A case of the large retroperitoneal solitary fibrous tumor

A rare autopsy case of the extremely large retroperitoneal solitary fibrous tumor is reported. A 52-year-old female with a huge abdominal distention was found dead at home. She showed remarkable emaciation. The autopsy revealed a huge retroperitoneal tumor weighing 11.9 kg (36 × 30 × 20 cm in size), which occupied the entire intraperitoneal cavity. Histologically, the tumor consisted of spindle parenchymal cells with fibrous tissues. Immunohistochemically, CD34 was positively stained, whereas S-100, smooth muscle actin, and factor VIII were negative. Her cause of death was diagnosed as emaciation due to the compression of the entire intestine by the tumor. This is a rare case of the extremely large retroperitoneal solitary fibrous tumor, which caused the occasional intestinal obstruction. This disease should be considered in the differential diagnosis of retroperitoneal large tumors that cause accidental deaths in forensic autopsies.     

An autopsy case of spontaneous esophageal perforation (Boerhaave syndrome)

A 45-year-old male, an alcohol addict with asthma, was found dead in his home, after several days of continued drinking. A forensic autopsy was performed 3 days after the discovery of his death in order to specify the cause of death.A longitudinal perforation penetrating all layers of the esophagus measuring 1.8 cm was present on the left wall approximately 2.0 cm from the gastroesophageal junction. There were 1900 mL of greenish to brownish turbid liquid in the left pleural cavity and 150 mL of greenish viscous liquid in the stomach. Histopathologically, an infiltration of numerous neutrophils was evident in the submucosa layer, proper muscular layer, and serous membrane of the esophagus, corresponding to the esophageal laceration. The serum C-reactive protein (CRP) concentration was determined to be 3.1 mg/dL. The alcohol concentrations were determined to be 1.49 mg/g in the right cardiac blood, 1.31 mg/g in the left cardiac blood, and 2.48 mg/g in urine.Based upon the autopsy and histopathological findings, as well as the biochemical and toxicological analyses, we concluded that the cause of death was respiratory failure by pleural effusion, resulting from spontaneous esophageal perforation. This was the first report of a spontaneous esophageal perforation eventually causing respiratory failure.     

CT and MRI findings of type I and type II epithelial ovarian cancer

ObjectiveTo assess whether types I and II epithelial ovarian cancer (EOC) differ in CT and MRI imaging features.MethodsFor this retrospective study, we enrolled 65 patients with 68 ovarian lesions that have been pathologically proven to be EOC. Of these patients, 38 cases underwent MR examinations only, 15 cases underwent CT examinations only, and 12 cases completed both examinations. The clinical information [age, CA-125, menopausal status, and Ki-67] and imaging findings were compared between two types of EOCs. The diagnostic performance of image findings were assessed by receiver-operating characteristic curve(ROC) analysis. The association between EOC type and imaging features was assessed by multivariate logistic regression analysis. The random forest approach was used to build a classifier in differential diagnosis between two types of EOCs.ResultsOf the 68 EOC lesions, 24 lesions were categorized as types I and other 44 lesions as type II based on the immunohistochemical results, respectively. Patients in type I EOCs were more likely to involve menopausal women and showed lower CA-125 and Ki-67 values (Ki–67 < 30%) than patients in type II EOCs. The imaging characteristics of type II EOCs frequently demonstrated a solid or predominantly solid mass (38.6% vs. 12.5%, P < 0.05), smaller lesions (diameter <6 cm; 27.3% vs. 4.2%, P < 0.05), absence of mural nodules (65.9% vs. 25.9%, P = 0.001), and mild enhancement (84.1% vs. 54.2%, P < 0.05) compared to type I EOCs. Combination of tumor size, morphology, mural nodule, enhancement degrees (AUC = 0.808) has a higher specificity (87.50%) and positive predictive value (90.0%) than any single image finding alone in differential diagnosis between two types of EOCs. The multivariate logistic regression analysis showed that enhancement degrees(OR 0.200, P < 0.05),mural nodule(OR 0.158, P < 0.05) significantly influence EOC classification. Random forests model identified both as the most important discriminating variables. The diagnostic accuracy of the classifier was 73.53%.ConclusionsDifferences in imaging characteristics existed between two types of EOCs. Combination of several image findings improved the preoperative diagnostic performance, which is helpful for the clinical treatment and prognosis evaluation.     

