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Radiologic findings of six cases of malignancy associated with chronic empyema 5-39 years in duration were reviewed. Pathologic examination confirmed three B-cell non-Hodgkin lymphomas, one round-cell sarcoma, one mesothelioma, and one adenocarcinoma. Retrospective findings on plain chest radiographs suggested the occurrence of malignancy: increased radiopacity in the thoracic cavity, soft-tissue bulgings and/or unsharpness of fat planes in the chest walls, destruction of bone near the empyema, and extensive medial deviation of the calcified pleurae. Computed tomography delineated masses with soft-tissue attenuation more clearly than radiography in all cases. Magnetic resonance images of three cases were informative because empyema cavities were surrounded by low-intensity rims, and two of them showed a signal intensity different from that of necrotic tumors. Scintigraphy revealed increased uptake of gallium in all cases. Ultrasonography was useful for biopsy guidance. Every radiologist should know this entity in observation of chest radiographs obtained in patients with chronic empyema, and further radiologic assessment and aggressive biopsy are recommended if malignancy is suspected.

A case of hepatocellular carcinoma is reported in which a calculated T2 value of the tumor was exceptionally long and differentiation from cavernous hemangioma based on T2 signal intensity was difficult. Pathologically, the mass consisted of dense, homogeneous acinar formation (pseudoglandular type). The T2 prolongation of the mass was probably due to abundant fluid in the acini.

A functional MR study was performed using a 0.064 T permanent magnet MR system. The shoulder joints, elbow joints, hip joints, and knee joints of three volunteers (mean height and weight, 176 cm and 71 kg, respectively) were examined at incremental joint angles in three to eight stages during flexion-extension, abduction-adduction, or pronation-supination movement. Each set of 16 images was obtained in 4 min, 49 s using three-dimensional Fourier transformation methods with gradient echo pulse sequences. The images were evaluated in static mode and sometimes in cine mode. The findings obtained about the physiology of these normal joints was generally compatible with findings previously accumulated in the field of kinesiology. The study suggests that this method can be useful for in vivo study of kinesiology and pathogenesis of diseases and that patients with most types of contracture or deformity can be examined by MR imaging.

Methacetin undergoes rapid O-dealkylation by hepatic microsomal enzyme systems, and the resultant CO2 is present in the expired air. The rate of O-dealkylation of methacetin was assessed by the [13C]methacetin breath test in seven healthy volunteers and 30 patients with histologically proven chronic liver diseases. The 30-min recovery of orally administered [13C]methacetin as 13CO2 in the exhaled air was significantly reduced in patients with chronic aggressive hepatitis and in those with liver cirrhosis but not in patients with chronic persistent hepatitis or healthy controls. Patients with either advanced cirrhosis or hepatocellular carcinoma showed significantly lower values than those with well-compensated cirrhosis. The levels in two patients with late primary biliary cirrhosis were reduced. These results show that the severity of liver damage can be effectively evaluated by [13C]methacetin breath test. In addition, this test is simple, safe, and time efficient.

Correlations between left ventricular (LV) function and infarct size estimated by computer-assisted thallium (Tl)-201 scintigraphy were studied in 16 patients in the acute or convalescent phase of the first attack of transmural myocardial infarction (MI). Tl-201 estimation of the infarct size was done using a "corrected" circumferential profile method, by which the total defect score could be obtained. The LV function was evaluated by radionuclide angiography, echocardiography and cardiac catheterization study. The following results were obtained : 1) A close inverse relationship was found between the defect score and the ejection fraction (r=-0.649, r

Thirty-six patients with hepatic tumors (28 hepatocellular carcinomas, seven cavernous hemangiomas, one metastatic tumor) were examined with serial magnetic resonance (MR) imaging, after a bolus intravenous injection of 0.05 mmol/kg gadolinium-diethylenetriaminepentaacetic acid. A typical MR imaging pattern for hemangiomas (present in five of seven cases [71.4%]) was a lesion of diminished signal intensity on precontrast images, peripheral contrast enhancement during the bolus dynamic phase, and complete fill-in of high signal intensity on delayed scan images. Twenty-eight hepatocellular carcinomas showed a variety of contrast enhancement patterns during the dynamic phase. In 21 patients (75%), there was no area of high signal intensity within the tumor on the delayed phase. A peripheral halo with delayed enhancement was noticed in 12 patients (42.8%) Histologic correlation in hepatocellular carcinomas showed that the degree of contrast enhancement corresponded to tumor vascularity and that the peripheral halo corresponded to fibrous capsular structure.

