Shuichi Murashima

Superselective Bronchial Artery Embolization for Hemoptysis with a Coaxial Microcatheter System

PURPOSE To compare the effectiveness and safety of superselective bronchial artery embolization with that of nonsuperselective embolization in the control of hemoptysis. MATERIALS AND METHODS Retrospective case analysis was done for 47 patients with hemoptysis originating from a variety of causes. In 22 patients, embolization was performed superselectively using a microcatheter inserted into the bronchial artery beyond the spinal or mediastinal branches (superselective group). In the remaining 25 patients, embolization was performed at the opening of the bronchial artery with a 5-F catheter (nonsuperselective group). RESULTS Initial hemoptysis control rates were 96% (21 of 22) in the superselective group and 88% (22 of 25) in the nonsuperselective group. Cumulative hemoptysis control rates of the superselective and nonsuperselective groups were 80% and 67% at 6 months, 79% and 56% at 1 and 2 years, and 79% and 48% at 3 years, respectively (not significant; generalized Wilcoxon test). One major complication (spinal infarction) occurred in the nonsuperselective group. CONCLUSIONS Superselective embolization is safer and more effective way to control hemoptysis than the ordinary (nonsuperselective) method.

Pulmonary ventilation-perfusion MR imaging in clinical patients.

The purpose of this study was to evaluate the feasibility of comprehensive magnetic resonance (MR) assessment of pulmonary perfusion and ventilation in patients. Both oxygen‐enhanced ventilation MR images and first‐pass contrast‐enhanced perfusion MR images were obtained in 16 patients with lung diseases, including pulmonary embolism, lung malignancy, and bulla. Inversion recovery single‐shot fast spin‐echo images were acquired before and after inhalation of 100% oxygen. The overall success rate of perfusion MR imaging and oxygen‐enhanced MR imaging was 94% and 80%, respectively. All patients with pulmonary embolism showed regional perfusion deficits without ventilation abnormality on ventilation‐perfusion MR imaging. The results of the current study indicate that ventilation‐perfusion MR imaging using oxygen inhalation and bolus injection of MR contrast medium is feasible for comprehensive assessment of pulmonary ventilation‐perfusion abnormalities in patients with lung diseases. J. Magn. Reson. Imaging 2001;14:419–424.

Assessment of factors influencing FDG uptake in non-small cell lung cancer on PET/CT by investigating histological differences in expression of glucose transporters 1 and 3 and tumour size

PURPOSE The objective of this study was to evaluate the major factors influencing on FDG uptake in non-small cell lung cancer (NSCLC) by investigating histological difference in the expression of glucose transporters 1 and 3 (Glut-1 and Glut-3) and tumour size. METHODS This study enrolled 32 patients including 9 with squamous cell carcinoma (SCC) and 23 with adenocarcinoma (AC). The AC cases comprised 16 AC with mixed subtypes (AC-mixed) and 7 localized AC in situ (localized bronchioloalveolar carcinoma). Partial volume effect corrected maximum standardized uptake values (cSUVmax) and tumour size were obtained using FDG PET/CT. Glut-1 and Glut-3 expression were evaluated using five-point grading scales. RESULTS Overexpression of Gluts was observed at high rates (88% for Glut-1 and 97% for Glut-3). They were mutually correlated. cSUVmax showed better correlation with size than with Gluts overexpression. AC and SCC showed a high positive expression rate for both Glut-1 and Glut-3, although the degree of overexpression was significantly higher in SCC than AC. In addition, localized AC in situ revealed a considerably higher positive expression rate and similar degrees of overexpression for both Glut-1 and Glut-3 compared with AC-mixed. By contrast, localized AC in situ alone was significantly smaller in both cSUVmax and size than either SCC or AC-mixed. No significant difference was found in cSUVmax or size between SCC and AC-mixed. CONCLUSIONS The FDG uptake of NSCLC might be dependent on size rather than on overexpression of Glut-1 or Glut-3. Low FDG uptake in localized AC in situ might result from its small size rather than Glut overexpression.

