Update on respiratory lesions in patients with IgG4-related autoimmune pancreatitis.

We previously reported respiratory involvement in 25 patients with autoimmune pancreatitis, a pancreatic manifestation of IgG4-related disease that responds well to glucocorticoid treatment. However, whether all respiratory lesions in patients with autoimmune pancreatitis have genuine respiratory involvement is unclear. This study aimed to update respiratory lesions' clinical and radiological characteristics in patients with autoimmune pancreatitis. We retrospectively reviewed the clinical and radiological data of 74 consecutive patients diagnosed with autoimmune pancreatitis at Shinshu University Hospital and treated with glucocorticoid. Clinical features and chest high-resolution computed tomography findings before and after therapy were reviewed. Fifty-one patients (68.9%) had respiratory lesions. In 65 of the 74 patients, chest high-resolution computed tomography results were evaluated before and after treatment. Patients with IgG4-related disease and respiratory lesions showed significantly higher serum IgG4 levels and hypocomplementemia than those without respiratory lesions; they also had more affected organs. While most abnormal thoracic findings improved, 4 cases of 7 with reticular opacities and all 11 cases with emphysema did not improve. Therefore, these lesions with poor response to glucocorticoid treatment should not be considered due to respiratory involvement of autoimmune pancreatitis based on the current classification criteria for IgG4-related disease. Patients with autoimmune pancreatitis and respiratory lesions exhibited higher disease activity than those without. Most chest high-resolution computed tomography lesions were responsive to glucocorticoid treatment, whereas reticular opacities and emphysema were poorly responsive.

Can expiratory or inspiratory contrast-enhanced computed tomography be more efficient for fast-track cannulation of the right adrenal vein in adrenal venous sampling?

PURPOSE: This study compares the usefulness of expiratory arterial phase (EAP)-contrast-enhanced computed tomography (CT) (CECT) with that of inspiratory arterial phase (IAP)-CECT in adrenal venous sampling (AVS). METHODS: Sixty-four patients who underwent AVS and CECT at the authors' hospital between April 2013 and June 2019 were included in this study. The patients were classified into the following two groups: EAP (32 patients) and IAP (32 patients) groups. The single arterial phase images were obtained at 40 seconds in the IAP group. The double arterial phase images were obtained at 40 seconds in the early arterial phase and 55 seconds in the late arterial phase in the EAP group. The authors then compared the right adrenal vein (RAV) visualization rate on the CECT, the difference between the CECT images and adrenal venograms in the localization of the RAV orifice, the cannulation time to the RAV, and the volume of contrast agent administered intraoperatively between the two groups. RESULTS: The rates of the RAV visualization in the EAP group were 84.4% in the early arterial phase, 93.8% in the late arterial phase, and 100% in the combined early and late arterial phases. The rate of the RAV visualization in the IAP group was 96.9%. There was no significant difference between the two groups in terms of the rate of the RAV visualization. However, there was a small difference in the location of the RAV orifice between the CECT images and adrenal venograms in the EAP group as compared with the IAP group (P < 0.001). The median time to the RAV catheterization was significantly shorter in the EAP group (27.5 minutes) than in the IAP group (35.5 minutes; P = 0.035). The rates of the RAV visualization in the EAP group were not significant between the early arterial phase, late arterial phase, and combined early and late arterial phases (P = 0.066). However, the mean volume CT dose index in the combined early and late arterial phases was significantly higher than in the early and late arterial phases (P < 0.001). CONCLUSION: The EAP-CECT is more useful for increasing the speed of the RAV cannulation due to the small difference in the localization of the RAV orifice compared to IAP-CECT. However, since EAP-CECT has double contrast arterial phases and increased radiation exposure compared to IAP-CECT, only the late arterial phase may be acceptable to reduce radiation exposure.

Improvement of catatonia-induced rapid respiratory failure with electroconvulsive therapy: A case report.

We encountered a case of sudden respiratory failure during treatment of catatonia that required intensive care. Electroconvulsive therapy (ECT) was administered in the intensive care unit while the patient was under systemic control. The catatonia symptom was relieved, and respiratory failure improved. Although a proximal venous thrombus was observed, anticoagulation therapy was continued during ECT, and the patient was successfully treated without causing a pulmonary embolism. It is crucial to monitor the patient's physical and psychological symptoms because respiratory status may deteriorate rapidly in a catatonic state.

Is using a consolidation tumor ratio 0.5 as criterion feasible in daily practice? Evaluation of interobserver measurement variability of consolidation tumor ratio of lung cancer less than 3 cm in size.

