Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica最新文献

Purpose: A multicenter study was conducted to evaluate the efficacy of strontium chloride (89SrCl2) for palliation of painful bony metastases using the Visual Analogue Scale (VAS), Brief Pain Inventory (BPI) and Functional Assessment for Cancer Therapy-General (FACT-G).

Methods: Ninety patients received a single injection of 2.0 MBq/kg and were classified as responders if VAS scores decreased without increased use of analgesics or if analgesic consumption decreased without an increase in the VAS.

Results: In the 69 subjects that could be evaluated, mean VAS values decreased significantly from 48.0 +/- 20.8 mm at baseline to 24.1 +/- 22.3 mm at last visit(Week 12) (p < 0.0001). VAS decreased more than 10 mm in 58.0% of these subjects, and analgesic consumption was reduced more than 10% in 39.1% of subjects. The response rates were 46.4% (95% confidence interval (CI) 34.3-58.8%) in the 69 subjects that could be evaluated and 43.3% (95% CI 32.9-54.2%) in all subjects. The scoring in BPI for interference in daily life improved together with improvement in its pain scores. Total FACT-G score showed significant improvement, as did its score in the subsection of physical well-being. Both platelets and leucocytes decreased by 22% at nadir (week 8), and such profiles of myelosuppression by 89SrCl2 were similar to those in the previous clinical studies.

Conclusion: These results suggest the clinical utility of 89SrCl2 for pain palliation, which leads to QOL improvement in patients with painful generalized bone metastases.

We have been performing TRUS-guided transperineal prostate brachytherapy with I-125 for prostate-confined adenocarcinoma since October 2003. We examined prostate volume using CT scanning on Day 1, Day 15, and Day 30 in the initial 15 patients, and investigated time-dependent changes of edema associated with I-125 prostate brachytherapy. Prostate volume had increased to 173% of the average on the first day after implantation. Improvements in the swelling of the prostate showed decreases in 30% in the first 2 weeks (Days 1-15) and 12% in the second 2 weeks (Days 15-30). V100 and D 90% showed statistically significant increases of 5.5% and 8.4% in the first 2 weeks after implantation and 2.3% and 5.2% in the second 2 weeks (Days 15-30). We considered one month a suitable time at which to calculate post-planning because V100 and D 90% changed little statistically.

Purpose: To investigate the usefulness of MRI for predicting pelvic control (PC) of cervical cancer treated with radiation therapy (RT).

Materials and methods: Forty-four cervical cancer patients treated with definitive RT were retrospectively analyzed. MRIs were completed before and after RT, and the longest diameter (LD) of the residual tumor was measured on post-RT MRI. Pathologic evaluation for residual tumor was also performed. Therapeutic response was assessed using MRI. Median follow-up time for the 44 patients was 34 months. The correlations between PC rate, MRI, and pathological findings were investigated.

Results: The 3-year PC rates of LD = 0 cm (n = 23) after RT, 0 < LD 2 cm (n = 6) were 85%, 80%, and 0%, respectively (p < 0.0001). There was no significant difference in PC according to the presence (n = 8) or absence (n = 36) of residue in the pathologic materials (3-year PC rate: 63% vs. 77%). Three-year PC rates according to therapeutic responses were 85% in complete response (n = 23), 72% in partial response (n = 18), and 0% in stable disease or progressive disease (n = 3) (p < 0.0001).

Conclusion: MRI is useful for predicting PC in cervical cancer treated with RT, and LD greater than 2 cm after RT is a good marker for poor PC.

Purpose: To evaluate the diagnostic ability of multiplanar reformation (MPR) images of the lung in comparison with thin-section source CT images.

Materials and methods: MPR images were reconstructed for 79 patients with suspected pulmonary disease. Slice thicknesses of source images were 2 mm in 24, 1 mm in 30, and 0.5 mm in 25 cases. The presence of centrilobular nodules, emphysema, bronchiectasis, ground-glass opacity (GGO), consolidation, interstitial thickening, and pulmonary nodule was evaluated on thin-section source images by an experienced chest radiologist to establish gold standards and then subsequently assessed on the MPR images independently by two radiologists. The sensitivity, specificity, and accuracy of each finding were calculated regarding the results of thin-section source images as the gold standards. Accuracy for the detection of findings was also statistically compared among the three groups of different source slice thicknesses using Fisher's exact test.

Results: Accuracy for the detection of findings was significantly less (p < 0.05) in 2 mm slice MPR for centrilobular nodule, GGO, and interstitial thickening than in 1 mm or 0.5 mm slice MPR. No statistically significant difference was observed for any of the findings between 0.5 mm and 1 mm slice MPR. Rates of sensitivity, specificity, and accuracy of the MPR images for detection of the findings were 89-100%, 73-95%, and 84-95%, respectively.

Conclusion: In comparison with thin-section source images, MPR images are comparably sensitive but not as specific for the detection of findings. When producing MPR images, the slice thickness of source images should be less than 2 mm.

Purpose: To present the initial experience and preliminary clinical results of patients treated mainly with proton irradiation at the newly developed proton therapy facility at Shizuoka Cancer Center.

Materials and methods: We reviewed 125 patients who underwent proton therapy between July 2003 and December 2004. Of these 125 patients, 11 had head and neck malignancies, 15 non-small cell lung cancers, 22 hepatocellular carcinomas, 62 prostate cancers, and 15 other malignant tumors.

Results: Most patients experienced Grade 0-1 acute morbidities (NCI-CTC) in skin or mucosa, while a temporary Grade 2-3 reaction was observed in a high dose area. Response rates were 73% for H & N malignancies, 100% for NSCLC, and 77% for HCC. PSA evaluation for patients with prostate cancer revealed a high rate of complete response.

Conclusion: The efficacy and safety of proton therapy at Shizuoka Cancer Center was demonstrated for patients with early-stage cancer or locally advanced disease.

We evaluated radionuclide cisternography for the diagnosis of intracranial hypotension in terms of the rate of appearance of abnormal findings in 23 patients, their correlation with therapy, and the most suitable scanning method and timing for visualization of leakage. During the first hour after injection, dynamic lumbar images or consecutively repeated whole-body images were acquired. Whole body images then were acquired at 1, 5, and 24 hours. Until 5 hours after injection, patients were kept in bed resting. Visualization of the leakage (direct finding) and that of the bladder (indirect finding) were observed in 78.3% (18/23) and 60.9% (14/23), respectively. Leakage was visualized most frequently at 5 hours after injection. There were three cases in which the leakage was only visualized at 24 hours. Therefore, there must be cases that show intermittent CSF leakage. To avoid overlooking these cases, a 24-hour whole-body image is also important. The appropriate procedure of radionuclide cisternography is very important to detect CSF leakage, and our procedure proved to be more effective for detecting the abnormal findings.

Purpose: To evaluate the usefulness of MR imaging for the detection of severe facial nerve damage in patients with facial nerve palsy.

Materials and methods: We retrospectively reviewed 26 consecutive patients with facial nerve palsy (13 non-responders and 13 responders). T1-weighted, T2-weighted, and postcontrast T1-weighted images were obtained in all patients. FLAIR images were also obtained in 3 non-responders.

Results: The geniculate ganglion, labyrinthine segment, and tympanic segment or mastoid segment showed high signal intensity on T2-weighted images in 9 of 13 non-responders, whereas high signal intensity of the nerve was only seen in 1 of 13 responders. FLAIR imaging revealed high signal intensity lesions of the distal intrameatal segment in 2 non-responders. Contrast enhancement of the facial nerve showed a similar pattern in non-responders and responders. High signal intensity lesions on T2-weighted or FLAIR images showed enhancement on postcontrast T1-weighted images.

Conclusion: These results suggest that a high signal intensity area on T2-weighted images is a marker of severe facial nerve damage. FLAIR imaging is useful for identification of T2-prolongation in the distal intrameatal segment.

The paranasal sinus is an aerated space constructed of bones. Its draining pathway for secreted mucus is narrow and surrounded by structures such as the palate, orbit, and anterior cranial fossa. Many minute openings traverse the bony structure for innervation and blood supply. Therefore, CT and MRI play a complementary role in diagnosing sinonasal disease. When paranasal sinusitis is suspected, CT is conducted to evaluate the drainage passages, deviation of the nasal septum or normal variants, and bone sclerosis for preoperative planning of endoscopic sinus surgery. When a unilateral space-occupying lesion or bone destruction is detected by CT, malignancy may be considered. However, contrast resolution on CT is limited, and the procedure should be complemented by MRI. MRI is superior to CT in contrast resolution, and is more helpful in illustrating tumor extension or invasion into soft tissues such as the masticator space or into the orbital or intracranial space. The present report discusses sinonasal non-neoplastic and neoplastic diseases that have typical and characteristic findings on CT and MRI.