Impella insertion for residual aortic dissection

Acute aortic dissection with coronary malperfusion is a life‐threatening disease, resulting in demanding postoperative management. We report a successful insertion of percutaneous heart pump Impella through the intact true lumen in a patient with residual aortic dissection after the graft replacement. Careful evaluation of the access site and the Impella size selection is required.     

Whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography images before and after chemotherapy for Kaposi sarcoma and highly active antiretrovirus therapy

Kaposi sarcoma is an acquired immunodeficiency syndrome-related disease that mainly involves the skin, gastrointestinal gut, and lungs. Whole-body 18F-fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT) scanning is useful for simultaneous detection of multiple lesions of Kaposi sarcoma. We present a 67-year-old man with a history of infection with human immunodeficiency virus who presented with numerous cutaneous lesions. FDG-PET/CT images showed lesions in the skin, lung, and lymph nodes. The gastrointestinal lesions were detected using gastric fiberscopy (GF) and colon fiberscopy (CF). After Kaposi sarcoma therapy, the uptake in the lesions of the skin, lung, and lymph nodes decreased, but new lesions were detected in the pancreas and lumbar spine. He had pancreatitis and Candida spondilitis. Whole-body FDG-PET/CT is useful for detecting lesions and determining the extension to which the disease has spread, adding the gastrointestinal lesions by GF and CF. After therapy, FDG-PET/CT can be used to demonstrate which lesions remain active and to determine the overall response to treatment. In this case, we show how useful FDG-PET/CT is and how difficult it is to treat Kaposi sarcoma.     

Imaging spectrum and pitfalls of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with tuberculosis

Mycobacterium tuberculosis (TB) is one of the most prominant diseases frequently causing false positive lesions in oncologic surveys using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), since TB granulomas are composed of activated macrophages and lymphocytes with high affinity for glucose. These pitfalls of ¹⁸F-FDG PET/CT are important for radiologists. Being familiar with ¹⁸F-FDG images of TB could assist in preventing unfavorable clinical results based on misdiagnoses. In addition, ¹⁸F-FDG PET/CT has the advantage of being able to screen the whole body, and can clearly detect harboring TB lesions as high uptake foci. This article details the spectrum and pitfalls of ¹⁸F-FDG PET/CT imaging in TB.     

The current status of an FDG-PET cancer screening program in Japan, based on a 4-year (2006–2009) nationwide survey

Objective

The aim of this study was to survey the 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening program conducted in Japan.

Methods

The “FDG-PET cancer screening program” included both FDG-PET and positron emission tomography with computed tomography (PET/CT) with or without other combined screening tests that were performed for cancer screening in asymptomatic subjects. A total of 155,456 subjects who underwent the FDG-PET cancer screening program during 2006–2009 were analyzed.

Results

Of the 155,456 subjects, positive findings suggesting possible cancer were noted in 16,955 (10.9 %). The number of cases with detected cancer was 1,912 (1.23 % of the total screened cases, annual range 1.14–1.30 %). Of the 1,912 cases of detected cancer, positive findings on FDG-PET were present in 1,491 cases (0.96 % of the total number of screened cases). According to the results of further examinations, the true positive rate for subjects with suggested possible cancer (positive predictive value) was 32.3 % with FDG-PET. Cancers of the colon/rectum, thyroid, lung, and breast were most frequently found (396, 353, 319, and 163 cases, respectively) with high PET sensitivity (85.9, 90.7, 86.8, 84.0 %, respectively). Prostate cancer and gastric cancer (165 and 124 cases, respectively) had low PET sensitivity (37.0 and 37.9 %, respectively). The Union for International Cancer Control (UICC) clinical stage of cancer found with the FDG-PET cancer screening program was mainly Stage I.

