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Purpose To establish an objective method of [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) that can assist in the diagnosis of glucose transporter 1 deficiency syndrome (GLUT1-DS). Methods FDG-PET was performed in 8 patients with a mean age of 12.5 years (range, 2–22 years) with GLUT1-DS. Their PET findings were compared with those of 45 controls with a mean age of 11.2 years (range, 2–21 years) by statistical parametric mapping (SPM12, Welcome Neurological Institute). The controls had epilepsy of unknown etiology and normal MRI findings. The age-adjusted ratios of mean radioactivities in regions of interest (ROIs) of bilateral lenticular nuclei, thalami, and the whole cerebral cortex were also measured. The sensitivities and specificities of the ratios for the differential diagnosis of GLUT1-DS were also determined. Results SPM showed significantly decreased uptake in bilateral thalami and increased uptake in bilateral lenticular nuclei in patients with GLUT1-DS. There were no areas in the cerebral cortex with significant differences between patients and controls. On ROI analysis, by setting the cut-off value of the age-adjusted lenticular nuclei/thalami radioactivity ratio to 1.54, patients with GLUT1-DS were differentiated from controls with sensitivity of 1.00 and specificity of 0.98. Conclusion The age-adjusted lenticular nuclei/thalami radioactivity ratio on PET can distinguish patients with GLUT1-DS from patients with epilepsy of unknown etiology with high sensitivity and specificity. It is important to pay attention to the metabolism of the lenticular nuclei and thalami on PET for the diagnosis of GLUT1-DS.

Objective The objective of this study was to assess the correlation between dual-energy computed tomography quantitative parameters and hemodynamics in patients with chronic thromboembolic pulmonary hypertension. Methods Dual-energy computed tomography of 52 chronic thromboembolic pulmonary hypertension patients were evaluated retrospectively. The mean lung perfused blood volume (lung PBV) and the mean pulmonary artery (PA) enhancement measured at pulmonary parenchymal phase were compared with the hemodynamics by Spearman rank correlation coefficient (rs) and receiver operating characteristic analysis. Results Lung PBV was correlated with mean pulmonary arterial pressure (rs = 0.47, P < 0.001). Pulmonary artery enhancement was correlated with cardiac index (rs = −0.49, P < 0.001) and pulmonary vascular resistance (rs = 0.48, P < 0.001). The areas under the curves were 0.86 for lung PBV to predict mean pulmonary arterial pressure of >50 mm Hg and 0.86 for PA enhancement to predict pulmonary vascular resistance of >1000 dyne·s/cm5. Conclusions Lung PBV and PA enhancement could be indicators of hemodynamics.

This study aimed to quantitatively evaluate the effects of age, mammographic density, menopausal status, and menstrual cycle on background parenchymal uptake (BPU) using ring-shaped dedicated breast positron emission tomography (dbPET).This study included 186 adult women who underwent mammography and dbPET on the same day and had no abnormalities classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 on both examinations. The volume of interest (VOI) was placed in the glandular tissue of both breasts, and the maximum standardized uptake value (SUVThe SUVBPU in normal breast tissues assessed using ring-shaped dbPET was associated with mammographic density, menopausal status, and women's menstrual cycle. The menstrual cycle was significantly associated with BPU in premenopausal women with dense breasts but not in women with non-dense breasts.

PURPOSE This paper aims to explore the role of a metabolic parameter on F-FDG-PET/CT for clinical T-classification in early-stage adenocarcinoma. PATIENTS AND METHODS One hundred six surgically resected pathological TNM stage (p-stage) 0/I lung adenocarcinomas were retrospectively reviewed. The solid size (SS) measured on thin-section CT and the pathological invasive size (IS) of tumors were recorded. The SUVmax and metabolic tumor volume with SUV ≥1.0 (MTV1.0) derived from PET/CT data were measured on a workstation, and the metabolic tumor diameter with SUV ≥1.0 (MTD1.0) was calculated automatically from MTV1.0. For the correlations between the IS and the SS, MTD1.0, or SUVmax, Pearson's correlation coefficients were compared using the Meng-Rosenthal-Rubin method. Additionally, the reproducibility between the clinical TNM stage (c-stage), based on the SS or MTD1.0, and the p-stage was analyzed using the kappa coefficient (k). RESULTS For the correlations between the IS and the other parameters, Pearson correlation coefficient was 0.630 for the SS, 0.600 for the SUVmax, and 0.725 for MTD1.0. MTD1.0 correlated significantly and more strongly with the IS than the SS and the SUVmax did (P = 0.040, and P = 0.008, respectively). The reproducibility between p-stage and c-stage based on the SS was moderate (k = 0.529, P < 0.001), whereas that between p-stage and c-stage based on MTD1.0 was substantial (k = 0.676, P < 0.001). CONCLUSIONS MTD1.0 on FDG-PET/CT was correlated significantly and more strongly with the pathological IS in lung adenocarcinomas than with the SS on thin-section CT. FDG-PET/CT could classify more precisely early-stage lung adenocarcinoma than the presently used T-classification based on thin-section CT findings.

Objective Recent many studies have shown that whole body “diffusion-weighted imaging with background body signal suppression” (DWIBS) seems a beneficial tool having higher tumor detection sensitivity without ionizing radiation exposure for pediatric tumors. In this study, we evaluated the diagnostic performance of whole body DWIBS and 18F-FDG PET/CT for detecting lymph node and bone metastases in pediatric patients with neuroblastoma. Methods Subjects in this retrospective study comprised 13 consecutive pediatric patients with neuroblastoma (7 males, 6 females; mean age, 2.9 ± 2.0 years old) who underwent both 18F-FDG PET/CT and whole-body DWIBS. All patients were diagnosed as neuroblastoma on the basis of pathological findings. Eight regions of lymph nodes and 17 segments of skeletons in all patients were evaluated. The images of 123I-MIBG scintigraphy/SPECT-CT, bone scintigraphy/SPECT, and CT were used to confirm the presence of lymph node and bone metastases. Two radiologists trained in nuclear medicine evaluated independently the uptake of lesions in 18F-FDG PET/CT and the signal-intensity of lesions in whole-body DWIBS visually. Interobserver difference was overcome through discussion to reach a consensus. The sensitivities, specificities, and overall accuracies of 18F-FDG PET/CT and whole-body DWIBS were compared using McNemer’s test. Positive predictive values (PPVs) and negative predictive values (NPVs) of both modalities were compared using Fisher’s exact test. Results The total numbers of lymph node regions and bone segments which were confirmed to have metastasis in the total 13 patients were 19 and 75, respectively. The sensitivity, specificity, overall accuracy, PPV, and NPV of 18F-FDG PET/CT for detecting lymph node metastasis from pediatric neuroblastoma were 100, 98.7, 98.9, 95.0, and 100%, respectively, and those for detecting bone metastasis were 90.7, 73.1, 80.3, 70.1, and 91.9%, respectively. In contrast, the sensitivity, specificity, overall accuracy, PPV, and NPV of whole-body DWIBS for detecting bone metastasis from pediatric neuroblastoma were 94.7, 24.0, 53.0, 46.4 and 86.7%, respectively, whereas those for detecting lymph node metastasis were 94.7, 85.3, 87.2, 62.1, and 98.5%, respectively. The low specificity, overall accuracy, and PPV of whole-body DWIBS for detecting bone metastasis were due to a high incidence of false-positive findings (82/108, 75.9%). The specificity, overall accuracy, and PPV of whole-body DWIBS for detecting lymph node metastasis were also significantly lower than those of 18F-FDG PET/CT for detecting lymph node metastasis, although the difference between these 2 modalities was less than that for detecting bone metastasis. Conclusion The specificity, overall accuracy, and PPV of whole-body DWIBS are significantly lower than those of 18F-FDG PET/CT because of a high incidence of false-positive findings particularly for detecting bone metastasis, whereas whole-body DWIBS shows a similar level of sensitivities for detecting lymph node and bone metastases to those of 18F-FDG PET/CT. DWIBS should be carefully used for cancer staging in children because of its high incidence of false-positive findings in skeletons.

