Traditional Imaging Studies Research Articles

Role of radiomics in the diagnosis and treatment of gastrointestinal cancer.

Gastrointestinal cancer (GIC) has high morbidity and mortality as one of the main causes of cancer death. Preoperative risk stratification is critical to guide patient management, but traditional imaging studies have difficulty predicting its biological behavior. The emerging field of radiomics allows the conversion of potential pathophysiological information in existing medical images that cannot be visually recognized into high-dimensional quantitative image features. Tumor lesion characterization, therapeutic response evaluation, and survival prediction can be achieved by analyzing the relationships between these features and clinical and genetic data. In recent years, the clinical application of radiomics to GIC has increased dramatically. In this editorial, we describe the latest progress in the application of radiomics to GIC and discuss the value of its potential clinical applications, as well as its limitations and future directions.

A collagen-based microwell migration assay to study NK-target cell interactions

Natural killer (NK) cell cytotoxicity in tissue is dependent on the ability of NK cells to migrate through the extracellular matrix (ECM) microenvironment. Traditional imaging studies of NK cell migration and cytotoxicity have utilized 2D surfaces, which do not properly reproduce the structural and mechanical cues that shape the migratory response of NK cells in vivo. Here, we have combined a microwell assay that allows long-term imaging and tracking of small, well-defined populations of NK cells with an interstitial ECM-like matrix. The assay allows for long-term imaging of NK–target cell interactions within a confined 3D volume. We found marked differences in motility between individual cells with a small fraction of the cells moving slowly and being confined to a small volume within the matrix, while other cells moved more freely. A majority of NK cells also exhibited transient variation in their motility, alternating between periods of migration arrest and movement. The assay could be used as a complement to in vivo imaging to study human NK cell heterogeneity in migration and cytotoxicity.

Intraductal papillary neoplasm of the bile duct: two case reports and review of the literature

Background: Intraductal Papillary Neoplasm of the Bile Duct (IPNB) is a rare disease that is characterized by papillary lesions in the intra and extrahepatic biliary tree. Traditional imaging studies may show biliary dilation and/or filling defects. Endoscopic retrograde cholangiopancreatography can demonstrate diffuse bile duct dilatation as well as amorphous filling defects, however visualization of the biliary system can be limited by obstruction by the papillary lesions or mucin. Digital single operator cholangioscopy can be used to aid in diagnosis.Case Presentation: We report two elderly Caucasian males that presented with fatigue and obstructive jaundice. In both cases, the diagnosis of IPNB of was made. In one case, digital single operator cholangioscopy was used successfully to make the diagnosis.Conclusions: We present two cases of IPNB as well as a review of the clinical characteristics of IPNB and the utility of digital single operator cholangioscopy to aid in diagnosis. In IPNB, timely diagnosis is paramount. Traditional imaging studies can be inadequate, digital single operator cholangioscopy allows for quick diagnosis and, if indicated, further intervention.

Detection of Subclinical Atherosclerosis in Subclavian Arteries of Subjects with Vascular Risk Factors and Normal Carotid Ultrasound

Most risk scores that use imaging methods to determine the presence of subclinical atherosclerosis assess the carotid and coronary arteries. The value of assessing subclavian arteries to improve the predictive capacity of traditional imaging studies is not known. We studied subjects without cardiac, cerebral, or peripheral vascular symptoms and normal carotid ultrasound. They had at least 1 traditional vascular risk factor. We assessed prevalence of atherosclerotic plaques in the right subclavian artery. We studied 625 subjects aged 54 ± 12. Most participants had 1 vascular risk factor. Using the Framingham Heart Study score, 62% were categorized as low risk, 29% intermediate risk, and 9% high risk. A total of 169 subjects (27%) had atheromatous plaques in the right subclavian artery. The prevalence of this finding was greater in women than in men (64% versus 36%, P < .00001) and was greater in subjects older than 54 years than in younger individuals (72% versus 28%, P < .00001). Plaques in the subclavian artery were present in 27% of subjects with high risk, 34% with intermediate risk, and 24% with low risk. Plaques in subclavian arteries are often detected in asymptomatic subjects with vascular risk factors and normal carotid arteries even with low vascular risk scores. Study of the subclavian arteries appears as a simple strategy for the detection of subclinical atherosclerosis. Its role for improving cardiovascular risk scales and predicting coronary and cerebrovascular events needs to be further explored.

