Search

PURPOSE The purpose of this study was to assess whether the infrahyoid skeletal muscle index (IHSMI) can be used instead of the L3 skeletal muscle index (L3SMI) to define sarcopenia and predict prognosis in patients with locally advanced head and neck squamous cell carcinoma (LHNSCC). METHODS Patients treated for LHNSCC between January 2009 and April 2018 were assessed. The muscular area at the L3 transverse process and infrahyoid was contoured on absorption-corrected computed tomography prior to treatment. Sarcopenia based on L3SMI (S-L) was defined as values of

Background: Post-operative pancreatic fistula (POPF) can be life-threatening, and gadoxetic acid-enhanced MRI is routinely performed in patients undergoing pancreatic surgery. However, previous reports have not investigated if gadoxetic acid-enhanced MRI can be used to predict POPF risk. Objective: This study aims to explore if gadoxetic acid-enhanced MRI can predict pancreatic fibrosis and the need for POPF treatment before surgery. Methods: We retrospectively analyzed gadoxetic acid-enhanced MR images from 142 patients who underwent pancreatic surgery between January 1, 2011, and April 30, 2018. Pre-dynamic signal intensity (SI) and values for the portal, transitional, and hepatobiliary phase standardized based on pre-dynamic study values were analyzed. The diameter of the main pancreatic duct (DMPD) was measured, and the degree of pancreatic fibrosis was classified as F0 – F3. We defined POPF higher than grade B as significant. Results: Odds ratios for combinations that led to any degree of fibrosis higher than grade B were defined as significant risk factors. The highest odds ratio was obtained for F0 vs. F1 – F3 (p = 0.038). DMPD (p < 0.001), pre-SI (p = 0.008), portal-SI/pre-SI (p < 0.001), transitional-SI/pre-SI (p < 0.001), and hepatobiliary-SI/pre-SI (p = 0.012) were significantly correlated with the presence of fibrosis. Moreover, the presence of fibrosis was best detected by DMPD (AUC = 0.777). Individual specificity values of transitional-SI/pre-SI and DMPD were 95.5% and 86.6%, respectively, and their combined specificity was 97.7%. Conclusion: The absence of pancreatic fibrosis is a risk factor for developing POPF higher than grade B. DMPD was the most useful diagnostic indicator for the presence of fibrosis among our analysis, and its specificity increased when combined with transitional-SI/pre-SI.

Hypothyroidism may occur after definitive radiotherapy in rare cases of early glottic carcinoma. However, to the best of our knowledge, no study to date has examined the risk factors for hypothyroidism specifically after definitive radiotherapy in patients with early glottic carcinoma. The present study determined risk factors for hypothyroidism after definitive radiotherapy in patients with early glottic carcinoma. This was a retrospective study that included 73 patients with T1 or T2, N0 glottic squamous cell carcinoma who underwent radiotherapy between June 3, 2009 and December 25, 2020. Demographic and clinical characteristics, including age, sex, tumor stage and pretreatment thyroid volume, were examined to elucidate the clinical risk factors for hypothyroidism. Field size, total prescribed dose and thyroid receiving dose were evaluated as dosimetric risk factors for hypothyroidism. Irradiated underlying thyroid volumes of more than 5, 10, 20, 30, 40, 50, 60 and 65 Gy (V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, V60Gy and V65Gy) and mean thyroid dose were included as thyroid receiving doses. The median follow-up duration was 61 months (range, 7-150 months). Hypothyroidism was present in 15 (21%) of the 73 patients, including 12 and 3 patients with grade 1 and 2 hypothyroidism, respectively. Among the demographic and clinical factors, sex and pretreatment thyroid volume were significantly associated with hypothyroidism (P=0.007 and P0.001, respectively). Among the dosimetric factors, the presence of hypothyroidism was significantly associated with V5Gy (P=0.012), V10Gy (P=0.015), V20Gy (P=0.020), V30Gy (P=0.024), V40Gy (P=0.028), V50Gy (P=0.028), V60Gy (P=0.027) and mean thyroid dose (P=0.023). In conclusion, sex, pretreatment thyroid volume and thyroid receiving dose were associated with hypothyroidism after definitive radiotherapy in patients with early glottic carcinoma. Particularly, the receiving dose to the thyroid gland should be reduced in female patients and in those with small thyroid volumes who are at higher risk for hypothyroidism following radiotherapy.

