Objectives
SMARCA4
-deficient thoracic sarcoma (SMARCA4-DTS) is a recently identified aggressive subtype of sarcoma. The aim of this study was to characterize the CT imaging features of SMARCA4-DTS.
...Methods
From June 2011 to May 2017, 21 adult patients with histologically proven SMARCA4-DTS were identified in the radiological database of 2 French sarcoma reference centers with at least one chest CT scan available. The locations, sizes, heterogeneity, margin definitions, and local extensions of the tumors were reported together with their impact on surrounding organs and regional and distant metastases. Pathological findings, molecular analyses, and patients’ outcomes were retrieved.
Results
Of the 21 included patients (median age 48, range 30–74), 18 (85.7%) were male and 18 (85.7%) had a smoking history. Four main radiological patterns were identified depending on the location of the main tumor burden: mediastinal (
n
= 13), pleural (
n
= 6), cervical (
n
= 1), and retroperitoneal (
n
= 1). Median size was 120 mm (range 46–266). Characteristic CT imaging features of primary tumors included ill-defined margins (
n
= 21), heterogeneous enhancement after injection (
n
= 20), multi-compartment extension from mediastinum to lung apex, pleura, or neck (
n
= 20), compressive effect responsible for atelectasis (
n
= 11), vascular encasement (
n
= 16—5 superior vena cava syndrome), and esophagus invasion (
n
= 5). Primary tumors showed strong
18
F-FDG avidity in eight patients with PET-CT. Necrotic lymphadenopathies were found in 19 patients, with a surrounding infiltrate in 13 patients. Metastatic locations at baseline mainly involved adrenal (
n
= 10), lung (
n
= 6), and bone (
n
= 5). Median overall survival was 5 months (range 1–13).
Conclusion
Most SMARCA4-DTS present with compressive and infiltrative chest masses with ill-defined necrotic lymphadenopathies. The diagnosis of SMARCA4-DTS should enter in the differentials of the radiologist, especially in the case of a rapidly evolving thoracic mass in young smoking males.
Key Points
• SMARCA4-DTS is a very aggressive poorly differentiated sarcoma with a predilection for young and middle-aged adult male smokers.
• SMARCA4-DTS, which is mostly located in the chest cavity, can compress and infiltrate all adjacent organs leading to superior vena syndrome, lung atelectasis, epiduritis, spinal cord compression, and esophagus invasion.
• SMARCA4-DTS typically demonstrates several ill-defined necrotic lymphadenopathies spreading in axillar, subclavian, cervical, mediastinum, and retroperitoneum.
Abstract
First-line selective internal radiation therapy (SIRT) showed promising outcomes in patients with uveal melanoma liver metastases (UMLM). Patient survival depends on liver’s disease control. ...SIRT planning is essential and little is known about dosimetry. We investigated whether
99m
Tc-MAA-SPECT/CT dosimetry could predict absorbed doses (AD) evaluated on
90
Y-PET/CT and assess the dose–response relationship in UMLM patients treated with first-line SIRT. This IRB-approved, single-center, retrospective analysis (prospectively collected cohort) included 12 patients (median age 63y, range 43–82). Patients underwent MRI/CT,
18
F-FDG-PET/CT before and 3–6 months post-SIRT, and
90
Y-PET/CT immediately post-SIRT. Thirty-two target lesions were included. AD estimates in tumor and non-tumor liver were obtained from
99m
Tc-MAA-SPECT/CT and post-SIRT
90
Y-PET/CT, and assessed with Lin’s concordance correlation coefficients (
ρ
c
and
C
b
), Pearson’s coefficient correlation (
ρ
