Detection Of Liver Metastases Research Articles

Imaging in Gastric Cancer: Current Practice and Future Perspectives

Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients.

Liver function indicators in patients with breast cancer before and after detection of hepatic metastases-a retrospective study.

Liver metastases are common in patients with breast cancer, and determining the factors associated with such metastases may improve both their early detection and treatment. Given that liver function protein level changes in these patients have not been determined, the aim of our study was to investigate liver function protein level changes over time, spanning 6 months before the detection of liver metastasis to 12 months after. We retrospectively studied 104 patients with hepatic metastasis from breast cancer who were treated at the Departments of Internal Medicine I and the Department of Obstetrics and Gynecology at the Medical University of Vienna between 1980 and 2019. Data were extracted from patient records. Aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, lactate dehydrogenase and alkaline phosphatase were significantly elevated when compared to normal range 6 months before the detection of liver metastases (p<0.001) Albumin was decreased (p<0.001). The values of aspartate aminotransferase, gamma-glutamyltransferase, and lactate dehydrogenase were significantly increased at the time of diagnosis compared to 6 months prior (p<0.001). Patient- and tumor-specific parameters had no influence on these liver function indicators. Elevated aspartate aminotransferase (p = 0.002) and reduced albumin (p = 0.002) levels at the time of diagnosis were associated with shorter overall survival. Liver function protein levels should be considered as potential indicators when screening for liver metastasis in patients with breast cancer. With the new treatment options available, it could lead to prolonged life.

Abstract B031: A multi-gene predictor for detection and monitoring liver metastasis in lung cancer patients: An algorithmic, in-vitro and in-vivo approach

Abstract Liver metastasis has known to affect outcome in prostate, pancreatic and colorectal cancers, but it is less explored in lung cancer with an extensively low 5-year survival rate. Late-stage diagnosis is one of the major confounders for poor prognosis, as there are no disease-specific biomarkers available for early risk prediction. Some of the major limitations of invasive tissue biopsies are inadequacy of tissue, difficulty in accessing deep sites, and potential risk for the patient. Therefore, it is crucial to identify sensitive and specific circulatory biomarkers using non-invasive techniques. In this study, we validated 8 gene panel, in CTC, cfRNA and exosomes using real time PCR in primary lung cancer patients with &amp; without metastasis and healthy controls, identified in our previous study in the tissue samples of the same cohort. ROC curve analysis was used to determine the sensitivity and specificity of the shortlisted gene panel and its correlation with the most accurate source of liquid biopsy component for early prediction of liver metastasis. Further DEP expression, clinic-pathological factors and survival analysis correlations were performed. Lastly, the role of exosomes was identified in the development of liver metastasis by generating an in vitro and in-vivo model. Our results demonstrated that in comparison to our tissue data from the previous study, exosomes demonstrated a good discriminative value for lung cancer liver metastasis and the AUC was 0.7247, with specificity and sensitivity of 72.48 % and 96.87% respectively for the shortlisted 8 gene panel. Further when we analyzed the genes based on the individual gene patterns we shortlisted a 5- gene panel that showed an AUC of 0.9488 (p = &amp;lt;0.001) and 0.9924 (p = &amp;lt;0.001) respectively for tissue and exosomes suggesting that exosomes could be used as a non-invasive component for the early prediction of liver metastasis. Survival analysis suggested that four out of five gene expression levels in exosomal fraction, were independently associated with poor overall survival. Moreover, the in-vitro study demonstrated that exosome uptake by A549 cells induced migratory/invasive changes in a concentration and time- dependent manner and activated the cell cycle phases leading to cell proliferation. Moreover, we observed that these five genes were differentially expressed when A549 cells were treated with exosomes demonstrating an important role in altering the tumor microenvironment. In –vivo model showed an elevated level of serum SGPT &amp; SGOT whereas histopathological examination showed patches of pneumonitis in lung and severe inflammation in the liver. Conclusively this study suggests that these exosomal gene panel could be used as potential surrogate non-invasive biomarkers for early detection and monitoring of liver metastasis in lung cancer patients. Furthermore, it depicts an undisputable role of these exosomes as key modulators in the formation of the pre-metastatic niche ultimately leading to distant metastasis. Citation Format: Kanisha Shah, Rakesh Rawal. A multi-gene predictor for detection and monitoring liver metastasis in lung cancer patients: An algorithmic, in-vitro and in-vivo approach [abstract]. In: Proceedings of the AACR Special Conference: Cancer Metastasis; 2022 Nov 14-17; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_2):Abstract nr B031.