Here, we report the case of a 59-year-old male patient who underwent transcatheter embolization of bilateral renal artery aneurysms, using 2 microballoons and 1 microcatheter, all carried within a single guiding sheath. During coil embolization in a visceral artery, there are situations that can require multiple microdevices. We developed a new 6-Fr Shephard-hook type guiding sheath (Parent Plus 60) with a lumen large enough to deliver three microdevices simultaneously. This technique can be used broadly in different clinical scenarios, and it may provide novel treatment strategies to clinicians in the future.

BACKGROUND Reactive lymphoid hyperplasia (RLH) of the liver is a rare liver lesion. It is considered difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies. CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver. The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy. However, histopathological analysis revealed RLH. The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging. On diffusion-weighted imaging (DWI), we encountered linear hyperintensity along the portal tract consecutive to the liver lesion, which is a new characteristic radiologic finding. This finding corresponded to the lymphoid cell infiltration of the portal tract. Furthermore, there was strongly restricted diffusion on the apparent diffusion coefficient map. We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease. CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.

Background: β-blockers are widely used for lowering heart rate (HR) during coronary computed tomography angiography (CCTA); however, they should be used with caution for patients with heart failure as they may have a negative inotropic effect. Objective: To clarify the effects of β-blockers (oral and intravenous injection) on cardiac function using CCTA. Methods: A total of 244 patients (men: women = 166: 78; mean age, 64.4 years old) suspected of having ischemic cardiac disease and had undergone echocardiography within 3 months before and after CCTA were included in the study. Systematic errors in ejection fraction (EF) were corrected by calculating ΔEF from the EF difference between echocardiography and CCTA in patients not using β- blockers. Univariate and multivariate analyses were performed for factors affecting ΔEF. In addition, HR between, before, and during CCTA were compared by Wilcoxon’s test. Results: Temporary oral or intravenous administration of β-blockers at the CCTA had no significant effects on EF (p = 0.70), whereas HR was significantly decreased (p < 0.001). However, regular administration of β-blockers increases the EF on CCTA. Conclusion: The administration of β-blockers immediately before CCTA affects HR but not EF. Premedication with β-blockers can be safely used for patients who undergo CCTA, and CCTA is useful for EF evaluation, independent of the use of β-blockers.

The detection and characterization of liver lesions are problematic in patients with bronchial asthma, renal dysfunction, or a history of allergy to gadolinium-based magnetic resonance contrast media or iodine-computed tomography contrast media because these contrast media cannot be used. Hence, the information on the lesion vascularity cannot be obtained. Therefore, this retrospective case-control study evaluated the feasibility of superparamagnetic iron oxide (SPIO) in patients with one or more of these contraindications who underwent SPIO-enhanced magnetic resonance imaging for the assessment of liver lesions.Twenty-six patients with a total of 48 lesions were analyzed. SPIO was used in the case of all patients because each patient had at least one reason not to use iodine contrast or gadolinium-based contrast media. Additionally, all patients were subjected to the perfusion study. A total volume of 1.3 mL of SPIO was injected via the cubital vein at a rate of 3 mL per second, followed by 40 mL saline at the same speed. The scanning of the perfusion study was started 4 s after the beginning of superparamagnetic iron oxide injection and scanning took 50 s. Two radiologists independently evaluated whether the lesion was malignant or benign. Receiver operating characteristic analysis (ROC) was performed to determine the additional benefit of the perfusion study.There were no adverse effects associated with SPIO. The area under the curve (AUC) value without perfusion study for observers 1 and 2 were 0.473 (P=0.794, 95% CI: 0.275-0.672) and 0.602 (P=0.305, 95% CI: 0.407-0.798), respectively, whereas the Az values with perfusion study for observers 1 and 2 were 0.782 (P=0.011, 95% CI: 0.565-0.998) and 0.784 (P=0.004, 95% CI: 0.591-0.977), respectively. Az value became significantly better when the perfusion study has added (P=0.001 and 0.012 by observers 1 and 2).SPIO can be used safely in patients with bronchial asthma, renal dysfunction, or a history of contrast media allergy. Furthermore, the diagnostic accuracy of SPIO was acceptable.

