RESUMEN
BACKGROUND: The detection of occult bone metastases is a key factor in determining the management of patients with renal cell carcinoma (RCC), especially when curative surgery is considered. This prospective study assessed the sensitivity of (18)F-labelled sodium fluoride in conjunction with positron emission tomography/computed tomography ((18)F-NaF PET/CT) for detecting RCC bone metastases, compared with conventional imaging by bone scintigraphy or CT. PATIENTS AND METHODS: An adaptive two-stage trial design was utilized, which was stopped after the first stage due to statistical efficacy. Ten patients with stage IV RCC and bone metastases were imaged with (18)F-NaF PET/CT and (99m)Tc-labelled methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy including pelvic single photon emission computed tomography (SPECT). Images were reported independently by experienced radiologists and nuclear medicine physicians using a 5-point scoring system. RESULTS: Seventy-seven lesions were diagnosed as malignant: 100% were identified by (18)F-NaF PET/CT, 46% by CT and 29% by bone scintigraphy/SPECT. Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by (18)F-NaF PET/CT. On an individual patient basis, (18)F-NaF PET/CT detected more RCC metastases than (99m)Tc-MDP bone scintigraphy/SPECT or CT alone (P = 0.007). The metabolic volumes, mean and maximum standardized uptake values (SUV mean and SUV max) of the malignant lesions were significantly greater than those of the benign lesions (P < 0.001). CONCLUSIONS: (18)F-NaF PET/CT is significantly more sensitive at detecting RCC skeletal metastases than conventional bone scintigraphy or CT. The detection of occult bone metastases could greatly alter patient management, particularly in the context when standard-of-care imaging is negative for skeletal metastases.
Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Fluorodesoxiglucosa F18/farmacocinética , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Imagen Multimodal/métodos , Proyectos de Investigación , Medronato de Tecnecio Tc 99m/farmacocinética , Anciano , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/secundario , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/secundario , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía de Emisión de Positrones/métodos , Pronóstico , Estudios Prospectivos , Cintigrafía , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodosRESUMEN
Encapsulating peritoneal sclerosis (EPS) is a rare entity most commonly associated with peritoneal dialysis (PD). Several imaging features at computed tomography (CT) are common to many diseases; however, appreciation of the features unique to this condition interpreted with the appropriate clinical findings is crucial to diagnosis.
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Fibrosis Peritoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Humanos , Diálisis Peritoneal/efectos adversos , Fibrosis Peritoneal/etiologíaRESUMEN
AIMS: To study the expression of CD2-associated protein (CD2AP), an adaptor protein involved in T-cell signalling and renal function, in normal, reactive and neoplastic human lymphoid tissues. METHODS AND RESULTS: We used immunohistochemical techniques to evaluate monoclonal antibodies against CD2AP on over 400 formalin fixed paraffin embedded tissue blocks retrieved from the host institutions of three authors. The samples tested included normal, reactive and neoplastic lymphoid tissue. In lymphoid tissues, strong CD2AP staining was observed in plasmacytoid dendritic cells (pDCs), weak and variable in mantle zone B cells and moderate in rare germinal center cells. CD2AP labeled cortical and rare medullary thymocytes and isolated mononuclear cells in bone marrow trephines. Furthermore, epithelial and endothelial cells expressed CD2AP. Among neoplasms, the greatest number of CD2AP-positive cases were found in diffuse large B cell (21/94), NK T-cell lymphomas (7/67), "blastic plasmacytoid dendritic cell neoplasms" (9/10) and some types of solid tumor. CONCLUSIONS: Our finding that mature peripheral T cells are CD2AP-negative but immature cortical thymocytes are positive may prove useful for diagnostic purposes. Moreover, our results demonstrate that CD2AP represents a useful marker of normal and neoplastic pDC and may be used in a diagnostic panel in reactive or neoplastic lymphoid proliferations.
