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Jia W, Li F, Cui Y, Wang Y, Dai Z, Yan Q, Liu X, Li Y, Chang H, Zeng Q. Deep Learning Radiomics Model of Contrast-Enhanced CT for Differentiating the Primary Source of Liver Metastases. Acad Radiol 2024:S1076-6332(24)00221-6. [PMID: 38702214 DOI: 10.1016/j.acra.2024.04.012] [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: 02/17/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a deep learning radiomics (DLR) model based on contrast-enhanced computed tomography (CT) to identify the primary source of liver metastases. MATERIALS AND METHODS In total, 657 liver metastatic lesions, including breast cancer (BC), lung cancer (LC), colorectal cancer (CRC), gastric cancer (GC), and pancreatic cancer (PC), from 428 patients were collected at three clinical centers from January 2018 to October 2023 series. The lesions were randomly assigned to the training and validation sets in a 7:3 ratio. An additional 112 lesions from 61 patients at another clinical center served as an external test set. A DLR model based on contrast-enhanced CT of the liver was developed to distinguish the five pathological types of liver metastases. Stepwise classification was performed to improve the classification efficiency of the model. Lesions were first classified as digestive tract cancer (DTC) and non-digestive tract cancer (non-DTC). DTCs were divided into CRC, GC, and PC and non-DTCs were divided into LC and BC. To verify the feasibility of the DLR model, we trained classical machine learning (ML) models as comparison models. Model performance was evaluated using accuracy (ACC) and area under the receiver operating characteristic curve (AUC). RESULTS The classification model constructed by the DLR algorithm showed excellent performance in the classification task compared to ML models. Among the five categories task, highest ACC and average AUC were achieved at 0.563 and 0.796 in the validation set, respectively. In the DTC and non-DTC and the LC and BC classification tasks, AUC was achieved at 0.907 and 0.809 and ACC was achieved at 0.843 and 0.772, respectively. In the CRC, GC, and PC classification task, ACC and average AUC were the highest, at 0.714 and 0.811, respectively. CONCLUSION The DLR model is an effective method for identifying the primary source of liver metastases.
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Affiliation(s)
- Wenjing Jia
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China; Shandong First Medical University, Jinan, China.
| | - Fuyan Li
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China.
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Yong Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
| | - Zhengjun Dai
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China.
| | - Qingqing Yan
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Xinhui Liu
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Yuting Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Huan Chang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Qingshi Zeng
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Schön F, Sinzig R, Walther F, Radosa CG, Nebelung H, Eberlein-Gonska M, Hoffmann RT, Kühn JP, Blum SFU. Value of Clinical Information on Radiology Reports in Oncological Imaging. Diagnostics (Basel) 2022; 12:diagnostics12071594. [PMID: 35885499 PMCID: PMC9321157 DOI: 10.3390/diagnostics12071594] [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: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Radiological reporting errors have a direct negative impact on patient treatment. The purpose of this study was to investigate the contribution of clinical information (CI) in radiological reporting of oncological imaging and the dependence on the radiologists’ experience level (EL). Sixty-four patients with several types of carcinomas and twenty patients without tumors were enrolled. Computed tomography datasets acquired in primary or follow-up staging were independently analyzed by three radiologists (R) with different EL (R1: 15 years; R2: 10 years, R3: 1 year). Reading was initially performed without and 3 months later with CI. Overall, diagnostic accuracy and sensitivity for primary tumor detection increased significantly when receiving CI from 77% to 87%; p = 0.01 and 73% to 83%; p = 0.01, respectively. All radiologists benefitted from CI; R1: 85% vs. 92%, p = 0.15; R2: 77% vs. 83%, p = 0.33; R3: 70% vs. 86%, p = 0.02. Overall, diagnostic accuracy and sensitivity for detecting lymphogenous metastases increased from 80% to 85% (p = 0.13) and 42% to 56% (p = 0.13), for detection of hematogenous metastases from 85% to 86% (p = 0.61) and 46% to 60% (p = 0.15). Specificity remained stable (>90%). Thus, CI in oncological imaging seems to be essential for correct radiological reporting, especially for residents, and should be available for the radiologist whenever possible.
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Affiliation(s)
- Felix Schön
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
- Correspondence: ; Tel.: +49-351-458-19089
| | - Rebecca Sinzig
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Felix Walther
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (F.W.); (M.E.-G.)
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus Dresden, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany
| | - Christoph Georg Radosa
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Heiner Nebelung
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Maria Eberlein-Gonska
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (F.W.); (M.E.-G.)
| | - Ralf-Thorsten Hoffmann
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Jens-Peter Kühn
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Sophia Freya Ulrike Blum
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (F.W.); (M.E.-G.)
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Malla RR, Kumari S, Kgk D, Momin S, Nagaraju GP. Nanotheranostics: Their role in hepatocellular carcinoma. Crit Rev Oncol Hematol 2020; 151:102968. [DOI: 10.1016/j.critrevonc.2020.102968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/24/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022] Open
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Tan S, Yang H, Xue S, Qiao J, Salarian M, Hekmatyar K, Meng Y, Mukkavilli R, Pu F, Odubade OY, Harris W, Hai Y, Yushak ML, Morales-Tirado VM, Mittal P, Sun PZ, Lawson D, Grossniklaus HE, Yang JJ. Chemokine receptor 4 targeted protein MRI contrast agent for early detection of liver metastases. SCIENCE ADVANCES 2020; 6:eaav7504. [PMID: 32083172 PMCID: PMC7007242 DOI: 10.1126/sciadv.aav7504] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/22/2019] [Indexed: 05/22/2023]
Abstract
Liver metastases often progress from primary cancers including uveal melanoma (UM), breast, and colon cancer. Molecular biomarker imaging is a new non-invasive approach for detecting early stage tumors. Here, we report the elevated expression of chemokine receptor 4 (CXCR4) in liver metastases in UM patients and metastatic UM mouse models, and development of a CXCR4-targeted MRI contrast agent, ProCA32.CXCR4, for sensitive MRI detection of UM liver metastases. ProCA32.CXCR4 exhibits high relaxivities (r 1 = 30.9 mM-1 s-1, r 2 = 43.2 mM-1 s-1, 1.5 T; r 1 = 23.5 mM-1 s-1, r 2 = 98.6 mM-1 s-1, 7.0 T), strong CXCR4 binding (K d = 1.10 ± 0.18 μM), CXCR4 molecular imaging capability in metastatic and intrahepatic xenotransplantation UM mouse models. ProCA32.CXCR4 enables detecting UM liver metastases as small as 0.1 mm3. Further development of the CXCR4-targeted imaging agent should have strong translation potential for early detection, surveillance, and treatment stratification of liver metastases patients.
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Affiliation(s)
- Shanshan Tan
- Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Hua Yang
- Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA
| | - Shenghui Xue
- InLighta Biosciences LLC, Atlanta, GA 30303, USA
| | - Jingjuan Qiao
- Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Mani Salarian
- Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Khan Hekmatyar
- Bioimaging Research Center, University of Georgia, Athens, GA 30602, USA
| | - Yuguang Meng
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Rao Mukkavilli
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA
| | - Fan Pu
- Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | | | - Wayne Harris
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Yan Hai
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA 30303, USA
| | - Melinda L. Yushak
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | | | - Pardeep Mittal
- Department of Radiology and Imaging, Augusta University, Augusta, GA 30912, USA
| | - Phillip Z. Sun
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - David Lawson
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | | | - Jenny J. Yang
- Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
- Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30303, USA
- Corresponding author.
