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Phosphorylated H2AX (γH2AX) is a sensitive biomarker of DNA double-strand breaks (DSBs). To assess the adverse effects of low-dose radiation (

The utility of occluding the bleeding artery using an occlusion balloon catheter during stent-graft placement for visceral artery bleeding was evaluated. Stent-graft placement for visceral artery bleeding was performed using a balloon catheter in 6 patients. All bleeding occurred after biliary or pancreatic surgery. Since 1 patient underwent the procedure twice, 7 procedures were assessed in total. Technical success, procedure-related adverse events, and 30-day mortality rates were evaluated. Technical success was defined as the placement of the stent-graft at the target site and the resolution of extravasation or pseudoaneurysm. In all procedures, stent-graft placement was successfully performed (technical success rate, 100%). Focal liver infarction occurred in 2 of 7 patients (29%), but did not require further treatment and was considered a minor adverse event. The 30-day mortality rate was 0%. In conclusion, the use of an occlusion balloon in the feeding artery facilitated successful stent-graft repair of hemorrhage from visceral arteries.

Introduction In Western countries, the risk of a testicular germ cell tumor in men with male factor infertility is greater than in the general population. However, Japanese data on this risk are lacking. Additionally, the clinical course for the pathogenesis involved has not been clearly characterized. Case presentation A 35‐year‐old Japanese male underwent a right orchiectomy because of a mass in his right scrotum. He had a previous history of microdissection testicular sperm extraction undertaken 6 years ago. The final diagnosis of the right scrotal mass was a stage I seminoma. However, a relapse occurred in the left inguinal lymph node 2 years after surgery and the patient was consequently treated with systemic chemotherapy. Pathological analysis of a microdissection testicular sperm extraction sample yielded a germ cell neoplasia in situ in the right testis. Conclusion In Japan, men who seek an evaluation for infertility might be more likely to develop testicular germ cell tumor.

Background Heat shock protein 90 (HSP90) is a molecular chaperone that is responsible for the conformational maintenance of several client proteins that play important roles in DNA damage repair, apoptosis following radiation, and resistance to radiation therapy. DS-2248 (tricyclic pyrazolopyrimidine derivative) is a newly-developed, orally available inhibitor of HSP90 with low adverse effects. We investigated the combined effects of radiation and DS-2248 in vitro and in vivo. Methods SCCVII squamous cell carcinoma cells and tumors transplanted in C3H/HeN mice were used. In vitro combined effects of X-ray radiation and DS-2248 were investigated using a colony assay. Phosphorylated histone H2AX (γH2AX) was quantified after 2-Gy irradiation with or without 24-hour pretreatment with DS-2248. The mice bearing SCCVII tumors received oral DS-2248 10 times over 2 weeks and received local irradiation with doses of 1, 2, 3, and 4 Gy delivered 6 times over 2 weeks. Then, tumor volumes were measured. Results Radiation plus pretreatment with 50 nM DS-2248 for 24 hours produced synergistic effects on SCCVII cells. γH2AX foci persisted after radiation for longer periods (6 and 24 hours) in DS-2248-treated cells than in control cells. In vivo, the combined effects appeared to be additive when 5 or 10 mg/kg DS-2248 was combined with total radiation doses of 6–18 Gy, but the effect was considered supra-additive when 15 mg/kg of DS-2248 was combined with a total dose of 24 Gy. Conclusions The combined effects of DS-2248 and radiation were additive at low drug and radiation doses, but may have been supra-additive at higher doses. Inhibition of slow repair of DNA double strand breaks (i.e., homologous recombination) was considered to contribute to this combined effect.

Reoxygenation has a significant impact on the tumor response to radiotherapy. With developments in radiotherapy technology, the relevance of the reoxygenation phenomenon in treatment efficacy has been a topic of interest. Evaluating the reoxygenation in the tumor microenvironment throughout the course of radiation therapy is important in developing effective treatment strategies. In the current study, we used electron paramagnetic resonance imaging (EPRI) to directly map and quantify the partial oxygen pressure (pO

