Dynamic contrast-enhanced MRI for the assessment of spinal tumor vascularity: correlation with angiography.

PURPOSE: To determine if dynamic contrast-enhanced MRI (DCE-MRI) could correlate well with invasive angiography in the characterization of spinal tumor vascularity. METHODS: Totally 40 patients with untreated spinal tumors underwent MRI before preoperative angiography and embolization. Tumors were assigned to hypervascular, moderate, or hypovascular groups based on angiographic appearance. Tumor vascularity was also evaluated with enhancement degree on standard MR and with DCE-MRI parameters via ROI analysis of enhanced tumor area. The Spearman correlation coefficient was calculated to determine the correlation between the degree of angiographic vascularity and enhancement on MRI and DCE-MRI parameters. ROC analysis was conducted to assess the appropriate cut-off value. RESULTS: There were 12 hypervascular, 12 moderate, and 16 hypovascular tumors, respectively. The Spearman correlation coefficient between DCE-MRI parameter and the degree of angiographic vascularity was 0.899 (RSlopemax), 0.847 (Slopemax), 0.697 (E max), 0.694 (ERmax), and -0.587 (TTP), respectively, which showed excellent-to-moderate relationships. The RSlopemax cut-off value of 1.325 provided the highest specificity of 100 % and sensitivity of 87.5 % in predicting hypovascular tumors and the value of 1.85 provided the highest sensitivity of 100 % and specificity of 96.4 % in characterizing hypervascular ones. CONCLUSIONS: DCE-MRI is an accurate technique for the assessment of spinal tumor vascularity, which may have a potential value in the decision-making of preoperative embolization.

Clear cell adenocarcinoma of the lung: a population-based study.

BACKGROUND: Clear cell adenocarcinoma of the lung (CCAL) is a rare diagnosis with poorly understood clinicopathological characteristics and disease progression. METHODS: A population cohort study was conducted using prospectively extracted data from the Surveillance, Epidemiology and End Results database for patients with histological diagnoses of CCAL. Propensity-matched analysis was performed for survival analysis. RESULTS: A total of 1,203 patients with CCAL were included. The median overall survival (OS) for all patients was 19.0 months (95% CI 16.0-22.0 months). Data for 1-, 3-, and 5-year OS were 58.7, 37.3, and 27.7%, respectively. Log-rank analysis showed that the prognoses of CCAL patients were better than those with non-CCAL adenocarcinoma after propensity-matched analysis (P<0.001). Cancer-directed surgery significantly improved median OS by almost 40 months (45.0 vs 5.0 months; P<0.01). Radiotherapy after surgery prolonged survival compared with patients who only received surgery (37.0 vs 17.0 months; P<0.01). Multivariate Cox analysis showed that older age (>65 years), larger lesions, and lymph node and distant metastases were independent prognostic factors for worse survival, while cancer-directed surgery was an independent protective factor. Five independent prognostic factors were identified and entered into the nomogram. The concordance index of the nomogram for predicting survival was 0.72 (95% CI 0.69-0.74). The calibration curves for the probability of 3-, 5-, and 10-year OS showed optimal agreement between nomogram prediction and actual observation. CONCLUSION: CCAL is a rare pathology, and older age, larger lesions, metastases, and cancer-directed surgery were associated with prognosis. A prognostic nomogram was established to provide individual prediction of OS.