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Abdullayev N, Große Hokamp N, Lennartz S, Holz JA, Romman Z, Pahn G, Neuhaus V, Maintz D, Krug B, Borggrefe J. Improvements of diagnostic accuracy and visualization of vertebral metastasis using multi-level virtual non-calcium reconstructions from dual-layer spectral detector computed tomography. Eur Radiol 2019; 29:5941-5949. [DOI: 10.1007/s00330-019-06233-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 02/14/2023]
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Baliyan V, Kordbacheh H, Davarpanah AH, Mozafarry A, Sahani DV, Kambadakone A. Orthopedic metallic hardware in routine abdomino-pelvic CT scans: occurrence and clinical significance. Abdom Radiol (NY) 2019; 44:1567-1574. [PMID: 30386880 DOI: 10.1007/s00261-018-1818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the occurrence of orthopedic metallic hardware in routine abdomen/pelvic computed tomography (CT) scans and their impact on image quality (IQ) and diagnostic evaluation. MATERIAL AND METHODS In this retrospective single institution study, we analyzed 3500 consecutive abdomen/pelvis CT scans for occurrence of orthopedic metallic hardware. In the cohort of patients with metallic hardware detected on CT scans, subjective and objective IQ analysis was performed to estimate diagnostic acceptability (DA, 4-point scale), subjective noise (SN, 3-point scale), presence of artifacts (PA, 4-point scale) and objective noise. The clinical significance of metallic hardware was determined by evaluating the impact of artifacts on radiological diagnosis according to the clinical indication and disease type. RESULTS Orthopedic metallic hardware was encountered in 4.97% of abdomino-pelvic CT scans (n = 174/3500), and artifacts related to the hardware in the region of clinical interest were identified in 82% (n = 144/174) of scans. The overall mean DA was 2.66 (n = 174), and it was severely limited (score < 2) in 32% of cases particularly affecting patients with bilateral hip implants (92.6%, n = 25/27). The artifacts due to hardware significantly limited diagnostic evaluation in 58.6% of cases (PA score ≥ 3), and the image noise was unacceptable in 71% of cases (SN score > 2) in the region of clinical interest. CONCLUSION Orthopedic metallic hardware is encountered in nearly 5% of abdomino-pelvic CT scans and causes significant image degradation limiting diagnostic evaluation in the region of clinical interest.
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Affiliation(s)
- Vinit Baliyan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Hamed Kordbacheh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Amirhossein Mozafarry
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University - Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Best Protocol for Combined Contrast-Enhanced Thoracic and Abdominal CT for Lung Cancer: A Single-Institution Randomized Crossover Clinical Trial. AJR Am J Roentgenol 2018; 210:1226-1234. [DOI: 10.2214/ajr.17.19185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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8
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Ben-Cohen A, Klang E, Kerpel A, Konen E, Amitai MM, Greenspan H. Fully convolutional network and sparsity-based dictionary learning for liver lesion detection in CT examinations. Neurocomputing 2018. [DOI: 10.1016/j.neucom.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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9
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Ben-Cohen A, Klang E, Diamant I, Rozendorn N, Raskin SP, Konen E, Amitai MM, Greenspan H. CT Image-based Decision Support System for Categorization of Liver Metastases Into Primary Cancer Sites: Initial Results. Acad Radiol 2017; 24:1501-1509. [PMID: 28778512 DOI: 10.1016/j.acra.2017.06.008] [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] [Received: 02/16/2017] [Revised: 03/31/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to provide decision support for the human expert, to categorize liver metastases into their primary cancer sites. Currently, once a liver metastasis is detected, the process of finding the primary site is challenging, time-consuming, and requires multiple examinations. The proposed system can support the human expert in localizing the search for the cancer source by prioritizing the examinations to probable cancer sites. MATERIALS AND METHODS The suggested method is a learning-based approach, using computed tomography (CT) data as the input source. Each metastasis is circumscribed by a radiologist in portal phase and in non-contrast CT images. Visual features are computed from these images, combined into feature vectors, and classified using support vector machine classification. A variety of different features were explored and tested. A leave-one-out cross-validation technique was conducted for classification evaluation. The methods were developed on a set of 50 lesion cases taken from 29 patients. RESULTS Experiments were conducted on a separate set of 142 lesion cases taken from 71 patients with four different primary sites. Multiclass categorization results (four classes) achieved low accuracy results. However, the proposed system was found to provide promising results of 83% and 99% for top-2 and top-3 classification tasks, respectively. Moreover, when compared to the experts' ability to distinguish the different metastases, the system shows improved results. CONCLUSIONS Automated systems, such as the one proposed, show promising new results and demonstrate new capabilities that, in the future, will be able to provide decision and treatment support for radiologists and oncologists, toward more efficient detection and treatment of cancer.
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Moghbel M, Mashohor S, Mahmud R, Saripan MIB. Automatic liver tumor segmentation on computed tomography for patient treatment planning and monitoring. EXCLI JOURNAL 2016; 15:406-23. [PMID: 27540353 PMCID: PMC4983804 DOI: 10.17179/excli2016-402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/22/2016] [Indexed: 12/25/2022]
Abstract
Segmentation of liver tumors from Computed Tomography (CT) and tumor burden analysis play an important role in the choice of therapeutic strategies for liver diseases and treatment monitoring. In this paper, a new segmentation method for liver tumors from contrast-enhanced CT imaging is proposed. As manual segmentation of tumors for liver treatment planning is both labor intensive and time-consuming, a highly accurate automatic tumor segmentation is desired. The proposed framework is fully automatic requiring no user interaction. The proposed segmentation evaluated on real-world clinical data from patients is based on a hybrid method integrating cuckoo optimization and fuzzy c-means algorithm with random walkers algorithm. The accuracy of the proposed method was validated using a clinical liver dataset containing one of the highest numbers of tumors utilized for liver tumor segmentation containing 127 tumors in total with further validation of the results by a consultant radiologist. The proposed method was able to achieve one of the highest accuracies reported in the literature for liver tumor segmentation compared to other segmentation methods with a mean overlap error of 22.78 % and dice similarity coefficient of 0.75 in 3Dircadb dataset and a mean overlap error of 15.61 % and dice similarity coefficient of 0.81 in MIDAS dataset. The proposed method was able to outperform most other tumor segmentation methods reported in the literature while representing an overlap error improvement of 6 % compared to one of the best performing automatic methods in the literature. The proposed framework was able to provide consistently accurate results considering the number of tumors and the variations in tumor contrast enhancements and tumor appearances while the tumor burden was estimated with a mean error of 0.84 % in 3Dircadb dataset.
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Affiliation(s)
- Mehrdad Moghbel
- Dept. of Computer & Communication Systems, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Syamsiah Mashohor
- Dept. of Computer & Communication Systems, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Rozi Mahmud
- Cancer Resource & Education Center, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - M Iqbal Bin Saripan
- Dept. of Computer & Communication Systems, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Kim J, Kim JH, Yoon SH, Choi WS, Kim YJ, Han JK, Choi BI. Feasibility of Using Volumetric Contrast-Enhanced Ultrasound with a 3-D Transducer to Evaluate Therapeutic Response after Targeted Therapy in Rabbit Hepatic VX2 Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3131-3139. [PMID: 26365926 DOI: 10.1016/j.ultrasmedbio.2015.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to assess the feasibility of using dynamic contrast-enhanced ultrasound (DCE-US) with a 3-D transducer to evaluate therapeutic responses to targeted therapy. Rabbits with hepatic VX2 carcinomas, divided into a treatment group (n = 22, 30 mg/kg/d sorafenib) and a control group (n = 13), were evaluated with DCE-US using 2-D and 3-D transducers and computed tomography (CT) perfusion imaging at baseline and 1 d after the first treatment. Perfusion parameters were collected, and correlations between parameters were analyzed. In the treatment group, both volumetric and 2-D DCE-US perfusion parameters, including peak intensity (33.2 ± 19.9 vs. 16.6 ± 10.7, 63.7 ± 20.0 vs. 30.1 ± 19.8), slope (15.3 ± 12.4 vs. 5.7 ± 4.5, 37.3 ± 20.4 vs. 15.7 ± 13.0) and area under the curve (AUC; 1004.1 ± 560.3 vs. 611.4 ± 421.1, 1332.2 ± 708.3 vs. 670.4 ± 388.3), had significantly decreased 1 d after the first treatment (p = 0.00). In the control group, 2-D DCE-US revealed that peak intensity, time to peak and slope had significantly changed (p < 0.05); however, volumetric DCE-US revealed that peak intensity, time-intensity AUC, AUC during wash-in and AUC during wash-out had significantly changed (p = 0.00). CT perfusion imaging parameters, including blood flow, blood volume and permeability of the capillary vessel surface, had significantly decreased in the treatment group (p = 0.00); however, in the control group, peak intensity and blood volume had significantly increased (p = 0.00). It is feasible to use DCE-US with a 3-D transducer to predict early therapeutic response after targeted therapy because perfusion parameters, including peak intensity, slope and AUC, significantly decreased, which is similar to the trend observed for 2-D DCE-US and CT perfusion imaging parameters.
