[Evaluation of bronchial arterial infusion (BAI) for high risk lung cancer].

MATERIALS AND METHODS: Seventeen lung cancer patients with advanced age, complications or severe symptoms from the tumor were examined. Standard systemic chemotherapy, irradiation or operation was not indicated in these cases due the patients' systemic condition. BAI was performed using CDDP (40-50 mg/m2) + ETP (70 mg/m2) or CPT-11 (40 mg/m2). The therapeutic effects and side effects were examined. A pharmacokinetic/pharmacodynamic study was done in thirteen cases. RESULTS: Two patient (12%) revealed partial response and fifteen revealed minor response or no change. BAI was effective especially in six cases of malignant pleural effusion. Clinical effects were recognized in thirteen patient with severe chest symptoms (cough in 8, hemosputum in 2 and chest pain in 3). Side effects of over grade II were vomiting in 2 and leukopenia in one. The median survival was 240 days and the cumulative 2-year survival rate was 19.2%. The results of pharmacokinetic studies showed BAI was similar to standard systemic chemotherapy. COMMENT: BAI using low-dose anti-cancer agents was safe and effective and provided improved quality of life in cases of high risk lung cancer.

Usefulness of cerebral blood flow (CBF) measurements to predict the functional outcome for rehabilitation in patients with cerebrovascular disease (CVD).

PURPOSE: The objectives of this study were to (1) elucidate the relationship between the mean CBF in the whole brain (Av.mCBF) before rehabilitation of CVD patients and the BI score before and after rehabilitation, (2) determine whether the efficacy of rehabilitation can be predicted by measurement of the Av.mCBF, and (3) investigate what part of the brain was most important to improving the BI score. MATERIALS AND METHODS: The Av.mCBFs in 160 patients with CVD were calculated by Patlak plots with 99mTc-HMPAO before rehabilitation, and we determined the BI score before and after rehabilitation. Based on the BI scores before and after rehabilitation, patients were divided into four groups: Group A, BI = 100; Group B, 80 < or = BI < or = 99; Group C, 60 < or = BI < or = 79; Group D, 0 < or = BI < or = 59. We evaluated the relationship between the Av.mCBF and BI score before and after rehabilitation. RESULTS: The Av.mCBF before rehabilitation showed a tendency to be more correlated with the BI score after rehabilitation (r = 0.414, p < 0.0001) than before rehabilitation (r = 0.272, p = 0.0006). After rehabilitation, there was a tendency for the Av.mCBF value to increase in direct proportion to the BI score of the group: it was highest in Group A and lowest in Group D. The strongest correlation was found between the frontal lobe regional CBF before rehabilitation and the BI score after rehabilitation (r = 0.343, p < 0.0001). CONCLUSIONS: Measurement of the Av.mCBF before rehabilitation of CVD patients will permit prediction of the efficacy of rehabilitation. Also the regional CBF of the frontal lobe is most important for improving the BI score.

Tuberculosis peritonitis: gallium-67 scintigraphic appearance.

Tuberculosis peritonitis is a rare manifestation of extrapulmonary tuberculosis. The results of gallium-67 scintigraphy of three patients with tuberculosis peritonitis were reviewed to assess its usefulness in the diagnosis of this condition. Tuberculosis peritonitis was associated with diffuse or focal abdominal localization and decreased hepatic accumulation of gallium-67. These gallium-67 scan features of tuberculosis peritonitis may help to optimize the diagnosis and management of this disease.

[Linac-based stereotactic radiosurgery for arteriovenous malformations (AVMs) in brain: estimation for efficacy of therapeutic response using angiography].

The purpose of this study was to determine whether it is possible to predict the efficacy of therapeutic response to linac-based stereotactic radiosurgery for AVMs on the basis of the stagnation rate in the nidus, which was defined as follows: [(pooling time of contrast material in the nidus of AVM)/ (intracranial circulation time)] x 100. Cerebral angiograms of twenty-five AVMs were retrospectively evaluated, and the stagnation rates in the nidus were calculated before and one year after stereotactic radiosurgery. Reduction rate was also calculated by using angiography, and we statistically evaluated the relationship between the stagnation rates in the nidus and the reduction rates. The stagnation rates in the nidus prior to linac-based stereotactic radiosurgery were positively correlated with the reduction ratios of AVMs after stereotactic radiosurgery (r = 0.406, p = 0.0432). Our study suggested that a higher stagnation rate in the nidus of the AVM might be obliterated faster after linac-based stereotactic radiosurgery. Thus, calculation of the stagnation rate in the nidus before stereotactic radiosurgery is useful in predicting the efficacy of therapeutic response to linac-based stereotactic radiosurgery for AVMs.

[Influence of cerebellopontine angle tumor on cerebellar circulation--possibility of remote effect to the cerebellum].