Conclusions

The FDG-PET screening program in Japan has detected a variety of cancers at an early stage. However, several cancers were found in repeated FDG-PET cancer screening program, indicating the limitation of a one-time FDG-PET cancer screening program. The value of the FDG-PET cancer screening program is left to the judgment of individuals with regard to its potentials and limitations.     

Evaluation of Wegener’s granulomatosis using 18F-fluorodeoxyglucose positron emission tomography/computed tomography

Objective

Wegener’s granulomatosis (WG) is a relatively rare disease characterized by granulomatous necrotizing vasculitis that primarily involves small- and medium-sized vessels. Systemic findings observed on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) have not been well reported. The purpose of this study was to evaluate the FDG PET/CT imaging in the diagnosis and follow-up of patients with WG.

Materials and methods

Thirteen FDG PET/CT images obtained for 8 patients (2 men and 6 women) with WG were retrospectively analyzed. Of these, 6 were performed for diagnosis, 2 for restaging and follow-up, and 5 for assessment of treatment efficacy. Maximum standardized uptake values (max SUVs) and visual analyses were used to interpret the FDG PET/CT images. In addition, nonenhanced CT findings obtained during FDG PET/CT were described.

Results

WG lesions of the upper respiratory tract and lung were more clearly detected by FDG PET/CT fusion imaging than by nonenhanced CT alone, and all of the active lesions showed decreased FDG uptake after treatment. In addition, FDG PET/CT can provide complementary information to indicate biopsy site based on FDG uptakes.

Conclusions

FDG PET/CT is a feasible modality for evaluating lesion activities, therapeutic monitoring, and follow-up of WG. Furthermore, biopsy sites of WG lesions may be determined by FDG PET/CT.     

Detection of colorectal cancer and adenomas by FDG-PET cancer screening program: results based on a nationwide Japanese survey

Purpose

The aim of this study was to analyze the detection rate for CRC and adenomas for asymptomatic subjects in Japan by FDG-PET cancer screening program carried out between 2006 and 2009.

Methods

The “FDG-PET cancer screening program” included both PET and positron emission tomography with computed tomography (PET/CT) with or without other screening tests. A total of 154,783 asymptomatic subjects underwent FDG-PET cancer screening program; we analyzed the 1,808 cases with findings from any detection method that indicated suspected CRC.

Results

Among the 1,808 cases, the number of cases verified as CRC and adenoma was 394 and 679, respectively. The sensitivity and positive predictive value (PPV) of FDG-PET were 86.0 and 31.7 % for CRC, and 63.6 and 63.8 % for CRC and adenoma. The sensitivity and PPV of fecal occult blood test (FOBT) for CRC were lower than those of FDG-PET, but higher for adenoma. Therefore, FDG-PET and FOBT were complementary for screening for CRC, and CRC and adenoma. The majority of CRC detected by the FDG-PET imaging was UICC stage 0 or I, however, detection of smaller or less invasive cancer was limited.

Conclusion

The FDG-PET screening program in Japan has detected CRC at an early stage and adenomas as premalignant lesions. A combination of FDG-PET and FOBT yields the best results if the intent is to detect either CRC or adenoma. However, it is absolutely clear that an FDG-PET cancer screening program cannot detect all colon lesions.     

Prognostic value of post-treatment 18F-FDG PET/CT for advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy简