The sun beside the pancreatic neck: The lymph node gastrinoma (with video).

The sun beside the pancreatic neck: The lymph node gastrinoma (with video).

Detection of liver metastasis by 18F-FAPI PET/CT in the background of fatty liver.

A 48-year-old man with multiple hepatic occupancies was suspected of having an unknown primary tumor. Standardized diagnostic workup, including gastrointestinal endoscopy and subsequent18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT), failed to identify the primary site. He was enrolled in our study to perform 18F-fibroblast activation protein inhibitor (18F-FAPI) PET/CT for further diagnosis. CT images showed large areas of fatty liver with many hyperdense, well-defined annular and nodular areas in the remaining areas (Fig. 1A). Fused 18F-FDG PET/CT showed intense tracer uptake in the large annular and nodular areas, which are considered malignant (Fig. 1B). However, no high uptake was observed in some small hyperdense foci, which should be differentiated from focal fatty sparing in the background of fatty liver (Fig. 1B). 18F-FAPI PET/CT showed high tracer uptake in all hyperdense lesions, especially the small foci with no abnormal uptake on 18F-FDG images (SUVmax: 23.3 vs. 8.0), corresponding to low-intensity lesions revealed by gadolinium ethoxybenzyl diethylenetria-mine pentaacetic acid (Gd-EBO-DTPA)-enhanced magnetic resonance imaging (Fig. 1C and D). However, no suspected primary tumor was found outside the liver (Fig. 2A and B).

Real-Time Split-Dose PET/CT-Guided Ablation Improves Colorectal Liver Metastasis Detection and Ablation Zone Margin Assessments without the Need for Repeated Contrast Injection.

Real-time split-dose PET can identify the targeted colorectal liver metastasis (CLM) and eliminate the need for repeated contrast administration before and during thermal ablation (TA). This study aimed to assess the added value of pre-ablation real-time split-dose PET when combined with non-contract CT in the detection of CLM for ablation and the evaluation of the ablation zone and margins. A total of 190 CLMs/125 participants from two IRB-approved prospective clinical trials using PET/CT-guided TA were analyzed. Based on detection on pre-TA imaging, CLMs were categorized as detectable, non-detectable, and of poor conspicuity on CT alone, and detectable, non-detectable, and low FDG-avidity on PET/CT after the initial dose. Ablation margins around the targeted CLM were evaluated using a 3D volumetric approach. We found that 129/190 (67.9%) CLMs were detectable on CT alone, and 61/190 CLMs (32.1%) were undetectable or of poor conspicuity, not allowing accurate depiction and targeting by CT alone. Thus, the theoretical 5- and 10-mm margins could not be defined in these tumors (32.1%) using CT alone. When TA intraprocedural PET/CT images are obtained and inspected (fused PET/CT), only 4 CLM (2.1%) remained undetectable or had a low FDG avidity. The addition of PET to non-contrast CT improved CLM detection for ablation targeting, margin assessments, and continuous depiction of the FDG avid CLMs during the ablation without the need for multiple intravenous contrast injections pre- and intra-procedurally.

Clinical value of fluorine-18-fluorodeoxyglucose PET/MRI for liver metastasis in colorectal cancer: a prospective study.

