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Physical activity has been known to improve survival and quality of life of patients with breast cancer. To find factors associated with physical activity, we analyzed the dataset of the multicenter controlled trial of exercise intervention. Three hundred fifty-six participants were assigned to two groups: “Smart After-Care” (smartphone application and pedometer were provided) or exercise education only. Physical activity was measured by International Physical Activity Questionnaire–Short Form (IPAQ-SF) at baseline and after 12 weeks. The association between physical activity and other clinical characteristics was analyzed. At baseline, physical activity amount was 2315.5 ± 3513.2 MET min/week: 33.0% inactive, 49.6% minimally active, and 17.4% health-enhancing physical activity (HEPA) active. Factors associated with HEPA include cancer stage and grip strength. A significantly lower proportion was HEPA active among those with advanced stage than among those with stage 0. After intervention, physical activity was increased to 3466.2 ± 4712.5 MET min/week: 15.3% inactive, 50.4% minimally active, and 34.2% HEPA active. Physical activity was increased in 63.4% of the participants. Factors associated with physical activity increase include cancer stage, diarrhea, and type of exercise intervention. Participants with advanced stage have a 3.3 times higher chance of increasing physical activity. Participants who received “Smart After-Care” have a 64% higher chance of increasing physical activity. Before the intervention, participants with advanced stage are less likely to be HEPA active. Exercise intervention was more beneficial for those with advanced stage or physical symptoms. “Smart After-Care” was more effective than education only in increasing physical activity.

To investigate and compare the effects of mobile health (mHealth) and pedometer with conventional exercise program using a brochure on physical function and quality of life (QOL).The study was a prospective, quasi-randomized multicenter trial where 356 patients whose cancer treatment had been terminated were enrolled. All patients were instructed to perform a 12-week regimen of aerobic and resistance exercise. The mHealth group received a pedometer and a newly developed smartphone application to provide information and monitor the prescribed exercises. Those in the conventional group received an exercise brochure. Physical measurements were conducted at baseline, 6 weeks, and 12 weeks. Self-reported physical activity (international physical activity questionnaire-short form), general QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30), and breast cancer-specific QOL (Quality of Life Questionnaire Breast Cancer Module 23) were assessed at baseline and 12 weeks. A user satisfaction survey was assessed in the mHealth group.Basic characteristics were not different between the two groups except for age and previous radiotherapy. Physical function, physical activity, and QOL scores were significantly improved regardless of the intervention method, and changes were not significantly different between the two groups. Additionally, the mean Likert scale response for overall satisfaction with the service was 4.27/5 in the mHealth group.Overall, both the mHealth coupled with pedometer and conventional exercise education using a brochure were effective in improving physical function, physical activity, and QOL. This study provides a basis of mHealth research in breast cancer patients for progressing further developing field, although superiority of the mHealth over the conventional program was not definitely evident.

Purpose: As Parkinson’s disease (PD) can be considered a network abnormality, the effects of deep brain stimulation (DBS) need to be investigated in the aspect of networks. This study aimed to examine how DBS of the bilateral subthalamic nucleus (STN) affects the motor networks of patients with idiopathic PD during motor performance and to show the feasibility of the network analysis using crosssectional positron emission tomography (PET) images in DBS studies. Materials and Methods: We obtained [ 15 O]H2O PET images from ten patients with PD during a sequential finger-to-thumb opposition task and during the resting state, with DBS-On and DBS-Off at STN. To identify the alteration of motor networks in PD and their changes due to STN-DBS, we applied independent component analysis (ICA) to all the cross-sectional PET images. We analysed the strength of each component according to DBS effects, task effects and interaction effects. Results: ICA blindly decomposed components of functionally associated distributed clusters, which were comparable to the results of univariate statistical parametric mapping. ICA further revealed that STN-DBS modifies usage-strengths of components corresponding to the basal ganglia-thalamo-cortical circuits in PD patients by increasing the hypoactive basal ganglia and by suppressing the hyperactive cortical motor areas, ventrolateral thalamus and cerebellum. Conclusion: Our results suggest that STN-DBS may affect not only the abnormal local activity, but also alter brain networks in patients with PD. This study also demonstrated the usefulness of ICA for cross-sectional PET data to reveal network modifications due to DBS, which was not observable using the subtraction method.

The aim of this study was to evaluate the prognostic value of metabolic tumor volume (MTV) on pre-treatment F-18 fluorodeoxyglucose (FDG) PET/CT in patients with hepatocellular carcinoma (HCC). A total of 59 HCC patients who underwent FDG PET/CT before transarterial chemoembolization (TACE) or transarterial chemotherapy infusion (TACI) were retrospectively enrolled. The region of interest was drawn in the HCC and normal liver tissue. MTV2SD, defined as the sum of the voxels with higher standardized uptake values (SUV) than the SUV of the 97.5th percentile of voxels of the normal liver for each patient, was calculated using an intensity–volume histogram (IVH). The ratio of the maximum SUV of the tumor to the mean SUV of normal liver (T max/L mean) was also calculated. The prognostic significance of MTV2SD and Tmax/Lmean for progression-free survival (PFS) and overall survival (OS) was evaluated along with other clinical factors. The tumor number, Tmax/Lmean, and MTV2SD were significant prognostic factors affecting PFS (p

Pulmonary lesions from active tuberculosis patients are thought to contain persistent, nonreplicating bacilli that arise from hypoxic stress. Metronidazole, approved for anaerobic infections, has antituberculosis activity against anoxic bacilli in vitro and in some animal models and may target persistent, nonreplicating bacilli. In this double-blind, placebo-controlled trial, pulmonary multidrug-resistant tuberculosis subjects were randomly assigned to receive metronidazole (500 mg thrice daily) or placebo for 8 weeks in addition to an individualized background regimen. Outcomes were measured radiologically (change on high-resolution computed tomography [HRCT]), microbiologically (time to sputum smear and culture conversion), and clinically (status 6 months after stopping therapy). Enrollment was stopped early due to excessive peripheral neuropathies in the metronidazole arm. Among 35 randomized subjects, 31 (15 metronidazole, 16 placebo) were included in the modified intent-to-treat analysis. There were no significant differences by arm in improvement of HRCT lesions from baseline to 2 or 6 months. More subjects in the metronidazole arm converted their sputum smear ( P = 0.04) and liquid culture ( P = 0.04) to negative at 1 month, but these differences were lost by 2 months. Overall, 81% showed clinical success 6 months after stopping therapy, with no differences by arm. However, 8/16 (50%) of subjects in the metronidazole group and 2/17 (12%) of those in the placebo group developed peripheral neuropathy. Subjects who received metronidazole were 4.3-fold (95% confidence interval [CI], 1.1 to 17.1) more likely to develop peripheral neuropathies than subjects who received placebo. Metronidazole may have increased early sputum smear and culture conversion but was too neurotoxic to use over the longer term. Newer nitroimidazoles with both aerobic and anaerobic activity, now in clinical trials, may increase the sterilizing potency of future treatment regimens.

γ-aminobutyric acid (GABA)-A receptor–mediated neural transmission is important to promote practice-dependent plasticity after brain injury. This study investigated alterations in GABA-A receptor binding and functional and anatomic connectivity within the motor cortex in children with cerebral palsy (CP). Methods: We conducted 18F-fluoroflumazenil PET on children with hemiplegic CP to investigate whether in vivo GABA-A receptor binding is altered in the ipsilateral or contralateral hemisphere of the lesion site. To evaluate changes in the GABA-A receptor subunit after prenatal brain injury, we performed GABA-A receptor immunohistochemistry using rat pups with a diffuse hypoxic ischemic insult. We also performed diffusion tensor MR imaging and resting-state functional MR imaging on the same children with hemiplegic CP to investigate alterations in anatomic and functional connectivity at the motor cortex with increased GABA-A receptor binding. Results: In children with hemiplegic CP, the 18F-fluoroflumazenil binding potential was increased within the ipsilateral motor cortex. GABA-A receptors with the α1 subunit were highly expressed exclusively within cortical layers III, IV, and VI of the motor cortex in rat pups. The motor cortex with increased GABA-A receptor binding in children with hemiplegic CP had reduced thalamocortical and corticocortical connectivity, which might be linked to increased GABA-A receptor distribution in cortical layers in rats. Conclusion: Increased expression of the GABA-A receptor α1 subunit within the ipsilateral motor cortex may be an important adaptive mechanism after prenatal brain injury in children with CP but may be associated with improper functional connectivity after birth and have adverse effects on the development of motor plasticity.

