Taisuke Sasaki

Comparison of Scintigraphy and Magnetic Resonance Imaging for Stress Injuries of Bone

ObjectiveTo compare findings of radiography, scintigraphy, and magnetic resonance imaging (MRI) in stress injuries of bone and evaluate changes of these findings with time correlated with clinical symptoms. DesignProspective study. SettingA primary care hospital outpatient orthopedic clinic. PatientsAll 31 patients with stress injuries of bone who visited our clinic from July 1996 to June 2000. InterventionRadiography, scintigraphy, MRI, and clinical examinations were performed on the same day or at least within 1 week of eachother, and the findings were compared. If symptoms of stress injury of bone continued, these examinations were repeated at intervals of 2 months until symptoms disappeared. These radiologic findings were assessed by an independent radiologist who was blinded to the clinical symptoms of the patients. Main Outcome MeasuresCorrelation accuracy of MRI and scintigraphy findings with clinical symptoms. ResultsEven with negative initial radiographic findings, all initial scintigraphy and MRI indicated stress injury of bone. There were no patients with positive/negative examinations. Grade of scintigraphy and MRI were closely correlated, and these findings also correlated with the degree of clinical symptoms. Compared with scintigraphy, MRI showed more diagnostic information, such as fracture line and periosteal edema. Areas of increased activity in scintigraphy were consistent with the grades of MRI, especially high signal intensity areas of STIR (short tau inversion recovery) image. ConclusionsFrom these observations, MRI is less invasive, provides more information than scintigraphy, and is recommended for initial diagnosis and assessment stages of stress injury of bone.

Arterial infusion chemotherapy for advanced hepatocellular carcinoma using EPF and EAP therapies.

SummaryArterial infusion chemotherapy of EPF (etoposide, cisplatin, and 5-fluorouracil) or EAP (etoposide, Adriamycin, and cisplatin) was carried out in 28 cases of advanced hepatocellular carcinoma (HCC) between January 1988 and December 1990, and assessment was made of the anticancer efficacy of each treatment method. In all, 13 patients were treated with EPF therapy and 15 received EAP therapy. The anticancer agents were infused through a catheter inserted into the proper or common hepatic artery. The catheter was inserted via the axillary artery or common femoral artery using Seldingers method or the cut-down method. The results of each therapy were analyzed in relation to the tumor regression rate and the side effects encountered. The tumor regression rate was determined on the basis of two-dimensional evidence obtained by computed tomography performed before and after treatment. The treatment results were also compared with the results of chemoembolization therapy using a mixture of cisplatin (CDDP), Adriamycin (ADM) and lipiodol. Of the 28 patients treated with arterial infusion chemotherapy, 14 (50%) attained a regression rate of 50% (PR). In all, 46% of the EPF group and 53% of the EAP group achieved a PR. These results were superior to those obtained using chemoembolization therapy. In general, the side effects were relatively mild and transient.

Magnetic resonance imaging AIDS in detecting concomitant injuries in patients with tibial spine fractures.

Tibial spine fracture is one of the clinical entities of anterior cruciate ligament injury, and sometimes is accompanied by concomitant injuries. The purpose of this study was to review magnetic resonance imaging findings in 25 patients with tibial spine fractures and to assess the use of these findings in determining the presence of concomitant injuries. Of these 25 patients, 10 were children and 15 were considered adults (average age, 24.2 years old). A radiologist retrospectively assessed tibial spine fractures and concomitant injuries, such as meniscus and ligament injuries. Comparing the pediatric and adult groups, all additional ligament injuries were confirmed in the adult group. In the pediatric group, only one patient with a chronic injury had meniscus injuries. There were no meniscus tears in pediatric patients with acute injuries. In the adult group, three medial meniscus tears were found in two patients with chronic injuries and one patient with acute injury, and four lateral meniscus tears were found in one patient with a chronic injury and three patients with acute injuries. Because tibial spine fractures in adults may be accompanied by concomitant injuries requiring surgical treatment, magnetic resonance imaging is recommended. Level of Evidence: Diagnostic study, Level III-1 (study of nonconsecutive patients—no consistently applied reference “gold” standard). See the Guidelines for Authors for a complete description of levels of evidence.

Combination therapy consisting of arterial infusion chemotherapy (EPF, EAP) and transcatheter arterial embolization (TAE)

From January 1988 to January 1993, 45 patients with unresectable advanced hepatocellular carcinoma (HCC) were treated with a new combination therapy consisting of arterial infusion chemotherapy and TAE. The combination therapy was performed according to our treatment schedule as follows: two courses of arterial infusion chemotherapy were given first, and then transcatheter arterial embolization (TAE) using a mixture of Lipiodol and cisplatin powder was performed. Two arterial infusion chemotherapeutic regimens were employed: EPF (etoposide, cisplatin, and 5-fluorouracil) and EAP (etoposide, Adriamycin or Epi-adriamycin, and cisplatin). The anticancer drugs were infused through a catheter inserted into the proper or common hepatic artery. Assessment was made of the anticancer effect and survival rate of each treatment method. The response to each therapy was evaluated on the basis of CT performed prior to and after the treatment. In the EPF·TAE group, the response rate was about 46%, whereas in the EAP·TAE group it was 48%. Overall, 21 of 45 patients attained a regression rate of 50% or more. Furthermore, daughter nodules decreased in size or disappeared in about 67% of 15 patients. Additionally, tumor thrombi tended to show a similar response. In all of the cases, the average duration of survival was 30.3 months, and the 1-year survival value was 68%, the 2-year survival value was 44%, and the 3-year survival value was 35%. These results were superior to those obtained with TAE therapy alone.

Technical Note. Labral-ligamentous complex of the shoulder: Evaluation with double oblique axial MR arthrography

Purpose: To assess the ability of double oblique axial (DOA) MR arthrography in evaluating labral-ligamentous complex compared with conventional axial (CA) MR arthrography. Material and Methods: MR arthrography of 51 shoulders, subsequently examined with arthroscopy, were retrospectively reviewed. DOA imaging was performed in all 51 shoulders and both DOA and CA imaging in 37 using a 1.5 T unit with gradient recalled-echo T2*-weighted sequences. DOA imaging was performed using perpendicular planes to the long axis of the glenoid fossa obtained by an oblique sagittal scout image. We compared the ability of DOA with that of CA MR arthrography to assess labral injuries and to demonstrate the whole length of the anterior band of the inferior glenohumeral ligament (AIGHL), which were shown to be intact by arthroscopy. Results: For anterior labral injuries, sensitivity and specificity were 87% and 93% with CA, and 94% and 100% with DOA imaging, respectively. For posterior labral injuries, sensitivity and specificity were 47% and 100% with CA, and 79% and 96% with DOA imaging, respectively. There were no statistically significant differences between CA and DOA images, except for the ability to diagnose posterior labral injuries, where DOA imaging had a significant superior sensitivity (p = 0.0327). DOA images also demonstrated the whole length of the intact AIGHL in 10 of 11 shoulders, while CA imaging showed this in only 3 of 11. Conclusion: DOA imaging was equal or better than CA imaging for evaluating the labral-ligamentous complex.