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Cross-linking of collagen by Advanced Glycation End-products (AGEs) occurs by non-enzymatic glycation (Maillard reaction). The purpose of this study was to examine whether AGEs are formed in human dentinal collagen, and to consider any possible influence of AGEs on dentinal physiology. Mechanical characteristics, fluorescence spectra and immunohistochemical analyses of demineralized dentine sections from young subjects were compared with those of aged ones. The same investigations were performed with young dentine artificially glycated by incubation in 0.1M ribose solution. Indentation measurement indicated that the sections from aged dentine were mechanically harder than those from young dentine. The hardness of young dentine increased after incubation in ribose solution. Fluorescence peak wavelength of the young dentine was shorter than that of the aged one, but shifted towards the peak wavelength of the aged one after incubation in ribose solution. These changes were considered to be due to accumulation of AGEs. Existence of AGEs in dentinal collagen was confirmed by immunohistochemical analysis. The obtained results suggest that AGEs accumulation occurs in dentinal collagen and is affected by both human age and physiological conditions such as glucose level in blood because dentinal collagen receives nourishment via dental pulp and tubules.

Aim To evaluate ascites enhancement during abdominal oncological endovascular intervention (IVR) without iatrogenic extravasation and the factors associated with enhancement of ascites. Methods and materials CT images were obtained using an IVR-CT system for 73 patients with chronic liver disease and ascites. The CT images were obtained at least twice during each IVR. Radiodensity values of ascites at CT were measured for the first and last CT images in each procedure. The factors evaluated for their association with elevated ascitic fluid density were age, interval from the first to the last CT scan, Child–Pugh score, albumin level, total bilirubin level, prothrombin activity, the need for transcatheter arterial chemoembolization (TACE), estimated glomerular filtration rate, total amount of contrast material (CM) per square metre of body surface area (/m 2 ), amount of ascitic fluid, and the amount of CM entering the superior mesenteric artery (SMA) or coeliac artery/m 2 . Results The average ascitic radiodensity values for the first and last CT images were 18 and 51 HU, respectively. The percentage of patients with “significantly elevated” ascitic fluid density (≥10 HU) was 92%. Multivariate analysis showed that the total amount of CM/m 2 and the amount of ascitic fluid were significantly correlated and inversely correlated, respectively, with elevated ascitic fluid density. Conclusions Ascites enhancement without extravasation frequently occurs during abdominal oncological endovascular intervention in patients with chronic liver disease.

Diffusion-weighted imaging (DWI) produces contrast among different kinds of tissues according to their diffusibility characteristics. The purpose of our study was to evaluate the role of DWI including measurement of apparent diffusion coefficient (ADC) values in recognizing benignancy or malignancy of orbital masses.A total of 39 orbital masses were evaluated visually for signal characteristics on DWI and ADC maps. ADC values were calculated for each lesion. Visual signal characteristics were compared using the Fisher exact test. Receiver operating characteristic (ROC) analysis was carried out to determine sensitivity and specificity for distinguishing malignant from benign lesions using ADC values. The Mann-Whitney U test was applied to compare the ADC values between orbital lymphomas and idiopathic orbital inflammatory (IOI) lesions, and between optic nerve sheath meningiomas and gliomas.Visual assessment revealed no significant difference between benign and malignant lesions on DWI (p-value = 0.66). However, visual assessment of ADC maps revealed a statistically significant (p-value ≤ 0.0001) between benign and malignant lesions. ROC analysis showed a sensitivity of 83.33 % and a specificity of 85.71 % when using an optimal cut off ADC value of 0.84 × 10(-3) mm(2)/s for differentiating malignant from benign lesions. Significant differences in mean ADC values were observed between lymphomas and IOI lesions (p-value = 0.05), and between optic nerve sheath meningiomas and gliomas (p-value = 0.03).DWI is useful for differentiating malignant and benign orbital tumors if accompanied by visual assessment of ADC maps and ADC value calculations.

To assess the value of hepatic arterial-phase (HAP) imaging with a low tube voltage (80 kVp), using non-helical, volumetric acquisition with a 320-detector-rows area-detector CT (ADCT) scanner for evaluating hypervascular hepatocellular carcinoma (HCC) compared with routine 120-kVp HAP imaging. This study enrolled 128 patients with 148 HCCs. Seventy-six patients with 79 HCCs underwent HAP imaging with 80 kVp obtained using a 320-detector-rows ADCT scanner. The remaining 52 patients with 69 HCCs underwent routine HAP imaging with 120 kVp obtained by 64-slice helical acquisition. Image noise and tumor to liver contrast-to-noise ratio (CNR) of the two sets of images were compared. Three radiologists evaluated both sets of images using receiver operating characteristic analyses. Although there was a two-fold increase in the mean image noise with 80 kVp over that with 120 kVp (p

The purposes of this MR-based study were to calculate q-space imaging (QSI)-derived mean displacement (MDP) in meningiomas, to evaluate the correlation of MDP values with apparent diffusion coefficient (ADC) and to investigate the relationships among these diffusion parameters, tumour cell count (TCC) and MIB-1 labelling index (LI).MRI, including QSI and conventional diffusion-weighted imaging (DWI), was performed in 44 meningioma patients (52 lesions). ADC and MDP maps were acquired from post-processing of the data. Quantitative analyses of these maps were performed by applying regions of interest. Pearson correlation coefficients were calculated for ADC and MDP in all lesions and for ADC and TCC, MDP and TCC, ADC and MIB-1 LI, and MDP and MIB-1 LI in 17 patients who underwent subsequent surgery.ADC and MDP values were found to have a strong correlation: r = 0.78 (P = 0.0001). Both ADC and MDP values had a significant negative association with TCC: r = -0.53 (p = 0.02) and -0.48 (P = 0.04), respectively. MIB-1 LI was not, however, found to have a significant association with these diffusion parameters.In meningiomas, both ADC and MDP may be representative of cell density.• Diffusion-weighted MRI offers possibilities to assess the aggressiveness of meningiomas. • The q-space imaging-derived mean displacement correlates strongly with apparent diffusion coefficients. • Both diffusion parameters showed a strong negative association with tumour cell counts. • Derived mean displacement may help assess the aggressiveness of meningiomas preoperatively.

Intrafractional setup errors during hypofractionated stereotactic radiotherapy (SRT) were investigated on the patient under voluntary breath-holding conditions with non-invasive immobilization on the CT-linac treatment table. A total of 30 patients with primary and metastatic lung tumors were treated with the hypofractionated SRT with a total dose of 48–60 Gy with four treatment fractions. The patient was placed supine and stabilized on the table with non-invasive patient fixation. Intrafractional setup errors in Right/Left (R.L.), Posterior/Anterior (P.A.), and Inferior/Superior (I.S.) dimensions were analyzed with pre- and post-irradiation CT images. The means and one standard deviation of the intrafractional errors were 0.9 ± 0.7mm (R.L.), 0.9 ± 0.7mm (P.A.) and 0.5 ± 1.0 mm (I.S.). Setup errors in each session of the treatment demonstrated no statistically significant difference in the mean value between any two sessions. The frequency within 3mm displacement was 98% in R.L., 98% in P.A. and 97% in I.S. directions. SRT under the non-invasive patient fixation immobilization system with a comparatively loose vacuum pillow demonstrated satisfactory reproducibility of minimal setup errors with voluntary breath-holding conditions that required a small internal margin.