Decreased High–Molecular Weight Adiponectin–to–Total Adiponectin Ratio in Sera Is Associated With Insulin Resistance in Japanese Metabolically Obese, Normal-Weight Men With Normal Glucose Tolerance

Adiponectin is a key regulator of insulin resistance. Recent studies on multimer formation in human blood have demonstrated that high–molecular weight (HMW) adiponectin is the active form of the protein (1–3). Recently, Hara et al. (3) demonstrated that the ratio of HMW adiponectin to total adiponetin (HMWR) in systemic circulation is useful for the prediction of insulin resistance and metabolic syndrome. Metabolically obese, normal-weight (MONW) subjects (BMI <25 kg/m2) are characterized by excess visceral fat area (VFA; ≥100 cm2 by abdominal computed tomography scanning) and insulin resistance (4–6). In addition, we previously demonstrated that the …

A novel method for the assessment of autonomic neuropathy in type 2 diabetic patients: a comparative evaluation of 123I-MIBG myocardial scintigraphy and power spectral analysis of heart rate variability.

The correlation between the degree of sympathetic denervation measured through 123I‐MIBG Myocardial Scintigraphy and Power Spectral Analysis of consecutive R‐R records was investigated in order to evaluate their potential application for the assessment of myocardial autonomic neuropathy in patients with diabetes mellitus. This study comprised 42 patients with Type 2 diabetes. Low frequency (0.02–0.09 Hz) components of the power spectral density were measured as markers of sympathetic activity. The myocardial uptake of 123I‐MIBG was measured by using the single photon emission computed tomography (SPECT) and the early and delayed images were recorded. Scoring from 0 to 3 of the 123I‐MIBG uptake of various cardiac segments (7) was performed and the total uptake was calculated. The washout rate inthe whole myocardium was determined. The values obtained in the group with diabetic autonomic neuropathy (DAN) without orthostatic hypotension (OH) were significantly lower as compared to those of the (DAN (−)) group in the delayed images. The washout rate of the OH (−) group was also significantly higher than the DAN (−) group. There was significant difference between the images and the washout rate of OH (+) and OH(−) groups. There was a significant correlation between Power Spectral Analysis and SPECT (early, delayed images, and washout rate). Of these, the delayed image showed the strongest correlation (r = 0.55, p < 0.01). Further, the QTc interval showed a significant inverse correlation with the delayed image (r = −0.44, p < 0.05). In conclusion, these results suggest that the cardiac 123I‐MIBG scintigraphy could be a useful method for the assessment of the myocardial autonomic neuropathy in patients with diabetes mellitus.

Absolute blood contrast concentration and blood signal saturation on myocardial perfusion MRI: Estimation from CT data

To determine the optimal contrast injection rate and absolute blood gadolinium concentration for optimal first‐pass imaging.

Role of nitric oxide in airway remodelling

Airway remodelling, which is manifested by thickening of bronchial wall, is an important causative factor of bronchial hyper-responsiveness in asthma. The pathophysiological mechanism of airway remodelling is not clear. In the present study we evaluated the relationship between nitric oxide (NO) generation and airway wall thickening in patients with chronic asthma. As a marker of NO production, the levels of nitrite/nitrate were measured in induced sputum, and bronchial wall thickening was measured by high-resolution computed tomography. Sputum concentrations of nitrite/nitrate were significantly increased in asthmatic patients compared with controls. The ratio of airway wall thickness to lumen diameter was significantly correlated with the sputum concentration of nitrite/nitrate. Although statistical correlation does not prove causation, this finding suggests that NO may play a key role in the pathogenesis of airway remodelling.

Optimal Scan Parameters for CT Fluoroscopy in Lung Interventional Radiologic Procedures: Relationship between Radiation Dose and Image Quality

PURPOSE To evaluate the relationship between radiation doses and lung computed tomographic (CT) fluoroscopic scan parameters and to determine optimal scan parameters for performance of lung interventional radiologic (IR) procedures. MATERIALS AND METHODS The institutional review board approved this prospective study, which included 32 patients with a single lung tumor; written informed consent was obtained. CT fluoroscopic images were obtained with three tube voltages (80,120,135 kV) and three tube currents (10, 20, 30 mA) in each patient. The signal-to-noise ratios (SNRs) and the contrast-to-noise ratios (CNRs) were measured quantitatively. To evaluate the feasibility of performing lung IR procedures, four readers visually scored the image quality. Acceptable CT fluoroscopic images were determined by using agreement of at least three of the four readers. The weighted CT dose index for each CT scan parameter was measured. A piecewise linear regression equation was obtained from the relationship between radiation doses and visual image scores. RESULTS Both the SNR and the CNR improved as the radiation dose increased, leading to improvement in the image quality. Acceptable image quality was achieved in 94% (30 of 32) of patients when the radiation dose was 1.18 mGy/sec (120 kV, 10 mA) and in all patients when it was greater than 1.48 mGy/sec (135 kV, 10 mA). The piecewise linear curve showed rapid improvement in image quality until the radiation dose increased to 1.48 mGy/sec (135 kV, 10 mA). When the radiation dose was increased greater than 1.48 mGy/sec, improvement in the image quality became more gradual. CONCLUSION Results of this study can be used to guide the determination of optimal scan parameters in lung CT fluoroscopy.

