Predictive factors for the effectiveness of novel androgen receptor axis-targeted agents in patients with metastatic prostate cancer.

OBJECTIVE: Novel androgen receptor axis-targeted agents (ARATAs) have been developed for mCRPC and improved overall survival (OS). Here, we aimed to find predictors who will receive the greatest benefits from ARATAs. METHODS: We previously performed a multicenter study to identify prognostic factors for metastatic hormone-sensitive prostate cancer (mHSPC, n = 148) and mCRPC (n = 99), and showed that the bone scan index (BSI) was one of the significant prognostic factors for 3-year OS (PROSTAT-BSI study). mHSPC progressed to mCRPC (n = 101), for which 69 patients were treated with (n = 39) or without ARATAs (n = 30, prior to the approval of ARATAs). The 69 patients were divided into two groups according to patient factors, and these cohorts were further divided into two subgroups by usage of ARATAs. OS was compared between subgroups in each group. RESULTS: The predictors were age (<71.4 years), serum levels of C-reactive protein (≥0.16 ng/ml) and alkaline phosphatase (≥548 U/L), time to PSA progression after ADT (<8.9 months), the lowest PSA level (≥1 ng/ml) after ADT, and the rate of PSA decline 3 months after ADT (<0.987), whereas hemoglobin levels, PSA before ADT, Gleason scores, existence of visceral metastases, and BSI were not. CONCLUSIONS: The present study identified predictors for the effectiveness of ARATAs. The number of bone metastases (≒BSI), existence of visceral metastases, and Gleason scores, which were identified as high-risk factors in the LATITUDE study and disease volume in CHAARTED criteria, did not appear to be useful for predicting effectiveness from ARATAs.

Prognosis of patients with prostate cancer and bone metastasis from the Japanese Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index cohort study.

OBJECTIVE: To determine prognostic factors including the Bone Scan Index in prostate cancer patients receiving standard hormonal therapy and chemotherapy. METHODS: This multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index study involved 30 hospitals and enrolled 247 patients (age 71 ± 8 years) with metastatic hormone-sensitive prostate cancer (n = 148) under hormone therapy and metastatic castration-resistant prostate cancer (n = 99) under chemotherapy. The Bone Scan Index (%) was determined by whole-body bone scintigraphy using 99m Tc-methylenediphosphonate. Patients were classified into tertiles and binary groups, and predictors of all-cause death including Bone Scan Index, prostate-specific antigen, and bone metabolic markers were determined using survival and proportional hazard analyses. RESULTS: During a mean follow-up period of 716 ± 404 days, 81 (33%) of the patients died, and 3-year mortality rates were 20% and 52% in the metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer groups, respectively. Survival analysis showed that a Bone Scan Index >3.5% was a significant determinant of death in the metastatic hormone-sensitive prostate cancer group, whereas prostate-specific antigen >55 ng/mL before chemotherapy was a determinant of prognosis in the metastatic castration-resistant prostate cancer group. A Bone Scan Index >3.5% was also associated with a high incidence of prostate-specific antigen progression in the metastatic hormone-sensitive prostate cancer group. Patients with metastatic hormone-sensitive prostate cancer and a better Bone Scan Index response (>45%) to treatment had lower mortality rates than those without such response. CONCLUSION: The Bone Scan Index and hot spot number are significant determinants of 3-year mortality, and combining the Bone Scan Index with prostate-specific antigen should contribute to the management of prostate cancer patients with bone metastasis.

Role of bone scan index in the prognosis and effects of therapy on prostate cancer with bone metastasis: Study design and rationale for the multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index (PROSTAT-BSI) study.