Purpose To evaluate imaging characteristics of optic nerves by using magnetic resonance imaging, especially diffusion-weighted imaging (DWI) with apparent diffusion coefficient measurements in acute and chronic phases of optic neuritis (ON). Materials and Methods A retrospective study was conducted by using records of 14 patients with clinically suspected acute ON (15 nerves), 5 chronic ON (7 nerves), and 11 normal volunteers with no eye symptoms were used as controls. Magnetic resonance imaging was performed by a 1.5T scanner. Affected nerves were evaluated for sizes, signal characteristics on DWI and T2-weighted imaging (T2WI), contrast enhancement, and apparent diffusion coefficient values. Visually assessed characteristics were compared between the acute and chronic, whereas apparent diffusion coefficient values were assessed among acute ON, chronic ON, and the control groups by using the Fisher exact test and Mann-Whitney U test. Results There were significant differences in the diameter of the optic nerves, hyperintensity on DWI, and enhancement characteristics on post-enhanced images in acute and chronic phases of ON ( P = .0001, P < .0001, and P = .0022, respectively), apparent diffusion coefficient values of the optic nerves in acute ON, chronic ON, and control groups also differed significantly from each other. Conclusion In conclusion, DWI can add valuable information in assessment of damage to nerve and neuronal barriers and thus in predicting recovery in cases of ON.

Purpose: To compare diffusivity values between malignant and benign focal hepatic lesions using the intravoxel incoherent motion model. Materials and Methods: This study included 84 focal hepatic lesions in 84 patients. Final diagnoses were as follows: hepatocellular carcinoma (n = 45), cholangiocarcinoma (n = 6), metastatic liver tumor (n = 3), cyst (n = 20), hemangioma (n = 5), inflammatory pseudotumor (n = 2), abscess (n = 2), and focal nodular hyperplasia (n = 1). Diffusion-weighted images at 12 b-values were used to obtain the diffusion coefficient of pure molecular diffusion (D), diffusion coefficient of microcirculation or perfusion-related diffusion (D*), and perfusion-related diffusion fraction (f). Parameters of malignant and benign focal hepatic lesions were compared using the Wilcoxon test. The diagnostic performance for distinguishing between malignant and benign hepatic lesions was also analyzed. Results: Both the D value (1.15 ± 0.21 × 10−3 mm2/s [mean ± standard deviation]) and D* value (62.7 ±12.7 × 10−3 mm2/s) in malignant lesions was significantly lower than that in benign lesions (D value [2.46 ± 0.45× 10−3 mm2/s], P < 0.0001; D* value [87.6 ± 35.3 × 10−3 mm2/s], P = 0.0008). The f value did not differ significantly between malignant (25.0 15.1 ± 15.1%) and benign lesions (30.1 ± 16.3%). Conclusion: D* and D values were suppressed in malignant lesions. However, the D value was more reliable for distinguishing between malignant and benign focal hepatic lesions. J. Magn. Reson. Imaging 2013;37:1371–1376. © 2012 Wiley Periodicals, Inc.

Purpose To investigate prognostic and risk factors for recurrence after stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung carcinoma (NSCLC), focusing on dual time point [18]F-fluorodeoxyglucose positron emission tomography (FDG PET). Materials and methods We prospectively evaluated 57 patients with stage I NSCLC (45 T1N0M0 and 12 T2N0M0) who had undergone pretreatment FDG-PET/CT and were subsequently treated with SBRT. All patients received a whole-body PET/CT scan at 60 min and a whole-lung at 120 min after the injection. The maximum standardized uptake value (SUV) and retention index (RI) of the lesions were calculated. Local recurrence, regional lymph node metastasis, distant metastasis, and the recurrence pattern were evaluated. Cox proportional hazard regression analyses were performed to evaluate prognostic factors or risk factors of recurrence. Results During the median follow-up period of 27 months, local recurrence, regional lymph node metastasis, and distant metastasis were seen in 17 (30%), 12 (21%), and 17 (30%) of the 57 patients, respectively. The 3-year overall survival rate was 63.4%. SUV max did not affect any recurrence, DFS, OS, or CSS. RI significantly predicted higher distant metastasis (HR 47.546, p = 0.026). In contrast, RI tended to predict lower local recurrence (HR 0.175, p = 0.246) and regional lymph node metastasis (HR 0.109, p = 0.115). Conclusions SUV max at staging FDG-PET does not predict any recurrence, DFS, OS or CSS. In contrast, higher RI predicts higher distant metastasis and tended to predict lower local or regional lymph node metastasis.

Purpose To clarify the optimal iodine dose of contrast material for 3-dimensional multidetector-row CT angiography (3D-MDCTA) of the venous vasculature of the liver using volume rendering technique. Materials and methods This study included 103 patients who were randomly assigned to 5 contrast-enhanced MDCT protocol groups with different body-weight-tailored doses of contrast material: 500, 600, 630, 650, and 700 mgI/kg body weight. The arterial, portal, and hepatic parenchymal phases were obtained to evaluate enhancement values of the aorta, portal vein, and hepatic vein. Visualization of the portal and hepatic veins on the volume-rendering images of 3D-MDCTA was evaluated using a 5-point grade. Dunnett's test was used to compare the mean enhancement value and mean grades of image quality (700 mgI/kg dose group was control). Results The mean enhancement values of portal and hepatic vein in the group with 500 and 600 mgI/kg were significantly lower than those of the control group. During visual assessment, a significantly lower mean grades were observed in 500 mgI/kg groups for the portal vein, and 500 and 600 mgI/kg groups for hepatic vein. There were no significant intergroup differences in mean enhancement values and visual assessment among the groups using 630 mgI/kg or more. Conclusion Iodine doses of 630 mgI/kg was recommended for 3D-MDCTA.

To examine if liver stiffness measured by magnetic resonance elastography (MRE) is a risk factor for hepatocellular carcinoma (HCC) in patients with chronic liver disease. By reviewing the records of magnetic resonance (MR) examinations performed at our institution, we selected 301 patients with chronic liver disease who did not have a previous medical history of HCC. All patients underwent MRE and gadoxetic acid-enhanced MR imaging. HCC was identified on MR images in 66 of the 301 patients, who were matched to controls from the remaining patients without HCC according to age. MRE images were obtained by visualising elastic waves generated in the liver by pneumatic vibration transferred via a cylindrical passive driver. Risk factors of HCC development were determined by the odds ratio with logistic regression analysis; gender and liver stiffness by MRE and serum levels of aspartate transferase, alanine transferase, alpha-fetoprotein, and protein induced by vitamin K absence-II. Multivariate analysis revealed that only liver stiffness by MRE was a significant risk factor for HCC with an odds ratio (95 % confidence interval) of 1.38 (1.05–1.84). Liver stiffness measured by MRE is an independent risk factor for HCC in patients with chronic liver disease. • Magnetic resonance elastography can estimate liver stiffness, a marker of hepatic fibrosis. • Liver stiffness is an independent risk factor of hepatocellular carcinoma (HCC). • Liver stiffness seems a better indicator of HCC than tumour markers.

Purpose We evaluated the use of magnetic resonance (MR) elastography (MRE) for staging liver fibrosis in patients with chronic hepatitis C and compared the ability of MRE and serum fibrosis markers for discriminating each stage of fibrosis. Methods We evaluated 114 patients with chronic hepatitis C in whom the pathological fibrosis stage was determined (fibrosis stage 0 [F0], 3; F1, 15; F2, 28; F3, 25; and F4, 43). All patients underwent MRE using a 1.5-tesla MR system and pneumatic driver system. We measured stiffness values (kPa) of the liver in a circular region of interest placed on elastograms. We determined the optimal cutoff value and diagnostic ability for discriminating each stage of fibrosis using receiver operating characteristic (ROC) curve analysis and compared the discriminative ability of MRE with that of serum fibrosis markers. Results The mean stiffness values of the liver increased with stage of fibrosis: F0, 2.10±0.10 kPa; F1, 2.42±0.29 kPa; F2, 3.16±0.32 kPa; F3, 4.21±0.78 kPa; and F4, 6.20±1.08 kPa. The mean area under the ROC curve (Az) values for discriminating liver fibrosis stages were: ≥F1, 0.984 (95% confidence interval, 0.933-0.996); ≥F2, 0.986 (0.956-0.996); ≥F3, 0.973 (0.935-0.989); and ≥F4, 0.976 (0.945-0.990). The Az values for discriminating fibrosis stages were significantly higher for MRE than serum fibrosis markers. Conclusion MRE is a reliable technique for staging liver fibrosis and discriminating liver fibrosis stages in patients with chronic hepatitis C.

