Breath-hold High-resolution T1-weighted Gradient Echo Liver MR Imaging with Compressed Sensing Obtained during the Gadoxetic Acid-enhanced Hepatobiliary Phase: Image Quality and Lesion Visibility Compared with a Standard T1-weighted Sequence

PURPOSE

To evaluate the feasibility of breath-hold (BH) high-resolution (HR) T1-weighted gradient echo hepatobiliary phase (HBP) imaging using compressed sensing (CS) in gadoxetic acid-enhanced liver MRI in comparison with standard HBP imaging using parallel imaging (PI).

METHODS

The study included 122 patients with liver tumors with hypointensity in the HBP who underwent both HR HBP imaging with CS and standard HBP imaging with PI. Two radiologists evaluated the liver edge sharpness, hepatic vessel conspicuity, bile duct conspicuity, image noise, and overall image quality, as well as the lesion conspicuity on HR and standard HBP imaging and the contrast-enhanced (CE) MR cholangiography (MRC) image quality reconstructed from HBP images. As a quantitative analysis, the SNR of the liver and the liver to lesion signal intensity ratio (LLSIR) were also determined.

RESULTS

The liver edge sharpness, hepatic vessel conspicuity, bile duct conspicuity, and overall image quality as well as the lesion conspicuity and the LLSIR on HR HBP imaging with CS were significantly higher than those on standard HBP imaging (all of P < 0.001). The image quality of CE-MRC reconstructed from HR HBP imaging with CS was also significantly higher than that from standard HBP imaging (P < 0.001). Conversely, the SNR of liver in standard HBP was significantly higher than that in HR HBP with CS (P < 0.001).

CONCLUSION

BH HR HBP imaging with CS provided an improved overall image quality, lesion conspicuity, and CE-MRC visualization when compared with standard HBP imaging without extending the acquisition time.

Clinical implications of troponin-T elevations following TAVR

Funding Acknowledgements

Type of funding sources: None.

Background

Baseline and post-procedural elevations in serum troponin-T levels are associated with increased morbidity and mortality following transcatheter aortic valve replacement (TAVR). However, the prognostic impact of change in serum troponin-T level following TAVR remains unknown.

Methods

Among the patients with severe aortic stenosis who underwent TAVR, those with baseline serum troponin-T level ≥51.5 ng/L were excluded. The impact of increases in serum troponin-T level to an abnormally high range (≥51.5 ng/L) following TAVR on 2-year cardiovascular death or heart failure readmissions was investigated.

Results

Among 189 included patients (median 86 years old, 28% men), serum troponin-T level increased in 79 patients following TAVR. An increase in serum troponin-T was associated with a higher rate of 30-day adverse events, predominantly due to pacemaker implantation for complete atrio-ventricular block, and a higher 2-year cumulative incidence of the primary endpoint (hazard ratio 3.97, 95% confidence interval 1.51-10.4, p = 0.005) adjusted for the use of balloon-expandable valve and post-TAVR pacemaker implantation (Figure 1).

Conclusion

Post-procedural increase in serum troponin-T level was associated with adverse clinical outcomes following TAVR. Abstract Figure. Cumulative incidence of endpoint

The Evaluation of Transmural Healing by Low-dose Computed Tomography Enterography in Patients with Crohn's Disease

Objective Transmural healing (TH) has been attracting attention as a new therapeutic target for Crohn's disease, but there are few clinical data on TH in Japan. We introduced low-dose computed tomography enterography (CTE) as a monitoring method for Crohn's disease and retrospectively investigated the accuracy of evaluating TH by CTE. Methods Among Crohn's disease patients who underwent low-dose CTE at our hospital from January 2009 to March 2021, 122 patients who underwent colonoscopy or balloon endoscopy within 2 weeks were included. Results of radiological and endoscopic examinations were reviewed independently by radiologists and gastrointestinal endoscopists, respectively. The concordance rate of the diagnosis between CTE and endoscopy was evaluated. Results Twenty-six patients (21.3%) achieved TH, and the kappa index was 0.743. On comparing the TH and non-TH groups, the Crohn's disease activity index (p=0.02), endoscopic healing rate (p<0.001), serum albumin (p=0.043), and serum C-reactive protein level (p=0.018) showed significant differences. Among the 122 patients, 69 (56.5%) showed concordance between the diagnosis of CTE and endoscopy, and 22 (18.0%) achieved both TH and endoscopic healing. Conclusion This study provides real-world data on Crohn's disease evaluated with low-dose CTE in Japan. The TH criterion used in this study has a high kappa coefficient and can be used reproducibly in many institutions.

