Fumio Kotake

Tumor-detecting capacity and clinical usefulness of SPIO-MRI in patients with hepatocellular carcinoma

Abstract: The tumor-detecting capacity and clinical usefulness of superparamagnetic iron oxide (SPIO) magnetic resonance imaging (MRI) were examined in patients with hepatocellular carcinoma. The tumor detection rate of SPIO-MRI (64.5%) was comparable to those of dynamic computed tomography (CT) and plain MRI, but lower than that for Gd dynamic MRI (93.5%; P < 0.01%). A combination of Gd dynamic MRI and SPIO-MRI improved the detection rate; further, the tumor stage with respect to tumor blood-flow pattern was predicted by combining plain MRI with SPIO-MRI. This combination procedure may also be useful for selecting therapeutic strategies.

Insulin-derived Amyloidosis and Poor Glycemic Control: A Case Series

OBJECTIVES Insulin-derived amyloidosis is a rare skin-related complication of insulin therapy. The purpose of this study was to show the effects of insulin-derived amyloidosis on blood glucose levels, insulin dose requirements, and insulin absorption. METHODS Seven patients were found to have insulin-derived amyloidosis at the Tokyo Medical University Ibaraki Medical Center. The clinical characteristics and insulin therapy of the 7 patients were investigated. Insulin absorption was studied by comparing the serum insulin levels after insulin injections into insulin-derived amyloidosis sites versus injections into normal sites in 4 patients. RESULTS When the insulin-derived amyloidosis was discovered, the mean hemoglobin A1c level was 9.3%, and the mean daily insulin dose was 57 units. After changing the injection sites to avoid the insulin-derived amyloidosis, the blood glucose concentrations improved, and the mean daily insulin dose could be reduced to 27 units (P = .035; 53% reduction). The insulin absorption at insulin-derived amyloidosis sites was 34% of that at normal sites (P = .030). CONCLUSIONS Insulin-derived amyloidosis caused poor glycemic control and increased insulin dose requirements because of impairments in insulin absorption.

Multiplanar reconstruction MR image of primary adenoid cystic carcinoma of the central airway: MPR of central airway adenoid cystic carcinoma

Multiplanar reconstruction (MPR) is a method that allows free selection of computerized reconstruction images. We reviewed a total of six MPR magnetic resonance (MR) examinations in five cases of adenoid cystic carcinoma of the central airway, which is a rare low-grade malignant tumor. MPR MR provides images either longitudinally or at right angles to the longitudinal axis of the trachea and main bronchi, so it was useful to diagnose tumor extent along airways more precisely and to evaluate therapeutic effects. MPR MR may help in planning therapeutic strategy and in posttherapeutic follow-up.

Inflammatory pseudotumor of the liver in a patient with rectal cancer: a case report

Abstract. An inflammatory pseudotumor of the liver was discovered during a metastatic examination of a patient with rectal adenocarcinoma. Magnetic resonance imaging showed a three-component lesion that infiltrated a large portal vein, and CT arteriography and CT during arterial portography showed a portal obstruction. A histopathological examination proved that necrosis was present in the central zone; infiltration by proliferating connective tissue with chronic inflammatory cells was prominent in the middle zone; and fibrous changes, including pseudo-bile duct proliferation, were present in the peripheral zone. Magnetic resonance imaging revealed both portal infiltration and histopathological features including the above-noted three components. Magnetic resonance imaging is perhaps the most useful diagnostic modality.

The ratio of the maximum high attenuation area dimension to the maximum tumor dimension may be an index of the presence of lymph node metastasis in lung adenocarcinomas 3 cm or smaller on high-resolution computed tomography.

Background: Limited resection of the lung can improve the postoperative quality of life if there is no lymph node metastasis. Small adenocarcinomas frequently appear on radiographs with areas of ground glass attenuation. We examined whether there is a correlation between the presence of lymph node metastasis and the ratio of the intratumor high-attenuation area (greatest dimension of high-attenuation area [H] to the maximum tumor dimension [T], H/T ratio) on high-resolution computed tomography (HRCT). Methods: From January 1996 to June 2004, we studied 281 patients with lung adenocarcinomas of 3 cm or less in maximum dimension on preoperative HRCT. Each of the 281 patients had a lobectomy and lymph node dissection, and there was no case of limited resection. Results: Lymph node metastasis was present in 11.4% (32 of 281 cases, N1 = 13 cases, N2 = 19 cases). None of the 94 cases with an H/T ratio of 60% or less had lymph node metastasis. Moreover, lymph node metastasis was noted even in a 6-mm tumor when the H/T ratio was 100%. Of the 187 cases with tumors having an H/T ratio greater than 60%, 32 had lymph node metastasis. Conclusions: The relationship between the H/T ratio and lymph node metastases was evaluated by HRCT in lung adenocarcinomas 3 cm or smaller in maximum dimension. The H/T ratio may provide useful information in deciding on limited resection for lung cancer in such cases.

Usefulness of dynamic renal scintigraphy in a patient with renal arteriovenous fistula treated by transcatheter embolization

Tc-99m-DTPA renal scintigraphy was performed before and after transcatheter coll embolization in a patient with renal arteriovenous fistula (AVF). Before embolization, scintigraphy showed a characteristic accumulation pattern compatible with the hemodynamics of an aneurysmal type of AVF in the vascular phase. After embolization, the effects of treatment, such as a change in the split renal function on the treated-side and the disappearance of the shunt flow through the fistula were evident. It was concluded that dynamic renal scintigraphy was very useful for patients with an aneurysmal type of renal AVF scheduled for transcatheter embolization.

[A case of orbital myositis complicated with optic neuropathy--analysis of the pathological mechanism of optic neuropathy from magnetic resonance imaging findings].

BACKGROUND We observed a rare case of orbital myositis involving the optic nerve. CASE A 52-year-old woman complained of visual disturbance, lid swelling, ocular pain, and conjunctival injection in her right eye. Her corrected vision was 0.15 in the right eye and 1.2 in the left eye. Relative afferent pupillary defect(RAPD) and central scotoma in visual field test were noted in the right eye. Ocular movement of her right eye was moderately disturbed in all directions. Although laboratory data showed elevation of erythrocyte sedimentation rate, other hematological data such as thyroid function, autoimmune antibodies, and viral infection antibodies were normal. Magnetic resonance imaging(MRI) findings showed compression of the optic nerve at the orbital apex by marked thickening of the right lateral rectus muscle and superior rectus muscle, and inflammation directly invading the optic nerve. Based on the above findings, we diagnosed the case as orbital myositis complicated with optic neuropathy, and started corticosteroid therapy. Her right corrected vision improved dramatically, and the RAPD, central scotoma, and lid swelling disappeared shortly after administration. Enlargement of the extraocular muscles was still present one month after corticosteroid therapy. CONCLUSION MRI findings suggested that optic neuropathy in this case was induced not only by mechanical compression by the enlarged extraocular muscles at the orbital apex but also by direct inflammatory infiltration from the extraocular muscles.