RESUMEN
BACKGROUND: The study aimed to evaluate the diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) parameters in distinguishing sinonasal lymphoma from sinonasal carcinoma. METHODS: Forty-two participants with histologically confirmed sinonasal lymphomas and fifty-two cases of sinonasal carcinoma underwent imaging with a 3.0T MRI scanner. DCE-MRI and DWI were conducted, and various parameters including type of time-intensity curve(TIC), time to peak, peak enhancement, peak contrast enhancement, washout rate, apparent diffusion coefficient (ADC), and relative ADC were measured. Binary logistic regression and receiver operating characteristic (ROC) curve analysis were employed to assess the diagnostic capability of individual and combined indices for differentiating nasal sinus lymphoma from nasal sinus carcinoma. RESULTS: Sinonasal lymphoma predominantly exhibited type II TIC(n = 20), whereas sinonasal carcinoma predominantly exhibited type III TIC(n = 23). Significant differences were observed in all parameters except washout ratio (p < 0.05), and ADC value emerged as the most reliable diagnostic tool in single parameter. Combined DCE-MRI parameters demonstrated superior diagnostic efficacy compared to individual parameters, with the highest efficiency (area under curve = 0.945) achieved when combining all parameters of DCE-MRI and DWI. CONCLUSIONS: Multiparametric evaluation involving contrast-enhanced dynamic MRI and DWI holds considerable diagnostic value in distinguishing sinonasal lymphoma from sinonasal carcinoma.
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Imagen de Difusión por Resonancia Magnética , Linfoma , Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de los Senos Paranasales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Diagnóstico Diferencial , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Adulto , Anciano , Estudios de Casos y Controles , Imagen de Difusión por Resonancia Magnética/métodos , Imágenes de Resonancia Magnética Multiparamétrica/métodos , Medios de Contraste , Carcinoma/diagnóstico por imagen , Curva ROC , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Multimodal medical image fusion is a perennially prominent research topic that can obtain informative medical images and aid radiologists in diagnosing and treating disease more effectively. However, the recent state-of-the-art methods extract and fuse features by subjectively defining constraints, which easily distort the exclusive information of source images. To overcome these problems and get a better fusion method, this study proposes a 2D data fusion method that uses salient structure extraction (SSE) and a swift algorithm via normalized convolution to fuse different types of medical images. First, salient structure extraction (SSE) is used to attenuate the effect of noise and irrelevant data in the source images by preserving the significant structures. The salient structure extraction is performed to ensure that the pixels with a higher gradient magnitude impact the choices of their neighbors and further provide a way to restore the sharply altered pixels to their neighbors. In addition, a Swift algorithm is used to overcome the excessive pixel values and modify the contrast of the source images. Furthermore, the method proposes an efficient method for performing edge-preserving filtering using normalized convolution. In the end,the fused image are obtained through linear combination of the processed image and the input images based on the properties of the filters. A quantitative function composed of structural loss and region mutual data loss is designed to produce restrictions for preserving data at feature level and the structural level. Extensive experiments on CT-MRI images demonstrate that the proposed algorithm exhibits superior performance when compared to some of the state-of-the-art methods in terms of providing detailed information, edge contour, and overall contrasts.
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Algoritmos , Neoplasias , Humanos , Neoplasias/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Imagen Multimodal/métodos , Procesamiento de Señales Asistido por Computador , Carcinoma/diagnóstico por imagenRESUMEN
ABSTRACT: We report a case of recurrent nasopharyngeal carcinoma postnasopharyngectomy, presenting with headaches. MRI revealed abnormal signals of the clivus with enhancement, and FDG PET/CT indicated intense uptake in the nasopharynx, clivus, and left neck lymph nodes. Bone SPECT/CT showed bony erosion and uptake in bilateral skull base areas. Biopsy confirmed aspergillosis. Despite the challenges in distinguishing tumor invasion from Aspergillus infection on MRI, bone SPECT/CT, and FDG PET/CT, the short postsurgery period and extensive uptake suggested skull base osteomyelitis.
