[Drawing up the guidelines for ventilation, draining and disposal of radioactive medical waste].
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Drainage, Sanitary↗
Biomedical subjects
Keigo Endo
Publications and source records attributed to Keigo Endo.
Cerebral metabolic reduction in severe malaria: fluorodeoxyglucose-positron emission tomography imaging in a primate model of severe human malaria with cerebral involvement.
Cerebral metabolic changes in Japanese macaques (Macaca fuscata) infected with Plasmodium coatneyi, a primate model of severe human malaria with cerebral involvement, were directly evaluated by fluorodeoxyglucose-positron emission tomography (FDG-PET). We observed diffuse and heterogeneous reduction of metabolism in the cerebral cortex in the acute phase of malaria infection. Neuropathologic examination showed preferential sequestration of parasitized red blood cells in the cerebral microvasculature. However, hemorrhagic change or necrosis was not observed in hematoxylin and eosin-stained and Nissl-stained brain tissues. This suggests that reduction of cerebral metabolism occurs before parenchymal changes appear in the brain. This may be one reason why more than half of the patients with cerebral malaria have no neurologic sequelae after recovery.
Animals↗
Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis.
UNLABELLED: Cardiac PET using (18)F-FDG under fasting conditions (fasting (18)F-FDG PET) is a promising technique for identification of cardiac sarcoidosis and assessment of disease activity. The aim of this study was to investigate the usefulness of fasting (18)F-FDG PET in detecting inflammatory lesions of cardiac sarcoidosis from a pathophysiologic standpoint. METHODS: Twenty-two patients with systemic sarcoidosis were classified into 2 groups of 11 each according to the presence or absence of sarcoid heart disease. Cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare guidelines for diagnosing cardiac sarcoidosis with the exception of scintigraphic criteria. Nuclear cardiac imaging with fasting (18)F-FDG PET, (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) SPECT, and (67)Ga scintigraphy were performed in all patients. PET and SPECT images were divided into 13 myocardial segments and the standardized uptake value (SUV) of (18)F-FDG was calculated and defect scores (DS) for (99m)Tc-MIBI uptake were assessed for each segment. The total SUV (T-SUV) and total DS (TDS) were calculated as the sum of measurements for all 13 segments, and the diagnostic accuracy of fasting (18)F-FDG PET was compared with that of the other nuclear imaging modalities. In addition, pathophysiologic relationships between inflammatory activity and myocardial damage were examined by segmental comparative study using the SUV and DS. RESULTS: In patients with cardiac sarcoidosis, fasting (18)F-FDG PET revealed a higher frequency of abnormal myocardial segments than (99m)Tc-MIBI SPECT (mean number of abnormal segments per patient: 6.6 +/- 3.0 vs. 3.0 +/- 3.2 [mean +/- SD], P < 0.05). The sensitivity of fasting (18)F-FDG PET in detecting cardiac sarcoidosis was 100%, significantly higher than that of (99m)Tc-MIBI SPECT (63.6%) or (67)Ga scintigraphy (36.3%). The accuracy of fasting (18)F-FDG PET was significantly higher than (67)Ga scintigraphy. The T-SUV demonstrated a good linear correlation with serum angiotensin-converting enzyme levels (r = 0.83, P < 0.01), and the TDS showed a significant negative correlation with the left ventricular ejection fraction (r = -0.82, P < 0.01). In abnormal myocardial segments on the nuclear scan, the SUV showed a significant negative correlation with the DS (r = -0.63, P < 0.0001). CONCLUSION: This study suggests that fasting (18)F-FDG PET can detect the early stage of cardiac sarcoidosis, in which fewer perfusion abnormalities and high inflammatory activity are noted, before advanced myocardial impairment.
Adult↗
Expression of Glut-1 and Glut-3 in untreated oral squamous cell carcinoma compared with FDG accumulation in a PET study.