BACKGROUND AND PURPOSE: Intramedullary high signal intensity on T2-weighted imaging was frequently observed in patients with CSM, although this finding does not well correlate with severity or prognosis of CSM. Instead of this nonquantitative information, another measure for CSM is desired. The work was focused primarily on assessing the relationships between ADC values and clinical and radiologic severity for the diagnosis of CSM. MATERIALS AND METHODS: The relationship between ADC values measured in the spinal cord at 322 intervertebral levels of 66 patients and clinical factors were analyzed. RESULTS: ADC values in the spinal cord significantly increased with the degree of spinal cord compression and decreased with time after decompression surgery. Patients with higher ADC values had lower preoperative JOA scores and tended to show poorer clinical recovery. CONCLUSIONS: ADC values appear to indicate the severity of spinal cord compression and clinical recovery after decompression surgery, so spondylotic myelopathy may partly be predicted preoperatively by using ADC values.

To describe imaging findings of early hepatocellular carcinoma (HCC) at gadoxetic acid-enhanced magnetic resonance (MR) imaging, dynamic contrast material-enhanced computed tomography (CT), CT during arterial portography (CTAP), and CT during hepatic arteriography (CTHA) and to compare the diagnostic performance of each modality for small (≤ 2 cm) HCC.The institute ethics committee deemed study approval unnecessary. One hundred eight resected small lesions in 64 patients were diagnosed as a dysplastic nodule (DN) (n = 12), progressed HCC (n = 66), or early HCC (n = 30). All but two patients underwent all imaging examinations. The imaging characteristics of the lesions with each modality were determined. To evaluate the diagnostic performance of the modalities, two radiologists graded the presence of HCC with use of a five-point confidence scale. The area under the receiver operating characteristic curve (A(z)), sensitivity, and specificity of each modality were compared.The imaging features that are statistically significant for differentiating an early HCC from a DN include fat-containing lesions at dual-echo T1-weighted MR imaging (seen in 16 of the 30 early HCCs and none of the DNs), low attenuation at unenhanced CT (seen in 13 of the 30 early HCCs and none of the DNs), low attenuation at CTAP (seen in 11 of the 30 early HCCs and none of the DNs), and low signal intensity at hepatocyte phase gadoxetic acid-enhanced MR imaging (seen in 29 of the 30 early HCCs and none of the DNs). The diagnostic performance of gadoxetic acid-enhanced MR imaging (A(z), 0.98 and 0.99) was significantly greater than that of contrast-enhanced CT (A(z), 0.87) and CTHA-CTAP (A(z), 0.85 and 0.86) owing to its significantly higher sensitivity (P.001).Gadoxetic acid-enhanced MR imaging is the most useful imaging technique for evaluating small HCC, including early HCC.

Purpose To compare the diagnostic accuracy of contrast-enhanced computed tomography (CE-CT), contrast-enhanced ultrasonography (CE-US), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), and gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in the evaluation of colorectal hepatic metastases. Materials and methods In all, 111 patients with colorectal cancers were enrolled in this study. Of the 112 metastases identified in 46 patients, 31 in 18 patients were confirmed histologically and the remaining 81 in 28 patients were confirmed by follow-up imaging. CE-CT, CE-US, SPIO-MRI, and Gd-EOB-MRI were evaluated. Mean (of three readers, except for CE-US) area under the receiver operating characteristic curve (A(z) ), sensitivities, and positive predictive values (PPV) were calculated. Each value was compared to the others by variance z-test or chi-square test with Bonferroni correction. Results For all lesions, mean A(z) and sensitivity of Gd-EOB-MRI (0.992, 95% [56/59]) were significantly greater than those of CE-CT (0.847, 63% [71/112]) and CE-US (0.844, 73% [77/106]). For lesions ≤1 cm, mean A(z) and sensitivity of Gd-EOB-MRI (0.999, 92% [22/24]) were significantly greater than those of CE-CT (0.685, 26% [13/50]) and CE-US (0.7, 41% [18/44]). Mean A(z) (95% CI) of SPIO-MRI for all lesions (0.966 [0.929-0.987]) and lesions ≤ 1 cm (0.961 [0.911-0.988]) were significantly greater than those of CE-CT and CE-US. Mean sensitivity of SPIO-MRI for lesions ≤1 cm (63%, 26/41) was significantly greater than that of CE-CT. Conclusion Gd-EOB-MRI and SPIO-MRI were more accurate than CE-CT and CE-US for evaluation of liver metastasis in patients with colorectal carcinoma.

Rationale and Objectives Q-space analysis using high b-value diffusion-weighted magnetic resonance (MR) data provides information on tissue microstructure in contrast to conventional MR imaging (MRI) based on low b-value diffusion-weighted imaging (DWI). The purpose of this study was to evaluate the use of mean displacement (MDP) map in stroke patients using q-space diffusion-weighted MRI (QSI). Materials and Methods Twenty-one patients presenting with a total of 22 acute or subacute cerebral infarctions were included. MR protocol consisted of conventional MR sequences, DWI (b-value; 1000 s/mm2) and QSI (b-value; maximum 12,000 s/mm2). Apparent diffusion coefficient (ADC) maps of conventional DWI and MDP maps of QSI data were obtained and compared in the ischemic lesions and corresponding normal tissues. Results Decreased ADC values were present in all lesions. There was no correlation between ADC and MDP values in the lesions (r = 0.21). MDP values of the lesions were 8.60 ± 1.26 μm (mean ± SD). Most of the lesions (16/22) had higher MDP values than normal brain tissue. Three lesions showed lower MDP values and three showed mixed MDP values. Conclusions The MDP maps using QSI data provides additional information for stroke patients compared to conventional DWI.

The aim of this study was to determine a standard deviation (SD) that most reduces the radiation dose without sacrificing the diagnostic accuracy of thinsection computed tomography (CT) for clinical use. A total of 120 patients were examined by multidetector CT. They were assigned to one of four SD groups: 8, 9, 11, and 12. Each SD group consisted of 30 patients. The CT images of the same patients with SD10 that had formerly been examined were used for comparison. Two radiologists independently evaluated the degrees of image noise and diagnostic acceptability of the pulmonary diseases using a point score grading system. We compared the scores between each SD and the SD10 group. Generally, image noise was significantly more prominent in the higher-SD groups. The mean score of diagnostic acceptability was significantly lower in the SD12 group (4.2 ± 1.6) than in the SD10 group (4.6 ± 1.1) group (P < 0.001), whereas no difference was present between the SD8 (4.9 ± 0.7), SD9 (4.8 ± 1.0), and SD11 (4.4 ± 1.5) groups and the SD10 group (4.7 ± 1.1, 4.6 ± 1.4, 4.6 ± 1.1, respectively). Thin-section CT with SD12 is not acceptable. SD11 seems to be the setting with the lowest radiation dose while providing acceptable imaging quality for pulmonary thin-section CT.

PURPOSE We aimed to determine the displacement parameters in the brains of normal individuals relative to brain parenchymal abnormalities, such as multiple sclerosis (MS) and low-grade glioma, by q-space imaging (QSI) using 1.5-T magnetic resonance (MR) scanner. MATERIALS AND METHODS Thirty-five normal, three pathologically proven low-grade glioma, and five MS subjects were imaged by a 1.5-T MR unit for QSI (b-values, 0-12,000 s/mm2). Mean displacement (MD) values in white matter (WM), gray matter (GM), and lateral ventricle (cerebrospinal fluid [CSF]) of normal subjects, plaques, and normal appearing WM (NAWM) of MS subjects and glioma lesions were calculated. Mann-Whitney U test was used for comparison. RESULTS In normal subjects, MD values were 6.6 ± 0.2, 8.44 ± 0.41, and 17.08 ± 0.80 μm for WM, GM, and CSF, respectively, while those for NAWM and WM plaques in MS, and glioma lesions were significantly higher at 7.0 ± 0.17, 9.3 ± 2.3, and 9.6 ± 0.40 μm, respectively, compared to WM in normal subjects. CONCLUSION We propose that the relative values of MD obtained by QSI in control and diseased tissues can be useful for diagnosing various WM abnormalities.

The purpose of this study was to compare the diagnostic performance of (18)F-FDG PET/CT, MRI with and without diffusion-weighted imaging (DWI), and contrast-enhanced MDCT in the detection of peritoneal dissemination of malignant tumors.We retrospectively evaluated the cases of 107 patients who underwent PET/CT and 130 patients who underwent MRI and contrast-enhanced MDCT. Twenty-six patients who underwent PET/CT and 23 who underwent MRI and contrast-enhanced MDCT were found to have peritoneal dissemination. All images were independently evaluated by two radiologists using a 5-point grading system. The results of PET/CT, T1- and T2-weighted MRI without DWI, MRI with DWI (b = 1,000 s/mm(2)), and contrast-enhanced MDCT were compared patient by patient and lesion by lesion by use of receiver operating characteristics analysis. Sensitivity, specificity, and positive predictive value were calculated and compared by use of the chi-square test.Patient by patient, the area under the receiver operating characteristics curve of MRI without DWI (0.88) was significantly less than that of the other modalities (contrast-enhanced MDCT, 0.91; MRI with DWI, 0.93; PET/CT, 0.97). The sensitivity of PET/CT (94%) was significantly higher than that of MRI without DWI (70%). The specificities of the modalities were not significantly different. In lesion-by-lesion analysis, MRI without DWI had significantly lower sensitivity (56%) than the other modalities (contrast-enhanced MDCT, 76%; MRI with DWI, 84%; PET/CT, 89%). The positive predictive value of PET/CT (93%) was significantly higher than that of the other three modalities (contrast-enhanced MDCT, 73%; MRI without DWI, 70%; MRI with DWI, 72%).PET/CT is the most useful technique for pathologic staging in the care of patients with malignant disease. If PET/CT is not available, DWI can be used as a screening tool.

金沢大学医薬保健研究域医学系, Percutaneous coronary intervention (PCI) using a drug-eluting stent (DES) leads to less re-stenosis than PCI using a bare metal stent (BMS), however there is still controversy whether use of a DES for severe coronary disease leads to an acceptable outcome in patients with diabetes mellitus (DM). In this study 8159 lesions were treated in 6739 patients (mean age 68.9 years) with coronary artery disease. Use of a DES significantly decreased the re-stenosis rate compared with BMS in both DM (9.6% versus 21.3%) and non-DM (9.5% versus 17.1%) patients. The re-stenosis rate was significantly higher in DM than in non-DM patients in the BMS group but not in the DES group. There was no statistically significant difference in event-free survival after stenting of patients with left main coronary artery (LMCA) disease between the BMS and DES groups. It was concluded that, compared with BMS, DES reduced re-stenosis in patients with DM, however, we advise careful treatment after using DES for severe coronary disease, including LMCA lesions, in patients with DM. © 2011 Field House Publishing LLP.

The aim of this study was to estimate inter-rater reliability and validate magnetic resonance elastography (MRE) as a tool to measure liver elasticity.The study protocol was approved by the institutional review board at our institution. In all, 10 normal volunteers and 110 patients, who provided written informed consent, were enrolled. The pathological fibrosis score was applied as a standard reference of liver fibrosis in 21 patients. MRE was performed with a 1.5-T magnetic resonance imaging scanner with a cylindrical passive longitudinal shear wave driver placed over the right chest wall to deliver vibrations. A gradient-echo MRE sequence was used to acquire axial wave images, which were automatically converted to elastograms representing elasticity (in kilopascals, or kPa). The region of interest was placed in the right lobe of the liver on elastograms by two raters independently. To evaluate interrater reliability, the intraclass correlation coefficient was calculated. The elasticity measurements correlated with the pathological fibrosis score (F1-F4) in 21 patients.The intraclass correlation coefficient was almost perfect (0.993) between the elasticities measured by the two raters. The mean elasticity value for patients with F4 was 5.7 kPa; F3, 4.4 kPa; F2, 3.1 kPa; F1, 2.2 kPa; and F0, 2.1 kPa.MRE is a reliable tool to measure liver elasticity.

To retrospectively determine findings at gadoxetic acid-enhanced magnetic resonance (MR) imaging in hypervascular pseudolesions that were observed at computed tomography (CT) during hepatic arteriography, with special focus on distinguishing these pseudolesions from hypervascular hepatocellular carcinomas (HCCs).The institute ethics committee deemed study approval unnecessary. The study population comprised 80 patients (55 men, 25 women) with chronic liver disease who underwent CT during hepatic arteriography and arterial portography, gadoxetic acid-enhanced MR imaging, and follow-up dynamic contrast material-enhanced CT. The diagnosis of 104 pseudolesions and 123 HCCs was confirmed by means of histopathologic or multimodality evaluation. Two radiologists assessed the MR imaging findings of HCCs and pseudolesions in consensus, including the signal intensities (SIs) of the lesions on T2-weighted, diffusion-weighted (DW), and contrast-enhanced hepatocyte-phase images. The findings of nodular pseudolesions and HCCs were compared with the Fisher exact test. Additionally, the hepatocyte-phase SI ratio (ratio of lesion SI to liver SI) for HCCs and pseudolesions was compared by means of the Mann-Whitney U test.There were 62 wedge-shaped, 32 nodular, and 10 linear pseudolesions. On gadoxetic acid-enhanced hepatocyte-phase MR images, 15% of pseudolesions (16 of 104) were hypointense compared with surrounding liver tissue. The mean hepatocyte-phase SI ratio of HCCs (0.65 +/- 0.14 [standard deviation]) was significantly lower (P.01) than that of the nodular pseudolesions (0.95 +/- 0.11). The optimal cutoff value of hepatocyte-phase SI ratio for distinguishing between HCC and nodular pseudolesion was 0.84. No nodular pseudolesions were visible on DW images.Gadoxetic acid-enhanced hepatocyte-phase MR imaging and DW imaging could be used to distinguish hypervascular pseudolesions from hypervascular HCCs; a hepatocyte-phase SI ratio below 0.84 and visibility on DW images were findings specific for HCCs rather than pseudolesions.

The aim of this study was to characterize computed tomography (CT) manifestations of local recurrence after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC). A total of 27 stage I NSCLC patients who were treated with SBRT, including 5 patients with local recurrence, were retrospectively analyzed for serial CT examinations. A bulging margin appeared in 4 of the 5 cases (80%) with local recurrence and 1 of 22 cases (5%) without local recurrence. Air bronchograms were seen in 3 of 5 cases with local recurrence and 21 of 22 cases without local recurrence, but they subsequently disappeared in all 3 cases (100%) with local recurrence and in 4 of the 21 cases (19%) without local recurrence. Ipsilateral pleural effusion was observed in all 5 cases (100%) with local recurrence and in 5 of 22 cases (22%) without local recurrence. The opacity increased in size even after 12 months from the completion of SBRT in cases with local recurrence, whereas it decreased or did not change in size in cases without recurrence. Local recurrence should be suspected on CT when there was (1) a bulging margin, (2) disappearance of air bronchograms, (3) appearance of pleural effusion, or (4) increase in the abnormal opacity after 12 months.

