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Although the efficacy and feasibility of coil embolization of coronary arteriovenous fistulas have been reported, the procedure may be complicated by migration of the coil into peripheral vessels or pulmonary arteries. We report two cases of successful coil embolization of such lesions using an interlocking detachable coil. This system can provide safer and more effective coil embolization in patients with coronary arteriovenous fistula.

We present our experience in visualizing mediastinal tumours using 99Tcm tetrofosmin. Three patients with thymic tumours and two patients with a mediastinal tumour (seminoma and small cell carcinoma) were found to have anterior mediastinal masses on chest radiographs, and subsequently underwent computed tomography and magnetic resonance imaging. In addition, the patients underwent single photon emission computed tomography (SPECT) with 99Tcm tetrofosmin and 201Tl. Intense uptake was seen on early 99Tcm tetrofosmin images in three patients with thymoma, invasive thymoma and mediastinal tumour (small cell carcinoma). In the remaining two patients with thymic carcinoma and mediastinal seminoma, there was intense 99Tcm tetrofosmin uptake on early images which reduced on delayed images. 201Tl uptake was intense on both early and delayed images. These findings suggest that different 99Tcm tetrofosmin uptake in early and delayed imaging may offer new information on these mediastinal tumours.

Esophageal cancer patients with distant organ metastasis have usually been treated only to palliate symptoms without multimodality therapy. The current study evaluates the role of multimodality therapy in esophageal squamous cell cancer patients with distant organ metastasis. Between February 1988 and January 2007, 80 esophageal squamous cell cancer patients with distant organ metastases were treated at our institution. Multimodality therapy was performed in 58 patients: 43 patients received chemoradiotherapy, 13 underwent surgery followed by chemotherapy and/or radiation therapy, and two received chemotherapy or chemoradiotherapy followed by surgery. Thirteen patients received single-modality therapy; chemotherapy, radiotherapy, or surgery alone. The remaining nine patients received best supportive care alone. The metastatic organ was the liver (n= 40), the lungs (n= 33), bone (n= 10), and other (n= 6). Nine patients had metastasis in two organs. There was no difference in the median survival among the sites of organ metastasis, lung, liver, or bone (P= 0.8786). The survival of patients treated with multimodality therapy was significantly better than that of the patients who received single-modality therapy or best supportive care alone (P0.0001). In patients treated with multimodallity therapy, there was no difference in survival for patients treated with surgery compared with patients treated without surgery (P= 0.1291). This retrospective study involves an inevitable issue of patient selection bias. However, these results suggested that multimodality therapy could improve survival of the esophageal squamous cell cancer patients with distant organ metastasis.

PURPOSE/AIM OF THE EXHIBIT: The purpose of this exhibit is: 1. To explain "resampling", an image data processing, performed by the digital radiographic system based on flat panel detector (FPD). 2. To show the influence of "resampling" on the basic imaging properties. 3. To present accurate measurement methods of the basic imaging properties of the FPD system.1. The relationship between the matrix sizes of the output image and the image data acquired on FPD that automatically changes depending on a selected image size (FOV). 2. The explanation of the image data processing of "resampling". 3. The evaluation results of the basic imaging properties of the FPD system using two types of DICOM image to which "resampling" was performed: characteristic curves, presampled MTFs, noise power spectra, detective quantum efficiencies. CONCLUSION/SUMMARY: The major points of the exhibit are as follows: 1. The influence of "resampling" should not be disregarded in the evaluation of the basic imaging properties of the flat panel detector system. 2. It is necessary for the basic imaging properties to be measured by using DICOM image to which no "resampling" is performed.

In responders to neoadjuvant chemoradiotherapy for locally-advanced esophageal cancer, there was no significant difference in the long-term outcome between patients who underwent esophagectomy and those who did not. Esophagectomy might be unnecessary for patients who achieve a complete response with chemoradiotherapy for an esophageal cancer, in cases when salvage surgery is considered in order to treat any future recurrence.

In this study, the optimal volume of contrast medium in the liver for three-dimensional (3D) imaging of the hepatic and portal veins by helical CT were determined by intravenous injection using the MIP technique. In the 48 cases examined, CT images of the liver were obtained following the administration of contrast medium (90, 120, or 150 ml and 1.0,or = 1.5 ml; 1.5,or = 2.0 ml; 2.0,or = 2.5 ml or 2.5,or = 3.0 ml/kg) for determination of the optimal volume. The mean body weight of the patients was 59 kg. Contrast medium (Iopamidol 300 mgl/ml) was injected at a rate of 3 ml/sec, and scanning was initiated 70 sec after the beginning of injection. Images were obtained throughout the entire liver using 5-mm collimation. MIP images were graded from poor to excellent based on their visualization of the hepatic vessels. Images produced with 120 ml of contrast medium presented excellent images of hepatic vessels, superior to those produced with 90 ml (hepatic vein: p.001, portal vein: p.001). Images produced with 2.0,or = 2.5 ml/kg of contrast medium presented excellent images of the portal vein, superior to those produced with 1.5,or = 2.0 ml/kg ml (p0.05). It is evident from the present data that a contrast medium volume of more than 120 ml or 2.0,or = 2.5 ml/kg is sufficient for three-dimensional imaging of hepatic vessels. These images may be a useful diagnostic tool in patients with hepatic disease.

We describe a patient with bilateral traumatic subdural hematomas in whom CT findings of hyperattenuation in the basal cisterns and subarachnoid spaces falsely suggested superimposed acute subarachnoid hemorrhage.

Routine chest radiographs of a 52-year-old woman displayed abnormal opacities in the right lower lung field. A computed tomographic (CT) scan of the chest disclosed irregular nodular opacities in the peripheral zone of the right S6. Reconstructed three-dimensional images obtained by helical CT displayed the lesions as agglutinated small nodules, with other small nodules near the bronchi appearing as "tree-in-bud" formations. Specimens obtained by transbronchial lung biopsy of the right B6b revealed atypical glandular structures, thus leading to suspected adenocarcinoma of primary lung cancer. A right lower lobectomy was performed; cut-surface specimens of the resected tissues showed multiple lobulate, milky-white nodules near the bronchi. Histopathologic examination found no malignant cells. PAS staining revealed numerous cryptococcal organisms, thus yielding the final diagnosis of primary pulmonary cryptococcosis.

We herein describe a metastatic diaphragmatic tumor, an entity that has rarely been reported radiologically. The primary lesion was advanced colon cancer, and the root of the metastasis was thought to be the peritoneal stoma(ta) of the diaphragm, which has previously been shown to absorb both intraperitoneal fluid and small particles.

Benzodiazepine receptor binding was assessed in four Japanese men with Machado-Joseph disease.The distribution of benzodiazepine receptors was measured by radionuclide imaging (SPECT) after intravenous administration of 123I-iomazenil (Ro 16-0154).SPECT demonstrated decreased binding throughout the cerebral cortex and cerebellum in all patients. Binding potential (receptor concentration x affinity) was diffusely decreased in cerebral cortex, thalamus, striatum and cerebellum compared with control subjects, suggesting that GABAergic function may be decreased globally in these patients. Cerebral blood flow was largely normal, and no cerebral cortical atrophy was evident on MRI.Iodine-123-iomazenil SPECT may become a potent method for detecting impairment of the cerebral cortex even before brain perfusion SPECT or MRI can reveal early abnormalities.

In a 41-year-old man with an abnormal left lower lobe opacity on a chest radiograph, magnetic resonance (MR) angiography showed a large abnormal vessel extending from the left side of the descending thoracic aorta, supplying the left lower lobe. Furthermore, the lung parenchyma showed no evidence of sequestrated lung. This entity corresponded to type-I of intralobar pulmonary sequestration, as classified by Pryce.