The computed tomographic (CT) and ultrasonographic (US) appearances of retained surgical sponges are described. In each case, the presence of a sponge was confirmed at repeat operation. CT examinations were performed in nine patients. In six cases, a low-density mass was demonstrated; in two cases, a complex mass with areas of both low and medium density was seen. The remaining case was a high-density mass. After intravenous administration of contrast material, dense and prolonged enhancement of the rim of the mass was noted in five of eight cases. Calcification was found in four cases, and spongiform gas in one. US performed in six patients revealed an echogenic area with strong acoustic shadowing in three cases and a complex mass, a hypoechoic mass, and a cystic mass with irregular internal echoes in one case each. Granuloma caused by a retained surgical sponge should be considered as a cause of an abdominal mass in patients with a history of prior abdominal surgery.

The value of preoperative bone scans in patients with primary breast and prostate cancer was evaluated prospectively. Of 414 patients with breast cancer, clinical stage I is 14, II is 219, IIIA is 59, IIIB is 39 and IV is 14. Of 88 patients with prostate cancer, clinical stage I is 14, II is 15, III is 18 and IV is 41. 11 percent of patients with breast cancer and 54 percent of patients with prostate cancer had bone metastases. Clavicle, ribs, thoracic spine, lumbar spine and pelvis metastasized most frequently. The incidences of bone metastases were 18.4% with Scirrhous carcinoma, 15.4% with Medullary tubular carcinoma and 3.8% with Papillotubular carcinoma. The methodology and results of ROC analysis were described in our other papers. Some results of data analysis were described in this paper.

New method of differential diagnosis of gastric cancer was reported. After intravenous 32P administration, lesion was counted by small catheter-type readiation detector system under gastrofiberscopic direct vision control. Optimum counting time was examined in man and it was found to be between 20 to 50 hours after intravenous administration of 32P. Under the currently available technology of miniature detector, still beta-emitting carcinopohilic agent was found to be the agent of choice to this end, since gamma-emitting carcinophilic agents can not provide data originated only from the gastric mucosa in question.

We studied 23 long-term catheterized kidneys in 14 patients. The uptake of /sup 99m/Tc acid (/sup 99m/Tc-DMSA) was measured at one- and two-hour intervals after injection, and the uptake was corrected for variations in renal depth. These values were compared with inulin, creatinine, and para-amino hippurate (PAH) clearances which were measured in each kidney by collecting urine through long-term catheterization. Correlation coefficient was obtained between PAH clearance corrected for the body surface area and the two-hour uptake of /sup 99m/Tc-DMSA. The correlation coefficients between the two-hour uptake of /sup 99m/Tc-DMSA and the clearance values are not significantly different from those between the one-hour uptake and the clearance values. Corrections of the uptake for variations in renal depth did not improve the correlation coefficients. The results show that /sup 99m/Tc-DMSA is an excellent method to estimate the renal plasma flow and the one-hour uptake without correction for renal depth is clinically sufficient to evaluate the split renal function.

Nambu PVA gel which is produced by repeated freezing and thawing of PVA solution has overcome almost all of the problems which present substances have: (1) It is close to human soft tissue in MRI parameters. (2) MRI parameters (1H density, T1, T2) are adjustable to some extent. (3) It has appropriate physical characteristics. The important problem with PVA gel is long-term stability. It is assumed that this problem can be solved by its periodic calibration and replacement. © 1986 Academic Press, Inc.

過去4カ年間に65歳以上の高齢者を対象とする慢性硬膜下血腫21例を経験したので, その臨床症状と予後について報告する. 対象者の平均年齢は77.1歳で性差は認めない. 本症の既往で大切なのは頭部外傷95%, 高血圧症52%, 糖尿病19%, そして慢性アルコール中毒14%である. 入院前の発症および初発症状を家族から聞くと, 一番多いのは歩行障害43%で (下肢脱力, 半身不全麻痺, 片麻痺), 精神障害及び人格変化24%, 失禁29%, 頭痛24%, 痴呆24%, 意識障害24%, さらに痙攣や目まい5%である. 本院入院前の診断名は脳梗塞43%, 脳動脈硬化症14%, 脳出血14%, 老年痴呆10%そして頭部外傷, 脳腫瘍, 髄膜炎など同じように5%である. 入院前の種々様々な診断名から老齢者において慢性硬膜下血腫を老年痴呆, 脳血管障害, 他の血管系痴呆などと鑑別診断することは極めて難しい. 入院時の主症状は意識障害43%, 精神障害38%, 半身不全麻痺と片麻痺71%, 失禁29%, 頭痛24%, 言語障害24%そして Aphasia が10%である. 瞳孔不同とウッ血乳頭は非常に少なく3%であった. 髄液所見では180mmH2O以上は7例で33%, 120mmH2O以下は8例で38%であった. 髄液蛋白が50ml/dl以上のものは陳旧性脳卒中と脳梗塞の例であった. 脳血管撮影を施行した17例の全例に無血管領野を認めて確定診断ができた. 予後判定は臨床症状とCBFの結果を観察した. CBFの改善を示したのは術後3カ月目であった. 改善が成大に較べて, 老人の本症が遅延するのは, 脳血行障害がすでに存在し, 脳実質圧迫がより少なくても, 脳萎縮もあり, しかも頭蓋内腔の拡大が存在するからである.