To evaluate the diagnostic performance of liver 18F-FDG PET/MRI in addition to whole-body PET/CT and to compare it with MRI in the detection and clinical management of liver metastasis in patients with colorectal cancer (CRC). Seventy-eight patients with CRC who underwent whole-body 18F-FDG PET/CT followed by liver PET/MRI were prospectively included. Histopathological confirmation and/or at least 3 months of clinical follow-up after PET/MRI were accepted as gold standard. Lesion and patient-based analyses were performed to evaluate the diagnostics performances of PET/CT, PET/MRI and MRI. In addition, changes of clinical management were evaluated. On lesion-based analysis, for PET/CT, PET/MRI and MRI; sensitivity (Se): 55.6%, 97.2% and 100%; specificity (Sp): 98.5%, 100% and 80.5%; and accuracy (Acc): 70.7%, 98.2% and 93.1% were calculated, respectively. Se and Acc of PET/MRI and MRI were significantly superior than PET/CT (P < 0.001). Se and Acc of PET/MRI and MRI were comparable; however, Sp of PET/MRI was significantly better than MRI (P < 0.001). On patient-based analysis, Se: 75.6%, 100% and 100%; Sp: 97.3%, 100% and 86.5%; and Acc: 85.9%, 100% and 93.5% were calculated, respectively. Se and Acc of PET/MRI were significantly superior than PET/CT (P < 0.001). Also, Se of MRI was significantly superior than PET/CT (P < 0.001). Se of PET/MRI and MRI were comparable, but Sp and Acc of PET/MRI were significantly better than MRI. The additional information obtained from liver PET/MRI changed treatment strategy in 14/78 (18%) patients compared to PET/CT or alone liver MRI. Diagnostic performances of PET/MRI and MRI for detection of CRC liver metastasis is superior to PET/CT. PET/MRI especially helps in the accurate detection of liver metastases that are suspicious on MRI and has the potential to change the clinical management of especially oligometastatic patients by identifying uncertain liver lesions.

PSMA PET for the Evaluation of Liver Metastases in Castration-Resistant Prostate Cancer Patients: A Multicenter Retrospective Study.

To evaluate the diagnostic performance of PSMA-PET compared to conventional imaging/liver biopsy in the detection of liver metastases in CRPC patients. Moreover, we evaluated a PSMA-PET/CT-based radiomic model able to identify liver metastases. Multicenter retrospective study enrolling patients with the following inclusion criteria: (a) proven CRPC patients, (b) PSMA-PET and conventional imaging/liver biopsy performed in a 6 months timeframe, (c) no therapy changes between PSMA-PET and conventional imaging/liver biopsy. PSMA-PET sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for liver metastases were calculated. After the extraction of radiomic features, a prediction model for liver metastases identification was developed. Sixty CRPC patients were enrolled. Within 6 months before or after PSMA-PET, conventional imaging and liver biopsy identified 24/60 (40%) patients with liver metastases. PSMA-PET sensitivity, specificity, PPV, NPV, and accuracy for liver metastases were 0.58, 0.92, 0.82, 0.77, and 0.78, respectively. Either number of liver metastases and the maximum lesion diameter were significantly associated with the presence of a positive PSMA-PET (p &lt; 0.05). On multivariate regression analysis, the radiomic feature-based model combining sphericity, and the moment of inverse difference (Idm), had an AUC of 0.807 (95% CI:0.686-0.920). For liver metastases assessment, [68Ga]Ga-PSMA-11-PET demonstrated moderate sensitivity while high specificity, PPV, and inter-reader agreement compared to conventional imaging/liver biopsy in CRPC patients.

Individualized and generalized models for predicting observer performance on liver metastasis detection using CT.

Purpose: Radiologists exhibit wide inter-reader variability in diagnostic performance. This work aimed to compare different feature sets to predict if a radiologist could detect a specific liver metastasis in contrast-enhanced computed tomography (CT) images and to evaluate possible improvements in individualizing models to specific radiologists. Approach: Abdominal CT images from 102 patients, including 124 liver metastases in 51 patients were reconstructed at five different kernels/doses using projection domain noise insertion to yield 510 image sets. Ten abdominal radiologists marked suspected metastases in all image sets. Potentially salient features predicting metastasis detection were identified in three ways: (i)logistic regression based on human annotations (semantic), (ii)random forests based on radiologic features (radiomic), and (iii)inductive derivation using convolutional neural networks (CNN). For all three approaches, generalized models were trained using metastases that were detected by at least two radiologists. Conversely, individualized models were trained using each radiologist's markings to predict reader-specific metastases detection. Results: In fivefold cross-validation, both individualized and generalized CNN models achieved higher area under the receiver operating characteristic curves (AUCs) than semantic and radiomic models in predicting reader-specific metastases detection ability ( ). The individualized CNN with an AUC of mean (SD) 0.85(0.04) outperformed the generalized one [ , ]. The individualized semantic [ ] and radiomic models [ ] outperformed the respective generalized versions [semantic , ; radiomic , ]. Conclusions: Individualized models slightly outperformed generalized models for all three feature sets. Inductive CNNs were better at predicting metastases detection than semantic or radiomic features. Generalized models have implementation advantages when individualized data are unavailable.

