[en] Cranial stereotactic irradiation (STI) of a metastatic brain tumor (BT) was planned by fusing CT images with MRI images using the landmark method of the X-Knife System. The MRI images revealed the BT, the critical optic nerve and brain stem of structures and the eyeball and blood vessels that are landmarks. It was important to improve visibility of the BT with sufficient contrast. Therefore, comparison examinations were performed using the two dimensions fast spin echo (2DFSE), the two dimensions fast spoiled gradient echo (2DFSPGR), and the three dimensions fast spoiled gradient echo (3DFSPGR) methods of T1-weighted imaging with Gd-DTPA contrast. Critical structures and the internal structures of the landmark method were suitable for planning STI when the results of three or more points were combined in visual evaluations. However, the 2DFSE method could showed three or more points. The BT also be visually evaluated using three or less points by the FSPGR method, but had reduced visibility. From detailed contents, the fall of visual evaluation by the small thin and solid BT of the diameter of a BT was characteristic. In the whole signal noise ratio (SNR), the 3DFSPGR method is excellent in images analysis, and the 2DFSE method was excellent in contrast noise ratio (CNR) of a BT. The cystic BT accompanied by dropsy was images with clear and good depiction in all scan parameter. However, the FSPGR method was the boundary not clear in the small solid BT, the FSE method was able to recognize the maximum of the diameter of BT most, and depiction was good. Artifacts of blood flow and motion of the FSE method is a fault. However, the FSE method had the highest useful depiction ability of all BT in the STI plan. (author)

[en] A 73-year-old woman with a large esophagorespiratory fistula underwent bronchoscopy and computed tomographic (CT) virtual endoscopy before stenting. Noninvasive CT virtual endoscopy showed the large fistula, and the CT findings agreed with the bronchoscopic findings

[en] Merits over demerits of combining chemotherapy (CT) and radiotherapy for primary brain malignant lymphoma (PBML) has recently been emphasized. In our institution solo-local brain irradiation (LB) supported with chemotherapy has been performed on four patients to avoid therapeutic brain damage. Results in radiotherapy in 17 patients with PBML from 1987 to 1995 were retrospectively analyzed. 16 patients completed the radiation schedule with consisting of 45.9±6.5 Gy. Among the 16 patients three were treated with whole brain irradiation (WB) nine with WBLB and the four LB. Complete disappearance (CR) was obtained in 81.3%. Early death occurred in 4 out of 5 patients with non-telencephalic, i.e., mid brain pontine and ventricular based lesions. Overall MST was 25.5 months. Disease free survival (DFS) was better in WB + WBLB group than LB (p<0.05). Averaged relapsing time was 24.8 month in WB + WBLB and 8.2 in LB. No statistical differences were found in survival rate between WB (+) and WB (-) and in DFS between CT (+) and CT (-). Activity index was improved in 7 but worsened in 4 patients after radiotherapy. In conclusion solo-local brain irradiation supported with chemotherapy did not show any merit than whole brain based therapy. (author)

[en] A high signal-to-noise ratio (SNR) can be obtained in three-Tesla (3T) MRI, and it is possible to use it to shorten imaging time and improve spatial resolution. However, reports of its disadvantages have been increasing. We attempted to describe a high-resolution evaluation image that made the best use of a decrease in specific absorption rate (SAR) and high SNR by using the LAVA (liver acquisition with volume acceleration) method, a kind of three-dimensional GRE (3D gradient echo) method that did not show the above-mentioned disadvantage in obtaining a shadow inspection of the female pelvic area with 3T MRI. A 0.8 mm isovoxel image of excellent SNR could be obtained within about one and one-half minutes by using the LAVA method as a result of the examination. Moreover, a SAR that was problematic with the 3T MR device was able to be decreased, and was useful. (author)

[en] Automatic exposure control technology can reduce the radiation dose during CT. The purpose of this study is to reveal the important points regarding the usage of organ effective modulation (OEM), by evaluating the characteristics of OEM, an automatic exposure control technology. An analysis of the dosage profiles revealed that OEM may not work with the first rotation of the X-ray tube in the helical method and wide volume method. This phenomenon can be avoided by using the orbital synchronism helical method. This was also demonstrated upon measurement of the integrated absorption dose at the imaging start position. An analysis of standard deviation measurement revealed that with the combined use of OEM and x-y modulation, the reduction in dose may significantly vary depending on the presence or absence of the gantry tilt. Based on the above results, when using OEM to reduce the dose at the imaging start position, the combined use of x-y modulation should be avoided and the orbital synchronism helical method should be used. (author)

[en] In order to treat fistulated esophageal cancer using a flexible stent, a covered flexible stent was constructed by wrapping a nitinol stent with a thin sheet of Gore-Tex, preserving the stents original advantages of flexibility and a low-profile introducer system. This stent was used to perform standard radiotherapy in a case of fistulated esophageal cancer

No abstract available

[en] Purpose: To assess the efficacy of Doppler ultrasonography (US) as a noninvasive method for monitoring patency of the transjugular intrahepatic portosystemic shunt (TIPS). Methods: Twenty-nine patients who had received TIPS for bleeding esophagogastric varices and/or refractory ascites with portal hypertension underwent Doppler US studies within 2 weeks after TIPS. Further studies were performed in 15 of them at 6 months, in 9 at 1 year, and in 4 at 2 years for a total of 57 US studies. The US findings were compared with the angiographic findings obtained at the same time. Results: In 45 of the 57 studies, shunt patency was found by Doppler US, correlating to 44 patencies and one occlusion on angiography. Doppler signal in the shunt could not be detected in 12 studies resulting in the diagnosis of shunt occlusion. This correlated with angiographic occlusion in 8 studies and patency in the remaining 4. All angiographically patent shunts that were occluded by Doppler US had various degrees of stenosis. A number of technical factors were found to be responsible for Doppler US false-positive or false-negative diagnoses, some related to the type of stent used. The Doppler US sensitivity was therefore 92%, the specificity 89%. Conclusion: Doppler US is a reliable noninvasive method to evaluate patency of TIPS

[en] Purpose. We evaluated the suitability of Dacron, polytetrafluoroethylene (PTFE), and small intestinal submucosa (SIS) as a covering material for stent-grafts placed in the portal vein as compared with a bare stent. Methods. Using 24 beagle dogs, either bare stents or stent-grafts covered with Dacron, PTFE, or SIS were placed in the main trunk of the portal vein in 6 animals each. Portography was performed immediately after stent placement, and at 2, 4, and 12 weeks thereafter. Next, the extracted stents or stent-grafts were examined histopathologically. Neointimal thickness adjacent to the stent wire and at the midportion between the stent wires was compared among the groups. Then, the neointimal thickness at the sub- and supragraft sites was compared between each stent-graft group. Serial changes in the histologic features of the thickened neointima were also investigated. Results. No significant difference was noted in the mean stenotic ratio of the portal vein diameter between the bare stent and PTFE groups, whereas it was significantly higher in the Dacron and SIS groups compared with the bare stent group. In neither of the studies on neointimal thickness adjacent to the stent wire and at the midportion between the stent wires were any significant differences noted between the neointimal thickness of the bare stent group and the sum of the neointimal thickness of the PTFE group, whereas the sum of the neointimal thickness of the Dacron and SIS groups was significantly greater than that of the bare stent group at both sites. In the comparison of the supragraft neointimal thickness, the SIS group showed significantly greater thickness than the PTFE group, while the difference between the Dacron and PTFE groups was not significant. In the comparison of the subgraft neointimal thickness, the Dacron and SIS groups showed significantly greater thickness than the PTFE group. Conclusion. The present results indicate that of the three covering materials examined here, PTFE is the most suitable material for grafts placed in the portal vein

[en] A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS