Multiphasic helical CT criteria for differentiation of recurrent neoplasm and desmoplastic reaction after laparoscopic resection of renal mass lesions

BACKGROUND AND PURPOSE: Differentiation of recurrent neoplasm and desmoplastic reaction following laparoscopic resection of renal mass lesions poses a problem. The usefulness of multiphasic helical CT-generated criteria based on enhancement and morphologic characteristics was investigated. PATIENTS AND METHODS: The findings in 5 female and 12 male patients aged 29 to 68 years having renal-cell carcinoma (11-38 mm; N = 15) or solitary angiomyolipomas (N = 2) treated by laparoscopic resection (N = 15) or open segmental surgery (N = 2) were analyzed. Multiphasic helical CT was performed in the preenhancement, arterial corticomedullary, parenchymal, and excretory phases generating 2.5- to 7-mm slices. RESULTS: Both recurrent neoplasms showed median postcontrast enhancement of 119 HU in the arterial corticomedullary phase; the median enhancement of desmoplastic masses was 48 HU. In the parenchymal and excretory phase, recurrent neoplasms showed progressive loss of enhancement, whereas desmoplastic lesions sustained enhancement at about the same level. Recurrent neoplasms presented a defined mass with characteristic spiculation, whereas desmoplastic reaction was characterized by an ill-defined mass with spidery projections extending to abutting fat and residual fascial planes. On 2- to 3-month follow-up scans, recurrent neoplasms showed progressive increases in size and desmoplastic reaction a sharp decrease. CONCLUSION: Enhancement of the mass at the operative site on arterial corticomedullary-phase CT to >90 HU strongly suggests recurrent renal-cell carcinoma, while progressive decrease in size on 1- to 3-month follow-up CT suggests a desmoplastic reaction.     

Detection of medullary and papillary necrosis at an early stage by multiphasic helical computerized tomography

PURPOSE: Multiphasic helical computerized tomography (CT) is advocated to identify early manifestations of papillary and medullary necrosis based on decreased enhancement of circumscribed areas in the medullary pyramid. At this stage the devascularizing process can be reversed if causative conditions such as infections or diabetes mellitus are effectively treated. MATERIALS AND METHODS: Multiphasic helical CTs were performed in 31 male and 26 female patients with complaints of microscopic hematuria (41), macroscopic hematuria (2), bacteriuria (39) and pyuria (9). Pre-enhancement, arterial, early corticomedullary, parenchymal and excretory phase helical CTs generated 1.25 to 5 mm. thick slices. Followup examination included multiphasic helical CT at 1 and 3 months, and excretory urography for some patients at 3 months. RESULTS: Bacteriuria was identified as the probable cause of medullary and papillary necrosis in 39 patients, of whom 28 were treated with effective antibiotic therapy, resulting in normalization and re-perfusion of the initial lesion in 16, no change in 5 and progressive disease in 7 at 3-month followup. Of 8 lesions not treated with specific antibiotic therapy 4 progressed and 4 remained unchanged. CONCLUSIONS: Multiphasic helical CT unlike the excretory urogram can identify medullary and papillary necrosis at an early stage when effective treatment of the underlying cause can reverse the process of devascularization and prevent sloughing of medullary tissues.     

Multiphasic helical computerized tomography for the assessment of microscopic hematuria: a prospective study

PURPOSE: We evaluated multiphasic helical computed tomography for the detection and characterization of lesions responsible for hematuria not diagnosed on prior urological surveillance studies. MATERIALS AND METHODS: A total of 393 men and 207 women with recurrent microscopic hematuria but negative urological surveillance studies were examined at 4 participating institutions by multiphasic helical computerized tomography, consisting of pre-enhancement, arterial corticomedullary, parenchymal and excretory phase sequences generating 2 to 5 mm slices through the kidney and lower pelvis. RESULTS: The cause of microscopic hematuria was established in 256 of 600 patients with prior negative urological surveillance examinations with 0.91 sensitivity and 0.94 specificity. The diagnosis was correct in all subsequently proven cases of calculous and renal vascular disease. A total of 67 of 70 inflammatory kidney lesions, 24 of 25 renal neoplasms, 15 of 16 bladder neoplasms, 27 of 35 inflammatory bladder conditions and 21 of 23 ureteral lesions were also correctly diagnosed. The diagnosis of renal medullary and papillary necrosis, and neoplastic lesions of the kidney and bladder allowed the early institution of medical therapy or appropriate surgery. CONCLUSIONS: Multiphasic helical computerized tomography diagnosed lesions responsible for microhematuria in 42.6% of 600 patients with negative urological surveillance examinations. This relatively low cost and low co-morbidity examination is advocated for patients with negative urological surveillance examinations or even as a first examination.     