Gene expression profile of human colorectal cancer identified NKTR as a biomarker for liver metastasis.

Objective: Liver metastasis is one of the prognostic factors of colorectal cancer (CRC). The aim of this study is to identify biomarkers that facilitate easier detection of liver metastasis.Methods: Significance Analysis of Microarrays (SAM) and Array Data Analyzer (ADA) were applied used for the analysis of differentially differently expressed mRNAs. mRNA expression was verified by quantitative real-timer reverse transcriptiontase polymerase chain reaction (qRT-PCR). Immunohistochemistry were was used to show natural killer-tumor recognition (NKTR) expression in CRC. NKTR-knockdown CRC cells were constructed obtained by using short hairpin RNA (shRNA). Followed by CCK-8 assay, plate colony formation test, and transwell assay were used to evaluate the influence of NKTR on cell proliferation, migration, and invasion in vitro.Results: SAM yielded showed 256 up-regulated and 224 down-regulated differentially differently expressed genes. Seven genes were identified by using ADA, tools and four genes were verified by using qRT-PCR. Three genes (metastasis associated lung adenocarcinoma transcript 1 (MALAT1), nuclear factor I/B (NKTR), and nuclear factor I/B (NFIB)) showed a statistically significant considerabley difference between CRC with and liver metastasis and CRC without liver metastasis. Immunohistochemical analysis showed that NKTR expression was much lower in primary CRC with liver metastasis than that in primary CRC without liver metastasis. The NKTR protein plays a role in the lytic function of natural killer (NK) cells and it has been rarely studied in the CRC. The down-regulation of NKTR by shRNA interference in CRC cells increased cell proliferation, migration, and invasion in vitro.

Expressions of ZEB1 of patients with colorectal cancer in Indonesia: Correlations with clinicopathological characteristics and liver metastasis profile

Zinc finger E-box binding homeobox 1 (ZEB1) and ZEB2 in the ZEB1/2 isoform complex are known to play an important role in the progression, invasion, and metastasis of colorectal cancer (CRC). In cancer cells, ZEB1 regulates the epithelial-mesenchymal transition (EMT). This study aimed to identify the ZEB1 expression in CRC and its correlation with clinicopathological and metastatic status. Using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), we compared different ZEB1 expressions in fresh-frozen tissue from non-tumor tissue (NT), primary tumor tissue without metastasis (PT), and primary tumor tissue with liver metastasis (PTLM). The correlation between ZEB1 expression and clinicopathological characteristics was also investigated. Statistical analysis revealed that ZEB1 expression is significantly higher in the primary tumor tissues (PT and PTLM) than in NT (p&lt;0.05), and high ZEB1 expression is associated with PTLM (p&lt;0.05). ZEB1 expression is significantly correlated with white blood cells (p=0.005), blood glucose (p=0.017), tumor invasion (p=0.001), pathological grading (p=0.002) and metastasis profile (p=0.001). There was no significant correlation between ZEB1 expression and age, body mass index, hemoglobin, albumin, platelet count, alanine aminotransferase, aspartate aminotransferase, carcinoembryonic antigen and tumor location. These findings suggest that ZEB1 expression has diagnostic value in predicting tumor progression and detecting liver metastases.

Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain

Background and aimsMagnetic resonance imaging (MRI) with gadoxetic acid is widely used in clinical practice in Spain for the diagnosis, treatment, and follow-up of patients with liver metastases, although its use varies. This paper aims to provide recommendations for the use of MRI with gadoxetic acid in the detection and diagnosis of liver metastases in clinical practice in Spain. Material and methodsThis project was undertaken by a group of nine experts who analyzed a series of recommendations about the use of gadoxetic acid extracted from international consensus documents. From this analysis, the experts decided to reject, adopt, contextualize, or adapt each of the recommendations. Once established, the final recommendations were voted on by the same group of experts. ResultsThe experts reached a consensus about five recommendations related to the use of this imaging technique in the management of liver metastases in three clinical situations: (i) in the detection, (ii) in the diagnosis and preoperative characterization, and (iii) in the detection after a chemotherapy treatment. ConclusionThe results support a clinical benefit for MRI with gadoxetic acid in the detection of liver metastases, favoring preoperative planning, especially in metastases measuring less than 1 cm, thus facilitating early diagnosis of metastatic spread.

