Combination of mean CT value and maximum CT value as a novel predictor of lepidic predominant lesions in small lung adenocarcinoma presenting as solid nodules.

Lung adenocarcinomas presenting as solid nodules are occasionally diagnosed as lepidic predominant lesions. The aim of this study was to clarify the histological structure and to identify factors predictive of lepidic predominant lesions. We retrospectively reviewed 38 patients that underwent lobectomy for small (≤ 2 cm) adenocarcinoma presenting as solid nodules. Resected tumor slides were reviewed and histological components were evaluated. Clinical and radiological data were analyzed to identify factors predictive of lepidic predominant lesions. Of 38 solid nodules, 9 (23.7%) nodules were lepidic predominant lesions. Five-year disease-free survival (DFS) rates were 100% for lepidic predominant lesions (n = 9) and 74.6% for non-lepidic predominant lesions (n = 29). Mean CT values (p = 0.039) and maximum CT values (p = 0.015) were significantly lower in lepidic predominant lesions compared with non-lepidic predominant lesions. For the prediction of lepidic predominant lesions, the sensitivity and specificity of mean CT value (cutoff, - 150 HU) were 77.8% and 82.8%, respectively, and those of maximum CT value (cutoff, 320 HU) were 77.8% and 72.4%, respectively. A combination of mean and maximum CT values (cutoffs of - 150 HU and 380 HU for mean CT value and maximum CT value, respectively) more accurately predicted lepidic predominant lesions, with a sensitivity and specificity of 77.8% and 86.2%, respectively. The prognosis of lepidic predominant lesions was excellent, even for solid nodules. The combined use of mean and maximum CT values was useful for predicting lepidic predominant lesions, and may help predict prognosis.

Supercritical fluid chromatography-mass spectrometry enables simultaneous measurement of all phosphoinositide regioisomers.

Phosphoinositide species, differing in phosphorylation at hydroxyls of the inositol head group, play roles in various cellular events. Despite the importance of phosphoinositides, simultaneous quantification of individual phosphoinositide species is difficult using conventional methods. Here we developed a supercritical fluid chromatography-mass spectrometry method that can quantify the molecular species of all seven phosphoinositide regioisomers. We used this method to analyze (1) profiles of phosphoinositide species in mouse tissues, (2) the effect of lysophosphatidylinositol acyltransferase 1-depletion on phosphoinositide acyl-chain composition in cultured cells, and (3) the molecular species of phosphatidylinositol-3-phosphate produced during the induction of autophagy. Although further improvement is needed for the absolute quantification of minor phosphoinositide regioisomers in biological samples, our method should clarify the physiological and pathological roles of phosphoinositide regioisomers at the molecular species level.

Treatment with antifibrotic agents in idiopathic pleuroparenchymal fibroelastosis with usual interstitial pneumonia.

BACKGROUND: There are no established therapeutic options available for idiopathic pleuroparenchymal fibroelastosis (IPPFE) apart from supportive care and lung transplantation. Furthermore, it is known that IPPFE with a usual interstitial pneumonia (UIP) pattern and lower lobe predominance is a disease entity distinct from idiopathic pulmonary fibrosis (IPF). To our knowledge, few studies are available that report on the efficacy of antifibrotic agents for IPPFE with UIP. AIM: The aim of this study was to compare the efficacy of antifibrotic agents between IPPFE with UIP and typical IPF in real-world clinical practice. PATIENTS AND METHODS: A retrospective analysis was performed on the medical records of all patients at two interstitial lung disease centres. Sixty-four patients were diagnosed as having IPPFE with UIP and 195 patients were diagnosed with typical IPF. We compared the efficacy of antifibrotic agents between these two groups. RESULTS: Survival time was significantly shorter in the patients with IPPFE with UIP. Some 125 patients were administered antifibrotic agents for over 6 months (34 with IPPFE with UIP and 91 with typical IPF). Reduced forced vital capacity (FVC) 6 months after treatment with antifibrotic agents was significantly greater in the IPPFE with UIP group than in those in the typical IPF group. Moreover, the change in % predicted FVC was significantly greater during the follow-up in patients with IPPFE with UIP compared with those with typical IPF. CONCLUSIONS: The efficacy of antifibrotic agents was limited in patients with IPPFE with UIP. Thus, IPPFE with UIP remains a fatal and progressive disease.

