Retrospective case series of 15 patients treated with chemoradiation using 5-FU and nedaplatin for gynecological malignancy: with regard to hemotoxicity.

We conducted a retrospective comparison of the hemotoxicity of the sequential administration of 5-Fluorouracil (5-FU) prior to Nedaplatin (NDP) (FN therapy) and that of its reverse sequence (NF therapy) for gynecological malignancy. From February 2002 to November 2004, a total of 15 gynecological malignancy patients were treated with radiation therapy combined with NDP and 5-FU. Of these 15 patients, 5 were treated with NF therapy, and 10 were treated with FN therapy. No significant differences were detected between the FN and NF groups with regard to white blood cell count (WBC), hemoglobin level (Hb), and platelet count. The results of this study do not show that the FN group has a lesser degree of hemotoxicity than the NF group.

Evaluation and comparison of 11C-choline uptake and calcification in aortic and common carotid arterial walls with combined PET/CT.

PURPOSE: Inflamed atherosclerotic plaques may rupture and cause acute myocardial infarction, stroke and other thrombotic events. Early detection of these unstable plaques could, in many cases, prevent such potentially fatal events. 11C-choline or 18F-labelled choline derivatives for visualizing the synthesis of phospholipids, are promising markers of plaque inflammation with potential advantages over 18F-FDG. Their potential for plaque characterization in humans is, however, unclear. In this study the prevalence and distribution of 11C-choline uptake in the aortic and common carotid arterial walls of elderly male patients was evaluated with combined PET/CT. Additionally, the localization of radiotracer uptake and calcification was correlated in various vessel segments. METHODS: Image data from 93 consecutive male patients between 60 and 80 years old who had undergone whole-body 11C-choline PET/CT assessment for prostate cancer were evaluated retrospectively. 11C-choline uptake and calcification were analysed qualitatively and semiquantitatively and compared. RESULTS: 11C-choline uptake was found in 95% of patients, calcification in 94% throughout all vessel segments. In 6% of the patients radiotracer uptake was colocalized with calcifications, whereas less than 1% of calcification sites showed increased radiotracer uptake. CONCLUSION: Both 11C-choline uptake and calcification in the aortic and common carotid arterial walls are common in elderly men. Radiotracer uptake and calcification are, however, only rarely colocalized. 11C-choline has the potential to provide information about atherosclerotic plaques independent of calcification measurement.

Monitoring of fatigue in radiologists during prolonged image interpretation using fNIRS.

PURPOSE: To determine whether functional near-infrared spectroscopy (fNIRS) allows monitoring fatigue in radiologists during prolonged image interpretation. MATERIALS AND METHODS: Nine radiologists participated as subjects in the present study and continuously interpreted medical images and generated reports for cases for more than 4 h under real clinical work conditions. We measured changes in oxygenated hemoglobin concentrations [oxy-Hb] in the prefrontal cortex using 16-channel fNIRS (OEG16ME, Spectratech) every hour during the Stroop task to evaluate fatigue of radiologists and recorded fatigue scale (FS) as a behavior data. RESULTS: Two subjects showed a subjective feeling of fatigue and an apparent decrease in brain activity after 4 h, so the experiment was completed in 4 h. The remaining seven subjects continued the experiment up to 5 h. FS decreased with time, and a significant reduction was observed between before and the end of image interpretation. Seven out of nine subjects showed a minimum [oxy-Hb] change at the end of prolonged image interpretation. The mean change of [oxy-Hb] at the end of all nine subjects was significantly less than the maximum during image interpretation. CONCLUSION: fNIRS using the change of [oxy-Hb] may be useful for monitoring fatigue in radiologists during image interpretation.

Computer-aided differentiation of malignant from benign solitary pulmonary nodules imaged by high-resolution CT.

We investigated the possibility of using computer analysis of high-resolution CT images to radiologically classify the shape of pulmonary nodules. From a total of 107 HRCT images of solid, solitary pulmonary nodules with prior differentiation as benign (n=55) or malignant (n=52), we extracted the desired pulmonary nodules and calculated two quantitative parameters for characterizing nodules: circularity and second central moment. Using discriminant analysis for two thresholds in differentiating malignant from benign states resulted in a sensitivity of 76.9%, a specificity of 80%, a positive predictive value of 78.4%, and a negative predictive value of 78.6%.

