|
1
|
Barat M, Marchese U, Pellat A, Dohan A, Coriat R, Hoeffel C, Fishman EK, Cassinotto C, Chu L, Soyer P. Imaging of Pancreatic Ductal Adenocarcinoma: An Update on Recent Advances. Can Assoc Radiol J 2022; 74:351-361. [PMID: 36065572 DOI: 10.1177/08465371221124927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pancreatic ductal carcinoma (PDAC) is one of the leading causes of cancer-related death worldwide. Computed tomography (CT) remains the primary imaging modality for diagnosis of PDAC. However, CT has limitations for early pancreatic tumor detection and tumor characterization so that it is currently challenged by magnetic resonance imaging. More recently, a particular attention has been given to radiomics for the characterization of pancreatic lesions using extraction and analysis of quantitative imaging features. In addition, radiomics has currently many applications that are developed in conjunction with artificial intelligence (AI) with the aim of better characterizing pancreatic lesions and providing a more precise assessment of tumor burden. This review article sums up recent advances in imaging of PDAC in the field of image/data acquisition, tumor detection, tumor characterization, treatment response evaluation, and preoperative planning. In addition, current applications of radiomics and AI in the field of PDAC are discussed.
Collapse
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris543341, Paris, France.,Université Paris Cité, Faculté de Médecine, 555089Paris, France
| | - Ugo Marchese
- Université Paris Cité, Faculté de Médecine, 555089Paris, France.,Department of Digestive, Hepatobiliary and Pancreatic Surgery, 26935Hopital Cochin, AP-HP, Paris, France
| | - Anna Pellat
- Université Paris Cité, Faculté de Médecine, 555089Paris, France.,Department of Gastroenterology, 26935Hopital Cochin, AP-HP, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris543341, Paris, France.,Université Paris Cité, Faculté de Médecine, 555089Paris, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, 555089Paris, France.,Department of Gastroenterology, 26935Hopital Cochin, AP-HP, Paris, France
| | | | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Christophe Cassinotto
- Department of Radiology, CHU Montpellier, 27037University of Montpellier, Saint-Éloi Hospital, Montpellier, France
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris543341, Paris, France.,Université Paris Cité, Faculté de Médecine, 555089Paris, France
| |
Collapse
|
|
2
|
Mahajna H, Vaknin K, Ben Shimol J, Watad A, Abu-Much A, Mahroum N, Shovman O, Shoenfeld Y, Amital H, Davidson T. The Utility of 18FDG-PET/CT in Diagnosing Fever of Unknown Origin: The Experience of a Large Tertiary Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105360. [PMID: 34069883 PMCID: PMC8157390 DOI: 10.3390/ijerph18105360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/14/2022]
Abstract
Fever of unknown origin (FUO) poses a diagnostic challenge, and 18-fluorodexoyglucose positron emission tomography with computed tomography (18FDG-PET/CT) may identify the source. We aimed to evaluate the diagnostic yield of 18FDG-PET/CT in the work-up of FUO. The records of patients admitted to Sheba Medical Center between January 2013 and January 2018 who underwent 18FDG-PET/CT for the evaluation of FUO were reviewed. Following examination of available medical test results, 18FDG-PET/CT findings were assessed to determine whether lesions identified proved diagnostic. Of 225 patients who underwent 18FDG-PET/CT for FUO work-up, 128 (57%) met inclusion criteria. Eighty (62.5%) were males; mean age was 59 ± 20.3 (range: 18-93). A final diagnosis was made in 95 (74%) patients. Of the 128 18FDG-PET/CT tests conducted for the workup of FUO, 61 (48%) were true positive, 26 (20%) false positive, 26 (20%) true negative, and 15 (12%) false negative. In a multivariate analysis, weight loss and anemia were independently associated with having a contributary results of 18FDG-PET/CT. The test yielded a sensitivity of 70%, specificity of 37%, positive predictive value of 70%, and negative predictive value of 37%. 18FDG-PET/CT is a valuable tool in the diagnostic workup of FUO. It proved effective in diagnosing almost half the patients, especially in those with anemia and weight loss.
