肝转移癌的CT检测与CT指导下的局部治疗

目的对肝转移癌的病理、供血状况、检测方法及局部治疗进行探讨．方法100例肝转移癌在团注动态增强CT图象上被分为两类：单发孤立组与多发病灶组．53例单发孤立转移癌采用局部治疗，包括肝动脉灌注，选择性化疗栓塞（混合碘油），术中直接局部注射及CT引导下无水酒精注射等．其余47例多发病灶组采用系统治疗．随访观察治疗前后1～3个可测量病灶的大小．结果局部治疗反应使96．3％的单发组病例病灶缩小达50％以上．结论局部治疗是治疗肝肿瘤的理想方法，无论在解剖生理还是临床疗效中均显示了极有潜力的治疗效果，尤其对于单发的肝转移癌，CT是敏感检测肝转移癌有效指导治疗的有力工具．     

超声引导射频消融联合缓释化疗粒子植入治疗肝转移癌

目的探讨超声引导射频消融联合缓释化疗粒子植入对肝转移癌的治疗效果及临床应用价值。方法58例肝转移癌患者（89个病灶）行超声引导下射频治疗,同时植入缓释化疗粒子。结果随访3～18个月,52例存活（89．7％）。肿瘤直径≤5cm的43个癌灶中,超声检查完全缓解、部分缓解、稳定分别为27、13、3个;肿瘤直径〉5cm的15个癌灶,完全缓解、部分缓解、稳定、恶化分别为3、6、4、2个。1个月后CT增强扫描显示87个病灶完全失去活性。结论超声引导射频消融联合缓释化疗粒子植入术是治疗肝转移癌安全、有效的新手段。     

CO2冷冻联合钳夹治疗婴幼儿淋巴结瘘型气管支气管结核的疗效和安全性研究

目的: 评估CO₂冷冻联合钳夹介入治疗对婴幼儿淋巴结瘘型气管支气管结核(tracheobronchial tuberculosis,TBTB)的疗效和安全性。方法: 回顾性分析2012年7月至2020年7月天津市儿童医院呼吸科接受纤维支气管镜介入治疗的7例淋巴结瘘型TBTB患儿的临床资料(包括年龄、性别、临床症状、诊断结果、CT特点、支气管镜下病灶特征),通过描述性总结分析介入治疗前后的咳嗽等级、CT及支气管镜下病灶改变。结果: 7例患儿中,男6例,女1例,年龄8个月至3岁,病程5~70d。所有患儿主要采用支气管镜下CO₂冷冻联合钳夹治疗,介入次数为1~3次。介入治疗3个月后,5例患儿咳嗽评分从2分降为0分,治疗显效,2例患儿咳嗽评分从3分降为1分,治疗有效;5例患儿复查CT显示:肺门、纵隔肿大钙化的淋巴结、支气管阻塞、肺气肿、肺不张等表现与介入治疗前比较明显改善和好转。5例患儿中,4例患儿肺部病灶吸收≥1/2,治疗显效,1例患儿肺部病灶吸收<1/2,治疗有效。7例患儿复查纤维支气管镜可见镜下瘘口基本闭合,支气管病变明显吸收好转,管腔狭窄或阻塞情况较前减轻,支气管黏膜相对光滑。7例患儿中,5例患儿支气管病变吸收≥2/3,治疗显效,2例患儿支气管病变吸收好转但<2/3,治疗有效。所有患儿术中均无呼吸困难及血氧饱和度的下降。所有患儿术后均未出现气胸、纵隔气肿、气道痉挛、管腔水肿、大出血等严重并发症。应用纤维支气管镜介入随访3~6个月,除1例患儿失访,6例患儿均未见病灶复发。结论: CO₂冷冻联合钳夹介入治疗婴幼儿淋巴结瘘型TBTB取得良好的治疗效果,未见气管支气管狭窄、软化、阻塞性肺炎、肺不张等合并症的发生,该治疗方式安全有效。     