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Affiliation(s)
- Jeehyun Kim
- Department of Molecular and Cell Biology, University of California at Berkeley, Berkeley, California, USA
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Young Jae Kim
- Department of Radiology, Soonchunhyang University Hospital, Youngsan-Ku, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Ben-Cohen A, Klang E, Diamant I, Rozendorn N, Amitai MM, Greenspan H. Automated method for detection and segmentation of liver metastatic lesions in follow-up CT examinations. J Med Imaging (Bellingham) 2015; 2:034502. [PMID: 27014712 DOI: 10.1117/1.jmi.2.3.034502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 07/06/2015] [Indexed: 11/14/2022] Open
Abstract
This paper presents a fully automated method for detection and segmentation of liver metastases in serial computed tomography (CT) examinations. Our method uses a given two-dimensional baseline segmentation mask for identifying the lesion location in the follow-up CT and locating surrounding tissues, using nonrigid image registration and template matching, in order to reduce the search area for segmentation. Adaptive region growing and mean-shift clustering are used to obtain the lesion segmentation. Our database contains 127 cases from the CT abdomen unit at Sheba Medical Center. Development of the methodology was conducted using 22 of the cases, and testing was conducted on the remaining 105 cases. Results show that 94 of the 105 lesions were detected, for an overall matching rate of 90% making the correct RECIST 1.1 assessment in 88% of the cases. The average Dice index was [Formula: see text], the average sensitivity was [Formula: see text], and the positive predictive value was [Formula: see text]. In 92% of the rated cases, the results were classified by the radiologists as acceptable or better. The segmentation performance, matching rate, and RECIST assessment results hence appear promising.
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Affiliation(s)
- Avi Ben-Cohen
- Tel Aviv University , Faculty of Engineering, Department of Biomedical Engineering, Medical Image Processing Laboratory, Tel Aviv 69978, Israel
| | - Eyal Klang
- Sheba Medical Center , Diagnostic Imaging Department, Abdominal Imaging Unit, Tel Hashomer 52621, Israel
| | - Idit Diamant
- Tel Aviv University , Faculty of Engineering, Department of Biomedical Engineering, Medical Image Processing Laboratory, Tel Aviv 69978, Israel
| | - Noa Rozendorn
- Sheba Medical Center , Diagnostic Imaging Department, Abdominal Imaging Unit, Tel Hashomer 52621, Israel
| | - Michal Marianne Amitai
- Sheba Medical Center , Diagnostic Imaging Department, Abdominal Imaging Unit, Tel Hashomer 52621, Israel
| | - Hayit Greenspan
- Tel Aviv University , Faculty of Engineering, Department of Biomedical Engineering, Medical Image Processing Laboratory, Tel Aviv 69978, Israel
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Toth DF, Töpker M, Mayerhöfer ME, Rubin GD, Furtner J, Asenbaum U, Karanikas G, Weber M, Czerny C, Herold CJ, Ringl H. Rapid detection of bone metastasis at thoracoabdominal CT: accuracy and efficiency of a new visualization algorithm. Radiology 2013; 270:825-33. [PMID: 24475821 DOI: 10.1148/radiol.13130789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively assess the use of a combination of cancellous bone reconstructions (CBR) and multiplanar reconstructions (MPRs) for the detection of bone metastases at thoracoabdominal computed tomography (CT) compared with the use of MPRs alone. MATERIALS AND METHODS The study was approved by the local institutional review board. Included were 156 consecutive patients with confirmed cancer who underwent a whole-body positron emission tomography (PET)/CT examination for clinical purposes (93 male and 63 female patients; mean age ± standard deviation, 59.8 years ± 14.9; range, 11-85 years). Only the CT images were processed with the CBR algorithm, which segments the bones and removes the cortical layer from the images. The PET images served as part of the reference standard. Images from 15 patients were used as a training set. Four radiologists independently evaluated images of half of the remaining 141 patients by using CBRs and MPRs together, and the other half by using MPRs only. Radiologists were blinded to patient names, and patient order was randomized. Results for detection rates and reporting time were recorded and compared with a standard of reference for each patient that was created by one senior radiologist and one nuclear medicine specialist by using all available CT and PET data, CBRs, and follow-up examinations. General estimation equations were used for statistical analysis. RESULTS There were 349 lesions found in 103 patients, with 203 classified as malignant. Each patient was assessed by two readers per method, leading to a total of 698 lesions. The detection rate for all bone lesions was 35% (247 of 698) for MPRs and 74% (520 of 698) when CBRs and MPRs were used together, which was significantly higher (P < .001). The average reading time decreased from 85 to 43 seconds (P < .001) when both reconstructions were used. CONCLUSION Advanced visualization of cancellous bone significantly increased the detection of bone metastases and reduced the time for interpretation.
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Affiliation(s)
- Daniel F Toth
- From the Departments of Radiology (D.F.T., M.T., M.E.M., J.F., U.A., M.W., C.C., C.J.H., H.R.) and Nuclear Medicine (G.K.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; and Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.)
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A radiologist's guide to treatment response criteria in oncologic imaging: anatomic imaging biomarkers. AJR Am J Roentgenol 2013; 201:237-45. [PMID: 23883205 DOI: 10.2214/ajr.12.9862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the imaging biomarkers of treatment response and provide an overview of anatomic imaging biomarkers. CONCLUSION Imaging biomarkers of treatment response have evolved into the primary endpoint of response in most phase 2 studies. Anatomic imaging biomarkers are applied to depict change in tumor size in response to treatment and are currently the most commonly applied method of treatment response evaluation.
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Linguraru MG, Richbourg WJ, Liu J, Watt JM, Pamulapati V, Wang S, Summers RM. Tumor burden analysis on computed tomography by automated liver and tumor segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2012; 31:1965-76. [PMID: 22893379 PMCID: PMC3924860 DOI: 10.1109/tmi.2012.2211887] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The paper presents the automated computation of hepatic tumor burden from abdominal computed tomography (CT) images of diseased populations with images with inconsistent enhancement. The automated segmentation of livers is addressed first. A novel 3-D affine invariant shape parameterization is employed to compare local shape across organs. By generating a regular sampling of the organ's surface, this parameterization can be effectively used to compare features of a set of closed 3-D surfaces point-to-point, while avoiding common problems with the parameterization of concave surfaces. From an initial segmentation of the livers, the areas of atypical local shape are determined using training sets. A geodesic active contour corrects locally the segmentations of the livers in abnormal images. Graph cuts segment the hepatic tumors using shape and enhancement constraints. Liver segmentation errors are reduced significantly and all tumors are detected. Finally, support vector machines and feature selection are employed to reduce the number of false tumor detections. The tumor detection true position fraction of 100% is achieved at 2.3 false positives/case and the tumor burden is estimated with 0.9% error. Results from the test data demonstrate the method's robustness to analyze livers from difficult clinical cases to allow the temporal monitoring of patients with hepatic cancer.
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Affiliation(s)
- Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC 20010, USA.