OBJECTIVE: To present the study design and rationale of Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index, a prospective study aiming to determine the role of the bone scan index, the amount of bone metastasis, in the treatment and prognosis of prostate cancer patients. METHODS: A total of 237 patients were recruited at 30 hospitals in Japan. All had prostate cancer with bone metastasis and were scheduled to undergo either hormonal therapy (group H) or chemotherapy (group C). Bone scans were carried out with 99m Tc-methylenediphosphonate. Follow-up studies are planned to continue for 3 years, and changes in biochemical and tumor markers in response to hormonal therapy and chemotherapy will be recorded in addition to skeletal-related events, recurrence, disease progression and death. RESULTS: The basic characteristics of the patients (n = 200) at the time of registration during December 2016 were as follows: mean age 71 ± 8 years; median bone scan index calculated on-site 1.9% (range 0.02-13.3%); median number of hot spots 18 (range 1-128); median prostate-specific antigen 155 ng/mL (range 0.04-22 412 ng/mL); and the most frequent Gleason score 9 (47%). The prostate-specific antigen value was higher in group H than group C (288 vs 33 ng/mL, P < 0.0001), whereas bone scan indexes were comparable (1.7 vs 2.3%, not significant) between the two groups. Liver metastasis was more frequent in group C than group H (6.1% vs 0.8%, P = 0.035). CONCLUSIONS: The baseline characteristics of the Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index database have been established. This collaborative study can now proceed with clarifying the role of the bone scan index for patient management including treatment strategies and prognosis.

Flare phenomenon visualized by 99mTc-bone scintigraphy has prognostic value for patients with metastatic castration-resistant prostate cancer.

OBJECTIVE: This study aimed to determine the prognostic value of the flare phenomenon in patients with metastatic castration-resistant prostate cancer (mCRPC) using the bone scan index (BSI) derived from 99mTc-methylenediphosphonate (MDP) bone scintigraphy images. METHODS: We categorized 72 patients from the PROSTAT-BSI registry with mCRPC who were followed-up for 2 years after starting docetaxel chemotherapy to groups based on pre-chemotherapy BSI values of < 1, 1-4, and > 4. We assessed the effects of the flare phenomenon (defined as a > 10% increase in the BSI within 3 months of starting chemotherapy, followed by > 10% improvement within the next 3 months) on survival using Kaplan-Meier curves and Cox proportional hazard analyses. RESULTS: The flare phenomenon was found in 26 (36%) of the 72 patients. Prostate-specific antigen (PSA), alkaline phosphatase (ALP), and hemoglobin (Hb) levels steadily increased, then deteriorated in patients with and without flare, respectively. Elevated BSI and PSA values at 3 months after starting therapy and the absence of abiraterone or/and enzalutamide therapy led to poor 2-year overall survival (OS) in the group without flare. In contrast, no influence was noticeable in the group with flare. The results of multivariable analyses that included only factors associated with PSA and BSI showed that increased baseline BSI (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.04-1.86; P = 0.023) and PSA (HR, 7.15; 95% CI 2.13-24.04; P = 0.0015) values could be independent risk factors for patients with mCRPC without flare. However, these factors lost significance during flare. The risk for all-cause death was significantly higher among patients with BSI > 4 without, than with flare. The results of univariable analyses indicated that flare positively impacted survival (HR, 0.24; 95% CI 0.06‒0.91; P = 0.035). Multivariable analysis did not identify any factors that could predict outcomes. CONCLUSION: Favorable prognosis, with fewer disturbances from other factors such as the use of abiraterone or/and enzalutamide, PSA changes, and BSI, was attainable in cases when the mCRPC patient demonstrated flare phenomenon. Follow-up bone scintigraphy at least every 3 months could help to determine the prognosis of patients with bone metastasis of mCRPC.

Efficacy of Androgen Receptor-targeted Drugs After Prostate Cancer Recurrence With Bone Metastases: PROSTAT-BSI Sub-analysis.

