Orbital hydatid cysts: Sonographic and CT appearance

Two cases of unilateral proptosis due to orbital hydatid cysts were evaluated by ultrasound and computed tomography. Image morphology of this rare disease is presented.     

Tuberous sclerosis: Ultrasound,CT and MRI features of two cases with multiple organ involvement

The cases of two patients with tuberous sclerosis with multiple sites of involvement are presented. Both patients had characteristic cerebral lesions of tuberous sclerosis associated with bilateral renal angiomyolipomas and hepatic hamartomas. Additionally there were diffuse pulmonary cystic changes in one patient and cardiac rhabdomyoma in the other.     

Mesenteric Castleman’s disease: Ultrasound,computed tomography and angiographic appearance

The localized form of Castleman’s disease is rare, and a mesenteric location is particularly unusual. A case of an asymptomatic young woman having the hyaline vascular type is presented and the ultrasound, CT and angiographic features of the condition are demonstrated.     

Bilateral vertebral artery tortuosity with concomitant vertebral erosion: CT and MRA findings

Focal vertebral artery tortuosity has been periodically reported as a rare cause of cervical vertebral body and foraminal erosion. Almost all reported cases are unilateral. A case of bilateral vertebral artery tortuosity is described with computed tomography and magnetic resonance angiography findings included.     

Cadherin-11 in poor prognosis malignancies and rheumatoid arthritis: common target,common therapies

Cadherin-11 (CDH11), associated with epithelial to mesenchymal transformation in development, poor prognosis malignancies and cancer stem cells, is also a major therapeutic target in rheumatoid arthritis (RA). CDH11 expressing basal-like breast carcinomas and other CDH11 expressing malignancies exhibit poor prognosis. We show that CDH11 is increased early in breast cancer and ductal carcinoma in-situ. CDH11 knockdown and antibodies effective in RA slowed the growth of basal-like breast tumors and decreased proliferation and colony formation of breast, glioblastoma and prostate cancer cells. The repurposed arthritis drug celecoxib, which binds to CDH11, and other small molecules designed to bind CDH11 without inhibiting COX-2 preferentially affect the growth of CDH11 positive cancer cells in vitro and in animals. These data suggest that CDH11 is important for malignant progression, and is a therapeutic target in arthritis and cancer with the potential for rapid clinical translation     

Cd8(+)/V beta 5.1(+) large granular lymphocyte leukemia associated with autoimmune cytopenias,rheumatoid arthritis and vascular mammary skin lesions: successful response to 2-deoxycoformycin

We report a case of CD8(+)/V beta 5.1(+) T-cell large granular lymphocyte leukemia (T-LGL leukemia) presenting with mild lymphocytosis, severe autoimmune neutropenia, thrombocytopenia, polyarthritis and recurrent infections with a chronic disease course. Immunophenotyping showed an expansion of CD3(+)/TCR alpha beta(+)/CD8(+bright)/CD11c(+)/CD57(-)/CD56(-) large granular lymphocytes with expression of the TCR-V beta 5.1 family. Southern blot analysis revealed a clonal rearrangement of the TCR beta-chain gene. Hematopoietic growth factors, high dose intravenous immunoglobulin and corticosteroids were of limited therapeutic benefit to correct the cytopenias. During the disease course, the patient developed a severe cutaneous leg ulcer and bilateral vascular mammary skin lesions. Treatment with 2-deoxycoformycin resulted in both clinical and hematological complete responses, including the resolution of vascular skin lesions. Combined immuno-staining with relevant T-cell associated and anti-TCR-V beta monoclonal antibodies proved to be a sensitive method to assess the therapeutic effect of 2-deoxycoformicin and to evaluate the residual disease.     