Purpose: To clarify the factors that predict enhancement of the liver parenchyma in hepatocyte-phase of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging. Materials and Methods: Gd-EOB-DTPA–enhanced hepatocyte-phase MR images of 198 patients with chronic liver diseases (Child-Pugh class A in 112 patients, class B in 74 patients, and class C in 12 patients) were retrospectively analyzed. The hepatocyte-phase images were obtained using fat-suppressed T1-weighted gradient-echo images with a 3D acquisition sequence 10 min and 20 min after IV administration of Gd-EOB-DTPA (0.025 mmol/kg body weight). The quantitative liver–spleen contrast ratio (Q-LSC) was calculated using the signal intensities of the liver and spleen. Serum albumin levels, total bilirubin levels, prothrombin activity, and the results of indocyanine green clearance tests (ICGs) were recorded and correlated with the Q-LSC. Logistic regression analysis was performed to analyze which factors predict sufficient liver enhancement using a Q-LSC of 1.5 as a cutoff value. Results: Only ICGs and Child-Pugh classifications showed a statistically significant correlation with the Q-LSC. Logistic regression analysis showed that ICGs were the only factors that accurately predicted liver enhancement on hepatocyte-phase images. Conclusion: ICGs were found to be predictors of sufficient liver enhancement on hepatocyte-phase images. J. Magn. Reson. Imaging 2009;30:1042–1046. © 2009 Wiley-Liss, Inc.

Purpose To elucidate whether a contrast agent dilution method (dilution method), in which gadoxetate disodium (Gd-EOB-DTPA) is diluted with saline, is useful for good-quality arterial-phase images. Materials and Methods In this study we observed 494 hypervascular hepatocellular carcinomas (HCCs) in 327 patients with chronic liver disease. Three Gd-EOB-DTPA injection methods were adopted for comparison: 1) test injection method (undiluted Gd-EOB-DTPA and modified scan delay), in which a test dose of 0.5 mL of Gd-EOB-DTPA was injected to determine scan delay; 2) conventional method (undiluted Gd-EOB-DTPA and fixed scan delay); and (3) dilution method (diluted Gd-EOB-DTPA and fixed scan delay), in which Gd-EOB-DTPA was diluted to 20 mL with saline. Lesion-liver contrast was calculated. Image quality and lesion detectability were evaluated by two radiologists blinded to the injection methods. Results The lesion-liver contrast of the dilution method was significantly higher than that of the other two methods. Lesion detectability of the conventional method (64%) was significantly lower than that of the other two methods (contrast agent dilution method, 95%; test injection method, 93%). The image quality of the contrast agent dilution method was significantly better than that of the other two methods. Conclusion The dilution method contributed to improved image quality, high lesion-liver contrast, and high lesion detectability in the arterial-phase images of GD-EOB-DTPA-enhanced MRI. J. Magn. Reson. Imaging 2009;30:849–854. © 2009 Wiley-Liss, Inc.

Objective Cholangiolocellular carcinoma (CLC) is a rare subtype of intrahepatic cholangiocarcinoma as categorized according to the World Health Organization criteria. Recent study also revealed that CLC would originate from hepatic progenitor cells, which are liver-specific stem cells. We reviewed the imaging findings of CLCs, including those of intrahepatic metastases. Methods Eight patients who underwent partial hepatectomy were included in this study. Images, including dynamic computed tomographic and magnetic resonance images, were reviewed. Results On arterial phase images, the lesions appeared as masses exhibiting early and complete enhancement or predominantly peripheral enhancement. Retention of the contrast media in the lesions was observed in half of the lesions. The metastatic nodules had indistinct borders and showed early enhancement along with delayed central enhancement. Conclusions Although CLC with dense central fibrosis exhibits imaging features similar to those exhibited by intrahepatic cholangiocarcinoma, early enhancement in most lesions with persistent delayed enhancement is one of the characteristic imaging findings of this rare tumor.

Aim: To examine if it is possible to shorten the examination time of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB)-enhanced MRI by omitting hepatocyte-phase images of 20-min delay time (Im-20) for detecting focal liver lesions. Materials and methods: Four hundred ninety-five malignant focal liver lesions observed on Im-20 in 265 patients were included. The hepatocyte phase was obtained 10 min (Im-10) and 20 min (Im-20) after Gd-EOB injection. Liver enhancement was evaluated using a 4-point scale [excellent/good/poor/non-diagnostic; visual liver-spleen contrast (V-LSC)] and a quantitative liver–spleen contrast ratio (Q-LSC). Two radiologists evaluated lesion conspicuity for assessing the sensitivity of lesion detection. As Im-20 was used as the standard of reference for the lesions, Im-20 artificially had 100% sensitivity. Results: The results showed that although sensitivities and Q-LSC significantly increased from Im-10 to Im-20 (sensitivity/mean Q-LSC: Im-5, 81%/1.4 Im-10, 96%/1.7: Im-20, 100%/1.9), the sensitivity of Im-10 achieved 100% (the same as Im-20) in patients with good/excellent V-LSC or Q-LSC of more than 1.5. On Im-10, 202 patients (77%) were assigned as having good/excellent V-LSC (78%), and 161 (61%) were assigned as having Q-LSC of more than 1.5. Conclusion: We concluded that Im-20 can be omitted in at least 61% of the patients.

To evaluate the relationship between SUVmax of primary lung cancers on FDG-PET and lymph node metastasis.The subjects were a total of consecutive 66 patients with lung cancer who were examined by FDG-PET and subsequently underwent surgery between October 2004 and January 2008. There were 41 males and 25 females, ranging in age from 45 to 83 years with an average of 68 years. The pathological subtypes of the lung cancers consisted of 49 adenocarcinomas, 11 squamous cell carcinomas, 2 adenosquamous carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, 1 pleomorphic carcinoma and 1 mucoepidermoid carcinoma. We statistically compared (1) the mean SUVmax of lung cancer between the groups with and without lymph node metastasis (2) the frequency of lymph node metastasis between higher and lower SUVmax of lung cancer groups that were classified by using the median SUVmax of lung cancer, and (3) evaluated the relationship between the SUVmax of lung cancer and frequency of lymph node metastases, and (4) correlations between the SUVmax of lung cancer and number of the metastatic lymph nodes and pathological n stages.The difference in the average of the SUVmax of lung cancer between the cases with and without lymph node metastases was statistically significant (p = 0.00513). Lymph node metastasis was more frequently seen in the higher SUVmax of lung cancer group (17/33, 52%) than in the lower SUVmax of lung cancer group (7/33, 21%) with a statistically significant difference. There was no lymph node metastasis in lung cancers with an SUVmax of lung cancer less than 2.5, and lung cancers with an SUVmax of lung cancer more than 12 had a 70% frequency of lymph node metastasis. There were moderate correlations between SUVmax of lung cancer, and the number of the metastatic lymph nodes (gamma = 0.404, p = 0.001) and pathological n stage (gamma = 0.411, p = 0.001).The likelihood of lymph node metastasis increases with an increase of the SUV of a primary lung cancer.

Aim: This study aimed to evaluate the validity of 0.5-mm thin-section computed tomography (CT) for the assessment of pulmonary nodular lesion in comparison with 1-mm CT. Materials and Methods: A total of 38 focal lesions from 30 patients, which were scanned with 0.5- and 1.0-mm collimation, were evaluated regarding the extent of ground-glass opacity (GGO) and well-defined margin, and the presence of pleural indentation, spicula, and internal air density. The frequency of each finding was statistically compared between 0.5- and 1-mm CT using the McNemar test. Results: No statistically significant difference was observed between 0.5- and 1-mm CT for each finding. Conclusion: The use of 0.5-mm CT is not justified if the original collimation of multi-detector row CT is near 1 mm.

