Comparison of DWIBS/T2 image fusion and PET/CT for the diagnosis of cancer in the abdominal cavity.

Fusion images of diffusion-weighted whole-body imaging with background body signal suppression and T2-weighted image (DWIBS/T2) demonstrate a strong signal for malignancies, with a high contrast against the surrounding tissues, and enable anatomical analysis. In the present study, DWIBS/T2 was compared with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for diagnosing cancer in the abdomen. Patient records, including imaging results of examination conducted between November 2012 and May 2014, were analyzed retrospectively. In total, 10 men (age, 73.6±9.6 years) and 8 women (age, 68.9±7.1 years) were enrolled into the current study. Of the enrolled patients, 2 were diagnosed with hepatocellular carcinoma, 1 with cholangiocellular carcinoma, 1 with liver metastasis, 2 with pancreatic ductal adenocarcinoma, 1 with renal cell carcinoma and 1 with malignant lymphoma. Benign lesions were also analyzed, including adenomyomatosis of the gallbladder (5 patients), intraductal papillary mucinous neoplasm (4 patients) and right adrenal adenoma (1 case). All the patients with cancer showed positive results on DWIBS/T2 images. However, only 7 out of 8 patients were positive with PET/CT. One patient with right renal cellular carcinoma was positive with DWIBS/T2, but negative with PET/CT. All the patients with benign lesions were negative with DWIBS/T2 and PET/CT. In conclusion, DWIBS/T2 was more sensitive in diagnosing cancer of organs in the abdominal cavity compared with PET/CT. Furthermore, negative results with DWIBS/T2 and PET/CT were useful for the diagnosis of benign lesions, such as adenomyomatosis of the gallbladder and intraductal papillary mucinous neoplasm.

Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion for the diagnosis of colorectal polyp and cancer.

Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion (DWIBS/T2) is useful for the diagnosis of cancer as it presents a clear contrast between cancerous and non-cancerous tissue. The present study investigated the limitations and advantages of DWIBS/T2 with regards to the diagnosis of colorectal polyp (CP) or cancer (CRC). The current study included patients diagnosed with CP or CRC following colonoscopy, who were subjected to DWIBS/T2 between July 2012 and March 2015. Patient records were analyzed retrospectively. Patients were subjected to DWIBS/T2 when they presented with abdominal cancers or inflammation. Colonoscopy was performed as part of screening, or if patients had suspected colon cancer or inflammatory bowel disease. A total of 8 male and 7 female patients were enrolled in the present study. All patients, with the exception of one who had been diagnosed with CRC following colonoscopy, had positive results and all patients diagnosed with CP following a colonoscopy, with the exception of one, had negative results on DWIBS/T2. Thus, CRC was detected by DWIBS/T2, while CP was not (P=0.0028). The diameter of CRC lesions was significantly larger than that of CP (P<0.0001) and that of lesions positive on DWIBS/T2 was significantly larger than that of negative lesions (P=0.0004). The depth of invasion tended to be greater for lesions positive on DWIBS/T2 compared with that of negative ones. This indicated that DWIBS/T2 may be suitable for the detection of CRC but not for detection of CP. The results of DWIBS/T2 may also be affected by lesion diameter and depth of invasion.

Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion and positron emission tomography/computed tomography of upper gastrointestinal cancers.

PURPOSE: Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion (DWIBS/T2) strongly contrasts cancerous tissue against background healthy tissues. Positron emission tomography/computed tomography (PET/CT) applies the uptake of 18-fluorodeoxyglucose in the diagnosis of cancer. Our aim was to compare DWIBS/T2 and PET/CT in patients with upper gastrointestinal cancers. METHODS: Patient records, including imaging results from July 2012 to March 2015, were analyzed retrospectively. Four men (age, 72.5 ± 5.3 years) and ten women (age, 71.6 ± 4.0 years) were enrolled in this study. The numbers of patients with esophageal cancer, gastric cancer, gastrointestinal stromal tumor, and duodenal cancer were one, eight, three, and two, respectively. RESULTS: Six out of eight patients with gastric cancer had positive results on both DWIBS/T2 and PET/CT. The diameter and depth of invasion of gastric cancer was larger in patients with positive DWIBS/T2 and PET/CT findings than those with negative findings. These results suggested that patients with gastric cancer with larger pixel numbers might tend to show positive results with DWIBS/T2. CONCLUSIONS: DWIBS/T2 and PET/CT have similar sensitivity for the diagnosis of upper gastrointestinal cancer. The diameter and depth of invasion affected the detectability of gastric cancer.

[18F]FDG uptake in proximal muscles assessed by PET/CT reflects both global and local muscular inflammation and provides useful information in the management of patients with polymyositis/dermatomyositis.

OBJECTIVE: This study aimed to determine whether [(18)F]fluorodeoxyglucose-PET/CT ([(18)F]FDG-PET/CT) discriminates PM/DM from non-muscular diseases and also whether FDG uptake in proximal muscles reflects the activity and severity of muscular inflammation in PM/DM. METHODS: Twenty treatment-naïve PM/DM patients who underwent [(18)F]FDG-PET/CT were retrospectively identified by reviewing medical records. The same number of age- and sex-matched control patients with non-muscular diseases were also identified. Standardized uptake value (SUV) was calculated for each of the seven proximal muscles. For patient-based assessment, mean proximal muscle SUV was calculated by averaging the SUVs for these proximal muscles bilaterally. RESULTS: Mean proximal muscle SUVs were significantly greater in PM/DM patients than in control patients (median 1.05 vs 0.69, P < 0.001). Mean proximal muscle SUVs significantly correlated with mean proximal manual muscle test scores (ρ = 0.49, P = 0.028) and serum levels of creatine kinase (ρ = 0.54, P = 0.015) and aldolase (ρ = 0.64, P = 0.002). Furthermore, SUVs in proximal muscles from which biopsy specimens were obtained significantly correlated with histological grade for inflammatory cell infiltration (ρ = 0.66, P = 0.002). CONCLUSION: Our results suggest that [(18)F]FDG-PET/CT is useful in the diagnosis of PM/DM when inflammation in proximal muscles is globally assessed with quantitative measurements. Our results also indicate that local FDG uptake in a proximal muscle reflects the activity of inflammation in the same muscle and provides useful information in determining the region for muscle biopsy.

Use of F-18 fluorodeoxyglucose positron emission tomography with dual-phase imaging to identify intraductal papillary mucinous neoplasm.

BACKGROUND & AIMS: We investigated the usefulness of dual-phase F-18 fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) to differentiate benign from malignant intraductal papillary mucinous neoplasms (IPMNs) and to evaluate branch-duct IPMNs. METHODS: We used FDG-PET/CT to evaluate IPMNs in 48 consecutive patients who underwent surgical resection from May 2004 to March 2012. IPMNs were classified as benign (n = 16) or malignant (n = 32) on the basis of histology analysis. The ability of FDG-PET/CT to identify branch-duct IPMNs was compared with that of the International Consensus Guidelines. RESULTS: The maximum standardized uptake value (SUVmax) was higher for early-phase malignant IPMNs than that for benign IPMNs (3.5 ± 2.2 vs 1.5 ± 0.4, P < .001). When the SUVmax cutoff value was set at 2.0, early-phase malignant IPMNs were identified with 88% sensitivity, specificity, and accuracy. The retention index values for malignant and benign IPMNs were 19.6 ± 17.8 and -2.6 ± 12.9, respectively. When the SUVmax cutoff was set to 2.0 and the retention index value to -10.0, early-phase malignant IPMNs were identified with 88% sensitivity, 94% specificity, and 90% accuracy. In identification of branch-duct IPMNs, when the SUVmax cutoff was set to 2.0, the sensitivity, specificity, and accuracy values were 79%, 92%, and 84%, respectively. By using a maximum main pancreatic duct diameter ≥7 mm, the Guidelines identified branch-duct IPMNs with greater specificity than FDG-PET/CT. The Guidelines criteria of maximum cyst size ≥30 mm and the presence of intramural nodules identified branch-duct IPMNs with almost equal sensitivity to FDG-PET/CT. CONCLUSIONS: Dual-phase FDG-PET/CT is useful for preoperative identification of malignant IPMN and for evaluating branch-duct IPMN.

Treatment of azo dye Acid Orange 7 containing wastewater using up-flow constructed wetland with and without supplementary aeration.

The aim of this study is to examine and compare the treatment performance of Acid Orange 7 (AO7) containing wastewater by up-flow constructed wetland (UFCW) at different AO7 concentrations, hydraulic retention times (HRT) and alternative of supplementary aeration. The aerated wetland reactor outperformed the non-aerated one in the removal of organic matters, NH(4)-N and aromatic amines. The T-P removal efficiency for both wetland reactors was not much different throughout the study and the supplementary aeration showed no significant effect on T-P removal. As influent AO7 concentration increased from 50 to 100 mg/L, the performance in biodegradation of organic matters and nitrification in the non-aerated wetland reactor, and denitrification and decolorization in the aerated wetland reactor were affected. As HRT increased from 3 to 6 d, the removal of NH(4)-N and NO(3)-N in the aerated wetland reactor was not significantly different, but the NH(4)-N removal efficiency improved tremendously in the non-aerated wetland reactor.

Performance evaluation of laboratory scale up-flow constructed wetlands with different designs and emergent plants.

