Post-treatment Imaging Findings Research Articles

Early and Post-Treatment Imaging Findings in Perineural Spread: A Pathway to Diffuse Muscle Metastasis in Recurrent Bladder Carcinoma.

Perineural spread (PNS) from pelvic carcinoma has been regarded as a pathway to muscle and bone metastasis. However, few cases have been reported, especially in patients with bladder carcinoma. In the present report, we discuss a case of diffuse cancer involvement in the muscle 5 years after radical cystectomy for advanced bladder carcinoma. Careful observation of temporal changes on medical images confirmed PNS as the pathway to muscle metastasis (i.e., primary PNS). Our report presents early and post-treatment CT, MRI and FDG-PET/CT findings of PNS from the bladder carcinoma.

The role of preoperative serum CA-125 levels in predicting lymph node metastasis in patients undergoing treatment for endometrial cancer

Aims: Endometrial cancer stands as the most prevalent gynecological malignancy in developed nations, often detected at an early stage, and generally carries a positive prognosis. The stage of the disease is important for survival, but many factors such as tumor grade, histopathology, myometrial invasion, age, and spread are also effective. Our objective was to assess the significance of preoperative Cancer antigen 125 (CA-125) concentrations in the prediction of lymph node metastasis in patients with endometrial cancer and to identify a suitable threshold value. Methods: This retrospective analysis was carried out on 286 female patients diagnosed with endometrial cancer at a specialized gynecologic oncology facility from 2012 to 2022. We examined clinical-pathological and demographic attributes, including preoperative serum CA-125 concentrations, surgical interventions conducted for each patient, post-treatment physical assessments, imaging findings, and cytological outcomes. CA-125 was measured using electrochemiluminescence immunoassay. Results: Statistically significant differences were observed in CA-125 levels among patients in terms of grade, invasion depth, lymph node involvement, cervical involvement, and stage (respectively, p<0.001, p=0.042, p<0.001, p<0.001, p<0.001). The FIGO advanced stage ratio was 30.6 times higher for serum CA-125 concentrations above the cutoff of 21 IU/ml (95% CI: 10.7-87.6) (p<0.001). Lymph node involvement was 29.7 times more likely for serum CA-125 values above the cutoff of 35 IU/ml (95% CI: 25.3-74.8) (p<0.001). Conclusion: Early identification of high-risk endometrial cancer patients is vital for prognosis and guiding adjuvant therapy. CA-125, a tumor marker, has been found useful in assessing myometrial invasion depth, lymph node involvement, stage differentiation, and tumor grade.

Imaging of the Posttreatment Head and Neck: Expected Findings and Potential Complications.

Interpretation of posttreatment imaging findings in patients with head and neck cancer can pose a substantial challenge. Malignancies in this region are often managed through surgery, radiation therapy, chemotherapy, and newer approaches like immunotherapy. After treatment, patients may experience various expected changes, including mucositis, soft-tissue inflammation, laryngeal edema, and salivary gland inflammation. Imaging techniques such as CT, MRI, and PET scans help differentiate these changes from tumor recurrence. Complications such as osteoradionecrosis, chondroradionecrosis, and radiation-induced vasculopathy can arise because of radiation effects. Radiation-induced malignancies may occur in the delayed setting. This review article emphasizes the importance of posttreatment surveillance imaging to ensure proper care of patients with head and neck cancer and highlights the complexities in distinguishing between expected treatment effects and potential complications. Keywords: CT, MR Imaging, Radiation Therapy, Ear/Nose/Throat, Head/Neck, Nervous-Peripheral, Bone Marrow, Calvarium, Carotid Arteries, Jaw, Face, Larynx © RSNA, 2024.

Rhino-orbital-cerebral mucormycosis: Pre- and posttreatment imaging findings

Mucormycosis is a fungal infection typically affecting diabetic or immunocompromised patients. Very few cases have been reported in the literature in the past but multiple studies have shown that it is increasing, especially in this COVID era. It is highly invasive in nature hence early diagnosis is obligatory. Radiological imaging plays an important role in its diagnosis and to evaluate the extent of disease, in turn facilitating timely intervention. The objective of this clinical report is to evaluate a case of rhino-orbital-cerebral mucormycosis that involved the medical and surgical treatment of an immunocompromised male patient. In this interventional case study, a comprehensive evaluation of presenting features and imaging diagnostic evaluation are discussed in detail.

Immunotherapy-related renal toxicity causes reversible renal enlargement.

