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Radiomic Features from Post-Operative 18F-FDG PET/CT and CT Imaging Associated with Locally Recurrent Rectal Cancer: Preliminary Findings. J Clin Med 2023; 12:jcm12052058. [PMID: 36902845 PMCID: PMC10004457 DOI: 10.3390/jcm12052058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Locally Recurrent Rectal Cancer (LRRC) remains a major clinical concern; it rapidly invades pelvic organs and nerve roots, causing severe symptoms. Curative-intent salvage therapy offers the only potential for cure but it has a higher chance of success when LRRC is diagnosed at an early stage. Imaging diagnosis of LRRC is very challenging due to fibrosis and inflammatory pelvic tissue, which can mislead even the most expert reader. This study exploited a radiomic analysis to enrich, through quantitative features, the characterization of tissue properties, thus favoring an accurate detection of LRRC by Computed Tomography (CT) and 18F-FDG-Positron Emission Tomography/CT (PET/CT). Of 563 eligible patients undergoing radical resection (R0) of primary RC, 57 patients with suspected LRRC were included, 33 of which were histologically confirmed. After manually segmenting suspected LRRC in CT and PET/CT, 144 Radiomic Features (RFs) were generated, and RFs were investigated for univariate significant discriminations (Wilcoxon rank-sum test, p < 0.050) of LRRC from NO LRRC. Five RFs in PET/CT (p < 0.017) and two in CT (p < 0.022) enabled, individually, a clear distinction of the groups, and one RF was shared by PET/CT and CT. As well as confirming the potential role of radiomics to advance LRRC diagnosis, the aforementioned shared RF describes LRRC as tissues having high local inhomogeneity due to the evolving tissue's properties.
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Papp ZM, Szakács L, Hajivandi SS, Kalina I, Varga E, Kiss G, Solymos F, Takács I, Dank M, Dudás I, Szanka T, Dózsa CL, Rékassy B, Merkely B, Maurovich-Horvat P. Impact of a Targeted Project for Shortening of Imaging Diagnostic Waiting Time in Patients with Suspected Oncological Diseases in Hungary. Medicina (B Aires) 2023; 59:medicina59010153. [PMID: 36676777 PMCID: PMC9865166 DOI: 10.3390/medicina59010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Background and Objectives: Medical imaging is a key element in the clinical workup of patients with suspected oncological disease. In Hungary, due to the high number of patients, waiting lists for Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were created some years ago. The Municipality of Budapest and Semmelweis University signed a cooperation agreement with an extra budget in 2020 (HBP: Healthy Budapest Program) to reduce the waiting lists for these patients. The aim of our study was to analyze the impact of the first experiences with the HBP. Material and Methods: The study database included all the CT/MRI examinations conducted at Semmelweis University with a referral diagnosis of suspected oncological disease within the first 13 months of the HBP (6804 cases). In our retrospective, two-armed, comparative clinical study, different components of the waiting times in the oncology diagnostics pathway were analyzed. Using propensity score matching, we compared the data of the HBP-funded patients (n = 450) to those of the patients with regular care provided by the National Health Insurance Fund (NHIF) (n = 450). Results: In the HBP-funded vs. the NHIF-funded patients, the time interval from the first suspicion of oncological disease to the request for imaging examinations was on average 15.2 days shorter (16.1 vs. 31.3 days), and the mean waiting time for the CT/MRI examination was reduced by 13.0 days (4.2 vs. 17.2 days, respectively). In addition, the imaging medical records were prepared on average 1.7 days faster for the HBP-funded patients than for the NHIF-funded patients (3.4 vs. 5.1 days, respectively). No further shortening of the different time intervals during the subsequent oncology diagnostic pathway (histological investigation and multidisciplinary team decision) or in the starting of specific oncological therapy (surgery, irradiation, and chemotherapy) was observed in the HBP-funded vs. the NHIF-funded patients. We identified a moderately strong negative correlation (r = -0.5736, p = 0.0350) between the CT/MR scans requested and the active COVID-19 case rates during the pandemic waves. Conclusion: The waiting lists for diagnostic CT/MR imaging can be effectively shortened with a targeted project, but a more comprehensive intervention is needed to shorten the time from the radiological diagnosis, through the decisions of the oncoteam, to the start of the oncological treatment.
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Affiliation(s)
- Zsombor Mátyás Papp
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, 1125 Budapest, Hungary
| | - László Szakács
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Shayan-Salehi Hajivandi
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Ildikó Kalina
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Edit Varga
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Gergely Kiss
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Ferenc Solymos
- Directorate for Core IT Infrastructure and Critical Applications, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Magdolna Dank
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Ibolyka Dudás
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Tímea Szanka
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
| | - Csaba László Dózsa
- Municipality of Budapest, Városház utca 9-11, 1052 Budapest, Hungary
- Health Sciences Faculty, University of Miskolc, 3515 Miskolc-Egyetemváros, Hungary
| | - Balázs Rékassy
- Municipality of Budapest, Városház utca 9-11, 1052 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor u. 2, 1083 Budapest, Hungary
- Correspondence: ; Tel.: +36-20-6632485
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Mercaldo F, Belfiore MP, Reginelli A, Brunese L, Santone A. Coronavirus covid-19 detection by means of explainable deep learning. Sci Rep 2023; 13:462. [PMID: 36627339 PMCID: PMC9830129 DOI: 10.1038/s41598-023-27697-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
The coronavirus is caused by the infection of the SARS-CoV-2 virus: it represents a complex and new condition, considering that until the end of December 2019 this virus was totally unknown to the international scientific community. The clinical management of patients with the coronavirus disease has undergone an evolution over the months, thanks to the increasing knowledge of the virus, symptoms and efficacy of the various therapies. Currently, however, there is no specific therapy for SARS-CoV-2 virus, know also as Coronavirus disease 19, and treatment is based on the symptoms of the patient taking into account the overall clinical picture. Furthermore, the test to identify whether a patient is affected by the virus is generally performed on sputum and the result is generally available within a few hours or days. Researches previously found that the biomedical imaging analysis is able to show signs of pneumonia. For this reason in this paper, with the aim of providing a fully automatic and faster diagnosis, we design and implement a method adopting deep learning for the novel coronavirus disease detection, starting from computed tomography medical images. The proposed approach is aimed to detect whether a computed tomography medical images is related to an healthy patient, to a patient with a pulmonary disease or to a patient affected with Coronavirus disease 19. In case the patient is marked by the proposed method as affected by the Coronavirus disease 19, the areas symptomatic of the Coronavirus disease 19 infection are automatically highlighted in the computed tomography medical images. We perform an experimental analysis to empirically demonstrate the effectiveness of the proposed approach, by considering medical images belonging from different institutions, with an average time for Coronavirus disease 19 detection of approximately 8.9 s and an accuracy equal to 0.95.
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Affiliation(s)
- Francesco Mercaldo
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Antonella Santone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
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Ma Y, Mao J, Qin H, Liang P, Huang W, Liu C, Gao J. Nano-Metal-Organic Framework Decorated With Pt Nanoparticles as an Efficient Theranostic Nanoprobe for CT/MRI/PAI Imaging-Guided Radio-Photothermal Synergistic Cancer Therapy. Front Bioeng Biotechnol 2022; 10:927461. [PMID: 35875484 PMCID: PMC9298652 DOI: 10.3389/fbioe.2022.927461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
The multifunctional theranostic nanoplatforms, which can realize changing the contrasts of medical images and enhance cancer therapies simultaneously, have attracted tremendous attention from chemists and medicine in past decades. Herein, a nanoscale metal–organic framework-based material was first synthesized and then decorated with platinum (NMOF545@Pt) successfully for multimodal imaging-guided synergistic cancer therapy. The obtained NMOF545@Pt is advantageous in shortening the longitudinal relaxation time (T1), enhancing photoacoustic effects, and elevating X-ray absorption efficiently. Thus, the enchantments of tripe imaging modalities, computed tomography (CT)/magnetic resonance imaging (MRI)/photoacoustic imaging (PAI), were realized with NMOF545@Pt administration simultaneously and can be cleared from the mice. Meanwhile, in vitro and in vivo experiments demonstrate that the synthesized NMOF545@Pt can dramatically increase photothermal therapy (PTT) and radiotherapy (RT) efficacy. Convincing evidence proves that tumor growth can be wholly inhibited without noticeable side effects or organ damage. The results demonstrated the promise of multifunctional nanocomposites NMOF545@Pt to improve biomedical imaging and synergistic tumor treatments.