Prospective evaluation of magnetic resonance imaging after endovascular treatment of infrarenal aortic aneurysms.

OBJECTIVES: to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the detection of type II endoleaks during follow-up after endovascular treatment of intra-renal aortic aneurysms. DESIGN: prospective study. MATERIAL AND METHODS: between March 1996 and November 1999, 31 patients with infra-renal aortic aneurysms who underwent stentgraft implantation were followed with helical CT and MRI, including magnetic resonance angiography (MRA), at 1 and 6 months after the procedure. Arteriography was performed between 6 and 12 months after intervention. The parameters studied included the change in the maximum anteroposterior and transverse diameters, the nature of the signal on T1 and T2 weighted sequences (homogeneous vs heterogeneous), the presence or absence of Gadolinium uptake on MRI or of contrast uptake on helical CT (early and late phases) in the sac of the aneurysm. On MRA, stentgraft patency and endoleak detection were studied. RESULTS: arteriography demonstrated an endoleak in 19 patients (18 type II, and 1 type I endoleak). MRI at 6 months detected 18/19 endoleaks on T1 weighted sequences after injection of Gadoliniumj; there were 2 false positives. MRA sequences confirmed stentgraft patency in all patients, but did not diagnose type II endoleaks. Helical CT (late phase) at 6 months detected 10/19 endoleaks; there was 1 false positive. The sensitivity of MRI after injection of Gadolinium and of helical CT for the detection of type II endoleaks were 94% and 50% (p=0.003) respectively. The mean maximal anteroposterior and transverse diameters were similar on MRI and on helical CT at 1 month and at 6 months. CONCLUSION: MRI after injection of Gadolinium is more sensitive than helical CT in the detection of type II endoleaks after stentgraft implantation. Its more widespread use may permit earlier intervention in such patients.     

Role of multiphasic helical computed tomography in planning surgical treatment for pelvi-ureteric junction obstruction

OBJECTIVE: To evaluate the role of multiphasic helical computed tomography (CT) in planning surgical treatment for pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS: Multiphasic helical CT was used in 60 consecutive patients (mean age 32 years, sd 13.72) with primary PUJO. The different images were interpreted before surgery by a urologist and radiologist. The number, type and relation of the crossing vessels to the PUJ were detected. Pyeloplasty (open or laparoscopic) was used in patients where there was a significant crossing vessel (i.e. > 2 mm in diameter and passing at the PUJ) or with ballooning of the renal pelvis. Endopyelotomy (antegrade or retrograde) was used in the other patients. Subjective and objective success rates were determined 3-6 months after treatment and then every 6 months. RESULTS: Hyperdense renal stones were detected in precontrast images in 15 patients, significant crossing vessels in 33 (55%), and anterior malrotation of the renal pelvis in 23 (38%; 19 associated with significant crossing vessels, i.e. ureterovascular hydronephrosis). A large para-pelvic cyst compressing the PUJ and upper ureter was detected in one patient. Pyeloplasty was used in 45 patients, among whom the sensitivity of multiphasic helical CT in detecting crossing vessels was 97%, the specificity 92% and accuracy 96%. Uncomplicated endopyelotomy was used in 14 patients and percutaneous aspiration of the para-pelvic cyst in one. CONCLUSION: Multiphasic helical CT can accurately delineate the spatial anatomy of the renal and peri-renal area; it may be important in planning surgical treatment for PUJO, especially when endopyelotomy is considered.     