The purpose of this study is to evaluate the clinical efficacy of liver SPECT (single photon emission computed tomography). Eleven hospitals which are in or near Tokyo are participating in this study. Planar liver images and SPECT images of 134 cases which were retrospectively confirmed for its final diagnosis were collected. At the first study, the planar images (PS) were read by 13 nuclear medicine physicians. The second, the image reading by the combination of the planar images and the SPECT images (PS + SPECT) were performed. The confidence level of diagnosis for SOL (space occupying lesion) obtained by the image reading of PS and PS + SPECT has been analyzed by using the SOL detection model. The SOL detectability of PS + SPECT was higher than that of PS only. However, these differences were not statistically significant.

Cystic neoplasms of the pancreas are divided into two major groups: microcystic adenomas and mucinous cystic neoplasms. Five microcystic adenomas and seven mucinous cystic neoplasms (three cystadenomas and four cystadenocarcinomas) were examined with both magnetic resonance (MR) imaging and computed tomography (CT). The cystic content was differentiated more easily with MR imaging than with CT. It was homogeneous in four of the five microcystic adenomas, all of which had lobulated borders best seen on T2-weighted images. The mucinous cystadenomas and cystadenocarcinomas were all composed of multiple compartments that varied in signal intensity. The septa, shape, and wall thickness were demonstrated on T1- and/or T2-weighted MR images almost as well as on CT scans. Overall, MR imaging was equal or slightly superior to CT in the diagnosis of pancreatic cystic neoplasms, except in its limited ability to demonstrate calcifications of the tumor wall and septa.

著者らは当院で過去5年間に生前脳スキャンを受け, のち剖検され, その病理組織像が明らかにされている62例 (脳硬塞55・脳出血7) を対象とし, retrospective study を行い脳スキャンによるCVDの予後判定が可能かどうかを予後の違いによるグループ別に, 脳スキャン陽性度, 陽性病巣サイズ, 病巣部位について検討した. CVD発症後1カ月以内, 2カ月目～6カ月, 7カ月目～12カ月, 2年目以上に死亡した例を各々1群 (6例), 2群 (28例), 3群 (12例), 4群 (16例) とした.脳硬塞においては陽性症例は55%, 陽性スキャン頻度は58%, 経過観察平均スキャン回数は1.5回, 陽性度平均は1.9±1.2度, 陽性サイズ平均5.9±3.2cmであった. 脳出血においては上記の順に夫々43%, 44%, 1.3回, 1.7±1.1度, 6.5±1.7cmの結果であり陽性サイズのみ脳硬塞より高い値を示した.脳硬塞例では発症5カ月後迄が陽性期であり陽性度よりみると発症後4週目に陽性ピークがあった. 脳スキャン陽性度平均は第1群で2.3±1.1, 第2群で2.3±1.2, 第3群1.7±1.0, 第4群で1.3±1.1度と差がみられた. 即ち脳スキャン陽性度平均と予後の長短は相関が認められた. 予後の悪い第1群, 第2群では最初から高い陽性度を示し予後のよい第4群では急速な陰性化を示すことが特長的であった. しかし4群別に検討した経時的陽性度平均の最大値は上記の順に3.0, 3.2, 2.7 3.0度と差はみられなかった. 陽性スキャンの頻度は上記の順に各々75, 68, 68, 33%であった. 陽性病巣サイズ平均は上記の順に各々7.0±5.0, 6.8±3.7, 4.8±1.4, 5.1±2.1cmと重症例程陽性病巣サイズが大きい傾向はみられたがSDが大きく平均値による検討は意味付けが難しかった. 陽性度と陽性サイズに相関があるかどうかを検討した所, 両者の相関はなく陽性度と病巣の大きさの持つ臨床的意義は別である事が分った.

