Efficacy and reliability of highly functional open source DICOM software (OsiriX) in spine surgery

We evaluated the feasibility and reliability of open source Digital Imaging and COmmunication in Medicine (DICOM) imaging software, OsiriX (Antoine Rosset, 2003-2009), in spine surgery. CT data were used and processed with OsiriX and with commercial software for comparison. Images were reconstructed and compared in volume rendering (VR) and multi-planar reconstruction (MPR) mode. When all images were compared, the three-dimensional (3D) reconstructed images from both software packages showed considerable consistency in VR mode. Measurements in MPR mode also showed similar values with no statistically significant difference. These results demonstrate that OsiriX has approximately equivalent values to commercial software and provides reliable preoperative 3D information for the surgical field. In addition, any clinician, can obtain information using OsiriX at any time. Thus, OsiriX is a helpful tool in preoperative planning for spine surgery.

Rotational hypermobility of disc wedging using kinematic CT: preliminary study to investigate the instability of discs in degenerated scoliosis in the lumbar spine

The number of patients showing lumbar degenerative scoliosis, including disc wedging, has increased, and examination of the mechanism of spinal nerve compression due to lateral and rotational mobility of the lumbar spine is necessary. Thirty-two patients with L4-L5 disc wedging but without antero- or retrospondylolisthesis and ten age-matched controls were examined. The angle of disc wedging and change in the angle between left and right bending were evaluated by anterior-posterior X-ray images of patients while they were in a standing position. The degree of disc degeneration and existence of vacuum phenomena were evaluated at the L4-L5 discs. Rotational mobility between maximal right and left rotation was examined by computed tomography (CT). Rotational mobility was measured using the spinal transverse processes of L4 and L5. The relationship between these factors was statistically evaluated using multivariate analysis and Spearman's correlation test. There was a significant increase in the average rotational mobility of the L4-L5 disc-wedging group. In the L4-L5 disc-wedging group, the increased angle of disc wedging and change in the angle between left and right bending correlated with increased rotational mobility. The degree of disc degeneration did not affect rotational mobility. However, existence of vacuum phenomena increased the rotational mobility of the L4-L5 disc-wedging group. This is the first study to evaluate the rotational hypermobility of L4-L5 disc wedging in patients without antero- or retrospondylolisthesis using kinematic CT. Increases in the wedging angle and abnormal instability of lateral bending correlated with increased rotational mobility. For surgical planning of degenerative L4-L5 disc wedging, it is important to consider rotational hypermobility using kinematic CT or X-ray imaging findings of lateral bending.

Quantitative measurement of blood flow using perfusion CT for assessing clinicopathologic features and prognosis in patients with rectal cancer

PURPOSE

The ability to evaluate clinicopathologic features and prognosis before surgery by contrast-enhanced CT would be valuable for managing rectal cancer. This study was designed to evaluate the clinical usefulness of perfusion CT in patients with rectal cancer before surgery.

METHODS

Forty-four consecutive patients (27 men, 17 women; median age, 63.6 years) with rectal cancer underwent perfusion CT before surgery. We retrospectively investigated the correlations between tumor blood flow generated by perfusion CT and clinicopathologic features.

RESULTS

There was a significant correlation between blood flow and wall invasion (P = 0.04). Well-differentiated tumors showed significantly higher blood flow than moderately differentiated tumors (P = 0.03). There was a significant tendency for tumors with low blood flow to show lymph node metastasis (P = 0.0005), vascular invasion (P = 0.004), lymphatic invasion (P = 0.04), and distant metastasis (P = 0.0005). For blood flow, accuracy was 75% for detection of tumors with lymph node metastasis if the cutoff point was set at 55 ml/100 g per minute. Patients with high blood flow tumors survived significantly longer than those with low blood flow tumors (P = 0.002).

CONCLUSIONS

Blood flow of rectal cancers may be useful to evaluate pathologic features and prognosis before surgery.

Chronic obstructive pulmonary disease and interstitial lung disease in patients with lung cancer

BACKGROUND AND OBJECTIVE

Although lung cancer is frequently accompanied by COPD and interstitial lung disease (ILD), the precise coincidence of these diseases with lung cancer is not well understood. The objectives of this study were to determine the prevalence of abnormal CT and spirometric findings suggestive of COPD or ILD in a population of patients with untreated lung cancer, and to estimate the lung cancer risk in this population.

METHODS

The study population consisted of 256 patients with untreated lung cancer and 947 subjects participating in a CT screening programme for lung cancer. Semi-quantitative analysis of low attenuation area (LAA), fibrosis and ground glass attenuation (GGA) on CT was performed by scoring. Gender- and age-matched subpopulations, with stratification by smoking status, were compared using the Mantel-Haenszel projection method.