腹腔镜射频消融治疗多病灶肝癌的疗效及安全性

目的:探讨腹腔镜射频消融(radiofrequency ablation,RFA)治疗多病灶肝癌的可行性、安全性及疗效。方法:2001年10月-2005年8月,我院对15例多病灶肝癌患者在全麻下进行治疗。其中男12例,女3例,平均(51.5±9.0)岁。术前经超声、螺旋CT或MRI发现瘤体36个,其中2个病灶11例,3个病灶2例,4个病灶2例。肿瘤平均直径(3.1±1.1)cm。乙型肝炎13例,丙型肝炎2例。合并肝硬化13例,胆囊结石2例。结果:15例均顺利完成手术,同时行胆囊切除术2例。单个病灶RFA平均时间(30.2±13.3)min,平均总手术时间(98.7±28.5)min,平均总出血量(145.3±82.8)ml。未出现腹腔出血、胃肠道损伤、膈肌损伤及肝功能衰竭等严重并发症。术后1个月螺旋CT增强扫描证实,病灶完全坏死率达100%。随访12-52个月(平均35个月),1例发现肝内新病灶,3例消融部位复发,均采用经皮射频消融进行治疗。3例分别在术后24、28、36个月死于肝内复发及肝功能衰竭。结论:腹腔镜RFA治疗多病灶肝癌安全可行,近期疗效肯定,最大程度保存了受损的肝功能。但应选择肿瘤位于肝脏表面、肝左外叶或邻近胆囊的病例进行治疗。     

Radiologic follow-up of patients with T1–3a,b,c or T4N+M0 renal cell carcinoma after radical nephrectomy

Objectives. To determine the pattern of disease recurrence after radical nephrectomy in patients with node-positive renal cell carcinoma (RCC) in order to design a schedule for subsequent radiologic evaluation.Methods. We reviewed the postoperative radiologic studies of 45 patients with T1–3a,b,c or T4N+M0 RCC enrolled in a prospective trial of adjuvant autolymphocyte therapy (ALT) after radical nephrectomy for node-positive disease. Chest radiograph and abdominal computed tomography (CT) were performed quarterly, and bone scan and head CT were performed every 6 months until disease recurrence, or earlier if clinically indicated. Time from surgery to recurrence and sites of recurrence were analyzed.Results. Twenty-nine patients (64%) had disease progression, with a mean time to progression of 14.9 months. Mean follow-up of patients without progression was 39 months. The sites of recurrence were retroperitoneal lymph nodes (n = 14), lung (n = 11), liver (n = 5), bone (n = 5), mediastinal lymph nodes (n = 4), renal fossa (n = 3), pelvis (n = 2), brain (n = 2), contralateral kidney (n = 1), retrocecum (n = 1), and skin (n = 1). Fourteen patients had recurrence at more than one site. Of the patients whose disease progressed, 59% did so by 12 months, 83% by 24 months, and 93% by 36 months. Mean time to progression in the ALT group was delayed compared with the observation group, but the sites of disease recurrence were not different between the two groups. Abdominal CT alone detected recurrent lesions in 79% of patients with progression, and the combination of abdominal CT and chest radiograph detected lesions in 100% of patients with progression.Conclusions. Abdominal CT with chest radiograph detects recurrence in all patients with T1–3a,b,c or T4N+M0 RCC whose disease progresses, and more than 90% of recurrences occur within the first 3 years after surgery. We recommend abdominal CT and chest radiograph every 6 months for at least 3 years and yearly thereafter in this high-risk group of patients.     

Transxiphoid video-assisted pulmonary metastasectomy: relevance of helical computed tomography occult lesions

Background. The new transxiphoid video-assisted approach allows manual palpation of both lungs, thus permitting better evaluation of helical computed tomography (CT) in detection of pulmonary metastases.

Methods. From December 1995 to May 1999, 22 patients underwent a transxiphoid video-assisted pulmonary metastasectomy. Manual palpation of both lungs was possible in 18 patients, whereas only 13 had radiologic evidence of unilateral disease. Primaries were colon-rectum (n = 8), kidney (n = 3), uterus (n = 2), larynx (n = 2), limb osteosarcoma (n = 2), and one each of breast, skin melanoma, prostate, fibrosarcoma, and ovary.

Results. No perioperative death occurred. Fifty-eight lesions, 49 metastatic, were resected, whereas only 46 had been predicted by helical CT scan. Twelve occult lesions were discovered, eight of which were malignant. Overall sensitivity for proved metastases was 83.7% (41 of 49) and 75.8% (22 of 29) for those less than or equal to 5 mm. Mean follow-up was 15.27 months. Only 2 patients had pulmonary relapse at 6 and 12 months.

Conclusions. Despite helical CT, occult metastases may still be identified in almost one-third of the patients. The transxiphoid approach allows routine bilateral palpation and safe resection, and overcomes this critical limitation of video-assisted metastasectomy.     

