Intense accumulation of indium-111 leukocytes in peritonitis carcinomatosa

In order to detect the infectious foci in a case of terminal recurrent cancer of the sigmoid colon with intense inflammation, In-111 oxine leukocyte scintigraphy was performed. Leukocytes labeled with In-111 oxine quickly localized within the region of peritonitis carcinomatosa and could be imaged after 4 hours. With time, high activity appeared in this area. And 48 hours after injection, the large intestine was clearly seen. However, no activity was seen in the main recurrent tumor. This suggested that the labeled leukocytes had accumulated in regions of inflammation rather than in malignant tissue. When performing In-111 leukocyte scintigraphy for diseases in which tumor cells and inflammation are mixed, distinguishing the two components is particularly important, and time-sequential scanning is very useful.

Ga-67 scintigraphy in chromomycosis

We examined an interesting case of chromomycosis that had a characteristic Ga-67 accumulation. This patient had had widespread chromomycosis skin lesions for 8 years. We performed Ga-67 scintigraphy in an attempt to obtain additional information on the site and extent of the lesion. Ga-67 scintigraphy revealed not only all subcutaneous nodules but also an unsuspected enlarged lymphnode and a visceral lesion. This case indicates that Ga-67 scintigraphy is a very useful method to use in detecting the site and extension of chromomycosis, especially in the nodal and the visceral lesions, and sometimes might help in differential diagnosis.

[Clinical evaluation of indium-111-labeled leukocyte imaging in bone infection]

In-111-oxine-labeled leukocyte imaging was performed on twenty-one patients suspected of having bone infection. Nine of eleven cases (82%) were diagnosed as having active infection as demonstrated by abnormal accumulation of In-111-labeled leukocytes at the site of infection. There are two false negative (18%) cases. Two cases without active infection showed abnormal uptake. Four cases revealed cold defects on the scintigraphy. Marked uptake of radiotracer was noted not only in the case of acute osteomyelitis with acute septicaemia but also in the case with persistent chronic active osteomyelitis. It was observed that for precise evaluation of the test results it was equally important to compare the imaging findings with physical signs and laboratory investigations. It is concluded that In-111-oxine-labeled leukocyte imaging is a useful tool for the evaluation of the progression of bone infection.

Evaluation of myocardial perfusion abnormality by profile analysis for digital subtraction angiogram

For quantitative estimation of ischemia, ECG-synchronized digital subtraction angiography was performed for selective coronary arteriography. The authors obtained sequential myocardial perfusion images at the arterial, capillary, and venous phases. Profile densitometry was performed along the cross section perpendicular to the long axis of the left ventricle to assess regional myocardial perfusion at the capillary phase quantitatively. By this densitometry, the volumes of vascular bed perfused by the left coronary artery could be estimated, and further, nontransmural myocardial infarction could be differentiated from transmural myocardial infarction through the profile of its density curve. This method appears to be useful for the analysis of myocardial perfusion of ischemic heart disease.

[Bone dynamic study--evaluation for factor analysis of hip joint]

Factor analysis was applied to dynamic study of Tc-99m MDP for the evaluation of hip joint disorders. Fifteen patients were examined; eight were normal, six were osteoarthritis in which one accompanied synovitis was included, and one was aseptic necrosis on the head of the femur. In normals, according to the Tc-99m MDP kinetics, three factor images and time-activity curves were obtained which were named as blood vessel, soft tissue, and bone factor images and curves. In the patient with osteoarthritis, increased accumulation of the hip joint was shown in bone factor image only. But in one patient, who took osteoarthritis with synovitis, marked accumulations of the Tc-99m MDP appeared not only on the bone factor image but also on the soft tissue. Operation revealed thickening synovial tissue around the hip joint, caused by inflammatory process. In follow-up studies of the patient with aseptic necrosis on the head of the left femur, excessive accumulations, which were seemed in his left hip joint on both bone and soft tissue factor images at first, were decreased respondently to the treatment of this lesion. In conclusion, the factor analysis was useful for differencial diagnosis of the hip joint disorders and observation of the clinical course of the hip joint disorders.

