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Positron emission tomography using 18F-fluorodeoxyglucose (FDG-PE) was performed in four patients with non-Hodgkin's lymphoma on the day after initial chemotherapy, in an attempt to predict the effects of chemotherapy earlier than standard methods. Twelve regions displaying intense uptake on baseline FDG-PET were selected, and decreases in the rate for each region were calculated from standardized uptake values on the day following chemotherapy. Seven of the 12 regions demonstrated decrease rates of 60% or more, and two decreased by 100%. This study indicates that FDG-PET on the day after first chemotherapy seems to reflect the effect of chemotherapy on malignant lymphoma.

Purpose: An inner-covered Spiral Z-stent (IC-SZ) developed by our group was examined for its effectiveness in preventing migration by experimental comparison with commercially available esophageal covered stents., Materials and Methods: The following six types of stents were used: inner-covered Spiral Z-stents with diameters of 16 mm (small IC-SZ) and 19 mm (large IC-SZ), outer-covered Spiral Z-stent (OC-SZ), covered Wallstent, covered Ultraflex stent, and Cook Z-stent. Experimental models were prepared using clay to simulate stenosis of the esophagogastric junction or anastomosis site due to tumor, and each stent was placed in the clay. After the stent had been fully expanded with a balloon catheter, one of its ends was pulled until the stent migrated out of the clay, and the traction force was measured. The inner cavity of the stent placed in the clay was observed using an endoscope., Results: The mean maximal traction force required to pull the stents out of the clay were as follows, in decreasing order: 4.14 +/- 0.39 kg for the large IC-SZ, 4.12 +/- 0.83 kg for the small IC-SZ, 3.64 +/- 0.44 kg for the Cook Z-stent (p < 0.05), 3.34 +/- 0.62 kg for the covered Ultraflex stent (p < 0.05), 1.53 +/- 0.43 kg for the OC-SZ (p < 0.01), and 0.56 +/- 0.16 kg for the covered Wallstent (p < 0.01). The force required to pull out the large IC-SZ stent was the greatest, showing a significant difference from the values for the other four types of stents (excluding the small IC-SZ). Observation using an endoscope revealed that the wire of the IC-SZ stent was almost entirely embedded in the clay, whereas the wires of other stents were not., Conclusion: The IC-SZ stent may be less likely to migrate than other esophageal covered stents.

To clarify the correlation between the histopathological findings and MR signal intensity of the cyst wall, fifteen cystic metastatic brain tumors of eleven patients were imaged using a 0.5T MR unit just before surgery, and the MRI findings were correlated with the histopathological findings of resected lesions. On T2-weighted images, all cyst walls showed hypointensity. On T1-weighted images, the intensity of the cyst wall could be classified into three groups, compared with the cerebral cortex. Walls with hyperintensity on T1WI(group H; n = 6) consisted of ample tumor cells, blood vessels and connective tissues, suggesting viable tumor cells. Iso-intense walls on T1W1(group I; n = 3)had abundant reactive glial tissues. Hypointense walls on T1W1 (group L; n = 5)revealed hemorrhage and/or hemosicerin in the wall, suggesting hemorrhagic necrosis. Thus a good correlation was demonstrated between the MR signal intensities and histopathological findings of cyst walls of cystic metastatic brain tumors. This may contribute not only to more precise diagnosis on MRI but also to more planning for treatment of cystic brain metastases.

The usefulness of color Doppler sonography for the assessment of intrahepatic hemodynamics and shunt patency was evaluated in a total of eight patients in whom the intrahepatic hemodynamics before and after transjugular intrahepatic portosystemic shunt (TIPS) could be serially examined by color Doppler sonography. In six of these patients the serial sonographic examinations could be followed for more than one year after TIPS creation. Within one month after TIPS creation, Vmax in the shunt was ranged from 87 cm/sec to 242 cm/sec (mean: 142.5 cm/ sec), and the flow direction in the right anterior portal vein was reversed in all patients. More than 70% stenosis of the shunt could be diagnosed by color Doppler sonography. When the shunt was confirmed by angiography to be more than 70% stenotic or occluded, Vmax in the shunt was decreased to less than 50 cm/sec and the blood flow in the right anterior portal vein become hepatopetal. From three months before stenosis or occlusion of the shunt, it was confirmed that Vmax in the shunt was less than 70 cm/sec or the blood flow of right anterior portal vein was hepatopetal. Color Doppler sonography was useful for the assessment of intrahepatic hemodynamics, and shunt patency and prediction of shunt stenosis or occlusion following TIPS creation.

