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Sample records for hepatic tumors ct

  1. Lipiodol enhanced CT scanning of malignant hepatic tumors.

    PubMed

    Eurvilaichit, C

    2000-04-01

    From August 1984 to March 1991, 41 patients with malignant liver tumors, 30 males and 11 females, aged 30-75 years were treated at Ramathibodi Hospital with injection of mitomycin-C lipiodol emulsion into the tumor via the feeding artery followed by embolization of the feeding artery with gelfoam particles. The patients comprised 30 cases of hepatocellular carcinoma, 4 cases of cholangiocarcinoma and 7 cases of metastatic tumors of which one was from CA stomach, three were from CA breast, and three from CA colon. The vascularity of the tumor was assessed in angiogram obtained prior to treatment and retention pattern of lipiodol in the tumor was evaluated in lipiodol-enhanced CT scan images taken 2-4 weeks following therapy. The results showed that lipiodol CT scan images exhibited four patterns of lipiodol retention in the tumor appearing as opacity as follows (1) homogenous (2) heterogeneous (3) ring-like and (4) none. Lipiodol retention pattern appeared to be somewhat related to vascularity of the tumor. Most of the hypervascular tumors such as hepatocellular carcinoma had homogeneous lipiodol accumulation pattern if the tumor size was less than 5 cm. Metastatic tumors and cholangiocarcinoma showed heterogeneous or ring-like pattern of lipiodol accumulation because they were relatively hypovascular. Hypervascular hepatocellular carcinoma may exhibit heterogeneous or ring-like pattern if they are larger than 5 cms, and have multiple feeding arteries, necrosis or AV shunting. Hepatocellular carcinoma with AV shunting may not show any lipiodol accumulation at all.

  2. Hepatic perfusion in a tumor model using DCE-CT: an accuracy and precision study

    NASA Astrophysics Data System (ADS)

    Stewart, Errol E.; Chen, Xiaogang; Hadway, Jennifer; Lee, Ting-Yim

    2008-08-01

    In the current study we investigate the accuracy and precision of hepatic perfusion measurements based on the Johnson and Wilson model with the adiabatic approximation. VX2 carcinoma cells were implanted into the livers of New Zealand white rabbits. Simultaneous dynamic contrast-enhanced computed tomography (DCE-CT) and radiolabeled microsphere studies were performed under steady-state normo-, hyper- and hypo-capnia. The hepatic arterial blood flows (HABF) obtained using both techniques were compared with ANOVA. The precision was assessed by the coefficient of variation (CV). Under normo-capnia the microsphere HABF were 51.9 ± 4.2, 40.7 ± 4.9 and 99.7 ± 6.0 ml min-1 (100 g)-1 while DCE-CT HABF were 50.0 ± 5.7, 37.1 ± 4.5 and 99.8 ± 6.8 ml min-1 (100 g)-1 in normal tissue, tumor core and rim, respectively. There were no significant differences between HABF measurements obtained with both techniques (P > 0.05). Furthermore, a strong correlation was observed between HABF values from both techniques: slope of 0.92 ± 0.05, intercept of 4.62 ± 2.69 ml min-1 (100 g)-1 and R2 = 0.81 ± 0.05 (P < 0.05). The Bland-Altman plot comparing DCE-CT and microsphere HABF measurements gives a mean difference of -0.13 ml min-1 (100 g)-1, which is not significantly different from zero. DCE-CT HABF is precise, with CV of 5.7, 24.9 and 1.4% in the normal tissue, tumor core and rim, respectively. Non-invasive measurement of HABF with DCE-CT is accurate and precise. DCE-CT can be an important extension of CT to assess hepatic function besides morphology in liver diseases.

  3. Differential diagnosis of hepatic tumor-like lesions in dog by using dynamic CT scanning.

    PubMed

    Taniura, Tokunori; Marukawa, Kazushi; Yamada, Kazutaka; Hikasa, Yoshiaki; Ito, Katsuhide

    2009-03-01

    Dynamic liver CT scanning is used to observe the hemodynamics of hepatic tumor-like lesions by taking images sequentially after administration of contrast media. In this study in dogs, we compared the hemodynamic patterns of hepatocellular carcinoma (HCC), one of the malignant tumors, and nodular hyperplasia (NH), a benign tumor that is more common in older dogs. Thirty-six dogs with HCC and 40 dogs with NH, which were histopathologically diagnosed at Taniura Animal Hospital, were used as subjects. Dynamic CT scanning was performed and the data of each scanning phase were collected. Dilated blood vessels, septum formation, and capsule formation were noted in the tumors from 25, 17, and 25 animals with HCC, respectively. In the arterial phase, high density and low contrast were noted in 8 and 23 dogs, respectively. Low density was noted in 34 dogs in the equilibrium phase. In contrast, no dilated blood vessels, septum formation, or capsule formation was noted in the dogs with NH. High density, low contrast, and low density were noted in 8, 9, and 23 dogs, respectively, in the arterial phase. In the equilibrium phase, the enhancement level was equal to the surrounding liver tissues in all animals. The CT values of HCC in the plain, the arterial phase, portal venous phase and equilibrium phase after the administration of contrast media, were significantly (p < 0.05 to 0.001) lower than those of the surrounding liver tissues. In the arterial phase, the percent incidence of low density was significantly less in HCC than NH, while that of low contrast was significantly greater (p < 0.001) in HCC than NH. Dynamic CT scanning identified differences between the hemodynamics and internal structures of HCC and NH in dogs. Dynamic liver CT scanning can therefore be considered a useful technique in the differential diagnosis of hepatic tumor-like lesions in dogs.

  4. CT-Guided Percutaneous Microwave Ablation of Tumors in the Hepatic Dome: Assessment of Efficacy and Safety.

    PubMed

    Asvadi, Nazanin H; Anvari, Arash; Uppot, Raul N; Thabet, Ashraf; Zhu, Andrew X; Arellano, Ronald S

    2016-04-01

    To evaluate the technique, efficacy, safety, and clinical outcomes of CT-guided microwave ablation of tumors in the hepatic dome. Retrospective review was conducted of 46 consecutive patients (31 men and 15 women; mean age, 64 y) treated with CT-guided microwave ablation for hepatic-dome tumors between June 2011 and December 2014. Baseline demographics of sex, tumor diagnosis, tumor location, tumor size, and technical details were recorded. Technical success was evaluated. Treatment response was assessed per European Association for the Study of the Liver criteria. Overall success and overall survival were calculated, and complications were recorded. Forty-eight tumors were treated. Tumor locations included segments VIII (n = 32), VII (n = 10), and VIa (n = 6). Mean tumor size was 2.4 cm (range, 0.9-5.2 cm). Thirty-four tumors (70%) were treated following creation of artificial ascites with 0.9% normal saline solution (mean volume, 1,237 mL; range, 300-3,000 mL). The technical success rate was 100%, and the complete response rate was 94%. Overall survival rate was 73.9% over 24.7 months of follow-up. There were no major complications. Two patients experienced small, asymptomatic pneumothoraces that were aspirated at the time of the procedure and required no further treatment. CT-guided microwave ablation of tumors in the hepatic dome is associated with a high technical success rate, high complete response rate, and low complication rate. Published by Elsevier Inc.

  5. Dynamic-thresholding level set: a novel computer-aided volumetry method for liver tumors in hepatic CT images

    NASA Astrophysics Data System (ADS)

    Cai, Wenli; Yoshida, Hiroyuki; Harris, Gordon J.

    2007-03-01

    Measurement of the volume of focal liver tumors, called liver tumor volumetry, is indispensable for assessing the growth of tumors and for monitoring the response of tumors to oncology treatments. Traditional edge models, such as the maximum gradient and zero-crossing methods, often fail to detect the accurate boundary of a fuzzy object such as a liver tumor. As a result, the computerized volumetry based on these edge models tends to differ from manual segmentation results performed by physicians. In this study, we developed a novel computerized volumetry method for fuzzy objects, called dynamic-thresholding level set (DT level set). An optimal threshold value computed from a histogram tends to shift, relative to the theoretical threshold value obtained from a normal distribution model, toward a smaller region in the histogram. We thus designed a mobile shell structure, called a propagating shell, which is a thick region encompassing the level set front. The optimal threshold calculated from the histogram of the shell drives the level set front toward the boundary of a liver tumor. When the volume ratio between the object and the background in the shell approaches one, the optimal threshold value best fits the theoretical threshold value and the shell stops propagating. Application of the DT level set to 26 hepatic CT cases with 63 biopsy-confirmed hepatocellular carcinomas (HCCs) and metastases showed that the computer measured volumes were highly correlated with those of tumors measured manually by physicians. Our preliminary results showed that DT level set was effective and accurate in estimating the volumes of liver tumors detected in hepatic CT images.

  6. Therapeutic response assessment using 3D ultrasound for hepatic metastasis from colorectal cancer: Application of a personalized, 3D-printed tumor model using CT images

    PubMed Central

    Choi, Ye Ra; Park, Sang Joon; Hur, Bo Yun; Han, Joon Koo

    2017-01-01

    Background & aims To evaluate accuracy and reliability of three-dimensional ultrasound (3D US) for response evaluation of hepatic metastasis from colorectal cancer (CRC) using a personalized 3D-printed tumor model. Methods Twenty patients with liver metastasis from CRC who underwent baseline and after chemotherapy CT, were retrospectively included. Personalized 3D-printed tumor models using CT were fabricated. Two radiologists measured volume of each 3D printing model using 3D US. With CT as a reference, we compared difference between CT and US tumor volume. The response evaluation was based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Results 3D US tumor volume showed no significant difference from CT volume (7.18 ± 5.44 mL, 8.31 ± 6.32 mL vs 7.42 ± 5.76 mL in CT, p>0.05). 3D US provided a high correlation coefficient with CT (r = 0.953, r = 0.97) as well as a high inter-observer intraclass correlation (0.978; 0.958–0.988). Regarding response, 3D US was in agreement with CT in 17 and 18 out of 20 patients for observer 1 and 2 with excellent agreement (κ = 0.961). Conclusions 3D US tumor volume using a personalized 3D-printed model is an accurate and reliable method for the response evaluation in comparison with CT tumor volume. PMID:28797089

  7. Effects of monoterpenes and mevinolin on murine colon tumor CT-26 in vitro and its hepatic "metastases" in vivo.

    PubMed

    Broitman, S A; Wilkinson, J; Cerda, S; Branch, S K

    1996-01-01

    Tumors derived from the colonic epithelium exhibit cholesterol metabolism which is clearly different from that in fibroblasts, hepatocytes, adrenals, and ovaries. In hepatocytes and fibroblasts MEV inhibition of the rate limiting step in cholesterol synthesis HMG Co A reductase can be overcome by the uptake of LDL. Colon cancer cells however do not overcome MEV inhibition by LDL uptake but rather exhibit further growth suppression Mevinolin (Mevacor), a drug used to lower serum cholesterol levels has the advantage of accumulating in the liver to approximately 95% with the first pass. A small but variable percentage of non-sterol precursors may escape inhibition and be utilized for other pathways in the isoprenylation of certain proteins, among them members of the ras family. Mutated ras, an oncogene, is found in 40-50% of colon tumors and the expression of a functional gene product is dependent on isoprenylation for anchorage to the tumor cell membrane. d-Limonene, a relatively non-toxic monoterpene found in orange skin oil, selectively inhibits isoprenylation and also accumulates to some extent in the liver. It was hypothesized that the differences in mevalonate metabolism between hepatocytes and colon tumor cells could provide a chemotherapeutic advantage in which MEV and/or d-limonene could effectively inhibit cholesterol synthesis and post-translational modification of proteins with non-sterol cholesterol precursors in colon tumor derived hepatic metastases and thus inhibit their growth. Since each drug affects aspects of mevalonate synthesis at different points, the effects of the combination of their agents on inhibiting tumor metastases was investigated to ascertain if these could be additive. In tissue culture, MEV and d-limonene significantly inhibited the growth of CT-26, a murine transplantable colon tumor. Cholesterol synthesis assessed in these cells indicated that in lipid deficient media the following additions-25-hydroxycholesterol, and LDL

  8. Intraarterial Chemotherapy or Chemoembolization for Locally Advanced and/or Recurrent Hepatic Tumors: Evaluation of the Feeding Artery with an Interventional CT System

    SciTech Connect

    Hirai, Toshinori; Korogi, Yukunori; Ono, Ken; Maruoka, Kousei; Harada, Kazunori; Aridomi, Satoshi; Takahashi, Mutsumasa

    2001-05-15

    Purpose: To evaluate the utility of an interventional CT system for intraarterial chemotherapy or chemoembolization for locally advanced and/or recurrent hepatic tumors.Methods: Thirty-eight patients with locally advanced or recurrent hepatic tumors underwent 73 intraarterial contrast-enhanced CT (IA-CECT) examinations immediately before chemotherapy or chemoembolization. The degree of tumor vascularity on angiography and enhancement on IA-CECT was classified into three grades: no, mild, or marked vascularity. The IA-CECT grades were compared with the angiographic grades.Results: Twenty-nine (69%) of 42 examinations that were interpreted as having no or mild vascularity on angiography were classified as marked enhancement on IA-CECT. Based on IA-CECT findings, the position of the catheter was changed in 14 (19%) of 73 CT examinations. The reasons for the reposition were as follows: weak or no enhancement of the tumor (n = 11) or strong enhancement of the gallbladder wall (n = 3). The treatment strategy was changed in three patients (8%). No major complications relating to the interventional procedures were observed.Conclusions: IA-CECT is a reliable method when evaluating the perfusion of the tumor and adjacent normal tissues. The interventional CT system is useful for performing safe and effective intraarterial chemotherapy or chemoembolization in patients with locally advanced and/or recurrent hepatic tumors.

  9. Primary hepatic carcinoid tumor.

    PubMed

    Gao, Jinbo; Hu, Zhijian; Wu, Junwei; Bai, Lishan; Chai, Xinqun

    2011-11-19

    Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

  10. An Unusual Case of Hepatic Tumor

    PubMed Central

    Frena, Antonio; Zanetti, Gianfranco; Gozzetti, Giuseppe

    1991-01-01

    A case is reported of a large hepatic tumor in a patient aged 71. Preoperative diagnostic techniques, including echography, CT and angiography, did not provide sufficient criteria for a precise diagnosis. The mass was removed with an extended right hepatectomy with no particular physiopathological consequences. Histological analysis revealed that this was a metastasis from a melonoma of the choroid, operated on 17 years previously. PMID:1859802

  11. CT densities in delayed iodine hepatic scanning

    SciTech Connect

    Perkerson, R.B. Jr.; Erwin, B.C.; Baumgartner, B.R.; Phillips, V.M.; Torres, W.E.; Clements, J.L. Jr.; Gedgaudas-McClees, K.; Bernardino, M.E.

    1985-05-01

    Sixty patients underwent CT scanning of the liver prior to, immediately after, and four hours after intravenous administration of 60% meglumine diatrizoate. Twenty patients received a 50 ml bolus of contrast material, 20 received 100 ml, and 20 received 200 ml. In each group, delayed CT scanning safely raised the inherent density of the liver significantly. Thus, delayed scanning with doses presently used in abdominal and neurological CT examinations may be helpful in detecting hepatic lesions.

  12. Hepatic tumor ablation.

    PubMed

    Sindram, David; Lau, Kwan N; Martinie, John B; Iannitti, David A

    2010-08-01

    Ablation of liver tumors is part of a multimodality liver-directed strategy in the treatment of various tumors. The goal of ablation is complete tumor destruction, and ultimately improvement of quality and quantity of life for the patient. Technology is evolving rapidly, with important improvements in efficacy. The current state of ablation technology and indications for ablation are described in this review.

  13. Hepatic perivascular epithelioid cell tumor

    PubMed Central

    Tang, Da; Wang, Jianmin; Tian, Yuepeng; Li, Qiuguo; Yan, Haixiong; Wang, Biao; Xiong, Li; Li, Qinglong

    2016-01-01

    Abstract Rational: Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers. PEComas are found in a variety locations in the body, but up to now only approximately 30 cases about hepatic perivascular epithelioid cell tumor are reported in English language worldwide. Patient concerns: A 32-year-old woman was admitted in our hospital with intermittent right upper quadrant pain for 1 month and recent (1 day) progressive deterioration. Diagnoses: Based on the results of the laboratory examinations and the findings of the computed tomography, the diagnosis of hepatic hamartoma or the hepatocecullar carcinoma with hemorrhage was made. Interventions: The patient underwent a segmentectomy of the liver, and the finally diagnosis of hepatic PEComa was made with immunohistochemical confirmation with HMB-45 and SMA. Outcomes: There is no clinical or radiographic evidence of recurrence 9 months after surgery. Lessons: This kind of tumor is extremely rare and the natural history of PEComa is uncertain, as the treatment protocol for hepatic PEComa has not reached a consensus. But the main treatment of the disease may be surgical resection. Only after long term follow-up can we know whether the tumor is benign or malignant. It appears that longer clinical follow-up is necessary in all patients with hepatic PEComas. PMID:28002331

  14. [Hepatic tumors and radiotherapy].

    PubMed

    Rio, E; Mornex, F; Peiffert, D; Huertas, A

    2016-09-01

    Recent technological developments led to develop the concept of focused liver radiation therapy. We must distinguish primary and secondary tumors as the indications are restricted and must be discussed as an alternative to surgical or medical treatments. For hepatocellular carcinoma 5 to 10cm (or more), a conformational radiation with or without intensity modulation is performed. Stereotactic body radiotherapy (SBRT) is being evaluated and is increasingly proposed as an alternative to radiofrequency ablative treatment for primary or secondary tumors (typically less than 5cm). Tumor (and liver) movements induced by respiratory motions must be taken into account. Strict dosimetric criteria must be met with particular attention to the dose-volume histograms to liver and the hollow organs, including cases of SBRT.

  15. CT of hepatic schistosomiasis mansoni

    SciTech Connect

    Fataar, S.; Bassiony, H.; Satyanath, S.; Rudwan, M.A.; Khaffaji, S.; El Magdy, W.; Al-Ansari, A.G.; Hanna, R.

    1985-07-01

    Schistosomal periportal fibrosis produced a typical pattern on computed tomography in five patients. Low-density periportal tissue, present throughout the liver, enhanced strongly after the administration of contrast medium. While rounded in cross section, the thickened periportal tissue produced linear and branching patterns when imaged in longitudinal section. In all cases, the sonographic features were typical of schistosomal periportal fibrosis. A lack of awareness of the distinctive features of periportal fibrosis may result in a mistaken diagnosis of hepatic metastases.

  16. Uncommon hepatic tumors: iconographic essay - Part 2.

    PubMed

    Pedrassa, Bruno Cheregati; da Rocha, Eduardo Lima; Kierzenbaum, Marcelo Longo; Bormann, Renata Lilian; Francisc, Viviane Vieira; D'Ippolito, Giuseppe

    2014-01-01

    In cases where typical aspects are shown, the diagnosis of most frequent hepatic lesions can be made with some safety by means of several imaging methods; on the other hand, uncommon lesions generally represent a diagnostic challenge for the radiologist. In the present second part of the study, the authors describe four rare hepatic lesions, as follows: primary hepatic lymphoma, myofibroblastic tumor, primary hepatic neuroendocrine tumor and desmoplastic small round cell tumor, approaching their main characteristics and imaging findings with emphasis on computed tomography and magnetic resonance imaging.

  17. Hepatic tumor angiography: a subject review

    SciTech Connect

    Chuang, V.P.

    1983-09-01

    The dual blood supply of the normal hepatic parenchyma and the single arterial supply of hepatic neoplasms are important factors in the interpretation of celiac and hepatic arteriograms. Depending on whether the hepatic artery, portal vein, or both are opacified, three types of hepatogram can occur: arterial, portal, or mixed. On the celiac arteriogram, the densely opacified hepatic parenchyma makes the less well opacified tumor appear relatively hypovascular; and conversely, on the hepatic arteriogram the nonopacified portal flow has a ''wash-out'' effect on the normal parenchyma so that the neoplasm remains hypervascular. Thus most hepatic neoplasms are hypervascular on the hepatic arteriogram, and conversion of a hypervascular tumor to a hypovascular one is indicative of its response to treatment.

  18. Intra-abdominal desmoplastic small round cell tumors: CT and FDG-PET/CT findings with histopathological association.

    PubMed

    Chen, Jingjing; Wu, Zengjie; Sun, Binbin; Li, Dacheng; Wang, Zhenguang; Liu, Fangjun; Hua, Hui

    2016-05-01

    Desmoplastic small round cell tumors (DSRCTs) are rare and aggressive malignant tumors. The aim of the present study was to analyze computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET)/CT imaging features of intra-abdominal desmoplastic DSRCT, and investigate the association of these features with histopathological results. The present study was a retrospective investigation of 4 patients with DSRCT. All patients underwent CT and dynamic CT, and 1 additionally underwent FDG-PET/CT scanning. Following a tumor resection, routine hematoxylin and eosin staining, and immunostaining, were performed and evaluated. Multiple large abdominopelvic masses were identified in all 4 patients; however, no indications of their site of origin were demonstrated. CT revealed soft-tissue masses with patchy foci of hypodense lesions. Contrast-enhanced CT revealed slightly or moderately heterogeneous enhancement of the lesions. Other observations from these patients included calcification (n=2), peritoneal seeding (n=3), hepatic metastasis (n=3), retroperitoneal lymphadenopathy (n=3) and ascites (n=2). FDG-PET/CT revealed multiple nodular increased FDG uptake in the abdominopelvic masses, and in the liver and peritoneum in 1 case. Intra-abdominal DSRCT demonstrated significant diagnostic characteristics on plain and contrast-enhanced CT. Multiple, bulky soft-tissue masses inside the peritoneal cavity, particularly in male adolescents and young adults, should be considered as potential cases of DSRCT. FDG-PET/CT techniques may be utilized to aid the staging of tumors.

  19. A rare case of a primary hepatic neuroendocrine tumor

    PubMed Central

    Kulkarni, Prasad

    2016-01-01

    Neuroendocrine tumors are well-differentiated low grade malignant neoplasms. Their pathogenesis is thought to be secondary to the unrestricted proliferation of neuroendocrine cells. They most commonly arise in the bronchopulmonary or gastrointestinal tract but can originate from almost any organ. While the liver is a common site of metastases, primary hepatic neuroendocrine tumors are an exceedingly rare pathology, of which fewer than 100 cases have been described in world literature. Thus, there exists a paucity of data regarding the clinical presentation, diagnosis and management of this disease. We present a case of a 35-year-old patient who presented to our facility for evaluation of a cough and cervical lymphadenopathy. Two biopsies of the lymph nodes were negative, however on workup for an occult malignancy a hypodense heterogeneous hypervascular lesion measuring 3.7 cm × 2.7 cm in segment IVb of the liver was noted on computer tomography (CT) scan. The levels of laboratory studies such as liver enzymes, alkaline phospatase, chromogranin A, 24-hour 5 hydroxyindoleacetic acid (5-HIAA) and tumor markers including alpha fetoprotein were not elevated. An MRI confirmed the mass, and the patient underwent CT guided biopsy of the hepatic lesion. Staining from the biopsy resulted in cells reactive for synaptophysin, chromogranin, anti-Cytokeratin (CAM 5.2), MOC31, CD 56 and mucin glycoprotein (MUC) confirming a nonsecretory neuroendocrine tumor. Patient underwent octreotide scan, PET scan, CT chest, MRI head along with EUS, EGD and colonoscopy to evaluate for a primary source, however, none was found. The well localized presentation without extensive hepatic invasion made the patient a candidate for surgical resection which was successfully performed. The patient remains disease free over 36 months after initial presentation. Primary hepatic neuroendocrine tumors are an exceedingly rare entity whose variable presentation necessitates provider familiarity with this

  20. Dynamic perfusion CT in brain tumors.

    PubMed

    Yeung, Timothy Pok Chi; Bauman, Glenn; Yartsev, Slav; Fainardi, Enrico; Macdonald, David; Lee, Ting-Yim

    2015-12-01

    Dynamic perfusion CT (PCT) is an imaging technique for assessing the vascular supply and hemodynamics of brain tumors by measuring blood flow, blood volume, and permeability-surface area product. These PCT parameters provide information complementary to histopathologic assessments and have been used for grading brain tumors, distinguishing high-grade gliomas from other brain lesions, differentiating true progression from post-treatment effects, and predicting prognosis after treatments. In this review, the basic principles of PCT are described, and applications of PCT of brain tumors are discussed. The advantages and current challenges, along with possible solutions, of PCT are presented. Copyright © 2015. Published by Elsevier Ireland Ltd.

  1. The added value of PET/Ce-CT/DW-MRI fusion in assessment of hepatic focal lesions: PET/Ce-CT/DW-MRI fusion in hepatic focal lesion.

    PubMed

    Salem, Shahenda; Houseni, Mohamed; Zidan, Lamiaa; Kandil, Ahmed

    2015-07-01

    The liver hosts a variety of benign and malignant tumors. Accurate diagnosis can be challenging in certain cases, especially in patients with a history of malignancy or in those with underlying liver pathology, such as cirrhosis. To evaluate the added clinical value of multi-modality liver imaging utilizing PET/Ce-CT/DW-MRI for characterization of hepatic focal lesions (HFL) and compare it with each diagnostic modality when interpreted alone. The study included 35 patients with HFL. They were 7 females & 28 males; their age ranged from 41 to 78years, all patients underwent PET/Ce-CT and DW-MRI scans. Ce-CT, PET and DW-MR images were reviewed independently, and then combined PET/Ce-CT, PET/DW-MRI and PET/Ce-CT/DW-MRI scans were analyzed. The results were correlated with histopathology or clinical/imaging follow-up. The 35 patients had 98 focal lesions. Fifty-three lesions were finally diagnosed as primary hepatocellular carcinoma, 18 lesions were metastases, 7 lesions were lymphoma and 20 lesions were benign. On a patient based analysis; the sensitivity, specificity, PPV, NPV and accuracy were 100%, 67%, 94%, 100% and 94% for PET/Ce-CT compared to 97%, 83%, 97%, 83% and 94 % for DW-MRI, respectively. Combined PET/Ce-CT/DW-MR scans raise those parameters up to 100%. On a lesion based analysis; the sensitivity, specificity, PPV, NPV and accuracy were 94%, 75%, 94%, 75%, 90% for PET/Ce-CT compared to 94%, 95%, 99%, 97% and 94 % for DW-MRI, respectively. All these parameters were 100 % with PET/Ce-CT/DW-MRI. The addition of DW-MRI to PET/Ce-CT is valuable in the characterization of hepatic focal lesions. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Microwave ablation of hepatic tumors abutting the diaphragm is safe and effective.

    PubMed

    Smolock, Amanda R; Lubner, Meghan G; Ziemlewicz, Timothy J; Hinshaw, J Louis; Kitchin, Douglas R; Brace, Christopher L; Lee, Fred T

    2015-01-01

    The purpose of this study was to evaluate the incidence of clinically significant diaphragmatic injuries and local tumor progression after microwave ablation of hepatic tumors abutting the diaphragm. This retrospective study included 55 peripheral hepatic tumors abutting the diaphragm treated by microwave ablation versus a control group of 15 centrally located tumors. Treated tumors were further subdivided according to the use of artificial ascites (fluid vs no fluid) and whether instilled fluid achieved displacement of the liver surface away from the diaphragm (displaced vs nondisplaced). Measurements of tumor size, distance to the diaphragm, ablation zone size, displacement distance, length of the ablation zone along the liver capsule, diaphragm thickness, diaphragmatic hernia, and local tumor progression were made on pre- and postablation CT and MRI. The electronic medical record was reviewed for patient self-reported pain scores and other symptoms. Data were analyzed by use of the Kruskal-Wallis and Fisher exact tests. There were no cases of diaphragmatic hernia in peripheral or central tumors. Postablation diaphragm thickness was higher in peripheral hepatic tumors than in control tumors. Peripheral tumors had an overall higher incidence of postprocedure shoulder pain (18% vs 0%) and local tumor progression (5.5% vs 0%) compared with control tumors, but these differences did not achieve statistical significance (p = 0.2 and p = 1, respectively). Our study shows that microwave ablation of peridiaphragmatic hepatic tumors is safe, without incidence of diaphragmatic hernia, and can be performed with a low rate of local tumor progression.

  3. CT-guided radiofrequency tumor ablation in children.

    PubMed

    Botsa, Evanthia; Poulou, Loukia S; Koutsogiannis, Ioannis; Ziakas, Panayiotis D; Koundouraki, Antonia; Alexopoulou, Efthimia; Thanos, Loukas

    2014-11-01

    Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5-18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3-2.8 cm). The median time for ablation was 8 min (range 7-10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients.

  4. [Epithelioid hemangioendothelioma: a rare hepatic tumor].

    PubMed

    Botella, M T; Cabrera, T; Sebastián, J J; Navarro, M J; Alvarez, R; Uribarrena, R

    1995-10-01

    We present a case of epithelioid hemangioendothelioma of the liver (EHL). The imaging techniques did not permit the diagnosis. A liver biopsy was done under laparoscopy. One year later, the patient remains without symptoms in spite of the presence of lung metastases and the therapeutic abstention. The most outstanding aspects of this rare hepatic tumor are discussed.

  5. Primary Hepatic Carcinoid Tumor with Poor Outcome.

    PubMed

    Parkash, Om; Ayub, Adil; Naeem, Buria; Najam, Sehrish; Ahmed, Zubair; Jafri, Wasim; Hamid, Saeed

    2016-03-01

    Primary Hepatic Carcinoid Tumor (PHCT) represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 opted for palliative care and expired in one month’s time. Surgical resection was advised to the second case, but he left against medical advice.

  6. Multidetector CT of hepatic artery pathologies.

    PubMed

    Karaosmanoglu, D; Erol, B; Karcaaltincaba, M

    2012-01-01

    The hepatic artery can be involved by a variety of pathology and diseases.Today MDCT enables high quality imaging of the hepatic artery using axial, MIP and volume rendered images. We illustrate MDCT findings of anatomical variations, aneurysm, dilatation, dissection, arteriovenous fistula, thrombosis and stenosis. Aneurysms can be saccular, fusiform and multiple and may develop due to atherosclerosis, vasculitis, trauma and biopsy. Dilatation of hepatic artery can be seen in portal hypertension, Osler-Weber-Rendu disease and hemangiomatosis. Hepatic artery can be occluded after trauma and transplantation. Dissection develops due to atherosclerosis, Marfan and Ehler Danlos syndromes and during pregnancy. Arteriovenous fistula can be congenital and acquired. We conclude that various hepatic artery pathologies can be confidently diagnosed by MDCT.

  7. Uncommon hepatic tumors: iconographic essay - Part 1*

    PubMed Central

    Pedrassa, Bruno Cheregati; da Rocha, Eduardo Lima; Kierszenbaum, Marcelo Longo; Bormann, Renata Lilian; Torres, Lucas Rios; D'Ippolito, Giuseppe

    2014-01-01

    Most malignant liver tumors are represented by hepatocellular carcinoma and cholangiocarcinoma; however a variety of other uncommon hepatic lesions might also be found. Common lesions such as hemangioma, focal nodular hyperplasia and metastases are well known and have already been extensively documented in the literature. The diagnosis of typical hepatic lesions may be done with some reliability by means of several imaging methods; on the other hand, uncommon lesions normally represent a diagnostic challenge for the radiologist. In this first part of the study, the authors will approach five uncommon liver tumors - angiosarcoma, angiomyolipoma, cystadenoma/biliary carcinoma, epithelioid hemangioendothelioma, and fibrolamellar hepatocellular carcinoma -, describing their main characteristics and image findings with focus on computed tomography and magnetic resonance imaging. PMID:25741106

  8. Uncommon hepatic tumors: iconographic essay - Part 1.

    PubMed

    Pedrassa, Bruno Cheregati; da Rocha, Eduardo Lima; Kierszenbaum, Marcelo Longo; Bormann, Renata Lilian; Torres, Lucas Rios; D'Ippolito, Giuseppe

    2014-01-01

    Most malignant liver tumors are represented by hepatocellular carcinoma and cholangiocarcinoma; however a variety of other uncommon hepatic lesions might also be found. Common lesions such as hemangioma, focal nodular hyperplasia and metastases are well known and have already been extensively documented in the literature. The diagnosis of typical hepatic lesions may be done with some reliability by means of several imaging methods; on the other hand, uncommon lesions normally represent a diagnostic challenge for the radiologist. In this first part of the study, the authors will approach five uncommon liver tumors - angiosarcoma, angiomyolipoma, cystadenoma/biliary carcinoma, epithelioid hemangioendothelioma, and fibrolamellar hepatocellular carcinoma -, describing their main characteristics and image findings with focus on computed tomography and magnetic resonance imaging.

  9. Hepatic perfusion abnormalities during CT angiography: Detection and interpretation

    SciTech Connect

    Freeny, P.C.; Marks, W.M.

    1986-06-01

    Twenty-seven perfusion abnormalities were detected in 17 of 50 patients who underwent computed tomographic angiography (CTA) of the liver. All but one of the perfusion abnormalities occurred in patients with primary or metastatic liver tumors. Perfusion abnormalities were lobar in nine cases, segmental in 11, and subsegmental in seven; 14 were hypoperfusion and 13 were hyperperfusion abnormalities. The causes for the abnormalities included nonperfusion of a replaced hepatic artery (n = 11), cirrhosis and nodular regeneration (n = 3), altered hepatic hemodynamics (e.g., siphoning, laminar flow) caused by tumor (n = 7), contrast media washout from a nonperfused vessel (n = 1), compression of adjacent hepatic parenchyma (n = 1), and unknown (n = 4). Differentiation of perfusion abnormalities from tumor usually can be made by comparing the morphology of the known tumor with the suspected perfusion abnormality, changes of each on delayed CTA scans, and review of initial angiograms and other imaging studies.

  10. Effect of heat sink on the recurrence of small malignant hepatic tumors after radiofrequency ablation.

    PubMed

    Lin, Zheng-Yu; Li, Guo-Lin; Chen, Jin; Chen, Zhong-Wu; Chen, Yi-Ping; Lin, Sun-Zhi

    2016-12-01

    The aim of this study was to investigate the effect of heat sink on the recurrence of hepatic malignant tumors <3 cm after percutaneous radiofrequency ablation (RFA). This study included 564 hepatic malignant tumors <3 cm in 381 patients. Preoperative images were used to determine whether these tumors were adjacent to vessels, and the diameter of adjacent vessels was measured. RFA was performed computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) guidance, and postoperative imaging follow-up was then conducted. SPSS software version 17.0 was used for data processing, and the χ2 test was used for comparative analysis. Two-sided P < 0.05 indicated statistical significance. A total of 33 recurrences were found: 15 in the MR group (15/468), 12 in the US group (12/53), and 6 in the CT group (6/43). Of the 101 lesions adjacent to blood vessels larger than 3 mm, 20 showed recurrence: 10 in the MR group (10/77), 7 in the US group (7/17), and 3 in the CT group (3/7). The recurrence rate of perivascular lesions was higher than that of nonperivascular lesions, and the rate in the MR group was lower those in the US and CT groups. The curative effect of MRI-guided RFA is better than those of US- and CT-guided ablation. The heat sink effect is an important factor affecting recurrence of hepatic malignant tumors after RFA.

  11. Askin tumor: CT and FDG-PET/CT imaging findings and follow-up.

    PubMed

    Xia, Tingting; Guan, Yubao; Chen, Yongxin; Li, Jingxu

    2014-07-01

    The aim of the study was to describe the imaging findings of Askin tumors on computed tomography (CT) and fluorine 18 fluorodeoxyglucose-positron emission tomography (FDG-PET/CT).Seventeen cases of Askin tumors confirmed by histopathology were retrospectively analyzed in terms of CT (17 cases) and FDG-PET/CT data (6 cases).Fifteen of the tumors were located in the chest wall and the other 2 were in the anterior middle mediastinum. Of the 15 chest wall cases, 13 demonstrated irregular, heterogeneous soft tissue masses with cystic degeneration and necrosis, and 2 demonstrated homogeneous soft tissue masses on unenhanced CT scans. Two mediastinal tumors demonstrated the irregular, heterogeneous soft tissue masses. Calcifications were found in 2 tumors. The tumors demonstrated heterogeneously enhancement in 16 cases and homogeneous enhancement in 1 case on contrast-enhanced scans. FDG-PET/CT images revealed increased metabolic activity in all 6 cases undergone FDG-PET/CT scan, and the lesion SUVmax ranged from 4.0 to 18.6. At initial diagnosis, CT and FDG-PET/CT scans revealed rib destruction in 9 cases, pleural effusion in 9 cases, and lung metastasis in 1 case. At follow-up, 12 cases showed recurrence and/or metastases, 4 cases showed improvement or remained stable, and 1 was lost to follow-up.In summary, CT and FDG-PET/CT images of Askin tumors showed heterogeneous soft tissue masses in the chest wall and the mediastinum, accompanied by rib destruction, pleural effusion, and increased FDG uptake. CT and FDG-PET/CT imaging play important roles in the diagnosis and follow-up of patients with Askin tumors.

  12. Diffuse hepatic amebiasis detected by FDG PET/CT.

    PubMed

    Zhou, Weiyan; Zhao, Jinhua; Xing, Yan; Chen, Xiang; Song, Jianhua

    2015-02-01

    A 39-year-old man presented with sudden decreased visual acuity in his left eye. Orbital CT and MRI revealed a soft tissue lesion in his left orbital apex. FDG PET/CT showed increased FDG uptake by the left orbital lesion, abnormal focal FDG uptake in the soft tissues of the external ears, and abnormal heterogeneous FDG activity throughout the liver. Percutaneous liver biopsy, external auditory canal discharge, and stool specimens revealed amebiasis. The patient responded to antiamebic therapy, and his lesions improved. The case demonstrates that during its early stage, hepatic amebiasis may be associated with a relatively heterogeneous pattern of FDG uptake.

  13. Primary Neuroendocrine Tumor of the Left Hepatic Duct: A Case Report with Review of the Literature

    PubMed Central

    Bhandarwar, Ajay H.; Shaikh, Taher A.; Borisa, Ashok D.; Palep, Jaydeep H.; Patil, Arun S.; Manke, Aditya A.

    2012-01-01

    Primary Biliary Tract Neuroendocrine tumors (NET) are extremely rare tumors with only 77 cases been reported in the literature till now. We describe a case of a left hepatic duct NET and review the literature for this rare malignancy. To the best of our knowledge the present case is the first reported case of a left hepatic duct NET in the literature. In spite of availability of advanced diagnostic tools like Computerized Tomography (CT) Scan and Endoscopic Retrograde Cholangio Pancreaticography (ERCP) a definitive diagnosis of these tumors is possible only after an accurate histopathologic diagnosis of operative specimens with immunohistochemistry and electron microscopy. Though surgical excision remains the gold standard treatment for such tumors, patients with unresectable tumors have good survival with newer biologic agents like Octreotride. PMID:23213596

  14. Automated 3D vascular segmentation in CT hepatic venography

    NASA Astrophysics Data System (ADS)

    Fetita, Catalin; Lucidarme, Olivier; Preteux, Francoise

    2005-08-01

    In the framework of preoperative evaluation of the hepatic venous anatomy in living-donor liver transplantation or oncologic rejections, this paper proposes an automated approach for the 3D segmentation of the liver vascular structure from 3D CT hepatic venography data. The developed segmentation approach takes into account the specificities of anatomical structures in terms of spatial location, connectivity and morphometric properties. It implements basic and advanced morphological operators (closing, geodesic dilation, gray-level reconstruction, sup-constrained connection cost) in mono- and multi-resolution filtering schemes in order to achieve an automated 3D reconstruction of the opacified hepatic vessels. A thorough investigation of the venous anatomy including morphometric parameter estimation is then possible via computer-vision 3D rendering, interaction and navigation capabilities.

  15. Intra-hepatic arterioportal shunt mimicking a metastatic liver tumor: report of a case.

    PubMed

    Haruki, Koichiro; Wakiyama, Shigeki; Shiba, Hiroaki; Ishida, Yuichi; Yanaga, Katsuhiko

    2012-04-01

    The differential diagnosis of an arterioportal shunt (APS) is difficult and important. We report a case of an intra-hepatic APS mimicking a metastatic liver tumor on imaging scans in a patient without hepatic cirrhosis. The patient was a 64-year-old woman, who had undergone low anterior resection of the rectum for advanced rectal cancer, followed 2 months later by right hemihepatectomy, including the middle hepatic vein, for a synchronous metastatic liver tumor. About 2 years after the hepatectomy, a follow-up CT scan showed a new mass in the remnant liver, suggestive of a metastatic liver tumor, the assumption of which was further supported by an elevated serum carcinoembryonic antigen (CEA) level. However, the findings of magnetic resonance imaging were not consistent with a malignant tumor, and Doppler ultrasonography showed a low echoic area connected with the portal vein branch and the hepatic artery branch. Thus, we diagnosed intra-hepatic APS. The patient remains well without signs of growth of the hepatic lesion, although with fluctuating serum CEA levels.

  16. Comparison between CT tumor size and pathological tumor size in frozen section examinations of lung adenocarcinoma.

    PubMed

    Isaka, Tetsuya; Yokose, Tomoyuki; Ito, Hiroyuki; Imamura, Naoko; Watanabe, Masato; Imai, Kentaro; Nishii, Teppei; Woo, Tetsukan; Yamada, Kouzo; Nakayama, Haruhiko; Masuda, Munetaka

    2014-07-01

    We examined the appropriate measurement for pathological tumor size by comparing radiological and pathological tumor size of resected lung adenocarcinoma in FSE. We reviewed records of 59 resected specimens of lung adenocarcinoma for FSE from January to December 2008. Specimens were well-inflated with saline by using an injector before cutting into segments. After selecting the tumor segment of maximal diameter, we compared three ways of measuring pathological tumor size by using paired t-test: (I) macroscopic tumor size (MTS), measured with a metal straight ruler, (II) microscopic frozen section tumor size (FSTS), and (III) microscopic paraffin section tumor size (PSTS). We compared each discrepancy rate (DR) [DR=(CT tumor size-pathological tumor size)/CT tumor size×100] (%) between tumors that were air-containing type and solid-density type on CT scans, and also compared the tumors with lepidic component rates (LCR) ≥50% and LCR <50%, by using Mann-Whitney U-tests. FSE could diagnose malignancy with 100% accuracy. The mean CT tumor size was 18.36mm, and the mean pathological tumor sizes (MTS, FSTS, and PSTS) were 17.81, 14.29, and 14.23mm, respectively. FSTS and PSTS were significantly smaller than CT tumor size (p<0.001). The DR calculated with PSTS was significantly larger in air-containing than in solid-density tumors, and also larger in LCR ≥50% than in LCR <50% tumors. FSE with the inflation method diagnosed malignancy with 100% accuracy. The lung specimen must be sufficiently inflated to prevent tissue shrinking, and we propose MTS as the definition for pathological tumor size in FSE. The greater discordance observed between CT tumor size and microscopic tumor size was assumed to be due to shrinkage of the lepidic component in the tumor. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Evaluation of CT Perfusion Biomarkers of Tumor Hypoxia

    PubMed Central

    Qi, Qi; Yeung, Timothy Pok Chi; Lee, Ting-Yim; Bauman, Glenn; Crukley, Cathie; Morrison, Laura; Hoffman, Lisa; Yartsev, Slav

    2016-01-01

    Background Tumor hypoxia is associated with treatment resistance to cancer therapies. Hypoxia can be investigated by immunohistopathologic methods but such procedure is invasive. A non-invasive method to interrogate tumor hypoxia is an attractive option as such method can provide information before, during, and after treatment for personalized therapies. Our study evaluated the correlations between computed tomography (CT) perfusion parameters and immunohistopathologic measurement of tumor hypoxia. Methods Wistar rats, 18 controls and 19 treated with stereotactic radiosurgery (SRS), implanted with the C6 glioma tumor were imaged using CT perfusion on average every five days to monitor tumor growth. A final CT perfusion scan and the brain were obtained on average 14 days (8–22 days) after tumor implantation. Tumor hypoxia was detected immunohistopathologically with pimonidazole. The tumor, necrotic, and pimonidazole-positive areas on histology samples were measured. Percent necrotic area and percent hypoxic areas were calculated. Tumor volume (TV), blood flow (BF), blood volume (BV), and permeability-surface area product (PS) were obtained from the CT perfusion studies. Correlations between CT perfusion parameters and histological parameters were assessed by Spearman’s ρ correlation. A Bonferroni-corrected P value < 0.05 was considered significant. Results BF and BV showed significant correlations with percent hypoxic area ρ = -0.88, P < 0.001 and ρ = -0.81, P < 0.001, respectively, for control animals and ρ = -0.7, P < 0.001 and ρ = -0.6, P = 0.003, respectively, for all animals, while TV and BV were correlated (ρ = -0.64, P = 0.01 and ρ = -0.43, P = 0.043, respectively) with percent necrotic area. PS was not correlated with either percent necrotic or percent hypoxic areas. Conclusions Percent hypoxic area provided significant correlations with BF and BV, suggesting that CT perfusion parameters are potential non-invasive imaging biomarkers of tumor

  18. Pattern of Retained Contrast on Immediate Postprocedure Computed tomography (CT) After Particle Embolization of Liver Tumors Predicts Subsequent Treatment Response

    SciTech Connect

    Wang Xiaodong Erinjeri, Joseph P.; Jia Xiaoyu Gonen, Mithat; Brown, Karen T. Sofocleous, Constantinos T. Getrajdman, George I. Brody, Lynn A. Thornton, Raymond H. Maybody, Majid Covey, Ann M. Siegelbaum, Robert H. Alago, William Solomon, Stephen B.

    2013-08-01

    PurposeTo determine if the pattern of retained contrast on immediate postprocedure computed tomography (CT) after particle embolization of hepatic tumors predicts modified Response Evaluation Criteria in Solid Tumors (mRECIST) response.Materials and MethodsThis study was approved by the Institutional Review Board with a waiver of authorization. One hundred four liver tumors were embolized with spherical embolic agents (Embospheres, Bead Block, LC Bead) and polyvinyl alcohol. Noncontrast CT was performed immediately after embolization to assess contrast retention in the targeted tumors, and treatment response was assessed by mRECIST criteria on follow-up CT (average time 9.0 {+-} 7.7 weeks after embolization). Tumor contrast retention (TCR) was determined based on change in Hounsfield units (HUs) of the index tumors between the preprocedure and immediate postprocedure scans; vascular contrast retention (VCR) was rated; and defects in contrast retention (DCR) were also documented. The morphology of residual enhancing tumor on follow-up CT was described as partial, circumferential, or total. Association between TCR variables and tumor response were assessed using multivariate logistic regression.ResultsOf 104 hepatic tumors, 51 (49 %) tumors had complete response (CR) by mRECIST criteria; 23 (22.1 %) had partial response (PR); 21 (20.2 %) had stable disease (SD); and 9 (8.7 %) had progressive disease (PD). By multivariate analysis, TCR, VCR, and tumor size are independent predictors of CR (p = 0.02, 0.05, and 0.005 respectively). In 75 tumors, DCR was found to be an independent predictor of failure to achieve complete response (p < 0.0001) by imaging criteria.ConclusionTCR, VCR, and DCR on immediate posttreatment CT are independent predictors of CR by mRECIST criteria.

  19. Automatic detection of new tumors and tumor burden evaluation in longitudinal liver CT scan studies.

    PubMed

    Vivanti, R; Szeskin, A; Lev-Cohain, N; Sosna, J; Joskowicz, L

    2017-08-30

    Radiological longitudinal follow-up of liver tumors in CT scans is the standard of care for disease progression assessment and for liver tumor therapy. Finding new tumors in the follow-up scan is essential to determine malignancy, to evaluate the total tumor burden, and to determine treatment efficacy. Since new tumors are typically small, they may be missed by examining radiologists. We describe a new method for the automatic detection and segmentation of new tumors in longitudinal liver CT studies and for liver tumors burden quantification. Its inputs are the baseline and follow-up CT scans, the baseline tumors delineation, and a tumor appearance prior model. Its outputs are the new tumors segmentations in the follow-up scan, the tumor burden quantification in both scans, and the tumor burden change. Our method is the first comprehensive method that is explicitly designed to find new liver tumors. It integrates information from the scans, the baseline known tumors delineations, and a tumor appearance prior model in the form of a global convolutional neural network classifier. Unlike other deep learning-based methods, it does not require large tagged training sets. Our experimental results on 246 tumors, of which 97 were new tumors, from 37 longitudinal liver CT studies with radiologist approved ground-truth segmentations, yields a true positive new tumors detection rate of 86 versus 72% with stand-alone detection, and a tumor burden volume overlap error of 16%. New tumors detection and tumor burden volumetry are important for diagnosis and treatment. Our new method enables a simplified radiologist-friendly workflow that is potentially more accurate and reliable than the existing one by automatically and accurately following known tumors and detecting new tumors in the follow-up scan.

