Kenzo Suzuki

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices: A Feasibility Study

AbstractPurpose: To evaluate the clinical feasibility of balloon-occluded retrograde transvenous obliteration (BORTO) for gastric varices. Methods: BORTO was performed in 14 patients with gastric varices due to liver cirrhosis. The gastric varices were confirmed by endoscopy, and their feeding and draining veins were identified by contrast-enhanced computed tomography (CT) and angiography. A 6 Fr Simmons-shaped balloon catheter was inserted into the gastrorenal shunt. The balloon was inflated, and 5% ethanolamine oleate iopamidol was infused slowly through the catheter. Patients were followed up with endoscopy and enhanced CT at 1 week, 1, 3, and 6 months after the procedure and every 6 months thereafter. Results: The gastric varices completely disappeared in 12 of 14 patients and was partially resolved in the remaining 2 patients. Neither a recurrence nor an aggravation of gastric varices were found. No major complications were experienced. Conclusion: BORTO is a safe and effective treatment for gastric varices.

Reassessment of quantitative thallium-201 brain SPECT for miscellaneous brain tumors.

In order to reassess the value of quantitative thallium-201 brain SPECT in the differentiation of miscellaneous brain tumors, we studied a total of 89 patients—35 pre-operative patients suspected of having a brain tumor and 54 post-operative patients with a brain tumor. We came to the conclusion that quantitative Tl-201 brain SPECT was very useful in discriminating cerebral radiation necrosis from recurrent tumor, estimating residual tumor burden, and detecting tumor regrowth earlier in postoperative patients. In preoperative patients, however, Tl-201 SPECT cannot be used effectively to differentiate glioma from other intracranial tumors, although intense uptake of Tl-201 may provide evidence of glioblastoma or a hypervascular lesion.

Prediction of survival in patients with suspected recurrent cerebral tumors by quantitative thallium-201 single photon emission computed tomography

PURPOSE To assess whether quantitative 201Tl single photon emission computed tomography (SPECT) can be used as a prognostic test in patients with suspected recurrent cerebral tumor, regardless of various combined therapies given. METHODS AND MATERIALS The study population consisted of 22 patients with grade 4, 3, or 2 glioma and 7 patients with solitary cerebral metastasis. All patients had undergone combined radiotherapy and chemotherapy after or during surgical debulking. Each patient underwent 201Tl brain SPECT to differentiate recurrent tumor from cerebral radiation necrosis, because the prior computed tomography and/or magnetic resonance imaging showed a mass lesion with an irregularly enhanced rim in the irradiation field. RESULTS Higher values of 201Tl index (L/N ratio) showed a tendency for shorter survival (r = -0.502, p < 0.05). In patients with grade 3 glioma or solitary cerebral metastasis, survival time was definitely dependent upon 201Tl index values, that is, above or below the baseline index of 2.5. Grade 4 glioma patients, however, had a very short-term survival independent of 201Tl index values. CONCLUSION Quantitative 201Tl SPECT may be a useful tool for predicting survival of patients with suspected recurrent cerebral tumor and may be used in place of fluorine-18-2-deoxy-2-fluoro-D-glucose (18F-FDG) scan.

Primary malignant lymphoma of the central nervous system by Ga-67 and TI-201 brain SPECT.

Two patients with primary lymphoma of the central nervous system underwent both Ga-67 and TI-201 brain SPECT. Ga-67 scans showed remarkable accumulation of radiotracer corresponding to tumors detected by CT and MRI. More avid uptake was noted on the Ga-67 scans than on the TI-201 scans. In one patient, the intense tracer uptake had disappeared in the Ga-67 study performed after irradiation with 50 Gy. We are convinced that Ga-67 SPECT is useful for detecting and following the progress of primary lymphoma of the central nervous system.

Combined201Tl and67Ga brain SPECT in patients with suspected central nervous system lymphoma or germinoma: Clinical and economic value

Background: Surgical resection is costly and an unfavorable prognostic factor for primary central nervous system (CNS) lymphoma and germinoma patients.Objective: To assess the diagnostic and economic impact of combined201TI and67Ga brain SPECT on the management of patients suspected of having CNS lymphoma or germinoma.Methods: Sequential201TI and67Ga brain SPECT was performed in 40 patients with cranial tumorts to assess the diagnostic and economic impact of combined201TI and67GA SPECT on the management of patients suspected of having CNS lymphoma or germinoma. All intracranial masses were pathologically confirmed. The final diagnoses of a total of 47 foci were: 11 non-Hodgkins lymphomas in 10 patients, 3 germinomas in 2 patients, 10 glioblastomas in 9 patients, 10 cerebral metastases in 8 patients, 13 meningiomas in 11 patients. Decision-tree sensitivity analysis for pretest probability regarding expected cost saving was performed for introduction of the combined study.Results: All but one focus of CNS lymphomas or germinomas (92.9%, 13/14) exhibited more intense uptake of67Ga than of201TI (p<0.001). All foci of glioblastomas (10/10) and meningiomas (13/13), and 60% of metastatic foci (6/10) exhibited higher uptake of201TI than of67Ga (p<0.035). Expected cost saving in the 1% to 50% range of pretest probability of CNS lymphoma or germinoma would be from minus

Clinical significance of ventilation/perfusion scans in collagen disease patients.

842US to plus

Usefulness of Ga-67 brain SPECT in patients with CNS malignant lymphoma

2,047US per patient for introduction of the combined study, because of substitution of stereotactic biopsy for craniotomy. The pretest probability was the key factor for cost saving of the combined study.Conclusions: A67Ga-positive and201TI-positive pattern with more intense uptake of67Ga than201TI probably suggests CNS lymphoma or germinoma. This combination study appears to be cost-effective only in patients highly suspected of having CNS lymphoma or germinoma.

``Oblique Path''— The Optimal Needle Path for Computed Tomography-Guided Biopsy of Small Subpleural Lesions

The purpose of this study was to detect disturbances in pulmonary circulation in collagen disease patients by means of a non-invasive technique.Methods: Ventilation/perfusion scans with133Xe gas and99mTc-macroaggregated albumin (MAA) were performed in 109 patients with various collagen diseases. Functional images of V, Vol, Q and V/Q ratio were obtained at total lung capacity. Wash-out time was calculated from the wash-out curve. Whole body scans were performed in 65 patients to evaluate intra-pulmonary shunts.Results: Increased V/Q areas were observed in 74 patients (67.9%), suggesting some impairment of pulmonary perfusion. Decreased perfusion, probably due to vasculitis or intravascular microcoagulation, was observed often, even in patients without pulmonary fibrosis. Shunt ratios over 10% were observed in 8 of the 65 patients (12.3%), indicating formation of PA-PV shunts secondary to peripheral vascular impairment. Wash-out time was prolonged in 37 patients (33.9%), shortened in 18 (16.5%), and within the normal range in 54 (49.6%). The prolonged and normal wash-out times in the patients with pulmonary fibrosis may represent obstructive changes in the small airways superimposed on the fibrosis.Conclusion: Ventilation/perfusion scans are a very useful tool for evaluating collagen lung diseases, and they might contribute to treatment decisions for the patients.

Pulmonary and bronchial arteriography in lung cancer : Angiographic and histologic type correlations

The efficacy of Ga-67 SPECT imaging of CNS malignant lymphoma was investigated in 14 studies of 11 patients. As compared with planar images, the SPECT imaging improved the detectability of the focus of CNS malignant lymphoma. All untreated cases showed L/N ratios higher than 3.0. And the L/N ratios also changed according to remission or relapse of CNS malignant lymphoma.