Altered transmission of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter, may contribute to the development of schizophrenia. The purpose of the present study was to investigate the presence of GABA-A/benzodiazepine (BZ) receptor binding abnormalities in individuals at ultra-high risk (UHR) for psychosis in comparison with normal controls using [(18)F]-fluoroflumazenil (FFMZ) positron emission tomography (PET). In particular, we set regions of interest in the striatum (caudate, putamen, and nucleus accumbens) and medial temporal area (hippocampus and parahippocampal gyrus).Eleven BZ-naive people at UHR and 15 normal controls underwent PET scanning using [(18)F]-FFMZ to measure GABA-A/BZ receptor binding potential. The regional group differences between UHR individuals and normal controls were analyzed using Statistical Parametric Mapping 8 software. Participants were evaluated using the structured interview for prodromal syndromes and neurocognitive function tasks.People at UHR demonstrated significantly reduced binding potential of GABA-A/BZ receptors in the right caudate.Altered GABAergic transmission and/or the imbalance of inhibitory and excitatory systems in the striatum may be present at the putative prodromal stage and play a pivotal role in the pathophysiology of psychosis.

Manifestation of the functionalities from the structural brain network is becoming increasingly important to understand a brain disease. With the aim of investigating the differential structure-function couplings according to network systems, we investigated the structural and functional brain networks of patients with spastic diplegic cerebral palsy with periventricular leukomalacia compared to healthy controls. The structural and functional networks of the whole brain and motor system, constructed using deterministic and probabilistic tractography of diffusion tensor magnetic resonance images and Pearson and partial correlation analyses of resting-state functional magnetic resonance images, showed differential embedding of functional networks in the structural networks in patients. In the whole-brain network of patients, significantly reduced global network efficiency compared to healthy controls were found in the structural networks but not in the functional networks, resulting in reduced structural-functional coupling. On the contrary, the motor network of patients had a significantly lower functional network efficiency over the intact structural network and a lower structure-function coupling than the control group. This reduced coupling but reverse directionality in the whole-brain and motor networks of patients was prominent particularly between the probabilistic structural and partial correlation-based functional networks. Intact (or less deficient) functional network over impaired structural networks of the whole brain and highly impaired functional network topology over the intact structural motor network might subserve relatively preserved cognitions and impaired motor functions in cerebral palsy. This study suggests that the structure-function relationship, evaluated specifically using sparse functional connectivity, may reveal important clues to functional reorganization in cerebral palsy. Hum Brain Mapp 38:5292-5306, 2017. © 2017 Wiley Periodicals, Inc.

Purpose: To demonstrate the significance of simultaneous electroencephalography (EEG) recording during 2-deoxy-2-[ 18 F] fluoro-D-glucose (FDG)-positron emission tomography (PET) in childhood partial epilepsy. Materials and Methods: We included 46 children with partial epilepsy who underwent simultaneous EEG during PET. We compared the epileptogenic area of several EEG features including epileptiform discharges, focal polymorphic slow waves, and electrographic seizures, with the abnormal metabolic region on PET. We also compared the epileptogenic area of simultaneous EEG and PET with findings on magnetic resonance imaging (MRI) and video/EEG, as well as the histopathological diagnosis of the resected cortical area, in eight patients who underwent surgical resection of the epileptogenic area. Results: Hypometabolic regions on interictal PET were concordant with epileptogenic areas of epileptiform discharges and focal polymorphic slow waves, according to their frequency and/or severity, with odds ratios of 1.35 and 1.81, respectively (p

Periventricular leucomalacia has long been investigated as a leading cause of motor and cognitive dysfunction in patients with spastic diplegic cerebral palsy. However, patients with periventricular leucomalacia on conventional magnetic resonance imaging do not always have motor dysfunction and preterm children without neurological abnormalities may have periventricular leucomalacia. In addition, it is uncertain whether descending motor tract or overlying cortical injury is related to motor impairment. To investigate the relationship between motor pathway injury and motor impairment, we conducted voxelwise correlation analysis using tract-based spatial statistics of white matter diffusion anisotropy and voxel-based-morphometry of grey matter injury in patients with periventricular leucomalacia and spastic diplegia ( n = 43, mean 12.86 ± 4.79 years, median 12 years). We also evaluated motor cortical and thalamocortical connectivity at resting state in 11 patients using functional magnetic resonance imaging. The functional connectivity results of patients with spastic diplegic cerebral palsy were compared with those of age-matched normal controls. Since γ-aminobutyric acidA receptors play an important role in the remodelling process, we measured neuronal γ-aminobutyric acidA receptor binding potential with dynamic positron emission tomography scans ( n = 27) and compared the binding potential map of the patient group with controls ( n = 20). In the current study, white matter volume reduction did not show significant correlation with motor dysfunction. Although fractional anisotropy within most of the major white matter tracts were significantly lower than that of age-matched healthy controls ( P

OBJECTIVE In previous studies, some brain areas, including parahippocampal gyrus, were suggested to be associated with panic disorder. Both panic disorder and somatoform disorders are associated with anxiety. This study sought to determine if there are shared neural activity underlying panic disorder and undifferentiated somatoform disorder. METHOD Sixteen nonmedicated patients with panic disorder, 16 nonmedicated patients with undifferentiated somatoform disorder, and 10 healthy subjects were scanned between February 2005 and August 2006. Diagnoses were made according to the Korean version of the Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Patient/Non-Patient Edition. Regional cerebral perfusion was measured by 99 m-Tc-ethyl cysteinate dimer single photon emission computed tomography (SPECT). Using statistical parametric mapping analysis, we compared the SPECT images between the groups. RESULTS Significant hyperperfusion was found at the left superior temporal gyrus and the left supramarginal gyrus in the panic disorder patients when compared to the controls (family-wise error [FWE], P < .001). The somatoform disorder patients showed hyperperfusion in the left hemisphere at the superior temporal gyrus, inferior parietal lobule, middle occipital gyrus, precentral gyrus, postcentral gyrus, and, in the right hemisphere, at the superior temporal gyrus when compared to the controls (false discovery rate [FDR], P < .001). In contrast, significant hypoperfusion was found at the right parahippocampal gyrus in each of panic disorder (FWE, P = .001) and somatoform disorder (FWE, P < .001) groups compared to healthy controls. However, no significant differences were found in regional cerebral perfusion between the 2 disorder groups. CONCLUSIONS Both panic disorder and undifferentiated somatoform disorder showed hyperperfusion in the left superior temporal gyrus and hypoperfusion in the right parahippocampal gyrus, which suggests that the 2 disorders are likely to share neural activity.

We observed bilateral pelvic foci of 18F-FDG uptake (BiPF) exclusively in females—a finding not previously reported—and assessed the frequency, anatomic localization, and clinical significance of the uptake. Methods: On 18F-FDG PET/CT and coregistered contrast-enhanced CT scans of 159 females (age, 16–81 y), the presence of BiPF and their location were evaluated. The findings were correlated with the age and menstrual history of the patient. Results: BiPF were seen in 14 (22%) of 63 patients up to 53 y old, predominantly at mid menstrual cycle, and were best coregistered to the fallopian tubes on contrast-enhanced CT. None of 96 patients older than 53 y showed BiPF. Conclusion: Fallopian 18F-FDG uptake was seen predominantly in premenopausal women at mid menstrual cycle. This finding is in accordance with known cyclic changes of fallopian tubes in response to ovarian hormones and may be the first, to our knowledge, imaging evidence revealing the influence of estrogen on the fallopian tubes.

Despite clinical and neuropsychological similarities between Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), recent studies have demonstrated that structural and pathological changes are more severe in DLB than in PDD.19 patients with probable PDD and 18 patients with probable DLB who had a similar overall severity of dementia and demographic characteristics were examined by a standardised neuropsychological test and voxel-based analysis of fractional anisotropy (FA) using diffusion tensor imaging (DTI).The patients with DLB performed significantly worse in visual recognition memory, semantic fluency and ideomotor praxis than those with PDD (p0.05). Compared with controls, the FA value in patients with PDD was significantly lower in bilateral frontal, left temporal and left parietal white matter. In patients with DLB, the pattern of FA reduction was similar to that of patients with PDD; however, white-matter abnormalities were more severe and extended into bilateral insular, bilateral posterior cingular and bilateral visual association regions. In a direct comparison between PDD and DLB, the FA value in patients with DLB was significantly decreased in bilateral posterior temporal, posterior cingular and bilateral visual association fibres extending into occipital areas.Despite global similarities in cognitive performance and white-matter pathology between DLB and PDD patients, those with DLB had more severely impaired frontal and temporal area-associated cognitive subsets, and more severe white-matter pathology in temporal and visual association fibres. These data suggest that differences in the underlying nature of PDD and DLB may exist with global similarities in their cognitive performance and white-matter pathology.

