Early evaluation of CAR-T cell therapy response in R/R DLBCL patients using 18F-FDG PET/CT.

OBJECTIVE: CD19-targeted chimeric antigen receptor T (CAR-T) cell therapy provides a durable response in patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). The role of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for early evaluation of response in patients with that immunotherapy was evaluated. SUBJECTS AND METHODS: Three separate 18F-FDG PET/CT examinations of 53 patients (29 males, 24 females; median 62 years old) with R/R DLBCL were conducted; before bridging therapy [time of decision (TD)], before CAR-T (tisagenlecleucel, n=37; lisocabtagenemaraleucel, n=16) infusion [time of CAR-T infusion (IT)], and one month (M1) after CAR-T infusion. Response was evaluated based on the Deauville 5-point scale and Lugano criteria. RESULTS: Among 21 patients (39.6%) with complete metabolic response (CMR) at IT-PET, 20 were able to continue CMR, while one showed progression at M1-PET. Among 32 patients (60.4%) with non-CMR at IT-PET, 12, 8, 4, and 8 showed CMR, partial metabolic response (PMR), (non-metabolic response (NMR), and progressive metabolic disease (PMD), respectively, at M1-PET as compared with IT-PET. Evaluations of M1-PET as compared with baseline TD-PET indicated 32, 7, 5, and 9 patients with CMR, PMR, NMR, and PMD, respectively. After a median 10.1 months, 26 patients showed progression and 13 had died from DLBCL. The 32 who achieved CMR showed significantly longer progression-free (P<0.0001) and overall survival (P<0.0001) periods as compared to the 21 non-CMR patients. CONCLUSION: Fluorine-18-FDG PET/CT findings obtained one month after CAR-T cell therapy showed accuracy for early response evaluation and prediction of progression in patients with R/R DLBCL.

Radiation Therapy for Breast Cancer With Oligometastatic Cervical Lymph Nodes: A Case Report.

Stage IV breast cancer is difficult to cure and is mainly treated with systemic therapy. However, when distant metastasis is oligometastatic, proactive treatment including local therapies for the primary lesion and distant metastases has been reported to improve prognosis. We encountered a patient who had left breast cancer with ipsilateral cervical lymph node metastases. The metastases were oligometastatic, and we treated them curatively. The patient was a female in her 50s who had been aware of a lump in the lower inner quadrant of the left breast for a few years. A biopsy was performed and left breast cancer was diagnosed pathologically. Radiological examination showed metastasis to ipsilateral axillary and cervical lymph nodes. The cervical lymph node metastases were oligometastatic, suggesting possible improvement in prognosis by multimodality treatment including local therapy. The multimodality treatment in this case comprised mastectomy with levels I and II axillary lymph node dissection, systemic therapy (including chemotherapy, endocrine therapy, and molecular targeted therapy), and postmastectomy radiation therapy. The left chest wall and left supraclavicular lymph node region were irradiated. Furthermore, following the postmastectomy radiation therapy, the cervical lymph node metastases were treated with radical radiation therapy. The cure was achieved, with recurrence-free status maintained for two years and four months after the completion of radiation therapy. This case suggests that, for breast cancer with oligometastatic involvement of cervical lymph nodes, locally treating these distant metastatic lesions with radical radiation therapy as part of multimodality treatment is beneficial.

Assessing Therapeutic Response to Radium-223 with an Automated Bone Scan Index among Metastatic Castration-Resistant Prostate Cancer Patients: Data from Patients in the J-RAP-BSI Trial.

To evaluate the usefulness of change in the automated bone scan index (aBSI) value derived from bone scintigraphy findings as an imaging biomarker for the assessment of treatment response and survival prediction in metastatic castration-resistant prostate cancer (mCRPC) patients treated with Ra-223. This study was a retrospective investigation of a Japanese cohort of 205 mCRPC patients who received Ra-223 in 14 hospitals between July 2016 and August 2020 and for whom bone scintigraphy before and after radium-223 treatment was available. Correlations of aBSI change, with changes in the serum markers alkaline phosphatase (ALP) and prostate-specific antigen (PSA) were evaluated. Additionally, the association of those changes with overall survival (OS) was assessed using the Cox proportional-hazards model and Kaplan-Meier curve results. Of the 205 patients enrolled, 165 (80.5%) completed six cycles of Ra-223. Following treatment, ALP decline (%ALP < 0%) was noted in 72.2% (148/205), aBSI decline (%aBSI < 0%) in 52.7% (108/205), and PSA decline (%PSA < 0%) in 27.8% (57/205). Furthermore, a reduction in both aBSI and ALP was seen in 87 (42.4%), a reduction in only ALP was seen in 61 (29.8%), a reduction in only aBSI was seen in 21 (10.2%), and in both aBSI and ALP increasing/stable (≥0%) was seen in 36 (17.6%) patients. Multiparametric analysis showed changes in PSA [hazard ratio (HR) 4.30, 95% confidence interval (CI) 2.32-8.77, p < 0.0001], aBSI (HR 2.22, 95%CI 1.43-3.59, p = 0.0003), and ALP (HR 2.06, 95%CI 1.35-3.14, p = 0.0008) as significant prognostic factors for OS. For mCRPC patients treated with Ra-223, aBSI change is useful as an imaging biomarker for treatment response assessment and survival prediction.

Novel nomogram developed for determining suitability of metastatic castration-resistant prostate cancer patients to receive maximum benefit from radium-223 dichloride treatment-Japanese Ra-223 Therapy in Prostate Cancer using Bone Scan Index (J-RAP-BSI) Trial.

PURPOSE: To develop a novel nomogram for determining radium-223 dichloride (Ra-223) treatment suitability for metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS: This Japanese Ra-223 Therapy in Prostate Cancer using Bone Scan Index (J-RAP-BSI) Trial was a retrospective multicenter investigation enrolled 258 mCRPC patients in Japan with Ra-223 treatment between June 2016 and August 2020, with bone scintigraphy findings before treatment, clinical data, and survival outcome available. A nomogram was constructed using prognostic factors for overall survival (OS) based on a least absolute shrinkage and selection operator Cox regression model. A sub-analysis was also conducted for patients meeting European Medicines Agency (EMA) guidelines. RESULTS: Within a median of 17.4 months after initial Ra-223 treatment, 124 patients (48.1%) died from prostate cancer. Predictive factors included (1) sum of prior treatment history (score 0, never prior novel androgen receptor-targeted agents (ARTA) therapy, never prior taxane-based chemotherapy, and ever prior bisphosphonate/denosumab treatment), (2) Eastern Cooperative Oncology Group (ECOG) performance status, (3) prostate-specific antigen doubling time (PSADT), (4) hemoglobin, (5) lactate dehydrogenase (LDH), and (6) alkaline phosphatase (ALP) levels, and (7) automated bone scan index (aBSI) value based on bone scintigraphy. The nomogram using those factors showed good discrimination, with apparent and optimism-corrected Harrell's concordance index values of 0.748 and 0.734, respectively. Time-dependent area under the curve values at 1, 2, and 3 years were 0.771, 0.818, and 0.771, respectively. In 227 patients meeting EMA recommendation, the nomogram with seven factors showed good discrimination, with apparent and optimism-corrected Harrell's concordance index values of 0.722 and 0.704, respectively. Time-dependent area under the curve values at 1, 2, and 3 years were 0.747, 0.790, and 0.759, respectively. CONCLUSION: This novel nomogram including aBSI to select mCRPC patients to receive Ra-223 with significantly prolonged OS possibility was found suitable for assisting therapeutic decision-making, regardless of EMA recommendation.

Optimal Clinical Target Volume of Radiotherapy Based on Microscopic Extension around the Primary Gross Tumor in Non-Small-Cell Lung Cancer: A Systematic Review.

A crucial issue in radical radiation therapy for non-small-cell lung cancer is how to define the clinical target volume (CTV). Although the scope of microscopic extension (ME) and microscopic proximal bronchial extension (PBE) from a primary tumor should be considered when defining the CTV, there has been limited research on ME and PBE. Therefore, we conducted this systematic review. The PubMed, ICHUSHI (Japanese database), and Cochrane Library databases were searched, and 816 articles were initially retrieved. After primary and secondary screenings, eight articles were ultimately selected. The results of this systematic review suggest the importance of a 0 mm margin in stereotactic radiotherapy for early-stage cancer and a 5-8 mm margin in curative irradiation for locally advanced cancer. Regarding PBE, this review yielded the conclusion that it is appropriate to consider the addition of an approximately 15 mm margin from the bronchial vasculature. Although there were few articles with a high level of evidence, this systematic review enabled us to collate results from previous studies and to provide recommendations, to some extent, regarding the CTV margin in the current clinical environment, where high-precision radiation therapy, such as image-guided radiotherapy and intensity-modulated radiotherapy, is predominant.

