Diagnosis and treatments of bone metastasis were reviewed with clinical experiments in National Medical center Hospital. As for diagnosis of bone metastasis, early detection of bone metastasis was significantly improved by using bone scintigrams recently progressed. But the results of reviews suggest the possible improvements in diagnosis of bone metastasis. X-CT (X-ray Computed Tomography) for diagnosis of bone metastasis is advantages in three dimensional delineation of the extend and spread of bone lesions in bone marrow over bone scintigram. MRI (magnetic resonance imaging) has clinically been developed since 1981, does not directly represent bone structures but soft tissues in bone marrow, giving useful information concerning changes and spread of metastatic bone tumor not only inside the bone but also around it. MRI is now in technical progress and expected some improvements, could be expected in early diagnosis of bone metastasis. Regarding as treatment, we have individually to choose from radiotherapy, hormonal therapy, chemotherapy, surgical therapy according to clinical circumstances and does themselves. Radiation treatment is widely approved not only much effective in relieving the pains from bone metastasis, but also it is considered at the first choice in treatment of the spinal cord paresis by vertebral metastasis, because of frequently bringing good therapeutic effects.

千葉大学病院のホールボディカウンタを用いて, 405名の健常人と186名の患者を対象に, 全身カリウム (K) 量の測定を行った。全身K量は以下に示すレファレンス値として算出した。すなわち20歳代の健康人の全身K量を標準値とし, 体表面積で除し, かつ年齢と男女差を加味して補正し%表示した。405名の健常人のレファレンス値は100.65±9.22%であった。各疾患ごとのレファレンス値は以下のようになった。肝硬変: 94.24±11.22%, 慢性肝炎: 95.74±11.24%, 甲状腺機能亢進症: 99.37±10.8%, バーター症候群: 82.0±9.01%, 周期性四肢麻痺: 93.99±9.86%, 筋無力症: 97.34±6.42%, 低カリウム血症: 90.64±11.76%であった。また子宮癌, 乳癌, 貧血, 高血圧症ではそれぞれ, 97.78±11.5%, 99.22±8.88%, 96.64±12.73%, 98.5±9.63%となった。14例が75%以下の異常低値を示した。その内訳は肝硬変1例, 高血圧症3例, 糖尿病1例, 低カリウム血症3例, 周期性四肢麻痺1例, バーター症候群2例, 薬物中毒2例, 乳癌1例であった。バーター症候群の1例, 周期性四肢麻痺の3例, 高血圧症2例, 肝硬変1例, 筋無力症1例では, 経時的に全身K量が測定され, 病状の経過との間に関連が見られた。

We describe a patient with non-Hodgkin's B-cell lymphoma of diffuse large cell type, which involved both adrenal glands without adrenocortical insufficiency. Magnetic resonance showed bilateral adrenal tumors with some enhancing septa.

Lactate dehydrogenase (LDH) levels sometimes act as a good index of response to the treatment of malignant lymphoma. The cause of increases in LDH levels during chemotherapy with recombinant granulocyte colony-stimulating factor (rG-CSF) is not always clear, i.e. whether or not these increases are because of the disease activity or are a side effect of rG-CSF therapy. In this study we evaluated the changes in LDH levels during chemotherapy supported by rG-CSF in patients with malignant lymphoma. A total of 128 courses of rG-CSF chemotherapy were administered to 42 patients with malignant lymphoma. 87 (66%) of these treatment courses were associated with abnormalities in LDH levels, white blood cell count (WBC) and/or alkaline phosphatase (ALP) levels. We found significant correlations between the dose of rG-CSF and the frequency of ALP and WBC, but not LDH, abnormalities. Increases in LDH levels during chemotherapy were more frequently seen in patients who had elevated pretreatment LDH levels. Although increases in LDH levels may be a side effect of rG-CSF therapy, we must be aware of the probability that they may represent the activity of malignant lymphoma, especially in patients with increased pretreatment LDH levels.

Dissection-like artifact (DLA) is noted only on one-second scanning time CT image. It is usually observed in the ascending aorta, and less commonly in the superior vena cava and right pulmonary artery. We evaluated 136 cases of thoracic CT (including 20 cases of heart failure), and examined how often and where the artifact is noted and why it is produced. DLA was noted in the ascending aorta in 99 cases. Among the 99 cases, the same artifacts were also shown in the superior vena cava in 26 cases, and in the right pulmonary artery in 10 cases. DLA was never observed in other great vessels, such as the descending aorta and inferior vena cava. This artifact was not demonstrated in patients with heart failure. We presume that DLA is produced by pulsation of the ascending aorta and pulmonary artery. If the artifact is observed, the patient does not have severe cardiac impairment.

Seven patients were studied with positron emission tomography (PET) using 11C-methionine. All had non-Hodgkin's lymphoma but one, who had Hodgkin's disease. By assuming a simple three-compartment model for dynamic data analysis, we used the graphic method proposed by Patlak et al., where Ki (K2K3/(K1+K3)) was compared with DAR (differential absorption ratio). Trichloroacetate was added to each plasma sample, and the activity of the acid-soluble fraction was counted to eliminate the influence of the protein-bound fraction of injected activity. Patlak data plots, using this acid-soluble fraction as an input factor, showed good linearity over the time of data collection. All tumors showed clear 11C-methionine accumulation. Tumor activity reached almost a plateau within 10 min and was kept at the same level for at least 30 min. Ki and DAR were 0.070 +/- 0.035 and 4.64 +/- 1.85 (mean +/- SD), respectively. There was no apparent correlation between histological type and Ki or DAR, while the correlation efficient between Ki and DAR was 0.875. Our conclusion is that DAR will give almost the same result as dynamic data in the analysis of methionine metabolism using PET.