Application of a self-expanding metallic stent to a strictured esophagojejunostomy

We placed a Gianturco self-expanding metallic stent across the recurrent stricture of an esophagojejunostomy in a patient with gastric cancer. Though excellent passage of food resulted, intractable reflux occurred. Two months later the patient succumbed to recurrent tumor. At autopsy, the stent was patent and was partially covered by esophageal mucosa. There were narrow but deep ulcers around the stent hooks. The Gianturco metallic stent may provide an additional option for treating recurrent enteric strictures after other methods fail. Further refinements of the technique appear necessary.

Resection of Mucinous Lung Adenocarcinoma Presenting with Intractable Bronchorrhea

A 59-year-old man who was a current smoker (30 packyears) was referred to the outpatient department of our hospital for evaluation of a huge left hilar mass with bilateral diffuse opacification of the lung fields on the chest x-ray. Although the patient had no symptoms at his first visit to our clinic, he soon developed progressive dyspnea of acute onset with hypoxemia necessitating oxygen supplementation and continuous bronchorrhea ( 300 mL/d). Moreover, he could not lie on his back because of the bronchorrhea flooding out of the nose in this position. The results of arterial blood gas analysis on room air were as follows: pH, 7.422; PaO2, 60.3 torr; PaCO2, 35.6 torr; HCO3, 23.2 mEq/L; BE, 0.6; O2 Sat, 91.7%. Fiberoptic bronchoscopy and transbronchial lung biopsy revealed the diagnosis of adenocarcinoma in specimens obtained from the apical segment of the left lower lobe; no malignant cells were identified in the bronchoscopic aspirates obtained from the other lobes. Although repeat sputum cytology did not reveal any malignant cells, the carcinoembryonic antigen level in the sputum was 128 mg/dL as compared with that of 4.2 mg/dL in the serum. High-resolution computed tomography (CT) revealed bilateral diffuse groundglass attenuation (GGA) of the pulmonary parenchyma, in addition to a huge round area of consolidation in the apical segment of the left lower lobe (Figure 1). Positron emission tomography with fluorine-18 fluorodeoxyglucose showed a high standardized uptake value of 7.4 in the pulmonary tumor and regional hilar lymph nodes, with no evidence of any metastatic disease (Figure 2). We obtained informed consent from the patient for surgery after explaining to him that the surgical procedure to be undertaken may not be curative, but palliative in terms of providing relief from the disabling symptoms of bronchorrhea and dyspnea and improving the arterial oxygen saturation, and performed a left lower lobectomy with systematic radical lymph node dissection. Although a lingular segment obtained by wedge resection did not reveal any evidence of metastasis, multiple small intrapulmonary metastases were evident in the resected left lower lobe. Histopathological examination revealed adenocarcinoma with mucinous bronchioloalveolar adenocarcinoma (BAC) features (Figure 3) and hilar lymph node metastases; pT3N1M0, stage IIIA. Epidermal growth factor receptor direct sequencing of exons 18 to 22 revealed the wild type. The postoperative course was uneventful. The symptoms of bronchorrhea and dyspnea disappeared rapidly, and by the end of day 2 postoperatively, the patient no longer needed oxygen supplementation; arterial blood gas analysis at this time showed a PaO2 of 88.1 torr on room air. A postoperative CT obtained 3 weeks after the surgery (Figure 4) revealed complete disappearance of the diffuse GGA in the residual pulmonary parenchyma. Although he has taken adjuvant chemotherapy with paclitaxel and carboplatin and been well without any pulmonary symptom, a postoperative CT obtained 4 months after surgery revealed difuuse GGA in bilateral lungs suggesting intrapulmonary recurrence.