Recurrent Takotsubo Syndrome Presenting with Different Ballooning Patterns and Electrocardiographic Abnormalities

A 73-year-old woman presented with takotsubo syndrome with apical ballooning patterns after quarreling with her husband. Two years later, she was admitted to the hospital with chest pain after experiencing the same emotional stress. Her electrocardiogram showed different abnormalities compared to the previous event, and her left ventriculogram demonstrated takotsubo syndrome with mid-ventricular ballooning patterns. Recurrence of takotsubo syndrome with different ballooning patterns is rare. We herein report our experience with a patient who developed recurrent takotsubo syndrome with various ballooning patterns and different electrocardiographic abnormalities along with a literature review.

Amiodarone-induced syndrome of inappropriate antidiuresis with hepatic transaminitis

A 72-year-old woman with hypertrophic cardiomyopathy was admitted to the hospital after an appropriate implantable cardioverter-defibrillator shock for ventricular fibrillation. She was discharged after the addition of amiodarone. Eight months after discharge, she was admitted to the hospital with a sign of somnolence. She had low levels of serum sodium and plasma osmolality, as well as hepatic transaminitis. She underwent a computed tomography scan, which detected high liver density. Amiodarone-induced syndrome of inappropriate antidiuresis with hepatic transaminitis was diagnosed, and amiodarone was discontinued. After discharge, her hepatic transaminitis improved, and there was no recurrence of hyponatremia with a sign of somnolence. Amiodarone is an important drug used to treat ventricular arrhythmias. However, it has a variety of adverse effects. Syndrome of inappropriate antidiuresis is a rare complication of amiodarone. If hyponatremia occurs after starting amiodarone, this complication should be considered.

Learning objective

Amiodarone is an important drug used to treat ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. However, amiodarone has a variety of adverse effects. Syndrome of inappropriate antidiuresis is a rare complication of amiodarone. If hyponatremia occurs after starting amiodarone, this complication should be considered.

Application of Resampling Techniques to the Statistical Analysis of the Brier Score

We investigated the application of resampling techniques to the statistical analysis of the Brier score (B), and extended them to the statistical comparison of two Bs derived from the same set of patients. The re-sampling techniques are helpful in the statistical analysis of B, and there are almost no differences between the jackknife method and the bootstrap method in this analysis. Thus, we believe that B should be used more often as an index to evaluate probabilistic judgments in the case in which the data sets for the assessment are “degenerate” as the “receiver operating characteristic data sets.”

Stabilization of novel high temperature phase yellow-emitting σ-type (Ba1−x−yEuxMgy)2P2O7 phosphors using a melt synthesis technique

Novel high-temperature phase σ-type (Ba_1−x−yEu_xMg_y)₂P₂O₇ phosphors were synthesized for the first time by a melt synthesis technique using an arc-imaging furnace.

Improvement of luminescence properties of rubidium vanadate, RbVO3, phosphors by erbium doping in the crystal lattice

The thermal quenching effect of RbVO₃ phosphor was effectively improved by Er³⁺ doping into the lattice, as a result, the emission intensity of the phosphor was successfully enhanced.

Improved synthesis of SrLiAl3N4:Eu2+ phosphor using complex nitride raw material

Narrow band deep-red emission SrLiAl₃N₄:Eu²⁺ phosphor was effectively synthesized using complex nitride Sr₃Al₂N₄ and Li₃AlN₂ as raw materials. The phosphor exhibited strong deep-red emission peaking at 654 nm under excitation at 450 nm.

Application of matrix decomposition algorithms for singular matrices to the Pawley method inZ-Rietveld

Z-Rietveldis a program suite for Rietveld analysis and the Pawley method; it was developed for analyses of powder diffraction data in the Materials and Life Science Facility of the Japan Proton Accelerator Research Complex. Improvements have been made to the nonlinear least-squares algorithms ofZ-Rietveldso that it can deal with singular matrices and intensity non-negativity constraints. Owing to these improvements,Z-Rietveldsuccessfully executes the Pawley method without requiring any constraints on the integrated intensities, even in the case of severely or exactly overlapping peaks. In this paper, details of these improvements are presented and their advantages discussed. A new approach to estimate the number of independent reflections contained in a powder pattern is introduced, and the concept of good reflections proposed by Sivia [J. Appl. Cryst.(2000),33, 1295–1301] is shown to be explained by the presence of intensity non-negativity constraints, not the intensity linear constraints.