  20. Hepatic Abscess After Yttrium-90 Radioembolization for Islet-Cell Tumor Hepatic Metastasis

    SciTech Connect

    Mascarenhas, Neil B.; Mulcahy, Mary F.; Lewandowski, Robert J.; Salem, Riad; Ryu, Robert K.

    2010-06-15

    Infectious complications after yttrium-90 (y-90) radioembolization of hepatic tumors are rare. Most reports describe hepatic abscesses as complications of other locoregional therapies, such as transcatheter arterial embolization or chemoembolization. These usually occur in patients with a history of biliary intervention and present several weeks after treatment. We report a case of hepatic abscess formed immediately after y-90 radioembolization of a hepatic metastasis in a patient who had no history of previous biliary instrumentation.

  1. Hepatic abscess after yttrium-90 radioembolization for islet-cell tumor hepatic metastasis.

    PubMed

    Mascarenhas, Neil B; Mulcahy, Mary F; Lewandowski, Robert J; Salem, Riad; Ryu, Robert K

    2010-06-01

    Infectious complications after yttrium-90 (y-90) radioembolization of hepatic tumors are rare. Most reports describe hepatic abscesses as complications of other locoregional therapies, such as transcatheter arterial embolization or chemoembolization. These usually occur in patients with a history of biliary intervention and present several weeks after treatment. We report a case of hepatic abscess formed immediately after y-90 radioembolization of a hepatic metastasis in a patient who had no history of previous biliary instrumentation.

  2. Hepatic Fibrosis: Evaluation with Semiquantitative Contrast-enhanced CT

    PubMed Central

    Varenika, Vanja; Fu, Yanjun; Maher, Jacquelyn J.; Gao, Dongwei; Kakar, Sanjay; Cabarrus, Miguel C.

    2013-01-01

    Purpose: To evaluate the feasibility of using contrast material–enhanced computed tomographic (CT) measurements of hepatic fractional extracellular space (fECS) and macromolecular contrast material (MMCM) uptake to measure severity of liver fibrosis. Materials and Methods: All procedures were approved by and executed in accordance with University of California, San Francisco, institutional animal care and use committee regulations. Twenty-one rats that received intragastric CCl4 for 0–12 weeks were imaged with respiratory-gated micro-CT by using both a conventional contrast material and a novel iodinated MMCM. Histopathologic hepatic fibrosis was graded qualitatively by using the Ishak fibrosis score and quantitatively by using morphometry of the fibrosis area. Hepatic fECS and MMCM uptake were calculated for each examination and correlated with histopathologic findings by using uni- and multivariate linear regressions. Results: Ishak fibrosis scores ranged from a baseline of 0 in untreated animals to a maximum of 5. Histopathologic liver fibrosis area increased from 0.46% to 3.5% over the same interval. Strong correlations were seen between conventional contrast-enhanced CT measurements of fECS and both the Ishak fibrosis scores (R2 = 0.751, P < .001) and the fibrosis area (R2 = 0.801, P < .001). Strong negative correlations were observed between uptake of MMCM in the liver and Ishak fibrosis scores (R2 = 0.827, P < .001), as well as between uptake of MMCM in the liver and fibrosis area (R2 = 0.643, P = .001). Multivariate linear regression analysis showed a trend toward independence for fECS and MMCM uptake in the prediction of Ishak fibrosis scores, with an R2 value of 0.86 (P = .081 and P = .033, respectively). Conclusion: Contrast-enhanced CT measurements of fECS and MMCM uptake are individually capable of being used to estimate the degree of early hepatic fibrosis in a rat model. © RSNA, 2012 Supplemental material: http

  3. Low contrast medium and radiation dose for hepatic computed tomography perfusion of rabbit VX2 tumor

    PubMed Central

    Zhang, Cai-Yuan; Cui, Yan-Fen; Guo, Chen; Cai, Jing; Weng, Ya-Fang; Wang, Li-Jun; Wang, Deng-Bin

    2015-01-01

    AIM: To evaluate the feasibility of low contrast medium and radiation dose for hepatic computed tomography (CT) perfusion of rabbit VX2 tumor. METHODS: Eleven rabbits with hepatic VX2 tumor underwent perfusion CT scanning with a 24-h interval between a conventional tube potential (120 kVp) protocol with 350 mgI/mL contrast medium and filtered back projection, and a low tube potential (80 kVp) protocol with 270 mgI/mL contrast medium with iterative reconstruction. Correlation and agreement among perfusion parameters acquired by the conventional and low dose protocols were assessed for the viable tumor component as well as whole tumor. Image noise and tumor-to-liver contrast to noise ratio during arterial and portal venous phases were evaluated. RESULTS: A 38% reduction in contrast medium dose (360.1 ± 13.3 mgI/kg vs 583.5 ± 21.5 mgI/kg, P < 0.001) and a 73% decrease in radiation dose (1898.5 mGy • cm vs 6951.8 mGy • cm) were observed. Interestingly, there was a strong positive correlation in hepatic arterial perfusion (r = 0.907, P < 0.001; r = 0.879, P < 0.001), hepatic portal perfusion (r = 0.819, P = 0.002; r = 0.831, P = 0.002), and hepatic blood flow (r = 0.945, P < 0.001; r = 0.930, P < 0.001) as well as a moderate correlation in hepatic perfusion index (r = 0.736, P = 0.01; r = 0.636, P = 0.035) between the low dose protocol with iterative reconstruction and the conventional protocol for the viable tumor component and the whole tumor. These two imaging protocols provided a moderate but acceptable agreement for perfusion parameters and similar tumor-to-liver CNR during arterial and portal venous phases (5.63 ± 2.38 vs 6.16 ± 2.60, P = 0.814; 4.60 ± 1.27 vs 5.11 ± 1.74, P = 0.587). CONCLUSION: Compared with the conventional protocol, low contrast medium and radiation dose with iterative reconstruction has no significant influence on hepatic perfusion parameters for rabbits VX2 tumor. PMID:25954099

  4. Automated segmentation of hepatic vessel trees in non-contrast x-ray CT images

    NASA Astrophysics Data System (ADS)

    Kawajiri, Suguru; Zhou, Xiangrong; Zhang, Xuejin; Hara, Takeshi; Fujita, Hiroshi; Yokoyama, Ryujiro; Kondo, Hiroshi; Kanematsu, Masayuki; Hoshi, Hiroaki

    2007-03-01

    Hepatic vessel trees are the key structures in the liver. Knowledge of the hepatic vessel trees is important for liver surgery planning and hepatic disease diagnosis such as portal hypertension. However, hepatic vessels cannot be easily distinguished from other liver tissues in non-contrast CT images. Automated segmentation of hepatic vessels in non-contrast CT images is a challenging issue. In this paper, an approach for automated segmentation of hepatic vessels trees in non-contrast X-ray CT images is proposed. Enhancement of hepatic vessels is performed using two techniques: (1) histogram transformation based on a Gaussian window function; (2) multi-scale line filtering based on eigenvalues of Hessian matrix. After the enhancement of hepatic vessels, candidate of hepatic vessels are extracted by thresholding. Small connected regions of size less than 100 voxels are considered as false-positives and are removed from the process. This approach is applied to 20 cases of non-contrast CT images. Hepatic vessel trees segmented from the contrast-enhanced CT images of the same patient are used as the ground truth in evaluating the performance of the proposed segmentation method. Results show that the proposed method can enhance and segment the hepatic vessel regions in non-contrast CT images correctly.

  5. Diffuse Infantile Hepatic Hemangioendothelioma With Early Central Enhancement in an Adult: A Case Report of CT and MRI Findings.

    PubMed

    Dong, Aisheng; Dong, Hui; Zuo, Changjing; He, Tianlin

    2015-12-01

    Infantile hepatic hemangioendothelioma (IHH) is the most common vascular tumor of the liver in infancy. Adult with IHH is extremely rare. We presented a diffuse IHH in an adult patient with computed tomography (CT) and magnetic resonance image (MRI) findings.A 39-year-old man was admitted to our hospital because of a 2-year history of abnormal liver function tests and a 7-day history of jaundice. Physical examination revealed enlarged liver. Unenhanced abdominal CT showed enlargement of the liver with diffuse hypodensity. Enhanced CT on the arterial phase revealed multiple centrally enhanced lesions diffusely involved the enlarged liver. The enhanced areas of the lesions became larger on the portal phase and all the lesions became homogeneous enhanced on the delayed phase. These lesions showed heterogeneously hyperintense on T2-weighted image, hypointense on T1-weighted image, and early centrally enhanced on dynamic gadolinium-enhanced MRI, with complete tumor enhancement after 180 s. The patient underwent orthotopic liver transplantation. IHH type 2 was confirmed by pathology. The patient died of tumor recurrence in the liver 4 months after transplantation.Unlike the previously described imaging appearances of IHH, this case showed diffuse nodules with early central enhancement on CT and MRI. Considering the importance of the ability to differentiate IHH from other hepatic tumors, radiologists should be aware of these imaging appearances to establish knowledge of the entire spectrum of IHH.

  6. Primary hepatic carcinoid tumor: case report and literature review

    PubMed Central

    Camargo, Éden Sartor; Viveiros, Marcelo de Melo; Corrêa, Isaac José Felippe; Robles, Laercio; Rezende, Marcelo Bruno

    2014-01-01

    Primary hepatic carcinoid tumors are extremely rare neoplasms derived from hormone-producing neuroendocrine cells. It is difficult to make their diagnosis before biopsy, surgical resection or necropsy. A recent publication described only 94 cases of these tumors. There is no sex predilection and apparently it has no association with cirrhosis or preexisting hepatic disease. The most effective treatment is hepatectomy, and resection is determined by size and location of the lesions. PMID:25628206

  7. Effectiveness of quantitative MAA SPECT/CT for the definition of vascularized hepatic volume and dosimetric approach: phantom validation and clinical preliminary results in patients with complex hepatic vascularization treated with yttrium-90-labeled microspheres.

    PubMed

    Garin, Etienne; Lenoir, Laurence; Rolland, Yan; Laffont, Sophie; Pracht, Marc; Mesbah, Habiba; Porée, Philippe; Ardisson, Valérie; Bourguet, Patrick; Clement, Bruno; Boucher, Eveline

    2011-12-01

    The goal of this study was to assess the use of quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) analysis for vascularized volume measurements in the use of the yttrium-90-radiolabeled microspheres (TheraSphere). A phantom study was conducted for the validation of SPECT/CT volume measurement. SPECT/CT quantitative analysis was used for the measurement of the volume of distribution of the albumin macroaggregates (MAA; i.e., the vascularized volume) in the liver and the tumor, and the total activity contained in the liver and the tumor in four consecutive patients presenting with a complex liver vascularization referred for a treatment with TheraSphere. SPECT/CT volume measurement proved to be accurate (mean error <7%) and reproducible (interobserver concordance 0.99). For eight treatments, in cases of complex hepatic vascularization, the hepatic volumes based on angiography and CT led to a relative overestimation or underestimation of the vascularized hepatic volume by 43.2 ± 32.7% (5-87%) compared with SPECT/CT analyses. The vascularized liver volume taken into account calculated from SPECT/CT data, instead of angiography and CT data, results in modifying the activity injected for three treatments of eight. Moreover, quantitative analysis of SPECT/CT allows us to calculate the absorbed dose in the tumor and in the healthy liver, leading to doubling of the injected activity for one treatment of eight. MAA SPECT/CT is accurate for volume measurements. It provides a valuable contribution to the therapeutic planning of patients presenting with complex hepatic vascularization, in particular for calculating the vascularized liver volume, the activity to be injected and the absorbed doses. Studies should be conducted to assess the role of quantitative MAA/SPECT CT in therapeutic planning.

  8. Hepatic abscess secondary to a fishbone penetrating the gastric wall: CT demonstration.

    PubMed

    Masunaga, S; Abe, M; Imura, T; Asano, M; Minami, S; Fujisawa, I

    1991-01-01

    Preoperative diagnosis of hepatic abscess due to foreign bodies penetrating the gastrointestinal tract is uncommon with conventional imaging methods. This report describes and illustrates a case of hepatic abscess secondary to a fishbone penetrating the gastric antrum wall which was diagnosed preoperatively by CT and confirmed at surgery. The value of CT in the preoperative diagnosis of cases of this kind is emphasized.

  9. Assessment of lung tumor response by perfusion CT.

    PubMed

    Coche, E

    2013-01-01

    Perfusion CT permits evaluation of lung cancer angiogenesis and response to therapy by demonstrating alterations in lung tumor vascularity. It is advocated that perfusion CT performed shortly after initiating therapy may provide a better evaluation of physiological changes rather than the conventional size assessment obtained with RECIST. The radiation dose,the volume of contrast medium delivered to the patient and the reproducibility of blood flow parameters remain an issue for this type of investigation.

  10. CT of irradiated solid tumor metastases to the brain.

    PubMed

    Brown, S B; Brant-Zawadzki, M; Eifel, P; Coleman, C N; Enzmann, D R

    1982-01-01

    Twenty patients with solid tumor metastases to the brain, demonstrated by CT scanning, had follow-up scans after radiation therapy of the metastatic focus. Nine patients (45%) showed no evidence of the metastasis on the initial follow-up scans. Another 10 patients (50%) showed some improvement in the size, enhancement, or surrounding edema of the lesion. Only one patient showed progression in spite of therapy. The CT scan identified those patients who achieved longer survival and/or longer time intervals before brain relapse. However, CT scans must be interpreted with caution in patients still on corticosteroid treatment. Additionally, other non-tumoral conditions may mimic tumor recurrence. Radiation therapy offered palliation in patients with brain metastases, and in some instances, sterilized patients of their metastatic brain involvement.

  11. CT and MR findings of Krukenberg tumors: Comparison with primary ovarian tumors

    SciTech Connect

    Kim, Seung Hyup; Kim, Won Hong; Park, Kyung Joo

    1996-05-01

    The purposes of this study were to evaluate the CT and MR findings of Krukenberg tumors and to compare them with those of primary ovarian tumors. This study included 20 patients with Krukenberg tumors and 65 patients with various primary ovarian tumors. CT/MR/both imaging studies were available in 15/1/4 patients with Krukenberg tumor and 31/10/24 patients with primary ovarian tumors, respectively. Imaging findings of the tumors were categorized into three subgroups: a solid mass with intratumoral cysts, a solid mass without intratumoral cysts, and a predominantly cystic mass. Among 32 Krukenberg tumors (bilateral in 12 patients), 22 were solid masses with intratumoral cysts, in 14 of which the wall of the intratumoral cysts showed apparently strong contrast enhancement on CT and/or MRI. Six Krukenberg tumors were solid masses without intratumoral cysts, and four were predominantly cystic masses. Imaging findings of 88 primary ovarian tumors (bilateral in 23 patients) were 5 solid masses with intratumoral cysts, 27 solid masses without intratumoral cysts, and 56 predominantly cystic masses. None of the five primary ovarian tumors with solid mass with intratumoral cysts demonstrated apparently strong contrast enhancement of the cyst wall. Krukenberg tumor should be suspected when one sees solid ovarian tumors containing well demarcated intratumoral cystic lesions, especially if the walls of those cysts demonstrate apparently strong contrast enhancement. 11 refs., 4 figs., 1 tab.

  12. Cone beam CT tumor vasculature dynamic study (Murine model)

    NASA Astrophysics Data System (ADS)

    Yang, Dong; Ning, Ruola; Conover, David; Ricardo, Betancourt; Liu, Shaohua

    2008-03-01

    Tumor angiogenesis is the process by which new blood vessels are formed from the existing vessels in a tumor to promote tumor growth. Tumor angiogenesis has important implications in the diagnosis and treatment of various solid tumors. Flat panel detector based cone beam CT opens up a new way for detection of tumors, and tumor angiogenesis associated with functional CBCT has the potential to provide more information than traditional functional CT due to more overall coverage during the same scanning period and the reconstruction being isotropic resulting in a more accurate 3D volume intensity measurement. A functional study was conducted by using CBCT to determine the degree of the enhancement within the tumor after injecting the contrast agent intravenously. For typical doses of contrast material, the amount of enhancement is proportional to the concentration of this material within the region of interest. A series of images obtained at one location over time allows generation of time-attenuation data from which a number of semi-quantitative parameters, such as enhancement rate, can be determined. An in vivo mice study with and without mammo tumor was conducted on our prototype CBCT system, and half scan scheme is used to determine the time-intensity curve within the VOI of the mouse. The CBCT has an x-ray tube, a gantry with slip ring technology, and a 40×30 cm Varian Paxscan 4030CB real time FPD.

  13. Multi-detector row CT of pancreatic islet cell tumors.

    PubMed

    Horton, Karen M; Hruban, Ralph H; Yeo, Charles; Fishman, Elliot K

    2006-01-01

    Pancreatic islet cell tumors (ICTs) are neuroendocrine neoplasms that produce and secrete hormones to a variable degree. These neoplasms can present a diagnostic challenge, both clinically and radiologically. ICTs can be classified as either syndromic or nonsyndromic on the basis of their clinical manifestations. Multi-detector row computed tomography (CT) plays an important role in the diagnosis and staging of both syndromic and nonsyndromic ICTs. In general, syndromic ICTs are less than 3 cm in size. They are typically hyperenhancing and are usually best seen on CT scans obtained during the arterial phase. Nonsyndromic ICTs tend to be larger than syndromic ICTs at presentation and are more likely to be cystic or necrotic. It is important for the radiologist to be familiar with appropriate CT protocol for the evaluation of patients with suspected pancreatic ICT and to understand the variable CT appearances of these neoplasms. (c) RSNA, 2006.

  14. Inflammatory angiomyolipoma of the liver: a rare hepatic tumor

    PubMed Central

    2012-01-01

    Angiomyolipoma (AML) is a rare mesenchymal neoplasm of the tumor, composed of a varying heterogeneous mixture of three tissue components: blood vessels, smooth muscle and adipose cells. Hepatic AML may demonstrate a marked histological diversity. We herein present one case of hepatic AML exhibiting prominent inflammatory cells in the background, which happened in a 61-year-old Chinese female patient, without signs of tuberous sclerosis. Histologically, the striking feature was the infiltration of numerous inflammatory cells in the background, including small lymphocytes, plasma cells, and eosnophils. The tumor cells were spindled and histiocytoid in shape, with slightly eosinophilic cytoplasm, and arranged along the vessels or scattered among the inflammatory background. Sinusoid structure was obviously seen in the tumor. Mature adipocytes and thick-walled blood vessels were focally observed at the boundaries between the tumor and surrounding liver tissues. The tumor cells were positive immunostaining for HMB-45, Melan-A, and smooth muscle actin. The inflammatory AML should be distinguished from other tumors with inflammatory background such as inflammatory myofibroblastic tumor and follicular dendritic cell tumor and deserves wider recognition for its occurrence as a primary hepatic tumor. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1828633072762370 PMID:22978636

  15. Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden

    PubMed Central

    Langman, Eun L.; Suhocki, Paul V.; Hurwitz, Herbert I.; Morse, Michael A.; Burbridge, Rebecca A.; Smith, Tony P.

    2016-01-01

    Background Patients with metastatic disease of the liver can have hyperbilirubinemia due to a number of reasons, including biliary obstruction. The purpose of this study was to analyze patient outcomes after percutaneous biliary drainage (PBD) catheter insertion in patients with extensive hepatic metastatic tumor burden. Methods Out of 746 PBD insertions, 44 patients (24 males, 20 females, mean age 57.4 years, range, 34–80 years) had metastatic malignancy with a hepatic tumor burden of greater than 20% parenchymal volume based on pre-procedure computed tomography (CT) or magnetic resonance imaging (MRI). Laboratory data before and after PBD insertion were compared. Survival and outcomes analysis performed. A subanalysis was performed on patients with CT-demonstrated catheter traversal of tumoral tissue. Results A PBD catheter was successfully inserted in all patients. The mean serum bilirubin level decreased significantly from 10.9±6.4 mg/dL immediately prior to PBD insertion to 7.1±5.6 mg/dL (P<0.001) within one month post PBD insertion. Four patients (11%) demonstrated normalization of bilirubin levels to less than 1.6 mg/dL. Of the 14 patients with a post-procedure CT or MRI, the PBD catheter traversed a tumor in 11 (79%). One of these patients required a transfusion after the procedure and one had recurrent catheter exchanges due to pericatheter leakage. The 30-day overall survival was 41% with a median survival of 19 days. The percentage decrease in serum bilirubin after PBD insertion and pre-procedure international normalized ratio (INR) were correlated with improved survival (OR =3.7, P=0.010 and OR =4.9, P=0.028 respectively). The PBD-associated major complication rate was 16%. Conclusions In patients with hyperbilirubinemia and extensive hepatic metastatic disease burden, survival was dismal after PBD catheter insertion. Serum bilirubin level normalization occurred rarely. PMID:28078111

  16. Cardiac calcified amorphous tumors: CT and MRI findings

    PubMed Central

    Yılmaz, Ravza; Demir, Ali Aslan; Önür, İmran; Yılbazbayhan, Dilek; Dursun, Memduh

    2016-01-01

    PURPOSE We aimed to evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac calcified amorphous tumors (CATs). METHODS CT and MRI findings of cardiac CATs in 12 patients were included. We retrospectively examined patient demographics, location, size, shape configuration, imaging features, calcification distribution of tumors, and accompanying medical problems. RESULTS There was a female predominance (75%), with a mean age at presentation of 65 years. Patients were mostly asymptomatic on presentation (58.3%). The left ventricle of the heart was mostly involved (91%). CT findings of CATs were classified as partial calcification with a hypodense mass in four patients or a diffuse calcified form in eight. Calcification was predominant with large foci appearance as in partially calcified masses. On T1- and T2-weighted magnetic resonance images, CATs appeared hypointense and showed no contrast enhancement. CONCLUSION The shape and configuration of cardiac CATs are variable with a narrow spectrum of CT and MRI findings, but large foci in a partially calcified mass or diffuse calcification of a mass on CT is very important in the diagnosis of cardiac CATs. Masses show a low signal intensity on T1- and T2-weighted images with no contrast enhancement on MRI. PMID:27705878

  17. CT Features of Colorectal Schwannomas: Differentiation from Gastrointestinal Stromal Tumors

    PubMed Central

    Kang, Ji Hee; Kim, Se Hyung; Kim, Young Hoon; Rha, Sung Eun; Hur, Bo Yun; Han, Joon Koo

    2016-01-01

    Purpose To find differential CT features of colorectal schwannomas from gastrointestinal stromal tumors (GISTs). Materials and Methods CT features of 13 pathologically proven colorectal schwannomas and 21 GISTs were retrospectively reviewed. The following CT items were analyzed: size, longitudinal and transverse location, shape, margin, homogeneity, necrosis, surface ulceration, calcification, degree of attenuation, the presence of enlarged lymph node (LN), and metastasis. Among the features, significant variables were evaluated using univariate statistical tests. The optimal cut-off point of tumor size was obtained by ROC analysis. Binary logistic regression analysis was used to find the most independent CT variables. Results Small size, non-rectum location, smooth margin, homogeneous high attenuation without necrosis, and the presence of enlarged LNs were found to be significant variables to differentiate schwannomas from GISTs (P<0.05). The optimized cut-off point for tumor size in distinguishing GISTs from schwannomas was 3.9 cm (AUC = 0.808, sensitivity = 66.7%, specificity = 92.3%, P<0.0001). Binary regression analysis revealed that only non-rectum location remained independent predictor for schwannomas differentiated from GISTs (odds ratio = 31.667, P = 0.001). Conclusion Colorectal schwannomas usually located in non-rectum and appear as small subepithelial nodules showing homogeneous high attenuation and smooth margin. Schwannomas exclusively accompany with enlarged LNs. PMID:28005903

  18. CT-guided percutaneous microwave ablation of pulmonary malignant tumors

    PubMed Central

    Ko, Wei-Chun; Lee, Yee-Fan; Chen, Yi-Chang; Chien, Ning; Huang, Yu-Sen; Tseng, Yao-Hui; Lee, Jang-Ming; Hsu, Hsao-Hsun; Chen, Jin-Shing

    2016-01-01

    Background Microwave ablation (MWA) of lung tumors is a new approach for local tumor control. The purpose of this retrospective study was to evaluate the preliminary results of safety and efficacy of MWA with a dynamic frequency range (902–928 MHz) and power (10–32 W) for local tumor control of thoracic malignancies. Methods From December 1, 2013 to February 1, 2016, there were total 32 lung tumors among 15 patients (7 men, 8 women, age range 43–82 years, mean 57.8±11.1 years of age) receiving MWA of thoracic neoplasms, including lung adenocarcinoma (n=5), metastatic colorectal cancer (n=7), invasive thymoma (n=1), metastatic uterine leiomyosarcoma (n=1), and metastatic ampullary carcinoma (n=1). Mean tumor size was 13.5 mm (range, 3.0–32.0 mm). The mean sequential ablation during each MWA was 2.3±1.1 times (range, 1–5 times). The outcomes of ablation were evaluated by follow-up computed tomography (CT) scans and the complications were assessed by medical records and CT scan after ablation. Results The mean follow-up interval of each tumor was 446.8 days (range, 196–902 days). Local tumor recurrence was found in 5 of the 32 tumors resulting in a local control rate 84.4%. No MWA-related mortality was noted. After MWA, the incidence of pneumothorax was 37.5% (12/32). Only one patient with pneumothorax required air evacuation. Third-degree skin burn adjacent to the entry site occurred in one patient and required debridement and closure with flap. Conclusions After appropriate patient selection, MWA with a dynamic frequency range (902–928 MHz) and power (10–32 W) is an effective and safe procedure for local tumor control of recurrent and metastatic lung tumors. PMID:28066666

  19. Intercostal Artery Supplying Hepatocellular Carcinoma: Demonstration of a Tumor Feeder by C-arm CT and Multidetector Row CT

    SciTech Connect

    Kim, Hyo-Cheol Chung, Jin Wook; Lee, In Joon; An, Sangbu; Seong, Nak Jong; Son, Kyu Ri; Jae, Hwan Jun; Park, Jae Hyung

    2011-02-15

    This study was designed to describe tumor feeders from the intercostal artery supplying hepatocellular carcinoma (HCC) on C-arm CT and multidetector row CT. From March 2008 to May 2009, C-arm CT of the intercostal artery was prospectively performed in 24 HCC patients. Two interventional radiologists, who performed C-arm CT, evaluated tumor feeders on C-arm CT and multidetector row CT scans by consensus. In total, 35 intercostal arteries were examined by C-arm CT. All tumor feeders except one showed a sharp upward turn at or near the costochondral junction. On axial C-arm CT images, all tumor feeders were observed as an enhancing dot in the upper intercostal space along the diaphragm. On multidetector CT scans, 17 tumor feeders were observed and 18 were not. Tumor feeders from the intercostal artery are observed as an enhancing dot along the diaphragm on C-arm CT and can be seen on multidetector row CT in approximately half of patients.

  20. Impact of Multislice CT Angiography on Planning of Radiological Catheter Placement for Hepatic Arterial Infusion Chemotherapy

    SciTech Connect

    Sone, Miyuki Kato, Kenichi; Hirose, Atsuo; Nakasato, Tatsuhiko; Tomabechi, Makiko; Ehara, Shigeru; Hanari, Takao

    2008-01-15

    The objective of this study was to assess prospectively the role of multislice CT angiography (MSCTA) on planning of radiological catheter placement for hepatic arterial infusion chemotherapy (HAIC). Forty-six patients with malignant liver tumors planned for HAIC were included. In each patient, both MSCTA and intra-arterial digital subtraction angiography (DSA) were performed, except one patient who did not undergo DSA. Comparison of MSCTA and DSA images was performed for the remaining 45 patients. Detectability of anatomical variants of the hepatic artery, course of the celiac trunk, visualization scores of arterial branches and interobserver agreement, presence of arterial stenosis, and technical outcome were evaluated. Anatomical variations of the hepatic artery were detected in 19 of 45 patients (42%) on both modalities. The course of the celiac trunk was different in 12 patients. The visualization scores of celiac arterial branches on MSCTA/DSA were 3.0 {+-} 0/2.9 {+-} 0.2 in the celiac trunk, 3.0 {+-} 0/2.9 {+-} 0.3 in the common hepatic artery, 2.9 {+-} 0.2/2.9 {+-} 0.3 in the proper hepatic artery, 2.9 {+-} 0.3/2.9 {+-} 0.4 in the right hepatic artery, 2.8 {+-} 0.4/2.9 {+-} 0.4 in the left hepatic artery, 2.9 {+-} 0.2/2.9 {+-} 0.3 in the gastroduodenal artery, 2.1 {+-} 0.8/2.2 {+-} 0.9 in the right gastric artery, and 2.7 {+-} 0.8/2.6 {+-} 0.8 in the left gastric artery. No statistically significant differences exist between the two modalities. Interobserver agreement for MSCTA was equivalent to that for DSA. Two patients showed stenosis of the celiac trunk on both modalities. Based on these imaging findings, technical success was accomplished in all patients. In conclusion, MSCTA is accurate in assessing arterial anatomy and abnormalities. MSCTA can provide adequate information for planning of radiological catheter placement for HAIC.

  1. Impact of multislice CT angiography on planning of radiological catheter placement for hepatic arterial infusion chemotherapy.

    PubMed

    Sone, Miyuki; Kato, Kenichi; Hirose, Atsuo; Nakasato, Tatsuhiko; Tomabechi, Makiko; Ehara, Shigeru; Hanari, Takao

    2008-01-01

    The objective of this study was to assess prospectively the role of multislice CT angiography (MSCTA) on planning of radiological catheter placement for hepatic arterial infusion chemotherapy (HAIC). Forty-six patients with malignant liver tumors planned for HAIC were included. In each patient, both MSCTA and intra-arterial digital subtraction angiography (DSA) were performed, except one patient who did not undergo DSA. Comparison of MSCTA and DSA images was performed for the remaining 45 patients. Detectability of anatomical variants of the hepatic artery, course of the celiac trunk, visualization scores of arterial branches and interobserver agreement, presence of arterial stenosis, and technical outcome were evaluated. Anatomical variations of the hepatic artery were detected in 19 of 45 patients (42%) on both modalities. The course of the celiac trunk was different in 12 patients. The visualization scores of celiac arterial branches on MSCTA/DSA were 3.0 +/- 0/2.9 +/- 0.2 in the celiac trunk, 3.0 +/- 0/2.9 +/- 0.3 in the common hepatic artery, 2.9 +/- 0.2/2.9 +/- 0.3 in the proper hepatic artery, 2.9 +/- 0.3/2.9 +/- 0.4 in the right hepatic artery, 2.8 +/- 0.4/2.9 +/- 0.4 in the left hepatic artery, 2.9 +/- 0.2/2.9 +/- 0.3 in the gastroduodenal artery, 2.1 +/- 0.8/2.2 +/- 0.9 in the right gastric artery, and 2.7 +/- 0.8/2.6 +/- 0.8 in the left gastric artery. No statistically significant differences exist between the two modalities. Interobserver agreement for MSCTA was equivalent to that for DSA. Two patients showed stenosis of the celiac trunk on both modalities. Based on these imaging findings, technical success was accomplished in all patients. In conclusion, MSCTA is accurate in assessing arterial anatomy and abnormalities. MSCTA can provide adequate information for planning of radiological catheter placement for HAIC.

  2. [Metrizamide CT cisternography in skull base tumors (author's transl)].

    PubMed

    Tsuyumu, M; Fujiwara, K; Yamaguchi, T; Hiratsuka, H; Inaba, Y

    1979-01-01

    Twenty-three cases suspected of skull base tumors were examined by CT cisternography (CTC) with CT scanner (EMI 1010) from April, 1977 to March, 1978. The lesions in 20 cases were diagnosed as positive and confirmed by operation and/or autopsies. These include five acoustic neurinomas, six pituitary adenomas, two craniopharyngiomas, two skull base meningiomas, one arachnoid cyst and miscellaneous tumors. Isotonic Metrizamide solution four of 2-10 ml was injected via lumbar route. Patients were kept in 30 degrees Trendelenburg position for 60 minutes until the first scanning. Scannings were obtained 1, 3, 6, 24 and in some cases 48 hours after lumbar injection. No side effects except for headache, nausea, vomiting occurred. There were no convulsions. In diagnosing cerebellopontine angle tumors, the indirect signs such as asymmetrical ambient cisterns are of importance, when combined with direct signs, i.e. a shadow defect. Parasellar tumors are usually difficult to diagnose with conventional CT due to streak artifact caused by adjacent bony structure. In CTC the extrasellar extension of pituitary tumors were clearly visible. The size, shape, dimensions and the relationship to the adjacent structures of the craniopharyngiomas were easily demonstrated with CTC especially when a coronal view was added. In arachnoid cyst, CTC demonstrated the delayed turnover of Metrizamide between the cyst cavity and the adjacent subarachnoid space. In conclusion, CTC is an useful neuroradiological diagnostic adjunct because of minimal bony streak artifact and high spatial resolution. It would be expected that small tumors of even 2-3 mm in diameter might be diagnosed, from the fact that the middle cerebral artery in the suprasellar cistern is clearly visible as a shadow defect.

  3. Primary hepatic neuroendocrine tumor: A case report and literature review

    PubMed Central

    Song, Jeong Eun; Kim, Byung Seok; Lee, Chang Hyeong

    2016-01-01

    Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare and difficult to distinguish from other liver tumors, such as hepatocellular carcinoma (HCC) and cholangiocarcinoma, based on medical imaging findings. A 70-year-old man was referred for evaluation of liver mass incidentally discovered on abdominal computed tomography. The characteristic finding from dynamic liver magnetic resonance imaging led to a diagnosis of HCC. The patient underwent right hepatectomy. Histopathological and immunohistochemical examination revealed grade 2 neuroendocrine tumor. The postoperative 24-h urinary excretion of 5-hydroxy-indolacetic acid was within the normal range. Further imaging investigations were performed. No other lesions were found making probable the diagnosis of PHNET. This case shows that the diagnosis of PHNET is a medical challenge, requiring differentiation of PHNETs other hepatic masses and exclusion of occult primary neuroendocrine tumors. The diagnosis of PHNET can be ascertained after long term follow-up to exclude another primary origin. PMID:27574614

  4. CT, MRI and DWI Features of a Solid Organizing Hepatic Abscess.

    PubMed

    Savastano, Sergio; Pellizzer, Giampiero; Di Grazia, Lorenzo; Giacomini, Dario; Beghetto, Mario

    2014-01-01

    Solid organizing hepatic abscess is a rare form of focal infection, which needs differentiation from benign and malignant solid masses. We report a case of a 30-year-old man with a solid organizing hepatic abscess, diagnosed by imaging and ex juvantibus criteria. CT and MRI findings are presented and role of DWI is outlined. Noninvasive diagnosis of a solid organizing hepatic abscess is possible in the appropriate clinical setting; percutaneous or surgical biopsy may be indicated in equivocal cases.

  5. Clinical applications of choline PET/CT in brain tumors.

    PubMed

    Giovannini, Elisabetta; Lazzeri, Patrizia; Milano, Amalia; Gaeta, Maria Chiara; Ciarmiello, Andrea

    2015-01-01

    Malignant gliomas and metastatic tumors are the most common forms of brain tumors. From a clinical perspective, neuroimaging plays a significant role, in diagnosis, treatment planning, and follow-up. To date MRI is considered the current clinical gold standard for imaging, however, despite providing superior structural detail it features poor specificity in identifying viable tumors in brain treated with surgery, radiation, or chemotherapy. In the last years functional neuroimaging has become largely widespread thanks to the use of molecular tracers employed in cellular metabolism which has significantly improved the management of patients with brain tumors, especially in the post-treatment phase. Despite the considerable progress of molecular imaging in oncology its use in the diagnosis of brain tumors is still limited by a few wellknown technical problems. Because 18F-FDG, the most common radiotracer used in oncology, is avidly accumulated by normal cortex, the low tumor/background signal ratio makes it difficult to distinguish the tumor from normal surrounding tissues. By contrast, radiotracers with higher specificity for the tumor are labeled with a short half-life isotopes which restricts their use to those centers equipped with a cyclotron and radiopharmacy facility. 11C-choline has been reported as a suitable tracer for neuroimaging application. The recent availability of choline labeled with a long half-life radioisotope as 18F increases the possibility of studying this tracer's potential role in the staging of brain tumors. The present review focuses on the possible clinical applications of PET/CT with choline tracers in malignant brain tumors and brain metastases, with a special focus on malignant gliomas.

  6. Image fusion for visualization of hepatic vasculature and tumors

    NASA Astrophysics Data System (ADS)

    Chou, Jin-Shin; Chen, Shiuh-Yung J.; Sudakoff, Gary S.; Hoffmann, Kenneth R.; Chen, Chin-Tu; Dachman, Abraham H.

    1995-05-01

    We have developed segmentation and simultaneous display techniques to facilitate the visualization of the three-dimensional spatial relationships between organ structures and organ vasculature. We concentrate on the visualization of the liver based on spiral computed tomography images. Surface-based 3-D rendering and maximal intensity projection algorithms are used for data visualization. To extract the liver in the serial of images accurately and efficiently, we have developed a user-friendly interactive program with a deformable-model segmentation. Surface rendering techniques are used to visualize the extracted structures, adjacent contours are aligned and fitted with a Bezier surface to yield a smooth surface. Visualization of the vascular structures, portal and hepatic veins, is achieved by applying a MIP technique to the extracted liver volume. To integrate the extracted structures they are surface-rendered and their MIP images are aligned and a color table is designed for simultaneous display of the combined liver/tumor and vasculature images. By combining the 3-D surface rendering and MIP techniques, portal veins, hepatic veins, and hepatic tumor can be inspected simultaneously and their spatial relationships can be more easily perceived. The proposed technique will be useful for visualization of both hepatic neoplasm and vasculature in surgical planning for tumor resection or living-donor liver transplantation.

  7. Hepatic perfusion abnormalities during treatment with hepatic arterial infusion chemotherapy: Value of CT arteriography using an implantable port system

    SciTech Connect

    Seki, Hiroshi; Kimura, Motomasa; Kamura, Takeshi; Miura, Tsutomu

    1996-05-01

    The purpose of this study was to evaluate CT arteriography (CTA) using an implantable port system in the detection of perfusion abnormalities occurring during hepatic arterial infusion chemotherapy (HAIC). In 51 patients with unresectable primary and metastatic liver tumors, who had implanted port systems for HAIC, CTA examinations through the infusion pump were performed. When perfusion abnormalities were found, selective angiography and/or digital subtraction angiography using the implantable port system were performed to determine the etiology. Forty-nine perfusion abnormalities were detected in 32 patients. Intrahepatic hypoperfusion was found in 24 cases. Of 11 patients in whom correction of the hypoperfusion was attempted, it was successful in 10. Of 13 patients in whom correction was not attempted, 6 patients showed progressive disease in nonperfused areas. Intrahepatic hyperperfusion was found in 14 cases, which showed no subsequent complication. Extrahepatic perfusion was found in 11 cases. We consider CTA to be useful in detecting perfusion abnormalities that may compromise HAIC. 22 refs., 3 figs., 3 tabs.

  8. Non-Rigid Registration of Liver CT Images for CT-Guided Ablation of Liver Tumors

    PubMed Central

    Luu, Ha Manh; Klink, Camiel; Niessen, Wiro; Moelker, Adriaan; van Walsum, Theo

    2016-01-01

    CT-guided percutaneous ablation for liver cancer treatment is a relevant technique for patients not eligible for surgery and with tumors that are inconspicuous on US imaging. The lack of real-time imaging and the use of a limited amount of CT contrast agent make targeting the tumor with the needle challenging. In this study, we evaluate a registration framework that allows the integration of diagnostic pre-operative contrast enhanced CT images and intra-operative non-contrast enhanced CT images to improve image guidance in the intervention. The liver and tumor are segmented in the pre-operative contrast enhanced CT images. Next, the contrast enhanced image is registered to the intra-operative CT images in a two-stage approach. First, the contrast-enhanced diagnostic image is non-rigidly registered to a non-contrast enhanced image that is conventionally acquired at the start of the intervention. In case the initial registration is not sufficiently accurate, a refinement step is applied using non-rigid registration method with a local rigidity term. In the second stage, the intra-operative CT-images that are used to check the needle position, which often consist of only a few slices, are registered rigidly to the intra-operative image that was acquired at the start of the intervention. Subsequently, the diagnostic image is registered to the current intra-operative image, using both transformations, this allows the visualization of the tumor region extracted from pre-operative data in the intra-operative CT images containing needle. The method is evaluated on imaging data of 19 patients at the Erasmus MC. Quantitative evaluation is performed using the Dice metric, mean surface distance of the liver border and corresponding landmarks in the diagnostic and the intra-operative images. The registration of the diagnostic CT image to the initial intra-operative CT image did not require a refinement step in 13 cases. For those cases, the resulting registration had a Dice

  9. Non-Rigid Registration of Liver CT Images for CT-Guided Ablation of Liver Tumors.

    PubMed

    Luu, Ha Manh; Klink, Camiel; Niessen, Wiro; Moelker, Adriaan; Walsum, Theo van

    2016-01-01

    CT-guided percutaneous ablation for liver cancer treatment is a relevant technique for patients not eligible for surgery and with tumors that are inconspicuous on US imaging. The lack of real-time imaging and the use of a limited amount of CT contrast agent make targeting the tumor with the needle challenging. In this study, we evaluate a registration framework that allows the integration of diagnostic pre-operative contrast enhanced CT images and intra-operative non-contrast enhanced CT images to improve image guidance in the intervention. The liver and tumor are segmented in the pre-operative contrast enhanced CT images. Next, the contrast enhanced image is registered to the intra-operative CT images in a two-stage approach. First, the contrast-enhanced diagnostic image is non-rigidly registered to a non-contrast enhanced image that is conventionally acquired at the start of the intervention. In case the initial registration is not sufficiently accurate, a refinement step is applied using non-rigid registration method with a local rigidity term. In the second stage, the intra-operative CT-images that are used to check the needle position, which often consist of only a few slices, are registered rigidly to the intra-operative image that was acquired at the start of the intervention. Subsequently, the diagnostic image is registered to the current intra-operative image, using both transformations, this allows the visualization of the tumor region extracted from pre-operative data in the intra-operative CT images containing needle. The method is evaluated on imaging data of 19 patients at the Erasmus MC. Quantitative evaluation is performed using the Dice metric, mean surface distance of the liver border and corresponding landmarks in the diagnostic and the intra-operative images. The registration of the diagnostic CT image to the initial intra-operative CT image did not require a refinement step in 13 cases. For those cases, the resulting registration had a Dice

  10. The use of virtual reality for the functional simulation of hepatic tumors (case control study).

    PubMed

    Chen, Gang; Li, Xue-cheng; Wu, Guo-qing; Wang, Yi; Fang, Bin; Xiong, Xiao-feng; Yang, Ri-gao; Tan, Li-wen; Zhang, Shao-xiang; Dong, Jia-hong

    2010-01-01

    To develop a technique for converting computed tomography (CT) data into a fully three-dimensional (3D) virtual reality (VR) environment. Preoperative simulation in 3D VR facilitates liver resection owing to the ability to view the tumor and its relative vessels. 3D-reconstruction of the liver was restored from spiral CT data by using LiVirtue software and the Dextrobeam (Volume Interactions Pte Ltd, Singapore) was applied to view this 3D model in the VR environment. In order to design a rational plan of operation, the liver and its anatomic structure were reconstructed to illuminate the location of the tumor and its related vessels. In our series of 38 hepatic resections, there was no significant difference between preoperatively calculated volumes of virtual resection part and actual volumes of resected specimen's weight. The LiVirtue can provide accurate and rapid results of individual hepatic volume and the character of anatomy structures. These models can be viewed and manipulated in the VR environment and on a personal computer. This preoperative simulation allowed surgeons to dissect the liver with reduced complications. Preoperative planning and intra-operative navigation based on this technique ensured the safety of liver resection. 3D models of the liver and its detailed structure articulate the possibility of intricate liver resection and the risk of the operation. This preoperative estimation from a 3D model of the liver benefits complicated liver resections greatly. Copyright 2009 Surgical Associates Ltd. All rights reserved.

  11. Pancreas tumor model in rabbit imaged by perfusion CT scans

    NASA Astrophysics Data System (ADS)

    Gunn, Jason; Tichauer, Kenneth; Moodie, Karen; Kane, Susan; Hoopes, Jack; Stewart, Errol E.; Hadway, Jennifer; Lee, Ting-Yim; Pereira, Stephen P.; Pogue, Brian W.

    2013-03-01

    The goal of this work was to develop and validate a pancreas tumor animal model to investigate the relationship between photodynamic therapy (PDT) effectiveness and photosensitizer drug delivery. More specifically, this work lays the foundation for investigating the utility of dynamic contrast enhanced blood perfusion imaging to be used to inform subsequent PDT. A VX2 carcinoma rabbit cell line was grown in the tail of the pancreas of three New Zealand White rabbits and approximately 3-4 weeks after implantation the rabbits were imaged on a CT scanner using a contrast enhanced perfusion protocol, providing parametric maps of blood flow, blood volume, mean transit time, and vascular permeability surface area product.

  12. MRI-guided laser ablation of neuroendocrine tumor hepatic metastases

    PubMed Central

    Perälä, Jukka; Klemola, Rauli; Kallio, Raija; Li, Chengli; Vihriälä, Ilkka; Salmela, Pasi I; Tervonen, Osmo

    2014-01-01

    Background Neuroendocrine tumors (NET) represent a therapeutically challenging and heterogeneous group of malignancies occurring throughout the body, but mainly in the gastrointestinal system. Purpose To describe magnetic resonance imaging (MRI)-guided laser ablation of NET liver metastases and assess its role within the current treatment options and methods. Material and Methods Two patients with NET tumor hepatic metastases were treated with MRI-guided interstitial laser ablation (LITT). Three tumors were treated. Clinical follow-up time was 10 years. Results Both patients were successfully treated. There were no local recurrences at the ablation site during the follow-up. Both patients had survived at 10-year follow-up. One patient is disease-free. Conclusion MRI-guided laser ablation can be used to treat NET tumor liver metastases but combination therapy and a rigorous follow-up schedule are recommended. PMID:24778794

  13. Bone Windows for Distinguishing Malignant from Benign Primary Bone Tumors on FDG PET/CT

    PubMed Central

    Costelloe, Colleen M.; Chuang, Hubert H.; Chasen, Beth A.; Pan, Tinsu; Fox, Patricia S.; Bassett, Roland L.; Madewell, John E.