This study aimed to investigate whether indices of left ventricular (LV) dyssynchrony by gated myocardial perfusion SPECT (GMPS) could be useful to predict prognosis in chronic kidney disease (CKD) patients with normal perfusion defect scores. One hundred and sixty-seven CKD patients with normal perfusion defect scores on adenosine-stress 201Tl GMPS and no previous history of overt heart diseases were enrolled. Phase standard deviation (PSD) and bandwidth (BW) were automatically calculated from GMPS. The major adverse cardiac events (MACEs) for a mean of 560 days were defined as sudden cardiac death, fatal arrhythmias, and acute coronary syndrome requiring urgent coronary revascularization. Patients were divided into two groups according to the presence or absence of MACEs. The MACEs occurred in 12 patients (7.1%). Patients who experienced MACEs showed significantly higher PSD and wider BW than those who did not. In the Kaplan-Meier event-free survival analysis, cardiac event rate was significantly higher in the high-PSD and wide-BW group (n = 81) than in the low-PSD and narrow-BW group (n = 71) (P = .002). The multivariate regression analysis revealed that the PSD was associated with MACEs (odds ratio 1.33, 95% confidence interval 1.05-1.69, P = .01). The LV dyssynchrony indices from GMPS may be novel prognostic predictors in CKD patients with normal perfusion defect scores.

We investigated the incidence of cholinergic symptoms related to irinotecan hydrochloride(CPT-11)and examined their association with clinical factors. The subjects were 61 patients with colorectal cancer for whom combination chemotherapy with CPT-11 was indicated between May 2008 and December 2014. The incidence of CPT-11-related cholinergic symptoms was investigated. Cholinergic symptoms were observed in 46 patients(75.4%), of whom 29(47.5%)showed Grade 2 or higher symptoms as follows: nasal discharge(47.5%), lacrimation(39.3%), nausea/vomiting(29.5%), and watery stool (26.2%). The results of the multivariate analysis showed that high-dose CPT-11 administration(150mg/m2)was a significant risk factor for the appearance of cholinergic symptoms and that PS 0 was a significant factor for reducing the onset of symptoms. It is important to adequately manage cholinergic symptoms, considering these clinical factors.

BACKGROUND AND PURPOSE: Despite the development of neuroimaging, identification of focal cortical dysplasia remains challenging. The purpose of this study was to show the longitudinal changes of MR imaging and FDG-PET in patients with West syndrome and subtle focal cortical dysplasia. MATERIALS AND METHODS: Among 52 consecutive patients with West syndrome, 4 were diagnosed with subtle focal cortical dysplasia on 3T MR imaging. MR imaging and PET findings were evaluated longitudinally at onset and at 12 and 24 months of age. RESULTS: At the onset of West syndrome, MR imaging demonstrated focal signal abnormalities of the subcortical white matter in 2 patients. In the other 2 patients, focal subcortical high-intensity signals became visible on follow-up T2WI as myelination progressed. PET at onset showed focal cortical hypometabolism in 3 patients, with 1 of these patients also having focal hypermetabolism and 1 having normal findings. On PET at 24 months, hypometabolism persisted in 2 patients and disappeared in 1, and hypermetabolism disappeared in 1. In 1 patient with normal MR imaging and PET findings at onset, focal hyperintensity and hypometabolism first appeared at 24 months of age. The findings on MR imaging and PET in these patients evolved differently with brain maturation and the clinical course. CONCLUSIONS: Subtle focal cortical dysplasia can be undetectable on MR imaging at the onset of West syndrome and is not always accompanied by hypometabolism or hypermetabolism on PET. Longitudinal MR imaging and PET studies may be useful for detecting such lesions. Even in West syndrome with a congenital structural abnormality, PET findings evolve differently with brain maturation and the clinical condition.

To identify prognostic factors associated with a low-iodine diet (LID) and the amount of remnant thyroid tissue in Japanese patients with differentiated thyroid cancer (DTC) who received initial I-131 remnant ablation (RAI) using a fixed low dose of I-131 (1110 MBq). In this prospective study, we enrolled 45 patients. Patients were classified into a self-managed LID group and a strict LID group. We measured the urinary iodine concentration on the day of RAI after patients consumed LID for 2 weeks. Thyroid-stimulating hormone-induced thyroglobulin (Tg) levels and I-131 uptake by the remnant thyroid tissue were also evaluated. A response-evaluation whole-body scan (WBS) was performed 6–8 months after RAI to determine the outcome of the therapy. Post-LID urinary iodine levels of the strict LID group tended to be lower than those of the self-managed LID group. Twenty-five cases (56%) showed absence of uptake, whereas 20 cases (44%) showed residual uptake on the response-evaluation WBS. There were no significant differences between “absence” and “residual” groups in urinary iodine concentrations and Tg levels (p = 0.253 and p = 0.234, respectively). However, significant differences were observed in I-131 uptake by the thyroid bed (p = 0.035). For patients following the current Japanese method of a 2-week LID, the urinary iodine concentration was not a predictive factor for the successful outcome of RAI. In contrast, low I-131 uptake by the thyroid bed, revealed by the scintigram after RAI, may serve as a favorable predictive factor.

Histological chorioamnionitis (CAM) is one form of intrauterine inflammation that is often seen in cases of preterm birth and are usually confirmed based on pathological examination after delivery. Histological CAM is related to significant neonatal morbidity and mortality; however, its etiology is unknown. The objective of this study was to determine the risk factors for histological CAM, using medical background, including fetal heart rate (FHR) patterns in preterm birth cases. The preterm birth cases delivered between 28 and 36 weeks were categorized into two groups according to the presence of histological CAM. Ninety-five preterm infants were included: 48 infants without histological CAM and 47 cases with histological CAM. The odds ratio for histological CAM was adjusted for FHR patterns, gestational age, and delivery mode (vaginal delivery or Caesarean section). Logistic regression analysis showed that vaginal delivery and gestational age were associated with histological CAM (odds Ratio [OR]: 3.1, 95% confidence interval [CI]: 1.0-9.4, p < 0.05, and OR: 0.8, 95% CI: 0.6-0.9, p < 0.05, respectively). However, there were no specific FHR patterns associated with histological CAM. Our study indicates that in preterm birth cases, histological CAM is not related to any specific FHR pattern. However, labor uterine contraction and immature gestational age at the delivery are related to histological CAM. These results may provide better delivery management methods for preterm birth cases.

Statistical image analysis of brain SPECT images has improved diagnostic accuracy for brain disorders. However, the results of statistical analysis vary depending on the institution even when they use a common normal database (NDB), due to different intrinsic spatial resolutions or correction methods. The present study aimed to evaluate the correction of spatial resolution differences between equipment and examine the differences in skull bone attenuation to construct a common NDB for use in multicenter settings. The proposed acquisition and processing protocols were those routinely used at each participating center with additional triple energy window (TEW) scatter correction (SC) and computed tomography (CT) based attenuation correction (CTAC). A multicenter phantom study was conducted on six imaging systems in five centers, with either single photon emission computed tomography (SPECT) or SPECT/CT, and two brain phantoms. The gray/white matter I-123 activity ratio in the brain phantoms was 4, and they were enclosed in either an artificial adult male skull, 1300 Hounsfield units (HU), a female skull, 850 HU, or an acrylic cover. The cut-off frequency of the Butterworth filters was adjusted so that the spatial resolution was unified to a 17.9 mm full width at half maximum (FWHM), that of the lowest resolution system. The gray-to-white matter count ratios were measured from SPECT images and compared with the actual activity ratio. In addition, mean, standard deviation and coefficient of variation images were calculated after normalization and anatomical standardization to evaluate the variability of the NDB. The gray-to-white matter count ratio error without SC and attenuation correction (AC) was significantly larger for higher bone densities (p