经皮穿刺瘤内注入碘油化疗药乳剂治疗原发性肝癌

目的 探讨经皮穿刺瘤内注入碘油化疗药乳剂(CALE)治疗原发性肝癌的疗效和安全性.方法 本组57例患者中肝细胞癌49例,胆管细胞癌8例.共进行了90例次的治疗,即分90个靶区.术前均已行经动脉化疗栓塞术(55例)或化疗灌注术(2例).所有患者动脉造影均表现为少血供或不能插管人供血动脉者.在透视或者CT引导下,经皮穿刺注入CALE.术后1周内行X线平片或CT和实验室检查.术后1个月、3个月、6个月、1年随访,以后每6个月随访一次.残留灶复发者,行再次治疗.结果 57例原发性肝癌患者,行90例次治疗.均穿刺和注药成功,技术成功率为100%.靶区大小及CALE的用量为:肿瘤直径<3 cm者40例次,乳剂剂量3.0～7.0 ml;3～5 cm者43例次,乳剂剂量12.0～20 ml;>5 cm者7例次,乳剂剂量为24～40 ml.AFP阳性患者43例,治疗后14例降到正常范围.术后1个月CT显示CALE在靶区沉积良好者54例次(60.0%),欠佳者34例次(37.7%).缺失者2例次.随访2个月～6年,中位随访时间16个月.患者中位生存时间400 d.术后的主要副作用有:发热22例次(24.4%),恶心、呕吐等胃肠反应11例次(12.2%),穿刺部位疼痛17例次(18.9%),均自行缓解.结论 采用经皮穿刺瘤内注射CALE治疗原发性肝癌是有效和安全的.     

结节性硬化症相关肾透明细胞癌一例报告并文献复习

目的 探讨结节性硬化症(tuberous sclerosis complex,TSC)相关肾细胞癌(renal cell carcinoma,RCC)的临床诊治特点.方法 回顾性分析1例TSC相关TCC患者的资料.男,22岁.自幼智障伴癫痫.发现双肾肿瘤5年,间断肉眼血尿2年,曾于1年内2次行超选择性左肾动脉栓塞术,但分别于术后6、10个月再次出现肉眼血尿.查体:智障表现,肥胖,头颈部血管纤维瘤及非创伤性趾甲沟纤维瘤.CT平扫检查左肾有一不规则实性占位,最大截面14.2 cm×9.0 cm,CT值45～54HU,增强扫描病变呈不均匀强化,CT值60～78 HU,左肾静脉内有充盈缺损;右肾见多发脂肪密度占位,CT值-38～-25 HU,最大截面7.2 cm × 5.7 cm.检索Pubmed和CBM数据库进行相关文献复习.结果 患者行经腹开放性左肾根治性切除术,病理诊断肾透明细胞癌,肾静脉内见瘤栓.随访4个月未发现肿瘤复发及转移.结论 TSC相关RCC临床罕见,诊断后可行肾部分切除术或根治性肾切除术.

Abstract：

Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma.Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation presented with a complaint of intermittent painless gross hematuria for the past 2 years.After superselective left renal artery embolization was done twice in the past year, painless gross hematuria was still repeated with 6- 10 months intervals.Physical examination showed retarded face, obesity, visible facial angiofibroma and a ditch fibroma.CT scan showed irregular lesions.The largest cross-section 14.2 cm × 9.0 cm in the left kidney was inhomogeneous enhanced from 45 - 54 HU in the plain phase to 60 - 78 HU in the contrast phase.Filling defect in the left renal vein and multiple fat-density lesions (CT value of -25 - -38 HU) with the largest cross-section 7.2 cm× 5.7 cm in the right kidney were also found in contrast CT scan.The PUBMED and CBM database were reviewed.Results Open retroperitoneal radical left nephrectomy was performed.Pathology showed renal clear cell carcinoma and renal vein thrombosis.There was no tumor recurrence or distant metastasis at 4-month follow-up.Conclusions Tuberous sclerosis complex associated renal cell carcinoma is rarely reported.Timely nephron-sparing surgery is necessary when the diagnosis is established, or radical nephrectomy is also necessary if nephron-sparing surgery is impossible.     