Comparison of 18F-FDG PET and bone scintigraphy in detection of bone metastases of thyroid cancer.

UNLABELLED: We compared the efficacies of (18)F-FDG PET and (99m)Tc-bone scintigraphy for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC). METHODS: We examined 47 patients (32 women, 15 men; mean age +/- SD, 57.0 +/- 10.7 y) with DTC who had undergone total thyroidectomy and were hospitalized to be given (131)I therapy. All patients underwent both whole-body (18)F-FDG PET and (99m)Tc-bone scintigraphy. The skeletal system was classified into 11 anatomic segments and assessed for the presence of bone metastases. Bone metastases were verified either when positive findings were obtained on >2 imaging modalities--(201)Tl scintigraphy, (131)I scintigraphy, and CT--or when MRI findings were positive if vertebral MRI was performed. RESULTS: Bone metastases were confirmed in 59 of 517 (11%) segments in 18 (38%) of the 47 study patients. The sensitivities (visualization rate) for bone metastases on a segment basis using (18)F-FDG PET and (99m)Tc-bone scintigraphy were 50 of 59 (84.7%) and 46 of 59 (78.0%), respectively; the difference between these values was not statistically significant. There were only 2 (0.4%) false-positive cases in a total of 451 bone segments without bone metastases when examined by (18)F-FDG PET, whereas 39 (8.6%) were false-positive when examined by (99m)Tc-bone scintigraphy. Therefore, the specificities of (18)F-FDG PET and (99m)Tc-bone scintigraphy were 449 of 451 (99.6%) and 412 of 451 (91.4%), respectively; the difference between these values was statistically significant (P < 0.001). The overall accuracies of (18)F-FDG PET and (99m)Tc-bone scintigraphy were 499 of 510 (97.8%) and 458 of 510 (89.8%), respectively; the difference between these was also statistically significant (P < 0.001). CONCLUSION: The specificity and the overall accuracy of (18)F-FDG PET for the diagnosis of bone metastases in patients with DTC are higher than those of (99m)Tc-bone scintigraphy, whereas the difference in the sensitivities of both modalities is not statistically significant. In comparison with (99m)Tc-bone scintigraphy, (18)F-FDG PET is superior because of its lower incidence of false-positive results in the detection of bone metastases of DTC.

Prostate cancer detection with 3-T MRI: comparison of diffusion-weighted and T2-weighted imaging.

OBJECTIVE: To compare the clinical value of diffusion-weighted (DW) and T2-weighted (T2W) imaging in detecting prostate cancer using a 3-Tesla (3T) magnetic resonance (MR) system. MATERIALS AND METHODS: Thirty-seven patients with suspected prostate cancer underwent T2W and DW imaging at 3T using an 8-channel phased-array coil. These images and apparent diffusion coefficient (ADC) maps were read retrospectively and blindly. The results were compared with histopathologic findings, and receiver operating characteristic (ROC) analysis was used to compare the cancer detection performance of T2W and DW imaging. RESULTS: The areas under the ROC curves for DW imaging and T2W imaging were 0.89 and 0.82, respectively. The performance of DW imaging in prostate cancer detection was significantly better than that of T2W imaging (P=0.0371). CONCLUSION: With a 3T MR system, the performance of DW imaging in detecting prostate cancer was better than that of T2W imaging. DW imaging appears to be a robust and reliable method to examine the whole prostate within an acceptable scan time in clinical settings.

Measurement and evaluation of the acoustic noise of a 3 Tesla MR scanner.

We measured the sound level and frequencies of the acoustic noise generated by a 3 Tesla (T) MR scanner, and investigated the subjective sound level for 30 healthy volunteers with either earplugs, headphones or both. The sound level of 3T was found to be higher than that of 1.5T in all sequences. The peak sound pressure level of 3T ranged from 125.7 dB for MR angiography to 130.7 dB for single shot EPI on the linear scale. The equivalent noise level was from 110.0 dB for FLAIR to 115.8 dB for T1-IR on the A-weighted scale, which exceeded 99 dB, the level regulated by the International Electrotechnical Commission (IEC). The study of the subjective sound level showed that the effect of noise reduction was not significantly different between earplugs and headphones. However, the use of both devices could reduce the subjective sound level significantly better than either one alone (P < 0.01). Thus we propose wearing both devices for ear-protection during 3T examinations.