    2013-01-01

    Objective. The default window setting on PET/CT workstations is soft tissue. This study investigates whether bone windowing and hybrid FDG PET/CT can help differentiate between malignant and benign primary bone tumors. Materials and methods. A database review included 98 patients with malignant (n=64) or benign primary bone (n=34) tumors. The reference standard was biopsy for malignancies and biopsy or >1 year imaging follow-up of benign tumors. Three radiologists and/or nuclear medicine physicians blinded to diagnosis and other imaging viewed the lesions on CT with bone windows (CT-BW) without and then with PET (PET/CT-BW), and separate PET-only images for malignancy or benignity. Three weeks later the tumors were viewed on CT with soft tissue windows (CT-STW) without and then with PET (PET/CT-STW). Results. Mean sensitivity and specificity for identifying malignancies included: CT-BW: 96%, 90%; CT-STW: 90%, 90%; PET/CT-BW: 95%, 85%, PET/CT-STW: 95%, 86% and PET-only: 96%, 75%, respectively. CT-BW demonstrated higher specificity than PET-only and PET/CT-BW (p=0.0005 and p=0.0103, respectively) and trended toward higher sensitivity than CT-STW (p=0.0759). Malignant primary bone tumors were more avid than benign lesions overall (p<0.0001) but the avidity of benign aggressive lesions (giant cell tumors and Langerhans Cell Histiocytosis) trended higher than the malignancies (p=0.08). Conclusion. Bone windows provided high specificity for distinguishing between malignant and benign primary bone tumors and are recommended when viewing FDG PET/CT. PMID:23983816

  14. Bone Windows for Distinguishing Malignant from Benign Primary Bone Tumors on FDG PET/CT.

    PubMed

    Costelloe, Colleen M; Chuang, Hubert H; Chasen, Beth A; Pan, Tinsu; Fox, Patricia S; Bassett, Roland L; Madewell, John E

    2013-01-01

    Objective. The default window setting on PET/CT workstations is soft tissue. This study investigates whether bone windowing and hybrid FDG PET/CT can help differentiate between malignant and benign primary bone tumors. Materials and methods. A database review included 98 patients with malignant (n=64) or benign primary bone (n=34) tumors. The reference standard was biopsy for malignancies and biopsy or >1 year imaging follow-up of benign tumors. Three radiologists and/or nuclear medicine physicians blinded to diagnosis and other imaging viewed the lesions on CT with bone windows (CT-BW) without and then with PET (PET/CT-BW), and separate PET-only images for malignancy or benignity. Three weeks later the tumors were viewed on CT with soft tissue windows (CT-STW) without and then with PET (PET/CT-STW). Results. Mean sensitivity and specificity for identifying malignancies included: CT-BW: 96%, 90%; CT-STW: 90%, 90%; PET/CT-BW: 95%, 85%, PET/CT-STW: 95%, 86% and PET-only: 96%, 75%, respectively. CT-BW demonstrated higher specificity than PET-only and PET/CT-BW (p=0.0005 and p=0.0103, respectively) and trended toward higher sensitivity than CT-STW (p=0.0759). Malignant primary bone tumors were more avid than benign lesions overall (p<0.0001) but the avidity of benign aggressive lesions (giant cell tumors and Langerhans Cell Histiocytosis) trended higher than the malignancies (p=0.08). Conclusion. Bone windows provided high specificity for distinguishing between malignant and benign primary bone tumors and are recommended when viewing FDG PET/CT.

  15. Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

    SciTech Connect

    Gaur, Shantanu K.; Friese, Jeremy L.; Sadow, Cheryl A.; Ayyagari, Rajasekhara; Binkert, Christoph A.; Schenker, Matthew P.; Kulke, Matthew; Baum, Richard

    2011-06-15

    Purpose: This study was designed to evaluate short (<3 months) and intermediate-term (>3 months) follow-up in patients with metastatic neuroendocrine tumor to the liver who underwent hepatic arterial chemoembolization with drug-eluting beads at a single institution. Methods: Institutional review board approval was obtained for this retrospective review. All patients who were treated with 100-300 or 300-500 {mu}m drug-eluting LC Beads (Biocompatibles, UK) preloaded with doxorubicin (range, 50-100 mg) for GI neuroendocrine tumor metastatic to the liver from June 2004 to June 2009 were included. CT and MRI were evaluated for progression using Response Evaluation Criteria In Solid Tumors (RECIST) or European Association for the Study of the Liver (EASL) criteria. Short-term (<3 months) and intermediate-term (>3 months) imaging response was determined and Kaplan-Meier survival curves were plotted. Results: Thirty-eight drug-eluting bead chemoembolization procedures were performed on 32 hepatic lobes, comprising 21 treatment cycles in 18 patients. All procedures were technically successful with two major complications (biliary injuries). At short-term follow-up (<3 months), 22 of 38 (58%) procedures and 10 of 21 (48%) treatment cycles produced an objective response (OR) with the remainder having stable disease (SD). At intermediate-term follow-up (mean, 445 days; range, 163-1247), 17 of 26 (65%) procedures and 8 of 14 (57%) treatment cycles produced an OR. Probability of progressing was approximately 52% at 1 year with a median time to progression of 419 days. Conclusions: Drug-eluting bead chemoembolization is a reasonable alternative to hepatic arterial embolization and chemoembolization for the treatment of metastatic neuroendocrine tumor to the liver.

  16. Additional value of hybrid SPECT/CT systems in neuroendocrine tumors, adrenal tumors, pheochromocytomas and paragangliomas.

    PubMed

    Wong, K K; Chondrogiannis, S; Fuster, D; Ruiz, C; Marzola, M C; Giammarile, F; Colletti, P M; Rubello, D

    The aim of this review was to evaluate the potential advantages of SPECT/CT hybrid imaging in the management of neuroendocrine tumors, adrenal tumors, pheochromocytomas and paragangliomas. From the collected data, the superiority of fused images was observed as providing both functional/molecular and morphological imaging compared to planar imaging. This provided an improvement in diagnostic imaging, with significant advantages as regards: (1) precise locating of the lesions; (2) an improvement in characterization of the findings, resulting higher specificity, improved sensitivity, and overall greater accuracy, (3) additional anatomical information derived from the CT component; (4) CT-based attenuation correction and potential for volumetric dosimetry calculations, and (5) improvement on the impact on patient management (e.g. in better defining treatment plans, in shortening surgical operating times). It can be concluded that SPECT/CT hybrid imaging provides the nuclear medicine physician with a powerful imaging modality in comparison to planar imaging, providing essential information about the location of lesions, and high quality homogeneous images. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  17. [The effect of tumor necrosis factor alpha on hepatic necrosis in viral hepatitis].

    PubMed

    Yu, Y; Si, C; Lang, Z

    1996-01-01

    In order to investigate the effect of tumor necrosis factor alpha (TNF alpha) on hepatocyte necrosis in viral hepatitis, TNF alpha with or without D-galactosamine (D-Gal) was injected into the abdominal cavity of rats. No effect was observed after injection of TNF alpha alone. After injection of TNF alpha with D-Gal, the total bilirubin level in rat blood increased and hepatocyte necrosis appeared (P < 0.05). Moreover, anti-TNF alpha McAb blocked the effect of hepatocyte necrosis produced by D-Gal and lipopolysaccharide (LPS). 130 samples of hepatic tissue were stained with anti-TNF alpha McAb by using ABC immunohistochemistry method. It was found that more severe the hepatocyte necrosis, more the positive cells expressing TNF alpha. There were more TNF alpha positive cells in the tissue of severe hepatitis. These results suggested that TNF alpha is a mediator in hepatocyte necrosis.

  18. Detection of local tumor progression by (18)F-FDG PET/CT following lung radiofrequency ablation: PET versus CT.

    PubMed

    Suzawa, Naohisa; Yamakado, Koichiro; Takao, Motoshi; Taguchi, Osamu; Yamada, Tomomi; Takeda, Kan

    2013-04-01

    The objective of this study was to compare the diagnostic performance for detecting local tumor progression between FDG PET and CT in patients who received lung radiofrequency (RF) ablation for the treatment of malignant lung tumors. A total of 469 FDG PET/CT studies were performed at 4 time points (3, 6, 9, 12 months) after lung RF ablation in 143 patients (87 male and 56 female patients) with 231 tumors. The SUVmax was calculated in treated tumors in each PET image. The percentage decrease (% decrease) in ablative zone size was evaluated in each CT image. The final response was judged based on follow-up findings and histology. Diagnostic performance of FDG PET and CT images was evaluated using receiver operating characteristic analysis. Local tumor progression was identified in 37 patients (25.9%, 37/143) having 47 tumors (20.4%, 47/231) during the median follow-up of 24 months (range, 8-75 months). The area under the receiver operating characteristic curve of PET was higher than that of CT at all 4 time points (0.71 vs 0.55 at 3 months, 0.82 vs 0.60 at 6 months, 0.84 vs 0.66 at 9 months, and 0.92 vs 0.68 at 12 months), and its diagnostic performance was significant at each time point (P = 0.0010 at 3 months and P < 0.001 at 6, 9, and 12 months). However, the area under the receiver operating characteristic curve of CT was significant at 9 months (P = 0.040) and 12 months (P = 0.032). FDG PET/CT is better able to assess local tumor progression at 3 and 6 months after lung RF ablation than CT alone.

  19. MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility

    PubMed Central

    Leyendecker, John R.; Menias, Christine O.; Oliveira, Erica P.; Narra, Vamsidhar R.; Chapman, William C.; Hassanien, Moataz H.; Elsharkawy, Mohamed S.; Brown, Jeffrey J.

    2007-01-01

    Objective. To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. Patients and methods. In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up. Results. MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). Conclusion. MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT. PMID:18333224

  20. Treatment of hepatic metastases of breast cancer with CT-guided interstitial brachytherapy - a phase II-study.

    PubMed

    Wieners, Gero; Mohnike, Konrad; Peters, Nils; Bischoff, Joachim; Kleine-Tebbe, Anke; Seidensticker, Ricarda; Seidensticker, Max; Gademann, Günther; Wust, Peter; Pech, Maciej; Ricke, Jens

    2011-08-01

    The aim of the study was the evaluation of feasibility, safety and effectiveness of interstitial brachytherapy for the treatment of hepatic metastases of breast cancer. Forty-one consecutive patients with 115 unresectable hepatic metastases of breast cancer were included in this phase-II-trial. They were treated in 69 interventions of CT-guided-interstitial-brachytherapy of the liver. Brachytherapy was applied as a single fraction high-dose-irradiation (15-25Gy (Gray)) using a (192)Ir-source of 10Ci. Nineteen patients presented systemically pretreated extrahepatic tumors. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 4.6 cm (1.5-11 cm). The median irradiation time per intervention was 26.5 min (range: 7-47 min). The applied median minimal dose at the CTV (clinical target volume) margin was 18.5 Gy (12-25 Gy). In 69 interventions and during the postinterventional period, one major complication (symptomatic post-interventional bleeding) (1.5%) and six minor complications occurred (8.7%). The median follow-up time was 18 months (range: 1-56). After 6, 12 and 18 months, local tumor control was 97%, 93.5% and 93.5%, intra- and extrahepatic progression free survival was 53%, 40% and 27%, and overall survival was 97%, 79% and 60%, respectively. CT-guided-brachytherapy is safe and effective for the treatment of liver metastases of breast cancer. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  1. Anatomy of hepatic arteriolo-portal venular shunts evaluated by 3D micro-CT imaging.

    PubMed

    Kline, Timothy L; Knudsen, Bruce E; Anderson, Jill L; Vercnocke, Andrew J; Jorgensen, Steven M; Ritman, Erik L

    2014-06-01

    The liver differs from other organs in that two vascular systems deliver its blood - the hepatic artery and the portal vein. However, how the two systems interact is not fully understood. We therefore studied the microvascular geometry of rat liver hepatic artery and portal vein injected with the contrast polymer Microfil(®). Intact isolated rat livers were imaged by micro-CT and anatomic evidence for hepatic arteriolo-portal venular shunts occurring between hepatic artery and portal vein branches was found. Simulations were performed to rule out the possibility of the observed shunts being artifacts resulting from image blurring. In addition, in the case of specimens where only the portal vein was injected, only the portal vein was opacified, whereas in hepatic artery injections, both the hepatic artery and portal vein were opacified. We conclude that mixing of the hepatic artery and portal vein blood can occur proximal to the sinusoidal level, and that the hepatic arteriolo-portal venular shunts may function as a one-way valve-like mechanism, allowing flow only from the hepatic artery to the portal vein (and not the other way around).

  2. Primary hepatic malignant peripheral nerve sheath tumor successfully treated with combination therapy: a case report and literature review

    PubMed Central

    Jung, Hae Il; Lee, Hyoung Uk; Ahn, Tae Sung; Lee, Jong Eun; Lee, Hyun Yong; Cho, Hyon Doek; Lee, Sang Cheol

    2016-01-01

    Primary malignant peripheral nerve sheath tumor (MPNST) in a young female patient, not associated with neurofibromatosis type-I is extremely rare in the liver. A 33-year-old female was admitted with a right flank pain for a weak. The CT scan showed 12.5-cm-sized mass located at the right hepatic lobe. At laparotomy, about 20.0-cm-sized mass was on the right hepatic lobe with attachment to right diaphragmatic pleura. Right hepatic lobe and adherent part of diaphragmatic pleura were resected. On histology and immunohistochemistry, it was diagnosed MPNST. Adjuvant radiotherapy for the right diaphragmatic pleura and adjuvant chemotherapy with adriamycin, ifosfamide and cisplatin were sequentially performed. The prognosis of MPNST is generally poor and it is associated with a highly aggressive course of recurrence, metastases, and death. Our case is probably a first report about combination therapy. PMID:27904856

  3. Reproducibility and variability of very low dose hepatic perfusion CT in metastatic liver disease

    PubMed Central

    Topcuoğlu, Osman Melih; Karçaaltıncaba, Muşturay; Akata, Deniz; Özmen, Mustafa Nasuh

    2016-01-01

    PURPOSE We aimed to determine the intra- and interobserver agreement on the software analysis of very low dose hepatic perfusion CT (pCT). METHODS A total of 53 pCT examinations were obtained from 21 patients (16 men, 5 women; mean age, 60.4 years) with proven liver metastasis from various primary cancers. The pCT examinations were analyzed by two readers independently and perfusion parameters were noted for whole liver, whole metastasis, metastasis wall, and normal-looking liver (liver tissue without metastasis) in regions of interest (ROIs). Readers repeated the analysis after an interval of one month. Intra- and interobserver agreements were assessed with intraclass correlation coefficients (ICC) and Bland-Altman statistics. RESULTS The mean ICCs of all ROIs between readers were 0.91, 0.93, 0.86, 0.45, 0.53, and 0.66 for blood flow (BF), blood volume (BV), permeability, arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI), respectively. The mean ICCs of all ROIs between readings were 0.86, 0.91, 0.81, 0.53, 0.56, and 0.71 for BF, BV, permeability, ALP, PVP, and HPI, respectively. There was greater agreement on the parameters measured for the whole metastasis than on the parameters measured for the metastasis wall. The effective dose of all perfusion CT studies was 2.9 mSv. CONCLUSION There is greater intra- and interobserver agreement for BF and BV than for permeability, ALP, PVP, and HPI at very low dose hepatic pCT. Permeability, ALP, PVP, and HPI parameters cannot be used in clinical practice for hepatic pCT with an effective dose of 2.9 mSv. PMID:27759566

  4. Early CT findings after interstitial radiation therapy for primary malignant brain tumors

    SciTech Connect

    Tolly, T.L.; Bruckman, J.E.; Czarnecki, D.J.; Frazin, L.J.; Lewis, H.J.; Richards, M.J.; Adamkiewicz, J.J. Jr.

    1988-11-01

    The CT findings after interstitial radiation therapy for brain tumors have not been extensively described. We evaluated retrospectively the CT scans of 13 patients who were treated with brachytherapy for malignant glioma. We found no typical CT appearance that differentiates recurrent tumor from radiation effect. After undergoing brachytherapy, eight of the 13 patients scanned demonstrated enhancement of brain tissue beyond the margins of the original enhancing tumor mass. In most cases, the pattern of enhancement diminished and extended more peripherally from the central necrotic area with time. We also report a new CT finding of focal calcification developing at the site of the radioactive implant.

  5. Gastrointestinal Stromal Tumor Showing Intense Tracer Uptake on PSMA PET/CT.

    PubMed

    Noto, Benjamin; Weckesser, Matthias; Buerke, Boris; Pixberg, Michaela; Avramovic, Nemanja

    2017-03-01

    A 70-year-old man with suspected prostate cancer was referred for Ga-PSMA-HBED-CC PET/CT (short PSMA PET/CT) for staging of tumor extent. Apart from vivid tracer uptake in the prostate gland and osseous metastasis, PSMA PET/CT revealed a large soft tissue mass with calcifications in the left upper abdomen showing intense tracer uptake. Histologic examination revealed the mass to be a gastrointestinal stromal tumor.

  6. Localization of islet cell tumors by dynamic CT: comparison with plain CT, arteriography, sonography, and venous sampling

    SciTech Connect

    Krudy, A.G.; Doppman, J.L.; Jensen, R.T.; Norton, J.A.; Collen, M.J.; Shawker, T.H.; Gardner, J.D.; McArthur, K.; Gorden, P.

    1984-09-01

    Ten patients with suspected islet cell tumors (seven with possible gastrinomas, three with insulinomas) underwent diagnostic evaluation with dynamic CT scanning, routine CT scanning, angiography, and sonography. Venous sampling was also performed in selected instances. Nine sites of gastrinoma and three insulinomas were confirmed surgically in eight patients. Two patients had negative surgical explorations. Routine CT demonstrated five of the nine gastrinomas and one of two insulinomas. Angiography was positive in six of nine gastrinomas and all three insulinomas. Sonography showed only two of the nine gastrinomas and two of the three insulinomas. Dynamic CT scanning demonstrated three additional lesions (two gastrinomas, on insulinoma) not visible on routine CT scanning. Although most of these lesions were visible arteriographically, dynamic CT scans at the appropriate level localized the pathology in the transverse plane and greatly aided in surgical resection of these lesions.

  7. Utility of Electrocardiography (ECG)-Gated Computed Tomography (CT) for Preoperative Evaluations of Thymic Epithelial Tumors.

    PubMed

    Ozawa, Yoshiyuki; Hara, Masaki; Nakagawa, Motoo; Shibamoto, Yuta

    2016-01-01

    Preoperative evaluation of invasion to the adjacent organs is important for the thymic epithelial tumors on CT. The purpose of our study was to evaluate the utility of electrocardiography (ECG)-gated CT for assessing thymic epithelial tumors with regard to the motion artifacts produced and the preoperative diagnostic accuracy of the technique. Forty thymic epithelial tumors (36 thymomas and 4 thymic carcinomas) were examined with ECG-gated contrast-enhanced CT using a dual source scanner. The scan delay after the contrast media injection was 30 s for the non-ECG-gated CT and 100 s for the ECG-gated CT. Two radiologists blindly evaluated both the non-ECG-gated and ECG-gated CT images for motion artifacts and determined whether the tumors had invaded adjacent structures (mediastinal fat, superior vena cava, brachiocephalic veins, aorta, pulmonary artery, pericardium, or lungs) on each image. Motion artifacts were evaluated using a 3-grade scale. Surgical and pathological findings were used as a reference standard for tumor invasion. Motion artifacts were significantly reduced for all structures by ECG gating (p=0.0089 for the lungs and p<0.0001 for the other structures). Non-ECG-gated CT and ECG-gated CT demonstrated 79% and 95% accuracy, respectively, during assessments of pericardial invasion (p=0.03). ECG-gated CT reduced the severity of motion artifacts and might be useful for preoperative assessment whether thymic epithelial tumors have invaded adjacent structures.

  8. Follow-up of Wilms tumor: comparison of CT with other imaging procedures

    SciTech Connect

    Brasch, R.C.; Randel, S.B.; Gould, R.G.

    1981-11-01

    In a retrospective review, computed tomography (CT) was compared to a ''routine'' combination of other diagnostic imaging procedures used for follow-up evaluations of 13 children being treated for Wilms tumor. The examined variables were diagnostic accuracy, expense, and duration of examination. Results from 13 patients indicated that CT most accurately answers diagnostic queries pertinent to follow-up evaluation of Wilms tumors: the presence and extent of bilateral renal tumors, local recurrence, contralateral renal hypertrophy, and metastasis to liver or lungs. For diagnosing pulmonary metastases, CT was superior to conventional chest radiography both in sensitivity (4/4 vs. 2/4) and specificity (9/9 vs. 6/9). In depiction of liver metastases, CT (3/3) was superior to liver scintigraphy (2/3). The extent of bilateral Wilms tumors was better defined by CT than by urography. In no instances were the alternative diagnostic imaging studies found to be more accurate than CT for the detection of recurrent tumor. Average cost for a CT examination ($344) is considerably less than the cost for a routine combination of the other imaging studies ($594). Examination time and diagnostic radiation doses are also reduced using CT. Pending larger comparison studies, CT is recommended as the primary diagnostic method for follow-up evaluation of patients with Wilms tumor.

  9. Cone-Beam Computed Tomography (CBCT) Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Performance Depicting Tumors and Tumor Feeders

    SciTech Connect

    Lee, In Joon; Chung, Jin Wook Yin, Yong Hu; Kim, Hyo-Cheol; Kim, Young Il; Jae, Hwan Jun; Park, Jae Hyung

    2015-10-15

    PurposeThis study was designed to analyze retrospectively the performance of cone-beam computed tomography (CBCT) hepatic arteriography in depicting tumors and their feeders and to investigate the related determining factors in chemoembolization for hepatocellular carcinoma (HCC).MethodsEighty-six patients with 142 tumors satisfying the imaging diagnosis criteria of HCC were included in this study. The performance of CBCT hepatic arteriography for chemoembolization per tumor and per patient was evaluated using maximum intensity projection images alone (MIP analysis) or MIP combined with multiplanar reformation images (MIP + MPR analysis) regarding the following three aspects: tumor depiction, confidence of tumor feeder detection, and trackability of tumor feeders. Tumor size, tumor enhancement, tumor location, number of feeders, diaphragmatic motion, portal vein enhancement, and hepatic artery to parenchyma enhancement ratio were regarded as potential determining factors.ResultsTumors were depicted in 125 (88.0 %) and 142 tumors (100 %) on MIP and MIP + MPR analysis, respectively. Imaging performances on MIP and MIP + MPR analysis were good enough to perform subsegmental chemoembolization without additional angiographic investigation in 88 (62.0 %) and 128 tumors (90.1 %) on per-tumor basis and in 43 (50 %) and 73 (84.9 %) on per-patient basis, respectively. Significant determining factors for performance in MIP + MPR analysis on per tumor basis were tumor size (p = 0.030), tumor enhancement (0.005), tumor location (p = 0.001), and diaphragmatic motion (p < 0.001).ConclusionsCBCT hepatic arteriography provided sufficient information for subsegmental chemoembolization by depicting tumors and their feeders in the vast majority of patients. Combined analysis of MIP and MPR images was essential to enhance the performance of CBCT hepatic arteriography.

  10. Detectability of hepatic tumors during 3D post-processed ultrafast cone-beam computed tomography

    NASA Astrophysics Data System (ADS)

    Paul, Jijo; Vogl, Thomas J.; Chacko, Annamma

    2015-10-01

    To evaluate hepatic tumor detection using ultrafast cone-beam computed tomography (UCBCT) cross-sectional and 3D post-processed image datasets. 657 patients were examined using UCBCT during hepatic transarterial chemoembolization (TACE), and data were collected retrospectively from January 2012 to September 2014. Tumor detectability, diagnostic ability, detection accuracy and sensitivity were examined for different hepatic tumors using UCBCT cross-sectional, perfusion blood volume (PBV) and UCBCT-MRI (magnetic resonance imaging) fused image datasets. Appropriate statistical tests were used to compare collected sample data. Fused image data showed the significantly higher (all P  <  0.05) diagnostic ability for hepatic tumors compared to UCBCT or PBV image data. The detectability of small hepatic tumors (<5 mm) was significantly reduced (all P  <  0.05) using UCBCT cross-sectional images compared to MRI or fused image data; however, PBV improved tumor detectability using a color display. Fused image data produced 100% tumor sensitivity due to the simultaneous availability of MRI and UCBCT information during tumor diagnosis. Fused image data produced excellent hepatic tumor sensitivity, detectability and diagnostic ability compared to other datasets assessed. Fused image data is extremely reliable and useful compared to UCBCT cross-sectional or PBV image datasets to depict hepatic tumors during TACE. Partial anatomical visualization on cross-sectional images was compensated by fused image data during tumor diagnosis.

  11. Primary Hepatic Osteosarcoma: A Rare Cause of Primary Liver Tumor

    PubMed Central

    Tamang, Tsering Gyalpo Lama; Shuster, Marina; Chandra, Abhinav B.

    2016-01-01

    INTRODUCTION Extraosseous osteosarcomas are rare, accounting for approximately 4% of all osteosarcomas. A literature review yields very few cases of osteosarcoma primarily arising from the hepatic parenchyma. CASE REPORT This report describes a case of a man in his 50s with a history of hepatitis C and cirrhosis who presented with 5 days of progressive right upper quadrant pain. Magnetic resonance imaging of the abdomen and pelvis demonstrated a 4.4 cm × 4.8 cm × 4.8 cm right hepatic lobe mass with a large area of necrosis and peripheral enhancement. The subsequent liver biopsy showed few cores of tumor composed of fibroblastic malignant cells producing lace-like osteoid matrix. Osteosarcomatous foci in other parts of the body were excluded by performing extensive physical examination, radiologic imaging, and biopsy. Hence, a primary osteosarcoma was diagnosed. The patient underwent portal vein embolization in preparation for a surgical resection of the right liver lobe. He was admitted six weeks after the embolization for dyspnea and abdominal distension and expired due to abdominal hematoma and pulmonary embolism. CONCLUSION Based on the rarity, lack of consensus in treatment, and dismal prognosis, extraosseous osteosarcoma should be considered a separate entity from osseous osteosarcoma. More data and research are needed in this rare and understudied malignancy. PMID:27081321

  12. Evaluation of Intrahepatic Perfusion on Fusion Imaging Using a Combined CT/SPECT System: Influence of Anatomic Variations on Hemodynamic Modification Before Installation of Implantable Port Systems for Hepatic Arterial Infusion Chemotherapy

    SciTech Connect

    Ikeda, Osamu Tamura, Yoshitaka; Nakasone, Yutaka; Shiraishi, Shinya; Kawanaka, Kouichi; Tomiguchi, Seiji; Takamori, Hiroshi; Chikamoto, Akira; Kanemitsu, Keiichirou; Yamashita, Yasuyuki

    2007-06-15

    Background. In some patients with hepatic tumors, anatomic variations in the hepatic arteries may require hemodynamic modification to render effective hepatic arterial infusion chemotherapy delivered via implantable port systems. We used a combined CT/SPECT system to obtain fused images of the intrahepatic perfusion patterns in patients with such anatomic variations and assessed their effects on the treatment response of hepatic tumors. Methods. Using a combined SPECT/CT system, we obtained fused images in 110 patients with malignant liver tumors (n = 75) or liver metastasis from unresectable pancreatic cancer (n = 35). Patients with anatomic hepatic arteries variations underwent hemodynamic modification before the placement of implantable port systems for hepatic arterial infusion chemotherapy. We evaluated their intrahepatic perfusion patterns and the initial treatment response of their liver tumors. The perfusion patterns on the fused images were classified as homogeneous, local hypoperfusion, and/or perfusion defect. Using the WHO criteria of complete response (CR), partial response (PR), no change (NC), and progressive disease (PD), we evaluated the patients' tumor responses after 3 months on multislice helical CT scans. The treatment was regarded as effective in patients who achieved a complete response or partial response. Results. Anatomic hepatic artery variations were present in 15 of the 110 patients (13.6%); 5 manifested replacement of the left hepatic artery (LHA), 8 of the right hepatic artery (RHA), and 1 each had replacement of the RHA and LHA, and replacement of the LHA plus an accessory RHA. In 13 of these 15 patients (87%), occlusion with metallic coils was successful. On fusion imaging, the perfusion patterns were recorded as homogeneous in 6 patients (43%), as hypoperfusion in 7 (50%), and 1 patient had a perfusion defect (7.1%) in the embolized arterial region. Of the 8 patients with RHA replacement, 4 manifested a homogeneous distribution and

  13. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans.

    PubMed

    Boas, F Edward; Kamaya, Aya; Do, Bao; Desser, Terry S; Beaulieu, Christopher F; Vasanawala, Shreyas S; Hwang, Gloria L; Sze, Daniel Y

    2015-04-01

    Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

  14. Diagnostic performance of Contrast-enhanced CT in Pyrrolizidine Alkaloids-induced Hepatic Sinusoidal Obstructive Syndrome

    PubMed Central

    Kan, Xuefeng; Ye, Jin; Rong, Xinxin; Lu, Zhiwen; Li, Xin; Wang, Yong; Yang, Ling; Xu, Keshu; Song, Yuhu; Hou, Xiaohua

    2016-01-01

    Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by pyrrolizidine alkaloids(PAs)-containing herbals. Since PAs exposure is obscure and clinical presentation of HSOS is unspecific, it is challenge to establish the diagnosis of PAs-induced HSOS. Gynura segetum is one of the most wide-use herbals containing PAs. The aim of our study is to describe the features of contrast-enhanced computed tomography (CT) in gynura segetum-induced HSOS, and then determine diagnostic performance of radiological signs. We retrospectively analyzed medical records and CT images of HSOS patients (71 cases) and the controls (222 cases) enrolled from January 1, 2008, to Oct 31, 2015. The common findings of contrast CT in PAs-induced HSOS included: ascites (100%), hepatomegaly (78.87%), gallbladder wall thickening (86.96%), pleural effusion (70.42%), hepatic vein narrowing (87.32%), patchy liver enhancement (92.96%), and heterogeneous hypoattenuation (100%); of these signs, patchy enhancement and heterogeneous hypoattenuation were valuable features. Then, the result of diagnostic performance demonstrated that contrast CT possessed better performance in diagnosing PAs-induced HSOS compared with various parameters of Seattle criteria. In conclusion, the patients with PAs-induced HSOS display distinct radiologic features at CT-scan, which reveals that contrast-enhanced CT provides an effective noninvasive method for diagnosing PAs-induced HSOS. PMID:27897243

  15. Hepatic arterial embolization in patients with neuroendocrine tumors

    PubMed Central

    2014-01-01

    Liver metastases occur in 46-93% of patients with neuroendocrine neoplasms (NENs). Presence and extension of liver metastases are considered important prognostic factors, as they may significantly impair the patient’s quality of life, because of either tumor bulk or hormonal hypersecretion. Therapies for NEN liver metastases include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy, but in most of NEN patients with liver metastases, when surgery can not be applied, minimally invasive therapeutic approaches are adopted. They include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), radiofrequency thermal ablation and new emerging techniques. TAE is based on selective infusion of particles in the branch of the hepatic artery supplying the tumor lesions. The goal of TAE is to occlude tumor blood vessels resulting in ischemia and necrosis. Many reports have shown that TAE can reduce tumor size and hormone output, resulting in palliation of symptoms without the use of cytotoxic drugs, resulting in better tolerability. This review will focus on TAE performance and safety in NEN patients with liver metastases. PMID:24887262

  16. Changes in Hepatic Blood Flow During Transcatheter Arterial Infusion with Heated Saline in Hepatic VX2 Tumor

    SciTech Connect

    Cao Wei; Li Jing; Wu Zhiqun; Zhou Changxi; Liu Xi; Wan Yi; Duan Yunyou

    2013-06-15

    Purpose. This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. Methods. All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 Degree-Sign C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 Degree-Sign C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. Results. After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. Conclusions. The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.

  17. Atlas of hepatic tumors and focal lesions: Arteriographic and tomographic diagnosis

    SciTech Connect

    Gutierrez, O.; Schwartz, S.I.

    1984-01-01

    This book describes the diagnosis of liver tumors. Topics considered include general considerations, hepatocellular carcinoma, hepatoblastoma, cholangiocarcinoma, mesenchyomoma, sarcoma, hemangioma, hepatic cell adenoma, focal nodular hyperlasia (FNH), hamartoma, echinococcus cyst, abscess, AV fistula, hepatic artery aneurysm, metastatic carcinoma-colon, metastatic cholangiocarcinoma, metastatic melanoma, metastatic merkel cell and extrahepatic tumor.

  18. Clinical application of SPECT-CT with 99mTc-Tektrotyd in bronchial and thymic neuroendocrine tumors (NETs).

    PubMed

    Sergieva, Sonya; Robev, Bozhil; Dimcheva, Milena; Fakirova, Albena; Hristoskova, Radka

    2016-01-01

    Neuroendocrine tumors (NETs) of the thorax including bronchial and thymic tumors belong to foregut NETs. Limited loco-regional thoracic NETs can be resected with surgery, but in extensive metastatic disease the treatment is mainly palliative. A high incidence and density of somatostatin receptors (SSTR2, SSTR3, and SSTR5) are found in thoracic NETs. The purpose of this study was to evaluate the role of SPECT-CT somatostatin receptor scintigraphy (SRS) with 99mTc-Tektrotyd for imaging, staging and follow up of patients with bronchial and thymic neuroendocrine tumors. Forty-one patients with thoracic tumors with neuroendocrine differentiation were studied. Sixty-eight examinations including SPECT-CT studies of the neck and chest and/or abdomen and pelvis were carried out 2-4 hrs. post i.v. administration of aver-age 740 MBq activity dose of 99mTc-EDDA/HYNIC-TOC (Tektrotyd, Polatom). In all 41 investigated patients we obtained 81.25% (13/16), 88% (22/25) and 85.36% (35/41) of sensitivity, specificity and accuracy of this diagnostic approach, respectively. Somatostatin-receptor scintigraphy correctly identified all primary NETs located in the lungs and thymus. SPECT-CT studies with 99mTc-EDDA/HYNIC-TOC resulted in exact pre-surgical and pre-treatment N/M staging of bronchial and thymic NETs, except 2 cases with multiple hepatic metastases and 1 with massive suprarenal metastasis. It can be concluded that SPECT-CT with 99mTc-EDDA/HYNIC-TOC is a valuable tool for staging and follow-up of patients with thoracic NETs.

  19. Findings of non-pathologic perfusion defects by CT arterial portography and non-pathologic enhancement of CT hepatic arteriography

    PubMed Central

    Li, Li; Wu, Pei-Hong; Lin, Hao-Gao; Li, Jin-Qing; Mo, Yun-Xian; Zheng, Lie; Lu, Li-Xia; Ruan, Chao-Mei; Chen, Lin

    1998-01-01

    AIM: To recognize the characteristic findings of non-pathologic perfusion defects with CT arterial portography (CTAP) and nonpathologic enhancement found in CT hepatic arteriography (CTHA). METHONDS: The manifestations of nonpathologic perfusion defects with CTAP and non-pathologic enhancement found in CTHA were analyzed in 50 patients with primary hepatocellular carcinoma. RESULTS: The false-positive rate of perfusion defects detected in CTAP was 15.1%. The shapes of perfusion defects were peripheral wedge, small, round, and patchy. The occurrence rate of non-pathologic enhancement found in CTHA was 22.0%. The shapes of non-pathologic enhancement were small, round, irregular, and wedge. CONCLUSION: There was high frequency of non-pathologic perfusion defects detected with CTAP and non-pathologic enhancement found in CTHA. The simultaneous use of both procedures may help decrease the false-positive rate, and increase the veracity of diagnosis for hepatocellular carcinoma. PMID:11819358

  20. Improving abdomen tumor low-dose CT images using a fast dictionary learning based processing

    NASA Astrophysics Data System (ADS)

    Chen, Yang; Yin, Xindao; Shi, Luyao; Shu, Huazhong; Luo, Limin; Coatrieux, Jean-Louis; Toumoulin, Christine

    2013-08-01

    In abdomen computed tomography (CT), repeated radiation exposures are often inevitable for cancer patients who receive surgery or radiotherapy guided by CT images. Low-dose scans should thus be considered in order to avoid the harm of accumulative x-ray radiation. This work is aimed at improving abdomen tumor CT images from low-dose scans by using a fast dictionary learning (DL) based processing. Stemming from sparse representation theory, the proposed patch-based DL approach allows effective suppression of both mottled noise and streak artifacts. The experiments carried out on clinical data show that the proposed method brings encouraging improvements in abdomen low-dose CT images with tumors.

  1. Azadirachta indica modulates electrical properties and type of cell death in NDEA-induced hepatic tumors.

    PubMed

    Bharati, Sanjay; Rishi, Praveen; Koul, Ashwani

    2014-09-01

    Tissue electrical conductivity is an important indicator of tissue structure and composition. Present study demonstrates modulatory effect of Azadirachta indica on the electrical conductivity and cell death in hepatic tumors. Hepatic tumors were generated by intraperitoneal injection of N-nitrosodiethylamine (cumulative dose: 200 μg/g body mass) to male BALB/c mice. Aqueous A. indica leaf extract (AAILE) was administered orally at a dosage of 100 μg/g body mass till the termination of experiment. At the end of experiment, electrical conductivity of hepatic tumors was measured with four-pin electrode method. Tissues and tumors were then processed for TUNEL assay and DNA fragmentation analysis. The levels of TNF-α were also determined in the normal hepatic and tumor tissue. Hepatic tumors had higher electrical conductivity compared to normal liver tissue. An increased necrotic cell percentage along with elevated TNF-α was also observed. Although, AAILE co-treatment resulted in tumors with higher electrical conductivity compared to normal animals. However, the electrical conductivity was decreased significantly compared to untreated tumors. A significant increase in apoptotic cell percentage and concomitant decrease in necrotic cell percentage along with the increased TNF-α level was observed in these tumors. The results suggest that A. indica modulated mode of cell death in tumors and type of cell death had significant contribution in determining hepatic tumor electrical conductivity.

  2. Is Non-Contrast CT Adequate for the Evaluation of Hepatic Metastasis in Patients Who Cannot Receive Iodinated Contrast Media?

    PubMed

    Jee, Han Bum; Park, Min Jung; Lee, Hye Sun; Park, Mi-Suk; Kim, Myeong-Jin; Chung, Yong Eun

    2015-01-01

    To evaluate the appropriateness of follow-up with only non-enhanced CT (NECT) in patients with gastrointestinal cancer. This retrospective study included 323 patients with colorectal and gastric cancer who underwent two consecutive CT examinations (CT1 and CT2), including non-contrast and portal venous phase CT images, with an interval of 1 year. Patients were divided into 2 groups: Group A included patients with no hepatic metastasis on CT1 and with or without newly developed metastasis on CT2 to evaluate the diagnostic performance of NECT for detecting newly developed hepatic metastasis; Group B included patients with known hepatic metastasis both on CT1 and CT2 to evaluate the accuracy of NECT for the assessment of hepatic metastasis based on RECIST criteria (version 1.1). Contrast-enhanced CT (CECT) images were considered as reference standards. Group A included 172 patients (M:F = 107:65; mean age, 62.6 years). Among them, 57 patients had 95 metastases (mean size, 2.2 ± 1.3 cm). Per patient and per lesion sensitivity for diagnosing newly developed hepatic metastasis was 56.1-66.7% and 52.6-56.8%, respectively. In terms of small metastases (<1.5 cm), per lesion sensitivity was significantly decreased to 28.1-34.4% (P < 0.05). Metastasis size measurements were significantly smaller on NECT (P < 0.001) compared with reference standards. In Group B, the accuracy of response evaluation based on RECIST criteria was 65.6-72.2%. NECT showed inadequate diagnostic performances in both detecting newly developed hepatic metastasis and evaluating the response of hepatic metastasis based on RECIST criteria.

  3. SU-E-J-267: Change in Mean CT Intensity of Lung Tumors During Radiation Treatment

    SciTech Connect

    Mahon, R; Tennyson, N; Weiss, E; Hugo, G

    2015-06-15

    Purpose: To evaluate CT intensity change of lung tumors during radiation therapy. Methods: Repeated 4D CT images were acquired on a CT simulator during the course of therapy for 27 lung cancer patients on IRB approved protocols. All subjects received definitive radiation treatment ± chemotherapy. CT scans were completed prior to treatment, and 2–7 times during the treatment course. Primary tumor was delineated by an experienced Radiation Oncologist. Contours were thresholded between −100 HU and 200 HU to remove airways and bone. Correlations between the change in the mean tumor intensity and initial tumor intensity, SUVmax, and tumor volume change rate were investigated. Reproducibility was assessed by evaluating the variation in mean intensity over all phases in 4DCT, for a subgroup of 19 subjects. Results: Reproducibility of tumor intensity between phases as characterized by the root mean square of standard deviation across 19 subjects was 1.8 HU. Subjects had a mean initial tumor intensity of 16.5 ± 11.6 HU and an overall reduction in HU by 10.3 ± 8.5 HU. Evaluation of the changes in tumor intensity during treatment showed a decrease of 0.3 ± 0.3 HU/day for all subjects, except three. No significant correlation was found between change in HU/day and initial HU intensity (p=0.53), initial PET SUVmax (p=0.69), or initial tumor volume (p=0.70). The rate of tumor volume change was weakly correlated (R{sup 2}=0.05) with HU change (p=0.01). Conclusion: Most lung cancer subjects showed a marked trend of decreasing mean tumor CT intensity throughout radiotherapy, including early in the treatment course. Change in HU/day is not correlated with other potential early predictors for response, such as SUV and tumor volume change. This Result supports future studies to evaluate change in tumor intensity on CT as an early predictor of response.

  4. PET-CT Fusion in Radiation Management of Patients with Anorectal Tumors

    SciTech Connect

    Anderson, Cynthia; Koshy, Mary; Staley, Charles; Esiashvili, Natia; Ghavidel, Sharam; Fowler, Zach; Fox, Tim; Esteves, Fabio; Landry, Jerome Godette, Karen

    2007-09-01

    Purpose: To compare computed tomography (CT) with positron emission tomography-CT (PET-CT) scans with respect to anorectal tumor volumes, correlation in overlap, and influence on radiation treatment fields and patient care. Patients and Methods: From March to November 2003, 20 patients with rectal cancer and 3 patients with anal cancer were treated with preoperative or definitive chemoradiation, respectively. Computed tomography simulation data generated a CT gross tumor volume (CT-GTV) and CT planning target volume (CT-PTV) and {sup 18}F-fluoro-2-deoxy-glucose PET (FDG-PET) created a PET-GTV and PET-PTV. The PET-CT and CT images were fused using manual coregistration. Patients were treated with three-dimensional conformal therapy to traditional doses. The PET, CT, and overlap volumes (OVs) were measured in cubic centimeters. Results: Mean PET-GTV was smaller than the mean CT-GTV (91.7 vs. 99.6 cm{sup 3}). The mean OV was 46.7%. As tumor volume increased, PET and CT OV correlated significantly (p < 0.001). In 17% of patients PET-CT altered the PTV, and in 26% it changed the radiation treatment plan. For 25% of patients with rectal cancer, PET detected distant metastases and changed overall management. Ten rectal cancer patients underwent surgery. When the pretreatment PET standardized uptake value was >10 and the posttreatment PET standardized uptake value was <6, 100% achieved pathologic downstaging (p = 0.047). Conclusions: Variation in volume was significant, with 17% and 26% of patients requiring a change in treatment fields and patient management, respectively. Positron emission tomography can change the management for anorectal tumors by early detection of metastatic disease or disease outside standard radiation fields.

  5. Precision of iodine quantification in hepatic CT: effects of reconstruction (FBP and MBIR) and imaging parameters

    NASA Astrophysics Data System (ADS)

    Chen, Baiyu; Samei, Ehsan; Colsher, James; Barnhart, Huiman; Marin, Daniele; Nelson, Rendon

    2011-03-01

    In hepatic CT imaging, the lesion enhancement after the injection of contrast media is of quantitative interest. However, the precision of this quantitative measurement may be dependent on the imaging techniques such as dose and reconstruction algorithm. To determine the impact of different techniques, we scanned an iodinated liver phantom with acquisition protocols of different dose levels, and reconstructed images with different algorithms (FBP and MBIR) and slice thicknesses. The contrast of lesions was quantified from the images, and its precision was calculated for each protocol separately. Results showed that precision was improved by increasing dose, increasing slice thickness, and using MBIR reconstruction. When using MBIR instead of FBP, the same precision can be achieved at 50% less dose. To our knowledge, this is the first investigation of the quantification precision in hepatic CT imaging using iterative reconstructions.

  6. Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery.

    PubMed

    Schelhorn, Juliane; Ertle, Judith; Schlaak, Joerg F; Mueller, Stefan; Bockisch, Andreas; Schlosser, Thomas; Lauenstein, Thomas

    2014-01-01

    Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including (99m)Tc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation. The other four patients presented with an abdominal wall (99m)Tc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

  7. Imaging Features of Radiofrequency Ablation with Heat-Deployed Liposomal Doxorubicin in Hepatic Tumors

    SciTech Connect

    Hong, Cheng William Chow, Lucy; Turkbey, Evrim B.; Lencioni, Riccardo; Libutti, Steven K.; Wood, Bradford J.

    2016-03-15

    IntroductionThe imaging features of unresectable hepatic malignancies in patients who underwent radiofrequency ablation (RFA) in combination with lyso-thermosensitive liposomal doxorubicin (LTLD) were determined.Materials and MethodsA phase I dose escalation study combining RFA with LTLD was performed with peri- and post- procedural CT and MRI. Imaging features were analyzed and measured in terms of ablative zone size and surrounding penumbra size. The dynamic imaging appearance was described qualitatively immediately following the procedure and at 1-month follow-up. The control group receiving liver RFA without LTLD was compared to the study group in terms of imaging features and post-ablative zone size dynamics at follow-up.ResultsPost-treatment scans of hepatic lesions treated with RFA and LTLD have distinctive imaging characteristics when compared to those treated with RFA alone. The addition of LTLD resulted in a regular or smooth enhancing rim on T1W MRI which often correlated with increased attenuation on CT. The LTLD-treated ablation zones were stable or enlarged at follow-up four weeks later in 69 % of study subjects as opposed to conventional RFA where the ablation zone underwent involution compared to imaging acquired immediately after the procedure.ConclusionThe imaging features following RFA with LTLD were different from those after standard RFA and can mimic residual or recurrent tumor. Knowledge of the subtle findings between the two groups can help avoid misinterpretation and proper identification of treatment failure in this setting. Increased size of the LTLD-treated ablation zone after RFA suggests the ongoing drug-induced biological effects.

  8. Fully automatic anatomical, pathological, and functional segmentation from CT scans for hepatic surgery

    NASA Astrophysics Data System (ADS)

    Soler, Luc; Delingette, Herve; Malandain, Gregoire; Montagnat, Johan; Ayache, Nicholas; Clement, Jean-Marie; Koehl, Christophe; Dourthe, Olivier; Mutter, Didier; Marescaux, Jacques

    2000-06-01

    To facilitate hepatic surgical planning, we have developed a new system for the automatic 3D delineation of anatomical and pathological hepatic structures from a spiral CT scan. This system also extracts functional information useful for surgery planning, such as portal vein labeling and anatomical segment delineation following the conventional Couinaud definition. From a 2 mm thick enhanced spiral CT scan, a first stage automatically delineates the skin, bones, lungs and kidneys, by combining the use of thresholding, mathematical morphological methods and distance maps. Next, a reference 3D model is immerged in the image and automatically deformed to the liver contour. Then an automatic Gaussians fitting on the imaging histogram allows to threshold the intensities of parenchyma, vessels and lesions. The next stage improves this first classification by an original topological and geometrical analysis, providing an automatic and precise delineation of lesions and veins. Finally, a topological and geometrical analysis based on medical knowledge provides the hepatic functional information invisible in medical imaging: portal vein labeling and hepatic anatomical segments. Clinical validation performed on more than 30 patients shows that this method allows a delineation of anatomical structures, often more sensitive and more specific than manual delineation by a radiologist.

  9. Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning

    SciTech Connect

    Arvold, Nils D.; Niemierko, Andrzej; Mamon, Harvey J.; Hong, Theodore S.

    2011-08-01

    Purpose: Pancreatic cancer primary tumor size measurements are often discordant between computed tomography (CT) and pathologic specimen after resection. Dimensions of the primary tumor are increasingly relevant in an era of highly conformal radiotherapy. Methods and Materials: We retrospectively evaluated 97 consecutive patients with resected pancreatic cancer at two Boston hospitals. All patients had CT scans before surgical resection. Primary endpoints were maximum dimension (in millimeters) of the primary tumor in any direction as reported by the radiologist on CT and by the pathologist for the resected gross fresh specimen. Endoscopic ultrasound (EUS) findings were analyzed if available. Results: Of the patients, 87 (90%) had preoperative CT scans available for review and 46 (47%) had EUS. Among proximal tumors (n = 69), 40 (58%) had pathologic duodenal invasion, which was seen on CT in only 3 cases. The pathologic tumor size was a median of 7 mm larger compared with CT size for the same patient (range, -15 to 43 mm; p < 0.0001), with 73 patients (84%) having a primary tumor larger on pathology than CT. Endoscopic ultrasound was somewhat more accurate, with pathologic tumor size being a median of only 5 mm larger compared with EUS size (range, -15 to 35 mm; p = 0.0003). Conclusions: Computed tomography scans significantly under-represent pancreatic cancer tumor size compared with pathologic specimens in resectable cases. We propose a clinical target volume expansion formula for the primary tumor based on our data. The high rate of pathologic duodenal invasion suggests a risk of duodenal undercoverage with highly conformal radiotherapy.