Diagnostic Performance of CT Attenuation Values of Focal 18F‐FDG Avid Breast Lesions Detected on Whole‐Body PET‐CT in Postoperative Breast Cancer Patients

To assess whether CT attenuation values help in differentiating benign from malignant etiology of focal ¹⁸F‐FDG avid breast lesions detected on whole‐body PET/CT exam in postoperative breast cancer patients. Institutional review board approval and waived informed consent were obtained for this HIPAA‐compliant retrospective study. Between January 2009 and July 2011, a total of 85 patients had 97 focal ¹⁸F‐FDG avid breast lesions on whole‐body PET/CT. Of these, 54 (56%) lesions were biopsy‐proven primary invasive breast carcinoma that had not undergone treatment at the time of PET/CT, 35 (36%) were benign lesions, and 8 were locally recurrent breast carcinoma. Mean attenuation values were retrospectively measured in Hounsfield units (HU) for the correlative lesion on the CT portion of the exam. Receiver‐operating characteristic curves (ROC) were calculated to determine the optimal cutoff values of HU that would best discriminate between benign and malignant lesions. Interobserver agreement for measured mean attenuation values was assessed by calculating the intraclass correlation coefficient (ICC). Mean HU for the benign lesions group and the local recurrence lesions group was ?11.0 ± 30.3 versus 32.9 ± 6.87 (p < 0.0002). ROC curve analysis comparing benign breast lesions to local recurrence lesions found an optimal cutoff value of 17 HU (area under curve = 0.982, p < 0.0001, Sensitivity = 100%, Specificity = 89%). ICC with regard to interobserver agreement in measuring the mean HU of the benign lesions was 0.84 (95% confidence interval 0.64–0.93) and for the malignant lesions was 0.88 (95% confidence interval 0.77–0.94). A CT attenuation threshold value of less than 17 HU suggests benign etiology of focal ¹⁸FDG avid breast lesions in postoperative breast cancer patients. If confirmed by additional studies, these findings may provide additional information to guide the treating physician regarding decisions for supplementary imaging or the need to biopsy.     

Epirubicin-loaded beads transarterial prostatic arterial chemoembolization is a promising treatment for advanced prostate cancer with lower urinary tract obstruction or hematuria—a case series report

BackgroundProstatic arterial embolization (PAE) is an effective minimally invasive treatment for lower urinary tract obstruction and hematuria in patients with benign prostatic hyperplasia (BPH). This study was aim to evaluate the safety and short-term efficacy of drug epirubicin-loaded beads transarterial prostatic arterial chemoembolization (DEB-PACE) for the treatment of advanced prostate cancer (PC) with lower urinary tract obstruction or hematuria.MethodsA total of 8 patients with advanced PC undergoing DEB-PACE from August 2020 to February 2022 were retrospectively enrolled. The patients were followed up at 1 week, 1, 3, 6 and 12 months after DEB-PACE. The origin of prostatic arteries, technical success, clinical success rate, duration of the indwelling urinary catheter, International Prostate Symptom Score (IPSS), QoL score (quality of life), prostate volume (PV), prostate-specific antigen (PSA) level and complications were recorded. The short-term efficacy (changes in IPSS, PV and QoL value from baseline to 3 months) were analysed.ResultsThere were 17 prostatic arteries in 8 patients, which mainly originated from internal pudendal artery (11/17, 64.7%), the technical success rate is 100%. After treatment, the symptoms of lower urethral obstruction in 8 patients were significantly improved that PSA, PV, IPSS and QoL level were significantly reduced. The catheter was successfully removed within 1 week on average, and 2 patients with hematuria disappeared within 5 days. The clinical success rate is 100%. At 1 month postoperatively, mean PV reduction was 30.28±6.963 cm³ (P=0.0457), mean IPSS reduction was 21.13±2.887 points (P=0.0042), mean QoL reduction was 3.75±0.366 points (P=0.006). At 3 months postoperatively, mean PV reduction was 46.14±8.906 cm³ (P=0.0112), mean IPSS reduction was 24.5±2.398 points (P=0.0003), mean QoL reduction was 4.25±0.25 points (P=0.0003). There were no serious complications occurred in all patients.ConclusionsDEB-PACE is a promising treatment for advanced PC with lower urinary tract obstruction or hematuria. However, the efficacy and safety of DEB-PACE for advanced PC is needed to validated by prospective large sample randomized controlled study.     