Undiagnosed late-onset chylothorax accompanied by fatal acute pulmonary thromboembolism after surgical treatment of lung cancer: An autopsy case and review of the literature

Late-onset chylothorax is a relatively rare and essentially benign postoperative complication. We describe an autopsy case of undiagnosed hemi-chylothorax accompanied by fatal acute pulmonary thromboembolism after pulmonary resection and lymph node dissection for lung cancer, reviewing the literature. The patient was a 60-year-old woman. She complained of dyspnea on the 20th postoperative day, which gradually increased. The patient suddenly died 2 days later. Autopsy demonstrated right chylothorax (1000 ml), and fatal acute pulmonary thromboembolism, mainly on the left side, originating from the lower extremities. Postoperative chylothorax, causing respiratory and pulmonary circulatory disturbance, may provide an important predisposition to ward fatality due to pulmonary thromboembolism even among those showing a milder type; thus careful management is necessary.     

A retrospective clinicopathological study of lung adenocarcinoma: Total tumor size can predict subtypes and lymph node involvement

PurposeTo analyze the predictive ability of total tumor size in lung adenocarcinoma subtype and lymph node involvement.Materials and methods1018 patients, ≤ 3 cm tumor, were enrolled. The maximum diameter and other variables of each tumor were measured.ResultsThe optimal cut-off value for total tumor size in differentiating AIS and MIA from IAC was < 1.15 cm, in distinguishing lymph node involvement, it was 1.65 cm.ConclusionsTotal tumor size could be a reliable predictor of lung adenocarcinoma subtype and lymph node involvement irrespective of ground glass, part solid and solid characteristics.     

A sudden infant death associated with atrial septal aneurysm and abnormality of the connecting site between the inferior vena cava and right atrium

An atrial septal aneurysm (ASA) is a rare cardiac anomaly characterized by varicose bulging of the atrial septum (oval fossa) into the left or right atrium. Pathogenesis and clinical significance of ASA are controversial. We report an autopsy case of a huge undiagnosed ASA with abnormality of the connecting site between the inferior vena cava and the right atrial ostium in a 2-month-old Japanese female who died suddenly and unexpectedly. She was born at 36 weeks 4 days (body weight 3,110 g). No abnormality was detected during pregnancy or delivery. The postnatal growth was normal with no cardiac problem detected at the 1-month checkup. The ASA bulged off in a mass to the left atrium (width, 0.8 cm; excursion ratio, 53%), reaching close to the inflow site of the right pulmonary vein, with dilation of the pulmonary vein. The connecting site between the inferior vena cava and the right atrium was atypically located 1.6 cm away from the atrioventricular groove. Although most cases of ASA in an infant resolve physiologically as the infant grows, the infant in the present case is thought to have had an exceptional pathological ASA, possibly causing supraventricular arrhythmia. The abnormality of the connecting site between the inferior vena cava and the right atrium might have affected the development and continuation of the ASA.     

An autopsy case of suction injury

The right upper extremity of a 38-year-old man was entrapped in an underwater intake of a water duct of a dam reservoir, and he died despite being promptly rescued. His right upper extremity was swollen and exhibited purplish-red discolourations. The skin had numerous blisters and increased tension. Severe subcutaneous and muscle bleeding were observed in the right upper extremity. The circumference and volume of the right upper extremity were approximately 1.2 and 1.4 times, respectively, that the circumference and volume of the left upper extremity. The increase in weight of the right extremity was calculated to be approximately 2.1 kg; this finding indicates a severe decrease in the victim’s central blood volume. Furthermore, it is possible that much more than 2.1 kg of blood accumulated in the upper extremity upon exposure to vacuum pressure. We conclude that the victim died of circulatory collapse that was attributable to haemorrhage and re-distribution of blood as a result of vacuum pressure on the right upper extremity. Thus, we have examined the cause of death and the effects of vacuum pressure on the human body.     

Diagnostic approach to drug-screening tests for fatal diabetic ketoacidosis: Forensic autopsy of a methamphetamine abuser

To diagnose the cause of death in autopsy cases, systematic examinations, such as macroscopic, pathological, biochemical, and toxicological are important. In this case report, drug examinations also gave very useful information to diagnose the cause of death, fatal diabetic ketoacidosis (DKA). A female methamphetamine abuser in her forties was found dead lying on a hotel bed. Diagnosing her cause of death was difficult only from the macroscopic findings because there was no fatal and/or serious injury or disease. On toxicological examination, acetone was detected at a high concentration (682 μg/mL in blood, 887 μg/mL in urine) using gas chromatography (GC). Using gas chromatography–mass spectrometry (GC–MS), methamphetamine was detected in the blood, urine, hair, and visceral organs; however, these concentrations were low. At the same time, GC–MS examination revealed a high glucose peak. From the results of the biochemical examination of urine, acetoacetic acid was 1940 μmol/L, β-hydroxybutyric acid was 14,720 μmol/L, and glucose was 4620 mg/dL. Histologically, Langerhans’ islets in the pancreas were fibrotic and atrophic, and no insulin-immunoreactive cells were observed. The subsequent police investigation also revealed that she had contracted diabetes mellitus type 1; therefore, we concluded that her cause of death was DKA, due to a lack of insulin injection.     

An autopsy case of cardiac tamponade caused by a ruptured ventricular aneurysm associated with acute myocarditis

We report an autopsy case of hemopericardium caused by rupture of a ventricular aneurysm associated with acute myocarditis in an infant boy aged 2 years and 10 months. Three days before his death, the patient developed fever. On the day of death, he described an urge to defecate and attempted to do so in an upright position. While straining to defecate without success for a prolonged period, he stopped breathing and collapsed. On autopsy, his heart weighed 91.7 g and cardiac tamponade was evident, the pericardial cavity being filled with 140 mL of blood that had come from a 1.5-cm-long rupture in a 2.7 × 1.5 cm ventricular aneurysm in the posterior left ventricular wall. Patchy grayish-white discoloration was noted in the myocardium. Histologically, CD3-positive T lymphocytic infiltration accompanied by pronounced macrophage infiltration was observed in the myocardium. Hemorrhagic necrosis was detected in the area of the ventricular aneurysm. Staining for matrix metalloproteinase (MMP) expression revealed abundant MMP-2, MMP-7, and MMP-9. Polymerase chain reaction to detect viruses failed to identify any specific causative viruses in the myocardium. In this case of lymphocytic (viral) and histiocytic myocarditis with pronounced macrophage infiltration and upregulation of MMP expression, myocardial remodeling and associated wall weakening had resulted in formation and rupture of an aneurysm.     

Energy efficiency and pulmonary artery flow after balloon pulmonary angioplasty for inoperable,chronic thromboembolic pulmonary hypertension: Analysis by phase-contrast MRI

PurposeThe aims of this study were to propose a new quantitative method for pulmonary artery (PA) flow energetics using phase-contrast magnetic resonance imaging (PC-MRI), and to investigate how balloon pulmonary angioplasty (BPA) impacts energetics in chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methodsPC-MRI at 3-Teslar and with a flow sensitive gradient echo was used to examine energetics prior to and following BPA for 24 CTEPH patients. Stroke volume (m; ml) and mean velocity (V; mm/s) for the main pulmonary artery (PA), right PA, and left PA were calculated from a time-flow curve derived from PC-MRI. Based on the Bernoulli principle, PA energy was identified as 1/2 mV² (μj/kg), and energy loss was defined as the following equation “energy loss = main PA energy − (rt. PA energy + lt. PA energy)”.ResultsRight PA energy was significantly greater post-BPA than pre-BPA (61 ± 55 vs. 32 ± 40 μj/kg). There was no difference in main PA and left PA energies. Energy loss was significantly decreased post-BPA (18 ± 97 μj/kg) than pre-BPA (79 ± 125 μj/kg). An optimal cutoff of left PA energy of 45 μj/kg pre-BPA can be used to predict patients with mPAP ≥ 30 mmHg after BPA, with an area under the curve of 0.91, 78% sensitivity, and 92% specificity.ConclusionAnalysis of PA energetics using phase-contrast MRI demonstrates that BPA improves energy loss in CTEPH. In addition, BPA responses can be predicted by PA energy status pre-treatment.     