  10. Ossifying renal tumor of infancy: findings at ultrasound, CT and MRI.

    PubMed

    Lee, Sang Hwan; Choi, Young Hun; Kim, Woo Sun; Cheon, Jung-Eun; Moon, Kyung Chul

    2014-05-01

    A 4-month-old boy presented with persistent gross hematuria. At ultrasonography, a 3.5-cm echogenic mass with posterior shadowing and tumor vascularity was detected within the right renal pelvis. Precontrast CT showed a slightly hyperattenuating mass in the renal pelvis. At MRI the mass was heterogeneously hypointense on T2-weighted images and isointense on T1-weighted images. Contrast-enhanced CT and MRI both revealed peripheral enhancement of the mass. A histological diagnosis of ossifying renal tumor of infancy was made after open pyelostomy and tumor enucleation. We suggest that ossifying renal tumor of infancy should be considered when a mass with posterior acoustic shadowing and tumor vascularity on US, hyperattenuation on precontrast CT and hypointensity on T2-weighted MRI is seen within the renal pelvis of an infant with hematuria.

  11. The importance of PET/CT in the evaluation of patients with Ewing tumors*

    PubMed Central

    Guimarães, Júlio Brandão; Rigo, Letícia; Lewin, Fabio; Emerick, André

    2015-01-01

    The effective evaluation for the treatment of patients with Ewing tumors depends on the accuracy in the determination of the primary tumor extent and the presence of metastatic disease. Currently, no universally accepted staging system is available to assess Ewing tumors. The present study aimed at discussing the use of PET/CT as a tool for staging, restaging and assessment of therapeutic response in patients with Ewing tumors. In spite of some limitations of PET/CT as compared with anatomical imaging methods, its relevance in the assessment of these patients is related to the capacity of the method to provide further physiological information, which often generates important clinical implications. Currently, the assessment of patients with Ewing tumor should comprise a study with PET/CT combined with other anatomical imaging modalities, such as radiography, computed tomography and magnetic resonance imaging. PMID:26185344

  12. Deriving the Intrahepatic Arteriovenous Shunt Rate from CT Images and Biochemical Data Instead of from Arterial Perfusion Scintigraphy in Hepatic Arterial Infusion Chemotherapy

    SciTech Connect

    Ozaki, Toshiro Seki, Hiroshi; Shiina, Makoto

    2009-09-15

    The purpose of the present study was to elucidate a method for predicting the intrahepatic arteriovenous shunt rate from computed tomography (CT) images and biochemical data, instead of from arterial perfusion scintigraphy, because adverse exacerbated systemic effects may be induced in cases where a high shunt rate exists. CT and arterial perfusion scintigraphy were performed in patients with liver metastases from gastric or colorectal cancer. Biochemical data and tumor marker levels of 33 enrolled patients were measured. The results were statistically verified by multiple regression analysis. The total metastatic hepatic tumor volume (V{sub metastasized}), residual hepatic parenchyma volume (V{sub residual}; calculated from CT images), and biochemical data were treated as independent variables; the intrahepatic arteriovenous (IHAV) shunt rate (calculated from scintigraphy) was treated as a dependent variable. The IHAV shunt rate was 15.1 {+-} 11.9%. Based on the correlation matrixes, the best correlation coefficient of 0.84 was established between the IHAV shunt rate and V{sub metastasized} (p < 0.01). In the multiple regression analysis with the IHAV shunt rate as the dependent variable, the coefficient of determination (R{sup 2}) was 0.75, which was significant at the 0.1% level with two significant independent variables (V{sub metastasized} and V{sub residual}). The standardized regression coefficients ({beta}) of V{sub metastasized} and V{sub residual} were significant at the 0.1 and 5% levels, respectively. Based on this result, we can obtain a predicted value of IHAV shunt rate (p < 0.001) using CT images. When a high shunt rate was predicted, beneficial and consistent clinical monitoring can be initiated in, for example, hepatic arterial infusion chemotherapy.

  13. Utility of Electrocardiography (ECG)-Gated Computed Tomography (CT) for Preoperative Evaluations of Thymic Epithelial Tumors

    PubMed Central

    Ozawa, Yoshiyuki; Hara, Masaki; Nakagawa, Motoo; Shibamoto, Yuta

    2016-01-01

    Summary Background Preoperative evaluation of invasion to the adjacent organs is important for the thymic epithelial tumors on CT. The purpose of our study was to evaluate the utility of electrocardiography (ECG)-gated CT for assessing thymic epithelial tumors with regard to the motion artifacts produced and the preoperative diagnostic accuracy of the technique. Material/Methods Forty thymic epithelial tumors (36 thymomas and 4 thymic carcinomas) were examined with ECG-gated contrast-enhanced CT using a dual source scanner. The scan delay after the contrast media injection was 30 s for the non-ECG-gated CT and 100 s for the ECG-gated CT. Two radiologists blindly evaluated both the non-ECG-gated and ECG-gated CT images for motion artifacts and determined whether the tumors had invaded adjacent structures (mediastinal fat, superior vena cava, brachiocephalic veins, aorta, pulmonary artery, pericardium, or lungs) on each image. Motion artifacts were evaluated using a 3-grade scale. Surgical and pathological findings were used as a reference standard for tumor invasion. Results Motion artifacts were significantly reduced for all structures by ECG gating (p=0.0089 for the lungs and p<0.0001 for the other structures). Non-ECG-gated CT and ECG-gated CT demonstrated 79% and 95% accuracy, respectively, during assessments of pericardial invasion (p=0.03). Conclusions ECG-gated CT reduced the severity of motion artifacts and might be useful for preoperative assessment whether thymic epithelial tumors have invaded adjacent structures. PMID:27920842

  14. Comparison of CT and MRI brain tumor imaging using a canine glioma model.

    PubMed

    Whelan, H T; Clanton, J A; Wilson, R E; Tulipan, N B

    1988-01-01

    A canine gliosarcoma model was used to study the effectiveness of magnetic resonance imaging (MRI) with gadolinium contrast enhancement in defining the histologic margins of brain tumors. The effectiveness of this technique was compared to conventional computed tomography (CT) using iodinated contrast enhancement. Cultured canine gliosarcoma cells were injected into the left hemisphere of adult mongrel dogs. The dogs developed brain tumors and progressive clinical signs. Serial MRI with and without gadolinium diethylene triamine penta-acetic acid was compared to serial CT with and without sodium iothalamate obtained on the same days. After the final scans, animals were sacrificed; the brains were removed and processed for routine histopathologic study. All tumors were visualized with contrast-enhanced MRI which proved most sensitive. Gadolinium di-ethylene triamine penta-acetic acid caused bright enhancement of tumors in a distribution that consistently corresponded to areas of pathologically proved tumor infiltration. Gross and microscopic autopsy findings correlated better with MRI than with CT which tended to produce poorer resolution and underrepresent the size of viable tumor. Gadolinium-enhanced MRI is more accurate than unenhanced MRI, unenhanced CT, or enhanced CT in defining the histologic margins of tumors.

  15. Segmentation of hepatic artery in multi-phase liver CT using directional dilation and connectivity analysis

    NASA Astrophysics Data System (ADS)

    Wang, Lei; Schnurr, Alena-Kathrin; Zidowitz, Stephan; Georgii, Joachim; Zhao, Yue; Razavi, Mohammad; Schwier, Michael; Hahn, Horst K.; Hansen, Christian

    2016-03-01

    Segmentation of hepatic arteries in multi-phase computed tomography (CT) images is indispensable in liver surgery planning. During image acquisition, the hepatic artery is enhanced by the injection of contrast agent. The enhanced signals are often not stably acquired due to non-optimal contrast timing. Other vascular structure, such as hepatic vein or portal vein, can be enhanced as well in the arterial phase, which can adversely affect the segmentation results. Furthermore, the arteries might suffer from partial volume effects due to their small diameter. To overcome these difficulties, we propose a framework for robust hepatic artery segmentation requiring a minimal amount of user interaction. First, an efficient multi-scale Hessian-based vesselness filter is applied on the artery phase CT image, aiming to enhance vessel structures with specified diameter range. Second, the vesselness response is processed using a Bayesian classifier to identify the most probable vessel structures. Considering the vesselness filter normally performs not ideally on the vessel bifurcations or the segments corrupted by noise, two vessel-reconnection techniques are proposed. The first technique uses a directional morphological operator to dilate vessel segments along their centerline directions, attempting to fill the gap between broken vascular segments. The second technique analyzes the connectivity of vessel segments and reconnects disconnected segments and branches. Finally, a 3D vessel tree is reconstructed. The algorithm has been evaluated using 18 CT images of the liver. To quantitatively measure the similarities between segmented and reference vessel trees, the skeleton coverage and mean symmetric distance are calculated to quantify the agreement between reference and segmented vessel skeletons, resulting in an average of 0:55+/-0:27 and 12:7+/-7:9 mm (mean standard deviation), respectively.

  16. Validation of intimate correlation between visceral fat and hepatic steatosis: Quantitative measurement techniques using CT for area of fat and MR for hepatic steatosis.

    PubMed

    Choi, Moon Hyung; Choi, Joon-Il; Park, Michael Yong; Rha, Sung Eun; Oh, Soon Nam; Jung, Seung Eun; Byun, Jae Young; Kannengiesser, Stephan; Son, Yohan

    2016-12-18

    The relationship between obesity and hepatic steatosis is well known, and there are many methods to measure obesity and severity of hepatic steatosis. Because of advances in radiologic techniques, the areas of certain body components can be measured on computed tomography (CT) while the severity of hepatic steatosis can be measured by magnetic resonance spectroscopy (MRS) with high accuracy. The aim of this study is to investigate the relationship between degree of fatty infiltration of the liver measured by MRS and body composition measured from CT images. We evaluated 95 potential liver donors who underwent abdomen CT and liver MRI (including MRS) between February 2014 and September 2015 in a tertiary university hospital. Body composition analysis was performed on CT images using commercial software. The areas of subcutaneous fat, visceral fat and abdominal circumference were measured automatically and the area of muscle was measured semi-automatically. The degree of hepatic steatosis was measured by MRS. The degree of hepatic steatosis showed a significant correlation with total fat area, visceral fat area, subcutaneous fat area, muscle area, abdominal circumference, BMI, and ratio of visceral fat to total fat. The strongest correlation was between hepatic steatosis and the area of visceral fat in all subjects (r=0.569). Multivariate regression analysis showed that male gender and visceral fat area were significantly associated with hepatic steatosis (P = 0.031, <0.001, respectively). The area of visceral fat has the most intimate correlation to the severity of hepatic steatosis among all significantly correlated parameters associated with body habitus. Accurate and quantitative body composition measurement and degree of hepatic steatosis can be noninvasively performed using advanced radiological techniques. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  17. Fluorine-18 labeled amino acids for tumor PET/CT imaging.

    PubMed

    Qi, Yiqiang; Liu, Xiaohui; Li, Jun; Yao, Huiqian; Yuan, Shuanghu

    2017-09-01

    Tumor glucose metabolism and amino acid metabolism are usually enhanced, (18)F-FDG for tumor glucose metabolism PET imaging has been clinically well known, but tumor amino acid metabolism PET imaging is not clinically familiar. Radiolabeled amino acids (AAs) are an important class of PET/CT tracers that target the upregulated amino acid transporters to show elevated amino acid metabolism in tumor cells. Radiolabeled amino acids were observed to have high uptake in tumor cells but low in normal tissues and inflammatory tissues. The radionuclides used in labeling amino acids include (15)O, (13)N, (11)C, (123)I, (18)F and (68)Ga, among which the most commonly used is (18)F [1]. Available data support the use of certain (18)F-labeled AAs for PET/CT imaging of gliomas, neuroendocrine tumors, prostate cancer and breast cancer [2, 3]. With the progress of the method of (18)F labeling AAs [4-6], (18)F-labeled AAs are well established for tumor PET/CT imaging. This review focuses on the current status of key clinical applications of 18F-labeled AAs in tumor PET/CT imaging.

  18. Ultrasound (US) and computed tomographic (CT) appearances of large (giant) hepatic cavernous hemangiomas.

    PubMed

    Samad, S A; Maimunah, A; Zulfiqar, A; Zaharah, M

    1995-03-01

    The sonographic and CT appearances of 9 large cavernous hemangiomas of the liver were studied. On sonography, 6 masses (67%) exhibit heterogenous echo pattern; where in 2 patients the echotexture was a mixture of hypoechoic and isoechoic areas and in 4 patients there are varying amounts of bright hyperreflective areas similar to the texture typical of small hemangiomas. The masses were predominantly hypoechoic in the remaining 3 patients (33%). Incremental bolus or bolus-infusion dynamic CT showed peripheral contrast enhancement of varying intensities and thickness in all patients. The lesions were incorrectly diagnosed as hepatomas in 4 patients, suspected as hemangiomas with a differential diagnosis of hepatomas in 4 patients and an early liver abscess in 1 patient. It is concluded that large cavernous hemangiomas of the liver do not exhibit the typical homogenous hyperreflective echotexture as exhibited by small lesions and they mimic primary and secondary hepatic neoplasms. However, the diagnosis of hemangioma should be entertained when such a mass contains bright hyperechoic areas within its heterogenous echo pattern and exhibit peripheral enhancement on contrast enhanced CT. In addition to correlation with appropriate clinical information, confirmation of diagnosis include delayed scanning during a routine incremental bolus dynamic CT, single-slice dynamic contrast enhanced CT, angiography or isotope scintigraphy and magnetic resonance imaging depending on the availability of facility.

  19. The effective dose assessment of C-arm CT in hepatic arterial embolisation therapy.

    PubMed

    Tyan, Y-S; Li, Y-Y; Ku, M-C; Huang, H-H; Chen, T-R

    2013-04-01

    To assess the effective dose of the liver C-arm computed tomography (CT) scan during hepatic arterial embolisation surgery with clinical dose-area product (DAP) data from Taiwan. The experiment used two kinds of phantoms: RANDO® Man and RANDO Woman (The Phantom Laboratory, Salem, NY), embedded with thermoluminescent dosemeters at locations according to the International Commission on Radiological Protection 103 report. The conversion factors of DAP to effective doses for males and females, respectively, were obtained. The clinical DAP data of liver C-arm CT scan during hepatic arterial embolisation surgery were collected in a hospital in Taiwan. There were 125 liver transarterial embolisation therapy cases, including 94 males and 31 females, from February 2009 to June 2010. C-arm CT was used 38 times for males and 17 times for females. The corresponding average and standard deviation of clinical DAP were 61.0±6.6 Gy cm(2) and 52.2±8.3 Gy cm(2), respectively. The DAP of RANDO Man and RANDO Woman phantoms simply scanned by C-arm CT are much lower than that of patients. After consideration of the clinical DAP of patients, the effective doses of a liver C-arm CT scan recommended for males and females in Taiwan are 11.5±2.3 mSv and 11.3±3.0 mSv, respectively. The conversion factors of DAP to effective doses for males and females are 0.19±0.03 mSv Gy(-1) cm(-2) and 0.22±0.05 mSv Gy(-1) cm(-2). Only if the actual DAP value of a patient scan is multiplied by the conversion factor can the correct effective dose be determined.

  20. Metastatic cervical adenopathy from tumors of unknown origin: the role of CT

    SciTech Connect

    Muraki, A.S.; Mancuso, A.A.; Harnsberger, H.R.

    1984-09-01

    A prospective CT study of seventeen patients with metastatic cervical adenopathy from tumors at an unknown primary site, believed most likely to be in the upper aerodigestive tract, was performed. CT suggested a primary site in ten cases, of which four were confirmed by surgery or biopsy. In four cases, CT did not identify a suspicious site and no primary site was identified during triple endoscopy, sometimes with blind biopsies. CT was able to suggest correct causes other than carcinoma in three cases and gave useful information about the extent of nodal disease. CT should be used as part of the routine evaluation of patients with this clinical problem. A diagnostic algorithm is suggested in which CT is integrated with modern endoscopic and aspiration cytologic techniques.

  1. Superb microvascular imaging technology for ultrasound examinations: Initial experiences for hepatic tumors.

    PubMed

    Lee, Dong Ho; Lee, Jae Young; Han, Joon Koo

    2016-11-01

    To explore whether superb microvascular imaging (SMI) technology could be helpful for the evaluation of hepatic tumors. Our institutional review board approved this study, and informed consent was obtained from all of the patients. Twenty-three patients with 29 hepatic tumors were enrolled in our study. The tumors consisted of hemangiomas (n=15), focal nodular hyperplasias (FNHs) (n=7), and hepatocellular carcinomas (n=7). All lesions were pathologically (n=2) or radiologically (n=27) confirmed. The mean tumor diameter was 1.9cm (range, 0.9cm to 5.0cm). Using SMI technology, all lesions were scanned and categorized into subgroups according to the flow pattern on the SMI. The hemangiomas exhibited nodular rim patterns (33%) and spotty dot-like patterns (20%), and both of these findings were very specific for the diagnosis of hemangioma. The FNHs exhibited spoke-wheel patterns (43%) and radiating vessel patterns (29%) that were very specific findings for the diagnosis of FNH. The other tumors did not exhibit any specific patterns on SMI. Evaluations of the inner vascularities of hepatic tumors with the SMI technique were feasible, and the SMI features were significantly different between the different types of hepatic tumors. These differences could aid the diagnoses of hepatic tumors with US. Copyright © 2016. Published by Elsevier Ireland Ltd.

  2. Preoperative dual-phase 3D CT angiography assessment of the right hepatic artery before gastrectomy.

    PubMed

    Yamashita, Keishi; Sakuramoto, Shinichi; Mieno, Hiroaki; Shibata, Tomotaka; Nemoto, Masayuki; Katada, Natsuya; Kikuchi, Shiro; Watanabe, Masahiko

    2014-10-01

    In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy. The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients. Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels' classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac-splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness. Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.

  3. Micro-CT Imaging of Tumor Angiogenesis: Quantitative Measures Describing Micromorphology and Vascularization

    PubMed Central

    Ehling, Josef; Theek, Benjamin; Gremse, Felix; Baetke, Sarah; Möckel, Diana; Maynard, Juliana; Ricketts, Sally-Ann; Grüll, Holger; Neeman, Michal; Knuechel, Ruth; Lederle, Wiltrud; Kiessling, Fabian; Lammers, Twan

    2014-01-01

    Angiogenesis is a hallmark of cancer, and its noninvasive visualization and quantification are key factors for facilitating translational anticancer research. Using four tumor models characterized by different degrees of aggressiveness and angiogenesis, we show that the combination of functional in vivo and anatomical ex vivo X-ray micro-computed tomography (μCT) allows highly accurate quantification of relative blood volume (rBV) and highly detailed three-dimensional analysis of the vascular network in tumors. Depending on the tumor model, rBV values determined using in vivo μCT ranged from 2.6% to 6.0%, and corresponds well with the values assessed using IHC. Using ultra-high-resolution ex vivo μCT, blood vessels as small as 3.4 mm and vessel branches up to the seventh order could be visualized, enabling a highly detailed and quantitative analysis of the three-dimensional micromorphology of tumor vessels. Microvascular parameters such as vessel size and vessel branching correlated very well with tumor aggressiveness and angiogenesis. In rapidly growing and highly angiogenic A431 tumors, the majority of vessels were small and branched only once or twice, whereas in slowly growing A549 tumors, the vessels were much larger and branched four to seven times. Thus, we consider that combining highly accurate functional with highly detailed anatomical μCT is a useful tool for facilitating high-throughput, quantitative, and translational (anti-) angiogenesis and antiangiogenesis research. PMID:24262753

  4. Improved Hyperthermia Treatment of Tumors Under Consideration of Magnetic Nanoparticle Distribution Using Micro-CT Imaging.

    PubMed

    Dähring, H; Grandke, J; Teichgräber, U; Hilger, I

    2015-12-01

    Heterogeneous magnetic nanoparticle (MNP) distributions within tumors can cause regions of temperature under dosage and reduce the therapeutic efficiency. Here, micro-computed tomography (CT) imaging was used as a tool to determine the MNP distribution in vivo. The therapeutic success was evaluated based on tumor volume and temperature distribution. Tumor-bearing mice were intratumorally injected with iron oxide particles. MNP distribution was assessed by micro-CT with a low radiation dose protocol. MNPs were clearly visible, and the exact distribution to nontumor structures was detected by micro-CT. Knowledge of the intratumoral MNP distribution allowed the generation of higher temperatures within the tumor and led to higher temperature values after exposure to an alternating magnetic field (AMF). Consequently, the tumor size after 28 days was reduced to 14 and 73 % of the initial tumor volume for the MNP/AMF/CT and MNP/AMF groups, respectively. The MNP distribution pattern mainly governed the generated temperature spots in the tumor. Knowing the MNP distribution enabled individualized hyperthermia treatment and improved the overall therapeutic efficiency.

  5. Carcinoid tumors: CT and I-131 meta-iodo-benzylguanidine scintigraphy

    SciTech Connect

    Adolph, J.M.; Kimmig, B.N.; Georgi, P.; zum Winkel, K.

    1987-07-01

    The diagnostic value of computed tomography (CT) and iodine-131 meta-iodo-benzylguanidine (MIBG) scintiscanning was studied in nine patients with histologically proved carcinoid tumors of intestinal (n = 4), bronchial (n = 3), or thymic (n = 2) origin. CT scans clearly depicted the tumors and metastases in relation to surrounding vital structures but did not provide findings specific for carcinoids. The appearance on CT of an abdominal soft-tissue mass with a radiating pattern of linear densities was found to be highly suggestive of intestinal carcinoid tumors. I-131 MIBG scintiscans disclosed intense tracer uptake in the tumors and metastases in five patients. MIBG studies correctly depicted nine of nine tumor manifestations in intestinal carcinoids and four of six tumor manifestations in bronchus carcinoids. No MIBG concentration was found in thymus carcinoids. Because of its selective uptake mechanism, I-131 MIBG scintigraphy can allow specific detection and localization of neuroendocrine tumor tissue in patients with suspected carcinoid tumors. MIBG scintigraphy has diagnostic potential as a screening procedure in carcinoid tumors, especially those of intestinal origin.

  6. Automatic co-segmentation of lung tumor based on random forest in PET-CT images

    NASA Astrophysics Data System (ADS)

    Jiang, Xueqing; Xiang, Dehui; Zhang, Bin; Zhu, Weifang; Shi, Fei; Chen, Xinjian

    2016-03-01

    In this paper, a fully automatic method is proposed to segment the lung tumor in clinical 3D PET-CT images. The proposed method effectively combines PET and CT information to make full use of the high contrast of PET images and superior spatial resolution of CT images. Our approach consists of three main parts: (1) initial segmentation, in which spines are removed in CT images and initial connected regions achieved by thresholding based segmentation in PET images; (2) coarse segmentation, in which monotonic downhill function is applied to rule out structures which have similar standardized uptake values (SUV) to the lung tumor but do not satisfy a monotonic property in PET images; (3) fine segmentation, random forests method is applied to accurately segment the lung tumor by extracting effective features from PET and CT images simultaneously. We validated our algorithm on a dataset which consists of 24 3D PET-CT images from different patients with non-small cell lung cancer (NSCLC). The average TPVF, FPVF and accuracy rate (ACC) were 83.65%, 0.05% and 99.93%, respectively. The correlation analysis shows our segmented lung tumor volumes has strong correlation ( average 0.985) with the ground truth 1 and ground truth 2 labeled by a clinical expert.

  7. Optimal Co-segmentation of Tumor in PET-CT Images with Context Information

    PubMed Central

    Song, Qi; Bai, Junjie; Han, Dongfeng; Bhatia, Sudershan; Sun, Wenqing; Rockey, William; Bayouth, John E.; Buatti, John M.

    2014-01-01

    PET-CT images have been widely used in clinical practice for radiotherapy treatment planning of the radiotherapy. Many existing segmentation approaches only work for a single imaging modality, which suffer from the low spatial resolution in PET or low contrast in CT. In this work we propose a novel method for the co-segmentation of the tumor in both PET and CT images, which makes use of advantages from each modality: the functionality information from PET and the anatomical structure information from CT. The approach formulates the segmentation problem as a minimization problem of a Markov Random Field (MRF) model, which encodes the information from both modalities. The optimization is solved using a graph-cut based method. Two sub-graphs are constructed for the segmentation of the PET and the CT images, respectively. To achieve consistent results in two modalities, an adaptive context cost is enforced by adding context arcs between the two subgraphs. An optimal solution can be obtained by solving a single maximum flow problem, which leads to simultaneous segmentation of the tumor volumes in both modalities. The proposed algorithm was validated in robust delineation of lung tumors on 23 PET-CT datasets and two head-and-neck cancer subjects. Both qualitative and quantitative results show significant improvement compared to the graph cut methods solely using PET or CT. PMID:23693127

  8. Automatic Lung Tumor Segmentation on PET/CT Images Using Fuzzy Markov Random Field Model

    PubMed Central

    Guo, Yu; Feng, Yuanming; Sun, Jian; Lin, Wang; Sa, Yu; Wang, Ping

    2014-01-01

    The combination of positron emission tomography (PET) and CT images provides complementary functional and anatomical information of human tissues and it has been used for better tumor volume definition of lung cancer. This paper proposed a robust method for automatic lung tumor segmentation on PET/CT images. The new method is based on fuzzy Markov random field (MRF) model. The combination of PET and CT image information is achieved by using a proper joint posterior probability distribution of observed features in the fuzzy MRF model which performs better than the commonly used Gaussian joint distribution. In this study, the PET and CT simulation images of 7 non-small cell lung cancer (NSCLC) patients were used to evaluate the proposed method. Tumor segmentations with the proposed method and manual method by an experienced radiation oncologist on the fused images were performed, respectively. Segmentation results obtained with the two methods were similar and Dice's similarity coefficient (DSC) was 0.85 ± 0.013. It has been shown that effective and automatic segmentations can be achieved with this method for lung tumors which locate near other organs with similar intensities in PET and CT images, such as when the tumors extend into chest wall or mediastinum. PMID:24987451

  9. Automatic lung tumor segmentation on PET/CT images using fuzzy Markov random field model.

    PubMed

    Guo, Yu; Feng, Yuanming; Sun, Jian; Zhang, Ning; Lin, Wang; Sa, Yu; Wang, Ping

    2014-01-01

    The combination of positron emission tomography (PET) and CT images provides complementary functional and anatomical information of human tissues and it has been used for better tumor volume definition of lung cancer. This paper proposed a robust method for automatic lung tumor segmentation on PET/CT images. The new method is based on fuzzy Markov random field (MRF) model. The combination of PET and CT image information is achieved by using a proper joint posterior probability distribution of observed features in the fuzzy MRF model which performs better than the commonly used Gaussian joint distribution. In this study, the PET and CT simulation images of 7 non-small cell lung cancer (NSCLC) patients were used to evaluate the proposed method. Tumor segmentations with the proposed method and manual method by an experienced radiation oncologist on the fused images were performed, respectively. Segmentation results obtained with the two methods were similar and Dice's similarity coefficient (DSC) was 0.85 ± 0.013. It has been shown that effective and automatic segmentations can be achieved with this method for lung tumors which locate near other organs with similar intensities in PET and CT images, such as when the tumors extend into chest wall or mediastinum.

  10. Artifacts in Conventional Computed Tomography (CT) and Free Breathing Four-Dimensional CT Induce Uncertainty in Gross Tumor Volume Determination

    SciTech Connect

    Fredberg Persson, Gitte; Nygaard, Ditte Eklund; Munch af Rosenschoeld, Per; Richter Vogelius, Ivan; Josipovic, Mirjana; Specht, Lena; Korreman, Stine Sofia

    2011-08-01

    Purpose: Artifacts impacting the imaged tumor volume can be seen in conventional three-dimensional CT (3DCT) scans for planning of lung cancer radiotherapy but can be reduced with the use of respiration-correlated imaging, i.e., 4DCT or breathhold CT (BHCT) scans. The aim of this study was to compare delineated gross tumor volume (GTV) sizes in 3DCT, 4DCT, and BHCT scans of patients with lung tumors. Methods and Materials: A total of 36 patients with 46 tumors referred for stereotactic radiotherapy of lung tumors were included. All patients underwent positron emission tomography (PET)/CT, 4DCT, and BHCT scans. GTVs in all CT scans of individual patients were delineated during one session by a single physician to minimize systematic delineation uncertainty. The GTV size from the BHCT was considered the closest to true tumor volume and was chosen as the reference. The reference GTV size was compared to GTV sizes in 3DCT, at midventilation (MidV), at end-inspiration (Insp), and at end-expiration (Exp) bins from the 4DCT scan. Results: The median BHCT GTV size was 4.9 cm{sup 3} (0.1-53.3 cm{sup 3}). Median deviation between 3DCT and BHCT GTV size was 0.3 cm{sup 3} (-3.3 to 30.0 cm{sup 3}), between MidV and BHCT size was 0.2 cm{sup 3} (-5.7 to 19.7 cm{sup 3}), between Insp and BHCT size was 0.3 cm{sup 3} (-4.7 to 24.8 cm{sup 3}), and between Exp and BHCT size was 0.3 cm{sup 3} (-4.8 to 25.5 cm{sup 3}). The 3DCT, MidV, Insp, and Exp median GTV sizes were all significantly larger than the BHCT median GTV size. Conclusions: In the present study, the choice of CT method significantly influenced the delineated GTV size, on average, leading to an increase in GTV size compared to the reference BHCT. The uncertainty caused by artifacts is estimated to be in the same magnitude as delineation uncertainty and should be considered in the design of margins for radiotherapy.

  11. Extracorporeal hepatic resection and autotransplantation for primary gastrointestinal stromal tumor of the liver.

    PubMed

    Mao, L; Chen, J; Liu, Z; Liu, C-J; Tang, M; Qiu, Y-D

    2015-01-01

    We report a case of primary gastrointestinal stromal tumor of the liver. A 60-year-old woman with a large mass in the liver was asymptomatic with no hepatic virus infection and negative tumor markers. Because the tumor was unresectable by conventional means, we used extracorporeal hepatic resection and autotransplantation (ECHRA) for operation. The pathology showed a gastrointestinal stromal tumor that was diagnosed based on positive immunostaining for c-kit and CD34. Mutation analysis revealed an acquired mutation in exon 11 of c-kit. As we know, this is the eighth case of a primary hepatic extragastrointestinal stromal tumor reported previously in English, and the first case of which that was treated with ECHRA. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Liver Transplantation for Malignant Primary Pediatric Hepatic Tumors.

    PubMed

    Khan, Adeel S; Brecklin, Brittany; Vachharajani, Neeta; Subramanian, Vijay; Nadler, Michelle; Stoll, Janice; Turmelle, Yumirle; Lowell, Jeffery A; Chapman, William C; Doyle, Mb Majella

    2017-07-01

    Malignant primary pediatric hepatic tumors (MPPHTs) are rare and account for approximately 1% of all childhood malignancies. In recent years, liver transplantation has emerged as a viable treatment options for select patients with MPPHTs. We performed a single-center retrospective study using a prospective database to compare outcomes of pediatric liver transplant recipients, with and without cancer, between January 2000 and December 2014. One hundred fifty-three children underwent 173 liver transplantations during the study period. Of these, 21 (12%) children received 23 (13.3%) transplants for unresectable MPPHTs: 16 hepatoblastomas (HBs), 3 embryonal cell sarcomas (ECS), and 2 hepatocellular carcinomas (HCCs). There was no significant difference in 1-, 3-, and 10-year patient and graft survival rates between MPPHT and non-MPPHT patients (95.2%, 81.2%, 81.2%, and 95.2%, 72,2%, 72.2% for MPPHT vs 92.7%, 89.8%, 87.6% and 85.4%, 81.1%, 75% for the non-MPPHT group, respectively) (p > 0.05). Rates of 1-, 5-, and 10-year disease-free survival for MPPHT patients were 76%, 76%, and 76%, respectively. Median age at transplantation for MPPHT patients was 3.1 years (range 58 days to 17 years), median listing time was 81 days, and median wait list time was 15 days. Eight (38%) children had 2 tumors or more and 4 of 16 (25%) HB patients had metastatic disease at presentation. All children received neoadjuvant treatment, with radiographic response in 19 of 21 patients. Presence of metastatic HB at presentation, International Society of Pediatric Oncology Epithelial Liver (SIOPEL) high risk status, and persistently elevated alpha fetoprotein levels after neoadjuvant chemotherapy might be risk factors for tumor recurrence and decreased survival. Liver transplantation is an excellent option for select patients with unresectable MPPHTs, with outcomes comparable to those after transplantation for nonmalignant causes. Copyright © 2017 American College of Surgeons. Published by

  13. [Radiological diagnosis of hepatic tumors. Part II: Identification and differential diagnosis].

    PubMed

    Layer, G; Delorme, S

    2007-10-01

    Focal hepatic lesions occur in 5% of the population. The clarification of such common occurrences is of major significance because oncological diseases play an important role with respect to morbidity and mortality of the population. The first part of this review article dealt with the most important aspects of classification, epidemiology and pathology of hepatic tumors for radiologists and the current technical situation with regards to the diagnostic procedure. This second part of the review deals with the significance of radiological procedures for identification and differential diagnosis of hepatic tumors.

  14. Hepatic Parasitic Abscess Caused by Clonorchiasis: Unusual CT Findings of Clonorchiasis

    PubMed Central

    Jang, Yun-Jin; Yoon, Seong Eon; Yu, EunSil

    2007-01-01

    Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts. PMID:17277566

  15. The effect of housing temperature on the growth of CT26 tumor expressing fluorescent protein EGFP

    NASA Astrophysics Data System (ADS)

    Yuzhakova, Diana V.; Shirmanova, Marina V.; Lapkina, Irina V.; Serebrovskaya, Ekaterina O.; Lukyanov, Sergey A.; Zagaynova, Elena V.

    2016-04-01

    To date, the effect of housing temperature on tumor development in the immunocompetent mice has been studied on poorly immunogenic cancer models. Standard housing temperature 20-26°C was shown to cause chronic metabolic cold stress and promote tumor progression via suppression of the antitumor immune response, whereas a thermoneutral temperature 30-31°C was more preferable for normal metabolism of mice and inhibited tumor growth. Our work represents the first attempt to discover the potential effect of housing temperature on the development of highly immunogenic tumor. EGFP-expressing murine colon carcinoma CT26 generated in Balb/c mice was used as a tumor model. No statistically significant differences were shown in tumor incidences and growth rates at 20°C, 25°C and 30°C for non-modified CT26. Maintaining mice challenged with CT26-EGFP cells at 30°C led to complete inhibition of tumor development. In summary, we demonstrated that the housing temperature is important for the regulation of growth of highly immunogenic tumors in mice through antitumor immunity.

  16. Expression of steroid hormone receptors in benign hepatic tumors. An immunocytochemical study.

    PubMed

    Masood, S; West, A B; Barwick, K W

    1992-12-01

    Many hepatic adenomas have been demonstrated to have a clear relationship with oral contraceptive use, and it is presumed that there may be hormone receptors within the cytoplasm or nucleus of adenoma cells that mediate tumor growth in response to hormonal stimulation. Only a small number of examples of benign hepatic tumors have been analyzed for the presence of estrogen and progesterone receptors, and there has been a lack of consensus with regard to the findings. All previous studies have determined receptor levels by biochemical methods. In a retrospective study, we employed specific monoclonal antibodies against estrogen and progesterone receptors in 10 benign paraffin-embedded hepatic lesions: five examples of hepatic adenoma and five examples of focal nodular hyperplasia. All patients were female, except for one male with adenoma and one male with focal nodular hyperplasia. No patient had received tamoxifen citrate or any other form of hormonal therapy for their hepatic lesion. Positive controls included benign and malignant breast tissue. No positive staining was seen in hepatic adenoma, focal nodular hyperplasia, or normal adjacent liver parenchyma. Intense positive staining was seen in all positive control tissues. This negative result with the use of specific monoclonal antibodies in an established immunohistochemical method for analysis of estrogen and progesterone receptors does not exclude the presence of these receptors in benign hepatic lesions, but does suggest that, if present, they occur in much smaller amounts than in benign and malignant breast tissue. The presence of hormone receptors in benign hepatic tumors deserves further study.

  17. Micro-CT molecular imaging of tumor angiogenesis using a magnetite nano-cluster probe.

    PubMed

    Liu, Ping; Li, Jing; Zhang, Chunfu; Xu, Lisa X

    2013-06-01

    Due to its high resolution, micro-CT is desirable for molecular imaging of tumor angiogenesis. However, the sensitivity of micro-CT to contrast agents is relatively low. Therefore, the purpose of this study is to develop high micro-CT sensitive molecular imaging probes for direct visualization and dynamic monitoring of tumor angiogenesis. To this end, Arg-Gly-Asp (RGD) peptides conjugated magnetite nano clusters (RGD-MNCs) were developed by assembling individual magnetite nano particles into clusters with amphiphilic (maleimide) methoxypoly(ethylene glycol)-b-poly(lactic acid) ((Mal)mPEG-PLA) copolymer and subsequently encoding RGD peptides onto the clusters for specific targeting alpha(v)beta3 integrin. The hydrodynamic size of RGD-MNCs was about 85 nm. To test its specificity, alpha(v)beta3 positive cells (H1299) were incubated with magnetite nano clusters (MNCs), RGD-MNCs or RGD-MNCs competition with free RGD peptides. Prussian Blue staining and inductively coupled plasma optical emission spectrometer (ICP-OES) measurements indicated that the cell uptake of RGD-MNCs was significantly more than that of MNCs, which could be inhibited by free RGD peptides. For detection of tumor angiogenesis, mice bearing H1299 tumors were injected intravenously with RGD-MNCs at the dose of 400 micro mol Fe/kg. Tumor angiogenic hot spots as well as individual angiogenic vessels could be clearly manifested by micro-CT imaging 12 h post injection, which was dynamically monitored with the extension of probe circulation time. Subsequent histological studies of tumor tissues verified that RGD-MNCs registered tumor angiogenic vessels. Our study demonstrated that RGD-MNC probes fabricated in this study could be used to effectively target alpha(v)beta3 integrin. Using high resolution micro-CT in combination with the probes, tumor angiogenesis could be studied dynamically.

  18. Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

    SciTech Connect

    Erinjeri, Joseph P. Deodhar, Ajita; Thornton, Raymond H.; Allen, Peter J.; Getrajdman, George I.; Brown, Karen T.; Sofocleous, Constantinos T.; Reidy, Diane L.

    2010-06-15

    Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.

  19. Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm: clinical assessment of the heat-sink effect of artificial ascites.

    PubMed

    Nam, Sang Yu; Rhim, Hyunchul; Kang, Tae Wook; Lee, Min Woo; Kim, Young-Sun; Choi, Dongil; Lee, Won Jae; Park, Yulri; Chang, Ilsoo; Lim, Hyo K

    2010-02-01

    This study was designed to assess whether artificial ascites has a heat-sink effect on the ablation zone for percutaneous radiofrequency ablation (RFA) of hepatic tumors abutting the diaphragm. We retrospectively assessed 28 patients who underwent percutaneous RFA for the treatment of a single nodular hepatic tumor that abutted the diaphragm from July 2000 to December 2006. All patients underwent ultrasound-guided RFA using internally cooled electrodes. A single ablation for 12 minutes was applied using 3-cm active-tip electrodes. We divided patients into two groups on the basis of whether artificial ascites was introduced before RFA: Group A consisted of patients who received artificial ascites with a mean of 760 mL of a 5% dextrose in water solution (n = 15) and group B consisted of patients who did not receive artificial ascites (n = 13). The volume of the ablation zone was measured on CT images obtained immediately after the ablation procedure, and imaging findings were compared for both groups using the Student's t test. We also compared the local tumor progression rate between both groups using the chi-square test (mean follow-up, 37.4 months). There was no significant difference between the two patient groups with regard to age, sex, Child-Pugh class, or tumor location (p > 0.05). The tumors were significantly smaller in group A patients (mean +/- SD, 1.6 +/- 0.5 cm) than in group B patients (2.1 +/- 0.7 cm) (p = 0.019). The mean volume of the RFA zone was 31.6 +/- 11.9 cm(3) in group A patients and 30.9 +/- 11.0 cm(3) in group B patients. There was no significant difference between the groups in the ablation volume (p = 0.871). Local tumor progression was noted in four patients (26.7%) in group A and in three patients (23.1%) in group B. There was no significant difference in the local tumor progression rate between the two groups (p = 0.83). Artificial ascites did not show a heat-sink effect on the volume of the ablation zone after percutaneous RFA for the

  20. Primary Hepatic Neuroendocrine Tumor with Unusual Thyroid Follicular-Like Morphologic Characteristics

    PubMed Central

    Ibrahim, Mohd Elmugtaba; Abadeer, Kerolos; Zhai, Qihui (Jim)

    2017-01-01

    We describe a primary hepatic neuroendocrine tumor of a 57-year-old Thai woman who presented in 2004 with a suspicious mass in the left hepatic lobe. She underwent left hepatectomy for the 10.5-cm mass, called intermediate grade neuroendocrine carcinoma of unknown origin, likely metastatic. The tumor recurred in 2007, then called recurrent primary hepatic neuroendocrine tumor (PHNET), and the patient underwent liver transplant. Because of similarity between the neuroendocrine tumor and a thyroid tumor—specifically, follicular-like characteristics—immunohistochemical stains for thyroglobulin, TTF1, and calcitonin were performed. However, all were negative. All imaging studies revealed no evidence of a primary lesion other than the liver mass. In 2008, the patient's liver transplant failed because of ischemic cholangiopathy, and she underwent a second liver transplant. Seven years later, in 2015, she presented with metastatic neuroendocrine tumor of intermediate grade to the lung, consistent with metastatic PHNET. She underwent left upper-lobe wedge resection to remove the tumor. The patient is alive with no evidence of disease at 13 years after initial diagnosis. This rare variant of PHNET had thyroid-like morphologic characteristics but there is no evidence of primary thyroid tumor or thyroid markers in the primary and recurrent hepatic tumors and lung metastasis. PMID:28316853

  1. FDOPA PET-CT of Nonenhancing Brain Tumors.

    PubMed

    Bund, Caroline; Heimburger, Céline; Imperiale, Alessio; Lhermitte, Benoît; Chenard, Marie-Pierre; Lefebvre, François; Kremer, Stéphane; Proust, François; Namer, Izzie-Jacques

    2017-04-01

    Primary brain tumor grading is crucial to rapidly determine the therapeutic impact and prognosis of a brain tumor as well as the tumors' aggressiveness profile. On magnetic resonance imaging, high-grade tumors are usually responsible for blood -brain barrier breakdowns, which result in tumor enhancement. However, this is not always the case. The main objective of this study was to evaluate the diagnostic value of FDOPA PET in the assessment of primary brain tumor aggressiveness with no contrast enhancement on MRI. Fifty-three patients were prospectively included: 35 low-grade and 18 high-grade histologically proven gliomas, with no contrast enhancement. Each patient underwent static PET acquisitions at 30 minutes. All patients had MRSI with measurements of different metabolites ratio. FDOPA was useful in the subgroup of low-grade gliomas, discriminating between dysembryoplastic neuroepithelial tumor and grade II oligodendroglioma (P < 0.01). An optimal threshold of the maximum standardized uptake value at 30 minutes (SUVmax (T/N)30) = 2.16 to discriminated low- from high-grade gliomas with a sensitivity of 60%, specificity of 100%, PPV of 100%, and NPV of 83.33% (P < 0.01). The nCho/Cr and nCho/NAA ratios were significantly higher in high- than in low-grade gliomas (P < 0.03 and P < 0.04, respectively). A significant positive correlation between MRSI ratios and SUVmax was found. Including data from amino acid metabolism used alone or in association with MRSI allows us to discriminate between dysembryoplastic neuroepithelial tumor and grade II oligodendroglioma and between low- and high-grade gliomas with no contrast enhancement on MRI.

  2. Hepatic Tumor Metastases Cause Enhanced PEGylated Liposome Uptake by Kupffer Cells.

    PubMed

    Ukawa, Masami; Fujiwara, Yukako; Ando, Hidenori; Shimizu, Taro; Ishida, Tatsuhiro

    2016-01-01

    Kupffer cells in livers bearing tumor metastases were found to have promoted tumor invasion and exacerbated the metastasis. This implies that the function of Kupffer cells might differ between animals bearing hepatic metastases and those that are healthy. Kupffer cells are considered responsible for the accumulation of liposomes in the liver. In this study, we hypothesized that the alteration in the function of Kupffer cells by hepatic metastasis would also affect the biodistribution of liposomes following intravenous administration. The hepatic accumulation and the blood concentration of PEGylated liposomes were compared between healthy mice and tumor-bearing mice. We noted that hepatic accumulation and elimination from the blood were significantly accelerated in tumor-bearing mice, indicating that our hypothesis was correct. In the tumor-bearing mice, the proportion of Kupffer cells taking up liposomes was significantly increased. Intravenous injection of oxaliplatin (l-OHP) containing PEGylated liposomes decreased the fraction of Kupffer cells, but this administration caused no injury to the hepatocytes. These results suggest that PEGylated liposomes containing l-OHP may have the potential to treat metastatic hepatic cancer-not only via the direct killing of the cancer cells but also via a reduction in tumor-supportive Kupffer cells.

  3. Automated localization and segmentation of lung tumor from PET-CT thorax volumes based on image feature analysis.

    PubMed

    Cui, Hui; Wang, Xiuying; Feng, Dagan

    2012-01-01

    Positron emission tomography - computed tomography (PET-CT) plays an essential role in early tumor detection, diagnosis, staging and treatment. Automated and more accurate lung tumor detection and delineation from PET-CT is challenging. In this paper, on the basis of quantitative analysis of contrast feature of PET volume in SUV (standardized uptake value), our method firstly automatically localized the lung tumor. Then based on analysing the surrounding CT features of the initial tumor definition, our decision strategy determines the tumor segmentation from CT or from PET. The algorithm has been validated on 20 PET-CT studies involving non-small cell lung cancer (NSCLC). Experimental results demonstrated that our method was able to segment the tumor when adjacent to mediastinum or chest wall, and the algorithm outperformed the other five lung segmentation methods in terms of overlapping measure.

  4. Hepatic perivascular epithelioid cell tumor (PEComa): a case report with a review of literatures

    PubMed Central

    Son, Hyun-Jin; Kang, Dong Wook; Kim, Joo Heon; Han, Hyun Young; Lee, Min Koo

    2017-01-01

    Hepatic perivascular epithelioid cell tumors (PEComas) are very rare. We report a primary hepatic PEComa with a review of the literature. A 56-year-old women presented with a nodular mass detected during the management of chronic renal failure and chronic hepatitis C. Diagnostic imaging studies suggested a nodular hepatocellular carcinoma in segment 5 of the liver. The patient underwent partial hepatectomy. A brown-colored expansile mass measuring 3.2×3.0 cm was relatively demarcated from the surrounding liver parenchyma. The tumor was mainly composed of epithelioid cells that were arranged in a trabecular growth pattern. Adipose tissue and thick-walled blood vessels were minimally identified. A small amount of extramedullary hematopoiesis was observed in the sinusoidal spaces between tumor cells. Tumor cells were diffusely immunoreactive for human melanoma black 45 (HMB45) and Melan A, focally immunoreactive for smooth muscle actin, but not for hepatocyte specific antigen (HSA). PMID:28288506

  5. Autoradiographic and histopathological studies of boric acid-mediated BNCT in hepatic VX2 tumor-bearing rabbits: Specific boron retention and damage in tumor and tumor vessels.

    PubMed

    Yang, C H; Lin, Y T; Hung, Y H; Liao, J W; Peir, J J; Liu, H M; Lin, Y L; Liu, Y M; Chen, Y W; Chuang, K S; Chou, F I

    2015-12-01

    Hepatoma is a malignant tumor that responds poorly to conventional therapies. Boron neutron capture therapy (BNCT) may provide a better way for hepatoma therapy. In this research, (10)B-enriched boric acid (BA, 99% (10)B) was used as the boron drug. A multifocal hepatic VX2 tumor-bearing rabbit model was used to study the mechanisms of BA-mediated BNCT. Autoradiography demonstrated that BA was selectively targeted to tumors and tumor vessels. Histopathological examination revealed the radiation damage to tumor-bearing liver was concentrated in the tumor regions during BNCT treatment. The selective killing of tumor cells and the destruction of the blood vessels in tumor masses may be responsible for the success of BA-mediated BNCT for liver tumors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Investigation of 1377C/T polymorphism of the Toll-like receptor 3 among patients with chronic hepatitis B.

