Mitsuhiro Kishino

Usefulness of PET/CT for detecting a second primary cancer after treatment for squamous cell carcinoma of the head and neck.

Purpose: Patients with squamous cell carcinoma of the head and neck have been reported to have a high rate of second primary cancer of the upper aerodigestive tract. This study was performed to determine whether positron emission tomography/computed tomography (PET/CT) is useful for detecting a second primary cancer after treatment for squamous cell carcinoma of the head and neck. Methods and Materials: The PET/CT findings in 279 consecutive patients (211 men, 68 women; mean age 62 years) who had been treated for squamous cell carcinomas of the head and neck were examined and compared with the findings obtained by other imaging modalities, the biopsy results, and the clinical data. Results: Thirty second primary cancers were documented in 28 of the 279 subjects. Based on PET/CT findings, the overall risk of a second primary cancer in 1 year was 9.9% and the risk in the upper aerodigestive tract region was 6.8% (19/279). Conclusions: PET/CT enabled early detection of a second cancer in patients treated for head and neck cancer.

Retrograde transvenous obliteration for uterine arteriovenous malformation.

BACKGROUND: Transarterial embolization is an established treatment for uterine arteriovenous malformation (AVM); however, in some cases, transarterial embolization is difficult. We present balloon-occluded retrograde transvenous obliteration as an alternative endovascular treatment for uterine AVM. CASE: A 24-year-old woman was diagnosed with uterine AVM. Her medical treatments were ineffective, and selective embolization was abandoned because of the extremely tortuous feeders. We used balloon-occluded retrograde transvenous obliteration, in which balloon catheters were inserted into the draining vein to stop the outflow. Then, a sclerosant was retrogradely injected through the catheter into the nidus. The abnormal vessels were fully obliterated, and there was no recurrence after the treatment. CONCLUSION: Balloon-occluded retrograde transvenous obliteration may be an alternative treatment for uterine AVMs with adequate vascular structures.

Bilateral renal angiomyolipoma in a patient with tuberous sclerosis treated with resection of one kidney and transarterial embolization of other kidney using CT during selective arteriography: a case report

Renal AML complicating tuberous sclerosis shows a rapid growth and its rupture is frequently associated with hemorrhagic shock as a result of profuse retroperitoneal bleeding, necessitating an aggressive therapeutic approach. This report describes the long-term clinical progress of 28 year-old woman with tuberous sclerosis with a ruptured giant AML that underwent unilateral nephrectomy, who has been followed up after treatment with concomitant application of computed tomography during selective arteriography to conserve the remaining normal renal parenchyma, and in whom the need for initiation of dialysis has been successfully avoided, with conspicuous reduction of the tumor size.

Anomalous arterial supply to the gallbladder from the superior mesenteric artery: angiography and computed tomography findings in two cases:

The arterial supply of the gallbladder usually arises from the right hepatic artery. Other origins include the left, proper, and common hepatic arteries. We report cases of the cystic artery arising from the superior mesenteric artery and arising from the dorsal pancreatic artery originating in turn from the superior mesenteric artery, as demonstrated by angiography and computed tomography.

Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion

We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.

Diffusion-weighted magnetic resonance imaging to differentiate malignant from benign gallbladder disorders.

