patients staged by preoperative integrated FDG-PET/CT. These findings would be helpful in selecting appropriate candidates for mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.

A preliminary report of breast cancer screening by positron emission mammography.

OBJECTIVE: Fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) and PET/computed tomography (PET/CT) have had a considerable impact on the detection of various malignancies. PET and PET/CT are minimally invasive methods that can provide whole-body imaging at one time. Therefore, an FDG-PET cancer screening program has been widely used in Japan. However, the breast cancer detection rate of FDG-PET cancer screening is relatively low. Therefore, FDG-PET screening is not recommended for breast cancer screening. Positron emission mammography (PEM) is a high-resolution molecular breast imaging technology. PEM can detect small breast cancers that cannot be detected on PET or PET/CT images due to limited spatial resolution. We have performed opportunistic breast cancer screening using PEM since 2011. To the best of our knowledge, this is the first report regarding PEM breast cancer screening. METHODS: This study enrolled 265 women. PEM images were analyzed by agreement of 2 experienced nuclear medicine physicians. The readers were given information from medical interview sheet. US findings were interpreted holistically. The number of participants, patient recall rate, further examination rate, and cancer detection rate by year were calculated. RESULTS: The overall recall rate was 8.3%; the work-up examination rate was 77.3%, and cancer detection rate was 2.3%. The positive predictive value of PEM was 27.3%. Six cancers were found by PEM screening. Five were invasive cancers and one was ductal carcinoma in situ. Histological tumor sizes were reported in three cases: 0.7, 1.2, and 2 cm. CONCLUSION: PEM screening appears to have potential for breast cancer screening.

Intraoperative power Doppler ultrasonography with a contrast-enhancing agent for intracranial tumors.

OBJECT: The goal of this study was to evaluate intraoperative power Doppler ultrasonography when used with a contrast-enhancing agent for operations on intracranial tumors. METHODS: Forty intracranial tumors were examined using power Doppler ultrasonography with a galactose microparticle-based ultrasonographic contrast-enhancing agent during operations on the brain. The tumors included 37 intracranial neoplasms (14 gliomas, six meningiomas, three hemangioblastomas, two malignant lymphomas, three other primary neoplasms, nine metastatic tumors, and three nonneoplastic lesions). All patients also underwent computerized tomography and magnetic resonance imaging, and all but three of the patients underwent digital subtraction (DS) angiography. Before injection of the ultrasonographic contrast agent, intra- and peritumoral power Doppler flow signals were detected in 32 of the intracranial tumors. After the injection, the signals were enhanced in blood vessels around the tumors and in the tumor parenchyma in 36 tumors. The duration of contrast enhancement continued for 70 to 365 seconds (mean 251.8 +/- 69 seconds) after the injection. Among the tumors, hemangioblastomas displayed particularly strong contrast enhancement. In these intracranial tumors, the echo signals obtained using contrast-enhanced power Doppler ultrasonography correlated with DS angiographic staining. Power Doppler ultrasonograms with the appropriate contrast agent provided better data on the precise real-time position of the tumors and their relationship to adjacent vessels than ultrasonograms obtained before the injection of the contrast agent. CONCLUSIONS: Intraoperative power Doppler ultrasonography performed using a contrast-enhancing agent can facilitate intraoperative real-time navigation and assessment of the intratumoral vasculature and peritumoral vessels, particularly for tumors having abundant vessels such as hemangioblastomas.

Identification of the segmental artery feeding the anterior spinal artery: correlation between helical CT and angiography.

PURPOSE: We investigated whether identification of the segmental artery feeding the anterior spinal artery (ASA) is possible by single-slice helical CT. MATERIAL AND METHODS: Enhanced CT and angiography were performed in 14 patients with retroperitoneal, liver, or bone tumor. A single-slice helical CT scanner with 7 mm collimation and a 1.0 helical pitch was used. Scanning was started 25 to 30 sec after an intravenous injection of 100 ml of contrast medium at a rate of 3.0 ml/sec. RESULTS: We predicted the segmental artery feeding the ASA in all 14 patients using enhanced CT images. In 12 of the 14 patients, the segmental artery feeding the ASA was angiographically identified. In 7 of these 12 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was the same level as that predicted by enhanced CT. In the remaining 5 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was one level higher or lower than the predicted spinal level. CONCLUSION: We could identify the segmental artery feeding the ASA by detailed examination and interpretation of single-slice helical CT images.

