Volumetric parameters of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography can predict histopathologic treatment response after neoadjuvant chemoradiotherapy in pancreatic adenocarcinoma

PurposeThe purpose of this study was to investigate the clinical potential of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (FDG PET/CT) to evaluate histopathologic effects of preoperative chemoradiotherapy (CRT) in pancreatic adenocarcinoma, with particular focus on volumetric PET/CT parameters.Material and methodsThis study included 25 patients with pancreatic adenocarcinoma who underwent radical surgery after gemcitabine- and S-1-based preoperative-CRT. The extent of residual tumor was graded using the Evans grading systems, and patients with more than 50% destruction of tumor cells were defined as responder. Peak SUV corrected for lean body mass (SUL_peak), metabolic tumor volume (MTV) with a threshold of SUV = 2.0, total lesion glycolysis (TLG) of pre- and post-CRT, and reduction rates of SUL_peak in those parameters were assessed by PET/CT. These parameters were compared using the student's t-test between responder and non-responder. The treatment effect was also assessed by contingency table analysis divided with median value of each parameter using chi-square tests.ResultsEight patients (32%) showed histopathologic poor response (Evans grade I), 11 cases (44%) had mild response (Evans grade IIa), and six cases (24%) had moderate response (Evans grade IIb); therefore, six cases (24%) were assigned to responders and others 19 cases (76%) were non-responders. With regards to volumetric PET parameters, post-CRT SUL_peak of responders was significantly lower than that of non-responders (p = 0.013). Post-CRT MTV and TLG were negative for all six cases of responders. There were significant differences between responder and non-responder on the contingency table analysis of post-CRT MTV and TLG status (p = 0.014 for both).ConclusionsThis study demonstrated that the volumetric PET/CT parameters, higher post-treatment SUL_peak and positive MTV/TLG could predict the unfavorable histopathological effects of CRT in patients with pancreatic adenocarcinoma.     

Early response evaluation using CT-perfusion one day after transarterial chemoembolization for HCC predicts treatment response and long-term disease control

PurposeTo determine the value of CT perfusion (CTP) for early response assessment after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Materials and methodsBetween April 2013 and April 2015, 41 HCC (16 patients) were included in this study. CT perfusion was performed before and one day after TACE. Blood flow (BF), blood volume (BV), time to start (TTS), arterial liver perfusion (ALP), portal liver perfusion (PVP) and hepatic perfusion index (HPI) were measured. Quantitative perfusion values before and after TACE were compared to the response assessed using mRECIST criteria six weeks after TACE and long-term outcome was assessed.ResultsTwenty-one lesions (51%) had complete remission (CR) and five (12%) had partial response (PR) six weeks after TACE. CTP parameters were significantly reduced after TACE in responders (PR, CR, p < 0.001) while no difference was observed in non-responders. ALP_post was superior in the prediction of CR compared to BF_post and BV_post (p < 0.001) with a sensitivity, specificity, PPV, NPV, and accuracy of 90%, 90%, 91%, 90%, and 91%, respectively. Only 3/21 lesions with CR recurred, with a mean local-recurrence-free survival of 19.6 months.ConclusionCT perfusion detects lesions with complete response one day after TACE, and is a feasible tool for early response assessment.     

18F-FDG-PET/CT in patients with breast cancer and rising Ca 15-3 with negative conventional imaging: A multicentre study

ObjectivesBreast cancer is the second cause of death in women in Europe and North America. The mortality of this disease can be reduced with effective therapy and regular follow up to detect early recurrence. Tumor markers are sensitive in detecting recurrent or residual disease but imaging is required to customize the therapeutic option. Rising tumor markers and negative conventional imaging (US, X-mammography, CT and MR) poses a management problem. Our aim is to assess the role of ¹⁸F-FDG-PET/CT in the management of post-therapy patients with rising markers but negative conventional imaging.Materials and methodsIn the period from January 2008 to September 2009, 89 female patients with breast cancer who developed post-therapy rising markers (serum Ca 15-3 levels = 64.8 ± 16.3 U/mL) but negative clinical examination and conventional imaging were investigated with ¹⁸F-FDG-PET/CT.ResultsTumor deposits were detected in 40/89 patients in chest wall, internal mammary nodes, lungs, liver and skeleton. The mean SUVmax value calculated in these lesions was 6.6 ± 1.7 (range 3.1–12.8). In 23/40 patients solitary small lesion were amenable to radical therapy. In 7 out of these 23 patients a complete disease remission lasting more than 1 year was observed.Conclusions¹⁸F-FDG-PET/CT may have a potential role in asymptomatic patients with rising markers and negative conventional imaging. Our findings agree with other studies in promoting regular investigations such as tumor markers and ¹⁸F-FDG-PET/CT rather than awaiting the developments of physical symptoms as suggested by current guidelines since the timely detection of early recurrence may have a major impact on therapy and survival.     

Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma

PurposeTo investigate the relationships between pretreatment volume-based quantitative ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters and overall survival (OS) in patients with malignant pleural mesothelioma (MPM).Materials and methodsWe retrospectively reviewed data from 201 MPM patients, of whom 38 underwent surgical resection, and calculated the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), including primary tumors and nodal or distant metastatic lesions, on pretreatment ¹⁸F-FDG PET/CT. Relationships between clinicopathological factors (age, sex, performance status, European Organization for Research and Treatment of Cancer [EORTC] score, histological subtype, TNM stage, and treatment strategy), volume-based quantitative PET/CT parameters, and OS were evaluated using a Cox proportional hazards model and log-rank test.ResultsThe median follow-up was 15 months (range, 1–96 months; median, 17 months). In a univariate analysis of all patients, older age (p < 0.05), high EORTC score (p < 0.001), non-epithelioid histological subtype (p < 0.001), high T stage (p < 0.001), positive N/M status (p < 0.05, p < 0.001), advanced TNM stage (p < 0.001), non-surgical treatment (p < 0.001), and high SUVmax (p < 0.001), MTV (p < 0.001), or TLG (p < 0.001) were associated with significantly shorter OS. A multivariate analysis confirmed non-epithelioid subtype (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.14–2.48; p < 0.05), non-surgical treatment (HR: 0.58, 95% CI: 0.34–0.95; p < 0.05), and high TLG (HR: 1.97, 95% CI: 1.14–3.44; p < 0.05) as independent negative predictors.ConclusionsPretreatment volume-based quantitative ¹⁸F-FDG PET/CT parameters, especially TLG, could serve as potential surrogate markers for MPM prognosis.     

Diagnostic value of dynamic contrast-enhanced CT with perfusion imaging in the quantitative assessment of tumor response to sorafenib in patients with advanced hepatocellular carcinoma: A feasibility study

PurposeTo investigate the feasibility of perfusion-CT (p-CT) measurements in quantitative assessment of hemodynamic changes related to sorafenib in patients with advanced hepatocellular carcinoma (HCC).Materials and methodsTwenty-two patients with advanced HCC underwent p-CT study (256-MDCT scanner) before and 2 months after sorafenib administration. Dedicated perfusion software generated a quantitative map of arterial and portal perfusion and calculated the following perfusion parameters in target liver lesion: hepatic perfusion (HP), time-to-peak (TTP), blood volume (BV), arterial perfusion (AP), and hepatic perfusion index (HPI). After the follow-up scan, patients were categorized as responders and non-responders, according to mRECIST. Perfusion values were analyzed and compared in HCC lesions and in the cirrhotic parenchyma (n = 22), such as between baseline and follow-up in progressors and non-progressors.ResultsBefore treatment, all mean perfusion values were significantly higher in HCC lesions than in the cirrhotic parenchyma (HP 47.8 ± 17.2 vs 13.3 ± 6.3 mL/s per 100 g; AP 47.9 ± 18.1 vs 12.9 ± 10.7 mL/s; p < 0.001). The group that responded to sorafenib (n = 17) showed a significant reduction of values in HCC target lesions after therapy (HP 29.2 ± 23.3 vs 48.1 ± 15.1; AP 29.4 ± 24.6 vs 49.2 ± 17.4; p < 0.01), in comparison with the non-responder group (n = 5) that demonstrated no significant variation before and after treatment of HP (46.9 ± 25.1 vs 46.7 ± 24.1) and AP (43.4 ± 21.7 vs 43.5 ± 24.6). Among the responder group, HP percentage variation (Δ) in target lesions, during treatment, showed a significantly different (p = 0.04) ΔHP in the group with complete response (79%) compared to the group with partial response or stable disease (16%).Conclusionsp-CT technique can be used for HCC quantitative assessment of changes related to anti-angiogenic therapy. Identification of response predictors might help clinicians in selection of patients who may benefit from targeted-therapy allowing for optimization of individualized treatment.     