Influence of liquid crystal display monitors on observer performance for detection of diffuse pulmonary disease on chest radiographs.

PURPOSE: The purpose of this study was to assess the influence of liquid crystal display (LCD) monitors on the detectability of diffuse pulmonary diseases depicted on chest radiographs by comparing them with a high-resolution cathode ray tube (CRT) monitor. MATERIALS AND METHODS: A group of 17 radiologists interpreted 87 soft-copy images on LCD monitors with pixel arrays of 1024 x 1280, 1200 x 1600, 1536 x 2048, and 2048 x 2560 and on a CRT monitor with a pixel array of 2048 x 2560. They were asked to indicate their individual confidence levels regarding the presence of diffuse pulmonary diseases. The luminance distributions of all monitors were adjusted to the same distributions, and the ambient illumination was 200 lux. Observer performance was analyzed in terms of the receiver operating characteristics (ROC). RESULTS: The average ROC curves for the five monitor types were similar, and there were no statistically reliable effects of the five monitor types on the readers' diagnostic performances (P = 0.7587). CONCLUSION: The detectability of diffuse pulmonary disease on the LCD monitors with a spatial resolution equal to or higher than a matrix size of 1024 x 1280 was found to be equivalent to that on the high-resolution CRT monitor.

Usefulness of FDG PET for diagnosis and radiotherapy of the patient with malignant lymphoma involving bone marrow.

We experienced a case of relapsed malignant lymphoma with multiple bone marrow or bone lesions. The case was diagnosed as follicular lymphoma by cytological biopsy of the right iliac bone, with (67)Ga scintigraphy showing abnormal, intense uptake in multiple bones. After about 10 months of systemic chemotherapy, a relapse was suspected because of pain in the bilateral legs and a high level of lactate dehydrogenase. Assessment of the lesions in the patient was difficult by computed tomography because the affected sites were localized mainly in the bone marrow. (18)F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was useful for detecting accurately the relapse sites in the bone marrow and enabled us to determine the field for radiotherapy. There are only a few reports of FDG-PET findings for such bone marrow malignant lymphomas. Therefore, we report the findings of FDG-PET for this case and review some of the literature about bone marrow lymphomas.

Low efficacy of 18F-FDG PET for detection of uveal malignant melanoma compared with 123I-IMP SPECT.

UNLABELLED: Earlier investigations showed that N-isopropyl-p-123I-iodoamphetamine SPECT (123I-IMP SPECT) is useful for the diagnosis of uveal malignant melanoma, whereas the feasibility and usefulness of 18F-FDG PET in uveal malignant melanoma have not yet been established. We compared the usefulness of 123I-IMP SPECT and 18F-FDG PET for the detection of uveal malignant melanoma on the same subjects. METHODS: Nineteen patients (10 men, 9 women) with suspected uveal malignant melanoma were examined by 123I-IMP SPECT. Thirteen of them were also examined by 18F-FDG PET. 123I-IMP SPECT was performed at 15 min or at 3 and 24 h after intravenous administration of 123I-IMP. RESULTS: In 12 of 19 study patients, 123I-IMP SPECT obtained at 24 h after intravenous administration of 123I-IMP delineated an area of increased uptake in the site corresponding to the ocular tumor. All of the ocular tumors in the 12 123I-IMP SPECT-positive patients were confirmed histopathologically and clinically to be uveal malignant melanoma. The other 7 123I-IMP-SPECT-negative patients have been monitored under the diagnosis of choroidal nevus, choroidal hemangioma, hyperplasia of the pigment epithelium of the retina, or idiopathic inflammatory lesions without any complications. In a total of 13 patients examined by 18F-FDG PET, 9 of whom were 123I-IMP SPECT positive and 4 were negative, only 1 patient showed abnormal uptake of 18F-FDG PET in the site corresponding to the ocular tumor. Therefore, 8 of 9 patients with uveal malignant melanoma showed false-negative results in 18F-FDG PET. The 18F-FDG PET-positive patient with uveal malignant melanoma had the largest tumor mass with a short diameter of 12 mm, a long diameter of 17 mm, and a height of 7 mm. In the other 8 18F-FDG PET-negative patients, the tumors had a dimension of 11 x 13 x 7 mm or less. CONCLUSION: 123I-IMP SPECT is a sensitive and accurate method for the detection of uveal malignant melanoma, whereas the efficacy of 18F-FDG PET for this purpose is low because of a high incidence of false-negative results. 123I-IMP SPECT is far more superior in comparison with 18F-FDG PET in detecting uveal malignant melanoma.

The effect of patient age on contrast enhancement during CT of the pancreatobiliary region.

OBJECTIVE: The objective of our study was to assess whether it is possible to reduce the dose and rate of contrast material injection in elderly patients in triple-phase contrast-enhanced CT of the pancreatobiliary region with an MDCT scanner. SUBJECTS AND METHODS: One hundred twelve patients were divided into three groups: contrast injection at 0.08 mL/kg body weight/s (an upper limit of 5 mL/s) over 30 seconds in patients 60 years old or younger (group 1, n = 49), the same contrast injection as group 1 in patients more than 60 years old (group 2, n = 32), and contrast injection at 0.07 mL/kg body weight/s (an upper limit of 4.5 mL/s) over 30 seconds in patients more than 60 years old (group 3, n = 31). Contrast enhancement in the aorta, portal venous system, pancreas, and liver was assessed quantitatively. Two radiologists blinded to the patients' clinical information and the injection protocol used to acquire the CT images graded the degree of contrast enhancement using a 5-point scoring system. The results for the different groups were statistically compared. RESULTS: Contrast enhancement in the main phases for all organs was significantly more intense in group 2 than in groups 1 and 3. Cases in which pancreatic enhancement in the pancreatic phase was graded as excessive were more frequently observed in group 2. No statistically significant differences were observed between groups 1 and 3 in either quantitative or visual assessment for enhancement of any organ in any phase. CONCLUSION: We recommend reducing the dose and rate of contrast material injection by at least 10% for elderly patients undergoing MDCT examination of the pancreatobiliary region.

Assessment of anomalous pancreaticobiliary ductal junction with high-resolution multiplanar reformatted images in MDCT.

OBJECTIVE: The objective of our study was to assess the capabilities of MDCT for the diagnosis of an anomalous pancreaticobiliary ductal junction using high-resolution multiplanar reformatted (multiplanar reconstruction) images. MATERIALS AND METHODS: This study included nine patients with and 54 without an anomalous pancreaticobiliary ductal junction confirmed on direct cholangiopancreatography. Multiplanar reconstruction images with 0.5-mm continuous slices were generated from isotropic or nearly isotropic pancreatic phase images. By mainly interpreting the multiplanar reconstruction images using the Scrolling mode, two blinded reviewers independently determined whether the confluence of the pancreatic and biliary ducts joined in the pancreatic parenchyma (in other words, outside the duodenal wall). The results were correlated with the findings of direct cholangiopancreatography. The diagnostic capabilities of CT for revealing associated pancreatobiliary diseases were assessed in patients with this anomaly. RESULTS: Interobserver agreement in the classification of the duct confluence was high (kappa = 0.804). The duct confluence was identified in all patients except four without an anomalous pancreaticobiliary ductal junction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for diagnosing an anomalous pancreaticobiliary ductal junction were 100% (9 of 9 patients), 87% (47 of 54 patients), 89% (56 of 63 patients), 75% (9 of 12 patients), and 100% (47 of 47 patients) in the final decisions, respectively. CT showed all associated pancreatobiliary diseases except bile duct stones in two patients. CONCLUSION: MDCT enabled the diagnosis of an anomalous pancreaticobiliary ductal junction by showing whether the pancreatic and biliary ducts join within the pancreatic parenchyma on high-resolution multiplanar reconstruction images.

Influence of rib structure on detection of subtle lung nodules.