动态增强CT与~(18)F-FDG PET-CT对肝脏占位病变诊断价值的比较研究

目的比较动态增强CT与18F-氟代脱氧葡萄糖(FDG)正电子发射断层显像(PET-CT)对肝脏占位病变诊断的价值。方法回顾性分析天津医科大学总医院2011年4月至2014年4月109例临床可疑肝脏占位病变患者的动态增强CT和18F-FDG PET-CT资料,以病理结果及临床随访结果作为诊断标准,评价两种检查方法对原发性肝癌和肝转移瘤的评估效能。结果动态增强CT和18F-FDG PET-CT评估原发性肝癌的效能分别为敏感度(85.0%对62.5%)、特异度(44.4%对55.6%)、准确性(77.6%对61.2%)、阳性预测值(40.0%对25%)、阴性预测值(87.2%对86.2%)。直径2 cm的肝转移瘤灶增强CT检出率为88.3%,PET-CT检出率为85.7%;1~2 cm的肝转移瘤灶增强CT检出率为76.8%,PET-CT检出率为88.4%。22例原发性肝癌患者行PET-CT检查后提高了临床再分期。结论动态增强CT对原发性肝癌探测的敏感度比18F-FDG PET-CT高,但是特异度低于PET-CT。两种检查方法对于2 cm肝转移瘤病灶敏感度相似,18F-FDG PET-CT对1~2 cm肝转移瘤病灶敏感度更高。18FDG-PET-CT有助于肝占位病变的鉴别诊断及临床准确分期。     

室间隔偏曲的婴儿法洛四联症外科根治术前的左心室大小评价方法

目的:本研究旨在对比64排CT和二维经超声心动图,对外科手术治疗室间隔偏曲的婴儿法洛四联症前的左心室评价的准确性。方法:2012年12月至2013年11月期间,接受法洛四联症根治手术的50例婴儿中的12例,(其中男婴7例,女婴5例,月龄6~12个月,体质量7~9.9kg),12例患儿术前均接受了标准的二维经胸超声心动图和64排CT检查,超声心动图均发现室间隔偏曲同时测量左心室舒张末期内径,64排CT定量左心室容积。所有的12例患儿均接受了法洛四联症的根治术,术后效果良好。结果:二维经胸超声心动图测量左心室舒张末期内径均明显低于同龄患儿的平均水平,64排CT用来定量左心室容积容积指数均30mL/m2。二维经胸超声心动图的测量较64排CT明显低估了左心室的发育情况。最后12例患儿均行根治术,未行分期手术,术后均没有低心排排出量综合征(低心排)的表现,12例患儿均没有死亡,恢复良好。结论:64排CT较二维经胸超声心动图能够更准确地评价室间隔偏曲的法洛四联症婴儿的左心室大小,以利外科手术的选择。     

三维CT血管成像在颅内动静脉畸形诊治中的价值

目的探讨三维CT脑血管成像（CTA）在颅内动静脉畸形（AVM）诊治中的价值。方法采用8排螺旋CT及静脉注射非离子型对比剂进行头部螺旋容积扫描,分析23例AVM的CT平扫、增强的影像表现,利用血管生成及图像融合技术对病变进行容积重建。依据CTA检查结果,对15例颅内AVM的患者进行手术病灶切除。通过手术所见,评价三维CTA对AVM的诊断和手术治疗的指导价值。结果行CTA检查发现23例25处AVM,手术切除AVM病灶15处。①手术中发现AVM的位置与三维CTA检查结果完全一致,符合率为100％。②三维CTA对供血动脉显示率为91．9％（34／37）,其中3例因供血动脉纤细、走行弯曲显示不清;引流静脉的显示率为77．8％,其中4例（6支）引流静脉因弯曲、血管团及供血动脉重叠,显示不清。18例引流静脉及所导入的静脉窦同时显影。③三维CTA检测15处畸形血管团平均累及范围为（13．75±0．48）cm^2;术中测量为（13．51±0．52）cm^2,CTA与手术结果比较,差异无统计学意义（P〉0．05）。结论多排螺旋CT血管成像技术可清晰完整地显示AVM的准确位置、畸形血管团、病灶范围、供血动脉、引流静脉全程及邻近组织的三维影像,能够提供手术所需的重要信息。     

