Prognostic value of different CT measurements in early therapy response evaluation in patients with metastatic colorectal cancer

Objectives: Patients with advanced stage colorectal carcinoma (CRC) display hepatic metastases on initial staging in up to 20% of cases. The effectiveness of chemotherapy is generally evaluated by computed tomography (CT) imaging using standardized criteria (RECIST). However, RECIST is not always optimal, and other criteria have been shown to correlate with pathologic response and overall survival. The aim of this study was to evaluate the prognostic value of different CT measurement for response assessment after initiation of chemotherapy in patients with synchronous colorectal cancer liver metastases. Methods: Fifty-five patients with CRC and synchronous hepatic metastases were evaluated retrospectively at 2 academic centers. Different size, volume, ratio and attenuation parameters were determined at baseline and after 3 cycles of chemotherapy. The prognostic value of baseline measurements and of the change between baseline and second measurements was analyzed using Kaplan–Meier estimates. Results: Median time to progression was 279 days, median overall survival was 704 days. In this selective patient population, neither a significant prognostic value of initial baseline CT parameters nor a prognostic value of the change between the first and the second CT measurements was found. Conclusion: Initial morphological response assessment using different CT measurements has no prognostic value concerning time to progression or overall survival in patients with synchronous colorectal liver metastases.

[Avascular necrosis of the hamate--case report]

Avascular necrosis of the hamate is a very rare condition. After repetitive stress a young male developed left wrist pain which was found to be an avascular necrosis of the hamate. After progression of the necrosis with cyst formation on follow-up magnetic resonance imaging (MRI) and persisting pain, the patient underwent successful revascularisation with a vascular bone graft of the distal radius.

[Long-term results following reconstruction of maxillary sinus wall defects with titanium micro-mesh: a CT-based study]

BACKGROUND

Extensive bony defects of maxillary sinus walls have to be reconstructed to prevent long-term complications. Different autogenous, allogeneic, and alloplastic materials, e.g., titanium mesh, are used for reconstruction.

MATERIAL AND METHODS

In 26 patients large defects of the facial and laterodorsal walls of the maxillary sinus were reconstructed using titanium micro-mesh. The mean follow-up period was 49 months (5 months-10 years). All patients were examined with computed tomography applying multiplanar reconstruction techniques and three-dimensional volume rendering.

RESULTS

In the CT scans stable scars of 3-6 mm thickness could be found on the antral surfaces of all titanium meshes bridging the defects. In 70% of the patients the volume of the reconstructed maxillary sinus reached 80-100% of the contralateral side. Volume losses were not due to poor adaptation of the titanium mesh but were caused by thickening of maxillary sinus walls or traumatic malpositions. In 77% of the patients ventilation of the maxillary sinus was undisturbed. After mesh removal neither facial contour disturbances nor changes of sinus volume were noted. Soft tissue invasion into the sinus was prevented by a stable scar which had formed underneath the mesh. Three-dimensional reconstruction confirmed symmetrical facial contours in all patients.

CONCLUSIONS

The titanium micro-mesh offers a simple and effective alternative to autogenous tissue with stable long-term results for reconstruction of large maxillary sinus wall defects.

[Teleradiology for emergency cranial computed tomography]

PURPOSE

We report our experience with the teleradiologic service provided by a center hospital (CH) for emergency cranial computed tomography (CCT) in two regional hospitals (RH) during a 12-month period. The clinical and economic impact of teleradiology will be discussed as well as the acceptance by the clinicians of the regional hospitals.

MATERIAL AND METHODS

In 2001, 213 CT-scans in 202 patients were performed and reported using teleradiology. Teleradiologic and final medical diagnosis were analysed by the medical reports. The transfer of the patients to a CH and their further treatment were checked. The referring physicians in the RH were asked to complete a questionnaire about the teleradiological support.

RESULTS

18 (9 %) patients had to be urgently transferred to a CH based on the CT findings in the teleradiological reports. 24 patients (11 %) were transferred to a center hospital during further treatment. 80 % of patients were treated in the RH.

CONCLUSION

CT data transfer is reliable and efficient. Teleradiology reduces costs by avoiding unnecessary transport of patients for diagnostic procedures. Teleradiology improves patient management by reducing time from admittance to decide about further treatment. Teleradiology enables rapid selection of the best-equipped center hospital for the management of the patient's disease. Teleradiology is well accepted by the physicians in the RH. In the RH, teleradiology has become an indispensable standard procedure in the emergency diagnostic workup of cerebral trauma patients and in patients with acute unclear neurological symptoms.