Pituitary macroadenoma: Accuracy of apparent diffusion coefficient magnetic resonance imaging in grading tumor aggressiveness.

PURPOSE: The purpose of this study is to evaluate the accuracy of apparent diffusion coefficient magnetic resonance imaging in grading tumor aggressiveness using histogram apparent diffusion coefficient values. MATERIALS AND METHODS: Eighteen patients with surgically proved pituitary macroadenomas were included in this study. Diffusion-weighted imaging with single-shot echo-planar sequence at 3-T with a 32-channel head coil was performed with b values of 0 and 1000 s/mm2. Calculated apparent diffusion coefficient maps were generated, and a 3-D volume of interest was placed on the tumor while superimposing contrast-enhanced magnetic resonance images. All apparent diffusion coefficient values within the volume of interest were used to compute the average apparent diffusion coefficient of the tumor. The apparent diffusion coefficient values were binned to construct the apparent diffusion coefficient histogram. Using the histogram, the mean, percentiles, skewness, and kurtosis of the apparent diffusion coefficient of the entire tumor were computed. Apparent diffusion coefficient histogram parameters were compared with the MIB-1 index, invasiveness, and recurrence for grading tumor aggressiveness of pituitary adenomas. RESULTS: The skewness of the apparent diffusion coefficient histogram only showed significant differences among MIB-1 indices ( p = 0.030). All apparent diffusion coefficient histogram parameters showed no significant differences between negative and positive invasion. The skewness and kurtosis of the apparent diffusion coefficient histogram showed significant differences between positive and negative recurrence (skewness p = 0.011, kurtosis p = 0.011). Receiver-operating characteristics analysis between positive and negative recurrence showed that both skewness and kurtosis of the apparent diffusion coefficient achieved area under the curve at 0.967. CONCLUSION: Skewness and kurtosis of the apparent diffusion coefficient histogram were the predictive parameters for assessing tumor proliferative potential and recurrence of pituitary adenomas.

Diagnostic Performance of Adaptive 4D Volume Perfusion CT for Detecting Metastatic Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma.

OBJECTIVE: The purpose of this study was to investigate the diagnostic performance of adaptive 4D volume perfusion CT covering the entire neck for detecting metastatic nodes in patients with head and neck squamous cell carcinoma. SUBJECTS AND METHODS: Thirty patients with histologically confirmed disease were enrolled. The relation between perfusion parameters and nodal size was analyzed, and perfusion parameters were compared between metastatic and benign nodes. The diagnostic capability for detecting metastatic nodes was evaluated. RESULTS: Significant inverse correlations with nodal size were found for blood flow (r = -0.40, p = 0.002), blood volume (r = -0.32, p = 0.02), and permeability surface product (r = -0.27, p = 0.04) of the metastatic nodes. All three parameters had significantly higher values in association with nodal maximum diameter < 10 mm compared with diameter ≥ 10 mm (blood flow, p = 0.004; blood volume, p = 0.01; permeability surface product, p = 0.02). Among the nodes with maximum diameter < 10 mm, blood flow of the metastatic nodes was significantly higher than that of the benign nodes (p = 0.02), whereas among the nodes ≥ 10 mm in diameter, the mean transit time of the metastatic nodes was significantly lower than that of the benign nodes (p = 0.04). In multivariate analysis, blood flow in nodes with maximum diameter < 10 mm had a significant association with the detection of metastatic nodes. The sensitivity and specificity of blood flow for differentiating metastatic from benign nodes were 73.3% and 70.8%. CONCLUSION: Findings from 4D volume perfusion CT covering the entire neck may be informative for characterization of cervical nodes. It is worthwhile to include the examination in nodal staging of head and neck squamous cell carcinoma.

Non-small cell lung cancer: Whole-lesion histogram analysis of the apparent diffusion coefficient for assessment of tumor grade, lymphovascular invasion and pleural invasion.

