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Showing papers in "Cancer Imaging in 2011"


Journal ArticleDOI
TL;DR: The design of the NELSON study including participant selection and the lung nodule management protocol, as well as results on validation of CT screening and first results on lung cancer screening are described.
Abstract: The Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON study) was designed to investigate whether screening for lung cancer by low-dose multidetector computed tomography (CT) in high-risk subjects will lead to a decrease in 10-year lung cancer mortality of at least 25% compared with a control group without screening. Since the start of the NELSON study in 2003, 7557 participants underwent CT screening, with scan rounds in years 1, 2, 4 and 6. In the current review, the design of the NELSON study including participant selection and the lung nodule management protocol, as well as results on validation of CT screening and first results on lung cancer screening are described.

166 citations


Journal ArticleDOI
TL;DR: QSPECT has high accuracy both in the phantom model and in clinical practice following [177Lu]octreotate therapy and has the potential to yield more accurate dosimetry estimates than planar imaging and facilitate therapeutic response assessment.
Abstract: Purpose: The combination of single photon emission computed tomography (SPECT) and computer tomography (CT) that incorporates iterative reconstruction algorithms with attenuation and scatter correction should facilitate accurate non-invasive quantitative imaging. Quantitative SPECT (QSPECT) may improve diagnostic ability and could be useful for many applications including dosimetry assessment. Using 177Lu, we developed a QSPECT method using a commercially available SPECT/CT system. Methods: Serial SPECT of 177Lu sources (89–12,400 MBq) were acquired with multiple contiguous energy windows along with a co-registered CT, and were reconstructed using an iterative algorithm with attenuation and scatter correction. Camera sensitivity (based on reconstructed SPECT count rate) and dead-time (based on wide-energy spectrum count rate) were resolved by non-linear curve fit. Utilizing these parameters, a SPECT dataset can be converted to a QSPECT dataset allowing quantitation in Becquerels per cubic centimetre or standardized uptake value (SUV). Validation QSPECT/CT studies were performed on a 177Lu cylindrical phantom (7 studies) and on 5 patients (6 studies) who were administered a therapeutic dose of [177Lu]octreotate. Results: The QSPECT sensitivity was 1.08 × 10−5 ± 0.02 × 10−5 s−1 Bq−1. The paralyzing dead-time constant was 0.78 ± 0.03 µs. The measured total activity with QSPECT deviated from the calibrated activity by 5.6 ± 1.9% and 2.6 ± 1.8%, respectively, in phantom and patients. Dead-time count loss up to 11.7% was observed in patient studies. Conclusion: QSPECT has high accuracy both in our phantom model and in clinical practice following [177Lu]octreotate therapy. This has the potential to yield more accurate dosimetry estimates than planar imaging and facilitate therapeutic response assessment. Validating this method with other radionuclides could open the way for many other research and clinical applications.

114 citations


Journal ArticleDOI
TL;DR: The best tool for risk stratification for malignancy in thyroid nodules is US and guided biopsy of nodules with suspicious imaging features and fine-needle biopsy is currently the best triage test for pre-operative evaluation of a thyroid nodule.
Abstract: Replacing palpating fingers with an ultrasound (US) probe has resulted in an epidemic of thyroid nodules. Despite the high prevalence of thyroid nodules in the general population, thyroid malignancy is rare. Although no imaging modality can accurately predict the nature of every nodule, high-resolution US is the most sensitive, easily available and cost-effective diagnostic test available to detect thyroid nodules, measure their dimensions and identify their structure. The presence of calcifications, irregular spiculated outline, hypoechogenicity in a solid nodule, chaotic intranodular vascularity and an elongated shape are well-known US features of malignancy in thyroid nodules. Cervical lymph node metastasis and extrathyroidal extension of a thyroid nodule are highly specific for malignancy but seen infrequently. Spongiform nodules, purely or predominantly cystic nodules, nodules with well-defined hypoechoic halo and echogenic as well as isoechoic nodules are usually benign. None of the US characteristics have 100% accuracy in detecting or excluding malignancy. Fine-needle biopsy is currently the best triage test for pre-operative evaluation of a thyroid nodule. There is no significant difference in the risk for malignancy between palpable and non-palpable nodules and size is not a reliable indicator for their malignant potential. The best tool for risk stratification for malignancy in thyroid nodules is US and guided biopsy of nodules with suspicious imaging features. This is especially relevant in patients with multinodular goitre.