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Aspergilosis , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Base del Cráneo , Humanos , Carcinoma Nasofaríngeo/diagnóstico por imagen , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/diagnóstico por imagen , Diagnóstico Diferencial , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Aspergilosis/diagnóstico por imagen , Masculino , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Persona de Mediana Edad , Carcinoma/diagnóstico por imagen , Imagen por Resonancia Magnética , RecurrenciaRESUMEN
PURPOSE: The goal of our study was to better characterize new CT diagnoses of peritoneal carcinomatosis (PC) in the ED, and to evaluate how to best identify the primary lesion. Prompt identification of the source of the carcinomatosis may allow for the patient to receive early initial care from the correct clinical service. METHODS: All new CT cases of PC-like appearance identified on CT in the ED from January 2017 through July 2020. Each report and corresponding medical record were manually reviewed. Patient demographics, presence/absence of intravenous contrast, source organ predicted by the radiologist in the CT scan report, pathologic diagnosis, and amount of ascites were tabulated. Chi-tests were used to test the statistical significance of differences between groups. RESULTS: Of the 131 CT cases of new PC-like appearance which received workup, 108 cases had pathologically proven PC and 23 cases had no underlying malignancy yielding a positive predictive value for actual PC of 82%. The most common cause of new PC in women was gynecological (66%), and in men was of GI tract origin (57%). Concordance between radiologist prediction and final pathology was higher with intravenous contrast (58%) compared to without contrast (40%); although this difference was not statistically significant (p = 0.19). A moderate or large amount of ascites was found in more than half of GYN primaries and in adenocarcinoma of unknown primary and there was a statistically significant difference in amount of ascites between cancer primaries (p = 0.01). CONCLUSION: A PC-like appearance on CT in the ED will likely be in patients with known malignancy, but of the new cases, there is a high PPV for it to represent new peritoneal carcinomatosis. Gynecological and GI malignancies are the most common cause in women and men, respectively, and this may help in focusing the radiologist's search pattern. Usage of intravenous contrast may help in identifying a primary lesion, and the presence of high-volume ascites should suggest a GYN primary or adenocarcinoma of unknown primary when there is no other obvious primary lesion.
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Medios de Contraste , Servicio de Urgencia en Hospital , Neoplasias Peritoneales , Tomografía Computarizada por Rayos X , Humanos , Neoplasias Peritoneales/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Anciano , Adulto , Estudios Retrospectivos , Carcinoma/diagnóstico por imagen , Anciano de 80 o más Años , Diagnóstico DiferencialRESUMEN
ABSTRACT: A 53-year-old man with newly diagnosed nasopharyngeal carcinoma (NPC) underwent 99m Tc-MDP bone scintigraphy for the potential bone metastases, and paired 68 Ga-DOTATATE and 68 Ga-FAPI PET/CT for initial staging. 68 Ga-DOTATATE PET/CT identified 2 abnormal foci with increased tracer uptake in the cervical vertebra and the ilium, whereas 68 Ga-FAPI PET/CT and bone scan detected only the ilium lesion. A subsequent biopsy confirmed NPC metastasis in the ilium. Furthermore, baseline and follow-up bone scintigraphy revealed that the positive lesion in the cervical vertebra, as indicated in 68 Ga-DOTATATE PET/CT, was also a bone metastasis. This case highlighted the potential superiority of 68 Ga-DOTATATE in NPC.
