An observational cohort study of interstitial lung abnormalities (ILAs) in a large Japanese health screening population (Kumamoto ILA study in Japan: KILA-J).

BACKGROUND: Interstitial lung abnormalities (ILAs) are subtle or mild parenchymal abnormalities observed in more than 5% of the lungs on computed tomography (CT) scans in patients in whom interstitial lung disease was not previously clinically suspected and is considered. ILA is considered to be partly undeveloped stages of idiopathic pulmonary fibrosis (IPF) or progressive pulmonary fibrosis (PPF). This study aims to clarify the frequency of subsequent IPF or PPF diagnosis, the natural course from the preclinical status of the diseases, and the course after commencing treatment. METHODS: This is an ongoing, prospective, multicentre observational cohort study of patients with ILA referred from general health screening facilities with more than 70,000 annual attendances. Up to 500 participants will be enrolled annually over 3 years, with 5-year assessments every six months. Treatment intervention including anti-fibrotic agents will be introduced in disease progression cases. The primary outcome is the frequency of subsequent IPF or PPF diagnoses. Additionally, secondary and further endpoints are associated with the efficacy of early therapeutic interventions in cases involving disease progression, including quantitative assessment by artificial intelligence. DISCUSSION: This is the first prospective, multicentre, observational study to clarify (i) the aetiological data of patients with ILA from the largest general health check-up population, (ii) the natural course of IPF or PPF from the asymptomatic stage, and (iii) the effects and outcomes of early therapeutic intervention including anti-fibrotic agents for progressive cases of ILA. The results of this study could significantly impact the clinical practice and treatment strategy for progressive fibrosing interstitial lung diseases. TRIAL REGISTRATION NUMBER: UMIN000045149.

Colon Capsule Endoscopy versus CT Colonography in Patients with Large Non-Polypoid Tumours: A Multicentre Prospective Comparative Study (4CN Study).

BACKGROUND/AIMS: Non-polypoid colon lesions compared with polypoid lesions has a high malignant potential. The diagnostic performance of colon capsule endoscopy (CCE) and CT colonography (CTC) for large colorectal non-polypoid tumours, that is, laterally spreading tumours is still unclear. The aim of this study is to evaluate the performance of CCE and CTC for the diagnosis of large non-polypoid tumours. METHODS: Thirty patients referred for endoscopic submucosal dissection of non-polypoid tumours measuring ≥20 mm were enrolled. Patients first underwent CCE, then colonoscopy (without resection) and CTC on the same day. An experienced gastroenterologist in a third hospital evaluated the CCE and recorded the location, size and morphology of all lesions detected, blinded to the colonoscopic findings. An experienced radiologist read the CTC under the same conditions. Colonoscopic findings were defined as the reference. RESULTS: A total of 30 lesions (T1 cancer: 3, Tis cancer: 7, adenoma: 14, sessile serrated adenoma/polyp: 6) in 27 patients were observed for evaluation. The capsule excretion rate within 8 h was 85% (23/27), and all capsules went beyond the target lesions. Non-polypoid tumours tend to be depicted as polypoid on CCE. Per patient sensitivities were 0.89 (24/27) by CCE and 0.70 (19/27) by CTC (p = 0.0253, McNemar), and per lesion sensitivities were 0.87 (26/30) and 0.67 (20/30) respectively (p = 0.0143). Most lesions missed by both modalities were located in the proximal colon. CONCLUSION: Eighty-seven per cent of non-polypoid tumours were detected by CCE, and the sensitivity using CCE was higher than that obtained using CTC (UMIN0000014772).

Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions.

BACKGROUND: Although the screening of small, flat polyps is clinically important, the role of CT colonography (CTC) screening in their detection has not been thoroughly investigated. PURPOSE: To evaluate the detection capability and usefulness of CTC in the screening of flat and polypoid lesions by comparing CTC with optic colonoscopy findings as the gold standard. MATERIAL AND METHODS: We evaluated the CTC detection capability for flat colorectal polyps with a flat surface and a height not exceeding 3 mm (n = 42) by comparing to conventional polypoid lesions (n = 418) according to the polyp diameter. Four types of reconstruction images including multiplanar reconstruction, volume rendering, virtual gross pathology, and virtual endoscopic images were used for visual analysis. We compared the abilities of the four reconstructions for polyp visualization. RESULTS: Detection sensitivity for flat polyps was 31.3%, 44.4%, and 87.5% for lesions measuring 2-3 mm, 4-5 mm, and ≥6 mm, respectively; the corresponding sensitivity for polypoid lesions was 47.6%, 79.0%, and 91.7%. The overall sensitivity for flat lesions (47.6%) was significantly lower than polypoid lesions (64.1%). Virtual endoscopic imaging showed best visualization among the four reconstructions. Colon cancers were detected in eight patients by optic colonoscopy, and CTC detected colon cancers in all eight patients. CONCLUSION: CTC using 64-row multidetector CT is useful for colon cancer screening to detect colorectal polyps while the detection of small, flat lesions is still challenging.

Computed tomographic colonography with a reduced dose of laxative using a novel barium sulfate contrast agent in Japan.