    PubMed

    Goktas, Emine Firat; Bulut, Cemal; Goktas, Mustafa Tugrul; Ozer, Erdem Kamil; Karaca, Ragip Ozgur; Kinikli, Sami; Demiroz, Ali Pekcan; Bozkurt, Atilla

    2016-07-01

    The immunopathogenesis of chronic hepatitis B (CHB) has not been clarified yet. Toll-like receptors (TLR) are a receptor family that initiates immunity with exogenous-endogenous ligands and plays a role in the pathogenesis of infections. In this study, we aimed to investigate the frequency of TLR 3 1377C/T (rs3775290) polymorphism and its role in patients with CHB. We included 50 healthy individuals as control group and 73 active and 43 inactive hepatitis B patients. All DNA samples were isolated from blood samples. For the detection of TLR 3 1377C/T single-nucleotide polymorphism, restriction fragment length polymorphism was used. A statistically significant difference was determined in Hepatitis B virus (HBV) DNA levels of CHB patients with the CC, CT, and TT genotypes (p = 0.013). The highest levels of HBV DNA were detected in individuals with TT genotypes. Additionally, the frequency of CC genotype was higher in the active CHB patients compared with that of the inactive CHB patients (p = 0.044). No statistically significant difference in TLR 3 1377C/T polymorphism was detected between healthy controls and the hepatitis B patients (p = 0.342). In conclusion, HBV DNA level was higher in the individuals with TT genotype, and CC genotype was more frequent in the active CHB patients. These results suggest a possible association between CHB and TLR 3 gene (1377C/T) polymorphism.

  7. Definition of hepatic tumor microcirculation by Single Photon Emission Computerized Tomography (SPECT)

    SciTech Connect

    Gyves, J.W.; Ziessman, H.A.; Ensminger, W.D.; Thrall, J.H.; Niederhuber, J.E.; Keyes, J.W. Jr.; Walker, S.

    1984-09-01

    Single photon emission computerized tomography coupled with Tc-99m MAA hepatic-arterial perfusion scintigraphy has been used to examine the density of the functional microcirculation of hepatic tumors relative to normal liver in 24 patients. In both colorectal and carcinoid tumors the authors have demonstrated an average three-fold greater arteriolar-capillary density in areas of tumor proliferation. The depth of the evoked tumor hypervascularity was found to extend about 4 cm. Tumors greater than 8-9 cm in diameter were uniformly found to have a central hypovascular core. These observations are of importance in the design of selective strategies utilizing therapeutic microspheres directed against the hypervascular proliferating regions of human tumors.

  8. Tungsten oxide nanorods: an efficient nanoplatform for tumor CT imaging and photothermal therapy.

    PubMed

    Zhou, Zhiguo; Kong, Bin; Yu, Chao; Shi, Xiangyang; Wang, Mingwei; Liu, Wei; Sun, Yanan; Zhang, Yingjian; Yang, Hong; Yang, Shiping

    2014-01-13

    We report here a facile thermal decomposition approach to creating tungsten oxide nanorods (WO2.9 NRs) with a length of 13.1 ± 3.6 nm and a diameter of 4.4 ± 1.5 nm for tumor theranostic applications. The formed WO2.9 NRs were modified with methoxypoly(ethylene glycol) (PEG) carboxyl acid via ligand exchange to have good water dispersability and biocompatibility. With the high photothermal conversion efficiency irradiated by a 980 nm laser and the better X-ray attenuation property than clinically used computed tomography (CT) contrast agent Iohexol, the formed PEGylated WO2.9 NRs are able to inhibit the growth of the model cancer cells in vitro and the corresponding tumor model in vivo, and enable effective CT imaging of the tumor model in vivo. Our "killing two birds with one stone" strategy could be extended for fabricating other nanoplatforms for efficient tumor theranostic applications.

  9. Automatic computer aided analysis algorithms and system for adrenal tumors on CT images.

    PubMed

    Chai, Hanchao; Guo, Yi; Wang, Yuanyuan; Zhou, Guohui

    2017-08-04

    The adrenal tumor will disturb the secreting function of adrenocortical cells, leading to many diseases. Different kinds of adrenal tumors require different therapeutic schedules. In the practical diagnosis, it highly relies on the doctor's experience to judge the tumor type by reading the hundreds of CT images. This paper proposed an automatic computer aided analysis method for adrenal tumors detection and classification. It consisted of the automatic segmentation algorithms, the feature extraction and the classification algorithms. These algorithms were then integrated into a system and conducted on the graphic interface by using MATLAB Graphic user interface (GUI). The accuracy of the automatic computer aided segmentation and classification reached 90% on 436 CT images. The experiments proved the stability and reliability of this automatic computer aided analytic system.

  10. CtIP, a candidate tumor susceptibility gene is a team player with luminaries.

    PubMed

    Chinnadurai, G

    2006-01-01

    CtIP is a nuclear protein conserved among vertebrates that was discovered as a cofactor of the transcriptional corepressor CtBP. CtIP also interacts with the tumor suppressors such as BRCA1 and the pRb family members through binding sites that are frequently mutated in human cancers. CtIP is a target for BRCA1-dependent phosphorylation by the ATM kinase induced by DNA double strand breakage. CtIP plays a role in DNA-damage-induced cell cycle checkpoint control at the G2/M transition. Homozygous inactivation of the Ctip gene causes very early embryonic lethality during mouse development. The Ctip(-/-) embryo cells are arrested in G1 and do not enter S phase. Depletion of Ctip in established mouse embryo fibroblasts arrests cells in G1 and results in an accumulation of hypophosphorylated Rb and the Cdk inhibitor p21, suggesting that CtIP is also a critical regulator of G1/S transition of the cell cycle. The Ctip gene contains a mononucleotide (A9) repeat and one of the alleles is mutated at a high frequency in colon cancers with microsatellite instability. The Ctip(+/-) mice develop multiple types of tumors suggesting that haploid insufficiency of Ctip leads to tumorigenesis. Among the various tumor types observed in Ctip(+/-) heterozygous mice, large lymphomas are prevalent. Recent studies raise the possibility that Ctip may itself be a tumor susceptibility gene and suggest that it might be important for the activities of tumor suppressors BRCA1, pRb family proteins and Ikaros family members.

  11. Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging.

    PubMed

    Romano, Luigia; Giovine, Sabrina; Guidi, Guido; Tortora, Giovanni; Cinque, Teresa; Romano, Stefania

    2004-04-01

    Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash when the wheel causes a compressive effect on thorax and abdomen. Associated lesions to left hepatic lobe injuries correlated to this mechanism are: sternal fractures, pancreatic, myocardial, gastrointestinal tract injuries. Lesions of the caudal lobe are extremely rare, usually not isolated and noted with other large parenchymal lesions. The Institution of Specialized Trauma Centers and the technical progress in imaging methodology developed in the last years a great reduction of mortality. New diagnostic methodologies allow a reduction of negatives laparotomies and allow the possibility of conservative treatment of numerous traumatic lesions; however, therapy depends from imaging findings and clinical conditions of the patient. Computed tomography (CT) certainly presents a large impact on diagnosis and management of patients with lesions from blunt abdominal traumas. It is important to establish a prognostic criteria allowing decisions for conservative or surgical treatment; CT findings

  12. A chance-constrained programming level set method for longitudinal segmentation of lung tumors in CT.

    PubMed

    Rouchdy, Youssef; Bloch, Isabelle

    2011-01-01

    This paper presents a novel stochastic level set method for the longitudinal tracking of lung tumors in computed tomography (CT). The proposed model addresses the limitations of registration based and segmentation based methods for longitudinal tumor tracking. It combines the advantages of each approach using a new probabilistic framework, namely Chance-Constrained Programming (CCP). Lung tumors can shrink or grow over time, which can be reflected in large changes of shape, appearance and volume in CT images. Traditional level set methods with a priori knowledge about shape are not suitable since the tumors are undergoing random and large changes in shape. Our CCP level set model allows to introduce a flexible prior to track structures with a highly variable shape by permitting a constraint violation of the prior up to a specified probability level. The chance constraints are computed from two given points by the user or from segmented tumors from a reference image. The reference image can be one of the images studied or an external template. We present a numerical scheme to approximate the solution of the proposed model and apply it to track lung tumors in CT. Finally, we compare our approach with a Bayesian level set. The CCP level set model gives the best results: it is more coherent with the manual segmentation.

  13. Hepatic Arterial Embolization with Doxorubicin-Loaded Superabsorbent Polymer Microspheres in a Rabbit Liver Tumor Model

    SciTech Connect

    Gupta, Sanjay Wright, Kenneth C.; Ensor, Joe; Van Pelt, Carolyn S.; Dixon, Katherine A.; Kundra, Vikas

    2011-10-15

    Objectives: The pharmacokinetic profile after hepatic arterial embolization with superabsorbent microspheres (QuadraSpheres) loaded with doxorubicin was studied. Methods: Rabbits with hepatic VX2 tumors were treated with intra-arterial administration of QuadraSpheres loaded with doxorubicin, or transarterial chemoembolization (TACE) using doxorubicin, Lipiodol and Embospheres, or hepatic arterial infusion (HAI) of doxorubicin. Tumor specimens were evaluated by fluorescence microscopy, and plasma and tumor concentrations of doxorubicin were measured. Results: The peak plasma concentration of doxorubicin was lower in the QuadraSphere group (309.9 ng/ml) than in the HAI (673.4 ng/ml) or TACE (360.5 ng/ml) groups, suggesting higher tumor retention in the QuadraSphere group. Intratumoral doxorubicin levels declined to negligible levels at 1 and 3 days after treatment, respectively, in the HAI and TACE groups. In the QuadraSphere groups, intratumoral doxorubicin level declined after day 1, but was still detectable at 14 days after treatment and was higher than that in the other groups at 1, 3, and 7 days. Intratumoral doxorubicin fluorescence was detected at all time points in the QuadraSphere group, but only at 1 day after treatment in the TACE group. Conclusions: Hepatic arterial administration of doxorubicin-loaded QuadraSpheres enables the sustained release of doxorubicin to hepatic tumors.

  14. Preliminary assessment of dynamic contrast-enhanced CT implementation in pretreatment FDG-PET/CT for outcome prediction in head and neck tumors.

    PubMed

    Abramyuk, Andrij; Wolf, Gunter; Shakirin, Georgy; Haberland, Ulrike; Tokalov, Sergey; Koch, Arne; Appold, Steffen; Zöphel, Klaus; Abolmaali, Nasreddin

    2010-09-01

    Recently published data show some controversy concerning the impact of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in predicting head and neck tumors (HNT) outcome. Assessment of tumor blood supply parameters using dynamic contrast-enhanced CT (DCE-CT) may deliver additional information concerning this important question. To evaluate the contribution of DCE-CT implemented in pretherapeutic FDG-PET/CT protocol for prognosis prediction in patients with HNT. Ten consecutive patients (median age 50 years, range 47-74 years) with histologically proven HNT underwent FDG-PET/CT with DCE-CT before treatment. FDG uptake was measured by maximum standardized uptake value (SUV(max)). Relative tumor blood volume (rTBV) was determined from DCE-CT using Patlak analysis. Intratumoral heterogeneity was assessed by means of lacunarity analysis. Obtained values were compared with time-to-progression and overall survival. PET and DCE-CT images were compared on a pixel-by-pixel basis using Pearson coefficient of correlation. Three patients with lower FDG uptake (SUV(max): 8+/-1) and five patients with higher FDG uptake (SUV(max): 15+/-4, P=0.004) were free of local recurrence for 24 months. Two groups of patients with significantly differing lower (group A: 0.37+/-0.02, n=6) and higher (group B: 0.52+/-0.01, n=4; P<0.01), tumor heterogeneity (lacunarity) were identified. Corresponding mean rTBV was higher in group A (9.6+/-1.8 ml/100 ml) than in group B (6.2+/-0.6 ml/100 ml). All six patients with homogeneous tumor blood supply (lower lacunarity) and higher rTBV were free of local recurrence during 24 months, while two of four patients with heterogeneous tumor blood supply (higher lacunarity) and lower rTBV died during follow-up due to tumor relapse. A weak correlation between FDG-PET and DCE-CT rTBV was observed (R(2)=0.1). FDG-PET/CT and DCT-CT are complementary methods for surveillance assessment in patients with HNT. Implementation of DCE-CT

  15. Adenovirus hepatitis presenting as tumoral lesions in an immunocompromised patient.

    PubMed

    Putra, Juan; Suriawinata, Arief A

    2014-01-01

    A 59-year-old man with T-cell prolymphocytic leukemia on alemtuzumab presented with neutropenic fever, intermittent nausea, and multiple ill-defined low attenuation foci in the liver on abdominal computed tomography scan which were suspicious for metastatic disease. Histological examination revealed the diagnosis of adenovirus hepatitis. Patient responded well to cidofovir. Adenovirus hepatitis is a rare but important entity to be considered by the clinicians, radiologists, and pathologists. Timely diagnosis and appropriate management are essential to improve the prognosis of adenovirus hepatitis in immunocompromised patients.

  16. Ki67 proliferation index, hepatic tumor load, and pretreatment tumor growth predict the antitumoral efficacy of lanreotide in patients with malignant digestive neuroendocrine tumors.

    PubMed

    Palazzo, Maxime; Lombard-Bohas, Catherine; Cadiot, Guillaume; Matysiak-Budnik, Tamara; Rebours, Vinciane; Vullierme, Marie-Pierre; Couvelard, Anne; Hentic, Olivia; Ruszniewski, Philippe

    2013-02-01

    An antiproliferative effect of somatostatin analogs was recently demonstrated. To identify factors associated with tumor control in a group of patients with well-differentiated malignant digestive neuroendocrine tumors treated with lanreotide. A retrospective study was conducted in 68 patients treated with lanreotide alone, with progression-free survival as the primary endpoint. The role of the following factors was searched for by univariate and multivariate analyses: age, sex, mode of discovery, site of the primary tumor, metastatic spread, Ki67 proliferation index, uptake on somatostatin receptor scintigraphy, pretreatment tumor growth, extent of liver involvement, resection of primary tumor, previous treatments, and tumor markers. Tumor progression was observed in 39/68 patients (57.4%). Median progression-free survival was 29 months. On multivariate analysis, a Ki67 proliferation index of up to 5% [hazard ratio (HR)=0.262, P=0.009], pretreatment stability (HR=0.241, P=0.008), and hepatic tumor load of up to 25% (HR=0.237, P=0.004) were significantly associated with disease stability under lanreotide therapy. In patients with well-differentiated malignant digestive neuroendocrine tumors, Ki67 proliferation index of up to 5%, stable disease before treatment, and low-to-moderate hepatic tumor involvement (≤ 25%) are associated with tumor control during lanreotide treatment. These data if confirmed in prospective trials will help in rationalizing the use of somatostatin analogs with antiproliferative intent.

  17. Anti-tumor and immunomodulatory activities of an exopolysaccharide from Rhizopus nigricans on CT26 tumor-bearing mice.

    PubMed

    Zhu, Lei; Cao, Jianfeng; Chen, Guochuang; Xu, Yanghui; Lu, Jingbo; Fang, Fang; Chen, Kaoshan

    2016-07-01

    This study was aimed to investigate the anti-tumor and immunomodulatory activities of an exopolysaccharide (EPS) from Rhizopus nigricans. Our results showed EPS could significantly inhibit the tumor growth and increase the immune organs index of CT26 tumor-bearing mice. EPS treatment increased the productions of interleukin-2 (IL-2) and tumor necrosis factor-α (TNF-α) levels in serum. The increase of percentage of CD8(+) cytotoxic T cells among total spleen T lymphocyte was also observed. Furthermore, EPS remarkably stimulate spleen lymphocytes proliferation in the absence or presence of mitogens. In addition, we found that EPS had synergistic effect with chemotherapy and improved immunosuppressive effect induced by 5-Fu. In summary, these findings indicated that the antitumor effects of EPS might be partly due to immune function activation and it might have potential to be used in the treatment for colorectal cancer.

  18. Rare Endobronchial Inflammatory Myofibroblastic Tumor in Pediatric Patient Detected on PET/CT Imaging.

    PubMed

    Kara, Pelin Ozcan; Koc, Zehra Pinar; Citak, Elvan Caglar; Nayci, Ali; Bahadir, Gokhan Berktug; Kara, Taylan

    2017-09-01

    Inflammatory myofibroblastic tumor (IMT) can be seen in all age groups, although it is more common in children and adolescents. We report the FDG PET/CT findings in an 8-year-old boy with endobronchial IMT. Endobronchial IMT is more commonly seen in young adults.

  19. CT-guided radiofrequency ablation in patients with hepatic metastases from breast cancer.

    PubMed

    Jakobs, Tobias F; Hoffmann, Ralf-Thorsten; Schrader, Angelika; Stemmler, Hans Joachim; Trumm, Christoph; Lubienski, Andreas; Murthy, Ravi; Helmberger, Thomas K; Reiser, Maximilian F

    2009-01-01

    The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated using the Kaplan-Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was 96%. During follow-up local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months. There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression, and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.

  20. CT-Guided Radiofrequency Ablation in Patients with Hepatic Metastases from Breast Cancer

    SciTech Connect

    Jakobs, Tobias F. Hoffmann, Ralf-Thorsten; Schrader, Angelika; Stemmler, Hans Joachim; Trumm, Christoph; Lubienski, Andreas; Murthy, Ravi; Helmberger, Thomas K.; Reiser, Maximilian F.

    2009-01-15

    The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated using the Kaplan-Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was 96%. During follow-up local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months. There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression, and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.

  1. For avid glucose tumors, the SUV peak is the most reliable parameter for [(18)F]FDG-PET/CT quantification, regardless of acquisition time.

    PubMed

    Sher, Avigaëlle; Lacoeuille, Franck; Fosse, Pacôme; Vervueren, Laurent; Cahouet-Vannier, Aurélie; Dabli, Djamel; Bouchet, Francis; Couturier, Olivier

    2016-12-01

    This study is an assessment of the impact of acquisition times on SUV with [(18)F]FDG-PET/CT on healthy livers (reference organ with stable uptake over time) and on tumors. One hundred six [(18)F]FDG-PET/CT were acquired in list mode over a single-bed position (livers (n = 48) or on tumors (n = 58)). Six independent datasets of different durations were reconstructed (from 1.5 to 10 min). SUVmax (hottest voxel), SUVpeak (maximum average SUV within a 1-cm(3) spherical volume), and SUVaverage were measured within a 3-cm-diameter volume of interest (VOI) in the right lobe of the liver. For [(18)F]FDG avid tumors (SUVmax ≥ 5), the SUVmax, SUVpeak, and SUV41% (isocontour threshold method) were computed. For tumors, SUVpeak values did not vary with acquisition time. SUVmax displayed significant differences between 1.5- and 5-10-min reconstruction times. SUV41% was the most time-dependent parameter. For the liver, the SUVaverage was the sole parameter that did not vary over time. For [(18)F]FDG avid tumors, with short acquisition times, i.e., with new generations of PET systems, the SUVpeak may be more robust than the SUVmax. The SUVaverage over a 3-cm-diameter VOI in the right lobe of the liver appears to be a good method for a robust and reproducible assessment of the hepatic metabolism.

  2. A clinical interactive technique for MR-CT image registration for target delineation of intracranial tumors.

    PubMed

    Luu, Q T; Levy, R P; Miller, D W; Shahnazi, K; Yonemoto, L T; Slater, J M; Slater, J D

    2005-06-01

    Replacement of current CT-based, three-dimensional (3D) treatment planning systems by newer versions capable of automated multi-modality image registration may be economically prohibitive for most radiation oncology clinics. We present a low-cost technique for MR-CT image registration on a "first generation" CT-based, 3D treatment planning system for intracranial tumors. The technique begins with fabrication of a standard treatment mask. A second truncated mask, the "minimask," is then made, using the standard mask as a mold. Two orthogonal leveling vials glued onto the minimask detect angular deviations in pitch and roll. Preservation of yaw is verified by referencing a line marked according to the CT laser on the craniocaudal axis. The treatment mask immobilizes the patient's head for CT. The minimask reproduces this CT-based angular treatment position, which is then maintained by taping the appropriately positioned head to the MR head coil for MR scanning. All CT and MR images, in DICOM 3.0 format, are entered into the treatment planning system via a computer network. Interactive registration of MR to CT images is controlled by real-time visual feedback on the computer monitor. Translational misalignments at the target are eliminated or minimized by iterative use of qualitative visual inspection. In this study, rotational errors were measured in a retrospective series of 20 consecutive patients who had undergone CT-MR image registration using this technique. Anatomic structures defined the three CT orthogonal axes from which angular errors on MR image were measured. Translational errors at the target isocenter were within pixel size, as judged by visual inspection. Clinical setup using the minimask resulted in overall average angular deviation of 3 degrees +/-2 degrees (mean +/- SD) and translational deviation within the edges of the target volume of typically less than 2 mm. The accuracy of this registration technique for target delineation of intracranial

  3. A huge malignant peripheral nerve sheath tumor with hepatic metastasis arising from retroperitoneal ganglioneuroma.

    PubMed

    Meng, Z H; Yang, Y S; Cheng, K L; Chen, G Q; Wang, L P; Li, W

    2013-01-01

    Ganglioneuromas (GNs) are the rarest and most benign of the neuroblastic tumors. We experienced a case of huge retroperitoneal GN which differentiated into malignant peripheral nerve sheath tumors (MPNST) with hepatic metastasis. The tumor was located in the upper right quarter of the abdomen and pressed the right lobe of the liver, which was initially misdiagnosed as a liver carcinoma. The tumor shared blood supply with the right liver lob and had rich blood supplies from the abdominal aorta, renal artery and hepatic artery. It was also associated with skin pigment and recurrence shortly following resection. Our finding demonstrated that MPNST is a potent invasive malignant tumor and metastasis earlier with very poor prognosis.

  4. Automated segmentation of middle hepatic vein in non-contrast x-ray CT images based on an atlas-driven approach

    NASA Astrophysics Data System (ADS)

    Kitagawa, Teruhiko; Zhou, Xiangrong; Hara, Takeshi; Fujita, Hiroshi; Yokoyama, Ryujiro; Kondo, Hiroshi; Kanematsu, Masayuki; Hoshi, Hiroaki

    2008-03-01

    In order to support the diagnosis of hepatic diseases, understanding the anatomical structures of hepatic lobes and hepatic vessels is necessary. Although viewing and understanding the hepatic vessels in contrast media-enhanced CT images is easy, the observation of the hepatic vessels in non-contrast X-ray CT images that are widely used for the screening purpose is difficult. We are developing a computer-aided diagnosis (CAD) system to support the liver diagnosis based on non-contrast X-ray CT images. This paper proposes a new approach to segment the middle hepatic vein (MHV), a key structure (landmark) for separating the liver region into left and right lobes. Extraction and classification of hepatic vessels are difficult in non-contrast X-ray CT images because the contrast between hepatic vessels and other liver tissues is low. Our approach uses an atlas-driven method by the following three stages. (1) Construction of liver atlases of left and right hepatic lobes using a learning datasets. (2) Fully-automated enhancement and extraction of hepatic vessels in liver regions. (3) Extraction of MHV based on the results of (1) and (2). The proposed approach was applied to 22 normal liver cases of non-contrast X-ray CT images. The preliminary results show that the proposed approach achieves the success in 14 cases for MHV extraction.

  5. CT and MRI Findings in a Rare Case of Renal Primitive Neuroectodermal Tumor

    PubMed Central

    Akkaya, Zehra; Peker, Elif; Gulpinar, Basak; Karadag, Hale; Erden, Ayse

    2016-01-01

    Summary Background Primary renal primitive neuroectodermal tumor/extraskeletal Ewing’s sarcoma (PNET/EES) is a very rare renal tumor. Case Report We report a case of primary renal PNET/EES of the kidney in an adult patient and describe its computed tomography and magnetic resonance imaging findings, including diffusion weighted images along with a review of the current medical literature. Conclusions Although very rare, a relatively large renal mass which shows very infiltrative growth pattern on CT and MR imaging and striking diffusion restriction should raise the suspicion of a renal primitive neuroectodermal tumor, in a young adult. PMID:27635170

  6. Endolymphatic Sac Tumor Showing Increased Activity on 68Ga DOTATATE PET/CT.

    PubMed

    Papadakis, Georgios Z; Millo, Corina; Sadowski, Samira M; Bagci, Ulas; Patronas, Nicholas J

    2016-10-01

    Endolymphatic sac tumors (ELSTs) are rare tumors arising from the epithelium of the endolymphatic sac and duct that can be either sporadic or associated with von Hippel-Lindau (VHL) disease. We report a case of a VHL patient with histologically proven residual ELST who underwent Ga DOTATATE PET/CT showing increased activity (SUVmax, 6.29) by the ELST. The presented case of a VHL-associated ELST with increased Ga DOTATATE uptake indicates cell-surface expression of somatostatin receptors by this tumor, suggesting the potential application of somatostatin receptor imaging using Ga DOTA-conjugated peptides in the workup and management of these patients.

  7. Angiogenesis dependent characteristics of tumor observed on rabbit VX2 hepatic carcinoma

    PubMed Central

    Guan, Liming

    2015-01-01

    Objective: To evaluate angiogenesis dependent characteristics of carcinoma proliferation, metastasis and to found if there is tumor vascularity architecture defect. Methods: 36 rabbits were random divided into 2 groups: Experimental group: 18 rabbits liver were implanted with VX2 tumor by surgery operation; Control group: 18 experimental rabbits performed the same surgery operation without tumor implantation, the course of tumor growth and blood vessel invasion was observed by autopsy. One slide was used for hematoxylin-eosin (HE) staining, one slide was used for elastic fiber staining by Victoria blue and Ponceau’s histochemical staining, and one slide was used for vascular endothelial cell immunohistochemical staining with biotinylated-ulex europaeus agglutinin I (UEA I); all three slides were observed under an optical microscopic. One additional slide was systematically observed by electron microscopy. SPSS 19.0 software was used for the statistical analyses of the data. Results: The tumor grew acceleration after tumor angiogenesis, volume of original tumors was correlated with vascular caliber. The central tumor found necrosis without enough blood supply while tumor grew rapidly after tumor angiogenesis. The tumor infiltrated into liver blood sinus, blood vessels in hepatic interstitial tissue, the liver capsular vein and important organs metastasis such as lungs, kidneys, abdominal cavity caused rabbits died. The average vascular density count of 18 experimental rabbits under 400 times light microscope were 43.17 ± 8.68/vessels/High Power Field; Tumor vascular diameter all within 200 μm. Vascular elastic fiber staining presented tumor blood vessels internal, external elastic plate intact, vascular endothelial cells organelles of tumor were integrity without endothelial cells architecture defect found by pathologic observation. Conclusion: Proliferation and metastasis of rabbit VX2 hepatic carcinoma was correlated with tumor angiogenesis and no tumor

  8. Molecular imaging of brain tumors with 18F-DOPA PET and PET/CT.

    PubMed

    Calabria, Ferdinando; Chiaravalloti, Agostino; Di Pietro, Barbara; Grasso, Cristina; Schillaci, Orazio

    2012-06-01

    The objective of this study was to give an overview of the potential clinical utility of [18F]-L-dihydroxyphenylalanine (18F-DOPA) PET and PET/CT for imaging of brain tumors. Review articles and reference lists were used to supplement the search findings. 18F-DOPA has been investigated as a PET tracer for primary brain tumors, metastases of somatic cancer, and evaluation of relapse of pathology in patients with brain tumor after surgery and/or radiotherapy on the basis of enhanced cell proliferation. Available studies have provided encouraging preliminary results for diagnosis of brain tumors and relapse after surgery/radiotherapy. In the brain, excellent discrimination between tumor and normal tissue can be achieved because of the low physiological uptake of 18F-DOPA and the high ratio between tumor and normal hemispheric tissue. Information on evaluation of brain metastases is limited but encouraging. PET and PET/CT with 18F-DOPA are useful in diagnosing primary brain tumors and should be recommended in the diagnosis of relapse of disease after surgical treatment and/or radiotherapy. Semiquantitative analysis could improve diagnosis while correlative imaging with MRI is essential. Limits are due to low knowledge of potential pitfalls.

  9. Nanosized multifunctional liposomes for tumor diagnosis and molecular imaging by SPECT/CT.

    PubMed

    Silindir, Mine; Erdoğan, Suna; Özer, A Yekta; Doğan, A Lale; Tuncel, Murat; Uğur, Ömer; Torchilin, Vladimir P

    2013-03-01

    Among currently used cancer imaging methods, nuclear medicine modalities provide metabolic information, whereas modalities in radiology provide anatomical information. However, different modalities, having different acquisition times in separate machines, decrease the specificity and accuracy of images. To solve this problem, hybrid imaging modalities were developed as a new era, especially in the cancer imaging field. With widespread usage of hybrid imaging modalities, specific contrast agents are essentially needed to use in both modalities, such as single-photon emission computed tomography/computed tomography (SPECT/CT). Liposomes are one of the most desirable drug delivery systems, depending on their suitable properties. The aim of this study was to develop a liposomal contrast agent for the diagnosis and molecular imaging of tumor by SPECT/CT. Liposomes were prepared nanosized, coated with polyethylene glycol to obtain long blood circulation, and modified with monoclonal antibody 2C5 for specific tumor targeting. Although DTPA-PE and DTPA-PLL-NGPE (polychelating amphilic polymers; PAPs) were loaded onto liposomes for stable radiolabeling for SPECT imaging, iopromide was encapsulated into liposomes for CT imaging. Liposomes [(DPPC:PEG(2000)-PE:Chol:DTPA-PE), (PL 90G:PEG(2000)-PE:Chol:DTPA-PE), (DPPC:PEG(2000)-PE:Chol:PAPs), (PL 90G:PEG(2000)-PE:Chol:PAPs), (60:0.9:39:0.1% mol ratio)] were characterized in terms of entrapment efficiency, particle size, physical stability, and release kinetics. Additionally, in vitro cell-binding studies were carried out on two tumor cell lines (MCF-7 and EL 4) by counting radioactivity. Tumor-specific antibody-modified liposomes were found to be effective multimodal contrast agents by designating almost 3-8 fold more uptake than nonmodified ones in different tumor cell lines. These results could be considered as an important step in the development of tumor-targeted SPECT/CT contrast agents for cancer imaging.

  10. CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors

    PubMed Central

    Brook, Olga R.; Thornton, Eavan; Mendiratta-Lala, Mishal; Mahadevan, Anand; Raptopoulos, Vassilious; Brook, Alexander; Najarian, Robert; Sheiman, Robert; Siewert, Bettina

    2015-01-01

    Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors. Materials and Methods. In this IRB-approved, HIPAA-compliant study CTs of 68 consecutive patients who underwent stereotactic radiotherapy for liver tumors between 01/2006 and 01/2010 were retrospectively reviewed. Two independent reviewers evaluated lesion volume and enhancement pattern of the lesion and of juxtaposed liver parenchyma. Results. 36 subjects with hepatocellular carcinoma (HCC), 25 with liver metastases, and seven with cholangiocarcinoma (CCC) were included in study. Mean follow-up time was 5.6 ± 7.1 months for HCC, 6.4 ± 5.1 months for metastases, and 10.1 ± 4.8 months for the CCC. Complete response was seen in 4/36 (11.1%) HCCs and 1/25 (4%) metastases. Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs. Partial response followed by local recurrence (>20% increase in long diameter from nadir) occurred in 2/36 (6%) HCCs and 4/25 (17%) metastases. Liver parenchyma adjacent to the lesion demonstrated a prominent halo of delayed enhancement in 27/36 (78%) of HCCs, 19/21 (91%) of metastases, and 7/7 (100%) of CCCs. Conclusion. Sustainable radiological partial response to stereotactic radiotherapy is most frequent outcome seen in liver lesions. Prominent halo of delayed enhancement of the adjacent liver is frequent finding. PMID:26221135

  11. Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout

    PubMed Central

    Furlan, A; Marin, D; Vanzulli, A; Patera, G Palermo; Ronzoni, A; Midiri, M; Bazzocchi, M; Lagalla, R; Brancatelli, G

    2011-01-01

    Objectives Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC). Methods 30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs. Results 48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p<0.001, McNemar’s test). Objective washout was present in 30 of the 46 HCCs (65%) during the hepatic venous phase and in 42 of the HCCs (91%) during the delayed phase (p=0.001). The delayed phase yielded significantly higher mean TLC absolute values compared with the hepatic venous phase (−16.1±10.8 HU vs −10.5±10.2 HU; p<0.001). Conclusions The delayed phase is superior to the hepatic venous phase for detection of tumour washout of pathologically proven HCC in cirrhotic patients. PMID:21081569

  12. Uncertainty analysis of quantitative imaging features extracted from contrast-enhanced CT in lung tumors

    PubMed Central

    Yang, Jinzhong; Zhang, Lifei; Fave, Xenia J.; Fried, David V.; Stingo, Francesco C.; Ng, Chaan S.; Court, Laurence E.

    2016-01-01

    Purpose To assess the uncertainty of quantitative imaging features extracted from contrast-enhanced computed tomography (CT) scans of lung cancer patients in terms of the dependency on the time after contrast injection and the feature reproducibility between scans. Methods Eight patients underwent contrast-enhanced CT scans of lung tumors on two sessions 2–7 days apart. Each session included 6 CT scans of the same anatomy taken every 15 seconds, starting 50 seconds after contrast injection. Image features based on intensity histogram, co-occurrence matrix, neighborhood gray-tone difference matrix, run-length matrix, and geometric shape were extracted from the tumor for each scan. Spearman’s correlation was used to examine the dependency of features on the time after contrast injection, with values over 0.50 considered time-dependent. Concordance correlation coefficients were calculated to examine the reproducibility of each feature between times of scans after contrast injection and between scanning sessions, with values greater than 0.90 considered reproducible. Results The features were found to have little dependency on the time between the contrast injection and the CT scan. Most features were reproducible between times of scans after contrast injection and between scanning sessions. Some features were more reproducible when they were extracted from a CT scan performed at a longer time after contrast injection. Conclusion The quantitative imaging features tested here are mostly reproducible and show little dependency on the time after contrast injection. PMID:26745258

  13. The value of emergency CT studies in spontaneous rupture of hepatocellular carcinoma. Analysis for tumor protrusion and hemorrhagic ascites.

    PubMed

    Ishihara, M; Kobayashi, H; Ichikawa, T; Cho, K; Gemma, K; Kumazaki, T

    1997-12-01

    CT characteristics of spontaneous rupture of HCC (n = 13) were reviewed retrospectively, and the value of emergency CT studies in this disease was evaluated. Especially, tumor protrusion ratio (TPR) and ascitic CT numbers were measured to for comparison with the data for unruptured HCCs and ordinary (e.g. non hemorrhagic) ascites (n = 13). As a result, except for diffuse type HCCs, the TPR was significantly higher than for the unruptured HCCs. Nine cases had intraperitoneal HDAs, and the laterality of the HDAs corresponded with that of the ruptured tumors in 8 cases. Also, the ascitic CT numbers apart from the HDA were still higher than the ordinary ascites. Therefore, a high TPR, HDAs adjacent to the tumor, and elevated ascitic CT numbers are important CT manifestations indicating HCC rupture. Diffuse HCCs, however, require careful clinical evaluation.

  14. SU-E-J-275: Review - Computerized PET/CT Image Analysis in the Evaluation of Tumor Response to Therapy

    SciTech Connect

    Lu, W; Wang, J; Zhang, H

    2015-06-15

    Purpose: To review the literature in using computerized PET/CT image analysis for the evaluation of tumor response to therapy. Methods: We reviewed and summarized more than 100 papers that used computerized image analysis techniques for the evaluation of tumor response with PET/CT. This review mainly covered four aspects: image registration, tumor segmentation, image feature extraction, and response evaluation. Results: Although rigid image registration is straightforward, it has been shown to achieve good alignment between baseline and evaluation scans. Deformable image registration has been shown to improve the alignment when complex deformable distortions occur due to tumor shrinkage, weight loss or gain, and motion. Many semi-automatic tumor segmentation methods have been developed on PET. A comparative study revealed benefits of high levels of user interaction with simultaneous visualization of CT images and PET gradients. On CT, semi-automatic methods have been developed for only tumors that show marked difference in CT attenuation between the tumor and the surrounding normal tissues. Quite a few multi-modality segmentation methods have been shown to improve accuracy compared to single-modality algorithms. Advanced PET image features considering spatial information, such as tumor volume, tumor shape, total glycolytic volume, histogram distance, and texture features have been found more informative than the traditional SUVmax for the prediction of tumor response. Advanced CT features, including volumetric, attenuation, morphologic, structure, and texture descriptors, have also been found advantage over the traditional RECIST and WHO criteria in certain tumor types. Predictive models based on machine learning technique have been constructed for correlating selected image features to response. These models showed improved performance compared to current methods using cutoff value of a single measurement for tumor response. Conclusion: This review showed that

  15. Automated detection of lung tumors in PET/CT images using active contour filter

    NASA Astrophysics Data System (ADS)

    Teramoto, Atsushi; Adachi, Hayato; Tsujimoto, Masakazu; Fujita, Hiroshi; Takahashi, Katsuaki; Yamamuro, Osamu; Tamaki, Tsuneo; Nishio, Masami; Kobayashi, Toshiki

    2015-03-01

    In a previous study, we developed a hybrid tumor detection method that used both computed tomography (CT) and positron emission tomography (PET) images. However, similar to existing computer-aided detection (CAD) schemes, it was difficult to detect low-contrast lesions that touch to the normal organs such as the chest wall or blood vessels in the lung. In the current study, we proposed a novel lung tumor detection method that uses active contour filters to detect the nodules deemed "difficult" in previous CAD schemes. The proposed scheme detects lung tumors using both CT and PET images. As for the detection in CT images, the massive region was first enhanced using an active contour filter (ACF), which is a type of contrast enhancement filter that has a deformable kernel shape. The kernel shape involves closed curves that are connected by several nodes that move iteratively in order to enclose the massive region. The final output of ACF is the difference between the maximum pixel value on the deformable kernel, and pixel value on the center of the filter kernel. Subsequently, the PET images were binarized to detect the regions of increased uptake. The results were integrated, followed by the false positive reduction using 21 characteristic features and three support vector machines. In the experiment, we evaluated the proposed method using 100 PET/CT images. More than half of nodules missed using previous methods were accurately detected. The results indicate that our method may be useful for the detection of lung tumors using PET/CT images.

  16. CT and angiography of primary extradural juxtasellar tumors

    SciTech Connect

    Moore, T.; Ganti, S.R.; Mawad, M.E.; Hilal, S.K.

    1985-09-01

    The computed tomographic and angiographic features of 15 histologically proven primary extradural juxtasellar tumors were retrospectively reviewed. Five chordomas were characterized by prominent bone erosion and a significant posterior fossa component. Four trigeminal nerve neuromas each demonstrated bone erosion centered about Meckel's cave and moderate to marked contrast enhancement. Two cavernous sinus meningiomas revealed moderate contrast enhancement, expansion of the cavernous sinus, and moderate angiographic stain. Two cavernous hemangiomas of the cavernous sinus were intensely enhancing and demonstrated angiographic stain. Opacification of the sphenoid sinus with prominent bone destruction and lack of contrast enhancement was characteristic of a sphenoid sinus mucocele. The dural reflection could be directly visualized or indirectly inferred in each case.

  17. Role of FDG-PET/CT for monitoring soft tissue tumors

    PubMed Central

    HOSHI, MANABU; OEBISU, NAOTO; TAKADA, JUN; IEGUCHI, MAKOTO; WAKASA, KENICHI; NAKAMURA, HIROAKI

    2014-01-01

    The aim of the current study was to evaluate the limitations of 2-deoxy-2-F18-fluoro-D-glucose positron emission tomography combined with computed tomography (FDG-PET/CT) when monitoring soft tissue tumors. The diagnostic criteria of malignancy was defined as the tumor having a maximum standardized uptake value (SUVmax) ≥2.0 and a maximum diameter ≥5 cm as measured using FDG-PET/CT. One-hundred-and-thirteen patients, that were either included in the criteria or not, were compared. In addition, the values of SUVmax of the primary tumor and relapse in 12 patients were evaluated. The Kaplan-Meier analysis demonstrated that patients with tumors measuring ≥5 cm size and ≥2.0 SUVmax were associated with a worse survival rate. Among the 12 patients with relapse, statistical significances were detected in the tumor diameters, however, not in the SUVmax values. Thus, the criteria identified patients that were associated with a poor prognosis, and the SUVmax of distant metastases and local recurrences were identified to be significantly affected by tumor size. PMID:24660036

  18. Comparison of DCE-CT models for quantitative evaluation of K(trans) in larynx tumors.

    PubMed

    Oosterbroek, J; Bennink, E; Philippens, M E P; Raaijmakers, C P J; Viergever, M A; de Jong, H W A M

    2015-05-07

    Dynamic contrast enhanced CT (DCE-CT) can be used to estimate blood perfusion and vessel permeability in tumors. Tumor induced angiogenesis is generally associated with disorganized microvasculature with increased permeability or leakage. Estimated vascular leakage (K(trans)) values and their reliability greatly depend on the perfusion model used. To identify the preferred model for larynx tumor analysis, several perfusion models frequently used for estimating permeability were compared in this study. DCE-CT scans were acquired for 16 larynx cancer patients. Larynx tumors were delineated based on whole-mount histopathology after laryngectomy. DCE-CT data within these delineated volumes were analyzed using the Patlak and Logan plots, the Extended Tofts Model (ETM), the Adiabatic Approximation to the Tissue Homogeneity model (AATH) and a variant of AATH with fixed transit time (AATHFT). Akaike's Information Criterion (AIC) was used to identify the best fitting model. K(trans) values from all models were compared with this best fitting model. Correlation strength was tested with two-tailed Spearman's rank correlation and further examined using Bland-Altman plots. AATHFT was found to be the best fitting model. The overall median of individual patient medians K(trans) estimates were 14.3, 15.1, 16.1, 2.6 and 22.5 mL/100 g min(  -  1) for AATH, AATHFT, ETM, Patlak and Logan, respectively. K(trans) estimates for all models except Patlak were strongly correlated (P  <  0.001). Bland-Altman plots show large biases but no significant deviating trend for any model other than Patlak. AATHFT was found to be the preferred model among those tested for estimation of K(trans) in larynx tumors.

  19. Comparison of DCE-CT models for quantitative evaluation of Ktrans in larynx tumors

    NASA Astrophysics Data System (ADS)

    Oosterbroek, J.; Bennink, E.; Philippens, M. E. P.; Raaijmakers, C. P. J.; Viergever, M. A.; de Jong, H. W. A. M.

    2015-05-01

    Dynamic contrast enhanced CT (DCE-CT) can be used to estimate blood perfusion and vessel permeability in tumors. Tumor induced angiogenesis is generally associated with disorganized microvasculature with increased permeability or leakage. Estimated vascular leakage (Ktrans) values and their reliability greatly depend on the perfusion model used. To identify the preferred model for larynx tumor analysis, several perfusion models frequently used for estimating permeability were compared in this study. DCE-CT scans were acquired for 16 larynx cancer patients. Larynx tumors were delineated based on whole-mount histopathology after laryngectomy. DCE-CT data within these delineated volumes were analyzed using the Patlak and Logan plots, the Extended Tofts Model (ETM), the Adiabatic Approximation to the Tissue Homogeneity model (AATH) and a variant of AATH with fixed transit time (AATHFT). Akaike’s Information Criterion (AIC) was used to identify the best fitting model. Ktrans values from all models were compared with this best fitting model. Correlation strength was tested with two-tailed Spearman’s rank correlation and further examined using Bland-Altman plots. AATHFT was found to be the best fitting model. The overall median of individual patient medians Ktrans estimates were 14.3, 15.1, 16.1, 2.6 and 22.5 mL/100 g min  -  1 for AATH, AATHFT, ETM, Patlak and Logan, respectively. Ktrans estimates for all models except Patlak were strongly correlated (P  <  0.001). Bland-Altman plots show large biases but no significant deviating trend for any model other than Patlak. AATHFT was found to be the preferred model among those tested for estimation of Ktrans in larynx tumors.

  20. CT Features and Pathological Correlation of Primitive Neuroectodermal Tumor of the Kidney.

    PubMed

    Dong, Junqiang; Xing, Jingjing; Limbu, Hangsha Hang; Yue, Songwei; Su, Lei; Zhang, Dandan; Gao, Jianbo

    2015-09-01

    The purpose of the study was to analyze the computed tomography (CT) findings of primitive neuroectodermal tumor (PNET) of the kidney and correlate them pathologically. Ten cases of pathologically confirmed renal PNET were collected and retrospectively reviewed. The CT features that were analyzed include tumor size, shape, margins, density, nature of enhancement, presence of thrombosis, and metastasis, etc. These parameters were correlated with pathological findings and combined with literature review. The median age of the patients was 30 years. CT images showed solitary, large, ill-defined, irregular, or lobulated heterogeneous mass. Invasive growth toward the renal cortex and pelvis with renal cortical interruptions were seen in eight cases with one case exhibiting invasion that extended beyond the renal capsule with soft tissue seen in the perirenal fat pace. The tumors were confined to the kidney contour with enlargement of kidney in six of the cases. Cystic changes with mural nodules were detected in three cases. Eight cases showed persistent moderate enhancement during the nephrographic phase. Irregular septum-like structures were seen in four cases. Thrombosis was detected in eight cases. Lymph node metastasis was detected in eight cases with bilateral lung metastasis in two and bone metastasis in one. Renal PNET is a rare highly aggressive disease affecting younger people. It should be considered as a strong differential when well confined, yet large tumors that cause enlargement of the kidney are seen and also when tumors expressing cystic changes along with mural nodules are seen. Although renal PNET has certain other characteristic CT features, pathological and immunohistochemistry report must also be sought for definitive diagnosis.

  1. Spectral CT imaging in the differential diagnosis of necrotic hepatocellular carcinoma and hepatic abscess.

    PubMed

    Yu, Y; Guo, L; Hu, C; Chen, K

    2014-12-01

    To explore the value of CT spectral imaging in the differential diagnosis of necrotic hepatocellular carcinoma (nHCC) and hepatic abscess (HA) during the arterial phase (AP) and portal venous phase (PP). Sixty patients with 36 nHCCs and 24 HAs underwent spectral CT during AP and PP. Iodine or water concentration were measured and the normalized iodine concentration (NIC) and lesion-normal parenchyma iodine concentration ratio (LNR) were calculated. The two-sample t-test was used to compare quantitative parameters. Two readers qualitatively assessed lesion types according to imaging features. Sensitivity and specificity were compared between the qualitative and quantitative studies. NIC and LNR in the AP for the wall of nHCC (0.14 ± 0.04 mg/ml; 2.77 ± 0.74) were higher than those of HA (0.13 ± 0.02 mg/ml; 1.4 ± 0.9). NIC and LNR in the PP for the wall of HA (0.66 ± 0.05 mg/ml; 1.2 ± 0.2) were higher than those of nHCC (0.5 ± 0.11 mg/ml; 0.94 ± 0.12). The differences in NIC in the AP were not significant but the differences in LNR in AP, and NIC and LNR in the PP were significant. The best quantitative parameter was LNR in AP, and a threshold of 1.52 would yield a sensitivity and specificity of 100% and 91.7%, respectively, for differentiating nHCC from HA. CT spectral imaging with quantitative iodine concentration analysis may help to increase the accuracy of differentiating nHCC from HA. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  2. Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery

    SciTech Connect

    Theysohn, Jens M.; Mueller, Stefan; Schlaak, Joerg F.; Ertle, Judith; Schlosser, Thomas W.; Bockisch, Andreas; Lauenstein, Thomas C.

    2013-08-01

    PurposeSelective internal radiotherapy (SIRT) with the beta emitter yttrium-90 (Y90) is a rapidly developing therapy option for unresectable liver malignancies. Nontarget irradiation of the gallbladder is a complication of SIRT. Thus, we aimed to assess different strategies to avoid infusion of Y90 into the cystic artery (CA).MethodsAfter hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin ({sup 99}mTc-HSA), 295 patients with primary or secondary liver tumors underwent single-photon emission computed tomography/computed tomography (SPECT/CT). Different measures were taken before repeated Y90 mapping and SIRT to avoid unintended influx into the CA where necessary. Clinical symptoms, including pain, fever, or a positive Murphy sign, were assessed during patient follow-up.ResultsA significant {sup 99}mTc-HSA accumulation in the gallbladder wall (higher {sup 99}mTc-HSA uptake than in normal liver tissue) was seen in 20 patients. The following measures were taken to avoid unintended influx into the CA: temporary/permanent occlusion of the CA with gelfoam (n = 5)/microcoil (n = 1), induction of vasospasm with a microwire (n = 4), or altering catheter position (n = 10). Clinical signs of cholecystitis were observed in only one patient after temporary CA occlusion with gelfoam and were successfully treated by antibiotics. Cholecystectomy was not required for any patient.ConclusionIt is important to identify possible nontarget irradiation of the gallbladder. The risk for radiation-induced cholecystitis can be easily minimized by temporary or permanent CA embolization, vasospasm induction, or altering the catheter position.