巨大少见神经纤维瘤的CT诊断(附3例报告)

神经纤维瘤是来源于周围神经的良性肿瘤, 可发生于身体任何部位。神经纤维瘤伴多发钙化临床少见, 当其位于四肢软组织时极易误诊, 且临床症状及影像学表现无特征, 术前准确诊断较为困难本文回顾性分析天津医科大学附属肿瘤医院骨与软组织肿瘤科1例经手术切除且病理证实的神经纤维瘤伴多发钙化的临床特点及影像学表现, 同时结合相关文献, 对神经纤维瘤伴钙化病例进行整理分析, 以期初步探讨神经纤维瘤伴多发钙化的临床特征、影像学表现及鉴别诊断要点, 提高对本病的认识。     

Prostate volume contouring: a 3D analysis of segmentation using 3DTRUS, CT, and MR

PURPOSE: This study evaluated the reproducibility and modality differences of prostate contouring after brachytherapy implant using three-dimensional (3D) transrectal ultrasound (3DTRUS), T2-weighted magnetic resonance (MR), and computed tomography (CT) imaging. METHODS AND MATERials: Seven blinded observers contoured 10 patients' prostates, 30 day postimplant, on 3DTRUS, MR, and CT images to assess interobserver variability. Randomized images were contoured twice by each observer. We analyzed length and volume measurements and performed a 3D analysis of intra- and intermodality variation. RESULTS: Average volume ratios were 1.16 for CT/MR, 0.90 for 3DTRUS/MR, and 1.30 for CT/3DTRUS. Overall contouring variability was largest for CT and similar for MR and 3DTRUS. The greatest variability of CT contours occurred at the posterior and anterior portions of the midgland. On MR, overall variability was smaller, with a maximum in the anterior region. On 3DTRUS, high variability occurred in anterior regions of the apex and base, whereas the prostate-rectum interface had the smallest variability. The shape of the prostate on MR was rounder, with the base and apex of similar size, whereas CT contours had broad, flat bases narrowing toward the apex. The average percent of surface area that was significantly different (95% confidence interval) for CT/MR was 4.1%; 3DTRUS/MR, 10.7%; and CT/3DTRUS, 6.3%. The larger variability of CT measurements made significant differences more difficult to detect. CONCLUSIONS: The contouring of prostates on CT, MR, and 3DTRUS results in systematic differences in the locations of and variability in prostate boundary definition between modalities. MR and 3DTRUS display the smallest variability and the closest correspondence.     

A phantom study of the accuracy of CT, MR and PET image registrations with a block matching-based algorithm

PURPOSE: The aim of the present study was to quantitatively assess the performance of a block matching-based automatic registration algorithm integrated within the commercial treatment planning system designated ISOgray from Dosisoft. The accuracy of the process was evaluated by a phantom study on computed tomography (CT), magnetic resonance (MR) and positron emission tomography (PET) images. MATERIALS AND METHODS: Two phantoms were used to carry out this study: the cylindrical Jaszczak phantom and the anthropomorphic Liqui-Phil Head Phantom (the Phantom Laboratory), containing fillable spheres. External fiducial markers were used to quantify the accuracy of 41 CT/CT, MR/CT and PET/CT automatic registrations with images of the rotated and tilted phantoms. RESULTS: The study first showed that a cylindrical phantom was not adapted for the evaluation of the performance of a block matching-based registration software. Secondly, the Liqui-Phil Head Phantom study showed that the algorithm was able to perform automatic registrations of CT/CT and MR/CT images with differences of up to 40 degrees in phantom rotation and of up to 20-30 degrees for PET/CT with accuracy below the image voxel size. CONCLUSION: The study showed that the block matching-based automatic registration software under investigation was robust, reliable and yielded very satisfactory results. This phantom-based test can be integrated into a periodical quality assurance process and used for any commissioning of image registration software for radiation therapy.     

Long‐standing Morel‐Lavallée lesion in the proximal thigh: Ultrasound and MR findings with surgical and histopathological correlation

A 65‐year‐old man presented with a soft mass in his proximal right thigh. Ultrasonography showed a well‐defined anechoic lesion with slightly internal echoes. On MRI, the mass was hypointense and minimally hyperintense compared with muscle at T1 and hyperintense at T2, with a hypointense peripheral rim on both sequences. No signal loss was observed on T1‐weighted fat‐suppression MRI. The clinical setting, imaging findings and histopathological features were consistent with a long‐standing Morel‐Lavallée lesion.     