Effect of more versus less frequent abdominopelvic computed tomography follow-up testing on overall survival in patients with stage II or III colon cancer.

3604 Background: Patients with colon cancer undergo an abdominopelvic computed tomography (AP-CT) scan surveillance every 6-12 months for five years after surgery. However, evidence of survival benefit from more intensive AP-CT patients in stage II and III colon cancer is still elusive. Methods: A total of 2,137 patients with stage II-III colon cancer who received curative aim surgery were analyzed in the Yonsei Cancer Registry Database between Jan 1, 2005, to Dec 31, 2015. The surveillance start date was defined as 90 days after curative resection or one day after adjuvant chemotherapy. All patients had at least one AP-CT for two years after the surveillance period. The average interval of AP-CT per patient was calculated as the postoperative surveillance duration divided by the number of AP-CT examinations. Patients who underwent AP-CT with an average interval of 6 months and 12 months were assigned to the high-frequent and low-frequent surveillance groups. Association of AP-CT frequency and demographic factors with overall survival (OS) were evaluated. Univariate and multivariate analyses were conducted. Results: Among 2,137 patients who underwent curative aim surgery, the median intervals of AP-CT scan were 6.1 months in high-frequent surveillance and 10.8 months in the less-frequent surveillance group, respectively. The 5-year overall survival (OS) was not significantly different in both groups; however, OS was significantly longer in the high-frequent surveillance group of patients who harvested lymph nodes less than 12 in curative resection ( P = 0.015) or measured postoperative serum carcinoembryonic antigen (CEA) level higher than 5 ng/ml ( P = 0.023). Of note, high-frequent surveillance group detected liver metastasis earlier (6.7 months) than the low-frequent group, leading to more curative aim metastasectomy (28.0% vs 4.3%, P = 0.020), and significantly longer 5-year OS (62.2% vs 34.8%, P = 0.017). Multivariate analysis showed that harvesting lymph nodes less than 12 (HR = 4.37, P = 0.004) and postoperative CEA level higher than 5 ng/ml (HR = 7.39, P &lt; 0.001) were prognostic factors for overall survival. Conclusions: The average interval of AP-CT in patients with stage II-III colon cancer is not associated with improved OS. However, a high-frequent AP-CT enabled early detection of liver metastases, leading to the improved OS in high-risk patients, including the number of harvested lymph nodes less than 12 or postoperative CEA level is higher than 5 ng/ml. The risk-stratified approach is warranted to guide postoperative colon cancer surveillance.

Does contrast-enhanced intraoperative ultrasound improve the sensitivity and predictive value of colorectal cancer liver metastasis detection?

Does contrast-enhanced intraoperative ultrasound improve the sensitivity and predictive value of colorectal cancer liver metastasis detection?

Flow-compensated diffusion encoding in MRI for improved liver metastasis detection.

Magnetic resonance (MR) diffusion-weighted imaging (DWI) is often used to detect focal liver lesions (FLLs), though DWI image quality can be limited in the left liver lobe owing to the pulsatile motion of the nearby heart. Flow-compensated (FloCo) diffusion encoding has been shown to reduce this pulsation artifact. The purpose of this prospective study was to intra-individually compare DWI of the liver acquired with conventional monopolar and FloCo diffusion encoding for assessing metastatic FLLs in non-cirrhotic patients. Forty patients with known or suspected multiple metastatic FLLs were included and measured at 1.5 T field strength with a conventional (monopolar) and a FloCo diffusion encoding EPI sequence (single refocused; b-values, 50 and 800 s/mm2). Two board-certified radiologists analyzed the DWI images independently. They issued Likert-scale ratings (1 = worst, 5 = best) for pulsation artifact severity and counted the difference of lesions visible at b = 800 s/mm² separately for small and large FLLs (i.e., < 1 cm or > 1 cm) and separately for left and right liver lobe. Differences between the two diffusion encodings were assessed with the Wilcoxon signed-rank test. Both readers found a reduction in pulsation artifact in the liver with FloCo encoding (p < 0.001 for both liver lobes). More small lesions were detected with FloCo diffusion encoding in both liver lobes (left lobe: six and seven additional lesions by readers 1 and 2, respectively; right lobe: five and seven additional lesions for readers 1 and 2, respectively). Both readers found one additional large lesion in the left liver lobe. Thus, flow-compensated diffusion encoding appears more effective than monopolar diffusion encoding for the detection of liver metastases.

Chemotherapy-Induced Liver Injury in Patients with Colorectal Liver Metastases: Findings from MR Imaging

Chemotherapy-induced liver injury has been found to be quite common in cancer patients undergoing chemotherapy. Being aware of chemotherapy-induced hepatotoxicity is important for avoiding errors in detecting liver metastases and for defining the most appropriate clinical management strategy. MRI imaging has proven to be a useful troubleshooting tool that helps overcome false negatives in tumor response imaging after chemotherapy due to liver parenchyma changes. The purpose of this review is, therefore, to describe the characteristics of magnetic resonance imaging of the broad spectrum of liver damage induced by systemic chemotherapeutic agents in order to avoid misdiagnoses of liver metastases and disease progression and to define the most appropriate clinical management strategy.

The Role of FDG Positron Emission Tomography/Contrast--Enhanced Computed Tomography in Preoperative Staging and Postoperative Follow-up in Rectal Cancer Surgery.

&lt;b&gt; Introduction:&lt;/b&gt; F-18 fluorodeoxyglucose (F18-FDG) positron emission tomography-computed tomography (PET/CT) is a valuable functional imaging modality for the clinical diagnosis which provides physiological information based on the altered tissue metabolism. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Aim:&lt;/b&gt; This study aims to investigate the effectiveness of F-18 fluorodeoxyglucose (F18-FDG) positron emission tomography-computed tomography (PET/CT) in preoperative staging and postoperative local recurrence and distant metastases in patients with rectal cancer. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Material and methods:&lt;/b&gt; The imaging of 726 patients with rectal cancer who were operated on at Istanbul University, Istanbul School of Medicine and had F18-FDG PET/CT, CT, and magnetic resonance imaging (MRI) scans between September 2005 and October 2016 were retrospectively analyzed. Of these patients, 170 who had pre- and postoperative PET/CT scans, had their CT scans included in the study. The sensitivity and specificity of PET/CT in preoperative staging and detection of postoperative local recurrence and distant metastases were analyzed. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Results:&lt;/b&gt; Of the patients, 101 were males and 69 were females with a median age of 62.27 (range, 31 to 89) years. The sensitivity and specificity of preoperative PET/CT in detecting liver metastases were 100% (confidence interval [CI]: 66.37-100%) and 94.2% (CI: 89.72-100%), respectively (Cohen's kappa [κ]: 1.00; P &lt; 0.001). The sensitivity and specificity of postoperative PET/ CT in diagnosing liver metastases were 100% (CI: 88.06-100%) and 98% (CI: 9-100%), respectively (Cohen's κ: 1.00; P &lt; 0.001). The sensitivity and specificity of preoperative PET/CT in detecting lung metastases were 100% (CI: 66.37-100%) and 91.8% (CI: 89.72-100%), respectively (Cohen's κ: 1.00; P &lt; 0.001). The sensitivity and specificity of postoperative PET/CT in detecting lung metastases were 100% (CI: 91.4-100%) and 96% (CI: 95.8-100%), respectively (Cohen's κ: 1.00; P &lt; 0.001). The sensitivity and specificity of PET/CT in preoperative staging of pathological pelvic lymph nodes were 100% (CI: 63.06-100%) and 94.29% (CI: 80.84-99.3%), respectively (Cohen's κ: 0.860; P &lt; 0.001). The sensitivity and specificity of postoperative PET/CT in detecting local recurrences were 100% (CI: 78.2-100%) and 76.74% (CI: 61.37-88.24%), respectively (Cohen's κ: 0.219; P &lt; 0.08). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Given the fact that PET/CT can detect all primary rectal cancer in preoperative staging, it can be effectively used in selected cases, particularly in those suspected of local and advanced disease and with metastases (T3N0, T3N1, and/or T4N1). Due to a relatively low specificity in detecting local recurrences postoperatively, PET/CT can be combined with further modalities.

Imaging Assessment of Pancreatic Cancer Resectability After Neoadjuvant Therapy: AJR Expert Panel Narrative Review.

Despite important innovations in the treatment of pancreatic ductal adenocarcinoma (PDAC), PDAC remains a disease with poor prognosis and high mortality. A key area for potential improvement in the management of PDAC, aside from earlier detection in patients with treatable disease, is the improved ability of imaging techniques to differentiate treatment response after neoadjuvant therapy (NAT) from worsening disease. It is well established that current imaging techniques cannot reliably make this distinction. This narrative review provides an update on the imaging assessment of pancreatic cancer resectability after NAT. Current definitions of borderline resectable PDAC, as well as implications for determining likely patient benefit from NAT, are described. Challenges associated with PDAC pathologic evaluation and surgical decision making that are of relevance to radiologists are discussed. Also explored are the specific limitations of imaging in differentiating the response after NAT from stable or worsening disease, including issues relating to protocol optimization, tumor size assessment, vascular assessment, and liver metastasis detection. The roles of MRI as well as PET and/or hybrid imaging are considered. Finally, a short PDAC reporting template is provided for use after NAT. The highlighted methods seek to improve radiologists' assessment of PDAC treatment response after NAT.

Hepatic resection using intraoperative ultrasound and near-infrared imaging with indocyanine green fluorescence detects hepatic metastases from gastric cancer: A case report.

Introduction and importanceNear-infrared (NIR) imaging with indocyanine green (ICG) is a sensitive intraoperative tool for detecting liver tumors. NIR imaging has been used to distinguish metastatic liver cancer from colon cancer; however, its utility for identifying metastatic lesions from gastric cancer remains unknown. We present a case of advanced gastric cancer with multiple liver metastases, which was diagnosed and treated using intraoperative NIR imaging with ICG.Case presentationA 69-year-old man with advanced gastric cancer and simultaneous multiple liver metastases presented with gastric bleeding. He underwent gastrectomy and chemotherapy, which reduced the tumor burden. No new lesions were noted, and the patient was advised to undergo surgical resection of the residual liver metastases. Prior to surgery, 0.5 mg/kg of intravenous ICG was administered. NIR imaging was performed during hepatectomy, which revealed clear green fluorescence in several liver segments, indicating liver metastases. Two lesions were not identified during preoperative magnetic resonance imaging. All fluorescent areas were resected. The tumors identified by both preoperative and fluoresced intraoperatively demonstrated malignant features on histopathological examination. The two lesions that fluoresced intraoperatively but were not identified on preoperative images demonstrated normal liver parenchyma and no signs of malignancy. The patient remains tumor-free 1 year after surgery.Clinical discussionThis report demonstrates that hepatic metastases from gastric cancer can be diagnosed with intraoperative NIR imaging with ICG.ConclusionsNIR imaging with ICG can detect liver metastases but may provide false positive results. As the percentage of false positives is high, additional resections must be decided upon carefully.

Radiomics and Radiogenomics in Evaluation of Colorectal Cancer Liver Metastasis.

Colorectal cancer is one common digestive malignancy, and the most common approach of blood metastasis of colorectal cancer is through the portal vein system to the liver. Early detection and treatment of liver metastasis is the key to improving the prognosis of the patients. Radiomics and radiogenomics use non-invasive methods to evaluate the biological properties of tumors by deeply mining the texture features of images and quantifying the heterogeneity of metastatic tumors. Radiomics and radiogenomics have been applied widely in the detection, treatment, and prognostic evaluation of colorectal cancer liver metastases. Based on the imaging features of the liver, this paper reviews the current application of radiomics and radiogenomics in the diagnosis, treatment, monitor of disease progression, and prognosis of patients with colorectal cancer liver metastases.