Japan's Academic Barriers to Gender Equality as Seen in a Comparison of Public and Private Medical Schools: A Cross-Sectional Study.

Background: Gender inequalities persist in Japanese academic medicine. Some public medical schools have introduced various types of career support for women physicians, whereas few private schools have. Few studies describe the representation of women at different academic ranks and adequacy of career support in public and private medical schools in Japan. Study Design: Cross-sectional descriptive study. Methods: We used publicly available data from the 2018 National Survey on Career Support for Japanese Women Physicians published by the Association of Japanese Medical Colleges in March 2019, which was answered by departments regarding supporting women physicians. Participants represented 51 public and 29 private medical schools in Japan. The proportion of women at academic ranks and career support availability in private and public medical schools were determined using chi-squared test or Fisher's exact test. Results: The proportion of women in senior ranks was significantly higher in private (28.2%) than in public medical schools (25.4%) (p < 0.001). Excluding associate professors, the proportion of professors, lecturers, and assistant professors was significantly higher in private medical schools (3.8% vs. 5.8%, p = 0.002; 12.2% vs. 16.0%, p < 0.001; 20.5% vs. 29.9%, p < 0.001). More public medical schools provided position support and support for other job aspects (43.1% vs. 20.7%, p = 0.043; 70.6% vs. 20.7%, p < 0.001). Conclusions: Public medical schools have lower proportions of women in the academic hierarchy but provide more career support than do private medical schools. Further study is needed to reveal the possible causes of this pattern.

Quantitative 67Ga-citrate SPECT/CT for evaluating disease activity in patients with interstitial lung disease.

OBJECTIVE: To determine whether results of a standardized uptake value (SUV)-based semi-quantitative analytic method for gallium-67 (67Ga)-citrate single photon emission tomography/computed tomography (SPECT/CT) reflects disease activity in patients with interstitial lung disease. SUBJECTS AND METHODS: Gallium-67-citrate SPECT/CT was used to evaluate disease activity in 24 patients with interstitial pneumoniaon clinical grounds at a single institution from June 2018 to August 2020. SUV in a given volume of interest over the bilateral pulmonary parenchyma was calculated using a dosimetry software package. Correlations of maximum SUV (SUVmax) and mean SUV (SUVmean) with clinical factors, including KL-6, lactate dehydrogenase (LDH), and C-reactive protein (CRP), were evaluated in all 24, as well as in 15 patients with spirometry results using Pearson's rank correlation test. RESULTS: The mean bilateral pulmonary SUVmax value showed a moderately significant correlation with KL-6 (Pearson's correlation coefficient r=0.51, P=0.012) and LDH (r=0.51, P=0.010), a weak non-significant correlation with DLCO% (r=-0.26, P=0.34), and no correlation with CRP (r=-0.01, P=0.94), FVC% (r=0.11, P=0.71), or FEV1.0% (r=0.14, P=0.62). Eleven patients with high KL-6 (≥1000U/mL) were defined as having disease activity. Maximum SUV sensitivity, specificity, and accuracy for predicting interstitial lung disease activity were 72.7%, 76.9%, and 75.0%, respectively, with a best cut-off value of 3.78. CONCLUSION: Semi-quantitative values obtained with 67Ga-citrate SPECT/CT showed a moderate correlation with KL-6 and moderate diagnostic performance for predicting disease activity of interstitial lung disease. It is rather unlikely that quantitative 67Ga-citrate SPECT/CT will have a role into the algorithm of interstitial lung disease.

Nationwide survey of radiation therapy in Japan for lung cancer complicated with interstitial lung disease.

The purpose of this study was to clarify the opinions of radiation oncologists in Japan regarding treatment for lung cancer complicated with interstitial lung disease (ILD) by a questionnaire survey, and the risk of acute exacerbation (AE) after radiotherapy. Questionnaires were sent to all of the facilities in which radiation therapy is performed for lung cancer in Japan by using the mailing list of the Japanese Society for Radiation Oncology (JASTRO). The questionnaire survey was conducted to clarify who judges the existence of ILD, the indications for radiation therapy in cases of ILD-combined lung cancer, and the ratio of ILD-combined lung cancer in lung cancer patients treated with radiation therapy. Patients with ILD-combined lung cancer who received radiotherapy during the period from April 2014 to March 2015 were retrospectively analysed. Any cases of AE without any other obvious cause were included. ILD confirmation was performed by central radiologists using computed tomography images. A total of 47 facilities responded to the questionnaire. Radiation therapy was an option in cases of ILD-combined lung cancer in 39 (83%) of the facilities. The indication for radiation therapy was based on image findings in 35 (90%) of the 39 facilities in which radiation therapy was acceptable or was a choice in some cases of ILD. The final indication was based on the opinion of the pulmonologist in 29 (74%) of those 39 facilities. In fiscal year 2014, a total of 2128 patients in 38 facilities received chest irradiation. Seventy-eight (3.7%) of those 2128 patients had ILD-combined lung cancer. Sixty-seven patients were included in patient analysis. AE occurred in 5 patients (7.5%), and one of those 5 patients (20.0%) died from radiation-induced AE. The median period from radiotherapy to AE was 4 months (range, 2-7 months). The following four independent risk factors for AE were identified in univariate analysis: non-advanced age (<75 years), increased C-reactive protein level (≥0.3 mg/dl), adjuvant chemotherapy and ≥ Grade 2 radiation pneumonitis. Radiotherapy was an option for lung cancer even in cases with ILD in 83% (39/47) of the facilities in Japan. Seventy-eight (3.7%) of 2128 patients who received radiation therapy for lung cancer had ILD. Radiotherapy for ILD-combined lung cancer may induce AE at a substantial rate and AE can be life-threatening. Minimizing the risk of radiation pneumonitis might enable the risk of AE to be reduced.

Assessment of tumor response to definitive chemoradiotherapy and prognosis prediction in patients with esophageal cancer judged by PET response criteria in solid tumors: multicenter study in Japan.

OBJECTIVES: The aim of the study was to evaluate PET response criteria in solid tumors (PERCIST) to indicate therapeutic response to definitive chemoradiotherapy, as well as prediction of recurrence and death in patients with esophageal cancer. METHODS: Before and after recieving definitive chemoradiotherapy, 181 patients with esophageal cancer underwent fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT). PERCIST, reduction rates of tumor uptake and volume of whole lesions, tumor node metastasis (TNM) staging regarding progression-free survival (PFS), and overall survival (OS) were analyzed using log-rank and Cox methods. RESULTS: Complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD) shown by PERCIST were seen in 42 (23.2%), 113 (62.4%), 14 (7.7%), and 12 (6.6%) patients, respectively. Progression developed in 137 (75.7%) patients and 101 (56.1%) patients died (median follow-up 16.9, range 3.2-124.9 months). Those who achieved CMR showed significantly longer PFS and OS as compared with patients who did not (PMR, SMD, and PMD) (both P < 0.0001). In univariate analysis, initial clinical T status (P = 0.0048), N status (P = 0.011), and TNM stage (P = 0.0006), PERCIST (P < 0.0001), and reduction rate of peak lean body mass standardized uptake value (P < 0.0001), of metabolic tumor volume (P < 0.0001), and of total lesion glycolysis (TLG) (P < 0.0001) were associated with significantly increased OS. Multivariate analysis confirmed PERCIST [hazard ratio (HR): 13.15, 95% confidence interval (CI), 4.54-55.8; P < 0.0001], and TLG reduction rate (HR: 2.21, 95% CI, 1.04-4.68; P = 0.040) as independent OS predictors. CONCLUSION: PERCIST is useful for evaluating therapeutic response to definitive chemoradiotherapy, and predicting progression and death in patients with esophageal cancer.

Evaluation of Treatment Response in Prostate Cancer and Renal Cell Carcinoma Patients Using 11C-choline PET/CT Findings.

We investigated the effectiveness of 11C-choline-positron emission tomography/computed tomography (PET/CT) for evaluating treatment response in patients with prostate cancer or renal cell carcinoma. We performed 34 11C-choline PET/CT scans before/after a combined total of 17 courses of treatment in 6 patients with prostate cancer and 2 with renal cell carcinoma. The 17 treatments including hormonal therapy, radiotherapy, chemotherapy, radium-223, molecular target therapy, radiofrequency ablation, transcatheter arterial embolization, and cancer immunotherapy yielded 1 (5.9%) complete metabolic response (CMR), 3 (17.6%) partial metabolic responses (PMRs), 2 (11.8%) stable metabolic diseases (SMDs), and 11 (64.7%) progressive metabolic diseases (PMDs). Target lesions were observed in bone (n=14), lymph nodes (n=5), lung (n=2), prostate (n=2), and pleura (n=1), with CMR in 4, PMR in 10, SMD in 8 and PMD in 2 lesions. SUVmax values of the target lesions before and after treatment were 7.87±2.67 and 5.29±3.98, respectively, for a mean reduction of -35.4±43.6%. The response for the 8 prostate cancer-treatment courses was PMD, which correlated well with changes in serum prostatic specific antigen (PSA) (7 of 8 cases showed increased PSA). 11C-choline-PET/CT may be an effective tool for detecting viable residual tumors and evaluating treatment response in prostate cancer and renal cell carcinoma patients.

The value of CT findings for prognostic prediction of spontaneous superior mesenteric artery dissection.

BACKGROUND: Spontaneous superior mesenteric artery (SMA) dissection is rare cause of acute abdomen. Time-dependent change of SMA dissection has not been established. PURPOSE: To determine Sakamoto classification (SC) type of acute and chronic SMA dissection (aSMAD and cSMAD) to predict the treatment methods and outcome. MATERIAL AND METHODS: From April 2003 to March 2017, unenhanced and contrast-enhanced CT were used to diagnose acute symptomatic or chronic asymptomatic SMA dissection in 25 consecutive patients without aortic dissection. Correlations between SCs and treatment methods and outcomes were investigated. RESULTS: All 13 patients with aSMAD initially received conservative treatment. Initial SCs in aSMAD were type I = 1, type III = 9, and type IV = 3. Three of nine initial type III and two of three initial type IV changed to type I at follow-up. One of nine type III changed to type II at follow-up. Ohers did not change. One with initial type III required vascular repair, so the final SC was not available. Three patients required bowel resection. In cSMAD of 12 patients, the initial/final SC were type I and IV in ten and two patients, respectively, without change during follow-up. cSMAD was significantly older than aSMAD. The initial length of dissection of aSMAD was longer than in the cSMAD group. In aSMAD, the final length of dissection was significantly shorter than in the initial computed tomography scan. CONCLUSION: Initial SC differed significantly between aSMAD and cSMAD. Initial SC types in aSMAD were type III and IV mainly, and changed during the observation period. In cSMAD, SC types were I and IV without change.

Comparison of 11C-choline Positron Emission Tomography/Computed Tomography (PET/CT) and Conventional Imaging for Detection of Recurrent Prostate Cancer.

We aimed to compare 11C-choline positron emission tomography/computed tomography (PET/CT) with conventional imaging, including pelvic magnetic resonance imaging (MRI), contrast-enhanced chest, abdomen, and pelvic computed tomography (CT), and bone scintigraphy, for prostate cancer restaging. Thirty patients (median prostate-specific antigen [PSA: 11.8 ng/mL]) with suspected recurrent prostate cancer following definitive treatment underwent 11C-choline PET/CT and conventional imaging, including pelvic MRI, contrast-enhanced chest, abdomen, and pelvic CT, and bone scintigraphy. The results were compared with regard to patient- and lesion-based diagnostic performance for local recurrence, and for lymph node and bony metastases using receiver operating characteristic (ROC) analysis and McNemar's test. Documented local recurrence and node and bony metastases were present in 11 (36.7%), 10 (33.3%), and 17 (56.7%) cases, respectively, of the enrolled patients. Patient-based sensitivity / specificity / accuracy / area under the ROC curve for 11C-choline-PET/CT for diagnosing local recurrence were 90.9% / 94.7% / 93.3% / 0.975 and for conventional imaging were 90.9% / 100% / 96.7% / 1.0. Those who underwent 11C-choline-PET/CT for node metastasis were 90.0% / 95.0% / 93.3% / 0.925 and for conventional imaging were 70.0% / 95.0% / 86.7% / 0.905. Those who underwent 11C-choline-PET/CT for bone metastasis were 94.1% / 92.3% / 93.3% / 0.991 and who underwent conventional imaging were 94.1% / 84.6% / 90.0% / 0.982. No significant differences were observed among them. The lesion-based detection rate of 11C-choline PET/CT for local recurrences and node and bone metastases as compared to conventional imaging was 92.9% (13/14) vs. 92.9% (13/14); 87.1% (27/31) vs. 54.8% (17/31); and 96.9% (219/226) vs. 90.3% (204/226) respectively, with significant differences noted for detection of node and bone lesions (p=0.0044 and p=0.00030, respectively). 11C-choline-PET/CT is more accurate in the detection of recurrent prostate cancer nodes and bony metastatic lesions compared to conventional imaging and has the advantage of restaging the disease in a single step.