Comparative analysis of imaging sensitivity of positron emission mammography and whole-body PET in relation to tumor size.

OBJECTIVE: Positron emission mammography (PEM) consists of a dedicated PET scanner for breast imaging with a higher spatial resolution than whole-body PET (WBPET) scanners. This study compared the imaging sensitivity of PEM with WBPET in relation to tumor size. METHODS: Fifty-four Japanese women younger than 50 years with histologically confirmed breast lesions were retrospectively enrolled. Positron emission mammography and WBPET were conducted on the same day. Positron emission mammography and WBPET images were blindly evaluated and compared with histopathology. Tumors were classified into 3 groups based on size as follows: group 1, 1 cm or smaller; group 2, 1 to 2 cm; and group 3, larger than 2 cm. The sensitivities of PEM and WBPET were compared in overall subjects and in each size group. RESULTS: In visual analysis, the overall imaging sensitivity was 78.6% (33/42) for PEM and 47.6% (20/42) for WBPET. The overall sensitivity of PEM was significantly higher than that of WBPET (P < 0.001). The differences in sensitivities between PEM and WBPET were larger in smaller tumors: group 1 (66.7% vs 13.3%), group 2 (63.4% vs 36.4%), and group 3 (100.0% vs 87.5%). The sensitivity of PEM was significantly higher than that of WBPET in group 1 (P = 0.008); however, no significant differences were seen in group 2 (P = 0.500) or group 3 (P = 0.250). Overall, the imaging specificity of PEM and WEBPET was 90.6% (60/66) and 93.9% (62/66), respectively. CONCLUSIONS: The imaging sensitivity of PEM was higher than that of WBPET in Japanese women younger than 50 years. Positron emission mammography showed significant sensitivity in tumors smaller than 1 cm, which has been a weak point for WBPET.

FDG-PET scanning after radiation can predict tumor regrowth three months later.

PURPOSE: Positron emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) is well known for providing excellent clinical information regarding malignant tumors. We investigated whether dual-time FDG-PET performed immediately post radiation could predict early regrowth of malignant tumors. MATERIALS AND METHODS: Twenty patients with malignant tumors were included in this study. All patients received radiation, and each underwent FDG-PET before the initiation of therapy and within 10 days of completing their course of irradiation. PET images after irradiation were obtained at 60 min and 180 min post FDG injection. For 26 lesions in 20 patients, standardized uptake value (SUV) before and after treatment was calculated and then correlated with postradiation tumor response and outcome at 3 months status post irradiation. RESULTS: Retention index [RI = (SUV on delayed image - SUV on early image)/SUV on early image] after irradiation showed a significant difference between patients with residual tumor and those without residual tumor at 3 months status post irradiation (p < 0.0025). All 9 lesions in 6 patients with residual tumors showed more than 0.1 of RI, whereas none of the lesions with less than 0.1 of RI revealed residual tumors. CONCLUSIONS: Dual-time FDG-PET imaging just after irradiation is potentially useful for predicting early regrowth of malignant tumors.

Maximum standardized uptake value on FDG-PET is a strong predictor of overall and disease-free survival for non-small-cell lung cancer patients after stereotactic body radiotherapy.

INTRODUCTION: The maximum standardized uptake value (SUVmax) on F-fluorodeoxyglucose positron emission tomography is a predictor for overall survival (OS) in non-small-cell lung cancer (NSCLC) after resection. We investigated the association between SUVmax and outcomes in NSCLC after stereotactic body radiotherapy. METHODS: Between 2005 and 2012, 283 patients with early NSCLC (T1a-2N0M0) were treated with stereotactic body radiotherapy; the total doses were 40 to 60 Gy in five fractions. Patients who underwent staging F-fluorodeoxyglucose positron emission tomography scans by a single scanner and were followed up for more than or who died within 6 months were eligible. The optimal threshold SUVmax was calculated for each outcome. Outcomes were analyzed using the Kaplan-Meier method and log-rank test. Prognostic significance was assessed by univariate and multivariate analyses. RESULTS: One hundred fifty-two patients were eligible. Median follow-up was 25.3 (range, 1.3-77.4) months. Local, regional, and distant recurrences, cancer-specific deaths, and deaths from other reasons occurred in 14, 11, 27, 21, and 31 patients, respectively. The optimal threshold SUVmax for local, regional, and distant recurrences, and disease-free survival (DFS), cancer-specific survival, and OS were 2.47 to 3.64. Outcomes of patients with SUVmax lower than each threshold were significantly better than those with higher SUVmax (all p<0.005): 3-year DFS rates were 93.0% versus 58.3% (p<0.001) and 3-year OS rates were 86.5% versus 42.2% (p<0.001), respectively. By multivariate analysis, higher SUVmax was a significantly worse predictor for DFS (p<0.01) and OS (p=0.04). CONCLUSIONS: SUVmax was a predictor for DFS and OS. A high SUVmax may be considered for intensive treatment to improve outcomes.

