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Biomedical subjects

Yoshifumi Sugawara

Publications and source records attributed to Yoshifumi Sugawara.

At least 19 recordsLinked to original sources

Cardiac imaging using 256-detector row four-dimensional CT: preliminary clinical report.

PURPOSE: Along with the increase of detector rows on the z-axis and a faster gantry rotation speed, the spatial and temporal resolutions of the multislice computed tomography (CT) have been improved for noninvasive coronary artery imaging. We investigated the feasibility of the second specification prototype 256-detector row four-dimensional CT for assessing coronary artery and cardiac function. MATERIALS AND METHODS: The subjects were five patients with coronary artery disease. Contrast medium (40-60 ml) was intravenously administered at the rate of 3-4 ml/s. The patient's whole heart was scanned for 1.5 s to cover at least one cardiac cycle during breathholding without electrocardiographic gating. Parameters used were 0.5 mm slice thickness, 0.5 s/rotation, 120 Kv, and 350 mA, with a half-scan reconstruction algorithm (temporal resolution 250 ms). Twenty-six transaxial datasets were reconstructed at intervals of 50 ms. RESULTS: The assessability of the coronary arteries in AHA segments 1, 2, 3, 5, 6, 7, 9, and 11 was visually evaluated, resulting in 29 of 32 (90.9%) segments being assessable. Functional assessment was also performed using animated movies without banding artifacts in all cases. CONCLUSIONS: The 256-detector row four-dimensional CT can assess the coronary artery and cardiac function using data during 1.5 s without banding artifacts.

Aged↗

Heterogeneity of posterior limbic perfusion in very early Alzheimer's disease.

PURPOSE: This study was designed to quantify the heterogeneity of cerebral perfusion on SPECT images in elderly controls and Alzheimer's disease (AD) patients in mild stage using a three-dimensional fractal analysis (3D-FA). MATERIAL AND METHOD: Seventy-five patients with possible and probable AD based on the NINCDS/ADRDA criteria, and thirty-one elderly controls underwent 99mTc-HMPAO SPECT scanning. Dementia severity was assessed using the clinical dementia rating (CDR). Patients with CDR scores of 0.5 (n=33) were classified as "very early" and those with CDR 1 (n=42) as "early". We delineated the SPECT images using 2 cutoffs (35% and 50% cutoffs of the maximal voxel radioactivity) and measured the number of voxels in the areas included by the contours obtained with each cutoff level. The fractal dimension (FD) was calculated by relating the logarithms of cutoff level and the number of voxels. Posterior limbic images were reconstructed at 30 degrees positive to the coronal plane, and posterior limbic FD was calculated. RESULT: Posterior limbic FD for early AD, very early AD, and control groups were 1.03+/-0.16, 1.02+/-0.17, and 0.87+/-0.14 (P=0.001 versus early AD group, P=0.001 versus very early AD). Use of the posterior limbic FD and the ratio of posterior limbic FD to total FD separated very early AD patients from controls with a sensitivity of 76% and a specificity of 81%. CONCLUSION: 3D-FA indicated significant differences in the heterogeneity of CBF distribution between patients with AD in mild stage and elderly controls. Posterior limbic FD may be useful for easily and objectively distinguishing patients with very early AD from aging people.

Aged↗

Thallium-201 SPECT in prognostic assessment of malignant gliomas treated with postoperative radiotherapy.