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Affiliation(s)
- Yingjian Ma
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jing Mao
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou, China
| | - Haojie Qin
- Forensic Medicine School of Henan University of Science and Technology, Luoyang, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenpeng Huang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenchen Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ng KS, Lee PJ. Pelvic exenteration: Pre-, intra-, and post-operative considerations. Surg Oncol 2022. [DOI: 10.1016/j.suronc.2022.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Diagnostic performance of 18F-fluorodeoxyglucose-PET/MRI versus MRI alone in the diagnosis of pelvic recurrence of rectal cancer. Abdom Radiol (NY) 2021; 46:5086-5094. [PMID: 34402948 PMCID: PMC8502129 DOI: 10.1007/s00261-021-03224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023]
Abstract
Purpose To compare the diagnostic performance of 18F-fluorodeoxyglucose-PET/MRI and MRI in the diagnosis of pelvic recurrence of rectal cancer. Methods All PET/MRIs of patients in the follow-up of rectal cancer performed between 2011 and 2018 at our institution were retrospectively reviewed. Recurrence was confirmed/excluded either by histopathology or imaging follow-up (> 4 months). Four groups of readers (groups 1/2: one radiologist each, groups 3/4: one radiologist/one nuclear medicine physician) independently interpreted MRI and PET/MRI. The likelihood of recurrence was scored on a 5-point-scale. Inter-reader agreement, sensitivity, specificity, PPV/NPV and accuracy were assessed. ROC curve analyses were performed. Results Fourty-one PET/MRIs of 40 patients (mean 61 years ± 10.9; 11 women, 29 men) were included. Sensitivity of PET/MRI in detecting recurrence was 94%, specificity 88%, PPV/NPV 97% and 78%, accuracy 93%. Sensitivity of MRI was 88%, specificity 75%, PPV/NPV 94% and 60%, accuracy 85%. ROC curve analyses showed an AUC of 0.97 for PET/MRI and 0.92 for MRI, but the difference was not statistically significant (p = 0.116). On MRI more cases were scored as equivocal (12% versus 5%). Inter-reader agreement was substantial for PET/MRI and MRI (0.723 and 0.656, respectively). Conclusion 18F-FDG-PET/MRI and MRI are accurate in the diagnosis of locally recurrent rectal cancer. Sensitivity, specificity, PPV, NPV and accuracy are comparable for both modalities, but PET/MRI increases readers’ confidence levels and reduces the number of equivocal cases. Graphic abstract ![]()
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Furuke H, Arita T, Kuriu Y, Shimizu H, Kiuchi J, Yamamoto Y, Konishi H, Morimura R, Shiozaki A, Ikoma H, Kubota T, Nakanishi M, Fujiwara H, Okamoto K, Otsuji E. The survival after recurrence of colorectal cancer: a retrospective study focused on time to recurrence after curative resection. Surg Today 2021; 52:239-250. [PMID: 34269851 DOI: 10.1007/s00595-021-02336-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The significance of the duration of the recurrence-free survival after curative resection for colorectal cancer remains unclear. The purpose was to reveal the association between time to recurrence after surgery and the survival after recurrence. METHODS Patients with stage II and III colorectal cancer who underwent curative resection between 2007 and 2015 were retrospectively reviewed (n = 645). Patients with recurrence after surgery (n = 133) were divided into 2 groups: early recurrence (within 13 months after surgery, n = 63) and late recurrence (more than 13 months after surgery, n = 70). The overall survival after recurrence and clinicopathological features were compared between early recurrence, late recurrence, and without recurrence groups. RESULTS The overall survival after recurrence was significantly shorter in patients with early recurrence occurring at less than 13 months (hazard ratio: 1.70, p = 0.03). A high preoperative CA19-9 level (odds ratio [OR]: 2.38, p = 0.03), venous invasion (OR: 2.26, p = 0.03), and the absence of adjuvant chemotherapy (OR: 2.08, p = 0.04) were independently correlated with early recurrence. CONCLUSION Early recurrence was associated with a poor prognosis after recurrence. Venous invasion correlated with early recurrence. Adjuvant chemotherapy may reduce the risk of early recurrence. These results indicate the importance of prudent surveillance and the aggressive application of adjuvant chemotherapy.
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Affiliation(s)
- Hirotaka Furuke
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Jun Kiuchi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Yusuke Yamamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Masayoshi Nakanishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan
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Nishimuta M, Hamada K, Sumida Y, Araki M, Wakata K, Kugiyama T, Shibuya A, Hashimoto S, Ozeki K, Morino S, Kiya S, Baba M, Nakamura A. Long-Term Prognosis after Surgery for Locally Recurrent Rectal Cancer: A Retrospective Study. Asian Pac J Cancer Prev 2021; 22:1531-1535. [PMID: 34048182 PMCID: PMC8408410 DOI: 10.31557/apjcp.2021.22.5.1531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: Resection is usually recommended for locally recurrent rectal cancer (LRRC) for which R0 resection is possible, but its suitability varies by individual patient risk. Here, we report outcomes of resected LRRC in our hospital. Methods: We retrospectively evaluated short- and long-term results of 33 patients who underwent resections for LRRC from January 2003 to December 2019. Results: At the initial surgeries for these 33 patients, their disease stages at that time were Stage I: n=2, Stage II: n=12, Stage III: n=11, Stage IV: n=6, and unknown: n=2. Patients with Stage IV disease at their initial surgeries underwent radical one-step or two-step procedures. Metastasis to other organs was observed in 5 patients at the their initial LRRC diagnoses. At the LRRC surgeries, 7 patients received palliative surgeries; 26 received intent-to-treat resections, of which 17 were R0 resections. All-grade postoperative complications were observed in 11 patients, including 1 surgery-related death. Five-year overall survival rates were all cases: 38.4%; R0 group: 52.3%, R1 or R2 group: 19.4%, and palliative surgery group: 0%. The R0 group thus had significantly better prognosis than other patients (P = 0.0012). Eleven patients in the R0 group (64.7%) suffered re-recurrences but some patients achieved long-term survival through chemotherapy, radiation therapy, and surgery for metastasis to other organs, even after re-recurrence. Conclusion: Long-term prognosis after surgery for LRRC was significantly better for patients with R0 margins. Multimodal treatments may greatly improve survival for patients who suffer re-recurrences after local recurrence resections.
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Affiliation(s)
- Masato Nishimuta
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Kiyoaki Hamada
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Kouki Wakata
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Tota Kugiyama
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Ayako Shibuya
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Shintaro Hashimoto
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Keisuke Ozeki
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Shigeyuki Morino
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Soichiro Kiya
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Masayuki Baba
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
| | - Akihro Nakamura
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, Japan
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Ng KS, Lee PJM. Pelvic exenteration: Pre-, intra-, and post-operative considerations. Surg Oncol 2021; 37:101546. [PMID: 33799076 DOI: 10.1016/j.suronc.2021.101546] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/02/2021] [Indexed: 01/18/2023]
Abstract
This review outlines the role of pelvic exenteration (PE) in the management of certain locally-advanced primary and recurrent rectal cancers. PE has undergone significant evolution over the past decades. Advances in pre-, intra-, and post-operative care have been directed towards achieving the 'holy grail' of an R0 resection, which remains the most important predictor of survival, quality of life, morbidity, and cost effectiveness following PE. Patient selection for surgery is largely determined by assessment of resectability. Pelvic magnetic resonance imaging determines the extent of local disease, while positron emission tomography remains the most accurate tool for exclusion of distant metastases. PE in the setting of metastatic disease or with palliative intent remains controversial. The intra-operative approach is based on the anatomical division of the pelvis into five compartments (anterior, central, posterior, and two lateral). Within each compartment are various possible dissection planes which are elected depending on the extent of tumour involvement. Innovations in surgical technique have allowed 'higher and wider' dissection planes with resultant en bloc excision of major vessels, major nerves, and bone. Evidence of improved R0 resection and survival rates with these techniques justifies the radicality of these novel approaches. Post-operative care for PE patients is technically demanding with a substantial hospital resource burden. Unique considerations for PE patients include the 'empty pelvis syndrome', urological complications, and management of post-operative malnutrition. While undeniably a morbid procedure, quality of life largely returns to baseline at six months, and for long-term survivors is sustained for up to five years.
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Affiliation(s)
- Kheng-Seong Ng
- Royal Prince Alfred Hospital, Department of Colorectal Surgery, Sydney, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter J M Lee
- Royal Prince Alfred Hospital, Department of Colorectal Surgery, Sydney, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, Australia.
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Ragheb SR, Sharara SM. Can PET/CT detect recurrence in post-operative colorectal carcinoma patients with elevated CEA level? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00170-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
PET is considered to be the most sensitive and specific modality for the detection of recurrent colorectal cancer. This study is to assess the role of F18-FDG PET/CT in post-operative assessment in a patient with colorectal cancer with elevated CEA level to rule out local recurrence and/or metastasis and hence guiding the clinician to the proper management strategy.
Results
This study was performed on 45 patients who underwent surgical resection of the colon and/or rectal cancer; they were referred for PET/CT assessment at least 3 months after surgical resection. F18-FDG PET/CT sensitivity and specificity in detecting the recurrence and/or metastasis were 96.9 % and 83.3%, respectively. The positive predictive value was 94.2% while the negative predictive value was 90%.
Conclusion
For post-operative detection of loco-regional recurrence and metastasis in patients with colorectal cancer and elevated CEA level, 18F-FDG PET/CT can be considered as an efficient diagnostic imaging tool due to its high sensitivity and specificity which extensively affect further management.
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Liang W, Shao J, Liu W, Ruan S, Tian W, Zhang X, Wan D, Huang Q, Ding Y, Xiao W. Differentiating Hepatic Epithelioid Angiomyolipoma From Hepatocellular Carcinoma and Focal Nodular Hyperplasia via Radiomics Models. Front Oncol 2020; 10:564307. [PMID: 33123475 PMCID: PMC7573543 DOI: 10.3389/fonc.2020.564307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Background: We conduct a study in developing and validating two radiomics-based models to preoperatively distinguish hepatic epithelioid angiomyolipoma (HEAML) from hepatic carcinoma (HCC) as well as focal nodular hyperplasia (FNH). Methods: Totally, preoperative contrast-enhanced computed tomography (CT) data of 170 patients and preoperative contrast-enhanced magnetic resonance imaging (MRI) data of 137 patients were enrolled in this study. Quantitative texture features and wavelet features were extracted from the regions of interest (ROIs) of each patient imaging data. Then two radiomics signatures were constructed based on CT and MRI radiomics features, respectively, using the random forest (RF) algorithm. By integrating radiomics signatures with clinical characteristics, two radiomics-based fusion models were established through multivariate linear regression and 10-fold cross-validation. Finally, two diagnostic nomograms were built to facilitate the clinical application of the fusion models. Results: The radiomics signatures based on the RF algorithm achieved the optimal predictive performance in both CT and MRI data. The area under the receiver operating characteristic curves (AUCs) reached 0.996, 0.879, 0.999, and 0.925 for the training as well as test cohort from CT and MRI data, respectively. Then, two fusion models simultaneously integrated clinical characteristics achieved average AUCs of 0.966 (CT data) and 0.971 (MRI data) with 10-fold cross-validation. Through decision curve analysis, the fusion models were proved to be excellent models to distinguish HEAML from HCC and FNH in comparison between the clinical models and radiomics signatures. Conclusions: Two radiomics-based models derived from CT and MRI images, respectively, performed well in distinguishing HEAML from HCC and FNH and might be potential diagnostic tools to formulate individualized treatment strategies.
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Affiliation(s)
- Wenjie Liang
- Department of Radiology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jiayuan Shao
- Polytechnic Institute, Zhejiang University, Hangzhou, China
| | - Weihai Liu
- Department of Radiology, The People's Hospital of Beilun District, Ningbo, China
| | - Shijian Ruan
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Wuwei Tian
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Xiuming Zhang
- Department of Pathology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dalong Wan
- Department of Hepatobiliary and Pancreatic Surgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qiang Huang
- Department of Radiology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yong Ding
- Polytechnic Institute, Zhejiang University, Hangzhou, China.,College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Wenbo Xiao
- Department of Radiology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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12
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The added value of pelvic surveillance by MRI during postoperative follow-up of rectal cancer, with a focus on abbreviated MRI. Eur Radiol 2020; 30:3113-3124. [PMID: 32072254 DOI: 10.1007/s00330-020-06711-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the added value of MRI over CT for the detection of pelvic recurrence during postoperative surveillance after rectal cancer surgery and to compare the diagnostic accuracy for pelvic recurrence achieved with abbreviated MRI (aMRI) with that of conventional enhanced MRI (cMRI). METHODS Patients who underwent rectal cancer surgery followed by MRI in addition to the standard CT follow-up protocol were evaluated retrospectively. Two readers independently scored images from CT, cMRI, and aMRI, which consisted of T2-weighted and diffusion-weighted imaging, to rate the likelihood of recurrence. Diagnostic accuracy and ROC curves were calculated. The patients were divided into two groups for risk-adapted surveillance according to risk of recurrence: high-risk (n = 157) and low-risk (n = 169) groups. RESULTS In total, 579 MRIs from 326 patients were assessed. A total of 48 pelvic recurrences occurred in 33 patients. The AUC in cMRI, aMRI, and CT were 0.98, 0.99, and 0.84, respectively. The difference in performance between CT and cMRI or aMRI for identifying recurrence was statistically significant (p < 0.001). Both cMRI and aMRI showed superior performance compared with CT in the high-risk group (p < 0.001), but this was not the case in the low-risk group (p = 0.13). Furthermore, the diagnostic accuracy of aMRI was similar to that of cMRI. CONCLUSIONS The addition of MRI to the postoperative surveillance protocol may result in an improvement in the detection of pelvic recurrence after rectal cancer surgery. For patients at high risk of recurrence, an aMRI surveillance may be justified to improve the diagnostic yield. KEY POINTS • The addition of MRI to the postoperative surveillance protocol improved the diagnostic yield in patients at a high risk of recurrence. • Abbreviated non-enhanced MRI with DWI allows detection of pelvic recurrence with a diagnostic accuracy that is similar to that of contrast-enhanced MRI (AUC, 0.99 and 0.98, respectively; p = 0.12). • Abbreviated MRI that is restricted to high spatial resolution structural imaging and diffusion-weighted imaging takes less time and can be carried out without the need for injection of a contrast agent.
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13
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Ganeshan D, Nougaret S, Korngold E, Rauch GM, Moreno CC. Locally recurrent rectal cancer: what the radiologist should know. Abdom Radiol (NY) 2019; 44:3709-3725. [PMID: 30953096 DOI: 10.1007/s00261-019-02003-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite advances in surgical techniques and chemoradiation therapy, recurrent rectal cancer remains a cause of morbidity and mortality. After successful treatment of rectal cancer, patients are typically enrolled in a surveillance strategy that includes imaging as studies have shown improved prognosis when recurrent rectal cancer is detected during imaging surveillance versus based on development of symptoms. Additionally, patients who experience a complete clinical response with chemoradiation therapy may elect to enroll in a "watch-and-wait" strategy that includes imaging surveillance rather than surgical resection. Factors that increase the likelihood of recurrence, patterns of recurrence, and the imaging appearances of recurrent rectal cancer are reviewed with a focus on CT, PET CT, and MR imaging.
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Affiliation(s)
- Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Stephanie Nougaret
- Montpellier Cancer Research Institute, IRCM, Montpellier Cancer Research Institute, 208 Ave des Apothicaires, 34295, Montpellier, France
- Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Elena Korngold
- Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Gaiane M Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA.
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14
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Abstract
OBJECTIVE The purpose of this article is to review the most commonly used tumor markers in abdominal and pelvic tumors, describe their limitations and explain how to use them in the context of known cancer in order to optimize multidisciplinary care of oncologic patients. CONCLUSION Tumor markers are important for the diagnosis, staging, monitoring of treatment and detection of recurrence in many cancers. This knowledge is crucial in the daily interpretation of images of oncologic and non-oncologic patients. However, radiologists should also be aware of the limitations of the most commonly used tumor markers and they should not be used solely, but interpreted in conjunction with diagnostic imaging, clinical history and physical examination that will help optimize the multidisciplinary care and management of oncologic patients.
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15
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Bastiaenen VP, Hovdenak Jakobsen I, Labianca R, Martling A, Morton DG, Primrose JN, Tanis PJ, Laurberg S. Consensus and controversies regarding follow-up after treatment with curative intent of nonmetastatic colorectal cancer: a synopsis of guidelines used in countries represented in the European Society of Coloproctology. Colorectal Dis 2019; 21:392-416. [PMID: 30506553 DOI: 10.1111/codi.14503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/07/2018] [Indexed: 02/08/2023]
Abstract
AIM It is common clinical practice to follow patients for a period of years after treatment with curative intent of nonmetastatic colorectal cancer, but follow-up strategies vary widely. The aim of this systematic review was to provide an overview of recommendations on this topic in guidelines from member countries of the European Society of Coloproctology, with supporting evidence. METHOD A systematic search of Medline, Embase and the guideline databases Trip database, BMJ Best Practice and Guidelines International Network was performed. Quality assessment included use of the AGREE-II tool. All topics with recommendations from included guidelines were identified and categorized. For each subtopic, a conclusion was made followed by the degree of consensus and the highest level of evidence. RESULTS Twenty-one guidelines were included. The majority recommended that structured follow-up should be offered, except for patients in whom treatment of recurrence would be inappropriate. It was generally agreed that clinical visits, measurement of carcinoembryoinc antigen and liver imaging should be part of follow-up, based on a high level of evidence, although the frequency is controversial. There was also consensus on imaging of the chest and pelvis in rectal cancer, as well as endoscopy, based on lower levels of evidence and with a level of intensity that was contradictory. CONCLUSION In available guidelines, multimodal follow-up after treatment with curative intent of colorectal cancer is widely recommended, but the exact content and intensity are highly controversial. International agreement on the optimal follow-up schedule is unlikely to be achieved on current evidence, and further research should refocus on individualized 'patient-driven' follow-up and new biomarkers.
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Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - D G Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - J N Primrose
- University Surgery, University of Southampton, Southampton, UK
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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16
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Beware of False-Positive FDG PET/CT Interpretations for Presacral Recurrent Rectal Cancer. Clin Nucl Med 2019; 44:e342-e344. [PMID: 30888991 DOI: 10.1097/rlu.0000000000002545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
FDG PET/CT is considered an accurate method for the detection of recurrent rectal cancer in the pelvis. Excess presacral soft tissue is found in up to half of patients after (chemo)radiation and surgery for rectal cancer, and usually represents fibrosis that is metabolically inactive. However, presacral soft tissue that is FDG avid is generally considered suspicious for recurrent cancer. Nevertheless, FDG avidity in the presacral space not uncommonly proves to be due to benign inflammatory changes, and additional MRI may be diagnostically useful, as demonstrated in the presented 2 cases.
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17
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Pennings JP, de Haas RJ, Murshid KJA, de Jong KP, Dierckx RAJO, Kwee TC. FDG-avid presacral soft tissue mass in previously treated rectal cancer: Diagnostic outcome and additional value of MRI, including diffusion-weighted imaging. Eur J Surg Oncol 2018; 45:606-612. [PMID: 30594404 DOI: 10.1016/j.ejso.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/04/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study aimed to determine the positive predictive value (PPV) of positron emission tomography/computed tomography (PET/CT) with an 18F-fluoro-2-deoxy-D-glucose (FDG)-avid presacral lesion for locally recurrent rectal cancer, and the additional value of magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI). MATERIALS AND METHODS This retrospective study included 38 patients who completed primary rectal cancer treatment and who presented with a suspicious FDG-avid presacral lesion on PET/CT. Twenty-seven patients also underwent MRI, of whom 24 with DWI. PPV of FDG-PET/CT and additional value of MRI, including DWI, for the diagnosis of recurrent presacral cancer were determined. RESULTS The PPV of PET/CT with an FDG-avid presacral lesion for the diagnosis of locally recurrent rectal cancer was 58% (22/38). Air in the FDG-avid presacral lesion, as visible on the CT component of the PET/CT examination, favoured the diagnosis of benign presacral tissue with a sensitivity of 56.3% (9/16) and a specificity 81.8% (18/22). Areas under the receiver operating characteristic curve (AUCs) of MRI without DWI for the diagnosis of locally recurrent rectal cancer in FDG-avid presacral tissue were 0.765 and 0.840, for observers 1 and 2. AUCs of MRI with DWI were 0.803 and 0.811, for observers 1 and 2. There were no significant differences among any of these AUCs (P = 0.169 to 0.906). CONCLUSIONS FDG-PET/CT has a poor PPV for locally recurrent rectal cancer in the presacral space. The observation of air in the FDG-avid presacral lesion and additional MRI assessment are diagnostically helpful, without a significant additional value of DWI.
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Affiliation(s)
- Jan P Pennings
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robbert J de Haas
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kawthar J A Murshid
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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18
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Shao H, Ma X, Gao Y, Wang J, Wu J, Wang B, Li J, Tian J. Comparison of the diagnostic efficiency for local recurrence of rectal cancer using CT, MRI, PET and PET-CT: A systematic review protocol. Medicine (Baltimore) 2018; 97:e12900. [PMID: 30508883 PMCID: PMC6283203 DOI: 10.1097/md.0000000000012900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The risk of local recurrence (LR) continues to threat patients with rectal cancer after surgery or chemoradiotherapy. The main reason is that there is frequently extensive scarring and reactive changes after radiotherapy and resection. Thus, the diagnosis of LR can be challenging. There are different imaging modalities that have been used in the follow-up of rectal cancer, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and positron emission tomography-computed tomography (PET-CT) in clinical practice. METHODS We will systematically search PubMed, EMBASE, the Cochrane Library, and Chinese Biomedical Literature Database for diagnostic trials using CT, MRI, PET, and PET-CT to detect LR of rectal cancer in April, 2018. Two review authors will independently screen titles and abstracts for relevance, assess full texts for inclusion, and carry out data extraction and methodological quality assessment using the QUADAS-2 tool. We will use bivariate meta-analysis to estimate summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CT, MRI, PET, and PET-CT, as well as different sequences of MRI. For each index test, estimates of sensitivity and specificity from each study will be plotted in summary receive operating curve space and forest plots will be constructed for visual examination of variation in test accuracy. We will perform meta-analyses using the hierarchical summary receiver-operating characteristic model to produce summary estimates of sensitivity and specificity. Then, head-to-head and indirect comparison meta-analyses will be carried out. DISCUSSION This review will help determine the diagnostic accuracy of CT, MRI, PET, and PET-CT for the diagnosis of patients with LR of rectal cancer. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required, as this study is a systematic review. PROSPERO REGISTRATION NUMBER CRD42018104918.
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Affiliation(s)
- Hongsheng Shao
- Radiology Department, Rehabilitation Center Hospital of Gansu Province
| | - Xueni Ma
- The Second Clinical Medical College of Lanzhou University
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | | | - Jiarui Wu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing
| | - Bo Wang
- Department of Nursing, Rehabilitation Center Hospital of Gansu Province, Lanzhou, China
| | - Jipin Li
- The Second Clinical Medical College of Lanzhou University
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
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19
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Soundararajan A, Muralidhar R J, Dhandapani R, Radhakrishnan J, Manigandan A, Kalyanasundaram S, Sethuraman S, Subramanian A. Surface topography of polylactic acid nanofibrous mats: influence on blood compatibility. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:145. [PMID: 30159635 DOI: 10.1007/s10856-018-6153-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/18/2018] [Indexed: 05/05/2023]
Abstract
Fabricating nanofibrous scaffolds with robust blood compatibility remains an unmet challenge for cardiovascular applications since anti-thrombogenic surface coatings did not withstand physiological shear force. Hence, the present study envisages the influence of smooth and porous topographies of poly(lactic acid) (PLA) nanofibers on hemocompatibility as it could offer time-independent blood compatibility. Further, recent studies have evolved to integrate various contrasting agents for augmenting the prognostic properties of tissue engineered scaffolds; an attempt was also made to synthesize Curcumin-superparamagnetic iron oxide nanoparticle complex (Cur-SPION) as a contrasting agent and impregnated into PLA nanofibers for evaluating the blood compatibility. Herein, electrospun nanofibers of PLA with different topographies (smooth and porous) were fabricated and characterized for surface morphology, zeta potential, fluorescence, and crystallinity. The scaffolds with smooth, porous and rough surface topographies were thoroughly investigated for its hemocompatibility by evaluating hemolysis percentage, platelet adhesion, in vitro kinetic clotting time, serum protein adsorption, plasma recalcification time (PRT), capture and release of erythrocytes. Although the nanofibers of all three groups showed acceptable hemolytic percentage (HP < 5%), the adhered RBCs on Cur-SPION based fibers undergo morphological transformation from biconcave discocytes to echinocytes with cube-like protrusions. On the contrary, no morphological changes were observed in RBCs cultured on smooth and porous nanofibers. Porous fibers exhibited excellent anti-thrombogenic property and adhered lesser platelets and maintained the discoidal morphology of native platelets. Cur-SPION integrated PLA nanofibers showed inactivated platelets with anti-thrombogenic activity compared to smooth nanofibers. In conclusion, PLA nanofibers porous topography did not affect the RBC membrane integrity and maintained discoidal morphology of platelets with superior anti-thrombogenic activity. However, smooth and Cur-SPION integrated PLA nanofibers were found to activate the platelets and deform the RBC membrane integrity, respectively. Hence, the nanofibers with porous structures provide an ideal topography for time-independent hemocompatibility.
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Affiliation(s)
- Abiramy Soundararajan
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Jyorthana Muralidhar R
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Ramya Dhandapani
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Janani Radhakrishnan
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Amrutha Manigandan
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Sivashankari Kalyanasundaram
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Swaminathan Sethuraman
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India
| | - Anuradha Subramanian
- Centre for Nanotechnology & Advanced Biomaterials, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, 613 401, India.
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20
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Plodeck V, Rahbari NN, Weitz J, Radosa CG, Laniado M, Hoffmann RT, Zöphel K, Beuthien-Baumann B, Kotzerke J, van den Hoff J, Platzek I. FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences. Eur Radiol 2018; 29:422-428. [PMID: 29980927 DOI: 10.1007/s00330-018-5589-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/06/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the value of 18F-FDG-PET/MRI in the diagnosis and management of patients with pelvic recurrence of rectal cancer. METHODS Forty-four patients (16 women, 28 men) with a history of rectal cancer who received FDG-PET/MRI between June 2011 and February 2017 at our institution were retrospectively enrolled. Three patients received two FDG-PET/MRIs; thus a total of 47 examinations were included. Pelvic recurrence was confirmed either with histology (n = 27) or imaging follow-up (n = 17) (> 4 months). Two readers (one radiologist, one nuclear medicine physician) interpreted the images in consensus. Pelvic lesions were assessed regarding FDG uptake and morphology. Sensitivity, specificity, positive and negative predictive values as well as accuracy of PET/MRI in detecting recurrence were determined. RESULTS In 47 FDG-PET/MRIs 30 suspicious pelvic lesions were identified, 29 of which were malignant. Two patients underwent resection and had histologically proven pelvic recurrence without showing suspicious findings on FDG-PET/MRI. Changes in management due to FDG-PET/MRI findings had been implemented in eight patients. Eighty per cent (16/20) of resected patients had histologically negative resection margins (R0), one patient had uncertain resection margins. Sensitivity of FDG-PET/MRI in detecting recurrence was 94%, specificity 94%, positive/negative predictive value and accuracy were 97%, 90% and 94%, respectively. CONCLUSIONS FDG-PET/MRI is a valuable tool in the diagnosis and staging of pelvic recurrence in patients with rectal cancer. KEY POINTS • Metabolic information obtained from PET coupled with excellent soft tissue contrast from MRI could facilitate detection of rectal cancer recurrence and assist in treatment planning. • PET/MRI demonstrates high sensitivity and specificity for the diagnosis of local recurrence of rectal cancer • PET/MRI led to alterations in management in 18.2% of patients.