Sphingolipid Organization in the Plasma Membrane and the Mechanisms That Influence It.

Sphingolipids are structural components in the plasma membranes of eukaryotic cells. Their metabolism produces bioactive signaling molecules that modulate fundamental cellular processes. The segregation of sphingolipids into distinct membrane domains is likely essential for cellular function. This review presents the early studies of sphingolipid distribution in the plasma membranes of mammalian cells that shaped the most popular current model of plasma membrane organization. The results of traditional imaging studies of sphingolipid distribution in stimulated and resting cells are described. These data are compared with recent results obtained with advanced imaging techniques, including super-resolution fluorescence detection and high-resolution secondary ion mass spectrometry (SIMS). Emphasis is placed on the new insight into the sphingolipid organization within the plasma membrane that has resulted from the direct imaging of stable isotope-labeled lipids in actual cell membranes with high-resolution SIMS. Super-resolution fluorescence techniques have recently revealed the biophysical behaviors of sphingolipids and the unhindered diffusion of cholesterol analogs in the membranes of living cells are ultimately in contrast to the prevailing hypothetical model of plasma membrane organization. High-resolution SIMS studies also conflicted with the prevailing hypothesis, showing sphingolipids are concentrated in micrometer-scale membrane domains, but cholesterol is evenly distributed within the plasma membrane. Reductions in cellular cholesterol decreased the number of sphingolipid domains in the plasma membrane, whereas disruption of the cytoskeleton eliminated them. In addition, hemagglutinin, a transmembrane protein that is thought to be a putative raft marker, did not cluster within sphingolipid-enriched regions in the plasma membrane. Thus, sphingolipid distribution in the plasma membrane is dependent on the cytoskeleton, but not on favorable interactions with cholesterol or hemagglutinin. The alternate views of plasma membrane organization suggested by these findings are discussed.

Endoscopic Identification and Treating the Pain Generators in the Lumbar Spine that Escape Detection by Traditional Imaging Studies

Introduction: The ability to identify and treat pain generators in the lumbar spine is helped by incorporating diagnostic and therapeutic injections, followed by visualizing the pain generator with an endoscope. Although improvements in imaging are getting very sophisticated, visualization of the source of the pain generators is currently only possible with an endoscope. This has opened the door to more options for cost effective surgical treatment in staged manner by treating the pain source. Materials and methods: An FDA approved system endoscopic system and technique developed by A. Yeung in 1997, using a multichannel endoscope for the transforaminal approach to visualize the disc and foramen, is featured. After anesthetizing the disc foramen, and targeting the axilla of the foramen in the vicinity of the exiting and traversing nerve, known to spine surgeons as the “hidden zone” of MacNab, the technique has evolved to surgically provide pain relief for stratified conditions for patient selection. The standard translaminar approach to the disc and the spinal segment will usually miss visualizing the patho-anatomy of pain in this “hidden zone”, an area harboring common causes of “failed back surgery syndrome”. Recent minimally invasive techniques of decompression and fusion may help resolve the pain source, but fusion has its surgical morbidities and high costs. A less invasive highly successful transforaminal endoscopic method with 25-year data supports this technique. Discussion: Transforaminal Endoscopic Spine Surgery, the YESS™ technique, is effective using mobile cannulas to visualize and target the pain source. New instrumentation, techniques, specially configured endoscopes with different size working channels; facilitate effective surgical treatment of the pain generator. Incorporating visualization of the disc cavity to treat painful annular tears adds to the effectiveness of the procedure. The surgeon can also treat spinal stenosis with foraminoplasty by decompressing the ventral facet of the superior articular process as well as the axilla containing the exiting and traversing nerve. The purpose of this study is to demonstrate that the physiology of pain can be visualized as a pain generator. Patho-anatomy is identified and surgically decompressed. Diagnostic and therapeutic injections also aid in identifying pain generators by epidurography performed with the transforaminal approach. Conclusion: Interventional pain management, often the first line of minimally invasive treatment, provides pain relief only by targeting injections to block nerves. Visualizing the patho-anatomy with an endoscope targeting the patho-anatomy by the same interventional needle trajectories, however, provides a surgical option to decompress and ablate the pain generators.

Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer

BackgroundPancreatic adenocarcinoma (PCA) is one of the most lethal human malignancies, and radical surgery remains the cornerstone of treatment. After resection, the overall 5-year survival rate is only 10% to 29%. At the time of presentation, however, about 40% of patients generally have distant metastases and another 40% are usually diagnosed with locally advanced cancers. The remaining 20% of patients are indicated for surgery on the basis of the results of preoperative imaging studies; however, about half of these patients are found to be unsuitable for resection during surgical exploration. In the current study, we aimed to determine the clinicopathological characteristics that predict the resectability of PCA and to conduct a prognostic analysis of PCA after resection to identify favorable survival factors.MethodsWe retrospectively reviewed the medical files of 688 patients (422 men and 266 women) who had undergone surgery for histopathologically proven PCA in the Department of Surgery at Chang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinical characteristics of patients who underwent resection and patients who did not undergo resection in order to identify the predictive factors for successful resectability of PCA, and we conducted prognostic analysis for PCA after resection.ResultsA carbohydrate antigen 19–9 (CA 19–9) level of 37 U/ml or greater and a tumor size of 3 cm or more independently predicted resectability of PCA. In terms of survival after resection, PCA patients with better nutritional status (measured as having an albumin level greater than 3.5 g/dl), radical resection, early tumor stage and better-differentiated tumors were associated with favorable survival.ConclusionsBesides traditional imaging studies, preoperative CA 19–9 levels and tumor size can also be used to determine the resectability of PCA. Better nutritional status, curative resection, early tumor stage and well-differentiated tumors predict the favorable prognosis of PCA patients after resection.

Staging and Staging Errors in Bladder Cancer

Abstract Context The staging of bladder cancer (BCa) is crucial for optimal management of the disease. The staging process is known to be challenging and fraught with errors. Objective Our aim was to present current BCa grading and staging systems and to review the crucial steps of the staging process. Sources of errors and pitfalls in the staging process are also discussed. Evidence acquisition A comprehensive literature review was performed to identify relevant original articles, review articles, and clinical guidelines in the field of BCa staging. Evidence synthesis Staging error is extremely common with reported upstaging in up to 40% of patients. Sadly, little, if any, improvements have been reported during the past two decades. Quality of the transurethral resection of bladder tumor (TURBT) and pathologic evaluation of resected tissue by a specialized uropathologist is the cornerstone of BCa staging. In addition to primary resection, restaging transurethral resection is indicated in high-risk noninvasive cancers and also if incomplete resection is demonstrated or suspected. The accuracy of traditional imaging studies (computed tomography [CT], magnetic resonance imaging [MRI]) is of limited value both in the staging of the primary tumor and nodal status. Novel imaging studies, such as positron emission tomography–CT and USPIO (ultra–small-particle superparamagnetic iron oxide)–MRI are promising modalities and may improve the accuracy of imaging in the future. Nomograms provide some additional information, but novel variables, such as molecular markers, are needed to improve the accuracy of risk-stratification models. Conclusions Incorrect clinical staging and especially understaging is a serious problem in BCa, and improvements in all steps of the staging process are needed to achieve more accuracy and improved care for BCa patients.

Malignant transformation of ectopic pancreatic cells in the duodenal wall

Ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple's procedure and had an uneventful post-operative recovery. Traditional imaging studies are often inconclusive in the definitive diagnosis, whilst endoscopic ultrasonography and guided biopsy may aid accurate pre-operative diagnosis. Diagnostic uncertainty warrants surgical exploration and if necessary extended resection is indicated.

Complications of methylene blue dye infiltration for sentinel lymph node biopsy in breast cancer.

