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| 1.
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論文
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Kawano, Masaya ; Taki, Junichi ; Tsuchiya, Hiroyuki ; Tomita, Katsuro ; Tonami, Norihisa
概要:
金沢大学大学院医学系研究科<br />Distraction osteogenesis is an effective method for lengthening long bones and filling bone defects t
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hat result from bone resection. Insufficiency of bone consolidation in the distraction segment is problematic. In this study, we examined whether 3-phase bone scintigraphy can predict the outcome of distraction osteogenesis. We also investigated the effects of chemotherapy and surgical treatment on distraction osteogenesis. Methods: We performed 3-phase bone scintigraphy on 60 patients (9 high-grade malignant bone tumors as group A, 11 low-grade malignant or benign tumors as group B, 40 nontumoral conditions as group C) with distraction osteogenesis at the lengthening phase of the long bones. By setting the region of interest on the distraction segment and contralateral normal area, we calculated the perfusion index (PI), the uptake ratio of the blood-pool image (BPR), and the uptake ratio of the delayed image (DR). Patients were classified into poor and good consolidation groups from the radiographic findings of the distraction segment. Results: Good to fair correlations were obtained between the PI and BPR, the PI and DR, and the BPR and DR (r = 0.65, 0.45, and 0.57, respectively). The PI and BPR indicated no significant differences among group A-C (1.7 ± 0.6, 2.1 ± 0.7, and 1.8 ± 0.8 in PI, respectively; 1.8 ± 1.1, 1.9 ± 0.5, and 2.0 ± 0.7, in BPR, respectively). The DR of group A (2.4 ± 1.2) was significantly lower than that of group B (6.3 ± 1.8; P = 0.001) and group C (5.9 ± 2.8; P < 0.001). Eleven patients were classified in the poor consolidation group. The other 49 patients showed good consolidation. The poor consolidation group showed lower values in all indices obtained by 3-phase bone scintigraphy than the good consolidation group. The optimal cutoff levels, sensitivity, specificity, and accuracy of each index for detection of patients with poor consolidation were as follows: 1.1, 36%, 90%, and 80% in the PI, respectively; 1.2, 55%, 94%, and 87% in the BPR, respectively; and 2.2, 82%, 96%, and 93% in the DR, respectively. Conclusion: Three-phase bone scintigraphy is a promising method for the assessment of distraction osteogenesis. The delayed image of 3-phase bone scintigraphy, especially, is an excellent modality for predicting the outcome of distraction osteogenesis.
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| 2.
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Taki, Junichi ; Sumiya, Hisashi ; Higuchi, Takahiro ; Tsuchiya, Hiroyuki ; Takazawa, Kotaro ; Tomita, Katsuro ; Tonami, Norihisa
概要:
金沢大学大学院医学系研究科<br />In malignant bone and soft-tissue tumors, intra-arterial chemotherapy and limb-saving surgery have be
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come popular. Myocutaneous inflammatory change and necrosis are the major local side effects of intra-arterial chemotherapy. 99mTc-macroaggregated albumin (MAA) imaging with intra-arterial tracer administration was performed to evaluate drug distribution, and the ability of 99mTc-MAA imaging to predict local side effects was assessed. Methods: In 24 patients, 42 99mTc-MAA images were obtained with tracer injection through an intra-arterial catheter that was inserted into the proximal portion of the tumor-feeding artery. Abnormal uptake other than by tumor was assessed visually and quantitatively. Results: In visual analysis, abnormal 99mTc-MAA accumulation was observed in 21 of 42 images. In the first consecutive 13 of these 21 images, intra-arterial chemotherapy with cisplatin, doxorubicin, and caffeine was administered, and myocutaneous inflammation or necrosis in the area corresponding to the abnormal 99mTc-MAA uptake was observed in 11. In contrast, none of the 21 images without abnormal 99mTc-MAA uptake demonstrated any local adverse effect from intra-arterial chemotherapy. In the last consecutive 8 images with abnormal 99mTc-MAA uptake, intra-arterial chemotherapy was initiated with only cisplatin, and doxorubicin and caffeine administration was changed to the intravenous route. In all 8 of these images, no local adverse effects from chemotherapy were observed. Overall, the sensitivity, specificity, and accuracy of 99mTc-MAA imaging for the detection of myocutaneous damage were 100% (11/11), 91% (21/23), and 94% (32/34), respectively, and positive and negative predictive values were 85% (11/13) and 100% (21/21), respectively. In quantitative analysis, when the diagnostic threshold of the uptake ratio was set at 2.5, sensitivity, specificity, and accuracy for the detection of myocutaneous complications were 91% (10/11), 96% (22/ 23), and 94% (32/34), respectively, and positive and negative predictive values were 91% (10/11) and 96% (22/23), respectively. Conclusion: 99mTc-MAA imaging with intra-arterial infusion before intra-arterial chemotherapy for bone and soft-tissue tumors can facilitate prediction of local myocutaneous adverse effects due to chemotherapy.
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| 3.