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.     

Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT

PurposeTo directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy.Materials and methodsFifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR + PR) and 2) stable or progressive disease (SD + PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV_max, and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared.ResultsThe step-wise regression test showed that therapeutic effect (r² = 0.63, p = 0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV_max. Mean overall survival showed a significant difference for total perfusion (p = 0.003) and systemic arterial perfusion (p = 0.04).ConclusionDynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.     

Is gender still a predisposing factor in contrast-media associated adverse drug reactions? A systematic review and meta-analysis of randomized trials and observational studies

ObjectiveTo evaluate the role of gender as a risk factor for developing contrast media-associated adverse drug reactions (CM-ADRs) by comparing the incidence of CM-ADR between male and female patients according to study design, ADR type, and computed tomography (CT) examination.Material and methodsWe systematically searched three electronic databases for eligible studies. In the studies included (n = 18), we assessed effect estimates of the relative incidence of CM-ADR, analysed by experimental design, ADR type and CT examination. This was calculated by using a random effects model if clinical conditions showed heterogeneity; otherwise, a fixed effects model was used.ResultsWe identified 10,776 patients administered CM. According to the designs, studies were classified into randomised controlled trials (RCTs) and observational studies. Results were as follows: risk ratio (RR) = 1.07 (95% confidence interval (CI): 0.79–1.46, P = 0.66) for RCTs, and RR = 0.77 (95% CI: 0.58–1.04, P = 0.09) for observational studies. The results of analysis according to ADR type and for undergoing CT demonstrated that the incidence of CM-ADR did not differ between males and females.ConclusionsWe found no significant difference in the incidence of CM-ADRs between male and female patients according to study design, ADR type, or CT examination. Future studies to determine why gender has shown different roles as a risk factor between CM-ADRs and non-CM ADRs are needed.     

18F-FDG PET/CT and contrast-enhanced CT findings of pulmonary cryptococcosis

PurposePulmonary cryptococcosis is an uncommon cause of pulmonary nodules in non-AIDS patients. This study reports the ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET/CT) and contrast-enhanced CT (CE-CT) findings of 42 patients with pulmonary cryptococcosis.Materials and methodsA retrospective review of the ¹⁸F-FDG PET/CT and CE-CT findings of 42 patients with histologically proven pulmonary cryptococcosis was conducted. All patients underwent PET/CT and CE-CT in the same session. The CT diagnosis was based on the location, morphological features, and enhancement of lesions. The PET/CT findings were recorded, and clinical data and surgical and histopathological findings were collected.ResultsThe results of the PET scans revealed that 37 (88%) of 42 patients showed higher FDG uptake, and 5 (12%) patients demonstrated lower FDG uptake than the mediastinal blood pool. The maximum standardized uptake value (SUV) of pulmonary cryptococcosis ranged from 1.4 to 13.0 (average: 5.7 ± 3.3, median 4.9). A single nodular pattern was the most prevalent pattern observed and was found in 29 (69%) patients. This pattern was followed by scattered nodular (n = 4, 10%), clustered nodular (n = 3, 7%), mass-like (n = 3, 7%), and bronchopneumonic (n = 3, 7%) patterns. The most frequent pattern of immunocompetent patients was the single nodular pattern (29 of 33, 88%). Immunocompromised patients most frequently pattern exhibited mass-like (3 of 9, 33%) and bronchopneumonic (3 of 9, 33%) patterns.ConclusionPulmonary cryptococcosis most commonly appears as single nodules in immunocompetent patients. Mass-like and bronchopneumonic patterns were common in immunocompromised patients. In 88% of patients, lung lesions showed high FDG uptake, thus mimicking a possible malignant condition.     

Evaluation of sclerosis in Modic changes of the spine using susceptibility-weighted magnetic resonance imaging