OBJECTIVE: This study was designed to investigate the value of preoperative thallium-201 (201Tl) SPECT as a predictor of outcome in malignant glioma. METHODS: From January 1990 to September 2003, 109 patients with glioma were treated with postoperative radiotherapy. Of these, 36 patients with malignant gliomas who underwent preoperative 201Tl-SPECT were included in this study (grade 3: n=14, grade 4: n=22). On early (10 minutes) and delayed (2 hours) images after 111 MBq 201TlCl injection, we calculated radioactivity ratios of tumors to contralateral normal brain (T/N ratios) and retention indices (RIs). For early and delayed images, we compared outcome between a high T/N ratio group (T/N ratio equal or greater than the average) and a low T/N ratio group (T/N ratio less than the average). We also divided the patients into two groups on the basis of RI; a high RI group (RI equal or greater than the average) and a low RI group (RI less than the average), and similarly compared outcome between the two groups. RESULTS: Median survival time was 12 months for both grade 3 and grade 4 tumors; however, two-year survival was 53% for grade 3 and 15% for grade 4. In both early and delayed images, outcome was significantly better for patients with low T/N ratios (early < 4.71, delayed < 3.96) than those with high T/N ratios (early: p = 0.030, delayed: p = 0.049). However, no significant survival difference was apparent between the low- (< -12.25) and high RI groups. In grade 3 glioma, patients with high T/N ratios demonstrated a tendency toward poorer outcome, although this trend was not significant (early: p = 0.079, delayed: p = 0.099). Overall outcome was poor for grade 4 glioma, and the difference in survival between low and high T/N ratio groups was not significant (early: p = 0.51, delayed: p = 0.53). However, long survival was seen only in patients with lower T/N ratios. CONCLUSIONS: Differences of 201Tl uptake in malignant gliomas could predict outcome. 201Tl-SPECT is potentially useful in the management of patients with malignant gliomas.

Aged↗

Assessment of left ventricular wall motion using 16-channel multislice computed tomography: comparison with left ventriculography.

PURPOSE: Using the raw data from coronary computed tomography (CT) angiography, multislice CT (MSCT) can be used to evaluate cardiac function. However, the accuracy of left ventricular (LV) wall motion assessment by MSCT has not been thoroughly investigated. We investigated whether 16-channel MSCT could accurately assess LV wall motion by comparing its results with those of conventional biplane left ventriculography (LVG). MATERIALS AND METHODS: The study included 20 patients with various kinds of heart disease. All patients underwent both contrast-enhanced MSCT and biplane LVG. Using a retrospective electrocardiography-gating technique, 10 phases over one cardiac cycle were extracted. The left ventricle was divided into seven segments according to the American Heart Association classification. Wall motion was scored as follows: 1, normal; 2, mild to moderate hypokinesis; 3, severe hypokinesis; 4, akinesis; 5, dyskinesis; and 6, aneurysm. The scores obtained by MSCT were compared with those obtained by LVG. The wall motion scores were analyzed using the chi-squared independence test (6 x 6 contingency table). RESULTS: Wall motion could be assessed in all segments of the 20 patients using interactive multiplanar animation. Among a total of 140 segments in 20 patients, scores in 118 were concordant between MSCT and LVG (118/140, 84.3%). CONCLUSION: The 16-MSCT can accurately assess LV wall motion.

Adult↗

Subcutaneous fibrolipoma in the back.

A 65-year-old man presented with a subcutaneous giant mass in his upper back. The tumor had a massive fatty and non-adipose component that enhanced heterogeneously on contrast-enhanced computed tomography and magnetic resonance imaging. Therefore, the lesion was initially thought to be a liposarcoma or spindle cell lipoma. After surgery, the tumor was histologically diagnosed as a fibrolipoma. Subcutaneous fibrolipoma is a rare neoplasm that is defined as a subtype of lipoma.

Aged↗

Elevated concentration of hyaluronan in the cerebrospinal fluid is a secondary marker of spinal disorders: hyaluronan in the cerebrospinal fluid in patients with spinal disorders.

