Tomio Nakagawa

Endometrial carcinoma: Dynamic MRI with turbo-FLASH technique

PURPOSE Our goal was to investigate the usefulness of dynamic MRI with the turbo-FLASH technique in estimating myometrial invasion by endometrial carcinoma. METHOD Forty-six patients with endometrial carcinomas were evaluated with pathologic correlation. Dynamic MRI was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique. RESULTS The inner muscle layer showed more rapid contrast enhancement effects than the outer muscle layer even after menopause. Contrast-to-noise ratio between the inner muscle layer and endometrial carcinoma was maximum at approximately 50 s after administration of Gd-DTPA. In postmenopausal women, the accuracy in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MRI was 66.7, 77.8, and 92.6%, respectively. CONCLUSION Dynamic MRI with the turbo-FLASH technique is considered to be a useful imaging method for the estimation of myometrial invasion by endometrial carcinoma, especially in postmenopausal patients.

Analysis of factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy.

PURPOSE To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. METHODS AND MATERIALS A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for >or=2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause. RESULTS Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age (>or=50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was >or=50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. CONCLUSIONS Age (>or=50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy.

Struma ovarii: appearance on MR images

Abstract.Background: The purpose of this multi-institutional study was to examine the appearance of struma ovarii on magnetic resonance (MR) images. Methods: MR images of 12 patients with histologically proven struma ovarii were retrospectively reviewed. All patients underwent T1-weighted and T2-weighted imaging. Contrast-enhanced T1-weighted images with Gd-DTPA were available in 10 patients. The following determinations were made: tumor morphology, signal intensities, contrast-enhancement effects of solid components with Gd-DTPA, and comparison of MR images with resected specimens. Results: All 12 patients had both cystic and solid components, with a multilobulated surface and thickened septa. Signal intensities on T1-weighted images were mainly low, partly intermediate to high, or high, and those on T2-weighted images were mainly high, with different signal intensities. Contrast-enhancement effects were marked or moderate. The contents that showed low signal intensities on T1-weighted images and signal voids or low signal intensities on T2-weighted images were viscid gelatinous materials. Conclusions: A multicystic tumor with a solid component, a multilobulated surface, and signal intensities that indicate the presence of viscid gelatinous materials appear to be a characteristic MR finding of struma ovarii.

I-123 uptake in nonfunctional struma ovarii

A case of nonfunctional struma ovarii preoperatively diagnosed by scintigraphy of the pelvis using I-123 NaI is reported. US, CT, and MRI revealed a multilobulated mass composed of cystic and solid components. CT showed cystic components with slightly high density and MRI showed various signal intensities on T1- and T2-weighted images. I-123-scintigraphy of the pelvis showed uptake in the pelvic mass. Microscopic examination revealed the histologic appearance of thyroid tissue accompanied by follicular adenoma. I-123 scintigraphy of the pelvis was useful for reaching the correct preoperative diagnosis in this patient with nonfunctional struma ovarii.

Uterine cirsoid aneurysm : MRI and MRA

Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm.

Metastasis to the iris in squamous cell lung cancer

A 72-year-old Japanese woman, suffering from squamous cell lung cancer with brain metastasis, underwent 2 courses of combination chemotherapy, consisting of cisplatin and vindesine. Although both the primary tumor and the brain metastasis regressed markedly, she developed left ocular pain with blurred vision. An abnormal mass was found in the left iris, and cytologic examination of the aqueous aspirate revealed a few malignant cells, which, when examined by electron microscopy, were considered to be derived from squamous cell carcinoma of the lung.

2113 The results of radiotherapy for T1 glottic cancers; influence of radiation beam energy

We analyzed the influence of various parameters on the results of radiotherapy for T1 glottic cancer by assessing the outcomes of 60 patients with this cancer who received definitive radiotherapy between 1985 and 1994. Seven patients were treated with a cobalt-60 unit, and the other 53 with a linear accelerator (26 patients at 3-MV, 10 at 6-MV, and 17 at 10-MV). Of the 17 patients treated at 10-MV, 4 also received part of their treatment with a cobalt-60 unit. The total radiation dose ranged from 56 Gy to 70 Gy (mean, 61 Gy). The total radiation dose of 51 patients (85%) was 60 Gy. The factors found to influence local control were the strength of the radiation beam energy and whether or not there was gross tumor invasion of the anterior commissure. The local control rate was 71% in the patients treated with a 10-MV linear accelerator, 56% in those treated with a 6-MV linear accelerator and, 97% in those treated with a cobalt-60 unit or a 3-MV linear accelerator (P = 0.0173). The local control rate was 43% in the patients with gross anterior commissure invasion and 88% in those without (P = 0.0075). We conclude that low energy photon beams are more suitable for the treatment of early glottic cancers, especially if the lesion grossly invades the anterior commissure.

Left ventricular wall motion display using MRI myocardial tagging

We have developed a left ventricular wall motion analysis method, and developed a display method of the motion on personal computer monitor. To know precise rotation or deformity, identifiable landmarks must be located. The MRI tagging makes it possible to estimate the regional wall motion noninvasively. We tried to estimate the precise LV wall motion by the MRI tagging. Tagging is achieved by a selective saturation pulse method. The difference of the signal intensity between tagged and nontagged regions persists for 400-700 milliseconds. We display the tag point movement as animation, and display the rotation and contraction curve on the same computer monitor.

Detection of Metastatic Thyroid Carcinoma with 99mTc-MIBI Scintigraphy.

Accumulation of 99mTc-MIBI has been reported in several various carcinomas. In this study, 99mTc-MIBI scintigraphy was evaluated to detect recurrent or metastatic lesion in seven patients with thyroid carcinoma. The results were compared with those of 131I scintigraphy and 201T1 scintigraphy.Bone metastasis and lymphnode metastasis were well demonstrated in 99mTc-MIBI scintigraphy, but 131I scintigraphy allows the best visualization of pulmonary metastasis.99mTc-MIBI scintigraphy has desirable characteristics including the potential for no thyroid hormone withdrawal, immediate imaging postinjection, and low radiation burden.In conclusion, it is shown that 99mTc-MIBI scintigraphy is a useful procedure in follow-up of thyroid carcinoma and has the potential for visualization of metastasis when 131I was negative.