Clinical characteristics of participants enrolled in an early identification and healthcare management program for dementia based on cluster analysis and the effectiveness of associated support efforts.

OBJECTIVE: Although early identification and management services for dementia have become more widespread, their efficacy and the clinical characteristics of service have yet to be fully evaluated. Therefore, the objective of this study is to clarify these issues. MEASUREMENTS: The subjects were 164 Japanese users of an early identification and management program for dementia, known as the Initial-phase Intensive Support Team (IPIST), between 2013 and 2015. Nonhierarchical cluster analysis was used to derive subgroups based on cognitive status and ability in activities of daily living (ADL) and behavioral and psychological symptoms of dementia (BPSD). One-way analysis of variance was performed to evaluate differences among the groups derived by the cluster analysis. A paired t test was used to assess how the clinical status of the groups changed between baseline and follow-up. RESULTS: Four groups were identified by cluster analysis, i.e. a mild group, a moderate group, a BPSD group with moderate cognitive impairment and severe BPSD, and a severe group with severe cognitive impairment and severe BPSD. Although there were no significant improvements in cognitive impairment or ADL in any group, significant improvements were found in BPSD in the BPSD and severe BPSD groups. Caregiver burden was significantly lessened in all groups. Clinical diagnosis and long-term care insurance service utilization rates were significantly improved overall. CONCLUSION: The users of IPIST were classified into four subgroups based on their clinical characteristics. The IPIST program could improve the quality of life of people with dementia and their caregivers.

Toward improving prognosis prediction in patients undergoing small lung adenocarcinoma resection: Radiological and pathological assessment of diversity and intratumor heterogeneity.

OBJECTIVES: Prediction of prognosis based on the ground-glass opacity (GGO) ratio for small (≤2 cm) lung adenocarcinomas is not completely accurate. The aim of this study was to clarify the diversity of small adenocarcinomas and to identify ways to more accurately predict prognosis. MATERIALS AND METHODS: We retrospectively reviewed 62 patients (64 lesions) that underwent lobectomy for small (≤2 cm) lung adenocarcinoma. Proportions of histological components were measured and the presence of tumor spread through air spaces (STAS) was assessed. The correlations between GGO and histological components were examined. Furthermore, histological components of pure GGO lesions were analyzed using CT values. The intratumor heterogeneity of programmed death ligand 1 (PD-L1) expression was analyzed in 40 lesions. Furthermore, the relationship between CT/histological findings and prognoses was analyzed. RESULTS: In 13 pure GGO lesions, 7 (53.8%) lesions contained invasive components such as papillary, acinar, solid, and colloid. Tumor spread through air spaces (STAS) was also found in pure GGO lesions. Pure GGO lesions containing invasive components (p =  0.002) and STAS-positive lesions (p =  0.011) demonstrated strongly higher CT value. Differences in expression of PD-L1 among histological subtypes were observed in four of six (66.7%) PD-L1 positive lesions. Patients with papillary component, positivity for STAS, or CT value ≥ -140.6 Hounsfield units (HU) had significant poorer prognoses than patients without those in disease-free survival analyses (p =  0.007, p =  0.048, p = 0.012). Patients with the CT value < -383.4 HU and GGO ≥ 50% did not have recurrence. CONCLUSIONS: Invasive component and STAS can be present even in small GGO lesions, and patients with papillary components or STAS showed significantly poorer prognoses. STAS-positive lesions were strongly associated with a high CT value, and combined use of GGO ratio and CT value may be able to predict recurrences of lung cancer more accurately.

The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease.