Accurate preoperative evaluation of lymph nodes can provide optimal treatment for patients. However, in patients with clinical N1 disease (cN1) non-small cell lung cancer (NSCLC), no suitable predictor has been identified for hilar/intrapulmonary lymph node metastasis (pathological N1 disease; pN1). The purpose of this study was to identify pN1 in cN1 NSCLC patients. We retrospectively reviewed the clinicoradiological features of 109 patients with a discrete type of cN1 NSCLC who had undergone complete resection at our institution from 2004 to 2015. The association between clinicoradiological variables and nodal status was analyzed to identify predictors for pN1. The cohort consisted of 77 males and 32 females, ranging in age from 39 to 84 years. The breakdown by pathological N category was 40 (37%) pN0, 41 (38%) pN1, and 28 (25%) pN2 patients. Maximum lymph node diameter was identified as a significant predictor for pN1, with an odds ratio of 1.25 (P = 0.010). When limited to 63 patients who underwent positron emission tomography (FDG-PET) at our institution, the maximum standardized uptake value (SUVmax) of the lymph node was an independent predictor, with an odds ratio of 1.91 with logistic regression analysis (P = 0.004). The size of lymph node and the SUVmax were significant factors for pN1, with optimal cut-off values of 13 mm and 4.28, respectively. Among the patients with cN1, maximum lymph node size and SUVmax of the FDG-PET were significant predictors for pN1.

Purpose To compare dual-phase dual-energy CT (DE-CT) with FDG-PET/CT for predicting histopathological locoregional invasiveness of non-small cell lung cancers (NSCLCs). Materials and methods We selected 63 consecutive patients with NSCLC lesions (37 males, 26 females; age range, 44–85 years; mean age, 69 years) who were evaluated preoperatively by both DE-CT and PET/CT at our institution. Postoperative microscopic invasiveness (lymphatic permeation, vascular invasion, and/or pleural involvement) was reviewed, and we defined locoregionally invasive tumors as those that had at least one positive finding of microscopic invasiveness. DE-CT scanning in the arterial and delayed phases was performed after injection of iodinated contrast media using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation of primary tumors in the arterial and delayed phases was quantified automatically using “syngo Dual Energy Lung Nodules” application software, and the ratio of arterial phase to delayed phase enhancement (A/D ratio) was calculated. The A/D ratio and SUVmax on PET/CT were evaluated with respect to postoperative invasiveness by univariate logistic regression analysis. Results The A/D ratio was significantly correlated with lymphatic permeation, vascular invasion, and pleural involvement (p = 0.011, p = 0.021, and p = 0.010, respectively). In contrast, the SUVmax was significantly correlated with pleural involvement (p = 0.020) but not with lymphatic permeation or vascular invasion (p = 0.088 and p = 0.100, respectively). In the subgroup of patients with lesion diameters ≤2 cm, the A/D ratio was significantly correlated with locoregional invasiveness (p = 0.040), while the SUVmax was not (p = 0.121). Conclusion For the prediction of microscopic invasiveness of NSCLCs, the diagnostic performance of dual-phase DE-CT may be comparable to that of FDG-PET/CT.

We investigated the role ofFourteen patients with thymic epithelial tumors who underwent PET-CT before and after induction therapy were retrospectively analyzed. The relationship between the change in the maximum standardized uptake value (SUVThe study cohort consisted of 5 males and 9 females. Nine of the patients had thymoma, and 5 had thymic carcinoma. The induction therapy included chemotherapy in 9 cases, chemoradiation therapy in 4 cases and radiation therapy in 1 case. Among the 8 patients with a pathologic response of Ef0/1, 5 were clinically evaluated as having stable disease (SD), while 3 were found to have had a partial response (PR). The SUVIn comparison with CT, PET-CT seems to be useful for predicting the pathologic response to induction therapy in patients with thymic epithelial tumors.

We investigated a possible correlation between the maximum standardized uptake value (SUVmax), which is assessed by pretreatment 18F-fluorodeoxyglucose positron emission tomography with computed tomography, and the overall survival (OS) in patients with hypopharyngeal squamous cell carcinoma from two institutions on long-term follow-up, and examined whether SUVmax is correlated with several survival outcomes, including lung metastasis-free survival. A total of 81 patients were enrolled. The survival rate was calculated by the Kaplan–Meier method. Both univariate and multivariate survival analyses were assessed by a Cox proportional hazards model. SUVmax ≥15.2 in institution A (p = 0.0306) or SUVmax ≥8 in institution B (p = 0.0132) was significantly predictor of a lower OS. We disaggregated the data by high SUVmax (SUVmax ≥15.2 from institution A and SUVmax ≥8 from institution B) and low SUVmax (SUVmax

Objective The purpose of this study was to examine the 11C-methionine (MET) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) findings of central nervous system (CNS) germinoma and the diagnostic utility of these findings. Methods We retrospectively evaluated the cases of 10 patients who were diagnosed with CNS germinoma according to their histopathological or clinical findings. All the patients underwent pretreatment MET and/or FDG-PET scans, and the resultant images were assessed qualitatively and quantitatively. In the qualitative assessments, we used 3- and 5-grade visual scoring systems for the MET- and FDG-PET images, respectively. In the quantitative assessments, the maximal standardized uptake value (SUVmax) and the ratio of the SUVmax of the tumor (T) divided by the mean SUV for the normal white or gray matter [T/N (WM), T/N (GM)], was calculated. Results The mean and SD values of SUVmax, T/N (WM), and T/N (GM) were 1.9 ± 1.4, 2.5 ± 1.3, and 1.7 ± 0.9 on MET-PET and 5.8 ± 2.2, 1.6 ± 0.5, and 0.8 ± 0.2 on FDG-PET, respectively. On MET-PET, only one lesion was not detected. On the other hand, on FDG-PET all of the lesions exhibited uptake values that were intermediate between those of the normal white matter and gray matter. Conclusion In terms of its tumor-contouring ability, MET is a good tracer for diagnosing CNS germinomas; therefore, MET-PET is considered to be useful for planning biopsies or surgery. Although FDG-PET is capable of detecting CNS germinomas, it produced insufficient image contrast in the present study. Further studies are needed before FDG-PET can be used in clinical examinations of CNS germinoma.

To investigate possible causes for false-negative findings on PET scans for solid-type lung cancers, we retrospectively compared PET findings to clinical and pathological features using multivariate analysis.We reviewed PET/CT records, clinical records, preoperative thin-section CT images, and postoperative pathological records and selected only solid-type primary lung cancers with lesions ≤ 40 mm in diameter that had been definitively diagnosed by surgical resection. PET images with SUVmax of ≥ 2.5 were considered PET-positive. Logistic regression analysis was used to identify independent predictors of PET-positive or negative among five factors: body weight, blood glucose level, lesion size, location, and histological classification.A total of 187 solid-type primary lung cancers were selected. Forty lesions (21.4%) were judged as PET-negative and 147 lesions (78.6%) were judged as PET-positive. Multivariate logistic analysis for the 187 lesions revealed that lesion size (p0.001) and histological tumour type (p0.001) were significant factors for determining whether PET findings were negative.Among solid-type lung cancers, lesion size and histopathological findings were significantly associated with FDG uptake. In particular, it warrants attention that lesions ≤ 2 cm and bronchioloalveolar carcinoma and well-differentiated adenocarcinoma have a tendency for negative PET findings.

