[en] The purpose of this study is to evaluate the clinical usefulness of exercise (Ex) ECG test with sublingual nitroglycerin (NTG) and Ex cardiac scintigraphy in differentiating false positive responses from true positive responses of Ex ECG test. We examined 7 pts (age : 46+-7 years) with true positive Ex ECG test (TP) and 8 pts (age : 55+-10 years) with false positive Ex ECG test (FP). TP had significant coronary artery disease and FP did not. Ex test was done by multistage ergometer test. In 5 pts of TP and all pts of FP, Ex cardiac scintigraphy was performed. In TP, Ex cardiac scintigraphy revealed reversible perfusion deficit, but not in FP. NTG was administered 3 minutes before Ex test was started. Ex test with NTG was terminated at the same load as Ex test without NTG. Pressure-rate products at the end point of Ex test did not show significant difference between Ex test without NTG and that with NTG (TP: 203x10², 213x10², FP: 196x10², 206x10², respectively). In 7 pts of FP, ST depression in Ex test without NTG was not improved in Ex test with NTG. On the other hand, in all pts of TP, ST depression seen in Ex test without NTG, was not observed in Ex test with NTG. It may be concluded that Ex cardiac scintigraphy is diagnostic for differentiation of false positive responses from true positive responses of Ex ECG test, as well as Ex ECG test with NTG is. (author)

[en] Metabolic function-morphologic correlation throughout whole-body sections with F-18-fluorodeoxyglucose positron emission tomography (FDG PET)/CT scan is an excellent tool for diagnosis and treatment strategy of malignancies of various organs. As well as in other regions, the recent systemic review and meta-analysis of accumulated experiences over the world has comprehended the utility of this technique in diagnosis and treatment strategy of abdomino-pelvic tumors. Especially, the panel recommends the physicians to use this technique for initial staging, therapeutic response assessment, re-staging and detection of recurrent or progressive lesions after surgery or chemo-radiation therapy, and for prediction of prognosis. On the other hand, the panel has clarified some limitations of this technique for differential diagnosis and accurate assessment of local tumor extension and lymph node metastasis, and recommends the combined use of other imaging modalities. This second chapter describes the utility and limitation of FDG PET/CT scan in esophageal and gastric cancer, gastrointestinal stromal tumor (GIST), primary and metastatic liver tumors, biliary ductal tumors, pancreatic and splenic tumors and colorectal cancers, based on systemic review of recent literatures. (author)

[en] Cancer surveillance after 1980 has revealed that the incidence of second primary cancers (SPC) is 1.53-8.5% in patients with known malignant lesions and is being increased because of increasing population of elder patients and prolonged survival rate resultant from advanced effective treatment. Detection of SPC is important, since these cancers highly impact treatment algorithms. 2-[¹⁸F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET)/CT scan enables systemic survey of malignant tumors and has been expected to be a powerful tool for detecting SPC. The present study analyzed SPC detected by FDG PET/CT scan in 3374 patients who underwent this scan to evaluate known or suspected first primary cancers at our institution. A total of 18 SPC in 17 patients, including 10 synchronous and 8 metachronous cancers in other organs, were detected by FDG PET/CT scan. These cancers were most frequently found in patients with head and neck cancers, and in the lung and stomach. 6 (35.2%) of these cancers were not identified prior to FDG PET/CT scan. 7 (41.1%) of these SPC were operable. FDG PET/CT scan can play an important role for non-invasively detecting SPC in various organs. The knowledge of primary cancers and organs which have a relative high incidence of SPC is important for interpretation of this examination. (author)

[en] Positron emission tomography (PET) or PET/CT with 2-[fluorine 18] fluoro-2-deoxy-d-glucose (FDG) plays an important role for diagnosis and management in patients with various malignancies, as the recent meta-analysis has shown significant changes of management in approximately one-third patients with various malignancies with additional use of FDG PET scan. In gynecological region, the National Comprehensive Cancer Network Overian/Uterine Cancer Guideline recommends the use of FDG PET in detecting recurrent lesions with negative CT/MR imaging findings and rising tumor marker levels and in obtaining confirmative diagnosis of CT/MR-indeterminate lesions. In urogenital region, the evidences indicating of the utility of FDG PET for initial staging and re-staging after surgery are now being accumulated, regardless of some inherent limitations in evaluation primary lesions. At this final chapter for the review of the feasibility of FDG PET/CT in abdomino-pelvic regions, the content is focused on the utility and limitations of this technique in gynecological/urogenital oncology. (author)