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Proteínas Adaptadoras Transductoras de Señales/metabolismo , Linfocitos B/metabolismo , Proteínas del Citoesqueleto/metabolismo , Células Dendríticas/metabolismo , Linfoma/diagnóstico , Linfoma/metabolismo , Timocitos/metabolismo , Proteínas Adaptadoras Transductoras de Señales/genética , Proteínas Adaptadoras Transductoras de Señales/inmunología , Biomarcadores/metabolismo , Línea Celular , Proteínas del Citoesqueleto/genética , Proteínas del Citoesqueleto/inmunología , Humanos , Inmunohistoquímica , Linfocitos/citologíaRESUMEN
OBJECTIVE: Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide. Prognosis is predicted by size at diagnosis, vascular invasion and tumour proliferation markers. This study investigates if MRI features of histologically proven HCCs correlate with vascular invasion. METHODS: Between 2006 and 2008, 18 consecutive patients, with a total of 27 HCCs, had comprehensive MRI studies performed at our institution within a median of 36 days of histology sampling. Each lesion was evaluated independently on MRI by 3 radiologists (blinded to both the radiology and histopathology reports) using a 5-point confidence scale for 23 specific imaging features. The mean of the rating scores across readers was calculated to determine interobserver consistency. The most consistent features were then used to examine the value of features in predicting vascular invasion, using a χ(2 )test for trend, having eliminated those features without sufficient variability. RESULTS: 22 of the 23 imaging features showed sufficient variability across lesions. None of these significantly correlated with the presence of vascular invasion, although a trend was identified with the presence of washout in the portal venous phase on MRI and the median size of lesions, which was greater with vascular invasion. CONCLUSION: This study suggests that no single MRI feature accurately predicts the presence of vascular invasion in HCCs, although a trend was seen with the presence of washout in the portal venous phase post gadolinium. Larger prospective studies are required to investigate this further.
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Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética , Neoplasias Vasculares/patología , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios RetrospectivosRESUMEN
Pituitary carcinoma occurs in ~0.2% of resected pituitary tumours and carries a poor prognosis (mean survival <4 years), with standard chemotherapy regimens showing limited efficacy. Recent evidence suggests that temozolomide (TMZ), an orally-active alkylating agent used principally in the management of glioblastoma, may also be effective in controlling aggressive/invasive pituitary adenomas/carcinomas. A low level of expression of the DNA-repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) predicts TMZ responsiveness in glioblastomas, and a similar correlation has been observed in the majority of aggressive pituitary adenomas/carcinomas reported to date. Here, we report a case of a silent pituitary corticotroph adenoma, which subsequently re-presented with Cushing's syndrome due to functioning hepatic metastases. The tumour exhibited low immunohistochemical MGMT expression in both primary (pituitary) and secondary (hepatic) lesions. Initial TMZ therapy (200 mg/m² for 5 days every 28 days-seven cycles) resulted in marked clinical, biochemical [>50% fall in adrenocorticotrophic hormone (ACTH)] and radiological [partial RECIST (response evaluation criteria in solid tumors) response] improvements. The patient then underwent bilateral adrenalectomy. However, despite reintroduction of TMZ therapy (further eight cycles) ACTH levels plateaued and no further radiological regression was observed. We review the existing literature reporting TMZ efficacy in pituitary corticotroph tumours, and highlight the pointers/lessons for treating aggressive pituitary neoplasia that can be drawn from experience of susceptibility and evolving resistance to TMZ therapy in glioblastoma. Possible strategies for mitigating resistance developing during TMZ treatment of pituitary adenomas/carcinomas are also considered.
