Yasumasa Kajihara

Superselective cisplatin (CDDP)-carboplatin (CBDCA) combined infusion for head and neck cancers.

A group of 26 patients with carcinoma of the head and neck region was treated by superselective intra-arterial infusion of cisplatin (CDDP)-carboplatin (CBDCA). The tumor locations included the tongue (n = 4), oral base (n = 2), nasopharynx (n = 2), oropharynx (n = 8), hypopharynx (n = 4) and larynx (n = 4). Using the coaxial technique, a microcatheter was placed in the lingual, ascending pharyngeal, facial and superior thyroidal arteries according to the location of the tumor. Under imaging studies, CDDP (50 mg/m2)-CBDCA (300 mg/m2) was infused into the vessel, via injectors at the rate of 12.5 ml/min. One to five injections were given every 4 weeks. During and following the chemotherapy the patients received radiotherapy (n = 22), surgery (n = 4) or both (n = 3). Sixty-six sessions of intra-arterial chemotherapy were given with no major complications. Drug-related systemic side effects were mild. The overall response rate was 96% (complete response (CR) 50% and partial response (PR) 46%). Superselective CDDP-CBDCA combined infusion is feasible, relatively non-toxic, and important as multimodality therapy.

Detection of bone marrow and extramedullary involvement in patients with non-Hodgkin’s lymphoma by whole-body MRI: comparison with bone and 67Ga scintigraphies

The aim of this study was to evaluate the diagnostic potential of whole-body MRI (WB-MRI) for the detection of bone marrow and extramedullary involvement in patients with non-Hodgkin’s lymphoma. WB-MRI, which was performed on 34 patients, consisted of the recording of T1-weighted spin-echo images and a fast STIR sequence covering the entire skeleton. The WB-MRI findings for bone marrow and extramedullary involvement were compared with those from 67Ga and bone scintigraphies and bone marrow biopsy results. Two MRI specialists reviewed the WB-MRI results and two expert radiologists in the field of nuclear medicine reviewed the bone and 67Ga scintigraphy findings. Bone marrow and extramedullary involvement of non-Hodgkin’s lymphoma were confirmed by follow-up radiographs and CT and/or a histological biopsy. The detection rate of WB-MRI was high. More bone marrow involvement was detected by biopsy, and more lesions were detected by scintigraphies. In total, 89 lesions were detected by WB-MRI, whereas 15 were found by biopsy, 5 by 67Ga scintigraphy, and 14 by bone scintigraphy. WB-MRI could also detect more extramedullary lesions than 67Ga scintigraphy; i.e., 72 lesions were detected by WB-MRI, whereas 54 were discovered by 67Ga scintigraphy. WB-MRI is useful for evaluating the involvement of bone marrow and extramedullary lesions throughout the skeleton in patients with non-Hodgkin’s lymphoma.

T2-weighted MR imaging of prostate cancer: multishot echo-planar imaging vs fast spin-echo imaging

The aim of the present study was to assess the performance of pre-biopsy T2-weighted MR imaging using multishot echo-planar imaging (EPI) sequence for visualization of prostate cancer and to compare image quality with that of fast spin-echo (FSE) sequence. Thirty-nine patients with suspected prostate cancer and one healthy male volunteer were examined on a 1.5-T MR scanner equipped with a pelvic phased-array coil. Axial MR images were obtained using multishot EPI sequence with a multishot number of 16 and FSE sequence without fat suppression. Paired EPI and FSE images were independently evaluated by three radiologists. Furthermore, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between EPI and FSE images of 12 pathologically proven lesions of prostate cancer. Delineation of the periprostatic venous plexus, prostate zonal anatomy, and seminal vesicle on EPI was graded to be superior/inferior to FSE in 15.8/0, 14.6/0, and 21.5/4.3% of cases, respectively. On the other hand, delineation of the neurovascular bundle was superior/inferior to FSE in 2.6/13.2% of cases. The SNR and CNR of prostate cancer on EPI were significantly higher than those on FSE (7.99±2.51 vs 3.36±0.58, p<0.0001, and 5.51±2.02 vs 2.21±0.79, p<0.0001, respectively). In conclusion, multishot EPI has higher quality of contrast resolution for imaging of prostate cancer compared with FSE and would have the potential usefulness in the detection of prostate cancer, although these results obtained with a phased-array coil cannot be extrapolated to examinations performed with an endorectal coil.

