Norinari Honda

Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy

PurposeThe importance of the quality of life (QOL) and mental condition of patients being treated for cancer is now recognized. In this study, we evaluated QOL and mental condition in patients with cancer before and after radiotherapy.Materials and methodsThe subjects were 170 patients who had undergone radiotherapy. The examination of QOL was performed using the quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), and mental condition (anxiety and depression) was examined using the hospital anxiety and depression scale (HADS). These examinations were performed at the start of radiotherapy and immediately after radiotherapy.ResultsThe QOL score was slightly higher in all patients after the completion of radiotherapy than before the start of radiotherapy. In the palliative radiotherapy group, QOL score was significantly improved by treatment. Anxiety and depression were improved after radiotherapy. There was a correlation between the degrees of improvement of the HADS and QOL score.ConclusionWe could treat cancer patients by radiotherapy without reducing their QOL, and improvement in QOL was significant in the palliative radiotherapy group. Mental condition was also improved after radiotherapy.

Imaging of Ventilation with Dual-Energy CT during Breath Hold after Single Vital-Capacity Inspiration of Stable Xenon

PURPOSE To assess single-breath-hold technique for ventilation mapping by using dual-energy computed tomography (CT) in phantom experiments and volunteers. MATERIALS AND METHODS Institutional review board approved this study, and written informed consent was obtained from all volunteers. A rubber bag filled with a mixture of xenon (0%-35.4%) and oxygen was scanned with dual-source dual-energy CT (80 kV and 140 kV with tin [Sn] filter [Sn/140 kV] and 100 kV and Sn/140 kV). A cylinder containing six tubes of identical sizes with different apertures was ventilated once with a mixture of 35% xenon and 65% oxygen and was scanned in dual-energy mode (80 kV and Sn/140 kV). Xenon-enhanced images were derived by using three-material decomposition technique. Four volunteers were scanned twice in dual-energy mode (80 kV and Sn/140 kV) during breath hold after a single vital-capacity inspiration of air (nonenhanced) and of 35% xenon. Xenon-enhanced images were obtained by using two methods: three-material decomposition and subtraction of nonenhanced from xenon-enhanced images. Regression analysis with t and F tests was applied to the data of the rubber bag scans, with the significance level set at .05. RESULTS Mean pixel values of gas in the bag were linearly related to xenon concentration for all x-ray tube voltages (r(2) = 1.00, P < .00001). Pixel values of the xenon-enhanced images of the tubes were related to their aperture size. Nearly homogeneous (coefficient of variation: 0.22, 0.23, and 0.34) pixel values were found in the lungs of healthy volunteers, with higher pixel values in the trachea and lower pixel values in the bullae. Xenon-enhanced images calculated by using three-material decomposition had better image quality on visual comparison than those calculated by using subtraction. CONCLUSION Xenon-enhanced dual-energy CT with the single-breath-hold technique could depict ventilation in phantoms and in four volunteers.

Optimal preprocessing Butterworth-Wiener filter for Tl-201 myocardial SPECT

The optimal frequency characteristic of Butter-worth-Wiener filters (BWF) for improving the image quality of 201 Tl myocardial SPECT was determined by a phantom experiment. Thirty two projection images of the phantom containing 11.1 MBq of 201Tl with 4 different cold lesions were collected during a 180° arc of a gamma camera. A set of the projection images were processed with each of 27 different BWFs, and SPECT images were reconstructed by Shepp-Logan filtered backprojection. The SPECT images were evaluated for their diagnostic ability to visibly detect the cold lesions by four nuclear medicine physicians. The lesion contrasts were used as an adjunctive tool to determine the optimum filter. The optimal combination of the parameters determining BWF characteristics (for the data of about 100 count/pixel at the myocardium) is: 1) cutoff of 0.25/pixel, 2) FWHM of 3 pixels, 3) noise/signal ratio of 0.02. FWHM and noise/signal ratio affected lesion contrast much less than cutoff frequency. Clinical myocardial SPECT images processed with the optimal BWF showed less noise and sharper delineation of the myocardium.

