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Archive for July, 2011

For non–small cell lung cancer, early post RFA PET/CT is not required; six-month post RFA PET/CT findings mutually relate in a better way with clinical results at 1 year.

PET-CT_lung cancer

The medical research study was conducted by Don C. Yoo, Damian E. Dupuy, Shauna L. Hillman, Hiran C. Fernando, William S. Rilling, Jo-Anne O. Shepard and Barry A. Siegel from Department of Diagnostic Imaging, Warren Alpert Medical School, Rhode Island Hospital, Providence, RI; Mayo Clinic and Mayo Foundation, Rochester, MN; Department of Surgery, Boston University Medical Center, Boston, MA; Department of Radiology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiology, Massachusetts General Hospital, Boston, MA; Mallinckrodt Institute of Radiology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO.

The research objective was to assess primary experience with 18F-FDG PET/CT post pulmonary RF ablation of stage IA non–small cell lung cancer, to ascertain if treatment success or residual disorder can be anticipated with early postablation PET.

About 30 patients with stage IA non–small cell lung cancer, with mean tumor size of 2.0 cm – of inoperable stage passed through computed tomography guided radiofrequency ablation (RFA), for over a time period of 33 months. PET/CT was executed subsequently: in two months prior, in a week and six months – after radiofrequency ablation (RFA), and metabolic response was classified and equated with clinical event rate.

Of results, early PET/CT images acquired within a week of radiofrequency ablation were appraisable for 26 patients; the event rate of patients with complete metabolic response (43%) with partial and no response/disease progression (67%) at early PET/CT were equated through; same was done also for event rate at 6-month PET/CT – patients with complete metabolic response had 0% event rate, while partial response/disease progression showed altogether event rate of 75%.

Conclusion: early post radiofrequency ablation PET/CT is not required and six-month post radiofrequency ablation PET/CT findings mutually relate in a better way with clinical results at 1 year.

The effects of delineation of adrenal lesions with 3D GRE and MP GRE in phase and out phase MRI techniques are corresponding to that gained with the reference standard 2D GRE method. Varied thresholds must be picked for diverse assessment techniques.

Adrenal mass_MRI

The medical research study was conducted by Miguel Ramalho, Rafael O. P. de Campos, Vasco Heredia, Brian M. Dale, Penampai Tannaphai, Rafael M. Azevedo and Richard C. Semelka from Department of Radiology, University of North Carolina at Chapel Hill, NC; Siemens Healthcare, Cary, NC.

The research objective was to utilize previously depicted quantitative research techniques to equate the performance of three dimensional gradient recalled echo, and  magnetization prepared gradient recalled echo  (MP-GRE) in phase and out of phase order with standard two dimensional gradient recalled echo, in delineating adrenal lesions.

The research model had about 44 successively enrolled patients (men and women) with 50 adrenal lesions that passed through standard abdominal magnetic resonance imaging, which encompassed in phase and out of phase two dimensional GRE, three dimensional GRE, MP-GRE etc.

Independent sample student t test was utilized for to compute and equate subsequent, for all three methods: adrenal signal intensity index and adrenal-to-liver, adrenal-to-muscle, and adrenal-to-spleen signal intensity ratios. The region under receiver operating characteristic (ROC) curve for each assessment method was established, and equations of independent ROC curves were executed for all the sequences.

About the results, signal intensity ratios of adenomas and nonadenomas, and mean adrenal signal intensity index varied considerably for all the sequences. For MP-GRE and 3D GRE, modified adrenal-to-spleen ratio and adrenal signal intensity index had larger area under the safety response curve; the deviation was not statistically significant; varied thresholds for all the methods were suggested for to discern nonadenoma from adenoma.

Conclusion: the outcomes of characterization of adrenal lesions with 3D GRE and MP GRE in phase and out phase MRI techniques are comparable to that acquired with the reference standard 2D GRE method. Varied thresholds must be picked in relation to in phase and out of phase methods utilized, and for diverse assessment techniques.

Enhanced visualization of peripheral/central arteries can be achieved through with low energy pulmonary CT angiography, without considerable reduction in image quality.

Pulmonary CT angiography

The medical research study was conducted by Naama R. Bogot, Alexander Fingerle, Dorith Shaham, Izhak Nissenbaum and Jacob Sosna from Departments of Radiology – Hadassah-Hebrew University Medical Center and Shaare Zedek Medical Center (Jerusalem, Israel); University of Michigan Hospitals, Ann Arbor, MI; Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Beth Israel Deaconess Medical Center, Boston, MA.

The medical research objective was to likely equate visualization of peripheral/central pulmonary arteries on concurrently obtained standard and low energy pulmonary CT angiography.

