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

This study describes our experience with seed loss and retrieval through the urinary tract following seed implants for prostate cancer, and offers Japanese guidelines for safety and management. Two hundred consecutive patients were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with a Mick applicator under ultrasound guidance. All patients were instructed to return excreted seeds, if any, to our center. Seed loss occurred in 6% of patients and 0.13% of seeds. Seed loss tended to occur in the early period through either urine or ejaculation.

Radiation-induced cardiac disease has been observed in patients who have been irradiated to the mediastinum. A 68-year-old man who had been treated with chemoradiotherapy for esophageal cancer showed high FDG-uptake in his myocardium six months after the radiotherapy. The area of high FDG-uptake closely matched the irradiation field. This area also showed low 123I-BMIPP-uptake and delayed enhancement on Gd-MRI. These findings suggested the likelihood of radiation cardiomyopathy. There have been several studies on the detection of radiation cardiomyopathy by perfusion imaging, but few on detection by metabolic imaging or MRI. Early visualization and quantification of the degree of radiation cardiomyopathy might be possible by FDG-PET and 123I-BMIPP Gd-MRI.

Purpose: To evaluate whether selective transcatheter arterial embolization (TAE) contributes to preservation of liver function and improves local control and survival in patients with hepatocellular carcinoma.

Materials and methods: One hundred patients with hepatocellular carcinoma who underwent single or multiple TAE were retrospectively analyzed. The incidence of deterioration of liver function caused by TAE was compared between patients with Child class A disease and those having Child B/C disease. The correlation between extent of embolization and incidence of deterioration of liver function was analyzed. In addition, factors affecting deterioration of liver function after TAE were determined. Recurrence-free and overall survival rate were calculated using the Kaplan-Meier method. A Cox proportional hazard model was used to analyze prognostic factors affecting recurrence-free and overall survival.

Results: The incidence of deterioration of liver function in the Child B/C group (47%) was significantly higher than that in the Child A group (21%). Pretreatment Child-Pugh classification and extent of embolization were significant factors in the deterioration of liver function after TAE. Recurrence-free survival rates at 1, 2, and 3 years were 38%, 19%, and 8%, respectively. Overall survival rates at 1, 3, 5, and 7 years were 89%, 59%, 22%, and 22%, respectively. Findings of multivariate analyses of prognostic factors showed that tumor size and selectivity of TAE were significant for recurrence-free survival and the initial Child-Pugh classification was the most important factor for overall survival.

Conclusion: Selective TAE improves local control and avoids damage to nontumorous liver tissue. The selective technique appears to be associated with a favorable outcome.

Purpose: We clarified the images, impressions, and information about radiotherapy in standard Japanese patients and, at the same time, investigated their need for information about radiotherapy, in order to identify what we, as radiation oncologists, should do to decrease patient anxiety and create good physician-patient relationships.

Materials and methods: We handed out 10 questionnaires to 1529 patients from April 2002 through July 2002 in 22 Japanese institutions that were equipped with radiotherapy machines. Questionnaires contained 10 items asking about patients' background, their impression of radiotherapy, frequency of exposure to information about radiotherapy, need to obtain information about radiotherapy, and ideal additional medical informational resources or their content.

Results: About 60% of patients had had the opportunity to obtain information about radiotherapy "sometimes" or "often," but 80% of them were not satisfied with the availability of information and answered that it was inadequate. Ten percent responded that they had no idea about radiotherapy. Thirty percent felt unspecified anxiety concerning radiotherapy, and those who had less chance to be exposed to information about radiotherapy felt more anxiety than the others (33.2% vs. 25.2%, p=0.0008). The need for "explanation and information about adverse effects" was the top priority, followed by "explanation of outcome." Although they generally obtained information from their physician (radiation oncologist), they also wanted additional information via written media (662 patients, 43%). However, patients who were over 60 years old most wanted to obtain additional medical information directly from their own radiation oncologist (37.7%).