320排容积CT对胡桃夹综合征的诊断和辐射剂量评价

目的探讨320排容积CT诊断胡桃夹综合征的应用价值。方法对8例胡桃夹综合症的患者行双肾动脉晚期320排容积扫描,检查床处于静止状态,球管旋转一圈,扫描范围为16cm。30例其它病变患者作为对照组行64排螺旋扫描。通过多重加权CT齐0量指数计算出剂量长度乘积（DIJP）值,有效辐射剂量通过DLP值及转换系数（0．015）获得,对CT容积扫描与64~CT的有效剂量进行对比。结果320排容积成像能清晰、直观显示左肾静脉（LRV）的形态及立体走形,8例患者的肠系膜上动脉（SMA）与腹主动脉（AA）之间的夹角平均22．60°±7．30°,且出现LRV不同程度受压,近端扩张;对照组30例,SMA与AA之间的夹角平均58．3°±26．20°。病变组单期扫描的有效剂量为2．6mSv,对照组的有效剂量为4．9mSv。结论320排容积CT明显的缩短了扫描时间,辐射剂量明显低于对照组,通过后处理清楚显示AA、LRV及脊柱三者空间结构及立体走向,与多排CT相比,对胡桃夹综合征的诊断具有明显的优势。     

消化道肿瘤CT动脉造影分析83例

目的:总结消化道肿瘤CT动脉造影情况,探讨CT动脉造影诊断消化系统疾病价值．方法:选CT等其它法已明确和未明确的消化道肿瘤性患者83例,采用Seldinger技术经股动脉插管,行CT动脉造影,肝脏肿瘤同时行CT门脉造影．分析影像所见并与超声、CT、MRI等比较,结合临床探讨CT动脉造影诊断消化道肿瘤价值．结果:CT等已明确诊断肝癌的42例患者中,35例新发现卫星灶或周边小灶．14例临床疑肝癌,CT、彩超无异常,通过CT动脉造影10例诊断早期肝癌,2例弥漫性肝癌,2例正常．10例结肠癌患者,CT等方法未见肝转移,CT动脉造影发现7例有早期肝转移．7例肝占位待查患者,6例符合肝癌,1例符合血管瘤．6例疑胆囊癌患者,4例确诊胆囊癌．2 例胰腺癌患者,CT动脉造影显示明显强化．2例胃癌患者可清楚显示病变范围、血运程度及与周围脏器关系．结论:CT动脉造影可发现超声、CT等其它法不能发现的卫星小灶或肝内其它小癌灶,对诊断早期肝癌特殊敏感,对显示肝内早期转移灶和定性诊断优于其它影像技术,CT动脉造影更能准确显示病灶血运情况、病变范围及与邻近脏器关系．     

腹腔镜联合射频消融和125I粒子治疗肝转移癌

目的探讨腹腔镜切除并联合应用射频消融和^125I粒子植入治疗肝转移癌的临床价值。方法对62例术前经CT或MR确诊肝脏有转移灶的患者，行腹腔镜下肝转移瘤切除或射频消融，最后将^125粒子植入肝脏肿瘤部位。结果术中超声发现新病灶17个，所有患者均顺利行腹腔镜切除或射频消融及^125粒子植入。2例术后出现肝脓肿，1例术后发生腹腔少量出血，余无严重并发症。^125个转移病灶位于肝脏右后内叶或巨大仅行腹腔镜下射频消融及^125粒子植入，22例患者的38个边缘转移病灶行离体切除。随访12～25个月（平均22．3个月），有12例转移癌未见液化，行腹腔镜下二次射频及^125粒子植入。1年生存率为74．2％（46／62），2年生存率为59．7％（37／62）。结论腹腔镜切除并联合应用射频消融和^125粒子植入治疗肝转移癌具有微创、安全、有效，术后恢复快等优点。     

