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Pei X, Lu M, Liu Z, Liu B, Deng Y, Yuan H, Ma L. The value of enhanced multiparameteric MRI diagnostic model for preoperatively predicting surgical methods of inferior vena cava in patients with renal tumors and inferior vena cava tumor thrombus. BMC Med Imaging 2023; 23:86. [PMID: 37355601 PMCID: PMC10290788 DOI: 10.1186/s12880-023-01043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/05/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Inferior vena cava tumor thrombus (IVCTT) invading the IVC wall majorly affects the surgical method choice and prognosis in renal tumors. Enhanced multiparameteric MRI plays an important role in preoperative evaluation. In this work, an MRI-based diagnostic model for IVCTT was established so as to guide the preoperative decisions. METHODS Preoperative MR images of 165 cases of renal tumors with IVCTT were retrospectively analyzed, and imaging indicators were analyzed, including IVCTT morphology and Mayo grade, IVCTT diameter measurements, bland thrombosis, primary MRI-based diagnosis of renal tumor, and involvement of contralateral renal vein. The indicators were analyzed based on intraoperative performance and resection scope of the IVC wall. Multivariate logistic regression analysis was used to establish the diagnostic model. RESULTS The morphological classification of the IVCTT, primary MRI-based diagnosis of renal tumors, maximum transverse diameter of IVCTT, and length of the bland thrombus were the main indexes predicting IVC wall invasion. The MRI-based diagnostic model established according to these indexes had good diagnostic efficiency. The prediction probability of 0.61 was set as the cutoff value. The area under the curve of the test set was 0.88, sensitivity was 0.79, specificity was 0.85, and prediction accuracy was 0.79 under the optimal cutoff value. CONCLUSION The preoperative MRI-based diagnostic model could reliably predict IVC wall invasion, which is helpful for better prediction of IVC-associated surgical operations.
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Affiliation(s)
- Xinlong Pei
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Baohua Liu
- School of Public Health, Peking University, Beijing, China
| | - Yuhan Deng
- School of Public Health, Peking University, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China.
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A Predictive Model for Tumor Invasion of the Inferior Vena Cava Wall Using Multimodal Imaging in Patients with Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9530618. [PMID: 33083491 PMCID: PMC7563051 DOI: 10.1155/2020/9530618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Abstract
Purpose Developed a preoperative prediction model based on multimodality imaging to evaluate the probability of inferior vena cava (IVC) vascular wall invasion due to tumor infiltration. Materials and Methods We retrospectively analyzed the clinical data of 110 patients with renal cell carcinoma (RCC) with level I-IV tumor thrombus who underwent radical nephrectomy and IVC thrombectomy between January 2014 and April 2019. The patients were categorized into two groups: 86 patients were used to establish the imaging model, and the data validation was conducted in 24 patients. We measured the imaging parameters and used logistic regression to evaluate the uni- and multivariable associations of the clinical and radiographic features of IVC resection and established an image prediction model to assess the probability of IVC vascular wall invasion. Results In all of the patients, 46.5% (40/86) had IVC vascular wall invasion. The residual IVC blood flow (OR 0.170 [0.047-0.611]; P = 0.007), maximum coronal IVC diameter in mm (OR 1.203 [1.065-1.360]; P = 0.003), and presence of bland thrombus (OR 3.216 [0.870-11.887]; P = 0.080) were independent risk factors of IVC vascular wall invasion. We predicted vascular wall invasion if the probability was >42% as calculated by: {Ln [Pre/(1 - pre)] = 0.185 × maximum cornal IVC diameter + 1.168 × bland thrombus-1.770 × residual IVC blood flow-5.857}. To predict IVC vascular wall invasion, a rate of 76/86 (88.4%) was consistent with the actual treatment, and in the validation patients, 21/26 (80.8%) was consistent with the actual treatment. Conclusions Our model of multimodal imaging associated with IVC vascular wall invasion may be used for preoperative evaluation and prediction of the probability of partial or segmental IVC resection.
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Guler E, Smith DA, Somarouthu B, Gujrathi R, Ramaiya NH, Tirumani SH. Overview of imaging findings associated with systemic therapies in advanced epithelial ovarian cancer. Abdom Radiol (NY) 2020; 45:828-841. [PMID: 31396642 DOI: 10.1007/s00261-019-02175-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To provide an overview for radiologists of the systemic agents used in the treatment of advanced epithelial ovarian cancer (EOC) and their associated toxicities. RESULTS EOC is a common gynecological malignancy, with the majority of patients presenting with advanced stage disease at the time of diagnosis. Although primary cytoreductive surgery and chemotherapy are the principal treatments for EOC, recurrence rates of disease remain high. As several molecular targeted therapies have been developed in the last decade, various novel agents have shown efficacy in the treatment of advanced EOC. Advanced EOC will be discussed by outlining the relevant radiological features of toxicities. CONCLUSION Knowledge of the systemic therapies utilized in the treatment of advanced EOC and their associated radiological features is critical in diagnostic image interpretation.