  3. Tumor necrosis factor-alpha directly stimulates the overproduction of hepatic apolipoprotein B100-containing VLDL via impairment of hepatic insulin signaling.

    USDA-ARS?s Scientific Manuscript database

    Insulin resistant states are commonly associated with both increased circulating levels of tumor necrosis factor (TNF-a) and hepatic overproduction of very low density lipoproteins (VLDL). In the present study, we examined the potential mechanistic link between TNF-a and hepatic overproduction of ap...

  4. Three polymorphisms of tumor necrosis factor-alpha and hepatitis B virus related hepatocellular carcinoma

    PubMed Central

    Xiao, Qi; Fu, BiQi; Chen, Ping; Liu, Zhong Zhong; Wang, Wei; Ye, QiFa

    2016-01-01

    Abstract Background: To assess the association between tumor necrosis factor-alpha (TNF-α) G308A, G238A and C863T polymorphisms and hepatitis B virus related hepatocellular carcinoma (HBV-HCC) susceptibility. Methods: We interrogated the databases of Pubmed, Sciencedirect and Viley online library up to March 8, 2016. Odds ratios (ORs) and corresponding 95% confidence intervals (95%CIs) were calculated in a fixed-effects model or a random-effects model when appropriate. Results: In total, 12 case–control studies which containing 1580 HBV-HCC cases, 2033 HBV carrier controls, 395 HBV spontaneously recovered (SR) controls and 1116 healthy controls were included. Compared with GG genotype, the genotypes GA/AA of G308A were associated with a significantly increased HBV-HCC risk when the controls were all healthy individuals (AA vs. GG, OR 2.483, 95%CI 1.243 to 4.959; GA vs. GG, OR 1.383, 95%CI 1.028 to 1.860; GA/AA vs. GG, OR 1.381, 95%CI 1.048 to 1.820). Meanwhile, only the AA vs. GG model of G238A and HBV-HCC showed a statistic significance when the controls were healthy individuals (OR 4.776, 95%CI 1.280 to 17.819). CT genotype of TNF-α C863T could increase HBV-HCC risk whenever the controls were healthy individuals, HBV carriers or HBV recovers. Conclusion: This meta-analysis shows that AA genotype in TNF-α G308A and TNF-α G238A and CT genotype in TNF-α C863T may increase HBV-HCC risk. Therefore, HBV infection seemed to be a more important factor for tumorigenesis of HCC than genetic predisposition in G308A of TNF-α, and interaction between TNF-α C863T polymorphisms and HBV infection might be associated with increased HCC risk. PMID:27977601

  5. Anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor): CT and radiographic manifestations

    SciTech Connect

    Balthazar, E.J.; Streiter, M.; Megibow, A.J.

    1984-03-01

    Giant condyloma acuminatum (Buschke-Loewenstein tumor) is an unusual variety of venereal wart characterized by a large size, cauliflower-like appearance, and locally invasive nature. CT examination of two patients with anorectal giant condylomata revealed the papillomatous and invasive nature of the lesion and the extent of tumor; there was infiltration of the subcutaneous tissue, perirectal fascial planes, and luminal narrowing with marked thickening of the rectal wall. The pathologic specimens showed benign histologic finding in one case and a mixed pattern with areas of malignant degeneration in the other. CT accurately demonstrated the exact location and extent of the lesions. The presence of malignant degeneration in this inherently invasive lesion can be established only on histologic examination.

  6. Evaluation of anterior mediastinal solid tumors by CT perfusion: a preliminary study.

    PubMed

    Bakan, Selim; Kandemirli, Sedat Giray; Dikici, Atilla Süleyman; Erşen, Ezel; Yıldırım, Onur; Samancı, Cesur; Batur, Şebnem; Çebi Olgun, Deniz; Kantarcı, Fatih; Akman, Canan

    2017-01-01

    We aimed to assess the role of computed tomography (CT) perfusion in differentiation of thymoma from thymic hyperplasia, lymphoma, thymic carcinoma, and lung cancer invading anterior mediastinum. In this study, 25 patients with an anterior mediastinal lesion underwent CT perfusion imaging from January 2015 to February 2016. Diagnoses included thymoma (n=7), thymic hyperplasia (n=8), lymphoma (n=4), thymic carcinoma (n=3), and invasive lung cancer (n=3). Lymphoma, thymic carcinoma, and lung cancer were grouped as malignant tumors for statistical analysis. Values for blood flow, blood volume, and permeability surface were measured in CT perfusion. Blood flow and blood volume values were higher in thymoma in comparison to thymic hyperplasia; however, the difference was not statistically significant. Blood volume values were significantly higher in thymoma (mean, 11.4 mL/100 mL; range, 5.2-20.2 mL/100 mL) compared with lymphoma (mean, 5.3 mL/100 mL; range, 2.5-7.2 mL/100 mL) (P = 0.023). Blood flow and blood volume values were significantly higher in thymoma compared with non-thymoma malignant tumors (P = 0.025). CT perfusion is helpful in differentiating thymoma from non-thymoma malignancies including lymphoma, thymic carcinoma, and invasive lung cancer involving the anterior mediastinum.

  7. Evaluation of anterior mediastinal solid tumors by CT perfusion: a preliminary study

    PubMed Central

    Bakan, Selim; Kandemirli, Sedat Giray; Dikici, Atilla Süleyman; Erşen, Ezel; Yıldırım, Onur; Samancı, Cesur; Batur, Şebnem; Olgun, Deniz Çebi; Kantarcı, Fatih; Akman, Canan

    2017-01-01

    PURPOSE We aimed to assess the role of computed tomography (CT) perfusion in differentiation of thymoma from thymic hyperplasia, lymphoma, thymic carcinoma, and lung cancer invading anterior mediastinum. METHODS In this study, 25 patients with an anterior mediastinal lesion underwent CT perfusion imaging from January 2015 to February 2016. Diagnoses included thymoma (n=7), thymic hyperplasia (n=8), lymphoma (n=4), thymic carcinoma (n=3), and invasive lung cancer (n=3). Lymphoma, thymic carcinoma, and lung cancer were grouped as malignant tumors for statistical analysis. Values for blood flow, blood volume, and permeability surface were measured in CT perfusion. RESULTS Blood flow and blood volume values were higher in thymoma in comparison to thymic hyperplasia; however, the difference was not statistically significant. Blood volume values were significantly higher in thymoma (mean, 11.4 mL/100 mL; range, 5.2–20.2 mL/100 mL) compared with lymphoma (mean, 5.3 mL/100 mL; range, 2.5–7.2 mL/100 mL) (P = 0.023). Blood flow and blood volume values were significantly higher in thymoma compared with non-thymoma malignant tumors (P = 0.025). CONCLUSION CT perfusion is helpful in differentiating thymoma from non-thymoma malignancies including lymphoma, thymic carcinoma, and invasive lung cancer involving the anterior mediastinum. PMID:27924778

  8. Graph cut based co-segmentation of lung tumor in PET-CT images

    NASA Astrophysics Data System (ADS)

    Ju, Wei; Xiang, Dehui; Zhang, Bin; Chen, Xinjian

    2015-03-01

    Accurate segmentation of pulmonary tumor is important for clinicians to make appropriate diagnosis and treatment. Positron Emission Tomography (PET) and Computed Tomography (CT) are two commonly used imaging technologies for image-guided radiation therapy. In this study, we present a graph-based method to integrate the two modalities to segment the tumor simultaneously on PET and CT images. The co-segmentation problem is formulated as an energy minimization problem. Two weighted sub-graphs are constructed for PET and CT. The characteristic information of the two modalities is encoded on the edges of the graph. A context cost is enforced by adding context arcs to achieve consistent results between the two modalities. An optimal solution can be achieved by solving a maximum flow problem. The proposed segmentation method was validated on 18 sets of PET-CT images from different patients with non-small cell lung cancer (NSCLC). The quantitative results show significant improvement of our method with a mean DSC value 0.82.

  9. Tumor Uptake of Hollow Gold Nanospheres after Intravenous and Intra-arterial Injection: PET/CT Study in a Rabbit VX2 Liver Cancer Model

    PubMed Central

    Tian, Mei; Lu, Wei; Zhang, Rui; Xiong, Chiyi; Ensor, Joe; Nazario, Javier; Jackson, James; Shaw, Colette; Dixon, Katherine A.; Miller, Jennifer; Wright, Kenneth; Li, Chun; Gupta, Sanjay

    2014-01-01

    Purpose This study was designed to investigate the intratumoral uptake of hollow gold nanospheres (HAuNS) after hepatic intra-arterial (IA) and intravenous (IV) injection in a liver tumor model. Materials and Methods Fifteen VX2 tumor-bearing rabbits were randomized into five groups (N=3 in each group) that received either IV 64Cu-labeled PEG-HAuNS (IV-PEG-HAuNS), IA 64Cu-labeled PEG-HAuNS (IA-PEG-HAuNS), IV cyclic peptide (RGD)-conjugated 64Cu-labeled PEG-HAuNS (IV-RGD-PEG-HAuNS), IA RGD-conjugated 64Cu-labeled PEG-HAuNS (IA-RGD-PEG-HAuNS), or IA 64Cu-labeled PEG-HAuNS with lipiodol (IA-PEG-HAuNS-lipiodol). The animals underwent PET/CT 1 hour after injection, and uptake expressed as percentage of injected dose per gram of tissue (%ID/g) was measured in tumor and major organs. The animals were euthanized 24 hours after injection, and tissues were evaluated for radioactivity. Results At 1 hour after injection, animals in the IA-PEG-HAuNS-lipiodol group showed significantly higher tumor uptake (P < 0.001) and higher ratios of tumor-to-normal liver uptake (P < 0.001) than those in all other groups. The biodistribution of radioactivity 24 hours after injection showed that IA delivery of PEG-HAuNS with lipiodol resulted in the highest tumor uptake (0.33 %ID/g; P < 0.001) and tumor-to-normal liver ratio (P < 0.001) among all delivery methods. At 24 hours, the IA-RGD-PEG-HAuNS group showed higher tumor uptake than the IA-PEG-HAuNS group (0.20 %ID/g vs. 0.099 %ID/g; P < 0.001). Conclusion Adding iodized oil to IA-PEG-HAuNS maximizes nanoparticle delivery to hepatic tumors and therefore may be useful in targeted chemotherapy and photoablative therapy. PET/CT can be used to noninvasively monitor the biodistribution of radiolabeled HAuNS after IV or IA injection. PMID:23608932

  10. Head CT scan

    MedlinePlus

    Brain CT; Cranial CT; CT scan - skull; CT scan - head; CT scan - orbits; CT scan - sinuses; Computed tomography - cranial; CAT scan - brain ... conditions: Birth (congenital) defect of the head or brain Brain infection Brain tumor Buildup of fluid inside ...

  11. Microvascular Perfusion Changes following Transarterial Hepatic Tumor Embolization

    PubMed Central

    Johnson, Carmen Gacchina; Sharma, Karun V.; Levy, Elliot B.; Woods, David L.; Morris, Aaron H.; Bacher, John D.; Lewis, Andrew L.; Wood, Bradford J.; Dreher, Matthew R.

    2015-01-01

    Purpose To quantify changes in tumor microvascular (< 1 mm) perfusion relative to commonly used angiographic endpoints. Materials and Methods Rabbit Vx2 liver tumors were embolized with 100–300-µm LC Bead particles to endpoints of substasis or complete stasis (controls were not embolized). Microvascular perfusion was evaluated by delivering two different fluorophore-conjugated perfusion markers (ie, lectins) through the catheter before embolization and 5 min after reaching the desired angiographic endpoint. Tumor microvasculature was labeled with an anti-CD31 antibody and analyzed with fluorescence microscopy for perfusion marker overlap/mismatch. Data were analyzed by analysis of variance and post hoc test (n = 3–5 per group; 18 total). Results Mean microvascular density was 70 vessels/mm2 ± 17 (standard error of the mean), and 81% ± 1 of microvasculature (ie, CD31+ structures) was functionally perfused within viable Vx2 tumor regions. Embolization to the extent of substasis eliminated perfusion in 37% ± 9 of perfused microvessels (P > .05 vs baseline), whereas embolization to the extent of angiographic stasis eliminated perfusion in 56% ± 8 of perfused microvessels. Persistent microvascular perfusion following embolization was predominantly found in the tumor periphery, adjacent to normal tissue. Newly perfused microvasculature was evident following embolization to substasis but not when embolization was performed to complete angiographic stasis. Conclusions Nearly half of tumor microvasculature remained patent despite embolization to complete angiographic stasis. The observed preservation of tumor microvasculature perfusion with angiographic endpoints of substasis and stasis may have implications for tumor response to embolotherapy. PMID:26321051

  12. Rectal Neuroendocrine Tumor G1 with a Solitary Hepatic Metastatic Lesion

    PubMed Central

    Nagata, Kohei; Tajiri, Kazuto; Shimada, Seitarou; Ando, Takayuki; Hosokawa, Ayumu; Matsui, Koshi; Imura, Joji; Sugiyama, Toshiro

    2017-01-01

    Rectal neuroendocrine tumor (NET) is a relatively rare tumor. NET is classified as G1, G2, or G3 according to the degree of mitosis or Ki-67 proliferation index, which reflect the malignant potential of the tumor, such as metastasis. Advanced cases with metastasis are indicated for chemotherapy treatment. However, the efficacy of chemotherapy is limited. Therefore, resection is considered, even in metastatic cases, if complete resection is possible. We herein report a case of small rectal NET discovered with hepatic metastasis classified as G1. The patient showed good progress with no recurrence after undergoing hepatectomy and endoscopic resection of rectal NET. PMID:28154272

  13. Significance of functional hepatic resection rate calculated using 3D CT/99mTc-galactosyl human serum albumin single-photon emission computed tomography fusion imaging

    PubMed Central

    Tsuruga, Yosuke; Kamiyama, Toshiya; Kamachi, Hirofumi; Shimada, Shingo; Wakayama, Kenji; Orimo, Tatsuya; Kakisaka, Tatsuhiko; Yokoo, Hideki; Taketomi, Akinobu

    2016-01-01

    AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/99mTc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making. METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and 99mTc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/99mTc-GSA SPECT fusion images. RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death. CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative

  14. Significance of functional hepatic resection rate calculated using 3D CT/(99m)Tc-galactosyl human serum albumin single-photon emission computed tomography fusion imaging.

    PubMed

    Tsuruga, Yosuke; Kamiyama, Toshiya; Kamachi, Hirofumi; Shimada, Shingo; Wakayama, Kenji; Orimo, Tatsuya; Kakisaka, Tatsuhiko; Yokoo, Hideki; Taketomi, Akinobu

    2016-05-07

    To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/(99m)Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making. We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and (99m)Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/(99m)Tc-GSA SPECT fusion images. In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death. Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular

  15. Carbon nanotube based respiratory gated micro-CT imaging of a murine model of lung tumors with optical imaging correlation

    NASA Astrophysics Data System (ADS)

    Burk, Laurel M.; Lee, Yueh Z.; Heathcote, Samuel; Wang, Ko-han; Kim, William Y.; Lu, Jianping; Zhou, Otto

    2011-03-01

    Current optical imaging techniques can successfully measure tumor load in murine models of lung carcinoma but lack structural detail. We demonstrate that respiratory gated micro-CT imaging of such models gives information about structure and correlates with tumor load measurements by optical methods. Four mice with multifocal, Kras-induced tumors expressing firefly luciferase were imaged against four controls using both optical imaging and respiratory gated micro-CT. CT images of anesthetized animals were acquired with a custom CNT-based system using 30 ms x-ray pulses during peak inspiration; respiration motion was tracked with a pressure sensor beneath each animal's abdomen. Optical imaging based on the Luc+ signal correlating with tumor load was performed on a Xenogen IVIS Kinetix. Micro-CT images were post-processed using Osirix, measuring lung volume with region growing. Diameters of the largest three tumors were measured. Relationships between tumor size, lung volumes, and optical signal were compared. CT images and optical signals were obtained for all animals at two time points. In all lobes of the Kras+ mice in all images, tumors were visible; the smallest to be readily identified measured approximately 300 microns diameter. CT-derived tumor volumes and optical signals related linearly, with r=0.94 for all animals. When derived for only tumor bearing animals, r=0.3. The trend of each individual animal's optical signal tracked correctly based on the CT volumes. Interestingly, lung volumes also correlated positively with optical imaging data and tumor volume burden, suggesting active remodeling.

  16. Combined transductional untargeting/retargeting and transcriptional restriction enhance adenovirus gene targeting and therapy for hepatic colorectal cancer tumors

    PubMed Central

    Li, Hua-Jung; Everts, Maaike; Yamamoto, Masato; Curiel, David T.; Herschman, Harvey R.

    2009-01-01

    Unresectable hepatic colorectal cancer (CRC) metastases are a leading cause of cancer mortality. These tumors, and other epithelial tumors, often express both cyclooxygenase 2 (COX-2) and carcinoembryonic antigen (CEA). Because adenovirus vectors infect liver and lack tumor tropism, they cannot be utilized for systemic therapy of hepatic metastases. We used COX-2 transcriptional restriction, in combination with transductional adenovirus hepatic untargeting and tumor retargeting by a bispecific adapter, sCARhMFE, composed of sCAR (the Coxsackie and Adenovirus Receptor ectodomain) and MFE-23 (a single-chain anti-CEA antibody), to untarget liver following intravenous administration of adenovirus vectors expressing firefly luciferase and to retarget virus to hepatic colorectal tumor xenografts and non-small cell lung tumor xenografts. To improve both liver untargeting and tumor retargeting, we developed sCARfMFE, a trimerized sCARhMFE adapter. Trimerization greatly improves both untargeting of CAR-dependent adenovirus infection and CEA-dependent virus retargeting, in culture and in vivo. Combining sCARfMFE bispecific adapter transductional liver untargeting and transductional tumor retargeting with COX-2 transcriptional tumor-restricted transgene expression increases systemically-administered adenovirus therapeutic efficacy for hepatic CRC tumors, using Herpes Virus Type 1 thymidine kinase as a therapeutic gene in conjunction with the prodrug ganciclovir. Both transductional untargeting and COX-2 transcriptional restriction also reduce HSV1-tk/GCV hepatic toxicity. In addition, transductional sCARfMFE untargeting reduces the innate immune response to systemic adenovirus administration. Combined transductional liver Ad untargeting, transductional tumor retargeting and transcriptional transgene restriction suggests a means to engineer practical, effective therapeutic agents for hepatic CRC metastases in particular, as well as hepatic metastases of other epithelial

  17. Combined transductional untargeting/retargeting and transcriptional restriction enhances adenovirus gene targeting and therapy for hepatic colorectal cancer tumors.

    PubMed

    Li, Hua-Jung; Everts, Maaike; Yamamoto, Masato; Curiel, David T; Herschman, Harvey R

    2009-01-15

    Unresectable hepatic colorectal cancer (CRC) metastases are a leading cause of cancer mortality. These tumors and other epithelial tumors often express both cyclooxygenase-2 (COX-2) and carcinoembryonic antigen (CEA). Because adenovirus (Ad) vectors infect the liver and lack tumor tropism, they cannot be used for systemic therapy of hepatic metastases. We used COX-2 transcriptional restriction, in combination with transductional Ad hepatic untargeting and tumor retargeting by a bispecific adapter, sCARhMFE, composed of sCAR [the coxsackie/Ad receptor (CAR) ectodomain] and MFE-23 (a single-chain anti-CEA antibody), to untarget liver after i.v. administration of Ad vectors expressing firefly luciferase and to retarget virus to hepatic colorectal tumor xenografts and non-small cell lung tumor xenografts. To improve both liver untargeting and tumor retargeting, we developed sCARfMFE, a trimerized sCARhMFE adapter. Trimerization greatly improves both untargeting of CAR-dependent Ad infection and CEA-dependent virus retargeting in culture and in vivo. Combining sCARfMFE bispecific adapter transductional liver untargeting and transductional tumor retargeting with COX-2 transcriptional tumor-restricted transgene expression increases systemically administered Ad therapeutic efficacy for hepatic CRC tumors, using herpes virus type 1 thymidine kinase (HSV1-tk) as a therapeutic gene in conjunction with the prodrug ganciclovir (GCV). Both transductional untargeting and COX-2 transcriptional restriction also reduce HSV1-tk/GCV hepatic toxicity. In addition, transductional sCARfMFE untargeting reduces the innate immune response to systemic Ad administration. Combined transductional liver Ad untargeting, transductional tumor retargeting, and transcriptional transgene restriction suggests a means to engineer practical, effective therapeutic agents for hepatic CRC metastases in particular, as well as hepatic metastases of other epithelial cancers.

  18. The effect of diet on tumor necrosis factor stimulation of hepatic lipogenesis

    SciTech Connect

    Feingold, K.R.; Soued, M.; Serio, M.K.; Adi, S.; Moser, A.H.; Grunfeld, C. )

    1990-06-01

    In this study, we determined the effects of tumor necrosis factor (TNF) on serum lipid levels and hepatic lipid synthesis in animals whose diets and feeding conditions were varied to induce changes in baseline serum lipid levels and/or rates of hepatic lipid synthesis. In animals studied at both the nadir and peak of the diurnal cycle of hepatic lipid synthesis, TNF acutely increases serum triglyceride levels, stimulates hepatic fatty acid synthesis, and increases the quantity of newly synthesized fatty acids found in the serum. Similarly, in animals ingesting either high-sucrose or cholesterol-enriched diets, TNF induces the characteristic rapid increase in serum triglyceride levels, hepatic fatty acid synthesis, and quantity of labeled fatty acids in the serum. In animals fed a diet high in triglycerides, using either corn oil or lard, TNF stimulates hepatic fatty acid synthesis and increases the quantity of newly synthesized fatty acids in the serum, but serum triglyceride levels do not change. However, TNF inhibits gastric emptying, which results in a marked decrease in fat absorption in TNF-treated animals. It is likely that a decrease in the dietary contribution to serum triglyceride levels during high-triglyceride feeding counterbalances the increased hepatic contribution induced by TNF treatment. In animals fasted before TNF administration there was no acute change in either serum lipid levels, hepatic fatty acid synthesis, or the quantity of labeled fatty acids in the serum. Thus, TNF stimulates hepatic fatty acid synthesis and increases serum triglyceride levels under many diverse dietary conditions, suggesting that there is a strong linkage between the immune system and lipid metabolism that is independent of most dietary manipulations and may be of fundamental importance in the body's response to infection.

  19. Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging.

    PubMed

    Erhamamci, S; Reyhan, M; Nursal, G N; Torun, N; Yapar, A F

    2015-01-01

    Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All

  20. SU-E-I-58: Detecting Tumors with Extremely Low Contrast in CT Images

    SciTech Connect

    Sheng, K; Gou, S; Kupelian, P; Steiberg, M; Low, D

    2014-06-01

    Purpose: Tumors such as the prostate focal lesions and the brain metastases have extremely low CT contrast and MRI is usually used for target delineation. The target contours are propagated to the CT for treatment planning and patient positioning. We have employed an advanced denoising method eliminating the noise and allow magnification of subtle contrast of these focal lesions on CT. Methods: Five prostate and two brain metastasis patients with MRI T2, diffusion or dynamic contrast enhanced (DCE) images confirmed focal lesions were included. One brain patients had 5 metastases. A block matching 3D (BM3D) algorithm was adapted to reduce the noise of kVCT images used for treatment planning. The gray-level range of the resultant images was narrowed to magnify the tumor-normal tissue contrast. Results: For the prostate patients, denoised kVCT images showed focal regions at 5, 8,11-1, 2, and 8–10 oclock for the 5 patients, this is highly consistent to the radiologist confirmed focal lesions based on MRI at 5, 7, 11-1, 2 and 8–10 oclock in the axial plane. These CT focal regions matched well with the MRI focal lesions in the cranio-caudal position. The average increase in density compared to background prostate glands was 0.86%, which corresponds to ∼50% increase in cellularity and is lower than the average CT noise level of 2.4%. For the brain patients, denoised kVCT showed 5/6 metastases. The high CT-density region of a metastasis is 2-mm off from its corresponding elevated MRI perfusion center. Overall the detecting sensitivity was 91%. Conclusion: It has been preliminarily demonstrated that the higher tumor cellularity can be detected using kVCT. The low contrast-to-noise information requires advanced denoising to reveal. The finding is significant to radiotherapy by providing an additional tool to locate focal lesions for confirming MRI-CT registration and providing a highly accessible outcome assessment tool.

  1. CAR-T cell therapy in gastrointestinal tumors and hepatic carcinoma: From bench to bedside.

    PubMed

    Zhang, Qi; Zhang, Zimu; Peng, Meiyu; Fu, Shuyu; Xue, Zhenyi; Zhang, Rongxin

    2016-01-01

    The chimeric antigen receptor (CAR) is a genetically engineered receptor that combines a scFv domain, which specifically recognizes the tumor-specific antigen, with T cell activation domains. CAR-T cell therapies have demonstrated tremendous efficacy against hematologic malignancies in many clinical trials. Recent studies have extended these efforts to the treatment of solid tumors. However, the outcomes of CAR-T cell therapy for solid tumors are not as remarkable as the outcomes have been for hematologic malignancies. A series of hurdles has arisen with respect to CAR-T cell-based immunotherapy, which needs to be overcome to target solid tumors. The major challenge for CAR-T cell therapy in solid tumors is the selection of the appropriate specific antigen to demarcate the tumor from normal tissue. In this review, we discuss the application of CAR-T cells to gastrointestinal and hepatic carcinomas in preclinical and clinical research. Furthermore, we analyze the usefulness of several specific markers in the study of gastrointestinal tumors and hepatic carcinoma.

  2. CAR-T cell therapy in gastrointestinal tumors and hepatic carcinoma: From bench to bedside

    PubMed Central

    Zhang, Qi; Zhang, Zimu; Peng, Meiyu; Fu, Shuyu; Xue, Zhenyi; Zhang, Rongxin

    2016-01-01

    ABSTRACT The chimeric antigen receptor (CAR) is a genetically engineered receptor that combines a scFv domain, which specifically recognizes the tumor-specific antigen, with T cell activation domains. CAR-T cell therapies have demonstrated tremendous efficacy against hematologic malignancies in many clinical trials. Recent studies have extended these efforts to the treatment of solid tumors. However, the outcomes of CAR-T cell therapy for solid tumors are not as remarkable as the outcomes have been for hematologic malignancies. A series of hurdles has arisen with respect to CAR-T cell-based immunotherapy, which needs to be overcome to target solid tumors. The major challenge for CAR-T cell therapy in solid tumors is the selection of the appropriate specific antigen to demarcate the tumor from normal tissue. In this review, we discuss the application of CAR-T cells to gastrointestinal and hepatic carcinomas in preclinical and clinical research. Furthermore, we analyze the usefulness of several specific markers in the study of gastrointestinal tumors and hepatic carcinoma. PMID:28123893

  3. Soy protein isolate inhibits hepatic tumor promotion in mice fed a high-fat liquid diet.

    PubMed

    Mercer, Kelly E; Pulliam, Casey F; Pedersen, Kim B; Hennings, Leah; Ronis, Martin Jj

    2017-03-01

    Alcoholic and nonalcoholic fatty liver diseases are risk factors for development of hepatocellular carcinoma, but the underlying mechanisms are poorly understood. On the other hand, ingestion of soy-containing diets may oppose the development of certain cancers. We previously reported that replacing casein with a soy protein isolate reduced tumor promotion in the livers of mice with alcoholic liver disease after feeding a high fat ethanol liquid diet following initiation with diethylnitrosamine. Feeding soy protein isolate inhibited processes that may contribute to tumor promotion including inflammation, sphingolipid signaling, and Wnt/β-catenin signaling. We have extended these studies to characterize liver tumor promotion in a model of nonalcoholic fatty liver disease produced by chronic feeding of high-fat liquid diets in the absence of ethanol. Mice treated with diethylnitrosamine on postnatal day 14 were fed a high-fat liquid diet made with casein or SPI as the sole protein source for 16 weeks in adulthood. Relative to mice fed normal chow, a high fat/casein diet led to increased tumor promotion, hepatocyte proliferation, steatosis, and inflammation. Replacing casein with soy protein isolate counteracted these effects. The high fat diets also resulted in a general increase in transcripts for Wnt/β-catenin pathway components, which may be an important mechanism, whereby hepatic tumorigenesis is promoted. However, soy protein isolate did not block Wnt signaling in this nonalcoholic fatty liver disease model. We conclude that replacing casein with soy protein isolate blocks development of steatosis, inflammation, and tumor promotion in diethylnitrosamine-treated mice fed high fat diets. Impact statement The impact of dietary components on cancer is a topic of great interest for both the general public and the scientific community. Liver cancer is currently the second leading form of cancer deaths worldwide. Our study has addressed the effect of the protein

  4. In vivo assessment of intratumoral aspirin injection to treat hepatic tumors

    PubMed Central

    Saad-Hossne, Rogério; Teixeira, Fábio Vieira; Denadai, Rafael

    2013-01-01

    AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with VX2 hepatic tumor cells (104 cells/rabbit) via supra-umbilical median laparotomy. On day 4 post-implantation, when the tumors were about 1 cm in diameter, the rabbits were randomly divided into the following groups (n = 8 each group) to assess early (24 h) and late (7 d) antineoplastic effects of intratumoral injection of 10% bicarbonate aspirin solution (experimental groups) in comparison to intratumoral injection of physiological saline solution (control groups): group 1, 24 h control; group 2, 24 h experimental; group 3, 7 d control; group 4, 7 d experimental. The serum biochemistry profile (measurements of glycemia, alkaline phosphatase, gamma-glutamyl transferase, aspartate aminotransferase, and alanine aminotransferase) and body weight measurements were obtained for all animals at the following time points: D0, before tumor implant; D4, day of treatment; D5, day of sacrifice for groups 1 and 2; D11, day of sacrifice for groups 3 and 4. Gross assessments of the abdominal and thoracic cavities were carried out upon sacrifice. The resected liver tissues, including hepatic tumors, were qualitatively (general morphology, signs of necrosis) and quantitatively (tumor area) assessed by histopathological analysis. RESULTS: Gross examination showed no alterations, besides the left hepatic lobe tumors, had occurred in the thoracic and abdominal cavities of any animal at any time point evaluated. However, the features of the tumor foci were distinctive between the groups. Compared to the control groups, which showed normal unabated tumor progression, the aspirin-treated groups showed imprecise but limited tumor boundaries and a general red-white coloration (indicating hemorrhaging) at 24 h post-treatment, and development of yellow-white areas of a cicatricial

  5. Hepatic cavernous hemangioma: diagnosis with /sup 99m/Tc-labeled red cells and single-photon emission CT

    SciTech Connect

    Brodsky, R.I.; Friedman, A.C.; Maurer, A.H.; Radecki, P.D.; Caroline, D.F.

    1987-01-01

    During the performance of high-resolution real-time abdominal sonography, small echogenic hepatic masses are frequently discovered. A second imaging test to confirm the suspected diagnosis of hemangioma is often required. Planar labeled red-cell imaging will often not detect hemangiomas smaller than 3 cm. We studied 14 patients with labeled red-cell scintigraphy and single-photon emission CT (SPECT). Six hemangiomas were diagnosed by SPECT that would have been missed by planar imaging alone. All six were smaller than 2.5 cm. With the addition of SPECT, labeled red-cell scintigraphy has specificity and sensitivity that make it at least as reliable as dynamic CT for the noninvasive diagnosis of hepatic cavernous hemangioma.

  6. Preoperative tumor studies using MRI or CT in patients with clinically suspected insulinoma.

    PubMed

    Daneshvar, Keivan; Grenacher, Lars; Mehrabi, Arianeb; Kauczor, Hans-Ulrich; Hallscheidt, Peter

    2011-01-01

    Insulinomas are rare tumors that originate from the islet cells of the pancreas. The aims of this study were to localize insulinomas preoperatively using CT and/or MRI in correlation with postoperative pathological results. Between December 2001 and June 2010, 27 consecutive patients with clinically suspected insulinoma were surgically treated in our university hospital. Preoperative CT (14 of 27 patients) and MRI studies (14 of 27 patients, one patient had both MRI and CT), operation reports, intraoperative ultrasonography reports, and pathological diagnoses were analyzed retrospectively. For each lesion, images were analyzed based on the presence of enhancement or the characteristics of signal intensities. Pathologic correlation was available for all the lesions. The female: male ratio was 2.9, with a mean age of 47.5 years (range 12-82) . Preoperative tumor localization was achieved by means of MRI and CT. A focal pancreatic lesion, which was hypointense on T(1)-weighted sequences, was detected on all the MR images (14 of 27 patients; 100%). These lesions were isointense (4 cases) to slightly hyperintense (10 of 14 cases) on T(2)-weighted sequences. In T(1)-weighted fat-suppressed contrast-enhanced sequences, there were two types of enhancement: homogeneously hyperintense lesions (in 10 of 14 cases) or peripherally hyper-, centrally isointense (in 4 of 14 cases). On all the CT images (14 of 27 patients), there was no detectable lesion on precontrast series; on arterial series in 13 of 14 patients (arterial series has not been done in one patient), lesions enhanced hypervascular in contrast to the rest of the pancreas with a mean enhancement of 147 HU (range 113-248) and 95 HU (range 65-141), respectively. On venous series in 13 of 14 patients (venous series has not been done in one patient), there was an enhanced lesion in contrast to the rest of the pancreas with a mean enhancement of 110 HU (range 91-151) and 86 HU (range 65-137), respectively. Intraoperative

  7. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma: recently introduced spectral CT method.

    PubMed

    Lv, Peijie; Lin, Xiao Zhu; Li, Jianying; Li, Weixia; Chen, Kemin

    2011-06-01

    To investigate the usefulness of computed tomographic (CT) spectral imaging parameters in differentiating small (≤3 cm) hepatic hemangioma (HH) from small hepatocellular carcinoma (HCC), with or without cirrhosis, during the late arterial phase (AP) and portal venous phase (PVP). This prospective study was institutional review board approved, and written informed consent was obtained from all patients. The authors examined 49 patients (39 men, 10 women; 65 lesions) with CT spectral imaging during the AP and the PVP. Twenty-one patients had HH; nine, HCC with cirrhosis; and 19, HCC without cirrhosis. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in iodine concentration between the AP and PVP (ie, iodine concentration difference [ICD]) and the lesion-to-normal parenchyma ratio (LNR) were calculated. Two readers qualitatively assessed lesion types on the basis of conventional CT characteristics. Sensitivity and specificity were compared between the qualitative and quantitative studies. The two-sample t test was performed to compare quantitative parameters between HH and HCC. Normalized iodine concentrations (NICs) and LNRs in patients with HH differed significantly from those in patients with HCC and cirrhosis and those in patients with HCC without cirrhosis: Mean NICs were 0.47 mg/mL ± 0.24 (standard deviation) versus 0.23 mg/mL ± 0.10 and 0.23 mg/mL ± 0.08, respectively, during the AP and 0.83 mg/mL ± 0.38 versus 0.47 mg/mL ± 0.86 and 0.52 mg/mL ± 0.11, respectively, during the PVP. Mean LNRs were 5.87 ± 3.36 versus 2.56 ± 1.10 and 2.29 ± 0.87, respectively, during the AP and 2.01 ± 1.33 versus 0.96 ± 0.16 and 0.93 ± 0.26, respectively, during the PVP. The mean ICD for the HH group (1.37 mg/mL ± 0.84) was significantly higher than the mean ICDs for the HCC-cirrhosis (0.33 mg/mL ± 0.29) (P < .001) and HCC-no cirrhosis (0.82 mg/mL ± 0.99) (P

  8. Tungsten Oxide Nanorods: An Efficient Nanoplatform for Tumor CT Imaging and Photothermal Therapy

    PubMed Central

    Zhou, Zhiguo; Kong, Bin; Yu, Chao; Shi, Xiangyang; Wang, Mingwei; Liu, Wei; Sun, Yanan; Zhang, Yingjian; Yang, Hong; Yang, Shiping

    2014-01-01

    We report here a facile thermal decomposition approach to creating tungsten oxide nanorods (WO2.9 NRs) with a length of 13.1 ± 3.6 nm and a diameter of 4.4 ± 1.5 nm for tumor theranostic applications. The formed WO2.9 NRs were modified with methoxypoly(ethylene glycol) (PEG) carboxyl acid via ligand exchange to have good water dispersability and biocompatibility. With the high photothermal conversion efficiency irradiated by a 980 nm laser and the better X-ray attenuation property than clinically used computed tomography (CT) contrast agent Iohexol, the formed PEGylated WO2.9 NRs are able to inhibit the growth of the model cancer cells in vitro and the corresponding tumor model in vivo, and enable effective CT imaging of the tumor model in vivo. Our “killing two birds with one stone” strategy could be extended for fabricating other nanoplatforms for efficient tumor theranostic applications. PMID:24413483

  9. Texture Analysis of Preoperative CT Images for Prediction of Postoperative Hepatic Insufficiency: A Preliminary Study

    PubMed Central

    Simpson, Amber L; Adams, Lauryn B; Allen, Peter J; D’Angelica, Michael I; DeMatteo, Ronald P; Fong, Yuman; Kingham, T Peter; Leung, Universe; Miga, Michael I; Parada, E Patricia; Jarnagin, William R; Do, Richard K G

    2015-01-01

    Background Texture analysis is a promising method of analyzing imaging data to potentially enhance diagnostic capability. This approach involves automated measurement of pixel intensity variation that may offer further insight into disease progression than standard imaging techniques alone. We postulate that postoperative liver insufficiency, a major source of morbidity and mortality, correlates with preoperative heterogeneous parenchymal enhancement that can be quantified with texture analysis of cross-sectional imaging. Study Design A retrospective case-matched study (waiver of informed consent and HIPAA authorization, approved by the institutional review board) was performed comparing patients who underwent major hepatic resection and developed liver insufficiency (n=12) to a matched group of patients with no postoperative liver insufficiency (n=24) by procedure, remnant volume, and year of procedure. Texture analysis (with gray-level co-occurrence matrices) was used to quantify the heterogeneity of liver parenchyma on preoperative computed tomography (CT) scans. Statistical significance was evaluated using Wilcoxon’s signed rank and Pearson’s chi-squared tests. Results No statistically significant differences were found between study groups for preoperative patient demographics and clinical characteristics, with the exception of gender (p<0.05). Two texture features differed significantly between the groups: correlation (linear dependency of gray levels on neighboring pixels) and entropy (randomness of brightness variation) (p<0.05). Conclusions In this preliminary study, the texture of liver parenchyma on preoperative CT, was significantly more varied, less symmetric, and less homogeneous in patients with postoperative liver insufficiency; thus texture analysis has the potential to provide an additional means of preoperative risk stratification. PMID:25537305

  10. Hepatitis

    MedlinePlus

    ... CPR: A Real Lifesaver Kids Talk About: Coaches Hepatitis KidsHealth > For Kids > Hepatitis Print A A A ... have liver damage because of it. What Is Hepatitis? Hepatitis is an inflammation (say: in-fluh-MAY- ...

  11. The Optimal Body Size Index with Which to Determine Iodine Dose for Hepatic Dynamic CT: A Prospective Multicenter Study.

    PubMed

    Awai, Kazuo; Kanematsu, Masayuki; Kim, Tonsok; Ichikawa, Tomoaki; Nakamura, Yuko; Nakamoto, Atsushi; Yoshioka, Kunihiro; Mochizuki, Teruhito; Matsunaga, Naofumi; Yamashita, Yasuyuki

    2016-03-01

    To identify the body size parameter that exhibits the best correlation with aortic and hepatic enhancement at hepatic dynamic computed tomography (CT) in a large patient population enrolled in a multicenter study. This prospective study was approved by the ethics committee of each of the 31 participating institutions where 1342 patients were enrolled between April 2012 and September 2013. All patients provided either written or oral informed consent. All patients underwent hepatic dynamic CT, which included preenhanced, hepatic arterial phase (HAP), and portal venous phase (PVP) scanning, performed with the routine scanning protocol of each institution. Changes in CT number (in Hounsfield units) per gram of iodine in the aorta (eA/I) and liver (eL/I) during HAP and PVP scanning were recorded for each patient. Hierarchical multivariate linear regression analysis was performed in which the outcome variable was either eA/I or eL/I; the independent variables were age, sex, one body size parameter (height, body weight, body mass index, lean body weight [LBW], or body surface area), and liver function (aspartate aminotransferase, albumin, and total bilirubin levels). A two-level hierarchical model in which patients were level 1 and the institution was level 2 was used. Hierarchical multivariate linear regression analysis revealed that in the population not stratified by sex, body size was significantly correlated with eA/I and eL/I (P < .001) and that LBW exhibited the strongest correlation with eA/I and eL/I (r = -0.561 and r = -0.601, respectively). Sex-stratified analysis showed that LBW was more strongly correlated with eA/I and eL/I in women (r = -0.779 and r = -0.948, respectively) than in men (r = -0.500 and r = -0.494, respectively) or in the nonstratified total population. Among body size parameters, LBW exhibited the strongest correlation with aortic and hepatic enhancement, especially in women.

  12. Computer-assisted delineation of lung tumor regions in treatment planning CT images with PET/CT image sets based on an optimum contour selection method.

    PubMed

    Jin, Ze; Arimura, Hidetaka; Shioyama, Yoshiyuki; Nakamura, Katsumasa; Kuwazuru, Jumpei; Magome, Taiki; Yabu-Uchi, Hidetake; Honda, Hiroshi; Hirata, Hideki; Sasaki, Masayuki

    2014-11-01

    To assist radiation oncologists in the delineation of tumor regions during treatment planning for lung cancer, we have proposed an automated contouring algorithm based on an optimum contour selection (OCS) method for treatment planning computed tomography (CT) images with positron emission tomography (PET)/CT images. The basic concept of the OCS is to select a global optimum object contour based on multiple active delineations with a level set method around tumors. First, the PET images were registered to the planning CT images by using affine transformation matrices. The initial gross tumor volume (GTV) of each lung tumor was identified by thresholding the PET image at a certain standardized uptake value, and then each initial GTV location was corrected in the region of interest of the planning CT image. Finally, the contours of final GTV regions were determined in the planning CT images by using the OCS. The proposed method was evaluated by testing six cases with a Dice similarity coefficient (DSC), which denoted the degree of region similarity between the GTVs contoured by radiation oncologists and the proposed method. The average three-dimensional DSC for the six cases was 0.78 by the proposed method, but only 0.34 by a conventional method based on a simple level set method. The proposed method may be helpful for treatment planners in contouring the GTV regions. © The Author 2014. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  13. EBV-associated hepatic smooth muscle tumor of uncertain biologic behavior after heart transplantation in a pediatric patient: case report

    PubMed Central

    Liu, Yan; Chintalapati, Suneetha; Dietz, Robin; Raza, Adnan S.; Wang, Jun

    2017-01-01

    Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare neoplasm recognized in immunocompromised patients. There are less than 30 cases of EBV-SMT reported in pediatric population following solid organ transplantation. Herein, we report a case of an 8-year-old female who was incidentally noted to have multiple lesions in the liver 8 years after heart transplantation. The tumor was composed of a cellular proliferation of spindle-shaped cells with low mitotic activity. The diagnosis of EBV-SMT was confirmed by in situ hybridization for EBV-encoded small RNA (EBER) transcripts. Multiple additional lesions were detected by whole body positron emission tomography-computed tomography (PET-CT) scan 4 months after the initial finding of the hepatic lesions. Immunosuppression was switched to a mechanistic target of rapamycin (mTOR) inhibitor. We conclude that EBV-SMT should be included in the differential diagnoses in post-transplantation patients and further investigations should be performed to evaluate additional lesions. PMID:28280632

  14. SU-E-QI-20: A Review of Advanced PET and CT Image Features for the Evaluation of Tumor Response

    SciTech Connect

    Lu, W

    2014-06-15

    Purpose: To review the literature in using quantitative PET and CT image features for the evaluation of tumor response. Methods: We reviewed and summarized more than fifty papers that use advanced, quantitative PET/CT image features for the evaluation of tumor response. We also discussed future works on extracting disease-specific features, combining multiple and complementary features in response modeling, delineating tumor in multimodality images, and exploring biological explanations of these advanced features. Results: Advanced PET image features considering spatial information, such as tumor volume, tumor shape, total glycolytic volume, histogram distance, and texture features (characterizing spatial distribution of FDG uptake) have been found more informative than the traditional SUVmax for the prediction of tumor response. Advanced CT features, including volumetric, attenuation, morphologic, structure, and texture descriptors, have also been found advantage over the traditional RECIST and WHO criteria in certain tumor types. Conclusions: Advanced, quantitative FDG PET/CT image features have been shown promising for the evaluation of tumor response. With the emerging multi-modality imaging performed at multiple time points for each patient, it becomes more important to analyze the serial images quantitatively, select and combine both complementary and contradictory information from various sources, for accurate and personalized evaluation of tumor response to therapy.

  15. CT Pelvis in Children; Should We Routinely Scan Pelvis for Wilms Tumor and Hepatoblastoma? Implications for Imaging Protocol Development.

    PubMed

    Mirza, Waseem; McHugh, Kieran; Aslam, Mubashir; Sajjad, Zafar; Abid, Waqas; Youssef, Talaat; Ali, Arif; Fadoo, Zahra

    2015-10-01

    Wilms tumor and hepatoblastoma are the most common intra-abdominal solid organ childhood tumors. CT examination is one of the routinely performed procedures in hospitals for children with these tumors inspite of high radiation exposure associated with CT scans. Sixty patients (Wilms tumor = 45, hepatoblastoma = 16) were evaluated retrospectively. Higher proportion (44.4%) of metastatic disease was identified at presentation in the Wilms tumor subset as compared to hepatoblastoma (6.3%) [p=0.006]. Metastatic disease was noted in 6 patients having Wilms tumor on follow-up while it was also low in hepatoblastoma which was noted in only 2 patients (p > 0.05). No significant difference was identified in pelvic extension of disease at presentation in both studied population (p > 0.05). Pelvic metastasis was noted in 1 patient only with Wilms tumor on follow-up while no pelvic metastasis was seen in the hepatoblastoma patients (p-value > 0.05).

  16. Computerized segmentation of liver in hepatic CT and MRI by means of level-set geodesic active contouring.

    PubMed

    Suzuki, Kenji; Huynh, Hieu Trung; Liu, Yipeng; Calabrese, Dominic; Zhou, Karen; Oto, Aytekin; Hori, Masatoshi

    2013-01-01

    Computerized liver volumetry has been studied, because the current "gold-standard" manual volumetry is subjective and very time-consuming. Liver volumetry is done in either CT or MRI. A number of researchers have developed computerized liver segmentation in CT, but there are fewer studies on ones for MRI. Our purpose in this study was to develop a general framework for liver segmentation in both CT and MRI. Our scheme consisted of 1) an anisotropic diffusion filter to reduce noise while preserving liver structures, 2) a scale-specific gradient magnitude filter to enhance liver boundaries, 3) a fast-marching algorithm to roughly determine liver boundaries, and 4) a geodesic-active-contour model coupled with a level-set algorithm to refine the initial boundaries. Our CT database contained hepatic CT scans of 18 liver donors obtained under a liver transplant protocol. Our MRI database contains 23 patients with 1.5T MRI scanners. To establish "gold-standard" liver volumes, radiologists manually traced the contour of the liver on each CT or MR slice. We compared our computer volumetry with "gold-standard" manual volumetry. Computer volumetry in CT and MRI reached excellent agreement with manual volumetry (intra-class correlation coefficient = 0.94 and 0.98, respectively). Average user time for computer volumetry in CT and MRI was 0.57 ± 0.06 and 1.0 ± 0.13 min. per case, respectively, whereas those for manual volumetry were 39.4 ± 5.5 and 24.0 ± 4.4 min. per case, respectively, with statistically significant difference (p < .05). Our computerized liver segmentation framework provides an efficient and accurate way of measuring liver volumes in both CT and MRI.