Concurrent Chemoradiotherapy with Docetaxel, Cisplatin, and 5-fluorouracil Improves Survival of Patients with Advanced Esophageal Cancer Compared with Conventional Concurrent Chemoradiotherapy with Cisplatin and 5-fluorouracil.

Purpose: To compare treatment outcomes and adverse events between concurrent chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) and conventional concurrent chemoradiotherapy with cisplatin and 5-fluorouracil (CF-RT). Methods and Materials: We retrospectively investigated treatment outcomes and adverse events in 121 patients with advanced esophageal cancer who underwent concurrent chemoradiotherapy with CF-RT (n = 83) or DCF-RT (n = 38). In the CF-RT group, patients were administered cisplatin (70 mg/m2) and 5-fluorouracil (700 mg/m2) for 5 days; in the DCF-RT group, patients were administered docetaxel (50 mg/m2), cisplatin (50 mg/m2), and 5-fluorouracil (500 mg/m2) for 5 days. The radiotherapy dose was 1.8-2 Gy per session, up to a total of 50-60 Gy. Results: The complete response (CR) rate was 37.8% in the CF-RT group and 52.6% in the DCF-RT group. Overall survival (OS) rates at 2 and 3 years were 45.0% and 37.5%, respectively, in the CF-RT group and 62.9% and 56.7%, respectively, in the DCF-RT group, with a significant intergroup difference (p = 0.032). Progression-free survival rates at 2 and 3 years were 44.1% and 36.9%, respectively, in the CF-RT group and 45.0% and 45.0%, respectively, in the DCF-RT group (p = 0.10). Local control rates at 2 and 3 years were 59.1% and 54.6%, respectively, in the CF-RT group and 71.8% and 71.8%, respectively, in the DCF-RT group (p = 0.12). The incidence of Grade 3/4 leukopenia was 55.4% (n = 46) in the CF-RT group and 78.9% (n = 30) in the DCF-RT group, with a significant intergroup difference (p = 0.022). The incidence of Grade 3/4 neutropenia was 47.0% (n = 39) in the CF-RT group and 65.8% (n = 25) in the DCF-RT group, with a notable albeit not statistically significant difference between the groups (p = 0.054). There were no significant intergroup differences in anemia, thrombocytopenia, radiation-induced dermatitis, radiation esophagitis, or late adverse events. Conclusions: Rates of OS and CR were improved after treatment with DCF-RT compared with CF-RT. Although DCF-RT-treated patients had higher rates of leukopenia, treatment safety was ensured through proper management of myelotoxicity. DCF-RT is a promising treatment regimen for advanced esophageal cancer.

Hemosuccus pancreaticus successful treatment by double balloon-assisted coil embolization for active bleeding from the main trunk of the superior mesenteric artery.

We report a case of a 63-year-old man with hemosuccus pancreaticus due to large pseudoaneurysm originating from the main trunk of the superior mesenteric artery (SMA). The patient was treated successfully with the double balloon-assisted coil embolization technique combined with proximal and distal balloon inflation in the short segment of the SMA. This technique preserved the pancreaticoduodenal arterial arcade and the supply to the distal part of the SMA by embolizing SMA in a short segment.

Assessment of tumor response to chemoradiotherapy and predicting prognosis in patients with head and neck squamous cell carcinoma by PERCIST.

