Catheter-related bloodstream infections (CRBSIs) are driven by biofilm formation on catheter surfaces. Poly(2-methoxyethyl acrylate) (PMEA) is a blood-compatible polymer that suppresses protein adsorption and may inhibit bacterial attachment through a non-bactericidal anti-adhesive mechanism. This study evaluated the antibiofilm effect of PMEA coating using a blood-based in vitro model.A blood-based in vitro model was established using bovine blood to better reproduce the protein-rich intravascular environment associated with CRBSIs. Polyurethane catheter segments with or without PMEA coating were incubated for 7 days in bovine serum containing Staphylococcus aureus ATCC 29213 or Staphylococcus epidermidis ATCC 35984, with or without prior plasma exposure. Biofilm biomass was quantified by toluidine blue staining and spectrophotometric measurement of absorbance at 632 nm.PMEA coating significantly suppressed biofilm formation, corresponding to an approximately 92% reduction compared with uncoated catheters. Plasma exposure markedly enhanced biofilm formation, producing an approximately 23-fold increase relative to non-exposed conditions. PMEA coating did not affect planktonic bacterial growth, supporting a non-bactericidal mechanism of action.These findings suggest that PMEA suppresses catheter-associated biofilm formation by inhibiting plasma protein adsorption and subsequent bacterial attachment. Modulation of host protein-surface interactions may represent an effective strategy for preventing CRBSIs without relying on bactericidal activity.

Daily attendance requirements for radiotherapy (RT) make geographic accessibility a critical determinant of treatment adherence and completion. Although facility surveys indicate that advanced modalities such as intensity-modulated radiotherapy (IMRT) and brachytherapy are concentrated in urban centers, precise nationwide quantification of the resulting patient travel burden remains lacking. This study provides the first nationwide, modality-stratified assessment of geographic access to RT in Japan. Using the Open Source Routing Machine and a high-resolution dataset of 176 964 household-weighted 1-km mesh centroids, we calculated driving times to the nearest external-beam radiotherapy (EBRT), IMRT and brachytherapy facilities. Beyond standard distribution metrics, we generated high-resolution 'penalty maps' to quantify the incremental time tax imposed by advanced modality requirements. Although EBRT access was uniformly short nationwide, with a median travel time of 6.48 min, this increased to 8.26 min for IMRT and 14.06 min for brachytherapy. Crucially, the proportion of the population facing poor access (≥120 min) doubled from 0.24% for EBRT to 0.48% for brachytherapy. The spatial analysis identified specific 'newly poor-access' areas-regions that are accessible for EBRT but become remote when advanced care is needed-forming coherent geographic clusters in mountainous and island zones. These findings demonstrate that modality requirements introduce meaningful inequities despite strong national EBRT infrastructure. These indicators provide a vital evidence base for spatially optimizing resources to mitigate travel burdens for Japan's aging, mobility-limited population.

Objectives: Whereas irreversible compression of Digital Imaging and Communications in Medicine (DICOM) files can reduce data size, research on its impact on diagnostic ability when using artificial intelligence (AI) software is limited. The objective was to determine the effect that irreversible compression has on diagnostic ability when using AI software. In addition, the effect of nodal properties on computed tomography (CT) on detection rates was examined. Methods: A total of 335 patients with pulmonary nodules were included. Chest radiographs were subjected to irreversible compression at 10:1 and 50:1 ratios. The associations between the detection rate of the AI software and factors such as location on CT, morphology, and diameter, were determined. Results: The number of positive cases identified with the AI imaging software was as follows: 188 cases (56.1%) with no compression, 184 cases (54.9%) with 10:1 compression, and 175 cases (52.2%) with 50:1 compression. There was a significant difference between the uncompressed images and the 50:1 compressed images, as well as between the 10:1 compressed images and the 50:1 compressed images (all p < 0.05). With all compression ratios, there were significant differences in the associations between the AI software’s nodule detection rate and the target nodule’s maximum diameter, minimum diameter, morphology, and overlap with multiple organs on CT (all p < 0.0001). Conclusions: The detection rate by the AI software of lung tumors on chest radiographs showed no significant difference when images were subjected to 10:1 irreversible compression; however, there was a significant decrease when subjected to 50:1 irreversible compression.