To develop and validate a novel noncontrast time-resolved magnetic resonance angiography (NC TR-MRA) using consecutive beam pulses with variable flip angles for visualizing hemodynamics in the pulmonary artery, we performed phantom and volunteer studies and applied the novel NC TR-MRA to a 51-year-old woman with pulmonary arteriovenous malformation (PAVM).The novel NC TR-MRA sequence utilized consecutive multiple-beam saturation pulses with variable flip angles considering venous blood T1 relaxation to alter the visualized blood signal length. The flowing blood signal length is suppressed according to the number of beam saturation pulses. NC TR-MRA in each flow phase was assessed by subtracting the images with and without beam saturation pulses. In the flow phantom study, three flow velocities were used to simulate physiological pulmonary arterial blood flow. Signal profiles along the flow direction were evaluated in each flow phase. In the volunteer study, five healthy volunteers were recruited, and NC TR-MRA was applied to evaluate relationships between the flow-saturated time and signal enhancement rates. Four regions of interest (ROIs) were determined on the proximal and distal portions of the right basal artery. A patient with PAVM was included to validate whether a PAVM lesion could be visualized using NC TR-MRA. The visualized flow signal lengths extended proportionally with the number of beam saturation pulses in the steady-flow phantom at all velocities. In the volunteer study, NC TR-MRA images showed signal enhancement from the proximal to distal portions of the right basal artery with increase in the flow-saturated time. Signal enhancement rates in all ROIs were significantly positively correlated with the flow-saturated time (p 0.001 in all ROIs). Further, the lesion and its hemodynamics could be explicitly visualized in the patient with PAVM. Hence, NC TR-MRA using beam saturation pulse can visualize the hemodynamics of the pulmonary artery and may be useful for diagnosing and following patients with PAVM.

We report a case of ependymoma of the broad ligament occurring in a 21-year-old woman. CT and MRI findings showed a 40-mm-diameter, well-demarcated cystic mass with a lobulated solid component in the right pelvis. The solid component showed heterogeneous intermediate signal intensity on T2-weighted image and prolonged mild contrast enhancement. The tumor was resected and confirmed as ependymoma based on the histologic findings along with its immunohistochemical profile. To our knowledge, this is the first report of an adnexal ependymoma describing the precise radiological characteristics that resembled those of borderline or malignant epithelial ovarian tumors.

Introduction The prognosis of cancer of unknown primary is very poor. Such a prognosis can be improved by characterizing primary characteristics and developing tailored site-specific therapy, especially for androgen receptor-positive adenocarcinoma. However, in such cases without elevated prostate-specific antigen, the efficacy of androgen deprivation therapy is unclear. Case presentation Herein, we report a case that presented with a retroperitoneal cancer of unknown primary that was confirmed as an androgen receptor-positive adenocarcinoma without prostate-specific antigen elevation. Pelvic magnetic resonance imaging did not reveal any suspicious cancer lesions in the prostate. Furthermore, malignant cells were not present in a prostate biopsy specimen. In spite of the prostate-specific antigen level, on the basis of immunohistochemical analyses, including NKX3.1, the patient was first treated with androgen deprivation therapy, leading to long-term progression-free survival. Conclusion Early androgen deprivation therapy based on immunohistochemical analyses might lead to a good outcome in androgen receptor-positive adenocarcinoma cancer of unknown primary patients regardless of prostate-specific antigen level.

Introduction: This study had two objectives: (i) to evaluate oncological outcomes in a long-term follow-up of patients with bladder cancer after reduced-port laparoscopic radical cystectomy (RP-LRC) and (ii) to assess the effect of modified Glasgow prognostic scores (mGPS) on patient outcomes. Methods: Consecutive patients (n = 100) who received RP-LRC between March 2012 and December 2018 at our institution and affiliated hospital were retrospectively reviewed. Preoperative serum albumin and C-reactive protein levels were determined. Patients were grouped based on clinical T stage (≤cT2: n = 75, ≥cT3: n = 25) using pooled cumulative data. Oncological outcomes and mGPS as a prognostic biomarker were analyzed retrospectively. Kaplan-Meier curves displayed recurrence and survival rates. Univariate and multivariate Cox regression analyses evaluated potential prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Patient characteristics between the two groups were statistically similar for preoperative hematological and mGPS status, blood loss level, rate of allogeneic transfusion, and pneumoperitoneum time. After a median follow-up period of 55 months, 40/100 patients experienced disease relapse. RFS and CSS for ≤cT2 were significantly less than for ≥cT3 (p < 0.001, p < 0.05, respectively). Distant metastasis occurred in 30 patients with similar distributions of relapse sites between T-stage cohorts. Median RFS for mGPS 1/2 were 18.9 (95% confidence interval [CI]: 8.8–not assessed [NA]) and 35.0 (95% CI: 8.7–NA) months, respectively, significantly worse than for mGPS 0 (median NA, 95% CI: NA–NA); CSS was similar. Univariate and multivariate analyses revealed ≥cT3 stage, worse clinical N stage, and poor mGPS status were significant prognostic factors for short RFS and CSS. Conclusions: A large proportion of bladder cancer patients who undergo RP-LRC experience relapse, with ≥cT3 stage, worse clinical N stage or poor mGPS status identified as significant prognostic factors. Our findings may contribute to improved surgical procedures for such patients.