Evaluation for local failure by 18F-FDG PET/CT in comparison with CT findings after stereotactic body radiotherapy (SBRT) for localized non-small-cell lung cancer.

PURPOSE: Stereotactic body radiotherapy (SBRT) is the standard care for medically inoperable early non-small-cell lung cancer (NSCLC). However, it can be difficult to differentiate local recurrence from non-recurrence radiation-induced lung opacity. We retrospectively assessed (18)F-FDG PET/CT to detect local recurrence after SBRT for NSCLC. METHODS: Between 2005 and 2011, 273 NSCLCs in 257 patients were treated with SBRT. Prescribed doses were 50Gy and 40Gy per 5 fractions for peripheral and central lesions, respectively. Tri-monthly follow-up CT scans were acquired. (18)F-FDG PET/CT scans were scheduled for screening at one year after SBRT or when recurrence was highly suspected. The dual-time-point maximum standardized uptake values (SUVmaxs) and their retention indexes (RIs) were obtained. RESULTS: A total of 214 (18)F-FDG PET/CT scans were obtained for 164 localized NSCLC tumors in 154 patients. The median follow-up period was 24.9 months (range: 6.3-72.1). Among these, 21 scans of 17 tumors were diagnosed as local recurrence. The median SUVmaxs on early and late images of recurrence and their RI were 5.0 (range: 3.2-10.7), 6.3 (range: 4.2-13.4), and 0.20 (range; 0-0.41), respectively. These were significantly higher than the respective values of non-recurrence images of 1.8 (range: 0.5-4.6), 1.7 (range: 0.5-6.1), and 0.00 (range: -0.37-0.41) (all p<0.05). For SUVmaxs on early and late images, optimal thresholds were identified as 3.2 and 4.2. Using each threshold, the sensitivity and specificity were 100% and 96-98%, respectively. CT findings were classified into ground-glass opacity (N=9), scar or fibrotic change (N=96), consolidation with air-bronchogram (N=34), consolidation only (N=22), and nodule (N=17); the respective numbers of recurrence were 0, 0, 1, 3, and 17. CONCLUSION: SUVmaxs of (18)F-FDG PET/CT could detect local recurrence after SBRT for localized NSCLC. In contrast, CT scan results had a limited ability to diagnose local recurrence.

Positron emission mammography (PEM): reviewing standardized semiquantitative method.

PURPOSE: To validate semiquantitative analysis of positron emission mammography (PEM). METHODS: Fifty women with histologically confirmed breast lesions were retrospectively enrolled. Semiquantitative uptake values (4 methods), the maximum PEM uptake value (PUVmax), and the lesion-to-background (LTB) value (3 methods) were measured. LTB is a ratio of the lesion's PUVmax to the mean background; LTB1, LTB2, and LTB3 (which were calculated on different background) were used to designate the three values measured. Interobserver reliability between two readers for PUVmax and the LTBs was tested using the interobserver correlation coefficient (ICC). The likelihood ratio test was used to evaluate the relationship between ICCs. Receiver operating characteristic (ROC) curves were calculated for all methods. Diagnostic accuracy in differentiating benign tissue from malignant tissue was compared between PUVmax and LTB1. RESULTS: The ICC rate was 0.971 [95 % confidence interval (CI) 0.943-0.986] for PUVmax, 0.873 (95 % CI 0.758-0.935) for LTB1, 0.965 (95 % CI 0.925-0.983) for LTB2, and 0.895 (95 % CI 0.799-0.946) for LTB3. However, there were some technical difficulties in the practical use of LTB2 and LTB3. The likelihood ratio test between PUVmax and LTB1 was statistically significant (p < 0.001). ROC curves of the 4 methods had similar characteristics. The median PUVmax was 1.39 for benign lesions and 3.70 for malignant lesions. LTB1 was 1.92 for benign lesions and 4.78 for malignant lesions. Significant differences (p < 0.001) in both PUVmax and LTB1 were observed between groups. CONCLUSION: Due to its simplicity and reproducibility, PUVmax is superior to LTB as an indicator for PEM in semiquantitative analysis.