We compared power Doppler sonography (PDS) with conventional color Doppler sonography (CDS) in the visualization of intratumoral blood flow of hepatocellular carcinoma (HCC) and evaluated the usefulness of PDS for assessing of the effects of TAE with Lipiodol and anticancer agents (Lp-TAE) and for the diagnosis of recurrence of HCC after Lp-TAE. The ability of PDS and CDS to visualize intratumoral blood flow was compared in 36 patients with HCC, and the usefulness of PDS for the diagnosis of HCC was evaluated. Also, in 17 patients with HCC who underwent Lp-TAE, the usefulness of PDS for evaluating the therapeutic effects of Lp-TAE and the diagnosis of recurrence after Lp-TAE was examined. The ability of PDS to visualize intratumoral blood flow and delineate tortuous and meandering intratumoral vasculature was superior to that of CDS. The effects of Lp-TAE could be evaluated and recurrence detected accurately and easily by PDS on the basis of residual intratumoral blood flow and the appearance of new blood flow. PDS is expected to achieve widespread acceptance as a useful imaging modality for the diagnosis of HCC, assessment of therapeutic effects of TAE, and detection of recurrence of HCC after TAE.

Renal ablation by transcatheter renal arterial embolization (TAE) was performed in 10 patients with benign renal disease (hydronephrosis n = 6; renovascular hypertension n = 3; nephrotic syndrome n = 1). Each affected kidney had little or no renal function. Six patients with hydronephrosis were treated with TAE using absolute ethanol alone in three patients and the combination of absolute ethanol and gelatin sponge in the other three. Each patient was followed by sclerotherapy of the pelvocalyceal system via nephrostomy using absolute ethanol. In four of the six patients, the embolized kidney had no urine, and there was very little urine in the remaining two. The size of the embolized kidney was markedly decreased on CT. The three patients with renovascular hypertension were pre-studied by selective and renal vein sampling for PRA, and the kidney excreting higher renin was embolized by TAE with absolute ethanol. Blood pressure has become manageable without antihypertensive drug in two patients and with a reduced amount of drug in one. The patient with nephrotic syndrome had end stage renal failure and showed significant protein excretion. To prevent further protein loss, both kidneys were embolized with stainless steel coils. Urine output was significantly decreased, and consequently, hypoalbuminemia improved. All patients tolerated the procedure well, and there were no significant complications. Renal ablation by TAE may be an alternative to surgical treatment in selected patients with benign renal disease, particularly in patients with contraindications to surgery and in the elderly. Absolute ethanol and gelatin sponge seem safe and effective for TAE in patients with hydronephrosis and renovascular hypertension. For hydronephrosis, we recommend combining TAE with sclerotherapy of the pelvocalyceal system via nephrostomy using absolute ethanol. Though we successfully applied steel coil for the patient with nephrotic syndrome, absolute ethanol may be equally effective.

To investigate the usefulness of MRI oral contrast media in enhancing the entire small intestine using FerriSeltz (Otsuka Pharmaceuticals, Tokyo), which contains ferric ammonium citrate, we compared the relaxation times and taste of 7 kinds of contrast media (Milk FerriSeltz A-G) that contain FerriSeltz dissolved in 7 different ratios of distilled water-milk. We also compared the homogeneity of the contrast enhancement of the entire small intestine on T1-weighted images between Milk FerriSeltz-F (a mixture of distilled water and milk at a ratio of 1:5 with FerriSeltz), which was found to be the best contrast medium based on the relaxation times and taste, and Milk FerriSeltz-A (distilled water with FerriSeltz) in 10 healthy volunteers. The T1 and T2 values decreased as the proportion of milk increased. The T1 and T2 values of Milk FerriSeltz-F were 71 msec and 28 msec, markedly shorter than those of Milk FerriSeltz-A (340 msec and 290 msec). T1-weighted images taken with Milk FerriSeltz-F showed more homogeneous enhancement of the entire small intestine than those taken with Milk FerriSeltz-A. There were no adverse effects in these 10 volunteers. Milk FerriSeltz-F seems to be an ideal oral contrast medium for enhancement of the entire small intestine.

