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At least 397 records · Page 22Linked to original sources
PubMed2003

A new accurate and precise 3-D segmentation method for skeletal structures in volumetric CT data.

We developed a highly automated three-dimensionally based method for the segmentation of bone in volumetric computed tomography (CT) datasets. The multistep approach starts with three-dimensional (3-D) region-growing using local adaptive thresholds followed by procedures to correct for remaining boundary discontinuities and a subsequent anatomically oriented boundary adjustment using local values of cortical bone density. We describe the details of our approach and show applications in the proximal femur, the knee, and the skull. The accuracy of the determination of geometrical parameters was analyzed using CT scans of the semi-anthropomorphic European spine phantom. Depending on the settings of the segmentation parameters cortical thickness could be determined with an accuracy corresponding to the side length of 1 to 2.5 voxels. The impact of noise on the segmentation was investigated by artificially adding noise to the CT data. An increase in noise by factors of two and five changed cortical thickness corresponding to the side length of one voxel. Intraoperator and interoperator precision was analyzed by repeated analysis of nine pelvic CT scans. Precision errors were smaller than 1% for trabecular and total volumes and smaller than 2% for cortical thickness. Intraoperator and interoperator precision errors were not significantly different. Our segmentation approach shows: 1) high accuracy and precision and is 2) robust to noise, 3) insensitive to user-defined thresholds, 4) highly automated and fast, and 5) easy to initialize.

Algorithms↗
PubMed2002

The inferomedial orbital strut: an anatomic and radiographic study.

PURPOSE: To study the anatomic and radiographic features of the inferomedial orbital strut (IOS), with particular emphasis on the region of the posterior IOS. METHODS: Cadaver dissection study of the IOS was performed on 20 orbits of 10 fresh-frozen cadaver specimens. Radiographic volumetric analysis was performed on CT scans of 20 orbits to measure the volume available for decompression in the region of the posterior IOS. RESULTS: The anterior IOS provided bony support to the orbit and served as a site of attachment for globe-supporting suspensory ligaments. The midportion of the IOS demonstrated a contiguous anatomic relation to the maxillary sinus ostium. The posterior IOS consisted of two components: the intraorbital process of the palatine bone and ethmoidal air cells that extended inferior and posterior to the IOS. Radiographic volumetric analysis demonstrated that there was an average of 2.1 mL of volume available for decompression in the region of the posterior IOS (range, 1.2 to 3.3 mL). CONCLUSIONS: The findings of this anatomic and radiographic study of the inferomedial orbital strut support the concept of a posterior inferomedial orbital decompression. The region of the posterior IOS appears to offer significant volume for axial globe mobilization while minimizing the risk of globe dystopia and/or impairment of the maxillary sinus drainage.

Anthropometry↗
PubMed1997

High-density oral barium sulfate in abdominal MRI: efficacy and tolerance in a clinical setting.

Bowel and anatomic delineation were evaluated on abdominal magnetic resonance imaging scans in patients who received high-density barium sulfate orally (n = 16, BA+ group) or underwent magnetic resonance imaging without oral contrast (n = 14, BA- group). On T1-weighted images, the BA+ group had better delineation of gastric fundus, duodenum, jejunum, and ileum (p < .005) and pancreatic head (p < .02) than did the BA- group. On T2-weighted images, gastric fundus (p < .005), jejunum (p < .02), and ileum (p < .02) were better delineated in the BA+ group than in the BA- group. Analysis of patients' prior CT scans, used to control for selection bias, showed no differences in anatomic or bowel delineation between BA+ and BA- groups that would account for the differences seen in magnetic resonance imaging. One-fourth of patients could tolerate only 150 cc of contrast. High-density oral barium sulfate is recommended in patients undergoing magnetic resonance imaging for pancreatic or gastrointestinal tract disease, although patient intolerance may limit its widespread use in abdominal magnetic resonance imaging.

Abdomen↗
PubMed1987

Computed tomography of posterior uveal melanomas.

Computed tomographic (CT) scans were obtained from 48 patients with posterior uveal melanoma. The CT measurements of maximal and minimal basal diameters and thickness of each tumor were compared with the assessments of these tumor dimensions obtained by ophthalmoscopic estimation (basal diameters only) and standardized A-scan ultrasonography (thickness only) and with the gross pathologic measurements of these tumors. The correlation between measurements of tumor thickness by CT scanning, standardized A-scan ultrasonography, and gross pathologic analysis was substantially better than that between the CT, ophthalmoscopic, and gross pathologic measurements of tumor basal diameters. Computed tomographic scanning appears to be a good method for determining the in vivo size of choroidal and ciliary body melanomas.