The maximum standardized uptake value (SUVmax) on FDG-PET is a strong predictor of local recurrence for localized non-small-cell lung cancer after stereotactic body radiotherapy (SBRT).

BACKGROUND: The maximum standardized uptake value (SUVmax) of FDG-PET may predict local recurrence for localized non-small-cell lung cancer (NSCLC) after stereotactic body radiotherapy (SBRT). METHODS: Among 195 localized NSCLCs that were treated with total doses of either 40Gy or 50Gy in 5 SBRT fractions, we reviewed those patients who underwent pre-treatment FDG-PET using a single scanner for staging. Local control rates (LCRs) were obtained by the Kaplan-Meier method and a log-rank test. Prognostic significance was assessed by univariate and multivariate analyses. RESULTS: A total of 95 patients with 97 lesions were eligible. Median follow-up was 16.0months (range: 6.0-46.3months). Local recurrences occurred in 9 lesions. By multivariate analysis, only the SUVmax of a primary tumor was a significant predictor (p=0.002). Two years LCRs for lower SUVmax (<6.0; n=78) and higher SUVmax (⩾6; n=19) were 93% and 42%, respectively. In subgroups with T1b and T2, LCRs were significantly better for lower SUVmax than for higher SUVmax (p<0.0005 and p<0.01). In both subgroups that received 40Gy and 50Gy, LCRs were also significantly better for lower SUVmax than for higher SUVmax (p<0.001 and p<0.01). CONCLUSIONS: SUVmax was the strongest predictor for local recurrence. A high SUVmax may be considered for dose escalation to improve local control. Additional follow-up is needed to determine if SUVmax is correlated with regional recurrence, distant metastasis, and survival.

Asymptomatic radiation-induced telangiectasia in children after cranial irradiation: frequency, latency, and dose relation.

PURPOSE: To determine the frequency, dose relation, and latency of radiation-induced telangiectasias in children after cranial irradiation. MATERIALS AND METHODS: The authors identified 90 children who had undergone cranial irradiation between 1981 and 2001 and undergone magnetic resonance (MR) imaging with follow-up for at least 6 months. Patients were assigned to low-dose (LD) and high-dose (HD) groups. All 24 children in the LD group received a radiation dose of 18.0 or 19.8 Gy. The 66 patients in the HD group received a dose of 32.0 Gy or greater. Telangiectasias were defined as small low-signal-intensity foci on intermediate- or T2-weighted MR images. For the patients who underwent serial MR imaging, the first depicted appearance of each telangiectatic lesion was recorded. Statistical analyses were performed. RESULTS: Telangiectasias in at least one area were observed in 18 (20%) patients. The frequency of telangiectasia was 13% (three of 24 patients) in the LD group as compared with 23% (15 of 66 patients) in the HD group; this difference was not significant (P =.22, Fisher exact test). In 12 patients (one from LD and 11 from HD group) who underwent serial MR imaging follow-up for up to 10 years (mean, 8.1 years), a total of 31 lesions were detected. Twelve (39%) of these lesions were detected by the 3rd year, and 21 (68%) were evident by the 5th year. Six (50%) of the 12 patients who underwent serial MR imaging had telangiectatic foci after 5 years. CONCLUSION: Radiation-induced telangiectasia appears to occur in at least 20% of children who undergo cranial irradiation. In this small series, higher radiation dose was not significantly associated with higher frequency of telangiectasia, although there was a trend in this direction.

Congenital absence of the portal vein: clinical and radiologic findings.

Congenital absence of the portal vein (CAPV) is a rare anomaly in which the intestinal and splenic venous drainage bypasses the liver and drains into the systemic veins through various venous shunts. In patients with CAPV, the portosystemic shunting causes disruption of the enterohepatic circulation and leads to various clinical manifestations. CAPV can be diagnosed without invasive techniques. This article illustrates the clinical and radiologic findings (including ultrasound, CT, and MRI) of CAPV.