Objective:Thoracic duct outflow obstruction is a recognized cause of refractory lymphatic leakage; however, the physiological consequences of such obstruction on thoracic duct pressure and its relationship to central venous pressure have not been fully characterized in vivo. This study aimed to evaluate changes in thoracic duct pressure and the pressure gradient between the thoracic duct and the central venous system in an experimental model of thoracic duct outflow obstruction. Methods:In a swine model, thoracic duct pressure and central venous pressure were directly measured using intravascular catheters positioned at matched vertebral levels. Thoracic duct embolization was performed at the upper thoracic level using coils and cyanoacrylate and was used as an experimental model of thoracic duct outflow obstruction. Pressure measurements were obtained before embolization and after confirmation of complete thoracic duct occlusion. Changes in thoracic duct pressure, central venous pressure, and the pressure relationship between the two systems were analyzed using paired statistical comparisons. Results:Thoracic duct outflow obstruction resulted in a significant increase in upstream thoracic duct pressure, with a median increase of approximately 6 to 8 mmHg compared with preobstruction values. Following obstruction, thoracic duct pressure consistently exceeded central venous pressure, creating a pressure gradient indicative of lymphatic hypertension. In contrast, central venous pressure did not change significantly after thoracic duct obstruction. No consistent cranio-caudal longitudinal pressure gradient along the thoracic duct was identified. Conclusions:Thoracic duct outflow obstruction induces lymphatic hypertension, as demonstrated by an increase in thoracic duct pressure relative to central venous pressure. This experimentally demonstrated pressure gradient provides physiological support for decompressive interventions by demonstrating a pressure gradient favorable for lymphatic drainage into the venous system. By directly quantifying intralymphatic and venous pressures in vivo, this study offers mechanistic insight into the pathophysiology of lymphatic leakage associated with thoracic duct obstruction and may help inform treatment selection between occlusive and decompressive strategies in lymphatic interventions. Clinical Relevance:Thoracic duct outflow obstruction is a cause of lymphatic leakage, yet the consequences of obstruction on thoracic duct pressure and its relationship to central venous pressure have remained unclear. In this experimental study, in vivo measurements demonstrated that thoracic duct outflow obstruction results in an increase in thoracic duct pressure, creating a pressure gradient relative to central venous pressure. This pressure relationship reflects lymphatic hypertension caused by outflow obstruction and supports decompressive interventions aimed at restoring lymphatic outflow.

ABSTRACT Introduction Radical cystectomy with pelvic lymph node dissection for muscle‐invasive bladder cancer may be complicated by postoperative lymphatic leakage when high‐output drainage persists despite conservative management. We describe treatment of diffuse lymphoascites after pelvic lymph node dissection using upstream lymphatic embolization. Case Presentation A man in his 70s developed lymphatic leakage with drainage > 1000 mL/day after radical cystectomy and pelvic lymph node dissection. Lymphoscintigraphy showed bilateral iliac leakage with diffuse intraperitoneal spread, making local sclerotherapy unsuitable. Intranodal lymphangiography via bilateral inguinal nodes identified iliac lymphatic duct leaks. Upstream embolization with a N‐butyl cyanoacrylate–ethiodized oil mixture through multiple inguinal nodes rapidly reduced drainage, allowing drain removal by day 4 and discharge by day 10 without persistent lymphedema. Conclusion Upstream lymphatic embolization is a minimally invasive option for refractory high‐output lymphatic leakage after pelvic lymph node dissection.