[18F]FDG PET/CT and PET/MR in Patients with Adrenal Lymphoma: A Systematic Review of Literature and a Collection of Cases

Aim. The present study aimed to assess the existing data about Primary Adrenal Lymphoma (PAL) evaluated with FDG PET and to describe a small monocentric series of cases. A systematic analysis (from 2010 to 2022) was made by using PubMed and Web of Science databases reporting data about the role of FDG PET/CT in patients with suspicious or known adrenal lymphoma. The quality of the papers was assessed by using QUADAS-2 criteria. Moreover, from a single institutional collection between 2010 and 2021, data from patients affected by adrenal lymphoma and undergoing contrast-enhanced compute tomography (ceCT)/magnetic resonance (MR) and FDG PET/CT or PET/MR were retrieved and singularly described. Seventy-eight papers were available from PubMed and 25 from Web of Science. Forty-seven (Nr. 47) Patients were studied, most of them in the initial staging of disease (n = 42; 90%). Only in one paper, the scan was made before and after therapy. The selected clinical cases were relative to the initial staging of disease, the restaging, and the evaluation of response to therapy. PET/CT and PET/MR always showed a high FDG uptake in the primary adrenal lesions and in metastatic sites. Moreover, PET metrics, such as maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV), were elevated in all primary adrenal lesions. In conclusions, FDG PET either coupled with CT or MRI can be useful in staging, restaging, and for the evaluation of treatment response in patients affected by PAL     

Lung Adenocarcinoma Manifesting as Pure Ground-Glass Nodules: Correlating CT Size,Volume, Density,and Roundness with Histopathologic Invasion and Size

ObjectivesThe aims of this study were to quantify the relationship between computed tomography (CT) size, volume, density, and roundness of lung adenocarcinomas (ACs) manifesting as pure ground-glass nodules (pGGNs) on CT images and to correlate these parameters with histologic features of invasiveness.MethodsFrom 2005 to 2015, 63 ACs manifesting as pGGNs on CT images were surgically resected at our institution. CT size was measured, and roundness, volumes and densities were computed. CT parameters were correlated to age and sex, as well as to size and number of invasive foci and histologic AC subcategories. Correlations were quantified with Spearman rank correlation coefficients.ResultsOf 63 ACs, 28 (44%) were AC in situ, 25 (40%) were minimally invasive AC, and 10 (16%) were invasive AC. Six of 35 nodules with invasive foci (17%) were smaller than 10 mm. Correlations between age and CT size, volume, density, and roundness were not significant (range r = –0.061 to 0.144, p = 0.285 to 0.902). Correlations between size and number of invasive foci with CT size (r = 0.417, p < 0.001 and r = 0.389, p = 0.003, respectively) were similar to the correlations with volume (r = 0.401, p = 0.001 and r = 0.350, p = 0.005, respectively) and stronger than the correlation with density (r = 0.237, p = 0.062 and r = 0.222, p = 0.081, respectively) and roundness (r = 0.059, p = 0.648 and r = –0.030, p = 0.831, respectively).ConclusionsIn ACs manifesting as pGGNs on CT images, nodule size is positively related to size and number of histologically invasive foci. However, invasive foci can be found in pGGNs smaller than 10 mm. Measuring volume and density of pGGNs provides no advantage over two-dimensional size measurements, which appear sufficient for risk estimation in clinical practice.     

A prospective study of PET/CT in initial staging of small-cell lung cancer: comparison with CT, bone scintigraphy and bone marrow analysis.

BACKGROUND: Small-cell lung cancer (SCLC) accounts for 15%-20% of all lung cancer cases. Accurate and fast staging is mandatory when choosing treatment, but current staging procedures are time consuming and lack sensitivity. PATIENTS AND METHODS: A prospective study was designed to examine the role of combined positron emission tomography/computed tomography (PET/CT) compared with standard staging (CT, bone scintigraphy and immunocytochemical assessment of bone marrow biopsy) of patients with SCLC. Thirty-four consecutive patients were included. Twenty-nine patients received initial PET/CT. RESULTS: PET/CT caused change of stage in 5/29 (17%). Excluding patients with unconfirmed findings or pleural effusion, the sensitivity for accurate staging of patients with extensive disease was the following: for standard staging 79%, PET 93% and PET/CT 93%. Specificity was 100%, 83% and 100%, respectively. CONCLUSION: The results from this first study on PET/CT in SCLC indicates that PET/CT can simplify and perhaps even improve the accuracy of the current staging procedure in SCLC. A larger clinical trial, preferably with consequent histological confirmation in case of discordance, however, is warranted.     

Towards integrating functional imaging in the treatment of prostate cancer with radiation: the registration of the MR spectroscopy imaging to ultrasound/CT images and its implementation in treatment planning

: Dose-escalation to intraprostatic tumor deposits detected by magnetic resonance spectroscopy (MRS) is an example of tumor-targeted radiation therapy. Because treatment planning for prostate brachytherapy is performed based on ultrasound (US)/computed tomography (CT) images, a sine qua non of this technique is the ability to map MRS-positive volumes (obtained in a gland deformed by the endorectal balloon coil) to the US/CT images. An empirical algorithm designed to perform this function, and its validation, are described.

: Mathematically, the problem of mapping points between the MR and US/CT domains comes to: (a) ascertaining that the position of any point in the interior of the prostate is uniquely determined by the shape of the gland, and (b) finding an algorithm that describes this relationship. The image registration algorithm described here is based on the assumption that points within the gland maintain the same relative position with respect to both the axial contours of the prostate and the center of the prostate along the superior-inferior direction. Relative positions of MRS-positive voxels are calculated with this method in both MR and US/CT space. For a particular voxel in the MR space, one obtains first the z coordinate in the US/CT space, that is, along the superior-inferior direction. This determines the axial slice in the US/CT frame of reference where the other two coordinates (x, y) will be calculated. The validity of this algorithm was examined with the aid of a pelvic phantom built to simulate realistically the prostate and its surrounding bony and tissue structures and with CT scans of implanted patients obtained, at several weeks’ intervals, as part of an edema-resolution study. Seventy-five “dummy” seeds were placed in the phantom, within the simulated prostate gland, in a quasi-regular pattern. The coordinates of these seeds were determined and thus served as markers of prostate deformation when an inflated rectal probe was introduced in the phantom. CT images of this phantom were taken for different volumes of the MR rectal probe and in each case the prostate outlines were contoured and seed coordinates calculated. Using these data, the predictions of the mapping algorithm could be directly verified.

: Absolute values of the 3D-positional errors in this algorithm were 2.2 mm ± 1.2 mm (average ± SD). Only 6 of 75 seeds had positional displacement of 4 mm or more. Similar results were obtained in the patient analysis.

: In comparison to the MRS voxel size (6.25 × 6.25 × 3.0 mm³), the present algorithm achieves the desired clinical accuracy. As well, with this 3D algorithm seed positions are reconstructed with an uncertainty that, along the z direction, is less than half the thickness of the typical US slice (0.5 cm).     

Colorectal cancer burden,trends and risk factors in China: A review and comparison with the United States

ObjectiveChina and the United States (the U.S.) have the heaviest colorectal cancer (CRC) burden with considerable variations in temporal trends. This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S. across the past three decades.MethodsData were extracted from the Global Burden of Disease (GBD) Study in 2019, including cases, deaths, disability-adjusted life-years (DALYs), age-standardized rate (ASR), and summary exposure value (SEV) of CRC in China and the U.S. between 1990 and 2019. Annual average percentage changes (AAPCs) of CRC burden were calculated using the Joinpoint regression model. The mortality in CRC attributable to potential risk factors was characterized by countries, gender, and age groups.ResultsIn 2019, there were 607,900 and 227,241 CRC cases, and 261,777 and 84,026 CRC deaths in China and the U.S., respectively. The age-standardized incidence rate (ASIR) was 30.55 per 100,000 in China and 41.86 per 100,000 in the U.S., and the age-standardized mortality rate (ASMR) was 13.86 per 100,000 in China and 14.77 per 100,000 in the U.S. CRC incidence, mortality, and DALY rate in the U.S. showed downward trends in the past three decades (AAPC=−0.47, −1.06, and −0.88, respectively), while upward trends were observed in China (AAPC=3.11, 1.05, and 0.91, respectively). Among the cause of CRC, the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S., respectively.ConclusionsFrom 1990 to 2019, the burden of CRC in China increased dramatically, particularly for males and middle-aged and elderly people. The management of the major risk factors associated with the high burden of CRC should be enhanced.     