Collapse
Affiliation(s)
- Hussein Mahajna
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Keren Vaknin
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Jennifer Ben Shimol
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Department of Medicine, E. Wolfson Medical Center, Holon 5822012, Israel
| | - Abdulla Watad
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Arsalan Abu-Much
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Naim Mahroum
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Ora Shovman
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Howard Amital
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Correspondence: ; Tel.: +972-3-5302986
| |
Collapse
|
|
3
|
Zampella E, Klain M, Pace L, Cuocolo A. PET/CT in the management of differentiated thyroid cancer. Diagn Interv Imaging 2021; 102:515-523. [PMID: 33926848 DOI: 10.1016/j.diii.2021.04.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 12/17/2022]
Abstract
The standard treatment of differentiated thyroid cancer (DTC) consists of surgery followed by iodine-131 (131I) administration. Although the majority of DTC has a very good prognosis, more aggressive histologic subtypes convey a worse prognosis. Follow-up consists of periodically measurements of serum thyroglobulin, thyroglobulin antibodies and neck ultrasound and 123I/131I whole-body scan. However, undifferentiated thyroid tumors have a lower avidity for radioiodine and the ability of DTC to concentrate 131I may be lost in metastatic disease. Positron emission tomography (PET)/computed tomography (CT) has been introduced in the evaluation of patients with thyroid tumors and the 2-[18F]-fluoro-2-deoxyd-glucose (18F-FDG) has been largely validated as marker of cell's metabolism. According to the 2015 American Thyroid Association guidelines, 18F-FDG PET/CT is recommended in the follow-up of high-risk patients with elevated serum thyroglobulin and negative 131I imaging, in the assessment of metastatic patients, for lesion detection and risk stratification and in predicting the response to therapy. It should be considered that well-differentiated iodine avid lesions could not concentrate 18F-FDG, and a reciprocal pattern of iodine and 18F-FDG uptake has been observed. Beyond 18F-FDG, other tracers are available for PET imaging of thyroid tumors, such as Iodine-124 (124I), 18F-tetrafluoroborate and Gallium-68 prostate-specific membrane antigen. Moreover, the recent introduction of PET/MRI, offers now several opportunities in the field of patients with DTC. This review summarizes the evidences on the role of PET/CT in management of patients with DTC, focusing on potential applications and on elucidating some still debating points.
Collapse
Affiliation(s)
- Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy.
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy
| | - Leonardo Pace
- Department of Medicine, Surgery and Dentistry, Università degli Studi di Salerno, 84084 Fisciano, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy
| |
Collapse
|
|
4
|
Achieving 'Marginal Gains' to Optimise Outcomes in Resectable Pancreatic Cancer. Cancers (Basel) 2021; 13:cancers13071669. [PMID: 33916294 PMCID: PMC8037133 DOI: 10.3390/cancers13071669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Improving outcomes in pancreatic cancer is achievable through the accumulation of marginal gains. There exists evidence of variation and undertreatment in many areas of the care pathway. By fully realising the existing opportunities, there is the potential for immediate improvements in outcomes and quality of life. Abstract Improving outcomes among patients with resectable pancreatic cancer is one of the greatest challenges of modern medicine. Major improvements in survival will result from the development of novel therapies. However, optimising existing pathways, so that patients realise benefits of already proven treatments, presents a clear opportunity to improve outcomes in the short term. This narrative review will focus on treatments and interventions where there is a clear evidence base to improve outcomes in pancreatic cancer, and where there is also evidence of variation and under-treatment. Avoidance of preoperative biliary drainage, treatment of pancreatic exocrine insufficiency, prehabiliation and enhanced recovery after surgery, reducing perioperative complications, optimising opportunities for elderly patients to receive therapy, optimising adjuvant chemotherapy and regular surveillance after surgery are some of the strategies discussed. Each treatment or pathway change represents an opportunity for marginal gain. Accumulation of marginal gains can result in considerable benefit to patients. Given that these interventions already have evidence base, they can be realised quickly and economically.
Collapse
|
|
5
|
CT and MRI of pancreatic tumors: an update in the era of radiomics. Jpn J Radiol 2020; 38:1111-1124. [PMID: 33085029 DOI: 10.1007/s11604-020-01057-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
Radiomics is a relatively new approach for image analysis. As a part of radiomics, texture analysis, which consists in extracting a great amount of quantitative data from original images, can be used to identify specific features that can help determining the actual nature of a pancreatic lesion and providing other information such as resectability, tumor grade, tumor response to neoadjuvant therapy or survival after surgery. In this review, the basic of radiomics, recent developments and the results of texture analysis using computed tomography and magnetic resonance imaging in the field of pancreatic tumors are presented. Future applications of radiomics, such as artificial intelligence, are discussed.
Collapse
|