BACKGROUND/OBJECTIVES:Trace metals, including copper (Cu) and zinc, are associated with the development and prognosis of hepatocellular carcinoma (HCC). However, their interference with magnetic resonance imaging (MRI) limits their use as potential biomarkers. This study investigated the usefulness of Synchrotron Radiation-excited X-ray Fluorescence (SR-XRF) imaging in studying the distribution of trace metals in HCC. METHODS:This case-control study analyzed 33 specimens from 32 patients with HCC who underwent surgical resection (n = 29) or biopsy (n = 3) at Kobe University Hospital between December 1999 and November 2002. The findings of SR-XRF were compared with those of MRI and histopathology. RESULTS:SR-XRF provided two-dimensional mapping of trace metal distribution with high spatial resolution (1.0 µm). The mean tumor-to-liver ratio (TLR) of Cu content was significantly higher in well-differentiated HCCs than in moderately and poorly differentiated HCCs (p < 0.05). Moreover, the mean TLRs of Cu content were significantly higher in high-intensity lesions than in iso- or low-intensity lesions on T1-weighted imaging (p < 0.05). CONCLUSIONS:This study supports previous evidence of the involvement of Cu in HCC development, suggesting its potential as a clinical biomarker for diagnosis and disease progression. Additionally, the results demonstrate that SR-XRF has potential for clinical application due to its ability to map trace metal distribution at high resolution. These findings suggest, rather than demonstrate, the association among Cu accumulation, tumor differentiation, and MRI signal characteristics.

OBJECTIVES:To evaluate the computed tomography (CT) findings of liver injury after chest compressions in patients who achieved return of spontaneous circulation following cardiopulmonary resuscitation. METHODS:This retrospective single-center study included consecutive patients who underwent abdominal CT after successful resuscitation (1/2006-9/2024). CT images were retrospectively reviewed to identify liver injury attributable to chest compressions. Imaging findings, injury distribution, hemorrhagic features were analyzed. RESULTS:Among 716 resuscitated patients who underwent CT, liver injury after chest compressions was identified in 11 patients (mean age, 60.5 years ± 15.8 [standard deviation]; 4 men, 7 women). All liver injuries were detected on contrast-enhanced CT (5.3%, 11/206), whereas only one liver injury was detectable on noncontrast CT (0.1%, 1/716). Lacerations predominantly involved the left lobe (64%) and caudate lobe (55%), with segment 4 being the most frequent dominant site. Right lobe involvement was uncommon. Bleeding along the falciform ligament was observed in 36% of cases. Hemoperitoneum occurred in two patients, both of whom died from hemorrhagic shock related to liver injury. CONCLUSION:Liver injury after chest compressions is an uncommon but clinically relevant complication in resuscitated patients. Contrast-enhanced CT is crucial for detection. Awareness of characteristic imaging features-including preferential involvement of the left and caudate lobes, and bleeding along the falciform ligament-can improve diagnostic recognition on post-resuscitation CT.

Background : This study aimed to demonstrate the effectiveness of a percutaneous method for treating intra-abdominal abscesses caused by gastrointestinal anastomotic leakage using tandem catheter placement for simultaneous drainage. Methods : This retrospective study involved 12 patients with intra-abdominal abscesses from anastomotic leakage who underwent image-guided percutaneous drainage. In the tandem drainage technique, one or more catheters were inserted into the abscess while an additional catheter was advanced into the gastrointestinal tract through the anastomotic dehiscence to decompress the tract and prevent further leakage. The study evaluated the technical and clinical success rates of this approach. Results : Technical success was achieved in nine of 12 patients (75.0%), with clinical success in eight of these nine patients (88.9%). The mean overall drainage duration after tandem placement was 65.0 days (range, 6-154 days), and the mean hospitalization duration for patients with clinical success was 66.7 days (range, 10-156 days). Conclusion : Simultaneous tandem drainage is a feasible treatment for intra-abdominal abscesses caused by anastomotic leakage and may be a viable option for patients who are not candidates for surgery.

