Clinical Outcomes of Intraoperative Radiotherapy, Postoperative Radiotherapy, and Definitive Radiotherapy for Non-metastatic Pancreatic Cancer

OBJECTIVE

The aim of this study is to evaluate the utility of adjuvant radiotherapy (intraoperative radiotherapy, IORT; postoperative radiotherapy, PORT), and definitive radiotherapy for non-metastatic pancreatic cancer.

METHODS

Ninety-nine patients were analyzed. Thirty patients underwent IORT with surgery, 31 underwent PORT after surgery, and 38 underwent definitive radiotherapy. Tumor stage [Union for International Cancer Control (UICC) 2009] was as follows: Stage I, 7; IIA, 16; IIB, 31; III, 45. The doses for IORT, PORT, and definitive radio therapy were 20 to 30, 40 to 64.6, and 50.4 to 61.2 Gy, respectively. Associations between clinical parameters including age, gender, tumor site, stage, performance status, surgical margin, and use of chemotherapy and local control (LC) or overall survival (OS) were analyzed.

RESULTS

Follow-up periods for all patients were 1.1-145 months (median, 11). OS rate in the IORT, PORT, and definitive radiotherapy groups was 22%, 16%, and 6%, respectively, at 2 years. The 5-year OS rate was 13%, 3.2%, and 0%, respectively. Local control rate at 2 years was 33%, 35%, and 0%, respectively. No Grade ≥ 3 tox icities were observed. Distant metastasis was less common in the IORT group. Stage and surgical margin were sig nificant factors for OS after IORT. Performance status and chemotherapy were significant factors for OS after PORT and definitive radiotherapy.

CONCLUSIONS

The present study showed the safety of the three treatment modalities, but the outcomes were not satisfactory. More intensive strategies including radiotherapy should be investigated.

Triaxial system in stent-graft placement for traumatic renal artery dissection: A case report

Stent-graft placement is an important treatment for traumatic renal artery dissection, but it may occasionally be technically difficult to advance a catheter through the lesion of the dissection due to severe stenosis of the true rumen. A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has recently become available, and it contributes to super-selective catheterization. We thought this system may be useful for passing catheters through the dissection. We herein report a 30-year-old male patient with traumatic renal artery dissection, who was successfully treated by stent-graft placement using the triaxial system.

2D-shear wave elastography in the prediction of type II endoleaks after endovascular aneurysm repair

PURPOSE

To evaluate the usefulness of 2D-shear wave elastography (2D-SWE) in the prediction of type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA).

MATERIAL AND METHODS

Twenty-nine patients underwent EVAR for AAA, and 2D-SWE was performed after EVAR. Follow-up contrast-enhanced CT and ultrasonography were performed to evaluate endoleaks in all patients. The median follow-up period was 12 months (range, 3-12 months). Patients were divided into two groups: one with an endoleak (endoleak group) and another without it (control group). We compared the elasticity index (EI) of intraluminal thrombus (ITL) and fresh thrombus (FT) between the two groups.

RESULTS

Type II endoleaks were confirmed in five of the 29 patients (endoleak group), and there were no endoleaks in the other 24 (control group). ILT was observed in 21 patients of the control group and in all patients of the endoleak group. There was a difference only in EI of ILT; the mean EI (± standard deviation) of ILT was 89 ± 16 kPA in the control group and 113 ± 25 kPA in the endoleak group (p=.037).

CONCLUSIONS

High EI of ILT may predict the occurrence of type II endoleaks after EVAR of AAA.

Internal mammary lymph node metastases in breast cancer: what should radiologists know?

The internal mammary lymph node (IMLN) chain is a pathway through which breast lymphatic drainage flows. The internal mammary lymphatic vessel runs around the internal mammary artery and veins with IMLN in the parasternal intercostal spaces. IMLN metastasis, which forms a part of clinical TNM staging, may negatively affect the prognosis of primary breast cancer patients. IMLN metastasis is clinically detected using ultrasound, computed tomography, magnetic resonance imaging, and ¹⁸F-deoxyglucose positron emission tomography computed tomography. The uptake of radioactive tracers in IMLN with clinically negative axillary lymph nodes is often identified using sentinel lymph node mapping (SLNM) in primary breast cancer patients. The indication for IMLN biopsy or resection that is clinically detected or visualized using SLNM is controversial. The clinically suspicious IMLN may be considered for ultrasound-guided fine-needle aspiration. First IMLN recurrence needs to be biopsied. Irradiation of the breast, chest wall, and/or regional nodal irradiation, including IMLN, following lumpectomy or postmastectomy is recommended. Although radiation therapy for IMLN recurrence may improve clinical outcomes, it is also associated with pulmonary and cardiac toxicities. This review covers the local anatomy of IMLN, lymph drainage and image findings of IMLN with a discussion.