Dynamic nuclear polarization (DNP) of 13 C-labeled substrates enables the use of magnetic resonance imaging (MRI) to monitor specific enzymatic reactions in tumors and offers an opportunity to investigate these differences. In this study, DNP-MRI chemical shift imaging with hyperpolarized [1-13 C] pyruvate was conducted to evaluate the metabolic change in glycolytic profiles after radiation of two glioma stem-like cell-derived gliomas (GBMJ1 and NSC11) and an adherent human glioblastoma cell line (U251) in an orthotopic xenograft mouse model. The DNP-MRI showed an increase in Lac/Pyr at 6 and 16 h after irradiation (18% ± 4% and 14% ± 3%, respectively; mean ± SEM) compared with unirradiated controls in GBMJ1 tumors, whereas no significant change was observed in U251 and NSC11 tumors. Metabolomic analysis likewise showed a significant increase in lactate in GBMJ1 tumors at 16 h. An immunoblot assay showed upregulation of lactate dehydrogenase-A expression in GBMJ1 following radiation exposure, consistent with DNP-MRI and metabolomic analysis. In conclusion, our preclinical study demonstrates that the DNP-MRI technique has the potential to be a powerful diagnostic method with which to evaluate GBM tumor metabolism before and after radiation in the clinical setting.

Dynamic nuclear polarization (DNP) of 13C‐labeled substrates enables the use of magnetic resonance imaging (MRI) to monitor specific enzymatic reactions in tumors and offers an opportunity to investigate these differences. In this study, DNP‐MRI chemical shift imaging with hyperpolarized [1‐13C] pyruvate was conducted to evaluate the metabolic change in glycolytic profiles after radiation of two glioma stem‐like cell‐derived gliomas (GBMJ1 and NSC11) and an adherent human glioblastoma cell line (U251) in an orthotopic xenograft mouse model. The DNP‐MRI showed an increase in Lac/Pyr at 6 and 16 h after irradiation (18% ± 4% and 14% ± 3%, respectively; mean ± SEM) compared with unirradiated controls in GBMJ1 tumors, whereas no significant change was observed in U251 and NSC11 tumors. Metabolomic analysis likewise showed a significant increase in lactate in GBMJ1 tumors at 16 h. An immunoblot assay showed upregulation of lactate dehydrogenase‐A expression in GBMJ1 following radiation exposure, consistent with DNP‐MRI and metabolomic analysis. In conclusion, our preclinical study demonstrates that the DNP‐MRI technique has the potential to be a powerful diagnostic method with which to evaluate GBM tumor metabolism before and after radiation in the clinical setting., Orthotopic brain tumor mice were subjected to 13C‐MRI using hyperpolarized [1‐13C] pyruvate to investigate the effect of radiation exposure on glucose metabolism by measuring lactate‐to‐pyruvate ratio in the tumor. Tissue sampling was conducted independently to quantify the lactate concentration and LDHA expression by metabolomic and immunoblot analyses, respectively. These indicated an acceleration of lactate‐to‐pyruvate conversion in one of the stem‐like cell‐derived gliomas after an irradiation during a 24‐h period of time.

To examine the relationship between local oxygen partial pressure and energy metabolism in the tumor, electron paramagnetic resonance imaging (EPRI) and magnetic resonance imaging (MRI) with hyperpolarized [1-13C] pyruvate were performed. SCCVII and HT29 solid tumors implanted in the mouse leg were imaged by EPRI using OX063, a paramagnetic probe and 13C-MRI using hyperpolarized [1-13C] pyruvate. Local partial oxygen pressure and pyruvate metabolism in the two tumor implants were examined. The effect of a single dose of 5-Gy irradiation on the pO2 and metabolism was also investigated by sequential imaging of EPRI and 13C-MRI in HT29 tumors. A phantom study using tubes filled with different concentration of [1-13C] pyruvate, [1-13C] lactate, and OX063 at different levels of oxygen confirmed the validity of this sequential imaging of EPRI and hyperpolarized 13C-MRI. In vivo studies revealed SCCVII tumor had a significantly larger hypoxic fraction (pO2 < 8 mmHg) compared to HT29 tumor. The flux of pyruvate-to-lactate conversion was also higher in SCCVII than HT29. The lactate-to-pyruvate ratio in hypoxic regions (pO2 < 8 mmHg) 24 hours after 5-Gy irradiation was significantly higher than those without irradiation (0.76 vs. 0.36) in HT29 tumor. The in vitro study showed an increase in extracellular acidification rate after irradiation. In conclusion, co-imaging of pO2 and pyruvate-to-lactate conversion kinetics successfully showed the local metabolic changes especially in hypoxic area induced by radiation therapy.