Fourteen patients with various portosystemic collaterals (seven esophageal varices, three paraumbilical veins, two splenorenal shunts, and two mesenteric varices) were imaged with magnetic resonance (MR) imaging using a superconducting imager. Collateral pathways were demonstrated as tortuous structures of no or low signal intensity on spin-echo image, and flow related enhancement did not cause any difficulty in evaluation. Direct sagittal images are especially useful for paraumbilical vein and coronal images for esophageal and mesenteric varix. The clinical role of MR in the assessment of portosystemic collaterals is discussed also in comparison with CT and ultrasound.

Scintigraphic manifestations of fibrous dysplasia were analyzed in 59 lesions of 26 patients (12 monostotic, 14 polystotic). Bone imaging with Tc-99m MDP revealed a high percentage of increased uptake of radioisotope in the lesions of fibrous dysplasia. Four (14%) of 29 cystic lesions and two (7%) of 30 lesions with the appearance of ground glass showed no increase in radioisotope uptake, although roentgenograms showed marked changes. Therefore, care must be taken in the diagnosis of fibrous dysplasia with bone imaging alone. Nuclear methods, however, are indispensable in evaluating the dynamic aspects of bone mineral behavior and in demonstrating disease where none was suspected, or in visualizing polyostotic involvement in those cases where only monostotic disease was suspected clinically. It is concluded that both scintigrams and roentgenograms are complementary procedures in the diagnosis of fibrous dysplasia.

After splenic injection of I131 MAA, its distribution in the liver and lungs was studied by scintiscanning method. Appearance of pulmonary scanning indicates the presence of portal systemic shunts. Three cases with hemolytic anemia, 2 cases having hepatitis and 1 with liver cirrhosis showed no accumula-tion of this material in the lungs. Among 4 cases with liver cirrhosis portal systemic shunts were revealed in 3 by this method. This method was evaluated in contrast with conventional methods such as roentgenologic study of esophageal varices and radioactive rare gas method, and the sensitiveness and usefulness of this new technique was thus suggested.Hepatic blood flow was measured in 9 patients using radioactive rare gas clearance from the liver. Average blood flow of 3 hemolytic anemias was calculated as 184±3.6 ml./100 Gm. min. by this method. Blood flow values in 2 heptitics and 4 cirrhotics were all markedly reduced compared with those of hemolytic anemias.

Healthy male volunteers were rendered tolerant to the pyrogenic and toxic activities of bacterial endotoxin by daily intravenous injections. Five subjects were given 0.5 µg Salmonella typhosa endotoxin for 7 days; four subjects were given Pseudomonas endotoxin, increasing over a period of 30 days from 25 to 250 µg. Reticuloendothelial system (RES) phagocytic activity was assessed by serial measurements of the clearance of I131-labeled aggregated human serum albumin. In no subject was an increase in RES phagocytic activity detectable. Such negative findings could not be attributed to decreased RES blood flow.—Additional studies on the pyrogenic responses of man to various schedules of endotoxin administration revealed: (a) Hyperreactivity of some subjects to a second injection of endotoxin administered 24 hours after the initial dose; (b) prevention of such hyperreactivity by plasma from donors tolerant to a heterologous endotoxin, but not from normal donors; (c) reduced reactivity to a second injection of endotoxin given 7 days after the initial dose; (d) reversal of induced tolerance by administration of half the dose of endotoxin followed 2 hours later by the second half; (e) reversal of induced tolerance 24 hours after administration of a heterologous endotoxin; (f) enhanced dermal reactivity to endotoxin induced inflammation during tolerance. The observations are consistent with the hypothesis that tolerance to the pyrogenic activity of endotoxin in man is not based upon generalized enhancement of RES phagocytic activity or exhaustion of host reactivity but rather involves the participation of specific antibody which assists the RES in the clearance and inactivation of the endotoxin molecule.

A catheter semiconductor radiation detector (CASRAD) probe which can be placed safely inside a human body for the measurement of beta-ray activity was developed. To fulfill specific requirements arising from medical purposes, the detector element of the CASRAD probe is made by a silicon p-n junction diode of single-ended coaxial structure, 2.3 mm in diameter and 1-4 mm long. Difficulties of electronic noise caused by vibration of a long cable approximately 120 cm in length was solved by using a subminiature noiseless coaxial cable. The overall noise level of the CASRAD probe at 20 V bias and 40°C is less than about 40 keV beta rays equivalent. Therefore, the probe can be used to detect beta rays from 14C, 85Kr, 32P etc., provided window thickness of the probe is chosen properly. The beta-ray sensitivity of a CASRAD probe type TCK-2 is about 5,000 cpm/?Ci/ml of 32P solution. The CASRAD probe type TCK-2 has been used to hemodynamic studies including measurement of circulation time, detection of left-to-right intracardiac shunt, continuous measurement of cardiac output and measurement of coronary blood flow. Pulmonary function also has been studied by using a CASRAD probe with a collimator and 85Kr as an indicator. Malignancies of various organs such as the esophagus, stomach, lung , uterus and breast have been diagnosed by means of 32P and the CASRAD probe.