~(125)I放射性粒子植入治疗肝转移癌的近期疗效

目的:分析应用125I放射性粒子植入近距离放疗治疗肝转移癌的近期疗效.方法:24例肝转移癌患者共32个病灶,因不宜或不同意外科手术切除而行粒子植入治疗,病灶直径4.5-12.8cm,平均7.8cm.术后复查随访统计有效率、局部控制率和生存率以及副反应等情况.结果:32个病灶中肿瘤完全缓解(CR)7个,部分缓解(PR)16个,无缓解(NR)5个,肿瘤进展(PD)4个;有效率CR+PR为71.9%.术后随访时间为7-22mo,平均16mo,局部控制率为65.6%,总生存率为70.1%,未发现严重并发症.结论:对于手术禁忌或不接受手术的肝转移癌患者,125I放射性粒子植入近距离放疗可以获得较好的近期疗效.     

Are we reproducible in measurement of NET liver metastasis?

Accurate measurement of well-differentiated neuroendocrine tumours (NET) liver metastases is critical to determine tumour slope and to assess treatment efficacy.Our objectives were to determine which CT or MRI sequence is the most reproducible to measure NET liver metastases and to assess the percentage of variability of measurements.Intra and inter-observer variability were studied on triphasic abdominal CT or liver MRI in 22 and 32 NET patients respectively. Patients were treatment-naïve or under somatostatin analogues. A maximum of 5 liver target lesions per patient was defined and three radiologists measured them on each sequence. Reproducibility were analysed by calculating the relative variation (RV) as defined by RECIST criteria.We analysed 1656 target measurements for CT and 3384 for MRI. Intra-observers RV were better than inter-observers. T2 for MRI and portal-phase for CT were associated with the lowest measurement variability. The MRI sequence offering the best intra and inter-observer reproducibility is the T2W-sequence. MRI allows more reproducible measurement than CT (inter-observer RV <20% in 96.8% for MRI and 81% for CT).Our study demonstrates intermediate to high imaging reproducibility of liver metastases measurements in NET patients. Non-enhanced MRI should be preferred to triphasic-CT for follow-up, assessment of treatment and trials.     

Progressive CT appearance of hepatic metastases from colorectal carcinoma

An 8-year retrospective review of 106 serial computed tomographic (CT) examinations performed on 32 patients with colorectal carcinoma metastatic to the liver was done to determine if the CT appearance of such metastases changed with a favorable response to chemotherapy or with progression of disease. Of these 32 patients, 15 underwent placement of an infusion pump for delivery of chemotherapy directly into the hepatic artery, 3 underwent partial hepatectomy, 1 underwent both procedures, and 13 underwent neither. Regression of hepatic metastases (7 patients), only seen following infusion pump placement, was associated with a decrease in size and an increase in margination of lesions. In two of these patients regression of metastases was seen in one area of the liver with subsequent progression or development of metastases in another region, presumably due to preferential delivery of chemotherapeutic agent. Progression of disease (23 patients) was associated with an increase in both size and number of lesions that became progressively less well marginated. Development of poorly marginated or infiltrative characteristics at the periphery of the lesion was associated with a poor prognosis. Thus, the CT characteristics of hepatic metastases from colorectal carcinoma differ with a favorable response to chemotherapy and with progression of disease.     