Assessment of gastric wall structure using ultra-high-resolution computed tomography

PURPOSE

To evaluate the image quality of ultra-high-resolution CT (U-HRCT) in the comparison among four different reconstruction methods, focusing on the gastric wall structure, and to compare the conspicuity of a three-layered structure of the gastric wall between conventional HRCT (C-HRCT) and U-HRCT.

METHOD

Our retrospective study included 48 patients who underwent contrast-enhanced U-HRCT. Quantitative analyses were performed to compare image noise of U-HRCT between deep-learning reconstruction (DLR) and other three methods (filtered back projection: FBP, hybrid iterative reconstruction: Hybrid-IR, and Model-based iterative reconstruction: MBIR). The mean overall image quality scores were also compared between the DLR and other three methods. In addition, the mean conspicuity scores for the three-layered structure of the gastric wall at five regions were compared between C-HRCT and U-HRCT.

RESULTS

The mean noise of U-HRCT with DLR was significantly lower than that with the other three methods (P < 0.001). The mean overall image quality scores with DLR images were significantly higher than those with the other three methods (P < 0.001). Regarding the comparison between C-HRCT and U-HRCT, the mean conspicuity scores for the three-layered structure of the gastric wall on U-HRCT were significantly better than those on C-HRCT in the fornix (5 [5-5] vs. 3.5 [3-4], P < 0.001), body (4 [3.25-5] vs. 4 [3-4], P = 0.039), angle (5 [4-5] vs. 3 [2-4], P < 0.001), and antral posterior (4 [3.25-5] vs. 2 [2-4], P < 0.001), except for antral anterior (4 [3-5] vs. 3 [3-4], P = 0.230) CONCLUSION: U-HRCT using DLR improved the image noise and overall image quality of the gastric wall as well as the conspicuity of the three-layered structure, suggesting its utility for the evaluation of the anatomical details of the gastric wall structure.

Three-Dimensional (3D) Breath-Hold Zoomed MR Cholangiopancreatography (MRCP): Evaluation of Additive Value to Conventional 3D Navigator Triggering MRCP in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms

BACKGROUND

To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP.

PURPOSE

To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas.

STUDY TYPE

Retrospective.

POPULATION

A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs.

FIELD STRENGTH/SEQUENCE

3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality.

STATISTICAL TESTS

Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P < 0.05).

RESULTS

Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients.

DATA CONCLUSION

3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern.

LEVEL OF EVIDENCE

4 TECHNICAL EFFICACY: Stage 2.

Correlation between pleural tags on CT and visceral pleural invasion of peripheral lung cancer that does not appear touching the pleural surface

OBJECTIVES

To evaluate the association between a sign and visceral pleural invasion (VPI) of peripheral non-small-cell lung cancer (NSCLC) that does not appear touching the pleural surface.

METHODS

A total of 221 consecutive patients with NSCLC that did not appear touching the pleural surface, ≤ 3 cm in solid tumor diameter, and was surgically resected between January 2009 and December 2015 were included. We focused on the flat distortion of the tumor caused by an arch-shaped linear tag between the tumor and the pleura on CT and named it a bridge tag sign. We evaluated the associations between the clinicopathological features of the tumor, including the bridge tag sign, and VPI. We also evaluated the associations between histopathological findings and the bridge tag sign. The utility of the bridge tag sign in the diagnosis of VPI was statistically assessed.

RESULTS

The bridge tag sign was observed in 48 (20.8%) patients. VPI was positive in 9 (4.1%) patients; among these, the bridge tag sign was positive in 8 patients. In multivariate analysis, a bridge tag sign was significantly associated with VPI. The bridge tag sign was associated with longer contact length of the pleura with the tumor and trapezoid type pleural retraction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the bridge tag sign in the diagnosis of VPI were 88.9%, 83.5%, 83.7%, 18.6%, and 99.4%, respectively.

CONCLUSIONS

A bridge tag sign on CT might improve the accuracy of the prediction of VPI.

KEY POINTS

• We present the bridge tag sign which is defined as a flat distortion of an NSCLC tumor by an arch-shaped linear tag between the tumor and chest wall or interlobar fissure. • The bridge tag sign was an independent predictive factor for visceral pleural invasion. • The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the bridge tag sign in the diagnosis of visceral pleural invasion were 88.9%, 83.5%, 83.7%, 18.6%, and 99.4%, respectively.

Hemodynamic changes of abdominal organs after CT colonography with transrectal administration of CO2: evaluation with early-phase contrast-enhanced dynamic CT

PURPOSE

To evaluate the hemodynamic changes in the liver, pancreas, gastric mucosa and abdominal vessels in early-phase dynamic contrast-enhanced (DCE) CT immediately after CT colonography (CTC) with carbon dioxide expansion.

