Are the recorded data of flash glucose monitoring systems influenced by radiological examinations?

The FreeStyle Libre Pro® flash glucose monitoring system is easy to use in diabetes care. However, the influence of radiological examination on recorded data has not been reported. The sensor should be removed prior to examinations involving strong magnetic or electromagnetic radiation. In the present study, it was assumed that radiological examination was performed without removing the FreeStyle Libre Pro® sensor in certain unanticipated situations. We researched the integrity of data recorded by the FreeStyle Libre Pro® system following exposure to chest X-rays, computed tomography (CT), radiotherapy (RT), and magnetic resonance imaging (MRI). Fifty sensors were exposed to chest X-ray, CT, RT, and MRI (1.5-T and 3.0-T), and the recorded data were compared with those obtained before the tests. Ten sensors were included in each group. There were no unread data or errors when the sensors were read. No change was observed before and after the examination for all tests.

Influence of arm position and respiration technique during liver examinations on the detectability of mammary lesions.

During liver computed tomography (CT), scanning is performed with the raised arm position and an inhalation technique. However, for liver magnetic resonance imaging (MRI), the arms are placed at the sides of the body and an exhalation technique is used. This study was aimed at evaluating the effect that the patient's arm position and respiration technique had on the ability to detect mammary glands in the scan range to discover unexpected mammary lesions during the liver MRI examination. Liver MRI and CT images were compared for 337 female patients. More than half of the mammary glands were included in 97.3% of MRI, but in 4.7% of CT. No mammary lesions were found during CT, whereas seven were found during MRI. The mammary lesions are more likely to be detected when the patient places her arms at the sides of the body and uses the exhalation technique during liver MRI.

Hepatobiliary phase images using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI as an imaging surrogate for the albumin-bilirubin grading system.

OBJECTIVES: To clarify the correlation between hepatobiliary phase (HBP) images using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) and albumin-bilirubin (ALBI) grading system. MATERIALS AND METHODS: We evaluated 220 consecutive patients who underwent liver magnetic resonance imaging with Gd-EOB-DTPA. Quantitative liver-spleen contrast ratio (Q-LSC) was calculated in HBP images approximately 20min after Gd-EOB-DTPA administration. To evaluate the degree of association between Q-LSC and ALBI grade, the Child-Pugh (C-P) score was used for comparison. Correlation coefficients were calculated, and median Q-LSC values were compared with the C-P scores and ALBI grades. The Steel-Dwass multiple comparison test was used for statistical analysis. RESULTS: The correlation coefficient between Q-LSC and C-P score was -0.35, P<0.0001, and the ALBI grade was -0.61, P<0.0001. Q-LSC of overall median, C-P A, B, and C were 1.94, 1.91, 1.96, and 1.33, respectively. The differences between C-P A and C-P B, C-P B and C-P C, and C-P A and C-P C were P=0.999, 0.126, and 0.149, respectively. Q-LSC of the overall median, ALBI grade 1, 2, and 3 were 1.94, 2.12, 1.69, and 1.30, respectively. The differences between ALBI grades 1 and 2, 2 and 3, and 1 and 3 were P<0.0001, P=0.0466, and P=0.0035, respectively. Q-LSC was better correlated and discriminated by ALBI grade than C-P score. CONCLUSION: A strong correlation was observed between Q-LSC of an HBP image with Gd-EOB-DTPA and ALBI grade; HBP imaging could be a surrogate for the ALBI grade.

A novel method for evaluating enhancement using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid in the hepatobiliary phase of magnetic resonance imaging.

To investigate whether quantitative liver-portal vein contrast ratio (Q-LPC) can be used as a substitute for quantitative liver-spleen contrast ratio (Q-LSC) in the hepatobiliary phase (HBP) contrasting degree. Q-LSC and Q-LPC were calculated in HBP images that were obtained approximately 20 min after gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid injection, and relationship between them was evaluated. A very strong correlation was observed between Q-LSC and Q-LPC with respect to Child-Pugh class. Furthermore, Q-LPC values were not significantly different between patients with splenectomy or Gamna-Gandy bodies and those without. Therefore, Q-LPC can be useful instead of Q-LSC in patients with splenectomy or Gamna-Gandy bodies.

Pertuzumab, trastuzumab and docetaxel reduced the recurrence of brain metastasis from breast cancer: a case report.

The CLEOPATRA trial reported the survival benefit of pertuzumab with trastuzumab plus docetaxel in HER2-positive metastatic breast cancer patients. However, there are a few case reports concerning the effects of a pertuzumab-containing regimen on brain metastases. A 55-year-old woman, who underwent curative surgery for breast cancer after neoadjuvant chemotherapy 5 years previously, developed repeated solitary brain metastasis in her right occipital lobe. Whole brain radiation therapy, stereotactic radiosurgery and 3 times of surgical resection were performed. Lapatinib and capecitabine plus tamoxifen were administered. The metastasis recurred in the stump of the previous surgery. Pertuzumab with trastuzumab plus docetaxel was initiated as second-line chemotherapy. A complete response of the brain metastasis was achieved, which persisted for 5 months. Pertuzumab with trastuzumab plus docetaxel was effective in reducing the brain metastases from breast cancer. Further studies are warranted to confirm the effect of this regimen on brain metastases.