Prior case reports have noted an increase in renal size and perinephric stranding accompanying immunotherapy-related renal toxicity due to checkpoint-inhibitor therapy. The purpose of this investigation was to systematically evaluate if immunotherapy-related renal toxicity affects renal size and possible associated imaging findings. This retrospective multi-hospital study included 25 patients (13 men), mean age 67years (range 46-83) who received immune-checkpoint inhibitors for cancer treatment, developed biopsy-proven immunotherapy-related nephritis, and who also had abdominal imaging before, during, and after nephritis was diagnosed. Long axis renal diameter, renal corticomedullary differentiation/enhancement and perinephric stranding were evaluated by two readers at three timepoints: (1) prior to checkpoint inhibitor therapy (baseline), (2) after biopsy-proven immunotherapy-related nephritis (post-treatment), and (3) following renal function recovery (follow-up). Intraclass correlation coefficient and Cohen's Kappa were calculated to quantify agreement. Logistic regression analysis was implemented to measure the association between each timepoint and imaging features. Reader agreement on kidney measurements was excellent (ICC = 0.87). There was an increase in renal size between baseline and post-treatment (p = 0.001), followed by a decrease between post-treatment to follow-up (p < 0.001). Agreement was perfect for abnormal renal corticomedullary differentiation/enhancement (Kappa = 1, p < 0.001) and almost perfect for perinephric stranding (Kappa = 0.97, p < 0.001). Neither post-treatment nor follow-up imaging findings were significantly associated with these findings compared to the baseline (p = 0.2-0.6). Immunotherapy-related renal toxicity was associated with an increase in renal size coincident with acute renal dysfunction.

Posttreatment Imaging of the Knee: Cruciate Ligaments and Menisci.

Cruciate ligament reconstruction and meniscal surgery are frequently performed for restoration of knee joint stability and function after cruciate ligament and meniscus injuries, and they contribute to the prevention of secondary osteoarthritis. In cruciate ligaments, the most common procedure is anterior cruciate ligament (ACL) reconstruction. Meniscal surgery most frequently consists of partial meniscectomy and suture repair, rarely of a meniscus transplant. In patients with symptoms following surgery, imaging reevaluation for a suspected intra-articular source of symptoms is indicated and mainly consists of radiography and magnetic resonance imaging. For proper imaging assessment of cruciate ligament grafts and the postoperative meniscus, it is crucial to understand the surgical techniques applied, to be familiar with normal posttreatment imaging findings, and to be aware of patterns and specific findings of recurrent lesions and typical complications. This article presents an updated review of the techniques and the imaging of cruciate ligament reconstruction and meniscus surgery, recurrent lesions, treatment failure, and potential complications.

Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases.

Simple SummaryIn the multi-modal treatment of brain metastasis (BM), the role of systemic therapy has undergone a recent revolution. Due to the development of multiple agents with modest central nervous system penetration of the blood-brain barrier, targeted therapies and immune checkpoint inhibitors are increasingly being utilized alone or in combination with radiation therapy. However, the adoption of sequential or concurrent strategies varies considerably, and treatment strategies employed in clinical practice have rapidly outpaced evidence development. Therefore, this review critically analyzes the data regarding combinatorial approaches for a variety of systemic therapeutics with stereotactic radiosurgery and provides an overview of ongoing clinical trials.Brain metastasis (BM) represents a common complication of cancer, and in the modern era requires multi-modal management approaches and multi-disciplinary care. Traditionally, due to the limited efficacy of cytotoxic chemotherapy, treatment strategies are focused on local treatments alone, such as whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and resection. However, the increased availability of molecular-based therapies with central nervous system (CNS) penetration now permits the individualized selection of tailored systemic therapies to be used alongside local treatments. Moreover, the introduction of immune checkpoint inhibitors (ICIs), with demonstrated CNS activity has further revolutionized the management of BM patients. The rapid introduction of these cancer therapeutics into clinical practice, however, has led to a significant dearth in the published literature about the optimal timing, sequencing, and combination of these systemic therapies along with SRS. This manuscript reviews the impact of tumor biology and molecular profiles on the management paradigm for BM patients and critically analyzes the current landscape of SRS, with a specific focus on integration with systemic therapy. We also discuss emerging treatment strategies combining SRS and ICIs, the impact of timing and the sequencing of these therapies around SRS, the effect of corticosteroids, and review post-treatment imaging findings, including pseudo-progression and radiation necrosis.