MATERIALS AND METHODS

This study included 82 patients with DCE-CT after CTC (CTC group) and 77 patients without CTC (control group). Contrast enhancement values of the gastric mucosa, liver, pancreas, portal vein (PV), splenic vein (SpV), superior mesenteric vein (SMV), and inferior mesenteric vein (IMV) in early-phase CT were measured. The presence of hepatic pseudolesions were also recorded.

RESULTS

The mean contrast enhancement values of the gastric mucosa, pancreas and SpV in the CE-CTC group were significantly lower than those in the control group (p < 0.001, p < 0.001, p = 0.014). Conversely, the mean contrast enhancement values of the liver, PV, SMV and IMV in the CE-CTC group were significantly higher than those in the control group (p = 0.003, p = 0.013, p < 0.001, p < 0.001). Hypovascular hepatic pseudolesions were seen in early-phase CT in six patients after CTC, while they were not seen in the control group.

CONCLUSIONS

On DCE-CT performed immediately after CTC with carbon dioxide expansion, it is important to be aware of the imaging findings induced by visceral hemodynamic changes.

Combined Use of Computed Tomography Enterography/Enteroclysis and Capsule Endoscopy Improves the Accuracy of Diagnosis of Small Bowel Bleeding

Objective CT enterography/enteroclysis (CTE) is listed in the clinical practice guidelines as a method for diagnosing small bowel bleeding, as is capsule endoscopy (CE), but there are no real-world data yet available on CTE in Japan. This study aimed to investigate the diagnostic ability of CTE and long-term prognosis after CTE in Japan. Patients We conducted a retrospective cohort study of patients suspected of having small bowel bleeding who underwent both CTE and CE within 30 days between April 2008 and March 2019. The number of patients free from rebleeding for up to 24 months was thus determined. Results Seventy-one patients were extracted from the database. The 43 patients (60.6%) with a definite and suspicious source of bleeding in the small bowel were detected by CTE. When the 31 patients with a definite source of bleeding in the small bowel were analyzed, the sensitivity of CTE was 19/31 (61.3%) and that of CE was 24/31 (77.4%), thus indicating no significant difference (p=0.332). However, the sensitivity when CTE and CE were used in combination was 30/31 (96.8%), which was significantly higher than that of CE alone (p=0.0412). No rebleeding was observed in the CTE and CE negative group (p=0.0965). Conclusion The combined use of CTE and CE increased the detection rate of small bowel bleeding. Therefore, in patients with suspected tumor/polyp lesions, not only CE, but also CTE should be performed. This study provides the first real-world data on the diagnostic accuracy of CTE for small bowel bleeding in Japan.

Image quality in dual-source multiphasic dynamic computed tomography of the abdomen: evaluating the effects of a low tube voltage (70 kVp) in combination with contrast dose reduction

PURPOSE

To compare the image quality of multiphasic (arterial, portal, and equilibrium phases) dynamic computed tomography (CT) of the abdomen obtained by a low tube voltage (70kVp) in combination with a half-dose iodine load using low-concentration contrast agent in high tube output dual-source CT with a standard tube voltage (120kVp) and full-dose iodine load using the same group of adult patients.

METHODS

Fifty-five patients who underwent both low-tube-voltage (70kVp) abdominal CT with a half-dose iodine load and standard-tube-voltage (120kVp) CT with a full-dose iodine load were analyzed. The mean CT values and signal-to-noise ratio (SNR) of the liver, aorta and portal veins were quantitatively assessed. In addition, the contrast enhancement of the abdominal organs and overall image quality were qualitatively evaluated.

RESULTS

The mean CT values and SNR of the liver parenchyma were significantly higher in 70-kVp protocol than in 120-kVp protocol in all 3 phases (p = 0.018 ~  < 0.001). Regarding the qualitative analysis, the overall image quality in the 70-kVp protocol was significantly better than in the 120-kVp protocol in all 3 phases (p < 0.001). In addition, the contrast enhancement scores of the liver parenchyma and hepatic vein in the equilibrium phase were also significantly higher in the 70-kVp protocol than in the 120-kVp protocol (p < 0.001).

CONCLUSION

A low tube voltage (70kVp) in combination with a half-dose iodine load using a low-concentration contrast agent and an iterative reconstruction algorithm in high tube output dual-source CT may improve the contrast enhancement and image quality in multiphasic dynamic CT of the abdomen in patients under 71 kg of body weight.