Transitioning from daytime to nighttime operations in military training has a temporary negative impact on dynamic balance and jump performance in U.S. Army Rangers

ObjectivesExplore the impact transitioning from daytime to nighttime operations has on performance in U.S. Army Rangers.MethodsFifty-four male Rangers (age 26.1 ± 4.0 years) completed the Y-Balance Test (YBT), a vertical jump assessment, and a grip strength test at three time points. Baseline testing occurred while the Rangers were on daytime operations; post-test occurred after the first night into the nighttime operation training (after full night of sleep loss), and follow-up testing occurred six days later (end of nighttime training).ResultsOn the YBT, performance was significantly worse at post-test compared to baseline during right posteromedial reach (104.1 ± 7.2 cm vs 106.5 ± 6.7 cm, p = .014), left posteromedial reach (105.4 ± 7.5 cm vs 108.5 ± 6.6 cm, p = .003), right composite score (274.8 ± 19.3 cm vs 279.7 ± 18.1 cm, p = .043), left composite score (277.9 ± 18.1 cm vs 283.3 ± 16.7 cm, p = .016), and leg asymmetry was significantly worse in the posterolateral direction (4.8 ± 4.0 cm vs 3.7 ± 3.1 cm, p = .030) and the anterior direction (5.0 ± 4.0 cm vs 3.6 ± 2.6 cm, p = .040). The average vertical jump height was significantly lower at post-test compared to baseline (20.6 ± 3.4 in vs 21.8 ± 3.0 in, p = .004). Baseline performance on YBT and vertical jump did not differ from follow-up.ConclusionsArmy Rangers experienced an immediate, but temporary, drop in dynamic balance and vertical jump performance when transitioning from daytime to nighttime operations. When feasible, Rangers should consider adjusting their sleep cycles prior to anticipating nighttime operations in order to maintain their performance levels. Investigating strategies that may limit impairments during this transition is warranted.     

Reliability of a portable fixed frame dynamometry system used to test lower limb strength in elite Australian Football League players

ObjectivesDeficits in strength of lower limb musculature have been associated with increased injury risk in a variety of athletic populations. As medical and performance staff seek to better understand the association between hip and knee strength measures and injury risk, measurement tools with high reliability and utility are required to profile and manage athletes effectively. The purpose of this study was to investigate the test-retest reliability of a portable fixed frame dynamometry system used to assess hip and knee strength of an elite Australian Football League team.DesignCase series.MethodsMaximum voluntary isometric strength of the hip abductors, hip adductors and knee flexors of 41 elite male Australian Football League footballers (mean age = 23.7 ± 4.1 years, height = 189.2 ± 7.0 cm, weight = 88.6 ± 8.4 kg) were tested during preseason training. Tests were performed one week apart on the same training day of a standard preseason week.ResultsTest-retest reliability was very high for left hip adduction (ICC 0.958), right hip adduction (ICC 0.955), left hip abduction (ICC 0.957), right hip abduction (ICC 0.945), left knee flexion (ICC 0.927) and right knee flexion (ICC 0.923). Furthermore, standard errors of measurement in per cent (SEM%) ranged from 3.21 to 5.03%, and minimal detectable change (MDC) from 3.93 to 6.65 kg for the different hip and thigh strength measures, making it possible to determine small changes in strength at the individual level.ConclusionsThis study demonstrated very high reliability when testing maximal voluntary isometric hip and knee strength using a portable fixed dynamometry system (KangaTech) in an elite male Australian Football League setting.     

