Flare phenomenon visualized by 99mTc-bone scintigraphy has prognostic value for patients with metastatic castration-resistant prostate cancer.

OBJECTIVE: This study aimed to determine the prognostic value of the flare phenomenon in patients with metastatic castration-resistant prostate cancer (mCRPC) using the bone scan index (BSI) derived from 99mTc-methylenediphosphonate (MDP) bone scintigraphy images. METHODS: We categorized 72 patients from the PROSTAT-BSI registry with mCRPC who were followed-up for 2 years after starting docetaxel chemotherapy to groups based on pre-chemotherapy BSI values of < 1, 1-4, and > 4. We assessed the effects of the flare phenomenon (defined as a > 10% increase in the BSI within 3 months of starting chemotherapy, followed by > 10% improvement within the next 3 months) on survival using Kaplan-Meier curves and Cox proportional hazard analyses. RESULTS: The flare phenomenon was found in 26 (36%) of the 72 patients. Prostate-specific antigen (PSA), alkaline phosphatase (ALP), and hemoglobin (Hb) levels steadily increased, then deteriorated in patients with and without flare, respectively. Elevated BSI and PSA values at 3 months after starting therapy and the absence of abiraterone or/and enzalutamide therapy led to poor 2-year overall survival (OS) in the group without flare. In contrast, no influence was noticeable in the group with flare. The results of multivariable analyses that included only factors associated with PSA and BSI showed that increased baseline BSI (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.04-1.86; P = 0.023) and PSA (HR, 7.15; 95% CI 2.13-24.04; P = 0.0015) values could be independent risk factors for patients with mCRPC without flare. However, these factors lost significance during flare. The risk for all-cause death was significantly higher among patients with BSI > 4 without, than with flare. The results of univariable analyses indicated that flare positively impacted survival (HR, 0.24; 95% CI 0.06‒0.91; P = 0.035). Multivariable analysis did not identify any factors that could predict outcomes. CONCLUSION: Favorable prognosis, with fewer disturbances from other factors such as the use of abiraterone or/and enzalutamide, PSA changes, and BSI, was attainable in cases when the mCRPC patient demonstrated flare phenomenon. Follow-up bone scintigraphy at least every 3 months could help to determine the prognosis of patients with bone metastasis of mCRPC.

Predictive factors for the effectiveness of novel androgen receptor axis-targeted agents in patients with metastatic prostate cancer.

OBJECTIVE: Novel androgen receptor axis-targeted agents (ARATAs) have been developed for mCRPC and improved overall survival (OS). Here, we aimed to find predictors who will receive the greatest benefits from ARATAs. METHODS: We previously performed a multicenter study to identify prognostic factors for metastatic hormone-sensitive prostate cancer (mHSPC, n = 148) and mCRPC (n = 99), and showed that the bone scan index (BSI) was one of the significant prognostic factors for 3-year OS (PROSTAT-BSI study). mHSPC progressed to mCRPC (n = 101), for which 69 patients were treated with (n = 39) or without ARATAs (n = 30, prior to the approval of ARATAs). The 69 patients were divided into two groups according to patient factors, and these cohorts were further divided into two subgroups by usage of ARATAs. OS was compared between subgroups in each group. RESULTS: The predictors were age (<71.4 years), serum levels of C-reactive protein (≥0.16 ng/ml) and alkaline phosphatase (≥548 U/L), time to PSA progression after ADT (<8.9 months), the lowest PSA level (≥1 ng/ml) after ADT, and the rate of PSA decline 3 months after ADT (<0.987), whereas hemoglobin levels, PSA before ADT, Gleason scores, existence of visceral metastases, and BSI were not. CONCLUSIONS: The present study identified predictors for the effectiveness of ARATAs. The number of bone metastases (≒BSI), existence of visceral metastases, and Gleason scores, which were identified as high-risk factors in the LATITUDE study and disease volume in CHAARTED criteria, did not appear to be useful for predicting effectiveness from ARATAs.

Efficacy of Androgen Receptor-targeted Drugs After Prostate Cancer Recurrence With Bone Metastases: PROSTAT-BSI Sub-analysis.