Transient respiratory motion artifacts in multiple arterial phases on abdominal dynamic magnetic resonance imaging: a comparison using gadoxetate disodium and gadobutrol

PURPOSE

To compare the occurrence of transient respiratory motion artifacts (TRMAs) in multiple arterial phases on abdominal magnetic resonance (MR) images between those obtained using gadobutrol and gadoxetate disodium.

MATERIALS AND METHODS

Two hundred and fourteen abdominal MR examinations (101 with gadoxetate disodium, 113 with gadobutrol) were evaluated. Dynamic three-dimensional contrast-enhanced T1-weighted imaging (CAIPIRINHA-Dixon-TWIST-VIBE) including single-breath-hold six arterial phase acquisitions was performed on a 3.0-T MRI scanner. The TRMAs frequency and the mean TRMA scores were compared between patients assessed with gadoxetate disodium and those assessed with gadobutrol. In addition, the timing of TRMAs appearing for the first time was also recorded and compared between the two groups.

RESULTS

The mean TRMA scores in all arterial phases using gadoxetate disodium were significantly worse than in those using gadobutrol (1.49 ± 0.78 vs. 1.18 ± 0.53, P < .001). Regarding the timing of the occurrence of TRMAs, the severe TRMAs frequency after the third arterial phase was significantly higher in patients using gadoxetate disodium (10/101, 10%) than in those using gadobutrol (0/113, 0%) (P < .001).

CONCLUSION

In multiple-arterial-phase dynamic MRI, the TRMAs frequency when using gadoxetate disodium increased compared with gadobutrol, due to intolerable respiratory suspension after the third arterial phase.

Quantification of pancreas fat on dual-energy computed tomography: comparison with six-point Dixon magnetic resonance imaging

OBJECTIVES

Although it is important to quantify the degree of fatty degeneration of the pancreas, it is difficult to make such a quantification using conventional computed tomography (CT). The present study evaluated the feasibility of pancreatic fat quantification by dual-energy CT (DECT) compared with T2*-corrected six-point Dixon magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Twenty-eight patients who underwent both DECT (100 and 150 kVp) and Dixon MRI without the use of contrast agents were analyzed. The region of interest (ROI) was placed at the head and body/tail of the pancreas on fat volume fraction (FVF) maps generated using the multi-material decomposition (MMD) algorithm on DECT. The FVF (%) of pancreatic parenchyma measured by DECT (CT-FVF) was compared with that measured on FVF maps calculated using Dixon MRI (MR-FVF) using the Spearman rank correlation coefficient.

RESULTS

The median CT-FVF (%) values of the head and body/tail of the pancreas on DECT were 14.2% (range 0.1-81.2%) and 9.4% (range 0-40.8%), respectively. The median MR-FVF (%) values of the head and body/tail of the pancreas on Dixon MRI were 12.2% (range 1.2-80.9%) and 8.1% (range 0.3-43.7%), respectively. CT-FVF (%) measured by DECT showed a significant correlation with the MR-FVF (%) measured by Dixon MRI in the head of the pancreas (ρ = 0.631, P < 0.001) as well as the body/tail of the pancreas (ρ = 0.526, P = 0.004).

CONCLUSION

DECT may be useful for quantifying the degree of fatty degeneration of the pancreas.

Incidentally detected pancreatic adenocarcinomas on computed tomography obtained during the follow-up for other diseases

PURPOSE

To determine imaging findings of pancreatic adenocarcinomas incidentally detected on contrast-enhanced multiphasic dynamic computed tomography (CT) obtained during the follow-up for other diseases.

METHODS

From January 2007 to December 2018, 14 patients with pancreatic adenocarcinomas incidentally detected on CT obtained during the follow-up for other diseases (incidental group) and 105 patients with pancreatic adenocarcinomas symptomatically detected on ultrasound or CT (non-incidental group) were included. Imaging characteristics of the tumor were compared between the two groups. Additionally, imaging findings prior to the detection of a tumor on previous CT images in the incidental group were also assessed.

RESULTS

In cancers of the pancreas body/tail, there was a significantly smaller tumor size (median, 17 mm vs. 42 mm, p < 0.001), a significantly lower incidence of loss of fatty marbling (p = 0.025), vascular involvement (p < 0.001), lymph node metastasis (p = 0.046) and distant metastasis (p = 0.017), and a significantly higher incidence of preserved lobulation (p < 0.001) in the incidental group than in the non-incidental group. Regarding the cancers of the pancreas head, there were no significant differences in the radiological findings between the two groups. On previous CT images, small pancreatic nodules, secondary signs, and loss of fatty marbling tended to be the preceding findings of incidental pancreatic adenocarcinomas.

