Detection of hepatocellular carcinoma with ferucarbotran (resovist)-enhanced breath-hold MR imaging: feasibility of 10 minute-delayed images.

PURPOSE: We evaluated the optimal timing for breath-hold MR imaging with bolus-injectable superparamagnetic iron oxide (SPIO) for detecting hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Twenty patients with 62 HCCs (52 hypervascular, 10 non-hypervascular) underwent MR imaging that included unenhanced and SPIO-enhanced T1-weighted gradient echo (GRE) and T2-weighted fast spin echo (FSE) sequences, perfusion study, and SPIO-enhanced T2*-weighted GRE sequences. We obtained SPIO-enhanced T2*-weighted sequences 10 and 30 min after injecting SPIO and made 2 image sets, comprising 10- or 30-min delayed T2*-weighted images. Three observers performed alternative free response receiver operating characteristic (AFROC) analysis, and quantitative evaluation was performed. RESULTS: Only Observers 2 and 3 recognized a significant difference in the area under the AFROC curve (Az) value in the 10-min delayed images; no significant difference was observed in the 30-min delayed images. There was no significant difference in the sensitivity of individual observers between 10- and 30-min delayed images. The contrast-to-noise (C/N) ratio of the 30-min delayed images was significantly higher than that of the 10-min delayed images. The C/N ratio of hypervascular HCCs in the 30-min delayed images was significantly higher than in the 10-min delayed images, but that of non-hypervascular HCCs showed no significant difference. CONCLUSION: In most cases, 10-min delayed SPIO-enhanced T2*-weighted images are sufficient to detect HCCs.

A phase I-II study of bi-weekly docetaxel combined with radiation therapy for patients with cancer of the larynx/hypopharynx.

BACKGROUND: We performed a phase I/II study of bi-weekly docetaxel in combination with concurrent radiotherapy to enhance the cytotoxic effect and radiosensitization and improve the rate of laryngeal preservation. METHODS: Patients with T2N0-1M0, T3N0M0 hypopharyngeal cancer or T2N0-1M0, T3N0-1M0 larynx cancer were enrolled. Docetaxel was administered bi-weekly (days 1, 15, 29) from the first day of radiotherapy, while 2 Gy/day of radiation was given on 5 days weekly from day 1, reaching a total of 60 Gy in 30 fractions. RESULTS: 12 patients took part in the phase I study. The maximum tolerated dose (MTD) was 40 mg/m2 and the recommended dose (RD) was determined as 35 mg/m2. The phase II study was conducted with docetaxel at 35 mg/m2 for 25 patients. Treatment was completed without interruption in 24 patients, with a protocol implementation rate of 96%. The complete response rate was 100% in laryngeal cancer, and 80% in hypopharyngeal cancer, and total (including partial response) overall response rate was 100%. The laryngeal preservation rate was 96%, and the overall local control rate was 92%. All patients have been alive for at least 3 years without any recurrence. CONCLUSIONS: The chemoradiation therapy using bi-weekly docetaxel is an extremely effective treatment for cancer of the larynx/hypopharynx, provided that it is used for the specified stage of cancer.

Favourable effects of nilvadipine on cognitive function and regional cerebral blood flow on SPECT in hypertensive patients with mild cognitive impairment.

OBJECTIVE: We compared the effects of nilvadipine and amlodipine on the cognitive function and regional cerebral blood flow (rCBF) in patients with mild cognitive impairment (MCI) and hypertension. METHODS: Twelve patients with MCI and hypertension were randomly assigned to receive nilvadipine or amlodipine for 12-16 weeks. Before and after treatment all patients underwent neuropsychological evaluation and single photon emission computed tomography (SPECT) studies with N-isopropyl-p-[123I]iodoamphetamine. RESULTS: Both nilvadipine (n=6) and amlodipine (n=6) groups had similar significant reduction in systolic and diastolic blood pressure after treatment. The Logical Memory subscore of the Wechsler Memory Scale-Revised increased significantly in the nilvadipine group, but not in the amlodipine group after treatment. Although SPECT demonstrated no significant differences in rCBF deficits at baseline between the two groups, the nilvadipine group showed an improvement of rCBF in the left frontal lobe, while the amlodipine group showed a decrease of rCBF in the left temporal lobe. CONCLUSION: Our results suggest that nilvadipine, a highly lipophilic agent that easily penetrates the central nervous system, may have additional benefits and be potentially useful for the treatment of patients with MCI and hypertension.

