Establishment and Internal Validation of a Prognostic Score for Post-hepatectomy Liver Failure Based on Functional Liver Parameters Estimated via TC-99m GSA.

Background The 99mTc-galactosyl human serum albumin (Tc-99m GSA) scintigraphy evaluates the future remnant liver function, which is an important prognostic factor for post-hepatectomy liver failure (PHLF). This study aimed to establish a new prognostic score for PHLF, including the functional liver parameters evaluated by Tc-99m GSA scintigraphy. Materials and methods This study reviewed a single-center, retrospective 368-patient database of those who underwent open and laparoscopic hepatectomy in Meiwa Hospital from January 2016 to October 2021. Moreover, 102 patients who underwent Tc-99m GSA scintigraphy following hepatectomy were analyzed. The index of blood clearance of the tracer was calculated from the uptake ratio of heart at 15 minutes to that at 3 minutes (HH15) and the index of hepatic accumulation was calculated from the uptake ratio of liver to liver plus heart at 15 minutes after the injection (LHL15) were calculated for the general functional parameters. The maximal removal rate of Tc-99m GSA (GSARmax) was also calculated, then the GSARmax of the remnant liver (GSARmax-RL) was estimated as the future remnant liver function depending on the hepatectomy. Multivariate analysis was conducted to identify the PHLF predictor, and then a risk-scoring system was established with the 1,000-times bootstrapped validation. Results PHLF (grade ≥ B) was observed in 13 of 102 patients. Multivariate analysis revealed that PHLF was independently predicted by GSARmax-RL (<0.26 mg/min) and LHL15 (<0.89). The risk score was assigned to each item and then classified into four subgroups, with a predicted PHLF of 3.7%, 14.4%, 42.8%, and 76.8%. Receiver operating characteristic (ROC) curve analysis demonstrated good discrimination (adjusted area under the curve (AUC) after bootstrapped validation, 0.779). The ROC curve analysis compared with other prognostic scores showed that the new model had the highest AUC values for accuracy. Conclusions The new prognostic score based on Tc-99m GSA scintigraphy could recognize patients with a high risk of progressing to PHLF and be helpful in planning therapeutic strategies.

Lymphoscintigraphy for Imaging of the Lymphatic Flow Disorders.

Lymphoscintigraphy has introduced with the great advantage for diagnostic imaging of the lymphatic flow disorders. Lymphoscintigraphy can be performed in patients of any age, including neonates, and even in patient in critical conditions. The procedure is quite simple, and it needs only subcutaneous injection of small amounts of radiotracers. From subcutaneous tissue the radiotracer is taken by the lymphatic vessels and gives off energy in the form of gamma radiation detected by a gamma camera. Radiotracers rarely cause the allergic reaction and can be administered to the patients with allergy to iodine contrast media. Comparing with the Lipiodol, radiotracers cannot cause pulmonary embolism; therefore, it is safe for the patients with respiratory dysfunction. The objective of this article is to describe the indication, technique, equipment, pitfalls, safety, and effectiveness of lymphoscintigraphy for imaging of the lymphatic flow disorders.

An investigation of the early detection of radiation induced apoptosis by 99mTc-Annexin V and 201thallium-chloride in a lung cancer cell line.

This study aims to investigate the efficacy of in vitro Thallium-201 Chloride (Tl-201) and in vitro and in vivo Tc-99m HYNIC-coupled Annexin V (TAV) in the early detection of radiation induced apoptosis, a proxy indicator of radiation therapy (RT) efficacy. In vitro Tl-201 and TAV accumulation and efflux in non-small cell lung cancer were measured post irradiation at 5 different gamma ray doses. The replication rates (RR) of the cell lines were also measured. The same non-small cell lung cancer line was inoculated into the left femur. In vivo non-invasive Tl-201 and TAV tracer biodistribution studies were performed. Cell RR decrease with increased radiation dose was observed 48 hours after irradiation. Apoptotic cell number was found to have increased in response to 9 Gy and 12 Gy radiation dose. Tl-201 accumulation in the 9 Gy and 12 Gy irradiation groups was found to be higher than the lower irradiation groups. Quick Tl-201 efflux was observed in the 9 Gy and 12 Gy irradiated cells. At 48 hours after irradiation with 9 Gy and 12 Gy, Annexin V accumulation was found to be higher than in the control and 3-6 Gy groups. In vivo mouse model confirmed the increased TAV uptake in implanted tumors for relatively high 9 Gy irradiation as compared to non-irradiated controls. TAV may prove to be an effective radiotracer for early assessment of radiation therapy efficacy, via apoptosis, in human lung cancers.

Effectiveness of treatment with donepezil hydrochloride and changes in regional cerebral blood flow in patients with Alzheimer's disease.

OBJECTIVE: The objective of this study was to elucidate the relationship between the effects of donepezil hydrochloride (donepezil) and cerebral blood flow, and to evaluate the usefulness of cerebral blood flow imaging in assessing and predicting treatment effectiveness. METHODS: The subjects were 29 outpatients (12 men and 17 women; age 50-82 years; mean age 69.2 years), who had received a diagnosis of Alzheimer's disease (AD). Efficacy was evaluated before donepezil administration; after 1 month, 3 months, and 6 months of drug administration; and at 1 year after completion of administration using the Japanese version of the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog), as a measure of cognitive function. The ADAS-cog has been frequently used to evaluate cognitive function in AD patients. Patients whose ADAS-cog scores improved by 3 or more points during the observation period were classified as responders, and those with no improvement were classified as nonresponders. (123)I-IMP was used for single photon emission computed tomography cerebral blood flow scintigraphy. RESULTS: On the basis of ADAS-cog score improvement, 22 of the 29 patients were responders (7 men and 15 women; age 50-82 years; mean age 69.0 years) and seven were nonresponders (5 men and 2 women; age 61-80 years; mean age 70.0 years). The results indicate that a difference in cerebral blood flow responsiveness after 1 month of treatment distinguishes responders from nonresponders. After 1 month, blood flow was significantly decreased in all regions of nonresponders, whereas significant increases in blood flow were seen in the anterior frontal lobe and parietal lobe of responders. At that time point, blood flow in the basal ganglion differed significantly between the two groups, indicating that this difference in responsiveness after 1 month of treatment may distinguish responders from nonresponders. CONCLUSIONS: In cognitive function testing, the group that exhibited a complete response showed improvement primarily in parameters reflecting frontal lobe function. Complete responders also showed significantly greater blood flow increases in the basal ganglion and thalamus early during the treatment period. This indicates that the drug responsiveness of the basal ganglion and thalamus affects frontal lobe function and distinguishes complete responders from patients who do not exhibit such a response.

A case of metastatic bone tumor of missed lung cancer showing unusual manifestations on chest radiogram.

We encountered a patient who had a primary unknown carcinoma with lumbago caused by lumbar vertebral metastasis as the initial chief complaint. Autopsy revealed primary pulmonary adenocarcinoma. Abnormal findings noted on plain chest radiogram and chest CT led to misdiagnosis as inflammatory changes. The primary lesion was poorly differentiated pulmonary adenocarcinoma that could not be diagnosed correctly using the diagnostic criteria of these diagnostic modalities.