The effect of glucagon on FDG uptake in skeletal muscle.

Glucagon is used as an anti-motility agent during gastrointestinal tract examinations. We experienced subjects with enhanced 18F-fluorodeoxyglucose (FDG) uptake in whole-body skeletal muscle when conducting positron emission tomography (PET). The subjects had been administered glucagon during gastroscopy just prior to PET. This observation prompted us to perform the present retrospective study to determine whether or not glucagon enhances FDG uptake in skeletal muscle. We randomly selected 30 cases, including subjects who had undergone PET and gastroscopy on the same day as cancer screening procedures, and classified them into three groups. In the NO group (n = 10), no medications were used prior to PET. In the SC group (n = 10), scopolamine butylbromide (10 mg) was intravenously administered during endoscopy. In the GL group (n = 10), glucagon (0.5 mg) was intravenously administered during endoscopy. Both drugs were administered 45-60 min prior to FDG administration. The mean standardized uptake value (SUV) for gluteal muscle was 0.7 ± 0.14, 0.69 ± 0.15, and 0.99 ± 0.7 in the NO, SC, and GL groups, respectively. The SUV in the GL group was highest, but the difference was not statistically significant. In the subject with the highest SUV (3.04; GL group), the quality of the oncologic PET image was impaired, perhaps because of a relative decrease of FDG distribution in the chest and abdomen. Because previous literature showed that via hyperglycemia and hyperinsulinemia glucagon has the effect of increasing FDG uptake in skeletal muscle, the use of glucagon should be avoided just prior to FDG PET, although in our subjects, no statistical proof that glucagon enhances FDG uptake in skeletal muscle was obtained.

[Acute urinary retention secondary to aseptic meningoencephalitis in an infant--case report].

We report the case of a 21-month-old boy with urinary retention secondary to aseptic meningitis. After high fever for 10 days, appetite loss, somnolence, acute transient urinary retention, constipation and mild dysesthesia in bilateral lower limbs developed. Brisk reflexes were present in the lower extremities along with a positive Babinski reflex. Cerebrospinal fluid (CSF) examination revealed mild mononuclear cell-dominant pleocytosis. Human herpes virus (HHV)-6 was not detected in the CSF by polymerase chain reaction (PCR) analysis; however, it was detected in the throat, plasma, and mononuclear cells of the peripheral blood. Virus-specific immunoglobulin M antibodies against HHV-6 were not detected by enzyme immunoassay. Brain magnetic resonance imaging (MRI) yielded normal results; however, T1-weighted MRI of the conus terminalis with contrast enhancement showed region of high intensity from the lower thoracic to lumbar meninges. In T2-weighted imaging, slight hyperintensity was observed in the lumbar spinal cord without enhancement effect. The catheter was removed 1 week after high-dose intravenous methyl-prednisolone treatment and the patient was able to walk 3 weeks later without any sequelae. Vesicorectal disturbance and the neurological symptoms observed in aseptic meningitis were similar to those of HSV type 2-induced lumbosacral meningo-radiculitis, designated as Elsberg syndrome or meningitis-retention syndrome in adults. The recurrence of HHV-6 might be immunologically related to this meningitis-retention syndrome based on the results of PCR analysis and enzyme immunoassay for virus-specific antibodies. Several reports have described lumbosacral meningo-radiculitis in adults and older children, but this appears to be particularly rare in infants.

Usefulness of early-phase helical CT for detecting recurrent rectal cancer.

PURPOSE: To evaluate the usefulness of dynamic enhancement of helical CT in the detection of local recurrence of resected rectal cancer. MATERIALS AND METHODS: In 142 patients with a history of curatively resected T2 or T3 rectal cancer, follow-up plain CT indicated that they had a loco-regional recurrent tumor; consequently, they underwent follow-up pelvic helical CT providing accurate early-phase contrast enhancement in the lower pelvic region. The patients were divided into four groups according to the grade of contrast enhancement of the suspected mass-like lesion before and after contrast enhancement, and the correlation between groups and results obtained by biopsy and/or surgery were assessed. If no correlation was found, patients were followed up for a period lasting from 400 days to two years. As of June 2002, results had been obtained for 80 patients, and correlation between these results and grouping by contrast enhancement ratio was analyzed. RESULTS: All patients in the highest-grade group (n=10) had local recurrence. When only the highest-grade group was considered positive, there were no false positives and only one false negative. CONCLUSION: Our results suggest that early-phase contrast enhancement is useful for accurately detecting recurrent rectal cancer. This can be easily achieved using the SmartPrep function, and should be used to distinguish recurrent tumors from postsurgical scar tissue, because these two tissue types do not exhibit similar enhancement patterns.

[The diagnostic imagings of liver metastases].

The liver is an organ susceptible metastases. Malignant neoplasms of many organs frequently metastasize to the liver, particularly colon malignancies. Most metastases enter the liver via the blood circulation, but metastases through lymphatic vessels and the peritoneum are also common. The morphologies of liver metastases and findings on diagnostic images vary considerably. Numerous modalities are available for diagnostic imaging of liver metastases: ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), angiography, nuclear medicine, and others. Ultrasonography is the simplest, most non-invasive, and cheapest, but relies on the skill of the operator. CT and MRI are also non-invasive, and the sensitivities of these techniques have recently been improved with the development of multidetector CT, contrast agents for MRI that specifically accumulate in the liver, and other advances. Moreover, positron emission CT using fluorine-18-deoxyglucose (FDG-PET) displays a high sensitivity. Angiography is an invasive modality, but is adopted with CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA), or for the purpose of interventional radiology. Rational selection of appropriate modalities for a given purpose requires familiarity with the characteristics of each modality. In the present paper, we describe the morphologic characters of liver metastases and investigate the associated characteristics and usefulness of each modality.