Computed tomographic findings of large cell neuroendocrine carcinoma of the lung.

The purpose of our study was to describe the computed tomography (CT) findings of large cell neuroendocrine carcinoma (LCNEC) and to correlate radiological and pathological findings. We reviewed the CT findings of 36 patients [including the high-resolution computed tomography (HRCT) findings of 29 patients] with resected LCNEC specimens. There were 33 men (92%), and 30 patients had a smoking history (83%). Only one case was of the central type. Mediastinal or hilar lymphadenopathy was seen in 12 (33%), but only one showed bulky lymphadenopathy. The HRCT findings of LCNEC consisted of irregular margins (66%), surrounding emphysema (41%), notching (38%), calcifications (21%), and pleural indentation (24%). Our study indicates that the CT image of LCNEC generally shows a peripherally located, expansively growing, irregularly margined pulmonary mass, with or without calcification, and without bulky lymphadenopathy. While the CT image of LCNEC resembles that of squamous cell carcinoma, cavitation is infrequent. LCNEC cannot be differentiated from poorly differentiated adenocarcinoma or atypical carcinoid on the basis of CT findings.

Image quality using dynamic MR imaging of the temporomandibular joint with true-FISP sequence.

We evaluated the quality of dynamic magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) in 20 normal volunteers with 40 TMJs. To confirm TMJ, we obtained static proton density weighted images (PDWI) before performing dynamic MR imaging with true-fast imaging in a steady-state precession (true-FISP) sequence. Four sequences of the first 10 volunteers were examined to determine the optimal sequence. The 4 sequences included the integrated parallel acquisition technique (iPAT) and/or fat saturation technique. The optimal sequence was then determined and performed in all 20 volunteers. The quality of imaging was evaluated, especially with respect to the conspicuity of the articular disk, mandibular condyle, articular eminence and lateral pterygoid muscle. One of 3 confidence levels was assigned for this evaluation. Neither iPAT nor fat saturation obtained the best quality imaging. Detection rates in the 20 volunteers were 83% for the articular disk, 95% for the mandibular condyle, 96% for the articular eminence and 7.5% for the lateral pterygoid muscle. We recommend dynamic MR imaging of the TMJ with the true-FISP sequence using neither iPAT nor fat saturation. Nevertheless, dynamic MR imaging was inferior to static imaging in detecting the articular disk and still requires improvement.

Differentiation of dementia with Lewy bodies from Alzheimer's disease using Mini-Mental State Examination and brain perfusion SPECT.

To determine whether combined studies of Mini-Mental State Examination (MMSE) and brain single photon emission CT (SPECT) would provide more useful means of differentiating between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), we studied 36 patients with probable DLB and 96 patients with probable AD. DLB patients had significantly better performance on word recall, but more impaired attention and copying than AD patients. We confirmed that a weighted score derived by Ala et al. [Ala, T.A., Hughes, L.F., Kyrouac, G.A., Ghobrial, M.W., Elble, R.J. The Mini-Mental State exam may help in the differentiation of dementia with Lewy bodies and Alzheimer' disease. Int J Geriatr Psychiatry 2002;17:503-9]: (Attention-5/3.Memory+5.Construction), was helpful in discriminating between DLB and AD. SPECT study revealed that medial occipital perfusion significantly decreased in DLB patients than AD patients. Combined studies of MMSE and brain SPECT achieved a high discrimination between DLB and AD with a sensitivity of 81% and a specificity of 85%, suggesting that there is a useful and practical approach to differentiate DLB from AD. Our findings will need to be substantiated in an independent and prospective study sample.