Objective：To clarify the prognostic value of post-treatment 18F-fluorodeoxyglucose （FDG） positron emission tomography （PET）/computed tomography （CT） in patients with advanced head and neck squamous cell carcinoma （HNSCC） after combined intra-arterial chemotherapy and radiotherapy （IACR）.Methods：Thirty-six patients with HNSCC who underwent IACR were recruited.The period from the end of IACR to the last post-treatment 18F-FDG PET/CT examination was 8-12 weeks.Both patient-based and lesion-based analyses were used to evaluate the PET/CT images.For lesion-based analysis,36 regions （12 lesions of recurrences and 24 scars at primary sites） were selected.The Kaplan-Meier method was used to assess the overall survival （OS） stratified by 18F-FDG uptake or visual interpretation results.Results：Twelve patients with recurrence were identified by six months after IACR.The sensitivity and specificity in the patient-based analysis were 67％ （8/12） and 88％ （21/24）,respectively.The mean OS was estimated to be 12.1 months （95％ CI,6.3-18.0 months） for the higher maximum standardized uptake value （SUVmax） group （n=7） and 44.6 months （95％ CI,39.9-49.3 months） for the lower SUVmax group （n=29）.OS in the higher SUVmax group （cut-off point,6.1） or positive visual interpretation group was significantly shorter than that in the lower SUVmax or negative visual interpretation group （P＜0.001 and P＜0.05,respectively）.Conclusions：The SUVmax and visual interpretation of HNSCC on post-IACR 18F-FDG PET/CT can provide prognostic survival estimates.     

6 cases of contralateral atelectasis immediately after thoracotomy in lateral position--its mechanism and treatment

Six cases of atelectasis developing in the unopened contralateral lung immediately after thoracotomy in the lateral position were presented, and its cause and treatment were discussed. Atelectasis due to retention of secretion showed various atelectatic X-ray shadows which differed in size by the segment or lobe unit. On the other hand, cases of atelectasis whose occurrence was surmised to be related to the lateral position and anesthesia showed mainly infiltrative shadows which extended from the outer region of the middle-lower lung field to the basal segments of the lung, although some cases were accompanied by atelectatic shadows of various size in terms of the segment or lobe unit. Therefore in order to prevent atelectasis, it is desirable to move sputum by aspiration and appropriately apply ventilation, intermittent pressurization and PEEP, while paying careful attention to the unopened lung. In the treatment of atelectasis, selective endobronchial pressurization using a bronchofiberscope equipped with a cuff was effective. It was also very effective to place an endotracheal tube for ordinary anesthesia near the target bronchus with the aid of a bronchofiberscope and perform selective endobronchial pressurization via that tube.     

Limited wrist arthrodesis versus radial osteotomy for advanced Kienb?ck's disease--for a fragmented lunate.

Thirty-eight patients with advanced Kienb?ck's disease treated by limited wrist arthrodesis (LWA: n = 10) or radial osteotomy (RO: n = 28) for a fragmented lunate were retrospectively examined after an average of 47.9 and 68.1 months, respectively. Compared with pre-operative values, the active flexion-extension range of motion decreased by about 16.0 degrees in LWA and increased approximately 9.7 degrees in RO and the grip strength improved by approximately 7.5 kg in LWA and 8.0 kg in RO. In both groups, radiographs showed no significant progression of carpal collapse. Although LWA caused some decrease in wrist flexion-extension, both procedures are appropriate for surgical treatment of advanced Kienb?ck's disease. Most patients experienced a reduction in pain and were able to return to work.     

石黑法治疗伴撕脱骨折的锤状指

目的评估应用石黑法及其改良法治疗伴撕脱骨折的锤状指的临床疗效. 方法采用石黑法及其改良法治疗27例伴撕脱骨折的锤状指,在透视下运用闭合穿针的方法,在远侧指间关节(DIP)屈曲位时于背侧插入阻挡针,然后用另一根克氏针将DIP固定于充分伸直位;当较大的骨折块向背侧有旋转移位时,可加用一根克氏针撬拨复位并固定骨折块. 术后随访2个月～ 6年6个月,采用改良的Crawford法从DIP的疼痛、关节活动度和捏力等3个方面评估疗效. 结果 27例骨折均愈合,愈合率为100%.术后DIP的总体主动活动范围为屈曲(54.19±14.45)度,伸直(-4.96±9.27)度,术后总优良率为66.7%.仅有1例X线片示轻度骨性关节炎表现. 结论石黑法治疗伴撕脱骨折的锤状指,不仅操作相对简便、疗效可靠,而且从美观的角度更易为患者所接受.