Emerging evidence shows a beneficial effect of estrogens for Parkinson's disease, yet the exact potency of these compounds implicated remain obscured. In this study, we investigated the neuroprotective effect of 17β-estradiol and estrone against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced striatal toxicity in mice. The neuroprotective effects of both compounds were evaluated by HPLC and Western blot analyses 5 days after the last of 4 consecutive injections of MPTP at 1-h intervals to mice. Subacute treatment (10 days) with estrone or 17β-estradiol at low doses (0.05 and 0.2 mg/kg) showed no significant changes against MPTP-induced damage of striatal dopamine terminals in mice. Furthermore, acute treatment with estrone at high doses (0.5 and 2.0 mg/kg) showed no significant alterations against MPTP-induced damage of striatal dopamine terminals in mice. In contrast, acute treatment with 17β-estradiol at high doses exhibited a neuroprotective effect against the damage of striatal dopamine terminals in both male and female mice after MPTP treatments. The results demonstrate that estrogen therapy with high doses may have a neuroprotective effect on the damage of striatal dopamine terminals in the MPTP-induced mice. These findings may lead to be development of estrogen therapy for the prevention and treatment of Parkinson's disease.

OBJECTIVE: We prospectively investigated the predictive value of diffusion tensor tractography for motor functional outcome in a case series of patients with intracerebral hemorrhage. METHODS: Diffusion tensor tractography was performed in 17 patients with intracerebral hemorrhage (putamen, nine patients; thalamus, seven patients; combined, one patient) within 5 days after onset. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values along the corticospinal tracts at the level of the hematoma were measured bilaterally, and the ratios of values (hematoma side/contralateral side) were determined as FA and ADC ratios, respectively. Patients were evaluated for motor function on admission and at 3 months after onset using the manual muscle test score and then divided into good (manual muscle test, 4-5) and poor (manual muscle test, 0-3) motor function groups. RESULTS: FA ratio measured shortly after the onset of intracerebral hemorrhage correlated well with motor functional outcome at 3 months (P < 0.05) but not with motor function on adrntssion. FA ratios in the group with good motor functional outcome were significantly higher than those in the group with poor motor functional outcome (P < 0.01). The ADC ratio did not correlate with motor function either on admission or at 3 months. All patients with an FA ratio greater than 0.8 had a good motor functional outcome. In three patients, however, motor functional outcomes were favorable even though FA ratios were not high; in these patients, ADC ratios tended to be elevated. CONCLUSION: Motor functional outcome in patients with infracerebral hemorrhage can be predicted by measuring FA values using diffusion tensor tractography.

This study aimed to evaluate the efficacy of thin-section CT of the mediastinum in the assessment of thoracic lymph nodes in comparison with conventional CT.A total of 193 CT examinations from 193 patients with suspected pulmonary disease were reconstructed into thin-section CT and conventional CT. The appearances of the lymph nodes were assessed and compared between thin-section CT and conventional CT.Intranodal fat was more often detected on thin-section CT than on conventional CT (P.001). There were no statistically significant differences in the frequencies of inhomogeneous enhancement and bulging margin of the hilar lymph node.Thin-section CT can improve clinical N-staging of lung cancer due to classification of enlarged mediastinal lymph nodes as benign based on identification of intranodal fat.

The purpose of this retrospective study was to determine the usefulness of delayed phase imaging for detecting small (or = 2 cm) hepatocellular carcinomas (HCCs) in patients with liver cirrhosis.Triphasic (arterial, portal venous, and delayed phases) dynamic CT was performed in 33 patients with 48 HCCs proven histopathologically and in 65 control subjects. Arterial, portal venous, and delayed phase images were obtained 30 seconds, 68-70 seconds, and 5 minutes after the start of contrast material injection, respectively. Three blinded observers reviewed the images independently and evaluated tumor attenuation. Diagnostic performance for the combination of phases was assessed using receiver operating characteristic (ROC) curve analysis.On arterial phase images, 28 of the 48 HCCs were hyperattenuating, nine were isoattenuating, and 11 were hypoattenuating. On portal venous phase images, three tumors were hyperattenuating, 17 were isoattenuating, and 28 were hypoattenuating. On delayed phase images, five tumors were isoattenuating, and 43 were hypoattenuating. The mean sensitivity for the combination of arterial and portal venous phase imaging was 86.8%, that for the combination of arterial and delayed phase imaging was 90.3%, and that for the combination of all three phase imaging was 93.8%. The area underneath composite ROC curve (A(Z)) for the combination of all three phase imaging (A(Z) = 0.940) was significantly higher than that for the combination of arterial and portal venous phase imaging (A(Z) = 0.917) and for the combination of arterial and delayed phase imaging (A(Z) = 0.922).Delayed phase imaging is useful for detecting small HCCs and should be included in dynamic CT examinations of patients with liver cirrhosis.

Purpose To compare dynamic-contrast enhanced multirow detector computed tomography (MDCT) including multiplanar reformatted images (MPR) and magnetic resonance imaging (MRI) including magnetic resonance cholangiopancreatography images for the detection and assessment of locoregional extension of pancreatic adenocarcinoma. Materials and methods Twenty-four patients with and 21 patients without pancreatic adenocarcinoma underwent triple-phase MDCT and MRI. Three radiologists independently attempted to detect pancreatic adenocarcinoma and assess locoregional extension in 3 sessions. First session involved MDCT images. In the second session, radiologists had access to coronal and sagittal MPR images together with the axial images (MDCT + MPR). Third session involved MR images. Results were compared with surgical findings using receiver operating characteristic analysis and kappa statistics. Results Regarding tumor detection, MDCT + MPR had a significantly higher value for areas under the curve (0.96 +/- 0.02) at receiver operating characteristic analysis compared with those of MRI (0.90 +/- 0.03) and MDCT (0.85 +/- 0.04). MDCT + MPR had the highest mean sensitivity (96%), and MRI had the highest mean specificity (98%). For locoregional extension, MDCT + MPR showed the highest kappa values of the study for all factors evaluated (range, 0.63-0.86). Conclusions In conclusion, multiphasic MDCT imaging with MPR images was superior to multiphasic MDCT imaging without MPR images and to comprehensive MRI employing 2-D sequences and magnetic resonance cholangiopancreatography for both the detection and assessment of locoregional extension of pancreatic adenocarcinomas. MRI might be used for further lesion characterization regarding its high specificity.

OBJECTIVE. The purpose of this article is to evaluate the usefulness of high-b-value diffusion-weighted MRI (DW-MRI) in the detection of colorectal adenocarcinoma.CONCLUSION. High-b-value DW-MRI allows detection of colorectal adenocarcinoma with a high sensitivity and specificity.

We report a case of intradiploic epidermoid cyst with focal internal enhancement. The patient was a 55-year-old woman presenting with right temporal head protrusion and head heaviness. Skull radiography and computed tomography demonstrated an expansile mass in the right diploic space. On magnetic resonance imaging, the mass showed makedly high signal T2-weighted images (T2WI) and intermediate to low signal on T1WI. On contrast-enhanced T1WI, there was nodular internal enhancement, which corresponded to neovascularity on pathology, as well as rim-like enhancement. It should be noted that internal enhancement, an indicator of malignant transformation, may be seen even in a benign epidermoid cyst.