Is targeted reconstruction necessary for evaluating contrast-enhanced chest computed tomography using a liquid crystal display monitor?

PURPOSE

The aim of this study was to examine whether 20-cm field-of-view (FOV) targeted reconstruction (TR) on contrast-enhanced (CE) chest computed tomography (CT) might improve the diagnostic value compared with simple zooming (SZ) from whole-thorax FOV images using a 2 million (2M)-pixel liquid crystal display (LCD) monitor.

MATERIALS AND METHODS

We prospectively evaluated 44 patients. SZ images were magnified from a FOV of 26-34 cm (mean 29.7 cm). Parameters were 512 x 512 matrix and 3 mm thickness and interval. Images were reconstructed using a soft-tissue kernel. Three radiologists evaluated contour, spiculation, notch, pleural tag, invasion, and internal characteristics of the lesions using 5-scale scores. We also performed a phantom study to evaluate the spatial resolution of images.

RESULTS

The diagnostic value of the TR images was similar to that of the SZ images, with the findings identified in 88%-100% of the cases. Artifacts from high-density structures deteriorated the image quality in six (14%), and the SZ images were judged to be preferable in five of them. In the phantom study, there was little difference in spatial resolution between the two images.

CONCLUSION

The SZ images from whole-thorax FOV on CE chest CT were similar in quality to TR images using a 2M-pixel LCD monitor.

Congenital Pulmonary Airway Malformation

OBJECTIVES

Congenital pulmonary airway malformation (CPAM) is classified into 5 subtypes (types 0 to 4). We attempted to correlate computed tomography (CT) findings with those of pathologic examination and evaluated the predictability of the CPAM subtype.

SUBJECTS AND METHODS

We retrospectively reviewed CT findings in 13 pathologically proven cases of CPAM seen between 1981 and 2005. Patient's age ranged from 4 days to 5 years and 10 months. Six were boys and 7 were girls. According to CT findings, lesions with a cyst larger than 2.5 cm, lesions with cysts 2.5 cm or less and solid lesions were classified into groups A, B, and C, respectively. We assumed that Stocker's types 1 and 4, type 2, and types 0 and 3 would correspond to CT groups A, B, and C, respectively. Then, we assessed whether this assumption is correct or not.

RESULTS

Eight, 3, and 2 cases were diagnosed as groups A, B, and C, respectively. All of the 8 cases diagnosed as group A were Stocker's type 1. One of the 3 cases diagnosed as group B was type 2, but the remaining 2 were type 1 and type 4, respectively. One of the 2 cases diagnosed as group C was type 3 but the other was type 2.

CONCLUSIONS

Lesions with the largest cyst being larger than 2.5 cm was type 1. It seemed, however, difficult to distinguish among types 1, 2, and 4 when they consisted of small cystic components and between types 2 and 3 when they appeared as a solid lesion.

Blunt renal trauma: Comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of superselective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast-enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT. Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with superselective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen.

Embolization for asymptomatic aneurysms of the first jejunal artery

In a 71-year-old man with a history of coronary artery bypassing using the left internal thoracic and gastroepiploic arteries, the first jejunal artery aneurysms were found by chance at 3D-CT performed to evaluate conditions of the grafts. He was successfully treated by transcatheter embolization using interlocking detachable coils. During a follow-up period of 5 months, the patient did well and had no sign of intestinal ischemia.