Effect of oral camostat mesilate on hematuria and/or proteinuria in children

The effects of camostat mesilate (CM), a derivative of gabexate mesilate developed for oral use, on primary glomerulonephritis (GN) and chance hematuria and/or proteinuria were evaluated. Fourteen patients (6 males, 8 females) with a mean age of 11 years and 3 months (range 4–16 years) were enrolled. Histological and clinical diagnoses of the 14 patients were as follows: IgA nephropathy 3, non-IgA GN 2, and asymptomatic significant microscopic hematuria [more than 100 red blood cells per high-power field (x400)] with or without proteinuria 9. They were consecutively treated with oral CM (100 mg twice a day) when they were confirmed to have continuous significant microscopic hematuria and/or proteinuria after a few months of observational follow-up. Urinary findings were normalized in 10 of the 14 patients (85.7%) between 1 month 1 week and 10 months (mean 4 months) after administration of CM. Hematuria cleared in 11 of 13 patients, and proteinuria disappeared in 4 of 5 patients. The mean duration of CM administration was 21.7±9.1 months (range 4–37 months). At present, 3–12 years after discontinuation of CM therapy, their urinary findings remain normal at 9 years 10 months to 26 years 6 months of age. In conclusion, there appears to be an association between the oral use of CM and reduction in significant microscopic hematuria and/or proteinuria. Oral CM therapy could represent a practical primary care approach to chance hematuria and/or proteinuria in children.     

Percutaneous Imaging–Guided Radiofrequency Ablation in Patients With Colorectal Pulmonary Metastases: 1-Year Follow-Up

Background: We assessed the safety and evidence of efficacy of radiofrequency ablation (RFA) for colorectal lung metastases with follow-up to 1 year.Methods: Twenty-three patients had percutaneous RFA for 52 colorectal pulmonary metastases under fluoro-computed tomography (CT). Patients received intravenous conscious sedation and local analgesia with routine hospitalization and monitoring for 24 hours after RFA. Patients had CT scanning at 1 month and then every 3 months, with serum carcinoembryonic antigen assessment monthly and every 3 months.Results: All ablations were technically successful. Tumor diameter ranged from .3 to 4.2 cm. Pneumothorax occurred in 43% (10 of 23) of patients. Six patients required intercostal chest drain placement. Six patients had a second RFA, four for new lesions and two for re-treatment of a previously treated lesion. The median admission was 2.0 days (range, 1–9 days). The median follow-up was 428 days (range, 173–829 days); data are reported to 1 year in this article. Five patients died at 5, 6, 8, 8, and 12 months after RFA from extrapulmonary (n = 1) or widespread (n = 4) disease. One patient developed a malignant pleural effusion at 6 months after RFA. Cavitation was seen in nine treated lesions (17%); all resolved with scar tissue contraction by 12 months. Eighteen patients with CT scan follow-up at 1 year have 40 lesions classified as disappeared (n = 17), decreased (n = 5), stable/same size (n = 4), or increased (n = 14).Conclusions: Percutaneous imaging–guided RFA of multiple colorectal pulmonary metastases is a minimally invasive treatment option with modest morbidity. A significant proportion of patients show good evidence of successful local control at 1 year.     

The radiologic appearance of intercostal muscle flap

Background

The intercostal muscle flap (ICMF) is commonly used in airway and esophageal surgery to reinforce an anastomosis or site of closure. These flaps undergo heterotopic ossification that may result in stenosis of adjacent airways or the esophagus. We evaluated the computer tomography (CT) scan, technetium-99m-methylene diphosphonate bone scan and positron emission tomography with 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (FDG-PET) findings of ICMF and the frequency of airway or esophageal stenosis.

Methods

A retrospective review was made of the radiologic records of 23 patients (9 women, 14 men) who underwent ICMF. The CT scans were obtained a mean of 36 months (range, 1 week to 58 months) after surgery and the size, morphology, and density of the ICMFs were recorded. Correlative bone scan in 13 patients and FDG-PET scans in 11 patients were reviewed.

Results

A discontinuous, thin, linear calcified stripe or parallel stripes (mean thickness, 4 mm; mean density, 430 Houndsfield unit [HU]) were present in all patients on CT. The flap contained fat density (mean, −59 HU) in 18 patients and soft tissue density (mean, 41 HU) in 8 patients and measured about 1 cm in thickness. The appearance of ICMF is characteristic when the ossification extends from the posterolateral chest wall to an adjacent bronchial stump. There was no increased uptake on bone scan or FDG-PET scan. None of the patients had airway or esophageal stenosis.

Conclusions

The ICMF manifests on CT as a thin, linear calcified stripe or parallel stripes with central fat or soft tissue density. Airway stenosis due to ICMF is likely quite rare. We did not detect any airway stenosis.     