Nine cases (4 men and 5 women, ranging in age from 39 to 73 years with a mean age of 51 years) of cerebello-pontine angle tumors were evaluated by cerebral blood flow scintigraphy on the basis of clinico-functional anatomy. In the 4 of 5 cases in which the middle cerebellar peduncle was compressed by the mass, definite hypoperfusion was revealed in the ipsilateral cerebellar hemisphere. On the other hand, in the 3 of 4 cases without compression of the middle cerebellar peduncle, no asymmetric perfusion was seen in either the right or left cerebellar hemisphere. There were neither supratentorial lesions nor signs of increased intracranial pressure in any of the 9 cases. On the vertebral angiograms of the 4 cases with compression of the middle cerebellar peduncle, non-opacification of the ipsilateral anterior inferior cerebellar artery occurred in only one case. There were no definite signs of reduction of cerebellar blood flow in the other 3 cases. The middle cerebellar peduncle is one of the largest bundles of centripetal fibers in the cerebellar hemispheres. Secondary neuronal fibers of the corticopontocerebellar pathway are the most prominent among these fibers. The mass lesion in the cerebellopontine cistern has a tendency to compress the middle cerebellar peduncle and may deactivate the corticopontocerebellar pathway even if it is small.(ABSTRACT TRUNCATED AT 250 WORDS)

[81mKr scintigraphic evaluation of hemodynamics in gynecologic malignancies under condition of angiotensin II-induced hypertension].

Transcatheter arterial infusion chemotherapy is one of the most useful therapeutic procedures for gynecologic malignancies. Recently, several reports have been published about Angiotensin II-induced hypertension chemotherapy and the efficacy of the method, but there have been no reports to evaluate an application for gynecologic malignancies. We evaluate the usefulness of the method for gynecologic malignancies demonstrating the changes of hemodynamics of the tumor using 81mKr scintigraphy. Thirteen patients with pathologically confirmed gynecologic malignancies were evaluated by angiography and continuous infusion of 81mKr via the catheter with and without Angiotensin II. At first, continuous infusion of 81mKr was performed under the superselective catheterization of the uterine artery. The radioactivities in the ROI were counted. Then, withdrew the catheter from the uterine artery to the internal iliac artery, and again continuously infused 81mKr and counted the radioactivities in the same ROI. Finally, keeping the catheter in the internal iliac artery, Angiotensin II and 81mKr were infused simultaneously. And counted the radioactivities. The radioactivities were highest when the catheter tip was placed in uterine arteries and lowest when the catheter tip was placed in internal iliac arteries. But radioactivities in the ROIs were definitely increased when Angiotensin II was used, even if the catheter tip was keeping in the internal iliac arteries. The optimal catheter position of transcatheter arterial chemotherapy for gynecologic malignancies is at proximal uterine artery. Since Angiotensin II-induced hypertension may increase blood flow of tumors, it seems to have indication for post-operative cases, highly advanced cases and cases with difficulties to perform superselective catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Re-appraisal of clinical usefulness of 67Ga-citrate scintigraphy for primary colorectal carcinoma: with evaluation of scintigram obtained from resected specimens.

Clinical usefulness of 67Ga-citrate scintigraphy for the diagnosis of colorectal carcinoma was reappraised at the standpoint of clinicopathological diagnosis. Fifty-eight patients with colonic carcinoma were subjected to this study. They underwent 67Ga scintigraphy before surgery. Colorectal carcinomas were detected in 38 patients, 65.5% by this procedure. Surgical specimens from thirty-seven patients underwent postoperative scanning. The scanning of the surgical specimen revealed accumulation of 67Ga-citrate in all 37 patients, suggesting that 67Ga-citrate accumulated in the carcinoma of the colon. The results suggested that detectability of carcinoma of the colon by 67Ga scintigraphy in this series was better than generally considered. 67Ga scintigraphy was considered to provide useful information in cases of severe stenosis and dolichocolon which were difficult to diagnose with a Barium enema and fiberscope. The problem is that abnormal accumulation is sometimes hard to distinguish from physiological excretion in the stools. However we believe that images should be carefully evaluated, keeping in mind the fact that 67Ga-citrate could accumulate in a colorectal carcinoma, and also believe that we radiologists should actively promote Ba-enema examination in positive cases rather than to devote time to the differentiation between physiological excretion of 67Ga in the stools and accumulation in a colorectal carcinoma.

[Non-quantitative analysis of the renography using 99mTc-DTPA; clinical efficacy and limitation].

The purpose of this paper is to evaluate the efficacy and limitation of the non-quantitative analysis of renography using 99mTc-DTPA, and to determine the clinical indication of the quantitative analysis of the study. We evaluated the clinical records of the patients and the findings of dynamic imagings and renograms. The non-quantitative analysis of the examination seemed to be useful to the selected cases, and quantitative analysis appeared to be dispensable except for the cases to evaluate the grade of parenchymal damages and causes of asymptomatic hematuria.