Evacuation of aged persons from inundated underground space

Underground is an important space that supports function of cities, such as subways, shopping malls and basement parking. However in consequence a new type of disaster, the "urban flood" menaces these spaces. In the last decade, urban floods struck Tokyo, Nagoya and Fukuoka. When underground inundation occurs, people must evacuate to the ground as soon as possible. But, when such an inundation situation happens, aged persons may not be able to evacuate quickly to ground level. In this paper, the method of safety assessment for aged persons is discussed on the experimental results and flood simulation data in an underground space. As a criterion of the safety evacuation, the specific force per unit width is used in this study. From the result of experiments, it is difficult to implement safety evacuation when the specific force per unit width is over 0.100 m(2) for the aged male.

Wavelength-Sensitive Photocatalytic Degradation of Methyl Orange in Aqueous Suspension over Iron(III)-doped TiO2Nanopowders under UV and Visible Light Irradiation

Well-crystallized iron(III)-doped TiO2 nanopowders with controlled Fe3+ doping concentration and uniform dopant distribution, have been synthesized with plasma oxidative pyrolysis. The photocatalytic reactivity of the synthesized TiO2 nanopowders with a mean particle size of 50-70 nm was quantified in terms of the degradation rates of methyl orange (MO) in aqueous TiO2 suspension under UV (mainly 365 and 316 nm) and visible light irradiation (mainly 405 and 436 nm). The photodecomposition of MO over TiO2 nanopowders followed a distinct two-stage pseudo first order kinetics. Interestingly, the photocatalytic reactivity depends not only on the iron doping concentration but also on the wavelength of the irradiating light. Under UV irradiation, nominally undoped TiO2 had much higher reactivity than Fe3+ -doped TiO2, suggesting that Fe3+ doping (> 0.05 at. %) in TiO2 with a mean particle size of approximately 60 nm was detrimental to the photocatalytic decomposition of methyl orange. Whereas, under visible light irradiation, the Fe3+ -doped TiO2 with an intermediate iron doping concentration of approximately 1 at. % had the highest photocatalytic reactivity due to the narrowing of band gap so that it could effectively absorb the light with longer wavelength. A strategy for improving the photocatalytic reactivity of Fe3+ -doped TiO2 used in the visible light region is also proposed.

Comparison of numerical and experimental simulations of a flood in a dense urban area

Although various numerical methods were used to simulate real floods occurring in cities, the validation of the models was never accurate because of the lack of data about location and event description and about observation for validation. In order to check the capacities of our 2-dimensional shallow water equations model to simulate an urban flood, we then decided to simulate numerically an experimental event with well known characteristics and accurate flow measurements. The physical model presented in (Ishigaki et al, 2003) represents the flooding of the city center of Kyoto in Japan due to an overflow from the Kamo river. The 2-dimensional numerical simulation of this event was then set up and the experimental and computed data were compared. It appears that the event was calculated quite fairly in terms of flow depth and flow rates in the streets and in terms of timing. However, some discrepancies appear between the measurements and the numerical results, mostly due to some topographical local uncertainties and to the capacities of the equations to model the complex flows in the crossroads.

The influence of liquid crystal display (LCD) monitors on observer performance for the detection of nodular lesions on chest radiographs

PURPOSE

To access the influence of liquid crystal display (LCD) monitors on the detectability of nodular lesions depicted on chest radiographs by comparing them with a high-resolution cathode ray tube (CRT) monitor.

