Current status and prospect of cryotherapy

Cryotherapy is the latest minimally invasive treatment classified as non-vascular interventional radiology（IVR）. Fine needles are used for percutaneous puncture of tumors under imaging guidance. Using high-pressure argon gas for freezing, the needle tip is brought to an extremely low temperature（-４０℃）or lower, and the tumor cells are frozen and destroyed. The advantages of this treatment are that the freezing range can be confirmed on imaging during the procedure, and pain is less intense during the treatment. Currently, in Japan, cryotherapy for tumors, such as renal cancer, is being performed in fewer than３０hospitals. Our hospital decided to introduce a cryotherapy device in ２０１６, and preparations for the operation started at the end of ２０１６. In ２０１７, three in-hospital briefings were held, and we also conducted a tour of facilities with installed cryotherapy devices. After this preparation period, the first treatment was performed at the Tokushima Prefecture in March ２０１８. By August ２０１９, cryotherapy had been performed in seven cases of renal cell carcinoma. In all cases, the treatment was completed without serious complications and could be performed during the scheduled hospital stay. At the follow-ups, no residual or recurrent tumors were found after only one treatment. Currently, only small-diameter renal malignancies are covered by insurance. Therefore, the Japanese Society of Interventional Radiology has submitted a request for the expansion of indications for cryotherapy to the Ministry of Health, Labor and Welfare. In the future, expansion of indications is expected for lung, breast, liver, bone, and soft tissue tumors, and we hope to respond flexibly

マルチスライスCTによる腰動脈バリエーション描出についての検討

Purpose : This study was designed to identify the anatomical variations of lumbar arteries on contrast-enhanced multi-detector row computed tomography (MDCT). Materials and Methods : Consecutive 100 colon cancer patients underwent preoperative 3-dimensional navigation studies, which include CT colonography (CTC) and CT angiography (CTA) for evaluation of anatomical relationship between the colon cancer and mesenteric vasculatures. After exclusion of inappropriate cases, 84 cases (33 women and 51 men ; mean age, 64 years) were finally analyzed. The visualization of lumbar arteries from the CTA was scored based on the agreement of two radiology specialists. Also the presence or absence of left and right common trunk of each lumbar artery was evaluated. Results : Visualization scores on both sides of L1 were significantly lower than those of L2-L4. No significant difference could be found on visualization of L1 lumbar arteries between the young and the elderly group. The common trunk tended to be in the lower lumbar levels (L1 in 2.4%, L2 in 9.5%, L3 in 11%, and L4 in 23%). Conclusion : The development and variation of lumbar arteries can be evaluated with CTA. Furthermore, CTA can provide sufficient anatomical information on variations of the lumbar arteries prior to surgery or catheterization

Intimal sarcoma from the iliac artery

We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone endovascular therapy with self-expanding stents to both iliac arteries that had occluded soon after placement. After salvage bypass grafting, a diagnosis of intimal sarcoma with angiosarcoma phenotype from the iliac artery was made. Further bypass graft surgery relieved symptoms temporarily. However, the tumor progressed and the left limb became ischemic. The chemotherapy of eribulin did not prevent tumor progression. The patient died of the disease 20 months after the first surgery

Suppression Effect of Radiated Emission from Twisted Pair Wires with Ferrite Core

Telecommunications signal emissions from unshielded twisted pair (UTP) cable should be suppressed to maintain EMC of telecommunication systems. This paper describes the suppression effects of the ferrite cores which are installed on the UTP cable. Twisted pair wire with ferrite core was modeled by 4-port network to evaluate suppression effect. Parameters of the networks which are constructed with UTP cable or ferrite core with wires were determined from calculation and measurement. Using the networks, the common-mode current distribution on the cable was obtained, and emitted electric field strength was calculated from the distribution. The emission suppression effect was obtained from the result, and the results were almost agreed with measured value. The calculation results suggest that 1) the ferrite cores should be arranged side by side, 2) these should be placed near the signal supply end of the cable.2003 IEEE Symposium on Electromagnetic Compatibility, August 18-22, 2003, Boston, MA, US

Macrophage centripetal migration drives spontaneous healing process after spinal cord injury.

