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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

Purpose We conducted a pilot study to prospectively evaluate the efficacy of PET/CT with 11C-choline (choline PET/CT) for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract (UUT-UC). Methods Enrolled in this study were 16 patients (9 men, 7 women; age range 51 – 83 years, mean ± SD 69 ± 10.8 years) with suspected UUT-UC. The patients were examined by choline PET/CT, and 13 underwent laparoscopic nephroureterectomy and partial cystectomy. Lymphadenectomy and chemotherapy were also performed as necessary in some of the patients. Of the 16 patients, 12 were confirmed to have UUT-UC (7 renal pelvis carcinoma and 5 ureteral carcinoma), 1 had malignant lymphoma (ureter), 1 had IgG4-related disease (ureter), and 2 had other benign diseases (ureter). Results Of the 16 study patients, 13 showed definite choline uptake in urothelial lesions, and of these, 11 had UUT-UC, 1 had malignant lymphoma, and 1 had IgG4-related disease. Three patients without choline uptake comprised one with UUT-UC and two with benign diseases. Of the 12 patients with UUT-UC, 3 had distant metastases, 2 had metastases only in the regional lymph nodes, and 7 had no metastases. Distant metastases and metastases in the regional lymph nodes showed definite choline uptake. The outcome in patients with UUT-UC, which was evaluated 592 – 1,530 days after surgery, corresponded to the patient classification based on the presence or absence of metastases and locoregional or distant metastases. Choline uptake determined as SUVmax 10 min after administration was significantly higher than at 20 min in metastatic tumours of UUT-UC (p

Using Ce-doped Gd2SiO5 (GSO) of different Ce concentrations, three-layer DOI block detectors were developed to reduce the parallax error at the edges of a pinhole gamma camera for high-energy gamma photons. GSOs with Ce concentrations of 1.5 mol% (decay time ~40 ns), 0.5 mol% crystal (~60 ns), 0.4 mol% (~80 ns) were selected for the depth of interaction (DOI) detectors. These three types of GSOs were optically coupled in the depth direction, arranged in a 22×22 matrix and coupled to a flat panel photomultiplier tube (FP-PMT, Hamamatsu H8500). Sizes of these GSO cells were 1.9 mm×1.9 mm×4 mm, 1.9 mm×1.9 mm×5 mm, and 1.9 mm×1.9 mm×6 mm for 1.5 mol%, 0.5 mol%, and 0.4 mol%, respectively. With these combinations of GSOs, all spots corresponding to GSO cells were clearly resolved in the position histogram. Pulse shape spectra showed three peaks for these three decay times of GSOs. The block detector was contained in a 2-cm-thick tungsten shield, and a pinhole collimator with a 0.5-mm aperture was mounted. With pulse shape discrimination, we separated the point source images of the Cs-137 for each DOI layer. The point source image of the lower layer was detected at the most central part of the field-of-view, and the distribution was the smallest. The point source image of the higher layer was detected at the most peripheral part of the field-of-view, and the distribution was widest. With this information, the spatial resolution of the pinhole gamma camera can be improved. We conclude that DOI detection is effective for pinhole gamma cameras for high energy gamma photons.

YSO (Ce-doped Y2SiO5) is a promising scintillator for a single-photon imaging system since it has relatively high light output and does not contain any natural radioactivity. Since YSO is not hygroscopic, it may be possible to fabricate a block with small pixels for a high-resolution system. For this purpose, we developed a high-resolution gamma camera system that employs smaller than 1-mm YSO pixels. The gamma camera’s detector used 0.8 × 0.8 × 7-mm YSO pixels. All the surfaces of these YSO pixels were mechanically polished, combined with a 0.1-mm-thick BaSO4 reflector to form a 48 × 48 matrix, and optically coupled to a high quantum efficiency, 2-inch square position sensitive photomultiplier tube (Hamamatsu Photonics H10966 A-100). The YSO block was 43.2 × 43.2 mm. The YSO gamma camera was encased in a 5-mm-thick tungsten container, and a parallel collimator was mounted on its front. The parallel hole collimator was made of a 3-layer (each layer was 5-mm thick) tungsten plate, and each plate had 48 × 48, 0.6-mm holes that were positioned by one-to-one coupling with the YSO pixels. Even with the 0.8-mm YSO pixels, we clearly resolved most of the pixels in a 2-dimensional histogram with a peak-to-valley ratio of 2.9 for the 122-keV gamma photons. The energy resolution was 20.4 % FWHM. The spatial resolutions with a parallel hole collimator 2 mm from the collimator surface were 0.7- and 1.3-mm FWHM for the 122- and ~35-keV gamma photons, respectively. We successfully obtained phantoms and small animal images with our YSO gamma camera system. Our high-resolution system has a potential to be useful for molecular imaging research.

