Staging Of Malignant Lesions Research Articles

Glucose metabolic rate from four-dimensional [18F]FDG PET/CT to differentiate sarcoid lesions from malignant lesions.

On 18F-Fludeoxyglucose (FDG) PET/CT, active sarcoid lesions are often difficult to differentiate from malignant lesions. We investigated the potential of the glucose metabolic rate (MRglc, mg/min/100 mL), a new quantification of glucose metabolic kinetics derived from direct reconstruction based on linear Patlak analysis, to distinguish between sarcoidosis and malignant lesions. A total of 100 patients with cardiac sarcoidosis (CS) and 67 patients with cancer who underwent four-dimensional FDG PET/CT were enrolled. The lesions with a standardized uptake value (SUV) ≥ 2.7 on the standard scan were included as active lesions in the analysis. SUV and MRglc were derived using data acquired between 30 min and 50 min on four-dimensional FDG PET/CT. The mean value in the volume of interest (size 1.5 cm3) was measured. The diagnostic performance of sarcoidosis using MRglc and SUV was evaluated using receiver-operating-characteristic (ROC) analysis. A total of 90 sarcoidosis lesions from 44 CS patients (18 males, 63.4 ± 12.2 years) and 87 malignant lesions from 57 cancer-bearing patients (32 males, 65 ± 14 years) were analyzed. SUV and MRglc for sarcoid lesions were significantly lower than those for malignant lesions (SUV, 4.98 ± 2.00 vs 6.21 ± 2.14; MRglc, 2.52 ± 1.39 vs 3.68 ± 1.61; p < 0.01). ROC analysis indicated that the ability to discriminate sarcoid patients from those with malignancy yielded areas under the curves of 0.703 and 0.754, with sensitivities of 64% and 77% and specificities of 75% and 72% for SUV 5.025 and MRglc 2.855, respectively. MRglc was significantly lower in sarcoid lesions than malignant lesions, and improved sarcoid lesions identification over SUV alone. MRglc improves sarcoid lymph node identification over SUV alone and is expected to shorten the examination time by eliminating delayed scans. Active sarcoid lesions are sometimes associated with FDG accumulation and should be differentiated from malignant lesions. SUV and metabolic rate of glucose (MRglc) strongly positively correlated, and MRglc could differentiate sarcoid and malignant lesions. MRglc allows for accurate evaluation and staging of malignant lesions.

Üçüncü Basamak Hastanede Endoskopik Ultrasonografi: Tek Merkez Deneyimi

Introduction : Endoscopic ultrasonography (EUS) is widely used to determine the character of lesions in the hepatobiliary system, pancreas, mediastinum, and rectum, in addition to subepithelial lesions of the upper gastrointestinal tract and for staging in addition to sampling from the lesion.Aim: The aim of this study is to present the endoscopic ultrasonography experience of our clinic over the last year. Material and Methods: EUS indication were performed by two gastroenterologists using a Pentax EPK-i5000 video processor and linear and radial echoendoscopes, under the guidance of an anesthesiologist under sedoanalgesia. Data were analyzed using descriptive statistics. The study results were analyzed using SPSS vn. 22.0 software.Results: Evaluation was made of 155 patients who underwent endoscopic ultrasonography, comprising 88 (56.8%) females and 67 (43.2%) males with a mean age of 56.3±14.2 years (range: 19-91 years). The 41 patients who underwent the EUS procedure for pancreatic lesion comprised 24 (59%) males and 17 (41%) females with a mean age of 54.3±17.1 years.EUS was performed in 74 patients due to subepithelial lesions of the upper gastrointestinal tract. These patients comprised 39 (52.7%) females and 35 (47.3%) males with a mean age of 55.2±13.5 years. Discussion The results of this study show that EUS is a reliable and very useful tool in appropriate indications, especially for the evaluation of subepithelial and malignant lesions of the gastrointestinal tract, pancreas, and ampulla pathologies. Conclusion and suggestions: Endoscopic ultrasonography; It is an effective and guiding method used in the diagnosis of submucosal lesions of the gastrointestinal tract, staging of malignant lesions, and the diagnosis of cystic and solid lesions of the pancreas.

CT and MRI of head and neck cutaneous lesions.