BACKGROUND: Hyaluronan (HA) was measured in cerebrospinal fluid (CSF) to ascertain the clinical significance of this substance in patients with spinal disorders, a topic that, to the best of our knowledge, has not previously been studied. METHODS: We examined correlations of CSF HA concentration with age, sex, height, body weight, and spinal disorders. By using a sandwich-binding protein assay, HA was measured in CSF samples obtained from 500 patients aged 12 to 104 years who underwent lumbar spinal anesthesia for surgery, myelography, or CSF examination. These patients were classified into 3 groups: (1) a control group (306 patients with injury or benign tumor of the lower limbs); (2) a cervical disorders group (84 patients with cervical disc herniation, cervical spondylotic myelopathy, or ossification of the posterior longitudinal ligament); and (3) a lumbar disorders group (110 patients with lumbar disc herniation, lumbar spinal canal stenosis tethered cord syndrome, lumbar fracture, or spondylolytic spondylolisthesis). RESULTS: CSF HA concentration was found to be positively correlated with age, and was significantly higher in patients with cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, or lumbar spinal canal stenosis tumor than in the control group. CONCLUSIONS: CSF HA concentration might be a secondary marker for inflammation in patients with spinal disease.

Adolescent↗

Image fusion of coronary tree and regional cardiac function image using multislice computed tomography.

BACKGROUND: Although trials of image fusion, such as positron emission computed tomography and multislice spiral computed tomography (MSCT), have already demonstrated clinical usefulness, fusion of the coronary artery image and functional image by MSCT alone has not been reported yet. Here, a new idea of data analysis is proposed in which both regional cardiac function and the responsible coronary arteries can be assessed by a fused image. METHODS AND RESULTS: The study group comprised 5 patients with coronary artery disease. At the first procedure, 3 dimensional (D) volume rendering coronary artery (3D-CTA) was extracted. At the second procedure, the systolic regional wall thickening was calculated and the color 3D functional surface map of systolic wall thickening (3D-SWT) was generated. At the final procedure, 3D-SWT was superimposed on the left ventricular surface with 3D-CTA using a transparency. In all 5 patients, image fusion of the coronary tree and cardiac function was correctly generated. Image fusion can be displayed as clear 3D images, offering better orientation to help assess both the coronary artery and regional function. CONCLUSIONS: Image fusion of coronary computed tomography angiography and the functional map by MSCT is potentially a new method of assessing both the coronary artery and cardiac function.

Coronary Angiography↗

Regional cerebral blood flow change in a case of Alzheimer's disease with musical hallucinations.

We examined alteration of regional cerebral blood flow (rCBF) in a case of Alzheimer's disease (AD) patient with musical hallucination. To detect regions related to musical hallucination, single-photon emission computed tomography (SPECT) imaging of the patient and nine sex, age, and cognitive function-matched AD patients without delusions and hallucinations were compared using statistical parametric mapping 99 (SPM99). In comparison with controls, the patient had increased rCBF in left temporal regions and left angular gyrus. This profile could be relevant to the neuroanatomical basis of musical hallucinations.

Aged↗

Effect of x-ray tube current on the accuracy of cerebral perfusion parameters obtained by CT perfusion studies.

The purpose of this study was to investigate the effect of x-ray tube current on the accuracy of cerebral perfusion parameters obtained by CT perfusion studies using multi-detector row CT (MDCT). Following the standard CT perfusion study protocol, continuous (cine) scans (1 s/rotation x 60 s) consisting of four 5 mm thick contiguous slices were performed using an MDCT scanner with a tube voltage of 80 kVp and a tube current of 200 mA. We generated the simulated images with tube currents of 50 mA, 100 mA and 150 mA by adding the corresponding noise to the raw scan data of the original image acquired above using a noise simulation tool. From the original and simulated images, we generated the functional images of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) in seven patients with cerebrovascular disease, and compared the correlation coefficients (CCs) between the perfusion parameter values obtained from the original and simulated images. The coefficients of variation (CVs) in the white matter were also compared. The CC values deteriorated with decreasing tube current. There was a significant difference between 50 mA and 100 mA for all perfusion parameters. The CV values increased with decreasing tube current. There were significant differences between 50 mA and 100 mA and between 100 mA and 150 mA for CBF. For CBV and MTT, there was also a significant difference between 150 mA and 200 mA. This study will be useful for understanding the effect of x-ray tube current on the accuracy of cerebral perfusion parameters obtained by CT perfusion studies using MDCT, and for selecting the tube current.