In pelvic irradiation, the volume of irradiated small intestine is one of the major factors responsible for both acute and late gastrointestinal complications. In this study, exclusion of the small intestine from the pelvic radiation field was attempted with lower abdominal wall compression and bladder distention in the prone position. The mobility of intrapelvic and several problems associated with this technique were investigated. In our results, the small intestine was effectively moved outside of the whole pelvic radiation field in all but two patients. Treatment interruption of 2 days was observed in only two patients. With the AP/PA opposing field method the abdominal skin dose near the compression pillow was revealed to be higher and the dose at the isocenter was inhomogeneous; thus, a three- or four-field technique is recommended if abdominal wall compression is used.

We applied 31P magnetic resonance spectroscopy (MRS) for the diagnosis of Duchenne muscular dystrophy (DMD), and evaluated its suitability for early-state DMD diagnosis. The spectral patterns showed typical differences between normal and diseased calf muscle. The signal intensity from each spectrum became weaker with advancing disease stage. We could detect abnormality even at the before imaging modalities.

To evaluate positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) as an diagnostic tool to determine tumor viability after anticancer therapy, fourteen patients were examined by FDG-PET after the end of the treatment. The lesions with residual viable tumor cells showed higher uptake of FDG than surrounding normal soft tissue. The lesions, in which tumor viability was lost or very low, showed higher uptake of FDG in four cases and similar uptake to normal soft tissue in three cases. The residual increased uptake of FDG was considered to be caused by remaining tumor cells and/or inflammatory reaction to anticancer treatment. FDG-PET after anticancer treatment should be interpreted by considering the reaction due to the treatment and the partial volume artifact of PET caused by the limited spatial resolution.

RATIONALE AND OBJECTIVES:A method for measuring the tumor blood flow (TBF) by means of dynamic computed tomography (DCT) was devised and investigated. METHODS:Twenty-seven patients with superficial tumors underwent measurement of TBF by the new DCT method. For all of the 27 patients, the thermal clearance method was employed to measure the relative tumor blood flow (RTBF). For 16 patients, TBF was measured by oxygen-15-gas positron-emission tomography (PET). The TBF values measured by DCT were compared with the RTBF by the thermal clearance method and the TBF by PET. RESULTS:The results demonstrated a linear relationship. CONCLUSIONS:The newly devised DCT method yields reliable data in measuring TBF.

To evaluate the usefulness of FDG-PET as a predictor of prognosis, 34 patients with untreated malignant lymphoma in the head and neck region were studied. After FDG-PET and treatment, they were observed from 15 to 50 months. Tumors which were aggressive and resistant to treatment tended to show high uptake of FDG. The survival rate of patients with high uptake of FDG, DAR > 8, was lower than the rate of the other patients. It is considered to be useful to add FDG uptake of the tumor to other prognostic factors for predicting the prognosis.

This study was conducted to determine bone scintigraphic findings in nontraumatic femoral head avascular necrosis and diagnostic value of SPECT imaging following a conventional planar imaging. Forty-three femoral heads in twenty-six cases with idiopathic femoral head necrosis (n = 2), systemic lupus erythematosus (n = 22), aplastic anemia (n = 1), and renal transplantation (n = 1) were studied. The diagnosis for femoral head necrosis was based on magnetic resonance imaging as well as other diagnostic studies in all cases. Scintigraphic findings of planar and SPECT images were classified into six categories: normal (N); cold or decrease (C); partial increase with cold or decrease (PH+C); ring-like increase with a cold center (RH+C); partial increase (PH); diffuse and/or irregular increase (DH). Avascular necrosis was confirmed in twenty-four femoral heads, in which planar and SPECT images showed scintigraphic findings of N (n = 3, 2), C (n = 1, 3), PH+C (n = 2, 8), RH+C (n = 2, 3), PH (n = 9, 2), and DH (n = 7, 6), respectively. Femoral heads without avascular necrosis demonstrated planar and SPECT findings of N (n = 16, 12), C (n = 0, 6), and DH (n = 3, 1), respectively. When considering C, PH+C, and RH+C as diagnostic findings for avascular necrosis, sensitivities of planar and SPECT images were 21% and 58%, and specificities were 100% and 68%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Fat suppression MR imaging is a valuable technique mainly used for the orbit, head and neck, and spine, where the high signal from fat can often obscure adjacent pathology. Fat suppression failure artifact manifested as a high signal area without geographic distortion. The purpose of this study was to investigate the frequency and common location of these artifacts in clinical MR imaging and to caution against their misinterpretation. Fat suppression MR imaging of the head and neck was performed in 30 consecutive patients. The artifact was found in the orbital floor (57%), the skull base (10%), and subcutaneous fat (10%), where the air-fat interface is parallel to the static magnetic field direction. The fat signal in the air-fat interface perpendicular to the static magnetic field was well suppressed. This artifact was independent of the duration of TE, frequency/phase encoding direction, and the strength of gradient amplitude, and appeared to be related to the amount of surrounding air. This may simulate pathology if fat suppression is only performed following Gd-DTPA administration. The radiologist should be aware of the presence of artifact by considering the geographic relation to the static magnetic field.