8例外周性原始神经外胚层肿瘤的病理、CT、MRI表现并文献复习

背景与目的:外周性原始神经外胚层肿瘤(primitive neuroectodermal tumor,pPNET)罕见。本研究目的是分析外周性PNET的影像学及病理学表现,以提高对本病的认识。方法:回顾性分析有完整影像学资料及经病理证实的8例PNET。结果:1例病灶位于上颌窦,1例位于鼻旁,1例位于肩颈部,2例位于胸腔,2例位于纵隔,1例位于骶尾部臀大肌。本组病例均表现为软组织肿块,CT显示病灶范围大、边界不清,密度不均匀且伴坏死囊变,部分病灶内有沙砾样钙化,增强后呈不均匀强化。软组织肿块侵蚀临近骨质时表现为溶骨性骨质破坏。在MRI SE T1WI上表现为等或低信号,T2WI上表现为不均匀高信号,部分病例可见假包膜或分隔样改变。病理形态上Homer-Wright菊形团为其特异性表现,免疫组织化学结果,肿瘤均表达CD99,3例检测NSE和VIM者结果均呈阳性,5例检测CK者结果均呈阴性,并且不表达白细胞共同抗原(LCA)等。结论:pPNETs的病理及免疫组化可提供诊断依据。pPNETs的CT与MRI缺乏特征性表现,但能较好的显示肿瘤的内部结构、明确肿瘤的范围,有助于指导制定治疗方案和评价治疗效果。     

Usefulness of bone turnover markers as predictors of mortality risk,disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study

Background:

Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA).

Methods:

This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4 mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (β-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded.

Results:

Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with β-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression.

Conclusion:

In patients with PCa and bone metastases treated with ZA, β-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important.     

Imaging primary prostate cancer with 11C-Choline PET/CT: relation to tumour stage,Gleason score and biomarkers of biologic aggressiveness

Background

As a significant overlap of 11C-Choline standardized uptake value (SUV) between prostate cancer and benign prostate hyperplasia (BPH) tissue, controversy exists regarding the clinical value of 11C-Choline PET/CT scan in primary prostate cancer. In this study, the SUVmax of the prostate lesions and the pelvic muscles were measured and their ratios (SUVmax-P/M ratio) were calculated. Then we evaluated whether the tracer 11C-Choline uptake, quantified as SUVmax-P/M ratio, correlated with tumour stage, Gleason score, and expression levels of several biomarkers of aggressiveness.

Methods

Twenty-six patients with primary prostate cancer underwent 11C-Choline PET/CT. Tumour specimens from these patients were graded histopathologically, and immunnohistochemistry for Ki-67, CD31, androgen receptor (AR), Her-2/neu, Bcl-2, and PTEN were performed.

Results

Both SUVmax and SUVmax-P/M ratio showed no significant difference between patients with tumour stage II and III, but significantly elevated in patients with tumour stage IV. SUVmax-P/M ratio was also significantly higher in lesions with Gleason score of 4+3 or higher versus less than or equal to 3+4. SUVmax-P/M ratio was found significantly correlated with expression levels of Ki-67 and CD31. In addition, a higher SUVmax-P/M ratio was demonstrated in Her-2/neu positive subgroup than negative subgroup. At the same time, Gleason score and expression levels of these biomarkers showed no significant association with SUVmax.

Conclusions

Using the parameter SUVmax-P/M ratio, 11C-Choline PET/CT may be a valuable non-invasive imaging technology in the diagnosis of primary prostate cancer.