Objectives: The study aimed to retrospectively investigate the apparent diffusion coefficient (ADC) of primary cervical cancer to examine the recurrence correlations in patients treated with radiotherapy (RT). Methods: The ADC of 31 patients with cervical cancer treated with RT were analyzed as possible risk factors for recurrence. A receiver operating characteristic (ROC) curve of the mean ADC (ADCmean) for the recurrence was generated to determine the cut-off value that yielded optimal sensitivity and specificity. The patient population was subdivided according to the risk factors for recurrence, and the disease-free survival (DFS) was analyzed. The following were investigated to explore the risk factors for recurrence: age, performance status, stage, pelvic lymph node metastasis, histologic tumor grade, maximal diameter of the primary tumor, chemotherapy, and ADCmean. Results: The median follow-up duration of the patients was 25 months. The recurrence was recognized in 9 (29%) of the 31 cases. The ROC analysis of recurrence showed that the area under the ADCmean curve was 0.889 (95% CI, 0.771–1.000; p = 0.001). The cut-off value of ADC mean was 0.900 × 10− 3 mm2/s, with a sensitivity of 86.4% and a specificity of 88.9%. By univariate analysis, the ADCmean was the only factor significantly associated with recurrence. Conclusion: The ADCmean of the primary tumor is a potential predictive factor for the recurrence in of cervical cancer. Advances in knowledge: The ADCmean of the primary tumor is a predictor of recurrence in patients with pre-treatment cervical cancer evaluation.

Background: Although intra-arterial chemoradiotherapy (CRT) followed by surgery has been the standard of care for patients with advanced maxillary sinus squamous cell carcinoma (MSSCC), concurrent intra-arterial chemotherapy and high-dose radiotherapy without surgery has emerged as a promising alternative. Objectives: This study aimed to evaluate the ability of intra-arterial CRT alone to increase the overall survival (OS) of patients with MSSCC. Patients and Methods: Forty patients with histologically confirmed MSSCC, who were treated at Tokyo Medical University Hospital (Tokyo, Japan) between February 1999 and June 2015, were enrolled in this study. Twenty-seven patients were treated with intra-arterial CRT (median dose of 60 Gy) without surgery (CRT group), whereas 13 patients were treated with neoadjuvant intra-arterial CRT (median dose of 40 Gy), followed by surgery (S group). The association of OS with age, performance status, T factor (mean tumor size according to the tumor-node-metastasis [TNM] grading system), N factor (mean lymph node involvement according to the TNM grading system), and treatment method was assessed. Results: The median follow-up duration was 36.0 months. There were no significant differences regarding the patients’ characteristics between the two groups. The treatment method was the only significant prognostic factor for OS. The five-year OS rates were 92% and 55% in the CRT and S groups, respectively (P = 0.01). Conclusion: The intra-arterial CRT (60 Gy) without surgery yielded improved survival outcomes in patients with advanced MSSCC as compared to the neoadjuvant intra-arterial CRT (40 Gy) followed by surgery.

