Multiparametric MRI in rectal cancer Gurses, Bengi; Boge, Medine; Altinmakas, Emre ...
Diagnostic and interventional radiology (Ankara, Turkey),
05/2019, Letnik:
25, Številka:
3
Journal Article
Recenzirano
Odprti dostop
MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with posttreatment evaluation. This ...occurs due to similar signal intensities of tumoral and posttreatment fibrotic, necrotic, and inflamed tissue. This limitation occurs with conventional MRI of the rectum with morphologic sequences. There is a need towards increasing the accuracy of MRI, especially for posttreatment evaluation. The term multiparametric MRI implies addition of functional sequences, namely, diffusion and perfusion to the routine protocol. This review summarizes the technique, potential implications and previously published studies about multiparametric MRI of rectal cancer.
The purposes of this study were to visualize the human median nerve on diffusion tensor imaging and to determine the normal fractional anisotropy (FA) value and apparent diffusion coefficient (ADC) ...of the normal median nerve.
The wrists of 20 healthy volunteers and of two patients with carpel tunnel syndrome were examined with a 3-T MRI system with a standard eight-channel sensitivity-encoding head coil. Diffusion tensor imaging was performed with a spin-echo echo-planar sequence. A T1-weighted sequence was performed for anatomic reference. After tractography, the FA value and ADC of the whole nerve were calculated automatically. Manual focal measurements also were obtained at the levels of the flexor retinaculum, wrist, and forearm.
We visualized the median nerve with MR diffusion tensor tractography and followed the nerve for approximately 77.5 mm. We found the normative diffusion values of the median nerve were an FA of 0.709 +/- 0.046 (SD) and an ADC of 1.016 +/- 0.129 x 10(-3) mm2/s. There was a statistically significant difference between the FA values obtained at the level of the flexor retinaculum and the values obtained from the other parts of the median nerve (p < 0.0001). We found a decrease in FA value (p < 0.01) and an increase in ADC (p < 0.05) with advancing age.
The normative diffusion values of the human median nerve can be used as a reference in evaluation, diagnosis, and follow-up of entrapment, trauma, and regeneration of the median nerve.
Purpose
This study aimed to compare local regrowth rates after total neoadjuvant therapy (TNT) versus standard neoadjuvant chemoradiotherapy (SNCRT) in locally advanced rectal cancer (LARC) patients ...that were strictly selected and assessed with a multimodal approach. Secondary outcomes were 4-year disease-free (DFS) and overall survival (OS) rates.
Methods
Locally advanced rectal cancer patients without distant metastases treated at Koç Healthcare Group between January 2014 and January 2021 were included. Patients were assessed for complete response with a combination of digital rectal exam, endoscopy, and magnetic resonance imaging with a dedicated rectum protocol. The systemic evaluation was performed with an upper abdomen MRI using intravenous hepatobiliary contrast agent and a thorax CT.
Results
Of the 270 patients with LARC, 182 fulfilled the inclusion criteria. Ninety-seven (53.3%) underwent TNT, while 85 (46.7%) underwent SNCRT. A cumulative combination of pathological and sustained clinical complete response was significantly higher in the TNT group than in the SNCRT (45.4% vs. 20.0%,
p
< 0.0001). After a median follow-up of 48 months, seven patients in the W&W group had regrowth TNT: 4 (10.8%) vs. SNCRT: 3 (23.1%),
p
= 0.357. Based on pathological examination, complete/near complete mesorectum rates (
p
= 1.000) and circumferential resection margin positivity rates (
p
= 1.000) were similar between the groups. The 4-year DFS and OS rates were comparable. The patients with clinical or pathological complete response had significantly longer overall survival (
p
= 0.017) regardless of the type of neoadjuvant treatment.
Conclusions
Multimodal assessment after TNT effectively detects complete responders, resulting in low local recurrence and increased cumulative complete response rates. However, these outcomes did not translate into a survival advantage.
In this study, we aimed to analyze the repeatability of quantitative multiparametric rectal magnetic resonance imaging (MRI) parameters with different measurement techniques.
All examinations were ...performed with 3 T MRI system. In addition to routine sequences for rectal cancer imaging protocol, small field-of-view diffusion-weighted imaging and perfusion sequences were acquired in each patient. Apparent diffusion coefficient (ADC) was used for diffusion analysis and ktrans was used for perfusion analysis. Three different methods were used in measurement of these parameters; measurements were performed twice by one radiologist for intraobserver and separately by three radiologists for interobserver variability analysis. ADC was measured by the lowest value, the value at maximum wall thickness, and freehand techniques. Ktrans was measured at the slice with maximum wall thickness, by freehand drawn region of interest (ROI), and at the dark red spot with maximum value.
