Extreme leanness, lower skeletal muscle quality, and loss of muscle mass during treatment are predictors of poor prognosis in cervical cancer treated with concurrent chemoradiation therapy.

BACKGROUND: Human papillomavirus vaccination is not widespread in Japan, and the low screening rates result in many cases of locally advanced cervical cancer. We investigated the prognostic significance of sarcopenia in patients with cervical cancer to guide healthcare policies to improve treatment outcomes. METHODS: This retrospective study included 83 patients with cervical cancer without distant metastasis who underwent primary concurrent chemoradiotherapy between 2013 and 2018. We analyzed the indicators of physical condition and muscle quantity using the SYNAPSE VINCENT software. Muscle mass and the relationship between treatment toxicity and prognosis were evaluated. RESULTS: The patients' median age was 60 (range 33‒80) years. Cancer stage distribution was as follows: cT2b or higher, 84.3%; N1, 65.1%; and MA, 27.7%. The overall sarcopenia (skeletal muscle index [SMI] < 38.5) rate was 30.1%, and the rate was 33.9 and 22.2% in patients aged < 64 and ≥ 65 years, respectively. No correlation was observed between clinical stage and musculoskeletal indices. Treatment resulted in decreased body weight and SMI; after treatment, the sarcopenia rate increased to 37.3%. A higher intramuscular adipose tissue content (IMAC) reduced the number of chemotherapy cycles needed. Treatment-associated SMI decreases of ≥ 7% indicated poor prognosis, with significant differences in progression-free survival and overall survival (p = 0.013 and p = 0.012, respectively). Patients who were very lean (body mass index < 18.5 kg/m2) before treatment had a poor prognosis (p = 0.016 and p < 0.001). CONCLUSIONS: Our findings emphasize the importance of assessing original nutritional status and maintaining muscle mass and quality during the treatment of patients with cervical cancer.

Can computed tomography differentiate adenocarcinoma in situ from minimally invasive adenocarcinoma?

BACKGROUND: Given the subtle pathological signs of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA), effective differentiation between the two entities is crucial. However, it is difficult to predict these conditions using preoperative computed tomography (CT) imaging. In this study, we investigated whether histological diagnosis of AIS and MIA using quantitative three-dimensional CT imaging analysis could be predicted. METHODS: We retrospectively analyzed the images and histopathological findings of patients with lung cancer who were diagnosed with AIS or MIA between January 2017 and June 2018. We used Synapse Vincent (v. 4.3) (Fujifilm) software to analyze the CT attenuation values and performed a histogram analysis. RESULTS: There were 22 patients with AIS and 22 with MIA. The ground-glass nodule (GGN) rate was significantly higher in patients with AIS (p < 0.001), whereas the solid volume (p < 0.001) and solid rate (p = 0.001) were significantly higher in those with MIA. The mean (p = 0.002) and maximum (p = 0.025) CT values were significantly higher in patients with MIA. The 25th, 50th, 75th, and 97.5th percentiles (all p < 0.05) for the CT values were significantly higher in patients with MIA. CONCLUSIONS: We demonstrated that quantitative analysis of 3D-CT imaging data using software can help distinguish AIS from MIA. These analyses are useful for guiding decision-making in the surgical management of early lung cancer, as well as subsequent follow-up.

Evaluation of extended thymectomy approaches based on residual fat tissue.

OBJECTIVES: This study analysed the patterns of extraction ranges, characteristics, advantages and disadvantages of median sternotomy (MS) and subxiphoid (SX) approaches for extended thymectomy. METHODS: This study included patients with anterior mediastinum tumour and myasthenia gravis who underwent extended thymectomy at our institution between 2015 and 2018. There were 5 MS and 6 SX extended thymectomy surgeries with the VINCENT software. On preoperative computed tomography, the thymus area and fat tissue surrounding the thymus, which were planned for extraction, were traced using VINCENT (Ver. 4.0). We then constructed three-dimensional images and calculated the volumes. Evaluation of the extended thymectomy approach based on the residual fat tissue was required to determine the area of extended thymectomy. RESULTS: No significant differences in operation time (min) [SX: 197.3 ± 34.0, MS: 206.6 ± 91.4, drainage duration (days), SX: 2.2 ± 1.0, MS: 2.2 ± 0.4, hospital stay (days), SX: 11.8 ± 1.2, MS: 13.4 ± 2.1, residual rate (%), SX: 29.9 ± 17.5, MS: 58.7 ± 18.0 (P = 0.0519)] were observed between the 2 groups. Bleeding was significantly lower for SX than for MS. The residual rate was lower for SX than for MS. CONCLUSIONS: Considering the amount of the residual fat tissue, the SX approach allows an adequate dissection area for extended thymectomy compared with the MS approach.

[Investigation of the columnar carbon-scatterer length for X-ray spectral measurement on 320-slice computed tomography].