BACKGROUND: When a clinical context is indeterminate for idiopathic pulmonary fibrosis (IPF), or a chest high-resolution computed tomography (HRCT) pattern is not indicative of typical or probable usual interstitial pneumonia (UIP) in patients with interstitial lung disease (ILD), surgical lung biopsy should be considered to make a confident diagnosis on the basis of multidisciplinary diagnosis (MDD). AIM: The aim of this study was to evaluate the role and safety of video-assisted thoracoscopic surgery (VATS) in patients with ILD. METHODS: A total of 143 patients with ILD underwent VATS at Toho University Medical Center Omori Hospital between March 2004 and April 2017. We conducted a retrospective study on the usefulness and safety of VATS in the diagnosis of ILD under MDD. RESULTS: The 30-day mortality was 0%. The postoperative complication rate was 12.6%, which included 5 cases of pneumothorax after discharge (3.5%), 4 cases of prolonged air leakage (2.8%), and 2 cases of acute exacerbation (1.4%). Three of 9 cases (33.3%) complicated by pneumothorax after discharge or prolonged air leakage were resected specimens of pleuroparenchymal fibroelastosis (PPFE). Two patients had acute exacerbation, who were ultimately diagnosed as having idiopathic unclassifiable IP and had histologically significant irregular dense fibrosis and numerous fibroblastic foci. The comparison between chest HRCT and histopathological findings revealed 55 cases of possible UIP [UIP (45%), NSIP (25%), and unclassifiable IP (29%)] and 21 cases of inconsistent with UIP [UIP (10%), NSIP (33%), organizing pneumonia (10%), unclassifiable IP (24%), and PPFE (24%)]. CONCLUSION: VATS can be safely performed to obtain a confident diagnosis for appropriate treatment strategies in patients with ILD.

[A Case Report of Surgery and Chemotherapy for a Patient with Rapidly Progressing Breast Cancer during Pregnancy].

A 33-year-old woman became aware of a right breast mass at her 28th week of pregnancy. From the biopsy results, we diagnosed her with right breast cancer. At her 33rd week of pregnancy, she underwent modified radical mastectomy (pT2N3aM0, Stage III C, ER-negative, PR-negative, HER2-positive), and she elected to receive adjuvant therapy after the surgery during her pregnancy. She received the first course of EC (epirubicin plus cyclophosphamide) therapy on the 13th postoperative day (35 weeks of gestation) and gave a natural, vaginal delivery at 36 weeks and 5 days of gestation. On the 4th day after birth, the patient noticed a contralateral left breast mass and was diagnosed with left breast cancer, after core needle biopsy. She received 4 courses of EC therapy and is currently undergoing PTX plus HER (paclitaxel plus trastuzumab) therapy. Regarding chemotherapy during pregnancy, we recommend that there is no need to perform artificial preterm birth, because chemotherapy has little influence on children after their second-trimester. After the second-trimester, chemotherapy can be safely performed.

Clinico-radiological features and efficacy of anti-fibrotic agents in atypical idiopathic pulmonary fibrosis.

BACKGROUND: Atypical idiopathic pulmonary fibrosis (IPF) including multiple cysts or markedly atelectatic induration in upper lung predominance occasionally can confirm the diagnosis of IPF through a multidisciplinary discussion (MDD) between clinician, radiologist and, pathologist in clinical practice. The aim of this study was to clarify the differences in clinico-radiological characteristics and the efficacy of anti-fibrotic agents between atypical IPF and typical IPF. METHODS: We retrospectively evaluated the differences in clinico-radiological characteristics between patients with atypical IPF (n=44) and those with typical IPF (n=87) and examined efficacy of anti-fibrotic agents in atypical IPF. Atypical IPF was characterized by the presence of markedly atelectatic induration in upper lung predominance (pleuroparenchymal fibroelastosis; PPFE like lesion) with and without multiple thick-walled large cysts (TWLC), so-called macrocystic honeycombing (TWLC; >2.5 cm in diameter with 1-3 mm thickness) in addition to honeycombing in the bilateral lower lobes predominance. RESULTS: There was no difference in the baseline disease severity for IPF between both groups. The annual change value of fibrotic score and traction bronchiectasis (TBE) score, and decreased changes in forced vital capacity (FVC) during 6 months were significantly higher in atypical IPF than those in typical IPF. Survival time was significantly lower in patients with atypical IPF (MST: 33.4 vs. 47.9 months, P=0.03). The multivariate Cox regression model demonstrated that the prognostic predictors were presence of atypical IPF and increased Gender-Age-Physiology (GAP) staging. Moreover, the rate of decrease in FVC value 6 months after treatment with anti-fibrotic agents was significantly higher in atypical IPF than those in typical IPF (-11.8%±14.0% vs. -1.0%±12.7%; P=0.01). CONCLUSIONS: This study demonstrated that the prognosis for atypical IPF was significantly worse than that for typical IPF. Future studies are required prospective analyses of efficacy of anti-fibrotic agents for patients with atypical IPF.