CONCLUSION

Incidentally detected pancreatic adenocarcinomas in the pancreas body/tail were characterized by an earlier tumor stage than in cases of symptomatically detected pancreatic adenocarcinoma. Several CT findings prior to the detection of a tumor may be useful for the early detection of pancreatic adenocarcinoma during the follow-up for other diseases.

Medication persistence rates and predictive factors for discontinuation of antifibrotic agents in patients with idiopathic pulmonary fibrosis: a real-world observational study

BACKGROUND

In patients with idiopathic pulmonary fibrosis (IPF), continuing treatment with antifibrotic agents is crucial to decrease the reduction of forced vital capacity and mortality rate. However, predictive factors for the discontinuation of antifibrotic agents are unknown. This study aims to investigate the clinical characteristics and predictive factors for the discontinuation of antifibrotic agents in patients with IPF.

METHODS

This was a double-center retrospective study that enrolled patients with IPF treated with pirfenidone or nintedanib between 2009 and 2017. We compared clinical parameters between the medication-continuing group and the discontinued group. The predictive factors were determined using Cox proportional hazards analyses.

RESULTS

A total of 66 subjects were included: 43 received pirfenidone and 23 received nintedanib. At 1 year, 23 of 66 patients had discontinued due to adverse events (n = 12), disease progression (n = 9), or death (n = 2). The characteristics of the discontinuation group were poor performance status (PS) and delay from diagnosis to treatment. In the receiver operating characteristic (ROC) analysis associated with the discontinuation of antifibrotic agents, PS was the highest area under the ROC curve (AUC) value (cut-off value, 2; AUC, 0.83; specificity, 63%; sensitivity, 87%). This finding was consistent even when analyzing, except for examples of death and adjusting for the type of antifibrotic agent. The treatment persistence rate by PS was PS 0-1 = 90%, PS 2 = 65%, and PS 3 = 19%. Analysis of the relationship between PS and administration period of antifibrotic agents revealed that delays from diagnosis to treatment led to worsening of dyspnea, a decline in lung function, and deterioration of PS.

CONCLUSIONS

PS may be informative for predicting discontinuation of medication. Our data reinforced the importance of early initiation of antifibrotic treatment, and we suggest PS should be used as a guide for starting antifibrotic agents in everyday practice. The reviews of this paper are available via the supplementary material section.

Tumor Spread Through Air Spaces Identifies a Distinct Subgroup With Poor Prognosis in Surgically Resected Lung Pleomorphic Carcinoma

BACKGROUND

Tumor spread through air spaces (STAS) has recently been reported as a novel form of lung adenocarcinoma invasion that can negatively affect survival; however, its role in pleomorphic carcinoma remains unclear. The goal of this study was to characterize tumor STAS in pleomorphic carcinoma, including its association with clinicopathologic features and prognosis.

METHODS

Tumor specimens obtained from 35 consecutive patients with pleomorphic carcinoma who underwent surgical resection between 2009 and 2015 were reviewed. Tumor STAS was defined as tumor cells spreading within the air spaces in the surrounding lung parenchyma beyond the edge of the primary tumor.

RESULTS

Fourteen patients (40%) had evidence of STAS-positive pleomorphic carcinomas. Three types of morphologic findings were observed: single cells, small tumor cell clusters, and tumor nests. Tumor necrosis tended to be more prevalent in STAS-positive tumors than in STAS-negative tumors (P = .094). Patients with STAS experienced significantly worse recurrence-free survival (P = .005) and overall survival (P = .002) rates than those without STAS. Moreover, multivariate analysis revealed that tumor STAS was an independent risk factor for both recurrence (P = .014) and poor overall survival (P = .042).

CONCLUSIONS

In this first study of its kind, tumor STAS in patients with pleomorphic carcinoma was shown to be associated with high recurrence rates and poor survival after surgical resection. Hence, tumor STAS can serve as a predictor of postoperative survival; this information will enable better risk stratification and more effective clinical management of patients with this rare type of tumor.

Air bronchogram in pleomorphic carcinoma of the lung is associated with favorable prognosis

Background

Pleomorphic carcinoma (PC) of the lung is a rare histological type of lung carcinoma. The association between computed tomography (CT) findings and histology with outcome remains unclear. We examined the relationships between CT features and histopathologic findings, and evaluated the impact of CT features and other clinicopathologic factors on survival.

Methods

Thirty‐five consecutive patients with PC of the lung who underwent surgery between October 2010 and December 2015 were enrolled in this study. The 35 tumors were classified with or without air bronchogram in the tumors, and with or without intratumoral ground glass opacity (GGO) on CT.