[en] We evaluated the usefulness of computed tomography (CT) in diagnosing and management acute appendicitis. We studied 133 patients diagnosed with acute appendicitis confirmed by plain CT between March 2004 and November 2008. Sixty-nine of these patients underwent appendectomy, 64 were treated conservatively. Recurrence of acute appendicitis was recognized in 13 out of 64 patients treated conservatively, and appendectomy was done in 8. On the CT findings of 77 patients who underwent appendectomy, appendicoliths were shown in 50 patients. In 64 patients treated conservatively, 14 patients had images of calcified appendicoliths. Eight out of 14 patients with appendicoliths had small calcifications, which were not obstructive in inner lumen of appendix. Inflammatory signs (increased white blood cell (WBC) and C reactive protein (CRP), and fever) with positive signs on CT, including calcifications, periappendicular infiltration, free fluid etc., are useful in confirming the clinical diagnosis and directing treatment (operative versus conservative) of patient. (author)

[en] F-18-2-Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT scan, which simultaneously provides metabolic function and morphology on the same tomographic section, is being the key imaging modality for diagnosis and treatment strategy of makignancies in various organs. FDG PET/CT scanning of the whole body beneficially allows the assessment of primary tumor and regional lymph nodes, and distant metastases and co-existed benign/other malignant lesions, as ''one stop shopping'' fashion. This technique contributes to the selection of the optimal treatment in individual patients, and also can predict histopathologic response to treatment and postoperative/post chemo-radiation therapeutic prognosis. In this paper, we describe the fundamental knowledge required for accurate interpretation of FDG PET/CT scan, and review the utility of this technique for diagnosis and treatment strategy of makignancies in abdominal and pelvic regions. (author)

[en] Neuroradiological modalities, particularly CT, for sellar and parasellar lesions were reviewed. Although accurate preoperative diagnosis is sometimes difficult, CT diagnosed 83% as far as pituitary adenoma, craniopharyngioma and meningioma were concerned and demonstrated abnormal findings in 95% of parasellar tumors. At the authors' department, CT visualized abnormalities in all cases, with the exception of suprasellar arachnoid cyst, but a histological diagnosis was possible only in 84%. Since lesions including tumors cannot be completely denied even if CT shows normal images, findings by modalities such as plain craniography, cerebral tomography, cerebral angiography and cisternography should be judged comprehensively. (Chiba, N.)

[en] Studies were conducted to know the availability of MRI in the diagnosis of lumbar canal stenosis (LCS). Seventy six patients of advanced age with low back pain were chosen; half of the patients showed neurological manifestations in their lower extremities (LCScases) but the remaining half did not (low back pain (LBP) cases). All patients underwent MRI of the lumbar spine and abnormal imagings were analyzed. The results showed that the following changes could be demonstrated at a high frequency in the cases of LCS as compared with those in LBP; (I) morphological changes classified as either the Trefoil or the Deficit type in the spinal canal cross section, (II) protrusion and degeneration of the intervertebral disk, (III) brightness changes of endplate, and (IV) increasing thickness of the yellow ligament. Individual change did not always correspond to the extent of the neurological manifestation of LCS. However, patients of 92 percent showed the changes of both (II) and (III) in LCS cases. Therefore, lumbar spine MRI provides useful information in the diagnosis of LCS when the changes are considered with clinical signs of patients. (author)

[en] Fourteen patients with tongue squamous cell carcinoma were treated with high-dose-rate interstitial brachytherapy. The patients consisted of nine males and five females aged from 40 to 88 years (median age, 71.0 years). As an initial treatment, external radiotherapy was combined for three patients, and intra-arterial chemotherapy was combined for eleven patients. Five-year local control rates were 92.9%. Local recurrence and delayed neck lymph nodes metastasis were detected in two cases (14.3%) and three cases (21.4%) respectively, but all patients lived in non-cancer bearing now, except the one who died from the other illness. The major adverse events were oral mucositis, xerostomia and bone exposure with ulcer. Especially oral mucositis was found in all case, and bone exposure and xerostomia often occurred as late complication. Our date suggested that high-dose-rate brachytherapy for tongue cancer patient may be an effective and an acceptable therapy as a functional preservation therapy against oral cancer. However, this therapy may have a risk of occurrence of radiation osteonecrosis. Thus, we must follow the patient closely. (author)

[en] Thyroid scintigraphy and the clinical evaluation during recent several years in department of radiology, Yamaguchi University Hospital were discussed: The transition of radionuclides, the comparison with scintigraphic findings and pathological patterns of patients, and the use of various radionuclides were studied. In thyroid scintigraphy, scanning with single radionuclide is very difficult to achieve the accurate diagnosis. The adequate combination of various radionuclide is preferable for the determination of diagnosis. The result of study suggest us that the adequate combination of various nuclide (Na¹³¹I, sup(99m)TcO₄^- and ²⁰¹Tl-chloride) is preferable for the determination of diagnosis. Medical Literature were discussed. (author)