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Neoplasias Óseas , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Compuestos Organometálicos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Medronato de Tecnecio Tc 99m , Humanos , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/diagnóstico por imagen , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/patología , Neoplasias Óseas/secundario , Neoplasias Óseas/diagnóstico por imagen , Radioisótopos de Galio , Carcinoma/diagnóstico por imagen , Carcinoma/secundarioRESUMEN
Exocrine pancreatic carcinomas are uncommon in dogs and cats, and diagnosis with diagnostic imaging can be challenging. This retrospective, multi-institutional, descriptive study was performed to evaluate the CT features of exocrine pancreatic carcinomas. The CT examinations of 18 dogs and 12 cats with exocrine pancreatic carcinomas diagnosed by cytology or histopathology were reviewed. The CT features of exocrine pancreatic carcinomas included a well-defined mass in 28/30 (93%) with contrast enhancement in 27/30 (90%), commonly heterogeneous 22/30 (73%); often with a nonenhancing fluid to soft tissue attenuating center 12/30 (40%). The right lobe of the pancreas was the most common location, 14/30 (47%), then the left lobe, 10/30 (33%), and the body, 6/30 (20%). Extrahepatic biliary duct dilation was present in six animals; 5/6 (83%) of the masses were located in the right pancreatic lobe. Additional findings included peripancreatic fat-stranding 17/30 (57%), lymphadenopathy 16/30 (57%), peripancreatic soft tissue nodules 12/30 (40%), and free fluid 10/30 (33%). When comparing the imaging features of dogs and cats, there was a large overlap in imaging characteristics. There was a significant difference between the height of the masses, with dogs having larger masses (P-value.0028). Lymphadenopathy was more likely in larger masses [increased height (P-value.029)]. Cats were significantly older than dogs (P-value.0355). Pancreatic carcinomas were commonly identified as masses with heterogeneous contrast enhancement and a nonenhancing fluid to soft tissue attenuating center with concurrent peripancreatic changes (fat-stranding and/or soft tissue nodules) and lymphadenopathy.
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Enfermedades de los Gatos , Enfermedades de los Perros , Neoplasias Pancreáticas , Tomografía Computarizada por Rayos X , Animales , Perros , Gatos , Enfermedades de los Gatos/diagnóstico por imagen , Enfermedades de los Gatos/patología , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/patología , Neoplasias Pancreáticas/veterinaria , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/veterinaria , Masculino , Femenino , Carcinoma/veterinaria , Carcinoma/diagnóstico por imagen , Carcinoma/patologíaRESUMEN
Canine prostatic carcinoma (PC) has incompletely defined CT features. The purpose of this multicenter retrospective case series was to assess prostatic, regional, and distant findings of PC. Thirty dogs were enrolled. Consistent prostatic features included postcontrast heterogeneity with hypoattenuating, nonenhancing areas (30/30), capsular distortion (29/30), prostatic urethral effacement, displacement, or invasion (28/30), precontrast heterogeneity (27/30), and mineralization (24/30) which was always within or at the margin of the hypoattenuating areas. Consistent extraprostatic features included medial iliac lymph node enlargement (20/30), internal iliac lymph node enlargement (15/30), and periprostatic fat streaking or fluid (15/29). In a minority of dogs, there was lymph node mineralization, bladder trigone invasion, ureteral dilation, ductus deferens invasion, and bony changes consistent with hypertrophic osteopathy. Strongly suspected and potential bony metastases were noted infrequently (8/26), all in vertebrae regional to the prostate. In conclusion, these findings provide guidance on the expected CT features of canine PC.
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Enfermedades de los Perros , Neoplasias de la Próstata , Tomografía Computarizada por Rayos X , Perros , Animales , Masculino , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/patología , Neoplasias de la Próstata/veterinaria , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/veterinaria , Próstata/diagnóstico por imagen , Próstata/patología , Carcinoma/veterinaria , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Carcinoma/secundarioRESUMEN
ABSTRACT: SMARCA4-deficient undifferentiated tumors (SMARCA4-dUT) are rare and aggressive neoplasms commonly found in male smokers and portend a poor prognosis. In this case, we reported 18 F-FDG and 68 Ga-FAPI-46 PET/CT findings in an occult SMARCA4-dUT located in the left pulmonary hilum along with mediastinal lymph node metastases. 68 Ga-FAPI-46 PET/CT showed superiority over 18 F-FDG for detecting SMARCA4-dUT lesions. This case highlighted that 68 Ga-FAPI-46 PET/CT may be a promising imaging modality in the evaluation of SMARCA4-dUT, particularly for detecting the occult SMARCA4-dUT arising in uncommon sites.