Single source dual layer dual energy MDCT was utilized for to scan 33 successive patients with suspected pulmonary embolism; image noise and attenuation were equated at the segmental and main pulmonary arteries, and signal-to-noise ratios were gauged by;

Independent blind study was performed by radiologists, as they evaluated arterial visibility in agreement, through utilization of maximum intensity projection (MIP) algorithm. Statistical analysis were done through kappa coefficient and non parametric test.

About the results, pulmonary embolism was discovered in about 3 patients; sub-segmental emboli/obstruction and segmental vessel were found merely for low energy images – with enhanced image visualization of segmental arteries. In contrast to standard images, greater amount of subsegmental vessels was observed on low energy MIP restoration; visualization of subsegmental vessels was higher in quality in most of the cases, through low-energy imaging There could be no considerable deviation established in standard against low energy computed tomography images over mean signal-to-noise-ratio.

Conclusion: Enhanced visualization of peripheral/central arteries can be achieved through with low energy pulmonary CT angiography, without considerable reduction in image quality.

The detection rate on nonopacified portal venous MDCT for upper urinary tract tumors is high; with lack of morphological attributes, implicative for urothelial malignancy, ureter with normal appearance can be promising.

Upper Urinary Tract

The medical research was conducted by Max Kupershmidt, Myles Margolis, Hyun-Jung Jang, Christine Massey and Ur Metser from Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto; Department of Biostatistics, Princess Margaret Hospital, Toronto, ON, Canada.

The research objective was to evaluate the recognition and negative predictive rate of upper urinary tract tumors in nonopacified urinary tracts on portal venous phase multi-row detector CT.

About 20 patients with upper urinary tract tumors were retroactively studied, and results were evaluated through blind study; reviewers tried to determine if the segments of the tract could be fully examined for presence and absence of tumors; the morphological attributes of tumors were characterized by, viz. urothelial thickening, polypoid mass etc.! The recognition rate of the proximate – upper urinary tract sections was considerably higher than that for distal sections, which were directed away.

The portal venous phase MDCT for tumor detection showed subsequent values: sensitivity – 95%; specificity – 97%; negative predictive value – 100%, in the order. Morphological attributes vital for the existence of tumor were urothelial thickening and discrete polypoid mass. Except for moderate consensus on urothelial thickening, interobserver agreement for all the attributes demonstrated good results.

Conclusion: the recognition rate on nonopacified portal venous MDCT for upper urinary tract tumors is high; with deficiency of morphological attributes, proposing urothelial malignancy, ureter with normal appearance can be satisfactory/assuring.

Multiparametric MRI protocol that encompasses diffusion weighted imaging facilitates for detection of local recurrence of tumor after high dose rate brachytherapy.

Prostate MRI

The medical research was conducted by Tsutomu Tamada, Teruki Sone, Yoshimasa Jo, Junichi Hiratsuka, Atsushi Higaki, Hiroki Higashi and Katsuyoshi Ito from Department of Radiology, Department of Urology, Department of Radiation Oncology (Kawasaki Medical School, Kurashiki City, Okayama, Japan).

The medical research objective was to retroactively assess the significance of prostate MRI for to discover locally recurrent prostate cancer, after high dose rate brachytherapy/internal radiotherapy.

About 16 subjects that had biochemical failure after high dose rate brachytherapy were made to pass through prostate MRI, inclusive of T2 weighted, dynamic contrast enhanced and diffusion weighted imaging, through 1.5T MRI system prior sample biopsy. Two radiologists, in agreement evaluated the existence of tumor on each arrangement -  from eight prostate regions, on grounds of biopsy/examination of tissue – two were from transition and other six were from peripheral zones.

About the results, tissue examination/biopsy disclosed locally recurrent prostate cancer in about 22 cases, of 128 regions; for T2 weighted imaging, the precision, specificity and sensitivity of each method in recognition of recurrent tumor was: 87%, 99% and 27%, respectively. The same for dynamic contrast enhanced MRI was: 90%, 98%, and 50%; for diffusion weighted imaging, it was – 91%, 95% and 68%, in the order.

The sensitivity of T2 weighted imaging in recognition of recurrent tumor was considerably lower than that of diffusion weighted imaging; except for inconsiderably reduced specificity, multiparametric MRI attained highest sensitivity.

Conclusion: multiparametric MRI procedure which comprises diffusion weighted imaging facilitates for a sensitive method, for to discover local recurrence of tumor after high dose rate brachytherapy.

The CNR and contrast enhancement ratio for hepatocellular carcinoma were not mutually related with histologic grades; contrast enhancement ratio was significantly lower in keratin 19–positive groups.