), and Bland–Altman analyses (mean difference ± standard deviation; 95% limits-of-agreement (LOA)). Influence of tumor characteristics and microsphere type on AD was analyzed. Tumor response was assessed according to size-based, enhancement-based and metabolic response criteria. Mean target lesion AD was 349 Gy (range 46–1586 Gy). Concordance between
99m
Tc-MAA-SPECT/CT and
90
Y-PET/CT tumor dosimetry improved upon dose correction for the recovery coefficient (RC) (
ρ
= 0.725,
ρ
c
= 0.703,
C
b
= 0.969) with good agreement (mean difference: − 4.93 ± 218.3 Gy, 95%LOA: − 432.8–422.9). Without RC correction, concordance was better for resin microspheres (
ρ
= 0.85,
ρ
c
= 0.998,
C
b
= 0.849) and agreement was very good between predictive
99m
Tc-MAA-SPECT/CT and
90
Y-PET/CT dosimetry (mean difference: − 4.05 ± 55.9 Gy; 95%LOA: − 113.7–105.6). After RC correction,
99m
Tc-MAA-SPECT/CT dosimetry overestimated AD (− 70.9 ± 158.9 Gy; 95%LOA: − 382.3–240.6). For glass microspheres, concordance markedly improved with RC correction (
ρ
= 0.790,
ρ
c
= 0.713,
C
b
= 0.903 vs without correction:
ρ
= 0.395,
ρ
c
= 0.244,
C
b
= 0.617) and
99m
Tc-MAA-SPECT/CT dosimetry underestimated AD (148.9 ± 267.5 Gy; 95%LOA: − 375.4–673.2). For non-tumor liver, concordance was good between
99m
Tc-MAA-SPECT/CT and
90
Y-PET/CT dosimetry (
ρ
= 0.942,
ρ
c
= 0.852,
C
b
= 0.904).
99m
Tc-MAA-SPECT/CT slightly overestimated liver AD for resin (3.4 ± 3.4 Gy) and glass (11.5 ± 13.9 Gy) microspheres. Tumor AD was not correlated with baseline or post-SIRT lesion characteristics and no dose–response threshold could be identified.
99m
Tc-MAA-SPECT/CT dosimetry provides good estimates of AD to tumor and non-tumor liver in UMLM patients treated with first-line SIRT.
Imaging of Oligometastatic Disease Vietti Violi, Naik; Hajri, Rami; Haefliger, Laura ...
Cancers,
03/2022, Letnik:
14, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Oligometastatic disease (OMD) is an emerging state of disease with limited metastatic tumor burden. It should be distinguished from polymetastatic disease due the potential curative therapeutic ...options of OMD. Imaging plays a pivotal role in the diagnosis and follow-up of patients with OMD. The imaging tools needed in the case of OMD will differ according to different parameters, which include primary tumor type, timing between measurement and treatment, potential metastatic location and the patient's individual risk for metastasis. In this article, OMD is defined and the use of different imaging modalities in several oncologic situations are described in order to better understand OMD and its specific implication for radiologists.
: Factors affecting morphological changes in the liver following selective internal radiation therapy (SIRT) are unclear, and the available literature focuses on non-anatomical volumetric assessment ...techniques in a lobar treatment setting. This study aimed to investigate quantitative changes in the liver post-SIRT using an anatomical volumetric approach in hepatocellular carcinoma (HCC) patients with different levels of treatment selectivity and evaluate the parameters affecting those changes. This retrospective, single-institution, IRB-approved study included 88 HCC patients. Whole liver, liver segments, tumor burden, and spleen volumes were quantified on MRI at baseline and 3/6/12 months post-SIRT using a segmentation-based 3D software relying on liver vascular anatomy. Treatment characteristics, longitudinal clinical/laboratory, and imaging data were analyzed. The Student's
-test and Wilcoxon test evaluated volumetric parameters evolution. Spearman correlation was used to assess the association between variables. Uni/multivariate analyses investigated factors influencing untreated liver volume (uLV) increase.
: Most patients were cirrhotic (92%) men (86%) with Child-Pugh A (84%). Absolute and relative uLV kept increasing at 3/6/12 months post-SIRT vs. baseline (all,
≤ 0.005) and was maximal during the first 6 months. Absolute uLV increase was greater in Child-Pugh A5/A6 vs. ≥B7 at 3 months (A5,
= 0.004; A6,
= 0.007) and 6 months (A5,
= 0.072; A6,
= 0.031) vs. baseline. When the Child-Pugh class worsened at 3 or 6 months post-SIRT, uLV did not change significantly, whereas it increased at 3/6/12 months vs. baseline (all
≤ 0.015) when liver function remained stable. The Child-Pugh score was inversely correlated with absolute and relative uLV increase at 3 months (rho = -0.21,
= 0.047; rho = -0.229,
= 0.048). In multivariate analysis, uLV increase was influenced at 3 months by younger age (
= 0.013), administered
Y activity (
= 0.003), and baseline spleen volume (
= 0.023). At 6 months, uLV increase was impacted by younger age (
= 0.006), whereas treatment with glass microspheres (vs. resin) demonstrated a clear trend towards better hypertrophy (f = 3.833,
= 0.058). The amount (percentage) of treated liver strongly impacted the relative uLV increase at 3/6/12 months (all f ≥ 8.407,
≤ 0.01).
: Liver function (preserved baseline and stable post-SIRT) favored uLV hypertrophy. Younger patients, smaller baseline spleen volume, higher administered
Y activity, and a larger amount of treated liver were associated with a higher degree of untreated liver hypertrophy. These factors should be considered in surgical candidates undergoing neoadjuvant SIRT.
Objectives
Mandibular anterior crowding can be treated by expanding the dental arch or by extracting teeth, usually premolars. The aim of this study was to assess long-term outcomes of extraction ...versus non-extraction therapies in terms of gingival recession.
Methods
Fifty consecutive patients were selected, including 26 non-extraction and 24 extraction cases. All had been treated with fixed appliances because of well-defined comparable moderate crowding and Angle Class I malocclusion. Patient age was documented before treatment, upon debonding, and during retention, thus, allowing the calculation of the duration of active treatment and retention. The records available for these three points in time included casts and cephalograms. The casts were used to quantify mandibular anterior crowding and the associated clinical crown lengths. Based on the cephalograms, a number of symphyseal variables were measured. Data analysis included descriptive statistics, correlation tests, and multiple regressions.
Results
For accurate comparison of the extraction and non-extraction treatment groups, we required and verified that no significant intergroup differences were present with regard to initial crowding, duration of retention, and age at final record-taking. Both groups revealed increases in crown length, which fell short of statistical significance but were twice as large for canines than for incisors. The treatment decisions to extract premolars did result in significantly different topographic positions of the lower incisors, but they made no difference in the recession outcomes. None of the variables in our regression analysis was found to predict gingival recession.
Conclusion
Findings of gingival recession in patients having undergone orthodontic treatment do not seem to be related to extraction/non-extraction treatment decisions.
Purpose
Even though transjugular intrahepatic portosystemic shunt (TIPS) using Fluency Stent-grafts provides good shunt patency rates, shunt dysfunction is a great concern after TIPS creation, ...occurring in up to 20% of cases within one year. The objective of this study was to describe shunt dysfunction patterns after TIPS creation using a combination of generic stent-grafts/bare-stents.
Materials and methods
Single-center retrospective study of all TIPS revisions between January 2005 and December 2020. TIPS revision angiograms were analyzed for stents’ positions, stenoses’ diameters, and stenoses’ locations.
Results
Out of 99 TIPS, a total of 33 TIPS revisions were included. The median time to TIPS revision was 10.4 months. Angiograms showed four patterns of TIPS dysfunction-associated features (DAF), defined as follows: Type 1 was defined as stenosis located after the stent end in the hepatic vein (HV), type 2 as intra-stent stenosis located in the hepatic vein, type 3 as intra-stent stenosis or a kink in the parenchymal tract or the portal vein end of the TIPS, and type 4 as a complete TIPS occlusion. Types 1, 2, 3, and 4 were seen in 23 (69.7%), 5 (15.2%), 2 (6.1%), and 3 (9.1%) TIPS respectively. TIPS revision was successful in 30 (90.1%) patients with median pre- and post-TIPS revision PSG of 18.5 mmHg and 8 mmHg respectively (
p
< .001).
Conclusion
Our results illustrate the four angiographic patterns of TIPS DAF after TIPS creation using a combination of generic stent-grafts/bare-stents and emphasize the need for appropriate stent length extending to the HV/inferior vena cava junction.
Objectives:
To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The ...proposed classification was evaluated retrospectively in a large population.
