Diagnostic value of computed high b-value whole-body diffusion-weighted imaging for primary prostate cancer

Purpose: To investigate the utility of post-acquisition computed diffusion-weighted imaging (cDWI) for primary prostate cancer (PCa) evaluation in biparametric whole-body MRI (bpWB-MRI). Methods: Patients who underwent pelvic MRI for PCa screening and subsequent bpWB-MRI for staging were included. Two radiologists assessed the diagnostic performance of the following datasets for clinically significant PCa diagnosis (grade group >= 2 according to the Prostate Imaging-Reporting and Data System, version 2.1): bpMRI(2000) (axial DWI scans with a b-value of 2,000 s/mm(2) + axial T2WI scans from pre-biopsy pelvic MRI), computed bpWB-MRI2000 (computed WB-DWI scans with a b-value of 2,000 s/mm(2) + axial WB-T2WI scans), and native bpWB-MRI1000 (native axial WB-DWI scans with a b-value of 1,000 s/mm(2) + axial WB-T2WI scans). Systemic biopsy was used as reference standard. Results: Fifty-one patients with PCa were included. The areas under the curve (AUCs) of bpMRI(2000) (0.89 for reader 1 and 0.86 for reader 2) and computed bpWB-MRI2000 (0.86 for reader 1 and 0.83 for reader 2) were significantly higher (p < 0.001) than those of native bpWB-MRI1000 (0.67 for both readers). No significant difference was observed between the AUCs of bpMRI(2000) and computed bpWB-MRI2000 (p = 0.10 for reader 1 and p = 0.25 for reader 2). Conclusions: The diagnostic performance of computed bpWB-MRI2000 was similar to that of dedicated pelvic bpMRI(2000) for primary PCa evaluation. cDWI can be recommended for implementation in standard WB-MRI protocols to facilitate a one-step evaluation for concurrent detection of primary and metastatic PCa

Clinical utility of the Bosniak classification version 2019:Diagnostic value of adding magnetic resonance imaging to computed tomography examination

Purpose: To assess the impact of the updated Bosniak classification (BC2019) for cystic renal masses (CRMs) on interobserver agreement between radiologists and urologists and the diagnostic value of adding MRI to CT examination (combined CT/MRI). Method: This study included 103 CRMs from 83 consecutive patients assessed using contrast-enhanced CT and MRI between 2010 and 2016. Nine readers in three groups (three radiologists, three radiology residents, and three urologists) reviewed CT alone and the combined CT/MRI using BC2019. Bosniak category was determined by consensus in each group for diagnosing malignancy, with a cut-off category of ?>= III. Interobserver agreement was assessed using Fleiss' kappa values. The effect of CT or combined CT/MRI on the diagnosis of malignancy was assessed using McNemar's test. Results: Interobserver agreement of BC2019 for CT alone was substantial for radiologists and residents, moderate for urologists (0.77, 0.63, and 0.58, respectively). Interobserver agreement of BC2019 for combined CT/MRI was substantial for all three groups (radiologists: 0.78; residents: 0.65; and urologists: 0.61). Among residents, the sensitivity/specificity/accuracy rates of combined CT/MRI vs. CT alone were 82.1/74.7/76.7% vs. 75.0/66.7/68.9%, and specificity and accuracy were significantly higher for combined CT/MRI than that for CT alone (p = 0.03 and 0.008, respectively). Similarly, sensitivity/specificity/accuracy values were significantly higher for combined CT/MRI among urologists (78.6/73.3/74.8% vs. 64.3/64.0/64.1%, p = 0.04/0.04/0.008). However, sensitivity/specificity/accuracy did not significantly differ between the two among radiologists (89.3/74.7/78.6% vs. 85.7/73.3/76.7%, p = 0.32/0.56/0.32). Conclusions: Combined CT/MRI is useful for diagnosing malignancy in patients with CRMs using BC2019, especially for non-expert readers

Diagnostic value of texture analysis of apparent diffusion coefficient maps for differentiating fat-poor angiomyolipoma from non-clear-cell renal cell carcinoma