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Affiliation(s)
- Verena Plodeck
- Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Nuh N Rahbari
- Klinik und Poliklinik fuer Viszeral-, Thorax- und Gefäßchirurgie, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Juergen Weitz
- Klinik und Poliklinik fuer Viszeral-, Thorax- und Gefäßchirurgie, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Christoph G Radosa
- Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Michael Laniado
- Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Klaus Zöphel
- Klinik und Poliklinik für Nuklearmedizin, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Bettina Beuthien-Baumann
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Joerg Kotzerke
- Klinik und Poliklinik für Nuklearmedizin, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Joerg van den Hoff
- Institut für Radiopharmazeutische Krebsforschung, Helmholtz-Zentrum Dresden Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Ivan Platzek
- Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
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Pellino G, Gallo G, Pallante P, Capasso R, De Stefano A, Maretto I, Malapelle U, Qiu S, Nikolaou S, Barina A, Clerico G, Reginelli A, Giuliani A, Sciaudone G, Kontovounisios C, Brunese L, Trompetto M, Selvaggi F. Noninvasive Biomarkers of Colorectal Cancer: Role in Diagnosis and Personalised Treatment Perspectives. Gastroenterol Res Pract 2018; 2018:2397863. [PMID: 30008744 PMCID: PMC6020538 DOI: 10.1155/2018/2397863] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 02/08/2023] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide. It has been estimated that more than one-third of patients are diagnosed when CRC has already spread to the lymph nodes. One out of five patients is diagnosed with metastatic CRC. The stage of diagnosis influences treatment outcome and survival. Notwithstanding the recent advances in multidisciplinary management and treatment of CRC, patients are still reluctant to undergo screening tests because of the associated invasiveness and discomfort (e.g., colonoscopy with biopsies). Moreover, the serological markers currently used for diagnosis are not reliable and, even if they were useful to detect disease recurrence after treatment, they are not always detected in patients with CRC (e.g., CEA). Recently, translational research in CRC has produced a wide spectrum of potential biomarkers that could be useful for diagnosis, treatment, and follow-up of these patients. The aim of this review is to provide an overview of the newer noninvasive or minimally invasive biomarkers of CRC. Here, we discuss imaging and biomolecular diagnostics ranging from their potential usefulness to obtain early and less-invasive diagnosis to their potential implementation in the development of a bespoke treatment of CRC.
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Affiliation(s)
- Gianluca Pellino
- Unit of General Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
- Colorectal Surgery Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, OU of General Surgery, University of Catanzaro, Catanzaro, Italy
- Department of Colorectal Surgery, Clinic S. Rita, Vercelli, Italy
| | - Pierlorenzo Pallante
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Via S. Pansini 5, Naples, Italy
| | - Raffaella Capasso
- Department of Medicine and Health Sciences, University of Molise, Via Francesco de Sanctis 1, 86100 Campobasso, Italy
| | - Alfonso De Stefano
- Department of Abdominal Oncology, Division of Abdominal Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, “Fondazione G. Pascale, ” IRCCS, Naples, Italy
| | - Isacco Maretto
- 1st Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Umberto Malapelle
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Shengyang Qiu
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Stella Nikolaou
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Andrea Barina
- 1st Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Giuseppe Clerico
- Department of Colorectal Surgery, Clinic S. Rita, Vercelli, Italy
| | - Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Antonio Giuliani
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Guido Sciaudone
- Unit of General Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, Via Francesco de Sanctis 1, 86100 Campobasso, Italy
| | - Mario Trompetto
- Department of Colorectal Surgery, Clinic S. Rita, Vercelli, Italy
| | - Francesco Selvaggi
- Unit of General Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
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Kang YH, Han E, Park G. Clinical Etiology of Hypermetabolic Pelvic Lesions in Postoperative Positron Emission Tomography/Computed Tomography for Patients With Rectal and Sigmoid Cancer. Ann Coloproctol 2018; 34:78-82. [PMID: 29742861 PMCID: PMC5951092 DOI: 10.3393/ac.2017.09.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/21/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to present various clinical etiologies of hypermetabolic pelvic lesions on postoperative positron emission tomography/computed tomography (PET/CT) images for patients with rectal and sigmoid cancer. Methods Postoperative PET/CT images for patients with rectal and sigmoid cancer were retrospectively reviewed to identify hypermetabolic pelvic lesions. Positive findings were detected in 70 PET/CT images from 45 patients; 2 patients who were lost to follow-up were excluded. All PET findings were analyzed in comparison with contrast-enhanced CT. Results A total of 43 patients were classified into 2 groups: patients with a malignancy including local recurrence (n = 30) and patients with other benign lesions (n = 13). Malignant lesions such as a local recurrent tumor, peritoneal carcinomatosis, and incidental uterine malignancy, as well as various benign lesions such as an anastomotic sinus, fistula, abscess, reactive lymph node, and normal ovary, were observed. Conclusion PET/CT performed during postoperative surveillance of rectal and sigmoid colon cancer showed increased fluorodeoxyglucose uptake not only in local recurrence, but also in benign pelvic etiologies. Therefore, physicians need to be cautious about the broad clinical spectrum of hypermetabolic pelvic lesions when interpreting images.
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Affiliation(s)
- Yun Hee Kang
- Department of Nuclear Medicine, Eulji University Hospital, Daejeon, Korea
| | - Eunji Han
- Department of Nuclear Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Geon Park
- Department of Radiology, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
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Bhoday J, Balyasnikova S, Wale A, Brown G. How Should Imaging Direct/Orient Management of Rectal Cancer? Clin Colon Rectal Surg 2017; 30:297-312. [PMID: 29184465 DOI: 10.1055/s-0037-1606107] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Modern rectal cancer management is dependent on preoperative staging, and radiological assessment is a crucial part of this process. Imaging must provide sufficient information to guide preoperative decision-making that is reliable and reproducible. Different methods have been used for local staging; however, magnetic resonance imaging (MRI) has shown to be the most reliable tool for this purpose. MRI offers prognostic information about the patients and guides the decision between neoadjuvant treatment and total mesorectal excision alone. Also, not only the initial staging but also restaging by MRI can provide significant information regarding tumor response that is essential when considering alternative approaches.
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Affiliation(s)
- Jemma Bhoday
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
| | - Svetlana Balyasnikova
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
| | - Anita Wale
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
| | - Gina Brown
- Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Sutton, Surrey, United Kingdom
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Doradla P, Joseph C, Giles RH. Terahertz endoscopic imaging for colorectal cancer detection: Current status and future perspectives. World J Gastrointest Endosc 2017; 9:346-358. [PMID: 28874955 PMCID: PMC5565500 DOI: 10.4253/wjge.v9.i8.346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/08/2017] [Accepted: 07/14/2017] [Indexed: 02/05/2023] Open
Abstract
Terahertz (THz) imaging is progressing as a robust platform for myriad applications in the field of security, health, and material science. The THz regime, which comprises wavelengths spanning from microns to millimeters, is non-ionizing and has very low photon energy: Making it inherently safe for biological imaging. Colorectal cancer is one of the most common causes of death in the world, while the conventional screening and standard of care yet relies exclusively on the physician's experience. Researchers have been working on the development of a flexible THz endoscope, as a potential tool to aid in colorectal cancer screening. This involves building a single-channel THz endoscope, and profiling the THz response from colorectal tissue, and demonstrating endogenous contrast levels between normal and diseased tissue when imaging in reflection modality. The current level of contrast provided by the prototype THz endoscopic system represents a significant step towards clinical endoscopic application of THz technology for in-vivo colorectal cancer screening. The aim of this paper is to provide a short review of the recent advances in THz endoscopic technology and cancer imaging. In particular, the potential of single-channel THz endoscopic imaging for colonic cancer screening will be highlighted.
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25
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Abstract
Imaging determines the optimal treatment for rectal cancer patients. High-resolution magnetic resonance imaging (MRI) overcomes many of the known limitations of previous methods. When performed in accordance with the recommended standards, MRI enables accurate staging of both early and advanced rectal cancer, accurate response assessment, the delineation of recurrent disease and planning surgical treatment in a safe and effective manner. Tumour-related high-risk features with known adverse outcomes can be preoperatively identified and treated with neoadjuvant chemoradiotherapy. Further, MRI post-treatment tumour response assessment using TRG grading system also predicts the likely survival outcomes and in the future will be used to modify treatment further by stratification into good and poor responders. There is a paucity of literature with validated outcome data concerning use of diffusion-weighted imaging and positron emission tomography (PET)/computed tomography (CT), and in the absence of any validated methods and outcome data, their use in the initial assessment and restaging after treatment is limited to research protocols. Combination MRI and CT is essential for distant spread assessment and recurrent disease, and currently PET-CT is sometimes used in the workup of patients with recurrent and metastatic disease.