MATERIAL AND METHODS

Ten radiologists interpreted 247 soft-copy images on LCD monitors with pixel arrays of 1,024x1,280, 1,200x1,600, 1,536x2,048 and 2,048x2,560, and a CRT monitor with a pixel array of 2,048x2,560, and were asked to indicate their individual confidence levels regarding the presence of a nodule. These images were chest radiographs with and without a lung nodule from the "Standard Digital Image Database" created by the Japanese Society of Radiological Technology. The luminance distributions of all monitors were adjusted to the same, and the ambient illumination was 200 lux. Observer performance was analyzed in terms of the receiver-operating characteristics.

RESULTS

No significant statistical differences in nodule detection performance were found among the four LCD monitors and the CRT monitor.

CONCLUSION

The nodule detection performance on the LCD monitors with a spatial resolution higher than a matrix size of 1,024x1,280 was found to be equivalent to that on the high-resolution CRT monitor.

Pyrogenic Iron(III)-Doped TiO2 Nanopowders Synthesized in RF Thermal Plasma: Phase Formation, Defect Structure, Band Gap, and Magnetic Properties

Iron(III)-doped TiO(2) nanopowders, with controlled iron to titanium atomic ratios (R(Fe/Ti)) ranging from nominal 0 to 20%, were synthesized using oxidative pyrolysis of liquid-feed metallorganic precursors in a radiation-frequency (RF) thermal plasma. The valence of iron doped in the TiO(2), phase formation, defect structures, band gaps, and magnetic properties of the resultant nanopowders were systematically investigated using Mössbauer spectroscopy, XRD, Raman spectroscopy, TEM/HRTEM, UV-vis spectroscopy, and measurements of magnetic properties. The iron doped in TiO(2) was trivalent (3+) in a high-spin state as determined by the isomer shift and quadrupole splitting from the Mössbauer spectra. No other phases except anatase and rutile TiO(2) were identified in the resultant nanopowders. Interestingly, thermodynamically metastable anatase predominated in the undoped TiO(2) nanopowders, which can be explained from a kinetic point of view based on classical homogeneous nucleation theory. With iron doping, the formation of rutile was strongly promoted because rutile is more tolerant than anatase to the defects such as oxygen vacancies resulting from the substitution of Fe(3+) for Ti(4+) in TiO(2). The concentration of oxygen vacancies reached a maximum at R(Fe/Ti) = 2% above which excessive oxygen vacancies tended to concentrate. As a result of this concentration, an extended defect like crystallographic shear (CS) structure was established. With iron doping, red shift of the absorption edges occurred in addition to the d-d electron transition of iron in the visible light region. The as-prepared iron-doped TiO(2) nanopowders were paramagnetic in nature at room temperature.

Multiple regional 1H-MR spectroscopy in multiple system atrophy: NAA/Cr reduction in pontine base as a valuable diagnostic marker

OBJECTIVE

We performed (1)H-MR spectroscopy ((1)H-MRS) on multiple brain regions to determine the metabolite pattern and diagnostic utility of (1)H-MRS in multiple system atrophy (MSA).

METHODS

Examining single voxels at 3.0 T, we studied metabolic findings of the putamen, pontine base, and cerebral white matter in 24 MSA patients (predominant cerebellar ataxia (MSA-C), n = 13), parkinsonism (MSA-P), n = 11), in 11 age and duration matched Parkinson's disease patients (PD) and in 18 age matched control subjects.

RESULTS

The N-acetylaspartate to creatine ratio (NAA/Cr) in MSA patients showed a significant reduction in the pontine base (p<0.0001) and putamen (p = 0.02) compared with controls. NAA/Cr in cerebral white matter also tended to decline in long standing cases. NAA/Cr reduction in the pontine base was prominent in both MSA-P (p<0.0001) and MSA-C (p<0.0001), and putaminal NAA/Cr reduction was significant in MSA-P (p = 0.009). It was also significant in patients who were in an early phase of their disease, and in those who showed no ataxic symptoms or parkinsonism, or did not show any MRI abnormality of the "hot cross bun" sign or hyperintense putaminal rims. NAA/Cr in MSA-P patients was significantly reduced in the pontine base (p = 0.001) and putamen (p = 0.002) compared with PD patients. The combined (1)H-MRS in the putamen and pontine base served to distinguish patients with MSA-P from PD more clearly.