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論文
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Wakabayashi, Hiroshi ; Taki, Junichi ; Inaki, Anri ; Sumiya, Hisashi ; Zen, Yoh ; Tsuchiya, Hiroyuki ; Kinuya, Seigo
概要:
Purpose: This study was aimed to determine whether Tc-99m-hexakis-2- methoxyisobutylisonitrile (MIBI) scintigraphy perfo
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rmed in the middle of preoperative chemotherapy has a prognostic value in patients with malignant bone and soft tissue tumors (MBST). Materials and Methods: In 90 patients with MBST, Tc-99m-MIBI scintigraphy was performed 15 minutes after tracer injection before the first and after the third chemotherapy cycles. After 5 cycles of chemotherapy and tumor resection, therapeutic effect was assessed by histopathology. The percent reduction of uptake ratio (AUR) was calculated according to the following equation: 100 × ([prechemotherapy UR - post-middle course of chemotherapy UR]/prechemotherapy UR). Results: The average follow-up for the entire population was 52 months. Twenty-one patients had clinically detectable metastases at initial presentation (primary metastasis). Kaplan-Meier analysis demonstrated that absence of metastasis was associated with good survival in all patients, in patients with bone tumor, and those with soft tissue tumor (P < 0.0001, P < 0.0001, and P = 0.0003, respectively), and AUR ≥30% was also associated with survival in all patients and patients with bone tumor (P = 0.011 and P = 0.047, respectively), but was marginal in those with soft tissue tumor (P = 0.091). Multivariate analysis showed that primary metastasis was the most powerful independent predictor of a lethal clinical outcome in all patients, in both patients with bone and soft tissue tumors (hazard ratio [HR]: 4.9, 95% confidence interval [CI]: 2.61-9.08, P < 0.0001; HR: 15.1, CI: 4.86-52.7, P < 0.0001; HR: 3.7, CI: 1.45-8.94, P = 0.0069, respectively) and showed that Tc-99m-MIBI scintigraphy had a good independent long-term prognostic value in all patients and patients with bone tumor (HR: 2.2, CI: 1.14-4.43, P = 0.017; HR: 6.0, CI: 2.01-21.6, P = 0.0009, respectively) but not in those with soft tissue tumor (HR: 1.5, CI: 0.61-4.09, P = 0.38). Good disease-free survival was associated with ΔUR §30% in all patients and patients with soft tissue tumor (P = 0.0093 and P = 0.017, respectively) but not in those with bone tumor (P = 0.19). Conclusions: Tc-99m-MIBI scintigraphy at the middle course of preoperative chemotherapy could be used as a prognostic indicator in patients with MBST. Copyright © 2012 by Lippincott Williams & Wilkins.<br />Thesis of Hiroshi Wakabayashi / 博士学位論文 若林 大志
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| 4.
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論文
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Taki, Junichi ; Inaki, Anri ; Wakabayashi, Hiroshi ; Sumiya, Hisashi ; Tsuchiya, Hiroyuki ; Zen, Yoh ; Kinuya, Seigo
概要:
金沢大学附属病院核医学診療科<br />PURPOSE: Tc-99m-methoxyisobutylisonitrile (MIBI) accumulates in only viable cells. In patients with
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bone and soft tissue sarcomas, preoperative chemotherapy is essential and the early prediction of the tumor response to chemotherapy would be beneficial for the planning of treatment strategy. The purpose of this study was to assess whether the change of Tc-99m-MIBI images from the prechemotherapy state to the early to midportion of chemotherapy can predict the final histopathological tumor response as accurately as the change of imaging after completion of chemotherapy. METHODS: Seventy-three patients with bone and soft tissue sarcomas underwent Tc-99m-MIBI scintigraphy before chemotherapy and at least 2 times after the second or third or fifth course of chemotherapy. The changes of the tracer uptake (ΔUR) and perfusion (ΔPI) from prechemotherapy to postchemotherapy were compared with histologic response. RESULTS: The sensitivity, specificity, and accuracy for the prediction of effective chemotherapy in ΔPI were 88%, 83%, 85% after second, 85%, 72%, 78% after third, and 81%, 71%, 76% after 5th chemotherapy, and those in ΔUR were 88%, 83%, 85% after 2nd, 85%, 92%, 89% after 3rd, and 94%, 77%, 85% after fifth chemotherapy, respectively. The area under the receiver operator characteristic curve of the ΔPI after second, third, and fifth chemotherapy were similarly good (0.842, 0.858, 0.811, respectively) and those of ΔUR were similarly excellent (0.915, 0.936, 0.931, respectively). CONCLUSION: In patients with bone and soft tissue sarcomas, the change of Tc-99m-MIBI images from prechemotherapy to early to middle of chemotherapy can predict the final histopathological tumor response to chemotherapy as accurately as the change of Tc-99m-MIBI images from prechemotherapy to the completion of the preoperative chemotherapy. © 2010 by Lippincott Williams & Wilkins.
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| 5.
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Nakase, Junsuke ; Inaki, Anri ; Mochizuki, Takafumi ; Toratani, Tatsuhiro ; Kosaka, Masahiro ; Ohashi, Yoshinori ; Taki, Junichi ; Yahata, Tetsutaro ; Kinuya, Seigo ; Tsuchiya, Hiroyuki
概要:
Purpose:This study investigated the effect of the FIFA 11+ warm-up program on whole body muscle activity using positron
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emission tomography.Methods:Ten healthy male volunteers were divided into a control group and a group that performed injury prevention exercises (The 11+). The subjects of the control group were placed in a sitting position for 20 min and 37 MBq of 18F-fluorodeoxyglucose (FDG) was injected intravenously. The subjects then remained seated for 45 min. The subjects of the exercise group performed part 2 of the 11+for 20 min, after which FDG was injected. They then performed part 2 of the 11+for 20 min, and rested for 25 min in a sitting position. Positron emission tomography-computed tomography images were obtained 50 min after FDG injection in each group. Regions of interest were defined within 30 muscles. The standardized uptake value was calculated to examine the FDG uptake of muscle tissue per unit volume.Results:FDG accumulation within the abdominal rectus, gluteus medius and minimus were significantly higher in the exercise group than in the control group (P<0.05).Conclusion:The hip abductor muscles and abdominal rectus were active during part 2 of the FIFA 11+ program. © 2013 Nakase et al.
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