[en] A 77 year-old man with bronchogenic epidermoid carcinoma in the left hilum received a course of radiotherapy, after completion of chemotherapy with Cisplatin and Vindesine. Primary lesion and the mediastinum were irradiated up to 70 Gy. Subsequently, he developed serious radiation pneumonitis bilaterally, and died of acute respiratory failure. High dose and wide field irradiation, irradiation to the mediastinum, concomitant chemotherapy and withdrawal of steroids were supposed to be important factors to cause such a serious bilateral pneumonitis. In this case, the most unique point was that the right lung, contralateral to the irradiated lung was affected more seriously than the irradiated lung. It was surmised that due to tumor invasion severely narrowed bronchi and pulmonary arteries in the left lung might have played a role in suppressing effect on the progress of pneumonitis in the left side. We could find no similar case in the literature. (author)

[en] Electrocardiogram-gated spin-echo magnetic resonance (MR) images of the chest were obtained in five normal controls and 35 patients with pulmonary disease (11 chronic obstructive pulmonary disease, 6 pulmonary thromboembolism, 5 primary pulmonary hypertension, 4 interstitial pulmonary disease, 4 pulmonary hypertension with disturbance of portal circulation, and 5 other diseases) who underwent right cardiac catheterization. In transverse images at the level of the right main pulmonary artery (rPA) and sagittal images at the level through the midsternal line and the spinal cord, the signal intensity of blood flow in the rPA was quantitatively evaluated, and the correlations with the MR signal intensity of intravascular flow and the parameters of hemodynamics were studied. In diastole MR images of both normal controls and patients mostly showed a significant signal and visible flow images. In systolic MR images, the mean values of hemodynamic parameters (mean pulmonary arterial pressure (mPAP), pulmonary arteriolar resistance (PAR), and cardiac index (CI)) were abnormal in patients with significant signal intensity of flow compared with those in patients without sufficient MR signal. The signal intensity was not correlated with mPAP; however, it significantly increased as PAR increased, and it increased as CI decreased both in diastole and in systole. Especially in systole, there was good correlation between the signal intensity in transverse MR images and CI and between signal intensity in sagittal MR images and PAR . These results suggest that the signal intensity of blood flow in the rPA on MR images can be used as an index of the severity of right heart failure associated with pulmonary disease. MR imaging is a useful modality to evaluate pulmonary circulation disturbance because of its ability to assess blood flow in the pulmonary artery noninvasively without interference from other structures such as bone and normal lung. (J.P.N.)

[en] On electrocardiogram (ECG)-gated spin-echo magnetic resonance (MR) images, differentiation of thrombi from slow blood flow in the pulmonary arteries (PA) is sometimes difficult in such cases with prominent pulmonary hypertension (PH) as they show high signal intensity of intraluminal slow flow in not only diastole but also systole. ECG-gated, double spin-echo MR images were obtained in eight patients with PH accompanied by the high signal intensity of blood flow in the right main PA in both diastole and systole. These images were compared with those of five patients with chronic pulmonary thromboembolism (CPTE). Slow flow, but not thrombi, significantly increased signal intensity relative to other tissues from the first-echo to the second-echo image. In two patients with both CPTE and PH discrimination between slow flow and central thrombi was established by this imaging technique. This study suggests that ECG-gated, double spin-echo technique is useful for differentiating central thrombi from slow flow. MR imaging can play an important role in detection and repeated noninvasive examination of proximal pulmonary thromboemboli. (author)