The clinical characteristics and the role of surgery and imatinib treatment in patients with liver metastases from c-Kit positive gastrointestinal stromal tumors (GIST)

The purpose of this study was to analyze the clinical features of the group of c-KIT positive GIST patients with liver metastases evaluated and treated in two referral institutions as well as to attempt to define the role of surgery in the management of GIST given the emergence to imatinib as an important part of treatment strategy in GIST patients. Between August 2001 and December 2002, 90 patients with c-KIT positive GIST were referred to our institutions. In 50 patients metastatic disease were disclosed. Of these, 35 patients (35/50; 70%) were rendered to have liver metastases and therefore offered imatinib or surgical therapy depend on CT assessment. The median follow-up of these 35 patients calculated from the time of first operation was 23 months (range 3-246 months). Male patients comprised the majority of patients (70%) with liver metastases. In 14 patients (40%) the metastases were confined only to the liver, in the others 21 patients (60%) the liver metastases were accompanied by intraperitoneal dissemination (17; 48.6%) or local recurrences (4; 11.4%). The period of time between the diagnosis of primary lesion and occurring liver metastases ranged from 0 to 164 months (median time of liver metastases presentation was 16 months for patients undergone primary curative surgery). The liver metastases were estimated as resectable in 3 cases (8.6%) and hepatic resection of all gross lesions was possible. Group of 32 patients with unresectable liver involvement was considered to treatment with imatinib. The median time of imatinib treatment for survivors is 7.5 months (range: 3.5-18.5 months). Twelve patients (37.5%) demonstrated partial response (PR) and 16 patients (50%) stable disease (SD) according to RECIST criteria. We did not observe any complete response (CR). At median follow-up 7 months, 32 of 35 patients (91.4%) were alive, 3 patients (8.6%)remained free of disease and 28 patients (87.5%) remained on imatinib treatment and have maintained disease although with partial response or stabilization only. Radical surgical resection remains the only possibility of cure for GIST patients because the complete response after imatinib therapy is restricted to a few patients only. However, despite the advanced metastatic disease, approximately 90% of patients are alive and continue imatinib treatment with median follow-up time more than 7 months. Surgery in combination with adjuvant imatinib treatment may result in improved survival with patients with advanced GIST.     

Short-term effectiveness of radiochemoembolization for selected hepatic metastases with a combination protocol

AIM:To introduce the combination method of radio-chemoembolization for the treatment of selected hepatic metastases. METHODS:Twenty patients with biopsy proven hepatic metastases were selected from those who underwent transarterial radiochemoembolization, a novel combination protocol, between January 2009 and July 2010. Patients had different sources of liver metastasis. The treatment included transarterial administration of three chemotherapeutic drugs (mitomycin, doxorubicin and cisplatin), followed by embolization with large (50-150 μm) radioisotope particles of chromic 32P. Multiphasiccomputer tomography or computer tomography studies, with and without contrast medium injections, were performed for all patients for a short-term period before and after the treatment sessions. The short-term effec-tiveness of this procedure was evaluated by modified response evaluation criteria in solid tumors (mRECIST), which also takes necrosis into account. The subjective percentage of necrosis was also assessed. The response evaluation methods were based on the changes in size, number, and the enhancement patterns of the lesions between the pre-and post-treatment imaging studies. RESULTS:Patients had liver metastasis from colorectal carcinomas, breast cancer, lung cancer and carcinoid tumors. The response rate based on the mRECIST criteria was 5% for complete response, 60% for partial response, 10% for stable disease, and 25% for progressive disease. Regarding the subjective necrosis percentage, 5% of patients had complete response, 50% had partial response, 25% had stable disease, and 20% had progressive disease. Based on traditional RECIST criteria, 3 patients (15%) had partial response, 13 patients (65%) had stable disease, and 4 patients (20%) had disease progression. In most patients, colorectal carcinoma was the source of metastasis (13 patients). Based on the mRECIST criteria, 8 out of these 13 patients had partial responses, while one remained stable, and 5 showed progressive disease. We also had 5 cases of breast cancer metastasis which mostly remained stable (4 cases), with only one partial response after the procedure. Six patients had bilobar involvement; three of them received two courses of radiochemoembolization. The follow up imaging study of these patients was performed after the second ses-sion. In the studied patients there was no evidence of extrahepatic occurrence, including pulmonary radioac-tive deposition, which was proven by Bremsstrahlung scintigraphy performed after the treatment sessions. For the short-term follow-ups for the 2 mo after the therapy, no treatment related death was reported. The mostly common side effect was post-embolizationsyndrome, presented as vomiting, abdominal pain, and fever. Nineteen (95%) patients experienced this syndrome in different severities. Two patient had ascites (with pleural effusion in one patient) not related to hepatic failure. Moreover, no cases of acute liver failure, hepatic infarction, hepatic abscess, biliary necrosis, tumor rupture, surgical cholecystitis, or non-targeted gut embolization were reported. Systemic toxicities such as alopecia, marrow suppression, renal toxicity, or cardiac failure did not occur in our study group. CONCLUSION:Radiochemoembolization is safe and effective for selected hepatic metastases in a short-term follow-up. Further studies are required to show the long-term effects and possible complications of this approach.     

Are recist criteria adequate in assessing the response to therapy in metastatic NEN?

Response to therapy criteria, known as RECIST (Response Evaluation Criteria in Solid Tumours), are widely used to evaluate neuroendocrine tumours (NET) metastatic to the liver, under treatment. RECIST criteria does not take in account many various distinct features such as tumour growth, secretory capacity and anatomical localisation with wide variation in clinical and biological presentation of different NETs. Key features of RECIST includes definitions of the minimal size of measurable lesions, instructions on how many lesions to measure and follow, and the use of unidimensional, rather than bidimensional, measures for overall evaluation of tumour burden. These measures are currently done with computed tomography (CT) or Magnetic Resonance Imaging (MRI). RECIST criteria are accurate in assessing tumour progression but sometimes inaccurate in assessing tumour response after locoregional therapy or under molecular targeted therapy, tumour vessels being part of the target of such treatments. There is poor correlation between a so called tumour necrosis and conventional methods of response assessment, which poses questions of how best to quantify efficacy of these targeted therapies. Variations in tumour density with computed tomography (CT) could theoretically be associated with tumour necrosis. This hypothesis has been studied proposing alternative CT criteria of response evaluation in metastatic digestive NET treated with targeted therapy. If preliminary results upon the poor relationship between density measured with CT (derived from CHOI criteria) evolution curves at CT and PFS are confirmed by further studies, showing that the correlation between density changing and response to non-targeted treatment is weak, the use of contrast injection, will probably be not mandatory to enable appropriate evaluation.

     

Volumetric and visual assessment of the mesial temporal structures in Alzheimer's disease

Background: Alzheimer's disease is the commonest cause of dementia. Clinical diagnosis of Alzheimer's disease may be difficult. Magnetic resonance imaging has a role to play in diagnosis.
Aim: To assess whether volumetric and/or visual assessment of the mesial temporal structures is useful in separating patients with Alzheimer's disease from age matched controls.
Methods: Twenty-four patients with Alzheimer's disease diagnosed by NINCDS/ADRDA criteria and 15 age matched controls were studied with magnetic resonance imaging (MRI) and volumetric techniques. Segmented volumes of the mesial temporal structures were assessed visually and volumetrically.
Results: Volumetric analysis demonstrated significant (p<.001) differences between the two groups, but showed overlap in individual cases. Discriminant function analysis predicted correct group membership (patient or control) in 85% of cases. Visual assessment alone demonstrated a sensitivity of 92% and a specificity of 93% in distinguishing the Alzheimer patients from controls.
Conclusion: Volumetric and visual assessment of the mesial temporal structures is useful in separating Alzheimer patients from controls. Overlap is present in individual cases. Visual assessment was as useful in separating the two groups as the volumetric analysis. (Aust NZ J Med 1994; 24: 547–553.)     

Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. A randomized trial

Objective: To compare the efficacy of direct hepatic arterial chemotherapy with systemic chemotherapy in patients with liver metastases from colorectal carcinoma. Design: Randomized trial with crossover allowed from systemic to intrahepatic therapy if tumor progression occurred on systemic therapy. Setting: Academic medical center, referral-based clinic. Patients: One hundred sixty-two patients with hepatic metastases from colorectal carcinoma agreed to be randomly assigned to treatment groups. At laparotomy, 63 were excluded from the study: 25 had hepatic resection; 33, extrahepatic disease; 1, infection; and 4, no tumor. Intervention: Fourteen-day continuous infusion of fluorodeoxyuridine each month using an infusaid pump (0.3 and 0.15 mg/kg body weight X d in the intrahepatic and systemic arms, respectively). Main Results: Intrahepatic therapy produced a significantly higher complete and partial response rate, 50%, compared with 20% for systemic therapy (p = 0.001). After tumor progression, 60% of the systemic patients crossed over to intrahepatic therapy; 25% then had a partial response, and 33% a minor response or stabilization of disease on intrahepatic therapy. Toxicity included ulcer disease (17%) and biliary sclerosis (8%) in patients receiving intrahepatic therapy and diarrhea (70%) in patients receiving systemic therapy. Extrahepatic disease occurred in 56% and 37% of the patients in the intrahepatic and systemic groups, respectively (p = 0.092). The median survivals were 17 and 12 months, for the intrahepatic and systemic groups, respectively. Conclusion: When compared with systemic therapy, hepatic arterial chemotherapy significantly increases response rate for hepatic metastases from colorectal carcinoma and appears to be a more effective treatment.     

Assessment of gastrointestinal stromal tumors with computed tomography following treatment with imatinib mesylate

AIM： To evaluate and characterize the patterns of disease progression of metastatic or unresectable gastrointestinal stromal tumor （GIST） treated with imatinib mesylate, and to determine the prognostic significance associated with disease progression. METHODS： Clinical data and computed tomography （CT） images were retrospectively reviewed in 17 GIST patients who were treated with imatinib mesylate from October 2002 to October 2006. Apart from using size measurement for evaluation of tumor response [Response Evaluation Criteria in Solid Tumors （RECIST） criteria], patterns of CT changes during treatment were evaluated and correlated with clinical data. RESULTS： There were eight non-responders and nine responders. Five patterns of CT change during treatment were found： focal progression （FP）, generalized progression （GP）, generalized cystic change （GC）, new cystic lesion （NC） and new solid lesion （NS）. At the end of study, all non-responders showed GP, whereas responders showed cystic change （GC and NC） and response according to RECIST criteria. Overall survival was significantly better in patients with cystic change or response within the RECIST criteria compared with GP patients （P = 0.0271）. CONCLUSION： Various patterns of CT change in patients with GIST who responded to imatinib mesylate were demonstrated, and might determine the prognosis of the disease. A combination of RECIST criteria and pattern of CT change are proposed for response evaluation in GIST.     

Liver metastases from esophageal carcinoma: is there a role for surgical resection?

Esophageal cancer recurrence rates after esophagectomy are high, and locally recurrent or distant metastatic disease has poor prognosis. Management is limited to palliative chemotherapy and symptomatic interventions. We report our experience of four patients who have undergone successful liver resection for metastases from esophageal cancer. All underwent esophagectomy and were referred to our unit with metastatic recurrent liver disease, two with solitary metastases and two with multi‐focal disease. The patients underwent multidisciplinary assessment and proceeded to a course of neoadjuvant chemotherapy followed by open or laparoscopic liver resection. Three patients were male, and the mean age was 57.5 (range 44–71) years. Response to chemotherapy ranged from partial to complete response. Following liver resection, two patients developed recurrent disease at 5 and 15 months, and both had disease‐specific mortality at 10 and 21 months, respectively. The other two patients remain disease free at 22 and 92 months. Recurrent metastatic esophageal cancer continues to have a poor prognosis, and the majority of patients with liver involvement will not be candidates for hepatic resection. However, this series suggests that in selected patients, liver resection of metastases from esophageal cancer combined with neoadjuvant and adjuvant chemotherapy is feasible, but further research is required to determine whether this can offer a survival advantage.