RESULTS

Inter-observer consistency was excellent for LAA, but not as good for fibrosis or GGA scores. Pooled odds ratios for lung cancer risk using LAA, fibrosis, GGA scores and reduced FEV(1)/FVC and %VC were 3.63, 5.10, 2.71, 7.17 and 4.73, respectively (P < 0.0001 for all parameters). Multivariate regression analyses confirmed these results.

CONCLUSION

Abnormal CT and spirometric parameters suggestive of COPD and ILD were strong risk factors for lung cancer, even after adjusting for gender, age and smoking status.

Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results

BACKGROUND AND AIMS

Although branch duct intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas without mural nodules are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied. The aim of this study was to elucidate the natural history of branch duct IPMNs without mural nodules.

METHODS

Eighty-two patients who had no apparent mural nodules on initial examination were selected for follow-up. All subjects underwent examinations by imaging modalities including endoscopic retrograde pancreatography, and were followed-up by regular examinations once or twice a year. Serial changes of the maximum cystic diameter and the appearance of mural nodules were studied during the observation periods ranging from 14 to 148 months (median, 61 months).

RESULTS

Nine (11.0%) of 82 patients exhibited obvious progression of cystic dilatation (median, 59 months). Of these nine patients with cystic enlargement, six continued with regular follow-up examinations. Three cases underwent surgical resection, and were pathologically diagnosed as adenoma in two and borderline in one. Four patients (4.9%) showed newly developed mural nodules in dilated branch ducts (median, 105 months). Histological analysis revealed three cases classified as adenoma and one as carcinoma in situ. None of the remaining 69 patients (84.1%) showed any changes in dilated branch ducts (median, 57 months).

CONCLUSIONS

Most branch duct IPMNs without mural nodules remained unchanged during long-term follow-up. Although follow-up with careful examination is required to detect newly developed mural nodules in dilated branch ducts, branch duct IPMNs without mural nodules can be followed-up without surgery.

Patient dose estimation for multi-detector-row CT examinations

The spread of Multi-detector-row computed tomography (MDCT) has been remarkable. Here, various organ and tissue doses were evaluated with six types of MDCT scanners in common use in Japan; using thermoluminescence dosimeters and anthropomorphic phantoms under condition of routine clinical examinations of the chest in adult and child, of the head in child and of the abdomen-pelvis in adult. Estimated lung doses and averaged effective dose in chest examinations were 19.2 +/- 2.03 mGy and 9.54 +/- 0.90 mSv for the adult and 15.7 +/- 1.88 mGy and 7.42 +/- 0.82 mSv for the child phantom, respectively. The numerical difference between effective dose and organ or tissue doses was about 2-2.5 times. For the adult abdomen-pelvis examinations, averaged effective dose was 13.0 +/- 3.72 mSv. Averaged effective dose for the child head examinations was 2.6 +/- 1.32 mSv. In one case, the dose approached 80 mGy for the brain in the head examination, giving a difference from the effective dose of 10 times or more.

Perfusion CT can predict the response to chemoradiation therapy and survival in esophageal squamous cell carcinoma: initial clinical results

The ability to predict the response to chemoradiation therapy (CRT) by contrast-enhanced CT would be valuable for managing esophageal squamous cell carcinoma. The purpose of this study was to evaluate the usefulness of Perfusion CT to predict the response to CRT in patients with esophageal squamous cell carcinoma. Thirty-one consecutive patients with esophageal squamous cell carcinoma underwent Perfusion CT before CRT. We retrospectively investigated the correlations between Perfusion parameters and the response to CRT. Clinicopathological markers and blood flow were compared in terms of survival. There were 21 clinical responders and 10 non-responders. Clinical responders showed significantly higher pre-CRT blood flow (P=0.0004), significantly higher pre-CRT blood volume (P=0.03) and a significantly shorter pre-CRT mean transit time (P=0.002) than non-responders. For pre-CRT blood flow, accuracy was 90.3% for detection of clinical responders when the cut-off point was set at 50 ml/100 g/min. Patients with high blood flow tumors survived significantly longer than those with low blood flow tumors (P=0.006). Multivariate analysis identified blood flow as a significant independent prognostic factor (P=0.01). Therefore, Perfusion CT may help to identify patients with advanced esophageal squamous cell carcinoma who will benefit from CRT.