PURPOSE: To evaluate therapeutic response to chemoradiotherapy and prediction of recurrence and death in patients with head and neck squamous cell carcinoma (HNSCC) using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST). MATERIALS AND METHODS: Forty-two patients (mean 63.4, range 20-79 years) with nasopharyngeal (n = 10), oropharyngeal (n = 13), hypopharyngeal (n = 11), or laryngeal (n = 8) cancer underwent fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) before and approximately 3 months (mean 95.0, range 70-119 days) after undergoing concurrent chemoradiotherapy. The effect of PERCIST regarding progression-free survival (PFS) and overall survival (OS) was examined using log-rank and Cox methods. RESULTS: Complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease shown by PERCIST were seen in 30 (71.4%), 9 (21.4%), 3 (7.1%), and 0 patients, respectively. Fourteen (33.3%) developed recurrent disease (median follow-up 27.2, range 8.7-123.1 months) and 9 (21.4%) died (median follow-up 43.6, range 9.6-132.6 months). Furthermore, 4 (13.3%) of 30 patients with CMR developed recurrence, while 7 (77.8%) of 9 with PMR and all 3 (100%) with SMD developed recurrence. Two (6.7%) of 30 patients with CMR, 4 (44.4%) of 9 with PMR, and all 3 (100%) with SMD died. Patients who achieved CMR showed significantly longer PFS and OS as compared to those who did not (PMR and SMD) (both, p < 0.0001). CONCLUSION: PERCIST is useful for evaluating therapeutic response to chemoradiotherapy and predicting recurrence and death in HNSCC patients.

Nonfatal air embolism complicating percutaneous CT-guided lung biopsy and VATS marking: Four cases from a single institution.

Systemic air emboli occur as a rare complication of percutaneous needle biopsy of the lung and video-assisted thoracoscopic surgery (VATS) marking. Here we present four cases of systemic air emboli from single institution and the imaging findings and embolism' kinetics using contrast-enhanced media during VATS color marking with indocyanine green. We suggest that early detection using routine whole-lung CT is required for asymptomatic patients with abnormal air. If abnormal air is found, we should keep the patient to the appropriate posture in order to prevent moving the air until it dissipates. Early detection of abnormal air can prevent severe complications.

Present and future roles of FDG-PET/CT imaging in the management of gastrointestinal cancer: an update.

Positron emission tomography/computed tomography (PET/CT) integrated with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) is a useful tool for acquisition of both glucose metabolism and anatomic imaging data, as only a single device and one diagnostic session is required, thus opening a new field in clinical oncologic imaging. FDG-PET/CT has been successfully used for initial staging, restaging, assessment of early treatment response, evaluation of metastatic disease response, and prognostication of intestinal cancer as well as various malignant tumors. We reviewed the current status and role of FDG-PET/CT for management of patients with esophageal cancer, gastric cancer, and colorectal cancer, with focus on both its usefulness and limitations.

The value of adding diffusion-weighted images for tumor detection and preoperative staging in renal pelvic carcinoma for the reader's experience.

PURPOSE: This retrospective study aimed to assess the value of adding diffusion-weighted magnetic resonance imaging (DWI) or gadolinium-enhanced fat-suppressed T1WI (CEI) to T2-weighted imaging (T2WI) for preoperative T categorization in renal pelvic carcinoma by the reader's experience using surgical specimens as the reference standard. METHODS: Two radiologists (Reader 1; 3 years, 2; 13 years) reviewed 49 cases with urothelial carcinoma who underwent magnetic resonance imaging examination before surgery, independently, using three image sets: T2WI alone, T2WI plus DWI, and T2WI plus CEI for tumor detection and T categorization. The differences in the apparent diffusion coefficient values between tumors and renal parenchyma, histopathologic grade were analyzed. RESULTS: T2WI plus CEI or DWI had high detection rates (93.4%) compared to T2WI alone. When discriminating T3a/T3b, for Reader 1, the use of T2WI plus DWI (88.0%) and T2WI plus CEI (92.0%) was significantly more accurate than T2WI alone (73%), with AUCs of 0.86, 0.86 and 0.77, respectively. For Reader 2, the accuracies were high on all image sets, with AUCs of 0.87-0.95, and the mean ADC of the tumors was significantly lower than that of the normal renal parenchyma. In addition, the mean ADC values of high-grade tumors were significantly lower than that of low-grade tumors. CONCLUSIONS: DWI and CEI could be more helpful than T2WI alone for preoperative T categorization by less-experienced reader and DWI could be used for preoperative T categorization and for predicting the histopathologic grade of renal pelvic carcinoma.