123I-IMP SPET in the diagnosis of primary central nervous system lymphoma.

We reviewed N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) single-photon emission tomography (SPET) images of brain tumours and assessed the usefulness of 123I-IMP SPET for the diagnosis of primary central nervous system (CNS) lymphoma. We analysed 52 tumours that showed enhancement on magnetic resonance imaging: 11 malignant lymphomas, 3 anaplastic astrocytomas, 17 glioblastomas, 12 meningiomas, 4 metastatic brain tumours and 5 other brain tumours. 123I-IMP uptake in the tumours on early (15-min) and delayed (4-h) scans was visually classified as high, moderate or low as compared with the contralateral brain cortex. Early and delayed 123I-IMP uptake ratios comparing tumours with contralateral brain cortex (T/N ratio) were also calculated. In malignant lymphomas, the visual uptake of 123I-IMP was moderate to high on the delayed scans. The delayed T/N ratios were significantly higher than the early ratios (P<0.05) and all lymphomas, with the exception of one small one, had delayed ratios greater than 0.9. In non-lymphomatous tumours, the visual uptake of 123I-IMP was low on the delayed scans. The delayed T/N ratios were significantly lower than the early ratios (P<0.01) and all non-lymphomatous tumours had delayed ratios of less than 0.8. The T/N ratios of lymphomas were significantly higher than those of non-lymphomatous tumours on both early and delayed scans (P<0.0001). These results suggest that 123I-IMP SPET may be a useful tool in the differential diagnosis of primary CNS lymphoma.

Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results.

PURPOSE: To clarify the immediate effect and long-term results of bronchial artery embolization (BAE) for hemoptysis due to benign diseases and the factors influencing the outcomes. METHODS: One hundred and one patients (aged 34-89 years) received bronchial artery embolization with polyvinyl alcohol particles and gelatin sponge for massive or continuing moderate hemoptysis caused by benign pulmonary diseases and resistant to medical treatment. RESULTS: After BAE, bleeding stopped in 94 patients (94%). The immediate effect was unfavorable in cases where feeder vessels were overlooked or the embolization of the intercostal arteries was insufficient. Long-term cumulative hemoptysis nonrecurrence rates after the initial embolization were 77.7% for 1 year and 62.5% for 5 years. In bronchitis (n = 9) and active tuberculosis (n = 4) groups, an excellent (100%) 5-year cumulative nonrecurrence rate was obtained. The rate was lower in groups with pneumonia/abscess/pyothorax (n = 8) or with pulmonary aspergillosis (n = 9) (53.3%, 1-year cumulative nonrecurrence). There were higher incidences of early recurrence among patients with massive hemorrhage or more marked vascularity and systemic artery-pulmonary artery shunt in angiography: however, these trends were not statistically significant CONCLUSIONS: BAE can yield long-term benefit in patients with hemoptysis due to benign diseases. Technical problems in the procedure had an impact on the short-term effect. The degree of hemorrhage or the severity of angiographical findings were not significant factors affecting the outcome. The most significant factor affecting long-term results was whether the inflammation caused by the underlying disease was medically well controlled.

Computed radiography angiography using storage phosphor imaging plates: eight year's experience.

We reviewed the indications, modalities, and quality of angiographic examinations performed in our department from 1987 to 1994 and compared the image characteristics and technical convenience of three modalities: conventional film-screen angiography, fluorographic digital subtraction angiography (F-DSA), and computed radiography angiography using biplane rapid changers of storage phosphor imaging plates (IP-CRA). IP-CRA has practically eclipsed conventional film-screen angiography in our radiology department. Sixty-percent of the total 700 examinations carried out in 1994 were performed using a combination of IP-CRA and fluorographic digital subtraction angiography (F-DSA). The remainder were performed with F-DSA alone. The post-processing functions of IP-CRA like subtraction and change of contrast or density were useful especially in such regions as pulmonary, bronchial, or external carotid arterial territories, where high natural contrast made image processing difficult with both F-DSA and film-screen angiography. The spatial resolution of IP-CRA was superior to that of F-DSA and comparable to the film-screen method. It was concluded that angiography using imaging plates was a useful part of the digital radiography system.

Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer.

The purpose of this study was to elucidate the roles of endoscopic ultrasonography (EUS), conventional US, CT, and MRI in differential diagnosis of gallbladder wall thickening. We scrutinized images for the presence of the multiple-layer patterns of the thickened gallbladder walls during preoperative images (EUS, n = 22; US, n = 23; CT, n = 20; MRI, n = 15) and retrospectively correlated them with surgical results in 25 patients. The pathological diagnoses included 7 gallbladder cancers, 9 cases of chronic cholecystitis, 5 cases of xanthogranulomatous cholecystitis, and 4 cases of adenomyomatosis. Multiple-layer patterns of gallbladder wall were observed in patients with inflammatory and benign diseases by US, EUS, CT, and MRI. This pattern was demonstrated by EUS more efficiently compared with other means of imaging. All subjects with loss of multiple layers were finally diagnosed by use of EUS as having gallbladder cancer at surgery. Loss of multiple-layer patterns of the gallbladder wall demonstrated by EUS was the most specific finding in diagnosing gallbladder cancer.

[A case of Takayasu arteritis diagnosed by magnetic resonance imaging].

We report a case of Takayasu arteritis. A woman, 24 years old, was admitted because of fever of unknown etiology. Infection was ruled out. Bruit and asymmetrical pulsation were not found. Ga-scintigram showed abnormal uptake in her upper abdomen. Abdominal echogram revealed neither evidence of abscess nor lymphadenopathy. On abdominal computed tomography, a wall thickening of the abdominal aorta was revealed. In addition, abdominal magnetic resonance imaging(MRI) showed a wall thickening and an enhanced image by gadrinium enhancement. Although we could not carry out conventional aortography because of an allergy to lidocaine, she was diagnosed as having Takayasu arteritis. In response to steroid therapy, the fever promptly dropped and the data indicating inflammation were improved. On the MRI examination after 40 days of steroid therapy, the wall thickening of the abdominal aorta was found to be less prominent. We conclude magnetic resonance imaging is useful for diagnosis and follow-up of early and acute stage of Takayasu arteritis.