SPECT follow-up study of cerebral blood flow changes during Donepezil therapy in patients with Alzheimer's disease.

BACKGROUND AND PURPOSE: Treatment with acetylcholinesterase inhibitors (AchEIs) is beneficial for patients with Alzheimer's disease (AD). But the clinical response varies. Functional neuroimaging techniques might allow objective evaluation of the topographic correlates of the effect of therapy on brain functioning. We attempted to evaluate the possible correlation between regional cerebral blood flow (rCBF) differences in patients with AD and response to donepezil hydrochloride (Donepezil) therapy. METHODS: The subjects of this study were 51 consecutive patients with AD receiving Donepezil who underwent SPECT at baseline and 10-14 months later. We divided the patients into stabilized (n = 19) and nonstabilized (n = 32) subgroups based on changes in the Mini Mental State Examination (MMSE) score. Analysis of single-photon emission computed tomography (SPECT) data was done using 3-dimensional stereotactic surface projections (3D-SSP) and the stereotactic extraction estimation (SEE) method. We compared differences in rCBF between the two subgroups at baseline and follow-up, and between the baseline and follow-up in each subgroup. RESULTS: Significant correlation was recognized between the mean Z score changes of the left frontal lobe, left limbic lobe, and MMSE change. There were no significant baseline differences in rCBF in any region of the brain between the two subgroups. At the study endpoint, the nonstabilized subgroup showed lower rCBF in the lateral and medial frontal lobes, limbic lobe, lower lateral temporal lobe, and cingulate gyrus compared to the stabilized subgroup. Both patient groups showed a significant post-treatment increase over baseline values in the frontal lobe, and the stabilized group had more extensive and intense increases in the lateral and medial frontal lobes and orbital surface. CONCLUSIONS: Our study suggests that the diversity of clinical responses to Donepezil therapy in patients with AD is associated with rCBF changes, mainly in the frontal lobe. SPECT may be a promising tool to assess the impact of AchEI therapy on the brain function of patients with AD.

New semiquantitative assessment of 123I-FP-CIT by an anatomical standardization method.

UNLABELLED: We evaluated a new semiquantitative procedure to more easily and objectively estimate the striatal uptake of 123I-FP-CIT in patients with Parkinsonian syndrome (PS) and essential tremor (ET), using an anatomical standardization method, the Neurostat. METHODS: Eleven patients with PS and 8 with ET were examined by clinical assessment and 123I-FP-CIT SPECT imaging. The modified Hoehn and Yahr Staging Scale and Unified Parkinson's Disease Rating Scale (UPDRS) were used to assess the stage and severity of the disease. The co-registered MR and SPECT images were created with fusion software included in Neurostat. On the cross section, which shows the largest area of striate, irregular shaped regions of interest corresponding to the striate and occipital cortex were drawn. Then the ratio of specific striatal uptake to non-specific occipital cortex, V3"(F), was calculated. Another calculation was done by VOIClassic, which is a software included in Neurostat to estimate the counts per voxel of anatomically defined regions such as caudate nucleus, putamen, occipital cortex, and total cortex. Using these count data, the ratio of specific striatal uptake to non-specific occipital cortex, V3"(OC), and total cortex, V3"(TC), was calculated. RESULTS: A fair linear correlation was observed between V3"(OC) and V3"(F) (y = 1.53x + 1.40; r = 0.756; p < 0.01), as well as between V3"(TC) and V3"(F) (y = 1.24x + 1.43; r = 0.713; p < 0.01). Both V3"(OC) and V3"(TC) yielded similar tendencies. Concerning discrimination between ET and PS, there was a significant difference between the mean V3" of PS and ET (p < 0.01). Concerning the correlation between V3" value and the severity of PS, the UPDRS motor score significantly correlated with the V3"(F) value (rs = -0.816). However, V3"(OC) and V3"(TC) correlated less with UPDRS (rs = -0.667 and -0.645, respectively). CONCLUSIONS: Semiquantitative parameters, V3"(OC) and V3"(TC), calculated by VOIClassic including the Neurostat system are useful and easily calculable parameters as well as V3"(F) for the differential diagnosis of PS from ET.