Background: We measured donor kidney weight (D-KW), functional renal volume (D-FRV), and single-kidney glomerular filtration rate (D-SKGFR), and then evaluated the impact of the indices to recipient body weight (R-BW) on graft function. Methods: This study included 44 recipients of live donor transplants without delayed graft function or acute rejection within 2 years of transplantation. Results: There was a statistically significant difference in serum creatinine between recipients with a D-KW/R-BW ratio of ≤4.25, D-FRV/R-BW ratio of ≤5.14, or D-SKGFR/R-BW ratio of ≤1.06 and recipients with a D-KW/R-BW ratio of >4.25, D-FRV/R-BW ratio of >5.14, or D-SKGFR/R-BW ratio of >1.06, respectively. D-KW/R-BW, D-FRV/R-BW, and D-SKGFR/R-BW strongly correlated with serum creatinine at 1 year and 2 years post-transplantation. In multivariate analysis, D-FRV and donor age were statistically significant risk factors which influenced serum creatinine at 1 year and 2 years post-transplantation. Conclusion: D-FRV/R-BW and donor age have significant impact on graft function. D-FRV/R-BW can be measured ahead of surgery. Therefore, measuring the D-FRV is useful to select a more optimal donor kidney among otherwise similar candidates during preoperative evaluation to improve posttransplant graft function.

To explore the morphological aspects of the functional reorganization of the blind's visual cortex, we analyzed the regional cortical thickness and cortical surface area in the congenitally blind subjects (CB) compared to the late-onset blind (LB) and sighted controls (SC). Cortical thickness was calculated from high-resolution T1-weighted magnetic resonance images of 21 young CB (blind from birth, mean age = 27.1 yr), 12 LB, and 35 young SC. Analysis of covariance of cortical layer thickness with global thickness, age, and gender as covariates was done node-by-node on the entire cortical surface. Further analysis of mean thickness and surface area was performed for 33 automatically parceled cortical regions. Voxel-based morphometry was also conducted to compare results with cortical thickness and surface area. We found increased cortical thickness in the regions involved in vision and eye movement, such as the pericalcarine sulcus, cingulate cortex, and right frontal eye field, but cortical thinning in the left somatosensory cortex and right auditory cortex of CB compared to SC. CB had significantly reduced surface extent in the primary and associated visual areas, which explains volumetric atrophies in the visual cortex of CB despite increased cortical thickness. Conversely, LB tended to have cortical thinning in the primary visual cortex with a slight or no significant reduction in the surface extent. These morphological alterations in CB may indicate cortical reorganization at the visual cortex in connection with other sensory cortices.

We analyzed the pattern of (11)C-acetate and (18)F-FDG uptake on PET/CT in patients with hepatocellular carcinoma (HCC). We also assessed the expression of important regulatory enzymes related to glycolysis and lipid synthesis in relation to (18)F-FDG and (11)C-acetate uptake in human HCC cell lines. The significance of (11)C-acetate uptake regulation was further evaluated with regard to cell viability.(18)F-FDG and (11)C-acetate uptake patterns in HCC in 11 patients and in 5 HCC cell lines were assessed. We evaluated the gene expression of metabolic enzymes related to glycolysis and lipid synthesis in a cell line with the highest (18)F-FDG uptake and another cell line with the highest (11)C-acetate uptake. They included hexokinase II, adenosine triphosphate citrate lyase, acetyl coenzyme A (CoA) synthetase 1 (ACSS1), acetyl CoA synthetase 2 (ACSS2), acetyl CoA carboxylase, and fatty acid synthase. In a cell line with high (11)C-acetate uptake, the enzymatic activities of ACSS1 and ACSS2 were blocked using respective small, interfering RNAs (siRNAs), and the impact on (11)C-acetate uptake and cell viability was assessed.In all 11 patients and 4 of the 5 cell lines, the uptake patterns of the 2 radiotracers were complementary. ACSS1 and ACSS2 were highly expressed in a cell line with low (18)F-FDG uptake and high (11)C-acetate uptake, whereas only ACSS2 was expressed in a cell line with high (18)F-FDG uptake and low (11)C-acetate uptake. Fatty acid synthase expression was seen in cells with high (18)F-FDG or (11)C-acetate uptake. These findings indicate the possibility that both glucose and acetate can be a compensatory carbon source for lipid synthesis in cancer. Transient transfection with ACSS1 or ACSS2 siRNA in cells with high (11)C-acetate uptake decreased (11)C-acetate uptake and cell viability.The patterns of (18)F-FDG and (11)C-acetate uptake seemed to complement each other in both human HCC and HCC cell lines. Fatty acid synthase expression was seen in cells with high (18)F-FDG or (11)C-acetate uptake, suggesting glucose- or acetate-dependent lipid synthesis. Acetyl CoA synthetase appears to be important in (11)C-acetate uptake and acetate-dependent lipid synthesis for the growth of cancer cells with a low-glycolysis phenotype. Inhibition of acetyl CoA synthetase in these cells may be promising for anticancer treatment.

Objectives: To determine the effects of treatment with donepezil on cortical metabolism in patients with traumatic brain injury using 18 F-fluorodeoxyglucose positron emission tomography. Methods: Twenty-six patients with cognitive impairment after traumatic brain injury were enrolled and randomly assigned into the donepezil-treated group and the control group. There was no significant difference between 2 groups in age, sex, education, and postinjury duration. Donepezil 5 mg was administered daily for 3 weeks and then 10 mg/d for 3 weeks to patients in the experimental groups. For both groups, we evaluated cognitive function with Mini-Mental State Examination, Wechsler Memory Test, Boston Naming Test, Colored Progressive Matrices upon initial evaluation and at the 6-week follow-up. An 18 F-fluorodeoxyglucose positron emission tomography of the brain was performed before and after 6 weeks of the donepezil-treated group. Effects of donepezil treatment on cortical metabolism were analyzed using Statistical Parametric Mapping software (Institute of Neurology, University College London, UK). Results: There was no significance difference between the 2 groups in initial evaluation of cognitive functions. After 6 weeks, compared with the control group, donepezil-treated group showed enhanced cognitive functions (P < 0.05), and 18 F-fluorodeoxyglucose positron emission tomography showed a statistically significant increase in the cerebral cortical metabolism for both of the frontal, parietal, occipital, and temporal cortices (P < 0.01) which are the key role of attention and object naming. Conclusions: Cholinergic augmentation by donepezil therapy in traumatic brain injury shows a cortical metabolic effect on the both of the frontal, parietal, occipital, and temporal cortices associated with clinical response to treatment.

Anhedonia, as a deficit symptom, may be associated with default-mode hypofrontality in schizophrenia. To explore whether trait anhedonia in schizophrenia pertains to altered hypofrontal resting state brain function, resting state metabolic activities were compared and correlated with the Physical and Social Anhedonia Scale scores in 29 patients with schizophrenia and 21 healthy controls using (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET). In patients with schizophrenia, Physical Anhedonia Scale scores showed a trend-level negative correlation with the hypoactive dorsomedial prefrontal metabolism while Positive and Negative Symptom Scale (PANSS) negative subscale scores positively correlated with hyperactive cerebellar metabolism. Voxelwise correlation analysis showed physical anhedonia correlates in resting state activities of the supplementary motor area, ventromedial and dorsolateral prefrontal cortex, insular gyrus, and the precuneus in patients with schizophrenia while no frontal metabolic correlates were found in healthy controls. The hypoactive dorsomedial prefrontal metabolism correlated with physical anhedonia-correlated resting state regional activities. These findings provide further evidence for the relation of functional hypofrontality to the deficit syndrome and possible involvement of the functional imbalance in the cortico-cerebellar-thalamic-cortical circuit in the resting state brain function of schizophrenia.

This study aimed to assess the prognostic value of (18)F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to (18)F-FDG uptake.Two hundred fourteen intermediate-to-advanced-stage HCC patients without extrahepatic metastasis who underwent staging (18)F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value.On multivariate analysis, age and TLR were independent prognostic factors for PFS (P0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P= 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less.(18)F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high (18)F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. (18)F-FDG PET/CT may help determine the treatment modality for intermediate-to-advanced-stage HCCs.