PURPOSE: To access the influence of anatomic noise on the detectability of subtle lung nodules depicted on chest radiographs. MATERIAL AND METHODS: From normal chest radiography images, 132 square regions were extracted, of which the centers were on the upper margin of a rib, the inside of a rib, the lower margin of a rib, and the central region between two adjoining ribs. Simulated nodules were digitally superimposed at the centers of these extracted square images. Twelve radiologists viewed 50 soft-copy images consisting of these 792 processed images, including the noise-added images. The observer's confidence level for the square images containing single nodules was used as an index of observer performance. RESULTS: Results indicated statistically reliable effects of the relationship between rib structures and nodule positions on the detection performance (P < 0.001). The nodule detectability on the images with a center located between two adjoining ribs was significantly the best, whereas it was significantly the worst on the noise-added images with a center located between two adjoining ribs. CONCLUSION: The rib structures overlying a subtle lung nodule on chest X-ray images have a detrimental effect on nodule detection performance as anatomic noise, regardless of the nodule location on ribs.

Influence of monitor luminance and room illumination on soft-copy reading evaluation with electronically generated contrast-detail phantom: comparison of cathode-ray tube monitor with liquid crystal display.

The influence of monitor brightness and room illumination on soft-copy diagnosis by both cathode-ray tube (CRT) monitor and liquid crystal display (LCD) was evaluated and compared using a contrast-detail phantom. Nine observers (7 radiologists and 2 radiological technicians) interpreted six types of electronically generated contrast-detail phantom images using a 21-inch CRT (2,048x2,560) and a 21-inch LCD (2,048x2,560) under 6 kinds of viewing conditions, i.e. monitor brightness of 330 cd/m2 or 450 cd/m2, and room illumination of 20, 100 or 420 lux at the center of the display. Observers were requested to determine the visible borderline of the objects. Between 330 cd/m2 and 450 cd/m2, no significant difference in the visible area was found under any of the three lighting conditions. However, in two low-contrast phantom images, the visible area on the LCD was significantly larger than that on the CRT, independent of both monitor brightness and room illumination. (p<0.05). The effect of room illumination was not significant, suggesting that the use of LCD at high room illumination is acceptable.

Evaluation of new image processing conditions for digital mammograms from Fuji computed radiography.

PURPOSE: A new processing parameter (T-type parameter) setting for gray scale was developed to improve the image quality of digital mammograms. To clarify the usefulness of this parameter setting, we have evaluated the image quality of digital mammograms (hard copy images) processed with this parameter, and compared it with S/F mammography. MATERIAL AND METHODS: Mammograms were made under the same radiographic conditions by the S/F and FCR systems (type 1, S/F; type 2 and 3, FCR with new T-type parameters; type 4 and 5, FCR with conventional parameters). A total of 49 images from 10 cases was selected for evaluation testing. Evaluation items were the contrast visibility of mammary glands and adipose tissues together with their granularity and sharpness. Eleven medical doctors participated in evaluating the images. RESULTS: The FCR hard copy images processed with the T-type parameter settings were significantly preferred over the conventional S/F images for the contrast visibility of mammary glands and adipose tissue. As for the other items (except for granularity), the FCR hard copy images processed with the T-type parameter settings were subjectively evaluated as slightly better than or equal to the S/F images. In contrast, the conventional S/F images were significantly preferred over the FCR hard copy images processed with the conventional parameter settings. CONCLUSION: The image quality of FCR hard copy images processed with the T-type parameter settings was preferred over that of conventional S/F images as evaluated by medical doctors who specialized in mammography interpretation.

Application of subsecond rotation scan to helical CT for lung cancer screening.

PURPOSE: To clarify whether the benefit of a reduced effective scan width obtained using a smaller pitch outweighs the disadvantage of increased noise in the application of a subsecond helical CT to mass screenings for lung cancer. MATERIALS AND METHODS: Twenty-two helical CT scans of the lung were obtained in 11 healthy subjects using the following parameters: 1) scan 1 was performed at 120 kVp, 50 mA, 10-mm collimation, 1-second/rotation, helical pitch of 2.0; and 2) scan 2 was performed at 120 kVp, 50 mA, 10-mm collimation, 0.75-second/rotation, helical pitch of 1.5. Computer-generated nodules measuring 10 mm and 6 mm in diameter showing ground-glass opacity were superimposed on these images. The detectability of each nodule was evaluated by six blinded readers using ROC analysis. RESULTS: Detectability of the 6-mm nodules was significantly higher in scan 2 than in scan 1. Detectability of the 10-mm nodules was not significantly different between scans 1 and 2. CONCLUSION: The use of a smaller pitch by employing a subsecond rotation scan in a helical CT for lung cancer screenings improves the detection of small lesions without increasing either the scanning time or radiation dose.