Background: Solitary fibrous tumors (SFTs) are rare and can be misdiagnosed because of their various radiological appearances. Purpose: To clarify the characteristic MRI findings of SFTs by analyzing their radiological-pathological correlation. Material and Methods: Nine consecutive patients with SFT who underwent magnetic resonance imaging (MRI) prior to surgery were analyzed. Eight patients underwent contrast-enhanced MRI, and three underwent dynamic MRI. Radiological-pathological correlation analysis, co-occurrence matrix, run-length matrix, and histogram analysis were performed to assess the relationship between pathological findings T1- and T2-weighted images (T1-WI and T2-WI). Results: All nine lesions ranged in size from 20 to 36 mm. Seven lesions were located in the superior portion of the retrobulbar space found outside of the muscle cone, and two lesions in the inferior portion were located within it. No significant correlation was observed between the amount of collagenous tissue and the qualitative evaluation of the signal on T1-WI and T2-WI. Kurtosis on T2-WI was significantly correlated with the amount of collagenous tissue ('ρ' = –0.97, 'p' < 0.0001) and endothelial cells ('ρ' = –0.49, 'p' = 0.0479). Conclusion: Kurtosis in the histogram analysis on T2WI showed a strong correlation with the amount of collagenous tissue.

Solitary fibrous tumors (SFTs) are derived from mesenchymal cells originating mainly from the pleura. Reports of bleeding SFTs in head and neck regions are rare. A number of reports have focused on tongue SFT treatments, but to the best of our knowledge, there are no reports on the usefulness of preoperative arterial embolization. Intraoperative and postoperative bleeding can also lead to airway problems. To avoid unnecessary tracheostomy and ligation of the external carotid artery, preoperative vascular embolism should be considered while removing large tumors or tumors with high blood flow. The current report outlines a case of a 32-year-old woman with a tongue solitary fibrous tumor, who underwent right lingual artery embolization with 300-500 and 500-700 µm embosphere microspheres through a vascular catheter the day before surgical resection. The encapsulated tumor was completely excised under general anesthesia with little to no bleeding during the operation.

Tracheobronchial chondritis is a rare immune-related adverse event (irAE) associated with immune checkpoint inhibitors. We report a case wherein tracheobronchial chondritis occurred while administering nivolumab for recurrent hypopharyngeal squamous cell carcinoma (SCC) in a man diagnosed with T2N3bM0 stage IVB hypopharyngeal SCC. After treatment with cisplatin and radiotherapy followed by left and right neck dissection, local recurrence was observed in the hypopharynx. Because of the difficulty of salvage surgery, we administered 240 mg/body of nivolumab. After 9 cycles of nivolumab, the patient was judged to have complete response. After 10 cycles, he had cough and sputum, for which prompting us to perform imaging tests. Computed tomography (CT) showed edematous thickening around the trachea and bilateral bronchi and elevated amounts of adjacent subcutaneous fat tissue. Positron emission tomography-CT showed diffuse fluorodeoxyglucose uptake in the trachea and bilateral bronchi, bronchial endoscopy showed redness and swelling throughout the bronchi, and biopsy showed partial mucosal erosion, inflammatory cell (lymphocyte) infiltration, interstitial edema, and desmoplasia. The patient was diagnosed with tracheobronchial chondritis as an irAE resulting from administering anti-programmed death-1 monoclonal antibody. After four-day prednisolone treatment, his cough and sputum disappeared; after two weeks, tracheobronchial chondritis no longer appeared on CT.

Background Small pulmonary nodules have been detected frequently by computed tomography (CT). Lung cancers with cavity formation are also easily detected. There are a few reports focused on the cavity wall, although cancer cells exist along the cavity wall, not inside. We evaluated the impact of cavity wall thickness on prognosis and assessed the clinicopathological features in non-small cell lung cancer (NSCLC) with cavity formation. Methods Between 2005 and 2011, 1,313 patients underwent complete resection for NSCLC. Of these cases, we reviewed 65 patients (5.0%) diagnosed with NSCLC with cavity formation by chest CT. We classified the patients into three groups based on the maximum cavity wall thickness, namely, ≤4 mm (Group 1, 8 patients), >4 and ≤15 mm (Group 2, 33 patients), and >15 mm (Group 3, 24 patients). Results The number of patients with pathological whole tumor size >3 cm was 2 (25%) in Group 1, 17 (52%) in Group 2, and 23 (96%) in Group 3 (P