  17. Polydopamine-coated gold nanostars for CT imaging and enhanced photothermal therapy of tumors

    NASA Astrophysics Data System (ADS)

    Li, Du; Shi, Xiangyang; Jin, Dayong

    2016-12-01

    The advancement of biocompatible nanoplatforms with dual functionalities of diagnosis and therapeutics is strongly demanded in biomedicine in recent years. In this work, we report the synthesis and characterization of polydopamine (pD)-coated gold nanostars (Au NSs) for computed tomography (CT) imaging and enhanced photothermal therapy (PTT) of tumors. Au NSs were firstly formed via a seed-mediated growth method and then stabilized with thiolated polyethyleneimine (PEI-SH), followed by deposition of pD on their surface. The formed pD-coated Au NSs (Au-PEI@pD NSs) were well characterized. We show that the Au-PEI@pD NSs are able to convert the absorbed near-infrared laser light into heat, and have strong X-ray attenuation property. Due to the co-existence of Au NSs and the pD, the light to heat conversion efficiency of the NSs can be significantly enhanced. These very interesting properties allow their uses as a powerful theranostic nanoplatform for efficient CT imaging and enhanced phtotothermal therapy of cancer cells in vitro and the xenografted tumor model in vivo. With the easy functionalization nature enabled by the coated pD shell, the developed pD-coated Au NSs may be developed as a versatile nanoplatform for targeted CT imaging and PTT of different types of cancer.

  18. Hepatic Radiofrequency Ablation–induced Stimulation of Distant Tumor Growth Is Suppressed by c-Met Inhibition

    PubMed Central

    Kumar, Gaurav; Moussa, Marwan; Wang, Yuanguo; Rozenblum, Nir; Galun, Eithan; Goldberg, S. Nahum

    2016-01-01

    Purpose To elucidate how hepatic radiofrequency (RF) ablation affects distant extrahepatic tumor growth by means of two key molecular pathways. Materials and Methods Rats were used in this institutional animal care and use committee–approved study. First, the effect of hepatic RF ablation on distant subcutaneous in situ R3230 and MATBIII breast tumors was evaluated. Animals were randomly assigned to standardized RF ablation, sham procedure, or no treatment. Tumor growth rate was measured for 3½ to 7 days. Then, tissue was harvested for Ki-67 proliferative indexes and CD34 microvascular density. Second, hepatic RF ablation was performed for hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and c-Met receptor expression measurement in periablational rim, serum, and distant tumor 24 hours to 7 days after ablation. Third, hepatic RF ablation was combined with either a c-Met inhibitor (PHA-665752) or VEGF receptor inhibitor (semaxanib) and compared with sham or drug alone arms to assess distant tumor growth and growth factor levels. Finally, hepatic RF ablation was performed in rats with c-Met–negative R3230 tumors for comparison with the native c-Met–positive line. Tumor size and immunohistochemical quantification at day 0 and at sacrifice were compared with analysis of variance and the two-tailed Student t test. Tumor growth curves before and after treatment were analyzed with linear regression analysis to determine mean slopes of pre- and posttreatment growth curves on a per-tumor basis and were compared with analysis of variance and paired two-tailed t tests. Results After RF ablation of normal liver, distant R3230 tumors were substantially larger at 7 days compared with tumors treated with the sham procedure and untreated tumors, with higher growth rates and tumor cell proliferation. Similar findings were observed in MATBIII tumors. Hepatic RF ablation predominantly increased periablational and serum HGF and downstream distant tumor

  19. Tumor Localization Using Cone-Beam CT Reduces Setup Margins in Conventionally Fractionated Radiotherapy for Lung Tumors

    SciTech Connect

    Yeung, Anamaria R.; Li, Jonathan G.; Shi Wenyin; Newlin, Heather E.; Chvetsov, Alexei; Liu, Chihray; Palta, Jatinder R.; Olivier, Kenneth

    2009-07-15

    Purpose: To determine whether setup margins can be reduced using cone-beam computed tomography (CBCT) to localize tumor in conventionally fractionated radiotherapy for lung tumors. Methods and Materials: A total of 22 lung cancer patients were treated with curative intent with conventionally fractionated radiotherapy using daily image guidance with CBCT. Of these, 13 lung cancer patients had sufficient CBCT scans for analysis (389 CBCT scans). The patients underwent treatment simulation in the BodyFix immobilization system using four-dimensional CT to account for respiratory motion. Daily alignment was first done according to skin tattoos, followed by CBCT. All 389 CBCT scans were retrospectively registered to the planning CT scans using automated soft-tissue and bony registration; the resulting couch shifts in three dimensions were recorded. Results: The daily alignment to skin tattoos with no image guidance resulted in systematic ({sigma}) and random ({sigma}) errors of 3.2-5.6 mm and 2.0-3.5 mm, respectively. The margin required to account for the setup error introduced by aligning to skin tattoos with no image guidance was approximately 1-1.6 cm. The difference in the couch shifts obtained from the bone and soft-tissue registration resulted in systematic ({sigma}) and random ({sigma}) errors of 1.5-4.1 mm and 1.8-5.3 mm, respectively. The margin required to account for the setup error introduced using bony anatomy as a surrogate for the target, instead of localizing the target itself, was 0.5-1.4 cm. Conclusion: Using daily CBCT soft-tissue registration to localize the tumor in conventionally fractionated radiotherapy reduced the required setup margin by up to approximately 1.5 cm compared with both no image guidance and image guidance using bony anatomy as a surrogate for the target.

  20. ⁶⁸Ga-DOTA-TOC-PET/CT detects heart metastases from ileal neuroendocrine tumors.

    PubMed

    Calissendorff, Jan; Sundin, Anders; Falhammar, Henrik

    2014-09-01

    Metastases from ileal neuroendocrine tumors (NETs) to the myocardium are rare and generally seen in patients with widespread metastatic NET disease. The objectives of this investigation were to describe the frequency of intracardiac metastases in ileal NET patients examined by (68)Ga-DOTA-TOC-PET/CT and to describe the cases in detail. All (68)Ga-DOTA-TOC-PET/CT examinations performed at the Karolinska University Hospital since 2010 until April 2012 were reviewed. In all, 128 out of 337 examinations were in patients with ileal NETs. Four patients had seven myocardiac metastases, yielding a frequency of 4.3 % in patients with ileal NETs. One patient had cardiac surgery while three were treated with somatostatin analogs. The cardiac metastases did not affect the patients' activity of daily life. (68)Ga-DOTA-TOC-PET/CT is an established imaging modality in identifying cardiac metastases in ileal NETs. Prospective studies are needed to confirm the true clinical value of (68)Ga-DOTA-TOC-PET/CT in detecting cardiac metastases in both ileal and non-ileal NETs.

  1. SU-F-207-06: CT-Based Assessment of Tumor Volume in Malignant Pleural Mesothelioma

    SciTech Connect

    Qayyum, F; Armato, S; Straus, C; Husain, A; Vigneswaran, W; Kindler, H

    2015-06-15

    Purpose: To determine the potential utility of computed tomography (CT) scans in the assessment of physical tumor bulk in malignant pleural mesothelioma patients. Methods: Twenty-eight patients with malignant pleural mesothelioma were used for this study. A CT scan was acquired for each patient prior to surgical resection of the tumor (median time between scan and surgery: 27 days). After surgery, the ex-vivo tumor volume was measured by a pathologist using a water displacement method. Separately, a radiologist identified and outlined the tumor boundary on each CT section that demonstrated tumor. These outlines then were analyzed to determine the total volume of disease present, the number of sections with outlines, and the mean volume of disease per outlined section. Subsets of the initial patient cohort were defined based on these parameters, i.e. cases with at least 30 sections of disease with a mean disease volume of at least 3mL per section. For each subset, the R- squared correlation between CT-based tumor volume and physical ex-vivo tumor volume was calculated. Results: The full cohort of 28 patients yielded a modest correlation between CT-based tumor volume and the ex-vivo tumor volume with an R-squared value of 0.66. In general, as the mean tumor volume per section increased, the correlation of CT-based volume with the physical tumor volume improved substantially. For example, when cases with at least 40 CT sections presenting a mean of at least 2mL of disease per section were evaluated (n=20) the R-squared correlation increased to 0.79. Conclusion: While image-based volumetry for mesothelioma may not generally capture physical tumor volume as accurately as one might expect, there exists a set of conditions in which CT-based volume is highly correlated with the physical tumor volume. SGA receives royalties and licensing fees through the University of Chicago for computer-aided diagnosis technology.

  2. Topology polymorphism graph for lung tumor segmentation in PET-CT images

    NASA Astrophysics Data System (ADS)

    Cui, Hui; Wang, Xiuying; Zhou, Jianlong; Eberl, Stefan; Yin, Yong; Feng, Dagan; Fulham, Michael

    2015-06-01

    Accurate lung tumor segmentation is problematic when the tumor boundary or edge, which reflects the advancing edge of the tumor, is difficult to discern on chest CT or PET. We propose a ‘topo-poly’ graph model to improve identification of the tumor extent. Our model incorporates an intensity graph and a topology graph. The intensity graph provides the joint PET-CT foreground similarity to differentiate the tumor from surrounding tissues. The topology graph is defined on the basis of contour tree to reflect the inclusion and exclusion relationship of regions. By taking into account different topology relations, the edges in our model exhibit topological polymorphism. These polymorphic edges in turn affect the energy cost when crossing different topology regions under a random walk framework, and hence contribute to appropriate tumor delineation. We validated our method on 40 patients with non-small cell lung cancer where the tumors were manually delineated by a clinical expert. The studies were separated into an ‘isolated’ group (n = 20) where the lung tumor was located in the lung parenchyma and away from associated structures / tissues in the thorax and a ‘complex’ group (n = 20) where the tumor abutted / involved a variety of adjacent structures and had heterogeneous FDG uptake. The methods were validated using Dice’s similarity coefficient (DSC) to measure the spatial volume overlap and Hausdorff distance (HD) to compare shape similarity calculated as the maximum surface distance between the segmentation results and the manual delineations. Our method achieved an average DSC of 0.881  ±  0.046 and HD of 5.311  ±  3.022 mm for the isolated cases and DSC of 0.870  ±  0.038 and HD of 9.370  ±  3.169 mm for the complex cases. Student’s t-test showed that our model outperformed the other methods (p-values <0.05).

  3. [Role of PET-CT in the follow-up of treated tumors of the head and neck].

    PubMed

    Mabille, L

    2008-01-01

    F-18 FDG PET-CT is a well established medical imaging technique used routinely for the follow-up of treated head and neck tumors. Currently, PET-CT is performed 4 months after the end of therapy to assess its efficacy. More recently it has been suggested that this delay could be reduced to one month with major therapeutic implications. During follow-up, PET-CT could improve sensitivity and specificity compared to other imaging techniques. Moreover, since PET-CT is a "whole body technique", it allows restaging in a single procedure.

  4. [Periinterventional cone-beam-CT: application at transarterial chemoembolization of liver tumors].

    PubMed

    Adamus, R; Uder, M; Wilhelm, M; Loose, R W

    2011-07-01

    Periinterventional Cone-Beam CT (CBCT) today is a valuable tool in complex radiological interventions. Only little experience exists about CBCT in transarterial chemoembolisations (TACE) of liver tumors. 25 patients underwent periinterventional CBCT. We used a C-arc DSA with 30 × 40 cm flat panel detector. Image data with axial, coronal and 3D-reconstruction were acquired by 217° rotation in 8 seconds. In all 25 cases CBCT had an influence on the TACE regarding the decision which vessels to catheterize, the amount of retention of the embolisation agent or an abort because of insufficient vascularisation. In comparison with DSA alone, CBCT allows a better visualisation of tumour vessels, simplifies selective catheterisation, the decision whether an embolisation is possible and enables a good visualisation of Lipiodol retention. Hence, CBCT is a helpful periinterventional tool but cannot substitute CT and MRI in follow up.

  5. [Using CT to diagnose brain tumors at the Point G Hospital in Mali].

    PubMed

    Keita, A D; Kane, M; Guinto, C O; Landoure, G; Traore, S; Karembe, M; Toure, M; Diallo, A K; Fongoro, S; Sidibe, S; Traore, M; Traore, I

    2007-01-01

    The authors report 27 cases of cerebral tumours in 22 men and 5 women age 1 to 81. Clinical symptoms were dominated by cranial hypertension (59.3%), focal motor impairment involving cranial nerves (51.9%.) and seizures due to epilepsy (44.4%). The main tumors detected with CT scan include glyoma (.5 cases), craniopharyngioma (3 cases), adenoma (3 cases), medulloblastoma (3 cases), and metastasis (3 cases). The supra tentoriel was predominant (76.9%). Neurosurgery was performed in 6 patients and 21 cases received medical treatment. We fund 13 cases of death. In conclasion, cerebral tumours are very severe pathologies because of the high mortality associated with. CT scan has contributed to diagnose the lesions, show their topography and to determinte the histological nature. Neurosurgery is necessary for the treatment of these lesions.

  6. Anti-Gr-1 antibody depletion fails to eliminate hepatic myeloid-derived suppressor cells in tumor-bearing mice.

    PubMed

    Ma, Chi; Kapanadze, Tamar; Gamrekelashvili, Jaba; Manns, Michael P; Korangy, Firouzeh; Greten, Tim F

    2012-12-01

    Recent studies show that the liver is a preferred organ for the accumulation of MDSC. In this study, we examined the effect of systemic RB6-8C5 treatment on hepatic MDSC in tumor-bearing mice. EL4 tumor-bearing mice were injected i.p. with RB6-8C5, and hepatic, splenic, and blood MDSCs were analyzed by flow cytometry. Unexpectedly, hepatic MDSC remained in the liver, although RB6-8C5 completely eliminated them from the spleen and peripheral blood 24 h after treatment. Secondary antibody staining confirmed the presence of RB6-8C5-bound MDSC in the liver of mice with s.c. tumors. Similar observations were made in two other (colon and melanoma) tumor models. Whereas RB6-8C5 injection induced cell death of hepatic MDSC, as shown by Annexin V/7-AAD staining, these cells were replaced immediately, leading to a constant, increased frequency of hepatic MDSC. Adoptively transferred MDSC migrated preferentially to the liver after RB6-8C5 treatment, suggesting that hepatic MDSCs are reconstituted rapidly after depletion. Finally, hepatic MDSC remained immunosuppressive despite RB6-8C5 injection. Our study demonstrates that RB6-8C5 is not suitable for depletion of hepatic MDSCs and analysis of their function.

  7. Random Walk and Graph Cut for Co-Segmentation of Lung Tumor on PET-CT Images.

    PubMed

    Ju, Wei; Xiang, Dehui; Xiang, Deihui; Zhang, Bin; Wang, Lirong; Kopriva, Ivica; Chen, Xinjian

    2015-12-01

    Accurate lung tumor delineation plays an important role in radiotherapy treatment planning. Since the lung tumor has poor boundary in positron emission tomography (PET) images and low contrast in computed tomography (CT) images, segmentation of tumor in the PET and CT images is a challenging task. In this paper, we effectively integrate the two modalities by making fully use of the superior contrast of PET images and superior spatial resolution of CT images. Random walk and graph cut method is integrated to solve the segmentation problem, in which random walk is utilized as an initialization tool to provide object seeds for graph cut segmentation on the PET and CT images. The co-segmentation problem is formulated as an energy minimization problem which is solved by max-flow/min-cut method. A graph, including two sub-graphs and a special link, is constructed, in which one sub-graph is for the PET and another is for CT, and the special link encodes a context term which penalizes the difference of the tumor segmentation on the two modalities. To fully utilize the characteristics of PET and CT images, a novel energy representation is devised. For the PET, a downhill cost and a 3D derivative cost are proposed. For the CT, a shape penalty cost is integrated into the energy function which helps to constrain the tumor region during the segmentation. We validate our algorithm on a data set which consists of 18 PET-CT images. The experimental results indicate that the proposed method is superior to the graph cut method solely using the PET or CT is more accurate compared with the random walk method, random walk co-segmentation method, and non-improved graph cut method.

  8. Automated segmentation of murine lung tumors in x-ray micro-CT images

    NASA Astrophysics Data System (ADS)

    Swee, Joshua K. Y.; Sheridan, Clare; de Bruin, Elza; Downward, Julian; Lassailly, Francois; Pizarro, Luis

    2014-03-01

    Recent years have seen micro-CT emerge as a means of providing imaging analysis in pre-clinical study, with in-vivo micro-CT having been shown to be particularly applicable to the examination of murine lung tumors. Despite this, existing studies have involved substantial human intervention during the image analysis process, with the use of fully-automated aids found to be almost non-existent. We present a new approach to automate the segmentation of murine lung tumors designed specifically for in-vivo micro-CT-based pre-clinical lung cancer studies that addresses the specific requirements of such study, as well as the limitations human-centric segmentation approaches experience when applied to such micro-CT data. Our approach consists of three distinct stages, and begins by utilizing edge enhancing and vessel enhancing non-linear anisotropic diffusion filters to extract anatomy masks (lung/vessel structure) in a pre-processing stage. Initial candidate detection is then performed through ROI reduction utilizing obtained masks and a two-step automated segmentation approach that aims to extract all disconnected objects within the ROI, and consists of Otsu thresholding, mathematical morphology and marker-driven watershed. False positive reduction is finally performed on initial candidates through random-forest-driven classification using the shape, intensity, and spatial features of candidates. We provide validation of our approach using data from an associated lung cancer study, showing favorable results both in terms of detection (sensitivity=86%, specificity=89%) and structural recovery (Dice Similarity=0.88) when compared against manual specialist annotation.

  9. Frequency of hepatic contour abnormalities and signs of portal hypertension at CT in patients receiving chemotherapy for breast cancer metastatic to the liver.

    PubMed

    Qayyum, Aliya; Lee, Gerard K; Yeh, Benjamin M; Allen, Jill N; Venook, Alan P; Coakley, Fergus V

    2007-01-01

    This study aimed to determine the frequency of hepatic contour abnormalities and signs of portal hypertension at serial CT in patients receiving chemotherapy for breast cancer metastatic to the liver. We retrospectively identified 91 women with breast cancer metastatic to the liver who received chemotherapy and underwent serial CT at our institution between 1998 and 2002. Two readers independently categorized hepatic contour abnormalities on the final CT examination as none, limited retraction, widespread retraction, or diffuse nodularity. Readers also recorded the development of hepatic atrophy or enlargement, ascites, portosystemic collateral veins, and splenomegaly. Interpretative discrepancies were resolved by consensus. Portal hypertension was defined as the presence of at least two of the following CT signs: simple ascites, portosystemic collateral veins, and splenomegaly. After a median follow-up interval of 15 months (range, 1-46), hepatic contour abnormalities were seen in 68 of 91 patients (75%) and consisted of limited retraction (n = 42), widespread retraction (n = 10), or diffuse nodularity (n = 16). Portal hypertension was found in 1 of 23 patients without contour abnormalities, in 1 of 42 patients with limited retraction, in none of 10 patients with widespread retraction, and in 6 of 16 patients with diffuse nodularity (P < .01). Hepatic contour abnormalities commonly develop at serial CT in patients undergoing chemotherapy for breast cancer metastatic to the liver and may be accompanied by signs of portal hypertension; the latter are particularly, but not exclusively, associated with the development of diffuse hepatic nodularity.

  10. Donor-Derived Hepatic Neuroendocrine Tumor: Pause Before Proceeding With Liver Retransplantation

    PubMed Central

    Al-Azzawi, Yasir; Stein, Lance L.; Shrestha, Roshan; Bhasin, Devina; Citron, Steven J.; Rubin, Raymond A.

    2016-01-01

    ABSTRACT Gastrointestinal neuroendocrine tumors (NET) are rare but the age-adjusted incidence in the United States has increased, possibly due to improved radiographic and endoscopic detection. In advanced NET, hepatic metastases are common. Orthotopic liver transplant (OLT) is currently considered an acceptable therapy for selected patients with limited hepatic disease or liver metastases where complete resection is thought to have curative intent. The development of NET of donor origin is very uncommon after organ transplant, and it is unclear if the same treatment strategies applied to hepatic NET would also be efficacious after OLT. Here, we describe a unique case of an OLT recipient with a donor-derived NET that was treated with redo OLT as the primary therapy. The donor-derived NET recurred in the recipient's second liver allograft suggesting an extrahepatic reservoir. This case describes the natural history of such a rare event. Here, we highlight the treatment options for hepatic NET and challenge the role of OLT for a donor-derived hepatic NET. PMID:27830182

  11. Image quality comparison between single energy and dual energy CT protocols for hepatic imaging.

    PubMed

    Yao, Yuan; Ng, Joshua M; Megibow, Alec J; Pelc, Norbert J

    2016-08-01

    Multi-detector computed tomography (MDCT) enables volumetric scans in a single breath hold and is clinically useful for hepatic imaging. For simple tasks, conventional single energy (SE) computed tomography (CT) images acquired at the optimal tube potential are known to have better quality than dual energy (DE) blended images. However, liver imaging is complex and often requires imaging of both structures containing iodinated contrast media, where atomic number differences are the primary contrast mechanism, and other structures, where density differences are the primary contrast mechanism. Hence it is conceivable that the broad spectrum used in a dual energy acquisition may be an advantage. In this work we are interested in comparing these two imaging strategies at equal-dose and more complex settings. We developed numerical anthropomorphic phantoms to mimic realistic clinical CT scans for medium size and large size patients. MDCT images based on the defined phantoms were simulated using various SE and DE protocols at pre- and post-contrast stages. For SE CT, images from 60 kVp through 140 with 10 kVp steps were considered; for DE CT, both 80/140 and 100/140 kVp scans were simulated and linearly blended at the optimal weights. To make a fair comparison, the mAs of each scan was adjusted to match the reference radiation dose (120 kVp, 200 mAs for medium size patients and 140 kVp, 400 mAs for large size patients). Contrast-to-noise ratio (CNR) of liver against other soft tissues was used to evaluate and compare the SE and DE protocols, and multiple pre- and post-contrasted liver-tissue pairs were used to define a composite CNR. To help validate the simulation results, we conducted a small clinical study. Eighty-five 120 kVp images and 81 blended 80/140 kVp images were collected and compared through both quantitative image quality analysis and an observer study. In the simulation study, we found that the CNR of pre-contrast SE image mostly increased with increasing k

  12. Dynamic magnetic resonance monitoring of interstitial laser photocoagulation of hepatic metastases from a colorectal tumor

    NASA Astrophysics Data System (ADS)

    Roberts, Hugh R.; Paley, Martyn; Buonaccorsi, Giovanni A.; Clemence, Matthew; Friedman, Emma P.; Allen, Clare; Hall-Craggs, Margret A.; Lees, William R.; Bown, Stephen G.

    1994-12-01

    Interstitial laser photocoagulation (ILP) is becoming an established treatment for hepatic metastases. Per-procedural ultrasound does not accurately define the tissue coagulated and dynamic computed tomography, while an accurate form of assessment, must be delayed until 24 hours after therapy; it too is, therefore, no use for per-procedural confirmation of total tumor ablation. By virtue of its good contrast, spatial and temporal resolution and the fact that T1 weighted images are temperature sensitive magnetic resonance imaging (MRI) is, theoretically, applicable to the per-procedural guidance of ILP. Our ex vivo porcine, and in vivo rat liver experiments showed good imaging-pathological agreement. We have treated with ILP two patients suffering from hepatic metastases using MRI guidance. Four to eight 400 micrometers optical fibers were passed through the lesion down Teflon sheaths under local anaesthetic and intravenous sedation using ultrasound guidance. Sets of 400 second laser burns at 1.5 - 2.0 W per fiber were then performed, with a 1 cm fiber withdrawal between each set, until the entire tumor had been coagulated. Therapy was monitored with dynamic MRI using a T1 weighted FLASH sequence. MRI showed an enlarging bright rimmed low signal area which correlated with the region of devascularization seen on enhanced helical computed tomography at 24 hours. MRI can monitor ILP of hepatic metastases and confirm tumor ablation at the time of treatment.

  13. Orbital masses: CT and MRI of common vascular lesions, benign tumors, and malignancies

    PubMed Central

    Khan, Sarah N.; Sepahdari, Ali R.

    2012-01-01

    A wide variety of space occupying lesions may be encountered in the orbit. CT and MR imaging frequently help confirm the presence of a mass and define its extent. Characteristic imaging features may help distinguish among lesions that have overlapping clinical presentations. This review focuses on some of the common orbital masses. Common vascular lesions that are reviewed include: capillary (infantile) hemangioma, cavernous hemangioma (solitary encapsulated venous-lymphatic malformation), and lymphangioma (venous-lymphatic malformation). Benign tumors that are reviewed include: optic nerve sheath meningioma, schwannoma, and neurofibroma. Malignancies that are reviewed include: lymphoma, metastasis, rhabdomyosarcoma, and optic glioma. Key imaging features that guide radiological diagnosis are discussed and illustrated. PMID:23961022

  14. Correlation of CT imaging features and tumor size with Fuhrman grade of clear cell renal cell carcinoma.

    PubMed

    Oh, Saelin; Sung, Deuk Jae; Yang, Kyung Sook; Sim, Ki Choon; Han, Na Yeon; Park, Beom Jin; Kim, Min Ju; Cho, Sung Bum

    2017-03-01

    Background Identification of clinical features to determine the aggressive potential of tumors is highly warranted to stratify patients for adequate treatment. Computed tomography (CT) imaging features of clear cell renal cell carcinoma (ccRCC) may contribute to personalized risk assessment. Purpose To assess the correlation between CT imaging features and Fuhrman grade of ccRCC, and to identify the predictors of high Fuhrman grade in conjunction with tumor size. Material and Methods CT scans of 169 patients with 173 pathologically proven ccRCCs were retrospectively reviewed in consensus by two radiologists for the presence of intratumoral necrosis and intratumoral cyst and tumor size. Histologic grade was classified as either low (Fuhrman grade I or II) or high (Fuhrman grade III or IV). Statistical significance was evaluated by using univariate, multivariate regression, receiver operating characteristic (ROC) curve, and Spearman correlation analyses. Results On CT, 20 of the 173 tumors had intratumoral cysts, 60 had intratumoral necrosis, and 93 showed entirely solid tumors. The odds of high grade were higher with intratumoral necrosis and entirely solid tumor than with intratumoral cyst ( P < 0.03). Intratumoral necrosis showed a significantly high odds ratio of 25.73 for high Fuhrman grade. The ROC curve showed a threshold tumor size of 36 mm to predict high Fuhrman grade for overall tumors (area under the ROC curve, 0.70). In ccRCCs with intratumoral necrosis or cyst, tumor size did not significantly correlate with Fuhrman grade. Conclusion Intratumoral necrosis on CT was a strong and independent predictor of biologically aggressive ccRCCs, irrespective of tumor size.

  15. Using X-ray in-line phase-contrast imaging for the investigation of nude mouse hepatic tumors.

    PubMed

    Tao, Qiang; Li, Dongyue; Zhang, Lu; Luo, Shuqian

    2012-01-01

    The purpose of this paper is to report the noninvasive imaging of hepatic tumors without contrast agents. Both normal tissues and tumor tissues can be detected, and tumor tissues in different stages can be classified quantitatively. We implanted BEL-7402 human hepatocellular carcinoma cells into the livers of nude mice and then imaged the livers using X-ray in-line phase-contrast imaging (ILPCI). The projection images' texture feature based on gray level co-occurrence matrix (GLCM) and dual-tree complex wavelet transforms (DTCWT) were extracted to discriminate normal tissues and tumor tissues. Different stages of hepatic tumors were classified using support vector machines (SVM). Images of livers from nude mice sacrificed 6 days after inoculation with cancer cells show diffuse distribution of the tumor tissue, but images of livers from nude mice sacrificed 9, 12, or 15 days after inoculation with cancer cells show necrotic lumps in the tumor tissue. The results of the principal component analysis (PCA) of the texture features based on GLCM of normal regions were positive, but those of tumor regions were negative. The results of PCA of the texture features based on DTCWT of normal regions were greater than those of tumor regions. The values of the texture features in low-frequency coefficient images increased monotonically with the growth of the tumors. Different stages of liver tumors can be classified using SVM, and the accuracy is 83.33%. Noninvasive and micron-scale imaging can be achieved by X-ray ILPCI. We can observe hepatic tumors and small vessels from the phase-contrast images. This new imaging approach for hepatic cancer is effective and has potential use in the early detection and classification of hepatic tumors.

  16. [Gastro-intestinal neuroectodermal tumor (GNET): A case report of a small intestine tumor with hepatic metastases].

    PubMed

    Kervarrec, Thibault; Lecointre, Claire; Kerdraon, Rémy; Bens, Guido; Piquard, Arnaud; Michenet, Patrick

    2015-12-01

    The gastro-intestinal neuroectodermal tumor (GNET) is a rare sarcoma of the digestive tract, which was recently recognised. The knowledge of the morphological, immunohistochemical and molecular diagnostic criteria is necessary to not mistake it for the metastasis of a melanoma or for another sarcoma of the digestive tract as the gastro-intestinal clear cells sarcoma or the malignant peripheral nervous system tumor (MPNST). We report the case of a 41-year-old patient with a GNET of the small intestine with hepatic metastasis. The histological examination showed a diffuse proliferation of epithelioid cells, which only express PS100. The presence EWSR1-ATF1 gene fusions with any melanocytic differentiation leads to the diagnosis of GNET.

  17. Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries.

    PubMed

    Kao, Yung Hsiang; Tan, Andrew E H; Khoo, Li Ser; Lo, Richard H G; Chow, Pierce K H; Goh, Anthony S W

    2011-06-01

    Yttrium-90 (Y-90) selective internal radiation therapy (SIRT) is increasingly used to treat inoperable hepatocellular carcinoma. We describe two patients where hepatic falciform ligament Technetium-99m-macroaggregated albumin (Tc-99m-MAA) activity was identified on single photon emission computed tomography with integrated low-dose CT (SPECT/CT) scan during pre-therapy planning, and the steps taken to prevent radiation dermatitis. The first patient underwent prophylactic coil embolization of the patent hepatic falciform artery; the second patient underwent super-selective infusion of Y-90 resin microspheres to avoid the patent hepatic falciform artery. The incidence of falciform ligament Tc-99m-MAA activity detected on SPECT/CT at our institution is 10%. Tc-99m-MAA SPECT/CT scan provides valuable diagnostic information for treatment planning prior to Y-90 SIRT.

  18. A semiautomatic CT-based ensemble segmentation of lung tumors: comparison with oncologists’ delineations and with the surgical specimen

    PubMed Central

    Velazquez, Emmanuel Rios; Aerts, Hugo J. W. L.; Gu, Yuhua; Goldgof, Dmitry B.; De Ruysscher, Dirk; Dekker, Andre; Korn, René; Gillies, Robert J.; Lambin, Philippe

    2013-01-01

    Purpose To assess the clinical relevance of a semiautomatic CT-based ensemble segmentation method, by comparing it to pathology and to CT/PET manual delineations by five independent radiation oncologists in non-small cell lung cancer (NSCLC). Materials and Methods For twenty NSCLC patients (stage Ib – IIIb) the primary tumor was delineated manually on CT/PET scans by five independent radiation oncologists and segmented using a CT based semi-automatic tool. Tumor volume and overlap fractions between manual and semiautomatic-segmented volumes were compared. All measurements were correlated with the maximal diameter on macroscopic examination of the surgical specimen. Imaging data is available on www.cancerdata.org. Results High overlap fractions were observed between the semi-automatically segmented volumes and the intersection (92.5 ± 9.0, mean ± SD) and union (94.2 ± 6.8) of the manual delineations. No statistically significant differences in tumor volume were observed between the semiautomatic segmentation (71.4 ± 83.2 cm3, mean ± SD) and manual delineations (81.9 ± 94.1 cm3; p = 0.57). The maximal tumor diameter of the semiautomatic-segmented tumor correlated strongly with the macroscopic diameter of the primary tumor (r = 0.96). Conclusion Semiautomatic segmentation of the primary tumor on CT demonstrated high agreement with CT/PET manual delineations and strongly correlated with the macroscopic diameter considered the “gold standard”. This method may be used routinely in clinical practice and could be employed as a starting point for treatment planning, target definition in multi-center clinical trials or for high throughput data mining research. This method is particularly suitable for peripherally located tumors. PMID:23157978

  19. Repeatability of quantitative FDG-PET/CT and contrast enhanced CT in recurrent ovarian carcinoma: test retest measurements for tumor FDG uptake, diameter and volume

    PubMed Central

    Rockall, Andrea G.; Avril, Norbert; Lam, Raymond; Iannone, Robert; Mozley, P. David; Parkinson, Christine; Bergstrom, Donald; Sala, Evis; Sarker, Shah-Jalal; McNeish, Iain A.; Brenton, James D.

    2014-01-01

    Purpose Repeatability of baseline FDG-PET/CT measurements has not been tested in ovarian cancer. This dual-center, prospective study assessed variation in tumor FDG uptake, tumor diameter (TD) and tumor volume (TV) from sequential FDG-PET/CT and contrast-enhanced CT (CECT) in patients with recurrent platinum-sensitive ovarian cancer. Methods Patients underwent two pre-treatment baseline FDG-PET/CT (n=21) and CECT (n=20) at 2 clinical sites with different PET/CT instruments. Patients were included if they had at least one target lesion (TL) in the abdomen with an SUV maximum (SUVmax) of ≥2.5 and a long axis diameter of ≥15mm. Two independent reading methods were used to evaluate repeatability of TD and SUV uptake: on site and at an imaging clinical research organization (CRO). TV reads were only performed by CRO. In each reading set, TLs were independently measured on sequential imaging. Results Median time between FDG-PET/CT was 2 days (range 1-7). For site reads, concordance correlation coefficient (CCC) for SUVmean, SUVmax and TD were 0.95, 0.94 and 0.99 respectively. Repeatability coefficients were 16.3%, 17.3% and 8.8% for SUVmean, SUVmax and TD respectively. Similar results were observed for CRO reads. TV CCC was 0.99 with a repeatability coefficient of 28.1%. Conclusions There was excellent test/retest repeatability for FDG-PET/CT quantitative measurements across two sites and two independent reading methods. Cut-off values for determining change in SUVmean, SUVmax and TV establish limits to determine metabolic and/or volumetric response to treatment in platinum-sensitive relapsed ovarian cancer. PMID:24573555

  20. Follow-up of hepatic and peritoneal metastases of gastrointestinal tumors (GIST) under Imatinib therapy requires different criteria of radiological evaluation (size is not everything!!!).

    PubMed

    Mabille, Mylène; Vanel, Daniel; Albiter, Marcela; Le Cesne, Axel; Bonvalot, Sylvie; Le Péchoux, Cécile; Terrier, Philippe; Shapeero, Lorraine G; Dromain, Clarisse

    2009-02-01

    To define computed tomography (CT) criteria for evaluating the response of patients with gastrointestinal stromal tumors (GIST) who are receiving Imatinib (tyrosine-kinase inhibitor therapy). This prospective CT study evaluated 107 consecutive patients with advanced metastatic GIST treated with Imatinib. Seventy patients had total or partial cystic-like transformation of hepatic and/or peritoneal metastases. These pseudocysts remained unchanged in size or stable in size on successive CT examinations (stable disease according to RECIST criteria). Forty-six patients developed metastases, 17 patients showed increasing parietal thickness and 29 patients with peripheral enhancing nodules. These CT changes represented local recurrence consistent with GIST resistance to Imatinib treatment. WHO or RECIST criteria did not provide a reliable evaluation of disease evolution or recurrence. Development of new enhancement of lesions (parietal thickness or nodule) was the only reliable criterion. The development of peripheral thickening or enhancing nodules within cystic-like metastatic lesions, even without any change in size, represented progressive GIST under Imatinib, growing in a short time and should alert the clinician for the possible need for a change in therapy.

  1. Initial experiences with MR Image-guided laparoscopic microwave coagulation therapy for hepatic tumors.

    PubMed

    Murakami, Koichiro; Naka, Shigeyuki; Shiomi, Hisanori; Akabori, Hiroya; Kurumi, Yoshimasa; Morikawa, Shigehiro; Tani, Tohru

    2015-09-01

    Percutaneous thermal ablation is used for treating hepatic tumors. Recent advances in laparoscopy and imaging modalities have led to the development of a novel image-guided minimally invasive loco-regional treatment. The aim of this trial was to apply laparoscopic assistance to magnetic resonance (MR) image-guided thermoablation instead of ultrasonography, because of its various advantages. Patients with hepatic tumors and liver cirrhosis underwent magnetic resonance (MR) image-guided laparoscopic microwave coagulation therapy using a borescope and endoscopic forceps. Six cases of laparoscopic microwave coagulation treatment using MR image guidance were successfully performed between January 2000 and December 2008. Tumors were detected, punctured, and ablated in an open-configured MR scanner. A total of nine hepatocellular carcinoma nodules were preoperatively identified in S3, S5 and S6 (mean diameter = 20.8 ± 5.4 mm). MR-guided microwave coagulation was laparoscopically achieved in all patients without any significant complications that required invasive treatment. The mean length of the operation was 275.3 ± 60.5 min, and the mean postsurgical hospital stay was 10.0 ± 2.3 days. Postoperative confirmation scanning was performed without moving the patients. MR-guided laparoscopic microwave coagulation therapy is an effective treatment for hepatic tumors adjacent to other organs, as it allows for more accurate detection of lesions and for tumors to be treated safely while avoiding adjacent organs. It is less invasive than conventional procedures, because the MR real-time guidance enabled continuous monitoring throughout the procedure.

  2. SUV of [68Ga]DOTATOC-PET/CT Predicts Response Probability of PRRT in Neuroendocrine Tumors.

    PubMed

    Kratochwil, C; Stefanova, M; Mavriopoulou, E; Holland-Letz, T; Dimitrakopoulou-Strauss, A; Afshar-Oromieh, A; Mier, W; Haberkorn, U; Giesel, F L

    2015-06-01

    The goal of our study was to quantify the expression of the somatostatin receptors (SSTR2) using the maximum standardized uptake value (SUVmax) of [(68)Ga]DOTA(0)-Phe(1)-Tyr(3)-octreotide (DOTATOC) positron emission tomography (PET)-computed tomography (CT) in liver metastases of patients with neuroendocrine tumors (NETs) prior to peptide receptor radiation therapy (PRRT) and compare the initial tumor uptake with the final treatment outcome. SSTR2 expression of the 60 liver metastases in 30 NET patients was assessed at baseline and after PRRT by measuring SUVmax, tumor to spleen ratio (T/S ratio), and tumor to liver ratio (T/L ratio). Based on morphological changes and tumor size measured at baseline and follow-up contrast-enhanced CT (after three cycles of PRRT), lesions were divided into two groups by the following: (i) responding (n = 40) and (ii) non-responding (n = 20). Statistically significant differences were observed in the mean SUVmax for non-responding vs. responding lesions at baseline (18.00 ± 3.59 vs. 33.55 ± 4.62, p < 0.05) and for the mean T/S ratio (1.20 ± 0.37 vs. 1.90 ± 0.45, p < 0.05) and the mean T/L ratio (3.15 ± 0.53 vs. 4.97 ± 0.62, p < 0.05). Using the receiver operating characteristic curves, SUVmax was found a better metric than both T/L ratio and T/S ratio (area under the curve (AUC) of SUVmax 0.87; T/L ratio 0.78; T/S ratio 0.73) as a stratification criterion. Using a threshold value of >16.4 for SUVmax, the sensitivity and specificity in predicting responding lesions were 95 and 60 %, respectively. We propose a SUVmax cutoff of >16.4 from [(68)Ga]DOTATOC-PET-CT to select patients for PRRT. A T/L ratio >2.2 might present a scanner-independent criterion that enables the translation of our results to other institutions. However, the robustness of this arbitrary unit still needs to be evaluated with different PET scanners.

  3. Stereotactic radiosurgery for intradural spine tumors using cone-beam CT image guidance.

    PubMed

    Monserrate, Andrés; Zussman, Benjamin; Ozpinar, Alp; Niranjan, Ajay; Flickinger, John C; Gerszten, Peter C

    2017-01-01

    OBJECTIVE Cone-beam CT (CBCT) image guidance technology has been widely adopted for spine radiosurgery delivery. There is relatively little experience with spine radiosurgery for intradural tumors using CBCT image guidance. This study prospectively evaluated a series of intradural spine tumors treated with radiosurgery. Patient setup accuracy for spine radiosurgery delivery using CBCT image guidance for intradural spine tumors was determined. METHODS Eighty-two patients with intradural tumors were treated and prospectively evaluated. The positioning deviations of the spine radiosurgery treatments in patients were recorded. Radiosurgery was delivered using a linear accelerator with a beam modulator and CBCT image guidance combined with a robotic couch that allows positioning correction in 3 translational and 3 rotational directions. To measure patient movement, 3 quality assurance CBCTs were performed and recorded in 30 patients: before, halfway, and after the radiosurgery treatment. The positioning data and fused images of planning CT and CBCT from the treatments were analyzed to determine intrafraction patient movements. From each of 3 CBCTs, 3 translational and 3 rotational coordinates were obtained. RESULTS The radiosurgery procedure was successfully completed for all patients. Lesion locations included cervical (22), thoracic (17), lumbar (38), and sacral (5). Tumor histologies included schwannoma (27), neurofibromas (18), meningioma (16), hemangioblastoma (8), and ependymoma (5). The mean prescription dose was 17 Gy (range 12-27 Gy) delivered in 1-3 fractions. At the halfway point of the radiation, the translational variations and standard deviations were 0.4 ± 0.5, 0.5 ± 0.8, and 0.4 ± 0.5 mm in the lateral (x), longitudinal (y), and anteroposterior (z) directions, respectively. Similarly, the variations immediately after treatment were 0.5 ± 0.4, 0.5 ± 0.6, and 0.6 ± 0.5 mm along x, y, and z directions, respectively. The mean rotational angles were 0

  4. Utility of PET/CT After Cryoablation for Early Identification of Local Tumor Progression in Osseous Metastatic Disease.

    PubMed

    Packard, Ann T; Broski, Stephen M; Callstrom, Matthew R; Atwell, Thomas D; Schmit, Grant D; Schmitz, John J; Morris, Jonathan M; Hunt, Christopher H; Kurup, A Nicholas

    2017-06-01

    The purpose of this study is to evaluate the utility of combined PET/CT for the detection of early local tumor progression after cryoablation of bone metastases. A retrospective single-institution review revealed 61 consecutive patients with 80 separate bone metastases treated with cryoablation who were evaluated with a preablation PET/CT and at least two postablation PET/CT examinations between September 2007 and July 2015. Patients were excluded if they had local therapy or pathologic fracture after ablation. The patients were grouped according to postcryoablation disease status (i.e., local tumor progression or not) and PET radiotracer (i.e., (11)C-choline or (18)F-FDG) used. The maximum standardized uptake value (SUVmax) ratio (i.e., ratio of SUVmax to blood pool) was calculated within each osseous metastasis before and after cryoablation, and these were then compared between groups. Of the 61 patients and 80 ablations performed, 32 patients were imaged with FDG PET/CT and 29 were imaged with (11)C-choline PET/CT. Twenty-three patients imaged with FDG and 13 patients imaged with (11)C-choline had evidence of local tumor progression on all postablation PET/CT examinations. The SUVmax ratio was significantly higher in patients with local tumor progression on the first and most remote postcryoablation PET/CT examinations for both FDG and (11)C-choline (p < 0.001 in all cases). There was no significant difference in the postablation systemic therapy between the groups with and without local tumor progression. Increased SUVmax ratio in patients after cryoablation for osseous metastatic disease should raise concern about local tumor progression independently of time after ablation.

  5. Hepatitis

    MedlinePlus

    ... clotting problems or chronic liver disease. previous continue Hepatitis B and Hepatitis C Although hep A is a ... does — through direct contact with infected body fluids. Hepatitis B and C are even more easily passed in ...

  6. Hepatitis

    MedlinePlus

    ... A if they've been vaccinated against it. Hepatitis B Hepatitis B is a more serious infection. It may lead ... of which cause severe illness and even death. Hepatitis B virus (HBV) is transmitted from person to person ...

  7. Hepatitis

    MedlinePlus

    ... a problem with the liver itself What Is Hepatitis A? Hepatitis A virus (HAV) is contagious, usually spreading to others ... objects contaminated by feces (poop) containing HAV. The hepatitis A vaccine has helped to make the infection rare ...

  8. CtBP1 Interacts with Ikaros and Modulates Pituitary Tumor Cell Survival and Response to Hypoxia

    PubMed Central

    Dorman, Katie; Shen, Zhongyi; Yang, Caimei; Ezzat, Shereen

    2012-01-01

    C-terminal binding protein (CtBP) is a transcriptional corepressor that plays an important role in mammalian development and tumorigenesis. We demonstrate that CtBP is expressed in adenohypophyseal cells and is expressed at high levels in human corticotroph, somatotroph, and lactotroph pituitary adenomas. CtBP interacts with Ikaros isoforms in GH4 and AtT20 pituitary tumor cells. Ikaros and CtBP1 expression is coordinately induced by hypoxia, and this response is abrogated by CtBP1 deficiency. Forced reduction of CtBP1 leads to reduced cell growth, up-regulation of Sprouty 2, and down-regulation of ectonucleotide pyrophosphatase phosphodiesterase 2 (Enpp2). Consistent with diminished Enpp2 activity, CtBP1-deficient pituitary cells are more susceptible to hypoxia-induced apoptosis, which is rescued by Enpp2-derived lysophosphatidic acid treatment. These results identify putative oncogenic properties of CtBP1 and provide new insights into the overlapping functions of two members of the chromatin remodeling network in the response to hypoxic pituitary tumor cell drive. PMID:22301782

  9. Perfusion CT Changes in Liver Metastases from Pancreatic Neuroendocrine Tumors During Everolimus Treatment.

    PubMed

    D'Onofrio, Mirko; Cingarlini, Sara; Ortolani, Silvia; Crosara, Stefano; DE Robertis, Riccardo; Vallerio, Paola; Grego, Elisabetta; Ciaravino, Valentina; Ruzzenente, Andrea; Landoni, Luca; Scarpa, Aldo; Bassi, Claudio; Tortora, Giampaolo

    2017-03-01

    To evaluate modifications of perfusional parameters assessed by perfusion computed tomography (P-CT) of liver metastases (LM) from pancreatic neuroendocrine tumors (PanNETs) during everolimus treatment. All patients with LMs from G1-2 PanNETs undergoing everolimus treatment between January 2013 and January 2015 were prospectively evaluated with P-CT at baseline, and after 2 and 4 months of therapy. Size, perfusion, blood volume (BV), peak enhancement intensity (PEI) and time to peak for each lesion were calculated. A total of 33 LMs in nine patients with G1-2 PanNETs were prospectively evaluated: 23/33 (69.7%) were responders, 10/33 (30.3%) were non-responders. Among perfusional parameters, only numerical peak enhancement intensity values significantly differed between the two groups at baseline (p=0.043). BV increase was the most significant perfusional modification identifying responding lesions, even at an early stage of treatment, with a high positive predictive value (89.47%). P-CT seems to be useful for prediction of response to everolimus of LMs from PanNETs. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  10. Correlation between CT Perfusion Parameters and Microvessel Density and Vascular Endothelial Growth Factor in Adrenal Tumors

    PubMed Central

    Wang, Xifu; Bai, Renju; Li, Yajun; Zhao, Jinkun

    2013-01-01

    We evaluated the correlation between computed tomography (CT) perfusion parameters and markers of angiogenesis in adrenal adenomas and non-adenomas to determine if perfusion CT can be used to distinguish between them. Thirty-four patients with pathologically-confirmed adrenal tumors (17 adenomas, 17 non-adenomas) received CT perfusion imaging before surgery. CT perfusion parameters (blood flow [BF], blood volume [BV], mean transit time [MTT], and permeability surface area product [PS]) were calculated. Tumor tissue sections were examined with immunohistochemical methods for vascular endothelial growth factor (VEGF) expression and microvessel density (MVD). The mean age of the 34 patients was 43 years. The median BV was significantly higher in adenomas than in non-adenomas [12.3 ml/100 g, inter-quartile range (IQR): 10.4 to 16.5 ml/100 g vs. 8.8 ml/100 g, IQR: 3.3 to 9.4 ml/100 g, p = 0.001]. Differences in BF, MTT, and PS parameter values between adenomas and non-adenomas were not significant (p>0.05). The mean MVD was significantly higher in adenomas compared to non-adenomas (98.5±28.5 vs. 53.5±27.0, p<0.0001). Adenomas also expressed significantly higher median VEGF than non-adenomas (65%, IQR: 50 to 79% vs. 45%, IQR: 35 to 67%, p = 0.02). A moderately strong correlation between BF and VEGF (r = 0.53, p = 0.03) and between BV and MVD among adenomas (r = 0.57, p = 0.02) exist. Morphology, MVD, and VEGF expression in adenomas differ significantly from non-adenomas. Of the CT perfusion parameters examined, both BF and BV correlate with MVD, but only BF correlates with VEGF, and only in adenomas. The significant difference in BV suggests that BV may be used to differentiate adenomas from non-adenomas. However, the small difference in BV shows that it may only be possible to use BV to identify adenomas vs. non-adenomas at extreme BV values. PMID:24260316

  11. Calculating tumor trajectory and dose-of-the-day using cone-beam CT projections

    SciTech Connect

    Jones, Bernard L. Westerly, David; Miften, Moyed

    2015-02-15

    Purpose: Cone-beam CT (CBCT) projection images provide anatomical data in real-time over several respiratory cycles, forming a comprehensive picture of tumor movement. The authors developed and validated a method which uses these projections to determine the trajectory of and dose to highly mobile tumors during each fraction of treatment. Methods: CBCT images of a respiration phantom were acquired, the trajectory of which mimicked a lung tumor with high amplitude (up to 2.5 cm) and hysteresis. A template-matching algorithm was used to identify the location of a steel BB in each CBCT projection, and a Gaussian probability density function for the absolute BB position was calculated which best fit the observed trajectory of the BB in the imager geometry. Two modifications of the trajectory reconstruction were investigated: first, using respiratory phase information to refine the trajectory estimation (Phase), and second, using the Monte Carlo (MC) method to sample the estimated Gaussian tumor position distribution. The accuracies of the proposed methods were evaluated by comparing the known and calculated BB trajectories in phantom-simulated clinical scenarios using abdominal tumor volumes. Results: With all methods, the mean position of the BB was determined with accuracy better than 0.1 mm, and root-mean-square trajectory errors averaged 3.8% ± 1.1% of the marker amplitude. Dosimetric calculations using Phase methods were more accurate, with mean absolute error less than 0.5%, and with error less than 1% in the highest-noise trajectory. MC-based trajectories prevent the overestimation of dose, but when viewed in an absolute sense, add a small amount of dosimetric error (<0.1%). Conclusions: Marker trajectory and target dose-of-the-day were accurately calculated using CBCT projections. This technique provides a method to evaluate highly mobile tumors using ordinary CBCT data, and could facilitate better strategies to mitigate or compensate for motion during

  12. Tumor specific mutations in TERT promoter and CTNNB1 gene in hepatitis B and hepatitis C related hepatocellular carcinoma.

