Japanese Journal of Radiology最新文献

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese Clinical Practice Guidelines for Vascular Tumors, Vascular Malformations, Lymphatic Malformations, and Lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

Objective: This study was conducted to examine relationships of pretreatment volume-based quantitative ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) parameters with overall survival (OS) in malignant peritoneal mesothelioma (MPeM) patients.

Materials and methods: Data for 71 patients with FDG-avid MPeM who underwent pretreatment ¹⁸F-FDG PET/CT were retrospectively reviewed. The highest maximum standardized uptake value (SUVmax), metabolic tumor volume (WB MTV), and total lesion glycolysis (WB TLG) were calculated, including primary tumors and metastatic lesions. Relationships of clinicopathological factors (histological subtype, primary peritoneal disease form, abdominal nodal metastasis, extra-abdominal metastasis, treatment regimen), as well as volume-based quantitative PET/CT parameters with OS were evaluated using a Cox proportional hazards model and log-rank test.

Results: Enrolled patients underwent follow-up for a mean period of 27.6 months (range 2.1-161.2 months, median 18.9 months), during which 49 (69.0%) died. Receiver operating characteristic curve analysis and log-rank testing indicated that those with high SUVmax (≥ 6.9), WB MTV (≥ 60), or WB TLG (≥ 230) had a significantly lower OS rate than patients with a low rate (< 6.9, < 60, < 230; p = 0.0002, p < 0.0001, p < 0.0001, respectively). Univariate analysis of all patients indicated an association of diffuse peritoneal disease form (p = 0.022), high level SUVmax (p = 0.0002), WB MTV (p < 0.0001), or WB TLG (p < 0.0001) level, extra-abdominal metastasis (p = 0.079) and treatment regimen (p = 0.058) with significantly shorter OS. Additionally, multivariate analysis results confirmed high WB MTV as an independent negative predictor (hazard ratio 2.51, 95% confidence interval 0.72-13.45; p = 0.039).

Conclusions: These findings indicate that pretreatment volume-based quantitative ¹⁸F-FDG PET/CT parameters, especially whole-body MTV, may be useful as surrogate markers for MPeM prognosis.

Background: Bone-avid tracers, such as ^99mTc-pyrophosphate (PYP) and ^99mTc-hydroxymethylene diphosphonate (HMDP), facilitate the noninvasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). In this study, we compared these two methods.

Methods: We retrospectively reviewed 83 patients with suspected or diagnosed cardiac amyloidosis (mean age, 79 years; 11 women) who underwent PYP and HMDP scintigraphy. Early (1 h) imaging was available for of 72/50 patients with PYP/HMDP, and all patients underwent delayed (3 h) imaging. Visual grading (Dorbala score), heart-to-contralateral lung (H/CL) ratios, and relative segmental uptake (RSU) derived from SPECT (3 h) polar map analysis using the quantitative perfusion SPECT software were compared.

Results: visual scores showed substantial agreement. The H/CL ratio showed a strong correlation. Bland-Altman analysis revealed fixed and proportional biases, with discrepancies increasing at higher uptake levels. The median H/CL values were comparable at 1 h, whereas HMDP showed slightly higher delayed values. Receiver operating characteristic analysis indicated excellent and good diagnostic accuracy at 1 and 3 h, respectively. Using routine diagnostic criteria, SPECT visual assessment demonstrated comparable diagnostic performance between PYP and HMDP. RSU analysis in 34 patients demonstrated similar segmental uptake distributions for both tracers, with basal and septal predominance, consistent with the apical-sparing patterns described previously.

Conclusions: PYP and HMDP demonstrated comparable diagnostic accuracies for ATTR-CA. PYP has been extensively validated and is suitable for early imaging, whereas HMDP has a slightly higher delayed uptake and lower blood pool activity. When interpreted using routine diagnostic criteria, SPECT provided equivalent diagnostic performance for PYP and HMDP. Segmental analyses confirmed the preservation of the characteristic apical sparing across the tracers. Both tracers are clinically interchangeable when standardized acquisition and interpretation protocols are applied.

Purpose: This study aimed to evaluate the diagnostic performance of a novel MRI-based parameter-MRI signal intensity per unit vertebral volume-in identifying low bone mineral density (BMD) in children and adolescents, alongside established MRI metrics including mean L1-L4 signal intensity and vertebral bone quality (VBQ) score.

Materials & methods: The study included 106 osteoporotic patients (aged 5-18 years) who had not yet reached 18 years of age, and 46 age-matched controls. Subjects were grouped into childhood (5-11 years) and adolescence (> 12 years). Using 1.5 T MRI, mean L1-L4 signal intensity, VBQ score, and signal intensity per unit volume were calculated. MRI findings were compared using t-tests and ANOVA; diagnostic accuracy was assessed via ROC curve analysis.