Purpose To evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs). Materials and Methods Thirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9–83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5–6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6–36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135–0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography. Results In 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2–47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization. Conclusions Hydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

Hypoxia is considered one of the microenvironmental factors associated with the malignant nature of glioblastoma. Thus, evaluating intratumoural distribution of hypoxia would be useful for therapeutic planning as well as assessment of its effectiveness during the therapy. Electron paramagnetic resonance imaging (EPRI) is an imaging technique which can generate quantitative maps of oxygen in vivo using the exogenous paramagnetic compound, triarylmethyl and monitoring its line broadening caused by oxygen. In this study, the feasibility of EPRI for assessment of oxygen distribution in the glioblastoma using orthotopic U87 and U251 xenograft model is examined. Heterogeneous distribution of pO2 between 0 and 50 mmHg was observed throughout the tumours except for the normal brain tissue. U251 glioblastoma was more likely to exhibit hypoxia than U87 for comparable tumour size (median pO2; 29.7 and 18.2 mmHg, p = .028, in U87 and U251, respectively). The area with pO2 under 10 mmHg on the EPR oximetry (HF...

Boron isotopes are widely used as a proxy of marine carbonate in paleoclimatology to reconstruct seawater pH and atmospheric pCO2, and precise and accurate boron isotopic analysis is required for this purpose. Determination of boron isotopic composition is susceptible to contamination, especially for sample analyses with small amounts of boron; however, sources of experimental and laboratory contamination are not clearly evaluated. In this study, boron and boron isotope contamination during the analysis of small carbonate samples were examined in detail during sample cleaning, sample storage, chemical separation, and isotope measurement. Repeated cleaning of foraminifera shells using H2O with ultrasonication effectively minimized boron contamination from clay-rich material; however, an additional cleaning step with methanol and H2O2 is recommended to obtain repeatable precise δ11B, δ18O, and Mg/Ca values. Boron contamination during sample storage in a glass vial was far greater than expected. Glass-derived boron attached to foraminifera shells could not be completely removed by any physical or chemical cleaning process and influenced the δ11B value significantly. Even when a low-boron HEPA, boron-free HEPA, or ULPA filter was used for air-handling in the laboratory, airborne contamination by gaseous boron can still be significant, with seasonal variation in abundance and isotopic composition. Although this affects the procedural blank of boron during chemical separation, an acid-removing chemical filter can reduce the airborne boron flux. An autosampler in the MC-ICPMS analysis might be an additional source of airborne boron contamination.

BACKGROUND: The effects of the reduction of low-energy X-ray spectrum on lung perfusion images created by dual-energy CT have not been well evaluated. The aim of this study is to investigate the reliability of lung perfusion blood volume (PBV) images created by dual-energy CT (DECT) equipped with or without a tin filter, focusing on its accuracy adjacent to high-attenuation areas. MATERIAL AND METHODS: Among 176 patients who underwent DECT for suspicion of pulmonary embolism, 38 patients (mean age, 64; range, 16 to 83 years) without apparent evidence of pulmonary embolism were evaluated in this study. They underwent DECT at 100/140 kVp with a tin filter on 140 kVp tube (Group A; n=18) or at 80/140 kVp without the filter (Group B; n=20). On the lung PBV images, the degrees of artifacts - pulmonary enhancement defect (PED) and pseudo-enhancement in the trachea (PTE) adjacent to the vena cava were evaluated using a four-point scale (0=minimal to 3=prominent). RESULTS: The mean degrees of artifact in Group A were significantly lower than those in Group B (0.8 vs. 1.9; P

Summary Background Spinal artery ischemia is a rare but serious complication of embolization for treatment of hemoptysis. When the spinal artery is visualized at angiography, embolization should not be performed. However, it has been reported that spinal artery feeders are not visible on angiography in patients with developing spinal infarction. Case Report A 70-year-old man with a history of pulmonary aspergillosis had hemoptysis and underwent contrast-enhanced CT, revealing a pulmonary artery pseudoaneurysm (PAP) in the left upper lobe. Systemic angiography from the fifth left intercostal artery showed the PAP at the distal site, but the access route to the PAP was very tortuous and long. Although the spinal branch could not be observed with that angiography, CT during angiography was performed, and it visualized the posterior spinal artery obviously. Thus, the artery distal and proximal to the PAP was then successfully coil-embolized from the pulmonary artery. Conclusions CT during angiography may be useful to confirm the presence of the spinal artery for treatment of hemoptysis by embolization.

Objective Oral mucositis is a common adverse reaction to radiotherapy for head and neck cancer, and there are concerns regarding a decreased quality of life in patients receiving radiotherapy. The purpose of this study was to investigate the relationship between the severity of radiation-induced oral mucositis and the myeloperoxidase (MPO) levels in irradiated tissues. Study Design Ninety-six F344 rats were divided into the following 4 groups: 10-Gy, 18-Gy, and 30-Gy irradiation groups, and a nonirradiation group. Oral mucositis was induced by the administration of single doses of radiation via exposure. After irradiation, the rats were evaluated on the basis of weight measurements, macroscopic findings according to a grading scale (Oral Mucositis Index [OMI]), and the results of tissue MPO assays. Results Weights decreased whereas the OMI scores and MPO levels increased, depending on the dose of exposure. The Spearman rank correlation test showed a significant correlation between the OMI scores and the MPO levels in the tissues with a correlation coefficient of 0.824 (P Conclusions In this study, the MPO levels in the irradiated tissue were increased in the cases involving severe radiation-induced oral mucositis evaluated in rats using a grading scale.