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Sosna J, Esses SJ, Yeframov N, Bernstine H, Sella T, Fraifeld S, Kruskal JB, Groshar D. Blind spots at oncological CT: lessons learned from PET/CT. Cancer Imaging 2012; 12:259-68. [PMID: 22935164 PMCID: PMC3458785 DOI: 10.1102/1470-7330.2012.0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Improved accuracy in oncological computed tomography (CT) could lead to a decrease in morbidity and improved survival for oncology patients. Visualization of metabolic activity using the glucose analogue [18F]fluorodeoxyglucose (FDG) in combination with the high anatomic resolution of CT in an integrated positron emission tomography (PET)/CT examination has the highest sensitivity and specificity for the detection of primary and metastatic lesions. However, PET/CT costs are high and patient access is limited; thus CT remains the primary imaging modality in oncology patients. We have noted that subtle lesions are more easily detected on CT by radiologists with PET/CT experience. We aimed to provide a brief review of the literature with comparisons of multi-detector computed tomography (MDCT) and PET/CT in primary and metastatic disease with an emphasis on findings that may be overlooked on MDCT in cancer of the breast, lung, colon, and ovaries, and in melanoma, as well as thrombosis in oncology patients. We further reviewed our experience for illustrative comparisons of PET/CT and MDCT studies. Experience in interpreting conventional CT scans alongside PET/CT can help the reader develop an appreciation for the subtle appearance of some lesions on CT that might otherwise be missed. This could improve detection rates, reduce errors, and improve patient management.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Dynamic Contrast-Enhanced Computed Tomography Imaging Biomarkers Correlated With Immunohistochemistry for Monitoring the Effects of Sorafenib on Experimental Prostate Carcinomas. Invest Radiol 2012; 47:49-57. [DOI: 10.1097/rli.0b013e3182300fe4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ha TK, Choi YY, Song SY, Kwon SJ. F18-fluorodeoxyglucose-positron emission tomography and computed tomography is not accurate in preoperative staging of gastric cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:104-10. [PMID: 22066108 PMCID: PMC3204564 DOI: 10.4174/jkss.2011.81.2.104] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 04/27/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the clinical benefits of F18-fluorodeoxyglucose-positron emission tomography and computed tomography ((18)F-FDG-PET/CT) over multi-detector row CT (MDCT) in preoperative staging of gastric cancer. METHODS FDG-PET/CT and MDCT were performed on 78 patients with gastric cancer pathologically diagnosed by endoscopy. The accuracy of radiologic staging retrospectively was compared to pathologic result after curative resection. RESULTS Primary tumors were detected in 51 (65.4%) patients with (18)F-FDG-PET/CT, and 47 (60.3%) patients with MDCT. Regarding detection of lymph node metastasis, the sensitivity of FDG-PET/CT was 51.5% with an accuracy of 71.8%, whereas those of MDCT were 69.7% and 69.2%, respectively. The sensitivity of (18)F-FDG-PET/CT for a primary tumor with signet ring cell carcinoma was lower than that of (18)F-FDG-PET/CT for a primary tumor with non-signet ring cell carcinoma (35.3% vs. 73.8%, P < 0.01). CONCLUSION Due to its low sensitivity, (18)F-FDG-PET/CT alone shows no definite clinical benefit for prediction of lymph node metastasis in preoperative staging of gastric cancer.
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Affiliation(s)
- Tae Kyung Ha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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Abstract
Quantification of tumor burden and assessment of changes in tumor size after chemotherapy are commonly performed to evaluate treatment response in oncology trials. Validation and adoption of different criteria have been attempted in the past to achieve uniformity in scanning techniques and measurement metrics so that comparison of different oncological trials is feasible. Response assessment of solid tumors is usually consisted of either bidimensional (World Health Organization criteria) or unidimensional (Response Evaluation Criteria in Solid Tumors [RECIST] guidelines) measurement of tumors before and after chemotherapy. RECIST 1.1 criteria have been recently published. In this article, we try to provide a comprehensive review of the tumor response evaluation guidelines that were recently updated in attempts to overcome limitations of the previous criteria as well as incorporate recent advances in imaging techniques.
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Morphological analysis of pancreatic adenocarcinoma on multidetector row computed tomography: implications for treatment response evaluation. Pancreas 2009; 38:799-803. [PMID: 19531968 DOI: 10.1097/mpa.0b013e3181ac7511] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Response Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape of tumors. Morphology of pancreatic adenocarcinoma (PAC) on multidetector row computed tomography was investigated to evaluate the applicability of RECIST guidelines. METHODS Study population comprised 16 patients with histologically confirmed localized PAC enrolled in a phase II clinical trial of chemoradiation. Pancreatic adenocarcinomas were segmented on baseline and follow-up multidetector row computed tomography with commercially available software. Tumor volumes (mL), RECIST diameter (mm), volume equivalent sphere diameter (VESD, mm), maximum 3-dimensional diameter (M3DD, mm), and elongation value were obtained. RECIST diameter, VESD and M3DD of the tumors at baseline and follow-up were compared to determine differences. Elongation values were analyzed. The significance level was set at P less than 0.05. RESULTS Mean volume, RECIST diameter, VESD, M3DD, and elongation for baseline versus follow-up studies were 23.12 mL versus 19.43 mL (P > 0.05), 41.86 mm versus 39.35 mm (P > 0.05), 33.14 mm versus 32.1 mm (P > 0.05), 51.76 mm versus 51.73 mm (P > 0.05), and 0.67 versus 0.76 (P > 0.05), respectively. There was a significant difference at baseline and follow-up between RECIST diameter, VESD, and M3DD (P < 0.05, in all instances). CONCLUSIONS Our results suggest that PACs are not spherical in shape. Evaluation of PAC treatment response based on RECIST guidelines may not be accurate.
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Ray S, Hagge R, Gillen M, Cerejo M, Shakeri S, Beckett L, Greasby T, Badawi RD. Comparison of two-dimensional and three-dimensional iterative watershed segmentation methods in hepatic tumor volumetrics. Med Phys 2009; 35:5869-81. [PMID: 19175143 DOI: 10.1118/1.3013561] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this work the authors compare the accuracy of two-dimensional (2D) and three-dimensional (3D) implementations of a computer-aided image segmentation method to that of physician observers (using manual outlining) for volume measurements of liver tumors visualized with diagnostic contrast-enhanced and PET/CT-based non-contrast-enhanced (PET-CT) CT scans. The method assessed is a hybridization of the watershed method using observer-set markers with a gradient vector flow approach. This method is known as the iterative watershed segmentation (IWS) method. Initial assessments are performed using software phantoms that model a range of tumor shapes, noise levels, and noise qualities. IWS is then applied to CT image sets of patients with identified hepatic tumors and compared to the physicians' manual outlines on the same tumors. The repeatability of the physicians' measurements is also assessed. IWS utilizes multiple levels of segmentation performed with the use of "fuzzy regions" that could be considered part of a selected tumor. In phantom studies, the outermost volume outline for level 1 (called level 1_1 consisting of inner region plus fuzzy region) was generally the most accurate. For in vivo studies, the level 1_1 and the second outermost outline for level 2 (called level 2_2 consisting of inner region plus two fuzzy regions) typically had the smallest percent error values when compared to physician observer volume estimates. Our data indicate that allowing the operator to choose the "best result" level iteration outline from all generated outlines would likely give the more accurate volume for a given tumor rather than automatically choosing a particular level iteration outline. The preliminary in vivo results indicate that 2D-IWS is likely to be more accurate than 3D-IWS in relation to the observer volume estimates.
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Affiliation(s)
- Shonket Ray
- Department of Biomedical Engineering, University of California, Davis, California 95616, USA.
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Siewert B, Sosna J, McNamara A, Raptopoulos V, Kruskal JB. Missed lesions at abdominal oncologic CT: lessons learned from quality assurance. Radiographics 2008; 28:623-38. [PMID: 18480475 DOI: 10.1148/rg.283075188] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The evaluation of oncology patients represents a substantial volume of the workload in many radiology departments. Interpreting the results of oncologic examinations is often challenging and time-consuming because many abnormalities are identified in the same examination and must be compared with the findings in previous studies. However, errors in the interpretation of oncologic computed tomographic (CT) scans can have significant effects on patient care. These effects may range from withdrawal from a clinical trial or cessation of therapy to repeat CT examination because of a technically inadequate study, CT-guided biopsy of newly identified lesions, or initiation of therapy for previously unrecognized lesions. A root cause analysis of reported errors in the interpretation of abdominal and pelvic CT scans led to the identification of potential pitfalls that may be encountered when interpreting oncologic CT scans and factors that contribute to these errors. Awareness of the spectrum of factors that contribute to misinterpretation of CT scans in oncology patients may improve the performance of the individual radiologist and ultimately translate into improved patient care.
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Affiliation(s)
- Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Keil S, Behrendt FF, Stanzel S, Sühling M, Koch A, Bubenzer J, Mühlenbruch G, Mahnken AH, Günther RW, Das M. Semi-automated measurement of hyperdense, hypodense and heterogeneous hepatic metastasis on standard MDCT slices. Comparison of semi-automated and manual measurement of RECIST and WHO criteria. Eur Radiol 2008; 18:2456-65. [DOI: 10.1007/s00330-008-1050-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 04/07/2008] [Accepted: 04/19/2008] [Indexed: 11/30/2022]
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Abstract
The wide availability of multidetector row computed tomography (MDCT) continues to change the way we manage patients. Once the domain of the specialist paediatric centre, imaging of the paediatric thorax now routinely occurs in many general hospitals. The paediatric respiratory and radiology teams should therefore be familiar with this technique. This review examines the indications for MDCT, the different types of scan, the use of low-dose protocols for paediatric imaging and appropriate reconstruction techniques. Patient preparation, with particular respect to sedation and optimal contrast bolus delivery, is also addressed.
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Affiliation(s)
- Navin Ramachandran
- Department of Imaging, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK.
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Hauth EAM, Stattaus J, Forsting M. [Comparison of unidimensional and bidimensional measurement to assess therapeutic response in the treatment of solid tumors]. Radiologe 2008; 47:628, 630-4. [PMID: 16440191 DOI: 10.1007/s00117-005-1329-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE In this prospective study we applied both the bidimensional WHO method and the unidimensional RECIST method in treatment follow-up of solid tumors. MATERIAL AND METHODS Computed tomography was performed in 80 patients before and after one chemotherapy cycle: 20 patients each with lung cancer, lymphoma, and metastases of the lung and the liver. In 207 tumor lesions unidimensional and bidimensional measurements were performed: 36 lesions of lung cancer, 51 lesions of lymphoma, and 60 lesions of metastases of the lung and the liver, respectively. We assigned the results to the corresponding response categories. RESULTS For tumor assessment, the kappa statistic produced a high agreement of 0.94 between the two methods for assessment of therapeutic response. CONCLUSION The unidimensional RECIST measurement is easier to perform in order to assess tumor size during treatment follow-up in oncologic radiology.
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Affiliation(s)
- E A M Hauth
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum, Essen.
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18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging 2007; 35:484-92. [PMID: 17952435 DOI: 10.1007/s00259-007-0533-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Uterine carcinosarcomas clinically confined to the uterus usually harbor occult metastases. We conducted a pilot study to evaluate the value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in uterine carcinosarcoma. METHODS Patients with histologically confirmed uterine carcinosarcoma were enrolled. Abdominal and pelvic magnetic resonance imaging (MRI)/whole-body computed tomography (CT) scan, and whole-body (18)F-FDG PET or PET/CT were undertaken for primary staging, evaluating response, and restaging/post-therapy surveillance. The clinical impact of (18)F-FDG PET was determined on a scan basis. RESULTS A total of 19 patients were recruited and 31 (18)F-FDG PET scans (including 8 scans performed on a PET/CT scanner) were performed. Positive impacts of scans were found in 36.8% (7/19) for primary staging, 66.7% (2/3) for monitoring response, and 11.1% (1/9) for restaging/post-therapy surveillance. PET excluded falsely inoperable disease defined by MRI in two patients. Aggressive treatment applying to three patients with PET-defined resectable stage IVB disease seemed futile. Two patients died of disease shortly after salvage therapy restaged by PET. With PET monitoring, one stage IVB patient treated by targeted therapy only was alive with good performance. Using PET did not lead to improvement of overall survival of this series compared with the historical control (n = 35) (P = 0.779). CONCLUSIONS The preliminary results suggest that (18)F-FDG PET is beneficial in excluding falsely inoperable disease for curative therapy and in making a decision on palliation for better quality of life instead of aggressive treatment under the guidance of PET. PET seems to have limited value in post-therapy surveillance or restaging after failure.
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King AD, Zee B, Yuen EHY, Leung SF, Yeung DKW, Ma BB, Wong JKT, Kam MKM, Ahuja AT, Chan ATC. Nasopharyngeal Cancers: Which Method Should be Used to Measure these Irregularly Shaped Tumors on Cross-Sectional Imaging? Int J Radiat Oncol Biol Phys 2007; 69:148-54. [PMID: 17513065 DOI: 10.1016/j.ijrobp.2007.02.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 02/13/2007] [Accepted: 02/15/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether the standard techniques of measuring tumor size and change in size after treatment could be applied to the measurement of nasopharyngeal cancers, which are often irregular in shape. METHODS AND MATERIALS The standard measurements of bidimensional (BDM) (World Health Organization criteria) and unidimensional (UDM) (Response Evaluation Criteria in Solid Tumors [RECIST] criteria), together with the maximum depth of the tumor perpendicular to the pharyngeal wall (DM), were acquired from axial magnetic resonance images of primary nasopharyngeal carcinoma in 44 patients at diagnosis and in 29 of these patients after treatment. Tumor volume measurements (VM), acquired from the summation of areas from the axial magnetic resonance images, were used as the reference standard. RESULTS There was a significant association between VM and BDM with respect to tumor size at diagnosis (p = 0.002), absolute change in tumor size after treatment (p < 0.001), and percentage change in tumor size after treatment (p = 0.044), but not between VM and UDM. There was also a significant association between VM and DM with respect to percentage change in tumor size after treatment (p = <0.0001) but not absolute change (p = 0.222). CONCLUSION When using simple measurements to assess irregularly shaped nasopharyngeal cancers, the BDM should be used to measure size at diagnosis and the BDM and percentage change in size with treatment. Unidimensional measurement does not reflect size or change in size, and therefore the RECIST criteria may not be applicable to all tumor shapes. The use of DM requires further evaluation.
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Affiliation(s)
- Ann D King
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR., China.
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Veit-Haibach P, Antoch G, Beyer T, Stergar H, Schleucher R, Hauth EAM, Bockisch A. FDG-PET/CT in restaging of patients with recurrent breast cancer: possible impact on staging and therapy. Br J Radiol 2007; 80:508-15. [PMID: 17537758 DOI: 10.1259/bjr/17395663] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We aimed to compare the value of combined positron emission tomography (PET)/CT, PET+CT (viewed side by side), CT alone and PET alone concerning the rTNM stage and influence on therapy in patients with recurrent breast cancer. 44 patients with suspicion of recurrent breast cancer underwent whole-body [18F]-2-fluoro-2-deoxy-d-glucose (FDG)-PET/CT. Images of combined PET/CT, PET+CT, PET alone and CT alone were evaluated by four blinded reader teams. Diagnostic accuracies and influence on therapy were compared. Histology and a mean clinical follow up of 456 days served as the standard of reference. Differences between the staging procedures were tested for statistical significance by McNemar's test. Overall TNM tumour stage was correctly determined in 40/44 patients with PET/CT, in 38/44 with PET+CT, in 36/44 with PET alone and in 36/44 patients with CT alone. No statistically significant difference was detected between all tested imaging modalities. PET/CT changed the therapy in two patients compared with PET+CT, in four patients compared with PET alone and in five patients compared with CT alone. Combined PET/CT appeared to be more accurate in assessing the rTNM and showed a moderate impact on therapy over PET and CT. Minor improvements were noted when compared with PET+CT. Experienced readers might therefore be able to provide accurate staging results for further therapy from separately acquired studies.
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Affiliation(s)
- P Veit-Haibach
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
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Chung HH, Jo H, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, Kang SB, Lee HP. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol 2007; 104:529-34. [PMID: 17049971 DOI: 10.1016/j.ygyno.2006.09.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/01/2006] [Accepted: 09/07/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the value and clinical impact of integrated PET/CT using (18)F-FDG in the diagnosis and management of women with suspected cervical cancer recurrence. METHODS Fifty-two patients with cervical cancer with suspected recurrence because of clinical, cytological, biochemical and radiological findings were retrospectively evaluated. A final diagnosis of recurrence was confirmed by histologic tissue biopsy or by further clinical or radiological evidence. The clinical impact of information provided by PET/CT on patient management was assessed on the basis of clinical follow-up data concerning further diagnostic or therapeutic approach. RESULTS Twenty-eight of 32 positive PET/CT scans (87.5%) were proven to have recurrent disease. Seventeen of 20 negative PET/CT scans (85.0%) had no evidence of disease. The sensitivity, specificity, and accuracy of PET/CT for detecting recurrence were 90.3%, 81.0%, and 86.5% respectively. PET/CT changed the management of 12 patients (23.1%) by changing treatment plan (5 patients), by initiating unplanned treatment strategy (4 patients), or by obviating the need for planned diagnostic procedures (3 patients). Median duration after performing PET/CT and last follow-up was 12 (range: 6-27) months, and the 2-year disease-free survival rate of patients with negative PET/CT scan for recurrence was significantly better than that of patients with positive PET/CT (85.0% vs. 10.9%, P=0002). CONCLUSIONS In patients with a suspected recurrence of cervical cancer, integrated PET/CT using (18)F-FDG provides good anatomic and functional localization of suspicious lesions, and the better diagnostic interpretation has an impact not only on clinical management and treatment planning of patients, but also on disease-free survival.
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Affiliation(s)
- Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea
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Three-dimensional and Four-dimensional Ultrasound: Techniques and Abdominal Applications. J Med Ultrasound 2007. [DOI: 10.1016/s0929-6441(08)60040-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Deglint HJ, Rangayyan RM, Ayres FJ, Boag GS, Zuffo MK. Three-Dimensional Segmentation of the Tumor in Computed Tomographic Images of Neuroblastoma. J Digit Imaging 2006. [DOI: 10.1007/10278-006-0769-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gorospe Sarasúa L, Echeveste Aizpurúa J, Raman S. Tomografía por emisión de positrones/tomografía computarizada: artefactos y pitfalls en pacientes con cáncer. RADIOLOGIA 2006; 48:189-204. [PMID: 17058646 DOI: 10.1016/s0033-8338(06)73156-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnostic accuracy and correct initial staging (or restaging) are fundamental in the management of oncological patients and can directly influence therapeutic decisions. The combination of positron-emission tomography (PET) and computed tomography (CT) in a single scanner (PET/TC) represents an important achievement in the fields of oncology, nuclear medicine, and radiology. These scanners allow morphologic images (obtained by CT) to be fused and correlated with metabolic images (obtained by PET) to a high degree of accuracy. In addition to an understanding of the physiopathology of cancer and the behavior of the different types of neoplasms, the correct interpretation of PET/CT images requires in-depth knowledge of the physiological distribution of the F-18 fluorodeoxyglucose molecule (FDG, currently the most widely used marker in oncology), of the frequent physiological variations in its distribution, and of the possible causes of non-malignant pathological FDG uptake. Furthermore, the use of CT data to correct attenuation and reconstruct PET images in PET/CT scanners can generate some characteristic artifacts specific to this new diagnostic tool, and these can lead to misinterpretation with potential therapeutic implications. This article reviews and illustrates some of the most common artifacts and pitfalls that can appear in PET/CT studies. The detection and correct interpretation of these findings are essential for the appropriate management of oncologic patients.
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Gorospe L, Raman S, Echeveste J, Avril N, Herrero Y, Herna Ndez S. Whole-body PET/CT: spectrum of physiological variants, artifacts and interpretative pitfalls in cancer patients. Nucl Med Commun 2006; 26:671-87. [PMID: 16000985 DOI: 10.1097/01.mnm.0000171779.65284.eb] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Accurate diagnosis and staging in oncology is essential in the evaluation of cancer for optimal patient outcome. Conventional imaging techniques, such as computed tomography (CT), rely basically on morphological changes for tumour detection. Clinical experience, however, shows that morphological criteria may be misleading and may not always allow differentiation between benign and malignant lesions. Positron emission tomography (PET) with [F]fluorodeoxyglucose (FDG) is rapidly gaining a critical role in the clinical evaluation of patients with cancer. However, PET lacks anatomical landmarks for topographic orientation, and identification of abnormal glucose metabolic activity in regions close to organs with variable physiological FDG uptake can be difficult. To overcome these difficulties, a combined PET/CT scanner that acquires both functional (PET) and CT images has been recently developed. Proper interpretation of PET (and PET/CT) images requires a thorough understanding of the normal physiological distribution of FDG in the body, along with a knowledge of frequently encountered physiological variations in FDG distribution, and recognition of non-malignant causes of FDG uptake that can be confused with a malignant neoplasm. In addition, because of the utilization of the CT transmission information for the correction of the attenuation of the PET emission data (and for the reconstruction of the PET images), some artifacts may be generated. As a consequence, CT based attenuation correction of PET images may result in erroneous PET/CT interpretations. The aim of this extensively illustrated paper is to demonstrate several potential pitfalls encountered during the interpretation of PET/CT images so that radiologists can avoid false positive diagnoses and recognize inherently non-specific findings on PET/CT images obtained for oncological diagnosis.
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Affiliation(s)
- Luis Gorospe
- Department of Radiology, La Paz University Hospital, Madrid, Spain.
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Farraher SW, Jara H, Chang KJ, Hou A, Soto JA. Liver and Spleen Volumetry with Quantitative MR Imaging and Dual-Space Clustering Segmentation. Radiology 2005; 237:322-8. [PMID: 16126927 DOI: 10.1148/radiol.2371041416] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this HIPAA-compliant, institutional review board-approved study was to assess the liver and spleen volumes calculated by using a semiautomated dual-space clustering segmentation technique, as compared with the volumes calculated by using the manual contour-tracing method. The quantitative magnetic resonance (MR) imaging data used as input were computed from images acquired by using a mixed fast spin-echo pulse sequence that was implemented with respiratory triggering. Linear regression analysis was used to assess agreement regarding the volumes calculated by using both segmentation techniques. There was strong agreement regarding the regression parameters for the liver (r = 0.98, P < .001) and the spleen (r = 0.99, P < .001) and the mean percentage volume differences for the liver (1.2%) and the spleen (0.9%). The mean segmentation time per patient was significantly shorter with use of the dual-space clustering method (P < .001).
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Affiliation(s)
- Steven W Farraher
- Department of Radiology, Boston Medical Center and Boston University School of Medicine, 88 E Newton St, Radiology Suite, Second Floor, Boston, MA 02118, USA.
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Abstract
Malignant pleural mesothelioma (MPM) is a seemingly uncommon tumor whose incidence has in fact increased steadily and progressively over the last 30 years. Indeed, an actual "epidemic" is expected in Europe over the next 20 years. Despite unquestionable improvement in the diagnostic methods at our disposal and the availability of new treatment strategies, the prognosis of MPM patients remains dramatically poor (12 to 18 months' median survival from diagnosis), although exceptional cases of long-survivors are reported in all literature series. The current review will cover the dramatic improvements in the treatment of this rare disease that have been recently achieved, as well as the promise that new, molecular-targeted therapies, such as bortezomid, mTOR ( m ammalian t arget o f r apamycin) inhibitors, and Met inhibitors, seem to offer for the next few years. With pemetrexed we now have a drug that is able to impact patient survival. Together with the newer drugs, rapidly emerging from the laboratory to be applied in the clinic, we have the hope of making further advances in the struggle against this disease.
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Ishimori T, Tatsumi M, Wahl RL. Tumor response assessment is more robust with sequential CT scanning than external caliper measurements. Acad Radiol 2005; 12:776-81. [PMID: 15935976 DOI: 10.1016/j.acra.2005.03.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 03/15/2005] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Measurements of tumor size are important in assessing response to cancer therapies. To date, preclinical studies of drug development have relied on direct caliper-based measurements of tumor size. We investigated the feasibility of using a human positron emission tomographic (PET)/computed tomographic (CT) scanner to assess tumor size before and after chemotherapy and compared this approach with caliper measurements. MATERIALS AND METHODS Fourteen rats with rat mammary tumor underwent high-resolution CT using a PET/CT scanner before and after chemotherapy, and tumor volumes were measured independently by two observers using calipers and CT images. RESULTS Tumor response could be detected after 1 day of treatment by means of CT imaging, but was not significant until 2 days or later by means of caliper measures because of their greater variability. Independent measurements of tumor size correlated well with one another by means of CT, but correlated less by means of calipers. CONCLUSION Tumor size measurements by means of CT from PET/CT were more reliable than caliper measurements because of their smaller variance, allowing earlier assessment of response. It is suggested that CT imaging-based methods of assessing tumor response replace traditional caliper-based measurements, much as CT has become a standard for assessing tumor response in humans.