[Preliminary study of pelvic CT with air enema].

In pelvic CT, several techniques (appropriate preparations) have been reported for the optimal diagnostic imagings. We demonstrated the usefulness and limitations of "Air Enema", which is one of preparations for hollow viscera in pelvic CT examination. From Oct. 1986 to Mar. 1987, 38 patients with gynecological abnormalities were evaluated by consecutive pre and post "Air Enema" CT. The patients aged 26-75 years with mean of 44.6 years. All patients were examined in prone position with 100 ml of 2% iopamidol in the urinary bladder and medical tampon in the vagina. Two consecutive scans were performed from the level of pubic symphysis to the 5th lumbar vertebra at 10 mm-15 mm intervals. The first scan was pre "Air Enema" CT, in which the rectum, entire colon and terminal ileum were not distended. The second scan was post "Air Enema" CT, in which the hollow viscera was distended by 1000 ml-1500 ml of air. Two images, each from pre and post "Air Enema" CT were evaluated on the efficacy for imaging diagnosis. In "Air Enema" CT, main useful effect was "replacement effect", which was that intrapelvic masses and/or intrapelvic paravascular spaces were clearly delineated by distended bowels. Detection and location of intrapelvic masses were correctly diagnosed when the masses were relatively small (5.3 cm in average diameter), but there were no advantages in cases in which the pelvic masses were large enough to occupy the pelvic cavity (12.7 cm in average diameter). Abdominal pain was the most common adverse reaction to this technique. But complaints usually disappeared in few hours after examination. Thus, "Air Enema" seems to be useful preparation for pelvic CT examination to detect relatively small intrapelvic masses and abnormalities.

[67Ga-scintigraphic finding of colorectal carcinoma; the basis of clinicopathologic viewpoint].

Twenty-seven cases of colorectal carcinoma were evaluated by 67Ga-scintigraphy on the basis of clinicopathologic viewpoint. On each cases, 67Ga-scintigraphy was performed just before the operation, and resected specimen was also examined after the operation. In 17 cases (63%), the lesions were demonstrated on preoperative 67Ga-scintigraphy, on the other hand, all the lesions were clearly detected on images taken from resected specimen. Thus, it seems to be no doubt to accumulate 67Ga-citrate to colorectal carcinoma, and 67Ga-scintigraphy appears to be more useful imaging modality to detect the disease when the routine detectability becomes more higher because of some technical application.

[A case of mixed müllerian tumor, usefulness of 67Ga-citrate scintigraphy].

Mixed Müllerian Tumor (M.M.T.) is a rare malignant neoplasm usually arising from uterine body in postmenoposal woman, and imaging diagnosis for the tumor has not been established. A 45-year-old female with pathologically confirmed M.M.T. was evaluated by 67Ga-citrate scintigraphy and CT on the basis of imaging diagnosis. 67Ga-citrate scintigraphy detected correctly not only primary lesions but also metastatic and recurrent-foci. The findings of 67Ga-citrate scintigraphy were confirmed to be correspond to autopsy findings. Generally, detectability of 67Ga-citrate scintigraphy for genito-urinary tract neoplasm was not appreciated, but in our case 67Ga-citrate scintigraphy was useful for detection of the primary lesion, metastatic and recurrent foci. The cellular components and grade of cell-differentiation of this tumor seemed to be responsible for good detection of the tumor. Thus, 67Ga-citrate scintigraphy was considered to be useful diagnostic imaging modality of M.M.T.

[Preliminary study of patients with vertigo and dizziness using 123I-IMP].

To study the application of cerebral blood flow scintigraphy with 123I-IMP for the evaluation of central dizziness, the difference in 123I-IMP accumulation between the right and left cerebellar hemispheres was determined as an asymmetry index (A.I.) in 8 normal subjects and compared with A.I. from patients with central dizziness. According to estimated lesions, 123I-IMP findings were compared with CT findings. The normal subjects had A.I. of 5.8 +/- 2.1%, whereas 36 patients with central dizziness had A.I. of 12.7 +/- 7.5%. On the basis of an A.I. of 8% or more as an abnormal finding on IMP scintigraphy, 11 of the 14 patients with estimated lesions of cerebellar hemispheres and 16 of the 20 with those of the whole cerebellum including the vermis were evaluated to have had abnormalities. Seven of 11 with estimated lesions of the brainstem and 4 of 5 with vertebrobasilar arterial insufficiency were evaluated to have had abnormalities. The findings of 123I-IMP cerebral blood flow scintigraphy were in good agreement with clinical symptoms in patients with central dizziness with estimated lesions of the cerebellar hemispheres, suggesting the possibility that this method is more useful than CT.