Cutaneous lesions are derived from the epidermis, dermis and cutaneous appendages. Whilst imaging may occasionally be performed to evaluate such lesions, they may be undiagnosed and demonstrated for the first time on head and neck imaging studies. Although usually amenable to clinical examination and biopsy, CT or MRI studies may also demonstrate characteristic imaging features which aid the radiological differential diagnosis. In addition, imaging studies define the extent and staging of malignant lesions, as well as the complications of benign lesions. It is important for the radiologist to understanding the clinical significance and associations of these cutaneous conditions. This pictorial review will describe and depict the imaging appearances of benign, malignant, overgrowth, blistering, appendage and syndromic cutaneous lesions. An increasing awareness of the imaging characteristics of cutaneous lesions and related conditions will help the framing of a clinically relevant report.

Comparative Study to Assess Diagnostic Reliability of Ultrasound and 3T-MRCP in Patient of Obstructive Jaundice

Background: Evaluation of jaundice patients should include proper history and examination, laboratory investigation and imaging investigations (non invasive like Ultrasound (U\S), CT and MRI or invasive like ERCP and PTC). Aim of Study: The aim of this prospective study is to evaluate the diagnostic reliability of U\S and MRI-MRCP in patients of obstructive jaundice in clinical practice. Original Research Article Rathore et al.; BJMMR, 8(11): 919-930, 2015; Article no.BJMMR.2015.522 920 Materials and Methods: This is a prospective study performed on 60 patients (31 male and 29 female) with an average age of 55.53 +/17.57 years presented with obstructive jaundice for whom abdominal ultrasound (U\S) and magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) on 3 Tesla was performed in the departments of radiology in Max super speciality teaching hospital, saket, Delhi, India from May 2012 to May 2013. The final diagnosis was achieved by endoscopic retrograde cholangiopancreatography (ERCP) and \or surgery and confirmed by histopathology. Results: The most common cause of obstructive jaundice in our study was common bile duct stones (51.65%) followed by tumors (33.3%) then benign strictures (10.0%), choledochal cyst (3.33%). In this study, MRI-MRCP could differentiate surgical from medical jaundice in all cases, while U\S could differentiate surgical from medical jaundice in 91.25% of cases. MRI-MRCP correctly defines the level of obstruction in all cases (100%). While U\S correctly define the level of obstruction in only 78% of the total cases. MRI-MRCP correctly suggests the most possible cause of obstruction in 96.25% of cases. While USG is correctly suggests the most possible cause in only 76.3%. Conclusion: So that USG as a screening modality is useful to confirm or exclude biliary dilatation & to choose patients for MRCP examination. MRI-MRCP is a useful non-invasive and essential method in the preoperative evaluation of patients with obstructive jaundice. In addition MRI-MRCP was superior to U\S or ERCP in studying the extent & staging of malignant lesions.

Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline.

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. ESGE/ESGAR do not recommend barium enema in this setting (strong recommendation, high quality evidence). 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).

Metabolic imaging with FDG: a primer.

The rapid advances in imaging technologies are a challenge for both radiologists and clinicians who must integrate these technologies for optimal patient care and outcomes at minimal cost. Multiple indications for functional imaging using fluorode-oxyglucose (FDG) are now well accepted in the fields of neurology, cardiology, and oncology, including differentiation of benign from malignant lesions, staging of malignant lesions, detection of malignant recurrence, and monitoring of therapy. The fusion of anatomic and molecular images (computed tomography [CT] and FDG) obtained with integrated positron emission tomography (PET)-CT systems, sequentially in time but without moving the patient from the imaging table, allows optimal co-registration of anatomic and molecular images, leading to accurate attenuation correction and precise anatomic localization of lesions with increased metabolism. This powerful technology provides a valuable new tool for diagnostic and therapeutic applications. The diagnostic accuracy is improved in approximately 50% of patients because of improvement of lesion detection on both CT and FDG PET images, better differentiation between physiologic and pathological foci of FDG uptake, and better localization of malignant foci of FDG uptake. This new technology affects the management of 10%-20% of cases by guiding further therapy. Promising clinical applications include guiding biopsy to the metabolically active sites of tumors, guiding surgery, and planning intensity-modulated radiation therapy. In addition, new PET radiopharmaceuticals are emerging for indications for which FDG has limitations. Some of the new PET tracers are labeled with (18)F, which has a practical half-life for commercial distribution. In the past few years, the clinical indications for FDG have broadened dramatically, and the rapid technical developments of integrated multimodality imaging systems and new PET tracers further extend the horizon.