Results

Air bronchogram and GGO were detected in 12 (34.3%) and 5 (14.3%) tumors, respectively. Multivariate analysis revealed that air bronchogram was significantly associated with the presence of adenocarcinoma components with lepidic growth patterns (P = 0.005), and predominance of adenocarcinomas (P = 0.026). GGO was significantly associated with the presence of adenocarcinoma component with lepidic growth pattern (P = 0.010). Air bronchogram was an independent favorable prognostic factor for overall survival, whereas GGO did not have a significant effect on survival.

Conclusion

Air bronchogram observed in PCs of the lung is strongly related with histological components of the tumor and favorable outcome.

Chondrosarcoma of the Rib Mimicking Malignant Pleural Mesothelioma

A 62-year-old man with a history of long-term asbestos exposure was found to have a chest wall tumor invading the sixth rib on chest computed tomography. The computed tomography also revealed multiple plaques in the pleura. Malignant pleural mesothelioma was suspected, and thoracoscopic surgery was performed. Thoracoscopy revealed that the tumor location was extrapleural. Thus, excisional biopsy was performed. The tumor was histologically diagnosed as chondrosarcoma. Additional wide resection of the chest wall, including the fifth, sixth, and seventh ribs, was performed. Chest wall reconstruction was performed with a polypropylene mesh.

Effectiveness of using low-dose computed tomography to assess patency in gastrointestinal tracts with a patency capsule

BACKGROUND/AIMS

A patency capsule (PC) is used to safely perform capsule endoscopy. When the PC is not excreted within the defined time frame, radiography often cannot localize the PC. Computed tomography (CT) localizes a PC more definitively than radiography. We evaluated the localization of PCs using low-dose (LD)-CT.

METHODOLOGY

Forty-nine patients received a PC and 33 did not excrete the PC within the defined time frame and underwent radiography and LDCT with a 90% exposure reduction.

RESULTS

LDCT localized the PC in 31 patients (93.9%), whereas radiography localized it in 7 (21.2%), indicating a significantly higher detection rate with LDCT (P<0.0001). PC retention in the small intestine was confirmed by LDCT in 4 patients. Retention was not observed during capsule endoscopy in the patients with confirmed patency of the gastrointestinal tract. In 21 patients who underwent LDCT with the conventional photographing area, the effective radiographic exposure dose associated with LDCT was 1.43±1.08 mSv. Conversely, in the 12 patients who underwent LDCT with a reduced photographing area, the effective dose was reduced to 0.62±0.27 mSv (P<0.05).

CONCLUSION

LDCT with a reduced exposure dose can definitively localize a PC. Therefore, this method may allow capsule endoscopy to be performed for more diseases.

Temperature dependence and P/Ti ratio in phosphoric acid treatment of titanium dioxide and powder properties

OBJECTIVE

Titanium dioxide has photocatalytic activity and is used as a white pigment for cosmetics. A certain degree of sebum on the skin is decomposed by the ultraviolet radiation in sunlight. In this work, titanium dioxide was shaken with phosphoric acid to synthesize a white pigment for cosmetics.

METHODS

Titanium dioxide was treated with 0.1 mol/L of phosphoric acid at various P/Ti molar ratios, and then shaken in hot water for 1 h. The chemical composition, powder properties, photocatalytic activity, colour phase, and smoothness of the obtained powder were studied.

RESULTS

The obtained materials indicated XRD peaks of titanium dioxide, however the peaks diminished subsequent to phosphoric acid treatment. The samples included small particles with sub-micrometer size. The photocatalytic activity of the obtained powders decreased, decomposing less sebum on the skin. Samples prepared at high P/Ti ratio with high shaking temperature indicated low whiteness in in L*a*b* colour space. The shaking and heating temperature and P/Ti ratio had influence on the smoothness of the obtained materials.

CONCLUSION

Phosphoric acid treatment of titanium dioxide is an effective method to inhibit photocatalytic activity for a white pigment.

CT enteroclysis/enterography findings in drug-induced small-bowel damage

OBJECTIVE

To evaluate the CT enteroclysis (CTE)/enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings.

METHODS

CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE).

RESULTS

Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE.

CONCLUSION

On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage.

ADVANCES IN KNOWLEDGE

Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE.

Persistent elevated C-reactive protein after treatment is an independent marker of a poor prognosis in patients with hepatocellular carcinoma

PURPOSE

The pretreatment C-reactive protein (CRP) level is reported to be a prognostic indicator in patients with hepatocellular carcinoma (HCC).