Purpose: To investigate the feasibility of texture analysis of apparent diffusion coefficient (ADC) maps for differentiating fat-poor angiomyolipomas (fpAMLs) from non-clear-cell renal cell carcinomas (non-ccRCCs). Methods: In this bi-institutional study, we included two consecutive cohorts from different institutions with pathologically confirmed solid renal masses: 67 patients (fpAML = 46; non-ccRCC = 21) for model development and 39 (fpAML = 24; non-ccRCC = 15) for validation. Patients underwent preoperative magnetic resonance imaging (MRI), including diffusion-weighted imaging. We extracted 45 texture features using a software with volumes of interest on ADC maps. Receiver operating characteristic curve analysis was performed to compare the diagnostic performance between the random forest (RF) model (derived from extracted texture features) and conventional subjective evaluation using computed tomography and MRI by radiologists. Results: RF analysis revealed that grey-level zone length matrix long-zone high grey-level emphasis was the dominant texture feature for diagnosing fpAML. The area under the curve (AUC) of the RF model to distinguish fpAMLs from non-ccRCCs was not significantly different between the validation and development cohorts (p = .19). In the validation cohort, the AUC of the RF model was similar to that of board-certified radiologists (p = .46) and significantly higher than that of radiology residents (p = .03). Conclusions: Texture analysis of ADC maps demonstrated similar diagnostic performance to that of board-certified radiologists for discriminating between fpAMLs and non-ccRCCs. Diagnostic performances in the development and validation cohorts were comparable despite using data from different imaging device manufacturers and institutions

脳死からの臓器摘出術における呼吸循環管理

今回われわれは，本邦で327例目，獨協医科大学越谷病院にて2例目となる脳死下臓器摘出術の呼吸循環管理を経験した．ドナーは30歳代男性で，くも膜下出血による脳死であった．獨協医科大学での最初の脳死下臓器摘出術は約7年前であり，この数年で管理方法が変化してきた．臓器摘出術における麻酔科の役割は麻酔ではなくドナーの呼吸循環管理であり，これにより摘出臓器の機能が大きく左右される．本症例での経験は，今後の本学における脳死下臓器摘出術に有用であると考えられる

Airway Obstruction due to Hematoma Following Internal Jugular vein Cannulation

A patient developed neck swelling and acute airway obstruction following an internal jugular vein cannulation. During laryngoscopy, glottic exposure was impossible because of a hematoma-induced anatomical distortion of standard laryngeal landmarks. Finally, a nasotracheal tube was intubated into the trachea fibreoptically. This life-threatening complication is rare, possible origin and mechanism for the sudden hematoma are discussed, as well as the airway management

ドッキョウ イカ ダイガク デ ハジメテ ノ ノウシ カラノ ゾウキ テキシュツ ジュツ ノ マスイ ケイケン

獨協医科大学で初めての脳死下臓器摘出術の麻酔を経験した.ドナーは50歳代の女性で,くも膜下出血による脳死であり,麻酔および摘出術は特に問題なく終了した.臓器摘出術の麻酔管理の主な要点は,各摘出臓器の機能を最大限に維持するための適切な循環および呼吸管理である.本症例におけるわれわれの経験は近い将来,獨協医科大学で行われるであろう臓器摘出術及び移植術の麻酔管理に有益な情報になると考えられた.We report the anesthetic management of the first case ofthe brain death for organ donation in Dokkyo Medical University.The donor was brain death after subarachnoidhemorrhage. Anesthesia and surgical procedure were doneuneventfully. The aims of anesthetic management are tomaintain optimal organ perfusion. We believe that this firstexperience will be helpful for the anesthetic management ofthe organ transplantation patient in the future of DokkyoMedical University

Block of the Ganglion Impar for Treatment of a Patieat with Non-malignant Chronic Perineal Pain

A 62 year-old woman with chronic perineal pain was successfully managed by chemical neurolysis. When she was referred to us, other practitioners had already investigated her. However, the cause of pain was not identified and the pain was refractory to conventional analgesic treatment. She underwent caudal block with 0.25% bupivacaine 5 ml six times to avoid placebo response of the block prior to therapeutic neurolysis. Then, block of the ganglion impar with phenol water under fluoroscopy was performed. Six months later, she still has no pain

A fragmented segment of a central venous catheter caused delayed ventricular fibrillation: a case report

Abstract Background Central venous port systems may be safely used for chemotherapy of patients with cancer, but several complications may occur associated with their use. Case presentation An 83-year-old man with heat stroke was transferred to our emergency department, where he was treated and became able to eat on the same day. He had been fit and healthy, except for colorectomy and chemotherapy using a central venous access port placed in the right upper jugular vein 8 years ago. The next day, he suddenly had ventricular fibrillation. Cardiopulmonary resuscitation was successful. Emergency coronary angiography showed a catheter-like foreign body in the coronary sinus. Physicians failed to remove the foreign body using catheter therapy, and ventricular fibrillation occurred repeatedly. After induction of general anesthesia, the fractured catheter was removed surgically. Postoperative course was uneventful. Conclusions A fragmented segment of a catheter may suddenly cause ventricular fibrillation years later