Traumatic spinal cord injury (SCI) brings numerous inflammatory cells, including macrophages, from the circulating blood to lesions, but pathophysiological impact resulting from spatiotemporal dynamics of macrophages is unknown. Here, we show that macrophages centripetally migrate toward the lesion epicenter after infiltrating into the wide range of spinal cord, depending on the gradient of chemoattractant C5a. However, macrophages lacking interferon regulatory factor 8 (IRF8) cannot migrate toward the epicenter and remain widely scattered in the injured cord with profound axonal loss and little remyelination, resulting in a poor functional outcome after SCI. Time-lapse imaging and P2X/YRs blockade revealed that macrophage migration via IRF8 was caused by purinergic receptors involved in the C5a-directed migration. Conversely, pharmacological promotion of IRF8 activation facilitated macrophage centripetal movement, thereby improving the SCI recovery. Our findings reveal the importance of macrophage centripetal migration via IRF8, providing a novel therapeutic target for central nervous system injury

FDG-PET/CT findings of soft tissue lesoions

Objective : To evaluate the correlations between F-18 FDG uptake imaged with PET/CT and pathological findings in soft tissue lesions. Methods : Fifty-four soft tissue lesions in 47 patients were evaluated. The correlations between the degree of FDG uptake, pathological type and grade, and MRI signal intensity and/or enhancement pattern were evaluated. Tumor FDG uptake was quantified by the maximum standardized uptake value (SUVmax). Results : Thirty-one lesions were malignant and twenty-three lesions were benign. The difference between SUVmax in the malignant and benign groups was statistically significant (p<0.001). Malignant myxoid lesions and well differentiated liposarcoma showed low FDG uptake. Benign neurogenic lesions showed low FDG uptake while malignant neurogenic tumors showed high FDG uptake, and the difference between SUVmax in the benign and malignant lesions was statistically significant (p<0.001). In a neurofibromatosis type-1 patient who had multiple neurogenic tumors, FDG-PET/CT could distinguish malignant peripheral nerve sheath tumors from other benign lesions with similar MRI findings. Conclusions : FDG-PET/CT is useful for differentiating malignant from benign soft tissue lesions, but malignant soft tissue lesions may show various patterns on FDG-PET, and MRI may be helpful for a differential diagnosis

PTBDにおけるVirtual Fluoroscopic Preprocedural Planningの有用性の検討

Purpose: To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage (PTBD) procedure. Materials and Methods: Twenty-two patients who were treated by PTBD were included in this study. Twelve patients were treated using PTBD intraoperative referencing coronal computed tomography (CT) images (i.e., coronal CT group), and 10 patients were treated using PTBD intraoperative referencing VFPP images (i.e., VFPP group). To analyze the effect of the intraoperative referencing VFPP image, the VFPP group was retrospectively compared with the coronal CT group. Results: The characteristics of both patient groups were not statistically significantly different. There were no significant differences in the targeted bile duct, diameter and depth of the target bile, breath-holding ability, number of targeted bile duct puncture attempts, change in the targeted bile duct, and exchange of the drainage catheter. However, the X-ray fluoroscopy time and the procedure time were significantly shorter in the VFPP group than in the coronal CT group (196 vs. 334 seconds, P < 0.05; and 16.0 vs. 27.2 minutes, P < 0.05). Conclusion: Intraoperative referencing using the VFPP imaging in PTBD intuitively can be a useful tool for better localization of the guidewire in the bile duct, and therebyshorten the X-ray fluoroscopy time and procedure 1 time while minimizing radiation exposure and complications

Using the MDCT thick slab MinIP method for the follow-up of pulmonary emphysema

Abstract : Purpose : The purpose of this study was to evaluate the usefulness of thick slabminimum intensity projection (MinIP) as a follow-up method in patients with pulmonaryemphysema. This method was used to determine the presence or absence of changes overtime in the lung field based on multi-detector-row CT (MDCT) data. Methods : Among patientsdiagnosed with pulmonary emphysema who underwent 16-MDCT (slice thickness,1 mm) twice at an interval of 6 months or more, 12 patients without changes in the lungfield and 14 with clear changes in the lung field were selected as subjects. An image interpretationexperiment was performed by five image interpreters. Pulmonary emphysemawas followed up using two types of thick slab MinIP (thick slab MinIP 1 and 2) andmulti-planar reformation (MPR), and the results of image interpretation were evaluatedby receiver operating characteristic (ROC) analysis. In addition, the time required forimage interpretation was compared among the three follow-up methods. Results : Thearea under the ROC curve (Az) was 0.794 for thick slab MinIP 1, 0.778 for the thick slabMinIP 2, and 0.759 for MPR, showing no significant differences among the three methods.Individual differences in each item were significantly more marked for MPR thanfor thick slab MinIP. The time required for image interpretation was around 18 secondsfor thick slab MinIP 1, 11 seconds for thick slab MinIP 2, and approximately 127 secondsfor MPR, showing significant differences among the three methods. Conclusion : Therewere no significant differences in the results of image interpretation regarding the presenceor absence of changes in the lung fields between thick slab MinIP and MPR. However,thick slab MinIP showed a shorter image interpretation time and smaller individualdifferences in the results among image interpreters than MPR, suggesting the usefulnessof this method for determining the presence or absence of changes with time in the lungfields of patients with pulmonary emphysema