An ultrasonographic method for detection of Achilles tendon xanthomas in familial hypercholesterolemia

The diagnosis of familial hypercholesterolemia (FH) is frequently made on clinical grounds and detection of tendon xanthomas is crucial for that. In order to clarify whether ultrasonography (US) can be used as a reliable and practical method for detection of Achilles tendon xanthomas in FH, the Achilles tendon thickness in the sagittal section was examined by US in 15 patients with heterozygous FH and 34 normocholesterolemic subjects. US visualized clearly the anterior and posterior borders of the Achilles tendon. The Achilles tendon thickness determined by US correlated with that measured by conventional radiography (r = 0.99). The mean values +/- SD of the Achilles tendon thickness determined by US were 4.5 +/- 0.5 mm in the normal controls and 11.9 +/- 5.1 mm in the patients and the difference was significant (P less than 0.001). In 13 of 15 patients, US visualized thickened Achilles tendons with convex shape in the sagittal section. All the thickened Achilles tendons revealed by US were confirmed by radiography. The data indicate that US can detect Achilles tendons thickened by xanthomas. We conclude that US is a useful aid in the clinical diagnosis of FH.

Relationship between MR relaxation time and muscle fiber composition

The relationship between magnetic resonance (MR) relaxation times and muscle fiber composition was investigated in 16 men, and a high positive correlation was found. Higher proportions of fast-twitch fiber were associated with longer relaxation times, indicating that fast-twitch fiber has a longer relaxation time than slow-twitch fiber. Multiple regression analysis, conducted to investigate the suitability of relaxation time as a model of estimating muscle fiber composition, revealed that T1 and T2 were significantly related to muscle fiber composition. These results indicate that MR relaxation time may be used to estimate muscle fiber composition.

Present status of PACS activities in Japan

Three PACS organizations in Japan are: J-PACS, JAMIT-PACS and JRS-PACS. J-PACS committee is composed of representatives of manufacturing companies. Many Japanese companies are actively engaged in developing PACS-related products and services. The annual JAMIT Symposium includes an International PACS day. The JRS-PACS Committee is working to bring academics and industry closer together in developing and implementing PACS technology. MIPS has two working groups which started in 1985. The Survey Working Group issued the draft on Survey study of integral technology and present state and trends of existing systems. The Standardization Working Group, which is to complete work in 1989, issued the draft of image data format on the magnetic tape and discussion about the standardization of online digital interface for PACS. The draft of the MIPS Standard was mostly based on ACR/NEMA Standard, but simplified and reduced. However, the number of minimum parameters essential in image transfer were retained. Early experiences with PACS in Tominaga Memorial Hospital, Kyoto University Hospital and Kochi Medical School Hospital was briefly mentioned. Japan is facing a period in the early 1990s in which PACS is to be widely introduced into the university hospitals.

Tricuspid regurgitation diagnosed by intravenous digital subtraction angiography

In spite of numerous available diagnostic methods, controversies concerning the precise diagnosis of tricuspid regurgitation (TR) still remain. In right ventriculography, catheter placement may modify tricuspid valvular function. Though noninvasive Doppler echocardiography is a useful method, it is sometimes too sensitive for clinical use. Furthermore, it is not applicable to cases in which ultrasound penetration is limited. In this study, we evaluated TR using intravenous digital subtraction angiography (DSA), which can provide good images even in cases with poorly recorded echocardiograms. For this study, we placed a catheter in the superior vena cava. Cardiac DSA examinations were performed in one hundred and one patients with heart disease. We injected 35 ml of contrast medium at a speed of 18 ml/sec via a catheter introduced in the superior vena cava. DSA images by continuous mode were obtained in the RAO projection for 15-20 sec. Sequential DSA images were observed and analyzed by time-density curves of the regions of interest (ROI) which were placed in the right ventricle (RV) and inferior vena cava (IVC). Doppler echocardiography was performed for 16 cases in which TR was suspected. Of these, phonocardiography with jugular pulse tracing was recorded for 14 and contrast echocardiography were performed for six, respectively. In cases without evidence of TR, regurgitation of contrast medium into the IVC during RV systole was not recorded by the DSA method. In cases of clinically-proven TR, regurgitation into the IVC during RV systole was observed. Thus, this was considered a diagnostic feature of positive TR using the DSA method, and 13 of the 16 cases undergoing Doppler echocardiography were diagnosed as having TR using the DSA method. The severity of TR was categorized as mild, moderate and severe according to analyses of time-density curves. The severity established by the DSA method showed a close correlation with the clinical severity of TR. Doppler echocardiography was negative for TR in two of the 13 cases, but positive for TR in two of the 16 suspected cases only by the Doppler method. In cases of moderate to severe TR diagnosed by the DSA method, jugular pulse tracings showed a regurgitant wave. By contrast echocardiography, TR was evident only in cases of severe TR diagnosed by the DSA method. In conclusion, the DSA method proved useful for diagnosing TR.

[The integrated score of prognostic factors with regard to the recurrence of cervical carcinoma]

Eighty-nine patients with carcinoma of the cervix received radical radiation therapy from May 1981 through 1983 at the hospital of the National Institute of Radiological Sciences. After a 2 to 4 year follow-up, primary cancer was found to be controlled in 59 patients, a recurrence was noted in 16 patients but 12 patients had died without precise information concerning recurrence. We examined the correlation between recurrence and seven prognostic factors. Among these factors, the tumor volume, age, and the red blood corpuscle sedimentation rate showed a relatively strong correlation. A multivariable analysis (quantification methods II) was undertaken in order to integrate these prognostic factors and the score that was calculated from this analysis showed a strong correlation to local control. We believe that this score can be used for predicting recurrences and can be applied to the selection of patients for new treatments like hyperthermia or high LET irradiation.

Effects of nifedipine on left ventricular systolic and diastolic function in patients with ischemic heart disease. Radionuclide angiocardiographic studies at rest and during exercise

The purpose of this study was to evaluate the acute effects of sublingual nifedipine (10 mg) on left ventricular systolic function (ejection fraction, peak ejection rate, time to peak ejection rate) and diastolic function (peak filling rate, time to peak filling rate, filling fraction during rapid filling) at rest and during exercise using radionuclide angiography in 17 patients with ischemic heart disease. The results of the study were as follows. Diastolic indexes in the patient group were significantly different from the values in the control group at rest and during exercise. Peak filling rate and filling fraction improved significantly after nifedipine administration. These values did not show significant differences from the values in normal subjects which were obtained before nifedipine administration. The peak filling rate during exercise after nifedipine administration increased significantly, although the value was lower than that in the control group. At rest, systolic indexes in the patient group showed abnormal values, although the differences from the control values were not significant. Ejection fraction and peak ejection rate were significantly lower than those in the control group during exercise. After nifedipine administration, peak ejection rate at rest and during exercise, and ejection fraction at rest in the patient group improved significantly. Seven of 17 achieved the same exercise workloads as control conditions without symptoms or ECG changes. These data suggest that nifedipine improved left ventricular systolic and diastolic dysfunction, as well as exercise tolerance in patients with ischemic heart disease.

Variable neurohumoral and hemodynamic responses to exercise in patients with exertional angina: influence of the severity of coronary artery disease

To assess neurohumoral and hemodynamic responses to exercise in patients with exertional angina, we measured plasma norepinephrine (NE) concentrations in 23 patients with exertional angina (with no heart failure) and compared the results with their coronary arteriographic findings. The 23 patients were divided into two groups: 14 cases with multiple vessel disease (MVD) and 9 cases with one-vessel disease. At resting state there were no significant differences between the two groups in levels of NE. At maximal exercise there were no significant differences between the groups in increases of heart rate, blood pressure, and rate-pressure product, but exercise-induced increase of plasma NE (%) was significantly larger in MVD (131.6 +/- 95.4%) (mean +/- SD) than in one-vessel disease (69.0 +/- 45.3%) (p less than 0.01). In conclusion, plasma NE responses to exercise differ between patients with multiple vessel disease and patients with one-vessel disease.

Daily variations of ECG and left ventricular parameters at exercise in patients with anginal attacks but normal coronary arteriograms

In 21 patients with typical exercise-induced anginal pain but normal coronary arteriograms (group N) and in 14 patients with angiographically proved coronary stenosis (group C), symptom-limited ergometer exercise ECG and radionuclide angiocardiography were performed twice on two different days. Exercise-induced ST changes showed larger variations between the two exercise tests in group N than in group C ([delta ST1-delta ST2]: 0.07 +/- 0.06 mV in group N, 0.03 +/- 0.03 mV in group C, p less than 0.05). Rate pressure product and left ventricular ejection fraction at exercise also showed larger variations between the two tests in group N than in group C (p less than 0.001, p less than 0.05, respectively). However, substantial overlaps existed in some cases in the two groups. In conclusion, some of the patients with exercise-induced anginal pain but normal coronary arteriograms may have a variable threshold of exertional chest pain probably caused by variation in coronary vascular tone, and the other patients may have a fixed threshold of chest pain caused by other mechanisms.

Synchrotron radiation at the Photon Factory for non-invasive coronary angiography: experimental studies

Synchrotron radiation available at the Photon Factory, National Laboratory for High Energy Physics, provides a new X-ray source which is highly suitable for K-edge subtraction. This is due to its high intensity, its parallelism and its monochromaticity, available in a monochromator system. Experiments were performed using wiggler synchrotron radiation. Since the beam size is relatively-small for in-vivo imaging, a phantom coupled with a detector was moved horizontally using a scanning table. K-edge subtraction was successfully applied both to the coronary artery phantom filled with barium sulphate, and to rat angiography using iodine contrast material. The potential use and value of energy subtraction was successfully demonstrated.

Isoproterenol infusion stress two-dimensional echocardiography in diagnosis of coronary artery disease in elderly patients. Comparison with the other stress testing methods

Since a dynamic exercise stress test cannot always be performed adequately in elderly patients, an alternative method is needed for evaluation of coronary reserve. We studied two-dimensional echocardiographic (2-DE) and electrocardiographic (ECG) responses to infusion of isoproterenol (ISP) at a rate of 0.02 micrograms/Kg/min in 40 elderly patients with chest pain. The results were compared with exercise ECG (EX-ECG) tests and exercise radionuclide angiocardiography (EX-RNA) in 13 of these patients. No serious complications were encountered in the ISP test. The diagnostic sensitivity for coronary artery disease (CAD) was 71% for ISP-2-DE, 71% for ISP-ECG, 86% for EX-ECG and 71% for EX-RNA. The specificity for CAD was 83% for ISP-2-DE, 33% for ISP-ECG, 50% for EX-ECG and 100% for EX-RNA. In conclusion, the ISP-2-DE test is a safe, easily available and useful method for the assessment of coronary artery disease in elderly patients.

Digital subtraction angiography: image-sequence analysis for regional myocardial perfusion dynamics

Digital subtraction angiography with selective coronary injections of contrast media has enabled us to obtain clear images, not only of the artery, but of the capillary and venous phases of the myocardial perfusion. In the present study, densitometry was used to estimate regional myocardial perfusion dynamics in 10 control cases and 11 anterior myocardial infarction cases. The time density curve showed that contrast material increased rapidly in the arterial phase and appeared to be washed out monoexponentially in the venous phase. The time from the onset of contrast medium injection to the maximal density of the contrast medium (Tp), and the time constant obtained from the washout curve (Tc) were analyzed. In the control group, Tp in the apical region was slightly prolonged as compared with Tp in the anterobasal region, but the difference was not significant (5.2 +/- 0.5 vs 4.2 +/- 0.4 sec: mean +/- SEM). Tc did not definitely change in any portion of the myocardium (anterobasal 5.1 +/- 0.5, anterior 4.8 +/- 0.5, apex 4.6 +/- 0.5 sec, respectively). In anterior myocardial infarction, Tp in the marginal region was significantly prolonged compared to Tp in the control region (6.0 +/- 0.3 vs 4.7 +/- 0.3 sec, p less than 0.01). Tp was prolonged for more than 10 sec in the infarcted region. Tc in the marginal region was markedly prolonged compared to Tc in the control region (7.4 +/- 0.9 vs 4.4 +/- 0.5 sec, p less than 0.025). Tc could not be determined in the infarcted regions because data acquisition time of our apparatus was inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)