BACKGROUND/AIM: This study aimed to evaluate the therapeutic benefit of novel androgen receptor-targeted agents (ARTAs) in castration-resistant prostate cancer (CRPC) with bone metastases in Japan. PATIENTS AND METHODS: In followup to our prospective observational study (PROSTAT-BSI) from 2012 to 2018 on metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic CRPC (mCRPC) before docetaxel initiation, we conducted this sub-analysis to investigate the benefit of ARTAs after clinical recurrence on overall survival (OS) in the real-world clinical setting in Japan. In this study, we compared patients who were treated with ARTA with those who received only vintage hormone therapy including docetaxel after clinical recurrence. RESULTS: In the mHSPC group, 69 patients became mCRPC and were treated with or without ARTAs. No significant difference was observed in prostate-specific antigen (PSA) progression-free survival between the ARTA (+) and ARTA (-) groups; however, OS after clinical recurrence was significantly better in the ARTA (+) group than in the ARTA (-) group (median OS 31.9 vs. 23.0 months; p<0.01). CONCLUSION: The ARTAs are beneficial even after mHSPC recurrence in Japanese patients in the real-world clinical setting. Since ARTAs are beneficial after clinical recurrence, it may be better to switch to ARTAs whenever necessary based on PSA response after combined androgen blockade therapy, considering the adverse effects and cost. This approach may be suitable to reduce overtreatment in Japanese patients with mHSPC.

Prognosis of patients with prostate cancer and bone metastasis from the Japanese Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index cohort study.

OBJECTIVE: To determine prognostic factors including the Bone Scan Index in prostate cancer patients receiving standard hormonal therapy and chemotherapy. METHODS: This multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index study involved 30 hospitals and enrolled 247 patients (age 71 ± 8 years) with metastatic hormone-sensitive prostate cancer (n = 148) under hormone therapy and metastatic castration-resistant prostate cancer (n = 99) under chemotherapy. The Bone Scan Index (%) was determined by whole-body bone scintigraphy using 99m Tc-methylenediphosphonate. Patients were classified into tertiles and binary groups, and predictors of all-cause death including Bone Scan Index, prostate-specific antigen, and bone metabolic markers were determined using survival and proportional hazard analyses. RESULTS: During a mean follow-up period of 716 ± 404 days, 81 (33%) of the patients died, and 3-year mortality rates were 20% and 52% in the metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer groups, respectively. Survival analysis showed that a Bone Scan Index >3.5% was a significant determinant of death in the metastatic hormone-sensitive prostate cancer group, whereas prostate-specific antigen >55 ng/mL before chemotherapy was a determinant of prognosis in the metastatic castration-resistant prostate cancer group. A Bone Scan Index >3.5% was also associated with a high incidence of prostate-specific antigen progression in the metastatic hormone-sensitive prostate cancer group. Patients with metastatic hormone-sensitive prostate cancer and a better Bone Scan Index response (>45%) to treatment had lower mortality rates than those without such response. CONCLUSION: The Bone Scan Index and hot spot number are significant determinants of 3-year mortality, and combining the Bone Scan Index with prostate-specific antigen should contribute to the management of prostate cancer patients with bone metastasis.

Proton magnetic resonance spectroscopy of lung cancer in vivo.

Proton magnetic resonance spectroscopy (1H-MRS) has demonstrated that in vitro, lung cancer has higher lactate and choline signals than those of normal tissues. The detection of these metabolites in lung cancer in vivo by 1H-MRS would be useful for clinical diagnoses of lung cancer. We report the in vivo detection of lactate and choline in lung cancer by 1H-MRS in a 41-year-old Asian man who was diagnosed with pT4N0M0 ⅢA stage, right upper lobe lung adenocarcinoma. A lactate-lipid peak was observed near 1.33 ppm in the spectrum of lung cancer in vivo at TE  =  30 ms, and it was inverted at TE  =  135 ms, indicating that a lactate signal is contained in the lactate-lipid peak. A choline peak was also observed near 3.2 ppm in the spectrum with fat suppression at TE  =  135 ms. An accumulation of similar cases will help determine the appropriate applications of 1H-MRS for lung cancer.

Radiation with concomitant superselective intra-arterial cisplatin infusion for maxillary sinus squamous cell carcinoma.

PURPOSE: To assess the efficacy and prognostic factors after superselective intra-arterial chemoradiation (RADPLAT) for maxillary sinus squamous cell carcinoma (MS-SCC). MATERIALS AND METHODS: Prognostic significance of age, gender, T and N factors, gross tumor volume of the primary-site (GTV), total cisplatin dosage, and total cisplatin dosage per GTV (CDDP/GTV) for primary-site recurrence-free survival rate (PRFS) were analyzed. RADPLAT was administered to 27 patients. The median follow-up period was 42.1 months. RESULTS: The 3-year rates of overall survival and PRFS were 59.2% and 53.9%, respectively. In univariate analysis, age, male, and total cisplatin dosage were significant factors for PRFS. In multivariate analysis, lymph node metastasis was significant factors for PRFS, and gender and total cisplatin dosage weakly influenced PRFS. In acute phase, no patient showed ≥ grade 3 hematologic toxicity, and grade 3 mucositis developed in 5 patients. Late toxicities were recognized in 3 patients (grade 2 phlegmon of the face, grade 3 maxillofacial osteonecrosis, and retinopathy). Twelve patients (44%) experienced recurrences. Of them, 8 patients showed recurrence at the primarysite. CONCLUSION: RADPLAT was effective for MS-SCC, with acceptable toxicity. Total cisplatin dosage is suggested to be important for primary tumor control.

[USEFULNESS OF VIVID (VISUALIZATION OF VARIOUS INTEGRATION WITH DIFFUSION) ON COGNITIVE FUSION PROSTATE BIOPSY].

(Purpose) We created an image reconstructing multiparametric MRI system called VIVID (Visualization of Various Integration with Diffusion) and examined the efficacy of VIVID in detecting prostate cancer. (Methods and materials) The subjects were 80 patients who underwent one target biopsy with reference to MRI images in addition to 8-20 biopsies. (Results) The significant cancer detection rate was 61%, the significant cancer detection rate of PI-RADS 4 or 5 was 55%, and the significant cancer detection rate of VIVID score 4 or 5 was 55%. Three cases with PI-RADS 4 at TZ lesion with positive T2WI only were evaluated as having VIVID scores 1 or 2. Cancer was not detected with target biopsy from the site. (Conclusion) Our finding suggest that VIVID correctly excludes TZ lesions with only T2WI positively in multiparametric MRI.

Role of bone scan index in the prognosis and effects of therapy on prostate cancer with bone metastasis: Study design and rationale for the multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index (PROSTAT-BSI) study.

OBJECTIVE: To present the study design and rationale of Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index, a prospective study aiming to determine the role of the bone scan index, the amount of bone metastasis, in the treatment and prognosis of prostate cancer patients. METHODS: A total of 237 patients were recruited at 30 hospitals in Japan. All had prostate cancer with bone metastasis and were scheduled to undergo either hormonal therapy (group H) or chemotherapy (group C). Bone scans were carried out with 99m Tc-methylenediphosphonate. Follow-up studies are planned to continue for 3 years, and changes in biochemical and tumor markers in response to hormonal therapy and chemotherapy will be recorded in addition to skeletal-related events, recurrence, disease progression and death. RESULTS: The basic characteristics of the patients (n = 200) at the time of registration during December 2016 were as follows: mean age 71 ± 8 years; median bone scan index calculated on-site 1.9% (range 0.02-13.3%); median number of hot spots 18 (range 1-128); median prostate-specific antigen 155 ng/mL (range 0.04-22 412 ng/mL); and the most frequent Gleason score 9 (47%). The prostate-specific antigen value was higher in group H than group C (288 vs 33 ng/mL, P < 0.0001), whereas bone scan indexes were comparable (1.7 vs 2.3%, not significant) between the two groups. Liver metastasis was more frequent in group C than group H (6.1% vs 0.8%, P = 0.035). CONCLUSIONS: The baseline characteristics of the Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index database have been established. This collaborative study can now proceed with clarifying the role of the bone scan index for patient management including treatment strategies and prognosis.

Japanese Expert Panel Meeting on the Management of Prostate Cancer with Bone Metastases.

INTRODUCTION: The incidence of prostate cancer in Japan continues to increase, necessitating the continued development of effective therapies and strategies. Recent advances in treatments have improved the prognosis of metastatic disease and highlighted the importance of treating bone metastases to reduce the incidence of skeletal complications and improve patients' quality of life. With the increasing number of treatment options that have become available, including bone-targeted therapy with the alpha emitter radium-223 dichloride (Ra-223), Japanese clinicians are faced with making difficult decisions on the choice of optimal treatment strategy. In such situations, guidance based on expert opinions can be beneficial. METHODS: A panel meeting of 27 Japanese experts in the management of prostate cancer was held to share opinions and to establish consensus recommendations on key clinical questions. Panelists were asked to vote on more than 40 questions pertinent to prostate cancer, and the answers helped guide a comprehensive discussion. RESULTS: The panel reached a consensus on key topics related to the optimal treatment strategy for Ra-223 therapy, namely, that patients with symptomatic, metastatic castration-resistant prostate cancer (CRPC) would benefit most from the use of this agent and that this treatment therapy should be provided before chemotherapy. Other topics that achieved consensus included: monitoring for osteoporosis and providing treatment if necessary during androgen deprivation therapy; performing magnetic resonance imaging in the presence of discrepancies in bone scintigram and computed tomography scans; monitoring alkaline phosphatase during CRPC treatment; using osteoclast-targeting in patients with CRPC with bone metastases; and using osteoclast-targeted agents combined with Ra-223. CONCLUSION: These consensus recommendations and the updated information which became available subsequent to the panel meeting included here provide useful information for clinicians to aid in designing optimal treatment strategies for their patients. FUNDING: Bayer Yakuhin Ltd.

Early predictive value of non-response to docetaxel in neoadjuvant chemotherapy in breast cancer using 18F-FDG-PET.

BACKGROUND: The aim of this prospective study of patients with breast cancer was to identify non-responders to docetaxel in neoadjuvant chemotherapy (NCT) using fluorine-18-fluorodeoxyglucose positron-emission tomography ((18)F-FDG-PET). PATIENTS AND METHODS: We analyzed the maximum standardized uptake value (SUVmax) of (18)F-FDG-PET before and after the first course and the reduction rate in tumor size shown by magnetic resonance imaging (MRI) before the first and after the fourth course of docetaxel. RESULTS: None of the eight patients (0%) whose SUVmax decrease was less than 18% revealed a clinical partial response or clinical complete response; Seven out of the sixteen patients (44%) with an SUVmax decrease over 45% achieved a complete response. CONCLUSION: An SUVmax reduction rate less than 18% is observed in patients with breast cancer after the first course of docetaxel in NCT and may be indicator of non-response to docetaxel.

Enhanced diagnostic accuracy for quantitative bone scan using an artificial neural network system: a Japanese multi-center database project.

BACKGROUND: Artificial neural network (ANN)-based bone scan index (BSI), a marker of the amount of bone metastasis, has been shown to enhance diagnostic accuracy and reproducibility but is potentially affected by training databases. The aims of this study were to revise the software using a large number of Japanese databases and to validate its diagnostic accuracy compared with the original Swedish training database. METHODS: The BSI was calculated with EXINIbone (EB; EXINI Diagnostics) using the Swedish training database (n = 789). The software using Japanese training databases from a single institution (BONENAVI version 1, BN1, n = 904) and the revised version from nine institutions (version 2, BN2, n = 1,532) were compared. The diagnostic accuracy was validated with another 503 multi-center bone scans including patients with prostate (n = 207), breast (n = 166), and other cancer types. The ANN value (probability of abnormality) and BSI were calculated. Receiver operating characteristic (ROC) and net reclassification improvement (NRI) analyses were performed. RESULTS: The ROC analysis based on the ANN value showed significant improvement from EB to BN1 and BN2. In men (n = 296), the area under the curve (AUC) was 0.877 for EB, 0.912 for BN1 (p = not significant (ns) vs. EB) and 0.934 for BN2 (p = 0.007 vs. EB). In women (n = 207), the AUC was 0.831 for EB, 0.910 for BN1 (p = 0.016 vs. EB), and 0.932 for BN2 (p < 0.0001 vs. EB). The optimum sensitivity and specificity based on BN2 was 90% and 84% for men and 93% and 85% for women. In patients with prostate cancer, the AUC was equally high with EB, BN1, and BN2 (0.939, 0.949, and 0.957, p = ns). In patients with breast cancer, the AUC was improved from EB (0.847) to BN1 (0.910, p = ns) and BN2 (0.924, p = 0.039). The NRI using ANN between EB and BN1 was 17.7% (p = 0.0042), and that between EB and BN2 was 29.6% (p < 0.0001). With respect to BSI, the NRI analysis showed downward reclassification with total NRI of 31.9% ( p < 0.0001). CONCLUSION: In the software for calculating BSI, the multi-institutional database significantly improved identification of bone metastasis compared with the original database, indicating the importance of a sufficient number of training databases including various types of cancers.