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.

A silicon photomultiplier (Si-PM) is a promising photodetector for high resolution PET systems due to its small channel size and high gain. Using Si-PMs, it will be possible to develop a high resolution imaging systems. For this purpose, we developed a small field-of-view (FOV) ultrahigh-resolution Si-PM-based dual-head coincidence imaging system for small animals and plant research. A new scintillator, Ce doped Gd 3 Al 12 Ga 3 O 12 (GAGG), was selected because of its high light output and its emission wavelength matched with the Si-PM arrays and contained no radioactivity. Each coincidence imaging block detector consists of 0.5×0.5×5 mm 3 GAGG pixels combined with a 0.1-mm thick reflector to form a 20×17 matrix that was optically coupled to a Si-PM array (Hamamatsu MPPC S11064-050P) with a 1.5-mm thick light guide. The GAGG block size was 12.0×10.2 mm 2 . Two GAGG block detectors were positioned face to face and set on a flexible arm based detector stand. All 0.5 mm GAGG pixels in the block detectors were clearly resolved in the 2-dimensional position histogram. The energy resolution was 14.4% FWHM for the Cs-137 gamma ray. The spatial resolution was 0.7 mm FWHM measured using a 0.25 mm diameter Na-22 point source. Small animal and plant images were successfully obtained. We conclude that our developed ultrahigh-resolution Si-PM-based dual-head coincidence imaging system is promising for small animal and plant imaging research.

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.

Objective: Previously we devised a method for estimating 123I-IMP activity at 10 min 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 the regional cerebral blood flow (rCBF). In this study, we attempted to develop a more simplified method for estimation of Ca10 and to validate its usefulness for quantification of rCBF in a number of patients with different cerebrovascular diseases.Methods: Consecutive 134 patients were examined for 123I-IMP ARG study. Dynamic images of the lungs for 5 min and brain SPECT images for 30 min (6×5 min) and Ca 10 values were acquired from the first 35 patients. Using the data of the 35 patients, the regression equation for estimating Ca10 was calculated by the multiple regression analysis. The regression equation was applied to the other 99 patients who comprised 29 patients with Parkinson’s disease, 32 with common or internal carotid artery occlusion or stenosis, 14 with moyamoya disease, 12 with cerebral infarction, and 12 with other diseases. The mean of rCBFs in various regions of the brain (mCBF) calculated using the estimated Ca10 was compared with that calculated using directly measured Ca10 in the 99 patients. Results: The regression equation obtained was as follows: Estimated Ca10 =1070.1 +2.17 ×10-3a-8.08 ∙ b - 2.23 ×c +2.47 ×10-3d, where a: the area under the time-activity curve of the lungs (UCL), b: body weight, c: sum of UCL and the counts of brain projection data from 10 to 15 min after injection (CB1), d: those from 35 to 45 min (CB6), respectively. The estimated Ca10 closely correlated with the directly measured Ca10 (r=077). The mCBF values calculated using the estimated Ca10 closely correlated with those calculated using the directly measured Ca10 in all the patient groups (r=0.80, 0.78, 0.62, 0.77, 0.85 and 0.79 in patients with Parkinson’s disease, common or internal carotid artery occlusion or stenosis, moyamoya disease, cerebral infarction, and the other diseases, and total 99 patients, respectively). Conclusion: This study verified that the newly developed noninvasive method, which is more simplified than the previous method, can estimate reliably the Ca10 values which are available for quantification of rCBF in different patient groups.