BackgroundComputed tomography (CT) fluoroscopy provides high-resolution images and is widely used for safe and accurate procedures, but it exposes operators to high radiation doses.PurposeTo develop and evaluate a tunnel-shaped shielding system to reduce operator exposure to scattered radiation during CT fluoroscopy-guided procedures.Material and MethodsThe shield, designed based on scattered radiation distribution, consists of a semi-cylindrical leaded acrylic part and a bottom plate with a non-lead shielding board surrounding the patient. Radiation doses were measured with and without the shield using patient and operator phantoms. Dosimeters were placed at 10 locations on the operator phantom, including the eye lens, thyroid, chest, abdomen, pelvis, legs, patient-side armpit, and needle-holding hand. Percentage reductions in radiation exposure were calculated.ResultsThe tunnel-shaped shield significantly reduced radiation exposure, with dose reductions of 83%-100% at the eye lens, 88%-96% at the thyroid, 84%-95% at the upper chest, 84%-92% at the lower chest, 88%-94% at the abdomen, 91%-94% at the pelvis, 57%-68% at the upper leg, 44%-83% at the lower leg, 90%-94% at the patient-side armpit, and 73%-86% at the needle-holding hand. All reductions were statistically significant.ConclusionPhantom experiments demonstrated that the tunnel-shaped shielding system effectively reduces operator exposure to scattered radiation during CT fluoroscopy-guided procedures.

BACKGROUND/AIM:The effect of modern molecular-targeted agents (MTAs), on vertebral metastases in non-small cell lung cancer (NSCLC) remains inadequately characterized. We investigated the local control effects of MTAs on vertebral metastases in patients with NSCLC. PATIENTS AND METHODS:We retrospectively analyzed 307 vertebral metastases in 85 patients with NSCLC, treated between 2019 and 2021. Patients were categorized based on prior systemic therapy exposure (19 with vs. 66 without) and the type of first-line therapy administered (32 MTA vs. 34 non-MTAs). Multivariate analyses were performed for the vertebral progression-free period (vPFP) and overall survival (OS) using a Cox proportional hazards model with propensity scores as covariates. p-Value correction for multiple pairwise comparisons was performed using the Bonferroni method. RESULTS:In treatment-naïve patients, MTAs presented superior outcomes compared with non-MTAs [1-year vPFP: 93.6% vs. 85.1%, p=0.02; 1-year overall survival (OS): 90.3% vs. 60.9%, p=0.004]. Patients without prior systemic therapy had significantly better outcomes than previously treated patients (1-year vPFP: 89.5% vs. 49.1%, p<0.001; 1-year OS: 75.2% vs. 34.2%, p=0.011). The multivariate analysis identified prior systemic therapy as a significant predictor of poor outcomes [vPFP: hazard ratio (HR)=6.78, p<0.001; OS: HR=2.13, p=0.030]. CONCLUSION:Modern systemic therapies, particularly MTAs, present significant efficacy in controlling vertebral metastases in patients with NSCLC without prior systemic therapy. Deferring local treatments may be feasible in patients without prior systemic therapy, whereas those who develop vertebral metastases after treatment may require additional treatment.

Metastatic liver tumors are more common than primary liver cancers and are the most common liver malignancies. Performing B-mode ultrasonography and contrast-enhanced computed tomography is generally necessary for the diagnosis of liver metastases. However, various modalities, including dynamic contrast-enhanced computed tomography and magnetic resonance imaging using liver-specific contrast agents such as gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, fluorodeoxyglucose positron emission tomography, and a combination of positron emission tomography and computed tomography, are also used. Improvements in imaging technology have made the detection of small liver masses possible, and liver metastases are being diagnosed more frequently, both before and after primary tumor treatment. The diagnosis of liver metastasis is related to treatment, and the benefits of liver resection depend on the primary tumor. For colorectal cancer, resection of liver metastases is beneficial. However, resection is not recommended for pancreatic or biliary tract cancers.

Lutetium-177 (177Lu) is a promising radionuclide for targeted cancer therapy due to its favorable theranostic properties. Transarterial lipiodol embolization is widely used for hepatocellular carcinoma (HCC), but the potential of 177Lu emulsified into lipiodol (177Lu-lipiodol) remains underexplored. This study aimed to evaluate the partition coefficient, biodistribution, and antitumor efficacy of 177Lu-lipiodol in a preclinical xenograft model. After synthesizing 177Lu-oxine from 177Lu-chloride, the product was emulsified in lipiodol. Its radiochemical purity and partition coefficient were measured. F344 NJcl rnu/nu rats (n = 5) bearing bilateral thigh tumors (HC-4 cells) were randomized to receive 177Lu-lipiodol (2.8 MBq in 50 μL) or non-labeled lipiodol (50 μL) via surgical exposure and direct puncture of the right femoral artery. SPECT/CT images were acquired over 14 days, and biodistribution was confirmed by gamma counting at day 28. Tumor volumes and body weights were monitored to assess treatment response and toxicity. The 177Lu-lipiodol emulsion was obtained with a high radiochemical purity (> 99