Intra- and interobserver agreement and performance score of breast phantom image interpretation: influence of ambient room lighting levels.

The influence of ambient room lighting conditions on soft-copy breast phantom image interpretation was evaluated by comparing cathode ray tube (CRT) monitors with liquid crystal displays (LCDs). Nine observers were asked to use a three-point scale to rate the visibility of various phantom objects (masses, specks, and fibers) displayed on a 21-inch CRT (2,560 x 2,048) and a 21-inch LCD (2,560 x 2,048) under three different levels of ambient lighting (20, 100 and 420 lux at the display center). Each phantom image was interpreted twice, and the reproducibility of judgment and inter-observer agreement was evaluated using kappa statistics. Except for the "mass" score, the LCD score showed a significantly higher value (p<0.05) compared with that of CRT. Nevertheless, no significant differences were found among the three lighting levels. Furthermore, intra- and inter-observer agreement in judgments showed no effects of room illumination. Although the breast phantom objects were better visualized on LCDs than on CRT monitors, room illumination did not affect the performance score of soft-copy reading.

Findings of fluorine-18-FDG PET in extranodal origin lymphoma--in three cases of diffuse large B cell type lymphoma.

F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) is an excellent modality for non-invasive functional imaging of malignant lymphoma and is highly sensitive and specific for the detection of lymphoma lesions. Here, we report the findings of FDG-PET for three cases of diffuse large B cell type lymphoma (DLBCL) with extranodal tumors in the breast, stomach, and liver plus spleen, respectively. The whole body FDG-PET findings showed no evidence of lymph node (LN) involvement or distant metastasis. Strong FDG accumulations were observed in the only extranodal sites by whole body FDG-PET. Therefore, we could confirm that these cases were extranodal primary origins. Whole body PET is useful to determine the primary sites, that is, extranodal origin DLBCL with its clear images.

An abnormal accumulation of fluorine-18-FDG PET in cytomegalovirus enteritis--a case report.

The source of a fever of unknown origin (FUO) and watery diarrhea in a 63-yr-old female with a history of disturbance of consciousness due to moyamoya disease was examined. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), colonoscopy, blood analysis, and determination of cytomegalovirus (CMV) antigenemia were performed. FDG was found to be accumulated in the wall of a dilated colon, and extended from the transverse to sigmoid colon. Colonoscopy revealed edematous, inflammatory, and punched out lesions in accordance with the areas of abnormal FDG uptake. A biopsy specimen showed the antibody of CMV in the colonic mucosa, and CMV antigenemia was detected by an immunohistochemical assay using a monoclonal antibody for CMV pp65 antigen. From these findings, we strongly suspected CMV enteritis.

Cerebral glucose metabolism change in patients with complex regional pain syndrome: a PET study.

PURPOSE: The aim of this study was to examine abnormalities of the central nervous system in patients with chronic pain who were diagnosed with complex regional pain syndrome (CRPS). MATERIALS AND METHODS: Brain activity was assessed using (18)F-fluorodeoxyglucose positron emission tomography. The data collected from 18 patients were compared with data obtained from 13 normal age-matched controls. RESULTS: Our results showed that glucose metabolism was bilaterally increased in the secondary somatosensory cortex, mid-anterior cingulated cortex (ACC) or posterior cingulated cortex (PCC) (or both), parietal cortex, posterior parietal cortex (PPC), and cerebellum as well as in the right posterior insula and right thalamus in our patients. In contrast, glucose metabolism was reduced contralaterally in the dorsal prefrontal cortex and primary motor cortex. Glucose metabolism was bilaterally elevated in the mid-ACC/PCC and the PPC, which correlated with pain duration. CONCLUSION: These data suggested that glucose metabolism in the brains of patients with CRPS changes dramatically at each location. In particular, glucose metabolism was increased in the areas concerned with somatosensory perception, possibly due to continuous painful stimulation.