Increased expression of glucose transporter-1 (Glut-1) and glucose transporter-3 (Glut-3) has been reported in many human cancers. The mechanism of glucose entry into oral squamous cell carcinoma (OSCC) remains unclear. In this study we investigated, in untreated human OSCC, the relationship between tumour fluorine-18 fluoro-2-deoxy-D-glucose (FDG) accumulation and the expression of Glut-1 and Glut-3, as well as the association between the expression of Glut-1 and of Glut-3. All patients underwent FDG positron emission tomography (PET) pre-operatively. Standardised uptake values (SUVs) were used for evaluation of tumour FDG uptake. Final diagnoses were established by histology. Immunohistochemical staining results were evaluated according to the percentage (%) of positive area, intensity and staining score. Tumour sections were stained by immunohistochemistry for Glut-1 and Glut-3. Glut-1 immunostaining revealed that 18 (94.7%) of the 19 tumours stained positively, while Glut-3 immunostaining yielded positive findings for 16 (84.2%) tumours. Overall, a relatively low level of agreement (36.8%) in the staining score was observed between Glut-1 and Glut-3 expression. No relationship was found between the staining pattern and tumour differentiation or T grade classification in either Glut-1 or Glut-3 immunostaining. Furthermore, no relationship was found between increased FDG SUV and tumour differentiation, but the former did correlate with T grade. In conclusion, high FDG uptake values were seen in OSCC with overexpression of Glut-1 and Glut-3. However, no significant correlation was found between FDG SUV and Glut-1 or Glut-3 expression.
Aged↗
Sentinel lymph nodes with technetium-99m colloidal rhenium sulfide in patients with esophageal carcinoma.
BACKGROUND: The authors assessed the detection of sentinel lymph nodes in patients with esophageal squamous cell carcinoma (SCC) using technetium-99m colloidal rhenium sulfide. They studied whether an analysis of sentinel lymph nodes using cytokeratin (CK) immunohistochemistry increased the accuracy of staging. METHODS: The authors observed 25 patients with thoracic esophageal carcinomas who underwent radical esophagectomy. The day before surgery, technetium-99m colloidal rhenium sulfide was injected into the submucosa at four sites around the primary tumor. Lymphoscintigraphy was performed. Esophagectomy and regional lymph node dissection were performed 17 hours after the technetium-99m injection. After surgery, the resected lymph nodes were evaluated by CK staining. RESULTS: Lymphoscintigraphy detected sentinel lymph nodes in 92% of the patients (23 of 25 patients). The accuracy of sentinel lymph node was 91.3% (21 of 23 patients), the sensitivity was 86.7% (13 of 15 patients), and the false-negative rate was 8.7% (2 of 23 patients). A comparison of the number of sentinel lymph nodes and clinicopathologic factors showed that there was a significant association between the number of sentinel lymph nodes and lymph node status (P < 0.01), pathologic stage (P < 0.05), and the number of metastatic lymph nodes (P < 0.05). Occult metastasis was detected by CK staining in 14 (56%) of the 25 patients and in 23 (1.7%) of 1406 lymph nodes. Because the 2 false-negative (sentinel lymph node-negative and nonsentinel lymph node-positive) patients who had occult metastases in the sentinel lymph nodes, the accuracy of sentinel lymph node evaluation using CK staining was 100% (23 of 23). CONCLUSIONS: Lymphatic mapping with technetium-99m colloidal rhenium sulfide was used to identify the lymphatic basin and was feasible in patients with esophageal SCC. An analysis of sentinel lymph nodes using CK immunohistochemistry increased the accuracy of sentinel lymph node.
Aged↗
Fluvoxamine modulates pain sensation and affective processing of pain in human brain.
To better understand the antinociceptive effect of fluvoxamine, we measured regional cerebral blood flow during laser-evoked pain and hot sensations using H(2)15O positron emission tomography and also subjective pain and hot sensations before and after fluvoxamine or placebo administration for 7 days to 12 healthy volunteers. The subjectively rated pain score was significantly reduced by fluvoxamine administration. Painful stimuli activated multiple brain regions. After fluvoxamine administration the ipsilateral anterior cingulate cortex (ACC), contralateral insular cortex (IC), and contralateral secondary somatosensory cortex (SII) activations were reduced. The bilateral IC activation was also reduced in the placebo group. These results suggest that fluvoxamine specifically reduced activation of the ACC and SII, which are areas concerned with the affective and integrative components of pain.
Adult↗
Utility of FDG-PET in differential diagnosis of benign and malignant fractures in acute to subacute phase.
OBJECTIVE: To evaluate the usefulness of positron emission tomography with [fluorine-18] 2-deoxy-2-fluoro-D-glucose (FDG-PET) for early differential diagnosis of benign and malignant fractures. MATERIALS AND METHODS: Among 1,164 patients who had received FDG-PET between January 1999 and December 2000, 20 patients were found to have an acute fracture on review of clinical charts and/or radiologic images taken within one month before or after FDG-PET examination. The fractures were finally diagnosed by clinical follow up of at least five months duration. Standardized uptake values (SUV) for the benign and malignant bone lesions were calculated and compared. RESULTS: Ten of the 20 patients were finally diagnosed to have a benign fracture, nine patients to have a malignant fracture, and one patient to have both a benign and a malignant fracture at different locations. A statistically significant difference in the SUV was found between the benign group (SUV: 1.36 +/- 0.49) and the malignant group (SUV: 4.46 +/- 2.12) (p = 0.0006, the nonparametric Mann-Whitney U test). CONCLUSIONS: FDG-PET can be a useful method for early differentiation between acute benign and metastatic fractures. Our retrospective study indicates that an acute benign fracture itself does not show significant FDG uptake.
Aged↗
High [18F] 2-fluoro-2-deoxy-D-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing's syndrome.
A 48-year-old woman with left adrenal tumor, which showed increased uptake of [18F] 2-fluoro-2-deoxy-D-glucose (FDG) was presented. Her adrenal tumor was incidentally discovered, although she had no remarkable illness, and her blood pressure was normal. Hormonal examination including dexamethason suppression test and diurnal variation in serum cortisol level confirmed preclinical Cushing's syndrome. CT, MRI and 131I-adosterol scintigraphy showed findings consistent with adenoma. FDG-PET revealed that tumor had standardized uptake value of 4.8, which was higher than usual benign tumors. Histological diagnosis of the resected adrenal tumor was adrenocortical adenoma without evidence of malignancy. Although the current literature showed that adenomas in general did not exhibit increased FDG uptake, adenoma in the present case with subclinical Cushing's syndrome showed intense uptake of FDG, suggesting FDG-PET could evaluate hormonal function of an adrenocortical adenoma in a completely asymptomatic normocortisolism patient.
Adrenal Cortex Neoplasms↗
FDG-PET for evaluating musculoskeletal tumors: a review.
Positron-emission tomography (PET) can provide an in vivo method for evaluating metabolism and physiology in normal and diseased tissues. Clinical trials with [(18)F]2-deoxy-2-fluoro- d-glucose (FDG), the most commonly used radiolabeled tracer for PET imaging, have demonstrated increased accumulation of FDG in several cancer tissues. In this article, we introduce the basic principles of FDG-PET and review current knowledge about FDG-PET for evaluating musculoskeletal tumors. Recent reports and our own experience suggest that FDG-PET cannot be a screening method for differential diagnosis between benign and malignant musculoskeletal lesions, including many neoplasms originating from different tissues altogether. FDG-PET might not accurately reflect the malignant potential of musculoskeletal tumors, but rather might implicate cellular components included in the lesions. A high accumulation of FDG can be observed in histiocytic, fibroblastic, and some neurogenic lesions, regardless of whether they are benign or malignant. More specific uses of FDG-PET, such as grading, staging, and monitoring of musculoskeletal sarcomas, should be considered for each tumor of a different histologic subtype.
Bone Neoplasms↗
Re: Giant lipoma of the adrenal gland.
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Adrenal Gland Neoplasms↗
Detection of lung cancer with positron coincidence gamma camera using fluorodeoxyglucose in comparison with dedicated PET.
OBJECTIVE: Dual-head gamma cameras with sodium iodide (NaI) detectors operated in coincidence mode provide a new approach for imaging with positron-labeled tracers. The purpose of this study was to evaluate the feasibility of FDG imaging with positron coincidence detection gamma camera (PCD) in detecting lung tumor in comparison with FDG imaging with the dedicated positron emission tomography (PET). METHODS AND MATERIAL: Twenty-six lesions of 13 patients with suspected lung cancer were studied with both FDG PET and FDG PCD on the same day. Pulmonary lesions were analyzed visually and semi-quantitatively using the ratio of target-to-background counts (T/B ratio). RESULTS AND CONCLUSIONS: FDG PCD and FDG PET could detect visually 21 lesions (80.8%) and 23 lesions (88.0%), respectively. The mean T/B ratio and standard deviation (S.D.) of FDG PCD was 4.6 +/- 3.9, significantly lower than that of FDG PET (11.4 +/- 6.6, P<0.001). When pulmonary lesions were no more than 2.0 cm in diameter, the sensitivity of FDG PCD was 37.5%, significantly inferior to that of FDG PET (62.5%, P<0.001). There was no statistically significant difference of the sensitivity between the FDG PCD and FDG PET in lesions of more than 2.0 cm in diameter. FDG PCD with uniform attenuation correction was clinically available in detecting lung cancer. However, the sensitivity for small lesions less than 2.0 cm was limited. The application of measured attenuation correction and scatter correction may to be needed to improve the detectability of FDG PCD, especially for detecting small lung cancer.
Adult↗
The effect of fatty infiltration on the liver tissue enhancement during portal phase computed tomography.
RATIONALE AND OBJECTIVES: To correlate the presence of fatty liver and the enhancement value of liver tissue during portal phase computed tomography. MATERIALS AND METHODS: Liver tissue enhancements during portal phase computed tomography were measured in 16 fatty liver and 35 control patients. All patients intravenously received 100 mL of non-ionic contrast material (320 mg iodine/ mL) at a rate of 3 mL/second, and the image acquisition started at 70 seconds. Attenuation values were measured on the 80-second portal phase images and the corresponding unenhanced images, and the contrast enhancement value (HU) of the liver tissue was calculated. Adjusted enhancement values were also calculated with the following equation: adjusted enhancement value = enhancement value (HU)/[dose (grams of iodine)/body weight (kg)]. RESULTS: The contrast enhancement value was significantly reduced in the fatty liver patients compared with the normal controls (37.0 +/- 7.2 vs 49.8 +/- 12.0 HU; P < .0001). This difference was still significant in adjusted enhancement value (80.1 +/- 13.7 vs 93.6 +/- 23.0 HU kg g(-1); P = .01). CONCLUSION: The liver tissue with fatty infiltration was less enhanced than controls, probably because of decreased portal perfusion.
Case-Control Studies↗
Contribution of the diagnostic test to the physician's diagnostic thinking: new method to evaluate the effect.
RATIONALE AND OBJECTIVES: The purpose of this study was to develop and test a method for evaluating the effect of diagnostic tests on physicians' diagnostic thinking. MATERIALS AND METHODS: The authors applied the method to data obtained in a previous study. The diagnoses of surgeons in the emergency department before and after contrast material-enhanced computed tomography (CT) and their certainty were collected from the cases of 125 adult patients with acute abdominal pain. When the pre- or post-CT diagnosis was not consistent with the final diagnosis, the diagnostic certainty reported by a physician was converted to a negative value (true diagnostic certainty). Change in true diagnostic certainty was calculated by subtracting the values for diagnostic certainty before CT from those after CT. RESULTS: In 118 cases, the change in true diagnostic certainty was positive, which indicates that the CT information was beneficial for the physician's diagnostic thinking. The true diagnostic certainty before CT was 32.9% +/- 57.6 (range: -90% to 100%; 95% confidence interval: 22.7%, 43.1%) and that after CT was 73.4% +/- 37.0 (range: -80% to 100%; 95% confidence interval: 66.8%, 80.0%; P < .0001). Thus, the increase in true diagnostic certainty was 40.5% +/- 58.8 (range: -160% to 170%; 95% confidence interval: 30.1%, 69.2%). CONCLUSION: This method may be useful for estimating the effect of diagnostic tests on physicians' diagnostic thinking in variable conditions.
Abdomen, Acute↗
Radioimmunoscintigraphy of intracranial glioma xenograft with a technetium-99m-labeled mouse monoclonal antibody specifically recognizing type III mutant epidermal growth factor receptor.
The type III mutant epidermal growth factor receptor (EGFR) is expressed on the cell surface of a subset of glioma, but not of normal tissues. In this study, we investigated the in vivo kinetics of 3C10 mouse monoclonal antibody (mAb), specifically recognizing the type III mutant EGFR (EGFRvIII), using athymic nude mice bearing the intracranial glioma xenograft overexpressing the EGFRvIII. Human glioma cell line, U87MG, expressing the wild type EGFR and the transfectant, named U87MG x deltaEGFR, expressing the EGFRvIII, were transplanted subcutaneously or intracranially to nude mice. 3C10 mAb labeled with a technetium-99m (99mTc) was intravenously injected into these nude mice and then the mice were sacrificed at 24 h later, and the 99mTc-uptake by xenografts and major normal organs was measured to determine the biodistribution of mAb. Furthermore, at 3, 6 and 24 h after injection of 99mTc-labeled 3C10 mAb, whole-body scintigraphy was obtained with a gamma camera to localize the tumor site. 3C10 mAb significantly accumulated to U87MG x deltaEGFR xenografts transplanted subcutaneously or intracranially in nude mice, showing high tumor-to-blood ratio of 10.30 and 4.01, respectively. In contrast, uptake of control antibody in the intracranial tumor was as low as 0.43. In scintigrams, intracranially transplanted U87MG x deltaEGFR xenografts were detectable at 3 h after injection of 99mTc-labeled 3C10 mAb. These results suggest that intravenously injected 3C10 mAb specifically accumulated to the subcutaneous or intracranial glioma xenograft expressing the EGFRvIII and 3C10 mAb is a potential diagnostic and therapeutic agent for patients with gliomas expressing the EGFRvIII.
Animals↗
Rhenium-188-HEDP therapy for the palliation of pain due to osseous metastases in lung cancer patients.
Rhenium-188-hydroxyethylidine diphosphonate (188Re-HEDP) is a novel and attractive radiopharmaceutical that localizes in areas of osseous metastases and emits beta particles with energy sufficient to be therapeutically useful. The aim of this study is to evaluate the effectiveness of 188Re-HEDP in patients with lung cancer for the palliation of painful osseous metastases. Intravenous administration of activities ranging between 1.15 GBq (31 mCi) and 4.6 GBq (124 mCi) of 188Re-HEDP was given to each of 30 patients with painful osseous metastases from lung cancer. The patients were clinically followed at weekly intervals for the first 2 months, and monthly thereafter up to 1 year. Hematologic testing was performed before treatment and thereafter for 6 weeks. Pain response was scored by a four-point pain-rating scale as complete, marked, mild, and no response. Prompt and significant relief of bone pain occurred in 80% with no significant side-effects or hematopoietic toxicity. Forty-six percent (46%) of the patients discontinued analgesics after treatment. This clinical study indicated that 188Re-HEDP can offer significant pain palliation and is a useful radiopharmaceutical for treating painful osseous metastases from lung cancer.
Adult↗
Brain microhemorrhages detected on T2*-weighted gradient-echo MR images.
BACKGROUND AND PURPOSE: Multifocal microhemorrhages have been reported to be commonly found in the brain of patients with systemic hypertension and spontaneous brain hemorrhage. The factors associated with these lesions detected on T2*-weighted gradient-echo images were examined to determine whether these lesions serve to indicate different types of microangiopathy and to predict a patient's risk for symptomatic hemorrhage. METHODS: The study population consisted of 2164 patients who underwent 2416 consecutive brain MR imaging studies performed during 3 years. The patients with intracerebral hemorrhages due to vascular malformations, neoplasms, trauma, or intracranial surgery and those with incomplete medical records were excluded; 2019 cases were analyzed. RESULTS: The overall incidence of microhemorrhages was 9.8%, predominantly in the lentiform nucleus (n = 96), thalamus (n = 88), and cortical-subcortical region (n = 93). Presence of microhemorrhages had the highest significant correlation with history of hemorrhagic stroke (P <.0001); advancing age, hypertension, and prominent white matter hyperintensity on T2-weighted images had the next highest significant correlation. Cortical-subcortical microhemorrhages were more frequently observed in patients who had previous lobar hemorrhagic stroke (P <.005). Among 139 patients with microhemorrhages who could be clinically followed up for more than 1 month, four (2.9%) had new hemorrhagic stroke. CONCLUSION: The presence of microhemorrhages may be not only a direct marker of bleeding-prone small-vessel diseases but also an indicator of different types of microangiopathy and a predictor of further hemorrhagic stroke.
Adult↗
[Phase III additional clinical study of 111In-pentetreotide (MP-1727): diagnosis of gastrointestinal hormone producing tumors based on the presence of somatostatin receptors].
Additional phase III multicenter clinical study was performed to investigate the efficacy, safety, and usefulness of somatostatin receptor scintigraphy using 111In-pentetreotide (MP-1727), which binds to somatostatin receptors. Forty patients were included in the study; Group A: 18 patients, gastrointestinal hormone producing tumors had been detected with conventional imaging modalities, Group B: 22 patients, no tumors had been detected with conventional imaging modalities in spite of high serum hormone levels. By comparing the results of the octreotide suppression test, 12/16 cases (75.0%) of Group A and 11/19 cases (57.9%) of Group B were assessed as "effective." By comparing the results of immunohistological examination, 5/9 cases (55.6%) of Group A and 2/4 cases (50.0%) of Group B were assessed as "effective." Severe adverse events were not observed in any of the evaluable 35 cases. MP-1727 was judged as clinically useful in 11/16 cases (68.8%) of Group A and 5/19 cases (26.3%) of group B. These results suggest that MP-1727 scintigraphy is very useful for the diagnosis and decision of the therapeutic strategy of gastrointestinal hormone producing tumors.
Aged↗
[Whether and under what conditions FDG-PET might be cost-effective in evaluating solitary pulmonary nodules depicted on lung cancer screening in Japan].
PURPOSE: To determine whether and under what conditions fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may be cost-effective in evaluating solitary pulmonary nodules depicted on lung cancer screening in Japan. MATERIALS AND METHODS: Three decision models for differentiating lung cancer from benign nodules were compared: CT alone, PET alone, and CT plus PET. The various paths of each strategy were dependent on variables determined from a review of the medical literature. Costs were based on Japanese health insurance. RESULTS: The prevalence of lung cancer among solitary pulmonary nodules detected on lung cancer screening was less than 10%. For this prevalence, the CT-plus-PET model was the cost-effective alternative to the CT-alone model (cost savings were yen 64,000 per patient) and provided greater accuracy (0.90 vs. 0.84). Both of these effects were the result of reducing the number of candidates who undergo unnecessary CT-guided or bronchofiberscopic biopsies or thoracotomy for a benign pulmonary nodule. CONCLUSION: The CT-plus-PET strategy is accurate and cost-effective for the characterization of solitary pulmonary nodules detected on lung cancer screening in Japan.
Cost-Benefit Analysis↗