Diffusion-weighted imaging and positron emission tomography in various cytological subtypes of primary lung adenocarcinoma.

The purpose of the study was to retrospectively characterize diffusion-weighted magnetic resonance imaging (DWI) and positron emission tomography for differentiating among the various cytological subtypes of primary lung adenocarcinomas. The maximum diffusion signal intensities and the maximum standardized uptake value (SUV max) of 31 lesions were analyzed after delineation of regions of interest on the images. Diffusion intensities were 0.934 for Clara type, 0.938 for type II type, 1.473 for nongoblet type, and 1.617 for poorly differentiated adenocarcinoma type based on Shimosato's cytological classification (P=.020). The SUV max values were 4.926, 5.491, 5.709, and 12.132, respectively (P=.044). DWI might reflect some of the cytological characteristics of the tumor cells for differentiating the subtypes of lung adenocarcinomas.

The detection of pCR after PST by contrast-enhanced ultrasonography for breast cancer.

BACKGROUND: Primary systemic therapy (PST; such as chemotherapy) has been approved as the standard therapy. Breast-conserving surgery is involved in 60-70% of breast cancer operations, and cancer can spread in the period between the initial treatment and preoperative chemotherapy. To reduce the residual tumor in persistent disease of breast tissue, determining the margin including normal tissue when removing the tumor is very difficult. With the development of the color Doppler method, contrast-enhanced ultrasonography (CEUS) allows visualization of the tumor bloodstream. The availability and efficacy of CEUS for setting the resection margin in breast-conserving surgery were examined and compared with MRI imaging as tools for making decisions for breast-conserving surgery. METHODS: One hundred seventy patients underwent breast cancer operations: 59 were PST(+) and 111 PST(-). Imaging studies, ultrasonography and MRI, to measure the size of the tumor were performed twice, before and after chemotherapy, for PST patients. This was carried out not only to measure the residual tumor size after PST, but also to detect whether pathologically complete response (pCR) had been achieved or not. Fifty-nine patients received CEUS after PST, and we determined the precision of CEUS and conventional US. RESULTS: The sensitivity of CEUS for pCR was 80.0% (95% CI 0.571-0.88), specificity 98.0% (95% CI 0.933-0.996), positive predictive value 88.9% (95% CI 0.635-0.978) and negative predictive value 96.0% (95% CI 0.914-0.976). The difference between the pathological examination and ultrasonography, conventional ultrasonography and CEUS was -4.455 ± 2.02 and 2.582 ± 2.298 cm (95% CI -13.11 to -0.96, p = 0.0235); CEUS was near the diameter of the actual pathological examination. CONCLUSION: Contrast-enhanced ultrasonography is suitable for the preoperative examination, especially after PST, to determine the resection margin before breast-conserving surgery and detects pCR, which can help to avoid surgical procedures in the future.

Immediate cytology improves accuracy and decreases complication rate in real-time computed tomography-guided needle lung biopsy.

Computed tomography-guided percutaneous transthoracic needle biopsy (CTNB) of the lung is a well-established diagnostic technique for the evaluation of thoracic lesions. At our institution, we have performed real-time CTNB using automated biopsy needles since 1998 and we introduced immediate cytology in 2004. We evaluate immediate cytology in CTNB to increase the diagnostic accuracy and to reduce the number of inadequate specimens. We retrospectively reviewed a consecutive series of 270 patients (group A: 98 patients before introduction, group B: 172 patients after introduction) who underwent CTNB between 2002 and 2009. We compared the diagnostic performance and the complication rates between two groups. There were no significant differences between groups A and B in patient and lesion characteristics. The rates of one time biopsy were significantly different: 56.1% (55/98) in group A and 69.2% (119/172) in group B. The rates of diagnostic accuracy in groups A and B were 79.6% (78/98) and 94.8% (163/172), respectively; the sensitivity were 74.0% (57/77) and 94.1% (127/135); the specificity were 100% (21/21) and 97.3% (36/37); the rates of major complications were 14.3% (14/98) and 2.9% (5/172). Group B had significantly higher diagnostic accuracy, sensitivity, and a lower complication rate in comparison with group A. CTNB with immediate cytology can improve diagnostic performance and decrease the complication rate. These improvements may help make CTNB less of a burden for patients.