METHODS

We investigated the prognostic implications of the changes in the CRP level after initial treatment in patients with HCC. We prospectively evaluated a cohort of 150 patients with newly diagnosed HCC. The patients were categorized into three groups: group 1 (n = 120) with pre- and post-treatment CRP <1.0 mg/dl, group 2 (n = 5) with pre-treatment CRP ≥1.0 mg/dl and post-treatment CRP <1.0 mg/dl, and group 3 (n = 25) with pre- and post-treatment CRP ≥1.0 mg/dl.

RESULTS

The 1- and 3-year overall survival rates were 92.3 and 82.9 % for group 1, 80.0 and 53.3 % for group 2, and 58.8 and 4.2 % for group 3. The overall survival rate for group 3 was significantly lower than that for group 1 (P < 0.0001), or group 2 (P = 0.003). No significant difference was found between groups 1 and 2 (P = 0.627). A multi-variate analysis showed that albumin level (P = 0.049), the CRP group (P < 0.0001), and the Cancer of the Liver Italian Program (CLIP) score (P < 0.0001) were independently associated with the overall survival.

CONCLUSIONS

A persistently elevated CRP level after initial treatment is an independent marker of a poor prognosis, and normalization of the CRP level after initial treatment is associated with a better outcome in patients with HCC.

Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma

Background:

Inflammation-based prognostic scores including the Glasgow Prognostic Score (GPS), neutrophil to lymphocyte ratio (NLR), and Prognostic Nutritional Index (PNI) are associated with survival in patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate the prognostic value of these inflammation-based prognostic scores in patients with HCC.

Methods:

In total, 150 patients with newly diagnosed HCC were prospectively evaluated. Patients were divided according to the GPS, modified GPS, NLR, platelet to lymphocyte ratio (PLR), Prognostic Index (PI), and PNI. The area under the receiver operating characteristics curve (AUC) was calculated to compare the predictive ability of each of the scoring systems. A univariate and multivariate analysis were performed to identify the clinicopathological variables associated with overall survival.

Results:

The GPS consistently had a higher AUC value at 6 months (0.768), 12 months (0.787), and 24 months (0.758) in comparison with other inflammation-based prognostic scores. A multivariate analysis showed that the GPS was independently associated with overall survival.

Conclusion:

This study demonstrates that the GPS, an inflammation-based prognostic score, is an independent marker of poor prognosis in patients with HCC and is superior to the other inflammation-based prognostic scores in terms of prognostic ability.

Computed tomography enteroclysis for recurrent severe gastrointestinal bleeding in a patient with vascular malformation of the small bowel

This is a case study of a 66-year-old woman who had a vascular malformation of the small bowel that was visualized on computed tomography enteroclysis (CTE). She presented with repeated tarry stool and severe anemia. Although the source of bleeding was not identified on upper and lower gastrointestinal endoscopy, active bleeding was revealed by capsule endoscopy in the deep jejunum. The cause of bleeding was not found on capsule endoscopy. CTE was requested as double-balloon endoscopy would have been difficult because of strong adhesion of the small intestine. A continual subtle vascular malformation of the jejunum, starting from the third jejunal branch end, was demonstrated on CTE with dynamic contrast enhancement. Because this vascular malformation was considered the cause of small intestinal bleeding, selective arterial coil embolization was performed. After embolization, the repeated tarry stool disappeared and the severe anemia dramatically improved. CTE may be a safe and useful method for determining the cause of small intestinal bleeding and for subsequent therapy.

Distinctive expression of lprcg in the heterozygous state on different genetic backgrounds

Much knowledge of the etiopathogenesis of human autoimmune diseases has been obtained from the mutant mouse models carrying lpr and gld. These autoimmune genes have been regarded as autosomal recessive. The novel lymphoproliferative and autoimmune mutation lprcg is unique in its interaction with gld despite their different chromosomal locations: chromosomes 19 and 1, respectively. Both lprcg and lpr mutations are shown to be the defects in the Fas antigen gene that controls apoptosis. Evidence has been provided for the partial expression of lpr in the heterozygous state and the significant influences of background genes on lpr-induced autoimmune disorders. To investigate the expression of the heterozygous lprcg and the effects of background genes on it, anatomical, serological, and pathological manifestations were compared among lprcg/lprcg,lprcg/+, and +/+ mice on both MRL/MpJ (MRL) and CBA/KlJms (CBA) backgrounds. On the MRL background, lymph nodes (LN) and spleens of lprcg/+ were significantly larger in weight than those of +/+, but far lower than those of lprcg/lprcg mice. In accord with this, these lprcg/+ mice had intermediate levels of anti-single-stranded DNA antibodies, circulating immune complexes, and serum Igs between those of lprcg/lprcg and +/+ mice and were similar to lprcg/lprcg mice in severity of glomerulonephritis. However, accumulation of anomalous CD4-8- T cells characteristic of the lpr disease was not proved in the enlarged lprcg/+ LN. On the CBA background, the LN and spleen weight increases in lprcg/+ were statistically significant compared to +/+ mice but were minimal, being regarded as clinically insignificant. In support of this, lprcg/+ mice were not different from +/+ mice in any of the serological and pathological parameters examined. The results clearly demonstrate that the lprcg gene can function to induce autoimmune disorders in the heterozygous state on the MRL but not on the CBA background.

Nephritogenicity of the lprcg gene on the MRL background

The novel lymphoproliferative and autoimmune lprcg gene, originally discovered in the CBA/K1Jms (CBA) strain of mice, was transferred onto the MRL/MpJ (MRL) strain background, and the resultant partially congenic MRL-lprcg/lprcg carrying 93% or more MRL genomes on average were examined for immune-complex glomerulonephritis and serological aberrations. Ordinary histological studies revealed that MRL-lprcg/lprcg mice developed glomerulonephritis histologically indistinguishable from that in MRL-lpr/lpr but at a lower frequency than in MRL-lpr/lpr mice. Glomerular immune complex deposition was almost the same in MRL-lprcg/lprcg and MRL-lpr/lpr mice. The levels of serum Ig, circulating immune complexes and autoantibodies in MRL-lprcg/lprcg were comparable to or even higher than those in MRL-lpr/lpr mice. Comparison of the serological abnormalities between MRL-lprcg/lprcg with glomerulonephritis and CBA-lprcg/lprcg without it evidenced the enhanced class switch from IgM to IgG responses in both class-specific autoantibody responses and serum Ig levels in MRL-lprcg/lprcg as in MRL-lpr/lpr mice. These results taken together indicate that the lprcg gene functions in much the same manner as lpr in induction of glomerulonephritis and serological abnormalities on the MRL background as expected from the allelism between the two mutant genes.

Interdigitating reticulum cells in human renal grafts

Seventeen human renal graft biopsies taken 1 h to 50 days after transplantation and 3 human renal non-graft biopsies (2 minimal change and 1 non-tumour portion of angiomyolipoma) were investigated with immunoelectron microscopy in order to identify interdigitating reticulum cells (IDC) or dendritic cells (DC) in renal tissues. The antibodies used consisted of a rabbit polyclonal antibody of antihuman S100 beta protein, mouse monoclonal antibodies of antihuman HLA-DR, anti-CD3, and anti-CD1a. IDC or DC were identified in 11 renal grafts. They were found both in the glomerular and interstitial (peritubular) capillary lumens but not in the interstitium of 1 case: both were present in the interstitial capillary lumens and interstitium of another case, and in the interstitium only of 9 cases. In the remaining 6 grafts and 3 non-grafts they were not detected. These 6 grafts and 3 non-grafts did not show any pathological change except for foot process fusion of the glomerular epithelia in 2 cases of minimal change. These findings suggest that IDC or DC are not normally present in human renal tissues. The presence of the cell in the glomerular and peritubular capillary lumens of a biopsy taken after 1 h and their presence in the interstitial capillary lumens of another graft biopsy, suggest that the IDC or DC in human renal grafts are derived from recipients, not donors, and that they migrate from the circulating blood toward the interstitium.

[HCG-producing intrahepatic cholangiocarcinoma]

The serum level of human chorionic gonadotropin (hCG) in a 60-year-old man with intrahepatic cholangiocarcinoma was found to be abnormal (44.6 mIU/ml) at the diagnosis. The patient underwent right hemihepatectomy, and the high serum hCG returned to normal 28 days postoperatively. Six months after the operation, the cholangiocarcinoma recurred in the remnant liver and the hCG level was again elevated to 268 mIU/ml. The patient died of liver failure eight months after the operation. Immunohistochemical studies of the resected tumor showed hCG-positive cells in the cancer nest. In this case, it is (believed) that the intrahepatic cholangiocarcinoma produced hCG and secreted it to the serum.

An analog data processor for chart records using a multielement photodetector

The apparatus, which is capable of computing the convolution integrals of electrically programmed functions and graphical data in the form of recorder traces, is described. The recorder trace is scanned by means of an optical scanner involving a multielement photodiode array. The signals from the scan head, which correspond to trace positions on the chart, are processed with analog circuits so arranged that the weighted moving average is accomplished. The over-all accuracy of the system, including the long-term drift of analog computing electronics, is better than 0.5%. To demonstrate the performance, spectroscopic data provided with conventional ir spectrophotometers are processed. This simple processor can also be utilized as a function generator or an instrument simulator.