Materials and Methods:
We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes.
Results:
According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (
p
< 0.001).
Conclusion:
The new AAD classification was feasible, and type C was easily identified (“non-A, non-B”). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments.
Objectives
The aim of the present study was to evaluate the effect of novel silane system coatings on zirconia and titanium implant surfaces and the attachment of the fungal pathogen Candida ...albicans.
Materials and methods
Titanium and zirconia specimens were silica‐coated and silanized either with a commercial silane primer (RelyX Ceramic Primer™, 3M ESPE) or a novel silane system primer. The novel silane system primer was a blend of 1.0 vol% 3‐acryloxypropyltrimethoxysilane and 0.3 vol% bis‐1,2‐(triethoxysilyl)ethane diluted in acidified ethanol‐water solvent. The surface roughness (Ra), the surface free energy and the chemical composition of substrate surfaces after treatments were evaluated. C. albcans biofilms were developed on silica‐coated + silanized surfaces during 48 h of incubation time. Colony forming units (CFU) and real‐time PCR (RT‐PCR) quantified the cells on the material surfaces. Statistical analyses were carried out by 1‐way ANOVA, Tukey post hoc and Games Howell post hoc test at 5% significance level (p).
Results
On zirconia and titanium surfaces, the Ra and the chemical composition of the specimens were equal (P < 0.05). The surface free energy was decreased on titanium specimens and increased on zirconia specimen after silanization. CFU of C. albicans was significantly lower on zirconia coated with RelyX Ceramic Primer™, (P < 0.001) and on titanium coated with both silanes (P = 0.002). RT‐PCR revealed no differences between the mean quantities of C. albicans (P ≥ 0.067).
Conclusion
Silica‐coating and silanization had modified the titanium and zirconia surfaces significantly. Both the control and experimental silane primers might inhibit the biofilm formation of C. albicans.
•Interventional radiology provides multiples localization techniques that can be used in the marking process of various pathologies.•Localization techniques can be used for non-palpable breast or ...lung, tumors before surgery, before stereotactic-radiotherapy of lung tumors, before percutaneous thermal ablation of non-visible hepatic tumors and a variety of other indications.•Localization techniques mostly include hook wire placement, marking with ethiodized oil (Lipiodol®), dyes or radioisotope, and micro-coils or fiducial marker placement.
Precise marking of lesions using image-guided techniques is essential, as imprecise targeting of a tumor can result in either insufficient excision/treatment with an increased risk of recurrence, or excessive removal of healthy tissue. Most frequent indications include localization of nonpalpable lesions before surgical resection (i.e., hook-wire localization of pulmonary nodules before video-assisted thoracoscopy) and definite marking of liver metastasis before neoadjuvant therapy. Other indications include marking of hepatocellular carcinomas that are not visible on ultrasound and unenhanced computed tomography before thermal ablation, of bone lesions before surgical excision, and of different visceral tumors before stereotactic radiotherapy. This review presents the different existing indications, assesses their usefulness, gives systematic details on the technique and lastly analyzes the current literature with emphasis on results and complications.
Renal peripelvic lymphangiectasia (RPL) is one of the rare conditions that mimic renal cysts. Its physiopathology remains unknown, but an association with renal vein thrombosis has been reported. We ...share the case of a male patient in his 20s suffering from antiphosphlipid syndrome. The patient was hospitalised for thrombosis of the inferior vena cava (IVC) extending from the iliac veins to the level of renal veins. Consecutive CT and clinical follow-up over the course of 14 years showed the development of numerous retroperitoneal venous collaterals and the apparition of several bilateral peripelvic cystic lesions after extensive thrombosis of the IVC and both renal veins. The renal function remained normal throughout the follow-up. We suggest that the development of RPL is secondary to bilateral renal vein thrombosis. The presumed mechanism would be an increased hydrostatic pressure in the kidney capillaries leading to a more important interstitial fluid drainage by the lymphatic system. To our knowledge, this is the first well-documented case of renal vein thrombosis followed by RPL, contrasting with the previous hypothesis that compression by the lymphangiectasia could cause the thrombosis.
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