MRI_Hepatocellular Carcinoma

The medical research was conducted by Jin-Young Choi, Myeong-Jin Kim, Young Nyun Park, Jeong Min Lee, Sun Kook Yoo, Sun Young Rha and Jae Yeon Seok from Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System; Department of Pathology, Department of Medical Engineering, Department of Internal Medicine, Yonsei Cancer Center, Cancer Metastasis Research Center (Yonsei University College of Medicine); Department of Radiology, Institute of Radiation Medicine, Seoul National University Hospital, Seoul; Department of Pathology, Ajou University College of Medicine, Suwon, Republic of Korea.

The medical research objective was to evaluate if gadoxetate disodium intensified hepatobiliary phase magnetic resonance imaging could identify out the histological factors, of hepatocellular carcinoma/liver cancer in patients.

About 51 patients were retroactively assessed, of 53 hepatocellular carcinoma cases histopathologically affirmed by surgery; all the subjects were passed through gadoxetate disodium intensified magnetic resonance imaging, prior surgical removal/resection.

Kruskal wallis test was utilized for to equate deviations in contrast enhancement ratio of the lesions, with deviations in contrast-to-noise-ratio (CNR) among histologic grades of hepatocellular carcinoma. Spearman’s non-parametric method was put in use to establish relationship between cell density ratio, contrast enhancement, contrast to noise ratio, and incontrovertibility for anti-hepatocyte antibody, keratin 19, and keratin 7.

About the results, of 53 cases of hepatocellular carcinoma, 50 demonstrated low signal intensity on hepatobiliary phase images, pertain to liver and biliary ducts, but 3 showed hyperintensity on the same in contrast with neighboring hepatic parenchyma/liver tissue. Even though well discerned HCCs inclined to demonstrate higher contrast enhancement, no statistical significance could be established amongst histological grade and contrast enhancement ratio of the tumors; there was even no considerable deviation amongst histologic grade and contrast-to-noise-ratio (CNR); the contrast enhancement ratios (tumors) were considerably higher in keratin 19 negative group, than in keratin 19 positive group. There was no significant relation between subsequent: cell density ratio, contrast enhancement ratio, and positivity for anti-hepatocyte antibody and keratin 7.

Conclusion: for hepatocellular carcinoma – the CNR and contrast enhancement ratio were not mutually related with histologic grades; contrast enhancement ratio was substantially lower in keratin 19–positive HCCs.

ACEI prompted angioedema of small intestine should be comprised in differential diagnosis (DDx) while patients are receiving ACEI therapy, showed with abdominal complaints, and CT findings of ascites, intestinal wall thickening and related.

Small bowel - angioneurotic edema_CT

The medical research was conducted by Christopher D. Scheirey, Francis J. Scholz, Michael J. Shortsleeve and Douglas S. Katz from Department of Radiology, Lahey Clinic, Burlington, MA; Department of Radiology, Mount Auburn Hospital, Cambridge, MA; Department of Radiology, Winthrop-University Hospital, Mineola, NY.

The research study objective was to retroactively examine clinical/radiologic discoveries in patients with angiotensin converting enzyme/catalyst inhibitor (ACEI) provoked small bowel-angioedema/quincke’s edema (intestine), with special importance on computed tomography findings.

Abdominal radiologists conscious of the nature of illness retroactively examined imaging discoveries (in significance with computed tomography) and clinical attributes of about 20 patients introduced to emergency departments of two varied institutions, from the time period of 1996-2010, with ACEI prompted angioedema of the small intestine; examinations were considered in agreement, to settle on common radiographic findings.

All the patients submitted for the study were in the age group of 23-83 years; most were obese women, with grave abdominal pain/stomach ache. All the patients were passed through abdominal/ventral computed tomography examinations; some had small bowel series procedures; others experienced surgery for surmised small bowel/intestinal ischemia/local anemia.

After few days of hospitalization, the symptoms were determined out for all the patients; computed tomography findings comprised subsequent, in patients: ascites/collection of serous fluid, intestinal wall thickening, mild dilatation/expansion, and straightening etc.! No small intestine/bowel hindrance could be established by.

Conclusion: ACEI prompted small bowel angioedema must be comprised in discriminatory diagnosis while patients are receiving ACEI therapy showed with abdominal ailments, with subsequent CT findings, on examination: ascites/collection of serous fluid, intestinal wall thickening, mild dilatation/expansion, and straightening etc.

No significant deviations were found amongst modified CT severity index and CT severity index in evaluation of severity of acute pancreatitis/ pancreatic necrosis.

In analogy with APACHE II, both the indexes more accurately identify the nature of clinically severe disorder and better connect with the need for intervention and pancreatic inflammation.

