Automated CT volumetry of pulmonary metastases: evaluation of varied volume change thresholds for response assessment

Autor: Marten, K, Rummeny, E J, Engelke, C, MacManus, M P, Alam, N, Hicks, R J, Ball, D L, Cronin, P, Dwamena, B, Kelly, A, Carlos, R, Rasmussen, K, Madsen, H T, Rasmussen, F, Rasmussen, T R, Baandrup, U, Pilegaard, H K, Pedersen, U, Palshof, T, Rehling, M, Vilarino-Varela, M J, Taylor, A, Rockall, A G, Reznek, R H, Powell, M E B, Anstee, A, Scott, F, Culver, L, Rustin, G, Padwick, M, Padhani, A R, Bhatia, K, Sahdev, A, Hogarth, K, Chew, S, Grossman, A, O’Regan, K, Hodnett, P, Corrigan, M, Redmond, H, Barry, J, Sandomenico, F, Catalano, O, Fazioli, F, Mattace Raso, M, De Chiara, A, Apice, G, Petrillo, A, De Lutio di Castelguidone, E, Siani, A
Jazyk: angličtina
Rok vydání: 2006
Předmět:
Zdroj: Cancer Imaging
ISSN: 1470-7330
1740-5025
Popis: Aim To evaluate volume change thresholds for reliable volumetric evaluation of pulmonary metastatic tumour response in comparison with the response evaluation criteria of solid tumours (RECIST). Methods Fifty consecutive patients with pulmonary metastases undergoing follow-up chest multidetector-row CT under chemotherapy were prospectively included. Metastatic volumes were estimated twice by two independent observers using commercially available automated volumetry software. Intra- and interobserver agreements of metastatic volume change were estimated by 95% limits of agreement. The response to chemotherapy, as defined by an incrementally increasing percentual metastatic volume change (20%–70%), was assessed by extended Kappa statistics. Categorical agreement was correlated with percentual volume change thresholds as defined for pulmonary tumour response. Results A total of 202 metastases were evaluated. The 95% intra- and interobserver limits of agreement were −2.16%–1.88% and −1.79%–2.14%, respectively. Partial response, total remission or progressive disease were present in 46% of patients using a 70% volume change threshold and in 48%, 56%, 62%, 70% and 82% of patients using 60%, 50%, 40%, 30% and 20% thresholds, respectively. Discordant response ratings occurred in 0%–6% of patients. General combined categorical agreement on treatment response was very good (κ=0.94–1), but was diminished with volume thresholds 0.05). Kappa values correlated in linear fashion with the threshold values (r2=0.868; p
Aim Relapse after chemoradiation for non-small cell lung cancer (NSCLC) carries a dismal prognosis. A prospective positron emission tomography (PET)-response database was used to estimate how many patients could benefit from response-adapted surgery. Method Pre- and post-treatment fluorodeoxyglucose (FDG)-PET scans were performed for 88 patients who received 60 Gy with concurrent platinum-based chemotherapy (n=73) or 60 Gy alone (n=15). Response categories were complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), or progressive metabolic disease (PMD). We considered that medically operable patients who attained a PMR with potentially resectable residual disease confined to the lung and patients who attained a CMR but subsequently relapsed locally with anatomically resectable disease could benefit from surgery. Twenty-four medically inoperable patients could not have tolerated thoracotomy, (predominantly chronic obstructive airways disease, but also heart disease (n=6), rheumatoid arthritis (n=1), and renal failure (n=1)). Of the remaining 64 patients, 29 attained CMR (45%), 25 PMR (39%), 4 SMD (6%) and 6 PMD (9%). Of 29 CMR patients, 5 ultimately had local relapses that could potentially have been prevented by surgery, 15 never relapsed and 9 relapsed with extensive disease. Of 26 PMR patients, 12 might have benefited from salvage surgery as they had absent (n=10) or minimal (2) evidence of mediastinal disease and potentially resectable residual parenchymal disease. Of 64 patients, potentially fit for thoracotomy, 17 might have benefited from salvage or adjuvant surgery after chemoradiation. To benefit 5 CMR patients, surgery would have been necessary in 29, including 15 who may have already been cured. PMR patients represent the best candidates for response-adapted salvage surgery.