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Affiliation(s)
- Takayoshi Ishimori
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 N Caroline Street, Room 3223A, Baltimore, MD 21287, USA
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Shankar S, vanSonnenberg E, Desai J, Dipiro PJ, Van Den Abbeele A, Demetri GD. Gastrointestinal stromal tumor: new nodule-within-a-mass pattern of recurrence after partial response to imatinib mesylate. Radiology 2005; 235:892-8. [PMID: 15833985 DOI: 10.1148/radiol.2353040332] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate a new pattern of tumor recurrence observed at imaging in patients with metastatic gastrointestinal stromal tumor (GIST) after initial partial response to imatinib mesylate. MATERIALS AND METHODS Ninety-two patients with metastatic GIST who underwent treatment in a clinical trial with oral imatinib mesylate were followed up for 29 months. An institutional review board-approved protocol was used. The study complied with the Health Insurance Portability and Accountability Act, and written informed consent was obtained from all patients. Images of the chest, abdomen, and pelvis, acquired with computed tomography (CT), positron emission tomography (PET), and, in some cases, magnetic resonance imaging, were evaluated for treatment response and disease recurrence. Thirty-nine patients (29 men, 10 women; age range, 18-84 years; mean, 49.2 years) had recurrent disease after an initial variable period of response (range, 2-24 months; median, 14.4 months). Initial response was determined with findings of decreased uptake of fluorine 18 fluorodeoxyglucose at PET, shrinkage of tumor, and decreased attenuation at CT. Images were evaluated for disease recurrence by two experienced radiologists who were blinded to each other's interpretation but not to clinical details. Final reading was performed by consensus. RESULTS A nodule within a mass was seen in 21 of 39 patients (in intrahepatic tumor [n = 8], extrahepatic tumor [n = 10], or both intra- and extrahepatic tumors [n = 3]) and was the first sign of disease progression in 17 of 21 patients. Other patterns of recurrence included new site of disease (n = 7), regrowth of preexistent lesion (n = 20), and mixed (more than one) pattern (n = 9). Disease progression was verified at needle biopsy (n = 16), follow-up imaging (n = 14), and/or surgical resection (n = 9). CONCLUSION A nodule within a mass is an important sign of recurrent GIST, but measurements of overall tumor size may not enable detection of such nodules.
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Affiliation(s)
- Sridhar Shankar
- Department of Radiology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass, USA.
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Hassan M, Little RF, Vogel A, Aleman K, Wyvill K, Yarchoan R, Gandjbakhche AH. Quantitative assessment of tumor vasculature and response to therapy in kaposi's sarcoma using functional noninvasive imaging. Technol Cancer Res Treat 2005; 3:451-7. [PMID: 15453810 DOI: 10.1177/153303460400300506] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two noninvasive methods, thermography and laser Doppler imaging (LDI), were assessed for their ability to quantitatively assess parameters of vascularity in lesions of HIV-associated Kaposi's sarcoma (KS). Thermography and LDI images of a representative KS lesion were recorded in 16 patients and compared to normal skin either adjacent to the lesion or on the contralateral side. Eleven of the 16 patients had greater than 0.5 degrees C increased temperature and 12 of the 16 patients had increased flux (measured by LDI) as compared to normal skin. There was a strong correlation between these two parameters (R = 0.81, p < 0.001). In ten patients, measurements were obtained prior to therapy and after receiving a regimen of liposomal doxorubicin and interleukin-12. After 18 weeks of therapy, temperature and blood flow of the lesions were significantly reduced from the baseline (p = 0.004 and 0.002 respectively). These techniques hold promise to assess physiologic parameters in KS lesions and their changes with therapy.
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Affiliation(s)
- M Hassan
- Laboratory of Integrative and Medical Biophysics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
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Grisaru D, Almog B, Levine C, Metser U, Fishman A, Lerman H, Lessing JB, Even-Sapir E. The diagnostic accuracy of 18F-Fluorodeoxyglucose PET/CT in patients with gynecological malignancies. Gynecol Oncol 2004; 94:680-4. [PMID: 15350358 DOI: 10.1016/j.ygyno.2004.05.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of integrated positron emission tomography/computerized tomography (PET/CT) in patients with gynecological cancer. METHODS Fifty-three consecutive patients with gynecologic malignancies were included. The patients were referred to our tertiary center to undergo a PET/CT scan. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT were compared with the conventional imaging assessments [CT, magnetic resonance imaging (MRI) and ultrasonography (US)]. RESULTS All tested values were higher for PET/CT than those for the conventional modalities: sensitivity 0.97 vs. 0.40, specificity 0.94 vs. 0.65, PPV 0.97 vs. 0.70, and NPV 0.94 vs. 0.34, respectively. CONCLUSION PET/CT is a reliable modality for assessing the extent of disease in patients with gynecologic malignancy.
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Affiliation(s)
- Dan Grisaru
- Department of Obstetrics and Gynecology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Ayres FJ, Zuffo MK, Rangayyan RM, Boag GS, Filho VO, Valente M. Estimation of the tissue composition of the tumour mass in neuroblastoma using segmented CT images. Med Biol Eng Comput 2004; 42:366-77. [PMID: 15191083 DOI: 10.1007/bf02344713] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neuroblastoma is the most common extra-cranial, solid, malignant tumour in children. Advances in radiology have made possible the detection and staging of the disease. Nevertheless, there is no method available at present that can go beyond detection and qualitative analysis, towards quantitative assessment of the tissue composition of the primary tumour mass in neuroblastoma. Such quantitative analysis could provide important information and serve as a decision-support tool to the radiologist and the oncologist, result in better treatment and follow-up and even lead to the avoidance of delayed surgery. The problem investigated was the improvement of the analysis of the primary tumour mass, in patients with neuroblastoma, using X-ray computed tomography (CT) images. A methodology was proposed for the estimation of the tissue content of the mass: it comprised a Gaussian mixture model for estimation, from segmented CT images, of the tissue composition of the primary tumour. To demonstrate the potential of the method, the results are presented of its application to ten CT examinations of four patients. The method provides quantitative information, and it was observed that the tumour in one of the patients reduced from 523 cm3 to 81 cm3 in volume, with an increase in calcification from about 20% to about 88% of the tumour volume, in response to chemotherapy over a period of five months. Results indicate that the proposed technique may be of considerable value in assessing the response to therapy of patients with neuroblastoma.
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Affiliation(s)
- F J Ayres
- Department of Electrical & Computer Engineering, University of Calgary, Calgary, Alberta, Canada
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Kumbasar B, Kamel IR, Tekes A, Eng J, Fishman EK, Wahl RL. Imaging of neuroendocrine tumors: accuracy of helical CT versus SRS. ACTA ACUST UNITED AC 2004; 29:696-702. [PMID: 15162235 DOI: 10.1007/s00261-003-0162-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Accepted: 01/14/2004] [Indexed: 12/14/2022]
Abstract
BACKGROUND We retrospectively compared the accuracy of somatostatin receptor scintigraphy (SRS) with that of helical computed tomography (CT) in the detection and localization of primary and metastatic neuroendocrine tumors. METHODS A medical record search identified 27 patients with known or clinically suspected neuroendocrine tumors who underwent helical CT and SRS within 3 months of one another at our institution. CT images were evaluated retrospectively by two blinded radiologists who used consensus reading. Images were evaluated for the presence or absence of primary tumor and hepatic and extrahepatic metastases. CT results were compared with the SRS report as interpreted by the nuclear medicine physicians. The results of the surgical, clinical follow-up, and pathologic findings were considered as the gold standard. Sensitivity, specificity, and accuracy were calculated for both imaging techniques. In addition, McNemar analysis was performed to determine statistically significant differences between CT and SRS. RESULTS Helical CT was more sensitive than SRS in the detection of extrahepatic metastases, and the difference between the two imaging modalities was statistically significant (p = 0.0312) as determined by the McNemar chi-square test. However, the difference between CT and SRS in detecting primary neuroendocrine tumors, hepatic metastasis, and combined hepatic and extrahepatic metastasis was not statistically significant (p = 0.625, 1.000, and 1.000, respectively). CONCLUSION Helical CT and SRS have similar sensitivity, specificity, and accuracy in detecting primary neuroendocrine tumor and hepatic metastasis. However, helical CT appears to be more sensitive in detecting extrahepatic metastasis from primary neuroendocrine tumors.