Conclusion: Information about radiotherapy given to patients and the general public is still insufficient in Japan. To fully utilize radiotherapy, which is a very effective treatment option against cancer, and to reduce anxiety about radiotherapy among cancer patients, more information is necessary.

Crossed cerebellar atrophy (CCA) on imaging study reflects secondary degeneration of the cerebellar hemisphere caused by neuronal disconnection with the contralateral cerebral hemisphere. We report an 11-month-old child with traumatic left acute subdural hematoma, who showed crossed cerebellar atrophy on MR images. Eighteen months after the trauma, MR images showed brain atrophy not only in the left cerebral hemisphere but also in the right cerebellar hemisphere. The cerebellar atrophy was prominent in the lateral part. This finding is consistent with CCA and may support neuronal interactions between the cerebral hemisphere and the lateral part of the contralateral cerebellar hemisphere.

Purpose: To assess the current practice of pediatric MDCT in Japan, with particular reference to age-related dose adjustment.

Materials and methods: During the first three months of 2004, a questionnaire was mailed to 996 institutions, among which listed MDCT users ranged from private hospitals to large university-based hospitals.

Results: We received responses from 348 (34.9%) institutions. Fifty-three percent of the respondents had four-detector MDCT units. Approximately 70% of examinations were head and 22% were body. Scanning parameters were determined by full-time radiologists in 40%, and by CT technologists in 28% of respondents. Eighty-nine percent (head CT) and 85% (abdominal CT) of respondents indicated that they changed parameters for children. More than 90% changed tube current for optimization. Change was based on the technologist's experience (56%, head CT; 43%, abdominal CT), and automatic exposure control has been used as a basis of mAs control in 17% of respondents for head CT and in 34% for abdominal CT. Age-related mAs settings for abdominal CT were almost the same as those published in a United States survey.

Conclusion: Although Japan has approximately 40% of the world's CT units, optimized pediatric MDCT settings might be moved away from a fixed mA protocol as recommended by the FDA and in conformity with the ALARA (as low as reasonably achievable) concept.

The optimal pulsating cardiac phantom is an important tool for the evaluation of cardiac images and cardiac applications on ECG-gated MDCT. The purpose of this study was to demonstrate the design and fabrication of the pulsating cardiac coronary phantom. The newly developed pulsating cardiac coronary phantom has the following five key advantages: 1) a driver component that uses only one servomotor to move the phantom in three dimensions (X, Y, and Z directions) with 16 presets of different heart types (heartbeat: 0-120 bpm; ejection fraction: 0-90%); 2) versatile pumping and filling phases to simulate a real heart in a cardiac cycle can be incorporated into the driver sequence including shift of patient heartbeat or irregular pulse (maximum: 200 different heart waves in one scan); 3) a cardiac coronary component constituted of an acrylic/silicon/rubber tube (2-6 mm inner diameter) with stent/in-stent restenosis/stenosis/soft plaque/calcification parts and maximum 16 coronary arteries that can be attached to the phantom in the same scan; 4) the complete phantom can be submerged in a tank to simulate the heart and its surrounding tissues; 5) ECG gating can be from interior trigger and exterior trigger. It has been confirmed that the developed pulsating cardiac phantom is very useful to quantitatively assess imaging of the heart and coronary arteries during phantom experiments.

We report a case of giant fibrovascular polyp of the esophagus. The patient was a 69-year-old man who complained of hematemesis. Barium swallowing revealed a long, expansile lesion within the esophagus. Endoscopy demonstrated a pedunculated lesion covered with normal esophageal epithelium. On MRI, the sagittal image showed the characteristic sausage-like shape of the lesion. On T2-weighted images, the lesion demonstrated predominantly low signal intensity, which reflected a fibrous tumor. Opposed-phase imaging showed the area of decreased intensity within the mass, which reflected adipose tissue. MRI was useful for the differential diagnosis of fibrovascular polyp.