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

Purpose: Recently, photomultiplier tubes(PMTs) and position sensitive PMTs (PSPMTs) with higher quantum efficiencies (HQE) have been developed. However, it remains unclear whether they actually improve such performances as the energy and spatial resolution for PET and SPECTdetectors. Methods: The authors evaluated the quantum efficiencies (QEs) for PMTs and PSPMTs and measured the energy resolution of a 3-in. round HQE PMT combined with various scintillators and compared the results with a conventional normal quantum efficiency (NQE) PMT of the same type. The authors also measured the position and energy performance of a 2-in. square HQE PSPMT combined with scintillator blocks and compared them with a NQE PSPMT of the same size. Results: The energy resolution of the 3-in. round HQE PMT showed higher energy resolution than the NQE with all scintillators. The improvement of the energy resolution was smaller, for all measurements, than the expected value from the quantum efficiency of the PMT but was higher for the scintillators with smaller light outputs. The energy and position performance of the HQE PSPMT based block detectors showed higher position and energy performance than those with NQE. Conclusions: From these results, the authors conclude that both HQE PMT and PSPMT contribute to improve the energy and position performance for PET and SPECTdetectors. Significant performance improvements will be expected in PET and SPECT systems by the use of the HQE PMTs or PSPMTs.

PURPOSE The simultaneous measurement of PET and magnetic resonance imaging (MRI) is an emerging field for molecular imaging research. Although optical fiber based PET∕MRI systems have advantages on less interference between PET and MRI, there is a drawback in reducing the scintillation light due to the fiber. To reduce the problem, the authors newly developed flexible optical fiber bundle based block detectors and employed them for a high resolution integrated PET∕MRI system. METHODS The flexible optical fiber bundle used 0.5 mm diameter, 80 cm long double clad fibers which have dual 12 mm × 24 mm rectangular inputs and a single 24 mm × 24 mm rectangular output. In the input surface, LGSO scintillators of 0.025 mol.% (decay time: ∼31 ns: 0.9 mm × 1.3 mm × 5 mm) and 0.75 mol.% (decay time: ∼46 ns: 0.9 mm × 1.3 mm × 6 mm) were optically coupled in depth direction to form depth-of-interaction detector, arranged in 11 × 13 matrix and optically coupled to the fiber bundle. The two inputs of the bundle are bent for 90°, bound to one, and are optically coupled to a Hamamatsu 1-in. square position sensitive photomultiplier tube. RESULTS Light loss due to the fiber bundle could be reduced and the performance of the block detectors was improved. Eight optical fiber based block detectors (16 LGSO blocks) were arranged in a 56 mm diameter ring to form a PET system. Spatial resolution and sensitivity were 1.2 mm full-width at half-maximum and 1.2% at the central field-of-view, respectively. Sensitivity change was less than 1% for 2 °C temperature changes. This PET system was integrated with a 0.3 T permanent magnet MRI system which has 17 cm diameter hole at the yoke area for insertion of the PET detector ring. There was no observable interference between PET and MRI. Simultaneous imaging of PET and MRI was successfully performed for small animal studies. CONCLUSIONS The authors confirmed that the developed high resolution PET∕MRI system is promising for molecular imaging research.

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.