84 citations


Journal ArticleDOI
TL;DR: In this article, the authors reviewed established and new techniques in CT, MRI and PET imaging in both primary and secondary peritoneal malignancies and provided an overview of peritoneality anatomy, function and modes of disease dissemination with illustration of common sites and imaging features of Peritoneal Malignancy.
Abstract: Imaging plays a vital role in the evaluation of patients with suspected or proven peritoneal malignancy. Nevertheless, despite significant advances in imaging technology and protocols, assessment of peritoneal pathology remains challenging. The combination of complex peritoneal anatomy, an extensive surface area that may host tumour deposits and the considerable overlap of imaging appearances of various peritoneal diseases often makes interpretation difficult. Contrast-enhanced multidetector computed tomography (MDCT) remains the most versatile tool in the imaging of peritoneal malignancy. However, conventional and emerging magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT techniques offer significant advantages over MDCT in detection and surveillance. This article reviews established and new techniques in CT, MRI and PET imaging in both primary and secondary peritoneal malignancies and provides an overview of peritoneal anatomy, function and modes of disease dissemination with illustration of common sites and imaging features of peritoneal malignancy.

77 citations


Journal ArticleDOI
TL;DR: Therapy response criteria need to be tested in prospective clinical studies that incorporate conventional measures of patient benefit and can potentially address unmet clinical and pharmaceutical needs for a reliable measure of tumour response.
Abstract: There are no universally accepted methods for assessing tumour response in skeletal sites with metastatic disease; response is assessed by a combination of imaging tests, serum and urine biochemical markers and symptoms assessments. Whole-body diffusion magnetic resonance imaging excels at bone marrow assessments at diagnosis and for therapy evaluations. It can potentially address unmet clinical and pharmaceutical needs for a reliable measure of tumour response. Signal intensity on high b-value images and apparent diffusion coefficient values can be related to underlying biophysical properties of skeletal metastases. Four patterns of change in response to therapy are described this review. Therapy response criteria need to be tested in prospective clinical studies that incorporate conventional measures of patient benefit.

64 citations


Journal ArticleDOI
TL;DR: The different uptake patterns on [18F]FDG and [68Ga]DOTATOC-PET/CT.
Abstract: Pulmonary carcinoids are histologically classified into typical and atypical. It is important to identify these preoperatively for treatment planning and prognosis. Structural imaging cannot conclusively differentiate between them. The aim of this study was to assess the possibility of differentiating the 2 variants using [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) and [68Ga]1,4,7,10-tetraazacyclododecane-NI–IIII-tetraacetic acid-(d)-Phe1-Thy3-octreotide (DOTATOC)-PET/CT. The imaging results of 20 patients with pulmonary carcinoids (13 typical, 7 atypical) on [18F]FDG-PET/CT and [68Ga]DOTATOC-PET/CT were assessed retrospectively. Six typical carcinoids failed to reveal significant uptake on [18F]FDG-PET/CT. All the atypical carcinoids revealed significant uptake on the [18F]FDG-PET/CT that was higher than that in typical carcinoids (standardized uptake value (SUV)max, 2.9–8.4, P = 0.001). The SUVmax in typical carcinoids on [68Ga]DOTATOC-PET/CT was significantly higher (SUVmax, 8.8–66) compared with atypical carcinoids (SUVmax, 1.1–18.5, P = 0.002). Ratios of SUVmax on [68Ga]DOTATOC-PET/CT to that on [18F]FDG-PET/CT were significantly higher (P < 0.001) in typical carcinoids compared with atypical carcinoids. The different uptake patterns on [18F]FDG and [68Ga]DOTATOC-PET/CT. and the ratio of SUVmax may be helpful in differentiating between typical and atypical carcinoids.

54 citations


Journal ArticleDOI
TL;DR: In the future, the TNM staging system should be integrated into the classification of SCLC, and recent data suggest that positron emission tomography can improve both staging accuracy and treatment planning in patients with SclC.
Abstract: Small cell lung cancer (SCLC) has been primarily classified as limited or extensive, with limited stage confined to the primary tumor and regional lymph nodes. In the future, the TNM staging system should be integrated into the classification of SCLC. The appropriate staging work-up for patients with SCLC has traditionally included contrast-enhanced computed tomography (CT) scans of the chest and abdomen, bone scan, and magnetic resonance imaging or CT scan of the brain. Recent data suggest that positron emission tomography can improve both staging accuracy and treatment planning in patients with SCLC. Treatment for limited-stage SCLC consists of chemotherapy plus radiotherapy, and such therapy can cure 20–25% of patients. Extensive-stage SCLC is incurable, but chemotherapy can improve quality of life and prolong life.

50 citations


Journal ArticleDOI
TL;DR: Early functional MRI-based evaluation can play an important role in tailoring treatment to the individual patient with RCC, as measured by DWI and T2*-perfusion MRI, 3 and 10 days after the start of the initial treatment.
Abstract: Objective: To assess the early vascular effects of sunitinib in patients with renal cell carcinoma (RCC) with diffusionweighted magnetic resonance imaging (DWI), dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and T2* perfusion MRI Patients and methods: In 10 patients with abdominal RCC lesions, DWI, DCE-MRI and T2* perfusion MRI measurements at 3 Tesla were performed at baseline, 3 and 10 days after start of sunitinib VEGF-A plasma levels were measured on days 0, 3 and 10 Results: DWI showed a significant increase in the apparent diffusion coefficient (� 10 � 6 s/mm 2 ) from baseline (mean 1158, range 814�2003) to day 3 (mean 1306, range 1008�2097, P ¼ 0015) followed by a decrease to baseline levels at day 10 (mean 1132, range 719�2005, P ¼ 0001) No significant changes were found in mean DCE-MRI parameters T2* perfusion MRI showed a significant decrease in relative tumor blood volume (rBV) and relative tumor blood flow (rBF) at day 3 (rBV P ¼ 0037, rBF P ¼ 0018) and day 10 (rBV P ¼ 0006, rBF P ¼ 0009) VEGF-A plasma levels significantly increased after 10 days, but did not correlate with MRI parameters Conclusions: Sunitinib induces antiangiogenic effects as measured by DWI and T2*-perfusion MRI, 3 and 10 days after the start of the initial treatment DCE-MRI did not show significant changes In the near future, early functional MRI-based evaluation can play an important role in tailoring treatment to the individual patient with RCC Further investigation is warranted

42 citations


Journal ArticleDOI
TL;DR: A role for functional imaging of classical mechanisms of MDR with an emphasis on readily available MIBI scintigraphy is described, which has been shown to be a non-invasive cost-effective in vivo assay of ATP-binding cassette transporters associated with MDR in cancer, including P-glycoprotein, multidrug-resistant protein 1 and breast cancer resistant protein.
Abstract: Primary intrinsic and/or acquired multidrug resistance (MDR) is the main obstacle to successful cancer treatment. Functional molecular imaging of MDR in cancer using single photon or positron emitters may be helpful to identify multidrug-resistant tumours and predict not only those patients who are resistant to treatment, with a clinically unfavourable prognosis, but also those who are susceptible to the development of drug toxicity or even certain tumours . Variations in the mdr1 gene product may directly affect the therapeutic effectiveness, and single nucleotide polymorphisms for the mdr1 gene may be associated with altered oral bioavailability of MDR1 substrates, drug resistance, and a susceptibility to some human diseases. The challenge of translating the concept of MDR modulation in vivo involves a complex cellular interplay between both malignant and normal cells. Integration and correlation of functional single photon emission tomography or positron emission tomography imaging findings with mdr1 genotype and clinical data may contribute to efficient management by selecting cancer patients with the appropriate molecular phenotype for maximal individual therapeutic benefit, as well as those who are non-responders. This review describes a role for functional imaging of classical mechanisms of MDR with an emphasis on readily available [(99m)Tc]MIBI scintigraphy. MIBI scintigraphy has been shown to be a non-invasive cost-effective in vivo assay of ATP-binding cassette transporters associated with MDR in cancer, including P-glycoprotein, multidrug-resistant protein 1 and breast cancer resistant protein. New imaging agents for molecular targets such as vascular endothelial growth factor and HER2 receptors, may potentially be combined with MDR imaging substrates to more accurately predict the therapeutic response to anticancer drugs, guiding individualised treatment while minimising the economic health costs of ineffective therapy in an era of personalised medicine

38 citations


Journal ArticleDOI
TL;DR: Practical guidelines for integrating multiparametric MRI into clinical practice are presented and effective communication by the use of scoring systems, structured reporting and a graphical interface that matches prostate anatomy are key elements.
Abstract: Multifunctional magnetic resonance imaging (MRI) techniques are increasingly being used to address bottlenecks in prostate cancer patient management. These techniques yield qualitative, semi-quantitative and fully quantitative biomarkers that reflect on the underlying biological status of a tumour. If these techniques are to have a role in patient management, then standard methods of data acquisition, analysis and reporting have to be developed. Effective communication by the use of scoring systems, structured reporting and a graphical interface that matches prostate anatomy are key elements. Practical guidelines for integrating multiparametric MRI into clinical practice are presented.

33 citations


Journal ArticleDOI
TL;DR: Breast MRI has been shown to have a role in monitoring of neoadjuvant chemotherapy, for the evaluation of therapeutic results during the course of therapy and for improving the early assessment of tumour response to therapy and the assessment of residual tumour after the end of therapy.
Abstract: The use of magnetic resonance imaging (MRI) for the assessment of breast lesions was first described in the 1970s; however, its wide application in clinical routine is relatively recent. The basic principles for diagnosis of a breast lesion rely on the evaluation of signal intensity in T2-weighted sequences, on morphologic assessment and on the evaluation of contrast enhancement behaviour. The quantification of dynamic contrast behaviour by dynamic contrast-enhanced (DCE) MRI and evaluation of the diffusivity of water molecules by means of diffusion-weighted MRI (DW-MRI) have shown promise in the work-up of breast lesions. Therefore, breast MRI has gained a role for all indications that could benefit from its high sensitivity, such as detection of multifocal lesions, detection of contralateral carcinoma and in patients with familial disposition. Breast MRI has been shown to have a role in monitoring of neoadjuvant chemotherapy, for the evaluation of therapeutic results during the course of therapy. Breast MRI can improve the determination of the remaining tumour size at the end of therapy in patients with a minor response. DCE-MRI and DW-MRI have shown potential for improving the early assessment of tumour response to therapy and the assessment of residual tumour after the end of therapy. Breast MRI is important in the postoperative work-up of breast cancers. High sensitivity and specificity have been reported for the diagnosis of recurrence; however, pitfalls such as liponecrosis and changes after radiation therapy have to be carefully considered.

Journal ArticleDOI
TL;DR: A case series of extranodal involvement of histologically proven cases of lymphomas detected on FDG-PET/CT at the institute is presented to demonstrate the challenges in interpretation of extransodal lymphoma.
Abstract: Lymphoma is the seventh most common type of malignancy in both sexes. It is a neoplastic proliferation of lymphoid cells at various stages of differentiation and affects lymph nodes with infiltration into the bone marrow, spleen and thymus. However, extra nodal involvement is frequently seen in many cases. With the development of dedicated positron emission tomography (PET) scanners with fused computed tomographic (CT) systems in the same gantry, [18F]fluorodeoxyglucose (FDG)-PET/CT has become a major tool in the evaluation of lymphomas and it is inimitable in certain situations such as assessment of response to therapy. Extranodal lymphoma can present with diverse manifestations and sometimes mimics other organ-related pathologies. Knowledge of the protean manifestations of extranodal lymphoma is required to accurately detect the disease and differentiate it from the various physiologic and benign causes of FDG uptake in various organs. We present a case series of extranodal involvement of histologically proven cases of lymphomas detected on FDG-PET/CT at our institute to demonstrate the challenges in interpretation of extranodal lymphoma.

Journal ArticleDOI
TL;DR: A possible role of RFA in resectable CRLM is reflected on after multiple attempts to assess the possible contribution of radiofrequency ablation to improve OS and progression-free survival (PFS) in patients with unresectable colorectal liver metastases.
Abstract: At diagnosis 10-25% of patients with colorectal liver metastases (CRLM) present as resectable disease. Liver resection is the gold standard treatment, resulting in a 5-year overall survival (OS) of 22-58%, local recurrence rates of 1.2-10.4% and a perioperative mortality of less than 5%. Multiple attempts have been made to assess the possible contribution of radiofrequency ablation (RFA) to improve OS and progression-free survival (PFS) in patients with unresectable colorectal liver metastases. The aim of this paper is to review the RFA literature in the setting of colorectal liver metastases: RFA with and without chemotherapy, RFA with and without resection, RFA for solitary unresectable CRLM, surgical and percutaneous imaging-guided RFA, RFA compared with chemotherapy. The reported OS, PFS, local recurrence rates, morbidity and mortality in these different settings are analyzed. This paper reflects on a possible role of RFA in resectable CRLM.