PURPOSE: Investigating the diagnostic accuracy of histogram analyses of apparent diffusion coefficient (ADC) values for determining non-small cell lung cancer (NSCLC) tumor grades, lymphovascular invasion, and pleural invasion. MATERIALS AND METHODS: We studied 60 surgically diagnosed NSCLC patients. Diffusion-weighted imaging (DWI) was performed in the axial plane using a navigator-triggered single-shot, echo-planar imaging sequence with prospective acquisition correction. The ADC maps were generated, and we placed a volume-of-interest on the tumor to construct the whole-lesion histogram. Using the histogram, we calculated the mean, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC, skewness, and kurtosis. Histogram parameters were correlated with tumor grade, lymphovascular invasion, and pleural invasion. We performed a receiver operating characteristics (ROC) analysis to assess the diagnostic performance of histogram parameters for distinguishing different pathologic features. RESULTS: The ADC mean, 10th, 25th, 50th, 75th, 90th, and 95th percentiles showed significant differences among the tumor grades. The ADC mean, 25th, 50th, 75th, 90th, and 95th percentiles were significant histogram parameters between high- and low-grade tumors. The ROC analysis between high- and low-grade tumors showed that the 95th percentile ADC achieved the highest area under curve (AUC) at 0.74. Lymphovascular invasion was associated with the ADC mean, 50th, 75th, 90th, and 95th percentiles, skewness, and kurtosis. Kurtosis achieved the highest AUC at 0.809. Pleural invasion was only associated with skewness, with the AUC of 0.648. CONCLUSIONS: ADC histogram analyses on the basis of the entire tumor volume are able to stratify NSCLCs' tumor grade, lymphovascular invasion and pleural invasion.

The role of changes in maximum standardized uptake value of FDG PET-CT for post-treatment surveillance in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy: preliminary findings.

OBJECTIVE: No clear consensus exists regarding the optimal interval and frequency of follow-up positron emission tomography (PET)-CT in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy (CRT). Here, we sought to clarify whether the changes in the maximum standardized uptake value (ΔSUVmax) may be a valid parameter to help decision-making for surveillance management after CRT. METHODS: 40 patients underwent PET-CT at pre-treatment and 3 months after CRT. Patients were followed by sequential PET-CT for 2 years after CRT. The ΔSUVmax of the primary tumour and the metastatic nodes were calculated between pre-treatment and 3 months after the CRT, and we evaluated the associations between ΔSUVmax and the manifestation of recurrence, time to recurrence and the patient survival. RESULTS: The ΔSUVmax of the primary tumour was significantly lower for the lesions with recurrence than that for those with non-recurrence for both the primary site and the nodal site (p = 0.007, 0.02). A significant correlation was found between the time to recurrence and the ΔSUVmax of the primary tumour (r = 0.63, p < 0.05). The threshold ΔSUVmax of the primary tumour of 1.04 revealed 76.9% sensitivity and 86.4% specificity for distinguishing recurrence from non-recurrence. The progression-free survival and overall survival of the two patient groups divided by the ΔSUVmax of the primary tumour at 1.04 showed a significant difference (p = 0.003, 0.02). The ΔSUVmax of the metastatic nodes did not show a significant association with recurrence or patient survival. CONCLUSION: The ΔSUVmax of the primary tumour showed a significant association with recurrence and patient survival. Advances in knowledge: The ΔSUVmax of the primary tumour may be a valid clinical parameter to help decision-making for the surveillance management of patients with HNSCC after CRT.

Correlation of HIF-1α/HIF-2α expression with FDG uptake in lung adenocarcinoma.