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Affiliation(s)
- Ezgi Guler
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Daniel A Smith
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Bhanusupriya Somarouthu
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rahul Gujrathi
- Department of Radiology, Harvard Medical School, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Frère C, Bournet B, Benzidia I, Jamelot M, Debourdeau P, Hij A, Rafii-Elayoubi H, Buscail L, Farge D. [Venous thromboembolism and pancreatic cancer]. JOURNAL DE MEDECINE VASCULAIRE 2018; 43:246-254. [PMID: 29981733 DOI: 10.1016/j.jdmv.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/22/2018] [Indexed: 06/08/2023]
Abstract
Pancreatic cancer (PC) is a devastating malignancy with an overall 5-year survival of 8% for all stages combined. Most of the PC patients diagnosed have an advanced disease (40%) or metastatic stage (40%), which eliminates surgery as a potentially curative treatment. The disease course is often complicated by venous thromboembolism (VTE) events, which per se account for significant morbidity and mortality, with significantly worsen survival. PC is associated with the highest risk of VTE among all cancer patients. We review the literature data to address the incidence and clinical outcomes of VTE in PC patients. VTE incidence varies from 5 to 41% according to epidemiological studies and is as high as 57% in postmortem series. Since 2013, international clinical practice guidelines recommend primary thromboprophylaxis with a grade 1B level of evidence as an adjuvant therapy in advanced PC. A recent meta-analysis of randomized controlled trials investigating the benefit and risk of low-molecular-weight heparins (LMWH) in ambulatory advanced PC patients under chemotherapy showed that the incidence of VTE was 2.1% in patients treated with LMWH and 11.2% in controls (risk ratio, 0.18; 95% CI, 0.083-0.39; P<0.0001). In conclusion, improved earlier diagnosis and effective management of VTE, a frequent and life-threatening complication in PC, is warranted to improve PC patient outcomes.
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Affiliation(s)
- C Frère
- Service d'hématologie biologique, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - B Bournet
- Pôle digestif, service de gastro-entérologie et de nutrition, hôpital Rangueil, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - I Benzidia
- Service de médecine interne, UF04 maladies auto-immunes et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75475 Paris cedex 10, France
| | - M Jamelot
- Service d'oncologie médicale, centre Henri-Becquerel, 76038 Rouen, France
| | - P Debourdeau
- Service oncologie, institut Sainte-Catherine, 84918 Avignon, France
| | - A Hij
- Service de médecine interne, UF04 maladies auto-immunes et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75475 Paris cedex 10, France
| | - H Rafii-Elayoubi
- Service de médecine interne, UF04 maladies auto-immunes et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75475 Paris cedex 10, France
| | - L Buscail
- Pôle digestif, service de gastro-entérologie et de nutrition, hôpital Rangueil, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - D Farge
- Service de médecine interne, UF04 maladies auto-immunes et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75475 Paris cedex 10, France
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Choi DK, Jeon HG, Jeong CW, Kwak C, Song C, Chung J, Hong SK, Hong SH, Seo SI. Surgical treatment of renal cell carcinoma: Can morphological features of inferior vena cava tumor thrombus on computed tomography or magnetic resonance imaging be a prognostic factor? Int J Urol 2017; 24:102-109. [DOI: 10.1111/iju.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Don Kyoung Choi
- Department of Urology; Hallym University Kangnam Sacred Heart Hospital; Hallym University School of Medicine; Seoul Korea
| | - Hwang Gyun Jeon
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Chang Wook Jeong
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheol Kwak
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheryn Song
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jinsoo Chung
- Department of Urology; National Cancer Center; Goyang Korea
| | - Sung Kyu Hong
- Department of Urology; Seoul National University Bundang Hospital; Seongnam Korea
| | - Sung-Hoo Hong
- Department of Urology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Seong Il Seo
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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Refaei M, Fernandes B, Brandwein J, Goodyear MD, Pokhrel A, Wu C. Incidence of catheter-related thrombosis in acute leukemia patients: a comparative, retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters. Ann Hematol 2016; 95:2057-2064. [PMID: 27542955 DOI: 10.1007/s00277-016-2798-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
Central venous catheters are a leading cause of upper-extremity deep vein thrombosis. Concomitant severe thrombocytopenia makes anticoagulation for catheter-related thrombosis (CRT) in patients with acute leukemia (AL) a challenge. Incidence of CRT has been reported to be increased in those with peripherally inserted central catheters (PICC) vs. those with centrally inserted ones (CICC). Our objective is to compare the incidence rate of CRT in leukemia inpatients who received either a PICC vs. CICC. We retrospectively reviewed adult inpatients admitted to hematology wards with a new diagnosis of AL and who received either a PICC or a CICC. Baseline patient and catheter characteristics were recorded. Our primary outcome was the incidence rate of CRT in each group. The secondary outcomes included rates of infectious and mechanical complications. Six hundred sixty-three patients received at least one PICC (338) or CICC (325) insertion. A total of 1331 insertions were recorded, with 82 (11.7 %) and 41 (6.5 %) CRT in the PICC and CICC groups, respectively. The incidence rates were 1.89 and 0.52 per 1000 catheter day in the PICC and CICC groups, respectively. A PICC, when compared to CICC, was a significant risk factor for CRT (sHR 2.5, p < 0.0001). The prevalence and incidence rates of CRT in our AL patients were higher than predicted for a general cancer patient population. These rates were higher in the PICC group compared to the CICC group. We recommend careful consideration of thrombotic and bleeding risks of AL inpatients when choosing a central venous catheter.
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Affiliation(s)
- Mohammad Refaei
- Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bruna Fernandes
- Department of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Brandwein
- Division of Hematology, Department of Medicine, University of Alberta, 4-112 Clinical Sciences Building, University of Alberta Hospital, 11350-83 Ave, Edmonton, Alberta, T6G2G3, Canada
| | - Marilyn Dawn Goodyear
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arun Pokhrel
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Cynthia Wu
- Division of Hematology, Department of Medicine, University of Alberta, 4-112 Clinical Sciences Building, University of Alberta Hospital, 11350-83 Ave, Edmonton, Alberta, T6G2G3, Canada.
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Jian J, Yang H, Zhao X, Xuan R, Zhang Y, Li D, Hu C. Visualization of microvasculature and thrombi by X-ray phase-contrast computed tomography in hepatocellular carcinoma. JOURNAL OF SYNCHROTRON RADIATION 2016; 23:600-605. [PMID: 26917149 DOI: 10.1107/s1600577516001016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
Visualization of the microvascular network and thrombi in the microvasculature is a key step to evaluating the development of tumor growth and metastasis, and influences treatment selection. X-ray phase-contrast computed tomography (PCCT) is a new imaging technique that can detect minute changes of density and reveal soft tissues discrimination at micrometer-scale resolution. In this study, six human resected hepatocellular carcinoma (HCC) tissues were investigated with PCCT. A histological stain was added to estimate the accuracy of PCCT. The results showed that the fine structures of the microvasculature (measuring 30-100 µm) and thrombi in tiny blood vessels were displayed clearly on imaging the HCC tissues by PCCT. Moreover, density distributions of the thrombi were obtained, which could be reliably used to distinguish malignant from benign thrombi in HCC. In conclusion, PCCT can clearly show the three-dimensional subtle structures of HCC that cannot be detected by conventional absorption-based computed tomography and provides a new method for the imageology of HCC.
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Affiliation(s)
- Jianbo Jian
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Hao Yang
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Ruijiao Xuan
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Yujie Zhang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Dongyue Li
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, People's Republic of China
| | - Chunhong Hu
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
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Rohatgi S, Howard SA, Tirumani SH, Ramaiya NH, Krajewski KM. Multimodality Imaging of Tumour Thrombus. Can Assoc Radiol J 2015; 66:121-9. [DOI: 10.1016/j.carj.2014.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/12/2014] [Indexed: 12/29/2022] Open
Abstract
Vascular thrombosis occurs commonly in cancer patients. Once the diagnosis of thrombosis is established, it is important to characterize the nature of thrombus, tumoural versus bland, as each have a different prognosis, clinical significance, and management. This review paper discusses the imaging spectrum of tumour thrombus and its clinical significance emphasizing the role of imaging in differentiating tumour from bland thrombus.
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Affiliation(s)
- Saurabh Rohatgi
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie A. Howard
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nikhil H. Ramaiya
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine M. Krajewski
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Vascular Toxicity Associated With Chemotherapy and Molecular Targeted Therapy: What Should a Radiologist Know? AJR Am J Roentgenol 2014; 203:1353-62. [DOI: 10.2214/ajr.13.11967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Farge-Bancel D, Bounameaux H, Brenner B, Büller HR, Kakkar A, Pabinger I, Streiff M, Debourdeau P. Implementing thrombosis guidelines in cancer patients: a review. Rambam Maimonides Med J 2014; 5:e0041. [PMID: 25386357 PMCID: PMC4222430 DOI: 10.5041/rmmj.10175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.
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Affiliation(s)
- Dominique Farge-Bancel
- Assistance Publique-Hôpitaux de Paris, Internal Medicine and Vascular Disease Unit, Saint-Louis Hospital; Sorbonne Paris Cité, Paris 7 Diderot University, Paris, France
| | - Henri Bounameaux
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - Ajay Kakkar
- Thrombosis Research Institute and Queen Mary University of London, London, UK
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
| | - Michael Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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