Three-dimensional stereotactic surface projection of brain perfusion SPECT improves diagnosis of Alzheimer's disease

Objectives: Alzheimer’s disease (AD) is diagnosed by either inspection of the brain perfusion SPECT, or three-dimensional stereotactic surface display (3D-SSP). The purpose was to compare diagnostic performances of these methods.Methods: Sixteen nuclear medicine physicians independently interpreted99mTc-ECD SPECT in one session and SPECT with 3D-SSP in another session without clinical information for 50 studies of AD patients and 40 studies of healthy volunteers. Probabilities of AD were reported according to a subjective scale from 0% (normal) to 100% (definite AD). Receiver operating characteristics curves were generated to calculate areas under the ROC curves (Az’s) for the inspection as well as for an automated diagnosis based on a mean Z value in the bilateral posterior cingulate gyri in a 3D-SSP template.Results: Mean Az for visual interpretation of SPECT alone (0.679 ± 0.058) was significantly smaller than that for visual interpretation of both SPECT and 3D-SSP (0.778 ± 0.060). Az for the automated diagnosis (0.883 ± 0.037) was significantly greater than that for both modes of visual interpretation.Conclusions: 3D-SSP enhanced performance of the nuclear medicine physicians inspecting SPECT. Performance of the automated diagnosis exceeded that of the physicians inspecting SPECT with and without 3D-SSP.

Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stonestreet formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm.

Abstract:  The incidence of stonestreet formation after extracorporeal shock wave lithotripsy (ESWL) rises with increasing stone burden. However, stonestreet after ESWL is often experienced even in stones smaller than 20 mm. To examine whether the non‐contrast helical computed tomography (CT) data could predict stonestreet formation in these stones, 53 radiopaque stones of 5–20 mm treated with ESWL were evaluated. Maximal dimension was measured on plain radiograph. From an attenuation value histogram graphed from the CT data, total stone volume and mean attenuation value were calculated. Seven stonestreets longer than 25 mm developed. There was no significant difference in maximal dimension and total stone volume between stones that did and stones that did not develop stonestreet. Mean attenuation value was the sole significant predictive factor. Application of mean attenuation value with cut‐off level of 650 HU would anticipate stonestreet formation with a sensitivity of 85.7% and a specificity of 71.7%. The estimated risk of stonestreet formation is high in the treatment of stones with higher mean attenuation value.

Scintigraphic and CT findings of Tietze's syndrome: Report of a case and review of the literature

A case of Tietzes syndrome is reported. A 43-year-old woman, who had experienced right anterior chest pain and tender swelling of the right first costosternal junction for seven months, showed increased accumulation of the right first, the right fourth, and the left first costochondral junction on bone imaging. Ga-67 imaging showed increased accumulation at the right first costosternal junction. CT showed sclerosis of the sternal manubrium, partial calcification of costal cartilage, and soft tissue swelling. Biopsy of the right first costal cartilage showed chronic inflammation with fibrosis and ossification. Increased uptake of bone gallium imaging is consistent with Tietzes syndrome.

Relation between pulmonary embolus volume quantified by multidetector computed tomography and clinical status and outcome for patients with acute pulmonary embolism

PurposeThe aim of this study was to determine whether pulmonary embolus volume (PEV) obtained with multi-detector row computed tomography is related to clinical status and outcomes.Materials and methodsSubjects comprised 48 patients with acute pulmonary embolism (PTE). PEV was measured by tracing the contours manually and compared between sets of two groups divided by clinical status. Correlations of PEV to blood gases and D-dimer levels were investigated. PEV was tested as a predictor of clinical probability of acute PTE using Wells’ criteria and as a predictor of survival after PTE by logistic regression analysis.ResultsThe PEV was greater in groups with respiratory symptoms (P < 0.001), PTE as pretest clinical diagnosis (P = 0.027), and heart rate >100 beats/min (P < 0.001). It was smaller in subjects with concurrent malignancy (P = 0.02). It was correlated with PaCO2 (P = 0.04, ρ = −0.37) and the D-dimer level (P = 0.002, ρ = 0.46); it was not a predictor of clinical probability of acute PTE or survival after PTE. The survival rate did not differ between groups with PEV > 10 ml (8/9) or ≤10 ml (32/36).ConclusionThe PEV in acute PTE may relate to the presence of respiratory symptoms, hypocapnia, and tachycardia. The PEV was smaller in patients with malignancy. It did not contribute to mortality in this study.