Aim To estimate the diagnostic accuracy of dynamic contrast enhanced (DCE) computed tomography (CT) and magnetic resonance (MR) imaging, and [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and Tc-99m depretiode single photon emission computed tomography (SPECT) imaging for the evaluation of solitary pulmonary nodules using a meta-analysis. Data sources Studies published between January 1990 and December 2005 in PubMed. Study selection Studies that examined (DCE) CT and MR imaging patterns and MR imaging signal characteristics, and studies that examined [18F]FDG PET, Tc-99m depretiode SPECT imaging for the evaluation of solitary pulmonary nodules and; enrolled at least 10 participants with a pulmonary nodule, with histological confirmation of the majority of lesions; and presented sufficient data to permit calculation of contingency tables were included in the analysis. Data extraction Two reviewers independently abstracted data regarding true positive, false positive, false negative and true negative of the imaging test, and independently assessed study quality and disagreements were resolved by a third reviewer. Data synthesis Forty-five studies met the inclusion criteria in total, 10 DCE CT studies, 6 DCE MRI studies, 22 [18F]FDG PET studies, and 7 99mTc-depreotide SPECT studies. Study methodological quality was fair. Sample sizes were small, minimum 20, maximum 356 and mean 65 subjects. We used a meta-analytic method to construct summary receiver-operating characteristic curves. These showed no statistically significant difference between the modalities although DCE CT performed slightly less well. Conclusions Dynamic contrast-enhanced CT and MR imaging and FGD PET and 99mTc-depreotide SPECT imaging are accurate non-invasive imaging tests for distinguishing malignant from benign solitary pulmonary nodules or mass lesions.
Aim To assess, separately and in combination, the diagnostic impact of high resolution computed tomography (HRCT) and 99mTc-depreotide (a somatostatin receptor scintigraphy), in patients with pulmonary lesions verified by CT. Methods We included 127 patients presenting with one or more pulmonary lesions suspected of malignancy on CT. Supplementary HRCT and 99mTc-depreotide tomography were performed. HRCT findings were classified into three groups: high, intermediate and low probability of malignancy. The final diagnosis was based on cytology, histology or CT follow-up. Results Sixty-one out of 127 patients had lung cancer. The overall sensitivity, specificity and accuracy of 99mTc-depreotide were 95%, 58%, and 76%, respectively. The sensitivity of 99mTc-depreotide in tumours >15 mm was 100%; the three false negatives were tumours ≤15 mm. HRCT showed high probability of malignancy in 58 patients; 48 had lung cancer. Twenty patients were classified as low probability, one was false negative. The intermediate group consisted of 49 patients (39%); 12 had lung cancer. When adding the intermediate group to the high probability group sensitivity, specificity and accuracy of HRCT were 98%, 29%, and 62%, respectively. Of the 49 patients in the intermediate group 99mTc-depreotide was positive in 23 patients (nine true positive) and negative in 26 (three false negative). Conclusion The sensitivity of 99mTc-depreotide alone was high in patients with lung lesions >15 mm. HRCT alone was accurate in the group of patients with high and low probability of malignancy. However, HRCT was indeterminate in 39% of the patients. In this group additional 99mTc-depreotide contributed to further diagnostic strategy.
Aim Accurate target volume delineation is essential for effective radiotherapy. Pelvic lymph nodes are not easily identifiable on conventional imaging, but can be visualised by contrast-enhanced magnetic resonance imaging (MRI) using intravenous ultra-small particles of iron-oxide (USPIO). We have previously reported pelvic node clinical target volume (CTV) delineation guidelines for use with conventional imaging, based on nodal mapping studies using USPIO. The aim of this study was to independently verify these guidelines in a further cohort of patients. Methods Ten patients with gynaecological malignancy underwent MRI with and without intravenous USPIO. MR sequences were transferred to a radiotherapy 3D planning system. The proposed guidelines were used to outline a pelvic node CTV on pre-contrast T2-weighted images. On post-contrast T2 *-weighted images the pelvic nodes were identified and outlined. The pre- and post-contrast images were co-registered and CTV examined for node coverage. Results By applying the guidelines, full coverage of 737 node outlines out of a total of 741 was achieved. Of the 4 outlines not fully covered, 2 were in the anterior external iliac and 2 in the lateral external iliac node regions. Conclusion MRI using USPIO has enabled the production of guidelines for localising a pelvic node CTV with conventional imaging. Application of these guidelines to a further cohort of patients resulted in coverage of 99.5% of node outlines demonstrating the reliability of this technique.