Comparative study of vascular enhancement on post-contrast CT using three dosages of iodinated contrast media for the aim of detecting brain metastasis in patients with lung cancer.

OBJECTIVE: A prospective double-blind randomized study was performed to compare the contrast of vascular enhancement using three dosages of iodinated contrast media for a possible metastatic lesion in the brain. MATERIALS AND METHODS: Sixty-six patients with lung cancer received brain computed tomography (CT) with intravenous administration of iodinated contrast medium (CM). The patients were randomly assigned to receive one of the three types of CM: 30 g iodine, 24 g iodine, and 15 g iodine. Three radiologists judged the degree of vascular contrast enhancement and diagnosed the presence of brain metastasis. The CT numbers in major arteries were also measured. RESULTS: The subjective average scores with standard deviation were 2.06+/-0.48, 1.97+/-048, and 1.44+/-0.43, and the measured average CT numbers with standard deviation (SD) were 168.5+/-39.6, 166.1+/-28.6, and 146.1+/-27.0 HU with 30 g, 24 g, and 15 g iodine, respectively. The scores and the CT numbers in 15 g iodine were less than those with 30 g and 24 g iodine. Brain metastasis was detected in one patient each in groups A and C, and one false-positive case was found in group B. CONCLUSION: CT study with a dose of 24 g iodine showed equivalent quality on vascular enhancement in comparison with a 30 g iodine dose.

Benign or malignant?: differentiating breast lesions with computed tomography attenuation values on dynamic computed tomography mammography.

OBJECTIVE: To evaluate enhancement effects of breast lesions with dynamic computed tomography (CT) and to determine characteristics to aid in differential diagnosis of benign and malignant lesions. METHODS: One hundred seventy-six women underwent preoperative dynamic CT, in which they were scanned with rapid injection of contrast media (3 mL/s) after 30 seconds and 2 minutes (early and delayed phases, respectively). The CT values and enhancement patterns of malignant lesions (n = 154) were compared with those of benign lesions (n = 22), and the cut point of CT values with the best validity was analyzed. RESULTS: The CT values of malignant lesions were higher than those of benign lesions in both phases (P < 0.0001). The cut point was determined to be 60 Hounsfield units (HU) in the early phase (44% validity, 90% sensitivity). Washout and plateau patterns were more commonly seen in the malignant group (73% specificity). CONCLUSIONS: The analysis of enhancement effects on CT may lead to more appropriate differentiation of benign and malignant lesions.

Accumulation of 99mTc-PMT in renal metastasis of hepatocellular carcinoma.

We describe here a case in which 99mTc-Sn-N-pyridoxy-5-methyltryptophan (99mTc-PMT) scintigraphy was useful in diagnosing renal metastasis of hepatocellular carcinoma (HCC). A 62-year-old man who had undergone hepatectomy for HCC presented 6 years after initial diagnosis with left flank pain and was found on CT and MRI to have a tumor in the left kidney. Hepatobiliary scintigraphy using 99Tc-PMT was performed, and 99mTc-PMT accumulation was found in the tumor. Nephrectomy was performed and metastasis of HCC was confirmed.

A simplified double-injection method to quantify cerebral blood flow and vascular reserve using iodine-123 IMP-SPECT.

UNLABELLED: We developed and evaluated a simplified double-injection method for iodine-123 N-isopropyl-p-iodoamphetamine (IMP) to quantify regional cerebral blood flow (rCBF) twice in a single SPECT session. The method enabled rapid calculations of rCBF with five 10-minute SPECT scans, a fixed distribution volume (Vd), and one-point arterial blood sampling to calibrate a standard input function (SIF). METHODS: Sixty neurological patients were examined to measure rCBF twice in a single session of IMP-SPECT. Patients underwent frequent arterial blood sampling with two injections of IMP and acetazolamide challenge. We generated the SIF and determined the optimal Vd and calibration time (t(cal)) for the SIF in 30 patients. Validities of the fixed t(cal) and Vd were assessed in the remaining 30 patients. Simulation studies were also performed to evaluate the error sensitivity of the method. RESULTS: The optimal t(cal) and Vd were 34 min and 30 ml/ml, respectively. The method was robust in rCBF calculation with noisy SPECT data and yielded rCBF with negligible bias and acceptable errors compared with those obtained by the double-injection method previously reported. CONCLUSION: The method can be applied to measure rCBF twice in a single SPECT session more easily and less invasively.