平扫CT值在常见肾上腺肿瘤鉴别诊断中的应用价值

目的:评价平扫CT值在肾上腺常见肿瘤诊断中的应用价值,并结合肿瘤大小优化选择肾上腺腺瘤与非腺瘤的鉴别阈值。方法:回顾性分析经手术及病理证实的肾上腺肿瘤209例(221个病灶),其中腺瘤137个,非腺瘤84个,分别测量肿瘤的大小及平扫CT值并计算不同CT值阚值鉴别腺瘤与非腺瘤的敏感度、特异度、准确度、阳性预测值及阴性预测值。结果:137个腺瘤平扫CT值-12～59(13.19±12.84)HU,直径0.3～7.3cm,其中包括88个无功能性腺瘤,平扫CT值-12～59(15.04±13.01)HU;醛固酮腺瘤43个,平扫CT值-8～42(10.19±12.26)HU;皮质醇腺瘤6个,平扫CT值-4.6～18(7.58±10.16)HU。84个非腺瘤平扫CT值15～69(38.33±10.08)HU,直径1.5～11.6cm,包括:嗜铬细胞瘤43个,平扫CT值15～69(38.67±11.05)HU;节细胞神经瘤5个,平扫CT值18～39(29.60±8.65)HU;皮质癌28个,平扫CT值26～58(38.96±8.84)HU;转移癌8个,平扫CT值28～54(39.75±8.24)HU;腺瘤和非腺瘤的平均平扫CT值差异有显著性意义(t=-15.281,P=0.000)。使用CT值25HU且肿瘤大小≤4cm作为鉴别腺瘤与非腺瘤的阈值时诊断腺瘤的敏感度73.7%,特异度100%,准确度83.7%,阳性预测值100%,阴性预测值70%。结论:平扫CT值在肾上腺腺瘤与非腺瘤的鉴别诊断上有重要价值,以平扫CT值≤25且肿瘤大小≤4cm作为腺瘤的诊断标准是比较合适的,特异度高,敏感度及准确度均较高。但在进一步鉴别腺瘤及非腺瘤的组织类型及具体临床诊断中的作用有限,需结合临床其他检测手段及病理结果做出全面准确的判断。     

胃肠间质瘤靶向治疗CT征象演变及其与预后的关系

目的 探讨胃肠间质瘤（GIST）靶向治疗过程中CT征象变化及其预测预后的能力.方法 对2003年4月至2008年6月北京大学肿瘤医院35例口服甲磺酸伊马替尼的GIST患者的临床资料进行回顾性分析.于靶向治疗前和治疗后2～6个月进行CT检查,CT轴位图像测量肿瘤最长径线及最大层面平均强化CT值,计算治疗前后长径及强化CT值变化率.以2年内肿瘤是否进展作为评价预后的指标,比较进展与未进展组患者CT分类指标（病灶数目、部位、肝转移、出血、囊变）及定量指标（病灶长径、强化CT值及其变化率）的差异.结果 本组患者中位随访时间28.5个月,其中肿瘤进展组13例,肿瘤未进展组22例.靶向治疗前,病灶数目大于或等于5个、累及多个部位者2年内进展比例高于病灶数少于5个、累及单个部位者（P＜0.05）.未进展组肿瘤长径变化率及强化CT值变化率分别为-14.29%（-67%,11%）和-12.25%（-55%,39%）,与进展组长径变化率15.09%（-45%,191%）及强化CT值变化率9.91%（-27%,135%）比较,差异有统计学意义（P＜0.01）.以长径变化率和强化CT值变化率为评价指标预测2年进展的ROC曲线下面积分别为0.790和0.797.结论 GIST靶向治疗前,病变数目和累及部位数与预后有关;靶向治疗后,CT病灶长径退缩率和强化CT值具有中等预测效能,可作为疗效的评价指标.     

Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary?

Background

Pulmonary metastasectomy is well accepted in patients with isolated metastases from an extrathoracic malignancy. The standard approach involves careful intraoperative palpation of the lungs because more metastases are frequently found than were seen by preoperative conventional computed tomography (CT). Helical CT detects more nodules than conventional CT, raising the question of whether palpation of the lungs is still necessary if helical CT is used.

Methods

Retrospective review was done of medical records of patients undergoing metastasectomy with curative intent at the University of North Carolina (UNC) from 1999 to 2003. During this time at UNC, helical CT was routinely performed using a standardized technique, and all metastasectomy patients underwent manual lung palpation. The primary outcome measure of this study was whether malignant nodules (palpated, resected, and proven histologically) were reliably detected preoperatively by helical CT.