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Dacarbazina/análogos & derivados , Neoplasias Hipofisarias/tratamiento farmacológico , Adenoma Hipofisario Secretor de ACTH/tratamiento farmacológico , Adenoma Hipofisario Secretor de ACTH/patología , Adenoma/tratamiento farmacológico , Anciano , Antineoplásicos Alquilantes/uso terapéutico , Dacarbazina/uso terapéutico , Resistencia a Antineoplásicos , Glioblastoma/tratamiento farmacológico , Humanos , Neoplasias Hepáticas/secundario , Masculino , O(6)-Metilguanina-ADN Metiltransferasa/metabolismo , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , TemozolomidaRESUMEN
INTRODUCTION: Dual-energy dual source CT can almost simultaneously image patients using two different tube potentials, allowing material decomposition and creation of 'virtual unenhanced' (VU) images from post-contrast series. METHODS: 75 patients undergoing triple-phase liver CT examinations were imaged using a second generation dual-source CT machine with tube potentials 140/100 kVp. Post-processing VU series were derived from arterial and portal phases. Regions-of-interest from liver parenchyma and within fat ('noise' assessment) were drawn to compare VU series to conventional unenhanced (CU) series. Subjective analysis assessed image quality and the suitability of VU to replace CU series. RESULTS: Mean Hounsfield unit (HU) values of liver were higher in the VU series: portal 51.9 (SD = 10.29), arterial 51.1 (SD = 10.05), compared to the CU series 49.2 (SD = 9.11); P<0.001. However, Pearson's correlation of the VU and CU series remained excellent: 0.838 (portal), 0.831 (arterial). Bland-Altman plots also showed good agreement between both VU and the CU datasets. Noise measurements were significantly lower in both VU series (P<0.001). For subjective analysis, image quality was rated as very good/excellent in 100% of CU images, 93.3% of portal VU and 88.7% of arterial VU series. Overall, portal VU and arterial VU images were acceptable replacements for the CU series in 97.4% and 96.1%, respectively. Post-processing was noted to create a number of artefacts in VU images--knowledge of these is essential for interpretation. CONCLUSIONS: Portal and arterial-derived VU images objectively correlate to CU images and demonstrate good image quality and acceptability. VU image sets could replace the conventional unenhanced images in the vast majority of cases, significantly reducing radiation dose.
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Hepatopatías/diagnóstico por imagen , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Artefactos , Femenino , Humanos , Masculino , Dosis de Radiación , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios RetrospectivosRESUMEN
AIM: To evaluate whether virtual unenhanced (VU) computed tomography (CT) images generated of the aorta were of sufficient quality to replace the conventional unenhanced (CU) images. MATERIALS AND METHODS: Forty-nine patients undergoing examination of the thoracic or abdominal aorta were examined using a dual-energy protocol. VU images were generated from the arterial phase images and compared to the CU images. Objective analysis was performed by drawing paired regions of interest (ROIs) within the thoracic and abdominal aorta and measuring the radiodensity in Hounsfield units attenuation within the ROIs. Subjective analysis was performed by two experienced readers evaluating the VU images in terms of noise, quality, calcium loss, and overall acceptability. RESULTS: The attenuation was significantly higher in the VU images compared to the CU images within the thoracic aorta (p < 0.01) but not within the abdominal aorta (p = 0.15). Overall the VU images of the abdominal aorta were deemed acceptable as replacements for the CU images in 93% of cases. For the thoracic aorta, the VU images were deemed acceptable in only 12% of cases, primarily due to pulsation artefact. CONCLUSION: VU images of the abdominal aorta are acceptable as replacements for the CU images in the vast majority of cases; however, they are not suitable as replacements for the CU images of the thoracic aorta.
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Aorta Abdominal/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Intensificación de Imagen Radiográfica/métodos , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Medios de Contraste , Femenino , Humanos , Masculino , Reproducibilidad de los ResultadosAsunto(s)
Peliosis Hepática , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Progresión de la Enfermedad , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias del Mediastino/tratamiento farmacológico , Peliosis Hepática/inducido químicamente , Peliosis Hepática/diagnóstico , Seminoma/tratamiento farmacológico , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Normal haemostasis relies on the complex interactions of the coagulation cascade, platelets, and the endothelium. In this review, the roles of each of these elements are described as well as common causes for their derangement. Haemostasis may be manipulated via pharmacological means and in recent years there has been a significant increase in the number of agents available for influencing haemostatic mechanisms. It is essential that radiologists are aware of these mechanisms and drugs if they are to perform image-guided procedures safely. In addition to describing the relevant pathways and drugs, practical tips are provided.