The purpose of this study was to clarify the usefulness of SPIO-enhanced MRI in the diagnosis of liver tumors in comparison with contrast-enhanced CT. The subjects were forty patients with 154 nodules in the liver. We compared SPIO-enhanced MRI with contrast-enhanced CT in terms of tumor-liver contrast and detectability of liver tumors. In terms of tumor liver contrast, SPIO-enhanced MRI was equal or superior to contrast-enhanced CT in 82% of cases. In the detectability of liver tumor, SPIO-enhanced MRI detected more tumors than contrast-enhanced CT, especially small tumors. Tumors undetected by SPIO-enhanced MRI that were detected by contrast-enhanced CT and/or plain MRI were adenomatous hyperplasia and inflammatory pseudotumor according to fine needle biopsy. There were no severe complications of SPIO-enhanced MRI. In conclusion, SPIO-enhanced MRI will be more useful than contrast-enhanced CT in the diagnosis of liver tumors. SPIO-enhanced MRI may be a promising diagnostic method for the detection of hepatic tumors, especially small ones.

Percutaneous ethanol injection therapy (PEIT) has become widely used in the treatment of HCC. However, the indications for this method are limited by the toxicity of ethanol itself. Against this background, the authors turned their attention to the heat coagulation necrosis effect induced by boiled physiological saline (hot water) and devised percutaneous hot water injection therapy (PHoT) as a new local treatment method. PHoT was performed a total of 41 times in 13 patients (16 nodules) with HCCs measuring < or = 3 cm. Changes in AFP values, CT findings, angiographic findings before and after treatment, and histopathological findings of needle biopsy or resected specimen were investigated. AFP values decreased in all of the seven patients who initially showed high values. On CT, all lesions receiving PHoT became hypodense, with this change thought to indicate necrosis. Disappearance of the tumor stain was confirmed in the four patients in whom follow-up angiography was performed. In the six patients in whom needle biopsy was performed, disappearance and scaring of tumor cells were observed, while in the one patient in whom the tumor was resected, complete necrosis of the tumor was confirmed. PHoT, despite a small number of punctures, shows good anti-tumor effects, and has promise not only as a curative local treatment method for small HCCs but also in combination with TAE for large HCCs.

Eight patients with histologically or clinically diagnosed hepatocellular carcinoma and a total of 23 nodules were studied. SE 2000/20 (PDW-SE), SE-2000/80 (T2W-SE), SE 500/20 (T1W-SE), GRE 167/13/70 degrees (T1W-GE), and GRE 167/13/15 degrees (T2*W-GE) were used. Using each pulse sequence the pre-and post-contrast detection rates of the 23 nodules visualized by CT arterial portography (CTAP) were compared. With plain MRI, the detection rates were PDW-SE: 48%, T2W-SE: 74%, T1W-SE: 52%, T1W-GE 48% and T2*W-GE: 48%. After the administration of contrast medium all pulses sequences showed enhanced detection rates: 100%, 83%, 87%, 91%, and 96% respectively. Superparamagnetic iron oxide particle enhanced MRI showed a high detection rate comparable to CTAP, suggesting that this agent can make a major contribution to the diagnosis of HCC, particularly the detection of small HCC.

To determine the usefulness of alpha-fetoprotein (AFP) in determining recurrence of HCC after interventional angiography (IVA) and to define the relation between AFP and the imaging diagnosis of HCC recurrence, changes in AFP values in 160 patients with hepatocellular carcinoma who were treated by IVA > or = two times were classified into four patterns: A: the AFP value was decreased after the first IVA, increased at recurrence and decreased again after the second IVA; B: the AFP value was unchanged after the first IVA, but increased at recurrence and decreased after the second IVA; C: the AFP value was decreased after the first IVA, but was not increased at recurrence; D: the AFP value showed no change. The frequency of each AFP pattern and the diagnosis of recurrence by AFP were determined. The relation between tumor type and AFP was defined. Pattern A was the most frequently detected. In 62.6%, AFP was increased at recurrence (A and B), and there was a positive correlation between changes in the AFP value and the findings of imaging diagnosis. In another 37.5%, AFP was not increased at recurrence (C and D), and therefore, the diagnosis of HCC recurrence by imaging methods was very important.

