Michiru Ide

Regional sympathetic denervation detected by iodine 123 metaiodobenzylguanidine in non-Q-wave myocardial infarction and unstable angina.

Previous studies have revealed that the sympathetic nervous system is more vulnerable to ischemia than the myocardium itself. Thus our study was undertaken to detect denervated myocardium in non-Q-wave myocardial infarction (MI) and unstable angina with iodine 123 metaiodobenzylguanidine (123I-MIBG), which can delineate myocardial sympathetic innervation. Eight patients with non-Q-wave MI and 12 with unstable angina were studied. Sequential 123I-MIBG and thallium-201 chloride (201TlCl) imaging and single-photon emission computed tomography (SPECT) were performed at rest 24 +/- 12 days after the last ischemic attack. Myocardial perfusion defect was not detected by 201TlCl in 4 of 8 patients with non-Q-wave MI, whereas 123I-MIBG SPECT imaging revealed defects corresponding to myocardial ischemic areas predicted by coronary angiography in all 8 patients. 123I-MIBG imaging revealed defects in 7 of 12 patients with unstable angina corresponding to coronary angiographic findings, whereas no myocardial perfusion defect was detected by 201TlCl imaging in any of them. In conclusion, 123I-MIBG SPECT is a sensitive method for detecting myocardium exposed to transient ischemia that cannot be detected by 201TlCl imaging.

F-18 FDG uptake in endometrial cancer.

Endometrial cancer, which is one of the most common malignant gynecologic diseases, was detected by F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in a 60-year-old woman with abdominal distention. FDG PET revealed heterogeneous and marked accumulation in the endometrium, which was thought to represent endometrial cancer. In addition, focal intense accumulation of FDG in both lungs suggestive of lung metastases were noted. Endometrial cancer and lung metastases were confirmed by endometrial biopsy and computed tomography of the chest, respectively.

Four cases of Warthin’s tumor of the parotid gland detected with FDG PET

In the cancer screening with FDG PET for 1,872 medical health club members, high FDG accumulation in the parotid gland was found in four males (age, 57–70 years). Warthin’s tumor was confirmed by surgical pathology. The exact mechanism of high FDG accumulation in Warthin’s tumor is not yet known. This tumor may be found incidentally during FDG PET studies. When high FDG accumulation is found in the parotid gland, integrated consideration of the results of the physical examination, medical history and99mTc-pertechnetate scintigraphy makes it possible to differentiate Warthin’s tumor from other lesions.

Recommendations for the Management of Intracranial Haemorrhage – Part I: Spontaneous Intracerebral Haemorrhage

This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European s

High fluorine-18 labeled deoxyglucose uptake in sarcoidosis.

A 72-year-old man underwent a whole-body fluorine-18 labeled deoxyglucose (FDG) PET study for cancer screening. On the PET images, multiple foci of intense FDG uptake were noted in the mediastinum. CT scan showed enlarged mediastinal nodes. Chest X-ray was normal. Mediastinoscopy and lymph node biopsy were performed. Histology results showed noncaseating granulomas and a diagnosis of sarcoidosis was obtained. The patient was asymptomatic and was observed without medications. Early reports have indicated that high FDG uptake can be observed in sarcoid granulomas. Inflammatory cells, especially macrophages, are characterized as cells with high glucose use. In interpreting multiple increased FDG accumulations in the mediastinum, sarcoidosis needs to be considered as a differential diagnosis.

Diffuse F-18 FDG uptake in chronic thyroiditis

A 52-year-old woman underwent whole-body F-18 FDG PET imaging for cancer screening. Diffuse F-18 FDG uptake was seen in the thyroid gland. A nodule with elevated F18 FDG uptake was seen protruding posteriorly in the right thyroid lobe. Ultrasonography also showed a thyroid nodule. Surgery was performed and histologically, the nodule was composed of atrophic thyroid tissue, fibrous stroma, and lymphoid cell infiltration; it was consistent with chronic thyroiditis. The patient had high antimicrosomal antibody titers. Thus, chronic thyroiditis may be found incidentally during FDG PET studies.