[Diagnostic value of high N-isopropyl-p-[123I] iodoamphetamine (IMP) uptake in brain tumors].

The diagnostic value of high N-isopropyl-p-[123I] iodoamphetamine (123I-IMP) uptake in histologically proven intracranial tumors was evaluated in 54 patients with both early (15-35 min after injection) and delayed (4 hours) SPECT before treatment. Higher uptake in the tumor compared with normal cerebral cortex was observed in early scans in all of the five patients with primary intracranial malignant lymphoma, in two of 16 meningiomas, two of seven astrocytomas, one of three pituitary adenomas, and one central neurocytoma. Among these 11 cases all the malignant lymphomas showed persistent high uptake in delayed scans, whereas other tumors showed decreased uptake in delayed scans. This persistent high 123I-IMP uptake was characteristic of primary intracranial malignant lymphomas and was useful in the diagnosis of intracranial malignant lymphoma.

[MR imaging of colonic cancer with retrograde administration of contrast material containing ferric ammonium citrate].

MR imaging was performed with the retrograde administration of ferro-magnetic contrast material and air in 10 patients with rectosigmoid colon cancer. The border of the lesions was well demonstrated in spin echo images, and MR imaging yielded additional diagnostic information to that provided by barium enemas and CT scans in all cases. In conclusion, this type of contrast material seemed promising in the MRI diagnosis of rectal lesions.

Characterization of an established transplantable adenocarcinoma of the gallbladder in Syrian golden hamster.

A carcinoma of the gallbladder was transplantable in Syrian golden hamsters. The tumor was induced by subcutaneous injection of N-nitrosobis (2-oxopropyl) amine (BOP) following dissection of the common duct and preparation of a cholecysto-duodenostomy. The histology revealed a poorly differentiated adenocarcinoma. The tumor was inoculated into the cavity of the gallbladder and subcutaneous tissue of the hamster and was transplantable (uptake rate was 100%). This tumor expressed blood group-related antigens, including A, H, and P-glycoproteins. To our knowledge, this is the first report of carcinoma of the gallbladder transplantable in a laboratory animal.

Induction of extrahepatic biliary carcinoma by N-nitrosobis(2-oxopropyl)amine in hamsters given cholecystoduodenostomy with dissection of the common duct.

The methods we used to produce a carcinoma in the extrahepatic bile duct and gallbladder in hamsters are described along with the characteristics of the induced tumors. Female Syrian golden hamsters were first subjected to cholecystoduodenostomy with dissection of the extrahepatic bile duct on the distal end of the common duct (CDDB) and were, 4 weeks later, treated with weekly subcutaneous injections of N-nitrosobis(2-oxopropyl)amine (BOP) at a dose of 10 mg/kg body weight for 9 weeks. The animals were killed at the 12th, 16th and 20th week after the initiation of BOP treatment. Extrahepatic bile duct carcinoma developed in 16%, 24% and 41% and gallbladder carcinoma occurred in 58%, 81% and 82% of the hamsters, respectively, at the corresponding times of killing. The incidences were significantly higher than those in sham-operated controls (P < 0.01). The induced extrahepatic bile duct carcinomas were predominantly of the polypoid type and gallbladder carcinomas were of the papillary type in growth form, being morphologically similar to early stage biliary carcinoma in humans. Immunohistochemical staining using bromodeoxyuridine and anti-bromodeoxyuridine monoclonal antibody demonstrated that the CDDB procedure greatly accelerated the cell kinetic activity of the biliary epithelium, and this was considered to be a major factor promoting the development of biliary carcinomas in this hamster model. In conclusion, this new model provides a high incidence of tumor development at the extrahepatic biliary tract and is expected to be useful for clarifying the characteristics of this highly malignant tumor.

Establishment of a transplantable carcinoma arising from the intrahepatic bile duct in Syrian golden hamsters.

A subcutaneously transplantable cancer line from the intrahepatic bile duct (IHBD) induced by N-nitrosobis(2-oxopropyl) amine was established in Syrian golden hamsters. The doubling time of this tumour was 2.6 days when 2 x 10(5) tumour cells were inoculated subcutaneously (take-up rate was 100%). Growth of the tumour was significantly faster in male hamsters but neither oestrogen nor androgen receptors were detected in the tumour. The primary and all allograft tumours were tubular adenocarcinomas with fibrosis and a scirrhous pattern resembling human IHBD carcinoma of the peripheral type. Transmission electron microscopic findings showed irregular glands covered with numerous microvilli. Blood-group-related antigens including A, B and H were positive. P-Glycoprotein, which is an indicator of multidrug resistance, was also positive. Carcinoembryonic antigen and CA19-9 as general tumour markers of the biliary tract were negative. The deoxyribonucleic acid (DNA) pattern of this transplantable carcinoma was diploid. This newly established animal model of a transplantable IHBD carcinoma can be used to examine the mechanisms of synthesis and secretion of tumour-associated antigens and to study potential therapeutic agents.

[Undifferentiated carcinoma of the ileum--a case report].

A 64-year-old man was admitted to Nagasaki Citizens' Hospital complaining of an abdominal tumor. Histological diagnosis was undifferentiated carcinoma of the terminal ileum. Multiple metastases of the bones were found after operation, and the patient died approximately 8 months after onset. In this paper, we describe the histological findings of undifferentiated carcinoma with a review of the literature.