Radiation medicine最新文献

Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation of cartilage in multiple sites of the body, including the auricles. Central nervous system involvement appears rare. We encountered a case of relapsing polychondritis with encephalitis that could be diagnosed by the unique appearance of the auricle with signal hyperintensity on diffusion-weighted magnetic resonance imaging.

Purpose: The importance of the quality of life (QOL) and mental condition of patients being treated for cancer is now recognized. In this study, we evaluated QOL and mental condition in patients with cancer before and after radiotherapy.

Materials and methods: The subjects were 170 patients who had undergone radiotherapy. The examination of QOL was performed using the quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), and mental condition (anxiety and depression) was examined using the hospital anxiety and depression scale (HADS). These examinations were performed at the start of radiotherapy and immediately after radiotherapy.

Results: The QOL score was slightly higher in all patients after the completion of radiotherapy than before the start of radiotherapy. In the palliative radiotherapy group, QOL score was significantly improved by treatment. Anxiety and depression were improved after radiotherapy. There was a correlation between the degrees of improvement of the HADS and QOL score.

Conclusion: We could treat cancer patients by radiotherapy without reducing their QOL, and improvement in QOL was significant in the palliative radiotherapy group. Mental condition was also improved after radiotherapy.

Purpose: Our aim was to investigate the diagnostic reliability of multidetector-row computed tomography (MDCT) for preoperative assessment of local tumoral spread in hilar cholangiocarcinoma. MATEIRALS AND METHODS: Thirteen of 30 consecutive patients with hilar cholangiocarcinoma who underwent surgery, excluding 17 patients who underwent biliary drainage or preoperative portal embolization, were retrospectively evaluated. Using MDCT systems of 4 detector rows or 16 detector rows, plain and dynamic contrast-enhanced images of three phases were obtained. Extent of tumor spread and lymph node metastasis were assessed with MDCT and compared with histopathological findings.

Results: The Bismuth-Corlette classification of hilar cholangiocarcinoma with MDCT were type I, 1 patient; type IIIa, 3 patients; type IIIb, 4 patients; and type IV, 5 patients; those with histopathological findings were type I, 1 patient; type IIIa, 2 patients; type IIIb, 4 patients; and type IV, 6 patients. One patient diagnosed as type IIIa with MDCT was pathologically diagnosed as type IV. Accuracy of MDCT in tumoral spread was 92.3%, although that of lymph node metastasis was 54%.

Conclusion: MDCT is likely to play an important role in evaluation of focal lesion spread especially in intrapancreatic tumor invasion, although a greater number of cohort cases are necessary to clearly define its role.

Purpose: A comparative treatment planning study has been performed between carbon ion radiotherapy (CIRT) and photon radiotherapy [three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT)] to assess the potential improvements and limitations that could result for locally advanced, nonresectable head and neck tumors.

Materials and methods: Seven patients, originally treated with CIRT, were randomly selected for the comparative study. The evaluations analyzed using dose-volume histogram parameters, conformity index, inhomogeneity coefficient, and dose to the organs at risk (OARs).

Results: The mean conformity index was 1.46, 1.43, and 1.22 for 3D-CRT, IMRT, and CIRT, respectively. The mean inhomogeneity coefficient was 0.05, 0.07, and 0.02 for 3D-CRT, IMRT, and CIRT respectively. Photon plans resulted in greater volumes of normal tissues at 10% to 95% isodose levels compared with the corresponding carbon ion plans where the volumes increased by a factor of 1.2 to 2.7 for 3D-CRT and 1.2 to 2.0 for IMRT.

Conclusion: CIRT has the potential to improve the target dose conformity, inhomogeneity coefficient, and OAR sparing when compared with 3D-CRT and IMRT. Compared with 3D-CRT, normal tissue exposure was reduced mainly in the mid-to low-isodose levels using IMRT. Additional improvement was obtained using CIRT.

We present a unique case of a cavernous sinus (CS) dural arteriovenous fistula (DAVF), which recurred at adjacent sinuses following repeated transvenous embolizations (TVEs). A 68-year-old woman presented with progressive left conjunctival chemosis and diplopia. Cerebral angiography revealed a left CS DAVF, which was completely obliterated by TVE via the left inferior petrosal sinus (IPS). Two years later, the DAVF recurred in the left IPS, and again in the left sigmoid sinus (SS) 3 years after the initial treatment in spite of a second TVE. Moreover, the left SS and the left internal jugular vein, which had been previously stenotic, had been occluded. The third TVE resulted in the complete obliteration of the SS DAVF. CS DAVFs may recur at adjacent sinuses even after complete obliteration by TVE. Careful follow-up is necessary to check for the recurrence of DAVFs, especially in cases with venous flow changes, such as sinus occlusion, following endovascular treatment.