CONCLUSIONS

(1)H-MRS showed widespread neuronal and axonal involvement in MSA. The NAA/Cr reduction in the pontine base proved highly informative in the early diagnosis of MSA prior to MRI changes and even before any clinical manifestation of symptoms.

Combined study with FDG PET and Tl SPECT in patients with idiopathic dilated cardiomyopathy

This study aimed to determine whether combined examinations of myocardial 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) and stress-redistribution 201Tl single-photon emission computed tomography (Tl SPECT) were useful in clarifying myocardial ischaemia and evaluating the prognosis in patients with idiopathic dilated cardiomyopathy (IDCM). Twenty-two patients with IDCM underwent echocardiography, cardiac catheterization, FDG PET, and Tl SPECT. In scintigraphic analysis, the total defect score (TDS) was semiquantitatively determined as the sum of scores of the 17 left ventricular (LV) segments with a 5-point scale (0 as normal to 4 as absent). Patients were classified according to the scintigraphic findings as follows: eight patients with small defects on Tl and FDG (TDS < or = 20) (group I), eight patients with small defects on FDG (TDS < or = 20) with FDG uptake increased relative to Tl or 'mismatch' (group II), and six patients with large defects on FDG and Tl (TDS >20) (group III). Eleven patients (50%) showed reversible defects on Tl and all showed preserved FDG uptake. The patients in group III had significantly lower LV ejection fraction (LVEF) (P<0.05, respectively) and a poorer prognosis as shown by the Kaplan-Meier event-free curve compared with those in groups I and II (P<0.01, respectively). Although patients in group II had significantly greater TDS on Tl compared with those in group I (P<0.01), no significant differences in LVEF and prognosis were found between patients in groups I and II. In multivariate analysis, a TDS on FDG revealed an independent predictor of subsequent cardiac events. In conclusion, such mismatched areas can be assumed to consist of impaired but viable myocardium, and may be associated with ischaemia of the microvasculature. Impaired myocardial glucose metabolism is a more powerful predictor of future cardiac events than perfusion abnormality in patients with IDCM.

Contrast enhancement of the cochlear aqueduct in MR imaging: its frequency and clinical significance

There have been no previous reports on contrast enhancement of the cochlear aqueduct in magnetic resonance imaging. The purpose of the present study was to evaluate the frequency and significance of this finding. Thirty-one patients (15 men and 16 women; age range 18-81 years) with otologic symptoms (sudden sensorineural hearing loss, vertigo, or tinnitus) were examined using contrast-enhanced imaging on a 1.5-T MR scanner. The normal ear served as the control. Two radiologists evaluated contrast enhancement in the area of the cochlear aqueduct. Forty-eight of 62 ears (77.4%) showed contrast enhancement of the cochlear aqueduct, but no significant differences in the frequency of contrast enhancement were observed between patients with and patients without vertigo, tinnitus, sensorineural hearing loss, cerebellopontine angle tumors, or a high-riding jugular bulb. In addition, no gender- or age-related differences were noted. Contrast enhancement of the cochlear aqueduct was frequently observed, but the frequency of enhancement in symptomatic ears was not significantly higher than in control ears. The results of this study may prove helpful in avoiding unnecessary examinations and potential diagnostic confusion.

Three-dimensional image display without special eyeglasses: observation of magnetic resonance angiography using the stereoscopic liquid crystal display