Diversity of RGD radiotracers in monitoring antiangiogenesis of flavopiridol and paclitaxel in ovarian cancer xenograft-bearing mice

IntroductionAlthough encouraging results had been shown in antiangiogenesis therapy monitoring, the underlying mechanism of RGD radiotracer accumulation needs to be further illustrated. This study was aimed to investigate the diversity of RGD radiotracers in monitoring antiangiogenic agent's effects and the underlying mechanism in ovarian cancer-bearing mice with a new agent flavopiridol compared with paclitaxel.MethodsOvarian cancer SKOV-3 xenograft-bearing mice were established and divided into three groups, flavopiridol, paclitaxel and control. Flavopiridol (5 mg/kg body weight) and paclitaxel (20 mg/kg body weight) were administered every 3 days for 16 days. Tumor growth and proliferation were monitored by caliper measurements and immunofluorescence staining. Antiangiogenic effects were determined by tumor microvessel density (MVD) in vivo and by endothelial cell tube formation assay in vitro, respectively. ^99mTc-3P-RGD₂ was prepared, and its biodistribution studies were carried out. The effect of antiangiogenesis therapy on integrin αvβ3 expression was studied by immunohistochemical staining and flow cytometry.ResultsBoth paclitaxel and flavopiridol therapy could apparently inhibit tumor growth and proliferation, and antiangiogenic effects of therapy were validated in vivo and in vitro. However, compared with the control group, ID%/g tumor uptake of ^99mTc-3P-RGD₂ showed a significant decrease at 2 hours (by 39.96% ± 8.23%, P = 0.044) and at 4 hours (by 35.76% ± 11.42%, P = 0.024) post injection in the paclitaxel-treated group, but a slight increase of tumor uptake in the flavopiridol-treated group at 2 hours (by 4.42% ± 0.24%, p = 0.898) and at 4 hours (by 12.2% ± 1.84%, P = 0.702). The further studies indicated flavopiridol therapy has a dual-effect, reducing integrin αvβ3 expression on endothelial cells due to the reduction of tumor MVD and up-regulating the integrin αvβ3 expression on tumor cells.ConclusionsThere is diversity in evaluating antiangiogenic response when using ^99mTc-3P-RGD₂, which may be an important reminder in future clinical applications of RGD radiotracers as a strategy for antiangiogenesis therapy response monitoring.     

Unexpected death of a patient with rheumatoid arthritis complicated by a cervical deformity

An elderly female with a 43-year history of rheumatoid arthritis died 2 weeks after the onset of chest discomfort, electrolyte disturbance, and interstitial pneumonia. She had frequent premature ventricular contractions, fluctuating heart rate, and hypotension. Ischemic heart disease and interstitial pneumonia were excluded as the cause of death based on clinical course and autopsy findings. A severe cervical deformity with myelopathy likely contributed to circulatory instability, possibly through injury to the intra-spinal sympathetic nervous system, which can induce cardiovascular instability and suppress respiratory function. This likely led to death.     

Dorsiflexion deficit during jogging with chronic ankle instability

The purpose of the study was to determine whether individuals with chronic ankle instability (CAI) demonstrate altered dorsiflexion/plantar flexion range of motion (ROM) compared to controls during jogging. The case control study took place in a university motion analysis laboratory. Fourteen volunteers participated in the study, seven suffered from CAI (age 25 ± 4.2 years, height 173 ± 9.4 cm, mass 71 ± 8.1 kg) and seven were healthy, matched controls (age 25 ± 4.5 years, height 168 ± 5.9 cm, mass 67 ± 9.8 kg). All subjects jogged on an instrumented treadmill while a ten-camera motion analysis system collected three-dimensional kinematics of the lower extremities. The main outcome measure was sagittal plane (dorsiflexion/plantar flexion) range of motion of the ankle throughout the gait cycle. CAI subjects had significantly less dorsiflexion compared to the control group from 9% to 25% during jogging (4.83 ± 0.55°). CAI subjects demonstrated limited ankle dorsiflexion ROM during the time of maximal dorsiflexion during jogging. Limited dorsiflexion ROM during gait among individuals with CAI may be a risk factor for recurrent ankle sprains. These deficits should be treated appropriately by rehabilitation clinicians.     