We report a case of laryngeal cancer with multiple lung metastases that maintained a complete response (CR) for 18 months after discontinuing nivolumab treatment, with colitis developing 5 months after drug discontinuation. A 65-year-old man was diagnosed with T3N2cM0 stage IVA right supraglottic squamous cell carcinoma that progressed after 1 course of TPF (cisplatin, docetaxel, and 5-fluorouracil) as induction chemotherapy. He underwent total laryngectomy, bilateral neck dissection, pharyngeal reconstruction with anterolateral thigh flap, and creation of a permanent tracheostoma; extranodal extension was detected in the right cervical lymph node metastasis, and the patient underwent adjuvant radiotherapy. Multiple lung metastases occurred during radiotherapy, and the patient was deemed platinum refractory; nivolumab treatment was thus initiated. The tumor proportion score for programmed death-ligand 1—evaluated via antibody testing of the laryngeal tumor—was

Purpose To evaluate the feasibility of short-segment coil embolization between 2 balloons for tight packing in an experimental vascular model. Materials and Methods Three coil embolization techniques were performed by 5 interventional radiologists as follows: (1) proximal balloon technique (proximal BT) which involved proximal balloon inflation and coil deployment over the balloon, (2) distal balloon technique (distal BT) which involved distal balloon inflation and coil deployment at the proximal side of the inflated balloon, and (3) double-balloon technique (DBT) which involved coil deployment between 2 inflated balloons. We used a 10-mm-diameter and 200-mm-long hydrocoil. The distance between the 2 inflated balloons was set at 5 mm in the perfused tube, and each procedure was performed twice. The longitudinal lengths of the deployed coil mass and volume embolization rates (VERs) at the embolization site obtained using the 3 techniques were compared statistically. Results The longitudinal lengths of the deployed coil mass were 26 mm (range, 21–34 mm), 10 mm (8–14 mm), and 5 mm (5–5 mm) in proximal BT, distal BT, and DBT, respectively. The median VERs were 15.9% (12.2–19.4%), 41.4% (29.6–51.8%), and 82.9% (82.9–82.9%), respectively. Significant differences in the lengths and VERs were observed among the 3 techniques (p

To investigate the prognostic significance of sarcopenia on long-term outcomes in patients with bladder cancer after radical cystectomy (RC). We retrospectively reviewed 136 patients undergoing RC for urothelial carcinoma at our institution. Prognostic impact of the preoperative clinical, laboratory, and radiologic parameters were evaluated by Cox proportional hazard model analyses, and a nomogram was developed to predict cancer-specific survival (CSS) after RC. The mean follow-up was 46.7 months. Patients with sarcopenia had a significantly shorter CSS than those without sarcopenia. On univariate Cox analysis, clinical T stage, histology of transurethral resection of bladder tumor (TURBT) specimen, pretreatment hemoglobin, pretreatment neutrophil-to-lymphocyte ratio (NLR), pretreatment serum C-reactive protein level, pretreatment serum albumin level, presence of hydronephrosis, and presence of sarcopenia were associated with significantly worse CSS. On multivariate Cox stepwise analysis, sarcopenia (hazard rate [HR] = 2.3, p = 0.015), clinical T stage (cT4: HR = 5.3; p = 0.0096), presence of hydronephrosis (HR = 2.0; p = 0.033), histology of TURBT specimen (HR = 2.2, p = 0.044), and NLR (HR = 1.3; p = 0.0048) were significant independent predictors of an unfavorable prognosis Based on the results of the multivariate analysis, we developed a nomogram to predict 1-, 3-, and 5-year CSS after RC. Sarcopenia, clinical T stage, presence of hydronephrosis, histology of TURBT specimen, and NLR are novel preoperative prognostic factors even after adjustment for other known preoperative predictors in patients undergoing RC for bladder cancer.

The dorsal pancreatic artery is a part of peripancreatic arcade connecting celiac artery to transpancreatic artery. A dorsal pancreatic artery aneurysm derived from dissection of celiac artery is a rare pathology, and it sometimes requires ingenious strategy in an endovascular surgery. Hereby, we report a case of a patient who underwent coil embolization for dorsal pancreatic artery aneurysm due to celiac artery dissection by applying transcirculation approach of a balloon catheter through the peripancreatic arcade, which was successfully achieved.