The objective of present study was to assess the simultaneous removal of organic pollutants and nutrients by five laboratory scale up-flow constructed wetlands (UFCWs). Aerobic and anaerobic regions were well developed at the upper and lower beds, respectively, in the UFCW reactors with supplementary aeration. The emergent plants employed were Phragmites australis and Manchurian wild rice. The COD, T-N, T-P, NH(4)-N and NO(3)-N removal efficiencies for the UFCW reactors were in the range of 90-94%, 69-92%, 29-52%, 59-98% and 45-100%, respectively. The organic matter and NH(4)-N removal efficiencies in the aerated wetland reactors were better than the non-aerated wetland reactors. The supplementary aeration has enhanced the aerobic biodegradation of organic matter and nitrification. The Manchurian wild rice outperformed P. australis in the removals of T-P, T-N and NH(4)-N.

Dual-time point scanning of integrated FDG PET/CT for the evaluation of mediastinal and hilar lymph nodes in non-small cell lung cancer diagnosed as operable by contrast-enhanced CT.

PURPOSE: To evaluate whether dual-time point scanning with integrated fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography and computed tomography (PET/CT) is useful for evaluation of mediastinal and hilar lymph nodes in non-small cell lung cancer diagnosed as operable by contrast-enhanced CT. MATERIALS AND METHODS: PET/CT data and pathological findings of 560 nodal stations in 129 patients with pathologically proven non-small cell lung cancer diagnosed as operable by contrast-enhanced CT were reviewed retrospectively. Standardized uptake values (SUVs) on early scans (SUVe) 1h, and on delayed scans (SUVd) 2h after FDG injection of each nodal station were measured. Retention index (RI) (%) was calculated by subtracting SUVe from SUVd and dividing by SUVe. Logistic regression analysis was performed with seven kinds of models, consisting of (1) SUVe, (2) SUVd, (3) RI, (4) SUVe and SUVd, (5) SUVe and RI, (6) SUVd and RI, and (7) SUVe, SUVd and RI. The seven derived models were compared by receiver-operating characteristic (ROC) analysis. k-Fold cross-validation was performed with k values of 5 and 10. p<0.05 was considered statistically significant. RESULTS: Model (1) including the term of SUVe showed the largest area under the ROC curve among the seven models. The cut-off probability of metastasis of 3.5% with SUVe of 2.5 revealed a sensitivity of 78% and a specificity of 81% on ROC analysis, and approximately 60% and 80% on k-fold cross-validation. CONCLUSION: Single scanning of PET/CT is sufficiently useful for evaluating mediastinal and hilar nodes for metastasis.

Simultaneous removal of color, organic compounds and nutrients in azo dye-containing wastewater using up-flow constructed wetland.

Combination of aerobic and anaerobic processes in constructed wetlands can enhance the treatment performance in textile wastewater. This study assessed the treatment of azo dye Acid Orange 7 (AO7) and nutrients using five laboratory-scale up-flow constructed wetlands (UFCW) with and without supplementary aeration, and with different emergent plants. Supplementary aeration controlled the size of aerobic and anaerobic zones in the UFCW reactors as evidenced by the oxidation-reduction potential (ORP) and dissolved oxygen (DO) profile of the UFCW. The AO7 removal efficiency was above 95% in all UFCW reactors and most of the color was extensively removed in the anaerobic region of the UFCW beds. The intermediates produced through the breakage of azo bond were significantly reduced in the UFCW reactors with supplementary aeration. The results indicated the applicability of the UFCW reactors to the treatment of azo dye-containing wastewater. The removals of T-N and T-P were in the range of 60-67% and 26-37%, respectively, among the UFCW reactors. The COD and NH(4)-N removals in the aerated reactors were about 86 and 96%, respectively. On the other hand, the COD and NH(4)-N removals were in the range of 78-82% and 41-48%, respectively, in the non-aerated reactors. The supplementary aeration enhanced the removal efficiencies in organic matter, NH(4)-N and aromatic amines in the UFCW reactors.

Noncardiogenic pulmonary edema as the first manifestation of pheochromocytoma: a case report.

We report here a case of pheochromocytoma presenting with noncardiogenic pulmonary edema, which is an unusual first manifestation of pheochromocytoma. Chest radiograph showed diffuse consolitaion and ground-glass opacity on both lungs. Neither pleural effusion nor cardiomegaly was present. High-resolution computed tomography (HRCT) showed widespread ground-glass opacity with fine intralobular reticular opacity (so-called "crazy-paving" appearance) and consolidation in a strikingly dependent distribution. The areas of ground-glass opacity and consolidation were sharply marginated by interlobular septa, showing a geographic appearance. The pulmonary edema and dyspnea resolved over three days without cardioactive or diuretic treatment. Noncardiogenic pulmonary edema is an unusual first manifestation of pheochromocytoma. It is important to recognize this unusual manifestation in the emergency situation.

