Akira Toriihara

Magnetic resonance enterocolonography is useful for simultaneous evaluation of small and large intestinal lesions in Crohn's disease

Background: We developed novel magnetic resonance enterocolonography (MREC) for simultaneously evaluating both small and large bowel lesions in patients with Crohns disease (CD). The aim of this study was to evaluate the diagnostic performance of MREC by comparing results of this procedure to those of endoscopies for evaluating the small and large bowel lesions of patients with CD. Methods: Thirty patients with established CD were prospectively examined by newly developed MREC. Patients underwent ileocolonoscopy (ICS) (24 procedures) or double‐balloon endoscopy (DBE) (10 procedures) after MREC on the same day. Two gastroenterologists and two radiologists who were blinded to the results of another study evaluated endoscopy and MREC findings, respectively. Results: In colonic lesions the sensitivities of the MREC for deep mucosal lesions (DML), all CD lesions, and stenosis were 88.2, 61.8, and 71.4%, respectively, while the specificities were 98.1, 95.3, and 97.7%, respectively. In small intestinal lesions, MREC sensitivities for DML, all CD lesions, and stenosis were 100, 85.7, and 100%, respectively, while specificities were 100, 90.5, and 93.1%, respectively. Endoscopic scores were significantly correlated with MREC scores. Eleven (46%) of the 24 patients who were clinically not suspected to show stricture were observed to demonstrate stricture by radiologists. Conclusions: Our results demonstrated that MREC can simultaneously detect the CD lesions of the small and large intestine. MREC can be performed without radiation exposure, the use of enema, or the placement of a naso‐jejunal catheter. MREC and endoscopy have comparable abilities for evaluating mucosal lesions of patients with CD. (Inflamm Bowel Dis 2010;)

Utility of F-18 FDG PET/CT in screening for paraneoplastic neurological syndromes.

Purpose: The aim of this study was to assess the utility of positron emission tomography/computed tomography (PET/CT) for the investigation of patients with suspected paraneoplastic neurologic syndrome (PNS). Materials and Methods: We reviewed the whole-body fluorodeoxyglucose (FDG) PET/CT studies (ordered by the neurology department) performed at our hospital between December 2005 and November 2010; 27 cases (16 men, 11 women; mean age, 65 years) who were suspected of having PNS were selected. Results: Of the 27 patients, 6 (22%) had an abnormal FDG uptake. Of these 6 patients, 5 (19%) were histologically confirmed as having a malignancy. Of the 27 patients, 7 were tested for the presence of well-characterized paraneoplastic antibodies (anti-Hu, anti-Ri, anti-Yo); 1 had anti-Hu, but the patient did not have an abnormal FDG uptake or malignancy. Conclusions: PET/CT may be a useful screening tool for patients with clinically suspected PNS who do not exhibit well-characterized paraneoplastic antibodies. Therefore, we recommended that PET/CT should be performed for patients with clinically suspicious PNS regardless of the presence of well-characterized paraneoplastic antibodies.

Can dual-time-point 18F-FDG PET/CT differentiate malignant salivary gland tumors from benign tumors?

OBJECTIVE The purpose of this study is to evaluate the usefulness of dual-time-point 18F-FDG PET/CT for discriminating between benign and malignant salivary gland tumors. MATERIALS AND METHODS Dual-time-point FDG PET/CT images of 40 salivary gland tumors (20 benign and 20 malignant) were evaluated retrospectively. The maximum standardized uptake values (SUVmax) in the early and delayed phases and the retention index of each tumor were calculated and compared between benign and malignant tumors by the Mann-Whitney U test. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic accuracy for malignant salivary gland tumors. The correlation between the delayed SUVmax and retention index was analyzed by calculation of the Spearman correlation coefficient. RESULTS There were no significant differences in the mean early phase SUVmax or mean delayed phase SUVmax between benign and malignant tumors. The mean (±SD) retention index of the malignant tumors was significantly higher than that of the benign tumors (20.1%±10.2% vs 8.5%±12.3%; p=0.006). When the cutoff value of retention index (15.0%) was used, the sensitivity, specificity, and accuracy each was determined to be 75.0%. ROC analysis did not reveal a significant difference in the diagnostic accuracy between the delayed phase SUVmax and retention index (p=0.139). A significant correlation between the delayed phase SUVmax and retention index was observed for the benign salivary gland tumors (r=0.839; p<0.001). CONCLUSION Dual-time-point FDG PET/CT is not useful for discriminating between benign and malignant salivary gland tumors, because benign tumors also show high FDG uptake, which increases in the delayed phase.

F-18 FDG PET/CT of polymyalgia rheumatica.

Abstract:We performed F-18 FDG PET/CT on a 69-year-old woman with polymyalgia rheumatica. In this case, FDG accumulated not only in the major joints of the extremities but also in the lumbar region. The anatomic structure on the PET/CT fused images turned out to be intervertebral joints, interspinal

Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography combined with ultrasonography-guided fine needle aspiration cytology for identifying axillary lymph node status in patients with breast cancer

AIM The aim of this study was to assess the diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in combination with ultrasonography-guided fine needle aspiration cytology (US-guided FNAC) for the preoperative diagnosis of axillary lymph node (ALN) metastases in patients with breast cancer. MATERIALS AND METHODS A total of 318 patients with breast cancer were recruited retrospectively. Some of the cases that underwent neoadjuvant chemotherapy (NAC) were included. The sensitivity and specificity of FDG-PET/CT were calculated. We assessed the relationship between the combined results for US-guided FNAC with FDG-PET/CT and the pathological ALN status. RESULTS A total of 271 patients underwent FDG-PET/CT. Of these patients, 41 underwent US-guided FNAC. The sensitivity and the specificity of FDG-PET/CT for the cases without NAC were 18.5%, 97.1%, respectively. The sensitivity in cases with NAC was 68.2%. As a whole, the sensitivity was 40.8%. ALN metastasis was detected using US-guided FNAC in a case with a negative FDG uptake in the ALN. The T stage was T2 in the case and the FDG uptake at the primary site was poor. CONCLUSION FDG-PET/CT has a good specificity for ALN metastasis, although its sensitivity is limited, especially in early-stage cases. In cases with a negative FDG uptake in the ALN, US-guided FNAC may play a role in the detection of lymph node metastasis when the primary tumor size is large and the FDG uptake in the primary tumor is low.

Optimal timing of post-treatment [18F]fluorodeoxyglucose-PET/CT for patients with head and neck malignancy.

ObjectivesThe aims of this study were to evaluate the ability of [18F]fluorodeoxyglucose (18F-FDG)-PET/computed tomography (CT) to identify tumor recurrence, nodal metastases, and distant metastases for surveillance and discuss the optimal timing of 18F-FDG-PET/CT examination after the completion of treatment for head and neck malignancy. MethodsA total of 319 patients who underwent a post-treatment 18F-FDG-PET/CT examination for head and neck malignancy were studied. 18F-FDG-PET/CT findings were compared with the final diagnosis confirmed by histopathological examinations or clinical and radiological follow-up for at least 6 months. Patients were divided into two groups according to the presence or absence of clinical suspicion of recurrent disease. The diagnostic accuracy of 18F-FDG-PET/CT was analyzed for each group. Patients were also categorized according to the time interval between the completion of treatment and the post-treatment 18F-FDG-PET/CT examination. Differences in diagnostic accuracy due to the time interval were also evaluated. ResultsThe diagnostic accuracy of 18F-FDG-PET/CT was high for both groups. The overall accuracy of 18F-FDG-PET/CT performed within 2 months (69%) after the completion of treatment was significantly inferior to that performed after 2 months (93%). Conclusion18F-FDG-PET should be performed immediately for patients with clinically suspected recurrent disease. In others, it should be performed at later than 2 months after the completion of the treatment.

Long-term follow-up using 18F-FDG PET/CT for postoperative olfactory neuroblastoma.

PurposeThe present study evaluated the usefulness of postoperative fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the management of olfactory neuroblastoma (ONB). Materials and methodsTen patients (eight men and two women; mean age, 48.5 years) with histologically confirmed ONB who underwent craniofacial resection were retrospectively included in this study. A total of 42 whole-body 18F-FDG PET/CT scans for postoperative surveillance or restaging were reviewed. The mean time from operation until the PET/CT scan was 42.1 months. We evaluated the 18F-FDG uptake and the presence of recurrent lesions during the follow-up period and compared the PET/CT results with the results of MRI and clinical examination (endoscopy). ResultsSeven of the 10 patients had 24 recurrent lesions, and 18 of these recurrent lesions (seven local recurrences, eight cervical lymph node metastases, one intracranial metastasis, and two distant metastases) were 18F-FDG positive (75.0%). Three local recurrences and three intracranial metastases were false negative and were detected by endoscopy and MRI, respectively. The mean time from operation until recurrence was 51.4 months, and 17 lesions (70.8%) occurred more than 2 years after the initial operation. ConclusionAlthough 18F-FDG PET/CT is useful for the detection of postoperative recurrences of ONB, long-term follow-up combined with endoscopy and MRI is mandatory.

Eligibility for Bevacizumab as an Independent Prognostic Factor for Patients with Advanced Non-Squamous Non-Small Cell Lung Cancer: A Retrospective Cohort Study

Background Bevacizumab requires some unique eligibility criteria, such as absence of hemoptysis and major blood vessel invasion by the tumor. The prognostic impact of these bevacizumab-specific criteria has not been evaluated. Methods Patients with stage IIIB/IV, non-squamous non-small cell lung cancer who started chemotherapy before the approval of bevacizumab were reviewed. Patients with impaired organ function, poor performance status or untreated/symptomatic brain metastasis were excluded before the evaluation of bevacizumab eligibility. We compared overall survival and time to treatment failure among patients who were eligible (Group A) or ineligible (Group B) to receive bevacizumab. Results Among 283 patients with stage IIIB/IV non-squamous non-small cell lung cancer, eligibility for bevacizumab was evaluated in 154 patients. Fifty-seven patients were considered ineligible (Group B) based on one or more of a history of hemoptysis (n = 20), major blood vessel invasion (n = 43) and cardiovascular disease (n = 8). The remaining 97 patients were classified into Group A. Overall survival was significantly better in Group A (median, 14.6 months) than in Group B (median, 7.1 months; p<0.0001). Time to treatment failure was also significantly longer in Group A (median, 6.9 months) than in Group B (median, 3.0 months; p<0.0001). Adjusted hazard ratios of bevacizumab eligibility for overall survival and time to treatment failure were 0.48 and 0.38 (95% confidence intervals, 0.33–0.70 and 0.25–0.58), respectively. Conclusion Eligibility for bevacizumab itself represents a powerful prognostic factor for patients with non-squamous non-small cell lung cancer. The proportion of patients who underwent first-line chemotherapy without disease progression or unacceptable toxicity can also be biased by bevacizumab eligibility. Selection bias can be large in clinical trials of bevacizumab, so findings from such trials should be interpreted with extreme caution.

Comparison of cerebral blood flow in oral somatic delusion in patients with and without a history of depression: a comparative case series

BackgroundA significant number of patients visit dental clinics because of unusual oral sensations for which no physical cause can be found. Such patients are recognized as having oral somatic delusion (OSD). OSD may be either primary (monosymptomatic) or secondary to another disease, such as depression or cerebral infarction. Although the presenting complaints of patients with primary and secondary OSD are nearly indistinguishable, symptoms in patients with secondary OSD seem to be resistant to treatment compared with those in patients with primary OSD. Moreover, right dominant cerebral blood flow (CBF) has been reported in patients with primary OSD, but the difference in CBF between patients with primary and secondary OSD remains unclear. The aim of this study was to assess the differences in clinical characteristics and CBF distribution between patients with monosymptomatic OSD (non-depression group) and OSD in conjunction with remitted depression (depression group).MethodsParticipants were 27 patients of a psychosomatic dentistry clinic, all diagnosed with OSD. They were categorized into either the non-depression group (17 patients) or the depression group (10 patients) on the basis of assessments by their personal medical providers. CBF was examined using single-photon emission computed tomography.ResultsThere was no difference in clinical presentation between the two groups. A significant right dominant asymmetry in the temporal and posterior cerebral regions was observed in both groups. In the central region, a right dominance was seen in the non-depression group, while a left dominance was seen in the depression group. Moreover, the mean regional CBF values for patients in the depression group were significantly lower in several regions (including bilateral callosomarginal, precentral, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, and hippocampus; and right central and cerebellum) than for patients in the non-depression group.ConclusionThese results suggest that the temporal and posterior cerebral regions are involved in in the pathophysiology of OSD, regardless of depression history, and that widespread CBF reduction is a characteristic of remitted depression.

Oral Dysesthesia Rating Scale: a tool for assessing psychosomatic symptoms in oral regions

BackgroundThe concept of cenesthopathy was first introduced by Dupré and Camus in 1907 to describe clinically unexplainable bodily sensations mainly attributed to psychiatric pathology. If it occurs in oral regions, it is termed oral cenesthopathy and it has been of special interest to psychiatrists and dentists. While there is no independently defined criteria for this condition, which is classified as either a delusional or a somatoform disorder, clinical practice and research require a standard scale to measure and rate its symptoms. In this study, we included any types of psychosomatic symptoms in oral regions as oral dysesthesia, and developed an Oral Dysesthesia Rating Scale (Oral DRS) and evaluated its validity and reliability as an assessment tool.MethodsThe scale was developed based on literature review and extensive clinical experience. Twelve reviewers assessed relevancy of each item to oral dysesthesia symptoms by 1–4 scoring scale and item content validity index was computed. To evaluate the inter-rater reliability of Oral DRS, pairs of raters administered the scale to 40 randomly selected patients with complaints of oral dysesthesia symptoms and Cohen’s weighted kappa coefficient was determined for each item.ResultsThe scale assesses the severity of feelings of foreign body [A1], exudation [A2], squeezing-pulling [A3], movement [A4], misalignment [A5], pain [A6], and spontaneous thermal sensation or tastes [A7], and the degree of impairment in eating [B1], articulation [B2], work [B3], and social activities [B4] on a scale of 0–5. Items A1, A2, A3, A4, B3, and B4 demonstrated acceptable content validity. Inter-rater reliabilities were good or excellent for all items evaluated.ConclusionThe Oral DRS can help define the nosography of clinically unexplainable oral dysesthesia through further case evaluation and clinical research and facilitate devising of treatment modalities.