Results

Thirty-four patients were identified who underwent 41 cases of pulmonary metastasectomy with lung palpation. Our analysis revealed that in 22% (9/41), more malignant nodules were found intraoperatively than were detected by helical CT. Of 88 malignant intraparenchymal nodules, 69 were detected by helical CT (sensitivity 78%). Subset analyses of tumor histology, disease-free interval, the presence of a single lesion versus multiple lesions, the interval between the CT and metastasectomy, and the size of the largest lesion were unable to identify a cohort in which lung palpation was no longer needed after preoperative helical CT.

Conclusions

Despite the advent of helical CT, palpation of the lung is necessary if the goal is to resect all detectable disease.     

Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter

OBJECTIVES: We previously showed that peak abdominal aortic aneurysm (AAA) wall stress calculated for aneurysms in vivo is higher at rupture than at elective repair. The purpose of this study was to analyze rupture risk over time in patients under observation. METHODS: Computed tomography (CT) scans were analyzed for patients with AAA when observation was planned for at least 6 months. AAA wall stress distribution was computationally determined in vivo with CT data, three-dimensional computer modeling, finite element analysis (nonlinear hyperelastic model depicting aneurysm wall behavior), and blood pressure during observation. RESULTS: Analysis included 103 patients and 159 CT scans (mean follow-up, 14 +/- 2 months per CT). Forty-two patients were observed with no intervention for at least 1 year (mean follow-up, 28 +/- 3 months). Elective repair was performed within 1 year in 39 patients, and emergent repair was performed in 22 patients (mean, 6 +/- 1 month after CT) for rupture (n = 14) or acute severe pain. Significant differences were found for initial diameter (observation, 4.9 +/-.1 cm; elective repair, 5.9 +/-.1 cm; emergent repair, 6.1 +/-.2 cm; P <.0001) and initial peak wall stress (38 +/- 1 N/cm(2), 42 +/- 2 n/cm(2), 58 +/- 4 N/cm(2), respectively; P <.0001), but peak wall stress appeared to better differentiate patients who later required emergent repair (elective vs emergent repair: diameter, 3% difference, P =.5; stress, 38% difference, P <.0001). Receiver operating characteristic (ROC) curves for predicting rupture were better for peak wall stress (sensitivity, 94%; specificity,81%; accuracy, 85% [with 44 N/cm(2) threshold]) than for diameter (81%, 70%, 73%, respectively [with optimal 5.5 cm threshold). With proportional hazards analysis, peak wall stress (relative risk, 25x) and gender (relative risk, 3x) were the only significant independent predictors of rupture. CONCLUSIONS: For AAAs under observation, peak AAA wall stress seems superior to diameter in differentiating patients who will experience catastrophic outcome. Elevated wall stress associated with rupture is not simply an acute event near the time of rupture.     

Health-related quality of life after retroperitoneoscopic and hand-assisted laparoscopic nephrectomy

BACKGROUND AND PURPOSE: The assessment of postoperative recovery typically involves the use of measures that are open to bias. Whilst there has been some work done on the short-term postoperative recovery comparison for hand-assisted laparoscopic nephrectomy (HALN) and retroperitoneoscopic nephrectomy (RPN), to our knowledge, this is the first study to look at long-term health outcomes for these two procedures. This study sought objectively to compare long-term postoperative health-related quality of life (HRQoL) after retroperitoneoscopic and hand-assisted transperitoneal laparoscopic nephrectomy undertaken for renal pathology. This was achieved by both reviewing perioperative data from medical records and by using the SF-36 questionnaire postoperatively. PATIENTS AND METHODS: Patients who had undergone elective retroperitoneoscopic (N = 19) or transperitoneal HALN (N = 32) between 2001 and 2004 at our institution underwent objective HRQoL assessment via a validated telephone questionnaire (SF-36) and by review of postoperative data from the medical records. This survey was administered between 3 and 6 months after surgery. The data then underwent statistical analysis using the paired Student's t-test. RESULTS: Perioperative data showed no significant difference in the postoperative complication rate in the two groups. The HRQoL scores gathered from the SF-36 questionnaire gave mean scores of 67.4 and 68.5 for the HALN and RPN groups, respectively (100 represents maximum quality of life). This difference was not statistically significant. CONCLUSIONS: This is the first study to look at long-term (mean follow-up 6 months) health outcomes for patients undergoing RPN and HALN. The results show no greater long-term health benefit for one procedure over the other. This finding supports the data in the literature on the benefits of HALN over RPN in terms of a less protracted learning curve, greater technical ease, fewer intraoperative complications, and consequently reduced operating times with no loss of the long-term health benefit that is traditionally associated with the standard laparoscopic technique.