Aim To record water diffusion coefficients of normal uterine structures and to correlate water diffusion with tumour grade and stage of endometrial cancer. Methods Seventeen women with endometrial cancer (85% undergoing hysterectomy) were evaluated at 1.5 and 3 T using multiplanar T2-weighted, dynamic T1-weighted contrast enhanced and single shot echo-planar imaging (EPI) diffusion-weighted magnetic resonance imaging (MRI) (b=0, 50, 150, 500, 1000 s /mm 2) for staging purposes. Apparent diffusion coefficients (ADC) (from all b-values) of imaging determined and histologically confirmed normal myometrium, cervix stroma and cervical mucosa were obtained. Tumour ADCs were correlated with histological grade and pathological stage. Results An overlap in ADC values between cervical mucosa (median = 1.33 × 10 −3 mm 2/s; inter-quartile range = 0.95–1.52 × 10 −3 mm 2/s) and myometrium (median = 1.25 × 10 −3 mm 2/s; inter-quartile range = 0.97–1.41 × 10 −3 mm 2/s) was observed but both were greater than cervix stroma (median = 0.62 × 10 −3 mm 2/s; inter-quartile range = 0.23–0.82 × 10 −3 mm 2/s) (Mann–Whitney test; p=0.002). Fifteen tumours, 13 endometrioid carcinomas (grade 1=6; grade 2=3; grade 3=6), 1 clear cell (grade = 3) and 1 mullerian tumour (grade = 3) were found at pathology. The pathological tumour stages for the 17 tumours were T0 = 1, T1a/b = 2, T1c = 8, T2 = 3, T3 = 3. There was a significant difference between the ADC values of tumours (median = 0.73 × 10 −3 mm 2/s; interquartile range = 0.66–0.78 × 10 −3 mm 2/s) and myometrium (p=0.001) with greater restriction in tumours. There was a negative Kendall’s rank correlation between adenocarcinoma ADC and histological grade (τ=−0.52, p=0.018) and pathological stage (τ=−0.60, and p=0.006); that is aggressive lesions had lower ADC values. Conclusion Intrinsic differences in water diffusion profile between normal myometrium and tumour enable tumour detection on MRI and also reflect aggressiveness of histological lesion.
Aim To evaluate and compare the performance of [123I]meta-iodobenzylguanidine (MIBG) with cross sectional imaging in the detection and localisation of adrenal and extra-adrenal phaeochromocytomas. Methods All patients between 1993 and 2005 with adrenal or extra-adrenal phaeochromocytomas that had computed tomography (CT) and magnetic resonance (MR) imaging were identified. Patients included in the study had biochemical or clinical evidence of a phaeochromocytoma or were part of a paraganglioma syndrome. Imaging features on CT and MRI including tumour location, size, and CT contrast enhancement, MRI signal characteristics and MIBG positivity were compared. In particular tumours not detected on MIBG were closely interrogated. Results We identified 65 patients with 72 adrenal phaeochromocytomas, 1 of which had metastases at presentation. 60 of these had [123I]MIBG (9 negative/51 positive). We identified 38 patients with extra-adrenal tumours (18 neck, 2 chest, 17 abdomen, 4 pelvis, 2 spine) including 7 with disseminated metastases and either resected primary or unknown primary at presentation. Thirty-three of these had MIBG studies (12 negative/21 positive). The sensitivity of MIBG when compared against CT and MRI was 85% and 63% for adrenal and extra-adrenal tumours respectively. The radiological features of phaeochromocytomas in patients with MIBG-negative studies are emphasised. Conclusion MIBG is more sensitive in detecting phaeochromocytomas at adrenal compared to extra-adrenal locations. MIBG is more likely to be negative in adrenal tumours with only a thin rim of peripheral viable tissue and central necrosis. No specific feature predicts negativity for extra-adrenal sites.