We examined whether the shortened breath-hold 3-dimensional volumetric interpolated breath-hold examination (3D-VIBE) sequence for high acceleration factor (AF) using the controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) could substitute for the conventional sequence using generalized autocalibrating partially parallel acquisition (GRAPPA) in patients undergoing routine gadoxetic acid-enhanced liver MRI. Thirty patients with clinically suspected focal liver lesions were scanned using 3D-VIBE sequences with GRAPPA with AF = 2 and AF = 4 and CAIPIRINHA with AF = 4 (acquisition times: 21, 14, and 12 s, respectively) during the hepatobiliary phase. Visual evaluations using a 3- or 5-point scale and signal-to-noise ratio (SNR) analysis were performed for the 3 sequences. For CAIPIRINHA with AF = 4, there was significantly less image noise in both visual evaluation and SNR analysis and fewer parallel imaging artifacts than for GRAPPA with AF = 4 (P

本論文の目的は、KINKの値毎でまとめられた、時価総額加重平均株式収益率の間に、有意な差があるのかを調べることである。KINKとは、最適支払利子額と実質支払利子額との比であり、資本構成を評価するのに使われる。先行研究で、私たちはKINKの平均回帰性について分析し、KINKは時間をかけてある範囲内に向けて回帰することを示した。つまり、KINKの値が小さい企業は、KINKが大きくなるように変化し、KINKの値が大きい企業は、KINKが小さくなるように変化するということだ。また、KINKの値が0から5の企業群を5つのグループに分け、一分位目に属する企業群の時価総額加重平均株式収益率と五分位目に属する企業群の時価総額加重平均株式収益率との間に、有意な差があるのか確認した。結果、その間には有意な差があった。しかしながら、KINKの値が0の企業は、その他の値の企業よりも非常に多い。それゆえに、先行研究の結果は、偏っている可能性がある。そこで本研究では、KINKの範囲に注目するのではなく、KINKの値に注目して分析を行う。, The purpose of this paper is to verify whether there are statistically significant differences among the capitalization weighted stock returns grouped by the value of “KINK". “KINK" is the ratio of the optimal interest payment to the actual interest payment, which is used to assess the capital structure. In the previous paper, we analyzed the mean reversion of KINK and verified that it reverts to within a certain range over time. In other words, the companies with small KINKs will undergo changes so that their KINKs increase, whereas those with large KINKs will undergo changes so that their KINKs decrease. Also, we divided the companies of KINKs from 0 to 5 into five groups and analyzed the significant differences of the capitalization weighted stock returns between the lowest group and the highest group. As a result, we observed the significant differences between two groups. However, the number of companies of the zero value of KINK is much larger than the number of other companies. Therefore, the empirical results of previous papers may be biased. Hence, in this paper, we need not to focus on the range concerning KINK but on its value.

Hypoxia is considered one of microenvironmental factors associated with the malignant nature of glioblastoma. Thus, evaluating intratumoral distribution of hypoxia would be useful for therapeutic planning as well as assessment of its effectiveness during the therapy. Electron paramagnetic resonance imaging (EPRI), is an imaging technique which can generate quantitative maps of oxygen in vivo using the exogenous paramagnetic compound, triarylmethyl and monitoring its line broadening caused by oxygen. In this study, the feasibility of EPRI for assessment of oxygen distribution in the glioblastoma using orthotopic U87 and U251 xenograft model. Heterogeneous distribution of pO(2) between 0 and 50 mmHg was observed throughout the tumors except for the normal brain tissue. U251 glioblastoma was more likely to exhibit hypoxia than U87 for comparable tumor size (median pO(2); 29.7 mmHg and 18.2 mmHg, P = 0.028, in U87 and U251, respectively). The area with pO(2) under 10 mmHg on the EPR oximetry (HF10) showed a good correlation with pimonidazole staining among tumors with evaluated size. In subcutaneous xenograft model, irradiation was relatively less effective for U251 compared to U87. In conclusion, EPRI is a feasible method to evaluate oxygen distribution in the brain tumor.

本論文では、企業の資本構成がどのように株価に影響をするのかを推定する。企業の成長に必要な資金を負債で調達するか新株発行により調達するかは極めて重要な選択であり、どちらが有効なのかという課題がある。その課題を解決する糸口を探すため、我々は最適な負債の量を支払利子額の観点から推定した。そして、その最適な負債額に近い負債をとっている企業と、その値から離れている企業とで、株価にはどのような影響が出ているのかを実証分析した。, This paper estimates how the capital structure of company influences on the stock price. Which is better for company, using equity capital or liabilities to raise the business valuation? To answer this question, we estimated the optimal amount of liabilities in terms of tax benefits. Then we analyzed how the gap between the optimal amount and the actual amount concerning liabilities influences on the stock price.

To investigate the usefulness of MRI for detection of sarcomatoid renal cell carcinoma (SRCC) components within RCC and differentiation from other renal tumors.Two observers independently interpreted T2-weighted images of 10 patients with pathologically confirmed RCCs with SRCC and 131 with non-SRCC renal tumors, with special reference to conspicuously low signal intensity (SI) areas (T2LIA) compared to the renal cortex. SRCC probability was classified as (1) definitely non-SRCC, no T2LIA; (2) probably non-SRCC,1 cm T2LIA; (3) low probability of SRCC, homogeneous tumor with 1-3 cm T2LIA; (4) probably SRCC, heterogeneous tumor with 1-3 cm T2LIA; and (5) definitely SRCC,3 cm T2LIA, multiple1 cm T2LIAs, or showing disruption of the pseudocapsule. The observers used chemical shift imaging to exclude the area representing hemorrhage or hemosiderin deposition from T2LIA. Scores of 4/5 were regarded as positive for evaluating the accuracy and area under the receiver operating characteristic curve. The SI ratio of the lowest SI in the tumor to that of the renal cortex in the 1 and ≥2 score groups was compared using Mann-Whitney's U test.Sensitivity, specificity, accuracy, and positive and negative predictive values were 90%, 95%, 94%, 56%, and 99%, respectively, and area under the receiver operating characteristic curve was 0.93. The mean SI ratio of the lowest SI in the tumor to that of the renal cortex was significantly lower in the ≥2 score group (0.58) than in the 1 score group (1.36).MRI predicted RCC with SRCC with a moderate positive predictive value and a high negative predictive value.

OBJECTIVES: Since the cancer stem-like cells (CSCs) play an important role in the resistance against radiation therapy due to its different metabolic profile, investigation of the specific metabolic characteristics of CSCs is valuable. Dynamic nuclear polarization (DNP) technique using 13C-labeled substrates enables magnetic resonance imaging (MRI) to monitor specific enzymatic reactions in tumors. In this study, DNP-MRI along with hyperpolarized [1-13C] pyruvate was conducted to evaluate the metabolic change in glycolytic profiles after irradiation between a glioblastoma cell line and a CSC-derived glioma using orthotopic xenograft mouse model. A microarray analysis was also performed to compare to the imaging study. METHODS: DNP-MRI A 3T MRI scanner along with a custom-made head coil was used. To obtain hyperpolarized [1-13C] pyruvate, 30 μL of [1-13C] pyruvic acid containing 15 mM of OX063 (trityl radical compound) and 2.5 mM of the gadolinium chelate were polarized at 3.35 T and 1.4 K in the Hypersense DNP polarizer. The hyperpolarized sample dissolved in a buffered medium was injected via the tail vein followed by an acquisition of 13C-two-dimensional MR-spectroscopy to measure the pyruvate-to-lactate ratios (Lac/Pyr) in the tumor region and the contralateral normal brain separately. Cell lines A human glioblastoma cell line, U251 and a glioma CSC line, NSC11 were cultured for stereotactic intracranial injection. Animal model Orthotopic brain tumor model was developed in athymic nude mice by intracranial implantation. When the tumor volume reached 50 +/- 10 mm3 on T2-weighted MRI, a sequence of DNP-MRI scans was performed 24 hours before and 6, 16 and 24 after 6-Gy whole-brain irradiation (N = 4 each with a non-irradiated control group). Independently, a microarray analysis using the tumor tissue samples excised 6 and 24 hours after irradiation was performed on Affymetrix Human Genome U133 Plus 2.0 array. RESULTS: DNP-MRI showed a decrease in Lac/Pyr 6 and 16 hours after irradiation compared to the control group in U251 whereas no significant change was observed in the NSC11 tumor. The microarray analysis showed a significant down-regulation of lactate dehydrogenase A (LDH-A) expression in U251 6 and 24 hours after irradiation, consistent with the finding of DNP-MRI. In the microarray analysis, SIRT2 and KLF4 expression also changed in the U251 tumor, suggested to regulate the LDH-A activity/expression. CONCLUSION: DNP-MRI demonstrated the difference in radiation response in glycolytic metabolism between the glioblastoma cell line and the CSC-derived glioma. This technique might be a feasible diagnostic method evaluating metabolic profiles of the brain tumors in the clinical settings of pretreatment and post-treatment. Citation Format: Tatsuya Kawai, Murali C. Krishna, Tamalee Kramp, Jeffery R. Brender, Philip Tofilon, Kevin A. Camphausen. Detection of metabolic change in glioblastoma after radiotherapy using hyperpolarized 13C-MRI: Glycolytic metabolism in cancer stem cell-like cell-derived tumor model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1944.