BACKGROUND/AIM: This study aimed to evaluate the therapeutic benefit of novel androgen receptor-targeted agents (ARTAs) in castration-resistant prostate cancer (CRPC) with bone metastases in Japan. PATIENTS AND METHODS: In followup to our prospective observational study (PROSTAT-BSI) from 2012 to 2018 on metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic CRPC (mCRPC) before docetaxel initiation, we conducted this sub-analysis to investigate the benefit of ARTAs after clinical recurrence on overall survival (OS) in the real-world clinical setting in Japan. In this study, we compared patients who were treated with ARTA with those who received only vintage hormone therapy including docetaxel after clinical recurrence. RESULTS: In the mHSPC group, 69 patients became mCRPC and were treated with or without ARTAs. No significant difference was observed in prostate-specific antigen (PSA) progression-free survival between the ARTA (+) and ARTA (-) groups; however, OS after clinical recurrence was significantly better in the ARTA (+) group than in the ARTA (-) group (median OS 31.9 vs. 23.0 months; p<0.01). CONCLUSION: The ARTAs are beneficial even after mHSPC recurrence in Japanese patients in the real-world clinical setting. Since ARTAs are beneficial after clinical recurrence, it may be better to switch to ARTAs whenever necessary based on PSA response after combined androgen blockade therapy, considering the adverse effects and cost. This approach may be suitable to reduce overtreatment in Japanese patients with mHSPC.

Evaluation of the maximum depth of intraluminal appendiceal fluid to diagnose appendicitis with a 64-detector row CT scanner.

OBJECTIVE: The objective of this study was to investigate whether the criterion "maximum depth of intraluminal appendiceal fluid greater than 2.6 mm" ("DEPTH >2.6 mm"), with the use of 64-detector row computed tomography, is useful to diagnose appendicitis. METHODS: We retrospectively evaluated 0.68-mm-thick images of 2894 intravenously enhanced abdominal-pelvic computed tomography using the following criteria: (1) appendiceal wall thickness greater than 3 mm, (2) appendiceal wall enhancement, (3) focal cecal wall thickening, (4) adjacent lymphadenopathy greater than 5 mm, (5) appendicolith, (6) periappendiceal inflammation, and (7) the new criterion, DEPTH >2.6 mm. Of the 2894 images, 1013 were classified into normal group (including 622 distended [diameter >6 mm] but normal appendices without adjacent lesions), modified group (235 distended normal appendices modified with adjacent lesions), proven-appendicitis group (82 operatively proven appendicitis cases), and clinical-appendicitis group (62 clinically certified appendicitis cases). RESULTS: The new criterion, DEPTH >2.6 mm, demonstrated both higher sensitivities and higher specificities in all groups (>90%), although this criterion showed lower specificities than some conventional criteria. In contrast, conventional criteria showed lower sensitivities or lower specificities (<60%) in one or more of these groups. CONCLUSIONS: DEPTH >2.6 mm is particularly useful for differentiating appendicitis from distended normal appendix.

Diffusion-weighted magnetic resonance imaging in differentiating the invasiveness of small lung adenocarcinoma.

BACKGROUND: Magnetic resonance imaging (MRI) with several sequences may provide a valuable additional modality for evaluating the grade of invasiveness lesions. Diffusion-weighted magnetic resonance imaging (DWI) represents the biological characteristics of tissues. PURPOSE: To retrospectively evaluate the usefulness of DWI for evaluating the invasiveness of small lung adenocarcinomas. MATERIAL AND METHODS: From May 2005 to June 2008, 46 patients with lung adenocarcinomas measuring 2 cm or less across the greatest dimension underwent a preoperative MRI study followed by surgery at the Gunma Prefectural Cancer Center. Fourteen of the tumors were bronchioloalveolar carcinomas (so-called Noguchi's type A+B group), 26 were adenocarcinomas with mixed subtypes (type C group) and six were other histological subtypes of adenocarcinomas (type D+E+F group). The mean signal intensities of a lesion (DWI) and the spinal cord (SC) were analyzed in the region of interests (ROIs), and the mean DWI/SC ratio was then calculated with the value of DWI divided by the value of SC. RESULTS: The calculated mean DWI/SC ratio for the lesions were as follows: 0.448±0.261 (mean±standard deviation [SD]) for type A+B group, 0.963±0.465 for type C group, and 0.816±0.291 for type D+E+F group. The mean DWI/SC ratio of type A+B group was significantly lower than that for the type C (P = 0.0005) or type D+E+F groups (P = 0.0117). CONCLUSION: DWI may thus provide useful supplementary information before determining the surgical strategy, including a limited resection.