Differences in magnetization transfer ratios of the hippocampus between dementia with Lewy bodies and Alzheimer's disease.

We compared magnetization transfer ratios (MTRs) in the brains of patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) to determine whether regional differences in the brain structures between DLB and AD are detectable with magnetization transfer imaging. Seventeen patients with DLB, 31 patients with AD and 18 elderly normal controls were included. Although no significant differences were found in MTRs in the frontal white matter between the three groups, MTRs in the hippocampus, parahippocampus, and posterior cingulate white matter in both patients with DLB and AD were significantly lower than those in age-matched control subjects. However, MTRs in the hippocampus of patients with DLB were significantly higher than those in patients with AD. Logistic regression analysis revealed that hippocampal MTR yielded a sensitivity of 76% and a specificity of 71% in discriminating DLB from AD. These results may reflect underlying histopathological differences with less severe neuronal degeneration in the hippocampus of DLB. MTR measurement of the hippocampus may contribute to the clinical differentiation between DLB and AD.

Perfusion study of hypervascular hepatocellular carcinoma with SPIO.

PURPOSE: We evaluated whether a perfusion study with Resovist is useful to assess blood flow in tumors in patients with hypervascular hepatocellular carcinoma (HCC). SUBJECTS AND METHODS: The subjects were 28 patients; the lesions consisted of 68 hypervascular HCC, 14 post-treatment nodules, and 7 hepatocellular hypovascular nodules. After rapid intravenous injection of Resovist, 7-phase imaging was performed using the single-shot echo-planar method. Diagnostic accuracy and tumor vascularity were evaluated by 3 radiologists using the alternative free response receiver operating characteristic method. Sensitivity, Az values, and positive predictive values were calculated. To assess interobserver variability, we evaluated the kappa static to measure the degree of agreement. RESULTS: The 3 observers indicated no significant difference in Az value related to the presence or absence of a perfusion study, and only one remarked a significant difference in sensitivity. However, kappa values were better in the presence than in the absence of a perfusion study. Blood flow assessment was poor in less than 1 cm. The 3 observers showed a positive predictive value of 90% or more. CONCLUSION: A perfusion study may facilitate the diagnosis of hypervascular HCC, improving the diagnostic accuracy.

Gd-EOB-DTPA enhanced MRI for hepatocellular carcinoma: quantitative evaluation of tumor enhancement in hepatobiliary phase.

OBJECTIVE: The purpose of this study was to evaluate the utility of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the quantitative evaluation of hepatocellular carcinoma (HCC) and dysplastic nodules in the hepatobiliary phase. MATERIAL AND METHODS: The subjects comprised 12 patients with 27 lesions (22 HCCs and 5 dysplastic nodules). Chemical-shift-selective fat-suppressed T1-weighted sequences were obtained before and 10, 20, and 40 min after the injection of Gd-EOB-DTPA. Quantitative analyses were performed with the enhancement ratio of the lesion and the contrast-to-noise (C/N) ratio. RESULTS: The enhancement ratios of the HCCs were 44.0+/-36.5, 44.7+/-46.8, and 47.7+/-52.8 (%) at 10, 20, and 40 min, respectively, after the injection of Gd-EOB-DTPA. The enhancement ratios of the dysplastic nodules were 36.2+/-34.3, 44.3+/-37.3, and 40.1+/-46.8 (%). The C/N ratios of the HCCs were 0.2+/-6.6 for the precontrast image, and -9.2+/-12.6, -9.9+/-14.8, and -12.7+/-15.7 at 10, 20, and 40 min, respectively, after the injection of Gd-EOB-DTPA. The C/N ratios of the dysplastic nodules were 1.4+/-8.0, -13.7+/-11.1, -13.3+/-7.6, and -13.1+/-10.4. No significant differences were found between the HCCs and the dysplastic nodules in the enhancement ratio and the C/N ratio. Only two HCCs showed a positive C/N ratio value, and these HCCs were pathologically confirmed to be a well differentiated and a moderately differentiated carcinoma, respectively. CONCLUSION: HCCs and some of the dysplastic nodules showed hypointensity in the hepatobiliary phase in Gd-EOB-DTPA-enhanced MRI. No specific enhancement was observed, regardless of tumor differentiation.