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Proteínas Nucleares , Tomografía Computarizada por Tomografía de Emisión de Positrones , Factores de Transcripción , Humanos , Masculino , Factores de Transcripción/genética , Proteínas Nucleares/genética , Proteínas Nucleares/deficiencia , ADN Helicasas/genética , Carcinoma/diagnóstico por imagen , Radioisótopos de Galio , Persona de Mediana Edad , Isótopos de GalioRESUMEN
BACKGROUND: The study aimed to investigate anatomical changes in the neck region and evaluate their impact on dose distribution in patients with nasopharyngeal carcinoma (NPC) undergoing intensity modulated radiation therapy (IMRT). Additionally, the study sought to determine the optimal time for replanning during the course of treatment. METHODS: Twenty patients diagnosed with NPC underwent IMRT, with weekly pretreatment kV fan beam computed tomography (FBCT) scans in the treatment room. Metastasized lymph nodes in the neck region and organs at risk (OARs) were redelineation using the images from the FBCT scans. Subsequently, the original treatment plan (PLAN0) was replicated to each FBCT scan to generate new plans labeled as PLAN 1-6. The dose-volume histograms (DVH) of the new plans and the original plan were compared. One-way repeated measure ANOVA was utilized to establish threshold(s) at various time points. The presence of such threshold(s) would signify significant change(s), suggesting the need for replanning. RESULTS: Progressive volume reductions were observed over time in the neck region, the gross target volume for metastatic lymph nodes (GTVnd), as well as the submandibular glands and parotids. Compared to PLAN0, the mean dose (Dmean) of GTVnd-L significantly increased in PLAN5, while the minimum dose covering 95% of the volume (D95%) of PGTVnd-L showed a significant decrease from PLAN3 to PLAN6. Similarly, the Dmean of GTVnd-R significantly increased from PLAN4 to PLAN6, whereas the D95% of PGTVnd-R exhibited a significant decrease during the same period. Furthermore, the dose of bilateral parotid glands, bilateral submandibular glands, brainstem and spinal cord was gradually increased in the middle and late period of treatment. CONCLUSION: Significant anatomical and dosimetric changes were noted in both the target volumes and OARs. Considering the thresholds identified, it is imperative to undertake replanning at approximately 20 fractions. This measure ensures the delivery of adequate doses to target volumes while mitigating the risk of overdosing on OARs.
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Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Cuello , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada , Tomografía Computarizada por Rayos X , Humanos , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/patología , Carcinoma Nasofaríngeo/radioterapia , Carcinoma Nasofaríngeo/diagnóstico por imagen , Cuello/diagnóstico por imagen , Masculino , Radioterapia de Intensidad Modulada/métodos , Persona de Mediana Edad , Femenino , Adulto , Tomografía Computarizada por Rayos X/métodos , Carcinoma/diagnóstico por imagen , Carcinoma/radioterapia , Planificación de la Radioterapia Asistida por Computador/métodos , Órganos en Riesgo/efectos de la radiación , Órganos en Riesgo/diagnóstico por imagen , Radiometría/métodosRESUMEN
Secretory carcinoma of the breast (SCB) is a rare and specific type of breast cancer. Owing to its rarity, the number of SCB reports available is limited, with most of them focusing on clinical and pathological characteristics but no reports on its multimodal ultrasound (US) features. Thus, we present a rare case of SCB, retrospectively analyzing manifestations of US and contrast-enhanced US, as well as its pathological basis, aiming to enhance the understanding of US image features of SCB and provide more valuable information for clinical diagnosis. Moreover, the treatment strategy adopted for this patient may serve as a template for future management of SCB.
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Neoplasias de la Mama , Carcinoma , Humanos , Femenino , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Ultrasonografía/métodos , Persona de Mediana Edad , Ultrasonografía Mamaria/métodos , Imagen Multimodal/métodos , AdultoRESUMEN
The term noninvasive tumor with a follicular growth pattern and nuclear features of papillary thyroid cancer (NIFTP) is used to describe a tumor currently considered as a pre-malignant lesion for which a conservative therapeutic approach (i.e., lobectomy without radioiodine therapy) is strongly suggested. However, some patients with NIFTP and loco-regional or distant metastases have been already reported. We present an adult male patient with a final histological diagnosis of NIFTP and lymph node metastasis noted at post-therapy whole-body scintigraphy performed some days after radioiodine therapy.
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Adenocarcinoma Folicular , Radioisótopos de Yodo , Metástasis Linfática , Neoplasias de la Tiroides , Humanos , Masculino , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/radioterapia , Metástasis Linfática/patología , Metástasis Linfática/diagnóstico por imagen , Adenocarcinoma Folicular/patología , Adenocarcinoma Folicular/secundario , Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/radioterapia , Radioisótopos de Yodo/uso terapéutico , Carcinoma Papilar/patología , Carcinoma Papilar/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Adulto , Persona de Mediana Edad , Carcinoma/patología , Carcinoma/diagnóstico por imagen , Carcinoma/radioterapiaRESUMEN
BACKGROUND: Although contrast-enhanced magnetic resonance imaging (MRI) detects early-stage nasopharyngeal carcinoma (NPC) not detected by endoscopic-guided biopsy (EGB), a short contrast-free screening MRI would be desirable for NPC screening programs. This study evaluated a screening MRI in a plasma Epstein-Barr virus (EBV)-DNA NPC screening program. METHODS: EBV-DNA-screen-positive patients underwent endoscopy, and endoscopy-positive patients underwent EGB. EGB was negative if the biopsy was negative or was not performed. Patients also underwent a screening MRI. Diagnostic performance was based on histologic confirmation of NPC in the initial study or during a follow-up period of at least 2 years. RESULTS: The study prospectively recruited 354 patients for MRI and endoscopy; 40/354 (11.3%) endoscopy-positive patients underwent EGB. Eighteen had NPC (5.1%), and 336 without NPC (94.9%) were followed up for a median of 44.8 months. MRI detected additional NPCs in 3/18 (16.7%) endoscopy-negative and 2/18 (11.1%) EGB-negative patients (stage I/II, n = 4; stage III, n = 1). None of the 24 EGB-negative patients who were MRI-negative had NPC. MRI missed NPC in 2/18 (11.1%), one of which was also endoscopy-negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI, endoscopy, and EGB were 88.9%, 91.1%, 34.8%, 99.4%, and 91.0%; 77.8%, 92.3%, 35.0%, 98.7%, and 91.5%; and 66.7%, 92.3%, 31.6%, 98.1%, and 91.0%, respectively. CONCLUSION: A quick contrast-free screening MRI complements endoscopy in NPC screening programs. In EBV-screen-positive patients, MRI enables early detection of NPC that is endoscopically occult or negative on EGB and increases confidence that NPC has not been missed.