OBJECTIVES: Hypoxia is a key element involved in the development and progression of tumors. HIF-1α may transiently induce and mediate the response to acute and severe hypoxia, while HIF-2α may induce a longer response and may control the response to chronic and moderate hypoxia. Hypoxia increases the cellular uptake of FDG. Therefore, HIF may play an important role in the process of the cellular uptake of FDG. The aim of this study was to compare HIF-1α/HIF-2α expression with FDG uptake, Glut-1 expression, and prognosis in the patients with lung adenocarcinoma and to investigate the role of HIF-1α/HIF-2α in the uptake of FDG in lung adenocarcinoma. METHODS: In the current work, we compared the immunohistochemical expression of HIF-1α and HIF-2α in surgical specimens of 44 patients with lung adenocarcinoma. The relationships between HIF-α expression and Glut-1 expression, FDG uptake, and clinicopathological factors, including prognosis, were analyzed. RESULTS: There was a marginal association between HIF-1α and HIF-2α expressions (P = 0.076). We found a significant correlation between HIF-2α expression and FDG uptake (P = 0.0001). HIF-1α expression showed a marginal association with FDG uptake (P = 0.066). FDG uptake correlated more significantly with HIF-2α expression than with HIF-1α expression. A significant correlation was noticed between Glut-1 expression and both HIF-1α and HIF-2α expressions (P = 0.005 and P = 0.003, respectively). Univariate analysis of disease-free survival demonstrated that FDG uptake and HIF-2α expression, but not HIF-1α expression, were related to recurrence (P < 0.0001). CONCLUSION: FDG uptake correlated more significantly with HIF-2α expression than with HIF-1α expression, and both FDG uptake and HIF-2α expression, but not HIF-1α expression was correlated with post-operative recurrence in the patients with lung adenocarcinoma. These results suggest that both FDG uptake and HIF-2α expression may represent a more aggressive phenotype and that HIF-2α may play a more important role than HIF-1α in the uptake of FDG in lung adenocarcinoma.

Evaluation of cytological radiation damage to lymphocytes after I-131 metaiodobenzylguanidine therapy by the cytokinesis-blocked micronucleus assay.

OBJECTIVE: The purpose of this study was to evaluate the degree of cytological radiation damage to lymphocytes occurring after I-131 metaiodobenzylguanidine (MIBG) therapy as determined by the cytokinesis-blocked micronucleus assay. The chromosomal damage to lymphocytes induced by I-131 in vivo should result in augmentation of the number of cells with micronuclei. METHODS: We studied 15 patients with pheochromocytoma (14/15) or ganglioneuroma (1/15), who were treated initially with 7.4 GBq of I-131-MIBG. Isolated lymphocytes collected from patients 10 days after the therapy were harvested and treated according to the cytokinesis-blocked method of Fenech and Morley. Serial blood samples were obtained periodically only from two patients for 2 years after therapy. Micronucleus number of micronuclei per 500 binucleated cells was scored by visual inspection. As controls, lymphocytes from the same patients before the therapy were also studied. In an in vitro study, lymphocytes from eight normal volunteers were exposed to doses varying from 0.5 to 2 Gy and studied with the same method. RESULTS: The mean number (mean ± SD) of micronuclei after treatment was significantly increased (p < 0.001) as compared to control subjects (49.4 ± 8.2 vs. 11.3 ± 6.4). Internal radiation absorbed doses estimated for the 15 patients were 1.6 ± 0.3 Gy in this external irradiation study. The frequency of micronuclei post-administration of I-131-MIBG gradually decreased to near baseline (i.e., pre-therapy) levels by 2 years. CONCLUSIONS: The relatively low frequency of lymphocyte micronuclei induced by I-131-MIBG in vivo and reversal of the increasing frequency of lymphocyte micronuclei after therapy suggest that the short-term non-stochastic damage induced by this therapy with 7.4 GBq of I-131-MIBG in pheochromocytoma or ganglioneuroma patients is limited and reversible.

Diagnostic Performance of Whole-Body Diffusion-Weighted Imaging Compared to PET-CT Plus Brain MRI in Staging Clinically Resectable Lung Cancer.

BACKGROUND: Precise staging of lung cancer is usually evaluated by PET-CT and brain MRI. Recently, however, whole-body diffusion-weighted magnetic resonance imaging (WB-DWI) has be applied. The aim of this study is to determine whether the diagnostic performance of lung cancer staging by WB-DWI is superior to that of PET-CT+brain MRI. MATERIALS AND METHODS: PET-CT + brain MRI and WB-DWI were used for lung cancer staging before surgery with 59 adenocarcinomas, 16 squamous cell carcinomas and 6 other carcinomas. RESULTS: PET-CT + brain MRI correctly identified the pathologic N staging in 67 patients (82.7%), with overstaging in 5 (6.2%) and understaging in 9 (11.1%), giving a staging accuracy of 0.827. WB-DWI correctly identified the pathologic N staging in 72 patients (88.9%), with overstaging in 1 (1.2%) and understaging in 8 patients (9.9%), giving a staging accuracy of 0.889. There were no significant differences in accuracies. PET-CT + brain MRI correctly identified the pathologic stages in 56 patients (69.1%), with overstaging in 7 (8.6%) and understaging in 18 (22.2%), giving a staging accuracy of 0.691. WB-DWI correctly identified the pathologic stages in 61 patients (75.3%), with overstaging in 4 (4.9%) and understagings in16(19.7%), giving a staging accuracy of 0.753. There were no significant difference in accuracies. CONCLUSIONS: Diagnostic efficacy of WB-DWI for lung cancer staging is equivalent to that of PET-CT + brain MRI.

Carotid artery protrusion and dehiscence in patients with acromegaly.

PURPOSE: Acromegaly is a systemic disease which causes multiple bony alterations. Some authors reported that acromegalic patients have risk factors for an intraoperative vascular injury due to the specific anatomical features of their sphenoid sinus. The objective of our study was to analyze the anatomic characteristics of sphenoid sinus in acromegalic patients compared with controls, by evaluation of computed tomography (CT) findings. METHODS: We examined 45 acromegalic (acromegaly group) and 45 non-acromegalic patients (control group) with pituitary adenomas who were matched for sex, age, height, tumor size, and cavernous sinus invasion (Knosp grade). Preoperative CT of the pituitary region including the sphenoid sinus was used to evaluate the following anatomic characteristics: type of sphenoid sinus (sellar or pre-sellar/conchal); intrasphenoid septa (non/single or multiple); carotid artery protrusion; carotid artery dehiscence; intercarotid distance. RESULTS: Sixteen acromegalic patients (35.5 %) and 6 controls (13.3 %) had carotid artery protrusion. Additionally, 10 acromegalic patients (22.2 %) and 3 controls (6.6 %) had carotid artery dehiscence. Carotid artery protrusion and dehiscence were more frequent in the acromegaly group than in control group (p = 0.013 and 0.035, respectively). Other anatomic characteristics (type of sphenoid sinus, intrasphenoid septa, and intracarotid distance) showed no significant differences between acromegaly and control groups. CONCLUSIONS: Our study suggests that carotid artery protrusion and dehiscence occur more frequently among acromegalic patients, compared with non-acromegalic patients. It is important for surgeons to be aware of these anatomic variations to avoid vital complications, such as carotid injuries, during surgery.

Diagnostic Performance of Diffusion-Weighted Imaging for Multiple Hilar and Mediastinal Lymph Nodes with FDG Accumulation.

BACKGROUND: It is sometimes difficult to assess patients who have multiple hilar and mediastinal lymph nodes (MHMLN) with FDG accumulation in PET-CT. Since it is uncertain whether diffusion-weighted magnetic resonance imaging (DWI) is useful in the assessment of such patients, its diagnostic performance was assessed. MATERIALS AND METHODS: Twenty-three patients who had three or more stations of hilar and mediastinal lymph nodes with SUVmax of 3 or more in PET-CT were included in this study. RESULTS: For diagnosis of disease, there were 20 malignancies (lung cancers 17, malignant lymphomas 2 and metastatic lung tumor 1), and 3 benign cases (sarcoidosis 2 and benign disease 1). For diagnosis of lymph nodes, there were 7 malignancies (metastasis of lung cancer 7 and malignant lymphoma 1) and 16 benign lymphadenopathies (pneumoconiosis/silicosis 7, sarcoidosis 4, benign disease 4, and atypical lymphocyte infiltration 1). The ADC value (1.57±0.29x10(-3) mm2/sec) of malignant MHMLN was significantly lower than that (1.99±0.24x10(-3) mm2/sec) of benign MHMLN (P=0.0437). However, the SUVmax was not significantly higher (10.0±7.34 as compared to 6.38±4.31) (P=0.15). The sensitivity (86%) by PET-CT was not significantly higher than that (71%) by DWI for malignant MHMLN (P=1.0). The specificity (100%) by DWI was significantly higher than that (31%) for benign MHMLN (P=0.0098). Furthermore, the accuracy (91%) with DWI was significantly higher than that (48%) with PET-CT for MHMLN (P=0.0129). CONCLUSIONS: Evaluation by DWI for patients with MHMLN with FDG accumulation is useful for distinguishing benign from malignant conditions.