Purpose This study aimed to evaluate the prognostic value of pretreatment 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in pediatric neuroblastoma patients. Methods The study included 50 pediatric neuroblastoma patients who underwent diagnostic work-up FDG PET before any treatment. The maximum standardized uptake value (SUV max ) of the primary tumor lesion ( P max ), the SUV max of all the tumor lesions, including the primary tumor lesion and metastatic lesions ( T max ), and the uptake ratio of T max to mean SUV of normal liver tissue ( T max / L mean ) were calculated and tested as prognostic factors. Results Of the 50 patients, 15 (30.0%) experienced disease progression and 21 (42.0%) died during the follow-up period. On univariate analysis, the histopathology, tumor stage, bone marrow involvement, serum levels of lactate dehydrogenase (LDH), neuron-specific enolase, and ferritin, primary tumor size, P max , T max , and T max / L mean were significant prognostic factors for disease progression-free survival (PFS), whereas the tumor stage, serum level of LDH, T max , and T max / L mean were determined to be significant for predicting overall survival (OS). On multivariate analysis, the histopathology and serum level of LDH were independent prognostic factors for PFS, and only the T max / L mean was an independent prognostic factor for OS. The 2-year PFS and OS rates were over 80.0% in patients with low FDG uptake, meanwhile, patients with high FDG uptake showed the 2-year PFS of less than 30.0% and OS of less than 55.0%. Conclusion FDG PET was an independent prognostic factor for OS in neuroblastoma patients. FDG PET can provide effective information on the prognosis for neuroblastoma patients.

This study evaluated the predictive value of 18F-FDG PET for distant metastasis-free survival and peritoneal recurrence-free survival as well as recurrence-free survival and overall survival after curative surgical resection in patients with advanced gastric cancer (AGC).Two hundred seventy-nine patients with AGC who underwent preoperative 18F-FDG PET and subsequent curative surgical resection were included. The tumor-to-normal liver uptake ratio (TLR) of cancer lesions was measured, and the prognostic significance of TLR and tumor factors for distant metastasis-free survival, peritoneal recurrence-free survival, recurrence-free survival, and overall survival was assessed.The 5-y recurrence-free survival, peritoneal recurrence-free survival, distant metastasis-free survival, and overall survival rates were 46.9%, 68.5%, 76.0%, and 58.1%, respectively. Depth of tumor invasion, lymph node metastasis, lymphovascular invasion, and TLR were independent prognostic factors for both recurrence-free survival and overall survival (P0.05). For distant metastasis-free survival, lymphovascular invasion and TLR were independent risk factors (P0.05). In patients with a TLR of 2.0 or less, the 5-y distant metastasis-free survival rate was 95.5%; in patients with a TLR greater than 2.0, the 5-y distant metastasis-free survival rate was 68.8%. For peritoneal recurrence-free survival, TLR showed no statistical significance (P=0.7) whereas pT stage, lymph node metastasis, Lauren classification, and Bormann type were independent prognostic factors (P0.05).18F-FDG uptake of AGC is an independent prognostic factor for distant metastasis-free survival, recurrence-free survival, and overall survival. The possibility of distant metastasis during follow-up should be considered in patients with high 18F-FDG uptake.

To evaluate the clinical implications of lymph node (LN) density onOne hundred and fifty-two patients with 271 mediastinal LNs who underwent PET/CT and endobronchial ultrasound-guided transbronchial needle aspiration for staging were enrolled. Maximum standardized uptake value (SUVmax), short axis diameter, LN-to-primary cancer ratio of SUVmax, and median Hounsfield unit (HU) based on CT histogram were correlated to histopathology.Of 271 nodes, 162 (59.8 %) were malignant. SUVmax, short axis diameter, and LPR of malignant LNs were higher than those of benign nodes. Among malignant LNs, 71.0 % had median HU between 25 and 45, while 78.9 % of benign LNs had values25 HU or45 HU. Using a cutoff value of 4.0, SUVmax showed the highest diagnostic ability for detecting malignant LNs with a specificity of 94.5 %, but showing a sensitivity of 70.4 %. Using additional density criteria (median HU 25-45) in LNs with 2.0SUVmax ≤4.0, the sensitivity increased to 88.3 % with the specificity of 82.6 %.LN density is useful for the characterization of LNs with mild• SUVmax showed the highest diagnostic ability for detecting malignant LNs. • LN density was useful in characterization of LNs with mild FDG uptake. • SUVmax and LN density together could stratify the risk of LN metastasis.

Goals: The aims of this study were to determine the clinical use of 18-fluorodeoxyglucose positron emission tomography ( 18 FDG-PET) in the differential diagnosis of patients with suspected pancreatic cancer and in the determination of tumor response after concurrent chemoradiotherapy for pancreatic cancer. Background: Despite advances in diagnostic tools for pancreatic cancer, it is difficult to differentiate pancreatic cancer from massforming pancreatitis. Even with current imaging modalities, it is also difficult to assess tumor response to therapeutic intervention. Study: One hundred two patients with suspected pancreatic cancer were selected for this study. Dynamic computerized tomography (CT) scan and 18 FDG-PET were used sequentially to diagnose pancreatic cancer. After diagnostic confirmation their diagnostic yields were compared. We also evaluated the treatment response in 15 patients who underwent chemoradiation therapy with dynamic CT scan and 18 FDG-PET and compared their results. Results: In 93 out of 102 patients, pancreatic cancer was confirmed. 18 FDG-PET showed higher diagnostic accuracy than CT scan (95.1% vs. 76.5%). 18 FDG-PET was also superior to CT in the detection of liver metastasis. 18 FDG-PET detected treatment response in 5 out of 15 cases after chemoradiation therapy, whereas CT could not detect any treatment response. Comparing responder and nonresponder, 18 FDG-PET was able to predict significantly different prognosis (399 vs. 233d, P < 0.05). Conclusions: 18 FDG-PET is a very useful tool in diagnosing pancreatic cancer. 18 FDG-PET may be also used as an adjunct for determining the treatment modality of pancreatic cancer and evaluating tumor response to chemoradiation therapy.

The purpose of the study is to propose a new framework for surface-based statistical parametric mapping of PET images using MRI-based cortical surface analysis, including partial volume correction, intensity normalization and spatial normalization on the cortical surface. Maximum PET intensities along the path between inner and outer layer of the cortical gray matter are mapped onto the cortical surface to generate a metabolic activity surface map. For the partial volume correction, the metabolic activity surface map was divided by the partial volume effect map. The regional metabolic activity was normalized by the global activity iteratively calculated at the surface nodes, statistically independent of the group, as measured by F statistics. After surface-based spatial normalization, a statistical evaluation of both cortical thickness and cortical metabolic activity was conducted on the normalized surfaces of 16 patients with schizophrenia and 16 age- and gender-matched healthy controls. The patients with schizophrenia were found to have significant cortical thinning in the temporal and inferior frontal cortices. Accordingly, their PET imaging was significantly affected by the partial volume effect, indicating that partial volume correction could change the statistical results. After correction of the partial volume effects, the patients showed hyperactivity in the temporal cortex, whereas hypoactivity in the prefrontal cortex, predominantly in the left hemisphere. Our results demonstrate that anatomical factors affect an analysis for functional data from the PET, and therefore the importance of combining anatomy and function in the analysis of imaging data for schizophrenia should be considered.

Purpose: The purpose of this study was to evaluate the long-term tumor response after phase IIb clinical study and the safety of percutaneous holmium-166 (166Ho)/chitosan complex injection (PHI) therapy for small hepatocellular carcinoma as a local ablative treatment. 166Ho is a radioactive isotope derived from natural holmium-165. We developed a 166Ho/chitosan complex (Milican, Dong Wha Pharmaceutical Co., Seoul, Korea) using chitosan as a vehicle to retain the radioactive material within the tumor. Experimental Design: Forty patients with single hepatocellular carcinoma Results: Two months after PHI, complete tumor necrosis was achieved in 31 of 40 patients (77.5%) with hepatocellular carcinoma lesions Conclusions: PHI was found to be a safe and novel local ablative procedure for the treatment of small hepatocellular carcinoma and could be used as a bridge to transplantation. A phase III randomized active control trial is clearly warranted among a larger study population.

Stomach cancer is one of the leading causes of cancer mortality worldwide. Complete resection of a gastric tumor and adjacent lymph nodes represents the only potentially curative intervention. Computed tomography (CT) has remained the modality of choice for the preoperative staging of gastric cancer and for follow-up. A recently developed advanced CT technique that makes use of thin sections, optimal contrast material enhancement, and multiplanar reformation allows more accurate staging. However, CT may be limited in the identification of nonenlarged lymph node metastasis, peritoneal dissemination, and small hematogenous metastasis. Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) has been recognized as a useful diagnostic technique in clinical oncology. FDG PET allows scanning of a larger volume than is possible with CT. Although FDG PET is not an appropriate first-line diagnostic procedure in the detection of stomach cancer and is not helpful in tumor staging, it may play a valuable role in the detection of distant metastases, such as those of the liver, lungs, adrenal glands, ovaries, and skeleton. FDG PET may also be helpful in the follow-up of patients undergoing chemotherapy, as it allows the identification of early response to treatment. Further studies are needed to determine the efficacy of FDG PET in the detection of local nodal metastases and peritoneal dissemination. Nevertheless, the combined use of CT and PET can be helpful in the preoperative staging of stomach cancer and in the therapeutic monitoring of affected patients.

Background. Whole-body 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used for whole-body imaging modality in detecting malignancy in clinical oncology. However, only a few reports of FDG PET in skin cancers have been described, except for melanoma and lymphoma. Objective. To report on the usefulness of FDG PET as a baseline workup study for patients with cutaneous squamous cell carcinoma (SCC). Methods. There were 12 cases of SCC (9 cases with high-risk SCC). Of the 12, FDG PET was performed for staging in 11 patients and for restaging in 1 patient 1 year after wide excision. Results. Primary lesions were detected in nine cases (83.3%), lymph node involvement in three cases (25.0%), and distant organ (lung) involvement in one case (8.3%). In one patient whose primary lesion was positive, stomach cancer with involvement of adrenal glands, omentum, and lymph nodes was incidentally detected. All of the patients with high-risk SCC showed FDG uptakes of the primary lesions, and the patients with FDG uptakes in lymph nodes and distant organ had high-risk SCC. Conclusion. There have been no comparative studies on the cost-effectiveness between sentinel lymph node biopsy and FDG PET in SCC patients. However, considering the noninvasiveness and thoroughness in checking the whole body, including distant organs, FDG PET may have clinical value as a baseline workup study for patients with high-risk SCC. SUNG BIN CHO, MD, WOO GIL CHUNG, MD, MIJIN YUN, MD, JONG DOO LEE, MD, PHD, MIN GEOL LEE, MD, PHD, AND KEE YANG CHUNG, MD, PHD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.

There is evidence that abnormalities in the dopaminergic system involving the dopamine transporter (DAT) are involved in the pathophysiology of Tourette's disorder (TD) from previous studies using [(123)I]2beta-carbomethoxy-3-(4-iodophenyl)tropane ([(123)I]beta-CIT) and single photon emission tomography (SPECT). However, because those studies were performed in medicated adult patients with TD, we decided to compare DAT densities in nine drug-naive children with TD and eight normal children. The children with TD did not suffer from associated psychiatric problems such as obsessive-compulsive symptoms, attention deficit hyperactivity disorder, anxiety, depression and developmental difficulties. We performed brain SPECT 2 h after the intravenous administration of I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl)tropane ([(123)I]IPT) and carried out both quantitative and qualitative analyses using the obtained SPECT data, which were reconstructed for the assessment of the specific/non-specific DAT binding ratio in the basal ganglia. We then investigated the correlation between the severity of tics in children with TD assessed with the Yale Global Tic Severity Scale (YGTSS) and the specific/non-specific DAT binding ratio of the basal ganglia. Drug-naive children with TD showed a significantly increased specific/non-specific DAT binding ratio in the basal ganglia compared with normal children that did not correlate significantly with the severity of tics. Our results with drug-naive children with TD between the ages of 6 and 12 may help to clarify previous findings concerning DAT binding in adult patients with TD and suggest that DAT densities may be associated directly with the pathophysiology of TD, regardless of disease progress or drug effect.

Purpose This retrospective study was conducted to determine the characteristic imaging and histopathologic features of breast fibroadenomas in kidney-transplant recipients given chronic cyclosporin A immunosuppressive therapy after the transplantation and to compare these characteristics with those from a control group. Methods From January 1, 1990, through December 31, 1999, 486 women underwent renal transplantation at our institution. All patients subsequently received immunosuppressive therapy with cyclosporin A and prednisolone. Ten (2%) of these women had developed breast fibroadenomas during this chemotherapy. We compared the data obtained on this group's fibroadenomas with those obtained from those in the control group, which comprised 100 women with fibroadenomas but who had never undergone organ transplantation or immunosuppressive therapy. Results Twenty-two fibroadenomas developed in the 10 transplant recipients. Eight of those 10 had multiple lesions, and 7 were affected bilaterally. The mean diameter of the fibroadenomas was 4.2 ± 2.5 cm. Mammographically, the lesions were round or oval high-density masses with well-circumscribed margins and no calcification or spiculation. Sonographically, the lesions were relatively highly echogenic and had a lower ratio of the longitudinal to the anteroposterior diameter (L /AP) than did those in the control group. Histopathologically, the features of these lesions were generally typical of fibroadenomas, but some were more typical of malignant lesions. Among the 100 control patients, 146 fibroadenomas developed; 33 women had multiple lesions, and 12 were affected bilaterally. Their fibroadenomas had a mean diameter of 2.1 ± 1.5 cm, and the imaging features of these lesions were typical of fibroadenomas. Conclusions The fibroadenomas that developed in kidney-transplant recipients given chronic cyclosporin A and prednisolone immunosuppressive therapy had a tendency to be multiple, bilateral, and larger than those that developed in the control patients. These fibroadenomas also exhibited some imaging features that differed from those of typical fibroadenomas that develop in women who have not undergone organ transplantation or immunosuppressive therapy. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:69–77, 2004

Surgical resection is the only curative treatment strategy for intrahepatic cholangiocarcinoma (CC). Therefore, accurate staging is essential for appropriate management of patients with CC. We assessed the usefulness of 2-[(18)F]fluoro-2-deoxy- d-glucose (FDG) positron emission tomography (PET) in the staging of CC. We undertook a retrospective review of FDG PET images in 21 patients (10 female, 11 male; mean age 57 years) diagnosed with CC. Ten patients had hilar CC and 11, peripheral CC. Patients underwent abdominal magnetic resonance imaging (MRI) ( n=20) and computed tomography (CT) ( n=12) for the evaluation of primary tumours, and chest radiography and whole-body bone scintigraphy for work-up of distant metastases. For semi-quantitative analysis, the maximum voxel standardised uptake value (SUV(max)) was obtained from the primary tumour. All peripheral CCs showed intensely increased FDG uptake, and some demonstrated ring-shaped uptake corresponding to peripheral rim enhancement on CT and/or MRI. In nine of the ten patients, hilar CCs demonstrated increased FDG uptake of a focal nodular or linear branching appearance. The remaining case was false negative on FDG PET. One patient with a false negative result on MRI demonstrated increased uptake on FDG PET. Among the ten hilar CCs, FDG uptake was intense in only two patients and was slightly higher than that of the hepatic parenchyma in the remaining patients. For the detection of lymph node metastasis, FDG PET and CT/MRI were concordant in 16 patients, and discordant in five (FDG PET was positive in three, and CT and MRI in two). FDG PET identified unsuspected distant metastases in four of the 21 patients; all of these patients had peripheral CC. FDG PET is useful in detecting the primary lesion in both hilar and peripheral CC and is of value in discovering unsuspected distant metastases in patients with peripheral CC. FDG PET could be useful in cases of suspected hilar CC with non-confirmatory biopsy and radiological findings.

In conclusion, the present study suggests that SPECT, using a sophisticated SPM analysis method, may be useful as a potential diagnostic tool for OCD and a possible predictor of treatment outcome for OCD patients undergoing bilateral anterior cingulotomy. The anterior cingulate gyrus seems to be an important structure in the pathogenesis of OCD symptoms. Furthermore, our operative technique of anterior cingulotomy, featuring a larger lesion, seems to be effective in ameliorating the symptoms of OCD without causing any serious complications.

Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder in childhood that is known to be associated with dopamine dysregulation. In this study, we investigated dopamine transporter (DAT) density in children with ADHD using iodine-123 labelled N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane ([(123)I]IPT) single-photon emission tomography (SPET) and postulated that an alteration in DAT density in the basal ganglia is responsible for dopaminergic dysfunction in children with ADHD. Nine drug-naive children with ADHD and six normal children were included in the study. We performed brain SPET 2 h after the intravenous administration of [(123)I]IPT and carried out both quantitative and qualitative analyses using the obtained SPET data, which were reconstructed for the assessment of the specific/non-specific DAT binding ratio in the basal ganglia. We then investigated the correlation between the severity scores of ADHD symptoms in children with ADHD assessed with ADHD rating scale-IV and the specific/non-specific DAT binding ratio in the basal ganglia. Drug-naive children with ADHD showed a significantly increased specific/non-specific DAT binding ratio in the basal ganglia compared with normal children. However, no significant correlation was found between the severity scores of ADHD symptoms in children with ADHD and the specific/non-specific DAT binding ratio in the basal ganglia. Our findings support the complex dysregulation of the dopaminergic neurotransmitter system in children with ADHD.

A 74-year-old woman with left hemiparesis due to a previous stroke presented with the sudden development of cognitive impairment and episodic complex visual hallucinations as manifestations of nonconvulsive status epilepticus (NCSE). Neuropsychological tests performed during NCSE demonstrated deficits encompassing several cognitive domains. The short-lasting complex visual hallucinations were stereotypical, vivid, and accompanied by intense fear. The seizure activity in the right temporo-parieto-occipital region, as documented by SISCOM and electroencephalogram (EEG) recording, was thought to be due to an unusual clinical presentation of NCSE. Subcortical cerebromalacia likely blocked the propagation route, restricting the ictal activities within this area.

This study aimed to evaluate the diagnostic accuracy of contrast-enhanced FDG PET/CT for unexpected ovarian lesions in patients with nongynecologic cancers.The present retrospective study was approved by the hospital institutional review board. We enrolled 72 nongynecologic cancer patients (33 colorectal cancer, 20 breast cancer, and 19 gastric cancer) who showed unexpected ovarian lesions on contrast-enhanced FDG PET/CT and subsequently underwent surgical resection of the ovarian lesions. The SUVmax values of the ovarian lesions were compared according to the histopathological results, and the accuracy of PET/CT was evaluated.A total of 103 ovarian lesions were surgically resected from 72 patients (64 ovarian lesions were metastases, 21 were benign, and 18 were malignant primary ovarian cancer). SUVmax among the 3 groups were different (P0.0001). Using a cutoff SUVmax of 2.5, the sensitivity, specificity, and accuracy of PET/CT for detecting malignant ovarian lesions were 80.5%, 81.0%, and 80.6%, respectively. Detection rates of PET/CT for colorectal, breast, and gastric cancer metastases, as well as primary ovarian cancers were 91.4%, 83.3%, 47.8%, and 100.0%, respectively. Using contrast-enhanced CT findings with SUVmax, the sensitivity, specificity, and accuracy of contrast-enhanced FDG PET/CT were improved to 95.1%, 76.2%, and 91.3%, respectively (P = 0.003).Conventional FDG PET/CT showed moderate diagnostic accuracy for the detection of malignant ovarian lesions mainly due to low detection rate in gastric cancer metastases. The PET/CT detection rate of malignant ovarian lesions can be improved using contrast-enhanced CT findings with FDG uptake measurement.

The aim of this study was to assess the range of normal adrenal FDG uptake, and to determine the diagnostic criteria of FDG PET-CT to differentiate adrenal nodule.A total of 117 healthy subjects who underwent FDG PET/CT for cancer screening, and 106 lung cancer patients who underwent FDG PET/CT for cancer staging without adrenal abnormality were enrolled to determine the normal range of adrenal standardized uptake value (SUV). In addition, another 24 lung cancer patients with suspicious adrenal masses were enrolled to evaluate the diagnostic performance of the different diagnostic criteria from FDG PET/CT.The adrenal maximal SUV (SUVmax) of the healthy group was 1.66 ± 0.21 in the right and 1.86 ± 0.30 in the left. The adrenal SUVmax of lung cancer group was 1.79 ± 0.30 in the right and 1.90 ± 0.37 in the left. Lung cancer group had a higher ratio of adrenal gland to liver (AL ratio) when compared with healthy subjects (0.77 ± 0.13 vs. 0.61 ± 0.10 on the right, 0.82 ± 0.12 vs. 0.68 ± 0.12 on the left: p0.001). The upper normal limits of adrenal SUVmax were calculated as the mean plus 2 standard deviations (right: 2.08 vs. 2.39, left: 2.46 vs. 2.64, in the normal group and lung cancer group, respectively). Using the upper limit from the lung cancer group, we achieved a sensitivity of 87 % and specificity of 100 %.We demonstrated that left adrenal gland had higher SUV than right adrenal gland both in healthy group and lung cancer group. Using the different normal range of bilateral adrenal SUVmax, we could successfully differentiate adrenal masses.

The purpose of this study was to investigate the prognostic value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with ampullary adenocarcinoma (AAC) after curative surgical resection.Fifty-two patients with AAC who had undergone (18)F-FDG PET/CT and subsequent curative resections were retrospectively enrolled. The maximum standardized uptake value (SUVmax) and tumor to background ratio (TBR) were measured on (18)F-FDG PET/CT in all patients. The prognostic significances of PET/CT parameters and clinicopathologic factors for recurrence-free survival (RFS) and overall survival (OS) were evaluated by univariate and multivariate analyses.Of the 52 patients, 19 (36.5%) experienced tumor recurrence during the follow-up period and 18 (35.8%) died. The 3-year RFS and OS were 62.3 and 61.5%, respectively. Preoperative CA19-9 level, tumor differentiation, presence of lymph node metastasis, SUVmax, and TBR were significant prognostic factors for both RFS and OS (p 0.05) on univariate analyses, and patient age showed significance only for predicting RFS (p 0.05). On multivariate analyses, SUVmax and TBR were independent prognostic factors for RFS, and tumor differentiation, SUVmax, and TBR were independent prognostic factors for OS.SUVmax and TBR on preoperative (18)F-FDG PET/CT are independent prognostic factors for predicting RFS and OS in patients with AAC; patients with high SUVmax (4.80) or TBR (1.75) had poor survival outcomes. The role of and indications for adjuvant therapy after curative resection of AAC are still unclear. (18)F-FDG uptake in the primary tumor could provide additive prognostic information for the decision-making process regarding adjuvant therapy.

Previous animal studies have established that the intra-articular injection of holmium-166-chitosan complex (DW-166HC) causes effective necrosis of the inflamed synovium with litle leakage of radioactivity from the injected joint. Based on these findings, we conducted a phase I/IIa study to examine the biodistribution of DW-166HC and to assess the safety of DW-166HC for the treatment of knee synovitis in patients with rheumatoid arthritis (RA). A total of 16 patients [1 man, 15 women; median age 49 (range 36-65) years] who had RA knee synovitis refractory to disease-modifying anti-rheumatic drug treatments of > 3 months' duration were randomly assigned to three treatment groups with different radiation doses of DW-166HC: 370 MBq (n = 6), 555 MBq (n = 5) and 740 MBq (n = 5). In each treatment group, blood and urine radioactivity were analysed by beta counter and biodistribution of the injected DW-166HC was evaluated using a gamma scan camera. Clinical assessment was done according to three variables (evaluation method): knee joint pain (visual analogue scale), range of motion (goniometry) and joint swelling (circumference of knee joint). The duration of follow-up observation was 3 months. Following the intra-articular injection of DW-166HC, the blood radioactivity was little changed from the baseline measurement and the accumulated radioactivity excreted in urine was minimal. Gamma scan study indicated that most of the injected radiochemical was localized within the injected joint cavity, and the extra-articular leakage was negligible at 24 h after the injection: brain, 0.3%; lung, 0.6%; abdomen, 0.7%; and pelvis, 0.8%. Major adverse events were transient post-injection knee joint pain and swelling. These results suggest that DW-166HC might be a safe agent for radiation synovectomy, particularly for the treatment of knee synovitis of RA, and further trials in a larger patient population are warranted to evaluate the therapeutic efficacy of DW-166HC.