Journal ArticleDOI
TL;DR: TRUS-MRI fusion after biopsy can be used to document the location of each biopsy site, which can then be correlated with MRI findings, and T2-weighted MRI and apparent diffusion coefficient maps derived from diffusion-weighting MRI are the most sensitive sequences.
Abstract: During transrectal ultrasound (TRUS)-guided prostate biopsies, the actual location of the biopsy site is rarely documented. Here, we demonstrate the capability of TRUS-magnetic resonance imaging (MRI) image fusion to document the biopsy site and correlate biopsy results with multi-parametric MRI findings. Fifty consecutive patients (median age 61 years) with a median prostate-specific antigen (PSA) level of 5.8 ng/ml underwent 12-core TRUS-guided biopsy of the prostate. Pre-procedural T2-weighted magnetic resonance images were fused to TRUS. A disposable needle guide with miniature tracking sensors was attached to the TRUS probe to enable fusion with MRI. Real-time TRUS images during biopsy and the corresponding tracking information were recorded. Each biopsy site was superimposed onto the MRI. Each biopsy site was classified as positive or negative for cancer based on the results of each MRI sequence. Sensitivity, specificity, and receiver operating curve (ROC) area under the curve (AUC) values were calculated for multi-parametric MRI. Gleason scores for each multi-parametric MRI pattern were also evaluated. Six hundred and 5 systemic biopsy cores were analyzed in 50 patients, of whom 20 patients had 56 positive cores. MRI identified 34 of 56 positive cores. Overall, sensitivity, specificity, and ROC area values for multi-parametric MRI were 0.607, 0.727, 0.667, respectively. TRUS-MRI fusion after biopsy can be used to document the location of each biopsy site, which can then be correlated with MRI findings. Based on correlation with tracked biopsies, T2-weighted MRI and apparent diffusion coefficient maps derived from diffusion-weighted MRI are the most sensitive sequences, whereas the addition of delayed contrast enhancement MRI and three-dimensional magnetic resonance spectroscopy demonstrated higher specificity consistent with results obtained using radical prostatectomy specimens.

Journal ArticleDOI
TL;DR: The International Neuroblastoma Risk Group (INRG) was established in 2004 to develop a consensus approach to pretreatment risk stratification which relies on imaging-defined risk factors (IDRFs) that are determined before surgery or other therapy.
Abstract: Neuroblastoma is the most common extracranial solid malignancy in children. The tumor has variable biological behavior that can be predicted by patient age, genetic features, tumor biology and extent of disease at diagnosis. Factors chosen by various cooperative groups to define risk of treatment failure have been non-uniform. Therefore, historically, it has been difficult to compare outcomes across clinical trials performed around the world. This has hindered the advancement of treatment strategies to improve survival of these patients. The International Neuroblastoma Risk Group (INRG) was established in 2004 to develop a consensus approach to pretreatment risk stratification. The result was the development of the INRG Staging System (INRGSS) which relies on imaging-defined risk factors (IDRFs) that are determined before surgery or other therapy. With the application of the INRGSS the radiologist's role in staging children with neuroblastoma is increased. This review provides an overview of the INRGSS and the IDRFs.

Journal ArticleDOI
TL;DR: Several issues need to be further investigated for successful cancer treatment with MR-HIFU, including patient selection criteria, definition of treatment margins and optimal transducer technology.
Abstract: Magnetic resonance (MR)-high-intensity focused ultrasound (HIFU) is an innovative, noninvasive tumour ablation technique. MR imaging and focused ultrasound are combined allowing real-time anatomic guidance and temperature mapping during treatment. Recently, the volumetric ablation approach has been introduced in order to reduce treatment length and provide more homogeneous tumour ablation. After successful treatment of uterine fibroids, MR-HIFU is currently being investigated for the treatment of malignant tumours. Palliative treatment of painful bone metastases is already applied in clinical practice. Several issues need to be further investigated for successful cancer treatment with MR-HIFU, including patient selection criteria, definition of treatment margins and optimal transducer technology.