Appendiceal diverticulitis: multidetector CT features

PurposeAppendiceal diverticulitis has been difficult to distinguish from acute appendicitis clinically and radiologically. The purpose of this study was to describe multidetector computed tomography (MDCT) features of cases of pathologically proved appendiceal diverticulitis at our institution over a 36-month period.Materials and methodsSeven of 156 patients who underwent appendectomy with the preoperative diagnosis of acute appendicitis were pathologically diagnosed with appendiceal diverticulitis. Two radiologists reviewed the MDCT images for these 7 patients.ResultsOn MDCT, a total of 8 inflamed diverticula were visualized as small fluid-filled luminal structures with thick enhanced walls or as solid enhanced masses protruding from the appendix for 6 of 7 patients. For 2 of these 6 patients, MDCT revealed a total of 5 normal diverticula visualized as small air-filled luminal structures with thin walls. For 1 of the 7 patients, neither inflamed or normal diverticula could be identified on MDCT. MDCT revealed appendiceal wall thickening with a tiny or no luminal fluid collection for 5 patients and with a moderate fluid collection for 1 patient, and a normal appendiceal wall for 1 patient.ConclusionOur results suggest that MDCT can reveal appendiceal diverticula and has potential in the preoperative diagnosis of appendiceal diverticulitis.

Quantitative lung perfusion scintigraphy and detection of intrapulmonary shunt in liver cirrhosis

Objective: Frequent association between liver cirrhosis and hypoxemia has been well documented. It is mostly attributable to intrapulmonary shunt due to dilation of pulmonary vasculature. We performed quantitative lung perfusion scintigraphy to detect an intrapulmonary shunt in cirrhosis patients.Methods: Prior to injection, Tc-99m MAA was applied to thin layer chromatography for quality control. Three cirrhosis patients who had hypoxemia were examined as well as 11 control subjects. After i.v. injection of Tc-99m MAA, whole body anterior and posterior images were taken at 5 min in patients with cirrhosis and at 8 time points up to 60 min in control subjects. Regions of interest were placed at the bilateral lungs and the whole body, and pulmonary accumulation was calculated.Results: All the control subjects demonstrated more than 90% of radioactivity in the lungs until 20 min. In contrast, all the patients showed values less than 80% at 5 min. In the cirrhosis patients with hypoxemia, the presence of intrapulmonary shunt was confirmed on quantitative lung perfusion scan. In control subjects, pulmonary accumulation of Tc-99m MAA dropped as a function of time and became less than 90% after 30 min.Conclusion: The timing, of measurements is essential in evaluating intrapulmonary shunt.

Background correction in estimating initial renal uptake. Comparison between Tc-99m MAG3 and Tc-99m DTPA.

&NA; A gamma camera method with no blood sampling assesses differential renal function based on initial renal uptake, and requires background correction. The effect of background correction on estimates of initial renal uptake was compared on renograms using Tc‐99m MAG3 and Tc‐99m DTPA renographies in 14 patients. Renal counts for 2‐3 minutes were obtained using three sets of regions of interest (ROIs): rectangular renal and subrenal background ROIs, rectangular renal and perirenal background ROIs, and hand‐drawn renal and subrenal background ROIs. Correlations between estimates of initial renal uptake by the three methods were higher for Tc‐99m MAG3 renography than for Tc‐99m DTPA imaging, suggesting higher reproducibility in evaluating differential renal function using Tc‐99m MAG3 renography and a gamma camera method. Although the ratio of counts in the suprarenal area to those in the subrenal area was significantly higher for the right side in the Tc‐99m MAG3 study, probably because of hepatic activity, the relative uptake in the right kidney for Tc‐99m MAG3 did not differ from that for Tc‐99m DTPA. Initial uptake of Tc‐99m MAG3 was well correlated with, and about threefold that, of Tc‐99m DTPA. It was suggested that initial renal uptake of Tc‐99m MAG3 may be an alternative to that of Tc‐99m DTPA, with less dependence on background correction in evaluating differential renal function.