PURPOSE: To test the tagging efficacy, patient acceptability, and accuracy of computed tomographic colonography (CTC) with a reduced dose of laxative using a novel barium sulfate (BaSO4) contrast agent. MATERIALS AND METHODS: CTC followed by optical colonoscopy (OC) was performed on 73 patients with positive results in fecal occult blood tests. They were administrated a BaSO4 suspension and a magnesium citrate solution for bowel preparation. Patients completed a questionnaire about the acceptability of bowel preparation. Tagging efficacy was estimated using a novel categorization system, which classified all segments into 8 categories. The accuracy of detecting protruded lesions ≥ 6 mm was calculated from the comparison of CTC and OC results, using the latter as a reference standard. RESULTS: Tagging efficacy was good in 77.3% of colonic segments where residue was observed. The acceptability of bowel preparation for CTC was significantly higher than that for OC. The sensitivity, specificity, and positive and negative predictive values were 0.778, 0.945, 0.824, and 0.929, respectively. All lesions ≥ 7 mm were successfully detected by CTC. CONCLUSION: CTC with a reduced dose of laxative using a novel BaSO4 contrast agent has a favorable tagging efficacy, patient acceptability, and accuracy.

[A patient with an angiomyolipoma of the liver in whom the course of enlargement could be confirmed].

The patients was a 54-year-old woman. In the liver, a high-echo phyma was detected. The lesion increased from 5 to 23mm over 2 years and 4 months. On CT and MRI, it was difficult to differentiate the phyma from hepatocellular carcinoma. However, angiography revealed early outflow to the hepatic vein. In the late CTHA phase of angio-CT, there was no ring-like dark staining reaction (corona), as observed in hepatocellular carcinoma patients, outside the tumor. Hepatectomy was performed, suggesting angiomyolipoma. The course of enlargement could be followed-up, and we present findings that may be useful for differentiating this tumor from hepatocellular carcinoma.

Colonic distention at screening CT colonography: role of spasmolytic agents and body habitus.

Sufficient colonic dilation is important when using CT colonography (CTC) for colorectal cancer screening. We investigated the effect of antispasmodic agents and the patient body habitus on the degree of colonic dilation in screening CTC.We assessed the effect of clinical characteristics [age, gender, body mass index (BMI), and the presence of diverticula] and the use of antispasmodics on colonic distention in 140 patients who underwent CTC for colorectal cancer screening. The CTC was performed in both the supine- and prone positions. Seventy patients received antispasmodics prior to CT examination and the other 70 did not. Colonic distention was scored using a 5-point scale: 1=collapsed, 2=poorly visualized, 3=visualized but underdistended, 4=acceptable, and 5=excellent. Images scored as 4 or 5 were considered to be of diagnostic quality. The mean visual evaluation score was significantly higher in the supine- than the prone position (4.2±0.5 vs. 4.0±0.5, p<0.01). For the supine position, only the use of antispasmodic was statistically associated with sufficient colonic dilation by univariate logistic analysis (odds ratio=2.365, p=0.03). For the prone position, age, BMI, and the use of antispasmodic were statistically associated with sufficient colonic dilation by multivariate analysis. The odds ratio of these parameters was 0.955 (p=0.02), 0.874 (p=0.03), and 2.391 (p=0.02), respectively.We obtained sufficient colonic dilation with an antispasmodic for CTC in both positions. Younger age and a lower BMI were also associated with better colonic dilation in the prone position.

[Clinical evaluation of gastric diverticulum on indirect radiograph for gastric mass survey].

The aim of this study was to evaluate the clinical conditions of gastric diverticulum. Fifty-four patients with gastric diverticulum (20 men and 34 women among 34,314 patients who underwent medical check-ups) were evaluated on indirect radiographs, for an incidence of 0.16% among the total number of examined cases, a rate lower than that of previous reports. Almost all cases were asymptomatic, had a single diverticulum, and showed a saccular shape. The age distribution indicated higher frequencies in the 5th and 6th decades, and the posterior wall of the fornix was the most common location. Size ranged from 0.6 cm to 12 cm, and 41 cases (75.9%) were between 1.0 cm and 4.0 cm in size. This entity should be kept in mind when reading radiographs of upper gastrointestinal series as well as recognition of pseudodiverticulum and aberrant pancreas as noted for the stomach in several past report. Diverticulum on the cardia, which was previously classified as gastric diverticulum, should be excluded because of the possibility of normal variation.

[Clinical evaluation of esophageal cancer complicated with head and neck cancer].

We prospectively investigated endoscopic findings of the upper digestive tract in patients with head and neck (H & N) cancer, from 1992 to 2001. Of 687 patients with H & N cancer, esophageal cancers were found to affect 74 patients (10.8%). The 74 patients consisted of 49 (66.2%) with the superficial type and 25 (33.8%) with the advanced type. Other additional cancers were detected in 32 cases (4.7%), including 21 gastric cancers. The incidence was highest in patients with hypopharyngeal cancer (32.4%), whereas the incidences in those with oral floor cancer and mesopharyngeal cancer were 14.3% and 13.1%, respectively. The incidence of stage I cancers was lower than that of stage II, III, or IV cancers. Therapy for superficial esophageal cancers consisted of trisection for endoscopic mucosal resection (EMR), surgery, and no treatment. Surgery, radiation therapy, or no treatment was selected in advanced type. For double cancers of H & N and esophagus, treatment should be selected in consideration of the prognosis of the disease. These findings suggest that endoscopy with the Lugol-spraying method should be performed in H & N cancers for early detection of esophageal cancers.