OBJECTIVE: The conventional methods for the estimation of regional cerebral blood flow (rCBF) using ¹²³I-labeled N-isopropyl-p-iodoamphetamine (¹²³I IMP) autoradiography (ARG) require continuous or 1-point arterial blood sampling. Patients who need rCBF quantification benefit from the avoidance of arterial puncture. In this study, we attempted to develop a method without any blood sampling to estimate ¹²³I IMP activity in the arterial blood sample at 10 minutes after injection of ¹²³I IMP (Ca10) for the purpose of rCBF quantification. For the evaluation of validity of this method, the mean of rCBFs in various regions of the brain (mean CBF) calculated by ¹²³I IMP ARG method using the estimated Ca10 was compared with that calculated using the Ca10 directly measured with the actual arterial blood sample. Both groups of the mean CBF values were also compared with those measured by O-15 H₂O PET ARG method. METHODS: I-123 IMP ARG study was applied to 23 patients, and O-15 H₂O PET ARG was applied to 20 patients of them. Dynamic images of the lungs, time series of static images of the brain, and brain SPECT images were acquired after injection of ¹²³I IMP. Arterial blood sampling was done 10 minutes after injection of ¹²³I IMP. Multiple regression analysis was used to estimate Ca10 using 5 parameters from the lung washout counts, time series of brain static counts, and brain SPECT average counts as the explanatory variables and the Ca10 directly measured with the actual arterial blood sample as the objective variable, and the regression equation was calculated. RESULTS: The regression equation was calculated by multiple regression analysis as follows: Estimated Ca10 = (2.09 × 10⁻² · LW3) - (2.29 × 10⁻⁴ · Cb5) - (9.87 × 10⁻³ · Cbpre-SPECT) + (1.06 · CbSPECTav) + (1.03 × 10⁻² · Cbpost-SPECT) + 165 (counts/s/g), where LW3: lung washout count at 3 minutes after injection, Cb5: brain count at 5 minutes, Cb pre-SPECT: brain count before SPECT, Cb SPECT av: average brain count during SPECT, and Cb post-SPECT: brain count after SPECT. The estimated Ca10 values closely correlated with the directly measured Ca10 values (r = 0.907, P < 0.01). The mean CBF values (mL/min/100 g) calculated by ¹²³I IMP ARG method using the estimated Ca10 also closely correlated with those calculated using the directly measured Ca10 (r = 0.818, P < 0.01). The mean CBF values calculated by the ¹²³I IMP ARG method using either the directly measured or the estimated Ca10 significantly correlated (r = 0.698 and 0.590, respectively; P < 0.01) with those measured by O-15 H₂O PET ARG method. CONCLUSIONS: The ¹²³I IMP arterial blood activity can be estimated reliably without any blood sampling using the ¹²³I IMP acquisition data from the lungs and brain. This method can serve for a convenient and noninvasive rCBF quantification technique instead of the conventional methods requiring arterial blood sampling.

Objective : The purpose of this study was to observe endocrinological responses of venoarterial and veno-venous extracorporeal membrane oxygenation (V-A and V-V ECMO) to support fetal oxygenation in utero. Methods : An ECMO system with a centrifugal pump was applied to six chronically instrumented fetal lambs, at 126-134 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 and concentrations of atrial natriuretic peptide (ANP), epinephrine and norepinephrine with both routes of ECMO. Results : Fetal carotid artery pH did not change during hypoxemia, but decreased after instituting V-A ECMO and V-V ECMO. After instituting V-A ECMO or V-V ECMO for 30 min, oxygen partial pressure (pO2) in the fetal cranial carotid artery recovered from the hypoxic level. The ANP concentration in V-V ECMO was significantly lower than that in V-A ECMO. Fetal serum epinephrine and norepinephrine concentrations significantly increased in association with hypoxic stimulation. There was a further increase in fetal serum epinephrine concentration after instituting V-A ECMO. No significant difference in concentration was found after instituting V-V ECMO from that of after the institution of V-A ECMO. Conclusions : This study suggested that V-V ECMO may possibly be less invasive than V-A ECMO for fetal heart, because ANP, a cardiac distress index, was lower in V-V ECMO than in V-A ECMO.

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.

Interval sentinel lymph nodes (ISLN) are defined as the lymph nodes located between the primary melanoma and anatomically well-defined lymph nodal basins. It was reported that the ISLN appeared to be at the same metastatic risk as sentinel lymph nodes (SLN) in the traditional nodal basins. This study aimed to examine the incidence and metastatic risk of the ISLN in melanoma patients. Between June of 1999 and December of 2008, 117 patients enrolled at Nagoya University Hospital underwent SLN biopsy for primary cutaneous melanoma with a Breslow thickness of at least 1.0 mm. Triple techniques with lymphoscintigraphy, blue dye injection and gamma probe were used for the biopsy except for 13 cases that underwent lymphoscintigraphy, ultrasonography and blue dye injection, but without gamma probe. Patients who had melanoma of the head and neck were excluded from this analysis. The SLN were identified in 253 nodal basins from 117 patients, and ISLN were found in six patients (5%). We recognized 41 (17%) SLN metastases in 246 conventional nodal basins and one (14%) in seven ISLN. Although ISLN were identified infrequently, the incidence of metastasis into the ISLN was similar to that into SLN in conventional nodal basins. It is therefore recommended that preoperative lymphoscintigraphy and intraoperative recognition of ISLN should be performed.

Males of the giant water bug Appasus (= Diplonychus) japonicus Vuillefroy (Belostomatidae: Heteroptera) carry egg masses on their back, but little is known about the relationship between seasonal abundance and breeding ecology of the species. In the present study, therefore, a field survey based on a mark-and-recapture census was carried out at three survey points within a rice paddy area (0.3 km2) where A. japonicus forms a meta-population in northern Okayama, Japan. We investigated the body size, seasonal abundance, dispersion, egg mass size (number of eggs within one egg mass), number of egg masses and the total eggs carried on the back of each male as fundamental parameters of the population and breeding. Significant differences in egg mass size, number of egg masses, and total number of eggs that males carried was found among the survey points. The present results suggested the possibility that the differences in breeding parameters of A. japonicus were influenced by differences in environmental factors among the microhabitats. These results are discussed in conjunction with previous reports on seasonal abundance and breeding systems in Belostomatidae bugs.

補光区, 遮光区および対照区の3実験区を設定してミニチュアローズRosa‘Fiesta Parade (POUlesta)’を秋, 春, 夏に栽培した. 秋栽培の補光区の草丈および生茎重は対照区を有意に上回った. 遮光区の葉面積, 葉数, 草丈, 生茎重は秋栽培において著しく抑制され, 対照区との間に有意な差が認められた. しかし, これらの遮光区と対照区との差は春栽培や夏栽培では小さくなった. 花蕾シュート数は夏栽培で最も多く, 春栽培, 秋栽培の順となり, いずれの栽培期間でも遮光区で有意に少なかった. 対照区における積算日射量, 積算昼間気温および積算夜間気温を説明変数として算出した葉面積, 生葉重, 生体重, 葉数および草丈の重回帰式は0.9以上の重相関係数を示し有意であった. 対照区で求めた重回帰式を用いて推定した補光区と遮光区の成育推定値と実測値との間には有意な正の相関が認められ, 各関係式の傾きは補光区で0.921～0.948,遮光区で0.930～1.013であった. したがって, 対照区で算出した重回帰式を用いて, 補光や遮光, 加温などの日射量や温度制御を行った場合の成育予測が可能であった.

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

Inflamed atherosclerotic plaques may rupture and cause acute myocardial infarction, stroke and other thrombotic events. Early detection of these unstable plaques could, in many cases, prevent such potentially fatal events. 11C-choline or 18F-labelled choline derivatives for visualizing the synthesis of phospholipids, are promising markers of plaque inflammation with potential advantages over 18F-FDG. Their potential for plaque characterization in humans is, however, unclear. In this study the prevalence and distribution of 11C-choline uptake in the aortic and common carotid arterial walls of elderly male patients was evaluated with combined PET/CT. Additionally, the localization of radiotracer uptake and calcification was correlated in various vessel segments. Image data from 93 consecutive male patients between 60 and 80 years old who had undergone whole-body 11C-choline PET/CT assessment for prostate cancer were evaluated retrospectively. 11C-choline uptake and calcification were analysed qualitatively and semiquantitatively and compared. 11C-choline uptake was found in 95% of patients, calcification in 94% throughout all vessel segments. In 6% of the patients radiotracer uptake was colocalized with calcifications, whereas less than 1% of calcification sites showed increased radiotracer uptake. Both 11C-choline uptake and calcification in the aortic and common carotid arterial walls are common in elderly men. Radiotracer uptake and calcification are, however, only rarely colocalized. 11C-choline has the potential to provide information about atherosclerotic plaques independent of calcification measurement.

Objective The aim of this study is to evaluate the correlation between brain perfusion and cognitive dysfunction in spinocerebellar ataxia type 6 (SCA6) patients. Methods Thirteen genetically confirmed SCA6 patients and 21 age- and education-matched control subjects were subjected to single photon emission computed tomography (SPECT) and neuropsychological tests. Brain perfusion was examined with SPECT analysis, while general cognition, verbal and visual memory, attention, visuospatial ability, language, executive function, depression, and anxiety were examined with the neuropsychological tests. Results SCA6 patients showed prefrontal hypoperfusion, and impairments of visual memory, verbal fluency, and executive function compared to control subjects. These neuropsychological impairments in SCA6 patients were significantly correlated with a decrease in prefrontal perfusion. This relation was not correlated to other factors, such as age, education and severity of cerebellar ataxia, which are possible relevant factors associated with cognitive performance. Conclusions SCA6 patients have mild cognitive impairment, and correlating prefrontal hypoperfusion. These results indicate cognitive impairment in SCA6 patients resulting from prefrontal hypoperfusion.

