Background: The reports of clinical outcomes of patients treated with chemoradiotherapy for primary thyroid non-Hodgkin’s lymphoma are rare. We report our results of chemoradiotherapy for primary thyroid non-Hodgkin’s lymphoma. Materials and Methods: The subjects were 67 patients with thyroid non-Hodgkin’s lymphoma among 269 patients with malignant lymphoma who received radiotherapy in our hospital during a period between May 1990 and June 2005. The patients included 16 men and 51 women, with a mean age of 66.2 ± 10.7 years (30 - 84 years). The disease stage was stage I in 42 patients, stage II in 24, and unclear in 1. The histologic type was B-cell lymphoma in 66 patients, MALT in 9, diffuse type in 52, follicular type in 5, and diffuse and follicular type in 1. CHOP chemotherapy regimen for malignant lymphoma patients was as follows. Intravenous drip infusion of cyclophosphamide 750 mg/m2, (drip) infusion of doxorubicin 50 mg/m2, and intravenous injection of vincristine 1.4 mg/m2 were administered on day 1, followed by 5 consecutive days of oral prednisolone 100 mg/m2. This regimen was repeated every 3 weeks (21 days) in 6 to 8 courses. Modified CHOP chemotherapy regimen was as follows. Intravenous drip infusion of cyclophosphamide 600 mg/m2, intravenous (drip) infusion of doxorubicin 40 mg/m2, intravenous infusion of vindesine 3 mg/m2, and intravenous drip infusion of prednisolone 60 mg/body were administered on day 1, and intravenous prednisolone was changed to oral prednisolone with the dose tapered gradually. After completing one course of this regimen, two courses of radiotherapy (a total of 36 Gy) were performed, followed by 6 courses of the chemotherapy regimen at lower doses (80% of the initial doses) repeated once a month. Results: Results of chemoradiotherapy in all patients were excellent. The 15-year survival rate was over 80%. Although there were no significant differences in the results of chemoradiotherapy among different histologic types of thyroid malignant lymphoma, the survival rate was 100% for MALT type, as compared with poor results for diffuse large type or diffuse mixed type. The analysis of the results of chemoradiotherapy according to the stage of malignant thyroid lymphomas revealed that therapeutic results were significantly better in stage I than in stage II. Conclusion: The CHOP chemoradiotherapy regimen and modified CHOP chemoradiotherapy regimen were excellent for primary thyroid non-Hodgkin’s lymphoma.

The ability of short injection duration of contrast material to reduce the total injection volume in 64-detector row CT coronary angiography was investigated. 45 patients were divided into three groups: (i) those receiving 0.8 ml kg(-1) of contrast material (350 mgI ml(-1)) injected with a fixed duration of 14 s (Group A; n = 16); (ii) those receiving 0.8 ml kg(-1) of contrast material injected with a fixed duration of 10 s (Group B; n = 15); and (iii) those receiving 0.7 ml kg(-1) of contrast material injected with a fixed duration of 10 s (Group C; n = 14). All patients then received 20 ml of saline. Contrast densities of the ascending aorta and proximal and distal coronary arteries were assessed where vessel diameters were >2.0 mm. The mean enhancement value in the ascending aorta for Group B was significantly higher than that for Groups A and C (p<0.05), whereas there was no significant difference between Groups A and C. All enhancement values in the coronary arteries were higher than 250 Hounsfield units. The mean enhancement value for each coronary artery in Group B was significantly higher than that for Group A (p<0.05), whereas there was no significant difference between Groups A and C. In conclusion, a short injection duration allows a reduction in the total volume of contrast material from 0.8 ml kg(-1) to 0.7 ml kg(-1) while a steady contrast enhancement is maintained in the ascending aorta and coronary arteries.

We report the therapeutic potential, longterm survival, and toxicity of neoadjuvant intraarterial chemotherapy (NAIC) using an original four-lumen double-balloon (4L-DB) catheter followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer.

