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1.
J Natl Compr Canc Netw ; 21(7): 753-782, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37433437

RESUMO

Ampullary cancers refer to tumors originating from the ampulla of Vater (the ampulla, the intraduodenal portion of the bile duct, and the intraduodenal portion of the pancreatic duct), while periampullary cancers may arise from locations encompassing the head of the pancreas, distal bile duct, duodenum, or ampulla of Vater. Ampullary cancers are rare gastrointestinal malignancies, and prognosis varies greatly based on factors such as patient age, TNM classification, differentiation grade, and treatment modality received. Systemic therapy is used in all stages of ampullary cancer, including neoadjuvant therapy, adjuvant therapy, and first-line or subsequent-line therapy for locally advanced, metastatic, and recurrent disease. Radiation therapy may be used in localized ampullary cancer, sometimes in combination with chemotherapy, but there is no high-level evidence to support its utility. Select tumors may be treated surgically. This article describes NCCN recommendations regarding management of ampullary adenocarcinoma.


Assuntos
Adenocarcinoma , Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Humanos , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/terapia , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Neoplasias Pancreáticas
2.
J Nucl Med ; 65(8): 1224-1230, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38960710

RESUMO

Functional liver parenchyma can be damaged from treatment of liver malignancies with 90Y selective internal radiation therapy (SIRT). Evaluating functional parenchymal changes and developing an absorbed dose (AD)-toxicity model can assist the clinical management of patients receiving SIRT. We aimed to determine whether there is a correlation between 90Y PET AD voxel maps and spatial changes in the nontumoral liver (NTL) function derived from dynamic gadoxetic acid-enhanced MRI before and after SIRT. Methods: Dynamic gadoxetic acid-enhanced MRI scans were acquired before and after treatment for 11 patients undergoing 90Y SIRT. Gadoxetic acid uptake rate (k1) maps that directly quantify spatial liver parenchymal function were generated from MRI data. Voxel-based AD maps, derived from the 90Y PET/CT scans, were binned according to AD. Pre- and post-SIRT k1 maps were coregistered to the AD map. Absolute and percentage k1 loss in each bin was calculated as a measure of loss of liver function, and Spearman correlation coefficients between k1 loss and AD were evaluated for each patient. Average k1 loss over the patients was fit to a 3-parameter logistic function based on AD. Patients were further stratified into subgroups based on lesion type, baseline albumin-bilirubin scores and alanine transaminase levels, dose-volume effect, and number of SIRT treatments. Results: Significant positive correlations (ρ = 0.53-0.99, P < 0.001) between both absolute and percentage k1 loss and AD were observed in most patients (8/11). The average k1 loss over 9 patients also exhibited a significant strong correlation with AD (ρ ≥ 0.92, P < 0.001). The average percentage k1 loss of patients across AD bins was 28%, with a logistic function model demonstrating about a 25% k1 loss at about 100 Gy. Analysis between patient subgroups demonstrated that k1 loss was greater among patients with hepatocellular carcinoma, higher alanine transaminase levels, larger fractional volumes of NTL receiving an AD of 70 Gy or more, and sequential SIRT treatments. Conclusion: Novel application of multimodality imaging demonstrated a correlation between 90Y SIRT AD and spatial functional liver parenchymal degradation, indicating that a higher AD is associated with a larger loss of local hepatocyte function. With the developed response models, PET-derived AD maps can potentially be used prospectively to identify localized damage in liver and to enhance treatment strategies.


Assuntos
Fígado , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Radioisótopos de Ítrio , Humanos , Masculino , Feminino , Fígado/diagnóstico por imagem , Pessoa de Meia-Idade , Radioisótopos de Ítrio/uso terapêutico , Idoso , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/diagnóstico por imagem , Gadolínio DTPA , Testes de Função Hepática , Dosagem Radioterapêutica
3.
AJR Am J Roentgenol ; 187(5): 1361-7, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17056930

RESUMO

OBJECTIVE: The purpose of this study was to directly compare nodule-enhancement CT and 18F-FDG PET in the characterization of indeterminate solitary pulmonary nodules (SPNs) greater than 7 mm in size. MATERIALS AND METHODS: Examinations from patients undergoing both nodule-enhancement CT and 18F-FDG PET to characterize the same indeterminate SPN were reviewed. For nodule-enhancement CT, an SPN was considered malignant when it showed an unenhanced to peak contrast-enhanced increase in attenuation greater than 15 H. Fluorine-18-FDG PET studies were blindly reinterpreted by two qualified nuclear radiologists. SPNs qualitatively showing hypermetabolic activity greater than the mediastinal blood pool were interpreted as malignant. These interpretations were compared with the original prospective clinical readings and to semiquantitative standardized uptake value (SUV) analysis. Results were compared with pathologic and clinical follow-up. RESULTS: Forty-two pulmonary nodules were examined. Twenty-five (60%) were malignant, and 17 (40%) were benign. Nodule-enhancement CT was positive in all 25 malignant nodules and in 12 benign nodules, with sensitivity and specificity of 100% and 29%, respectively, and with a positive predictive value (PPV) and negative predictive value (NPV) of 68% and 100%, respectively. Qualitative 18F-FDG PET interpretations were positive in 24 of the 25 malignant nodules and in four benign nodules. Fluorine-18-FDG PET was considered negative in one malignant nodule and in 13 of the 17 benign nodules. This correlates with a sensitivity and specificity of 96% and 76%, respectively, and with a PPV and NPV of 86% and 93%, respectively. Original prospective 18F-FDG PET and semiquantitative SUV analysis showed sensitivity, specificity, PPV, and NPV of 88%, 76%, 85%, and 81% and 84%, 82%, 88%, and 78%, respectively. CONCLUSION: Due to its much higher specificity and only slightly reduced sensitivity, 18F-FDG PET is preferable to nodule-enhancement CT in evaluating indeterminate pulmonary nodules. However, nodule-enhancement CT remains useful due to its high NPV, convenience, and lower cost. Qualitative 18F-FDG PET interpretation provided the best balance of sensitivity and specificity when compared with original prospective interpretation or SUV analysis.


Assuntos
Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Radiografia , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão
4.
Acad Radiol ; 12(1): 67-73, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15691727

RESUMO

RATIONALE AND OBJECTIVES: Multiple trials have documented wide interobserver variability between radiologists interpreting computed tomography colonography (CTC) exams. We sought to determine if nonradiologists could learn to interpret intraluminal findings at CTC with a high degree of sensitivity to determine if they could play a role as second readers in interpreting CTC exams. MATERIALS AND METHODS: Seven nonradiologists (five medical students, two radiologic technologists) undertook self-directed CTC training using a teaching file of 50 cases; thereafter, each reader blindly interpreted 50 cases with colonoscopic correlation (30 positive, 20 negative). Results were compared with a previously studied cohort of radiologists. The two technologists additionally repeated the exam after 6 weeks of clinical experience. RESULTS: The sensitivity of nonradiologists for small (5-9 mm) polyps, large (>9 mm) lesions, and cancers was similar to that of radiologists (0.45 versus 0.63, 0.74 versus 0.71, and 0.80 versus 0.88, respectively). After 6 weeks of clinical experience as second readers, the accuracy of one technologist significantly improved (from 74% to 90%, P = .008), whereas accuracy of the other tended toward improvement (from 74% to 86%%, P = .25). Nonradiologists detected, on average, 6/36 additional polyps (17%) missed by any radiologist, and the sensitivity of 5/7 nonradiologists was significantly greater than at least one of the radiologists (P = .05). CONCLUSION: Nonradiologists can perform similarly to radiologists in interpreting intraluminal findings at CTC, with nonradiologist performance improving even after experience with more than 100 cases. Skilled nonradiologists may play a vital role as a second reader of intraluminal findings or by performing quality control of examinations before patient dismissal.


Assuntos
Colonografia Tomográfica Computadorizada , Estudantes de Medicina , Tecnologia Radiológica , Estudos de Coortes , Neoplasias do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/estatística & dados numéricos , Humanos , Variações Dependentes do Observador , Radiologia/educação , Radiologia/normas , Sensibilidade e Especificidade , Tecnologia Radiológica/normas
5.
Comput Methods Programs Biomed ; 98(3): 241-52, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19854531

RESUMO

Tumor cryoablation is a clinical procedure where supercooled probes are used to destroy cancerous lesions. Cryoablation is a safe and effective palliative treatment for skeletal metastases, providing immediate and long term pain relief, increasing mobility and improving quality of life. Ideally, lesions are encompassed by an ice ball and frozen to a sufficiently low temperature to ensure cell death. "Lethal ice" is the term used to describe regions within the ice ball where cell death occurs. Failure to achieve lethal ice in all portions of a lesion may explain the high recurrence rate currently observed. Tracking growth of lethal ice is critical to success of percutaneous ablations, however, no practical methods currently exist for non-invasive temperature monitoring. Physicians lack planning tools which provide accurate estimation of the ice formation. Simulation of ice formation, while possible, is computationally demanding and too time consuming to be of clinical utility. We developed the computational framework for the simulation, acceleration strategies for multicore Intel x86 and IBM Cell architectures, and performed preliminary validation of the simulation. Our results demonstrate that the streaming SIMD implementation has better performance and scalability. Both accelerated and non-accelerated algorithms demonstrate good agreement between simulation and manually identified ice ball boundaries in phantom and patient images. Our results show promise for the development of novel cryoablation planning tools with real-time monitoring capability for clinical use.