The authors have developed a new stereoscopic liquid crystal display that provides real-time 3-dimensional image viewing without special eyeglasses. The device consists of 3 major parts: (1) an image display composed of a 10.4-inch color liquid crystal plate with a resolution of 640 x 480, (2) an automatic head tracking system, and (3) a special backlight unit for the right and left eyes. Eight radiologists interpreted 60 cases of magnetic resonance angiography (29 cases of cerebrovascular disease and 31 normal cases) to compare film display and the liquid crystal display (ie, pseudo 3-dimensional display and true 3-dimensional display). Using a continuously distributed scale ranging from 0% to 100%, the observers ranked their confidence levels in determining the presence or absence of steno-occlusive disease, aneurysm, and arteriovenous malformation (AVM) and their locations. For statistical evaluation, receiver operating characteristic (ROC) analysis and Brier score were used. For detecting AVM, film reading showed a significantly higher value in the area under the binormal ROC curve (Az) than did pseudo-3-dimensional display (P < .05). Excluding this, however, no significant difference existed in Az values among the 3 viewing methods. Also, there was no significant difference in Brier score between not only the stereoscopic view and nonstereoscopic view groups, but also the senior and junior groups. Subjective estimation of true 3-dimensional display showed that vessels were more distinguishable with less eye fatigue compared with stereoscopic film reading. The stereoscopic liquid crystal display provided almost equal efficacy to film reading; however, the short optimum distance for observation and the low resolution should be improved.

High- and moderately high-methionine uptake demonstrated by PET in a patient with a subacute cerebral infarction

In patients with cerebral tumors, high accumulations of L-methyl-11C-methionine (11C-Met) have been reported in some cases of cerebral ischemic disease, but no high accumulations of 11C-Met in areas where only transient arterial occlusions are most likely to occur have been reported. Herein we present a case of a high accumulation of 11C-Met in an area of frontal interhemispheric cerebral infarction and a moderately high accumulation with an unclear margin in a distant frontal convexity area. A craniotomy revealed a subacute stage of cerebral infarction in the interhemispheric lesion, and an ischemic change in the distant convexity area. Sixteen months after onset, CT scans demonstrated an infarction area in the interhemispheric lesion only, and no atrophic changes were observed in the distant convexity area indicating that no serious tissue damage had occurred.

Nulling interferometry by use of geometric phase

Nulling interferometry is a method of detecting a faint source near a bright one, in which destructive interference is realized for the light from the bright source. A nulling interferometer that makes use of geometric phase (Pancharatnam phase) is proposed. An experimental setup is constructed to simulate a stellar interferometer with geometric-phase modulation. We attained extinction of 6 x 10(-5) in white light.

Display method can affect interobserver agreement: comparison of ‘zoom-and-pan’ and ‘browse-and-paste’ for primary CT interpretation

Eight radiologists interpreted body CT images of 30 cases using a viewing station (six 17-in. monitors, 1024x1280). Using two different display methods, 'zoom-and-pan' and 'browse-and-paste', the readers described the presence or absence of liver tumors using a five-point rating scale and temporal changes between the current and previous studies using a seven-point rating scale. There was no significant difference in kappa values for tumor detection between the two display modes. However, in describing temporal changes, the kappa value of the browse-and-paste was significantly lower than that of zoom-and-pan (p<0.01). Browse-and-paste may have the disadvantage of greater interobserver variation.

Application of resampling techniques to the statistical analysis of the Brier score

We investigated the application of resampling techniques to the statistical analysis of the Brier score (B), and extended them to the statistical comparison of two Bs derived from the same set of patients. The resampling techniques are helpful in the statistical analysis of B, and there are almost no differences between the jackknife method and the bootstrap method in this analysis. Thus, we believe that B should be used more often as an index to evaluate probabilistic judgments in the case in which the data sets for the assessment are "degenerate" as the "receiver operating characteristic data sets."

Contrast-enhanced MR angiography of the carotid artery using 3D time-resolved imaging of contrast kinetics: comparison with real-time fluoroscopic triggered 3D-elliptical centric view ordering

PURPOSE

To evaluate contrast-enhanced MR angiography using the 3D time-resolved imaging of contrast kinetics technique (3D-TRICKS) by direct comparison with the fluoroscopic triggered 3D-elliptical centric view ordering (3D-ELLIP) technique.