A short length scatterer is adopted to measure the X-ray spectrum of computed tomography (CT) equipment with a wide irradiation field in the body axis direction. The purpose of this study is to compare X-ray spectra measured using different length scatterers and determine the most appropriate length for the scatterer. 320-slice CT equipment (Aquilion ONE) was used in this study. Circular carbonrods (3 cm diameter) with five different lengths (1-16 cm) were used as scatterers. The effect of the beam hardening phenomenon from different length carbon rods was evaluated according to the effective energy. The measurement accuracy for photon information was also evaluated based on the photon count corresponding to the characteristic X-ray. As a result, the beam hardening effect was scarcely observed when the 1 cm long scatterer was used, and the number of the photons measured for the characteristic X-ray was the most. Therefore, it was concluded that the 1 cm long circular carbon rod scatterer was the most suitable.

[Development of a batched image delete system for multi-vender picture archiving and communication system environment].

A picture archiving and communication system (PACS) for multi-vendor imaging servers is useful, since it can provide a variety of image-processing services. However, to delete an image file in the PACS, it is necessary to delete not only the image but all its associated images that are stored in multiple servers: this is a lengthy and painstaking process. To reduce this workload, we have developed a system consisting of a computer program with a graphical user interface that can delete the target image and all related images by means of batch processing. The developed system creates an extensible markup language (XML)-format file that describes the operation for deleting an image and forwards the XML file to the main server. Using a Windows file-sharing system (SMB/CIFS), each server shares the XML file and deletes the images in its own database in response to the instructions described in the XML file. We can also rigorously manage information concerning the deleted images using the information that is output from the main server to external storage. We also discuss the degree of load reduction in our system compared with that of ordinary systems.

Accuracy of intraoral radiography, multidetector helical CT, and limited cone-beam CT for the detection of horizontal tooth root fracture.

OBJECTIVE: The accuracies of intraoral radiography (IOR), multidetector helical computerized tomography (MDHCT) at slice thicknesses 0.63 mm and 1.25 mm, and limited cone-beam computerized tomography (LCBCT) were compared for detection of horizontal tooth root fracture. STUDY DESIGN: In 7 beagle dogs, 28 maxillary anterior teeth were used, of which 13 had artificially induced horizontal root fracture. The specimens were examined by the above-mentioned 4 modalities. Diagnosis of root fracture was based on direct visualization of radiolucent line in each image by 6 radiologists. RESULTS: Sensitivity, negative predictive value, and diagnostic accuracy (true positives + true negatives) for detecting fracture lines in LCBCT (0.96 +/- 0.04, 0.97 +/- 0.03, 0.93 +/- 0.04, respectively) were significantly higher than MDHCT at 0.63 mm (0.76 +/- 0.09, 0.8 +/- 0.05, 0.8 +/- 0.05, respectively), MDHCT at 1.25 mm (0.49 +/- 0.09, 0.66 +/- 0.04, 0.69 +/- 0.05, respectively), and IOR (0.51 +/- 0.18, 0.67 +/- 0.08, 0.69 +/- 0.08, respectively). Specificity and positive predictive value showed no significant intermethod difference among the 4 modalities. CONCLUSION: Limited cone-beam CT is more useful than the other 3 radiographic modalities for diagnostic imaging of horizontal tooth root fracture.

Comparison of occlusal condition and prevalence of bone change in the condyle of patients with and without temporomandibular disorders.

OBJECTIVE: The purpose of this study was to compare the differences in dental and occlusal conditions, and prevalence of bone change in the condyle, between a group of patients with temporomandibular disorders (TMD) and a group of dental patients without such complaints. STUDY DESIGN: A group of 504 patients with temporomandibular disorders (TMD patients) and a group of 970 patients without such complaints (dental patients), all 25 years of age or older, were compared using the criteria of age, sex, dental and occlusal condition, and prevalence of bone change in the condyle based on panoramic radiographs and imaging request forms. RESULTS: In both groups, the rate of complete dental arch was high for both jaws. According to Eichner's index, the rate for group A among the dental patients was 59.6%, whereas it was 84.7% in the TMD patients (P < .01). The prevalence of bone change in the condyle was 17.7% for the TMD patients and 11.6% for the dental patients (P < .01). Eichner's group C was somewhat high for the dental patients, and group A was high for the TMD patients. However, there were no significant differences in the occlusal conditions based on the prevalence of bone change. Deformity was the most common abnormality of bone change for both the dental and the TMD patients. In the TMD patients, the rate of osteophytes was the second most common abnormal finding. Osteophytes were the highest among the average age for all abnormal bone changes in the condyle. With the TMD patients, all the changes were more commonly found in Eichner's group A. CONCLUSIONS: It was demonstrated that the symptoms of TMD correlated with age, sex, and dental and occlusal conditions. However, the prevalence of bone change in the condyle correlated poorly with age, sex, and dental and occlusal condition with and without TMD.