Diffusion Weighted Imaging Can Distinguish Benign from Malignant Mediastinal Tumors and Mass Lesions: Comparison with Positron Emission Tomography.

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. It is uncertain whether DWI is more useful than positron emission tomography-computed tomography (PET-CT) for distinguishing benign from malignant mediastinal tumors and mass lesions. MATERIALS AND METHODS: Sixteen malignant mediastinal tumors (thymomas 7, thymic cancers 3, malignant lymphomas 3, malignant germ cell tumors 2, and thymic carcinoid 1) and 12 benign mediastinal tumors or mass lesions were assessed in this study. DWI and PET-CT were performed before biopsy or surgery. RESULTS: The apparent diffusion coefficient (ADC) value (1.51±0.46x10(-3) mm2/sec) of malignant mediastinal tumors was significantly lower than that (2.96±0.86x10(-3) mm2/sec) of benign mediastinal tumors and mass lesions (P<0.0001). Maximum standardized uptake value (SUVmax) (11.30±11.22) of malignant mediastinal tumors was significantly higher than that (2.53±3.92) of benign mediastinal tumors and mass lesions (P=0.0159). Using the optimal cutoff value (OCV) 2.21x10(-3) mm2/sec for ADC and 2.93 for SUVmax, the sensitivity (100%) by DWI was not significantly higher than that (93.8%) by PET-CT for malignant mediastinal tumors. The specificity (83.3%) by DWI was not significantly higher than that (66.7%) for benign mediastinal tumors and mass lesions. The accuracy (92.9%) by DWI was not significantly higher than that (82.1%) by PET-CT for mediastinal tumors and mass lesions. CONCLUSIONS: There was no significant difference between diagnostic capability of DWI and that of PET-CT for distinguishing mediastinal tumors and mass lesions. DWI is useful in distinguishing benign from malignant mediastinal tumors and mass lesions.

Lesion regression rate based on RECIST: prediction of treatment outcome in patients with head and neck cancer treated with chemoradiotherapy compared with FDG PET-CT.

The aim of this study was to evaluate whether the lesion regression rate (ΔLR) based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria could be used for the prediction of treatment outcome in head and neck squamous cell carcinoma (HNSCC) patients treated with chemoradiotherapy (CRT) compared with FDG PET-CT. A total of 33 patients underwent MRI and PET-CT at pretreatment and at 8 weeks after CRT. We assessed the treatment outcome by analyzing the following parameters: the RECIST criteria, ΔLR, the European Organization for Research and Treatment of Cancer (EORTC) criteria, and pretreatment SUVmax of the primary tumor and node. The correlation between the analysis of the parameters and the results of the long-term follow-up of the patients was determined. The RECIST did not significantly correlate with locoregional control (LRC) or survival. The ΔLR was significantly lower for the lesions with locoregional failure (LRF) than for those with LRC. A threshold ΔLR of 48% revealed a sensitivity of 72.7% and specificity of 77.3% for the prediction of LRF. Progression-free survival (PFS) of patients with ΔLR ≥ 48% was significantly better than that of patients with ΔLR < 48% (P = 0.001), but not overall survival. There was a significant correlation between LRC and the EORTC (P = 0.02). The patients who achieved a complete response by the EORTC criteria showed significantly better PFS and overall survival (P = 0.01 and 0.04, respectively). The ΔLR was inferior to FDG PET-CT with respect to the prediction of patient survival; however, it may be useful for selecting patients in need of more aggressive monitoring after CRT.

Median nerve conduction studies and wrist magnetic resonance imaging in acromegalic patients with carpal tunnel syndrome.