PurposeTo evaluate the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SWMR) for the differentiation of sclerotic and non-sclerotic Modic changes (MC) of the spine compared to computed tomography (CT) and radiographs.Materials and methodsThe Institutional Ethics-Review-Board approved this prospective study in advance. Written consent was obtained from all subjects. SWMR and standard T1/T2 MR of the cervical (n = 21) and/or lumbar spine (n = 34) were performed in 54 patients. 21 patients served as control. 18 patients were evaluated with CT; in all other patients radiographs were available. 67 Modic changes were identified on T1/T2 MR. On SWMR changes were classified as sclerotic and non-sclerotic based on signal intensity measurements. The sensitivity and specificity of SWMR and T1/T2 MR for differentiating between sclerotic and non-sclerotic Modic changes were determined with CT and radiographs as reference standard.ResultsOn SWMR, signal measurements between sclerotic and non-sclerotic Modic changes differed significantly (p < 0.01). On T1- and T2-weighted MR no significant difference (p > 0.05) was measured. On SWMR, a reliable differentiation between sclerotic and non-sclerotic Modic changes could be achieved, with a sensitivity of 100% and specificity of 95%. In contrast, the combination of T1-/T2-weighted MR yielded a significantly lower sensitivity to detect sclerosis (20%).ConclusionSWMR allows a reliable detection of sclerosis in Modic changes with a higher accuracy compared to standard spine MR sequences, using radiographs and CT as reference standard.     

Clinical usefulness of F-18 FDG PET in lymphoepithelioma-like gastric carcinoma

PurposeLymphoepithelioma-like carcinoma (LELC) is a rare type of gastric cancer. We evaluated the clinical usefulness of F-18 FDG positron emission tomography/computed tomography (PET/CT) in LELC of stomach.Materials and methodsA total of 28 patients (mean age = 59 years) who underwent preoperative F-18 FDG PET/CT were enrolled retrospectively. Nine patients underwent follow-up F-18 FDG PET/CT. Pathologic information was obtained through gastrectomy and the association with Epstein-Barr virus (EBV) was investigated in 26 patients.ResultsPET/CT detected 85.0% (17/20) of advanced gastric cancers (AGC) and 12.5% (1/8) of early gastric cancers (EGC). Most tumors (23/26, 88.5%) were EBV-associated. The maximum standardized uptake value of FDG-avid tumors was 7.5 ± 3.0. The sensitivity and specificity of PET/CT for the presence of lymph node metastasis was 47.8% (11/23) and 100.0% (13/13), respectively. PET/CT also detected a hepatic sarcomatoid carcinoma in one patient. The specificity of PET/CT for distant metastasis or second malignancy was 96.3%. Follow-up PET/CT detected malignant lesions in 3 of 9 patients; a liver metastasis, recurrent hepatic sarcomatoid carcinomas and a metachronous cholangiocarcinoma. PET/CT correctly excluded recurrence in the rest of the patients (6/6). The sensitivity and specificity of PET/CT for detecting recurrence or second malignancy was 100% and 100%, respectively.ConclusionF-18 FDG PET/CT would be a useful tool in evaluating distant metastasis or recurrence in patients with gastric LELC.     

Whole-body 18F-FDG PET/CT for M staging in the patient with newly diagnosed nasopharyngeal carcinoma: Who needs?

ObjectiveAlthough whole-body fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) (¹⁸F-FDG PET/CT) is commonly used for M staging of newly diagnosed nasopharyngeal carcinoma (NPC), some patients may not benefit from this procedure. The present study investigated which patients require this modality for M staging.MethodsWhole-body ¹⁸F FDG PET/CT results and clinical data were collected for 264 patients with newly diagnosed NPC. The relationships between distant metastasis and age, gender, pathological type, lesion size, SUVmax-T, T staging, N staging, SUVmax-N and Epstein-Barr virus (EBV) quantity were retrospectively analysed to identify factors associated with increased risk.ResultsOf the 264 patients, only 37 (14.0%) were diagnosed with distant metastasis. Using multiple logistic regression analysis, EBV-positivity (OR = 13.1; 95% CI:1.61,106.80), N staging (OR = 3.05; 95% CI:1.41,6.63) and T staging (OR = 2.16; 95% CI:1.10, 4.24) were significantly related to distant metastasis (all P < 0.05). EBV DNA levels ≥ 9000 copies/ml, N3 stage and T4 stage were identified as high risk factors. A low risk of distant metastasis was found in patients with 0–1 risk factors and in those with 2 specific risk factors, T3/T4 and N2/N3 staging. Patients with EBV DNA levels ≥9000 copies/ml and N3 or T4 staging and those with 3 risk factors had a medium or high risk, with a much higher incidence of distant metastasis (χ² = 29.896, P = 0.000), and needed a whole-body ¹⁸F FDG PET/CT for M staging.ConclusionsDue to the low incidence of distant metastasis, only patients with medium or high risk need to undergo a whole-body scan.     

Characteristics of clinical measurements between biomechanical responders and non-responders to a shoe designed for knee osteoarthritis

PurposeThe purpose of this study was to investigate the characteristics of biomechanical and clinical measurements in relation to the knee adduction moment when wearing a standard shoe and a shoe design for individuals with knee osteoarthritis (Flex-OA).MethodsKinematic and kinetic data were collected from thirty-two healthy individuals (64 knees) using a ten camera motion analysis system and four force plates. Subjects performed 5 walking trials under the two conditions and the magnitude of individuals’ biomechanical responses where explored in relation to the clinical assessment of the Foot Posture Index, hip rotation range, strength of hip rotators, and active ankle-foot motion, all of which have been described as possible compensation mechanisms in knee osteoarthritis.ResultsSignificant reductions in the first peak of the knee adduction moment (KAM) during stance phase (9.3%) were recorded (p < 0.0001). However, despite this difference, 22 of 64 knees showed either no change or an increased KAM, indicating a non-response or negative-response to the Flex-OA shoe. Significant differences were observed between the responder and non-responder subgroups in the hip rotation range ratio (p = 0.044) and the hip rotators strength ratio (p = 0.028).ConclusionSignificant differences were seen in clinical assessments of hip rotation range and hip rotator strength between responders and non-responders using a cut-off of 0.02 Nm/kg change in the KAM.     

Repeated CT scans in trauma transfers: An analysis of indications,radiation dose exposure,and costs

ObjectivesTo identify the number of CT scans repeated in acute trauma patients receiving imaging before being referred to a trauma center, to define indications, and to assess radiation doses and costs of repeated CT.MethodsThis retrospective study included all adult trauma patients transferred from other hospitals to a Level-I trauma center during 2014. Indications for repeated CT scans were categorized into: inadequate CT image data transfer, poor image quality, repetition of head CT after head injury together with completion to whole-body CT (WBCT), and follow-up of injury known from previous CT. Radiation doses from repeated CT were determined; costs were calculated using a nation-wide fee schedule.ResultsWithin one year, 85/298 (28.5%) trauma patients were transferred from another hospital because of severe head injury (n = 45,53%) and major body trauma (n = 23;27%) not manageable in the referring hospital, repatriation from a foreign country (n = 14;16.5%), and no ICU-capacity (n = 3;3.5%). Of these 85 patients, 74 (87%) had repeated CT in our center because of inadequate CT data transfer (n = 29;39%), repetition of head CT with completion to WBCT (n = 24;32.5%), and follow-up of known injury (n = 21;28.5%). None occurred because of poor image quality. Cumulative dose length product (DLP) and annual costs of potential preventable, repeated CT (inadequate data transfer) was 631mSv (81′304mGy*cm) and 35′233€, respectively.ConclusionA considerable number of transferred trauma patients undergo potentially preventable, repeated CT, adding radiation dose to patients and costs to the health care system.     

Photodynamic therapy in VEGF inhibition non-responders—Pharmacogenetic study in age-related macular degeneration assessed with swept-source optical coherence tomography

BackgroundTreatment of neovascular age-related macular degeneration (nAMD) remains a major challenge in ophthalmology. It is essential to determine which of VEGF inhibition non-responders can benefit from photodynamic therapy (PDT). As AMD is strongly related to gene polymorphisms, genetic factors can modify efficacy of treatment. Swept-source optical coherence tomography (SS-OCT) gives exceptional insight into the retina and choroid. SS-OCT usefulness needs to be evaluated in nAMD patients.MethodsProspective 6-month study included consecutive 110 patients (110 eyes) with predominantly classic neovascular AMD treated with photodynamic therapy. Only non-responders to anti-VEGF were included in the study. Greatest linear dimension (GLD) of the lesion, best corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and central choroidal thickness were assessed and compared between CFH and ARMS2 genotype groups. Success rate was the main endpoint. It was defined as not active CNV in the center of the fovea and no worsening in BCVA. Multiple regression was used to assess gene polymorphisms influence on PDT results. Wilcoxon tests were performed to determine significance of changes from baseline values.ResultsFollowing genotype frequencies were obtained—CFH CC 35 patients (31.8%), CT 52 (47.3%), TT 23 (20.9%); ARMS2 TT 28 patients (25.4%), GT 43 (39.1%), GG 39 (35.4%) success rate in CC/CT/TT CFH and TT/GT/GG ARMS2 groups were as follows respectively: 22.9%, 28.8%, 30.4% and 28.6%, 25.6%, 28.2%. The differences were not significant with highest odds ratio TT vs. CC CFH 1.57 (95% CI 0.48–5.2, p = 0.4). Significant increase in GLD was observed only in CC CFH group. Overall mean following measured parameters were obtained at baseline/day 7/month 3/month 6 (significant changes from baseline are marked with asterisk): GLD—3825 ± 1301 μm/3901 ± 1579 μm/3861 ± 1463 μm/3925 ± 1523 μm; CSMT—405 ± 203 μm/434 ± 257 μm*/321 ± 163 μm*/295 ± 157* μm; CCT—235 ± 103 μm/278 ± 157* μm/211 ± 113 μm*/201 ± 107* μm; BCVA—49.3 ± 12.5/43.2 ± 14.2*/49.6 ± 11.6/48.7 ± 12.2 letters on ETDRS charts. In all patients classic component of the lesion was assessed with SS-OCT with no need to be reaffirmed in FA. Thus FA was used mainly for lesion size calculation.ConclusionsCommon genetic factors seem not to influence PDT effectiveness in VEGF inhibitors non-responders. SS-OCT is a valuable tool of nAMD monitoring, especially for choroid assessment. Deterioration of retinal structure and function is observed one week after PDT. It is related to increase in both retinal and choroidal thickness and is accompanied by mild temporary BCVA decrease.     

Early liver metastases in resectable periampullary cancer: Incidence and risk factors

PurposeThe aim of the present study was to estimate the incidence of very early hepatic metastases (HMs) (<6 months) and their imaging patterns after cephalic duodenopancreatectomy (CDP) for periampullary carcinoma (excluding duodenal carcinoma) and to identify their associated risk factors.MethodsFrom January 2003 to June 2016, all patients who underwent surgical treatment for periampullary carcinoma by CDP at our institution and with adequate pre- and postoperative CT scans were included. Univariate and multivariate logistic regressions were performed to determine factors associated with very early HM and recurrence.ResultsOf the 132 patients included retrospectively, 27 (20.5%) patients developed HMs. The mean time to diagnosis of HM was 103.9 ± 55.2 days. HMs were multiple in 81.4% of cases and bilobar in 59.3% of cases; their mean maximum size was 16.7 ± 12.7 mm.In univariate logistic analysis, lymphovascular emboli were significantly associated with HM (p = 0.02). No independent risk factors for HM were found in multivariate analysis. In multivariate logistic analysis, two independent risk factors were identified for the occurrence of early recurrence: tumor size >23 mm on preoperative CT scan (OR: 3.3; 95% CI: [1.2–9.3]; p = 0.02) and tumor differentiation (poor vs. good: OR 15.5; 95 CI [1.5–158.3]; moderate vs. good: OR: 17.1; 95% CI: [1.9–154.4]; p = 0.04).ConclusionsNearly one in five patients developed HM after CDP within 6 months with a highly consistent pattern. A thorough preoperative assessment, combining CT scan and MRI with a delay of less than three weeks before surgery, appears essential. A routine systematic postoperative CT scan at 8 weeks is also required prior to initiating adjuvant chemotherapy.The type of surgical intervention does not seem to be a risk factor, although the risk of HM occurrence appears to be related to the lymphovascular invasion of the tumor and maybe its degree of differentiation, elements not assessable by imaging.     

The predictive value of computed tomography in the detection of reflux esophagitis in patients undergoing upper endoscopy

BackgroundReflux esophagitis (RE) may mimic symptoms requiring cross-sectional imaging.MethodsFrom 565 patients who had CT and esophagogastroduodenoscopy within four days apart, CT scans of 72 patients with RE confirmed by esophagogastroduodenoscopy and 108 matched patients without RE were evaluated for distal esophageal wall characteristics.ResultsIn RE patients the distal esophageal wall thickness was greater (5.2 ± 2.0 mm) compared to patients without RE (3.5 ± 1.2 mm, p < 0.0001) with AUC of 0.78 and 56% sensitivity, 88% specificity for a 5.0 mm cut-off.ConclusionsThere is a moderate association between distal esophageal wall thickness on CT and RE diagnosed by esophagogastroduodenoscopy as the reference standard.     