We investigated whether myocardial 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy predicts impairment of myocardial functional reserve in response to dobutamine stress in patients with idiopathic dilated cardiomyopathy (DCM). Forty DCM patients (LVEF 39 ± 12 %) underwent myocardial 123I-MIBG scintigraphy, echocardiography, and cardiac catheterization. Myocardial 123I-MIBG uptake was quantified as the delayed heart to mediastinum (H/M) ratio and washout rate (WR). Local denervation was evaluated on polar map images. LV dP/dt max and T1/2 were determined from left ventricular pressure curves at baseline and during dobutamine infusion (15 μg/kg /min). Patients were classified into two groups as follows: group A comprised 21 patients showing a delayed H/M ratio of

Positron emission tomography using [(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG-PET) plays an important role in many oncological settings. In this study, we assessed the utility of (18)F-FDG PET-CT for predicting the histologic type and stage of thymic epithelial tumours.We retrospectively analyzed 58 patients with thymic epithelial tumours who underwent PET-CT before treatment and investigated the relationship between the histologic type based on the World Health Organization classification and the maximum standardized uptake value (SUV(max)) of each tumour. We also analyzed the relationship between the Masaoka tumour stage and the SUV(max).The study included 31 males and 27 females, ranging in age from 25 to 80 years (median: 62 years). The tumour histology of 44 tumours was thymoma and that of the remaining tumours was thymic carcinoma, including 11 squamous cell carcinomas and 3 carcinoids. The Masaoka tumour stage was as follows: Stage I in 8, Stage II in 24, Stage III in 18 and Stage IV in 8 patients. The patients were divided into three groups according to a simplified histologic classification: low-risk thymomas (types A, AB and B1, n = 23), high-risk thymomas (types B2 and B3, n = 21) and thymic carcinomas (n = 14). The SUV(max) of the thymic carcinoma group was significantly higher than those of the low-risk thymoma and high-risk thymoma groups (P0.001, respectively). No significant differences between the low-risk thymoma and high-risk thymoma groups were observed (P = 0.204). The SUV(max) of Stages III and IV thymomas showed a higher trend toward Stages I and II thymomas (P = 0.060).PET-CT is a useful modality for predicting the histologic type and tumour stage of thymic epithelial tumours.

Background The diagnostic value of biliary cytology for hilar bile duct stricture is uncertain. This study prospectively examined three methods for the evaluation of biliary cytology in a consecutive group of patients. Methods Preoperative bile sampling by aspiration through a drainage catheter (aspiration samples), saline flush through a drainage catheter (saline samples) or direct sampling from a drainage bag (bag samples) was performed in consecutive patients with suspected perihilar cholangiocarcinoma who underwent resection after endoscopic nasobiliary drainage or percutaneous transhepatic biliary drainage. All bile sampling was performed three times on separate days. The accuracy of cytology in the diagnosis of carcinoma was determined. Results Of 100 consecutive patients with hilar strictures, 97 had histologically proven cholangiocarcinoma. The proportion of these 97 patients who had a positive finding on cytology in at least one of three sampling sessions was 55 per cent for aspiration samples, 48 per cent for bag samples and 38 per cent for saline samples (P = 0·021, aspiration versus saline). Tumour length correlated significantly with overall positivity. For aspiration samples, sensitivity was 55 per cent, specificity was 100 per cent and accuracy 56·0 per cent. Conclusion For biliary cytology, sampling by catheter aspiration is more effective than catheter flushing or sampling from a drainage bag. Repeated sampling increases sensitivity. Biliary cytology has modest diagnostic yield, but is easy to perform, highly specific, and can provide a definitive diagnosis.

We sought to determine the relationship between (99m)Tc-sestamibi washout and myocardial properties in hypertrophic cardiomyopathy (HCM) patients.Twenty-four HCM patients underwent biventricular cardiac catheterization, with a micromanometer-tipped catheter, both at rest and during atrial pacing, echocardiography and myocardial (99m)Tc-sestamibi scintigraphy at rest. The (99m)Tc-sestamibi washout rate (WR) was calculated using initial and delayed planar images. The HCM patients were divided into two groups as follows: Group A consisted of 13 patients showing (99m)Tc-sestamibi WR22.5%; group B of 11 patients showing (99m)Tc-sestamibi WR ≥ 22.5%. Significant correlations were observed between (99m)Tc-sestamibi WR and percentage changes in pressure half-time (T (1/2)), as well as those in the maximum first derivative LV pressure (LV dP/dt (max)) (r = .43, P = .033; r = -.63, P = .001). The percentage changes in LV dP/dt (max) and those in T (1/2) were significantly more reduced in group B than in group A (P.05). The biphasic force-frequency relation was more frequently observed in group B than in group A (82% vs. 18%).Increased (99m)Tc-sestamibi washout is associated with an impaired contractile reserve and prolonged relaxation, suggesting that myocardial (99m)Tc-sestamibi scintigraphy may be useful in noninvasively detecting the early impairment of myocardial function in HCM patients.

We assessed the performance of 37 MBq I-123 as a diagnostic imaging agent in patients with differentiated thyroid cancer using comparisons with their corresponding high-dose post-treatment I-131 scans. We reviewed diagnostic I-123 whole-body scans and post-treatment I-131 scans of 69 patients who underwent I-131 therapy for differentiated thyroid carcinoma (47 papillary and 22 follicular). Diagnostic scans were performed 24 h following the oral administration of 37 MBq of I-123. I-131 doses were administered 3 days after the I-123 diagnostic scans using 2.22–7.4 GBq (median = 5.55 GBq). All images for diagnostic I-123 scans and the corresponding post-treatment I-131 scans were interpreted by consensus of at least 2 experienced radiologists. They evaluated the accumulations of radioiodine in the following 5 sites: thyroid bed, cervical and mediastinal lymph nodes, lung, bone and others. The concordance rates between I-123 scans and I-131 scans were calculated. A total of 108 sites were identified on the post-treatment I-131 scans. Seventy-seven sites (71%) were also identified on the I-123 diagnostic scans. The concordance rates between I-123 diagnostic scans and I-131 post-treatment scans were high for thyroid bed and bone metastases (89 and 86%, respectively), while they were low for lymph node and lung metastases on post-treatment scans (61 and 39%, respectively). Diagnostic scanning with relatively low dose I-123 is not always predictive of subsequent therapeutic I-131 uptake, especially for lymph node and lung metastases of differentiated thyroid cancer.

Aims To examine the relation between mitochondrial dysfunction and myocardial contractile and relaxation reserves in hypertrophic cardiomyopathy (HCM). Methods and results Thirty HCM patients (LVEF ≥60%) underwent biventricular cardiac catheterization analysis both at rest and during atrial pacing as well as myocardial 99mTc-sestamibi scintigraphy at rest to calculate washout rate. Endomyocardial biopsy specimens were obtained for quantitative mRNA analysis and electron microscopy. The HCM patients were divided into two groups—group A: normal force–frequency relation and a pressure half-time ( T 1/2) of

Objective: We evaluated comprehensive neuropsychological tests and regional brain blood flow to compare cognitive dysfunction between two types of multiple system atrophy: predominant cerebellar ataxia (MSA-C) and predominant parkinsonism (MSA-P). Methods: Twenty-one patients with MSA-C, 14 patients with MSA-P, and 21 age- and education-matched control subjects were subjected to neuropsychological tests and SPECT. The neuropsychological tests examined general cognition, verbal and visual memory, working memory, visuospatial and constructional ability, language, executive function, depression, and anxiety, while SPECT analysis examined brain perfusion. Results: Patients with MSA-P showed severe involvement of visuospatial and constructional function, verbal fluency, and executive function compared with control subjects. Patients with MSA-C showed involvement only in visuospatial and constructional function compared with control subjects and a milder degree of involvement compared with patients with MSA-P. Patients with MSA-P tended toward a wide and severe impairment in cognitive function compared with patients with MSA-C. In addition, neuropsychological impairment in patients with MSA-P was significantly correlated with a decrease in prefrontal perfusion. This significant relation was not correlated to other factors such as age, education, and severity of cerebellar ataxia and parkinsonism, which are relevant factors associated with cognitive performance. Conclusions: Patients with multiple system atrophy–parkinsonism show more severe and more widespread cognitive dysfunctions than patients with multiple system atrophy–cerebellar ataxia. Our results also indicate that cognitive dysfunction in patients with multiple system atrophy–parkinsonism may be associated with prefrontal involvement. GLOSSARY: MSA = multiple system atrophy; MSA-C = MSA-cerebellar; MSA-P = MSA-parkinsonism.

In this study, we investigated the clinical factors associated with acute kidney injury (AKI) due to combination therapy with cisplatin (CDDP) for treating lung cancer. We classified cases according to the presence or absence of adequate hydration and magnesium(Mg)administered above the regulations of the registered regimen to evaluate the effect due to differences in hydration on AKI. We also investigated clinical factors before and after administration of CDDP in each case group, and examined their association with AKI. Seventy-four patients with lung cancer that were indicated for treatment with a CDDP combination regimen between December 2012 and April 2013 were studied. The patients whose conditions progressed to AKI of Bgrade 2 accounted for 0% (0/33) in the Mg administration group and 7.3%(3/41)in the Mg non-administration group. In particular, 2 cases of serious AKI (grade 4) were observed in the Mg non-administration without additional hydration group. When compared with other groups, a high antiemetic rate and favorable urine volume were observed in the Mg administration with additional hydration group. In the patients with AKI, many developed hyponatremia of Bgrade 3 within 1 week after administration of CDDP. Although Mg administration and ample hydration seem to be effective measures to deal with CDDP-caused AKI, comprehensive monitoring, including antiemesis therapy, after CDDP administration and correction of electrolytes is important.

The maximum standardized uptake value (SUVmax) of FDG-PET/CT is commonly used as an indicator to evaluate the invasiveness and prognosis of non-small-cell lung cancers (NSCLC). We investigated the correlation between SUVmax and tumor invasiveness or postoperative recurrence of solid type NSCLC and compared squamous cell carcinoma (SCC)/adenosquamous carcinoma (ASC) to adenocarcinoma (AC). A retrospective review of preoperative PET/CT, thin-section CT, and postoperative pathological records obtained over a 5-year period was conducted. Solid type NSCLC tumors on thin-section CT with confirmed diagnosis from surgical resection (diameter ≤3 cm) were included. Multivariate logistic regression was used to evaluate the correlation between tumor characteristics and pathological prognostic factors or postoperative recurrence. 150 patients (111 males, 39 females; mean age 67 years; 106 cases of AC, 36 cases of SCC, and 8 cases of ASC) were included. SUVmax was significantly correlated with pleural involvement (p = 0.047), lymphatic permeation (p = 0.003), lymph node metastasis (p = 0.027), and tumor invasiveness (p

We sought to identify the relationship between regional cerebral blood flow (rCBF) and error types on the Clock Drawing Test (CDT) in patients with Alzheimer's disease (AD).The CDT was administered to 142 patients with AD. We used the Mendez scoring method. Their rCBF values were measured by single-photon emission computed tomography. The correlation between the CDT total score and rCBF was examined on a voxel-by-voxel basis. After we excluded 37 patients whose drawings were inappropriate for assessing the CDT error types, we examined the relationships between each error type on the CDT and rCBF.Total score on the CDT was positively correlated with rCBF in the left posterior middle temporal lobe. We also found relationships between the error "non-existence of number 2, or not pointing toward number 2" and the left frontal lobe; the error "uneven number spacing" and the bilateral frontal lobe; "deviation of the clock center" and the left frontal lobe; "missing numbers" and the right parietal lobe; "uneven number distance from edge" and the right parietal and the temporal lobes; "same length hands" and the bilateral temporal lobe; and "unclosed circle" and the left temporal lobe.Each error type on the CDT appears to relate to a different brain region. These findings will be useful in the understanding of CDT performances and the underlying neuropsychological pathology. Geriatr Gerontol Int 2016; 16: 777-784.

The aim of this study was to examine abnormalities of the central nervous system in patients with chronic pain who were diagnosed with complex regional pain syndrome (CRPS). Brain activity was assessed using 18F-fluorodeoxyglucose positron emission tomography. The data collected from 18 patients were compared with data obtained from 13 normal age-matched controls. Our results showed that glucose metabolism was bilaterally increased in the secondary somatosensory cortex, mid-anterior cingulated cortex (ACC) or posterior cingulated cortex (PCC) (or both), parietal cortex, posterior parietal cortex (PPC), and cerebellum as well as in the right posterior insula and right thalamus in our patients. In contrast, glucose metabolism was reduced contralaterally in the dorsal prefrontal cortex and primary motor cortex. Glucose metabolism was bilaterally elevated in the mid-ACC/PCC and the PPC, which correlated with pain duration. These data suggested that glucose metabolism in the brains of patients with CRPS changes dramatically at each location. In particular, glucose metabolism was increased in the areas concerned with somatosensory perception, possibly due to continuous painful stimulation.

Single photon emission computed tomography was performed in three preterm infants with athetoid cerebral palsy due to kernicterus. No clinical signs and symptoms of kernicterus, or ultrasonographic abnormalities were seen during the neonatal period in any patients. Although MRI during infancy revealed high intensity areas in bilateral globi pallidi in all of them, MRI abnormalities were mild in two of them. On later MRI, subtle high intensity areas in the globi pallidi were recognized in only one of them. Single photon emission computed tomography demonstrated hypoperfusion in the basal ganglia regions in all patients. Regions of interest analyses showed decreased blood flow in the basal ganglia related to the cortical areas. Single photon emission computed tomography will be useful for the diagnosis of kernicterus, whereas MRI abnormalities become less clear beyond infancy.

The purpose of this study was to determine the applicability of veno-venous extracorporeal membrane oxygenation (V-V ECMO) to support fetal oxygenation in utero.An ECMO system with a centrifugal pump was applied to ten chronically instrumented fetal lambs, at 126 or 127 days of gestation. Blood was obtained through a double-lumen catheter inserted into the right atrium. After oxygenation, the blood was returned through a single-lumen catheter into either the carotid artery (veno-arterial; V-A ECMO) or the right atrium (V-V ECMO). After fetal hypoxia had been experimentally produced, V-A ECMO or V-V ECMO was instituted to maintain fetal oxygenation. We compared fetal blood gases with both routes of ECMO.Oxygen partial pressure (pO(2)) in the fetal cranial carotid artery decreased to 12.9 +/- 0.6 mmHg after reducing the fraction inspiratory oxygen of the mother. After instituting V-A ECMO, pO(2) was found to be 23.5 +/- 2.6 mmHg; after instituting V-V ECMO, pO(2) was found to be 20.3 +/- 1.9 mmHg. Thus, fetal acidosis increased under both procedures. Fetal heart rate and blood pressure were not altered significantly during the experiments.This study indicates that V-V ECMO could more effectively and less traumatically maintain oxygenation in hypoxic fetal lambs.

X-linked ichthyosis (XLI) is a relatively common genetic disorder that occurs in about one in every 2000-6000 male births. Clinically, XLI is characterized by a generalized scaling of the skin, with large, polygonal, dark brown scale, and more prominent on the extensor aspects of the limbs. It is known that an undetectable maternal serum, unconjugated estriol, associated with placental steroid sulfatase (STS) deficiency, may be the cause of cause of XLI. In most case, STS deficiency is caused by a complete or partial deletion of the STS gene mapped on chromosome Xp22.3. We describe here the prenatal detection of a male fetus affected with STS deficiency as a result of an undetectable unconjugated estriol in the second-trimester maternal serum screening. Microdeletion of the STS gene was confirmed by fluorescence in situ hybridization analysis of cultured amniotic fluid.

To determine the prevalence and clinical features of pathologically proven incidental cancer (IC) detected by whole-body fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT, as well as the incidence of false-positive and false-negative results.We retrospectively reviewed reports derived from (18)F-FDG PET/CT images of 3079 consecutive patients with known or suspected malignancies for 3 years. Discrete focal uptake indicating IC was identified from reports as well as pathological or clinical diagnoses, and the clinical courses were investigated. The false-positive result was defined as uptake indicating IC but not pathologically confirmed as malignant during follow-up. The false-negative result was defined as pathologically proven IC detected by another modality at initial clinical work-up or diagnosed during the follow-up period.We found (18)F-FDG uptake indicating IC in 6.7% of all patients, and IC was pathologically proven in 2.2% of all patients. The most common sites were the colon, lung and stomach. The median survival duration of patients with IC was 42 months. The results were false positive in 4.5% of all patients, and the results were false negative in 2.3% of all patients.(18)F-FDG PET/CT is a valuable tool for detecting IC. The rates of false-positive and false-negative results are within acceptable range.This is the first report to describe the survival of patients with IC, and the detailed features of false-negative results at actual clinical settings.

BACKGROUND AND PURPOSE: Developmental and seizure outcomes in patients with cryptogenic West syndrome are variable. Our aim was to clarify the relationship between FDG-PET findings in infancy and long-term seizure and developmental outcome in cryptogenic West syndrome. MATERIALS AND METHODS: From 1991 to 1999, we prospectively performed FDG-PET from the onset of cryptogenic West syndrome in 27 patients. PET was performed at onset and at 10 months of age. In 2012, we evaluated the educational status, psychomotor development, and seizure outcome in 23 of the 27 patients (13–22 years of age). The correlation between PET findings and outcome was evaluated. RESULTS: At onset, PET showed hypometabolism in 13 patients (57%). The second PET after the initial treatment revealed cortical hypometabolism in 7 patients (30%). While hypometabolism at onset disappeared on the second PET in 9 patients, it was newly revealed in 3 patients on the second PET. In 2012, seven patients had persistent or recurrent seizures. Eight patients had intellectual impairment. The first PET did not correlate with seizure or developmental outcome. Five of 7 patients (71%) with hypometabolism seen on the second PET had persistent or recurrent seizures, while 14 of 16 (88%) patients with normal findings on the second PET were free of seizures. Five of 7 patients (71%) showing hypometabolism on the second PET had intellectual impairment. Thirteen of 16 (81%) patients with normal findings on the second PET showed normal intelligence. A significant correlation was found between the second PET and long-term seizure ( P = .01) or developmental outcome ( P = .03). CONCLUSIONS: Cortical hypometabolism is not permanent; it changes with clinical symptoms. Hypometabolism after initial treatment predicts long-term seizures and poor developmental outcome.

A 75-year-old woman was diagnosed with esophageal cancer with difficulty in swallowing. She had a past history of rheumatoid arthritis, scleroderma, interstitial pneumonia, angina pectoris (with coronary artery bypass surgery) and arrhythmia (with pacemaker implantation). She refused surgery, and chemotherapy and radiotherapy were not performed because of the high risk accompanied with multiple comorbidities. She received proton therapy at another hospital and the primary lesion shrank. Bone metastasis in the thoracic vertebrae was diagnosed 10 months after diagnosis of esophageal cancer. Non-steroidal anti-inflammatory drugs and zoledronic acid were administered for back pain. Oxycodone was also administered but discontinued due to nausea. After strontium-89 ((89)Sr) chloride administration, her back pain was relieved. (89)Sr was administered five times every 3 months, and the pain did not worsen until her death due to pneumonia 2 years after diagnosis of esophageal cancer. (89)Sr was effective for pain from bone metastasis of esophageal cancer, and its repeated administration was safe.

Primary lung cancers have varying prognoses, even for tumors ≤3cm in diameter. Thus, a thorough evaluation is necessary for therapeutic planning. Two imaging biomarkers have been shown to be useful for predicting primary lung cancer prognosis: maximum standardized uptake values (SUVmax) on fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and the consolidation/tumor (C/T) ratio defined as the maximum diameter of consolidation within a tumor to the maximum tumor diameter on thin-section computed tomography (TSCT). We compared these biomarkers for predicting post-surgical recurrence in patients with small lung cancers.Clinical records, post-operative pathologic findings, and pre-operative PET/CT and TSCT images were reviewed. Solitary primary lung cancers of ≤3cm in diameter after surgical resection were selected for analysis. SUVmax and C/T ratios were recorded. Kaplan-Meier survival curves and Cox hazards ratios were used to identify independent predictors of lung cancer recurrence from among age, gender, surgical procedure, lesion size, C/T ratio, and SUVmax.A total of 169 patients (114 males and 55 females; age range: 34-87 years) with solitary lung cancers were evaluated. The median post-operative follow-up period was 42 months. Twenty-eight patients had cancer recurrence with significantly higher SUVmax (p0.001) and C/T ratios (p0.001) than patients without recurrence. Disease-free survival was significantly reduced for SUVmax of ≥2.5 vs. SUVmax of2.5 (p0.001) or for a C/T ratio of ≥50% vs. a C/T ratio of50% (p=0.030). For 19 patients with C/T ratios of50%, none had a post-operative recurrence. A Cox hazards ratio model showed that only SUVmax was an independent predictor of recurrence (hazards ratio=1.324; p0.001).SUVmax on FDG-PET/CT was a significant imaging biomarker relevant to the prognosis of patients with lung cancers, and was superior to the C/T ratio on TSCT for predicting postoperative recurrence, particularly for solid type lung cancer.

Background The ratio of the maximum diameter of consolidation to the maximum tumor diameter (C/T ratio) on thin-section computed tomography (TSCT) and the maximum standardized uptake value (SUVmax) on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) are often used as preoperative independent variables to evaluate the invasiveness of lung adenocarcinoma. We investigated the associations between these independent variables and pathologic invasiveness in pulmonary adenocarcinomas. Methods We selected patients with peripheral lung adenocarcinomas, definitively diagnosed by surgical resection, with diameters of ≤ 30 mm over a 4-year period ending in December 2010. The association between 3 independent variables (tumor size, SUVmax, and C/T ratio) and pathologic prognostic factors was evaluated using logistic analysis. Results We evaluated a total of 163 primary lung adenocarcinomas in 148 patients (93 males and 55 females; age range: 34 to 84 years). Using multivariate logistic regression analysis, SUVmax and the C/T ratio were significantly associated with tumor invasiveness (odds ratio [OR] = 1.227; p = 0.025 and OR = 1.019; p = 0.008, respectively). Tumor size was not associated with invasiveness (OR = 1.003; p = 0.925). For solid type adenocarcinomas, only SUVmax was significantly associated with invasiveness (OR = 1.558; p = 0.003). For subsolid type adenocarcinomas, only the C/T ratio was significantly associated with invasiveness (OR = 1.030; p = 0.009). Conclusions Both the C/T ratio and the SUVmax are significantly correlated with pathologic invasiveness in patients with small lung adenocarcinomas, while there was a difference between the 2 evaluations. Solid type adenocarcinomas with SUVmax values of ≥ 4.4 and subsolid type adenocarcinomas with C/T ratio ≥ 53% were so highly invasive.

Summary Aim: Previously, we devised a method for estimating 123I labeled N-isopropyl-p-iodo- amphetamine (123I IMP) arterial blood activity at 10 minutes after intravenous injection of 123I IMP (Ca10) without any blood sampling using 123I IMP autoradiography (ARG) acquisition data, and verified its usefulness for quantification of regional cerebral blood flow (rCBF). In this study, we attempted to develop an improved noninvasive method for estimating rCBF. Patients, methods: 123I IMP studies with 23 patients and 15O-H2O positron emission tomography (PET) ARG studies with 20 patients were evaluated. Multiple regression analysis was used to estimate an integral of the arterial blood counts during the time after injection of 123I (JCa) using parameters from the time series of the lung counts and brain counts as the explanatory variables and the fraction [brain single-photon emission computed tomography (SPECT) average count / the mean of rCBFs (mean CBF) measured by 15O-H2O PET ARG method] as the objective variable. Results: The regression equation was as follows: Estimated JCa = (7.09x10-3 · Cb12) - (1.57x10-4 · CbpreSPECT) + (9.48x10-5 · CbpostSPECT) + (1.35x10-4· L15) - (6.95x10-4· L33) + (7.61x10-4· L81) - (0.417), where Cb12: brain count at 12 minutes, Cbpre-SPECT: brain count before SPECT, Cbpost-SPECT: brain count after SPECT, L15, L33, and L81: lung count at 15, 33, and 81 seconds, respectively. The mean CBF values (ml/min/100g) calculated using the estimated JCa values more closely correlated with those measured by 15O-H2O PET ARG method (r = 0.833, p < 0.01) than those obtained by our previous method (r = 0.590, p < 0.01). Conclusion: The rCBFs obtained by this method approximated more accurately to the values measured by 15O-H2O PET ARG method than those obtained by our previous method.