Intranodal lymphangiography has replaced conventional pedal lymphangiography and has advanced lymphatic intervention. In this method, a lymph node is punctured and Lipiodol is injected to visualize the subsequent lymphatic vessels. This has facilitated the widespread adoption of lymphatic interventional radiology due to the simplicity of the technique and the shortened examination time of the procedure, which allows easy mapping of lymphatic vessels and lymphatic fluid dynamics. With this technique, lymphatic embolization was achieved by injecting an embolic substance into the lymph nodes upstream of the lymphatic leak. Although complications associated with lymphangiography are rare, caution should be exercised due to potential complications associated with the use of Lipiodol. This study summarizes intranodal lymphangiography techniques, complications, and lymphatic embolization.

The aim of this study was to evaluate the utility of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) in monitoring the response to Ra-223 therapy in patients with castration-resistant prostate cancer (CRPC) and bone metastasis. This retrospective study included 15 patients with CRPC and bone metastases. DWIBS scans were performed at baseline and after three cycles of Ra-223 therapy. Quantitative analysis of tumor total diffusion volume (tDV) categorized patients as stable disease (DWIBS-SD), partial response (DWIBS-PR), or progressive disease (DWIBS-PD). Kaplan–Meier analysis and log-rank tests were used to assess the correlation between DWIBS findings and survival. Of the 15 patients (median age 72 years ± 7.3), 7 (47

To validate a standardized MRI scoring system, tracheal invasion score (T-score) and vascular invasion score (V-score) against CT for detecting tracheal and major-vessel invasion in esophageal cancer, based on imaging obtained after neoadjuvant therapy. Twenty-six patients (mean age 65 years) who underwent both MRI and CT after preoperative therapy and prior to esophagectomy were retrospectively reviewed. Two radiologists independently assigned T- and V-scores on MRI and CT-based T-stage (12th Japanese Classification). Diagnostic performance was measured by the area under the ROC curve (AUC) and κ for inter-reader agreement. Patient-level bootstrap resampling (2000 iterations) compared the combined MRI score—defined as max (T, V)—with CT. MRI yielded higher AUCs than CT for tracheal invasion (0.943–0.990 vs. 0.529–0.706) and vascular invasion (0.878 for both readers). MRI achieved substantial-to-almost-perfect agreement (κ = 0.771–1.000), whereas CT was only moderate (κ = 0.369–0.487). Bootstrap analysis confirmed superior discrimination of the combined MRI score: ΔAUC + 0.19 (–0.05–0.43, p = 0.11) for Reader A and +0.38 (0.07–0.66, p = 0.02) for Reader B. A combined MRI T/V-score provides better accuracy and inter-reader reliability than CT for evaluating critical local invasion, even after preoperative therapy, supporting routine integration of MRI when CT findings are equivocal. Question Determine whether a standardized MRI scoring system for tracheal and vascular invasion improves diagnostic accuracy compared with contrast‑enhanced CT in esophageal cancer. Findings MRI outperforms CT in detecting tracheal and vascular invasion, with higher specificity and superior inter-reader agreement using standardized scoring criteria. Clinical relevance Standardized MRI scoring improves staging accuracy in suspected T4 esophageal cancer, aiding surgical decision-making and helping to avoid unnecessary surgery in inoperable patients as well as incomplete (R1/R2) resections.

Arteriovenous malformations in the abdominal region are rare, and they are known to occasionally cause portal hypertension. A 66-year-old man with a chief complaint of fatigue and blood tests showing hepatic dysfunction was seen for a more detailed examination. Abdominal contrast-enhanced computed tomography showed an anastomosis of the ileal artery and ileal vein via a nidus within the mesentery. In addition to alcoholic cirrhosis from a history of high alcohol intake, the patient was diagnosed with portal hypertension from increased portal pressure due to an arteriovenous malformation in the mesentery. Vascular embolization with a percutaneous transhepatic approach was performed for the mesenteric arteriovenous malformation. The ileal vein, which was the dominant outflow vein, was embolized, and the blood flow in the arteriovenous malformation disappeared. A decrease in portal pressure of 29% was confirmed. There were no complications from the embolization. In cases of mesenteric arteriovenous malformations that contribute to portal hypertension, treatment of the malformations can be expected to decrease portal pressure. Compared with surgical intestinal resection, endovascular treatment that can be done with low invasiveness is thought to be a possible option.

The liver is supplied by a dual blood flow system consisting of the portal vein and hepatic artery. Imaging techniques for diagnosing hepatocellular carcinoma (HCC) have been developed along with blood flow imaging, which visualizes the amount of arterial and portal blood flow. The diagnosis of HCC differentiation is important for early-stage liver cancer screening and determination of treatment strategies. Dynamic computed tomography/magnetic resonance imaging (MRI) includes blood flow imaging and MRI with contrast-enhanced ultrasound and liver-specific contrast agents are used in combination. In addition, unlike the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), which is the standard for determining treatment efficacy for solid tumors in general, tumor necrosis is generally considered a treatment effect in HCC, and the modified RECIST and Liver Cancer Direct Effectiveness Criteria (RECICL) are widely used. Familiarity with the definitions, criteria, and potential challenges of the mRECIST and RECICL is essential for their effective application in clinical practice. This review integrates the latest advancements in systemic treatments and imaging techniques, including the role of LI-RADS and updates on molecular-targeted therapies such as regorafenib, supported by some systematic review and meta-analysis.

Only a few studies have explored whether high-dose-rate interstitial brachytherapy (HDR-ISBT) can be indicated as a palliative/symptomatic treatment. We present the good results of palliative treatment using HDR-ISBT combined with external beam radiotherapy (ERT) in a patient of base of tongue cancer (cT4aN1M0). The patient was an 81-year-old male who complained of local pain. He had a previous irradiation history for head and neck cancer receiving ERT with systemic chemotherapy and radical surgery 15 years ago. Since it might be difficult for him to receive radical radiation doses using ERT alone, palliative ERT of relatively lower doses of 37.5 Gy in 15 fractions was selected. One month after ERT, HDR-ISBT was implemented as a booster. Considering the burden on physical condition, single-fraction HDR-ISBT was selected. We employed a new technique in which we did not penetrate the ventral surface of the tongue to reduce the risk of infection and bleeding. The planning-aim dose was 9.5 Gy. The dose that covered 90

BACKGROUND:The present study investigated the acute mucosal reaction (AMR) after high-dose-rate interstitial brachytherapy at 54 Gy/9 fractions (HDR54) as monotherapy administered twice a day for tongue cancer in 13 patients, and attempted to validate HDR54 by comparing the AMR with that of our previously reported HDR at 60 Gy/10 fractions (HDR60), and low-dose-rate interstitial brachytherapy at approximately 70 Gy (LDR70). METHODS:The European Organization for Research on Treatment of Cancer/ Radiation Therapy Oncology Group scoring system with modifications (score: 1-4.5) was used to evaluate AMR. The time courses of the AMR scores of HDR54 were recorded. The time courses of the AMR of HDR54, HDR 60, and LDR70 were each divided into 6 phases and compared. RESULTS:The number of cases in the HDR54 group with a lower score (1-2) at the time of the initial response was significantly higher (12 cases) than those in the HDR60 group (1 case) (p=0.0077) and LDR70 group (1 case) (p=0.0077). In the HDR54 group, the time between the end of treatment and appearance of the first response was significantly longer (median: 3 days) than those in the HDR60 group (median: 1 day) (p<0.001) and LDR70 group (median: 1 day) (p<0.001). No significant differences were observed in the maximum score, its duration, or other parameters. CONCLUSIONS:The results indicated that the AMR of HDR54 started later and was gentler and more easily tolerated than the other two methods, suggesting the validity of HDR54 in terms of AMR.