Evolving Role of MRI in Assessment of Response of Hepatocellular Carcinoma Patients Post Trans-Arterial Chemoembolization: What Does the Physician Want to Know?

Abstract Background: In clinical practice, Transarterial Chemoem-bolization (TACE) has been widely used for the treatment of Hepatocellular Carcinoma (HCC) beyond as well as within guideline recommendations. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play critical roles for assessing treatment response of Hepatocellular Carcinoma (HCC) after locoregional therapy. Interpretation is challenging because post-treatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. Aim of Study: To illustrate the prime role of MRI in accurate assessment and early monitoring of hepatocellular carcinoma response to treatment after transarterial chemoem-bolization. Patients and Methods: This study included 80 patients, 52 males and 28 females, patients ages ranged from 45 to 81 years with the mean age of 60 years underwent transarterial chemoembolization over a period of 23 months (Jan. 2019- Dec. 2020). All patients had liver cirrhosis related to chronic viral hepatitis. MRI was conducted at MRI unit in a private radiology centre. Results: Showed superior diagnostic performance of dynamic MRI compared to diffusion studies as dynamic MRI had a sensitivity of 90.9%, a specificity of 95.7%, PPV of 93.7%, NPV of 93.7% and overall agreement of 94% compared to 100%, 65.2%, 68%, 100% and 80% respectively of diffusion weighted imaging. The difference between the malignant residual and well-ablated groups ADC variables was statisti-cally significant p-value 0.006. Conclusion: MRI is a robust tool in detection of tumour viability after TACE of hepatocellular carcinoma and should be performed at regular time intervals. Imaging protocol should include dynamic study combined with diffusion imag-ing. DW MR imaging is a rapid promising technique for the non-invasive evaluation of tumor response after TACE par-ticularly when contrast medium administration is contraindicated. Dynamic study is the corner stone in detection of recurrent lesions.

Imaging After Locoregional Therapy for Hepatocellular Carcinoma with Emphasis on LIRADS Treatment Response Assessment Criteria

Radiologists play an essential role in assessing hepatocellular carcinoma treatment response and help guide further clinical management of patients. Interpretation of treatment response after locoregional therapy is challenging. The post-treatment imaging findings vary and depend on the type of treatment, the degree of treatment response, time interval after treatment and several other factors. Given the widespread use of local-regional therapies, understanding the appearance of treated lesions has become crucial to allow for a more accurate interpretation of post-treatment imaging. Several response criteria including the recently introduced Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) are currently used to assess treatment response. This review article describes the imaging assessment of HCC treatment response after several locoregional therapies using various response assessment criteria, emphasizing the LI-RADS treatment algorithm.

Non-occlusive hepatic artery hypoperfusion syndrome and imaging findings: a systematic review.

Non-occlusive hepatic artery hypoperfusion syndrome (NHAHS), in other words, splenic steal, is a rare disorder that can arise following liver transplantation.After liver transplantation, its frequency has been defined as between 0.6 and 10.1%. The diversion of flow from hepatic to splenic arteries results in low perfused hepatic artery which causes elevated liver enzymes, hyperbilirubinemia, and graft dysfunction. This may result from a high resistance in the hepatic arteries, enlarged splenic arteries, a limited hepatic arterial flow due to high portal flow, or a discordance of the graft size and hepatic arterial flow. There may be a need for some prophylactic and/or posttransplant treatment procedures. We aimed to describe pre and post-treatment imaging findings of NHAHS.

MRI Assessment of Hepatocellular Carcinoma after Local-Regional Therapy: A Comprehensive Review.

Nearly 80% of cirrhotic patients diagnosed with hepatocellular carcinoma (HCC) are not eligible for surgical resection and instead undergo local-regional treatment. After therapy for HCC, patients undergo imaging surveillance to assess treatment efficacy and identify potential sites of progressive tumor elsewhere within the liver. Accurate interpretation of posttreatment imaging is essential for guiding further management decisions, and radiologists must understand expected treatment-specific imaging findings for each of the local-regional therapies. Of interest, expected imaging findings seen after radiation-based therapies (transarterial radioembolization and stereotactic body radiation therapy) are different than those seen after thermal ablation and transarterial chemoembolization. Given differences in expected posttreatment imaging findings, the current radiologic treatment response assessment algorithms used for HCC (modified Response Evaluation Criteria in Solid Tumors classification, European Association for the Study of Liver Diseases criteria, and Liver Imaging and Reporting Data System Treatment Response Algorithm) must be applied cautiously for radiation-based therapies in which persistent arterial phase hyperenhancement in the early posttreatment period is common and expected. This article will review the concept of tumor response assessment for HCC, the forms of local-regional therapy for HCC, and the expected posttreatment findings for each form of therapy. Keywords: Abdomen/GI, Liver, MR-Imaging, Treatment Effects, Tumor Response © RSNA, 2020.