Association of Fatty Liver with Increased Ratio of Visceral to Subcutaneous Adipose Tissue in Obese Men

We studied the association of fatty liver with subcutaneous and visceral obesity in 46 male and 36 female patients with body mass index (BMI) over 22 kg/m2. The correlation coefficient between the ratio of the visceral adipose tissue to the subcutaneous adipose tissue (V/S) and the computed tomography (CT) number of the liver was -0.299 (P < 0.05) and that between the V/S ratio and the ratio of the CT number of the liver to that of the spleen (CT-L/CT-S) was -0.335 (P < 0.05) in the males. Partial correlation analysis after making correction for BMI showed an increased correlation coefficient of -0.485 (P < 0.05) between the V/S ratio and the CT-L/CT-S ratio in the males. The odds ratio in the males for CT-L/CT-S below 1.0 and V/S above 1.0 was 3.25 with a 95% confidence interval of 1.02 to 9.39. No such association between the V/S ratio and the CT-L/CT-S ratio was present in the female patients. Multiple regression analysis with serum level of alanine aminotransferase, a marker of fatty liver, as an independent variable revealed a partial regression coefficient of -17.7 for CT-L/CT-S (P < 0.05) in the males and -21.7 (P < 0.05) in the females, validating the CT-L/CT-S ratio as an index of fatty liver. The results indicate the association of fatty liver as determined by the CT-L/CT-S ratio with visceral obesity in males.

MRI in carcinomatous encephalitis

Abstract We report a rare case of miliary brain metastases presenting with symptoms similar to encephalitis (“carcinomatous encephalitis”). Contrast-enhanced MRI demonstrated miliary metastases more distinctly than other imaging methods and reproduced the pathological features.

Paraganglioma of the duodenum: a case report with radiological findings and literature review

Paraganglioma of the gastrointestinal tract is an uncommon, usually benign neoplasm. It usually occurs in the second section of the duodenum. A review of the literature reveals 73 reported cases. We studied a case of paraganglioma by hypotonic duodenography (HDG), computed tomography (CT), angiography and histological examination. The rare occurrence of this neoplasm and the first comparative study using HDG, CT and angiography justify this case report. A 65-year-old Japanese woman had been in excellent health until she presented to her physician with tarry stool. The bleeding site was not determined. Seven months later, she visited another physician because of general fatigue, and was found to be anaemic and bleeding from the gastrointestinal tract. She was referred to the Kawasaki Medical School Hospital for further evaluation. On admission, she was moderately anaemic but not jaundiced. The abdomen was flat and soft without rebound tenderness. A slightly rough-surfaced, gooseegg sized mass was palpable ...

A long-term survivor of leiomyosarcoma around the right side of the base of the skull: effective radiotherapy combined with intra-arterial chemotherapy.

Abstract We report a rare case of a leiomyosarcoma that developed around the right side of the base of the skull in a 51-year-old woman. The patient consulted our hospital complaining of pain in the right side of her neck and upper right arm in August 1994. A leiomyosarcoma, originating around the right side of the neck and base of the skull was diagnosed. Initially, surgery was planned, but invasion into the spinal canal was discovered. Curative resection of the leiomyosarcoma around the right side of the base of the skull was not possible. Therefore, external beam radiotherapy (EBRT) combined with intra-arterial chemotherapy and hyperthermia was employed. After the treatment, the tumor decreased in size to 45% of its initial volume, and, simultaneously, her symptoms completely disappeared. The patient initially remained clinically free of the disease, but showed reaggravations at the primary tumor site 3 years and 3 months, and 4 years and 11 months, after the first treatment. The reaggravations were treated with EBRT combined with intra-arterial chemotherapy. As a result, she survived for 5 years and 7 months after the first treatment.