Twenty patients with early-stage breast cancer treated with breast conservation surgery and definite radiation, underwent computed tomography (added HR-CT) of the lungs before, immediately after, and at one, six, and twelve months after radiotherapy. During the follow-up period, 17 (85%) of the patients developed parenchymal alterations in the irradiated lung volume. We classified the parenchymal alterations into seven patterns: pattern 1 = septal line, 2 = nodular opacity, 3 = ground-glass opacity, 4 = consolidation, 5 = curvilinear opacity, 6 = aircyst accumulation, and 7 = irregularity of pleural surface. From one to six months after radiotherapy, 14 patients developed nodular opacities and ground glass opacities in the irradiated lung field. At 12 months after radiotherapy, fourteen patients were found to have aircyst accumulation and irregularity of the pleural surface. In this study, none of the patients presented any abnormal findings immediately after irradiation. There was no relationship between central lung distance or boost irradiation and the parenchymal alterations in the lung. On the other hand, there was a close relationship between oral anti-cancer agents and lung lesions. In conclusion, HR-CT was useful to evaluate morphologic changes in the irradiated lung.

Japanese encephalitis (JE) is an acute encephalomyelitis which is a primary viral encephalitis accompanying a viral infection. Clinically, the patient who either resides in an endemic region or who has been exposed to the viral vector (mosquito) may have symptoms including high fever, headache, and impaired consciousness. JE involves many portions of the supratentorial and infratentorial compartments including the brain stem, hippocampus, thalamus, basal ganglia, and white matter. Classically MR imaging demonstrates the lesions of JE as hyperintense on T2-weighted images and hypointense on T1-weighted images. Hemorrhagic transformations have also been described in JE lesions, with corresponding expected T1 and T2 changes. Differential considerations based on the MRI appearance are somewhat broad, including but not limited to primary viral encephalitis, acute encephalopathy, limbic encephalitis, and acute disseminated encephalomyelitis. The therapy for JE is primarily conservative and supportive since there is no specific treatment for JE, and the disease has a high fatality rate. The prognosis depends on the extent of involvement at primary presentation, and on the autoimmune mechanisms of this disease.

A 22-year-old man was admitted with a spontaneous subarachnoid hemorrhage. Right vertebral angiography demonstrated an aneurysm arising from a distal segment of an anomalous posterior inferior cerebellar artery (PICA) at the level of C 1. The PICA originated from the third segment of the vertebral artery at the level of C2. The lesion was treated with endovascular techniques, and the patient suffered no residual neurological deficits.

We describe a patient with multiple myeloma who was found to have diffuse bone marrow uptake of 201Tl. Magnetic resonance (MR) imaging of the lumbar spine demonstrated abnormal low signal intensity on T1-weighted images and abnormal high signal intensity on T2-weighted images. The bone marrow consisted of 68% plasma cells, and the serum immunoglobulin (Ig)G concentration was 7900 mg/dL. After receiving chemotherapy, the percentage of plasma cells and serum IgG concentration declined and there was a decrease in the bone marrow uptake of 201Tl. However, the MR abnormalities in the lumbar spine showed no change after chemotherapy. This patient illustrates a limitation of the use of MR imaging for evaluation of disease state in patients with multiple myeloma, and demonstrates the potential usefulness of 201Tl imaging in these patients.

We report a case of synovial sarcoma of the chest wall in a 41-year-old man. Chest CT revealed a huge tumor of the left chest wall with heterogeneous enhancement. On MR imaging, the tumor showed the "bowl-of-fruit" mixed-signal appearance with fluid-fluid levels similar to those of synovial sarcoma of the extremities. Synovial sarcoma arising from the chest wall is extremely rare; only four cases have been reported in the English literature. As synovial sarcoma is considered a carcinosarcoma-like tumor with true epithelial differentiation, it is able to originate from various regions. Even if the tumor is found in a region distant from the synovial membrane, the differential diagnosis of a tumor which demonstrates such findings on MR imaging should include synovial sarcoma.