Efficacy of intraoperative electron beam radiotherapy (IOER) on N-nitrosobis (2-hydroxypropyl) amine (BHP) induced pancreatic carcinomas transplanted into the pancreas of the Syrian golden hamsters were studied and the following results were obtained. 1. Selective electron beam application to the carcinoma transplanted into the pancreas of hamsters was accomplished using an electron beam collimator. 2. Intra-pancreatic transplantability of BHP-induced serially transplantable subcutaneous pancreatic carcinomas was 100%. 3. Intra-pancreatic transplanted pancreatic carcinomas disappeared in 2 out of 19 hamsters (11%) by 10 Gy irradiation and 7 out of 15 (47%) by 20 Gy irradiation given 2 weeks after intra-pancreatic transplantation. 4. In contrast to the linear growth of tumor size in the non-irradiated group, the tumor size showed an electron dose-dependent reduction in the irradiated group. 5. Histologically, marked necrosis was noted in the irradiated group, and the intensity of necrosis differed between the 10 Gy and 20 Gy groups. 6. Direct invasion of tumor to the stomach, small intestine, large intestine, liver and abdominal wall was noted. Its incidence tended to decrease as the electron dose increased (5/19 or 26% for the control group, 4/19 or 21% for the 10 Gy group, and 1/17 or 6% for the 20 Gy group), although the difference was not statistically significant. 7. The incidences of liver and lymph node metastasis were not different between the non-irradiated and the irradiated groups. These results suggest that selective IOER on BHP-induced pancreatic carcinomas has an effectiveness to kill cancer cells in hamsters.

Thirty-five complete arterial occlusions of pelvis and extremity in 29 patients were treated with intraarterial urokinase infusion therapy. In 28 limbs, the occlusions were due to arteriosclerotic change and in 7 lesions, the occlusions were due to Burger's disease. The patients with arteriosclerotic change ranged in age from 52 to 84 years with a mean age of 68 years, and the patients with Burger's disease ranged in age from 35 to 47 years with a mean age of 43 years. There were 24 men and 5 women. The estimated duration of the occlusion was from 5 days to 5 years with a mean duration of 11 months. The length of the occluded segments ranged from 1 to 45 cm with a mean length of 13.9 cm. The occlusion was located in the iliac artery in 13 patients, the femoral artery in 11 patients, both the iliac and the femoral artery in 2 patients, the popliteal artery in 5 patients, the femoro-popliteal artery in 1 patient, the brachial artery in 2 patients and the radial artery in 1 patient. The infusion catheter was gently advanced into the proximal portion of the clot over a flexible guide wire, and urokinase was infused at a rate of 5000-10000 IU/min, as a short term high dose infusion (SHI), until antegrade blood flow was reestablished. The catheter was then withdrawn to a point proximal to all of the remaining clot, and the infusion rate was reduced to 10000-20000 IU/h as a continuous low dose infusion (CLI). After thrombolytic recanalization, a percutaneous transluminal angioplasty (PTA) was performed in those cases which demonstrated a residual narrowing of the lumen. The initial success rate was 86%. Reocclusions were observed in 5 lesions (17%) and a second recanalization was successful in 2 of 3 patients. The 1-year cumulative patency rate following recanalization was 88.4% and the 2-year patency rate was 78.6%. No significant complications directly related to the procedure were observed. SHI combined with CLI and PTA appears to be an effective and safe therapy for chronic long segmental arterial occlusion.

Gianturco expandable metallic stents were used in 4 cases with ASO of the iliac artery after PTA for the purpose of the prevention of restenosis. The insertion of stent was succeeded in all 4 cases, and the improvement of clinical symptoms and elevation of ankle pressure index were observed. Follow-up over 3 to 8 months revealed no occlusion and migration of stent. Expandable metallic stent was suggested to be contributable to the treatment of arterial occlusive disease.