Aged↗

A child who recovered completely after spinal cord injury complicated by C2-3 fracture dislocation: case report.

STUDY DESIGN: This was a case of a child who recovered completely after spinal cord surgery complicated by C2-C3 fracture dislocation. OBJECTIVES: To clarify the important issue with regard to the diagnosis and treatment of possible spinal cord injury complicated by C2-C3 fracture dislocation in children. SUMMARY OF BACKGROUND DATA: Reports on spinal cord injury complicated by C2-C3 fracture dislocation in children who recovered completely after surgery are very rare. Moreover, there are no reports of cases in which described MRI and magnetic resonance angiography obtained 5 years after surgery. METHODS: A 4-year-old girl with complete fracture dislocation of C2-C3 and spinal cord injury of Frankel B because of a traffic injury. A middle incision was made in a prone position under general anesthesia, and C2-C3 was fixed with interlaminal wiring according to the McGraw modified method. RESULTS: The postoperative course was excellent, and the patient recovered completely. An MRI performed 5 years after surgery revealed no definitive abnormality in spinal cord and patency of vertebral arteries. CONCLUSION: This was a very rare case of spinal cord injury complicated C2-C3 fracture dislocation in children. The present case is of interest in that it demonstrated the possibility of recovery in a child from spinal cord injuries of Frankel B immediately after injury, if complex injuries in multiple organs are controlled by systemic management.

Accidents, Traffic↗

Thallium-201 scintigraphy in bone and soft-tissue tumors: a comparison of dynamic, early and delayed scans.

OBJECTIVE: It has been reported that delayed scan of thallium-201 (201Tl) scintigraphy is useful for differentiating malignant tumors from benign lesions and for evaluating treatment response. However, physiological muscle uptake which usually increases in delayed scans, often makes it difficult to evaluate 201Tl uptake and its washout in bone and soft-tissue tumors. The purpose of this study was to evaluate whether the delayed scan is necessary and whether a dynamic scan is useful in the evaluation of bone and soft-tissue tumors. METHODS: We studied 175 cases of bone and soft-tissue tumors (malignant 45, benign 130). Dynamic scans were acquired every 5 seconds for 10 minutes after 201Tl injection, and time activity curves (TACs) were generated by adaptive smoothing methods. Early and delayed scans were acquired at 10-15 minutes and 2 hours after injection. 201Tl images were visually interpreted and the radioactivity count ratio (T/N) of tumors to normal tissues and washout rate [WR = (early T/N - delayed T/N)/early T/N] were defined. RESULTS: When there were no 201Tl uptake in dynamic (n = 67) and early scans (n = 68), no tumor uptake was also appreciated in delayed scans, and all but two cases of negative scans were benign. In 107 lesions, although there were significant differences in T/Ns between malignant and benign lesions both on early scans (2.84 +/- 1.45 vs. 2.05 +/- 1.13, p < 0.05) and delayed scans (2.17 +/- 1.03 vs. 1.58 +/- 0.64, p < 0.05), there was a substantial overlap. The T/Ns decreased in delayed scans (i.e., WR > 0) in 100 of 107 cases due to increase of surrounding muscle uptake, and there was no difference in WR between malignant tumors and benign lesions (0.21 +/- 0.14 vs. 0.19 +/- 0.14). CONCLUSIONS: For evaluating bone and soft-tissue tumors, delayed scan had little clinical usefulness and it may be time consuming. Dynamic scan would be useful for demonstrating the differences between tumor blood flow and 201Tl uptake in tumors.

Adolescent↗

A case of nodular-type muscular sarcoidosis: findings of imaging, histopathology, and polymerase chain reaction.