Abnormal parathyroid tissue can be identified by radionuclide imaging with either 99mTc-MIBI or 99mTc-tetrofosmin. This study compared the relative sensitivity of these two agents to localize parathyroid hyperplasia and adenoma.Twenty patients with primary (n = 9) or secondary (n = 11) hyperparathyroidism were studied with 99mTc-MIBI and 99mTc-tetrofosmin parathyroid imaging, ultrasonography and MRI. Radionuclide images of the neck were acquired 10 min and 2-3 hr after radiopharmaceutical injection. The images were visually evaluated for abnormal focal areas of increased tracer localization in the neck and mediastinum. A parathyroid gland/normal thyroid tissue activity ratio (referred to as the P/T uptake ratio) was calculated for each positive scan.Of the 46 parathyroid glands surgically explored, the overall sensitivity and specificity of MIBI imaging were 83% and 83% (38/46); tetrofosmin imaging 87% and 83% (40/46); ultrasonography 78% and 40% (36/46); and MRI 80% and 60% (37/46), respectively. Both radiopharmaceuticals performed well in the nine patients found to have adenoma. The sensitivity and specificity of MIBI imaging were 100% and 100% (9/9); tetrofosmin imaging 100% and 100% (9/9); ultrasonography 78% and 67% (7/9); and MRI 100% and 100% (9/9), respectively. In the 37 glands with hyperplasia, MIBI imaging had a sensitivity of 78% and specificity of 75%; tetrofosmin imaging 84% and 75%; ultrasonography 78% and 43%; and MRI 73% and 60%, respectively.All imaging techniques localized abnormal parathyroid glands. The radiotracers have equal sensitivity for the localization of abnormal parathyroid glands. The sensitivity of these tracers was high as compared to ultrasonography or MRI.

We examined the usefulness of imaging portosystemic collaterals accompanying liver cirrhosis by magnetic resonance angiography (MRA), which facilitates imaging of the vascular system without contrast medium.MRA was performed in 30 patients with liver cirrhosis. Of the 30 patients, percutaneous transhepatic portography (PTP) was performed in 10 patients, and conventional arterial portography (CAP) was performed in 20 patients. The three-dimensional (3D) phase contrast method was used for MRA. Study 1: The ability to image portosystemic collaterals was compared between PTP or CAP and MRA. Study 2: The usefulness of MRA for evaluating the effect of treatment on gastric and esophageal varices was examined.Study 1: In comparing PTP and MRA (n = 10), the left gastric vein (n = 10), splenorenal (gastrorenal) shunt (n = 5), and paraumbilical vein (n = 2) were imaged similarly. However, MRA did not reveal any esophageal varices (n = 10). In comparing CAP and MRA (n = 20), the left gastric vein (n = 17), splenorenal (gastrorenal) shunt (n = 10), and paraumbilical vein (n = 4) were imaged similarly. Whereas CAP revealed esophageal varices (n = 4) in four patients, MRA revealed esophageal varices in only one patient. Study 2: When the effect of treatment for varices was evaluated, MRA 3 wk after embolization therapy for gastric varices (n = 4) confirmed the disappearance of gastrorenal shunt. However, it was impossible to evaluate esophageal varices by MRA.It was possible to image portosystemic collaterals accompanying liver cirrhosis by MRA. MRA was useful as a routine examination. Furthermore, it was useful for evaluating the effect of embolization therapy on gastric varices.