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Coagulación Sanguínea , Endotelio Vascular , Hemostasis , Anticoagulantes/farmacología , Coagulación Sanguínea/efectos de los fármacos , Coagulación Sanguínea/fisiología , Coagulación Sanguínea/efectos de la radiación , Trastornos de la Coagulación Sanguínea/etiología , Plaquetas/fisiología , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiología , Endotelio Vascular/efectos de la radiación , Hemostasis/efectos de los fármacos , Hemostasis/fisiología , Hemostasis/efectos de la radiación , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto , Tiempo de Protrombina , Radiología Intervencionista/métodos , Radiología Intervencionista/normas , Trombocitopenia/etiologíaRESUMEN
AIM: To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for hepatocellular carcinoma (HCC) in cirrhotic patients undergoing liver transplantation. Secondary aims were to examine the effect of radiologist experience and lesion size on diagnostic accuracy. MATERIALS AND METHODS: Thirty-nine patients (72% male with a mean age of 56.5 years) underwent liver transplantation following preoperative triple-phase MDCT examination of the liver. MDCT examinations were retrospectively independently reviewed by three radiologists for the presence and location of suspected HCCs, with the diagnostic confidence recorded using a five-point confidence scale. MDCT examinations were compared with explant specimens for histopathological correlation. RESULTS: Histopathological results demonstrated 46 HCCs in 29 of the 39 patients. Analysis demonstrated a sensitivity of 65-75% and specificity of 47-88% for detection of HCC lesions. The sensitivity dropped to 48-57% for lesions of size ≤20mm. As the diagnostic confidence increased, there was a further decrease in the sensitivity (4-26%). The radiologist with the greatest number of years experience was found to have a significantly higher accuracy of detection of HCC lesions compared with the least experienced radiologist. CONCLUSION: Larger lesion size of HCC and greater number of years experience of the radiologist resulted in significantly higher accuracy of HCC lesion detection. The overall sensitivity and specificity results for MDCT detection of HCC are comparable to previous helical CT imaging.
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Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Trasplante de Hígado/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Carcinoma Hepatocelular/patología , Femenino , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Carga TumoralRESUMEN
Acute pancreatitis is a common condition (thought to be increasing in incidence worldwide), which has a highly variable clinical course. The radiologist plays a key role in the management of such patients, from diagnosis and staging to identification and treatment of complications, as well as in determining the underlying aetiology. The aim of this article is (i) to familiarize the reader with the pathophysiology of acute pancreatitis, the appearances of the various stages of pancreatitis, the evidence for the use of staging classifications and the associated complications and (ii) to review current thoughts on optimising therapy.
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Seudoquiste Pancreático/diagnóstico por imagen , Pancreatitis/diagnóstico por imagen , Absceso/diagnóstico por imagen , Absceso/etiología , Enfermedad Aguda , Consumo de Bebidas Alcohólicas/efectos adversos , Colelitiasis/complicaciones , Colestasis/diagnóstico por imagen , Colestasis/etiología , Humanos , Imagen por Resonancia Magnética , Necrosis/diagnóstico por imagen , Necrosis/etiología , Seudoquiste Pancreático/etiología , Pancreatitis/complicaciones , Pancreatitis/epidemiología , Pancreatitis/patología , Radiografía Intervencional , Sepsis/etiología , Vena Esplénica , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiologíaRESUMEN
The lymphomas are a heterogeneous group of malignancies, which exhibit a range of different molecular features, genetics, and clinical presentations. Consequently, therapeutic approaches and clinical outcomes differ greatly. Following therapy, the thorax may be a site of disease recurrence, but infection, drug reactions, and radiation pneumonitis are commonly encountered. We present a comprehensive review of these conditions, focussing on their radiological appearances, in order that radiologists may better engage their colleagues in haemato-oncology.
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Trasplante de Médula Ósea/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neumonitis por Radiación/diagnóstico por imagen , Enfermedades Respiratorias/diagnóstico por imagen , Adulto , Anciano , Anticuerpos Monoclonales , Anticuerpos Monoclonales de Origen Murino , Antineoplásicos/efectos adversos , Trasplante de Médula Ósea/efectos adversos , Femenino , Humanos , Neoplasias Pulmonares/terapia , Metástasis Linfática , Linfoma/terapia , Masculino , Persona de Mediana Edad , Enfermedades Respiratorias/inducido químicamente , Rituximab , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Multiple myeloma (MM) is a neoplastic proliferation of plasma cells within the bone marrow. The disease is characterized by a plasma cell infiltrate of the bone marrow, osteolytic bone lesions, and the presence of monoclonal protein in the serum or urine with extraosseous involvement by disease less common. Although the skeletal survey has long been the standard investigation in these patients, there have been significant recent advances in computed tomography (CT), magnetic resonance imaging (MRI), and functional imaging. We present a comprehensive review of the evidence for the use of each of these studies in the diagnosis, prognosis, assessment of complications, and response evaluation in patients with MM.