Journal ArticleDOI
TL;DR: The clinical significance of lesion movement due to respiration is detailed and various imaging techniques that have been investigated to manage the effects of respiratory motion in PET/CT scanning are discussed.
Abstract: Lesion movement during positron emission tomography (PET) scan acquisition due to normal respiration is a common source of artefact. A PET scan is acquired in multiple couch positions of between 2 and 5 min duration with the patient breathing freely. A PET-avid lesion will become blurred if affected by respiratory motion, an effect similar to that created when a person moves in a photograph. This motion also frequently causes misregistration between the PET and computed tomography (CT) scan acquired for attenuation correction and anatomical correlation on hybrid scanners. The compounding effects of blurring and misregistration in whole-body PET/CT imaging make accurate characterization of PET-avid disease in areas of high respiratory motion challenging. There is also increasing interest in using PET quantitatively to assess disease response in both clinical reporting and trials. However, at this stage, no response criteria take the effect of respiratory motion into account when calculating the standardized uptake value on a PET scan. A number of different approaches have been described in the literature to address the issue of respiratory motion in PET/CT scanning. This review details the clinical significance of lesion movement due to respiration and discusses various imaging techniques that have been investigated to manage the effects of respiratory motion in PET/CT scanning.

Journal ArticleDOI
TL;DR: In planning biopsies, CEUS can identify necrotic and viable areas of tumours and improve the diagnostic accuracy and Contrast-enhanced ultrasonography has a prominent role in lesion characterization with a diagnostic accuracy comparable with computed tomography and magnetic resonance imaging.
Abstract: In patients with known malignant disease, 51% of liver lesions less than 1.5 cm turn out to be benign. Whether the probability of malignancy is high or low, further investigations are often necessary to definitely exclude malignancy. Contrast-enhanced ultrasonography has a prominent role in lesion characterization with a diagnostic accuracy comparable with computed tomography and magnetic resonance imaging. Anti-angiogenic treatment is common in most oncological institutions and the response evaluation is a new challenge with a research focus on the change in tumour vasculature and perfusion. In planning biopsies, CEUS can identify necrotic and viable areas of tumours and improve the diagnostic accuracy.

Journal ArticleDOI
TL;DR: This review describes the methods of staging patients with locally advanced primary and recurrent rectal cancer prior to surgery emphasizing the role that radiologists have in this process.
Abstract: Radical resection is the only potential cure for patients with locally advanced primary and recurrent rectal cancer and is considered curative only when the histologic margins are clear of tumour. Early diagnosis of the disease is essential as it increases the likelihood of a potentially curative resection and prevention of dissemination. Clinical examination, tumour markers and radiologic modalities such as ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography are routinely used in an effort to accurately stage these patients and provide useful information for the selection of patients for further treatment/management. This review describes the methods of staging patients with locally advanced primary and recurrent rectal cancer prior to surgery emphasizing the role that radiologists have in this process.

Journal ArticleDOI
TL;DR: MRE can be sufficient and useful in the diagnosis of CRE and for treatment planning, especially in patients with significant comorbidities who have had radiotherapy in the past, and in post-radiotherapy patients with acute/subacute gastrointestinal symptoms.
Abstract: The diagnosis of chronic radiation enteritis (CRE) is considerably challenging both for clinicians and radiologists. The aim of this study was to evaluate the role of magnetic resonance enterography (MRE) in the diagnosis of CRE. To the best of our knowledge, there are no reports on the role of MRE in the diagnosis of CRE specifically. In this report, we present MRE findings of 4 patients with CRE. The most important factors in CRE diagnosis are the clinical findings and medical history, but focal abnormal bowel loop in the region of a known radiation field is the most important information. This abnormal loop is generally located in the distal ileum as present in our patients. Other associated findings helpful for the diagnosis are small bowel thickening, contrast material enhancement in a long segment, mesenteric stranding and luminal narrowing. MRE can be sufficient and useful in the diagnosis of CRE and for treatment planning, especially in patients with significant comorbidities who have had radiotherapy in the past. Adding MRE into the diagnostic algorithm can be helpful in post-radiotherapy patients with acute/subacute gastrointestinal symptoms.

Journal ArticleDOI
Qian Xu1, Kai Xu, Chun Yang, Xiuli Zhang, Yankai Meng, Qiang Quan 
TL;DR: The imaging features, differential diagnosis, pathology and prognosis of this rare disease, mainly occurring in children and adolescents, are focused on.
Abstract: Askin tumor is an uncommon malignant neoplasm in the thoracopulmonary region mainly occurring in children and adolescents. Four young patients with histologically proven Askin tumors were treated in our hospital. In all patients, chest computed tomography imaging demonstrated a chest wall mass with or without destruction of ribs. All patients underwent radical mass resection and postoperative chemotherapy. By the time this article was completed, two of the patients had died with local chest wall recurrences. Here we focus on the imaging features, differential diagnosis, pathology and prognosis of this rare disease.