Assuntos
Simulação por Computador , Criocirurgia/normas , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador/métodos
6.
AJR Am J Roentgenol ; 183(5): 1367-74, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15505305

RESUMO

OBJECTIVE: The purposes of our study were to describe the CT appearance of recurrent intraductal papillary mucinous neoplasms of the pancreas after surgical resection and estimate the performance of CT in detecting recurrent neoplasms. MATERIALS AND METHODS: A single unblinded reviewer characterized the presence and appearance of recurrent intraductal papillary mucinous neoplasms on 66 CT scans of 17 patients with proven recurrence, noting location and appearance of recurrent neoplasm. These results, described in this article, were summarized in tabular format and shown to three blinded observer. The observers then evaluated one postoperative CT examination from every patient at our institution who underwent surgical removal of intraductal papillary mucinous neoplasms (n = 45) for the presence or absence of local or distant recurrence. RESULTS: The unblinded reviewer found 11 cases of local recurrence. Extrapancreatic local recurrences tend to have solid components (5/6), tend to be located adjacent to the resection margin (5/6), and may exhibit vascular invasion (2/6). Intrapancreatic neoplasms are usually cystic (4/5). Nine patients had distant metastases. Prospective sensitivity for recurrent tumor ranged from 76% (13/17) to 94% (16/17). Sensitivity for local recurrence ranged from 55% (6/11) to 82% (9/11). Specificity ranged from 79% (22/28) to 96% (27/28). Interobserver agreement for predicting recurrence was moderate to substantial (kappa = 0.51-0.65). CONCLUSION: Locally recurrent intraductal papillary mucinous neoplasms of the pancreas tend to be either extrapancreatic and solid at the resection margin or intrapancreatic and cystic. CT can detect most recurrent intraductal papillary mucinous neoplasms of the pancreas with moderate to substantial interobserver agreement.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico por imagem , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Papilar/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adenocarcinoma Mucinoso/secundário , Adenocarcinoma Mucinoso/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Sensibilidade e Especificidade
7.
AJR Am J Roentgenol ; 182(4): 897-903, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15039161

RESUMO

OBJECTIVE: Our purpose was to determine whether abdominal CT can detect pancreatic cancer before its clinical diagnosis. SUBJECTS AND METHODS: Two radiologists interpreted in a blinded manner 62 CT scans in 28 pancreatic cancer patients that were obtained before histologic diagnosis and 89 CT scans in 89 control subjects and noted specific CT findings. The presence of pancreatic cancer was characterized as definite, suspicious, low probability, or normal. The scans of the pancreatic cancer patients were divided into four groups on the basis of the time interval preceding cancer diagnosis (0-2, 2-6, 6-18, or > 18 months), and one scan (closest to 18 months) was selected per patient per time interval. Sensitivity and specificity for pancreatic cancer and interobserver agreement for CT findings were calculated. RESULTS: Radiologists agreed that CT findings definite or suspicious for pancreatic cancer were present in 50% of the scans obtained 2-6 and 6-18 months before the diagnosis of pancreatic cancer (3/6 and 4/8 scans, respectively), but they noted such CT findings in only 7% (1/15) of the scans obtained more than 18 months before diagnosis. Pancreatic duct dilatation and cutoff were early CT findings identified by both radiologists and were associated with near-perfect and substantial interobserver agreement (kappa = 0.84 and 0.76, respectively). Ninety-five percent confidence intervals of specificity for tumor absence ranged from 92% to 100%. CONCLUSION: CT can detect a significant proportion of asymptomatic incident pancreatic cancers before the clinical diagnosis of pancreatic cancer. CT should be considered in screening at-risk patient populations. Pancreatic duct dilatation and cutoff are early findings associated with the development of pancreatic cancer and can be detected on CT with a high degree of reproducibility.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Radiografia Abdominal , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo
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