Differentiation and diagnosis of benign and malignant testicular lesions using 18F-FDG PET/CT

ObjectivesThe purpose of this study was to evaluate the differential diagnostic value of ¹⁸F-fluorodeoxy glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for benign and malignant testicular lesions.MethodsThe PET/CT scans of 53 patients with testicular lesions confirmed by biopsy or surgical pathology were retrospectively analyzed. There were 32 cases of malignant tumors and 21 cases of benign lesions. Differences in the maximum standardized uptake value (SUVmax) measurements and the SUVmax lesion/background ratios between benign and malignant lesions were analyzed. The diagnostic value of this PET/CT modality for the differential diagnosis of benign versus malignant testicular lesions was calculated.ResultsThe differences in the SUVmax measurements and the SUVmax lesion/background ratios between benign and malignant lesions were statistically significant (SUVmax: Z = −4.295, p = 0.000; SUVmax lesion/background ratio: Z = −5.219, p = 0.000); specifically, both of these indicators were higher in malignant lesions compared to benign lesions. An SUVmax of 3.75 was the optimal cutoff value to differentiate between benign and malignant testicular lesions. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this PET/CT modality in the differential diagnosis of benign versus malignant testicular lesions were 90.6%, 80.9%, 86.8%, 87.9%, and 85.0%, respectively.Conclusions¹⁸F-FDG PET/CT can accurately identify benign and malignant testicular lesions.     

Higher breast cancer conspicuity on dbPET compared to WB-PET/CT

ObjectivesThe purpose of this study was to evaluate lesion detectability of a dedicated breast positron-emission tomography (dbPET) scanner for breast cancers with an updated reconstruction mode, comparing it to whole-body positron-emission tomography/computed tomography (WB-PET/CT).Materials and methodsA total of 179 histologically-proven breast cancer lesions in 150 females who underwent both WB-PET/CT and dbPET with ¹⁸F-fluorodeoxyglucose were retrospectively analyzed. The patient/breast/lesion-based sensitivities based on visual analysis were compared between dbPET and WB-PET/CT. For lesions visible on both PET images, SUVmax values of the tumors were measured, and tumor-to-background ratios (T/B ratios) of SUVmax were compared between the two scans. Subgroup analyses according to clinical tumor stage, histopathology and histological grade were also performed.ResultsPatient/breast/lesion-based sensitivities were 95%, 95%, and 92%, respectively, for dbPET, and 95%, 94%, and 88%, respectively, for WB-PET/CT. Mean ± standard deviation SUVmax values of FDG-avid tumors were 13.0 ± 9.7 on dbPET and 6.4 ± 4.8 on WB-PET. T/B ratios were also significantly higher in dbPET than in WB-PET/CT (8.1 ± 7.1 vs. 5.1 ± 4.5). In the subgroup analysis, no significant differences in sensitivities between dbPET and WB-PET/CT were found. However, T/B ratios of dbPET were significantly higher than those of WB-PET/CT in cT1c, cT2, cT3, invasive cancer, invasive carcinoma of no special type, mucinous carcinoma and Grades 1–3.ConclusionNo significant differences in sensitivities were identified between dbPET using an updated reconstruction mode and WB-PET/CT; however, T/B ratios of dbPET were significantly higher than those of WB-PET/CT, indicating higher tumor conspicuity on dbPET.     

Single source dual energy CT: What is the optimal monochromatic energy level for the analysis of the lung parenchyma?

ObjectiveTo determine the optimal monochromatic energy level for lung parenchyma analysis in spectral CT.MethodsAll 50 examinations (58% men, 64.8 ± 16yo) from an IRB-approved prospective study on single-source dual energy chest CT were retrospectively included and analyzed.Monochromatic images in lung window reconstructed every 5 keV from 40 to 140 keV were independently assessed by two chest radiologists. Based on the overall image quality and the depiction/conspicuity of parenchymal lesions, each reader had to designate for every patient the keV level providing the best diagnostic and image quality.Results72% of the examinations exhibited parenchymal lesions.Reader 1 picked the 55 keV monochromatic reconstruction in 52% of cases, 50 in 30% and 60 in 18%. Reader 2 chose 50 keV in 52% cases, 55 in 40%, 60 in 6% and 40 in 2%. The 50 and 55 keV levels were chosen by at least one reader in 64% and 76% of all patients, respectively.Merging 50 and 55 keV into one category results in an optimal setting selected by reader 1 in 82% of patients and by reader 2 in 92%, with a 74% concomitant agreement.ConclusionThe best image quality for lung parenchyma in spectral CT is obtained with the 50–55 keV monochromatic reconstructions.