PURPOSE To retrospectively evaluate the utility of apparent diffusion coefficient (ADC) and lesion to spinal cord ratio (LSR) in diffusion-weighted magnetic resonance (MR) imaging (DWI) as compared with morphological assessment alone, for differentiating malignant from benign gallbladder disorders. METHODS This study was approved by the ethics committee, and written informed consent was waived. Ninety-one patients (13 malignancy and 78 benignancy) were reviewed. ADC was calculated using two DW images with different motion-probing gradient strengths (b=0, 1000s/mm(2)). LSR was measured by dividing the signal intensity of a thickened gallbladder wall by the maximum signal intensity of the lumbar enlargement of the spinal cord. In addition, the morphology of the gallbladders was assessed with conventional MR imaging. RESULTS In receiver operating characteristic curve analysis, the areas under the curves for ADC and LSR were 0.861 and 0.906, respectively. Three morphological findings were considered: a massive formation, a disrupted mucosal line, and the absence of a two-layered pattern. When a combination of two or more of these morphological findings was positive for malignancy, the sensitivity, specificity, and accuracy were 76.9%, 84.0%, and 83.0%, respectively. When a combination of three or more of the above morphological findings together with ADC of less than 1.2 × 10(-3)mm(2)/s or LSR of more than 0.48 were positive for malignancy, these values were 73.0%, 96.2%, and 92.9%, respectively. There were significant differences in specificity and accuracy. CONCLUSION Use of ADC and LSR in DWI can improve diagnostic performance for differentiating malignant from benign gallbladder disorders.

Embolosclerotherapy by the Transvenous Approach for Lower Extremity Arteriovenous Malformation in Cowden Syndrome: A Case Report

A 69-year-old female with Cowden syndrome presented with pain at rest in the right leg. Arteriovenous malformations (AVMs) of the right lower extremity were detected by computed tomography and magnetic resonance imaging. Angiography indicated arteriolovenous fistulae, which were initially treated using a transarterial approach with minimal therapeutic effect. In contrast, excellent outcomes were achieved with a transvenous approach using coil embolization and liquid sclerotherapy for the venous component of the nidus. At 15 months after embolosclerotherapy, no angiographic evidence of AVM recurrence was noted. Embolosclerotherapy by the transvenous approach for AVM in Cowden syndrome was a useful therapeutic strategy for arteriolovenous fistulae.

Diagnostic Imaging of Chest Wall Tumors

There are several imaging devices routinely utilized for evaluation of chest wall tumors predominantly focused in determining the extent of tumor involvement and the potential for respectability. This comprises computed radiography (CR), ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), [F-18] FDG positron-emission tomography (PET)/CT, and [F-18] FDG PET/MRI. CR, CT, and MRI are the first line; of these MRI allows tissue characterization, accurate assessment of tumor extent, differentiation from adjacent inflammation, information of blood flow, diffusion capacity, texture features, and specification of metabolites within tumors. Imaging devices are also noninvasive methods which have revolutionized oncological imaging by combination of metabolic activities and morphologic features. They are also useful in guiding biopsy, evaluating patient prognosis, staging the disease, monitoring therapeutic response, and detecting recurrences in chest wall tumors. This leads to the appropriate management of patients with these masses. In vivo morphologic and metabolic information obtained by these several modalities plays an important role to manage patients with chest wall tumors.

The possibility of free tissue transfer as a nutrient flap for critical ischemic foot: A case report

Microsurgical procedure of free tissue transfer in critical limb ischemia patients with large ulceration has already been established. The nutrient flap concept was that transferred tissue functioned not only to cover the skin defect but also as a supplementary blood supply to the ischemic lower leg. This report showed the justification for this concept, which was rarely discussed. A 58‐year‐old male patient with progressive forefoot gangrene caused by arteriosclerosis obliterans was presented. The distal bypass procedure was performed as revascularization surgery, and a latissimus dorsi (LD) myocutaneous flap was transplanted to cover ulceration. The arterial pedicle of the flap was anastomosed to the vein graft in an end‐to‐end manner, and the venous pedicle was anastomosed to the posterior tibialis vein in an end‐to‐end manner. Bypass graft blood flow went straight to the LD flap only. The postoperative course was uneventful. The free flap and right foot survived successfully and the patient was ambulatory with no recurrence of ulceration wearing order‐made shoes more than three years after transplantation. Vessel‐selective angiography was performed two months after surgery. An angiographic catheter was inserted into the bypass graft, which ran straight through the flap nutrient artery. The results obtained showed that not only the transferred flap area, but also the remaining original foot soft tissue (including the sole and heel) was clearly visualized radiologically only through the flap nutrient vessel. This findings of the angiography appear to provide direct evidence for the nutrient flap concept.