Perfusion CT can predict the response to chemoradiation therapy and survival in esophageal squamous cell carcinoma: initial clinical results

The ability to predict the response to chemoradiation therapy (CRT) by contrast-enhanced CT would be valuable for managing esophageal squamous cell carcinoma. The purpose of this study was to evaluate the usefulness of Perfusion CT to predict the response to CRT in patients with esophageal squamous cell carcinoma. Thirty-one consecutive patients with esophageal squamous cell carcinoma underwent Perfusion CT before CRT. We retrospectively investigated the correlations between Perfusion parameters and the response to CRT. Clinicopathological markers and blood flow were compared in terms of survival. There were 21 clinical responders and 10 non-responders. Clinical responders showed significantly higher pre-CRT blood flow (P=0.0004), significantly higher pre-CRT blood volume (P=0.03) and a significantly shorter pre-CRT mean transit time (P=0.002) than non-responders. For pre-CRT blood flow, accuracy was 90.3% for detection of clinical responders when the cut-off point was set at 50 ml/100 g/min. Patients with high blood flow tumors survived significantly longer than those with low blood flow tumors (P=0.006). Multivariate analysis identified blood flow as a significant independent prognostic factor (P=0.01). Therefore, Perfusion CT may help to identify patients with advanced esophageal squamous cell carcinoma who will benefit from CRT.

Abnormal collateral arterial systems in Takayasu's arteritis and Leriche's syndrome evaluated by whole body acquisition using multislice computed tomography

Takayasu's arteritis causes various arterial changes, including wall thickening, occlusion, aneurysm, and calcification. Similarly, Leriche's syndrome causes occlusion of the abdominal aorta or iliac arteries accompanied by ischemic symptoms of the distal lower extremities. Both diseases are potentially associated with the development of unexpected collateral arteries throughout the body. We evaluated whole body arteries in subjects with Takayasu's arteritis and Leriche's syndrome using 16-slice multislice CT and concluded that it was a useful tool to detect unexpected collateral arterial systems in Takayasu's arteritis or Leriche's syndrome in a non-invasive fashion.

Anatomy of the middle hepatic vein: applications to living donor liver transplantation

BACKGROUND/AIMS

In living donor liver transplantation, right lobe graft without a middle hepatic vein (MHV) results in potential venous congestion in the anterior segment, while transplantation with MHV represents an important ethical issue from the perspective of donor safety. The present study assessed ramification patterns of the MHV and relationships between hepatic venous drainage of the anterior and medial segments, to plan optimal harvesting of the right lobe as a graft.

METHODOLOGY

The authors reviewed 102 patients with normal livers who underwent contrast-enhanced multi-detector row CT.

RESULTS

The hepatic vein that drained S4sup (V4sup) joined only the left hepatic vein (LHV) in 60 patients (58%), only the MHV in 25 (25%), and both LHV and MHV in 17 (17%). Both V4sup and the hepatic vein that drained S8 (V8) joined the MHV in 42 patients (42%), and V8 joined proximal to V4sup in 18 of these 42 patients.

CONCLUSIONS

In donation of a right lobe graft including MHV, preservation of V4sup in the remnant donor liver seems possible in most donors.

Influence of heart rate on the detectability and reproducibility of multislice computed tomography for measuring coronary calcium score using a pulsating calcified mock-vessel in comparison with electron beam tomography

BACKGROUND

The influence of heart rate on detectability and reproducibility of multislice computed tomography (MSCT) for measuring coronary calcium score was evaluated using pulsating calcified mock-vessels and compared with electron beam tomography (EBT).

MATERIALS AND METHODS

Four calcified mock-vessels with 200-350 HU were made to pulsate at a rate of 40-80 beat/min. Retrospective ECG-gating MSCT (Light Speed Ultra 16) scanning with 0.625 mm slice-thickness was performed twice at each pulsation rate. For comparison, EBT (Imatron C150 XP) was performed with 3 and 1.5 mm beam collimation with prospective ECG-gating and calcium scores were measured.

RESULTS

The comparison revealed that MSCT did not have better reproducibility than EBT, but the calcium scores with MSCT were less influenced by pulsation rates than those with EBT. Especially in mild calcification, the calcium scores decreased with EBT with 3 mm beam collimation with increasing pulsation rate, but the scores were stable in any rate with MSCT.

CONCLUSION

MSCT effectively detects coronary calcification, especially mild calcification, without being influenced by heart rate. This is accomplished by reducing the partial volume effect in the through plane using sub millimeter slice thickness, and using appropriate reconstruction methods, which improve temporal resolution.