Bowen's disease can be treated by various methods, including surgical excision, cryosurgery, laser ablation, curettage, Mohs' microsurgery and ionizing radiation. Radiotherapy has been a useful therapeutic modality in the treatment of Bowen's disease and other skin cancers in areas which are difficult to excise, especially the central areas of the face, including eyelids, nose and lips. To overcome some of the disadvantages of external radiotherapy, a specially designed skin patch coated with high-energy beta-emitter holmium-166 was made for topical application at our institute. Twenty-nine sites of Bowen's disease in eight patients, confirmed by skin biopsy, were treated with 166Ho patches. The patches were applied to the surface of skin cancers for 30-60 min for a total radiation dose of 35 Gy (3500 rads). One to two weeks after application of the 166Ho patch, desquamation, erythema or erosion developed in treated sites, but these acute radiation reactions healed gradually with epithelial regeneration, and they showed good functional and cosmetic results without any complications. Follow-up biopsies were performed 1-5 months after 166Ho patch therapy, and they did not show any signs of Bowen's disease. One to two years after treatment with 166Ho skin patches, there were no recurrences of Bowen's diseases and no late complications. The 166Ho patch is an effective and convenient alternative method for the treatment of Bowen's disease that yields good cosmetic and functional results.

Purpose Perfusion defects can be demonstrated reliably at an early stage with regional cerebral blood flow studies using SPECT. The administration of thrombolytic therapy in ischemic stroke is targeted at restoring cerebral perfusion immediately, leading to salvage of ischemic penumbra, smaller infarct size, and improved clinical outcome. This study considered the role of brain perfusion SPECT in the evaluation of reperfusion and brain function recovery of the infarcted area after early recanalization (less than 6 hours) of the occluded artery using intracarotid arterial urokinase therapy (ICAU). Methods Intracranial artery occlusion was confirmed in seven patients using emergency carotid angiography performed within the initial 6-hour period. Intracarotid arterial urokinase (500,000 to 800,000 units) was administered into the occluded arterial system (the left middle cerebral artery in four and the right middle cerebral artery in three patients). CT scanning was performed when the patients arrived in the emergency department and was repeated 24 to 48 hours after ICAU and at 7 days or earlier if clinically indicated. All patients had two SPECT studies, the first before urokinase administration and the second 24 or 48 hours later. Results Complete recanalization of the occluded vessels was seen in one patient after ICAU, effective partial recanalization was achieved in four patients, and minimal recanalization occurred in the other two. Before ICAU, Tc-99m HMPAO brain SPECT showed decreased uptake of the infarcted area in all patients, whereas the follow-up brain SPECT performed 24 or 48 hours after ICAU revealed improvement in the uptake of the recanalized area on qualitative and semiquantitative assessments using an asymmetry index, suggestive of brain function recovery and clinical improvement. Hemorrhagic transformation adjacent to the reperfused regions occurred in two patients with partial recanalization of the left middle cerebral artery. Conclusions Reperfusion of the recanalized area and brain function recovery could be achieved if the occluded artery is recanalized within the initial 6-hour period using ICAU, and this was documented using brain perfusion SPECT without a delay in the therapeutic time window. Because the number of patients we studied was limited, further study is necessary to evaluate the effect of ICAU and to determine its prognostic significance.

It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. However, no cardiac imaging modality has been able to demonstrate abnormal sympathetic innervation in patients with coronary artery spasm. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation using iodine 123-metaiodobenzylguanidine (123I-MIBG) single photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of 123I-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm. Coronary arteriography and a provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (20 men, 6 women, mean age 48.2±12.0 years, range 20 to 67 years) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups: group 1 (n=18) comprised subjects with negative provocative provocative test result, and group 2 (n=8) comprised subjects with negative provocative test results. Ten healthy subjects served as controls. No abnormal MIBG uptake was observed in the control subjects. Abnormal sympathetic nervous innervation using 123I-MIBG SPECT was observed either as a reduced uptake or a defective pattern in the perfused areas in 13 of the 18 regions supplied by vessels of ergonovine-induced vasospasm. Normal sympathetic innervation, as evidenced by normal 123I-MIBG uptake, was noted in all of the 60 segments of normal vessel territories. Reduced uptake of 123I-MIBG was not detected in the perfused areas of 5 vasospasm-induced vessels (perfusion territory of left anterior descending coronary artery [LAD] and the right coronary artery [RCA] in 2 and 3 patients, respectively). The sensitivity and specificity of 123I-MIBG for detection of coronary artery spasm were 72.2% (95% confidence interval, [CI] 55% to 89%) and 100%, respectively. The positive predictive and negative predictive values were 100% and 92.3% (95% CI 91% to 93%), respectively. 123I-MIBG SPECT is a feasible method to evaluate noninvasively and localize the territories of coronary arteries with spasm. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan results, but showing abnormalities in 123I-MIBG SPECT.

This study assessed the prognostic value of pre-operative 2-[(18)F] fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in patients with epithelial ovarian cancer.A total of 175 patients with epithelial ovarian cancer who underwent (18) F-FDG PET/CT and subsequent cytoreductive surgery were retrospectively enrolled. Maximum standardized uptake value (SUVmax) on (18)F-FDG PET/CT was measured for all patients. Because nine patients showed low tumor-to-background uptake ratios, MTV and TLG were measured in 166 patients. Univariate and multivariate analyses were performed to evaluate the prognostic significance of SUVmax, MTV, TLG, and clinicopathological factors for disease progression-free survival.Disease progressed in 78 (44.6 %) of the 175 patients, and the 2-year disease progression-free survival rate was 57.5 %. Univariate analysis showed that tumor stage, histopathological type, presence of regional lymph node metastasis, residual tumor after cytoreductive surgery, pre-operative serum carbohydrate antigen 125 (CA125) level, SUVmax, MTV, and TLG were significant prognostic factors (p 0.05). Among these variables, tumor stage (p = 0.0006) and TLG (p = 0.008) independently correlated with disease progression-free survival on multivariate analysis. The disease progression rate was only 2.3 % in stage I-II patients with low TLG (≤100.0), compared to 80.0 % in stage III-IV patients with high TLG (100.0).Along with tumor stage, TLG is an independent prognostic factor for disease progression after cytoreductive surgery in patients with epithelial ovarian cancer. By combining tumor stage and TLG, one can further stratify the risk of disease progression for patients undergoing cytoreductive surgery.

Purpose: To evaluate the distribution and degree of radioactivity on sequential Tc-99m methylene diphosphonate (Tc-99m MDP) scans in the diagnosis of postoperative loosening in asymptomatic patients who underwent cementless total hip replacement. Material and Methods: Tc-99m MDP scans were obtained every three months where possible, for one year in those patients who underwent total hip replacement using a Harris Galante cementless prosthesis. Eighty-three scans from 45 patients were obtained. Uptake was assessed within the five periprosthetic zones (zone 1: greater trochanter; 2: lateral stem of the prosthesis; 3: tip of the prosthesis; 4: medial stem of the prosthesis; and 5: lesser trochanter) using an arbitrary 5-point grading system. Grade 1 indicated normal uptake and Grade 5 indicated highest uptake. The grade of uptake within each zone was then analyzed against their postoperative ages. Results: The radioactivity regressed to Grade 1 or 2 from Grade 4 or 5 within 12 months after cementless total hip replacement in 87.5% and 93.8% of patients in zones 2 and 4, respectively. Even though the radioactivity within zones 1, 3, and 5 tended to decrease, persistent elevation of activity (over grade 2) lasted up to 12 months after surgery in 31% or 37% of the patients. Conclusion: The radioactivity after cementless total hip replacement tended to regress in proportion to the postimplant age. The regression rate varied depending on the periprosthetic zones.

To assess the role of coregistered (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting radiographically occult distant metastasis (DM) at staging in patients with locally advanced pancreatic cancer (LAPC) and to study whether FDG-PET parameters can predict relatively long-term survival in patients who are more likely to benefit from chemoradiation therapy (CRT).From our institutional database, we identified 388 LAPC patients with M0 on conventional computed tomography (CT) who were planned to undergo CRT. Coregistered FDG-PET staging was offered to all patients, and follow-up FDG-PET was used at the clinical discretion of the physician.FDG-PET detected unsuspected CT-occult DM in 33% of all 388 patients and allowed them to receive systemic therapy immediately. The remaining 260 patients (PET-M0) underwent CRT selectively as an initial treatment. Early DM arose in 13.1% of 260 patients, and the 1-year estimated locoregional recurrence rate was 5.4%. Median overall survival (OS) and progression-free survival (PFS) were 14.6 and 9.3 months, respectively, at a median follow-up time of 32.3 months (range, 10-99.1 months). Patients with a baseline standardized uptake value (SUV)3.5 and/or SUV decline ≥60% had significantly better OS and PFS than those having none, even after adjustment for all potential confounding variables (all P.001).FDG-PET can detect radiographically occult DM at staging in one-third of patients and spare them from the potentially toxic therapy. Additionally, FDG-PET parameters including baseline SUV and SUV changes may serve as useful clinical markers for predicting the prognosis in LAPC patients.