Preoperative localization of hyperactive parathyroid glands is useful to minimize operative time and reduce patient morbidity. This investigation compared the sensitivity of radionuclide imaging with 99mTc tetrofosmin with that of ultrasonography and magnetic resonance (MR) imaging in patients with hyperparathyroidism.Twenty-six patients with primary (n = 7) or secondary (n = 19) hyperparathyroidism were imaged with 99mTc tetrofosmin, ultrasound and MR imaging of the neck and thorax to localize the lesions. The presence of hyperparathyroidism was identified by an intact parathyroid hormone in vitro assay. The parathyroid/normal thyroid tissue activity ratio was calculated for all patients with evidence of an abnormality on tetrofosmin images. Pathological findings were compared with the results of imaging in 18 of the 26 patients who underwent parathyroidectomy.Technetium-99m tetrofosmin scans demonstrated focal uptake in 46 glands of 26 patients. The uptake was categorized as slight in 78.3% (36/46) and intense (parathyroid/normal thyroid tissue activity ratio,1.4) in 21.7% (10/46). Ultrasonography and MR imaging identified 44 and 47 glands, respectively, in these patients. Eleven of the 18 patients who underwent parathyroidectomy within 1 mo after tetrofosmin imaging had hyperplastic glands, while 7 had parathyroid adenomas. Tetrofosmin imaging successfully localized 7 of 7 (100%) adenomas and 27 of 37 (73.0%) hyperplastic glands. The sensitivities of each technique for localizing abnormal parathyroid glands were 77.3% (34/44) for tetrofosmin imaging: 68.2% (20/44) for ultrasonography: and 68.2% (30/44) for MR imaging. Technetium-99m tetrofosmin uptake ratio in the 18 patients with surgical exploration was not proportional to several oxyphil cells.Technetium-99m tetrofosmin parathyroid imaging may be useful for localizing abnormal glands in patients with primary and secondary hyperparathyroidism. The sensitivity of 99mTc tetrofosmin parathyroid imaging was high as compared to ultrasonography or MR imaging. The prolonged retention of tetrofosmin may not depend on the number of mitochondria-rich oxyphil cells.

This case report describes a 71-year-old man with a lung tumor in the posterior inferior segment of the right lung, detected on a screening chest radiograph. The patient underwent myocardial imaging with 99mTc tetrofosmin and 201Tl, using single photon emission CT (SPECT), and the tumor showed intense focal uptake of the radiotracer. This observation supports the recent suggestion that 99mTc tetrofosmin may be useful for oncologic imaging of lung carcinoma, and further studies may be warranted.

Helical CT makes possible imaging of the entire liver in as few as 20 seconds during a single breath hold. This method is thus superior to conventional dynamic CT. In this study, optimal late scanning time and optimal volume of contrast medium in the liver were determined with helical CT in routine studies. (1) Optimal late scanning time In 50 cases, CT images of the liver were obtained at various times following the administrations of contrast medium (1.4 ml/kg). Scanning was started at 60,90,120,150 and 180 seconds after injection. Enhancement of the liver and detection of hepatic and portal veins were best at 60 seconds, followed at 90 seconds. However, a scanning delay of 60 seconds still had an effect on the arterial phase. The optimal late scanning time was thus concluded to be at 90 seconds. (2) Optimal volume of contrast medium In 40 cases, CT images of the liver were obtained following the administration of various amounts of contrast medium (1.0 ml, 1.2 ml, 1.4 ml, 1.6 ml/kg) to determine the optimal volume. No significant difference was found between 1.6 ml/kg compared and 1.4 ml/kg of administered contrast medium. It is evident from the present data that a scanning delay of 90 seconds appears to be optimal and a contrast medium volume of 1.4 ml/kg (body weight) is best for conducting helical dynamic CT on the liver.

Left lateral chest radiographs with normal studies were evaluated in 100 Japanese (50 females and 50 males) to compare the radiolucency of the retrosternal space (RSS) with that of the retrocardiac space (RCS) and to measure the RSS. In 56 (56%) cases, the RSS was equally radiolucent to the RCS. In 40 (40%) cases, the RSS was less radiolucent than the RCS (33 of 50 females and 7 of 50 males). The difference between the sexes was statistically significant (p = 0.0001). The RSS was more radiolucent than the RCS in only 4 (4%) males. Frontal chest radiographs of 50 females were classified into one of three groups (Small, Medium, or Large) depending on the size of soft tissue opacity of the breast. The differences between the radiolucency of the RSS and RCS were statistically significant between the Small and Medium and the Small and Large groups (both p0.0001). The strength of the relationship between the radiolucency and body-to-fat ratio was statistically significant (p = 0.0028). Results of data comparison between females and males remained significant when adjusted for differences in body-to-fat ratio (p0.0001). The distance on the chest radiograph from the sternum to the most anterior aortic border (the distance of RSS) could be measured on only 37 (37%) lateral chest radiographs, and the averages and standard deviations were as follows: 2.2 +/- 0.5 in all cases, 2.0 +/- 0.5 in females, and 2.4 +/- 0.5 in males. The difference between the sexes was statistically significant (p0.05). In conclusion, an RSS that is more opaque (less radiolucent) than the RCS is a frequent normal finding because of the opacity of the breast and fat tissue, especially in females, and the length of the RSS is shorter in females than in males.

This study was performed to assess the relationship between 201Tl chloride uptake and brain tumor proliferation using monoclonal antibody Ki-67 and proliferating cell nuclear antigen (PCNA).Thirty-four patients with brain tumors were studied. Serial SPECT images were recorded and thallium uptake (Tl index) and washout rates in the tumors were calculated. Imaging results were compared with those from biopsy and histology. Cell proliferation was determined by PCNA or Ki-67 monoclonal antibody staining.Thallium-201-chloride indices of the astrocytoma were 1.73 +/- 0.17 and 1.48 +/- 0.07 on early and delayed images, respectively. On the other hand, 201TI indices for anaplastic astrocytoma were 2.60 +/- 1.05 and 1.76 +/- 0.93 and 3.26 +/- 1.63 and 2.23 +/- 0.56 for glioblastoma. The correlation between the 201TI (delay) and Ki-67 indices for astrocytic tumor. There were no significant differences between Ki-67/PCNA indices and washout rates.There was a positive correlation between PCNA but not the Ki-67 labeling index and the 201Tl index. With the use of a noninvasive technique, 201TI index supports the PCNA index.

We evaluated the detectability of colon cancer by using transabdominal ultrasonography (US). Fifty-three cases of proven advanced colon cancer were examined in this study. Screening by US was carried out in 27 of 53 cases and US was performed in all cases after the definite diagnosis. Lesions of the colon were examined by using a 3.5 MHz convex and 5 MHz or 7.5 MHz linear probe (Yokogawa RT-2800, RT-4600). Localized hypertrophy of the irregular wall of more than 10 mm or massive tumor without the normal layered structure was defined as colon cancer on US. The rate of detection by screening test was 52%. The detection rate by US after definite diagnosis was 75%. A high detection rate was obtained in cases with a tumor diameter of more than 4 cm. Eight of 13 cases which were not detected by the screening test were visualized by US after definite diagnosis. US examination is useful for the detection of certain extended lesions of colon cancer. With technical improvements of the examination method, it is considered that cancer in the gastrointestinal tract may be discovered early on screening tests using US.

We examined the usefulness of cine-MR imaging for evaluation of the invasion of esophageal cancer to the aorta in 12 cases. We used the technique of field echo pulse sequence. When the low intensity stripe was recognized between the tumor and the wall of aorta, we interpreted it as negative finding of the direct tumor invasion. By using this criteria, 11 of the 12 cases (92%) of the esophageal cancer for aortic wall invasion were correctly diagnosed as compared with 75% correct diagnosis by conventional MR imaging.

Fifty-one patients with clinical stage I B-cell lymphomas were treated between 1980 and 1988. For the entire group, the actuarial 5-year survival rate and 5-year freedom from relapse rate were 78% and 64%, respectively. Primary site, tumor bulk and performance status were the prognostic factors. Twenty-three patients were intensively treated with local radiotherapy alone, because (1) they had histologically low grade (7 patients) or follicular large cell (1 patients) tumors, (2) Waldeyer's ring was the site of the primary (11 patients) or (3) the tumor was less than 4 cm in maximum diameter (4 patients). Among them, only one patient died due to lymphoma (5-year survival rate: 95%), and 19 remained disease free (5-year freedom from relapse rate: 80%). In contrast, of the remaining 23 patients treated with both radiation therapy and combination chemotherapy (VEMP or CHOP), the 5-year survival rate and 5-year freedom from relapse rate were 70% and 54%, respectively. These results suggest that high-risk patients should be treated with more aggressive combination chemotherapy as well as radiotherapy. However, low-risk patients with stage I B-cell lymphomas can be treated by local radiotherapy alone.

Between 1980 and 1988, we treated 68 patients with clinical stage I non-Hodgkin lymphomas. Fifteen patients had lesions classified as T-cell type lymphomas, and the remainder as B-cell type lymphomas. The actuarial 5-year survival rate was 42% for patients with T-cell type and 78% for patients with B-cell (p less than 0.03), and freedom from relapse was 25% and 67%, respectively (p less than 0.01). The main relapse sites for patients with T-cell type were extranodal (5 patients) and multiple sites (2 patients). These results suggest that patients with T-cell type lymphomas should be treated by aggressive combination chemotherapy as well as radiotherapy, even though their disease may appear to be limited to one region.

Eighteen cases of intracranial meningioma that received preoperative or post-operative irradiation with60Cobalt or Linac have been reviewed. Eight patients received preoperative irradiation because their tumours were very large, hypervascular, and surgically not readily accessible. Two angioblastic meningiomas of the haemangiopericytoma type responded well to irradiation and were easily extirpated. One of these developed a local recurrence and metastases to the lungs and liver nine years after surgery. The recurrent intracranial tumour and nodules in the lungs responded well to irradiation. The other six cases of meningiomas of meningothelial, transitional, or haemangioblastoma types, did not improve clinically or radiologically after irradiation. Ten cases received postoperative irradiation because their tumours were only partially removed or were histologically malignant. In all cases irradiation was most effective for recurrent tumours of the haemangiopericytoma type. This study indicates that irradiation is useful in tumours of the haemangiopericytoma type as an adjunct to surgery or for palliation in advanced stages. Irradiation may have been effective in supressing recurrences in two cases of other types of meningioma, although the number of cases is too small to allow any definite conclusion.

All screening radiographs of the chest and other medical records of 107 patients with histologically proved lung cancer in a fixed population were reviewed to assess the efficacy of biennial chest radiography in detecting lung cancer. Radiographic abnormalities caused by tumors were initially detected in 58 patients (54%); the other 49 (46%) were detected radiographically in subsequent examinations. Thirty-six of the 40 solitary tumors were less than or equal to 4.0 cm in diameter when detected. There were no symptoms in 76% of cases, possibly associated with the predominance of peripheral adenocarcinomas. Routine 36 X 43-cm radiographs, postero-anterior stereoscopic and lateral projections, and comparison with previous radiographs facilitated detection of relatively small tumors in asymptomatic patients. The corrected 5-year survival rate from the time of detection was 20%.

The clinical features of 102 patients with low grade non-Hodgkin's lymphomas treated from 1972 to 1981 among the hospitals belonging to the JLRTG were retrospectively reviewed. According to the Rappaport classification, there were 29 cases of NPDL, 26 of NM and 47 of DWDL. The survival rate and relapse-free survival rate for all patients at 10 years were 49% and 41%, respectively. No obvious difference in survival rate was seen by histologic type, but patients with DWDL had a better relapse-free survival rate than those with NM (P less than 0.01). This study also suggested that patients with stages I and II low grade lymphomas might be treated by irradiation alone, if they are staged properly.

Incidence of rib fracture was analyzed for 118 postoperated breast cancer patients who were tangentially irradiated at the Department of Radiology, Kyushu University, from 1961 to 1976 and followed more than 5 years. Rib fracture was observed in 5% and 50% of cases treated with total radiation doses of 32.5 Gy and 52.5 Gy respectively.

From 1972 to 1982, 563 patients with Stage I and II non-Hodgkin's lymphoma received radiation therapy in the department of radiology which belongs to the JLRTS group. Local control failures were seen in only 5 cases (0.9%). The regional recurrences were found in 30 cases (5%). 17 of recurrences occurred during the first 5 years. 17 cases had remissions again, and 5 cases had 5 year survivals.

A case history of a 39-year-old woman with a follicular, medium-size cell type lymphoma (Nodular poorly differentiated lymphocytic lymphoma) is reported. In spite of receiving no treatment, her lymphoma had changed little for 13 years. This case is regarded as a good example for considering the treatment of low grade malignant lymphomas.

A total of 234 patients of Hodgkin's disease treated at 7 institutions from 1972 through 1985 were analyzed. Male to female ratio was 157: 77, mean age was 39.8 years, and overall 5- and 10-year survival were 67% and 56%, respectively. Of 126 patients treated by radiotherapy with more than 36 Gy, alone or preceded to other treatments, 5- and 10-year survival rates were 84% and 80% for Stage I (43 patients), 79% and 69% for Stage II (71 pts.), and 52% and none for Stage III (12 pts.), respectively. Survival rate was better for LP, NS and MC histologies as compared to LD, better for patients without constitutional symptoms, as compared to patients with B, and better for patients with ages younger than 59 years as compared to those with ages over 60 years. Relapse was observed in 57 out of 126 patients. Relapse within the irradiation field was observed in only 4, and nodal areas outside the field, especially of abdomen (1/3), were the most common sites. Half of the relapses occurred within 20 months, and 80%, 40 months. Five-year survival of patients after relapse to lower torso lymph nodes (19 patients) was 37%, which was worse than patients after relapse to upper torso lymph nodes (15 patients: 63%) (z = 1.507, N.S.).

A retrospective analysis of 245 patients with stage II non-Hodgkin's lymphoma of the Waldeyer's ring treated between 1972 and 1985 was performed. Treatment consisted of radiation therapy alone in 96 patients and 149 patients were treated with chemotherapy combined. Five-year survival and relapse-free survival rates were 57% and 50%, respectively. For cases with DH, they were 64% and 55% respectively, and for DLPD 31% and 27%, respectively. Of the cases with relapse, 21% were seen in stomach or intestine. There were no difference on survival rates between radiation therapy alone and chemotherapy combined with radiation therapy.

Retrospective analysis of patients with malignant lymphoma of the brain was carried out. All cases were mainly treated with radiation therapy. Overall survival was 44% and 37% at two and five year. Survival was statistically better for patients with diffuse medium-sized cell or diffuse mixed type compared with diffuse large cell type by the LSG classification, for the age group less than 50 years compared with greater than or equal to 50 years, and for the group with Karnofsky Index greater than or equal to 50% compared with less than or equal to 40%. In 11 of 15 patients the first recurrent site was the central nervous system.

In a review of 193 patients with carcinoma of the tongue who underwent interstitial radiotherapy in our hospital from November 1978 to 1986, 5 year actuarial local control rate were 97%, 87%, 58% and 77% for T1, T2, T3 and T4 respectively. Mucosal ulcers with tissue defects and bone exposure of the mandible occurred in 5 years after the treatments, 6%, 22%, 44%, and 100% for T1, T2, T3 and T4, respectively. Therapeutic ratio was 1 in patients with T1 who underwent interstitial radiotherapy (70 Gy/7 days) alone while it was less than 1 in those with T2 or more. Therapeutic gain factor was less than 1 in patients with combined external radiotherapy.