Adult↗
PubMed2004

Reliability of a semi-automated technique of cerebral infarct volume measurement with CT.

BACKGROUND: A reliable method of infarct volume measurement is needed if infarct volume is to be used as an outcome measure in clinical stroke trials. We investigated the reproducibility of a semi-automated method of computed tomography (CT) infarct volume measurement amongst three stroke research fellows with no formal neuroradiology training and two consultant neuroradiologists. METHODS: CT brain scans for volumetric analysis were performed at 5 to 7 days in 34 patients with acute ischaemic stroke, of which 28 scans showed visible recent infarction. Five observers independently traced the infarct boundary on digitised images with a cursor. Volumetric analysis incorporated pixel thresholding with preset Hounsfield thresholds. One of the observers repeated the analyses on 21 of the scans in order to assess intraobserver variation. RESULTS: Median infarct volume was 35.7 cm3 (range 0.2-318 cm3). The closest limits of observed agreement (mean +/- 1.96 SD) between pairs of observers were between a research fellow and neuroradiologist (-29 to 21 cm3). The widest limits of agreement were between a different research fellow and the same neuroradiologist (-39.1 to 41.4 cm3). The limits of agreement between infarct volumes measured on two separate occasions by one of the research fellows were -7 to 8 cm3. CONCLUSIONS: Intraobserver reliability of CT infarct volume measurements performed by a stroke research fellow was superior to interobserver reliability between any pair of observers. The wide limits of agreement between different observers using manual tracing may not be acceptable in multicentre trials of acute ischaemic stroke treatment, but volume measurement by a single observer appears to be more reliable.

Aged↗
PubMed1994

A rapid, reliable, and valid method for measuring infarct and brain compartment volumes from computed tomographic scans.

BACKGROUND AND PURPOSE: Clinical stroke trials require objective and reproducible end point variables. Morphometry of cerebral structures, including infarct volume, provides numerical measures that represent the amount of tissue damaged and potentially salvaged by therapy. However, morphometry may be time-consuming and labor-intensive, and it requires standardization across multiple centers, which may be difficult to achieve in large multicenter trials. We developed a brain morphometry method that is unbiased, rapid, reliable, and based on well-accepted stereological techniques. We now extend this method to analysis of routine computed tomographic (CT) scans such as might be obtained during a clinical stroke trial. METHODS: We studied CT scans from 18 stroke patients and 14 asymptomatic control patients obtained over 5 years at the San Diego Veterans Administration Medical Center. Three observers independently measured the volume of the cranial vault, cerebrum, cortex, white matter, deep gray structures, ventricle, sulcal cerebrospinal fluid space, visible infarction, and cerebellum/brain stem. RESULTS: The two patient groups were well matched demographically. The intracranial volume of 1400 +/- 40 mL in control subjects was not different from the 1311 +/- 41 mL in patients. Cerebral volume was 1250 +/- 36 mL compared with 1070 +/- 36 mL (control subjects versus patients, P < .001), and infarction volume was 55 +/- 16 mL in patients. For all structures, intraclass correlation coefficients among the observers ranged from 0.87 to 0.03; the best agreement was found for lesion, ventricle, and intracranial volume. White matter and cortex volume predicted the National Institutes of Health Stroke Scale score but not the late outcome scores on the Barthel Index or Rankin Scale. Each scan required 70 to 90 minutes for analysis. CONCLUSIONS: We developed a stereological method for cerebral morphometry from CT scans that is reliable, rapid, and simple. The measurements are unbiased, can be made on slices of any known thickness, and are independent of machine variables. Our results are remarkably similar to values obtained with more labor-intensive methods. This method should be of use in large-scale, multicenter trials of stroke therapy.

Aged↗
PubMed1996

Clinical and computed tomographic characteristics of amyloid tumor of the lacrimal gland.