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Affiliation(s)
- B Kumbasar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287, USA
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Abstract
Liver imaging in patients with a history of known or suspected malignancy is important because the liver is a common site of metastatic spread, especially tumours from the colon, lung, pancreas and stomach, and in patients with chronic liver disease who are at risk for developing hepatocellular carcinoma. Since benign liver lesions are common, liver-imaging strategies should incorporate liver lesion detection and characterisation. Survey examination in patients with a known extra-hepatic malignancy to exclude the presence of hepatic and extra-hepatic involvement is normally undertaken with a contrast-enhanced computed tomography examination. When patients with hepatic metastases are being considered for metastasesectomy, they undergo a staging examination with contrast-enhanced magnetic resonance imaging (MRI) using tissue-specific contrast agents. Patients with chronic liver disease who are at risk for hepatocellular carcinoma undergo periodic liver screening for focal liver detection, usually with ultrasonography (US) with MRI being used when US is equivocal. Finally, contrast-enhanced MRI with extra-cellular gadolinium chelates is preferred for characterisation of indeterminate hepatic masses with liver biopsy used when tissue diagnosis is needed.
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Affiliation(s)
- Maria Raquel Oliva
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 270 55 Fruit Street, Boston, MA 02114, USA
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Antoch G, Kaiser GM, Mueller AB, Metz KA, Zhang H, Kuehl H, Westermann S, Broelsch CE, Mueller SP, Bockisch A, Debatin JF. Intraoperative Radiation Therapy in Liver Tissue in a Pig Model: Monitoring with Dual-Modality PET/CT. Radiology 2004; 230:753-60. [PMID: 14764888 DOI: 10.1148/radiol.2303021183] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess, in a pig model, the value of dual-modality positron emission tomography (PET)/computed tomography (CT) for monitoring radiation therapy. MATERIALS AND METHODS Central bile duct resection followed by creation of a biliodigestive anastomosis was performed in nine pigs. Six of these pigs were also treated with intraoperative radiation therapy (IORT) (20 Gy) in the area of the anastomosis. Two, 4, and 8 weeks postoperatively, contrast material-enhanced fluorine 18 fluorodeoxyglucose (FDG) PET/CT of the liver was performed in all of the animals. The radioactive tracer concentration in the region of the anastomosis was quantified, and the values were compared intraindividually with the values at the liver periphery. Histologic evaluation of the liver was performed 8 weeks postoperatively. The PET/CT images were assessed for changes in liver volume and bile duct diameter over time. RESULTS In all nine pigs, the region of the anastomosis could be clearly defined on the fused PET/CT images. PET/CT revealed a decreased concentration of FDG in the irradiated field 2 and 4 weeks after IORT. At 8 weeks, however, the distribution of the tracer in the irradiated pigs did not differ from that in the nonirradiated pigs. Homogeneous tracer uptake in all liver regions was observed in the nonirradiated animals. The CT images showed an increase in liver volume in all pigs and bile duct dilatation that increased over time in the irradiated pigs. CONCLUSION The morphologic and functional changes due to IORT in liver tissue can be accurately monitored with dual-modality PET/CT. By enabling the integration of functional and morphologic data, PET/CT may have an important role in monitoring radiation treatment.
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MESH Headings
- Anastomosis, Roux-en-Y
- Animals
- Bile Ducts, Extrahepatic/radiation effects
- Bile Ducts, Extrahepatic/surgery
- Brachytherapy/instrumentation
- Combined Modality Therapy
- Dilatation, Pathologic/pathology
- Energy Metabolism/radiation effects
- Female
- Fluorodeoxyglucose F18
- Hepatic Artery/pathology
- Hepatic Artery/radiation effects
- Hepatic Duct, Common/pathology
- Hepatic Duct, Common/radiation effects
- Image Interpretation, Computer-Assisted
- Jejunum/radiation effects
- Jejunum/surgery
- Liver/pathology
- Liver/radiation effects
- Liver Regeneration/radiation effects
- Necrosis
- Particle Accelerators
- Portal Vein/pathology
- Portal Vein/radiation effects
- Radiation Injuries, Experimental/diagnosis
- Radiation Injuries, Experimental/pathology
- Sensitivity and Specificity
- Swine
- Tomography, Emission-Computed
- Tomography, X-Ray Computed
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Affiliation(s)
- Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Germany.
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Abstract
X-ray CT technology has been available for more than 30 years, yet continued technological advances have kept CT imaging at the forefront of medical imaging innovation. Consequently, the number of clinical CT applications has increased steadily. Other imaging modalities might be superior to CT imaging for some specific applications, but no other single modality is more often used in chest imaging today. Future technological developments in the area of high-resolution detectors, high-capacity x-ray tubes, advanced reconstruction algorithms, and improved visualization techniques will continue to expand the imaging capability. Future CT imaging technology will combine improved imaging capability with advanced and specific computer-assisted tools, which will expand the usefulness of CT imaging in many areas.
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Affiliation(s)
- Deborah Walter
- Computed Tomography Systems and Applications Laboratory, GE Global Research Center, One Research Circle, Niskayuna, NY 12309, USA.
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Park SH, Choi BI, Han JK, Yoon CJ, Lee JW, Kim SS, Han H. Volumetric tumor measurement using three-dimensional ultrasound: in vitro phantom study on measurement accuracy under various scanning conditions. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:27-34. [PMID: 14962605 DOI: 10.1016/j.ultrasmedbio.2003.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Revised: 09/18/2003] [Accepted: 09/25/2003] [Indexed: 05/24/2023]
Abstract
Factors influencing volumetric tumor measurement using 3-D ultrasound (US) were investigated. A 3-D US unit equipped with 4- to 8-MHz curved-array and 5- to 10-MHz linear-array mechanical volume transducers, and a US phantom made of 20 ham pieces (8.6 approximately 10.5 mL) embedded in agar gel that simulated hyperechoic tumors, were used. Volumetric tumor measurement was significantly affected by the position of US focus and tumor depth. When focus was at 2 cm and 8 cm below the transducer, 5-cm-deep tumors were measured 5.6% +/- 2.8% (mean +/- SD) and 8.3% +/- 2.2% bigger, respectively, than when focus was at 5 cm below the transducer, the same position as tumors (p < 0.01). Tumors were measured 11.8% +/- 2.9% bigger when they were 8-cm deep below the transducer than when they were 5-cm deep below the transducer (p < 0.001). Setting focus at the same position as tumors and keeping tumor depth consistent during serial 3-D US examinations may be necessary for reliable volumetric assessment of tumors.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology, Seoul National University College of Medicine and Institute of Radiation Medicine, SNUMRC, Seoul, South Korea
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Abstract
Biomarkers enable the characterization of patient populations and quantitation of the extent to which new drugs reach intended targets, alter proposed pathophysiological mechanisms and achieve clinical outcomes. In genomics, the biomarker challenge is to identify unique molecular signatures in complex biological mixtures that can be unambiguously correlated to biological events in order to validate novel drug targets and predict drug response. Biomarkers can stratify patient populations or quantify drug benefit in primary prevention or disease-modification studies in poorly served areas such as neurodegeneration and cancer. Clinically useful biomarkers are required to inform regulatory and therapeutic decision making regarding candidate drugs and their indications in order to help bring new medicines to the right patients faster than they are today.
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