A set of GaAs biomedical probes for in vivo measurement of s- and ?-ray emitting radioactive elements has been fabricated from liquid-phase epitaxial and boat grown GaAs materials. The probes use a GaAs surface barrier diode as a radiation sensing element and utilize three diode structure shapes, such as side window, frontal window and single ended coaxial structures. The noise performance of GaAs biomedical probe was less than 18 keV at room temperature. Some of GaAs probes developed had good counting efficiency for s- and g=g-ray emitting radioisotopes and also had good energy resolution for low energy ?-ray and X-ray. The preliminary results of GaAs biomedical probes developed to diagnose malignant tumor and measure regional blood flow were good. The feasibility of GaAs detector as a fluorescent X-ray detector operating at room temperature in nuclear medicine is also discussed.

When human serum albumin is aggregated under standardized conditions, a polymer is obtained that can be successfully used to study the phagocytic capacity of the reticuloendothelial system (RES) in man. In addition to careful control of pH, temperature, amount of agitation, and concentration of the albumin solution, it is necessary to monitor the changes in optical density, to insure adequacy of the prepared material by bioassay in man, or dog, or both, and to conduct simultameous control studies in normal subjects during the study of patients. Large doses of aggregated albumin can be safety administered over prolonged periods to human subjects without evidence of hypersensitivity or excessive radiation. The phagocytic capacity of the RES in both man and dog was determined experimentally with the analytical method of Michaelis and Menten. In man, this maximal rate of phagocytosis of aggregated albumin was 1.07 mg per minute per kg of body weight. (auth)

Coronary circulation time was measured in 17 closed-chest dogs. Meas-urement was made by injecting P32 into the left ventricle, and detecting its arrival into the right ventricle with a catheter type micro G-M counter in situ. This technic was devised to exclude sources of significant error inherent to conventional dye dilution technic.Average coronary circulation time in dogs was 2.2 (0.9-3.8) sec., and was significantly shorter than that reported in published works. Appearance of P32 in the superior and inferior vena cava through systemic circulation took 5.0 and 4.6 sec. on average, respectively, occurring appreciably later than that in the right ventricle through coronary circuit. The "coronary" dilution curve, however, could not be separated from "systemic" one in the right ventricle.Discussion was also made about characteristics of the micro G-M counter, and it was suggested to be useful for in vivo measurement of radioisotopes in various ways.

Regional pulmonary blood flow was determined by measuring the amount of accumulation of I131 labelled macroaggregated albumin using modified quantitative scanning method. With this method, the regional pulmonary blood flow can be measured with simple procedure, at any posture or condition of the subject.By this method, it was demonstrated that in normal subjects supine position produced almost even distribution of blood flow to the entire lung, whereas upright position increased the flow in lower portion of the lung. Marked increase of pulmonary blood flow in the upper region of both lungs was observed in patients with mitral stenosis as well as certain case of congestive heart failure.

In 5 anesthetized dogs, "carbonized microsphere" labeled with Sr-85 was injected into left atrium, and then the heart was excised and divided into 4 heart chambers and interventricular septum. Total and regional myocardial blood flow was calculated from the relative distribution of radioactivity, the weight of each myocardium samples and cardiac output, by the principle that the injected microspheres are distributed in the heart in proportion to the distribution of the regional myocardial blood flow. Total myocardial blood flow was 5.35±1.00% of the cardiac output, and the average myocardial flow per 100Gm. of the myocardium was 76.3±15.5ml./min./100Gm. Right ventricle was supplied significantly less blood flow than left ventricle. The blood flow in the basal portion of right ventricle was less than that in the apical. There was no significant difference among the perfusion areas of left ventricle, but endocardial side of left ventricle was supplied with more flow than epi-cardial side. Interventricular septum had a similar pattern of flow distribution to left ventricular free wall. The total coronary sinus flow was collected during the injection of the microspheres using a cannula introduced into coronary sinus via right auricular appendage, and no significant coronary arteriovenous shunt was found.