Aim Malignant melanoma is the commonest cause of skin-cancer related deaths worldwide. Nodular melanoma is an aggressive type of melanoma due to its vertical growth and tendency to metastasise. Its incidence may also be increasing. The aims of this study were to review a cohort of patients with histologically proven nodular melanoma to determine if the incidence is increasing. We also investigated the incidence and distribution of metastatic spread of nodular melanoma based on follow-up computed tomography (CT) imaging. Methods A retrospective review was performed using a local database of melanoma patients in a tertiary referral centre. Radiological investigations were reviewed and evidence of the development of visceral, skeletal or soft tissue metastases based on follow up CT imaging was recorded. Results A total of 269 patients with malignant melanoma were identified. Histological analysis was available in 144 of these patients. Nodular melanoma accounted for 46% (n=66) of these patients. Metastatic disease was identified in 15% (n=10) of patients with nodular melanoma, either at presentation or on follow-up CT examination. The commonest sites of metastatic spread included lung (50%), liver (30%), spleen (20%), skin (20%) and peritoneum (20%). Sentinel lymph node mapping was negative in 50% (n=5) of patients who subsequently developed distant metastases. Conclusion Nodular melanoma is an aggressive condition and may be increasing in incidence with 46% prevalence in our study. Sentinel node status is not a reliable predictor of disease progression in patients with nodular melanoma. Nodular melanoma metastasised to distant sites more often than other histological subtypes in our study and therefore close follow-up of these patients is recommended.
Aim To discuss the role of contrast-enhanced ultrasonography (CEUS) in the evaluation of soft-tissue tumors and to correlate these results with those from computed tomography (CT) and magnetic resonance imaging (MRI). Methods Twenty-seven patients with soft tissue tumors evaluated with SonoVue contrast agent (Bracco, Italy) and Technos software (Esaote, Italy) were reviewed. Cases included: malignant fibrous histiocytoma (2), myxoid liposarcoma (2), well-differentiated liposarcoma of the salivary gland (1), recurring fibrosarcoma (2), Merckel tumour (1), breast MALToma (1), low-grade sarcoma (1), hepatocellular carcinoma (HCC) subcutaneous seeding (2), soft-tissue metastasis (5), benign nerve sheath tumor (2), post-traumatic neuroma (2), lipoma (3), intramuscular haemangioma (1), elastofibroma dorsi (2). We subjectively evaluated intralesional microcirculation and macrocirculation, intensity and distribution of contrast enhancement and identified five patterns: (1) absence of enhancement; (2) slight enhancement; (3) diffuse macrocirculation with slow wash-out; (4) macrocirculation and microcirculation with fast enhancement and quick wash-out; (5) diffuse, intense, and heterogeneous enhancement with macrocirculation and persistent microcirculation. Ten of these patients were examined with contrast enhanced CT, 17 patients with MRI. Results Pattern 1 was found in lipomas, pattern 2 in elastofibroma dorsi and post-traumatic neuroma, pattern 3 in haemangioma and neurinomas, pattern 4 in fibrosarcoma, Merckel tumor, well-differentiated sarcoma and seeding HCCs; pattern 5 in malignant fibrous histiocytomas, myxoid liposarcomas, and subcutaneous metastasis. Only in the well-differentiated liposarcoma of the salivary gland, did CEUS demonstrate a pattern 1 with erroneous diagnosis of lipoma. In all other lesions there was good correlation with CT, MRI, and histological exams. Conclusion CEUS is a non-invasive diagnostic method in the initial work-up of soft-tissue tumors. The description of vascular patterns can be important for diagnosis and differentiation of benign from malignant tumours.
Databáze: OpenAIRE
Externí odkaz: