[Two cases of radiation myositis probably induced by recall phenomenon].

Two cases of radiation myositis following gemcitabine-based chemotherapy for advanced non-small cell lung cancer are presented. In the two cases, myositis appeared 3 and 5.5 months after the completion of radiation therapy and 2 and 2.5 months after the beginning of chemotherapy, respectively. The affected areas, the upper back and right thigh, appeared as areas of increased signal intensity on T2-weighted MR imaging and were enhanced by the administration of Gd-DTPA in the skeletal muscles. These coincided with the previously irradiated area. Although radiation myositis is a rare complication, it is important to be careful of radiation recall induced by chemotherapeutic agents.

Evaluation of gastroesophageal reflux disease following various reconstructive procedures for a distal gastrectomy.

BACKGROUND AND AIMS: Some patients develop gastroesophageal reflux disease (GERD) after a distal gastrectomy. In these patients, the evaluation of GERD with 24-h pH monitoring could be difficult because they may have an insufficient amount of gastric acid. PATIENTS AND METHODS: To evaluate GERD following a distal gastrectomy, we retrospectively evaluated 38 patients postoperatively with an acid reflux test (ART), a barium study, endoscopy, and esophageal manometry. Three reconstructive procedures, Billroth I (B-I group: 14 patients), Billroth II (B-II group: 11 patients), and jejunal interposition (interposition group: 13 patients) were compared with respect to GERD and short- term operation results. RESULTS: Operation time and postoperative hospital stay were longest in the interposition group. Reflux symptoms were present in ten patients (26%). The ART, barium study and endoscopy demonstrated evidence of GERD in 22 (58%), 10 (26%) and 4 (11%) of the 38 patients, respectively. The frequency of a positive ART in the interposition group was significantly lower than in both the B-I and the B-II groups. The abdominal length of the lower esophageal sphincter in the interposition group was higher than that in the B-II group ( P<0.05). CONCLUSION: Although jejunal interposition required longer operation time and hospital stay, the lower esophageal sphincter function following jejunal interposition appears to be superior to that following a Billroth-I or Billroth-II procedure.

HRCT findings of pulmonary complications in non-AIDS immunocompromised patients: are they useful in differential diagnosis?

PURPOSE: This study was designed to evaluate the diagnostic value of characteristic HRCT findings in the differential diagnosis of acute pulmonary complications (APCs) in immunocompromised patients and to investigate how to improve diagnostic accuracy. MATERIALS AND METHODS: We reviewed the chest CT images of 103 consecutive immunocompromised non-AIDS patients with APCs. The presence, extent, and anatomical distribution of the CT findings were assessed by two radiologists. The sensitivity and positive predictive value (PPV) of each criterion determined by the combination of CT findings that were characteristic in previous studies were calculated. RESULTS: The average sensitivity of each criterion was 0.50 in the total cases. There were many false positives, and the PPVs of some criteria were low. Among the significantly less frequent CT findings, the frequency of bronchovascular bundle thickening was 0% in cytomegaloviral pneumonia (CMV P). The absence of this finding improved the diagnostic accuracy of CMV P. CONCLUSION: Because the combination of only characteristic HRCT findings in each disease was of relatively limited value in making a diagnosis, infrequent findings should be also added to the CT criteria to improve accuracy.

The probability of malignancy in small pulmonary nodules coexisting with potentially operable lung cancer detected by CT.

The aim of this study was to assess the probability of malignancy in one or two small nodules 1 cm or less coexisting with potentially operable lung cancer (coexisting small nodules). The preoperative helical CT scans of 223 patients with lung cancer were retrospectively reviewed. The probability of malignancy of coexisting small nodules was evaluated based on nodule size, location, and clinical stage of the primary lung cancers. Seventy-one coexisting small nodules were found on conventional CT in 58 (26%) of 223 patients, and 14 (6%) patients had malignant nodules. Eighteen (25%) of such nodules were malignant. The probability of malignancy was not significantly different between two groups of nodules larger and smaller than 0.5 cm ( p=0.1). The probability of malignancy of such nodules within primary tumor lobe was significantly higher than that in the other lobes ( p<0.01). Metastatic nodules were significantly fewer in clinical stage-IA patients than in the patients with the other stage ( p<0.01); however, four (57%) of seven synchronous lung cancers were located in the non-primary tumor lobes in the clinical stage-I patients. Malignant coexisting small nodules are not infrequent, and such nodules in the non-primary tumor lobes should be carefully diagnosed.

Crackle analysis for chest auscultation and comparison with high-resolution CT findings.

PURPOSE: The purpose of our study was to clarify the correlation between respiratory sounds and the high-resolution CT (HRCT) findings of lung diseases. MATERIALS AND METHODS: Respiratory sounds were recorded using a stethoscope in 41 patients with crackles. All had undergone inspiratory and expiratory CT. Subjects included 18 patients with interstitial pneumonia and 23 without interstitial pneumonia. Two parameters, two-cycle duration (2CD) and initial deflection width (IDW) of the "crackle," were induced by time-expanded waveform analysis. Two radiologists independently assessed 11 HRCT findings. An evaluation was carried out to determine whether there was a significant difference in the two parameters between the presence and absence of each HRCT finding. RESULTS: The two parameters of crackles were significantly shorter in the interstitial pneumonia group than the non-interstitial pneumonia group. Ground-glass opacity, honeycombing, lung volume reduction, traction bronchiectasis, centrilobular nodules, emphysematous change, and attenuation and volume change between inspiratory and expiratory CT were correlated with one or two parameters in all patients, whereas the other three findings were not. Among the interstitial pneumonia group, traction bronchiectasis, emphysematous change, and attenuation and volume change between inspiratory and expiratory CT were significantly correlated with one or two parameters. CONCLUSION: Abnormal respiratory sounds were correlated with some HRCT findings.

Imaging findings of an intercostal hemangioma.

SUMMARY: The authors present the imaging findings in a 44-year-old woman with a rare intercostal hemangioma that originated from the connective tissue between the intercostal muscle and parietal pleura and protruded into the thoracic cavity. The contrast-enhanced computed tomography (CT) showed a markedly enhancing mass, whereas dynamic magnetic resonance (MR) images showed heterogeneous and strong enhancement with incomplete early eccentric enhancement peripherally followed by complete filling-in on delayed scans. The imaging features of CT and MR imaging of a hemangioma may be useful for proper preoperative diagnosis.