Results: In the childhood group, all MRI parameters significantly differed between low bone mineral density and control subjects (p < 0.05). In adolescents, only mean signal intensity and signal intensity per unit volume were significant. The new parameter demonstrated the highest diagnostic value, with AUCs of 0.792 and 0.836 in childhood and adolescence groups, respectively.

Conclusions: MRI signal intensity per unit vertebral volume showed superior performance in detecting low BMD compared to existing MRI-based indices. This parameter offers a radiation-free, size-adjusted alternative to DXA, particularly valuable in pediatric patients requiring long-term monitoring.

Purpose: The aim of this study was to evaluate late genitourinary (GU) toxicities on receiving intensity-modulated radiation therapy (IMRT) in patients with prostate cancer (PCa) who had a history of invasive interventions for the prostate or bladder.

Materials and methods: Among patients who received IMRT for PCa at our institution between August 2000 and December 2022, clinical outcomes among those with a history of invasive interventions for the prostate or bladder were retrospectively analyzed. Cumulative incidence rates of late ≥ grade 2 and ≥ grade 3 GU and gastrointestinal toxicities, and rates of overall survival (OS) and biochemical failure-free survival (BFFS) were evaluated.

Results: A total of 32 consecutive patients were analyzed, among whom 28 received conventional fractionated IMRT with a median dose of 74 Gy in 37 fractions, and 4 underwent moderately hypo-fractionated IMRT with a median dose of 54 Gy in 15 fractions. The median follow-up period was 77.3 months after IMRT. Cumulative incidence rates of ≥ grade 2 and ≥ grade 3 GU toxicities were 20.7 and 4.3% at 5 years, and 26.4 and 4.3% at 8 years, respectively. More than 10 years after IMRT, 18.8% of patients developed ≥ grade 2 GU toxicities. OS and BFFS rates were 89.5 and 76.0% at 5 years, and 89.5 and 60.7% at 8 years, respectively.

Conclusion: Prostate IMRT for patients with a history of invasive interventions for the prostate or bladder was considered a safe and feasible treatment option, although the incidence of late GU toxicities was relatively high. Long-term follow-up with close attention to the detection of GU toxicities is recommended for such a population. Clinical outcomes of IMRT in 32 patients with prostate cancer and a history of invasive interventions for the prostate or bladder were retrospectively analyzed. Although the incidence of late genitourinary toxicities was relatively high, prostate IMRT was considered a safe and feasible treatment option for such a population.

Purpose: To evaluate the diagnostic utility of integrating [⁶⁸Ga]Ga-Pentixafor PET with contrast-enhanced CT (CECT) for the visualization and localization of adrenal lesions in patients with primary aldosteronism (PA).

Methods: Thirty-five patients with clinically suspected PA who underwent [⁶⁸Ga]Ga-Pentixafor PET and integrated CECT scans were retrospectively enrolled in this study. Adrenal lesions were identified and segmented using non-threshold methods. PET parameters (SUVmax, lesion-to-contralateral adrenal ratio [LCR], lesion-to-liver ratio [LLR]) and CT parameters (attenuation values, absolute and relative washout) were measured, and their correlations were analyzed. Abdominopelvic CT angiography was reconstructed to rule out vasogenic hypertension, and three-dimensional volume reconstruction from CECT data was applied for the visualization and localization of adrenal lesions. Additionally, a logistic regression model with cross-validation was constructed to predict aldosterone-producing adenomas (APA).

Results: Among these 35 patients, a total of 56 adrenal lesions including APA (n = 26), idiopathic hyperplasia (IHA, n = 26), nonfunctioning adenomas (NFA, n = 3), and familial hyperaldosteronism (n = 1) were identified and segmented from both [⁶⁸Ga]Ga-Pentixafor PET and CECT images. APA demonstrated significantly higher SUVmax, LCR, and LLR, as well as lower delayed-phase CT values and greater absolute/relative washout compared with non-APA lesions (P < 0.05). One (1/35) patient exhibited mild renal artery stenosis, while no patients were found to have other renal abnormalities. A multivariable model incorporating SUVmax, relative washout, and diameter of lesions, achieved excellent discrimination between APA and non-APA lesions (area under the curve [AUC] = 0.912), outperforming individual parameters.

Conclusion: The integration of [⁶⁸Ga]Ga-Pentixafor PET with CECT provides a non-invasive, comprehensive diagnostic approach for PA, enhancing lesion detection, subtype classification, and surgical planning, which may be incorporated into clinical practice.