METHODS

3D-TRICKS and 3D-ELLIP were directly compared on a 1.5-Tesla MR unit using the same spatial resolution and matrix. In 3D-TRICKS, the central part of the k-space is updated more frequently than the peripheral part of the k-space, which is divided in the slice-encoding direction. The carotid arteries were imaged using 3D-TRICKS and 3D-ELLIP sequentially in 14 patients. Temporal resolution was 12 sec for 3D-ELLIP and 6 sec for 3D-TRICKS. The signal-to-noise ratio (S/N) of the common carotid artery was measured, and the quality of MIP images was then scored in terms of venous overlap and blurring of vessel contours.

RESULTS

No significant difference in mean S/N was seen between the two methods. Significant venous overlap was not seen in any of the patients examined. Moderate blurring of vessel contours was noted on 3D-TRICKS in five patients and on 3D-ELLIP in four patients. Blurring in the slice-encoding direction was slightly more pronounced in 3D-TRICKS. However, qualitative analysis scores showed no significant differences.

CONCLUSION

When the spatial resolution of the two methods was identical, the performance of 3D-TRICKS was found to be comparable in static visualization of the carotid arteries with 3D-ELLIP, although blurring in the slice-encoding direction was slightly more pronounced in 3D-TRICKS. 3D-TRICKS is a more robust technique than 3D-ELLIP, because 3D-ELLIP requires operator-dependent fluoroscopic triggering. Furthermore, 3D-TRICKS can achieve higher temporal resolution. For the spatial resolution employed in this study, 3D-TRICKS may be the method of choice.

Automated detection of pulmonary nodules in helical CT images based on an improved template-matching technique

The purpose of this study is to develop a technique for computer-aided diagnosis (CAD) systems to detect lung nodules in helical X-ray pulmonary computed tomography CT) images. We propose a novel template-matching technique based on a genetic algorithm (GA) template matching (GATM) for detecting nodules existing within the lung area; the GA was used to determine the target position in the observed image efficiently and to select an adequate template image from several reference patterns for quick template matching. In addition, a conventional template matching was employed to detect nodules existing on the lung wall area, lung wall template matching (LWTM), where semicircular models were used as reference patterns; the semicircular models were rotated according to the angle of the target point on the contour of the lung wall. After initial detecting candidates using the two template-matching methods, we extracted a total of 13 feature values and used them to eliminate false-positive findings. Twenty clinical cases involving a total of 557 sectional images were used in this study. 71 nodules out of 98 were correctly detected by our scheme (i.e., a detection rate of about 72%), with the number of false positives at approximately 1.1/sectional image. Our present results show that our scheme can be regarded as a technique for CAD systems to detect nodules in helical CT pulmonary images.

CT and MR imaging of pancreatic cancer

Recent improvements in imaging techniques have made it possible to improve the diagnostic accuracy for detection, staging, and indicating surgical resectability of pancreatic cancer. The latest advance in the computed tomography technique, is the introduction of subsecond multislice helical scanning that improves z-axis resolution in the reformatted images and three-dimensional rendering with a large volume data. Magnetic resonance imaging provides versatile information including magnetic resonance cholangiopancreatography that allows noninvasive delineation of the pancreatic and biliary duct systems. The presence of pancreatic cancer may best be evaluated by dynamic computed tomography or dynamic magnetic resonance imaging with administration of intravenous contrast material. Both computed tomography and magnetic resonance imaging are valuable for the preoperative assessment of local invasion and vascular involvement. Multislice helical computed tomography is currently considered as the best single modality for the diagnosis of pancreatic cancer as it provides excellent image quality. When advanced magnetic resonance imaging equipment is used as a primary modality, in the future, it may have a possibility to replace other imaging modalities.

Muscular sarcoidosis

There are four types of muscular sarcoidosis: nodular, chronic myopathy, acute myositis, and asymptomatic. The nodular type is important because it may be confused with a soft tissue tumor. Magnetic resonance (MR) imaging provides specific findings. A star-shaped central structure of decreased signal intensity, a "dark star" sign, is seen on the axial images. A long nodule with an inner stripe of decreased signal intensity and outer stripes of increased signal intensity, a "three stripes" sign, is seen on the coronal and sagittal images. In the chronic myopathy type, the role of MR imaging is limited. Gallium scintigraphy, which reflects activity of inflammation, may show increased uptake. In the acute myositis type, MR imaging shows increased signal intensity, and gallium scintigraphy shows increased uptake; however, these findings are nonspecific.