Atrophy of the substantia innominata on magnetic resonance imaging and response to donepezil treatment in Alzheimer's disease.

Atrophy of the substantia innominata on magnetic resonance imaging (MRI), reflecting degeneration of cholinergic neurons in the nucleus basalis of Meynert, may be an in vivo marker of cholinergic damage. We attempted to investigate whether the MRI features of the substantia innominata predict response to donepezil treatment in Alzheimer's patients. The thickness of the substantia innominata was measured on the coronal T2-weighted MRI through the anterior commissure. Seventy-two patients treated with donepezil were divided into the two groups (responders and non-responders) based on changes in Mini-Mental State Examination (MMSE) scores from baseline to study endpoint. Atrophy of the substantia innominata was more pronounced in responders than non-responders. There was a significant inverse correlation between thickness of the substantia innominata and MMSE changes. MRI analysis of the substantia innominata may be a simple and practical method for the selection of possible treatment responders.

Differences in regional cerebral blood flow patterns in male versus female patients with Alzheimer disease.

BACKGROUND AND PURPOSE: There may be some differences in the pathophysiology between men and women with Alzheimer disease (AD). This study was undertaken to explore the possible influence of sex on regional cerebral blood flow (rCBF) patterns in patients with AD. METHODS: Single photon emission CT (SPECT) was performed in 30 men and 30 women with AD, and the SPECT data were analyzed by using 3D stereotactic surface projections. RESULTS: There were no significant differences in age, duration of disease, years of education, cognitive deficits and patterns, and MR imaging findings (grade of brain atrophy and extent of white matter hyperintensity lesions) between the two groups. Both male and female patient groups showed decreased rCBF patterns in the parietotemporal lobe, posterior cingulate cortex, and precuneus, which are considered to be the characteristic SPECT findings of AD. There were, however, some differences in rCBF patterns: men had a more severe decrease of rCBF in the parietal and posterior cingulate cortex, whereas women had a more severe decrease of rCBF in the medial temporal region and frontal lobe. CONCLUSION: These data provide evidence that patterns of rCBF deficits differ between the sexes, a finding that supports the concept of heterogeneity of the underlying pathophysiology of AD.

MR analysis of the substantia innominata in normal aging, Alzheimer disease, and other types of dementia.

BACKGROUND AND PURPOSE: The substantia innominata can be visualized on coronal thin-section T2-weighted MR images. The purpose of this study was to investigate the morphologic changes of the substantia innominata in normal aging by using MR imaging and to determine whether the changes in this structure on MR images were specific to Alzheimer disease (AD). METHODS: The thickness of the substantia innominata was measured on the coronal T2-weighted image obtained through the anterior commissure in 39 healthy control subjects (age range, 25-86 y; mean age, 62 y); 39 patients with AD; and 36 patients with non-AD dementia, including vascular dementia, frontotemporal dementia, and Parkinson disease with dementia. RESULTS: In the control subjects, the thickness of the substantia innominata significantly decreased with age. Compared with age-matched control subjects, both patients with AD and patients with non-AD dementia had significant atrophy of the substantia innominata. The thickness of the substantia innominata significantly correlated with scores from the Mini-Mental State Examination in patients with AD but not in patients with non-AD dementia. CONCLUSION: MR analysis reveals age-related shrinkage of the substantia innominata. Atrophy of the substantia innominata, which reflects degeneration in the nucleus basalis of Meynert, is pronounced both in patients with AD and in those with non-AD dementia. MR imaging features in this structure may not be specific to AD.

