Contrast-enhanced ultrasonography in the follow-up of patients with hepatic metastases from breast carcinoma

PURPOSE: Oncological treatment planning relies on the evaluation of treatment response, which is defined by the change in size of measurable lesions. The purpose of this study was to evaluate the use of contrast-enhanced ultrasound (CEUS) to obtain a precise measurement of hepatic metastases in breast cancer patients with fatty-liver disease. MATERIALS AND METHODS: Twelve consecutive patients with 25 liver metastases from breast cancer and fatty liver disease, as defined by US criteria, were enrolled in this prospective study. All patients underwent conventional US, CEUS and multidetector computed tomography (MDCT), used as the gold standard for measuring the maximum diameter of lesions. Agreement between US, CEUS and MDCT measurements was analysed using Altman-Bland plots; 95% confidence limits were calculated for the difference among means. RESULTS: Mean diameter as measured by MDCT was 26.2 mm (range 11-83). US allowed measurement of 20/25 lesions. In 15 lesions, CEUS measurements were more accurate than those obtained by US. The difference among means was 1.1 mm with a 95% confidence interval (-9.2, 11.4) for US measurements and 0.6 mm with a 95% confidence interval (-2.0, 3.1) for CEUS. CONCLUSIONS: Our preliminary data show that CEUS can be used to obtain more accurate measurements than conventional US for the follow-up of patients with metastases in fatty liver.     

Radioembolization in patients with hepatic metastases from breast cancer

PURPOSE: To determine the safety of and survival outcomes associated with single-session, whole-liver radioembolization with Yttrium-90 (90Y)-labelled resin microspheres in patients with nonresectable liver metastases from breast cancer that were refractory to other treatments. MATERIALS AND METHODS: Thirty patients underwent radioembolization with 90Y-labeled resin microspheres infusion in a single-session, whole-liver treatment. All patients had undergone polychemotherapy regimens including at least anthracyclines and taxanes, hormonal therapy, and trastuzumab where applicable. Follow-up data were available for 23 patients. After treatment, the authors assessed tumor response with computed tomography and/or magnetic resonance imaging by using Response Evaluation Criteria in Solid Tumors (RECIST), laboratory and clinical toxicities, and survival. RESULTS: A mean activity of 1.9 GBq of 90Y was delivered. Follow-up at a median of 4.2 months demonstrated partial response, stable disease, and progressive disease in 61%, 35%, and 4% of patients, respectively. With respect to tumor diameters, imaging revealed a maximum and minimum response of -64.8% to +23.6%, respectively (mean, 29.2%; median, 39.7%). The median follow-up time was 14.2 months. The median overall survival was 11.7 months. The median survival of responders and nonresponders was 23.6 and 5.7 months, respectively, and the median survival of patients with and patients without extrahepatic disease was 9.6 and 16 months. Clinically significant toxicities with the appearance of increasing transaminase level, increasing bilirubin level, nausea and vomiting, gastric ulcers, and ascites occurred in eight of 30 patients. One patient's death was attributed to treatment-related hepatic toxicity. CONCLUSIONS: Single-session, whole-liver 90Y radioembolization can be performed with an acceptable toxicity profile in patients with liver metastases from breast cancer. Response to radioembolization in these patients is supported by the decrease in tumor size. Further investigation is warranted to prove survival benefit.     

Contrast-enhanced ultrasonography findings using a perflubutane-based contrast agent in patients with early hepatocellular carcinoma

Objective

We evaluated the contrast-enhanced ultrasonography (US) imaging features of early hepatocellular carcinomas (HCCs) and compared these findings with those obtained using contrast-enhanced computed tomography (CT).

Subjects and methods

Forty-three patients with 52 early HCCs with a mean maximal diameter of 15.6 mm were enrolled in this retrospective study. After confirming the location of the target lesion using fusion imaging combining conventional US and hepatobiliary phase of contrast-enhanced magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid, we evaluated findings of contrast-enhanced US using a perflubutane-based contrast agent. The contrast-enhanced US detection rates for hyper-vascularity in early HCCs were compared with those obtained for contrast-enhanced CT.

Results

Transient hypo-vascularity subsequent to iso-vascularity during arterial phase and iso-vascularity during portal and post-vascular phases were the predominant contrast-enhanced US findings seen for 25 (48.1%) of the 52 early HCCs. Nine (17.3%) showed iso-vascularity during all three phases, while 1 (1.9%) showed hypo-vascularity during all three phases. The remaining 17 (32.7%) showed partial or whole hyper-vascularity during arterial phase, iso-vascularity during portal phase, and iso- or hypo-vascularity during post-vascular phase. The detection rate for the hyper-vascularity of early HCCs using contrast-enhanced US (32.7%, 17/52) was significantly higher than that obtained using contrast-enhanced CT (21.2%, 11/52) (P < 0.05 by McNemar test).

Conclusion

Hypo-vascularity, iso-vascularity, and hyper-vascularity were observed during the arterial phase of contrast-enhanced US in 50.0%, 17.3%, and 32.7% of the early HCCs, respectively. Contrast-enhanced US was more sensitive than contrast-enhanced CT for the detection of hyper-vascularity in early HCCs. Of note, early HCCs might not exhibit the early arterial enhancement that is generally considered to be a typical finding for HCCs.     

Parotid metastases from carcinoma of the breast

Two patients are described in whom a parotid metastasis occurred 10 years after initial treatment for carcinoma of the breast. The parotid is a very unusual site of metastasis and in both patients it was only one detectable. Parotidectomy with post-operative radiotherapy is advocated in this situation not only to obtain local tumour control but to exclude a primary parotid tumour.     

MRI and PET/CT of patients with bone metastases from breast carcinoma

3.0Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45-85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.     

Osteoblastic metastases from breast carcinoma with false-negative bone scan

 The authors report a case of metastatic breast carcinoma that on investigation was shown to have a negative bone scan in spite of multiple densely sclerotic metastases on radiography and CT and a positive bone biopsy. The literature is reviewed with regard to the subject of negative bone scans in this situation.     

Diagnosis of colorectal hepatic metastases: Contrast-enhanced ultrasonography versus contrast-enhanced computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging with diffusion-weighted imaging

Purpose:

To create a reliable rat model with small renal cortical scars and evaluate the accuracy and sensitivity of dynamic contrast‐enhanced MRI in detecting the kinds of lesions that are associated with reflux nephropathy.

Materials and Methods:

In 16 rats, three unilateral renal cortical lesions were created using either electrocautery or pure alcohol with the contralateral kidney serving as control. MRI on a 1.5 Tesla GE Signa was performed 10–14 days after surgery. After bolus injection of 0.2 mM/Kg Gd‐DTPA, sequential MRI acquisitions were performed using a 4‐inch quadrature birdcage coil. Renal and scar volumes and pathology were compared after scanning and killing.

Results:

Of the 48 points of injury, 40 (83%) in the 16 rats were detected grossly. Under microscopy, 36 injuries (75%) were detected on mid‐kidney cross‐sections. The average lesion was 4.2 mm³ corresponding to 0.5% of the kidney volume. Using pathological findings as the gold standard, the sensitivity and specificity of scar detection using MRI was 69% and 93%, respectively.

Conclusion:

A rat model was created to demonstrate the sensitivity of dynamic contrast‐enhanced MRI for detecting renal scars. Alcohol and electrocautery created reliable renal scars that were confirmed pathologically. MRI detected these lesions that averaged 4.2 mm³ (0.5% total renal volume) with sensitivity and specificity of 69% and 93%, respectively. J. Magn. Reson. Imaging 2010;31:1132–1136. © 2010 Wiley‐Liss, Inc.     

Localization of 99mTc-HMDP in hepatic metastases from colonic carcinoma

To evaluate the significance and frequency of skeletal imaging agent localization in hepatic metastases from colonic carcinoma, scintigrams from 54 patients were retrospectively studied. Of 54 patients, 22 had hepatic metastases, and skeletal metastases were present in seven of 54. Six of the seven patients with skeletal metastases had concurrent hepatic deposits. Two patterns of bone agent localization in liver metastases occurred: diffuse and mild (10 patients) and ringlike in appearance (two patients). Twelve of the 22 patients had localization of skeletal imaging agent in hepatic metastases and extensive or large liver lesions. Concurrent serum calcium values for nine of 12 patients were reviewed; none had a high level of serum calcium. Among available plain films and /or CT scans of the abdomen for 21 of the 22 patients, only one patient with extensive colonic metastases had multiple calcifications shown on CT but not seen in plain films. The data indicate a high frequency of hepatic metastases in colon carcinoma (22/54, 40%) and a high frequency of skeletal imaging agent localization in the hepatic colonic metastases (12/22, 54.5%). Once skeletal metastases are observed, there are almost always hepatic metastases present (6/7). There was no relation between elevated serum calcium values and bone agent localization in hepatic deposits. The relation between skeletal imaging agent localization or radiographic calcifications and histopathology of colonic carcinoma was inconclusive. The presence of bone agent localization in a 99mTc hydroxymethylene diphosphonate (HMDP) bone study indicates colonic hepatic metastases that are substantially widespread and/or bulky.     

Prognostic importance of superior diaphragmatic adenopathy at computed tomography in patients with resectable hepatic metastases from colorectal carcinoma

PURPOSE: To determine the prognostic importance of superior diaphragmatic adenopathy at CT in patients with resectable hepatic metastases from colorectal carcinoma. MATERIALS AND METHODS: We retrospectively identified 85 patients who underwent contrast-enhanced abdominal computed tomography (CT) at our institution before surgical resection of hepatic metastases from colorectal carcinoma. The study group consisted of 45 men and 40 women with a mean age of 60 years (range, 27-89 years). The presence, size, and number of superior diaphragmatic nodes were recorded on preoperative CT images. Kaplan-Meier analysis was used to investigate the association between the presence, number, and size of superior diaphragmatic nodes and postoperative outcome. RESULTS: One or more superior diaphragmatic nodes were seen on preoperative CT in 43 (51%) of 85 patients, and 29 (34%) patients had nodes of 5 mm or more in short-axis diameter. After a median follow-up of 599 days (range, 3-1960 days), 49 patients were alive, and 36 were dead. Kaplan-Meier analysis showed no association between the presence (P = 0.67), size (P = 0.74), or number (P = 0.95) of superior diaphragmatic nodes and patient outcome. CONCLUSIONS: The presence, size, or number of superior diaphragmatic nodes at preoperative CT are unrelated to postoperative outcome in patients with resectable hepatic metastases from colorectal carcinoma, suggesting that superior diaphragmatic adenopathy in this setting may be reactive rather than metastatic.     

超声造影对氩氦刀治疗肝癌近期临床疗效的评价

目的 了解超声造影对氩氦刀治疗肝癌近期临床疗效评价的应用价值.方法 选取23例共26个肝癌病灶为观察对象.采用第二代新型对比剂SonoVue以及CPS(Contrast Pluse Sequencing)造影软件.全部病灶氩氦刀治疗后1周至3个月采用超声造影,评价治疗效果,并与常规超声和增强CT或MRI检查结果进行比较.结果 氩氦刀治疗后超声造影显示20个治疗区各期均无异常增强,判断肿瘤完全灭活;5个病灶局部有早期增强,提示有肿瘤残存;1枚可疑残存肿瘤.超声造影显示11枚新生病灶,较常规超声增加8枚,其中肿瘤直径≤1 cm的微小病灶6枚.1例微小复发灶超声造影未能显示,以最终诊断为金标准.超声造影诊断准确率为96.1%,与增强CT或MRI检查结果相同.结论 超声造影可较准确地判断氩氦刀治疗后肿瘤灭活程度,是评价氩氦刀疗效的一种有效方法,并有助于发现微小新病灶.     

Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

Objectives

Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.

Methods

During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar’s test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities.

Results

Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0 % (+3.1 %), specificity to 87.7 % (+45.7 %), PPV to 76.2 % (+36.5 %) and NPV to 100.0 % (+2.9 %) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p?<?0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p?<?0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed.

Conclusion

CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening.

Key Points

? CESM is feasible in the workflow of referrals from routine breast screening. ? CESM is superior to mammography, even in low disease prevalence populations. ? CESM has an extremely high negative predictive value for breast cancer. ? CESM is comparable to MRI in assessment of breast cancer extent. ? CESM is comparable to histopathology in assessment of breast cancer extent.     

Prognostic factors in patients with brain metastases from lung carcinoma

Between September 1980 to December 1983, 70 consecutive patients were entered into two randomly allocated trials in order to investigate the effectiveness of different time-dose radiotherapy schemes (i.e., 30 Gy/ten fractions/two weeks versus 50 Gy/20 fractions/four weeks) and the prognostic factors on the palliation for patients with brain metastases from lung carcinoma. The most important factors for predicting poor prognosis in this series, which were shown by stepwise proportional hazard (Cox) model, were lactate dehydrogenase (LDH) and general performance status. In normal LDH group, the most important factors for predicting poor prognosis were multiplicity of brain metastases (p less than 0.001), treatment methods (p less than 0.0005) and age (p less than 0.0053). In high LDH group any items were not shown for meeting of the 0.05 significant level.     

Bilateral ovarian metastases from breast carcinoma on FDG PET-CT

We report the PET-CT appearance of bilateral ovarian metastases in a 51-year-old woman with a history of right breast carcinoma with osseous metastasis diagnosed 14 years earlier. The colon and stomach are the most common primary tumor sites in ovarian metastasis, followed by the breast, lung, and contralateral ovary. It is important to consider this form of neoplasm in the differential diagnosis because the treatment and prognosis will be different from a dyssynchronous primary tumor.     

F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging

AIM: To evaluate the role of F-18-fluorodeoxyglucose positron-emission tomography (F-18 FDG PET) in the follow-up of breast carcinoma in case of clinical suspicion of local recurrence or distant metastases and/or tumor marker increase in correlation to conventional imaging. MATERIAL AND METHODS: Retrospective analysis of the results of F-18 FDG PET (ECAT ART(R), Siemens CTI MS) of 62 patients (age 58.5 +/- 12.8) with surgically resected breast carcinoma (time interval after surgery, 86 +/- 82 months, mean follow-up 24 +/- 12.6 months). Patient- and lesion-based comparison with conventional imaging (CI) including mammography (MG), ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI), radiography (XR) and bone scintigraphy (BS). Furthermore, we evaluated the influence on tumor stage and therapeutic strategy. A visual qualitative evaluation of lesions was performed. RESULTS: On a patient base, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting local recurrence or distant metastases were calculated to be 97%, 82%, 87%, 96% and 90% compared with 84%, 60%, 73%, 75% and 74% with CI. On a lesion base, significantly more lymph node (84 vs. 23, P < 0.05) and fewer bone metastases (61 vs. 97, P < 0.05) could be detected by using F-18 FDG PET compared with CI. Sclerotic bone lesions were predominantly detected by BS. On the other hand, there were several patients with more FDG positive bone lesions and also mixed FDG positive/Tc-99m methylenediphosphonate (MDP) negative and FDG negative/Tc-99m MDP positive metastases. In case of normal tumor markers, sensitivity, specificity, PPV, NPV and accuracy for detecting local recurrence or distant metastases were calculated to be 100%, 85.0%, 78.6%, 100% and 90.3% for FDG PET and 80%, 50%, 50%, 80% and 61.5% for CI. An upstaging could be observed in 9.7% (6/62) and downstaging in 12.9% (8/62), leading to a change in therapeutic regimen in 13 patients (21%). CONCLUSIONS: F-18 FDG PET demonstrates apparent advantages in the diagnosis of metastases in patients with breast carcinoma, compared with conventional imaging on a patient base. On a lesion base, significantly more lymph node and less bone metastases can be detected by using F-18 FDG PET compared with conventional imaging, including bone scintigraphy. In patients with clinical suspicion but negative tumor marker profile, too, F-18 FDG PET seems to be a reliable imaging tool for detection of tumor recurrence or metastases. Considering the high predictive value of F-18 FDG PET, tumor stage and therapeutic strategy will be reconsidered in several patients.     

Radiotherapy of choroid metastases in breast carcinoma

From 1975 to 1984, thirteen patients were submitted to radiotherapy for choroid metastases of mammary carcinoma. Bilateral manifestation was found in three cases, thus sixteen eyes have been treated. All irradiations were performed with high voltage equipment. The posterior section of the eye was irradiated with 25 to 50 Gy over 2.5 to 5 weeks. Complete regression was achieved in nine out of sixteen cases, five patients showed an improvement of at least 50%, no considerable effect was found in two cases. The survival is 4 to 48 months (median survival 20 months) from the beginning of radiotherapy. Radiotherapy is a quick, efficient, and sparing treatment in choroid metastases. If applied in due time, it can prevent a visual disorder or amaurosis, thus improving the patients' quality of life.     

肝动脉热化疗及热碘油栓塞治疗结肠直肠癌肝转移

目的评价肝动脉热化疗及热碘油栓塞治疗结肠直肠癌肝转移瘤的效果。方法68例结肠直肠癌肝转移瘤患者分为2组,采用肝动脉热化疗及热碘油栓塞治疗的34例作为热疗组,采用常温动脉化疗及碘油栓塞治疗的34例作为常规组。结果热疗组有效率为65％（22／34）,常规组有效率为32％（11／34）,两组间差异有统计学意义。两组术后肝功能变化差异无统计学意义。6、12、18和24个月生存率热疗组分别为100％、82％、44％和18％,常规组分别为91％、47％、15％和6％。结论肝动脉热化疗及热碘油栓塞治疗结肠直肠癌肝转移是一种有效的方法,而对肝功能无明显的损害。