Abstract Abstract #4140 Background: Isosulfan blue has proven invaluable for sentinel lymph node identification in breast cancer. However, an intermittent supply shortage of this agent over the last few years has led to alternative usage of methylene blue. Worldwide, methylene blue is traditionally viewed as a less expensive and safer equivalent to isosulfan, with few reports of significant side effects. Its increased usage has led to anecdotal reports of local skin reactions. This study serves to review the rate of local complications observed following subareolar infiltration of methylene blue for sentinel lymph node identification in breast cancer staging.&amp;#x2028; Material Methods: This is a retrospective review of prospectively collected data in a university based surgical oncology practice. Records of all patients undergoing sentinel lymph node biopsy for breast cancer between August, 2007 and April, 2008 were reviewed (the switch from Isosulfan to Methylene blue was made in August of 2007). Local complication of fat necrosis was recorded. Tumor stage, neoadjuvant therapy, volume and dilution of dye used were analysed for association with fat necrosis.&amp;#x2028; Results: One hundred and three patients underwent sentinel node biopsy for breast cancer during the study period. Seven (7%) patients developed fat necrosis at the site of injection. The rate of injection site fat necrosis is associated with the volume of methylene blue [0% for &amp;lt;3cc and 7.2% for &amp;gt; 3cc (p = 0.0071)]; there was no association with tumor stage [3.2% for stage &amp;lt;1, 13.1% for stage 2 and 0% for stage 3 (p=0.343)] and tumor type [7.3% for invasive ductal cancer, 8.3% for invasive lobular and 0% for in situ cancer (p=1.000)].&amp;#x2028; Discussion: While methylene blue has typically been viewed as an inert agent for sentinel node biopsy, our study documents a 7% rate of fat necrosis. This is clinically significant in terms of painful symptoms and also the work-up that it may necessitate as a new mass in a breast cancer patient which has suspicious appearance on traditional imaging studies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4140.

Imaging of Eating Disorders: Multiple Techniques to Demonstrate the Dynamic Brain

Imaging of Eating Disorders: Multiple Techniques to Demonstrate the Dynamic Brain

Wireless capsule endoscopy for obscure small-bowel disorders: Final results of the first pediatric controlled trial

Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents. Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group. Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy. Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.

Percutaneous oocyte retrieval from an inguinal ovary

Ectopic locations of the ovary are rare, but should be considered when an ovary is absent on traditional imaging studies. The images presented are of a patient with recurrent pregnancy loss and infertility. Of note, she also had a corrected tetralogy of Fallot and normal karyotype. Hysterosalpingogram revealed a right unicornuate uterus with the presence and patency of only the right fallopian tube. Magnetic resonance imaging showed an absent left kidney and ovary and a left inguinal hernia. The left ovary was discovered on the seventh day of ovarian stimulation for in vitro fertilization when a mass was seen in the inguinal region (Fig. 1) with follicles visualized by transabdominal ultrasound. The risk of ovarian torsion was discussed with the patient who elected to continue the cycle. Oocyte retrieval was performed from the right ovary transvaginally. Then, using a transvaginal ultrasound probe with needle guide (Figs. 2 and 3), the needle was advanced percutaneously through the abdominal wall into the inguinal ovary allowing aspiration of normal-appearing oocytes. The patient did not conceive with the fresh transfer of a single blastocyst but conceived after a thaw transfer of a single embryo and delivered a healthy female at 34 weeks’ gestation. She plans to undergo corrective surgery to repair the inguinal hernia and reposition the ovary into the pelvic cavity.

STONE DISEASE

Imaging studies used for the detection and characterization of urinary tract calculi are presented in this article. Comparisons of traditional imaging studies are made with noncontrast helical CT scanning, the most recent addition to stone imaging. Imaging findings for noncontrast helical CT and an approach to dealing with various combinations of CT studies are also presented.

Pediatric uroradiology--1997.

The imaging of common pediatric urological problems is in evolution. Modifications of standard techniques such as substitution of cyclic voiding cystourethrography in the neonate and infants, introduction of newer modalities (Doppler ultrasound), and new nuclear renal agents (Tc-MAG3) have enhanced our ability to detect anomalies and abnormalities. In this brief article, some of the recent developments in imaging are reviewed and the ways in which these developments interface with traditional imaging studies are presented.

Imaging of sacrococcygeal germ cell tumors.

Sacrococcygeal teratoma is the most common solid tumor in neonates. Malignant sacrococcygeal germ cell tumors also occur in infants and children. Diagnostic imaging studies help confirm the diagnosis of a clinically palpable sacrococcygeal mass, determine its relationship to other structures, and detect metastases. Despite the relative frequency of sacrococcygeal germ cell tumors, characteristics of these lesions as evaluated with computed tomography (CT) and magnetic resonance (MR) imaging have received little attention in radiologic literature. We outline important clinical information, review the spectrum of manifestations of these tumors with traditional imaging studies, and illustrate the value of CT and MR imaging for diagnosis and staging of sacrococcygeal germ cell tumors.