[Three (3) cases of advanced hepatocellular carcinoma (HCC) treated successfully by transcatheter arterial infusion of cisplatin followed by gelatin particles].

Hepatic artery chemotherapy with transarterial infusion (TAI) of a cisplatin formulation designed for intra-arterial injection (IA-call®) is recognized as an established treatment for advanced hepatocellular carcinoma (HCC). We experienced three patients whose multiple HCC(Stage III) was successfully treated by TAI using IA-call combined with embolization by porous gelatin particles (Gelpart®), after a series of treatments such as hepatectomy, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), and TAI. Cisplatin-based TAI was not effective, but porous gelatin particles showed a therapeutic effect in one patient by reducing his hepatic arterial blood flow. The two other patients responded to combination therapy after the second treatment. Adverse events from the treatment were mild. This therapy has benefits even for multiple intra-hepatic lesions that are resistant to TACE and TAI because of its widespread effect on the entire liver, and it could be an effective treatment option for advanced HCC.

Computed tomography criterion for the diagnosis of appendicitis without periappendiceal inflammation in children using the maximum depth of intraluminal appendiceal fluid.

OBJECTIVE: The objective of this study was to evaluate whether maximum depth of intraluminal appendiceal fluid (DEPTH) is useful in differentiating appendicitis without periappendiceal inflammation from enlarged normal appendices in children. METHODS: We retrospectively evaluated 826 intravenously enhanced abdominal-pelvic computed tomographic examinations in children (aged 0-18 years) using the following criteria for appendicitis: (1) appendiceal wall thickness greater than 3 mm, (2) appendiceal wall enhancement, (3) focal cecal wall thickening, (4) adjacent adenopathy, (5) appendicolith, and (6) DEPTH. Of 826, 192 were classified into the noncomplicated-normal appendix group (85 enlarged normal appendices [diameter >6 mm] without adjacent lesions), the complicated-normal appendix group (44 enlarged normal appendices with adjacent lesions), or the our-appendicitis group (63 operatively proved appendicitis without periappendiceal inflammation). RESULTS: The criterion "DEPTH greater than 2.6 mm" determined by receiver operating characteristic analysis between our-appendicitis and complicated-normal appendix groups demonstrated both higher sensitivity and higher specificity in all groups (>90%). In contrast, the other criteria showed lower sensitivities (<58%) in our-appendicitis group. CONCLUSIONS: The criterion "DEPTH greater than 2.6 mm" is particularly useful for differentiating appendicitis without periappendiceal inflammation from enlarged normal appendices in children.

Proton magnetic resonance spectroscopy of lung cancer in vivo.

Proton magnetic resonance spectroscopy (1H-MRS) has demonstrated that in vitro, lung cancer has higher lactate and choline signals than those of normal tissues. The detection of these metabolites in lung cancer in vivo by 1H-MRS would be useful for clinical diagnoses of lung cancer. We report the in vivo detection of lactate and choline in lung cancer by 1H-MRS in a 41-year-old Asian man who was diagnosed with pT4N0M0 ⅢA stage, right upper lobe lung adenocarcinoma. A lactate-lipid peak was observed near 1.33 ppm in the spectrum of lung cancer in vivo at TE  =  30 ms, and it was inverted at TE  =  135 ms, indicating that a lactate signal is contained in the lactate-lipid peak. A choline peak was also observed near 3.2 ppm in the spectrum with fat suppression at TE  =  135 ms. An accumulation of similar cases will help determine the appropriate applications of 1H-MRS for lung cancer.

Prospective examination of patients suspected of having appendicitis using new computed tomography criteria including "maximum depth of intraluminal appendiceal fluid greater than 2.6 mm".

OBJECTIVE: The objective of this study was to perform prospective computed tomography (CT) examination of patients suspected of having appendicitis to determine whether our criteria (which include the new criterion "maximum depth of intraluminal appendiceal fluid greater than 2.6 mm") are useful for improving sensitivity and/or specificity in comparison with conventional major criteria. METHODS: Two hundred eighty consecutive patients older than 15 years old and suspected of having appendicitis were examined using CT. We prospectively diagnosed appendicitis when a patient satisfied the following criteria (our criteria): (A) maximum appendiceal diameter greater than 6 mm in the presence or the absence of periappendiceal inflammation, (B) maximum depth of intraluminal appendiceal fluid greater than 2.6 mm, and (C) absence of an alternative lesion explaining the clinical manifestations. These patients were also prospectively examined using conventional major criteria (excluded criterion B from our criteria). Computed tomography findings were compared with the findings at surgery, pathology, and clinical follow-up. RESULTS: Use of our criteria yielded a sensitivity of 97.3% (109/112), a specificity of 100% (168/168), and an accuracy of 98.9% (277/280) for the diagnosis of appendicitis. Using conventional major criteria, these values were 66.1% (74/112), 100% (168/168), and 86.4% (242/280), respectively, and sensitivity was lower than the value obtained using our criteria (P < 0.001 by the MacNemer test), although there is no significant difference in specificity between these criteria (P = 1 by the MacNemer test). CONCLUSIONS: Our criteria can improve sensitivity in comparison with conventional major criteria because our criteria enabled us to differentiate appendicitis without periappendiceal inflammation from a normal appendix.

Radiation with concomitant superselective intra-arterial cisplatin infusion for maxillary sinus squamous cell carcinoma.

PURPOSE: To assess the efficacy and prognostic factors after superselective intra-arterial chemoradiation (RADPLAT) for maxillary sinus squamous cell carcinoma (MS-SCC). MATERIALS AND METHODS: Prognostic significance of age, gender, T and N factors, gross tumor volume of the primary-site (GTV), total cisplatin dosage, and total cisplatin dosage per GTV (CDDP/GTV) for primary-site recurrence-free survival rate (PRFS) were analyzed. RADPLAT was administered to 27 patients. The median follow-up period was 42.1 months. RESULTS: The 3-year rates of overall survival and PRFS were 59.2% and 53.9%, respectively. In univariate analysis, age, male, and total cisplatin dosage were significant factors for PRFS. In multivariate analysis, lymph node metastasis was significant factors for PRFS, and gender and total cisplatin dosage weakly influenced PRFS. In acute phase, no patient showed ≥ grade 3 hematologic toxicity, and grade 3 mucositis developed in 5 patients. Late toxicities were recognized in 3 patients (grade 2 phlegmon of the face, grade 3 maxillofacial osteonecrosis, and retinopathy). Twelve patients (44%) experienced recurrences. Of them, 8 patients showed recurrence at the primarysite. CONCLUSION: RADPLAT was effective for MS-SCC, with acceptable toxicity. Total cisplatin dosage is suggested to be important for primary tumor control.

[USEFULNESS OF VIVID (VISUALIZATION OF VARIOUS INTEGRATION WITH DIFFUSION) ON COGNITIVE FUSION PROSTATE BIOPSY].

(Purpose) We created an image reconstructing multiparametric MRI system called VIVID (Visualization of Various Integration with Diffusion) and examined the efficacy of VIVID in detecting prostate cancer. (Methods and materials) The subjects were 80 patients who underwent one target biopsy with reference to MRI images in addition to 8-20 biopsies. (Results) The significant cancer detection rate was 61%, the significant cancer detection rate of PI-RADS 4 or 5 was 55%, and the significant cancer detection rate of VIVID score 4 or 5 was 55%. Three cases with PI-RADS 4 at TZ lesion with positive T2WI only were evaluated as having VIVID scores 1 or 2. Cancer was not detected with target biopsy from the site. (Conclusion) Our finding suggest that VIVID correctly excludes TZ lesions with only T2WI positively in multiparametric MRI.

5-Fluorouracil-related gene expression in primary sites and hepatic metastases of colorectal carcinomas.

UNLABELLED: The aim of this study was to investigate the correlation of the mRNA expressions of 5-fluorouracil (5FU)-related genes in the primary sites and liver metastases of colorectal carcinomas. PATIENTS AND METHODS: Patients with liver metastases from colorectal carcinomas were included (n = 43). The expression ratios to beta-actin of mRNA of thymidine synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP) and oroteta phosphoribosyl transferase (OPRT) were measured in primary and liver metastases of colorectal carcinomas by laser-captured microdissection and real time PCR. RESULTS: The ratios for the expression of TS, DPD, TP and OPRT mRNAs were significantly correlated between paired primary sites and liver metastases. The mRNA expression ratios of DPD and TP showed a significant correlation both in primary sites and in liver metastases. CONCLUSION: Enzymes of the primary colorectal carcinomas can be used in predicting the therapeutic efficacy of 5FU against liver metastases.

5-Fluorouracil-related gene expression in hepatic artery infusion-treated patients with hepatic metastases from colorectal carcinomas.

AIM: To predict the therapeutic efficacy of hepatic arterial infusion (HAI) with 5-fluorouracil (5FU) for patients with liver metastases from colorectal carcinomas, 5FU-related gene expressions were examined in primary colorectal carcinomas. PATIENTS AND METHODS: Thirty-eight patients with liver metastases from colorectal carcinoma received HAI of 5FU. The expressions of the mRNAs for thymidine synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP), and oroteta phophoribosyl transferase (OPRT) in primary colorectal carcinomas were measured by RT-PCR. RESULTS: The response rate was 52.6% (20/38). The overall median survival time was 29.1 months. DPD and TP expression was significantly higher in the progressive disease (PD) group than in the complete response (CR) or partial response (PR) group (p = 0.032, p = 0.014), respectively. The levels of DPD and TP mRNAs showed a significant correlation (r = 0.76, p = 0.0001). CONCLUSION: The expression of DPD and TP mRNAs in primary colorectal carcinomas was significantly predictive of the therapeutic response to 5FU HAI.

Japanese Expert Panel Meeting on the Management of Prostate Cancer with Bone Metastases.

INTRODUCTION: The incidence of prostate cancer in Japan continues to increase, necessitating the continued development of effective therapies and strategies. Recent advances in treatments have improved the prognosis of metastatic disease and highlighted the importance of treating bone metastases to reduce the incidence of skeletal complications and improve patients' quality of life. With the increasing number of treatment options that have become available, including bone-targeted therapy with the alpha emitter radium-223 dichloride (Ra-223), Japanese clinicians are faced with making difficult decisions on the choice of optimal treatment strategy. In such situations, guidance based on expert opinions can be beneficial. METHODS: A panel meeting of 27 Japanese experts in the management of prostate cancer was held to share opinions and to establish consensus recommendations on key clinical questions. Panelists were asked to vote on more than 40 questions pertinent to prostate cancer, and the answers helped guide a comprehensive discussion. RESULTS: The panel reached a consensus on key topics related to the optimal treatment strategy for Ra-223 therapy, namely, that patients with symptomatic, metastatic castration-resistant prostate cancer (CRPC) would benefit most from the use of this agent and that this treatment therapy should be provided before chemotherapy. Other topics that achieved consensus included: monitoring for osteoporosis and providing treatment if necessary during androgen deprivation therapy; performing magnetic resonance imaging in the presence of discrepancies in bone scintigram and computed tomography scans; monitoring alkaline phosphatase during CRPC treatment; using osteoclast-targeting in patients with CRPC with bone metastases; and using osteoclast-targeted agents combined with Ra-223. CONCLUSION: These consensus recommendations and the updated information which became available subsequent to the panel meeting included here provide useful information for clinicians to aid in designing optimal treatment strategies for their patients. FUNDING: Bayer Yakuhin Ltd.

New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid.