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Detección Precoz del Cáncer , Infecciones por Virus de Epstein-Barr , Herpesvirus Humano 4 , Imagen por Resonancia Magnética , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Humanos , Neoplasias Nasofaríngeas/virología , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/patología , Masculino , Persona de Mediana Edad , Femenino , Imagen por Resonancia Magnética/métodos , Detección Precoz del Cáncer/métodos , Adulto , Herpesvirus Humano 4/aislamiento & purificación , Carcinoma Nasofaríngeo/virología , Carcinoma Nasofaríngeo/diagnóstico por imagen , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/patología , Estudios Prospectivos , Anciano , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , ADN Viral/sangre , Carcinoma/diagnóstico por imagen , Carcinoma/virología , Carcinoma/diagnóstico , Carcinoma/patología , Sensibilidad y Especificidad , Endoscopía/métodos , Estadificación de Neoplasias , Tamizaje Masivo/métodos , Medios de Contraste/administración & dosificaciónRESUMEN
OBJECTIVES: Controversy exists on how to handle central lymph nodes in papillary thyroid carcinoma, particularly regarding indications for prophylactic central neck dissection (CND). Central node metastases are more difficult to diagnose preoperatively than lateral node metastases. METHODS: We enrolled 493 patients with papillary thyroid carcinoma treated at our department in the past 22 years. Metastatic lymph nodes were diagnosed preoperatively mainly by ultrasonography. In principle, CND was performed for all cases; ipsilateral CND was performed for hemithyroidectomy, and bilateral CND was performed for total thyroidectomy. Lateral neck dissection (levels II to V; LND) was performed for metastases to lateral neck lymph nodes (clinical node (cN) 1b). RESULTS: The cN stage was cN0 in 365 patients, cN1a in 10, and cN1b in 118. Of the 357 patients with stage cN0 who underwent CND, 42.9 % had pathologically positive nodes (pN+) in level VI, and of the 118 with stage cN1b who underwent CND, 78.0 % had pN+ in level VI. Cases with advanced T stage were significantly more common with pN+ in level VI. Level VI metastases were significantly associated with pN+ in level IV. As the total number of pN+ at each level of the lateral neck increased, the rate of patients with pN+ in level VI increased, and in patients with 3 or more pN+, about 85 % had level VI metastases. CONCLUSION: Because about half of the patients with cN0 patients had pN+ in level VI, and the rate of pN+ in level VI in each clinical T stage was 46 to 65 %, prophylactic CND should be performed, considering the various clinical benefits. Central nodes will have metastases in about 80 % of cases with lateral node metastases, requiring more accurate dissection. In lateral node metastases, there is a significant association between metastases in levels IV and VI.
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Carcinoma Papilar , Carcinoma , Neoplasias de la Tiroides , Humanos , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/cirugía , Metástasis Linfática/patología , Ganglios Linfáticos/patología , Disección del Cuello/efectos adversos , Tiroidectomía , Estudios RetrospectivosRESUMEN
Sarcomatoid carcinoma is a rare type of tumour and most commonly arises in the lungs. However, rarely can it also be found in the abdomen. Sarcomatoid tumours are aggressive with large tumoural volume showing cancerous epithelial cells mixed with sarcomatous (nerve, muscle, fat etc.) features on histopathology. Most of the carcinosarcomas arise in the background of pleomorphic adenoma, originating from a myoepithelial precursor. These tumours are resistant to treatment and rapidly metastasize. We present a unique case of hepatocellular sarcomatoid sarcoma, evaluated through F18-FDG PET/CT.