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.

エブアンドフロー方式でのミニチュアローズの鉢物生産において, 気象要因を用いて推定した総葉面積とペンマン法による蒸発散位から蒸発散量を推定した. 実測した蒸発散量と総葉面積を用いて推定した蒸発散量との関係から, 推定値が実測値より大きな値を示し, LAIを考慮した総葉面積を用いて蒸発散量を推定する必要があった. LAIを用いて修正した葉面積とペンマン法による蒸発散位から求めた蒸発散量と実測した蒸発散量との間にはY=1.07X (R2=0.75)の有意に高い相関が認められ, 気温, 湿度, 日射量を用いて30分ごとの蒸発散量をある程度推定できた. しかし, ピンチ後の10日間の生育が劣っている時期やLAI>2.8のシュートの生育が旺盛な時期では蒸発散量の推定値が実測値と大きく異なる場合が認められ, 蒸発散量推定式の精度を低下させていた. 鉢内土壌の水分量とpF値との間には有意な相関がみられ, 潅水点pF2.1の鉢内土壌水分量は93.0 ml pot-1であった. 鉢土の圃場容水量はミチュアローズの生育や栽培時期の影響を受けず210.0 ml pot-1で一定であり, 潅水点までの総蒸発散量は117.0 ml pot-1と推定できた. 本研究の結果から, ミニチュアローズの鉢物生産における蒸発散量をある程度予測できる可能性が示唆されたことから, 気温, 湿度, 日射量などの気象データに基づいた潅水点の予測が可能であるかもしれない.

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.

Recently myocardial perfusion SPECT imaging acquired using the cardiac focusing-collimator (CF) has been developed in the field of nuclear cardiology. Previously we have investigated the basic characteristics of CF using physical phantoms. This study was aimed at determining the acquisition time for CF that enables to acquire the SPECT images equivalent to those acquired by the conventional method in 201TlCl myocardial perfusion SPECT. In this study, Siemens Symbia T6 was used by setting the torso phantom equipped with the cardiac, pulmonary, and hepatic components. 201TlCl solution were filled in the left ventricular (LV) myocardium and liver. Each of CF, the low energy high resolution collimator (LEHR), and the low medium energy general purpose collimator (LMEGP) was set on the SPECT equipment. Data acquisitions were made by regarding the center of the phantom as the center of the heart in CF at various acquisition times. Acquired data were reconstructed, and the polar maps were created from the reconstructed images. Coefficient of variation (CV) was calculated as the mean counts determined on the polar maps with their standard deviations. When CF was used, CV was lower at longer acquisition times. CV calculated from the polar maps acquired using CF at 2.83 min of acquisition time was equivalent to CV calculated from those acquired using LEHR in a 180°acquisition range at 20 min of acquisition time.

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.

To confirm that the dimming luminance change in the CRT monitor will have a detrimental effect on diagnostic performance, we performed the four-alternative forced choice experiments on the CRT monitor with the 11 luminance conditions simulating CRT degraded by long-term usage. Six radiologists and one pulmonary physician performed a detection task for 11,000 test areas on 110 test images. The 11 monitor conditions significantly affected the correct detection rates of simulated nodules in the four-alternative forced choice experiments. The gradual deterioration in CRT monitor luminance will have certainly a detrimental effect on detection performance.

After daily treatments with Mt. Fuji ground water containing natural vanadium (approximately 65 microg/l) at doses of 0.53 microg/kg/day for 12 weeks, blood glucose (BG), serum hemoglobin A1C (HbA1C) levels and insulin secretion from the pancreas of Goto-Kakisaki (GK) rats, a genetic model of Type 2 diabetes, were improved. In GK rat liver insulin receptors, the binding properties of [125I] insulin, and the activities of insulin receptor beta subunit and primary insulin-like growth factor-1beta all recovered to normal levels of those found in Wistar rats. These results suggest that daily treatment with small concentrations of natural vanadium improves hyperglycemia by ameliorating liver insulin receptor activity.

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.

To evaluate the effect of epidural spinal cord electrical stimulation (SCS), the response of the brain with chronic pain was examined “before” and “during” stimulation, using fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). The thalamus was considered to have an important role for the response.