OBJECTIVE: The purpose of this study was to evaluate whether a new criterion-maximum depth of the intraluminal appendiceal fluid-is useful to differentiate between a normal appendix with diameter greater than 6 mm and appendicitis without periappendiceal inflammation. MATERIALS AND METHODS: The study included 59 patients showing a normal appendix with diameter greater than 6 mm and having no adjacent lesions (noncomplicated-normal-appendix group), 30 patients showing a normal appendix with diameter greater than 6 mm and having adjacent lesions (complicated-normal-appendix group), and 38 patients showing appendicitis without periappendiceal inflammation (appendicitis group). The following specific CT findings were retrospectively evaluated: maximum appendiceal diameter greater than 6 mm, maximum appendiceal wall thickness greater than 3 mm, appendiceal wall enhancement, focal cecal wall thickening, adjacent adenopathy, appendicolith, and maximum depth of the intraluminal appendiceal fluid. RESULTS: The mean maximum depth of the intraluminal appendiceal fluid in the appendicitis group was significantly higher than in the two groups with a normal appendix (Mann-Whitney U test: p < 0.001). When using maximum depth of the intraluminal appendiceal fluid greater than 2.6 mm for a criterion of appendicitis, sensitivity and specificity for differentiation between the appendicitis group and the other two groups with a normal appendix were both greater than 80%. In contrast, when using another CT a criterion, either sensitivity or specificity was 50% or less. CONCLUSION: The new CT criterion based on the maximum depth of the intraluminal appendiceal fluid greater than 2.6 mm is particularly useful for differentiating appendicitis without periappendiceal inflammation from a normal appendix with a diameter greater than 6 mm.

Relationship between apparent diffusion coefficient and signal intensity in endometrial and other pelvic cysts.

We evaluated whether apparent diffusion coefficient (ADC) value is more useful than signal intensity for differentiating endometrial cysts from other pelvic cysts. In an in vitro study, signal intensity and diffusion coefficients were measured in whole blood phantoms in which blood oxidation was gradually increased and concentration subsequently diluted. Although both signal intensity and diffusion value were largely affected by blood concentration, diffusion value was almost independent of blood oxidation and red blood cell lysis-related diminution of magnetic nonhomogeneity, both factors greatly affecting signal intensity on T1- and T2-weighted images. In an in vivo study, differentiation between endometrial and other pelvic cysts was attempted by means of ADC values and signal ratios of cysts to muscles on T1- and T2-weighted images (T1- and T2-ratios). Endometrial cysts tended to show lower T2-ratios, higher T1-ratios, and lower ADC values than other pelvic cysts (p < 0.001). However, ADC values were not correlated with T1- and T2-ratios (p < /0.15/). The ability of ADC value to discriminate between these two groups (discriminant rate, 91.4%) was higher than that of T2-ratio (71.4%) or T1-ratio (88.6%). If combined, ADC and T1-ratio (or T2-ratio) showed higher discriminant rate (94.3%) than the combination of T1- and T2 ratios (88.6%). ADC value might be useful for evaluating the blood concentration of a cystic lesion, because diffusion value is more closely related to blood concentration and almost independent of blood oxidation and red blood cell lysis that largely affect signal intensity.

Early predictive value of non-response to docetaxel in neoadjuvant chemotherapy in breast cancer using 18F-FDG-PET.

BACKGROUND: The aim of this prospective study of patients with breast cancer was to identify non-responders to docetaxel in neoadjuvant chemotherapy (NCT) using fluorine-18-fluorodeoxyglucose positron-emission tomography ((18)F-FDG-PET). PATIENTS AND METHODS: We analyzed the maximum standardized uptake value (SUVmax) of (18)F-FDG-PET before and after the first course and the reduction rate in tumor size shown by magnetic resonance imaging (MRI) before the first and after the fourth course of docetaxel. RESULTS: None of the eight patients (0%) whose SUVmax decrease was less than 18% revealed a clinical partial response or clinical complete response; Seven out of the sixteen patients (44%) with an SUVmax decrease over 45% achieved a complete response. CONCLUSION: An SUVmax reduction rate less than 18% is observed in patients with breast cancer after the first course of docetaxel in NCT and may be indicator of non-response to docetaxel.