Determination of preferred walking speed on treadmill may lead to high oxygen cost on treadmill walking

The energy consumption of walking relates to the intensity of physical effort and can be affected by the alterations in walking speed. Therefore, walking speed can be accepted as a crucial, determinant of energy consumption measurement for a walking test. We aimed to investigate the differences in preferred walking speed (PWS) determined both on overground and on a treadmill and, to measure walking energy expenditure and spatio-temporal parameters of gait on a treadmill at both, speeds. Participants (n = 26) walked on a treadmill at two pre-determined speeds for 7 min while, indirect calorimetry measurements were being performed. Spatio-temporal parameters were collected, by video-taping during each walking session on a treadmill. The average overground preferred walking speed (O-PWS) was 85.96 ± 12.82 m/min and the average treadmill preferred walking speed (T-PWS), was 71.15 ± 13.85 m/min. Although T-PWS was lower, oxygen cost was statistically higher when, treadmill walking at T-PWS (0.158 ± 0.02 ml/kg/m) than when the treadmill walking at O-PWS, (0.1480 ± 0.02 ml/kg/m). Cadence (127 ± 9.13 steps/min), stride (134.02 ± 14.09 cm) and step length (67.02 ± 6.90 cm) on the treadmill walking at O-PWS were significantly higher than cadence (119 ± 10 steps/min), stride (117.96 ± 14.38 cm) and step length (59.13 ± 7.02 cm) on the treadmill walking at TPWS. In conclusion, walking on treadmill using O-PWS is more efficient than walking on treadmill using TPWS, in walking tests. Since using T-PWS for treadmill walking tests overestimates the oxygen cost of walking, O-PWS should be used for oxygen consumption measurement during treadmill walking tests.     

Photodynamic process induced by chloro-aluminum phthalocyanine nanoemulsion in glioblastoma

BackgroundGlioblastoma multiforme (GBM) is a tumor characterized by rapid cell proliferation and migration. GBM constitutes the most aggressive and deadly type of brain tumor and is classified into several subtypes that show high resistance to conventional therapies. There are currently no curative treatments for malignant glioma despite the numerous advances in surgical techniques, radiotherapy, and chemotherapy. Therefore, alternative approaches are required to improve GBM treatment.MethodsOur study proposes the use of photodynamic therapy (PDT) for GBM treatment, which uses chloro-aluminum phthalocyanine (AlClPc) encapsulated in a new drug delivery system (DDS) and designed as a nanoemulsion (AlClPc/NE). The optimal dark non-cytotoxic AlClPc/NE concentration for the U87 MG glioma cell model and the most suitable laser light intensity for irradiation were determined. Experimental U87 MG cancer cells were analyzed via MTT cell viability assay. Cellular localization of AlClPc, morphological changes, and cell death via the necrotic and apoptotic pathways were also evaluated.ResultsAlClPc remained in the cytoplasmic region at 24 h after administration. Additionally, treatment with 1.0 μmol/L AlClPc under light irradiation at doses lower than 140 mJ/cm resulted in morphological changes with 50 ± 6% cell death (p < 0.05). Moreover, 20 ± 2% of U87 MG cells underwent cell death via the necrotic pathway. Measurement of Caspase-9 and -3 activities also suggested that cells underwent apoptosis. Taken together, these results indicate that AlClPc/NE-PDT can be used in the treatment of glioblastoma by inducing necrotic and apoptotic cell death.ConclusionsOur findings suggest that AlClPc/NE-PDT induces cell death in U87 MG cells in a dose-dependent manner and could thus serve as an effective adjuvant treatment for malignant glioma. AlClPc/NE-PDT utilizes a low dose of visible light and can be used in combination with other classic GBM treatment approaches, such as a combination of chemotherapy and surgery.     

Body height estimation from post-mortem CT femoral F1 measurements in a contemporary Swiss population