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Carcinoma , Sarcoma , Humanos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Rayos X , Tomografía de Emisión de Positrones , Carcinoma/diagnóstico por imagen , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Abdomen , RadiofármacosRESUMEN
OBJECTIVE: Identifying MRI texture parameters able to distinguish inflammation, fibrosis, and residual cancer in patients with naso-oropharynx carcinoma after radiochemotherapy (RT-CHT). MATERIAL AND METHODS: In this single-centre, observational, retrospective study, texture analysis was performed on ADC maps and post-gadolinium T1 images of patients with histological diagnosis of naso-oropharyngeal carcinoma treated with RT-CHT. An initial cohort of 99 patients was selected; 57 of them were later excluded. The final cohort of 42 patients was divided into 3 groups (inflammation, fibrosis, and residual cancer) according to MRI, 18F-FDG-PET/CT performed 3-4 months after RT-CHT, and biopsy. Pre-RT-CHT lesions and the corresponding anatomic area post-RT-CHT were segmented with 3D slicer software from which 107 textural features were derived. T-Student and Wilcoxon signed-rank tests were performed, and features with p-value < 0.01 were considered statistically significant. Cut-off values-obtained by ROC curves-to discriminate post-RT-CHT non-tumoural changes from residual cancer were calculated for the parameters statistically associated to the diseased status at follow-up. RESULTS: Two features-Energy and Grey Level Non-Uniformity-were statistically significant on T1 images in the comparison between 'positive' (residual cancer) and 'negative' patients (inflammation and fibrosis). Energy was also found to be statistically significant in both patients with fibrosis and residual cancer. Grey Level Non-Uniformity was significant in the differentiation between residual cancer and inflammation. Five features were statistically significant on ADC maps in the differentiation between 'positive' and 'negative' patients. The reduction in values of such features between pre- and post-RT-CHT was correlated with a good response to therapy. CONCLUSIONS: Texture analysis on post-gadolinium T1 images and ADC maps can differentiate residual cancer from fibrosis and inflammation in early follow-up of naso-oropharyngeal carcinoma treated with RT-CHT.
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Carcinoma , Neoplasias Orofaríngeas , Humanos , Estudios Retrospectivos , Gadolinio , Neoplasia Residual , Tomografía Computarizada por Tomografía de Emisión de Positrones , Imagen por Resonancia Magnética/métodos , Fibrosis , Carcinoma/diagnóstico por imagen , Carcinoma/terapia , QuimioradioterapiaRESUMEN
OBJECTIVE: The present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). MATERIAL AND METHODS: Included in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. RESULTS: The mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. CONCLUSIONS: Pleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery.
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Carcinoma , Neoplasias Ováricas , Enfermedades Pleurales , Derrame Pleural Maligno , Derrame Pleural , Femenino , Humanos , Persona de Mediana Edad , Derrame Pleural Maligno/diagnóstico por imagen , Derrame Pleural Maligno/etiología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Carcinoma/complicaciones , Carcinoma/diagnóstico por imagen , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico por imagen , Carcinoma Epitelial de OvarioRESUMEN
Obstructive or nonobstructive hypertensive hydrocephalus is reported in choroid plexus tumors. Choroid plexus tumors typically present as T2-weighted hyperintense intraventricular masses with occasional cerebrospinal fluid-drop metastasis. Acquired neoplastic nonobstructive hydrocephalus without visible mass lesion in magnetic resonance imaging is not reported in dogs. A 4.5-year-old Rhodesian Ridgeback presented with reduced mental status, unilaterally absent pupillary light reflex, and neck pain. Magnetic resonance imaging revealed a nonobstructive hydrocephalus and widened lumbar subarachnoid space with no evidence of a primary mass lesion. Postmortem examination confirmed a disseminated choroid plexus tumor affecting the ependyma and choroid plexi of all ventricles and the cerebral and lumbar subarachnoid space. Disseminated choroid plexus carcinomatosis should be considered as a possible cause of hypertensive hydrocephalus even in absence of a primary mass.