Effect of Ethanol Induced Occlusion of the Renal Artery in Rabbit Kidney Implanted with VX2 Carcinoma

The effects of injection of absolute ethanol into the renal artery were investigated in 13 rabbit kidneys previously implanted with VX2 carcinoma. Eight rabbits with implanted tumors served as controls. The effects were evaluated by angiography and histology. Three days after implantation, tumors were demonstrated by angiography as relatively hypovascular areas in the subcapsular cortex of the kidneys. Following angiography, absolute ethanol (0.3 ml/kg) was injected into the renal artery. Repeat angiography with barium sulphate was performed after an additional 3 days (10 ethanol treated animals, 2 controls), 10 days (2 treated, 1 control) or 14 days (1 treated, 0 control). In treated animals the tumors were markedly smaller in comparison with those of the control group. The occlusion procedure, however, did not completely eradicate tumor cells. The histologic study of the implanted tumor confirmed the findings previously reported that viable tumor cells still remained in the peripheral portions of infarcted areas. This study demonstrated the beneficial, though not curative, short-term effects of transcatheter renal artery treatment with absolute ethanol in malignant renal tumors.

Observation and analysis of microcirculation using high-spatial-resolution image detectors and synchrotron radiation

A microangiography system using monochromatized synchrotron radiation has been investigated as a diagnostic tool for circulatory disorders and early stage malignant tumors. The monochromatized X-rays with energies just above the contrast agent K-absorption edge energy can produce the highest contrast image of the contrast agent in small blood vessels. At SPring-8, digital microradiography with 6 - 24 micrometer pixel sizes has been carried out using two types of detectors designed for X-ray indirect and direct detection. The indirect-sensing detectors are fluorescent-screen optical-lens coupling systems using a high-sensitivity pickup-tube camera and a CCD camera. An X-ray image on the fluorescent screen is focused on the photoconductive layer of the pickup tube and the photosensitive area of the CCD by a small F number lens. The direct-sensing detector consists of an X-ray direct- sensing pickup tube with a beryllium faceplate for X-ray incidence to the photoconductive layer. Absorbed X-rays in the photoconductive layer are directly converted to photoelectrons and then signal charges are readout by electron beam scanning. The direct-sensing detector was expected to have higher spatial resolution in comparison with the indict-sensing detectors. Performance of the X-ray image detectors was examined at the bending magnet beamline BL20B2 using monochromatized X-ray at SPring-8. Image signals from the camera are converted into digital format by an analog-to- digital converter and stored in a frame memory with image format of 1024 X 1024 pixels. In preliminary experiments, tumor vessel specimens using barium contrast agent were prepared for taking static images. The growth pattern of tumor-induced vessels was clearly visualized. Heart muscle specimens were prepared for imaging of 3-dimensional microtomography using the fluorescent-screen CCD camera system. The complex structure of small blood vessels with diameters of 30 - 40 micrometer was visualized as a 3- dimensional CT image.

Evaluation of serum KL-6 as a predictive marker of radiation pneumonitis in patients with breast-conservation therapy

BackgroundAlthough radiation pneumonitis in radiotherapy following breast-conservation surgery is rare, it may lead to severe pneumonitis as well as to other types of pulmonary dysfunction. This study examined the usefulness of the serum KL-6 level as a new marker for the early detection of radiation pneumonitis.MethodsTwenty-nine consenting patients served as subjects (age range, 32–78 years; mean age, 51 years) between 2001 and 2002. A total tangential irradiation dose of 50 Gy/25 fractions (fr) was administered for 5 weeks, using a 4-MV X-ray, and an additional 10 Gy/5 fr for 1 week of 6-MeV electron-beam irradiation was performed for patients with pathological tumor cell findings in the excised tumor margins. Levels of serum KL-6 were measured before and after radiotherapy.ResultsFour patients developed radiation pneumonitis, all of whom had elevated post-therapy KL-6 levels. Patients with lower or unchanged KL-6 levels did not develop radiation pneumonitis. There was a significant difference in serum KL-6 levels between patients with and without radiation pneumonitis (P = 0.0421). KL-6 levels remained below the threshold value of 465 U/ml in all patients.ConclusionFor the early detection of radiation pneumonitis following breast-conservation surgery, and to assess the efficacy of therapy, the monitoring and measuring of changes in KL-6 levels before and after radiotherapy is more important than comparing KL-6 levels against the threshold value. Measuring KL-6 serum levels is also useful in assessing the efficacy of therapy for radiation pneumonitis.