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26
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Barral M, Eveno C, Hoeffel C, Boudiaf M, Bazeries P, Foucher R, Pocard M, Dohan A, Soyer P. Diffusion-weighted magnetic resonance imaging in colorectal cancer. J Visc Surg 2016; 153:361-369. [PMID: 27618699 DOI: 10.1016/j.jviscsurg.2016.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Magnetic resonance imaging (MRI) plays now a major role in patients with colorectal cancer regarding tumor staging, surgical planning, therapeutic decision, assessment of tumor response to chemoradiotherapy and surveillance of rectal cancer, and detection and characterization of liver or peritoneal metastasis of colorectal cancers. Diffusion-weighted MRI (DW-MRI) is a functional imaging tool that is now part of the standard MRI protocol for the investigation of patients with colorectal cancer. DW-MRI reflects micro-displacements of water molecules in tissues and conveys high degrees of accuracy to discriminate between benign and malignant colorectal conditions. Thus, in addition to morphological imaging, DW-MRI has an important role to accurately detect colorectal neoplasms and peritoneal implants, to differentiate benign focal liver lesions from metastases and to detect tumor relapse within fibrotic changes. This review provides a comprehensive overview of basic principles, clinical applications and future trends of DW-MRI in colorectal cancers.
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Affiliation(s)
- M Barral
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France; Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Eveno
- Department of digestive surgery, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, CHU de Reims, 51092 Reims cedex, France
| | - M Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France
| | - P Bazeries
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France.
| | - R Foucher
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France; Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Pocard
- Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Department of digestive surgery, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Dohan
- UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Soyer
- Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Kang YH, Park G. Characteristics of 18F-fluorodeoxyglucose uptake in anastomotic sinus and fistula following rectal cancer surgery. Clin Imaging 2016; 41:33-36. [PMID: 27744195 DOI: 10.1016/j.clinimag.2016.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 08/08/2016] [Accepted: 08/22/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the characteristics of 18F-fluorodeoxyglucose (FDG) uptake in persisting anastomotic sinus and fistula following rectal cancer surgery. METHODS Eight patients with anastomotic sinus and fistula were retrospectively studied. RESULTS A total of 13 anastomotic sinuses (n=11) and fistulas (n=2) were observed. Sixteen FDG-positron emission tomography/computed tomography studies for 13 lesions performed and 26 uptake patterns were evaluated. Twenty-one lesions were found to have diffuse increased uptake, whereas four lesions had focal uptake. There was only one lesion without FDG uptake. CONCLUSIONS Increased FDG uptake is frequently observed in anastomotic sinus and fistula, which should be known to avoid making wrong diagnosis.
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Affiliation(s)
- Yun Hee Kang
- Department of Nuclear Medicine, Eulji University Hospital, 96 Dunsanseoro, Seo-gu, Daejeon, 35233, Republic of Korea.
| | - Geon Park
- Department of Radiology, The Catholic University of Korea, Daejeon Saint Mary's Hospital, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
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28
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Petrillo A, Fusco R, Catalano O. Imaging Modalities. Updates Surg 2016. [DOI: 10.1007/978-88-470-5767-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Doradla P, Alavi K, Joseph C, Giles R. Single-channel prototype terahertz endoscopic system. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:080501. [PMID: 25111144 DOI: 10.1117/1.jbo.19.8.080501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/14/2014] [Indexed: 05/26/2023]
Abstract
We demonstrate the design and development of an innovative single-channel terahertz (THz) prototype endoscopic imaging system based on flexible metal-coated THz waveguides and a polarization specific detection technique. The continuous-wave (CW) THz imaging system utilizes a single channel to transmit and collect the reflected intrinsic THz signal from the sample. Since the prototype system relies on a flexible waveguide assembly that is small enough in diameter, it can be readily integrated with a conventional optical endoscope. This study aims to show the feasibility of waveguide enabled THz imaging. We image various objects in transmission and reflection modes. We also image normal and cancerous colonic tissues in reflectance mode using a polarization specific imaging technique. The resulting cross-polarized THz reflectance images showed contrast between normal and cancerous colonic tissues at 584 GHz. The level of contrast observed using endoscopic imaging correlates well with contrast levels observed in ex vivo THz reflectance studies of colon cancer. This indicates that the single-channel flexible waveguide-based THz endoscope presented here represents a significant step forward in clinical endoscopic application of THz technology to aid in in vivo cancer screening.
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Affiliation(s)
- Pallavi Doradla
- University of Massachusetts Lowell, Department of Physics, Massachusetts 01854, United StatesbBiomedical Terahertz Technology Center, Lowell, Massachusetts 01854, United States
| | - Karim Alavi
- University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Worcester, Massachusetts 01605, United States
| | - Cecil Joseph
- University of Massachusetts Lowell, Department of Physics, Massachusetts 01854, United StatesbBiomedical Terahertz Technology Center, Lowell, Massachusetts 01854, United States
| | - Robert Giles
- University of Massachusetts Lowell, Department of Physics, Massachusetts 01854, United StatesbBiomedical Terahertz Technology Center, Lowell, Massachusetts 01854, United States
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Viswanathan C, Truong MT, Sagebiel TL, Bronstein Y, Vikram R, Patnana M, Silverman PM, Bhosale PR. Abdominal and Pelvic Complications of Nonoperative Oncologic Therapy. Radiographics 2014; 34:941-61. [DOI: 10.1148/rg.344140082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Young PE, Womeldorph CM, Johnson EK, Maykel JA, Brucher B, Stojadinovic A, Avital I, Nissan A, Steele SR. Early detection of colorectal cancer recurrence in patients undergoing surgery with curative intent: current status and challenges. J Cancer 2014; 5:262-71. [PMID: 24790654 PMCID: PMC3982039 DOI: 10.7150/jca.7988] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite advances in neoadjuvant and adjuvant therapy, attention to proper surgical technique, and improved pathological staging for both the primary and metastatic lesions, almost half of all colorectal cancer patients will develop recurrent disease. More concerning, this includes ~25% of patients with theoretically curable node-negative, non-metastatic Stage I and II disease. Given the annual incidence of colorectal cancer, approximately 150,000 new patients are candidates each year for follow-up surveillance. When combined with the greater population already enrolled in a surveillance protocol, this translates to a tremendous number of patients at risk for recurrence. It is therefore imperative that strategies aim for detection of recurrence as early as possible to allow initiation of treatment that may still result in cure. Yet, controversy exists regarding the optimal surveillance strategy (high-intensity vs. traditional), ideal testing regimen, and overall effectiveness. While benefits may involve earlier detection of recurrence, psychological welfare improvement, and greater overall survival, this must be weighed against the potential disadvantages including more invasive tests, higher rates of reoperation, and increased costs. In this review, we will examine the current options available and challenges surrounding colorectal cancer surveillance and early detection of recurrence.
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Affiliation(s)
- Patrick. E. Young
- 1. Department of Medicine, Division of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- 3. Department of Medicine, Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Craig M. Womeldorph
- 2. Department of Medicine, Division of Gastroenterology, San Antonio Military Medical Center, San Antonio, TX, USA
- 3. Department of Medicine, Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Eric K. Johnson
- 4. Department of Surgery, Madigan Army Center, Tacoma, WA, USA
| | - Justin A. Maykel
- 5. Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | | | | | | | - Aviram Nissan
- 7. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Scott R. Steele
- 4. Department of Surgery, Madigan Army Center, Tacoma, WA, USA
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Li C, Lan X, Yuan H, Feng H, Xia X, Zhang Y. 18F-FDG PET predicts pathological response to preoperative chemoradiotherapy in patients with primary rectal cancer: a meta-analysis. Ann Nucl Med 2014; 28:436-46. [PMID: 24623152 DOI: 10.1007/s12149-014-0837-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 02/27/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to assess the performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in predicting pathological response to preoperative chemoradiotherapy (CRT) in patients with primary rectal cancer. METHODS Potentially relevant articles were searched in the databases of PubMed and Embase from January 1990 to September 2013. The Quality Assessment for Diagnostic Accuracy Studies criteria was employed to assess the quality of all of the included studies. The pooled sensitivity and specificity were calculated, and the area under the curve of the summary receiver operating characteristic curve was obtained. Subgroup analysis was conducted to explore the sources of heterogeneity. RESULTS Thirty-one eligible studies involving 1527 patients were ultimately included in the meta-analysis. Four main quantitative or qualitative parameters [response index (RI), post-treatment maximum standardized uptake value (SUVmax-post), visual response (VR) and the percentage change in total lesion glycolysis (TLG) before and after CRT (deltaTLG%)] related to PET or positron emission tomography/computed tomography (PET/CT) were assessed for the prediction of histopathological response. The pooled sensitivities of these four parameters were comparable and were 74, 74, 75 and 78%, respectively (P>0.05). The pooled specificity of deltaTLG% was higher than that of the other three parameters (RI, SUVmax-post and VR) and was 81, 66, 64 and 67%, respectively (P<0.05). The results from subgroup analysis showed that the RI and SUVmax-post had higher specificity in predicting tumor regression grade (TRG) than complete pathological response (pCR) [RI, 71 vs. 59% (P=0.0275); SUVmax-post, 72 vs. 61% (P=0.0178)].The diagnostic sensitivity and specificity of the RI and SUVmax-post when the post-treatment PET or PET/CT scan was performed at two different time points (during CRT and after the completion of CRT) were 82 vs. 72% (P=0.0630) and 78 vs. 63% (P=0.0059), respectively. CONCLUSIONS 18F-FDG PET could be a potentially powerful non-invasive tool for predicting pathological response; the related parameters RI and SUVmax-post may be more suitable for the prediction of TRG than pCR. The current data also suggested that the optimum post-treatment 18F-FDG PET scan could be carried out during CRT.
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Affiliation(s)
- Chongjiao Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, No. 1277, Jiefang Ave., Wuhan, Hubei, People's Republic of China
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Oh JS, Koea JB. Radiation risks associated with serial imaging in colorectal cancer patients: Should we worry? World J Gastroenterol 2014; 20:100-109. [PMID: 24415862 PMCID: PMC3885998 DOI: 10.3748/wjg.v20.i1.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/31/2013] [Accepted: 08/09/2013] [Indexed: 02/06/2023] Open
Abstract
To provide an overview of the radiation related cancer risk associated with multiple computed tomographic scans required for follow up in colorectal cancer patients. A literature search of the PubMed and Cochrane Library databases was carried out and limited to the last 10 years from December 2012. Inclusion criteria were studies where computed tomographic scans or radiation from other medical imaging modalities were used and the risks associated with ionizing radiation reported. Thirty-six studies were included for appraisal with no randomized controlled trials. Thirty-four of the thirty-six studies showed a positive association between medical imaging radiation and increased risk of cancer. The radiation dose absorbed and cancer risk was greater in children and young adults than in older patients. Most studies included in the review used a linear, no-threshold model to calculate cancer risks and this may not be applicable at low radiation doses. Many studies are retrospective and ensuring complete follow up on thousands of patients is difficult. There was a minor increased risk of cancer from ionizing radiation in medical imaging studies. The radiation risks of low dose exposure (< 50 milli-Sieverts) are uncertain. A clinically justified scan in the context of colorectal cancer is likely to provide more benefits than harm but current guidelines for patient follow up will need to be revised to accommodate a more aggressive approach to treating metastatic disease.
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Walker AS, Zwintscher NP, Johnson EK, Maykel JA, Stojadinovic A, Nissan A, Avital I, Brücher BL, Steele SR. Future directions for monitoring treatment response in colorectal cancer. J Cancer 2014; 5:44-57. [PMID: 24396497 PMCID: PMC3881220 DOI: 10.7150/jca.7809] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023] Open
Abstract
Treatment of advanced colon and rectal cancer has significantly evolved with the introduction of neoadjuvant chemoradiation therapy so much that, along with more effective chemotherapy regimens, surgery has been considered unnecessary among some institutions for select patients. The tumor response to these treatments has also improved and ultimately has been shown to have a direct effect on prognosis. Yet, the best way to monitor that response, whether clinically, radiologically, or with laboratory findings, remains controversial. The authors' aim is to briefly review the options available and, more importantly, examine emerging and future options to assist in monitoring treatment response in cases of locally advanced rectal cancer and metastatic colon cancer.
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Affiliation(s)
- Avery S Walker
- 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA
| | - Nathan P Zwintscher
- 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA
| | - Eric K Johnson
- 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA
| | - Justin A Maykel
- 2. University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Alexander Stojadinovic
- 3. Department of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Aviram Nissan
- 4. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Scott R Steele
- 1. Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Fort Lewis, WA, USA
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35
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EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 2014; 50:1.e1-1.e34. [DOI: 10.1016/j.ejca.2013.06.048] [Citation(s) in RCA: 298] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023]
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Izuishi K, Yamamoto Y, Mori H, Kameyama R, Fujihara S, Masaki T, Suzuki Y. Molecular mechanisms of [18F]fluorodeoxyglucose accumulation in liver cancer. Oncol Rep 2013; 31:701-6. [PMID: 24297035 DOI: 10.3892/or.2013.2886] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/25/2013] [Indexed: 11/06/2022] Open
Abstract
To elucidate the molecular mechanisms underlying the insufficient sensitivity in the detection of hepatocellular carcinoma (HCC) by [18F] 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), the characteristics of glucose metabolism-related protein expression in HCC were examined in liver metastasis from colorectal cancer (Meta). Thirty-four patients (14 Meta and 20 HCC) who underwent FDG-PET and hepatectomy were studied. The relationships between the maximum standardized uptake value (SUV) in tumors and the mRNA expression of glucose metabolism-related proteins [hexokinase (HK), glucose transporter 1 (GLUT1), and glucose-6-phosphatase (G6Pase)] and proliferating cell nuclear antigen (PCNA) were examined in snap-frozen specimens with quantitative PCR. Tumor detection rates were lower in HCC (15/20) compared to Meta (13/14) patients. HK and GLUT1 expression was lower and G6Pase expression was higher in HCC compared to Meta. In particular, GLUT1 overexpression was 92-fold in Meta and 11-fold in HCC compared to the surrounding liver. The SUV correlated with GLUT1 and PCNA expression in HCC, but not Meta patients. Of note, four cases of poorly differentiated (P/D) HCC compared to moderately differentiated (M/D) HCC produced completely different results for FDG uptake (SUV, 14.4 vs. 4.0) and mRNA expression (G6Pase expression, 0.007 vs. 1.5). Variations in the expression of glucose metabolism-related enzymes between HCC and Meta patients are attributed to origin or degree of differentiation. Low FDG uptake in M/D HCC reflected low GLUT1 and high G6Pase expression, while high FDG accumulation in P/D HCC could reflect increased GLUT1 and decreased G6Pase expression. These results may explain why M/D HCC is not detected as sensitively by FDG-PET.
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Affiliation(s)
- Kunihiko Izuishi
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
| | - Hirohito Mori
- Department of Internal Medicine of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
| | - Riko Kameyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
| | - Shintaro Fujihara
- Department of Internal Medicine of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
| | - Tsutomu Masaki
- Department of Internal Medicine of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
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Colosio A, Soyer P, Rousset P, Barbe C, Nguyen F, Bouché O, Hoeffel C. Value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer. J Magn Reson Imaging 2013; 40:306-13. [PMID: 24311014 DOI: 10.1002/jmri.24366] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 07/29/2013] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To prospectively assess the added value of gadolinium-enhanced and diffusion-weighted (DWI) MRI for the diagnosis of pelvic recurrence from colorectal cancer (CRC). MATERIALS AND METHODS Fifty-two patients with suspected pelvic recurrence from CRC underwent pelvic MRI with T2-weighted ("T2"), gadolinium-enhanced fat-suppressed T1-weighted ("gadolinium") and DWI MR sequences. Three readers (senior radiologist: R1, two residents: R2, R3) scored the likelihood of recurrence on "T2," "T2 + DWI," and "T2 + Gadolinium." RESULTS Twenty-seven patients had 42 sites of pelvic recurrence. On "T2," R1 achieved AUC of .95, sensitivity 88.4%, specificity 95.2%. For R2, these figures were .89, 81.4%, 90.5%, for R3 .90, 83.7%, 76%. Both Gadolinium injection and DWI significantly improved AUCs for residents but not for the senior radiologist: up to .988 (R2, P = 0.006) and to .98 (R3, P = 0.01) with DWI and to .96 (R2, P = 0.04), .98 (R3, P = 0.01) after gadolinium. All readers achieved slightly better AUCs with "T2 + DWI" than with "T2+Gadolinium" but not significantly (P = 0.68, P = 0.11, P = 0.3; respectively). CONCLUSION For diagnosis of pelvic recurrence from CRC, both DWI and gadolinium-enhanced MRI significantly increase diagnostic performances compared with "T2" MRI for residents. DWI may be helpful in patients with contra-indications to intravenous administration of gadolinium.
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Affiliation(s)
- Alban Colosio
- Department of Radiology, Hôpital Robert Debré, Avenue du Général Koenig, Cedex, France
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Efficiency of apparent diffusion coefficients in differentiation of colorectal tumor recurrences and posttherapeutical soft-tissue changes. Eur J Radiol 2013; 82:1702-9. [DOI: 10.1016/j.ejrad.2013.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022]
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Xing XH, Cheng YS. Magnetic resonance functional and molecular imaging for diagnosis of rectal cancer: Recent research advances. Shijie Huaren Xiaohua Zazhi 2013; 21:1726-1732. [DOI: 10.11569/wcjd.v21.i18.1726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the most common gastrointestinal malignant tumors in China. Because of the difficulties in early diagnosis, the incidence and mortality of colorectal cancer have been increasing year by year. Molecular and functional imaging plays an important role in detecting rectal cancer earlier and more specifically and reducing patients' mortality. In this paper we discuss the present and future applications of magnetic resonance molecular and functional imaging in the diagnosis of rectal tumors.
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40
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Clinical, MRI, and PET-CT criteria used by surgeons to determine suitability for pelvic exenteration surgery for recurrent rectal cancers: a Delphi study. Dis Colon Rectum 2013; 56:717-25. [PMID: 23652745 DOI: 10.1097/dcr.0b013e3182812bec] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical resection with clear margins is the major predictor of long-term survival in recurrent rectal cancer. The extent of pelvic exenteration surgery depends on many factors including clinical and radiological criteria. OBJECTIVE The aim of this study was to establish which clinical, MRI, and PET criteria were considered important by surgeons who perform pelvic exenteration surgery, when assessing a patient with recurrent rectal cancer for pelvic exenteration surgery. DESIGN A 2-stage Delphi study was conducted among an international panel of 36 colorectal surgeons recruited via a snowball-sampling method. Surgeons rated the importance of 99 clinical and radiological criteria by using a 9-point scale. MAIN OUTCOME MEASURES Consensus was attained when at least 85% of the panel rated criteria within 3 points. RESULTS Clinical factors suggestive of systemic disease, symptoms of advanced local recurrence such as pain, surgical fitness, and cognitive impairment were considered important by the panel when considering suitability for surgery. Agreement regarding the indication for surgery was reached for 20 radiological factors. Strong agreement was achieved for factors associated with tumor involvement in the axial and anterior compartments. For only 16 of these 20 radiological factors was there an agreement that a clear resection margin was likely to be achieved. LIMITATIONS Further rounds of Delphi may have yielded greater consensus. CONCLUSION This study has identified a set of criteria considered by experts to be important in evaluating patients' suitability for pelvic exenteration surgery. Evaluation of these criteria is required to determine their clinical utility in predicting a negative resection margin at pelvic exenteration surgery.
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Abstract
In the last 10 years, a number of important European randomized published studies investigated the optimal management of rectal cancer. In order to define an evidence-based approach of the clinical practice based, an international consensus conference was organized in Italy under the endorsement of European Society of Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO) and European Society of Therapeutic Radiation Oncology (ESTRO). The aim of this article is to present highlights of multidisciplinary rectal cancer management and to compare the conclusions of the international conference on 'Multidisciplinary Rectal Cancer Treatment: looking for an European Consensus' (EURECA-CC2) with the new National Comprehensive Cancer Network (NCCN) guidelines.
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Affiliation(s)
- B De Bari
- Istituto del Radio O. Alberti, Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italie.
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Abstract
CLINICAL/METHODICAL ISSUE Staging and follow-up of colorectal cancer are usually performed with multimodal imaging strategies. These can be time-intensive and potentially lead to examiner-dependent bias. Alternatively, whole body magnetic resonance imaging (WB-MRI) provides oncologic imaging with a systemic approach. STANDARD RADIOLOGICAL METHODS Ultrasound, multislice computed tomography (MSCT), dedicated MRI and positron emission tomography/CT (PET/CT). METHODICAL INNOVATIONS High-resolution WB-MRI with focused examination of various organs, such as the pelvis and abdomen, lungs, brain and skeletal system, using different sequence and contrast techniques. PERFORMANCE Detection of colorectal tumor recurrence with WB-MRI provides 83% accuracy (lymph node metastases 80%, organ metastases 86%). ACHIEVEMENTS Potential cost reduction through decreased examination time and personnel costs. PRACTICAL RECOMMENDATIONS Whole body MRI is a radiation-free alternative to standard sequential algorithms of staging and follow-up of colorectal cancer.
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Affiliation(s)
- G Schmidt
- Institut für klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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Liong SY, Kochhar R, Renehan AG, Manoharan P. Utility of 18-fluorodeoxyglucose positron emission/computed tomography in the management of recurrent colorectal cancer. ANZ J Surg 2012; 82:729-36. [DOI: 10.1111/j.1445-2197.2012.06237.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Sue Y. Liong
- Department of Clinical Radiology; The Christie; Manchester; UK
| | - Rohit Kochhar
- Department of Clinical Radiology; The Christie; Manchester; UK
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Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Inflammation-Based Prognostic System Predicts Postoperative Survival of Colorectal Cancer Patients with a Normal Preoperative Serum Level of Carcinoembryonic Antigen. Ann Surg Oncol 2012; 19:3422-31. [DOI: 10.1245/s10434-012-2384-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Indexed: 12/14/2022]
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Fiocchi F, Iotti V, Ligabue G, Malavasi N, Luppi G, Bagni B, Torricelli P. Role of carcinoembryonic antigen, magnetic resonance imaging, and positron emission tomography-computed tomography in the evaluation of patients with suspected local recurrence of colorectal cancer. Clin Imaging 2011; 35:266-73. [PMID: 21724118 DOI: 10.1016/j.clinimag.2010.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 07/15/2010] [Indexed: 02/09/2023]
Abstract
The role of carcinoembryonic antigen (CEA), magnetic resonance imaging (MRI), and positron emission tomography (PET)-computed tomography (CT) in detection of local recurrence of colorectal cancer is evaluated in 71 patients, selected due to suspected relapse at CT follow-up. Recurrence was confirmed by histology in 18 cases and excluded in 25 cases. Sensitivity, specificity, positive and negative predictive values, and accuracy were as follows: 44.4%, 92.5%, 66.7%, 83.1%, and 80.3% for CEA; 88.9%, 73.6%, 53.3%, 95.1%, and 77.5% for MRI; and 94.4%, 73.6%, 54.8%, 97.5%, and 78.9% for PET-CT. A diagnostic protocol integrating CEA and dedicated imaging studies is to be advocated.
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Affiliation(s)
- Federica Fiocchi
- Dipartimento Integrato dei Servizi Diagnostici e per Immagine, Via del Pozzo 71, 41100 Modena, Italy.
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Lizarazu A, Enríquez-Navascués JM, Placer C, Carrillo A, Sainz-Lete A, Elósegui JL. [Surgical approach to the locoregional recurrence of cancer of the rectum]. Cir Esp 2011; 89:269-74. [PMID: 21429480 DOI: 10.1016/j.ciresp.2011.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 11/19/2022]
Abstract
A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT, NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients.
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Affiliation(s)
- Aintzane Lizarazu
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Donostia, San Sebastián, España
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Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol 2011; 21:1250-8. [PMID: 21240647 PMCID: PMC3088810 DOI: 10.1007/s00330-010-2052-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/22/2010] [Accepted: 11/25/2010] [Indexed: 12/30/2022]
Abstract
Objectives To evaluate the accuracy of standard MRI, diffusion-weighted MRI (DWI) and fusion images for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Methods Forty-two patients with a clinical suspicion of recurrence underwent 1.5-T MRI consisting of standard T2-weighted FSE (3 planes) and an axial DWI (b0,500,1000). Two readers (R1,R2) independently scored the likelihood of recurrence; [1] on standard MRI, [2] on standard MRI+DWI, and [3] on T2-weighted+DWI fusion images. Results 19/42 patients had a local recurrence. R1 achieved an area under the ROC-curve (AUC) of 0.99, sensitivity 100% and specificity 83% on standard MRI versus 0.98, 100% and 91% after addition of DWI (p = 0.78). For R2 these figures were 0.87, 84% and 74% on standard MRI and 0.91, 89% and 83% with DWI (p = 0.09). Fusion images did not significantly improve the performance. Interobserver agreement was κ0.69 for standard MRI, κ0.82 for standard MRI+DWI and κ0.84 for the fusion images. Conclusions MRI is accurate for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Addition of DWI does not significantly improve its performance. However, with DWI specificity and interobserver agreement increase. Fusion images do not improve accuracy.
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Schiepers C, Dahlbom M. Molecular imaging in oncology: the acceptance of PET/CT and the emergence of MR/PET imaging. Eur Radiol 2010; 21:548-54. [PMID: 21174096 PMCID: PMC3032196 DOI: 10.1007/s00330-010-2033-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 01/11/2023]
Abstract
In the last decade, PET-only systems have been phased out and replaced with PET-CT systems. This merger of a functional and anatomical imaging modality turned out to be extremely useful in clinical practice. Currently, PET-CT is a major diagnostic tool in oncology. At the dawn of the merger of MRI and PET, another breakthrough in clinical imaging is expected. The combination of these imaging modalities is challenging, but has particular features such as imaging biological processes at the same time in specific body locations.
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Affiliation(s)
- Christiaan Schiepers
- Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, 200 Medical Plaza, Suite B-114, Los Angeles, CA 90095-7370 USA
| | - Magnus Dahlbom
- Molecular & Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, 200 Medical Plaza, Suite B-114, Los Angeles, CA 90095-7370 USA
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Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review. Insights Imaging 2010; 1:245-267. [PMID: 22347920 PMCID: PMC3259411 DOI: 10.1007/s13244-010-0037-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/11/2010] [Accepted: 07/26/2010] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.
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50
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Bamba Y, Itabashi M, Kameoka S. Management of local recurrence of colorectal cancer: the role of PET/CT. ACTA ACUST UNITED AC 2010; 36:322-6. [DOI: 10.1007/s00261-010-9639-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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