BACKGROUND: Lacrimal gland masses, whose soft-tissue contour analysis, on computed tomographic (CT) scanning, shows molding to surrounding orbital structures, include inflammatory and lymphoproliferative lesions. The authors present a patient with orbital amyloidosis isolated to the lacrimal gland who also demonstrates this specific CT presentation. In addition, the literature on this rare condition is reviewed, and characterization of the typical presentation is provided. METHODS: A retrospective review of the four previously reported patients and the authors' additional patient with amyloid tumor of the lacrimal gland was performed. A summary of the clinical characteristics of the disorder was formulated. Special attention was given to to the unique CT findings of the authors' patient. RESULTS: Five patients with amyloid tumor of the lacrimal gland have been described. All patients have been women, with average age of 53 years, and who had the primary, localized variant of the disease. Neither visual impairment nor evidence of optic nerve dysfunction has developed in any of the patients. In the authors' patient, the CT soft-tissue contour analysis of the lacrimal gland mass demonstrated molding to adjacent orbital tissues. CONCLUSIONS: Amyloidosis of the lacrimal gland presents as a primary, localized disease process. It typically affects middle-aged women without visual morbidity. The early CT findings may mimic those seen in inflammatory or lymphoproliferative disorders of the lacrimal gland.

Aged↗
PubMed2001

Combined CT venography and pulmonary angiography: how much venous enhancement is routinely obtained?

OBJECTIVE: Combined CT venography and helical pulmonary angiography is a new diagnostic test that permits radiologists to check both the pulmonary arteries for embolism and the deep veins of the abdomen, pelvis, and legs for thrombosis in a single examination. The purpose of this study was to determine the degree of venous enhancement routinely obtained using this combined CT examination. MATERIALS AND METHODS: We identified all patients at a single institution who, during a 29-month period, had symptoms suggestive of pulmonary embolism and who underwent CT venography and helical pulmonary angiography. The examinations were performed after the patients received a rapid (3--5 mL/sec) IV injection of 150 mL of nonionic contrast medium (240 mg I/mL). CT venography of the abdomen, pelvis, and lower extremities was performed as follows: Beginning 3 min after the start of contrast medium infusion for helical CT pulmonary angiography, 1-cm axial images obtained at 5-cm intervals were acquired from an area ranging from the diaphragm to the calves. Patients who had evidence of deep venous thrombosis on CT scans were excluded from further analysis. The venous portions of the remaining 429 examinations were retrospectively reviewed at a CT console or workstation by one of two radiologists, and Hounsfield unit measurements were recorded from the inferior vena cava as well as from the right and left external or internal iliac, common femoral, superficial femoral, and popliteal veins. A single Hounsfield unit measurement was obtained from the center of each vessel using a region of interest that was approximately half the diameter of the vessel. Mean Hounsfield unit measurements were then calculated for these venous stations. RESULTS: Mean Hounsfield unit measurements at the inferior vena cava and at the right and left external or internal iliac veins were 97, 95, and 95 H, respectively. Mean measurements at the common femoral veins were 95 H for both the right and left; the mean measurements at the superficial femoral veins were 91 H for both the right and left, and those at the popliteal veins were 97 H for the right and 94 H for the left. CONCLUSION: CT venography of the abdomen, pelvis, and lower extremities begun 3 min after the start of contrast medium infusion for helical CT pulmonary angiography routinely produced high mean levels of venous enhancement.

Angiography↗
PubMed1997

CT appearance of parapneumonic effusions in children: findings are not specific for empyema.

OBJECTIVE: Although definitive differentiation of empyema from transudative parapneumonic effusion is based on the analysis of pleural fluid, certain CT findings have been described as highly suggestive of empyema. This study compares the CT findings of parapneumonic effusions with the results of thoracentesis, thoracoscopy, or both to determine whether these CT findings can reliably differentiate empyemas from transudative parapneumonic effusions in children. MATERIALS AND METHODS: CT scans obtained to evaluate pleural or parenchymal complications of pneumonia were reviewed. Parapneumonic effusions were evaluated for the CT findings of pleural enhancement; parietal pleural thickening; thickening, increased attenuation, or both of the extrapleural subcostal fat: and edema of the extracostal chest wall. Each parapneumonic effusion was assigned a CT score on the basis of these CT findings. Individual CT findings and the CT score were correlated with the presence of empyema as determined by thoracentesis or thoracoscopy. RESULTS: Thirty patients were identified as having a parapneumonic pleural effusion revealed on contrast-enhanced CT scans and by pleural fluid analysis. Twenty-one of these parapneumonic effusions met the clinical criteria for empyema, and nine were considered not to be empyemas. Neither any individual CT finding nor the CT score accurately differentiated empyema from transudative parapneumonic effusions (p > .1): pleural enhancement (empyema 100%, transudative effusion 89%), pleural thickening (empyema 57%, transudative effusion 56%), abnormal extrapleural space (empyema 66%, transudative effusion 67%), extracostal chest wall edema (empyema 33%, transudative effusion 56%), and average CT score (empyema 2.5. transudative effusion 2.3). CONCLUSION: CT characteristics of parapneumonic effusions do not allow radiologists to accurately predict empyema. The presence or absence of such CT findings should not influence therapeutic decisions concerning the management of parapneumonic effusions.

Adolescent↗
PubMed2003

Toward a dynamic real-time intraoperative permanent prostate brachytherapy methodology.

PURPOSE: To evaluate dosimetry and source location relative to CT-based dosimetry when performing real-time dynamic permanent prostate brachytherapy (PPB) with inverse treatment planning. METHODS AND MATERIALS: A treatment algorithm for dynamic PPB was developed using inverse treatment planning. The technique utilizes real-time transrectal ultrasound prostate imaging connected to the treatment planning software. The implementation of the plan with the Mick interstitial gun is monitored with up-to-date dosimetry assessments based on the registration of each seed when placed. Real-time dose assessment is monitored and adjustments can be made during the case, if necessary. A final OR dosimetric (OR-D) assessment based on the registered seed locations is performed. Postoperative CT scans obtained at 3 weeks are used for traditional dosimetry analysis (CT-D). A matrix algorithm was developed to match the seed locations from the ultrasound registration to that of the CT-scan parameters. RESULTS: Twenty-six consecutive patients with clinically localized prostate cancer underwent PPB using the algorithm designed for dynamic real-time planning. The OR-D identified a mean D90 of 109% (range 100-118%) whereas the mean CT-D D90 at 3 weeks was 105% (range 89-122%) (p=0.894). Analysis of the OR-D V100 and V150 relative to the 3-week CT-dose V100 and V150 were also insignificant (p=0.112 and 0.167, respectively). Assessment of seed locations relative to the intraoperative ultrasound and postimplant CT identified a mean root-mean-square error of 4.6 mm (0-21 mm). The mean error for the x, y, and z coordinates were 2.01 mm, 2.24 mm, and 2.85 mm, respectively. CONCLUSIONS: This study reports the preliminary results of a new treatment algorithm for PPB that incorporates intraoperative inverse planning with dynamic dosimetry assessment during the case. Correlation was seen between the completed intraoperative, postimplant plan and the CT based plan at 3 weeks. Seed to seed deviations between the OR-D matched well with the CT-D. Additional study is necessary to assess whether this approach can assist in improving implant dosimetry and whether it appropriately documents the OR-dose without the need for postimplant dosimetry.

Adenosarcoma↗
PubMed2002

[Actinomycosis of the appendix. Report of two cases].

INTRODUCTION: We report two patients with actinomycosis of the appendix extending to the caecum and the ileum, and diagnosed postoperatively on histological analysis, the authors reviewed the literature. EXEGESIS: Actinomycosis of the appendix can be acute or chronic. Diagnosis may be obtained preoperatively on the analysis of aspiration or biopsy material under CT scan control. It is frequently done postoperatively on the analysis of surgical specimen. Actinomycosis can be treated with antibiotics only during six months if the diagnosis is made preoperative, by surgery followed by antibiotics during 6-12 months, according to the extension of the actinomycosis, if the diagnosis is made after surgery, and by a combination of a surgery and antibiotics in complex forms. CONCLUSION: Actinomycosis of the appendix is an infrequent pathology that merits to be known. With antibiotic therapy, we can avoid surgery or wide resections.

Actinomycosis↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMed2004

Cochlear implant surgery at 12 months of age or younger.

OBJECTIVES: Early presentation of congenitally deaf children for cochlear implantation is leading to surgery in younger candidates. The safety of cochlear implantation in children aged 12 months and younger is reviewed with radiologic assessment of mastoid bone anatomy and surgical outcome data. STUDY DESIGN: Analysis of case records and temporal bone computed tomography (CT) scans with description of surgical technique in infants. METHODS: Chart analysis of children aged 12 months or younger at cochlear implantation. Mastoid bone anatomy was compared with older children (mean age 2 years) using CT scans. RESULTS: Twenty-five infants received implants at 7 to 12 months of age because of meningitis (n = 4) or early detection of deafness (n = 21). Mastoid marrow content on CT scan was significantly greater in this age group (P < .001 Mann-Whitney rank sum test), but pneumatization was always adequate for safe identification of surgical landmarks. The smaller size of the mastoid bone was not restrictive. An extended postauricular approach was used in the first 11 cases and a 2.5 cm hair-line incision in the remainder. Ligature tie-down of the device was completed in all cases. No complications occurred. All are full-time implant users, except one with other neurologic sequelae of preoperative meningitis. CONCLUSIONS: In our experience, cochlear implant surgery is safe in children aged 7 to 12 months with appropriate anesthetic and postoperative support. The small incision technique is particularly suited to this age group. Ligature fixation of the device is considered advisable because of the increased risk of displacement from frequent falls when learning to walk.

Age Factors↗
PubMed1993

Thickness and resistivity variations over the upper surface of the human skull.

A study of skull thickness and resistivity variations over the upper surface was made for an adult human skull. Physical measurements of thickness and qualitative analysis of photographs and CT scans of the skull were performed to determine internal and external features of the skull. Resistivity measurements were made using the four-electrode method and ranged from 1360 to 21400 Ohm-cm with an overall mean of 7560 +/- 4130 Ohm-cm. The presence of sutures was found to decrease resistivity substantially. The absence of cancellous bone was found to increase resistivity, particularly for samples from the temporal bone. An inverse relationship between skull thickness and resistivity was determined for trilayer bone (n = 12, p < 0.001). The results suggest that the skull cannot be considered a uniform layer and that local resistivity variations should be incorporated into realistic geometric and resistive head models to improve resolution in EEG. Influences of these variations on head models, methods for determining these variations, and incorporation into realistic head models, are discussed.

Body Composition↗
PubMed2000

[Effect of periosteum on induced bone formation by autolyzed, antigen-extracted, allogeneic bone. Determination of the extent of bone formation using quantitative computerized tomography].

Autolyzed, antigen-extracted, allogenic (AAA) bone is an osteoinductive preparation of completely demineralized bone matrix. It has been clinically applied for years. In an experimental study in rabbits, we evaluated the influence of cortical bone and periosteum on the amount of bone formation following augmentation with AAA bone. Two implants of standardized size were placed on the femoral bone of rabbits. A cell-excluding PTFE membrane was wrapped circularly around the femur as well as the anterior implant shielding the implant from the surrounding periosteum. The posterior implant was exposed directly to the periosteum while being shielded from the cortical bone by the membrane. Thus, two compartments were created selectively, preventing contact between the periosteum or cortical bone and the implants. For each compartment the area and volume of the induced new bone were evaluated by computerized radiograph analysis and quantitative CT (pQCT) scans. Implantation of AAA bone led to new bone formation in both compartments. Contact of the periosteum and the implant led to an almost four-fold increase in bone volume. Although bone formation showed interindividual variations, the difference of both compartments was highly significant using the Student's t-test for paired samples (P < 0.0001). The data show that periosteum is the primary source of new bone formation in augmentations with osteoinductive materials as it is rich in inducible progenitor cells and is well vascularized. In osseous augmentations with AAA bone, the periosteum should be preserved in order to achieve a close contact of the osteoinductive implant. Shielding from the periosteum, e.g., by cell-excluding membranes, leads to significantly less bone formation following implantation of AAA bone and should therefore be avoided.

Animals↗
PubMed2000

Effects of troglitazone on insulin sensitivity in HIV-infected patients with protease inhibitor-associated diabetes mellitus.