Interstitial lung disease (ILD) is an occasionally fatal adverse event associated with cetuximab (Cmab) therapy. Our objective was to clarify to what degree pulmonary emphysema is a risk factor in the treatment of head and neck cancer with Cmab through a retrospective analysis.Subjects were 116 patients who were administered Cmab for head and neck squamous cell carcinoma. The degree of pulmonary emphysema before initiating treatment with Cmab was visually assessed retrospectively, with scoring according to the Goddard classification used in Japanese chronic obstructive pulmonary disease (COPD) guidelines for chest computed tomography (CT). Scoring was conducted by two diagnostic radiologists and mean scores were used. Cutoffs for the development and nondevelopment of ILD were examined by receiver operating characteristic (ROC) analysis and Fisher's exact test. Values of p .05 were considered to indicate a significant difference.Among the 116 patients, 11 (9.5%) developed ILD, and 105 (90.5%) did not. In ROC analysis, the optimal Goddard score cut-off of3.0 offered 55% sensitivity and 81% specificity (p = .015). With a cutoff of3.0, even very mild pulmonary emphysema would represent a risk factor for ILD when using Cmab.

The purpose of this study was to evaluate the effectiveness of CT assist for intraarterial chemotherapy in relation to the therapeutic outcomes of intraarterial chemoradiation for advanced head and neck cancer with extension across the anatomical midline (EAM).This retrospective study evaluated 64 consecutive patients. In total, 26 and 38 patients had cancer with or without EAM, respectively. These patients underwent an intraarterial cisplatin infusion (200 mg/m(2), days 1 and 35) and intravenous 5-FU infusion (800 mg/m(2), days 1-5 and 36-39) concomitantly with radiotherapy. Angiography-assisted CT was performed to confirm complete coverage during the intraarterial chemotherapy. The accuracy of diagnosing tumor vessels by digital subtraction angiography (DSA) was evaluated using receiver-operating characteristic analysis by two radiologists. The overall survival and locoregional control rates were calculated by the Kaplan-Meier method.DSA was not useful for diagnosing tumor vessels. The 2-year overall survival rates for the patients with cancer with or without EAM were 83 and 90 %, while the 2-year locoregional control rates were 95 and 82 %, respectively. Locoregional control or the overall survival rates showed no significant differences.Intraarterial chemotherapy using angiography-assisted CT during chemoradiation therapy can achieve comparable therapeutic outcomes for cancer with and without EAM.

To evaluate the feasibility of short-segment coil embolization between 2 balloons for tight packing in an experimental vascular model.Three coil embolization techniques were performed by 5 interventional radiologists as follows: (1) proximal balloon technique (proximal BT) which involved proximal balloon inflation and coil deployment over the balloon, (2) distal balloon technique (distal BT) which involved distal balloon inflation and coil deployment at the proximal side of the inflated balloon, and (3) double-balloon technique (DBT) which involved coil deployment between 2 inflated balloons. We used a 10-mm-diameter and 200-mm-long hydrocoil. The distance between the 2 inflated balloons was set at 5 mm in the perfused tube, and each procedure was performed twice. The longitudinal lengths of the deployed coil mass and volume embolization rates (VERs) at the embolization site obtained using the 3 techniques were compared statistically.The longitudinal lengths of the deployed coil mass were 26 mm (range, 21-34 mm), 10 mm (8-14 mm), and 5 mm (5-5 mm) in proximal BT, distal BT, and DBT, respectively. The median VERs were 15.9% (12.2-19.4%), 41.4% (29.6-51.8%), and 82.9% (82.9-82.9%), respectively. Significant differences in the lengths and VERs were observed among the 3 techniques (p 0.001).DBT achieved the tight packing of a hydrocoil in a short segment of an experimental vascular model compared with proximal BT and distal BT, suggesting DBT as the optimal embolization technique in this model.