MR cisternography of the cerebellopontine angle: comparison of three-dimensional fast asymmetrical spin-echo and three-dimensional constructive interference in the steady-state sequences

BACKGROUND AND PURPOSE

MR cisternography has been used as the noninvasive screening tool of the cerebellopontine angle. The purpose of this study was to directly compare two currently dominant types of sequences for heavily T2-weighted MR cisternography.

METHODS

Three-dimensional fast asymmetric spin-echo (3D-FASE) sequences, which are 3D half-Fourier rapid acquisition with relaxation enhancement and 3D constructive interference in the steady-state (3D-CISS) sequences, were compared on a clinical 1.5-T MR unit using the same scan times. In five healthy volunteers, the contrast-to-noise ratio (C/N) between CSF and the cerebellum was measured at three locations. Then, for qualitative analysis, the quality of the labyrinth was scored on the original source multiplanar reformatted images, the virtual endoscopic images, and the maximum intensity projection (MIP) images. In 20 consecutive patients with suspected cerebellopontine angle tumors, visualization of the tumors was evaluated using 3D contrast-enhanced spoiled gradient-echo imaging as the standard of reference.

RESULTS

Both sequences showed comparable mean C/N values; however, in qualitative analysis, the scores for 3D-CISS on the source, virtual endoscopic, and MIP images were significantly lower than those on the images obtained with 3D-FASE, owing to more prominent flow and magnetic susceptibility artifacts on the 3D-CISS sequences. In all subjects, discontinuity of the semicircular canals was seen on the virtual endoscopic and MIP images obtained with 3D-CISS, owing to susceptibility artifacts, but not on those obtained with 3D-FASE. All 12 tumors were detected by both sequences, but 3D-CISS gave one false-positive result.

CONCLUSION

3D-FASE is considered the method of choice because artifacts are reduced and specificity is increased.

Determination of optimal radiation energy for different breast sizes using CT-simulator [correction of simulatior] in tangential breast irradiation

BACKGROUND

The purpose of this study is to determine and recommend the optimal radiation source according to breast size for tangential irradiation in breast conserving therapy.

METHODS

Twenty-eight patients treated at our department from January 1994 to January 1996 were studied. The dose distribution within the irradiated breast was calculated using a (60)Co-gamma ray and 6 MV-X ray. Then we compared 3-D dose distributions of the (60)Co-gamma ray and 6 MV-X ray in different-sized breasts. Three parameters (breast volume, chest wall separation, and breast height) were adopted as representative of breast size. We also examined correlations among the three parameters.

RESULTS

When the breast size was large (breast volume >400 cm(3), chest wall separation > 19.5 cm, or breast height > 6.5 cm), the average volume of normal tissue which received more than 110% of the isocenter dose ("hot spot") was significantly greater with the (60)Co-gamma ray than with the 6 MV-X ray (p < 0.05). A similar result was obtained with regard to hot spots in the clinical target volume. The cold area that received less than 95% of the isocenter dose was greater using a 6 MV-X ray when the breast size was small (breast volume <200 cm(3), chest wall separation <17.5 cm, or breast height <5.0 cm). However, the difference was not significant. There was a significant correlation between breast volume and chest wall separation (r =0.849, p <0.001). Breast volume and breast height were also significantly correlated (r =0.813, p <0.001).

CONCLUSIONS

Since breast volume and shape are different in each patient, the optimal energy should be selected for each case to obtain uniform dose distribution in breast-conserving therapy. Chest wall separation or breast height, which are measurable without a 3-D planning system, can substitute for breast volume as parameters for breast size. We recommend that the (60)Co-gamma ray not be used for treating large breasts, those with chest wall separation > or =19.5 cm or breast height > or =6.5 cm.