Safety and efficacy of mechanical thrombectomy with stent-retrievers in anticoagulated patients with anterior circulation stroke

To assess the safety and efficacy of mechanical thrombectomy (MT) with stent-retrievers in anterior circulation stroke (ACS) patients due to the occlusion of major cerebral arteries, and to compare the results achieved in patients on oral anticoagulation (OAC) and those not on OAC. The present retrospective study comprised 285 consecutive patients (115 males; mean age 74±13 years). The following data were collected: baseline characteristics, occurrence of risk factors, pre-event treatment with OAC, neurological deficit at the time of treatment, time to therapy, recanalisation rate (successful recanalisation defined as Thrombolysis in Cerebral Infarction score ≥2b), post-treatment imaging findings. The 90-day clinical outcome was assessed using modified Rankin scale (good outcome defined as 0-2). The following statistically insignificant differences were found in 26 patients on OAC versus 259 patients without OAC: occurrence of symptomatic intracerebral haemorrhage 7.7% versus 8.1%, achievement of successful recanalisation 69.2% versus 82.6%, good 90-day clinical outcome 34.6% versus 56.8%, 90-day mortality 26.9% versus 20.8% (p>0.05 in all cases). Age and neurological deficit at the time of treatment were identified as independent negative predictors of good 90-day clinical outcome (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.88-0.94 and OR=0.83, 95% CI: 0.77-0.90, respectively) and as independent positive predictors of mortality (OR=1.12, 95% CI: 1.06-1.18 and, OR=1.17, 95% CI: 1.07-1.27, respectively; p<0.05 in all cases). MT with stent-retrievers is safe and effective in ACS patients on OAC.

Clinical utility of one month imaging following selective internal radiation therapy

The goal of this retrospective review was to determine the clinical relevance of one-month post-treatment imaging in the selective internal radiation therapy (SIRT) patient population by reporting the incidence of change in clinical management. Between January 2012 and January 2016, 85 patients underwent 109 SIRT treatments for either primary or secondary hepatic malignancies. There were 59 men and 26 women with a mean age of 62.4 years (range: 39-89 years). Patients' medical records were retrospectively reviewed for procedural, historical, laboratory and imaging information. The imaging study was considered to have changed patients' clinical management if it resulted in the addition of a new procedure, canceling of a planned procedure or change in systemic therapy. The one-month post-treatment imaging findings led to management changes in 10 of 109 (9.2%) of treatments. When evaluated by cancer type, 2/61 (3.3%) hepatocellular carcinoma (HCC) treatments had management changed while 8/48 (16.7%) non-HCC treatments underwent management change (P=0.03). This difference was also significant at multivariate analysis (P=0.03; odds ratio: 0.17 [0.03-082]). Management is rarely changed by one-month post-SIRT imaging in patients with HCC and thus is likely unwarranted. Conversely, in non-HCC patients, one month post-SIRT imaging led to a significant percentage of clinical management changes suggesting that one month imaging in this setting is likely warranted.

Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know.

Radioembolization using beta-emitting yttrium-90 microspheres is being increasingly used for the treatment of primary and metastatic liver cancers. It is a form of intra-arterial brachytherapy which delivers intense radiation to liver tumors with little embolic effect; this mode of action results in unique post-treatment imaging findings. It is important to understand these imaging findings to avoid misinterpretation of tumor response and to determine further management of the disease. Herein, we discuss the current concepts for assessing tumor response, common post-treatment imaging features, and associated complications following radioembolization.

The Management and Imaging of Vestibular Schwannomas.

Vestibular schwannomas are the most common cerebellopontine angle tumor. During the past century, the management goals of vestibular schwannomas have shifted from total resection to functional preservation. Current treatment options include surgical resection, stereotactic radiosurgery, and observation. Imaging has become a crucial part of the initial screening, evaluation, and follow-up assessment of vestibular schwannomas. Recognizing and understanding the management objectives, various treatment modalities, expected posttreatment findings, and complications allows the radiologist to play an essential role in a multidisciplinary team by providing key findings relevant to treatment planning and outcome assessment. The authors provide a comprehensive discussion of the surgical management, role of radiation therapy and observation, imaging differential, and pre- and posttreatment imaging findings of vestibular schwannomas.

Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications.

Uterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.

Liver-Directed Therapy for Hepatocellular Carcinoma: An Overview of Techniques, Outcomes, and Posttreatment Imaging Findings.

The purposes of this article are to describe the indications, techniques, and results of arterially directed therapies and ablation and to review the imaging assessment of response and complications. Most patients with hepatocellular carcinoma are not eligible for surgery, and systemic treatments are suboptimal. Therefore, locoregional therapy plays a large role in this disease. Locoregional therapies include arterially directed therapies, ablation, and radiation therapy.

Comparison of Mammographic Changes Across Three Different Fractionation Schedules for Early-Stage Breast Cancer

As the use of hypofractionated breast radiation therapy (RT) increases, so will the need for long-term data on post-RT mammographic changes. The purpose of the present study was to longitudinally compare the incidence of common mammographic sequelae seen after breast conserving surgery and RT in patients treated with accelerated partial breast irradiation (APBI), hypofractionated whole breast irradiation (HWBI), and conventionally fractionated whole breast irradiation (WBI). Patients treated with either APBI or HWBI after breast conserving therapy and with ≥3 mammograms of the treated breast were identified. They were matched 1:1 by age ±5years to patients treated with WBI. The mammograms were evaluated for common post-RT breast findings by a mammographer who was unaware of the treatment. The outcomes were analyzed using a cumulative logistic regression model; P<.05 indicated statistically significance. Of 89 patients treated with RT from 2006 to 2011, 29 had received APBI, 30 had received HWBI, and 30 had received WBI. Their median age was 60years (range 33-83). A total of 605 mammograms were evaluated, with a median follow-up of 48months. The treatment technique did not affect the severity of architectural distortion when the groups were evaluated longitudinally. The likelihood of finding skin thickening decreased with increasing follow-up duration (odds ratio 0.6; P<.001) adjusted for fractionation schemes. No differences were seen with respect to changes in skin thickening, fluid collections, or calcifications among the treatment groups, after adjustment for the follow-up time. The clinical characteristics, including age, race, T stage, and chemotherapy use, were not linked to the likelihood of finding several mammographic phenomena over time. Although specific post-treatment imaging findings evolved over time, RT fractionation did not alter the relative incidence or severity of architectural distortion, skin thickening, fluid collections, or calcifications. These findings will be useful to both radiologists and radiation oncologists when counseling patients regarding follow-up studies after RT.

Spots and dots in the bones

Cancer imaging is frequently at the cutting edge of new imaging techniques which are often rapidly incorporated into routine use. Skeletal metastatic disease is a frequent complication of neoplastic conditions, and results in specific challenges to the general radiologist and specialist oncological radiologist alike. Non-neoplastic conditions and normal variants may simulate skeletal metastases, and the radiologist must recognise such cases and avoid over-investigation and unnecessary treatment. This lecture will briefly review standard imaging techniques and demonstrate normal appearances, normal variants and non-neoplastic lesions that mimic primary and secondary skeletal malignancy, and will then review a spectrum of malignancy-associated bone lesions with the use of standard and more specialised imaging techniques, including PET MRI, PET CT and diffusion weighted imaging,. Expected post treatment imaging findings, and treatment-associated complications will also be discussed.

Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial

To evaluate the safety and efficacy of multimodal endovascular treatment (EVT) of acute basilar artery occlusion (BAO), including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT], to compare particular EVT techniques and identify predictors of clinical outcome. This retrospective, multi-centre study comprised 72 acute ischaemic stroke patients (51 males; mean age 59.1 ± 13.3 years) with radiologically confirmed BAO. The following data were collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, localization of occlusion, time to therapy, recanalization rate, post-treatment imaging findings. Thirty- and 90-day outcomes were evaluated using the modified Rankin scale with a good clinical outcome defined as 0-3 points. Successful recanalization was achieved in 94.4% patients. Stepwise binary logistic regression analysis identified the presence of arterial hypertension (OR = 0.073 and OR = 0.067, respectively), National Institutes of Health Stroke Scale (NIHSS) at the time of treatment (OR = 0,829 and OR = 0.864, respectively), and time to treatment (OR = 0.556 and OR = 0.502, respectively) as significant independent predictors of 30- and 90-day clinical outcomes. Data from this multicentre study showed that multimodal EVT was an effective recanalization method in acute BAO. Bridging therapy shortens the time to treatment, which was identified as the only modifiable outcome predictor.