Consensus development of quality indicators for end-of-life care for elders in Japan.

AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics. RESULTS: Quality indicators were identified in 7 major areas: advance directives and surrogate continuity, ethical daily care, care preferences and decisions about life-sustaining treatment, assessment and management of pain and other symptoms, daily care for the dying, family care, and institutional systems for end-of-life care. CONCLUSIONS: These quality indicators represent the first attempt to develop a best practices approach toward improving the quality of elderly end-of-life care in nursing.

Pirfenidone for acute exacerbation of idiopathic pulmonary fibrosis: A retrospective study.

BACKGROUND: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a rapid and ultimately fatal condition, and no effective treatment has been established. Pirfenidone has antifibrotic effects in IPF; however, its efficacy for AE-IPF is unclear. OBJECTIVES: To evaluate the efficacy of pirfenidone for AE-IPF. METHODS: We retrospectively reviewed the medical records of 135 IPF patients treated during the period from April 2008 to April 2015 and identified and extracted 47 AE-IPF patients (42 men, 5 women; mean age, 73.5 years). The clinical features and outcomes of the 20 patients treated with pirfenidone were compared with those of the 27 patients treated without pirfenidone. We then excluded the 25 patients who did not receive recombinant human soluble thrombomodulin (rhTM) and analyzed data from the remaining 22 patients (20 men, 2 women; mean age, 73.7 years). Clinical features and outcomes were compared between the 10 patients treated with pirfenidone and the 12 patients who did not receive pirfenidone. RESULTS: There were no significant differences between the two groups in baseline characteristics, except for pirfenidone use before onset. Three-month survival was significantly better in patients treated with pirfenidone than in the control group (55% vs 34%, p = 0.042). In univariate analysis, nonuse of pirfenidone was a potential risk factor for death at 3 months (hazard ratio, 6.993; p = 0.043) in patients treated with rhTM. CONCLUSION: A regimen of pirfenidone combined with corticosteroids and rhTM may improve survival in patients with AE-IPF.

Acute exacerbation of idiopathic interstitial pneumonia after nonpulmonary surgery under general anesthesia: a retrospective study.

Background: Idiopathic interstitial pneumonia (IIP) is associated with increased risk of acute exacerbation after lung surgery, which has a poor prognosis and can be fatal. Although some studies have investigated acute exacerbation of IIP after lung surgery, the incidence and risks of acute exacerbation of IIP after nonpulmonary surgery have not been reported. The aim of present study to evaluate the characteristics and risk factors for acute exacerbation of IIP after nonpulmonary surgery. Methods: We retrospectively reviewed the clinical characteristics of 2908 consecutive patients (1620 men, 1288 women; mean age, 61.7) who underwent nonpulmonary surgery under general anesthesia between April 2008 to April 2013. Using preoperative chest computed tomography images, we identified IIP cases and compared preoperative characteristics, laboratory findings, and anesthesia conditions among patients who did and did not develop AE. Results: We extracted 103 IIP patients who underwent nonpulmonary surgery; postoperative acute exacerbation of IIP developed in 8 (7.8%). Univariate analysis identified several risk factors, namely, emergency surgery, preoperative prednisolone use, high serum C-reactive protein, lactate dehydrogenase, white blood cell count, low serum albumin and propofol use during anesthesia. Conclusion: The results suggest that the incidences of postoperative acute exacerbation of IIP are similar after nonpulmonary and pulmonary surgery. In addition, propofol use during anesthesia is a possible risk factor for acute exacerbation of IIP after nonpulmonary surgery. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 156-164).

Two cases of genital neutrophilic sebaceous adenitis.

Sebaceous glands without a follicular structure are present in the eyelid margin (meibomian glands), lip, glans penis and vulva. Inflammatory disease of a sebaceous gland lacking follicles is rare, except for meibomitis. We report the first two cases of vulval sebaceous adenitis. Painful, yellowish-orange papules/nodules recurred at the vulval mucocutaneous junction or mucosa during the luteal phase of the menstrual cycle. Histopathologically, a dense neutrophilic infiltration was observed within the sebaceous ducts. In both cases, oral minocycline improved the condition. They had been treated with antiherpetic agents. It is possible that women diagnosed with recurrent genital herpes have genital neutrophilic sebaceous adenitis.

Simultaneous determination of water-soluble vitamins in beverages and dietary supplements by LC-MS/MS.

An LC-MS/MS method was developed for the simultaneous determination of 15 water-soluble vitamins that are widely used as additives in beverages and dietary supplements. This combined method involves the following simple pre-treatment procedures: dietary supplement samples were prepared by centrifugation and filtration after an extraction step, whereas beverage samples were diluted prior to injection. Chromatographic analysis in this method utilised a multi-mode ODS column, which provided reverse-phase, anion- and cation-exchange capacities, and therefore improved the retention of highly polar analytes such as water-soluble vitamins. Additionally, the multi-mode ODS column did not require adding ion pair reagents to the mobile phase. We optimised the chromatographic separation of 15 water-soluble vitamins by adjusting the mobile phase pH and the organic solvent. We also conducted an analysis of a NIST Standard Reference Material (SRM 3280 Multi-vitamin/Multi-element tablets) using this method to verify its accuracy. In addition, the method was applied to identify the vitamins in commercial beverages and dietary supplements. By comparing results with the label values and results obtained by official methods, it was concluded that the method could be used for quality control and to compose nutrition labels for vitamin-enriched products.

Minimization of carryover for high-throughput liquid chromatography with tandem mass spectrometry analysis of 14 mycotoxins in corn grits.

A method for the simultaneous analysis of 14 mycotoxins with the minimization of carryover was developed. Our verification experiments suggested that the carryover occurred due to the chelation of fumonisins with the metal. To wash the fumonisins from the metal, the inner surface of the injection needle was rinsed with 10 mM trisodium citrate and 1% formic acid in water/methanol/acetonitrile/isopropanol after each injection, and the analysis was performed on a metal-free Mastro C18 column. This approach remarkably minimized the carryover of fumonisins. Fourteen mycotoxins in samples were extracted with 2% acetic acid in water/acetonitrile and a quick, easy, cheap, effective, rugged, and safe extraction kit, purified on a MultiSep 229 Ochra, and then quantified by liquid chromatography with tandem mass spectrometry. Determinations performed using this method produced a linearity greater than 0.99 and recoveries ranging from 72.6 to 117.4%, with good intraday precision from 4.0 to 12.4%, and interday precision from 6.5 to 17.0%. The limits of detection ranged from 0.01 to 0.71 µg/kg, demonstrating that a highly sensitive method for the simultaneous analysis of mycotoxins over a wide range of concentrations was achieved with minimal carryover. When 12 samples of commercially available corn grits were analyzed with this method, deoxynivalenol, fumonisin B1, fumonisin B2, fumonisin B3, and zearalenone were present most frequently.

Preparation of biological fish silage and its effect on the performance and meat quality characteristics of quails (Coturnix coturnix japonica)

The aim of the present study was to produce fish silage by lactic acid fermentation and evaluate its use in feeding of quails (Coturnix coturnix japonica). An oven-dried mixture of fish silage and soybean meal (1:1 w/w) was used to prepare the diets with different levels of inclusion (0, 10, 20 and 30%) and evaluate its effect on the performance and meat quality of 160 quails. The inclusion level did not affect the growth and feed conversion ratio. The carcass yield (70.3%) and sensory quality of breast meat were not significantly different among the treatments (p>0.05). However, the concentration of unsaturated fatty acids such as oleic (C18:1n9C), linoleic (C18:2n6C), linolenic (C18:3n3), arachidonic (C20:4n6), cis eicosapentaenoic (C20:5n3) and cis docosahexaenoic (C22:6n3) increased in quail breast meat with the inclusion of fish silage:soybean mixture in the diet (p<0.05). Fish silage and its use in quail diets could offer a good alternative for fish waste utilization as feedstuff component for the improvement of fatty acid composition in its breast meat.

Malignant neoplasm related mortality and morbidity of hypertensive outpatients in Japanese men and women.

OBJECTIVES: To investigate the cause of reduced malignant neoplasm-related mortality in hypertensive outpatients. BACKGROUND: In previous studies, hypertensive outpatients have had modest improvement in overall mortality rate as compared with standard risk groups. While excessive mortality rates for cardiovascular disease and stroke were evident in hypertensive outpatients, the mortality rate of malignant neoplasm was greatly reduced. METHODS: Using database systems of Sumitomo Life Insurance Co, Japan, standard life tables were generated, and ratios or rates for mortality and morbidity of hypertensive outpatients were extrapolated and analyzed. RESULTS: The mortality ratio of all cancers was significantly low, 85% (95% CI: 77%-93%), and the morbidity ratio was significantly increased, 121% (95% CI: 109%-133%). The mortality ratio of each of categorized malignant neoplasm was below 100% except for colorectal cancer (111%, 95% CI: 83%-138%). The mortality ratios of stomach cancer (56%, 95% CI: 41%-72%) and liver cancer (52%, 95% CI: 32%-80%) were significantly decreased. The morbidity ratios of colorectal cancer, breast cancer, esophageal cancer, and others were over 100%, and was statistically significant in colorectal cancer (140%, 95% CI: 112%-167%) and others (139%, 95% CI: 113%-165%). The differences between the mortality ratio and the morbidity ratio of stomach cancer and others were statistically significant. The relative lethality of all but pancreatic cancer and leukemia were less than 1.0, and there was a positive correlation between the general prognosis of each cancer and the relative lethality. CONCLUSIONS: The decreased malignant neoplasm-related mortality ratio in hypertensive outpatients was indicative of an improved prognosis and likely benefited from close medical surveillance.

Computer-aided detection of lung nodules on multidetector CT in concurrent-reader and second-reader modes: a comparative study.

PURPOSE: To compare the reading times and detection performances of radiologists in concurrent-reader and second-reader modes of computer-aided detection (CAD) for lung nodules on multidetector computed tomography (CT). MATERIALS AND METHODS: Fifty clinical multidetector CT datasets containing nodules up to 20mm in diameter were retrospectively collected. For the detection and rating of non-calcified nodules larger than 4mm in diameter, 6 radiologists (3 experienced radiologists and 3 resident radiologists) independently interpreted these datasets twice, once with concurrent-reader CAD and once with second-reader CAD. The reference standard of nodules in the datasets was determined by the consensus of two experienced chest radiologists. The reading times and detection performances in the two modes of CAD were statistically compared, where jackknife free-response receiver operating characteristic (JAFROC) analysis was used for the comparison of detection performances. RESULTS: Two hundreds and seven nodules constituted the reference standard. Reading time was significantly shorter in the concurrent-reader mode than in the second-reader mode, with the mean reading time for the 6 radiologists being 132s with concurrent-reader CAD and 210s with second-reader CAD (p<0.01). JAFROC analysis revealed no significant difference between the detection performances in the two modes, with the average figure-of-merit value for the 6 radiologists being 0.70 with concurrent-reader CAD and 0.72 with second-reader CAD (p=0.35). CONCLUSION: In CAD for lung nodules on multidetector CT, the concurrent-reader mode is more time-efficient than the second-reader mode, and there can be no significant difference between the two modes in terms of detection performance of radiologists.