A total of 30 patients with biopsy-proven rectal adenocarcinoma were included in the study. The mean values of the parameters measured by the first radiologist on the first and second measurements were as follows: mean lowest ADC, 721.31±147.18 mm2/s and 718.96±135.71 mm2/s; mean ADC value on the slice with maximum wall thickness, 829.90±144.24 mm2/s and 829.48±149.23 mm2/s; mean ADC value measured by freehand ROI on the slice with maximum wall thickness, 846.56±136.31 mm2/s and 848.23±144.15 mm2/s; mean ktrans value on the slice with maximum wall thickness, 0.219±0.080 and 0.214±0.074; mean ktrans by freehand ROI technique (including as much tumoral tissue as possible), 0.208±0.074 and 0.207±0.069; mean ktrans measured from the dark red foci, 0.308±0.109 and 0.311±0.105. Intraobserver agreement was very good among diffusion and perfusion parameters obtained with all three measurement techniques. Interobserver agreement was very good, except for one of the measurement techniques. As far as interobserver variability is considered, only ADC value measured on the slice with maximum wall thickness differed significantly.
Multiparametric MRI of rectum, using ADC as the diffusion and ktrans as the perfusion parameter is a repeatable technique. This technique may potentially be used in prediction and evaluation of neoadjuvant treatment response. New studies with larger patient groups are needed to validate the role of multiparametric MRI.
•The real challenge during a radical prostatectomy is establishing the balance between well spared neurovascular bundles and tumor-free surgical margins especially in men requesting to keep their ...potency.•There are only very few papers published on Neurosafe (NS) addressing the relationship of nerve sparing with the preoperative imaging incorporating especially the Ga-PSMA PET/CT together with multiparametric magnetic resonance imaging.•NS led to more preserved bundles with less positive surgical margins.•NS was especially useful in patients with D'Amico high-risk disease and preoperative extracapsular extension suspicion in imaging together.
We aimed to analyze the effect of preoperative risk assessment including Ga-68 PSMA PET and multiparametric magnetic resonance imaging (mpMRI) on nerve sparing practices, positive surgical margin (PSM) rates and oncological outcomes based on a comparison between patients underwent RARP with and without Neurosafe (NS).
Patients underwent RARP with NS (RARP-NS) or without (RARP-only) NS retrospectively evaluated. Suspicion for extracapsular extension on mpMRI and/or Ga-68 PSMA PET was recorded as i(imaging)T3. NS was performed according to the Martini-Klinik technique. PSM at preserved bundle side were called PSM at region of interest (ROI) while the others were elsewhere.
A total of 208 patients (90 in RARP-NS, 118 in RARP-only groups) were included. Preoperatively the RARP-only group showed significantly higher mean PSA (p = .01) and PIRADS 5 (p = .002) findings and had more D'Amico high risk (DAHR) patients (p = .08). The overall PSM rates for pT2 versus pT3 disease were 7.5% versus 21.6 and 15.6% versus 55% in RARP-NS and RARP-only groups, respectively. NS resulted in more bilaterally preserved bundles (81.1% vs. 66.3%) and less PSM at the ROI (3.3% vs. 23.4%) than RARP-only group. NS outperformed RARP-only in all clinical settings had its highest differential benefit in more bilateral nerve sparing and less PSM at ROI in patients with both DAHR and iT3 disease. BCR rates were 2.2% and 2.5% for RARP-NS and RARP only groups, respectively (p = .4). One patient in RARP-NS and 9 in RARP-only groups had PSA persistence (p = .02).
RARP-NS led to more preserved bundles with less PSM. It was especially useful in DAHR patients with preoperative extracapsular extension suspicion in imaging simultaneously.
Preoperative individual risk assessment together with appropriate imaging incorporating Ga-68 PSMA PET is very important in decision-making for the extent of the nerve sparing and keeping the margins tumor-free during a RARP. Neurosafe procedure led to more preserved keeping the margins tumor-free during a RARP. Neurosafe procedure led to more preserved and preoperative extracapsular extension suspicion in imaging together.
Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with ...synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management.
This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements.
Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term “early metachronous metastases” applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with “late metachronous metastases” applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed.
The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
Introduction: Pneumothorax is a pathologic condition in which air is accumulated between the visceral and parietal pleura. After clinical suspicion, in order to diagnose the severity of the ...condition, imaging is necessary. By using the help of Picture Archiving and Communication Systems (PACS) direct conventional X-rays are converted to gray-scale and this has become a preferred method among many physicians.
Methods: Our study design was a case-control study with cross-over design study. Posterior-anterior chest X-rays of patients were evaluated for pneumothorax by 10 expert physicians with at least 3years of experience and who have used inverted gray-scale posterior anterior chest X-ray for diagnosing pneumothorax.