Cerebral blood flow patterns in Binswanger's disease: a SPECT study using three-dimensional stereotactic surface projections.

We investigated regional cerebral blood flow (rCBF) patterns in Binswanger's disease (BD) patients using single photon emission computed tomography (SPECT). SPECT data on 22 patients with BD were analyzed using three-dimensional stereotactic surface projections (3D-SSP) and were compared with those of 22 patients with Alzheimer's disease (AD). rCBF patterns in patients with BD were different from those with AD. The BD group had greater CBF reduction in the frontal and anterior cingulate cortices, while the AD group had greater CBF reduction in the temporoparietal and posterior cingulate cortices. However, the rCBF pattern of each patient was more variable, and could be divided into three patterns: anterior cerebral hypoperfusion, posterior cerebral hypoperfusion, and diffuse cerebral hypoperfusion patterns. A distinct CBF reduction in the temporoparietal and/or posterior cingulate cortices, indistinguishable from the CBF pattern observed in AD, was demonstrated in 8 of 22 (36%) patients with BD, in particular there was bilateral hemispheric involvement with a diffuse hypoperfusion pattern. Although no pathological confirmation could be performed, some of the BD patients with CBF reduction in the posterior cerebral cortices may represent additional changes in the brain due to AD. In the future, a longitudinal study including pathology will be needed to determine whether these patients have coexisting AD pathology.

Effect of age on regional cerebral blood flow patterns in Alzheimer's disease patients.

The purpose of this study was to explore the influence of age on regional cerebral blood flow (rCBF) patterns in patients with Alzheimer's disease (AD). Single photon emission computed tomography (SPECT) was performed in 79 patients with AD, including 31 younger and 48 older patients divided according to age at examination (<70 and > or = 70 years), and the SPECT data were analyzed using three-dimensional stereotactic surface projection. Although no significant differences in severity and duration of disease between the two groups were found, there were some differences in rCBF patterns. Patients with younger AD had a more severe decrease of rCBF in the parietotemporal and posterior cingulate cortex, while patients with older AD had a more severe decrease of rCBF in the medial temporal region and medial frontal lobe. This observer-independent analysis of SPECT data provides an objective assessment of cortical rCBF abnormalities in patients with AD and is useful in demonstrating the differences in rCBF patterns between younger and older patients with AD.

Differential diagnosis of hepatic nodules using delayed parenchymal phase imaging of levovist contrast ultrasound: comparative study with SPIO-MRI.

T2-weighted fast spin echo images and T2*-weighted gradient-echo images of superparamagnetic iron oxide magnetic resonance imaging (SPIO-MRI) have been reported to reflect the number and function of macrophages in reticuloendothelial organs and be useful to differentiate malignant tumors from benign nodules of liver. We tried to prove that contrast-enhanced ultrasound can diagnose hepatocellular carcinoma (HCC) by comparing the findings of SPIO-MRI and the findings of the liver parenchyma on the delayed parenchymal phase of ultrasound imaging using the intravenous contrast agent Levovist, not through the evaluation of vascular imaging. Forty-six patients (52 nodules) with histopathological diagnosis of hepatic tumors were studied. They consisted of 11 non-malignant nodules (six regenerative nodules and five dysplastic nodules) and 41 HCC. All the patients were examined by Levovist contrast-enhanced ultrasonography and SPIO-MRI. The delayed liver parenchymal images of contrast-enhanced ultrasound using the intravenous contrast agent Levovist were similar to those observed on SPIO-MRI. The similarity of both findings suggests that delayed phase imaging by Levovist is closely related to the number and function of Kupffer cells in liver tumors. The diagnostic accuracy of contrast-enhanced ultrasound for HCC was high (90.4%) demonstrating that it is as reliable as SPIO-MRI.