Ovarian fibroma (fibrothecoma) with extensive cystic degeneration: unusual MR imaging findings in two cases.

Two cases of ovarian fibroma (fibrothecoma) with extensive cystic degeneration are described. One case revealed a large multiloculated cystic mass with a small solid part. Each locule showed variable signal intensity on both T1- and T2-weighted magnetic resonance (MR) images. The other case revealed a parviloculated cystic mass with a small solid part. In both cases, the solid parts were located at the periphery of the mass and showed distinct low signal intensity on both T1- and T2-weighted MR images and slight enhancement. It should be noted that ovarian fibromas (fibrothecomas) with extensive cystic degeneration are a rare exception to the rule that solid components in a cystic adnexal mass imply malignancy.

Relationship between CT findings of pulmonary tuberculosis and the number of acid-fast bacilli on sputum smears.

PURPOSE: To investigate the relationship between computed tomography (CT) findings in patients with active pulmonary tuberculosis (PTB) and the number of acid-fast bacilli (AFB) on sputum smears. METHODS: We reviewed CT scans of 173 patients with active PTB. The patients were divided into groups according to the number of AFB on sputum smears as follows: A, negative (n = 40); B, doubtful (n = 21); C, + (n = 34); and D, ++ or greater (n = 78). The presence or absence and the number of lobes that included micronodules, nodules, consolidation and cavitation, the number of cavities and the maximum diameter of the cavity lumen were noted. RESULTS: The frequency of micronodules and nodules did not significantly differ among the four groups. In contrast, the frequency of consolidation and cavitation increased with the number of AFB (P < .0001). Differences in the number of lobes involving micronodules, nodules, consolidation and cavitation were significant between Group D and the other groups (P < .0001), but not between Groups A or B and C. The number and maximum size of cavities significantly differed between Group D and the other groups (P < .0001). CONCLUSIONS: CT findings correlated with the number of AFB in sputum smears to some extent. However, CT findings do not reliably discriminate between smear-negative patients and those with very few AFB excreting smear-positive patients.

Bronchoarterial ratio and bronchial wall thickness on high-resolution CT in asymptomatic subjects: correlation with age and smoking.

OBJECTIVE: The purpose of this study was to determine whether the values of the bronchoarterial ratio and bronchial wall thickness, as viewed during high-resolution CT, relate to age and smoking status in asymptomatic healthy subjects. SUBJECTS AND METHODS: High-resolution CT was performed prospectively in 85 subjects without cardiopulmonary disease. The subjects were divided into three groups according to age: 29 subjects were 21-40 years old; 29 subjects, 41-64 years old; and 27 subjects, 65 years or older. Both bronchoarterial ratios, defined as the diameter of the bronchial lumen divided by the diameter of its accompanying artery, and the T/D ratio, defined as wall thickness (T) divided by the total diameter of the bronchus (D), were measured at the segmental and subsegmental levels of the apical and posterior basal segments. Each calculated ratio was evaluated according to age and smoking status. RESULTS: Significant correlation was found between the bronchoarterial ratio and age (r = 0.768, p < 0.0001), with the bronchoarterial ratio increasing with age and exceeding 1 in 41% of subjects older than 65 years. No significant correlation was seen between the T/D ratio and age. No significant differences in bronchoarterial ratio and T/D ratio were seen between smokers and nonsmokers in subjects overall; but in the elderly group, the T/D ratio was significantly higher in smokers than in nonsmokers (p = 0.021). CONCLUSION: The bronchoarterial ratio is influenced by aging. The normal bronchoarterial ratio in a substantial number of subjects older than 65 years overlaps with the ratio considered to represent bronchiectasis. Thus, when this ratio is used for the quantitative analysis of pulmonary and cardiovascular disease, the influence of age should be considered.

Effect of the rate of gadolinium injection on magnetic resonance pulmonary perfusion imaging.

PURPOSE: To determine whether the injection rate of contrast agent affects the dynamics of enhancement of the pulmonary parenchyma on magnetic resonance (MR) pulmonary perfusion imaging. MATERIALS AND METHODS: Fifteen healthy volunteers underwent enhanced MR pulmonary perfusion imaging to evaluate the effects of different injection rates. Injection rates were 1, 3, or 5 mL/second. Regions of interest (ROIs) were chosen in the lung and aorta to analyze the change in signal intensity over time. RESULTS: As the injection rate increased, the peak enhancement occurred significantly earlier (P = 0.0012), but the peak enhancement signal-to-noise ratio (SNR) value was not affected (P = 0.25). With the 3- and 5-mL/second injection rates, images of both the pulmonary circulation and systemic circulation were obtained separately. However, with 1 mL/second, higher enhancement of the aorta was overlapped with peak enhancement of the lung tissue. CONCLUSION: The injection rate affects the enhancement profiles of the pulmonary parenchyma.