Purpose: To determine whether staining of the lens capsule with trypan blue 0.1% and indocyanine green (ICG) 0.5% diminishes with time and whether it differs between the anterior and posterior capsules. Setting: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Methods: Crystalline lenses removed from porcine eyes were stained for 10 seconds with 0.1 mL of trypan blue 0.1% or indocyanine green 0.5%. They were then placed in distilled water and observed for the persistence of staining over time. In a second experiment, the anterior chamber and internal aspects of the anterior capsule and internal and vitreous aspects of the posterior capsule were gently irrigated with 0.1 mL of trypan blue 0.1% or ICG 0.5%. After 10 seconds, the capsules were irrigated with distilled water and the staining intensities were compared. Results: Staining was not diminished 30 seconds, 5 minutes, or 1 hour after application of either dye. No difference was evident in staining intensity or diminution with time between the anterior and posterior capsules, but the external aspects were stained more than the internal aspects with both dyes. Trypan blue produced more intense staining than ICG. Conclusions: Since the intensity of capsule staining in the intact lens did not change during a 1-hour immersion in water, capsule dyes may not dissipate fully during cataract surgery. As possible long-term adverse effects have not been ruled out, capsule dyes should be used in a low concentration for a short exposure time.

We investigate the formation process of eigenstates in electromagnetic fields. Electronic eigenfunctions in crystalline solids in the electromagnetic fields are localized wavepackets associated with the discrete energy levels. The properties of such states (e.g. Landau levels in magnetic fields and Stark-ladders in electric fields) have been well revealed. However, it is obscure how transformation from the extended Bloch functions to the localized states occurs. By using the path-integral theory, we describe the transformation process of wave functions into quantized eigenstates. It is shown that self-interference, which may be interpreted as an afterimage of electronic motion, plays an important role in the transformation.

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.

Using a 21-in. cathode ray tube (CRT) monitor (2048 x 2560 x 8bits), six radiologists interpreted 12 images with interstitial lung disease under six conditions of CRT luminance (50 and 400 cd/m(2)) and room illuminance (20, 120 and 480lx), and 10 radiologists interpreted 25 images with pulmonary nodules under nine conditions of CRT luminance (50, 200 and 500 cd/m(2)) and room illuminance (20, 120 and 480lx). Observer's performance for interstitial disease was relatively better at 120lx. Four hundred and eighty lux illuminance with 50 cd/m(2) CRT luminance, which degraded the detectability of pulmonary nodule significantly (p0.05), should be avoided for clinical use.

Cerenkov-light imaging is a new molecular imaging technology that detects visible photons from high-speed electrons using a high sensitivity optical camera. However, the merit of Cerenkov-light imaging remains unclear. If a PET/Cerenkov-light hybrid imaging system were developed, the merit of Cerenkov-light imaging would be clarified by directly comparing these two imaging modalities.The authors developed and tested a PET/Cerenkov-light hybrid imaging system that consists of a dual-head PET system, a reflection mirror located above the subject, and a high sensitivity charge coupled device (CCD) camera. The authors installed these systems inside a black box for imaging the Cerenkov-light. The dual-head PET system employed a 1.2×1.2×10 mm3 GSO arranged in a 33 × 33 matrix that was optically coupled to a position sensitive photomultiplier tube to form a GSO block detector. The authors arranged two GSO block detectors 10 cm apart and positioned the subject between them. The Cerenkov-light above the subject is reflected by the mirror and changes its direction to the side of the PET system and is imaged by the high sensitivity CCD camera.The dual-head PET system had a spatial resolution of ∼1.2 mm FWHM and sensitivity of ∼0.31% at the center of the FOV. The Cerenkov-light imaging system's spatial resolution was ∼275 μm for a 22Na point source. Using the combined PET/Cerenkov-light hybrid imaging system, the authors successfully obtained fused images from simultaneously acquired images. The image distributions are sometimes different due to the light transmission and absorption in the body of the subject in the Cerenkov-light images. In simultaneous imaging of rat, the authors found that 18F-FDG accumulation was observed mainly in the Harderian gland on the PET image, while the distribution of Cerenkov-light was observed in the eyes.The authors conclude that their developed PET/Cerenkov-light hybrid imaging system is useful to evaluate the merits and the limitations of Cerenkov-light imaging in molecular imaging research.

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.