Evaluation of endometrial cancer with 3D-VIBE (volume interpolated breath-hold examination) using intrauterine CO2 gas.

To evaluate the myometrial infiltration of the endometrial cancer prior to aggressive treatment, dynamic MRI (magnetic resonance imaging) has attracted attention. However, it has also been found that in a number of cases, MRI exhibits inconsistent results with regards to the extent of the infiltration into this component of the uterine body. To overcome this limitation, the authors designed a method to delineate the tumor morphology more clearly by injecting CO2 gas into the uterine cavity. This procedure was combined with VIBE (volumetric interpolated breath-hold examination) to determine more precisely the depth of the tumor invasion. From our clinical results, the efficacy of the method was evaluated. On four patients with endometrial cancers (stage Ia-Ic), CO2 was injected to dilate the intra-uterine space through a catheter equipped with a balloon that had been introduced into the uterine cavity, after which VIBE was conducted. The images were interpreted by MPR (multiplanar reconstruction) and the findings from these images were compared against the histopathological findings. By employing this method, it was possible to delineate clearly the tumorous lesion in the uterine body, and three-dimensional images of the tumor invasion was acquired. The site and extent of tumor invasion in the myometrium were generally consistent with the histopathological findings. This method allows one to observe multiple planes by using thin slices. By dilating the uterine cavity, the site of involvement and the extent of invasion can be more precisely defined before treatment. It is truly a revolutionary procedure for determining-prior to surgery-the depth of invasion of a cancer located in the uterine body.

Clinical usefulness of iodine-123-MIBG scintigraphy for patients with neuroblastoma detected by a mass screening survey.

UNLABELLED: The purpose of this study was to evaluate the usefulness in a clinical setting of iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy, planar and single photon emission computed tomography (SPECT) images, in patients with neuroblastoma as detected by a mass screening survey. METHODS: 123I-MIBG planar whole body images, and regional SPECT images of patients with neuroblastoma in 51 studies were reviewed. They were all detected by a mass screening survey performed in the 6th month after birth using vanil mandelic acid (VMA), and homovanillic acid (HVA) and the neuroblastoma had been confirmed by surgery. Scintigraphy was performed 24 hours after injection of 111 MBq of 123I-MIBG. We assessed the accuracy of the planar whole body images in order to demonstrate the extent of the lesion and the correlation between the degree and extent of the lesions of 123I-MIBG accumulation and clinical staging with tumor markers, such as urinary VMA, urinary HVA, serum neuron specific enolase (NSE) and serum lactate dehydrogenase (LDH). Additionally, we evaluated SPECT how useful supplemental SPECT might be in a clinical setting as compared with planar whole body images. RESULTS: 123I-MIBG planar whole body images revealed all 33 (100%) primary lesions, 4 of the 5 cases (80%) with liver metastasis, 3 of the 13 (23%) with lymph nodes metastasis and 1 of 3 (33%) with bone marrow infiltration. The extent and degree of accumulation correlated with the values of urinary VMA, urinary HVA and serum NSE. SPECT images helped to understand the positional relation in all cases and provided useful additional information for clinical staging in 7 cases. CONCLUSION: 123I-MIBG scintigraphy with planar and SPECT images is useful for evaluating patients with neuroblastoma, following detection by a mass screening survey.

Gallium-67 accumulation to the tumor thrombus in anaplastic thyroid cancer.

A sixty-five-year-old woman was hospitalized for examination of swelling in the left arm. Gallium-67 scintigraphy showed the same radioactivity in the left lobe of the thyroid gland and the junction of the internal jugular vein and the subclavian vein. Operation then proved obstruction of the left internal jugular vein and subclavian vein due to tumor thrombus accompanied by anaplastic thyroid cancer. Gallium-67 scintigraphy was extremely useful in grasping the extent and feature of the tumor.