Background The effects of a tin filter on virtual non-enhanced (VNE) images created by dual-energy CT have not been well evaluated. Purpose To compare the accuracy of VNE images between those with and without a tin filter. Material and Methods Two different types of columnar phantoms made of agarose gel were evaluated. Phantom A contained various concentrations of iodine (4.5–1590 HU at 120 kVp). Phantom B consisted of a central component (0, 10, 25, and 40 mgI/cm3) and a surrounding component (0, 50, 100, and 200 mgI/cm3) with variable iodine concentration. They were scanned by dual-source CT in conventional single-energy mode and dual-energy mode with and without a tin filter. CT values on each gel at the corresponding points were measured and the accuracy of iodine removal was evaluated. Results On VNE images, the CT number of the gel of Phantom A fell within the range between –15 and +15 HU under 626 and 881 HU at single-energy 120 kVp with and without a tin filter, respectively. With attenuation over these thresholds, iodine concentration of gels was underestimated with the tin filter but overestimated without it. For Phantom B, the mean CT numbers on VNE images in the central gel component surrounded by the gel with iodine concentrations of 0, 50, 100, and 200 mgI/cm3 were in the range of –19–+6 HU and 21–100 HU with and without the tin filter, respectively. Conclusion Both with and without a tin filter, iodine removal was accurate under a threshold of iodine concentration. Although a surrounding structure with higher attenuation decreased the accuracy, a tin filter improved the margin of error.

To construct a diagnostic model for differentiating carcinosarcoma from carcinoma of the uterus. Twenty-six patients with carcinosarcomas and 26 with uterine corpus carcinomas constituted a derivation cohort. The following nine MRI features of the tumors were evaluated: inhomogeneity, predominant signal intensity, presence of hyper- and hypointense areas, conspicuity of tumor margin, cervical canal extension on T2WI, presence of hyperintense areas on T1WI, contrast defect area volume percentage, and degree of enhancement. Two predictive models—with and without contrast—were constructed using multivariate logistic regression analysis. Fifteen other patients with carcinosarcomas and 30 patients with carcinomas constituted a validation cohort. The sensitivity and specificity of each model for the validation cohort were calculated. Inhomogeneity, predominant signal intensity on T2WI, and presence of hyperintense areas on T1WI were significant predictors in the unenhanced-MRI-based model. Presence of hyperintensity on T1WI, contrast defect area volume percentage, and degree of enhancement were significant predictors in the enhanced-MRI-based model. The sensitivity/specificity of unenhanced MRI were 87/73 and 87/70% according to reviewer 1 and 2, respectively. The sensitivity/specificity of the enhanced-MRI-based model were 87/70% according to both reviewers. Our diagnostic models can differentiate carcinosarcoma from carcinoma of the uterus with high sensitivity and moderate specificity.

Objective To assess the value of contrast-enhanced MRI, apparent diffusion coefficient (ADC) measurement, and CA-125 measurement for differentiating borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MEOTs). Material and methods This retrospective study included 43 patients with BOTs and 43 patients with stage I MEOTs who underwent contrast-enhanced MRI with DWI and CA-125 analysis. Two radiologists evaluated the MRI findings in consensus. Univariate and multivariate analyses were performed to detect the best predictor variables for MEOTs. Results Mixed cystic/solid and predominantly solid appearances, as well as thickened irregular septa, were more frequent in MEOTs. A papillary architecture and internal branching (PA&IB) pattern was more frequent in BOTs. MEOTs had thicker walls and septa, larger solid components, and higher CA-125 values. The mean ADC value of solid components (ADCmean) and minimum ADC value of whole lesions (ADCmin) were lower in MEOTs. Multivariate analysis revealed that ADCmin and maximum diameter of the solid components were independent indicators of MEOTs with an AUC, sensitivity, and specificity of 0.86, 81%, and 84%, respectively. Conclusion ADCmin and maximum diameter of solid components were useful for differentiating BOTs from MEOTs.

Summary Background: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, CT examination is susceptible to coil artifacts, which sometimes makes it difficult to assess recanalization. We report 2 cases where recanalization was successfully visualized using time-resolved magnetic resonance angiography after coil embolization of visceral artery aneurysms (one case of right internal iliac artery aneurysm and one case of splenic artery aneurysm). Repeat coil embolization was successfully performed. Case Report: Case 1. An 80-year-old male patient with right internal iliac artery (IIA) aneurysm underwent coil embolization. Aneurysm was located at the bifurcation of the right IIA and therefore, after making a femorofemoral bypass, the distal part of the right IIA, aneurysm and the common iliac artery were embolized with a coil. One year later, the size of the aneurysm seemed to have increased on CT. However, the details were not determined because of metal artifacts. Thus, time-resolved MRA was performed and showed minute vascular flow inside the aneurysm. Angiography was subsequently performed and blood flow inside the aneurysm was visualized similar to the findings in time-resolved MRA. Coil embolization was performed once more and vascular flow inside the aneurysm disappeared. Case 2. A 36-year-old male patient with a splenic artery aneurysm underwent coil packing with preservation of splenic artery patency. Four years later, coil compaction was suspected in a CT scan, but CT could not evaluate recanalization because of severe metal artifacts. Angiography was subsequently performed, showing recanalization of the aneurysm as did the time-resolved MRA. Therefore, coil embolization of the aneurysm and splenic artery was performed again. Conclusions: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, it is sometimes difficult to assess recanalization with CT because of artifacts caused by metal. In our cases, recanalization of aneurysms was clearly shown by time-resolved MRA and re-embolization was successfully performed. In conclusion, time-resolved MRA appears to be useful in assessment of recanalization of visceral artery aneurysms after coil embolization.