PurposeThe present study aimed at the comparison of body height estimations from cadaver length with body height estimations according to Trotter and Gleser (1952) and Penning and Riepert (2003) on the basis of femoral F1 section measurements in post-mortem computed tomography (PMCT) images.MethodsIn a post-mortem study in a contemporary Swiss population (226 corpses: 143 males (mean age: 53 ± 17 years) and 83 females (mean age: 61 ± 20 years)) femoral F1 measurements (403 femora: 199 right and 204 left; 177 pairs) were conducted in PMCT images and F1 was used for body height estimation using the equations after Trotter and Gleser (1952, “American Whites”), and Penning and Riepert (2003).ResultsThe mean observed cadaver length was 176.6 cm in males and 163.6 cm in females. Mean measured femoral length F1 was 47.5 cm (males) and 44.1 cm (females) respectively. Comparison of body height estimated from PMCT F1 measurements with body height calculated from cadaver length showed a close congruence (mean difference less than 0.95 cm in males and less than 1.99 cm in females) for equations both applied after Penning and Riepert and Trotter and Gleser.ConclusionsFemoral F1 measurements in PMCT images are very accurate, reproducible and feasible for body height estimation of a contemporary Swiss population when using the equations after Penning and Riepert (2003) or Trotter and Gleser (1952).     

F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer

ObjectiveWe evaluated the prognostic impact of quantitative assessment by maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG) on [F-18] FDG PET/CT for patients with peritoneal carcinomatosis from epithelial ovarian cancer (EOC).MethodsThirty-one patients with EOC underwent PET/CT for an early restaging after cytoreductive surgery, having been diagnosed with carcinomatosis (before chemotherapy). The SUVmax, MTV (cm³; 42% threshold) and TLG (g) were registered on residual peritoneal lesions. The patients were followed up 20 ± 12 months thereafter. The PET/CT results were compared to overall survival (OS).ResultsThe Kaplan-Meier survival analysis for the SUVmax did not reveal significant differences in OS (p = 0.48). The MTV survival analysis showed a significant higher OS in patients presenting with a higher tumour burden than those with less tumour burden (p = 0.01; 26 vs. 14 months), whereas TLG exhibited a similar trend though not significant (p = 0.06). Apart from chemo-resistance, the higher the MTV, the better will be the response to chemotherapy.ConclusionsQuantitative assessment by MTV rather than by SUVmax and TLG on PET/CT may be helpful for stratifying patients who present with peritoneal carcinomatosis from EOC, in order to implement the appropriate therapeutic regimen.     

The value of true-FISP sequence added to conventional gadolinium-enhanced MRA of abdominal aorta and its major branches

To test true-fast imaging with steady-state precession (true-FISP) added to gadolinium-based MR angiography (Gd-MRA) for imaging abdominal aorta and major abdominal vessels, 35 consecutive patients (age 67 ± 11 years) with known or suspected abdominal and/or peripheral vascular disease were studied with sagittal and axial 2D true-FISP during free breathing and coronal 3D fast low-angle shot (FLASH) Gd-MRA (breath-holding, 0.2 mmol/kg of Gd-DOTA at 2 ml/s). We evaluated: suprarenal aorta, celiac trunk, superior mesenteric artery, right renal artery, left renal artery, infrarenal aorta, inferior mesenteric artery, aortic bifurcation/common iliac arteries, lumbar arteries and aortic atheromasia. The possible presence of accessory renal arteries, collateral vasculature and vascular prosthesis/stent was evaluated. A quality four-point score was assigned to each item on both sequences, from 0 (not visible) to 3 (good-to-excellent image quality) and Wilcoxon test was used. Main diagnoses resulted: normal or atheromasic aorta (n = 25); aortic aneurysm (n = 2); patent aorto-iliac surgical prosthesis (n = 2); patent vascular iliac stent (n = 2); aneurysm of iliac artery (n = 1); patent aortic endovascular prosthesis (n = 1); patent aorto-femural bypass (n = 1) and aorto-iliac surgical prosthesis endoleak (n = 1). We also found three patients with accessory renal arteries, two with collateral circulation, and three with surgical aorto-iliac prosthesis. The score of true-FISP (25.9 ± 4.1, median 27) was significantly higher (p = 0.003) than that of Gd-MRA (23.9 ± 3.6, median 24). True-FISP was superior for visualizing inferior mesenteric artery (score 2.5 ± 1.1 vs. 1.0 ± 1.4; p < 0.001) and atheromasic plaques (2.5 ± 1.1 vs. 1.2 ± 1.1; p < 0.001). One collateral vasculature was demonstrated only with Gd-MRA. Summarizing, true-FISP is a power and fast non-breath-hold sequence to be added to Gd-MRA, obtaining an information increase.