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Carcinoma , Neoplasias del Plexo Coroideo , Enfermedades de los Perros , Hidrocefalia , Perros , Animales , Plexo Coroideo/diagnóstico por imagen , Plexo Coroideo/patología , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/veterinaria , Neoplasias del Plexo Coroideo/complicaciones , Neoplasias del Plexo Coroideo/diagnóstico por imagen , Neoplasias del Plexo Coroideo/veterinaria , Imagen por Resonancia Magnética/veterinaria , Carcinoma/complicaciones , Carcinoma/diagnóstico por imagen , Carcinoma/veterinaria , Enfermedades de los Perros/diagnósticoRESUMEN
BACKGROUND: Radiomics, the field of image-based computational medical biomarker research, has experienced rapid growth over the past decade due to its potential to revolutionize the development of personalized decision support models. However, despite its research momentum and important advances toward methodological standardization, the translation of radiomics prediction models into clinical practice only progresses slowly. The lack of physicians leading the development of radiomics models and insufficient integration of radiomics tools in the clinical workflow contributes to this slow uptake. METHODS: We propose a physician-centered vision of radiomics research and derive minimal functional requirements for radiomics research software to support this vision. Free-to-access radiomics tools and frameworks were reviewed to identify best practices and reveal the shortcomings of existing software solutions to optimally support physician-driven radiomics research in a clinical environment. RESULTS: Support for user-friendly development and evaluation of radiomics prediction models via machine learning was found to be missing in most tools. QuantImage v2 (QI2) was designed and implemented to address these shortcomings. QI2 relies on well-established existing tools and open-source libraries to realize and concretely demonstrate the potential of a one-stop tool for physician-driven radiomics research. It provides web-based access to cohort management, feature extraction, and visualization and supports "no-code" development and evaluation of machine learning models against patient-specific outcome data. CONCLUSIONS: QI2 fills a gap in the radiomics software landscape by enabling "no-code" radiomics research, including model validation, in a clinical environment. Further information about QI2, a public instance of the system, and its source code is available at https://medgift.github.io/quantimage-v2-info/ . Key points As domain experts, physicians play a key role in the development of radiomics models. Existing software solutions do not support physician-driven research optimally. QuantImage v2 implements a physician-centered vision for radiomics research. QuantImage v2 is a web-based, "no-code" radiomics research platform.
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Nube Computacional , Biología Computacional , Radiología , Radiología/instrumentación , Radiología/métodos , Investigación , Programas Informáticos , Modelos Teóricos , Predicción , Carcinoma/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Humanos , Aprendizaje AutomáticoRESUMEN
BACKGROUND/AIMS: Some sessile serrated lesions (SSLs) progress into dysplasia and colorectal cancer, however, the clinical and endoscopic characteristics of SSLs with dysplasia remain to be determined. In this study, we elucidated these characteristics in SSLs with dysplasia/carcinoma, compared with those of SSLs without dysplasia. METHODS: We retrospectively collected the clinical, endoscopic, and pathological data of 254 SSLs from 216 patients endoscopically resected between January 2009 and December 2020. RESULTS: All SSLs included 179 without dysplasia and 75 with dysplasia/carcinoma, including 55 with low-grade dysplasia, 10 with high-grade dysplasia, and 10 with submucosal cancer. In clinical characteristics, SSLs with dysplasia/carcinoma were significantly associated with advanced age, metabolic diseases, and high-risk adenomas. In endoscopic characteristics, SSLs with dysplasia/carcinoma were significantly associated with the distal colon, large size, polypoid morphology, surface-changes, no mucus cap, and narrow-band imaging international colorectal endoscopic classification (NICE) type 2/3. In the multivariate analysis, high-risk adenomas (odds ratio [OR], 2.98; p = 0.01), large size (OR, 1.18; p < 0.01), depression (OR, 11.74; p = 0.03), and NICE type 2/3 (OR, 14.97; p < 0.01) were significantly associated with SSLs with dysplasia/carcinoma. CONCLUSION: SSLs had a higher risk of dysplasia in the distal colon than in the proximal colon. SSLs with large size, depression, and adenomatous surface-patterns, as well as those in patients with high-risk adenomas, increased the risk of dysplasia/ carcinoma. This suggests that the clinical and endoscopic characteristics can aid in the diagnosis and management of SSLs with dysplasia/carcinoma.
Asunto(s)
Adenoma , Carcinoma , Pólipos del Colon , Neoplasias Colorrectales , Humanos , Pólipos del Colon/cirugía , Pólipos del Colon/patología , Colonoscopía , Neoplasias Colorrectales/patología , Estudios Retrospectivos , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Carcinoma/patología , HiperplasiaRESUMEN
BACKGROUND: Prostate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice. OBJECTIVE: The aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System. METHODS: Overall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics. RESULTS: PET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature. CONCLUSIONS: PSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.