Purpose To implement line scan diffusion tensor MR imaging (LSDTI) on a 0.2 Tesla MR imager, and investigate the findings in the spinal cord of patients with cervical spondylotic myelopathy in an early clinical stage. Materials and Methods Fourteen patients with clinical symptoms of cervical myelopathy underwent LSDTI. The signal-to-noise ratio (SNR) in the spinal cord and cerebrospinal fluid (CSF) was evaluated. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured. We classified the ROIs into two groups: 1) unaffected (no clinical symptoms and no abnormality on conventional images) and 2) affected (some clinical symptoms but no abnormal signal on conventional images). Three-dimensional (3D) fiber-tracking was also studied. Results The isotropic ADC values (10–3mm2/sec) were 1.28 ± 0.11 in group 1 and 1.59 ± 0.23 in group 2. The FAs were 0.55 ± 0.07 in group 1, and 0.47 ± 0.11 in group 2. The ADC value in group 2 increased (P < .001, Mann-Whitney U-test) and the FA in group 2 decreased (P = 0.24) on average, compared to those in group 1. 3D fiber-tracking was successful in 64% (9/14) of the cases. Conclusion LSDT images at low field strength may be a sensitive method for elucidating the structural characteristics of spinal cord pathology in vivo. However, clinical correlation and a long-term follow-up study will be needed. J. Magn. Reson. Imaging 2006. © 2005 Wiley-Liss, Inc.

To retrospectively compare thin-section computed tomographic (CT) findings of Chlamydia pneumoniae pneumonia with those of Streptococcus pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia.Institutional review board and patient informed consent were not required. Twenty-four patients with C pneumoniae pneumonia (17 men, seven women; age range, 19-89 years) underwent thin-section CT; 41 patients with S pneumoniae pneumonia (28 men, 13 women; age range, 19-91 years) and 30 patients with M pneumoniae pneumonia (20 men, 10 women; age range, 16-67 years) were also enrolled. Thin-section CT scans of each patient were retrospectively and independently assessed by two chest radiologists for consolidation, ground-glass opacity (GGO), bronchovascular bundle thickening, nodules, pleural effusion, lymphadenopathy, reticular or linear opacity, airway dilatation, pulmonary emphysema, and bilateral lung involvement. Consensus was reached for disagreements. The frequency of each finding was compared among the three types of pneumonia by using the chi2 test.For C pneumoniae pneumonia, CT demonstrated consolidation in 20 patients, GGO in 13, bronchovascular bundle thickening in 17, nodules in 18, pleural effusion in six, lymphadenopathy in eight, reticular or linear opacity in 15, airway dilatation in nine, pulmonary emphysema in 11, and bilateral lung involvement in 12. Bronchovascular bundle thickening (P = .022) and airway dilatation (P = .034) were significantly more frequent in patients with C pneumoniae pneumonia than in those with S pneumoniae pneumonia. Reticular or linear opacity (P = .017), airway dilatation (P = .016), and associated pulmonary emphysema (P = .003) were significantly more frequent in patients with C pneumoniae pneumonia than in those with M pneumoniae pneumonia.C pneumoniae pneumonia demonstrates a wide spectrum of thin-section CT findings that are similar to those of S pneumoniae pneumonia and M pneumoniae pneumonia; airway dilatation and bronchovascular thickening were significantly more frequent in patients with C pneumoniae pneumonia.

Purpose To investigate and measure apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values using data obtained with line-scan diffusion-weighted imaging (DWI) of human brains on a 0.2 Tesla MR imager. Materials and Methods Diffusion-tensor imaging (DTI) was performed on eight healthy volunteers. The signal-to-noise ratios (SNRs) of white matter and cerebrospinal fluid were measured. ADC and FA were also measured from the data obtained from all subjects. Three-dimensional corticospinal fiber tracts were reconstructed from the DT images and a qualitative evaluation was done. Results The total scan time was 52 minutes 30 seconds for 18 slices with full-tensor images covering the whole brain. The ADCs and FAs show the appropriate values, in comparison with values obtained at high field strength in previous studies. Corticospinal fibers were demonstrated more clearly on images obtained at 0.2 T than at 1.5T. Conclusion DTI at low field strength may be feasible for clinical use to estimate the white matter of brain with limited coverage, which often may be sufficient. J. Magn. Reson. Imaging 2005. © 2005 Wiley-Liss, Inc.

Objective: This study examined the basal metabolic rate in patients with twin pregnancies and compared the results with those of singleton pregnancies and non-pregnant women. Methods: In 15 non-pregnant women, 14 patients with twin and 25 patients with singleton pregnancies, the resting energy expenditure was measured using an open-circuit ventilatory system during the third trimester of pregnancy. Results: The averaged resting energy expenditure in patients with twin pregnancy was 1,636 ± 174 kcal/day, significantly higher than that in patients with singleton pregnancy (1,456 ± 158 kcal/day; p < 0.05). Both of these levels are significantly higher than those in non-pregnant women (1,228 ± 132 kcal/day; p < 0.05). Conclusion: Our results indicate that the estimated increased metabolic demands in patients during the third trimester of twin pregnancy are about 10% higher than those in women with singleton pregnancy. A prospective clinical study concerning nutrition counseling is needed.

We have developed a novel irradiation technique for lung cancer that combines a linear accelerator and CT scanner with patient-controlled breath-hold and radiation beam switching. We applied this technique to stereotactic three-dimensional (3D) conformal radiotherapy for stage I non-small cell lung cancer (NSCLC) and evaluated the primary therapeutic outcomes. A total of 35 patients with stage I (15 IA, 20 IB) primary NSCLC (20 adeno, 13 squamous cell, and 2 others) were treated with this technique. Patients ranged from 65 to 92 years old (median, 78 years). Twenty-three (66%) patients were medically inoperable due to mainly chronic pulmonary disease or high age. Three-dimensional treatment plans were made using 10 different non-coplanar dynamic arcs. The total dose of 60 Gy was delivered in 10 fractions (over 5-8 days) at the minimum dose point in the planning target volume (PTV) using a 6 MV X-ray. After adjusting the isocenter of the PTV to the planned position by a unit comprising CT and linear accelerator, irradiation was performed under patient-controlled breath-hold and radiation beam switching. All patients completed the treatment course without complaint. Complete response (CR) and partial response (PR) rates were 8/35 (23%) and 25/35 (71%), respectively. Pulmonary complications of National Cancer Institute-Common Toxicity Criteria grade >2 were noted in three (9%) patients. During follow-up (range, 6-30 months; median, 13 months), two (6%) patients developed local progression and five (14%) developed distant or regional lymph node metastases. Two-year overall survival rates for total patients and medically operable patients were 58 and 83%, respectively. In conclusion, this new irradiation technique, utilizing patient-controlled radiation beam switching under self-breath-hold after precise alignment of the isocenter, allows safe high-dose stereotactic radiotherapy with sufficient margins around the CTV and reduced treatment times. Based on the initial results, excellent local control with minimal complications is expected for stage I NSCLC.

Background: Adenosine is an important metabolic modulator and its concentrations are affected by sympathetic nerve stimulation and cytokine production. Since hyperemesis gravidarum is characterized by overactivation of sympathetic nerves and enhanced production of tumor necrosis factor (TNF)-α, plasma adenosine concentrations may be altered. The present study evaluated plasma adenosine concentrations and their relation with norepinephrine and TNF-α concentrations in hyperemesis gravidarum. Methods: Plasma concentrations of adenosine, norepinephrine, and TNF-α were measured in 34 healthy nonpregnant women, and 34 women with hyperemesis gravidarum and normal pregnancies, matched for age, parity and gestational week. The relationships between plasma adenosine, and norepinephrine and TNF-α concentrations in hyperemesis gravidarum were evaluated. Results: Mean plasma adenosine, norepinephrine, and TNF-α concentrations were significantly increased in women with hyperemesis gravidarum compared to those in nonpregnant and normal pregnant women (p

Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure Study (HOMED BP Study) is the first large-scale intervention trial in Japan using a Prospective Randomized Open Blinded Endpoint (PROBE) design to determine an optimal target blood pressure (BP) level on the basis of self-measured BP at home, and an optimal initial course of antihypertensive medication. The registered patients are randomized to either a more intensive BP-lowering group (home systolic BP < 125 mmHg and diastolic < 80 mmHg) or a less intensive group (home systolic/diastolic BP within the range 134-125/84-80 mmHg) by host computer via the Internet. The differential effect of three classes of initial antihypertensive regimens on the prognosis, i.e., calcium antagonist (Ca-A), angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor antagonist (ARB), which are used most frequently in Japan, are examined. Three regimens are also randomly assigned to the host computer via the Internet. A pilot study was started in May 2001. In March 2002, the number of participating doctors was 461. At the end of March 2002, 546 patients were recruited. Of these, 412 (202 men and 210 women, aged 58.4 +/- 10.2 y) were randomized. Patients will be recruited until February, 2006 and followed for 7 years.

Purpose: To compare the signal pattern of True FISP (true fast imaging with steady state precession) with that of T2-weighted TSE (turbo spin echo) sequencing in several ovarian pathologies and to clarify the pathologies that may be misdiagnosed when True FISP is used as a fast T2-weighted MR (magnetic resonance) imaging technique. Methods: A total of 56 patients with 58 ovarian lesions were prospectively studied. The histopathological diagnoses were surgically confirmed in all patients. All MR images were acquired with a 1.5T MR scanner. After routine MR examination (T2-weighted sagittal imaging with a turbo spin echo sequence and T1 and T2 transverse imaging with a spin echo and turbo spin echo sequence, respectively), True FISP was performed in the sagittal plane with a fat-saturation technique. The acquisition times for the True FISP and TSE techniques were 27 s and 4 min, 42 s, respectively. Three radiologists interpreted all images according to three grading scores and with particular reference to the difference in signal pattern between the two sequences (1=similar signal patterns in the ovarian lesions in both True FISP and TSE images; 2=partially different signal patterns in both True FISP and TSE images; and 3=conflicting signal patterns in both True FISP and TSE images). Results: Those assigned a score of “1” included 30 patients with 30 ovarian lesions (12 malignant lesions and 18 benign lesions); those assigned a score of “2” included 10 patients with 10 lesions (two malignant and eight benign); and those assigned a score of “3” included 16 patients with 18 ovarian lesions (two malignant and 16 benign). With the influence of the fat-suppression technique excluded, eight ovarian lesions showed conflicting signal patterns between the two sequences and high signal intensity of hemorrhaging in the corresponding lesion in T1-weighted images. Lesions of both high and low signal intensity in TSE images appeared as lesions of high signal intensity in True FISP images. About 14% (8/56 lesions) of the True FISP and TSE signal patterns in ovarian pathology were conflicting in this study. Conclusion: The results indicate that the True FISP technique cannot replace the T2-weighted TSE technique in the evaluation of ovarian pathology. T1-weighted images with or without fat suppression are required for the evaluation of ovarian lesions with FISP images.

In embryo, before the establishment of acquired immunity, a variety of embryonic antigens like α-fetoprotein (AFP) are produced and secreted in the sera, which rapidly disappear after the birth. Such embryonic antigens sometimes reappear from various tumor cells and decrease in the case of remission, indicating embryonic antigens may alert immune system to control tumors. In the present study, to examine the evoked immune responses against the tumors expressing embryonic antigen, we administered AFP-gene-transfected EL4 cells into syngeneic C57BL/6 mice and established a killer line against the tumor cells. To our surprise, the killer line was CD4 + NK1.1 + , natural killer T (NKT)-like cells and eliminated not only AFP-expressing EL4 but YAC-1 cells. Moreover, the established line uniformly expressed Vβ11 and secreted IL-4, IL-10, IL-13, and IFN-γ. In vivo inoculation of the line markedly reduced the tumor growth in SCID mice, suggesting novelty of the NKT-like line for tumor surveillance.

Although pulmonary trophoblastic embolism is now considered a physiologic phenomenon of normal pregnancy, this phenomenon has not been demonstrated in a living asymptomatic patient. Recently we encountered a 26-year-old woman suspected of pulmonary embolism of villotrophoblastic tissues after therapeutic abortion. Although her serum beta-hCG was low, a computed tomography scan showed multiple nodules in both lungs. Histological examination of a nodule in a lung-biopsy specimen showed granulation tissue surrounding a hemorrhagic mass within which were structures resembling degenerating chorionic villi. Immunohistochemical study on the patient's lung nodule, and a second endometrial-curettage specimen, six control endometrial and tubal specimens containing degenerating chorionic villi, and four endometrial specimens containing viable chorionic villi were performed. The patterns of immunostaining for cytokeratin, human chorionic gonadotropin, human placental lactogen, placental alkaline phosphatase, and inhibin-alpha of the chorionic villus-like structures in the lung nodule were almost identical to those in the degenerating chorionic villi, but different from those of viable villi. This is a unique case of embolism of chorionic villi and trophoblast to the lung in a living patient after therapeutic abortion.

Docetaxel is a novel, potentially highly beneficial drug for the treatment of lung cancer, and has shown remarkable radio-sensitizing effects in vitro. In the present study, we evaluated whether weekly docetaxel (20 mg/m(2)) and conventionally fractionated radiotherapy with the two-dimensional (2D) technique could be tolerated and effective in the treatment of locally advanced non-small-cell lung cancer (NSCLC). Thirty-two stage III (IIIA:13, IIIB:19) NSCLC patients were treated with weekly administration of docetaxel (20 mg/m(2)) on days 1, 8, 15, 22, 29 and 36 in addition to concurrent radiation therapy. The total tumor dose was 60-66 Gy given with a 2D technique in 6-7 weeks. Complete response was observed in 9/32 (28%) patients and partial response in 20/32 (63%). Three (9%) patients died of chemoradiation-induced pneumonitis after completion of therapy. In total, grade3 toxicities included pneumonitis (47%) and esophagitis (16%). The median overall survival duration was 12 months. The dimensions of the radiotherapy port were larger in patients who produced severe (grade3) chemoradiation pneumonitis than in patients who did not (P0.05). The median survival time was 12.4 months and 2-year overall survival were 35%. The survival was better in patients whose first radiotherapy port dimensions were less than 150 cm(2) compared to patients whose first radiation port dimensions were==150 cm(2) (P0.05). In conclusion, concurrent weekly administration of docetaxel (20 mg/m(2)) with 2D radiotherapy for NSCLC, had good local response, but survival rate was not completely satisfactory due to chemoradiation pneumonitis, which was the principal toxicity that adversely affected prognosis in elderly patients whose radiotherapy port was large.

Relatively little is known about normal prefrontal lobe development. We used three-dimensional magnetic resonance imaging (MRI)-based brain volumetry to characterize developmental changes in prefrontal lobe volumes in infants and children. Prefrontal volumes were determined in 30 subjects aged 5 months to 18 years (221 months) and 3 adults aged 28-39 years (324-468 months). Images were acquired on a 1.5-T MRI system using T1-weighted gradient-echo sequences. Volumes of the frontal and prefrontal lobes were determined using a workstation, and the prefrontal-to-frontal volume ratio was calculated. Prefrontal lobe volume increased slowly until 8 years (96 months) of age, contrasting sharply with rapid growth between 8 and 14 years (96 and 168 months). The prefrontal-to-frontal volume ratio increased with age as a sigmoid growth curve. A prefrontal growth spurt occurs in late childhood. Knowledge of prefrontal lobe development is essential for understanding cognitive development and dysfunction.

We investigated the thermoregulatory alterations to coldness in hyperemesis gravidarum. In pregnant women with hyperemesis (n=22), thermographic measurements for skin temperature and heat dissipation from the back were made during immersions of hands in 15 degrees C water for 50 s. A thermogenic ratio (TR) was calculated as (A-B)/B, where A and B represent the rate of heat dissipation (Cal/hr) from the interscapular and the whole back area, respectively. Simultaneously, changes in serum nonesterified fatty acids (NEFAs) were measured in response to the stimulus. A comparison was made between the women with and without hyperemesis (n=13). Skin temperature did not respond to slight cold stimulus. However, TR increased rapidly and kept increasing (P