Results: The study included posterior anterior chest X-ray images of 268 patients of which 106 were diagnosed with spontaneous pneumothorax and 162 patients used as a control group. The sensitivity of Digital-conventional X-rays was found to be higher than that of inverted gray-scale images (95% CI (2,08–5,04), p<0,01). There was no statistically significant difference between the gold standard and digital-conventional images (95% CI (0,45–2,17), p=0,20), while the evaluations of the gray-scale images were found to be less sensitive for diagnosis (95% CI (3,16–5,67) p<0,01).
Conclusion: Inverted gray-scale imaging is not a superior imaging modality over digital-conventional X-ray for the diagnosis of pneumothorax. Prospective studies should be performed where diagnostic potency of inverted gray-scale radiograms is tested against gold standard chest CT. Further research should compare inverted grayscale to lung ultrasound to assess them as alternatives prior to CT.
Diagnostic utility of DTI in prostate cancer Gürses, Bengi; Tasdelen, Neslihan; Yencilek, Faruk ...
European journal of radiology,
08/2011, Letnik:
79, Številka:
2
Journal Article
Recenzirano
Abstract Purpose The aim of this study was to compare the diffusion tensor parameters of prostate cancer, prostatitis and normal prostate tissue. Materials and Methods A total of 25 patients with the ...suspicion of prostate cancer were included in the study. MRI was performed with 3 T system (Intera Achieva, Philips Medical Systems, The Netherlands). T2 TSE and DTI with ss-EPI were obtained in each subject. TRUS-guided prostate biopsy was performed after the MRI examination. Images were analyzed by two radiologists using a special software system. ROI's were drawn according to biopsy zones which are apex, midgland, base and central zone on each sides of the gland. FA and ADC values in areas of cancer, chronic prostatitis and normal prostate tissue were compared using Student's t -test. Results Histopathological analysis revealed carcinoma in 68, chronic prostatitis in 67 and was reported as normal in 65 zones. The mean FA of cancerous tissue was significantly higher ( p < 0.01) than the FA of chronic prostatitis and normal gland. The mean ADC of cancerous tissue was found to be significantly lower ( p < 0.01), compared with non-cancerous tissue. Conclusion Decreased ADC and increased FA are compatible with the hypercellular nature of prostate tumors. These differences may increase the accuracy of MRI in the detection of carcinoma and to differentiate between cancer and prostatitis.
Diffusion and diffusion tensor imaging techniques (DTI) are widely available and used both in central nervous system and body imaging, including gynecological diseases.
The aims of this study were to ...assess the capability of DTI of uterine zones in relation to the menstrual cycle and ascertain the normal apparent diffusion coefficient and fractional anisotropy values at 3T magnetic resonance imaging (MRI).
Prospective clinical study.
A total of 13 young reproductive and 12 postmenopausal healthy volunteers were included in the study. MRI examination included sagittal T2-weighted and single-shot echo planar imaging DTI obtained under free breathing. Fractional anisotropy (FA) values of the endometrium, junctional zone, and myometrium were determined.
The median (minimum-maximum) FA of the endometrium, myometrium, and junctional zone of the reproductive group were 0.31 (0.260-0.465), 0.42 (0.302-0.664), and 0.58 (0.420-0.745), respectively, in the proliferative phase and 0.26 (0.180-0.413), 0.48 (0.357-0.656), and 0.59 (0.490-0.675), respectively, in the secretory phase. In the postmenopausal group, the FA values of the endometrium, myometrium, and junctional zone were 0.275 (0.136-0.425), 0.255 (0.191-0.553), and 0.27 (0.129-0.397), respectively. Apparent diffusion coefficient (ADC) values of the endometrium, myometrium, and junctional zone of the reproductive group were 1.25±0.254 (0.970-1.463), 1.67 (1.213-1.854), and 1.23 (0.853-1.301), respectively, in the proliferative phase and 1.32±0.283 (1.165-1.706), 1.55 (1.360-1.791), and 1.17 (1.163-1.705), respectively, in the secretory phase. In the postmenopausal group, the ADC values of the endometrium, myometrium, and junctional zone were measured as 1.100±0.192 (0.850-1.302), 1.14 (0.864-1.283), and 1.09 (0.912-1.291). The FA values of the endometrium and myometrium were lower in the secretory phase of the reproductive group, while ADC values were higher. However, both the FA and ADC values were lower in the postmenopausal group.
The present study showed that uterine DTI is feasible when used quantitatively. While FA values tend to decrease, ADC values increase significantly in all zones in the secretory phase except the junctional zone. Zonal FA and ADC values of postmenopausal women are lower in comparison to those in young women.
Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment ...has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydinlar and Koc Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data. Keywords: Consensus, evidence-based data, rectal cancer, treatment
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