Acute Pancreatitis

The medical research study was conducted by Thomas L. Bollen, Vikesh K. Singh, Rie Maurer, Kathryn Repas, Hendrik W. van Es, Peter A. Banks and Koenraad J. Mortele from Department of Radiology, Division of Abdominal Imaging and Intervention, Division of Gastroenterology, Center for Pancreatic Disease (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA); Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands; Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD.

The research objective was to equate CT severity index (CTSI) with modified CT severity index (MCTSI), for evaluation of severity parameters in acute pancreatitis/acute pancreatic necrosis – abrupt inflammation of the pancreas. Both the CT indexes were even equated with APACHE II index (Acute Physiology and Chronic Health Evaluation), to categorize severity of disease/illness in patients.

About 196 patients, of 397 successive medical cases of acute pancreatitis were passed through contrast-enhanced computed tomography, after a period of one week, with commencement of the disease symptoms. Single blind study by radiologists were executed for CT indexes; the severity parameters comprised subsequent – death rate, organ failure, pancreatic contamination, hospital admittance/intensive care unit stay, requirement for medical interference, clinical severity of pancreatic inflammation etc.! Kappa coefficient stats and discrimination analysis were executed, for the process.

About the results, no considerable deviation could be established amongst the CT indexes, though score and severity parameters showed some relationship, for both the indexes. Equated with the APACHE II index – both the CT indexes precisely correlated with the requirement for medical interference and pancreatic inflammation, and more precisely identified out clinically grave disorder; for both the CT severity indexes, the interobserver agreement demonstrated fine results.

Conclusion: No meaningful deviation could be established amongst modified CT severity index and CT severity index in assessment of severity of acute pancreatitis/pancreatic necrosis. In comparison with APACHE II, both the indexes more precisely identify out clinically grave disorder and better connect with the requirement for intervention and pancreatic inflammation.

In comparison to standard core biopsy procedure, cancer detection rate is higher through MR-guided biopsy.

MRI_Prostate

The clinical perspective was contributed by Andrew B. Rosenkrantz, Stephen M. Scionti, Savvas Mendrinos and Samir S. Taneja from Department of Radiology, New York University Langone Medical Center; Division of Urologic Oncology, Department of Urology; Department of Pathology, New York University Langone Medical Center, New York, NY.

The clinical perspective is available in American Journal of Roentgenology, and the objective was to examine possibilities of Magnetic resonance imaging in minimal-invasive focal ablative treatment for prostate cancer.

In union with biopsy, magnetic resonance imaging can affect patient selection for focal ablation, by aiding in to restrict clinically significant tumor foci. Some ablation can be executed through period-of-time MRI conduct. More to that, magnetic resonance imaging can be utilized for evaluation of degree of necrosis briefly after treatment, and for long-term supervision for recurring tumor.

For more on, how Magnetic Resonance imaging can reduce unnecessary prostate biopsies in men with persistently elevated PSA – please go through subsequent article:  MRI prostate

The tumors were desolate and well restricted of patients with surgicopathologic staging of nerve sheath tumor of the cervical vagus, over MR and CT studies.

On magnetic resonance imaging, the tumors were heterogeneously bright on T2WI, with strong inhomogeneous postgadolinium enhancement.

Nerve sheath tumor

The medical research study was conducted by Gopinathan Anil and Tiong-Yong Tan from Department of Radiology, Changi General Hospital, Singapore.

The study is available in American Journal of Roentgenology. Nerve sheath tumor is nervous system neoplasm – and emergence of it from the cervical vagus are uncommon. The research objective was to assess the role of Magnetic resonance imaging and Computed tomography in the diagnosis of these unusual neoplasms.

About 11 patients with surgicopathologic staging of nerve sheath tumor of the cervical vagus were selected had been referred to the institute from January 1999-2009, and their clinical data along with MR and CT studies were retroactively assessed. The tumors were appraised pertaining to: number, location, morphology, signal intensity/attenuation, patterns of mass effect and enhancement characteristics etc.

About the results, the tumors were desolate and well restricted. On computed tomography – 2 tumors were predominantly isodense, 8 were hypodense with poor enhancement; one had manifold cystic regions with enhancing solid components. On magnetic resonance imaging, the tumors in a heterogenous manner were bright on T2WI, with strong inhomogeneous postgadolinium enhancement. Subsequent were observed in some of patients: split fat sign, fascicular, entering and exiting nerve, hyperintense rim sign etc.

The common carotid artery was found anteriorly displaced in eight of the patients; except for a patient with posterolateral displacement, it maintained a neutral position for 2 of the patients. With exclusion of two, than other patients – the tumor acted as separation in between internal jugular vein and carotid artery.

Note: The spectrum of MRI and CT characteristics and patterns of mass effect of nerve sheath tumor of the cervical vagus were put forward as conclusion, along with observations for which we direct you more through http://www.ajronline.org