Automated segmentation of the skeleton in whole-body bone scans: influence of difference in atlas.

AIM: Automated segmentation of the skeleton is the first step for quantitative analysis and computer-aided diagnosis (CAD) of whole-body bone scans. The purpose of this study was to examine the influence of differences in skeletal atlas on the automated segmentation of skeletons in a Japanese patient group. METHODS: The study was based on a bone scan CAD system that included a skeletal atlas obtained using 10 normal bone scans from European patients and 23 normal bone scans from Japanese patients. These were incorporated into the CAD system. The performance of the skeletal segmentation, based on either the European or the Japanese Atlas, was evaluated independently by three observers in a group of 50 randomly selected bone scans from Japanese patients. RESULTS: The skeletal segmentation was classified as correct in 41-44 of the 50 cases by the three observers using the Japanese atlas. The corresponding results were 15-18 of the 50 cases using the European atlas, and this difference was statistically significant (P<0.001). The anatomical areas most commonly classified as not correct were the skull, cervical vertebrae, and ribs. CONCLUSION: Automated segmentation of the skeleton in a Japanese patient group was more successful when the CAD system based on a Japanese atlas was used than when the corresponding system based on a European atlas was used. The results of this study indicate that it is of value to use a skeletal atlas based on normal Japanese bone scans in a CAD system for Japanese patients.

Computer-aided diagnosis system for bone scintigrams from Japanese patients: importance of training database.

AIM: Computer-aided diagnosis (CAD) software for bone scintigrams have recently been introduced as a clinical quality assurance tool. The purpose of this study was to compare the diagnostic accuracy of two CAD systems, one based on a European and one on a Japanese training database, in a group of bone scans from Japanese patients. METHOD: The two CAD software are trained to interpret bone scans using training databases consisting of bone scans with the desired interpretation, metastatic disease or not. One software was trained using 795 bone scans from European patients and the other with 904 bone scans from Japanese patients. The two CAD softwares were evaluated using the same group of 257 Japanese patients, who underwent bone scintigraphy because of suspected metastases of malignant tumors in 2009. The final diagnostic results made by clinicians were used as gold standard. RESULTS: The Japanese CAD software showed a higher specificity and accuracy compared to the European CAD software [81 vs. 57 % (p < 0.05) and 82 vs. 61 % (p < 0.05), respectively]. The sensitivity was 90 % for the Japanese CAD software and 83 % for the European CAD software (n.s). CONCLUSION: The CAD software trained with a Japanese database showed significantly higher performance than the corresponding CAD software trained with a European database for the analysis of bone scans from Japanese patients. These results could at least partly be caused by the physical differences between Japanese and European patients resulting in less influence of attenuation in Japanese patients and possible different judgement of count intensities of hot spots.

Evaluation of the maximum depth of intraluminal appendiceal fluid to diagnose appendicitis with a 64-detector row CT scanner.

OBJECTIVE: The objective of this study was to investigate whether the criterion "maximum depth of intraluminal appendiceal fluid greater than 2.6 mm" ("DEPTH >2.6 mm"), with the use of 64-detector row computed tomography, is useful to diagnose appendicitis. METHODS: We retrospectively evaluated 0.68-mm-thick images of 2894 intravenously enhanced abdominal-pelvic computed tomography using the following criteria: (1) appendiceal wall thickness greater than 3 mm, (2) appendiceal wall enhancement, (3) focal cecal wall thickening, (4) adjacent lymphadenopathy greater than 5 mm, (5) appendicolith, (6) periappendiceal inflammation, and (7) the new criterion, DEPTH >2.6 mm. Of the 2894 images, 1013 were classified into normal group (including 622 distended [diameter >6 mm] but normal appendices without adjacent lesions), modified group (235 distended normal appendices modified with adjacent lesions), proven-appendicitis group (82 operatively proven appendicitis cases), and clinical-appendicitis group (62 clinically certified appendicitis cases). RESULTS: The new criterion, DEPTH >2.6 mm, demonstrated both higher sensitivities and higher specificities in all groups (>90%), although this criterion showed lower specificities than some conventional criteria. In contrast, conventional criteria showed lower sensitivities or lower specificities (<60%) in one or more of these groups. CONCLUSIONS: DEPTH >2.6 mm is particularly useful for differentiating appendicitis from distended normal appendix.

[Three (3) cases of advanced hepatocellular carcinoma (HCC) treated successfully by transcatheter arterial infusion of cisplatin followed by gelatin particles].

Hepatic artery chemotherapy with transarterial infusion (TAI) of a cisplatin formulation designed for intra-arterial injection (IA-call®) is recognized as an established treatment for advanced hepatocellular carcinoma (HCC). We experienced three patients whose multiple HCC(Stage III) was successfully treated by TAI using IA-call combined with embolization by porous gelatin particles (Gelpart®), after a series of treatments such as hepatectomy, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), and TAI. Cisplatin-based TAI was not effective, but porous gelatin particles showed a therapeutic effect in one patient by reducing his hepatic arterial blood flow. The two other patients responded to combination therapy after the second treatment. Adverse events from the treatment were mild. This therapy has benefits even for multiple intra-hepatic lesions that are resistant to TACE and TAI because of its widespread effect on the entire liver, and it could be an effective treatment option for advanced HCC.

Diffusion-weighted magnetic resonance imaging in differentiating the invasiveness of small lung adenocarcinoma.

BACKGROUND: Magnetic resonance imaging (MRI) with several sequences may provide a valuable additional modality for evaluating the grade of invasiveness lesions. Diffusion-weighted magnetic resonance imaging (DWI) represents the biological characteristics of tissues. PURPOSE: To retrospectively evaluate the usefulness of DWI for evaluating the invasiveness of small lung adenocarcinomas. MATERIAL AND METHODS: From May 2005 to June 2008, 46 patients with lung adenocarcinomas measuring 2 cm or less across the greatest dimension underwent a preoperative MRI study followed by surgery at the Gunma Prefectural Cancer Center. Fourteen of the tumors were bronchioloalveolar carcinomas (so-called Noguchi's type A+B group), 26 were adenocarcinomas with mixed subtypes (type C group) and six were other histological subtypes of adenocarcinomas (type D+E+F group). The mean signal intensities of a lesion (DWI) and the spinal cord (SC) were analyzed in the region of interests (ROIs), and the mean DWI/SC ratio was then calculated with the value of DWI divided by the value of SC. RESULTS: The calculated mean DWI/SC ratio for the lesions were as follows: 0.448±0.261 (mean±standard deviation [SD]) for type A+B group, 0.963±0.465 for type C group, and 0.816±0.291 for type D+E+F group. The mean DWI/SC ratio of type A+B group was significantly lower than that for the type C (P = 0.0005) or type D+E+F groups (P = 0.0117). CONCLUSION: DWI may thus provide useful supplementary information before determining the surgical strategy, including a limited resection.

Evaluation of noncirrhotic hepatic parenchyma with and without significant portal vein stenosis using diffusion-weighted echo-planar MR on the basis of multiple-perfusion-components theory.

To determine whether diffusion-weighted echo-planar MR images are sensitive to liver perfusion difference. Noncirrhotic livers of 71 patients (43 males, 28 females; age range, 22-87 years; mean, 61 years) without (n=51) and with (n=20) significant (>70%) portal vein stenosis (accompanying proximal hepatic arterial stenosis and/or biliary tract obstruction in 10) by tumors were examined with diffusion-weighted echo-planar sequences (modified for b factors of 1, 28, 66, 288 and 600 s/mm²). On the basis of multiple-perfusion-components theory, i.e., assuming logarithm of signal intensity for liver perfusion is linearly attenuated versus logarithm of a smaller b factor, we defined the slope of the line as the perfusion-related D' value. The D' values of these livers were calculated from images with b factors of 1, 28, and 66 s/mm². The livers' apparent diffusion coefficient values for diffusion (ADC(d) values) were calculated from images with b factors of 288 and 600 s/mm². The livers with significant portal vein stenosis had statistically lower mean D' values than the livers without portal vein stenosis (P<.001 on the Mann-Whitney U test). However, there was no significant difference in ADC(d) values between these liver types (P>.05). The D' value calculated from diffusion-weighted echo-planar sequences with plural smaller b factors may be sensitive to liver perfusion difference.