Increased FDG uptake in the wall of the right atrium in people who participated in a cancer screening program with whole-body PET

The purpose of this study was to evaluate the characteristics of patients who showed increased FDG uptake in the wall of the right atrium.We have encountered 10 patients with increased activity in the wall of the right atrium among a total of 2,367 examinees who participated in our cancer screening program with whole-body PET. The mean age of these examinees was 62.9 yr, higher than that of the total population. All suffered from cardiac disorders, especially atrial fibrillation. FDG accumulated almost exclusively in the wall of the right atrium, whereas only slight activity was seen in the wall of the left atrium. Although the average size of the right atria was significantly enlarged, left atria were more severely dilated than right ones. Therefore overload does not seem to account for the FDG accumulation in the wall of the right atrium.In conclusion, the increased activity in the wall of the right atrium was a rare finding that was made in older people who suffered from cardiac disease. Although the mechanism of induction of the high metabolic state of glucose in the wall of the right atrium remains unclear, this unusual activity would be another false positive finding in cancer screening with whole-body FDG PET.

Is whole-body FDG-PET valuable for health screening?

The survival of patients with various cancers, such as colorectal, breast and prostate carcinomas, has improved significantly since the 1970s [1], but unfortunately cancer remains the first or second most common cause of death among bothmen andwomen in developed countries. Presentdaymedical practice generally assumes that early detection of cancer offers the best chance of a good outcome. Finding a cancer in an asymptomatic person provides more treatment options, offers a better prognosis and cuts down on expenses compared with the cost incurred when cancers are detected at later stages. To detect cancers at an early stage, self-referral for mammography, routine or virtual colonoscopy, sigmoidoscopy, Pap smear screening, prostate-specific antigen testing and measurements of other tumour-specific markers have been actively recommended by consensual medical opinion, despite some continuing debate as to the value of these measures. With improvements in the standard of living and ready access to medical information via the internet and other mass media, more and more healthy lay persons are willing to undergo cancer screening. In Far Eastern countries (especially Japan), this tendency is strongly evident. Tumour screening can be defined as the application of diagnostic tests or procedures to asymptomatic people for the purpose of dividing them into two groups: those who have a condition that would benefit from early intervention and those who do not. The intention of traditional or conventional cancer screening has been the early detection of cancer in a target organ, but an ideal cancer screening test would be a non-invasive and painless procedure that can (a) simultaneously detect various cancers, regardless of the organ or site involved, at a time when they are curable, and (b) yield a high sensitivity and specificity [2]. Whole-body FDG-PET

Intrauterine accumulation of F-18 FDG during menstruation.

A 45-year-old woman underwent a whole-body FDG PET study during her menstrual cycle. On PET images, a focal area of increased F-18 FDG accumulation resembling a solitary pelvic tumor was noticed above the urinary bladder. MR imaging confirmed that the focal area was within the uterine cavity. After the PET study, a gynecologic examination including cytology was performed, and it revealed no pathologic lesion in the uterus. Fourteen months later, a second PET study was performed in the absence of menstruation. The PET result was normal. It is considered that during menstruation, high F-18 FDG accumulation can be observed in the uterus, probably due to intrauterine hemorrhage.

Stroke Risk of Asymptomatic Intra- and Extracranial Large-Artery Disease in Apparently Healthy Adults

Background: The predictive value of asymptomatic intracranial artery stenosis for future stroke remains uncertain. The aim of this study is to assess the stroke risk of asymptomatic intracranial artery stenosis and to compare it with that of extracranial artery disease. Methods: The study subjects were 2,924 participants (mean age 55 years) without any history of stroke. We examined the relation between intra- or extracranial large-artery disease and subsequent cerebrovascular events (mean follow-up 63 months). Results: The incidence rate of total cerebrovascular events in persons with intracranial artery stenosis was 1.3% per year. In the group without plaque in the extracranial carotid arteries, the annual rate of total cerebrovascular events was only 0.6%, but in the group with plaque, the rate was 3.6%. Kaplan-Meier analysis of total events showed a significant difference between the 2 groups (p = 0.002). Conclusions: The stroke risk in subjects with asymptomatic extracranial artery disease is markedly increased if intracranial artery stenosis is also present.