Background Transcatheter arterial chemoembolization (TACE) has been widely performed for inoperable hepatocellular carcinoma (HCC). Super-selective TACE is preferable to non-selective therapy and it is important to advance the catheter tip as close to the tumor as possible in the feeding artery. A new microcatheter with a 1.9-Fr non-tapered tip has recently become available and this new microcatheter can be inserted into a 2.7-Fr. microcatheter. It is called the triple co-axial (triaxial) system. Purpose To evaluate the clinical usefulness of super-selective TACE for HCC using the triaxial system. Material and Methods We evaluated 63 HCCs that underwent super-selective TACE. Requirements for inclusion in this study were: (a) HCCs 3 cm or less in diameter; (b) TACE performed by a single operator; and (c) no additional treatment in the absence of local progression. All patients were followed for more than 1 year after TACE. The median follow-up period for surviving patients was 20 months (range, 17–31 months). The conventional system was used in 35 HCCs (control group), and the triaxial system was used in 28 (triaxial group). We reviewed angiographies at TACE and follow-up CT, and then evaluated local tumor status in the two groups. Results Local tumor control rates at 3, 6, and 18 months were 64%, 36%, and 29%, respectively, in the triaxial group, and 40%, 14%, and 8.6%, respectively, in the control group ( P = 0.0086). There were no major complications in either group. Conclusion The triaxial system appears to be useful for super-selective TACE and may contribute to achieving higher local control rates for HCC.

Rationale and Objectives Evaluation of contrast enhancement of pulmonary lesions with ground-glass attenuation (GGA) is difficult with conventional techniques but might be possible using contrast-mapping images (CMIs) obtained by dual-energy computed tomography. To address this issue, a phantom study was conducted, and this technique was then applied to clinical cases. Materials and Methods Phantoms made of agarose gel and those made of hollow resin clay, containing various concentrations of iodine or calcium, were used to simulate soft tissue and GGA, respectively. They were scanned using a dual-energy computed tomographic scanner, and the relationship between iodine concentration and calculated iodine value on CMIs was examined. The influence of calcium was also evaluated. In addition, contrast enhancement of 24 GGA lesions was evaluated on CMIs. Results There was a good correlation between iodine value and iodine concentration in the soft-tissue models ( r 2 = 0.996). In the GGA models, the former tended to exceed the latter when default parameters for calculating CMIs were used, but this could be corrected by modifying the parameters ( r 2 = 0.998). The iodine value increased with calcium concentration in both models. On CMIs, contrast enhancement was visible in 22 adenocarcinomas but not in a pulmonary hemorrhage and an inflammatory change. Conclusions Dual-energy computed tomography can evaluate contrast enhancement of GGA lesions.

Objectives: Transcatheter arterial chemoembolisation (TACE) has been widely used for inoperable hepatocellular carcinoma (HCC). Super-selective TACE is preferable to non-selective therapy, because it maximises the impact of treatment on the tumour while minimising damage to tumour-free liver parenchyma. It is therefore important to advance the catheter tip as close as possible in the feeding artery. There is now a new microcatheter with a 1.9-Fr tip with no taper, which can be inserted into a 2.7-Fr microcatheter. In this study we describe the new technique of using the two microcatheters called the triaxial microcatheter method. Methods: We evaluated 30 TACE procedures to investigate whether or not the catheter tip could be advanced closer to HCC with the triaxial microcatheter method than with previous TACE using a conventional microcatheter. Results: With conventional microcatheters, the level of embolisation was a lobar artery in 4 cases, segmental in 8 cases, subsegmental in 15 cases and sub-subsegmental in only 1 case. TACE could not be performed in two cases. When using the triaxial microcatheter method the level of embolisation was subsegmental in 8 cases, including 2 in which the level was the same as that with a conventional microcatheter, subsubsegmental in 13 cases and more distal in 7 cases. In the two cases in which TACE could not be performed with the conventional microcatheter, it could be performed sufficiently using the new method. As a whole, in 28 of the 30 procedures (93%) we could successfully advance a catheter tip closer than with the previous TACE. Conclusion: The triaxial microcatheter method appears to be useful.