To determine whether intraocular lens (IOL) material influences the membranous proliferation of lens epithelial cells (LECs) on the anterior surface of the IOL.Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.This prospective study included 87 eyes of 87 consecutive patients who had cataract surgery with IOL implantation. Patients were randomly assigned to receive a single-piece poly(methyl methacrylate) (PMMA) IOL, a 3-piece silicone IOL, or a 3-piece acrylic IOL. Postoperatively, the IOL optic was examined by slitlamp microscopy at 1 and 10 days and 1, 2, and 3 months to determine the incidence, duration, and extent of membranous LEC proliferation. The optic was also examined at 6, 9, and 12 months if proliferation persisted.Thirteen eyes were excluded from analysis because of incomplete coverage of the IOL rim by the anterior capsule margin; 74 remaining eyes were studied. All patients obtained good postoperative visual acuity (20/25 or better). Incidence (P =.0024) and duration (P =.0002) of membranous LEC proliferation with the acrylic IOL was greater than with the other 2 types. Proliferation on the acrylic IOL was more extensive than on the PMMA IOL 10 days postoperatively (P.05) and on the silicone IOL at 10 days (P.01) and 1 month (P.01). However, LEC proliferation on the 3 types of IOLs usually decreased by the third postoperative month, and proliferation did not disturb visual acuity.The material of an IOL influenced membranous proliferation of LECs on its anterior surface. Proliferation on the acrylic IOL persisted longer than on the other 2 types but did not cause visual symptoms.

We compared the efficacies of ¹⁸F-fluoride positron emission tomography (¹⁸F-fluoride PET)/CT, ¹⁸F-fludeoxyglucose PET (¹⁸F-FDG PET)/CT, and ⁹⁹mTc bone scintigraphy [planar and single photon emission CT (SPECT)] for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC).We examined 11 patients (8 females and 3 males; mean age 6 standard deviation, 61.968.7 years) with DTC who had been suspected of having bone metastases after total thyroidectomy and were hospitalized to be given ¹³¹I therapy. Bone metastases were verified either when positive findings were obtained on both ¹³¹I scintigraphy and CT or when MRI findings were positive if MRI was performed.Metastases were confirmed in 24 (13.6%) of 176 bone segments in 9 (81.8%) of the 11 patients. The sensitivities of ¹⁸F-fluoride PET/CT and ⁹⁹mTc bone scintigraphy (SPECT) were significantly higher than those of ¹⁸F-FDG PET/CT and ⁹⁹mTc bone scintigraphy (planar) (p,0.05). The accuracies of ¹⁸F-fluoride PET/CT and mTc bone scintigraphy (SPECT) were significantly higher than that of ⁹⁹mTc bone scintigraphy (planar) (p,0.05).The sensitivity and accuracy of ¹⁸F-fluoride PET/CT for the detection of bone metastases of DTC are significantly higher than those of ⁹⁹mTc bone scintigraphy (planar). However, the sensitivity and accuracy of ⁹⁹mTc bone scintigraphy (planar) are improved near to those of ¹⁸F-fluoride PET/CT when SPECT is added to a planar scan. The sensitivity of ¹⁸F-FDG PET/CT is significantly lower than that of 18F-fluoride PET/CT or ⁹⁹mTc bone scintigraphy (SPECT).

We report an 8-year-old girl with seizures induced by micturition. Her seizures were characterized by extension of upper extremities with preserved consciousness. Magnetic resonance imaging and interictal electroencephalograms were normal. Ictal electroencephalogram showed low voltage fast waves without clear focal features followed by frontal dominant rhythmic multiple spikes. Subtraction ictal single photon emission computed tomography revealed a significant increase in blood flow in the mesial frontal area.

The purpose of this study was to evaluate an association found between overall survival of patients with pharyngeal squamous cell carcinoma (SCC) and pretreatment [(18)F]-2-fluorodeoxyglucose ((18)F-FDG) uptake, which are assessed by positron emission tomography combined with computed tomography (PET/CT). Next, we asked whether (18)F-FDG uptake is correlated with overall survival in patients with pharyngeal SCC who underwent radical treatments such as surgery and radiotherapy in the multivariate analysis with adjustments for the clinical stage, primary site and treatment group.Forty-nine patients who were newly diagnosed as resectable pharyngeal SCC underwent pretreatment (18)F-FDG-PET/CT. We used the maximum standardized uptake value (SUVmax) as (18)F-FDG uptake. Overall survival rate was calculated by the Kaplan-Meier method. Univariate survival analysis was analyzed by log-rank test, and multivariate survival analysis was performed by a Cox proportional hazards model.Patients with SUVmax of the primary site ≥8 significantly exhibited shorter overall survival in univariate analysis (p0.04). Moreover, SUVmax of the primary site ≥8 was a significant prognostic factor in the multivariate analysis (p0.03).These results suggested that SUVmax of the primary site obtained by pretreatment (18)F-FDG-PET/CT assessment is an important prognostic factor in patients with pharyngeal SCC.

Since a high resolution PET system is needed for small animal imaging, especially for mouse studies, we developed a new small animal PET system that decreased the size of the scintillators to less than 1 mm. Our developed PET system used 0.5 × 0.7 × 5m m 3 LYSO pixels arranged in an 11 × 13 matrix to form a block with a 0.1 mm BaSO4 reflector between the pixels. Two LYSO blocks were optically coupled to two optical fiber based angled image guides. These LYSO blocks and image guides were coupled to a Si-PM array (Hamamatsu MPPC S11064–050P) to form a block detector. Eight block detectors (16 LYSO blocks) were arranged in a 34 mm inner diameter ring to form a small animal PET system. The block detector showed good separation for the 22 × 13 LYSO pixels in the two-dimensional position histogram. The energy resolution was 20% full-with at half-maximum (FWHM) for 511 keV gamma photons. The transaxial resolution reconstructed by filtered backprojection was 0.71 to 0.75 mm FWHM and the axial resolution was 0.70 mm. The point source sensitivity was 0.24% at the central axial fieldof-view. High resolution mouse images were obtained using our PET system. The developed ultrahigh resolution PET system showed attractive images for small animal studies and has a potential to provide new findings in molecular imaging researches. (Some figures may appear in colour only in the online journal)

The purpose of this study was to assess the value of magnetic resonance imaging (MRI) and additional (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC).Data on 40 patients with LARC, who were treated with NAC and underwent MRI and FDG-PET/CT before and after NAC, were analyzed retrospectively. Surgery was performed at a median of 6 weeks after NAC and the images were compared with the histological findings. The tumor regression grade 3/4 was classified as a responder.Sixteen patients were pathological responders. Receiver operating characteristic (ROC) analysis revealed that MRI total volume after NAC (MRI-TV2) and ΔMRI-TV had the highest performance to assess responders (area under the ROC curve [AUC] 0.849 and AUC 0.853, respectively). The reduction rate of the maximum standardized uptake value (ΔSUVmax) was also an informative factor (AUC 0.719). There seems no added value of adding FDG-PET/CT to MRI-TV2 and ΔMRI-TV in assessment of NAC responders judging from changes in AUC (AUC of ΔSUVmax and MRI-TV2 was 0.844, and AUC of ΔSUVmax and ΔMRI-TV was 0.846).MRI-TV2 and ΔMRI-TV were the most accurate factors to assess pathological response to NAC. Although ΔSUVmax by itself was also informative, the addition of FDG-PET/CT to MRI did not improve performance. Patients with LARC who were treated by induction chemotherapy should receive an MRI examination before and after NAC to assess treatment response. A more than 70 % volume reduction shown by MRI volumetry may justify the omission of subsequent radiotherapy.

Differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis is important to avoid unnecessary operative procedures. This study was aimed at evaluating the efficacy of PET/CT with F-FDG (FDG PET/CT) for the differential diagnosis between them.FDG-PET/CT was performed in 47 study patients with pancreatic masses and without any detectable metastases, 33 of which cases were finally diagnosed as pancreatic cancer and the other 14 as pancreatitis, and the corresponding imaging data were evaluated retrospectively. The maximal SUV (SUVmax) within the masses were determined at 1 hour and mostly at 2 hours after intravenous injection of FDG.SUVmax at 1 hour in pancreatic cancer was significantly higher than that in mass-forming pancreatitis, and the change in SUVmax from 1- to 2-hour time points was more consistent with pancreatic cancer than with mass-forming pancreatitis. However, there remained considerable overlapping between the SUVmax values of both diseases except either at the higher range for pancreatic cancer (7.7 at 1 hour or9.98 at 2 hours) or at the lower range for mass-forming pancreatitis (3.37 at 1 hour or3.53 at 2 hours). No obvious difference was found in the FDG uptake patterns of the mass areas between both diseases.Differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis is difficult by FDG-PET/CT due to considerable overlapping between the SUVmax values of the two diseases, although the differential diagnosis may be possible either at the higher range of SUVmax (7.7 at 1 hour or9.98 at 2 hours) for pancreatic cancer or at the lower range of SUVmax (3.37 at 1 hour or3.53 at 2 hours) for mass-forming pancreatitis.

BACKGROUND After abdominal aortic aneurysm (AAA) repair, relatively low survival during long-term follow-up remains an unresolved issue. Stress myocardial perfusion single-photon emission computed tomography (SPECT) well predicts future mortality overall, as well as providing diagnoses of coronary artery disease. The prognostic value of myocardial SPECT findings after AAA repair, however, remains unclear. METHODS AND RESULTS This study followed 285 patients, all undergoing preoperative pharmacologic stress myocardial perfusion SPECT to determine summed stress score (SSS), then elective AAA repair by open AAA repair or endovascular aneurysm repair. The endpoint of the study was cardiac death. The median follow-up duration was 925 days (range, 541-1,095 days). Twenty-four (8%) died during follow-up. Kaplan-Meier analysis showed that patients with SSS≥9 had a significantly poorer prognosis than those with SSS

OBJECTIVES: To investigate the diagnostic value of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting thoracic aortic prosthetic graft infection. METHODS: Nine patients with clinically suspected thoracic aortic graft infection underwent FDG-PET/CT scanning. In these patients, the diagnoses could not be confirmed using conventional modalities. The patients’ clinical courses were retrospectively reviewed. RESULTS: On the basis of surgical, microbiological and clinical follow-up findings, the aortic grafts were considered infected in 4 patients and not infected in 5. All 4 patients with graft infection (root: 2 cases, arch: 1 case and descending: 1 case) eventually underwent in situ re-replacement. Two of the 4 patients also had abdominal grafts; however, only the thoracic grafts were replaced because uptake was low around the abdominal grafts. The maximal standardized uptake value (SUVmax) in the perigraft area was higher in the infected group than in the non-infected group (11.4 ± 4.5 vs 6.9 ± 6.4), although the difference was not statistically significant. According to the receiver operating characteristic analysis, SUVmax >8 appeared to be the cut-off value in distinguishing the two groups (sensitivity: 1.0 and specificity: 0.8). CONCLUSIONS: FDG-PET/CT is useful for confirming the presence of graft infection by detecting high uptake around grafts and excluding other causes of inflammation. An SUVmax value greater than 8 around a graft suggests the presence of graft infection. In addition, FDG-PET/CT can be used to clarify the precise extent of infection. This is especially useful if multiple separated prosthetic grafts have been implanted.

Purpose: The relationships between pharmacokinetic parameters of unchanged cisplatin (CDDP) and several markers for nephrotoxicity after CDDP infusion (80 mg/m2) over 2 and 4 h were quantitated in patients with various cancers (lung, stomach and colon cancers and mediastinal tumor). Methods: Plasma and urinary levels of unchanged CDDP were measured using a specific high-performance liquid chromatography method. Pharmacokinetic parameters were calculated according to the model-independent method. The nephrotoxicity markers, blood urea nitrogen (BUN), serum creatinine (SCr), plasma and urinary β2-microglobulin (BMGp and BMGu), urinary N-acetyl-β-D-glucosaminidase (NAG) and creatinine clearance (CCR) were monitored for 30 days following CDDP administration. Results: The maximum plasma concentration (Cmax), maximum urinary excretion rate (dAe/dtmax), area under the plasma concentration-time curve from time zero to infinity (AUC), cumulative amount excreted in urine from time zero to infinity (Ae), total clearance (Clt), renal clearance (Clr) and plasma half-life (t1/2) of unchanged CDDP were not significantly different between the 2-h and 4-h infusion schedules. The values of the nephrotoxicity markers changed significantly following CDDP administration, suggesting that CDDP chemotherapy (80 mg/m2) caused nephrotoxicity. The Cmax of unchanged CDDP was the most informative pharmacokinetic parameter for nephrotoxicity. Cmax was related to maximum BUN, maximum SCr and minimum CCR levels in 27 CDDP treatments according to an exponential model. Conclusion: In order to attain more effective CDDP chemotherapy with minimum nephrotoxicity, the present pharmacokinetic and pharmacodynamic studies suggest that the Cmax or steady-state plasma level of unchanged CDDP should be maintained between 1.5 and 2 μg/ml in a standard continuous infusion schedule over 2 h and 4 h.

Preoperative regional cerebral blood flow (rCBF) was measured in 92 patients with Parkinson's disease (PD) by iodine-123 N-isopropyl-p-iodoamphetamine single-photon emission computed tomography. Quantitative mapping of rCBF was performed using the stereotactic extraction estimation method. The clinical features of the patients were assessed according to the Unified Parkinson Disease Rating Scale (UPDRS). The correlation between rCBF and improvement in the UPDRS score following surgery was examined. rCBF in the fusiform gyrus, superior and inferior parietal gyri, middle occipital gyrus, superior frontal gyrus, and middle temporal gyrus of the Talairach Daemon Level 3 was significantly correlated with UPDRS part II (off stage) and III (on stage) scores (p0.05). rCBF in the middle temporal gyrus (p = 0.00147), medial frontal gyrus (p = 0.00713), and cerebellum (p = 0.048) of the Talairach Daemon Level 3 was significantly greater in 47 patients with60% improvement of UPDRS part III (off stage) score than in 37 patients with 40-60% improvement. The cutoff value of rCBF, which indicated that40% improvement in the surgical outcome could be expected, was 38.8 ± 6.2 ml/100 g/min in the frontal lobe. This study indicated that rCBF in patients with PD might be related to their clinical features, suggesting that quantitative mapping of rCBF may be useful for predicting surgical outcome.

We compared the effect of biconvex and convex-plano (posterior plano) intraocular lenses on posterior capsule opacification (PCO) following continuous curvilinear capsulorhexis (CCC) in 212 eyes. During the three years following surgery, the cumulative frequency of neodymium:YAG laser posterior capsulotomy, calculated with the Kaplan-Meier method, was significantly higher in patients in the biconvex group (32.5% by the third year) than in those in the convex-plano group (5.9% by the third year) (P < .05, Wilcoxon's test; P < .01, Cox-Mantel's test). Measured with the tracing method, the area within a 5 mm diameter central circle that developed Elschnig pearls was 2.93 +/- 4.91 mm2 in the biconvex group and 1.66 +/- 2.37 mm2 in the convex-plano group. In the study, PCO was less severe in the convex-plano group than in the biconvex group following CCC. These results are contrary to those reported previously in patients with can-opener capsulotomy.