We report a case of nodular-type muscular sarcoidosis with no systemic symptoms. Thallium-201 scintigraphy showed intense uptake in the muscular lesion mimicking malignant soft tissue tumor. Magnetic resonance imaging (MRI) demonstrated characteristic signal patterns of peripheral high intensity with central low intensity ("three stripes" pattern). Microscopy revealed sarcoid granuloma with typical histopathological characteristics. Propionibacterium acnes was detected on polymerase chain reaction analysis of the excised tissue.

Journal Article↗

Tl-201 and Tc-99m HMDP scintigraphic findings in extraskeletal osteosarcoma.

Extraskeletal osteosarcoma is an extremely rare high-grade malignant soft tissue tumor, which accounts for approximately 4% of osteosarcomas and less than 1% of all soft tissue sarcomas. There have been reports describing the scintigraphic findings of this tumor, especially with Tl-201. We report a biopsy-proven case of extraskeletal osteosarcoma in which the bone and thallium scans were found to be useful in monitoring chemotherapy response. The Tc-99m HMDP bone scan revealed increased extraskeletal uptake in the tumor.

Bone Neoplasms↗

Bone metastasis detected by FDG PET in a patient with breast cancer and fibrous dysplasia.

Bone scintigraphy is sensitive for detecting bone metastases in patients with malignancies. However, it is often difficult to differentiate bone metastases from other nonmalignant lesions. We encountered a patient with a history of breast cancer who showed substantial elevation of tumor markers 4 years after surgery. Although there were no subjective symptoms and the bone scan showed multiple hot spots, which were similar to previous scans and which had been diagnosed as fibrous dysplasia on radiographs, a whole-body FDG PET scan showed a solitary area of intense uptake at the site of one of the hot spots in the bone scan. A solitary bone metastasis was confirmed by MRI and the patient then received radiation therapy and the elevated tumor markers of CEA and CA 15-3 were normalized after the therapy.

Bone Neoplasms↗

Healing focal "flare" phenomenon after radiotherapy in a bone metastasis from bladder cancer.

"Flare" phenomenon has been primarily reported as a transient increase in the number or intensity of lesions on bone scans in patients receiving hormonal or chemotherapy. It has been well documented in patients with metastatic breast or prostate carcinoma, and recently reported in those with lung cancer. We present a case of bone metastasis from bladder carcinoma, in which healing flare phenomenon was observed after radiotherapy.

Aged↗

Measurement of radiation dose in cerebral CT perfusion study.

PURPOSE: To evaluate radiation dose in cerebral perfusion studies with a multi-detector row CT (MDCT) scanner on various voltage and current settings by using a human head phantom. MATERIALS AND METHODS: Following the CT perfusion study protocol, continuous cine scans (1 sec/rotation x60 sec) consisting of four 5-mm-thick contiguous slices were performed three times at variable tube voltages of 80 kV, 100 kV, 120 kV, and 140 kV with the same tube current setting of 200 mA and on variable current settings of 50 mA, 100 mA, 150 mA, and 200 mA with the same tube voltage of 80 kV. Radiation doses were measured using a total of 41 theroluminescent dosimeters (TLDs) placed in the human head phantom. Thirty-six TLDs were inside and three were on the surface of the slice of the X-ray beam center, and two were placed on the surface 3 cm caudal assuming the lens position. RESULTS: Average radiation doses of surface, inside, and lens increased in proportion to the increases of tube voltage and tube current. The lowest inside dose was 87.6+/-15.3 mGy, and the lowest surface dose was 162.5+/-6.7 mGy at settings of 80 kV and 50 mA. The highest inside dose was 1,591.5+/-179.7 mGy, and the highest surface dose was 2,264.6+/-123.7 mGy at 140 kV-200 mA. At 80 kV-50 mA, the average radiation dose of lens was the lowest at 5.5+/-0.0 mGy. At 140 kV-200 mA the radiation dose of lens was the highest at 127.2+/-0.6 mGy. CONCLUSION: In cerebral CT perfusion study, radiation dose can vary considerably. Awareness of the patient's radiation dose is recommended.

Basal Ganglia↗