Pseudoaneurysm of the cystic artery is rare; to our knowledge, fewer than 30 cases have been reported worldwide. We report the first case of an unruptured pseudoaneurysm of the cystic artery with concurrent acute calculous cholecystitis. We incidentally detected the aneurysm by contrast-enhanced computed tomography (CT) in the edematous, thickened wall of the gallbladder neck in a 71-year-old man, whereas in most of the reported cases the disease presented as hemobilia. Because of the high risk of aneurysm rupture in this location, we avoided such interventions as percutaneous cholecystostomy and laparoscopic cholecystectomy. The aneurysm was localized pathologically in the undisrupted gallbladder wall, and elective open cholecystectomy with ligation of the cystic artery was performed successfully. Our case highlights the usefulness of CT for both diagnosis and patient management. Open cholecystectomy with ligation of the cystic artery is demonstrated as a reasonable first line of treatment for this unusual condition.

Purpose: Although it has been clearly demonstrated that X-rays play a key role in diagnosing medical and dental problems, this type of ionizing radiation is also able to induce noxious activities, such as genetic damage. The aim of the present study was to evaluate DNA damage (micronucleus) and cellular death in exfoliated buccal mucosa cells from healthy individuals (smokers and nonsmokers) following dental X-ray exposure.

Material and methods: A total of 39 healthy people who had submitted to panoramic dental radiography were included in the study: 9 smokers and 30 nonsmokers.

Results: The results indicated no significant statistically differences (P>0.05) in micronucleated oral mucosa cells before and after dental X-ray exposure. On the other hand, X-ray exposure did increase other nuclear alterations closely related to cytotoxicity, such as karyorrhexis, pyknosis, and karyolysis. It seems that cigarette smoke did not affect X-ray outcomes induced in buccal cells.

Conclusion: These data indicate that dental panoramic radiography may not induce chromosomal damage, but it is able to promote cytotoxicity. Because cellular death is considered a prime mechanism in nongenotoxic mechanisms of carcinogenesis, dental X-ray should be used only when necessary.

Ureteroarterial fistula is a rare condition with life-threatening hematuria that should be diagnosed and treated immediately. We reported two patients of ureteroarterial fistula who underwent successful endovascular treatment by stent-grafts. They had undergone pelvic surgery followed by placement of an indwelling ureteral stent for stricture of the ureter before sudden hematuria occurred. Routine contrast-enhanced computed tomography did not reveal extravasation or a pseudo-aneurysm. Angiograms with multiple oblique views demonstrated small pseudoaneurysms of the iliac artery overriding the ipsilateral ureter. The endovascular treatment of ureteroarterial fistula using stent-grafts was successful, and the hematuria disappeared immediately after stent-graft deployment. The hematuria did not recur up to the last follow-up visits of 3 and 19 months, respectively.

Soft tissue perineurioma is an uncommon benign peripheral nerve sheath tumor, although it is the most common subtype of perineuriomas. We present a case of soft tissue perineurioma in the left groin of a 48-year-old man. Precontrast computed tomography showed a homogeneous hypodense mass that showed faint enhancement. The mass appeared with hypointensity on T1-weighted magnetic resonance (MR) images and heterogeneous hyperintensity on T2-weighted MR images. Slight contrast uptake was noted on enhanced T1-weighted MR images with fat suppression. Although these CT and MR imaging findings were nonspecific, the overall imaging features are similar to those of schwannomas.

Purpose: No filter protection devices for carotid artery stenting (CAS) have been formally approved for use in Japan; however, as of April 2008, the Angioguard XP (AGXP) was approved. This article describes our initial results using the AGXP during CAS for the treatment of carotid artery stenosis.

Material and methods: A group of 15 patients (14 men) with a mean age of 72.3 years (range 53-81 years) were treated by CAS using the AGXP. Among them, 10 were symptomatic with >50% stenosis of the common or internal carotid artery (ICA), and 5 were asymptomatic with >70% stenosis. The rates of technical success, periprocedural stroke, ICA flow impairment, filter movement, and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed.

Results: CAS using the AGXP was successful in all cases. There was one minor stroke, and flow impairment occurred in six patients. Filter movement averaged 1.9 vertebral bodies. DWI showed new ipsilateral ischemic lesions in eight of the patients.

Conclusion: Initial clinical experience using the AGXP for CAS has been generally sufficient. However, attention must be paid to three problems when using the AGXP: the filter may move after placement; the filter may disturb blood flow in the ICA; and debris may pass around the filter.