[Small sclerosing hemangioma combined with primary lung cancer; report of a case]

A 56-year-old woman underwent a surgery for right breast cancer when she was 51-year-old. In February 2002, computed tomography (CT) was performed as a part of a follow-up study and showed 2 small nodules in the lower lobe of her right lung: one was 10 mm nodule in S9, and another was 5 mm in S6. On a follow-up CT in March 2005, the S9 nodule had enlarged to 19 mm and was looked as ground glass opacity (GGO). We thought it was primary lung cancer. In contrast, the nodule in S6 had not enlarged and it was thought to be benign. In May 2005, right lower lobectomy was performed. The S9 nodule was diagnosed as adenocarcinoma, and the S6 nodule as sclerosing hemangioma.

[Mediastinal granular cell tumor: report of a case]

Mediastinal granular cell tumor is rare. We report a case of 16-year-old woman with a granular cell tumor in the right upper-middle mediastinum. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4.0 x 2.5 x 5.5 cm well circumscribed mass in the right upper-middle mediastinum. Tumor resection was performed. It was found that the tumor involved right vagus nerve. The tumor was completely excised with combined resection of the right vagus nerve peripheral to the right recurrent nerve. Histopathologically, the tumor consisted of round to polygonal cells with abundant eosinophilic granular cytoplasm, and diagnosed a granular cell tumor.

[Positron emission tomography (PET)-computed tomography (CT) suggesting small intestinal metastasis from lung cancer; report of a case]

A 75-year-old man admitted to our hospital due to an abnormal X-ray shadow detected during an annual health check-up. Chest computed tomography (CT) revealed 3.0 cm solid nodules with chest wall invasion in the left lung. We could not get a definitive diagnosis by transbronchial lung biopsy or CT-guided needle biopsy. Positron emission tomography (PET)-CT revealed positive findings in the tumor, aortopulmonary window lymph node and splenic flexure. Under a diagnosis of suspected lung cancer, thoracotomy was performed. As intraoperative diagnosis revealed a moderately differentiated squamous cell carcinoma, the patient underwent a left upper lobectomy, mediastinal lymph node dissection, and combined chest wall resection. Pathological stage was T3N2M0, stage IIIA. Ten days after surgery, the patient suffered from ileus and emergent surgery was performed. Subsequent pathological examination revealed lung cancer metastasis in the small intestine.

[Surgical resection of metachronous multiple lung cancer after complete response of small cell lung cancer; report of a case]

A 76-year-old man underwent combination chemotherapy with cisplatin and etoposide and 50 Gy radiotherapy for left-sided small cell lung cancer in 1999. He achieved clinical complete response and showed no sign of recurrence on follow-up study. In December 2004, chest computed tomography (CT) revealed a 1 cm nodule in the right lung. Although no diagnosis could be made by bronchoscope, we suspected metachronous multiple lung cancer because of high 18fluorodeoxyglucose uptake with positron emission tomography (PET). The patient underwent video-assisted thoracoscopic surgery in May 2005; the frozen section diagnosis was adenocarcinoma.

Lower serum magnesium levels are associated with more rapid decline of renal function in patients with diabetes mellitus type 2

AIMS

Hypomagnesemia has been implicated in adversely affecting diabetic complications. This is a retrospective study designed to determine whether there is any association between serum magnesium concentration [Mg2+] and the rate of renal function deterioration, as determined by the slope of serum creatinine reciprocals versus time (1/SCr-vs-t), in patients with diabetes mellitus type 2 (DM2).

MATERIALS AND METHODS

DM2 patients without known kidney disease seen at Olive View-UCLA Medical Center for any reason during January-March 2001 were included. For each patient, all available data from our electronic database for [Mg2+], hemoglobin A(1C) (HbA(1C), serum creatinine (SCr), lipid profiles, routine urinary analysis, as well as history of hypertension and pharmacy profiles were retrieved. The average of all parameters obtained and linear regression analyses for the slope of 1/SCr-vs-t plot were performed for each patient. Patients were stratified by gender and divided into four groups based on increasing [Mg2+]. Correlations between each parameter including the slope of 1/SCr-vs-t and the four magnesium groups were analyzed.

RESULTS

252 males and 298 females with a mean follow-up of 62.6 +/- 22.5 months were included. Patients belonging to lower [Mg2+] groups for both genders had significantly worse slopes of 1/SCr-vs-t plot independent of the presence of hypertension and use of ACEI/ARB, diuretics, HMG-CoA enzyme inhibitors or aspirin. In a multivariate regression analysis controlling for age, HbA(1C) and various components of the lipid profile, [Mg2+] remained an independent predictor for the slope of 1/SCr-vs-t. A trend for worse proteinuria based on routine urinary analysis was observed among patients belonging to the lowest [Mg2+] group.

CONCLUSIONS

Lower [Mg2+] is associated with a faster renal function deterioration rate in DM2 patients.