Objective: In this study, the authors discussed the feasibility and value of diffusion-weighted (DW) MR imaging in the detection of uterine endometrial cancer in addition to conventional nonenhanced MR images.Methods and materials: DW images of endometrial cancer in 23 patients were examined by using a 1.5-T MR scanner. This study investigated whether or not DW images offer additional incremental value to conventional nonenhanced MR imaging in comparison with histopathological results. Moreover, the apparent diffusion coefficient (ADC) values were measured in the regions of interest within the endometrial cancer and compared with those of normal endometrium and myometrium in 31 volunteers, leiomyoma in 14 patients and adenomyosis in 10 patients. The Wilcoxon rank sum test was used, with a p < 0.05 considered statistically significant.Results: In 19 of 23 patients, endometrial cancers were detected only on T2-weighted images. In the remaining 4 patients, of whom two had coexisting leiomyoma, no cancer was detected on T2-weighted images. This corresponds to an 83% detection sensitivity for the carcinomas. When DW images and fused DW images/T2-weighted images were used in addition to the T2-weighted images, cancers were identified in 3 of the remaining 4 patients in addition to the 19 patients (overall detection sensitivity of 96%). The mean ADC value of endometrial cancer (n = 22) was (0.97 +/- 0.19) x 10(-3) mm(2)/s, which was significantly lower than those of the normal endometrium, myometrium, leiomyoma and adenomyosis (p < 0.05).Conclusion: DW imaging can be helpful in the detection of uterine endometrial cancer in nonenhanced MR imaging. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND:To compare the frequency of "subjective" complications and their severity between conventional and short fractionation and to analyze the differences between the two groups.METHODS:Data from 350 patients with breast cancer who received breast conservation therapy between 1992 and 2003 were retrospectively analyzed. One hundred and ninety-six patients and 154 patients received 50 Gy in 25 fractions over 35 days (group C) and 44 Gy in 16 fractions over 22 days (group S), respectively. Early sequelae were evaluated at the end of radiation therapy (point A) and 7-10 days after the treatment (point B). Late sequelae were assessed at least 6 months after the end of radiation therapy (point C).RESULTS:The most commonly observed toxicity at point A was erythema, followed by heat sensation, sense of discomfort, and pain. There were no significant differences in these symptoms between the two groups. The frequency of these symptoms hardly changed between points A and B. At point C a sense of hardness more frequently appeared in group S than in group C with a significant difference. Other commonly noted symptoms had no significant difference between the two groups.CONCLUSIONS:Short fractionation results in acceptable patient "subjective" sequelae comparable to the sequelae experienced following conventional fractionation.

Background We assessed the value of magnetic resonance imaging (MRI), using ultrasmall superparamagnetic iron oxide (USPIO) with new diagnostic criteria, in the evaluation of regional lymph node metastases in gastric cancer. Methods Thirty-one patients with gastric cancer were enrolled. 1000 lymph nodes were dissected during surgery, and of these, 519 nodes (51.9 %) were identified by currently used MRI imaging analysis. We evaluated lymph nodes on USPIO-post-contrast T2*-weighted images using the following two criteria: (1) we diagnosed the nodes on T2*-weighted images according to conventional criteria, where a node having an overall low signal intensity (pattern A) was nonmetastatic, while a node having partial (pattern B) or overall (pattern C) high signal intensity was metastatic; (2) we subdivided pattern B nodes on T1-weighted images using the new criteria, in which a node for which the high-intensity area on T2*-weighted images was not defined as adipose tissue on T1-weighted images (pattern B1) was metastatic, while a node for which the high-intensity area was defined as adipose tissue (pattern B2) was nonmetastatic. Results (1) The results using the conventional criteria were 96.2% sensitivity, 92.5% specificity, 76.3% positive predictive value (PPV), 99.0% negative predictive value (NPV), and 93.3% accuracy. (2) The results using the new criteria were 96.2% sensitivity, 98.3% specificity, 90.1% PPV, 99.0% NPV, and 97.1% accuracy. Conclusion The assessment of lymph node metastases from USPIO-post-contrast MRI alone using the new criteria was useful in the diagnosis of regional lymph node metastases in gastric cancer.

BACKGROUND:In this study, the potential in detecting and evaluating pelvic lymph node metastases on body diffusion-weighted (DW) images was evaluated in patients with gynecologic malignancies.METHODS:This study included 18 patients with gynecologic malignancy who underwent magnetic resonance imaging in the pelvis using a 1.5-T superconductive magnet. The identification of pelvic nodes on only T2-weighted (T2W) axial images and on DW axial images in addition to T2W axial images was examined and compared. Moreover, we measured and calculated a short-axis diameter, a long-axis diameter, and a ratio of short- and long-axis diameter of nodes on the T2W images and the apparent diffusion coefficient (ADC) values of the nodes on the DW images. These results were compared with histopathologic results.RESULTS:First, 136 (40%) of 340 dissected nodes were identified on T2W images, and 249 (73%) of 340 dissected nodes were identified on DW images in addition to T2W images. Second, the differences in the short-axis diameter, the long-axis diameter, and the ratio of short- and long-axis diameter on T2W images between metastatic and nonmetastatic nodes were not significant. The differences in the ADC values between metastatic and nonmetastatic nodes were not significant.CONCLUSIONS:Body DW images are useful in detection of pelvic lymph nodes in patients with gynecologic malignancy. However, the measurement of ADC values does not contribute to a diagnosis of metastatic nodes.

Cell lines are very useful for clinical and basic research. The establishment of uterine malignant tumor cell lines with unusual histology is especially important. We describe the establishment and characterization of a new human endometrial stromal sarcoma cell line of the uterus. The cell line OMC-9 was established from a tumor mass in the uterine body of a 55-year-old woman. Characteristics of the cell line studied include morphology, chromosome analysis, heterotransplantation, tumor markers and chemosensitivity. This cell line has grown well for 196 months and has been subcultured more than 50 times. Monolayer cultured cells are polygonal in shape, appear to be spindle-shaped or multipolar and have a tendency to pile up without contact inhibition. The cells exhibit a human karyotype with a modal chromosomal number in the diploid range. The cells were able to be transplanted into the subcutis of nude mice and produced tumors resembling the original tumor. OMC-9 cells produced tissue polypeptide antigen. Both CD10, a sensitive and diagnostically useful marker of endometrial stromal neoplasms, and vimentin were identified immunohistochemically in the original tumor and the heterotransplanted tumor. The cells were sensitive to actinomycin D, doxorubicin, carboplatin, cisplatin and etoposide, drugs used commonly in the treatment of gynecologic cancer. Only three reports of uterine endometrial stromal sarcoma cell lines have thus far been reported in the literature. OMC-9 is the first endometrial stromal sarcoma cell line in which CD10 expression and chemosensitivity have been identified.

We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.

The aim of this study was to demonstrate the feasibility of body diffusion-weighted (DW) MR imaging in the evaluation of a pancreatic carcinoma.

Objective: To evaluate local invasion and lymph nodes metastasis of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography (MDCT) before laparoscopic colorectal surgery. Methods: Fifty-one patients with colorectal cancer underwent MDCT. The evaluation items were as follows: (1) local invasion; (2) detected lymph nodes evaluated by short-axis diameter, long-axis diameter, short/long axis diameter ratio, and computed tomography (CT) attenuation; and (3) visualization of mesenteric artery and vein by 3-dimensional-CT angiography. Results: First, in the evaluation of local invasion, overall accuracy was 94.1%. Second, the point of 0.8 or greater in short/long-axis diameter ratio was best index for the diagnosis of metastatic lymph nodes. Using this index, the accuracy of the diagnosis per node was 80.5%. Third, 3-dimensional-CT angiography correctly demonstrated variations of the mesenteric artery and vein. Conclusions: The MDCT was effective for evaluation of local invasion and lymph nodes metastasis of colorectal cancer and mesenteric vascular variations before laparoscopic surgery.

1659 Objectives: Some studies have demonstrated that a newly developed body diffusion-weighted (DW) MRI is useful for differentiating benign or malignant lesions in patients with bone and soft tissue tumors. Thallium-201 (Tl) SPECT has been widely used for clinically same purpose. We compared DW-MRI with Tl-SPECT to clarify the characteristics of these two methods. Methods: Both MRI and Tl-SPECT were performed on 42 bone and soft tissue tumors (12 malignant lesions and 30 benign lesions), whose final diagnosis was based on histology. DW-MRI was performed with an echo planar imaging sequence. The apparent diffusion coefficient (ADC) value (×10-3 mm2/sec) was calculated on the lesions. The early and delayed Tl-SPECT were performed, and the uptake ratio of the lesion to the contralateral normal tissue was obtained on the early images (early ratio; ER) as well as on the delayed images (delayed ratio; DR). The diagnostic accuracy of malignant lesions was evaluated by visual interpretation. The ADC values as well as ER and DR in the lesions were evaluated and compared for quantitative evaluation of DW imaging and Tl-SPECT, respectively. Results: High sensitivity was observed in both DW-MRI and Tl-SPECT in visual interpretation. Low specificity was observed on DW-MRI (44.4 %), suitable specificity was observed on Tl-SPECT (80%). In quantitative assessment, the sensitivity, specificity were calculated when the cut-off value of ADC was less than 1.7 on DW-MRI, and the cut-off value of ER was over 3.9 on Tl-SPECT. Specificity on ADC was only 36.4%, although high sensitivity 100 % was observed. There were significant differences between the uptake ratio of the benign and that of the malignant lesions (ER: 6.23 ± 2.13 vs 26.72 ± 8.91, p Conclusions: The ADC values of bone and soft tissue tumors overlapped and could not be used to differentiate between benign and malignant tumors. Whereas the ER values and delayed visual assessment of Tl-SPECT has high diagnostic ability for bone and soft tissue tumors. Therefore, Tl-SPECT has a better diagnostic ability than DW-MRI for evaluation of bone and soft tissue tumors.

275 Objectives: Diffusion-weighted MRI is known to provide images seemingly similar to those of FDG-PET. In the present study, we examined and compared lung cancer cases using FDG-PET/CT and diffusion-weighted imaging with background body signal suppression (DWIBS) on the same day. Methods: We examined 21 lesions that were confirmed to be lung cancer with lymph node metastasis based on biopsies in addition to one pulmonary hamartoma in 13 patients who underwent follow-up longer than 6 months. The mean lesion size was 20.8±9.4 mm (range: 10-45 mm). After 5-hour fasting, FDG was intravenously injected at a dose of 3.7 MBq/kg and then its distribution was analyzed using PET/CT (Discovery ST Elite, GE) one hour later. DWIBS was performed to the consented patients, immediately prior to PET analysis, by taking images (slice thickness = 6 mm, b-factor = 1000) with a single shot EPI method using a 8-ch body array coil with 1.5T MRI (SIGNA EXCITE, GE). Both images were visually evaluated. The tracer accumulation in the liver and the signals in the spinal cord were considered to be positive for PET, DWIBS, respectively. Results: Twenty (95.2%) of the 21 malignant lesions were positive on FDG-PET/CT, whereas 19 lesions (90.5%) were positive on DWIBS. There were no significant differences between the two modalities (p = 0.565). The benign pulmonary hamartoma was negative on PET, but positive on DWIBS. Pulmonary adenocarcinoma (12.6 mm) in the right upper lobe showed false-negative findings on PET, but CT scanning of this node indicated suspicious pulmonary adenocarcinoma. In addition, left pulmonary hilar lymph node metastasis (15 mm) associated with left upper lobe cancer and pulmonary adenocarcinoma (12 mm) in the right upper lobe showed false-negative findings on DWIBS. Conclusions: Both PET and DWIBS detected malignant lesions almost the same level. However, DWIBS is less efficient in differentiating malignant lesions from benign lesions because DWIBS showed benign lesions such as pulmonary hamartoma as positive.

The new magnetic resonance whole body diffusion-weighted imaging with background body signal suppression (DWIBS) uses short tau inversion recovery-echo planar imaging sequence under normal respiration. DWIBS is different from 2-[fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET) imaging in technology, but their images are similar. We compared the two modalities regarding the detection and characterization of malignant tumors.