Abstract Purpose Standardized perfusion value (SPV) is a universal indicator of tissue perfusion, normalized to the whole-body perfusion, which was proposed to simplify, unify and allow the ...interchangeability among the perfusion measurements and comparison between the tumor perfusion and metabolism. The aims of our study were to assess the standardized perfusion value (SPV) of the esophageal carcinoma, and its correlation with quantitative CT perfusion measurements: blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) of the same tumor volume samples, which were obtained by deconvolution-based CT perfusion analysis. Methods Forty CT perfusion studies of the esophageal cancer were analyzed, using the commercial deconvolution-based CT perfusion software (Perfusion 3.0, GE Healthcare). The SPV of the esophageal tumor and neighboring skeletal muscle were correlated with the corresponding mean tumor and muscle quantitative CT perfusion parameter values, using Spearman's rank correlation coefficient ( r S ). Results Median SPV of the esophageal carcinoma (7.1; range: 2.8–13.4) significantly differed from the SPV of the skeletal muscle (median: 1.0; range: 0.4–2.4), ( Z = −5.511, p < 0.001). The cut-off value of the SPV of 2.5 enabled discrimination of esophageal cancer from the skeletal muscle with sensitivity and specificity of 100%. SPV of the esophageal carcinoma significantly correlated with corresponding tumor BF ( r S = 0.484, p = 0.002), BV ( r S = 0.637, p < 0.001) and PS ( r S = 0.432, p = 0.005), and SPV of the skeletal muscle significantly correlated with corresponding muscle BF ( r S = 0.573, p < 0.001), BV ( r S = 0.849, p < 0.001) and PS ( r S = 0.761, p < 0.001). Conclusions We presented a database of the SPV for the esophageal cancer and proved that SPV of the esophageal neoplasm significantly differs from the SPV of the skeletal muscle, which represented a sample of healthy tissue. The SPV was validated against quantitative CT perfusion measurements and statistically significant correlation was proved.
Highlights • Neoadjuvant chemoradiation (nCRT) is standard therapy of esophageal carcinoma (EC). • Accurate response evaluation of EC to nCRT became the main diagnostic challenge. • Post-nCRT CT ...perfusion parameter values correlate with the histopathologic TRG. • BF and BV were gradually rose and MTT decreased as TRG increased from 1 to 4. • CT perfusion can improve accuracy in response evaluation of EC to nCRT.
Abstract Purpose To estimate if CT perfusion parameter values of the esophageal cancer, which were obtained with the deconvolution-based software and maximum slope algorithm are in agreement, or at ...least interchangeable. Methods 278 esophageal tumor ROIs, derived from 35 CT perfusion studies that were performed with a 64-MDCT, were analyzed. “Slice-by-slice” and average “whole-covered-tumor-volume” analysis was performed. Tumor blood flow and blood volume were manually calculated from the arterial tumor-time–density graphs, according to the maximum slope methodology (BFms and BVms ), and compared with the corresponding perfusion values, which were automatically computed by commercial deconvolution-based software (BFdeconvolution and BVdeconvolution ), for the same tumor ROIs. Statistical analysis was performed using Wilcoxon matched-pairs test, paired-samples t -test, Spearman and Pearson correlation coefficients, and Bland–Altman agreement plots. Results BFdeconvolution (median: 74.75 ml/min/100 g, range, 18.00–230.5) significantly exceeded the BFms (25.39 ml/min/100 g, range, 7.13–96.41) ( Z = −14.390, p < 0.001), while BVdeconvolution (median: 5.70 ml/100 g, range: 2.10–15.90) descended the BVms (9.37 ml/100 g, range: 3.44–19.40) ( Z = −13.868, p < 0.001). Both pairs of perfusion measurements significantly correlated with each other: BFdeconvolution , versus BFms ( rS = 0.585, p < 0.001), and BVdeconvolution , versus BVms ( rS = 0.602, p < 0.001). Geometric mean BFdeconvolution /BFms ratio was 2.8 (range, 1.1–6.8), while geometric mean BVdeconvolution /BVms ratio was 0.6 (range, 0.3–1.1), within 95% limits of agreement. Conclusions Significantly different CT perfusion values of the esophageal cancer blood flow and blood volume were obtained by deconvolution-based and maximum slope-based algorithms, although they correlated significantly with each other. Two perfusion-measuring algorithms are not interchangeable because too wide ranges of the conversion factors were found.
The aim of this retrospective study was to present and compare the results of using two different types of esophageal self‐expanding stents (uncovered and covered) for palliative treatment of ...patients with inoperable malignant stenosis of the esophagus and cardia. Over a period of 8 years, 152 patients underwent fluoroscopically guided insertion of metal esophageal stents. We inserted uncovered esophageal nitinol Strecker stents in 54 patients (group I) and covered esophageal Ultraflex stents in the remaining 98 patients (group II). The stent insertion procedure was successively performed in all patients. Closure of esophageal fistula by covered stents was achieved in 8/8 patients. Mean dysphagia score was significantly decreased in both patient groups at 4 weeks follow‐up: from 2.73 before stent insertion to 0.15 in group I, and from 2.67 to 0.05 in group II (on 0–4 scale). Eighty‐eight per cent of patients with covered stents and 54% with uncovered type were free of symptoms during follow‐up. Complications occurring during follow‐up and their comparative frequency in the two groups of patients were as follows (group I: group II%): stent migration (0 : 10%); tumor or granulation tissue ingrowth (100 : 53%); overgrowth at the ends of stents (17 : 30%); restenosis causing recurrent dysphagia (37 : 8%); and appearance of esophageal fistulas (8 : 6%). In conclusion, fluoroscopically guided insertion of self‐expandable esophageal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. In selection of a stent, covered types should be given priority for prevention of restenosis.