[The frontiers of diagnostic radiology--PET/CT, 3DCT--]

Recently, positron-emission tomography (PET) systems have been introduced in many institutions around Japan and their clinical importance should increase in the management of many malignant diseases particularly systems using 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG). Since March 2004, we have been using the first PET/computed tomography (CT) scanner in Japan with 4-slice multidetector CT (MDCT) and now have introduced a second PET/CT scanner with 8-slice MDCT because of its excellent diagnostic capability and higher throughput capacity than that of the ordinal PET scanner. MDCT was a landmark in the history of CT in 1998. Subsequently, 8-, 16-, 32-, and 40-slice MDCT was developed in rapid succession. Finally, 64-slice MDCT became commercially available in 2005. In the future, 256-slice MDCT and flat-panel CT will appear in the clinical setting. Using these MDCT systems, we can now obtain multidimensional CT images very easily. These multidimensional images are less-invasive methods that are gradually phasing out the use of invasive angiography including digital subtraction angiography. In this article we describe the current features of PET/CT and multidimensional CT using MDCT.

CT and MR findings of a pleomorphic adenoma in the peripheral lung

We report a rare case of pleomorphic adenoma in the peripheral lung and its appearance on both CT and MR. The findings correlated well with the pathological findings and corresponded to the nature of the cellular predominance type that is common in the lung but is rare in the salivary gland.

A case of right-sided aortic arch with isolation of the left subclavian artery: CT findings

We report a case of right-sided aortic arch with isolation of the left subclavian artery diagnosed using computed tomography (CT). This was a rare type in which the left subclavian artery, originating from the pulmonary artery via the arterial duct, was isolated after closure of the ductus. Collateral circulation was considered to be obtained mainly from the left intercostal artery via the costocervical trunk through the supreme intercostal artery.

A case of ganglioneuroma with fatty replacement: CT and MRI findings

We report a rare case of posterior mediastinal ganglioneuroma with fatty replacement together with its appearance on CT and MRI and suggest adding this entity to the differential diagnosis of fat-containing posterior mediastinal masses.

Diffuse pulmonary lesions in early phase Takayasu arteritis predominantly involving pulmonary artery

We report a case of early phase Takayasu arteritis that predominantly involved the pulmonary arteries and had, along with expected radiographic findings, the unusual pattern of diffuse pulmonary parenchymal lesions on CT. We suggest that this finding may be an additional feature in early phase Takayasu arteritis and need not require investigation for an additional diagnosis.

Covered stent placement for artificial cervical carotid aneurysms. Experimental study

SUMMARY

In order to evaluate the midterm patency and the effectiveness of Dacron-covered self-expanding metallic stent in the treatment of cervical carotid aneurysm, we made wide-necked carotid aneurysms with a technique of vein pouch end-to-side anastomosis, and implanted the stents percutaneously to occlude the aneurysms in dogs. The patency was angiographically followed up for 3 months with anticoagulation and antiplatelet medications. The Dacron-covered stent could make the aneurysms disappear angiographically within ten minutes if it was implanted in the correct place. The acute thrombotic obstruction was seen in one of the five regions. The delayed stenosis was seen in two of the five regions in two weeks. Only one of the five regions was patent three months after the stent placement without stenosis. In this case, no cerebral infarction of the brain was found histologically. The Dacron-covered stent can make wide-necked aneurysms occlude quickly. However, the short or midterm patency was poor, suggesting that it is not safe enough to be used clinically in carotid lesions. Further study should be needed to improve the materials for a covered stent before clinical applications.

Characterization of monoclonal antibodies against (1R,2R)-cyclohexanediamine platinum(II)-DNA adduct

Two monoclonal antibodies raised against Pt(II)(1R,2R-cyclohexanediamine)-DNA were prepared, and the specificity of the monoclonal antibodies against Pt(II)(cyclohexanediamine)-DNA derivatives was determined by competitive enzyme-linked immunosorbent assay. The binding affinity of the monoclonal antibodies is apparently influenced by the cyclohexanediamine moiety of Pt(II)(cyclohexanediamine)-DNA adducts, but the monoclonal antibodies can not bind to the low molecular analogue, Pt(II)(1R,2R-cyclohexanediamine)-d(GpG), which is the intrastrand binding model compound of Pt(II)(1R,2R-cyclohexanediamine)-DNA. Therefore, the monoclonal antibodies recognize the macromolecular parts, including DNA duplex, in addition to the cyclohexane moieties of the platinum complexes on Pt(II)(cyclohexanediamine)-DNA adducts.