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Mieloma Múltiple/diagnóstico , Fracturas Óseas/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Mieloma Múltiple/complicaciones , Mieloma Múltiple/patología , Estadificación de Neoplasias , Tomografía de Emisión de Positrones/métodos , Pronóstico , Tomografía Computarizada por Rayos X/métodosRESUMEN
The lymphomas are a heterogeneous group of malignant diseases. They are divided into two broad groups: Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Patients suffering from HD and NHL can be cured by appropriate chemotherapy and/or radiotherapy. Accurate staging and response assessment is essential to guide management decisions. The International Workshop Group (IWG) criteria, published in 1999, have become the widely accepted standard for response assessment in NHL. Although the IWG criteria have proved extremely useful in the standardization of treatment response, they do have a number of limitations. As a consequence of this, together with advances in functional imaging, revised criteria have been published recently. The aim of this review is to describe the evidence supporting the available imaging techniques, the limitations of each technique, and how these should be applied in clinical practice. We briefly review the corresponding response criteria for central nervous system (CNS) lymphomas, and take a look at novel imaging techniques that may play a role in the future.
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Neoplasias del Sistema Nervioso Central , Enfermedad de Hodgkin , Linfoma no Hodgkin , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Neoplasias del Sistema Nervioso Central/terapia , Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/terapia , Humanos , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/terapia , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Tomografía de Emisión de Positrones/métodos , Guías de Práctica Clínica como Asunto , Radiofármacos , Tomografía Computarizada por Rayos XRESUMEN
Recent years have witnessed an explosion of research into the molecular basis of glomerular disease resulting in nephrotic- range urinary protein leak using both human genetics and animal models. Löwik et al. describe the first case report of an early-onset nephrotic syndrome presenting in conjunction with a homozygous CD2AP mutation. These data demonstrate the convergence between basic and clinical approaches and their potential to transform our understanding of the pathogenetic mechanisms underlying human glomerular disease.
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Proteínas Adaptadoras Transductoras de Señales/deficiencia , Medicina Clínica , Proteínas del Citoesqueleto/deficiencia , Ciencia , Actinas/metabolismo , Proteínas Adaptadoras Transductoras de Señales/química , Proteínas Adaptadoras Transductoras de Señales/genética , Secuencia de Aminoácidos , Animales , Codón sin Sentido , Proteínas del Citoesqueleto/química , Proteínas del Citoesqueleto/genética , Homocigoto , Humanos , Glomérulos Renales/patología , Ratones , Modelos Biológicos , Datos de Secuencia Molecular , Mutación , Análisis de Secuencia de ADNRESUMEN
Placenta percreta is a potentially life-threatening complication of pregnancy, which is increasing in incidence. Ante-natal diagnosis with ultrasound and magnetic resonance imaging aids the obstetric team in planning further management. We present a case of placenta percreta with imaging and a brief review of the literature.
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Imagen por Resonancia Magnética/métodos , Placenta Accreta/diagnóstico , Adulto , Cesárea , Diagnóstico Diferencial , Femenino , Humanos , Placenta Accreta/cirugía , Embarazo , Resultado del EmbarazoRESUMEN
Epidermoid tumours are non-neoplastic inclusion cysts representing up to 1.1 per cent of all intracranial tumours, typically presenting with symptoms related to pressure or intracranial rupture in the fourth or fifth decade of life. The authors present a case of a parasellar epidermoid cyst which has ruptured in to the nasopharynx; to the best of their knowledge, this has not been previously reported. The computed tomography (CT) and magnetic resonance imaging (MRI) are presented. The pathology and radiological features of epidermoid tumours are discussed, particularly in relation to extracranial connections. The differential diagnosis of lesions eroding the central skull base is reviewed.