Journal ArticleDOI
TL;DR: Key clinical and radiologic features that may aid differentiation of primary from solitary secondary pancreatic malignancies are discussed.
Abstract: This pictorial essay illustrates the imaging appearances of a wide variety of metastases to the pancreas as seen on computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT. Key clinical and radiologic features (lesion distribution, non-contrast imaging appearance, enhancement pattern and pattern of spread) that may aid differentiation of primary from solitary secondary pancreatic malignancies are discussed.

Journal ArticleDOI
TL;DR: This review summarizes the early experiences with focal therapy with emphasis on early applications of laser, high-intensity focuses ultrasound, and photodynamic approaches.
Abstract: Prostate cancer screening has resulted in earlier diagnosis with lower-grade disease, leading to over-detection and over-treatment in a significant number of patients. Current whole-gland radical treatments are associated with significant rates of morbidity. The high prevalence of low-risk disease together with an inability to accurately identify those men harboring more aggressive cancers has led to tremendous research in low-morbidity focal therapies for prostate cancer. This review summarizes the early experiences with focal therapy with emphasis on early applications of laser, high-intensity focuses ultrasound, and photodynamic approaches.

Journal ArticleDOI
TL;DR: Recognition of anatomic variants and benign entities that mimic bladder cancer at computed tomography urography will help improve radiologists’ ability to diagnose bladder cancer.
Abstract: The objective of this review article is to learn how to recognize anatomic variants and benign entities that mimic bladder cancer at computed tomography (CT) urography. Building on recent data that suggest that CT urography can be used to diagnose bladder cancer, recognition of anatomic variants and benign entities will help improve radiologists' ability to diagnose bladder cancer.

Journal ArticleDOI
TL;DR: High grade demonstrated increased heterogeneity as measured from CTTA, which has the potential to quantify tumour heterogeneity more so than size and thereby differentiate between high- and low-grade gliomas.
Abstract: Aim: To preliminary assess whether computed tomography texture analysis (CTTA) has the potential to quantify tumour heterogeneity and thereby differentiate high-grade from low-grade gliomas. Methods: The study comprised 44 patients with brain tumours. Histology identified 33 as high-grade and 11 as low-grade gliomas. Contrast-enhanced CT images were acquired prior to brain biopsy. CTTA was carried out using a proprietary software algorithm (TexRAD) that selectively filters and extracts textures at different anatomical scales between filter values 1.0 (fine detail) and 2.5 (coarse features). Heterogeneity within the CT image (with or without filtration) was quantified using the following statistical parameters: entropy (indicates irregularity), uniformity (distribution of grey levels), total pixels (TP; indicates size), mean grey-level value and proportion of only those pixels with positive values (MPP and PPP), standard-deviation (SD), kurtosis (indicates peakedness) and skewness (indicates asymmetry). Texture parameters from high and low grade were compared with each other. Results: High grade demonstrated increased heterogeneity as measured from CTTA (entropy ↑, uniformity ↓, TP ↑, PPP ↓, SD ↑, skewness↑). Significant differences between tumour heterogeneity for high and low grade was observed for medium to coarse textures, with the highest being coarse textures; quantified as entropy (P = 0.0015), uniformity (P = 0.0026). Coarse texture values for entropy of >5.2(sensitivity 76%, specificity 82%), ≤0.025(sensitivity 64%, specificity 91%) for uniformity, was suggestive of high-grade glioma. TP (sensitivity 70%, specificity 73%) was higher in high grade than low grade, however less significant than texture. Conclusion: CTTA (e.g. TexRAD) has the potential to quantify tumour heterogeneity more so than size and thereby differentiate between high- and low-grade gliomas.

Journal ArticleDOI
TL;DR: A case of omental IMFT is reported in a 15-year-old girl who presented with multiple peritoneal masses on imaging and the diagnosis was confirmed on histopathology.
Abstract: Inflammatory myofibroblastic tumour (IMFT) is a relatively uncommon neoplasm with unpredictable malignant potential known to occur anywhere in the body. IMFT involving the omentum is a very rare entity with less than 15 cases reported so far. We report a case of omental IMFT in a 15-year-old girl who presented with multiple peritoneal masses on imaging and the diagnosis was confirmed on histopathology. In addition to its uncommon location, its presentation as multiple masses is extremely uncommon. This uncommon presentation as multifocal masses needs to be distinguished from other causes of peritoneal carcinomatosis.

Journal ArticleDOI
TL;DR: Systemically review the available literature regarding the diagnostic performance of positron emission tomography (PET) using 2-[18F]fluoro-2-deoxy-d-glucose ([18F)FDG) in patients with thymic epithelial tumors found it to be a useful radiological modality for differentiating between thymomas andThymic carcinoma.
Abstract: The purpose of this study was to systemically review the available literature regarding the diagnostic performance of positron emission tomography (PET) using 2-[18F]fluoro-2-deoxy-d-glucose ([18F]FDG) in patients with thymic epithelial tumors. We reviewed 13 studies that evaluated the diagnostic role of thymic epithelial tumors with [18F]FDG-PET. [18F]FDG-PET is a useful radiological modality for differentiating between thymomas and thymic carcinoma. However, [18F]FDG-PET may not be useful for differentiating low-risk thymoma and high-risk thymoma. One paper reported that [18F]FDG-PET has a predictive significance for treatment and prognosis in thymic epithelial tumors. Two papers reported that the degree of [18F]FDG uptake in thymic epithelial tumors is based on glucose metabolism. [18F]FDG-PET may have a further use for radiological differential diagnosis of thymomas and thymic carcinomas.

Journal ArticleDOI
TL;DR: In this commentary, some guidance and practical advice is provided for further investigation and management of the adnexal incidentaloma.
Abstract: There has been explosive growth in the utilization of cross-sectional imaging studies in the evaluation of patients with known or suspected abdominal and pelvic pathology. These imaging studies have led to a veritable epidemic of incidentally detected adnexal masses in both oncology and non-oncology patient populations that in the past remained undiscovered. In this commentary we provide some guidance and practical advice for further investigation and management of the adnexal incidentaloma.

Journal ArticleDOI
TL;DR: A critical evaluation of Radiofrequency-assisted intact specimen biopsy for percutaneous biopsy or removal of breast tumors shows its potential as a minimally invasive therapeutic procedure for removal of small breast tumors.
Abstract: Radiofrequency-assisted intact specimen biopsy (RFIB) has been introduced for percutaneous biopsy or removal of breast tumors. Using radiofrequency cutting, the system enables the radiologist to obtain an intact sample of the target lesion. According to the IDEAL recommendations, we performed a critical evaluation of our initial experience with RFIB. Between June and November 2010, radiography-guided RFIB was performed in 19 female patients. All patients presented with suspicious microcalcifications (BI-RADS III-V) on mammography. Biopsy specimen integrity, thermal damage and histologic diagnosis were assessed by an expert breast pathologist. Data on technical success, diagnostic and therapeutic accuracy and periprocedural complications were collected and analyzed. The median age of the patients was 59 years. Median lesion diameter on mammography was 8 mm (range 2–76 mm). The procedure was successful in 16/19 (84%) patients and unsuccessful in 3/19 (16%) patients (2 non-representative samples, 1 sample with extensive thermal damage). Histologic analysis of the RFIB specimen revealed 12/19 (63%) benign lesions and 7/19 (37%) malignancies (4 ductal carcinoma in situ (DCIS) lesions and 3 invasive ductal carcinomas). In 1 patient, a DCIS lesion was completely removed with RFIB. Overall, 3 periprocedural complications occurred (1 wound leakage, 1 arterial hemorrhage and 1 infection requiring oral antibiotics). Tissue sampling of suspicious breast lesions can be performed successfully with RFIB. In 1 patient DCIS was radically excised with RFIB, which illustrates its potential as a minimally invasive therapeutic procedure for removal of small breast tumors. This is an interesting focus for further research when larger probe sizes become available.

Journal ArticleDOI
TL;DR: Enough literature now exists such that doing a non-contrast abdominal or chest computed tomography scan for suspected mass lesions in children borders on malpractice, and a prior non-enhanced CT run exposes the child to unnecessary radiation.
Abstract: Enough literature now exists such that doing a non-contrast abdominal or chest computed tomography (CT) scan for suspected mass lesions in children borders on malpractice. Although there is great uncertainty regarding estimated radiation doses and long-term cancer risks in childhood, there is no doubt that an entirely unnecessary CT study does more harm than good. When a chest or abdominal mass is suspected in a child, only a post-intravenous contrast enhanced CT examination is needed, and a prior non-enhanced CT run exposes the child to unnecessary radiation.