Antiretroviral therapy (ART) is frequently associated with metabolic alterations, including insulin resistance and diabetes mellitus. In this pilot study, we evaluated the effect of the PPARgamma activator troglitazone on ART-associated insulin resistance in HIV-infected patients with ART-associated diabetes mellitus. Six patients with protease inhibitor (PI)-associated diabetes mellitus, lipodystrophy and dyslipidemia were treated with troglitazone 400 mg q.d. for 3 months. Previous oral antidiabetics were discontinued prior to the study. At baseline and after 3 months, insulin sensitivity (intravenous insulin tolerance test), body composition (multifrequence bioelectrical impedance analysis) and fat distribution (CT scan quantification) were assessed. Glycaemic control (fasting and postprandial blood glucose, fructosamine, glycosylated haemoglobin) and serum lipid status were determined monthly. In four of the six patients, there was a clear improvement in insulin sensitivity, resulting in a reversal of insulin resistance in two of these patients. Overall, there was an increase in lean body mass and a decrease in total body fat. The volume of visceral adipose tissue decreased whilst the volume of subcutaneous adipose tissue increased. Total cholesterol, LDL and HDL cholesterol increased, and total triglycerides and VLDL-cholesterol decreased. No adverse effects such as hepatotoxicity were observed. Treatment with troglitazone 400 mg q.d. can ameliorate and in some cases even reverse ART-associated insulin resistance. Therefore, further studies including non-diabetic patients with ART-associated insulin resistance may be helpful in evaluating the long-term effects of thiazolidinediones on ART-associated insulin resistance and other metabolic complications, such as adipose maldistribution and dyslipidaemia.

Adipose Tissue↗
PubMed2006

Prolonged psychosis after Amanita muscaria ingestion.

Amanita muscaria has a bright red or orange cap covered with small white plaques. It contains the isoxazole derivatives ibotenic acid, muscimol and muscazone and other toxins such as muscarine. The duration of clinical manifestations after A. muscaria ingestion does not usually exceed 24 hours; we report on a 5-day paranoid psychosis after A. muscaria ingestion. A 48-year-old man, with no previous medical history, gathered and ate mushrooms he presumed to be A. caesarea. Half an hour later he started to vomit and fell asleep. He was found comatose having a seizure-like episode. On admission four hours after ingestion he was comatose, but the remaining physical and neurological examinations were unremarkable. Creatine kinase was 8.33 microkat/l. Other laboratory results and brain CT scan were normal. Toxicology analysis did not find any drugs in his blood or urine. The mycologist identified A. muscaria among the remaining mushrooms. The patient was given activated charcoal. Ten hours after ingestion, he awoke and was completely orientated; 18 hours after ingestion his condition deteriorated again and he became confused and uncooperative. Afterwards paranoid psychosis with visual and auditory hallucinations appeared and persisted for five days. On the sixth day all symptoms of psychosis gradually disappeared. One year later he is not undergoing any therapy and has no symptoms of psychiatric disease. We conclude that paranoid psychosis with visual and auditory hallucinations can appear 18 hours after ingestion of A. muscaria and can last for up to five days.

Amanita↗
PubMed1987

Multi-modality treatment of primary nonresectable intrahepatic cholangiocarcinoma with 131I anti-CEA--a Radiation Therapy Oncology Group Study.

Thirty-seven patients with primary nonresectable intrahepatic cholangiocarcinoma (57% with prior treatment and/or metastasis) were prospectively treated with external radiation, chemotherapy, and 131I labelled anti-CEA. Therapy began in all trials with whole liver irradiation (21.0 Gy, 3.0 Gy/Fx, 4 days/week, 10 MV photons) with alternate treatment day chemotherapy (Adriamycin, 15 mg + 5-FU, 500 mg). One month after external beam therapy, chemotherapy was given (Adriamycin, 15 mg + 5-FU, 500 mg) followed the next day by the first administration of 131I anti-CEA. The treatment schedule used was 20 mCi day 0; 10 mCi day 5 as an outpatient. This schedule was derived from tumor dose estimates which indicated that 20 mCi (8-10 mCi/mg IgG) was sufficient to achieve tumor saturation with a tumor effective half-life of 3 to 5 days, depending upon the species of animal from which the antibody was obtained. The median tumor dose for the 20 mCi + 10 mCi regimen was 6.2 Gy. Antibody therapy was delivered in 2-month cycles using antibody generated in different species of animals; rabbit, pig, monkey, and bovine. Toxicity was limited to hematologic toxicity and was manifested as thrombocytopenia and leukocytopenia (3.2% Grade IV for each according to RTOG toxicity criteria). Tumor remission evaluated by CT scan digitized tumor volume analysis indicated a 26.6% partial response (PR). Tumor remission by physical examination indicated a 33.3% remission rate (25.9% PR and 7.4% complete remission (CR]. The median survival for patients who responded was 15.2 months. The actuarial median survival for the entire group of patients (metastases and previous treatment) was 6.5 months. The longest partial remission is presently more than 4 years.

Adenoma, Bile Duct↗