PURPOSE: Carpal tunnel syndrome (CTS) often occurs with acromegaly; however, the pathophysiology of CTS in acromegalic patients remains unclear. This study evaluated the median nerve in acromegalic patients with and without CTS. METHODS: We examined the median nerves of 21 acromegalic patients (eight patients with CTS and 13 patients without CTS) using electrophysiological nerve conduction studies and wrist magnetic resonance images. They underwent transsphenoidal surgery to resect their growth hormone-secreting pituitary adenomas. The median nerves of the patients with CTS were reassessed by the same studies. RESULTS: The sensory conduction velocity was significantly later in the median nerves of patients with CTS than in patients without CTS (34.9 vs. 45.8 m/s, respectively; P = 0.006). In the wrist magnetic resonance images, the cross-sectional area of the median nerve in CTS patients and non-CTS patients was 18.7 and 10.5 mm(2), respectively. The median nerve was significantly larger in patients with CTS than in patients without CTS (P < 0.003). The flattering ratio of the median nerve and palmar deviation of the flexor retinaculum were not significantly different between the two patient groups. After tumor resection, the nerve conduction velocities improved in patients with CTS, but the nerve remained enlarged. The CTS symptoms disappeared in all patients, except one. CONCLUSIONS: The median nerves of acromegalic patients with CTS were enlarged and had impaired nerve conduction. This finding represents a predominant intrinsic feature in the pathophysiology of the disease rather than an extrinsic feature such as a thickened transverse carpal ligament.

Recurrence and metastasis of lung cancer demonstrate decreased diffusion on diffusion-weighted magnetic resonance imaging.

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DWI) is reported to be useful for detecting malignant lesions. The purpose of this study is to clarify characteristics of imaging, detection rate and sensitivity of DWI for recurrence or metastasis of lung cancer. METHODS: A total of 36 lung cancer patients with recurrence or metastasis were enrolled in this study. While 16 patients underwent magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography-computed tomography (PET-CT), 17 underwent MRI and CT, and 3 underwent MRI and PET-CT. RESULTS: Each recurrence or metastasis showed decreased diffusion, which was easily recognized in DWI. The detection rate for recurrence or metastasis was 100% (36/36) in DWI, 89% (17/19) in PET-CT and 82% (27/33) in CT. Detection rate of DWI was significantly higher than that of CT (p=0.0244) but not significantly higher than that of PET-CT (p=0.22). When the optimal cutoff value of the apparent diffusion coefficient value was set as 1.70?10-3 mm2/sec, the sensitivity of DWI for diagnosing recurrence or metastasis of lung cancer was 95.6%. CONCLUSIONS: DWI is useful for detection of recurrence and metastasis of lung cancer.

Diagnostic performance of diffusion weighted imaging of malignant and benign pulmonary nodules and masses: comparison with positron emission tomography.

BACKGROUND: Diffusion-weighted imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. However, it is uncertain whether DWI has advantages over FDG-PET for distinguishing malignant from benign pulmonary nodules and masses. MATERIALS AND METHODS: One hundred- forty-three lung cancers, 17 metastatic lung tumors, and 29 benign pulmonary nodules and masses were assessed in this study. DWI and FDG-PET were performed. RESULTS: The apparent diffusion coefficient (ADC) value (1.27 ± 0.35 ?10-3 mm2/sec) of malignant pulmonary nodules and masses was significantly lower than that (1.66 ± 0.58 ?10-3 mm2/sec) of benign pulmonary nodules and masses. The maximum standardized uptake value (SUV max: 7.47 ± 6.10) of malignant pulmonary nodules and masses were also significantly higher than that (3.89 ± 4.04) of benign nodules and masses. By using optimal cutoff values for ADC (1.44?10-3 mm2/sec) and for SUV max (3.43), which were determined with receiver operating characteristics curves (ROC curves), the sensitivity (80.0%) of DWI was significantly higher than that (70.0%) of FDG-PET. The specificity (65.5%) of DWI was equal to that (65.5%) of FDG-PET. The accuracy (77.8%) of DWI was not significantly higher than that (69.3%) of FDG- PET for pulmonary nodules and masses. As the percentage of bronchioloalveolar carcinoma (BAC) component in adenocarcinoma increased, the sensitivity of FDG-PET decreased. DWI could not help in the diagnosis of mucinous adenocarcinomas as malignant, and FDG-PET could help in the correct diagnosis of 5 out of 6 mucinous adenocarcinomas as malignant. CONCLUSIONS: DWI has higher potential than PET in assessing pulmonary nodules and masses. Both diagnostic approaches have their specific strengths and weaknesses which are determined by the underlying pathology of pulmonary nodules and masses.

Relationships between EGFR mutation status of lung cancer and preoperative factors - are they predictive?

BACKGROUND: The epidermal growth factor receptor (EGFR) mutation status of lung cancer is important because it means that EGFR-tyrosine kinase inhibitor treatment is indicated. The purpose of this prospective study is to determine whether EGFR mutation status could be identified with reference to preoperative factors. MATERIALS AND METHODS: One hundred-forty eight patients with lung cancer (111 adenocarcinomas, 25 squamous cell carcinomas and 12 other cell types) were enrolled in this study. The EGFR mutation status of each lung cancer was analyzed postoperatively. RESULTS: There were 58 patients with mutant EGFR lung cancers (mutant LC) and 90 patients with wild-type EGFR lung cancers (wild-type LC). There were significant differences in gender, smoking status, maximum tumor diameter in chest CT, type of tumor shadow, clinical stage between mutant LC and wild-type LC. EGFR mutations were detected only in adenocarcinomas. Maximum standardized uptake value (SUVmax:3.66±4.53) in positron emission tomography-computed tomography of mutant LC was significantly lower than that (8.26±6.11) of wild-type LC (p<0.0001). Concerning type of tumor shadow, the percentage of mutant LC was 85.7% (6/7) in lung cancers with pure ground glass opacity (GGO), 65.3%(32/49) in lung cancers with mixed GGO and 21.7%(20/92) in lung cancers with solid shadow (p<0.0001). For the results of discriminant analysis, type of tumor shadow (p=0.00036) was most significantly associated with mutant EGFR. Tumor histology (p=0.0028), smoking status (p=0.0051) and maximum diameter of tumor shadow in chest CT (p=0.047) were also significantly associated with mutant EGFR. The accuracy for evaluating EGFR mutation status by discriminant analysis was 77.0% (114/148). CONCLUSIONS: Mutant EGFR is significantly associated with lung cancer with pure or mixed GGO, adenocarcinoma, never-smoker, smaller tumor diameter in chest CT. Preoperatively, EGFR mutation status can be identified correctly in about 77 % of lung cancers.

Internal carotid arterial shift after transsphenoidal surgery in pituitary adenomas with cavernous sinus invasion.

The intercarotid distance (ICD) between cavernous carotid arteries (CCAs) is an important factor for avoiding injury of the internal carotid artery during transsphenoidal surgery. The ICD between CCAs in pituitary adenoma patients is generally larger than in normal individuals. However, the movement of the CCA during transsphenoidal surgery is not known. The aim of this study is to measure the ICD between CCAs in pituitary adenoma patients before and after surgery. We reviewed 138 pituitary adenoma patients who were treated with resection via the transsphenoidal approach. The CCA diameter and the ICD between CCAs were measured from preoperative and postoperative MR images. The CCA diameter was similar at the preoperative and postoperative time points. On the other hand, the ICD between CCAs was shorter at postoperative time point (19.4 ± 4.5 mm) than at the preoperative time point (20.9 ± 4.9 mm) (P = 0.048). Above all, invasion type adenomas had more significant ICD change at the postoperative time point (23.8 ± 3.8 mm) than at the preoperative time point (21.6 ± 3.9 mm) (P = 0.008). Also in multivariate analysis, cavernous sinus invasion of adenoma was independently associated with ICD contraction >2 mm (P = 0.027). It is important to know the change in ICD between CCAs after transsphenoidal surgery, particularly for pituitary adenomas with cavernous sinus invasion. The position of the CCA should be known before and during transsphenoidal surgery, as well before and during the second operation to avoid vascular injuries.

Sensitive immunodetection of radiotoxicity after iodine-131 therapy for thyroid cancer using γ-H2AX foci of DNA damage in lymphocytes.

PURPOSE: The purpose of our study was to evaluate the degree of radiotoxicity to lymphocytes in thyroid cancer after iodine-131(I-131) therapy using γ-H2AX foci immunodetection. METHODS: This study focused on 15 patients who underwent I-131 therapy for differentiated thyroid cancer after surgery. All patients received 3.7 GBq of I-131. Venous blood samples were collected from each patient before therapy and 4 days thereafter. Lymphocytes were isolated from the blood samples and subjected to γ-H2AX immunofluorescence staining. RESULTS: The number (mean ± SD) of foci per lymphocyte nucleus was 0.41 ± 0.51 before and 6.19 ± 1.80 after radioiodine therapy, and this difference was statistically significant (P = 0.001 < 0.05). Absorbed doses estimated for the 15 patients were 0.77 ± 0.31 Gy applying standard line in vitro external radiation doses. CONCLUSION: γ-H2AX foci immunodetection in lymphocytes may detect radiation-induced DNA damage associated with I-131 therapy for thyroid cancer, and may facilitate estimation of the radiation doses absorbed with this therapy.

Seed migration after transperineal interstitial prostate brachytherapy with I-125 free seeds: analysis of its incidence and risk factors.

PURPOSE: The purpose of this study was to evaluate the incidence and predictors of seed migration after transperineal interstitial prostate brachytherapy. MATERIALS AND METHODS: From March 2007 to March 2011, 121 patients with stage T1-T2 prostate cancer underwent transperineal interstitial prostate brachytherapy. Pre-planning was performed 3 weeks prior to implantation, and the implants were inserted using the standard parallel needle insertion technique. All patients underwent a series of radiographs [chest radiography, kidney-ureter-bladder (KUB) radiography, and a CT scan] to assess whether seed migration had occurred on postoperative days 1 and 30, and 12 months. RESULTS: Seed migration occurred in 31 (25.6 %) of 121 patients. A total of 51 of 7,883 (0.65 %) implanted seeds migrated. Migration was detected on postoperative day 1 in 16 patients, day 30 in 13 patients and at 12 months in 4 patients (migration occurred at different times in 2 patients). The migrated seeds were found in the lungs, pelvis, heart, mediastinum, kidney, inguinal canal, liver and sacrum. The number of needles was a statistically significant factor in seed migration. CONCLUSIONS: The seeds migrated to many organs. No decrease in the dose administered to the prostate or adverse effects associated with seed migration were noted.

Usefulness of 4D-CT for radiation treatment planning of gastric MZBCL/MALT.

It is well known that significant variations in stomach size, shape, and respiratory motion lead to uncertainties in target localization during treatment for gastric lymphoma. In this study, the usefulness of 4D-CT for radiation planning of gastric MZBCL/MALT was evaluated. Treatment planning using 4DCT (plan A) and conventional planning with a uniform margin (plan B) were compared using dose volume histograms (DVH) of the planning target volume (PTV) and the organ at risk, as well as the dose coverage of the clinical target volume (CTV) assessed by weekly online cone beam CT (CBCT) during the treatment course. In addition, regarding the image quality of CBCT , the interobserver agreement for the delineated volume of the CTV on CBCT was analyzed. The mean PTV of plan A was significantly smaller than that of plan B (p = 0.008). The mean doses to the liver and heart in plan A were significantly lower than those in plan B (p = 0.02 and 0.03, respectively). The reductions of V(20) of each kidney in plan A compared with those in plan B were 4.8 ± 2.4% in the right kidney and 16.3 ± 10.4% in the left. There was no significant difference in the dose coverage of the CTV between the plans during the treatment course. The interobserver agreement for the volume of the CTV was moderate correlation. Treatment planning using 4DCT for gastric MZBCL/MALT was useful for effective and safe irradiation with minimizing exposure of the organ at risk.