BACKGROUND: Consolidation tumor ratio (CTR) calculated as the ratio of the tumor consolidation diameter to the tumor maximum diameter on thin-section computed tomography (CT) of lung cancer has been reported as an important prognostic factor. It has also been used for treatment decision-making. This study aimed to investigate the interobserver variability of CTR measurements on preoperative CT and propose a clinically useful CTR-based classification criterion. METHODS: We enrolled 119 patients who underwent surgery for suspected or diagnosed small-sized lung cancer (≤3.0 cm in diameter). Nine doctors reviewed preoperative CT scans to measure CTR. Interobserver variability of CTR measurements was evaluated using the coefficient of variation (CV) and Fleiss' κ. The prognostic effect of the CTR-based classification was assessed using the Kaplan-Meier method. RESULTS: Interobserver variability of CTR measurement was the highest for tumors with the lowest CTR (CTR = 0); it decreased as CTR increased and reached a plateaued level of low variability (CV <0.5) at CTR of 0.5. We proposed a three-group classification based on the findings of CTR interobserver variability (CTR < 0.5, 0.5 ≤ CTR < 1, and CTR = 1). Interobserver agreement of the judgment of the CTR-based classification was excellent (Fleiss' κ = 0.81). The classification significantly stratified patient prognosis (p < 0.001, 5-year overall survival rates with CTR < 0.5, 0.5 ≤ CTR < 1, and CTR = 1 were 100, 88, and 73.8%, respectively). CONCLUSIONS: CTR 0.5 is a clinically relevant and helpful cutoff for treatment decision-making in patients with early-stage lung cancer based on high interobserver agreement and good prognostic stratification.

Retrospective analysis of multi-institutional, patient-specific treatment planning results of high-dose-rate intracavitary brachytherapy for gynecological cancer using V100.

The objective of this study was to clarify the usefuleness of the K parameters of the independent verification method using V100% (the volume of water receiving 100% of the prescription dose) for institutions implementing the high-dose-rate (HDR) intracavitary brachytherapy for gynecological cancer. The data of 249 plans of 11 institutions in Japan were used, and the constant K value obtained by a parameter fit for single-192Ir, two-192Ir, and three-192Ir systems was calculated. The predicted total dwell time calculated using the constant K value was defined as Tpr, and the total dwell time calculated using a radiation treatment planning system was defined as TRTP. The ratio of Tpr and TRTP for each plan was calculated. The constant K values (95% CI) obtained for each system outlined above were 1233 (1227-1240), 1205 (1199-1211), and 1171 (1167-1175), respectively. Regarding the Tpr/TRTP, the entire data were within 0.9-1.1. For accurate verification, it was clarified that constant K values should be calculated for each system. The Nuclear Regulatory Commission considers a difference of 20% between the prescribed total dose and the administered total dose as a reportable medical event. There is a need for a quick method to verify the accuracy with a minimum of 10% threshold of a plan. The constant K values in this study were obtained from multiple institutions, and the variation in the values among these institutions was small. The data obtained by this study may be used as a parameter of this verification method employed by numerous institutions, particularly those who have recently initiated HDR brachytherapy. In addition, for institutions already using this method, this data might be useful for the validation of the parameters which were used in such institutions.

Improvement in radiological reading efficiency and residents' education and clinical contribution using the modified reading system "Triage Reader".

PURPOSE: To assess whether the modified reading system "Triage Reader" (TR) can improve the radiological reading work environment. MATERIALS AND METHODS: This retrospective, single-center study analyzed two reading systems for 26,786 computed tomography and magnetic resonance imaging examinations. In the conventional system (January 1-May 31, 2016), all reading work was mostly completed within the day. In the TR system (January 1-May 31, 2017), a radiology resident (TR) first read every image immediately after the examination and tagged each examination according to actual image findings and clinical demands. Routine reading work was finished when all high-priority cases were completed. Low-priority cases were assessed the following day. RESULTS: When using the TR system, the mean reading number in the evening decreased (P = 0.009). The mean elapsed time to finalize report of case with actual urgent image finding shortened from 4.26 to 1.97 h (P < 0.0001). The mean number of cases experienced per resident increased from 5.4 to 28.7 (P < 0.001). Subjective evaluation revealed a significant improvement in "Reading efficiency" and "Contribution to clinical practice." CONCLUSION: Introduction of the TR system can improve the reading efficiency and quality, educational effect among residents by increasing the number of experienced cases and work satisfaction.

Simple index for validity of the evaluation point for dosimetric verification results of intensity-modulated radiation therapy using a Farmer-type ionization chamber.

PURPOSE: Based on a retrospective analysis, this study aims to develop a simple index for validity of the evaluation point for the dosimetric verification of intensity-modulated radiation therapy (IMRT). METHODS: The results for the dosimetric verifications of a total of 69 IMRT plans were analyzed in this study. A Farmer-type ion chamber was used as a dose detector, and a solid water-equivalent phantom was used. Index values were obtained by dividing the difference between the maximum and minimum dosages by the mean dosage of the 69 plans, and the values were classified into five groups with index value <4, 4-8, 8-12, 12-16, and >16. A t-test was used to assess the statistical significance of the mean differences of the absolute values of the relative errors among these groups. RESULTS: We found that there was no significant difference between the groups with index value <4 and 4-8 (p = 0.152); however, there were significant differences between the other groups (p < 0.01). In addition, when the index values were smaller than 8, the pass ratio of 3% tolerance was 96.2% and the pass ratio of 5% tolerance was 99.9%. We observed that the smaller the index value, the smaller the uncertainty of the dose measurement. CONCLUSIONS: The results obtained in this study may prove to be useful for accurate dosimetric verifications of IMRTs when ion chambers are used.