The purpose of this study was to evaluate the diagnostic performance of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a single imaging agent in neuroblastoma in comparison with other imaging modalities.A total of 30 patients with pathologically proven neuroblastoma who underwent FDG PET for staging were enrolled. Diagnostic performance of FDG PET and abdomen CT was compared in detecting soft tissue lesions. FDG PET and bone scintigraphy (BS) were compared in bone metastases. Maximal standardized uptake value (SUVmax) of primary or recurrent lesions was calculated for quantitative analysis.Tumor FDG uptake was detected in 29 of 30 patients with primary neuroblastoma. On initial FDG PET, SUVmax of primary lesions were lower in early stage (I-II) than in late stage (III-IV) (3.03 vs. 5.45, respectively, p = 0.019). FDG PET was superior to CT scan in detecting distant lymph nodes (23 vs. 18 from 23 lymph nodes). FDG PET showed higher accuracy to identify bone metastases than BS both on patient-based analyses (100 vs. 94.4 % in sensitivity, 100 vs. 77.8 % in specificity), and on lesion-based analyses (FDG PET: 203 lesions, BS: 86 lesions). Sensitivity and specificity of FDG PET to detect recurrence were 87.5 % and 93.8, respectively.FDG PET was superior to CT in detecting distant LN metastasis and to BS in detecting skeletal metastasis in neuroblastoma. BS might be eliminated in the evaluation of neuroblastoma when FDG PET is performed.

In this study, we aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured on (18)F-FDG PET/CT in pancreatic cancer patients who underwent resection with curative intent.Eighty-seven patients with pancreatic ductal adenocarcinoma who underwent (18)F-FDG PET/CT and subsequent surgical resection with curative intent with (30 patients) or without (57 patients) neoadjuvant therapy were retrospectively enrolled. The maximum standardized uptake value (SUVmax), MTV, and TLG were measured on (18)F-FDG PET/CT in all patients. The prognostic significances of PET/CT parameters and tumor factors for recurrence-free survival (RFS) and overall survival (OS) were evaluated by univariate and multivariate analyses.Of the 87 patients, 57 (64%) experienced recurrence during the follow-up period. The tumor size, pathologic T (pT) stage, SUVmax, MTV, and TLG were significant prognostic factors for both RFS and OS (P0.05) on univariate analyses, and the presence of lymph node metastasis showed significance only for predicting RFS (P0.05). On multivariate analyses, the tumor size, MTV, and TLG were independent prognostic factors for RFS, and pT stage, MTV, and TLG were independent prognostic factors for OS. For the 57 patients who did not undergo neoadjuvant treatment, MTV and TLG remained significant predictive factors for tumor recurrence, along with tumor size and SUVmax.MTV and TLG are independent prognostic factors for predicting RFS and OS in patients with pancreatic cancer. Thus, (18)F-FDG PET/CT can provide useful prognostic information for patients undergoing resection of pancreatic cancer with curative intent irrespective of neoadjuvant treatment.

Objectives This study aims to evaluate whether (18)F-FDG excretion patterns reflect renal function in malignant obstructive uropathy and to evaluate if these patterns predict internal ureteral stent success. Methods One hundred twelve patients who underwent PET/CT for abdominal tumors and displayed hydronephrosis on CT and 59 patients who underwent PET/CT for cancer screening were included in a retrospective study. Hydronephrosis was graded by initial CT and correlated with visual analysis of (18)F-FDG renal parenchymal uptake and excretion patterns. Stent insertion was performed for 84 patients after PET. Follow-up CT was reviewed for hydronephrosis improvement. Results There were 4 PET patterns in obstructive hydronephrosis which correlated linearly with hydronephrosis severity and serum creatinine levels. Patients with no parenchymal retention and renal excretion (PET pattern 1) showed 97% (28/29) hydronephrosis improvement after stent insertion, and patients with no parenchymal retention and no renal excretion showed 0% (0/9) hydronephrosis improvement after stent insertion. Multivariate analysis showed creatinine levels and PET pattern predicted stent success, but CT hydronephrosis did not. Conclusions There are 4 PET patterns of obstructive hydronephrosis which correlated with hydronephrosis grade and creatinine levels. Some of these PET patterns can be useful in the prediction of hydronephrosis improvement after stent insertion. Recognition of these patterns in obstructive hydronephrosis may be helpful in improving patient prognosis and quality of life.

Background There is a correlation between 18F-fluorodeoxyglucose (FDG) uptake and the level of intracellular metabolic tumor activity, which in turn may be associated with active proliferation, invasion, and prognosis as well as distant metastases in head and neck cancer. This study was designed to assess whether tumor uptake of FDG positron emission tomography (PET) expressed as the maximum standardized uptake value (SUVmax) can be used to predict survival in subjects with paranasal sinus malignancy. Methods We enrolled 42 consecutive subjects with a histological diagnosis of squamous cell carcinoma in paranasal sinus malignancy, into a retrospective institutional imaging trial. Thirty-eight subjects (90.5%) underwent a baseline FDG-PET scan before curative treatment and were eligible for analysis. Results A total of 38 subjects with paranasal sinus malignancy undergoing PET/computed tomography imaging in the initial stages were assessed separately for a potential correlation between SUVmax and T staging, histological grading, and overall survival. Log-rank testing revealed a significant correlation between overall survival and histological grading (p = 0.046); and there was some correlation between SUVmax and histological grading, but not significantly different. The receiver operation characteristic curve was identified for cutoff value of SUVmax as a prognostic factor. We compared the low tumor of the SUVmax group with the high tumor of the SUVmax group divided by the cutoff value of SUVmax. We did find a significant correlation between SUVmax and disease control and mortality (p = 0.003, p < 0.001). Conclusion In our study, we concluded that subjects with higher tumor FDG uptakes should be considered for a more aggressive disease.

Signal-intensity characteristics of magnetic resonance (MR) images were assessed in five patients and in 10 rabbits with tuberculous arthritis. MR imaging findings were compared with histologic findings in the animal study. In both of clinical and experimental cases, tuberculous lesions showed both intermediate and high signal intensity on T2-weighted images, while they showed heterogeneously intermediate signal intensity on T1-weighted images. As T2-weighted images were compared with pathologic specimens, intermediate signal intensity corresponded to caseous necrosis, whereas high signal intensity related to granulomas or effusion. Postcontrast T1-weighted images showed enhancement at the peripheries rather than the centers of tuberculous lesions. These results indicate that tuberculous arthritis should be included in the differential diagnosis when intra-articular lesions with low or intermediate signal intensity are found on T2-weighted images.

Aims Hepatic resection can cure hepatocellular carcinoma (HCC). However, the optimal extent of resection remains controversial. Major hepatectomy could minimize a tumor recurrence, but it is harmful due to decreased hepatic functional reserve. [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) scans are known as their reflection tumor differentiation and biological activity in HCC. To evaluate a benefit of major hepatectomy for HCC, we performed this retrospective analysis in patients with well-preserved hepatic function, and further analyzed in the subset identified by preoperative FDG-PET. Methods We reviewed the medical records of 189 patients with HCC who underwent curative resection between August 2004 and December 2010 at two institutes. All patients underwent anatomical resection, either by major or minor hepatectomy. Results Median overall survival did not differ significantly between the major and minor hepatectomy groups (29.4 versus 26.3 months, p = 0.269). However, the major hepatectomy group had a better recurrence-free survival (24.5 versus 19.9 months, p = 0.004). On multivariate analysis, the presence of intrahepatic metastasis independently predicted overall survival (p = 0.009), but other examined variables did not. Overall survival and recurrence-free survival were significantly better following major hepatectomy rather than minor hepatectomy in patients whose preoperative FDG-PET indicated that the maximum standardized uptake value of the tumor (SUVtumor) was ≥4 and the tumor-to-nontumor SUV ratio (TNR) was ≥1.5. Conclusions Our findings suggest that preoperative FDG-PET may be useful in identifying patients with favorable hepatic reserve who are most likely to benefit from major rather than minor hepatectomy.