Visceral fat is considered a key factor in the development of metabolic syndrome and other pathological conditions and diseases associated with obesity. Therefore, analysis of the dynamics of ...reducing the amount of abdominal visceral fat is important for evaluating the therapeutic effects of different modalities of obesity treatment, including bariatric surgery. In 53 obese patients visceral and subcutaneous abdominal adipose tissue was measured by ultrasonography (US) before and after bariatric surgery, in the period of 1, 3, 6 months. At the same time, standard anthropometric parameters were assessed: body mass (m), BMI, waist circumference (WC), and hip circumference (HC). Five diameters of the visceral abdominal fat (VAF) were measured: IAFT (Intraabdominal Fat Thickness), LV (Lienal Vein), VF (Visceral Fat), MES sum (Mesenterial leafs) and Max PFT (Maximal Preperitoneal Fat Thickness), and three diameters of the subcutaneous abdominal adipose tissue (SCAF): Min SFT (Minimal Subcutaneous Fat), and MaxSFTa and MaxSFTb (Maximal Subcutaneous Fat Thickness a and b). Statistically significant decrease in all anthropometric parameters, except HC was registered 1, 3 and 6 months after the surgery. We registered the decline of almost all US diameters of abdominal adipose tissue in the follow-up period, but statistically significant decrease were found only in the diameters of visceral adipose tissue: IAFT after 1 and 3 months (p = 0.031 and p = 0.027); VF after 1 month (p = 0.031), LV after 6 months (p = 0.011), and MESsum after 3 and 6 months (p = 0.001 and p = 0.028), as well as MaxSFTb, at 1 month follow-up (p = 0.015). In the short-term follow-up period after the bariatric surgery, there was a significant decrease in body mass, BMI and WC, and ultrasonography revealed a significant reduction in the diameters of the visceral abdominal fat.
The authors describe their own experience with chemoembolization as a palliation in the treatment of non resectable hepatocellular carcinoma.
During period of 64 months procedure was performed in 41 ...patients with non resectable hepatocellular carcinoma. The combination of Lipiodol and chemotherapeutic agents were applied in a. hepatica propria and its branches via transfemorally placed catheter. Stages of neoplasms were defined by Okuda method.
The majority of tumors (30) were classified as Grade I. Liver cirrhosis was present in 36 patients, and abnormal levels of alpha-fetoprotein were found in 68% of cases. Each of twenty nine patients had more than one chemoembolization therapy, therefore, a total of 85 treatments were carried out. CT scanning perfomed one month following the procedure revealed more than 75% of Lipiodol retention in 42% of cases, and over 90% of neoplasm necrosis was recorded in 90% of cases, while all treated patients manifested lower levels of alpha-fetoprotein. All patients survived during three and six months, respectively, while the survival rate was 68% after 18 months. No letal outcome was reported during procedure, and morbidity in relation to total number of interventions was 19%.
Achieved effects of this relatively safe procedure in our series do not differ significantly from those in the literature.
Transcatheter antitumor therapy very quickly accepted during the last decade and their importance in the treatment of oncology patients will be increasing. By improvement of new targeted agents, ...which can be given intraarterial or systemic, efficiency of transcatheteric therapeutic approaches can be drastically increased. Numerous clinical trials (study phase I / II / III) relating to the synergy of two antitumor therapeutic approaches are already in progress. Preliminary results of these trials are already very encouraging. Further improvement in the development of specific therapeutics antitumor drugs and systemic applications will be a big step in the quest for medication against malignant tumors.
We presented the X-ray and CT findings characteristic for gastric cancers of different localizations (localized in different parts of the stomach). Particularly, esophagogastric junction (EGJ) ...carcinomas and antral carcinomas are singled out, as two localizations of gastric cancer that we usually meet in everyday clinical and radiological practice, and which have completely different radiological presentation. Advanced carcinomas of esophago-gastric junction, whose incidence is on the rise, usually affect the distal segment of the esophagus, cardia, and proximal part of the stomach, in different proportions. Siewert's, and the Japanese classification of these tumors are listed. Due to the involvement of the distal esophagus, scanning region, besides the abdomen, should be expanded to the chest. Advanced cancer of the antral part of the stomach is presented by the X-ray as a fungating, infiltrative, or combined form, often capturing the entire wall circumference. Possible infiltration of the left liver, the body and neck of the pancreas, colon and anterior abdominal wall should be estimated by CT.
A wide spectrum of nowadays availible radiological and imaging methods in the diagnostic evaluation of patients with colorectal cancer enabled not only the improvement of primary colorectal ...malignancy detection, precise staging, regional involvement and metastatic spread assessment, but also the posttherapeutical estimation and follow-up. Having in mind that the exact diagnostic assessment of colorectal carcinoma by use of different imaging modalities still raises a lots of contradictories, in this report we have tried to present the possibilities of newer imaging techniques in the diagnostic evaluation of the patients with colorectal cancer.
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