Improvement of pulmonary function by oral treatment with a VLA-4 antagonist in a mouse asthmatic model.

We investigated in vivo efficacies of the newly synthesized VLA-4 antagonist Compound A {trans-4-[1-[[2,5-Dichloro-4-(1-methyl-3-indolylcarboxamido)phenyl]acetyl]-(4S)methoxy-(2S)-pyrrolidinylmethoxy]cyclohexanecarboxylic acid} on Ascaris antigen-induced airway inflammation and hyperresponsiveness in a murine asthmatic model. Oral administration of Compound A significantly inhibited eosinophil infiltration into BALF and airway hyperresponsiveness 48 h after the antigen challenge. Histologic analysis of the lung sections confirmed the BALF result and revealed suppression of edema and mucus hyperplasia at 8 and 48 h after the challenge, respectively. These findings clearly show that orally active Compound A has therapeutic potential for treatment of asthma.

Contrast-enhanced multidetector-row computed tomography vs. Time-resolved magnetic resonance angiography vs. contrast-enhanced perfusion MRI: assessment of treatment response by patients with inoperable chronic thromboembolic pulmonary hypertension.

PURPOSE: To compare therapeutic effect assessment capability of multidetector-row computed tomography (MDCT), magnetic resonance angiography (MRA), and dynamic perfusion MRI for chronic thromboembolic pulmonary hypertension (CTEPH) patients. MATERIALS AND METHODS: Twenty-four consecutive CTEPH patients treated with conventional therapy underwent pre- and posttherapeutic MDCT, MRA, dynamic perfusion MRI, 6-minute walk distance (6-MWD), cardiac ultrasound (US), and right heart catheterization. According to therapeutic results, all patients were divided into response (n = 13) and nonresponse (n = 11) groups. CTEPH indexes for MDCT (CTEPH(CT) ) and MRA (CTEPH(MRA) ) were calculated on the basis of embolic burden. Pulmonary perfusion parameter maps were generated from all perfusion MR data, followed by determination of improvements in mean perfusion parameter at regions of interest (ROIs) for each patient. Receiver operating characteristic (ROC)-based positive tests were performed to determine the feasible threshold values for distinguishing two groups. Finally, diagnostic capabilities were compared by means of McNemar's test. RESULTS: When feasible threshold values adapted, specificity (90.9 〈10/11〉%, P < 0.05) and accuracy (95.8 〈23/24〉%, P < 0.05) for improvement in pulmonary blood flow were significantly higher than those for CTEPH(CTA) (specificity: 36.4 〈4/11〉%, accuracy: 70.8 〈17/24〉%). CONCLUSION: Dynamic perfusion MRI has better capability for assessment of therapeutic effect on CTEPH patients than does MDCT.

Comparison of capability of dynamic O2-enhanced MRI and quantitative thin-section MDCT to assess COPD in smokers.

PURPOSE: The purpose of this study was to directly and prospectively compare the capability of dynamic O(2)-enhanced MRI and quantitatively assessed thin-section MDCT to assess smokers' COPD in a large prospective cohort. MATERIALS AND METHODS: The GOLD criteria for smokers were used to classify 187 smokers into four clinical stage groups as follows: smokers without COPD (n=56) and with mild (n=54), moderate (n=52) and severe or very severe COPD (n=24). All smokers underwent dynamic O(2)-enhanced MRI, MDCT and pulmonary function tests. Mean relative enhancement ratio and mean wash-in time on MRI and CT-based functional lung volume (CT-based FLV) as well as the ratio of airway wall area to total airway area on MDCT were computationally calculated. Then, all indexes were significantly correlated with functional parameters. To determine the efficacy of all indexes for clinical stage classification, the indexes for the four clinical groups were statistically compared by using Tukey's honestly significant difference multiple comparison test. RESULTS: All indexes had significant correlations with functional parameters (p<0.0001). All indexes except CT-based FLV in all groups had significant differences each other (p<0.05). CONCLUSIONS: Dynamic O(2)-enhanced MRI for assessment of COPD in smokers is potentially as efficacious as quantitatively assessed thin-section MDCT.