    PubMed

    Pezzuto, Francesca; Izzo, Francesco; Buonaguro, Luigi; Annunziata, Clorinda; Tatangelo, Fabiana; Botti, Gerardo; Buonaguro, Franco M; Tornesello, Maria Lina

    2016-08-23

    Recurrent somatic mutations in the promoter region of telomerase reverse transcriptase (TERT) gene and in the exon 3 of CTNNB1 gene have been recognized as common events in hepatocellular carcinoma (HCC) with variable frequencies depending on etiology and geographical region. We have analyzed TERT promoter and CTNNB1 gene mutations in 122 cases of hepatitis B (HBV) and hepatitis C (HCV) related HCCs, in 7 cases of cholangiocarcinoma (CC) and hepatocholangiocarcinoma (HCC-CC) as well as in autologous cirrhotic tissues. Overall, 50.4% and 26% of HCC as well as 14.3% and none of CC and HCC-CC were mutated in TERT promoter and in CTNNB1 exon 3, respectively. TERT and CTNNB1 mutations were found more frequently in HCV related (53.6% and 26.4%, respectively) than HBV related (41.7% and 16.7%, respectively) HCCs and coexisted in 57.6% of CTNNB1 mutated tumors. Mutations in TERT and CTNNB1 were not associated with the functional promoter polymorphism rs2853669. No mutations were detected in the 129 non-HCC cirrhotic tissues. In conclusion, mutations in TERT promoter and in CTNNB1 gene represent specific cancer signatures in the pathogenesis of viral related HCC and could be promising early biomarkers as well as targets for tailored therapies.

  13. Tumor specific mutations in TERT promoter and CTNNB1 gene in hepatitis B and hepatitis C related hepatocellular carcinoma

    PubMed Central

    Pezzuto, Francesca; Izzo, Francesco; Buonaguro, Luigi; Annunziata, Clorinda; Tatangelo, Fabiana; Botti, Gerardo; Buonaguro, Franco M.; Tornesello, Maria Lina

    2016-01-01

    Recurrent somatic mutations in the promoter region of telomerase reverse transcriptase (TERT) gene and in the exon 3 of CTNNB1 gene have been recognized as common events in hepatocellular carcinoma (HCC) with variable frequencies depending on etiology and geographical region. We have analyzed TERT promoter and CTNNB1 gene mutations in 122 cases of hepatitis B (HBV) and hepatitis C (HCV) related HCCs, in 7 cases of cholangiocarcinoma (CC) and hepatocholangiocarcinoma (HCC-CC) as well as in autologous cirrhotic tissues. Overall, 50.4% and 26% of HCC as well as 14.3% and none of CC and HCC-CC were mutated in TERT promoter and in CTNNB1 exon 3, respectively. TERT and CTNNB1 mutations were found more frequently in HCV related (53.6% and 26.4%, respectively) than HBV related (41.7% and 16.7%, respectively) HCCs and coexisted in 57.6% of CTNNB1 mutated tumors. Mutations in TERT and CTNNB1 were not associated with the functional promoter polymorphism rs2853669. No mutations were detected in the 129 non-HCC cirrhotic tissues. In conclusion, mutations in TERT promoter and in CTNNB1 gene represent specific cancer signatures in the pathogenesis of viral related HCC and could be promising early biomarkers as well as targets for tailored therapies. PMID:27276713

  14. Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors.

    PubMed

    McCarville, M Beth; Lederman, Henrique M; Santana, Victor M; Daw, Najat C; Shochat, Stephen J; Li, Chin-Shang; Kaufman, Robert A

    2006-05-01

    To retrospectively assess whether computed tomographic (CT) findings can indicate the benign or malignant nature of pulmonary nodules in pediatric patients with malignant solid primary tumors. With institutional review board approval, waived parental and patient consent, and HIPAA compliance, the authors determined the incidence of malignancy among 81 pulmonary nodules that were sampled at biopsy within 3 weeks after chest CT (January 1999 to September 2003) in 41 young patients with malignant solid tumors. Three radiologists independently and retrospectively reviewed these scans and the available previously obtained scans, classifying nodules as benign, malignant, or indeterminate on the basis of their number, unilateral versus bilateral distribution, size, margins (indistinct vs distinct), calcification, growth, and associated adenopathy. These classifications were compared with nodule histologic type, and interreviewer agreement was assessed. The median patient age was 14.8 years (mean, 13.7 years; range, 5-21 years). Twenty-four of the 41 patients (58%) had at least one biopsy-proved malignant nodule. Four (10%) patients had both benign and malignant nodules; 17 (42%) had only benign nodules. Reviewer 1 classified 65% (39 of 60) of nodules correctly; reviewer 2, 57% (37 of 65); and reviewer 3, 67% (43 of 64). Interreviewer agreement was slight to moderate (kappa /= .32). The frequency of benign nodules and the inconsistency of predictions based on CT features suggest the need for better predictors of pulmonary nodules being malignant or benign, so as to reduce unnecessary thoracotomy in pediatric patients with solid malignancy. . (c) RSNA, 2006.

  15. Accurate tracking of tumor volume change during radiotherapy by CT-CBCT registration with intensity correction

    NASA Astrophysics Data System (ADS)

    Park, Seyoun; Robinson, Adam; Quon, Harry; Kiess, Ana P.; Shen, Colette; Wong, John; Plishker, William; Shekhar, Raj; Lee, Junghoon

    2016-03-01

    In this paper, we propose a CT-CBCT registration method to accurately predict the tumor volume change based on daily cone-beam CTs (CBCTs) during radiotherapy. CBCT is commonly used to reduce patient setup error during radiotherapy, but its poor image quality impedes accurate monitoring of anatomical changes. Although physician's contours drawn on the planning CT can be automatically propagated to daily CBCTs by deformable image registration (DIR), artifacts in CBCT often cause undesirable errors. To improve the accuracy of the registration-based segmentation, we developed a DIR method that iteratively corrects CBCT intensities by local histogram matching. Three popular DIR algorithms (B-spline, demons, and optical flow) with the intensity correction were implemented on a graphics processing unit for efficient computation. We evaluated their performances on six head and neck (HN) cancer cases. For each case, four trained scientists manually contoured the nodal gross tumor volume (GTV) on the planning CT and every other fraction CBCTs to which the propagated GTV contours by DIR were compared. The performance was also compared with commercial image registration software based on conventional mutual information (MI), VelocityAI (Varian Medical Systems Inc.). The volume differences (mean±std in cc) between the average of the manual segmentations and automatic segmentations are 3.70+/-2.30 (B-spline), 1.25+/-1.78 (demons), 0.93+/-1.14 (optical flow), and 4.39+/-3.86 (VelocityAI). The proposed method significantly reduced the estimation error by 9% (B-spline), 38% (demons), and 51% (optical flow) over the results using VelocityAI. Although demonstrated only on HN nodal GTVs, the results imply that the proposed method can produce improved segmentation of other critical structures over conventional methods.

  16. Fused 99m-Tc-GSA SPECT/CT imaging for the preoperative evaluation of postoperative liver function: can the liver uptake index predict postoperative hepatic functional reserve?

    PubMed

    Yoshida, Morikatsu; Shiraishi, Shinya; Sakaguchi, Fumi; Utsunomiya, Daisuke; Tashiro, Kuniyuki; Tomiguchi, Seiji; Okabe, Hirohisa; Beppu, Toru; Baba, Hideo; Yamashita, Yasuyuki

    2012-04-01

    To evaluate the role of hepatic asialoglycoprotein receptor analysis in the preoperative estimation of postoperative hepatic functional reserve. We obtained technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-GSA) SPECT/CT fusion images in 256 patients with liver disease scheduled for hepatic resection. The liver uptake value corrected for body surface area [LUV(BSA)] and liver uptake ratio (LUR) of the remnant were preoperatively estimated based on the fused images. These values were compared with the postoperative hepatic functional reserve. Significant correlations were observed between LUV(BSA), LUR, and most conventional indicators of hepatic functional reserve. Postoperatively, nonpreserved liver functional reserve was observed in 15 of the 256 patients (5.8%). Remnant LUV(BSA) showed better correlation than remnant LUR or the other indicators. No patients with remnant LUV(BSA) above 28.0 manifested poor nonpreserved functional reserve. Using a LUV(BSA) of 27.0, it was possible to predict postoperative poor hepatic functional reserve at a sensitivity of 91%, specificity of 81%, and accuracy of 81% postoperatively. According to multivariate analysis, a low remnant LUV(BSA) was the only significant independent predictor of poor hepatic functional reserve. Our 99mTc-GSA SPECT/CT fusion imaging method was clinically useful for evaluating regional hepatic function and for predicting postoperative hepatic functional reserve.

  17. The role of CT in demonstrating perivesical tumor growth in the preoperative staging of carcinoma of the urinary bladder

    SciTech Connect

    Sager, E.M.; Talle, K.; Fossa, S.; Ous, S.; Stenwig, A.E.

    1983-02-01

    Carcinoma of the urinary bladder was staged both clinically and by CT in 32 patients before they underwent total cystectomy. Eleven of the patients had perivesical growth demonstrated at histopathological examination of the cystectomy specimen. This was diagnoed by CT in all 11 of these patients before cystectomy, but it was discovered by clinical staging in only four patients prior to cystectomy. Seven patients without histopathologically proved perivesical growth were considered to have perivesical spread as demonstrated by CT findings. Three of these patients had perivesical fibrosis that was misinterpreted as perivesical tumor growth, and in all seven patients the perivesical changes were adjacent to the area of present or previous changes in the bladder wall. CT is a valuable addition to clinical staging because it demonstrates perivesical tumor growth.

  18. Serious hepatic complications of selective internal radiation therapy with yttrium-90 microsphere radioembolization for unresectable liver tumors.

    PubMed

    Kuo, James C; Tazbirkova, Andrea; Allen, Robert; Kosmider, Suzanne; Gibbs, Peter; Yip, Desmond

    2014-09-01

    Selective internal radiation therapy with yttrium-90 microsphere radioembolization has been used to treat unresectable liver tumors and its acute toxicity has been well described. Subacute and long-term hepatic complications related to radioembolization however may be underreported in the literature. This retrospective study describes the incidence and sequelae of serious hepatic complications in patients who underwent radioembolization for unresectable liver tumors. A retrospective review of clinical notes of patients who received radioembolization for unresectable liver tumors from 2001 to 2011 at two Australian institutions was performed to identify those who developed clinically significant hepatic complications. Relevant clinical data were obtained and analyzed to determine their incidence and sequelae. A total of 205 patients were identified, of whom 10 (4.9%) developed serious hepatic complications with 7 (3.4%) attributable to radioembolization-induced liver disease. None had preexisting underlying liver disease or progressive hepatic metastases at the time of developing hepatic complication. The median time to the onset of hepatic complications was 3.5 months (range 1-67 months); six patients had a complete resolution eventually, including one patient who subsequently underwent hepatic metastasectomy safely. Three patients died as a result of fulminant hepatic failure. Selective internal radiation therapy with radioembolization was associated with serious hepatic complications with an incidence of 4.9% and a mortality rate of 1.5% in 205 patients from two Australian institutions. The risk of serious hepatic toxicity therefore needs to be discussed when counseling patients regarding this potential treatment option. © 2014 Wiley Publishing Asia Pty Ltd.

  19. Common malignant brain tumors: can 18F-FDG PET/CT aid in differentiation?

    PubMed

    Purandare, Nilendu C; Puranik, Ameya; Shah, Sneha; Agrawal, Archi; Gupta, Tejpal; Moiyadi, Aliasgar; Shetty, Prakash; Shridhar, Epari; Jalali, Rakesh; Rangarajan, Venkatesh

    2017-09-15

    The objectives of this study were to evalute the metabolic characteristics of common malignant space-occupying lesions (SOL) of the brain and to determine the utility of fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT in differentiating between the common types of malignant brain SOL. All patients with brain SOL who were referred for an F-FDG PET/CT scan by a multidisciplinary team were included in this retrospective study. The metabolic characteristics of the brain lesions in the form of maximum standardized uptake value (SUVmax) along with tumor-to-background activity ratios were determined and differences were compared using nonparametric statistical tests. Histopathological confirmation was used as the gold standard in all patients. Receiver operating characteristic curve analysis was used to find the optimal SUVmax cutoff to differentiate the tumor types. Glioblastoma multiforme (GBM; n=30), lymphoma (n=25), and metastases (n=46) accounted for most malignant tumors (95.2%). Lymphomas showed a significantly high metabolic uptake (median SUVmax=20.3, range: 8.1-46.3) compared with GBM ( median SUVmax=10.3, range: 2.6-21.7) and metastases (median SUVmax=11.5, range: 2.9-19.6) (P=0.00). The tumor-to-background activity ratios for lymphomas were also significantly higher. There was an overlap in the metabolic uptake of GBM and metastases, with no significant difference between their SUVmax values (P=0.245). A SUVmax more than 15.5 showed an 84% sensitivity and an 80% specificity to diagnose lymphomas (area under the curve=0.876, P=0.00). Four patients with brain lymphoma had extracranial disease on F-FDG PET. Lung cancer was the most common primary malignancy in patients with brain metastases. Central nervous system lymphomas can be differentiated from GBM and metastases by their higher metabolic activity. In addition, F-FDG PET/CT can potentially impact therapeutic decisions by detecting primary malignancy in patients with metastatic brain lesions and extracranial

  20. CT-guided paravertebral block for microwave ablation of kidney tumors: a new technique.

    PubMed

    Dubut, Jonathan; Kastler, Bruno; Delabrousse, Eric; Nardin, Charlee; Chenet, Julien; Kleinclauss, François; Aubry, Sébastien

    2016-06-01

    In patients undergoing computed tomography (CT)-guided microwave ablation (MWA) for renal tumors, we developed a CT-guided anterior paravertebral block (PVB) associated with anesthesia of the kidney capsule and inhalation of an equimolar mixture of oxygen and nitrous oxide (EMONO). The primary objectives were to describe our technique and to study its efficacy in terms of procedural success. The secondary objective was to study the tolerance by evaluating patient pain scores and the number of complications. Patients suffering from renal carcinoma classified T1a and considered to be poor candidates for surgery were included in this prospective, single-center pilot study. They underwent MWA under CT-guided loco-regional anesthesia: an anterior variant of the PVB at the level of T10, ipsilateral to the renal MWA associated with anesthesia of the kidney capsule and EMONO. Technical success was defined as total thermal ablation without additional sedation and no side effect during the procedure. Maximal pain score during the procedure was assessed using a visual analog score. Four patients were included. All procedures were technical success. No side effects were reported, either due to the procedure or anesthesia. The maximal pain score recorded immediately after procedure was 2 ± 2.4 on the visual analog score. MWA of the kidney is feasible under CT-guided anterior paravertebral block. PVB is well tolerated and can be associated with anesthesia of the kidney capsule and EMONO. This new technique may be an alternative to general anesthetic or conscious sedation in clinical practice.

  1. [Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor].

    PubMed

    Li, H Y; Chen, X H

    2017-05-07

    Objective: To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer. Methods: One hundred and ninety-seven patients with primary laryngeal or hypopharyngeal cancer treated with surgery between January 2013 and December 2014 were included in this study. All patients underwent enhanced CT and MRI before surgery. With MRI using the techniques of fast recovery fast spin echo (FRFSE), spin echo echo planar imaging (SE-EPI) and diffusion weighted imaging (DWI), thyroid cartilage invasion was evaluated and the results of postoperative histopathological examination was used as a gold standard for the determination of thyroid cartilage invasion. The sensitivity, specificity, positive predictive value and negative predictive value of enhanced CT or MRI in detecting thyroid cartilage invasion by laryngeal and hypopharyngeal cancer were evaluated. Data were analyzed with SPSS17.0 software. Results: Among 197 patients, there were 35 cases with supraglottic laryngeal cancer, 92 cases with glottic laryngeal cancer, 9 cases with subglottic laryngeal cancer, and 61 cases with hypopharyngeal cancer. Postoperative pathologycal examinations showed that 63 (32.0%) of 197 patients had thyroid cartilage invasion by tumor. Based on TNM classification of AJCC (American Joint Commission for Cancer, 2010), there were 36 cases at T2 stage, 109 cases at T3 and 52 cases at T4; 117 cases with N0, 46 cases with N1 and 34 cases with N2. The sensitivity, specificity, positive predictive value and negative predictive value of CT for the detection of thyroid cartilage invasion were respectively 57%, 86%, 65% and 81%, and those of MRI were respectively 94%, 87%, 78% and 97%. Kappa values were 0.45 for CT and 0.77 for MRI in diagnosis of thyroid cartilage invasion, with statistically significant difference (χ(2)=6.78, P<0.05). Conclusion: MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid

  2. Generation of a murine hepatic angiosarcoma cell line and reproducible mouse tumor model.

    PubMed

    Rothweiler, Sonja; Dill, Michael T; Terracciano, Luigi; Makowska, Zuzanna; Quagliata, Luca; Hlushchuk, Ruslan; Djonov, Valentin; Heim, Markus H; Semela, David

    2015-03-01

    Hepatic angiosarcoma (AS) is a rare and highly aggressive tumor of endothelial origin with dismal prognosis. Studies of the molecular biology of AS and treatment options are limited as animal models are rare. We have previously shown that inducible knockout of Notch1 in mice leads to spontaneous formation of hepatic AS. The aims of this study were to: (1) establish and characterize a cell line derived from this murine AS, (2) identify molecular pathways involved in the pathogenesis and potential therapeutic targets, and (3) generate a tumor transplantation model. AS cells retained specific endothelial properties such as tube formation activity, as well as expression of CD31 and Von Willebrand factor. However, electron microscopy analysis revealed signs of dedifferentiation with loss of fenestrae and loss of contact inhibition. Microarray and pathway analysis showed substantial changes in gene expression and revealed activation of the Myc pathway. Exposing the AS cells to sorafenib reduced migration, filopodia dynamics, and cell proliferation but did not induce apoptosis. In addition, sorafenib suppressed ERK phosphorylation and expression of cyclin D2. Injection of AS cells into NOD/SCID mice resulted in formation of undifferentiated tumors, confirming the tumorigenic potential of these cells. In summary, we established and characterized a murine model of spontaneous AS formation and hepatic AS cell lines as a useful in vitro tool. Our data demonstrate antitumor activity of sorafenib in AS cells with potent inhibition of migration, filopodia formation, and cell proliferation, supporting further evaluation of sorafenib as a novel treatment strategy. In addition, AS cell transplantation provides a subcutaneous tumor model useful for in vivo preclinical drug testing.

  3. Hepatic tumor ablation with clustered microwave antennae: the US Phase II Trial

    PubMed Central

    Iannitti, David A.; Martin, Robert C.G.; Simon, Caroline J.; Hope, William W.; Newcomb, William L.; McMasters, Kelly M.; Dupuy, Damian

    2007-01-01

    Background: Thermal ablation techniques have become important treatment options for patients with unresectable hepatic malignancies. Microwave ablation (MWA) is a new thermal ablative technique that uses electromagnetic energy to produce coagulation necrosis. We report outcomes from the first clinical trial in the United States using MWA and a 915 MHz generator. Patients and methods: Patients with unresectable primary or metastatic liver cancer were enrolled in a multi-institutional trial from March 2004 through May 2006. Demographic information, diagnosis, treatment, and outcomes were documented. Results: Eighty-seven patients underwent 94 ablation procedures for 224 hepatic tumors. Forty-two ablations (45%) were performed open, 7 (7%) laparoscopically, and 45 (48%) percutaneously. The average tumor size was 3.6 cm (range 0.5–9.0 cm). Single antenna ablation volumes were 10.0 ml (range 7.8–14.0 ml), and clustered antennae ablation volumes were 50.5 ml (range 21.1–146.5 ml). Outcome variables were measured with a mean follow-up of 19 months. Local recurrence at the ablation site occurred in 6 (2.7%) tumors, and regional recurrence occurred in 37 (43%) patients. With a mean follow-up of 19 months, 41 (47%) patients were alive with no evidence of disease. There were no procedure-related deaths. The overall mortality rate was 2.3%. Conclusions: Microwave ablation is a safe and effective technology for hepatic tumor ablation. In our study, clustered antennae resulted in larger ablation volumes. Further studies with histological confirmation are needed to verify clinical results. PMID:18333126

  4. Hepatitis B virus surface proteins accelerate cholestatic injury and tumor progression in Abcb4-knockout mice

    PubMed Central

    Churin, Yuri; Herebian, Diran; Mayatepek, Ertan; Köhler, Kernt; Gattenlöhner, Stefan; Stinn, Anne; Tschuschner, Annette; Roderfeld, Martin; Roeb, Elke

    2017-01-01

    Understanding of the pathophysiology of cholestasis associated carcinogenesis could challenge the development of new personalized therapeutic approaches and thus improve prognosis. Simultaneous damage might aggravate hepatic injury, induce chronic liver disease and even promote carcinogenesis. We aimed to study the effect of Hepatitis B virus surface protein (HBsAg) on cholestatic liver disease and associated carcinogenesis in a mouse model combining both impairments. Hybrids of Abcb4−/− and HBsAg transgenic mice were bred on fibrosis susceptible background BALB/c. Liver injury, serum bile acid concentration, hepatic fibrosis, and carcinogenesis were enhanced by the combination of simultaneous damage in line with activation of c-Jun N-terminal kinase (JNK), proto-oncogene c-Jun, and Signal transducer and activator of transcription 3 (STAT3). Activation of Protein Kinase RNA-like Endoplasmic Reticulum Kinase (PERK) and Eukaryotic translation initiation factor 2A (eIF2α) indicated unfolded protein response (UPR) in HBsAg-expressing mice and even in Abcb4−/− without HBsAg-expression. CONCLUSION: Cholestasis-induced STAT3- and JNK-pathways may predispose HBsAg-associated tumorigenesis. Since STAT3- and JNK-activation are well characterized critical regulators for tumor promotion, the potentiation of their activation in hybrids suggests an additive mechanism enhancing tumor incidence. PMID:28881751

  5. Perioperative management of benign hepatic tumors in patients with glycogen storage disease type Ia.

    PubMed

    Oshita, Akihiko; Itamoto, Toshiyuki; Amano, Hironobu; Ohdan, Hideki; Tashiro, Hirotaka; Asahara, Toshimasa

    2008-01-01

    Glycogen storage disease type Ia (GSD-Ia; von Gierke disease) is an inherited disorder caused by glucose-6-phosphatase deficiency, and there have been some reports of hepatic tumors in patients with this disease. We report two patients with benign hepatic tumors with GSD-Ia. One is a 19-year-old man who underwent segmentectomy 4 for a focal nodular hyperplasia, and the other is a 31-year-old woman who underwent segmentectomies 3, 5, and 6 for hepatic adenomas. Two significant perioperative complications, resulting from the carbohydrate metabolic disorders, hypoglycemia and metabolic acidosis, occurred in both patients. We managed the metabolic complications successfully by administering a sufficient volume of glucose intravenously. Close perioperative monitoring of blood glucose and lactate concentrations is essential in the perioperative management of patients with GSD-Ia. The intravenous administration of glucose, starting with a smaller dose and then increasing the dose, is adequate management for lactic acidosis with or without hypoglycemia during the perioperative period.

  6. [Evaluation of reserved hepatic function in patients with hepatobiliary tumor by 99mTc-GSA: effect of hyperbilirubinemia and usefulness of regional reserved hepatic functional imaging].

    PubMed

    Wu, J; Ishikawa, N; Takeda, T; Sato, M; Fukunaga, K; Todoroki, T; Okumura, T; Hatakeyama, R; Itai, Y

    1996-02-01

    The evaluation of the reserved hepatic function was performed by 99mTc-galactosyl serum albumin (99mTc-GSA) in seventy patients with hepatobiliary tumor. The dynamic study was performed to evaluate global reserved hepatic function following the intravenous bolus injection of 99mTc-GSA, and the hepatic single photon emission computed tomography (SPECT) was obtained to assess the regional reserved hepatic function. The functional hepatic index (LHL15) was derived from liver time-activity data, and it was compared with serum total-bilirubin level, serum albumin level and plasma disappearance rate of indocyanine green (ICG15). In the patients with hepatocellular carcinoma, LHL15 value agreed well with ICG15 value, serum total-bilirubin level, and serum albumin level. Moderate or severe hepatic dysfunction was observed at 65.4% of these patients. In the patients with cholangiocellular carcinoma, a discrepancy of LHL15 value and ICG15 value was observed. Increment of the ICG15 value was correlated with that of the serum total-bilirubin level, whereas the correlations was not observed between the LHL15 value and the serum total-bilirubin level. These results indicate that 99mTc-GSA scintigraphy can evaluate the reserved hepatic function without the embellishment of jaundice. This method is useful for assessing the global and regional reserved hepatic function.

  7. Multimodality Non-Rigid Image Registration for Planning, Targeting and Monitoring during CT-guided Percutaneous Liver Tumor Cryoablation

    PubMed Central

    Elhawary, Haytham; Oguro, Sota; Tuncali, Kemal; Morrison, Paul R.; Tatli, Servet; Shyn, Paul B.; Silverman, Stuart G.; Hata, Nobuhiko

    2010-01-01

    Rationale and Objectives To develop non-rigid image registration between pre-procedure contrast enhanced MR images and intra-procedure unenhanced CT images, to enhance tumor visualization and localization during CT-guided liver tumor cryoablation procedures. Materials and Methods After IRB approval, a non-rigid registration (NRR) technique was evaluated with different pre-processing steps and algorithm parameters and compared to a standard rigid registration (RR) approach. The Dice Similarity Coefficient (DSC), Target Registration Error (TRE), 95% Hausdorff distance (HD) and total registration time (minutes) were compared using a two-sided Student’s t-test. The entire registration method was then applied during five CT-guided liver cryoablation cases with the intra-procedural CT data transmitted directly from the CT scanner, with both accuracy and registration time evaluated. Results Selected optimal parameters for registration were section thickness of 5mm, cropping the field of view to 66% of its original size, manual segmentation of the liver, B-spline control grid of 5×5×5 and spatial sampling of 50,000 pixels. Mean 95% HD of 3.3mm (2.5x improvement compared to RR, p<0.05); mean DSC metric of 0.97 (13% increase); and mean TRE of 4.1mm (2.7x reduction) were measured. During the cryoablation procedure registration between the pre-procedure MR and the planning intra-procedure CT took a mean time of 10.6 minutes, the MR to targeting CT image took 4 minutes and MR to monitoring CT took 4.3 minutes. Mean registration accuracy was under 3.4mm. Conclusion Non-rigid registration allowed improved visualization of the tumor during interventional planning, targeting and evaluation of tumor coverage by the ice ball. Future work is focused on reducing segmentation time to make the method more clinically acceptable. PMID:20817574

  8. Dendrimers meet zwitterions: development of a unique antifouling nanoplatform for enhanced blood pool, lymph node and tumor CT imaging.

    PubMed

    Xiong, Zhijuan; Wang, Yue; Zhu, Jingyi; Li, Xin; He, Yao; Qu, Jiao; Shen, Mingwu; Xia, Jindong; Shi, Xiangyang

    2017-08-31

    We report the synthesis and characterization of antifouling zwitterion carboxybetaine acrylamide (CBAA)-modified dendrimer-entrapped gold nanoparticles (Au DENPs) for enhanced CT imaging applications. The CBAA-modified nanodevice displays a better protein resistance property, less macrophage cellular uptake and liver accumulation, and longer blood half-delay time than the PEGylated counterpart material, thereby enabling enhanced blood pool, lymph node, and tumor CT imaging.

  9. Size effect of Au/PAMAM contrast agent on CT imaging of reticuloendothelial system and tumor tissue

    NASA Astrophysics Data System (ADS)

    Wang, Wei; Li, Jian; Liu, Ransheng; Zhang, Aixu; Yuan, Zhiyong

    2016-09-01

    Polyamidoamine (PAMAM)-entrapped Au nanoparticles were synthesized with distinct sizes to figure out the size effect of Au-based contrast agent on CT imaging of passively targeted tissues. Au/PAMAM nanoparticles were first synthesized with narrow distribution of particles size of 22.2 ± 3.1, 54.2 ± 3.7, and 104.9 ± 4.7 nm in diameters. Size effect leads no significant difference on X-ray attenuation when Au/PAMAM was ≤0.05 mol/L. For CT imaging of a tumor model, small Au/PAMAM were more easily internalized via endocytosis in the liver, leading to more obviously enhanced contrast. Similarly, contrast agents with small sizes were more effective in tumor imaging because of the enhanced permeability and retention effect. Overall, the particle size of Au/PAMAM heavily affected the efficiency of CT enhancement in imaging RES and tumors.

  10. Technetium-99m-labelled red blood cell imaging in the diagnosis of hepatic haemangiomas: the role of SPECT/CT with a hybrid camera.

    PubMed

    Schillaci, Orazio; Danieli, Roberta; Manni, Carlo; Capoccetti, Francesca; Simonetti, Giovanni

    2004-07-01

    Delayed liver single-photon emission computed tomography (SPECT) after (99m)Tc red blood cell (RBC) labelling is helpful in detecting hepatic haemangiomas; however, diagnosis can be difficult when lesions are situated adjacent to structures like the inferior vena cava, the heart or hepatic vessels, where blood activity persists. The aims of this study were to evaluate the usefulness of RBC SPECT and transmission computed tomography (RBC SPECT/CT) performed simultaneously with a hybrid imaging system for correct characterisation of hepatic lesions in patients with suspected haemangioma, and to assess the additional value of fused images compared with SPECT alone. Twelve patients with 24 liver lesions were studied. The acquisitions of both anatomical (CT) and functional (SPECT) data were performed during a single session. SPECT images were first interpreted alone and then re-evaluated after adding the transmission anatomical maps. Image fusion was successful in all patients, with perfect correspondence between SPECT and CT data, allowing the precise anatomical localisation of sites of increased blood pool activity. SPECT/CT had a significant impact on results in four patients (33.3%) with four lesions defined as indeterminate on SPECT images, accurately characterising the hot spot foci located near vascular structures. In conclusion, RBC SPECT/CT imaging using this hybrid SPECT/CT system is feasible and useful in the identification or exclusion of suspected hepatic haemangiomas located near regions with high vascular activity.

  11. Assessment of intratumor hypoxia by integrated 18F-FDG PET / perfusion CT in a liver tumor model

    PubMed Central

    Wang, Yong; Stewart, Errol; Desjardins, Lise; Hadway, Jennifer; Morrison, Laura; Crukley, Cathie

    2017-01-01

    Objectives Hypoxia in solid tumors occurs when metabolic demands in tumor cells surpass the delivery of oxygenated blood. We hypothesize that the 18F-fluorodeoxyglucose (18F-FDG) metabolism and tumor blood flow mismatch would correlate with tumor hypoxia. Methods Liver perfusion computed tomography (CT) and 18F-FDG positron emission tomography (PET) imaging were performed in twelve rabbit livers implanted with VX2 carcinoma. Under CT guidance, a fiber optic probe was inserted into the tumor to measure the partial pressure of oxygen (pO2). Tumor blood flow (BF) and standardized uptake value (SUV) were measured to calculate flow-metabolism ratio (FMR). Tumor hypoxia was further identified using pimonidazole immunohistochemical staining. Pearson correlation analysis was performed to determine the correlation between the imaging parameters and pO2 and pimonidazole staining. Results Weak correlations were found between blood volume (BV) and pO2 level (r = 0.425, P = 0.004), SUV and pO2 (r = -0.394, P = 0.007), FMR and pimonidazole staining score (r = -0.388, P = 0.031). However, there was stronger correlation between tumor FMR and pO2 level (r = 0.557, P < 0.001). Conclusions FMR correlated with tumor oxygenation and pimonidazole staining suggesting it may be a potential hypoxic imaging marker in liver tumor. PMID:28264009

  12. Assessment of hepatic VX2 tumors with combined percutaneous transhepatic lymphosonography and contrast-enhanced ultrasonographic imaging

    PubMed Central

    Liu, Cun; Liang, Ping; Wang, Yang; Zhou, Pei; Li, Xin; Han, Zhi-Yu; Liu, Shao-Ping

    2008-01-01

    AIM: To evaluate the feasibility and efficacy of percutaneous transhepatic lymphosonography (PTL) as a novel method for the detection of tumor lymphangiogenesis in hepatic VX2 of rabbits and to evaluate combined PTL and routine contrast-enhanced ultrasonographic imaging for the diagnosis of liver cancer. METHODS: Ten rabbits with VX2 tumor were included in this study. SonoVue (0.1 mL/kg) was injected into each rabbit via an ear vein for contrast-enhanced ultrasonographic imaging, and 0.5 mL SonoVue was injected into the normal liver parenchyma near the VX2 tumor for PTL. Images and/or movie clips were stored for further analysis. RESULTS: Ultrasonographic imaging showed VX2 tumors ranging 5-19 mm in the liver of rabbits. The VX2 tumor was hyperechoic and hypoechoic to liver parenchyma at the early and later phase, respectively. The hepatic lymph vessels were visualized immediately after injection of contrast medium and continuously visualized with SonoVue® during PTL. The boundaries of VX2 tumors were hyperechoic to liver parenchyma and the tumors. There was a significant difference in the values for the boundaries of VX2 tumors after injection compared with the liver normal parenchyma and the tumor parenchyma during PTL. CONCLUSION: PTL is a novel method for the detection of tumor lymphangiogenesis in hepatic VX2 of rabbits. Combined PTL and contrast-enhanced ultrasonographic imaging can improve the diagnosis of liver cancer. PMID:18609718

  13. Improving recognition of hepatic perivascular epithelioid cell tumor: Case report and literature review

    PubMed Central

    Maebayashi, Toshiya; Abe, Katsumi; Aizawa, Takuya; Sakaguchi, Masakuni; Ishibashi, Naoya; Abe, Osamu; Takayama, Tadatoshi; Nakayama, Hisashi; Matsuoka, Shunichi; Nirei, Kazushige; Nakamura, Hitomi; Ogawa, Masahiro; Sugitani, Masahiko

    2015-01-01

    A 58-year-old man presented with the chief complaint of abdominal bloating and was incidentally found to have a liver tumor. As diagnostic imaging studies could not rule out malignancy, the patient underwent partial resection of segment 3 of the liver. The lesion pathologically showed eosinophilic proliferation, in addition to immunohistochemical positivity for human melanoma black 45 and Melan-A, thereby leading to the diagnosis of a hepatic perivascular epithelioid cell tumor (PEComa). A PEComa arising from the liver is relatively rare. Moreover, the name ‘PEComa’ has not yet been widely recognized, and the same disease entity has been called epithelioid angiomyolipoma (EAML), further diminishing the recognition of PEComa. In addition, PEComa imaging findings mimic those of malignant liver tumors, and clinically, this tumor tends to enlarge. Therefore, a PEComa is difficult to diagnose. We conducted a systematic review of PEComa and EAML cases and discuss the results, including findings useful for differentiating perivascular epithelioid cell tumors from malignant liver tumors. PMID:25954119

  14. Variations in tumor size and position due to irregular breathing in 4D-CT: A simulation study

    SciTech Connect

    Sarker, Joyatee; Chu, Alan; Mui, Kit; Wolfgang, John A.; Hirsch, Ariel E.; Chen, George T. Y.; Sharp, Gregory C.

    2010-03-15

    Purpose: To estimate the position and volume errors in 4D-CT caused by irregular breathing. Methods: A virtual 4D-CT scanner was designed to reproduce axial mode scans with retrospective resorting. This virtual scanner creates an artificial spherical tumor based on the specifications of the user, and recreates images that might be produced by a 4D-CT scanner using a patient breathing waveform. 155 respiratory waveforms of patients were used to test the variability of 4D-CT scans. Each breathing waveform was normalized and scaled to 1, 2, and 3 cm peak-to-peak motion, and artificial tumors with 2 and 4 cm radius were simulated for each scaled waveform. The center of mass and volume of resorted 4D-CT images were calculated and compared to the expected values of center of mass and volume for the artificial tumor. Intrasubject variability was investigated by running the virtual scanner over different subintervals of each patient's breathing waveform. Results: The average error in the center of mass location of an artificial tumor was less than 2 mm standard deviation for 2 cm motion. The corresponding average error in volume was less than 4%. In the worst-case scenarios, a center of mass error of 1.0 cm standard deviation and volume errors of 30%-60% at inhale were found. Systematic errors were observed in a subset of patients due to irregular breathing, and these errors were more pronounced when the tumor volume is smaller. Conclusions: Irregular breathing during 4D-CT simulation causes systematic errors in volume and center of mass measurements. These errors are small but depend on the tumor size, motion amplitude, and degree of breathing irregularity.

  15. Improving abdomen tumor low-dose CT images using dictionary learning based patch processing and unsharp filtering.

    PubMed

    Chen, Yang; Yu, Fei; Luo, Limin; Toumoulin, Christine

    2013-01-01

    Reducing patient radiation dose, while maintaining a high-quality image, is a major challenge in Computed Tomography (CT). The purpose of this work is to improve abdomen tumor low-dose CT (LDCT) image quality by using a two-step strategy: a first patch-wise non linear processing is first applied to suppress the noise and artifacts, that is based on a sparsity prior in term of a learned dictionary, then an unsharp filtering aiming to enhance the contrast of tissues and compensate the contrast loss caused by the DL processing. Preliminary results show that the proposed method is effective in suppressing mottled noise as well as improving tumor detectability.

  16. Safety and Efficacy of 68Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors

    PubMed Central

    Deppen, Stephen A.; Liu, Eric; Blume, Jeffrey D.; Clanton, Jeffrey; Shi, Chanjuan; Jones-Jackson, Laurie B.; Lakhani, Vipul; Baum, Richard P.; Berlin, Jordan; Smith, Gary T.; Graham, Michael; Sandler, Martin P.; Delbeke, Dominique; Walker, Ronald C.

    2017-01-01

    Our purpose was to evaluate safety and efficacy of 68Ga-DOTATATE PET/CT compared with 111In-pentetreotide imaging for diagnosis, staging, and restaging of pulmonary and gastroenteropancreatic neuroendocrine tumors. Methods 68Ga-DOTATATE PET/CT and 111In-pentetreotide scans were obtained for 78 of 97 consecutively enrolled patients with known or suspected pulmonary or gastroenteropancreatic neuroendocrine tumors. Safety and toxicity were measured by comparing vital signs, serum chemistry values, or acquisition-related medical complications before and after 68Ga-DOTATATE injection. Added value was determined by changes in treatment plan when 68Ga-DOTATATE PET/CT results were added to all prior imaging, including 111In-pentetreotide. Interobserver reproducibility of 68Ga-DOTATATE PET/CT scan interpretation was measured between blinded and nonblinded interpreters. Results 68Ga-DOTATATE PET/CT and 111In-pentetreotide scans were significantly different in impact on treatment (P < 0.001). 68Ga-DOTATATE PET/CT combined with CT or liver MRI changed care in 28 of 78 (36%) patients. Interobserver agreement between blinded and nonblinded interpreters was high. No participant had a trial-related event requiring treatment. Mild, transient events were tachycardia in 1, alanine transaminase elevation in 1, and hyperglycemia in 2 participants. No clinically significant arrhythmias occurred. 68Ga-DOTATATE PET/CT correctly identified 3 patients for peptide-receptor radiotherapy incorrectly classified by 111In-pentetreotide. Conclusion 68Ga-DOTATATE PET/CT was equivalent or superior to 111In-pentetreotide imaging in all 78 patients. No adverse events requiring treatment were observed. 68Ga-DOTATATE PET/CT changed treatment in 36% of participants. Given the lack of significant toxicity, lower radiation exposure, and improved accuracy compared with 111In-pentetreotide, 68Ga-DOTATATE imaging should be used instead of 111In-pentetreotide imaging where available. PMID:26769865

  17. Simultaneous detection of multiple elastic surfaces with application to tumor segmentation in CT images

    NASA Astrophysics Data System (ADS)

    Li, Kang; Jolly, Marie-Pierre

    2008-03-01

    We present a new semi-supervised method for segmenting multiple interrelated object boundaries with spherical topology in volumetric images. The core of our method is a novel graph-theoretic algorithm that simultaneously detects multiple surfaces under smoothness, distance, and elasticity constraints. The algorithm computes the global optimum of an objective function that incorporates boundary, regional and surface elasticity information. A single straight line drawn by the user in a cross-sectional slice is the sole user input, which roughly indicates the extent of the object. We employ a multi-seeded Dijkstra-based range competition algorithm to pre-segment the object on two orthogonal multiplanar reformatted (MPR) planes that pass through the input line. Based on the 2D pre-segmentation results, we estimate the object and background intensity histograms, and employ an adaptive mean-shift mode-seeking process on the object histogram to automatically determine the number of surface layers to be segmented. The final multiple-surface segmentation is performed in an ellipsoidal coordinate frame constructed by an automated ellipsoid fitting procedure. We apply our method to the segmentation of liver lesions with necrosis or calcification, and various other tumors in CT images. For liver tumor segmentation, our method can simultaneously delineate both tumor and necrosis boundaries. This capability is unprecedented and is valuable for cancer diagnosis, treatment planning, and evaluation.

  18. Flat-Panel Cone-Beam Ct-Guided Radiofrequency Ablation of Very Small (≤1.5 cm) Liver Tumors: Technical Note on a Preliminary Experience

    SciTech Connect

    Cazzato, Roberto Luigi Buy, Xavier Alberti, Nicolas Fonck, Mariane; Grasso, Rosario Francesco; Palussière, Jean

    2015-02-15

    PurposeThe aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (<1.5 cm) liver tumors.Materials and MethodsPatients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized ≤1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients’ lesions and procedural variables were recorded and analyzed.ResultsThree patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted <120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 ± 5.7 min. Mean overall procedural time was 66.0 ± 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up.ConclusionPercutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.

  19. Assessment of contrast enhanced respiration managed cone-beam CT for image guided radiotherapy of intrahepatic tumors

    SciTech Connect

    Jensen, Nikolaj K. G.; Stewart, Errol; Lock, Michael; Fisher, Barbara; Kozak, Roman; Chen, Jeff; Lee, Ting-Yim; Wong, Eugene

    2014-05-15

    Purpose: Contrast enhancement and respiration management are widely used during image acquisition for radiotherapy treatment planning of liver tumors along with respiration management at the treatment unit. However, neither respiration management nor intravenous contrast is commonly used during cone-beam CT (CBCT) image acquisition for alignment prior to radiotherapy. In this study, the authors investigate the potential gains of injecting an iodinated contrast agent in combination with respiration management during CBCT acquisition for liver tumor radiotherapy. Methods: Five rabbits with implanted liver tumors were subjected to CBCT with and without motion management and contrast injection. The acquired CBCT images were registered to the planning CT to determine alignment accuracy and dosimetric impact. The authors developed a simulation tool for simulating contrast-enhanced CBCT images from dynamic contrast enhanced CT imaging (DCE-CT) to determine optimal contrast injection protocols. The tool was validated against contrast-enhanced CBCT of the rabbit subjects and was used for five human patients diagnosed with hepatocellular carcinoma. Results: In the rabbit experiment, when neither motion management nor contrast was used, tumor centroid misalignment between planning image and CBCT was 9.2 mm. This was reduced to 2.8 mm when both techniques were employed. Tumors were not visualized in clinical CBCT images of human subjects. Simulated contrast-enhanced CBCT was found to improve tumor contrast in all subjects. Different patients were found to require different contrast injections to maximize tumor contrast. Conclusions: Based on the authors’ animal study, respiration managed contrast enhanced CBCT improves IGRT significantly. Contrast enhanced CBCT benefits from patient specific tracer kinetics determined from DCE-CT.

  20. Artificial pleural effusion in percutaneous microwave ablation of hepatic tumors near the diaphragm under the guidance of ultrasound

    PubMed Central

    Wang, Gang; Sun, Yao; Cong, Lin; Jing, Xuehong; Yu, Jing

    2015-01-01

    Objective: To evaluate the feasibility, safety and efficacy of artificial pleural effusion in percutaneous microwave ablation of hepatic tumors near the diaphragm under ultrasound guidance. Methods: For localization and navigation of tumors near the dome of the diaphragm by ultrasound during microwave ablation in 14 tumors of 11 cases, artificial pleural effusion was performed in the volume of 1000~1500 ml of Normal saline or 5% Glucose injection solution via the right thoracic cavity. The tumor marker, AFP was monitored before and after operation in 6 times in a period of 2 years. We analyzed the successful rate and effectiveness of artificial pleural effusion. Results: The successful rate of artificial pleural effusion was 100% without complications. Artificial hydrothorax on the right eliminated the interference of intrapulmonary gas to the visualization of hepatic tumors near the diaphragm on ultrasound. In the follow-up of 2 years, the ablation rate reached to 92.9% with no serious complications. The AFP value before operation was in significant statistical difference with the others after operation (P = 0.000). Conclusions: Artificial pleural effusion aids the visualization of hepatic tumors near the diaphragm on ultrasound. A good therapeutic effectiveness can be reached in percutaneous microwave ablation of tumors in the hepatic dome under the guidance of ultrasound. PMID:26629218

  1. Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors.

    PubMed

    Mostafa, Elian M; Ganguli, Suvranu; Faintuch, Salomao; Mertyna, Pawel; Goldberg, S Nahum

    2008-12-01

    To determine the optimum combination strategy of transcatheter arterial chemoembolization and radiofrequency (RF) ablation in an experimentally induced hepatic tumor model. Twenty-five New Zealand White rabbits with VX2 carcinoma-induced hepatic tumors were randomly divided into five treatment groups, which received (i) chemoembolization followed 15 minutes later by RF ablation; (ii) RF ablation followed by chemoembolization; (iii) chemoembolization alone; (iv) RF ablation alone; and (v) bland embolization followed by RF ablation. Animals were euthanized at 48 hours to determine tumor infarction and coagulation, which were compared with analysis of variance. Representative histopathologic slides were compared. Significantly larger areas of coagulation were produced by chemoembolization followed by RF ablation (22.0 cm(3) +/- 7.7) compared with RF ablation followed by chemoembolization (13.1 cm(3) +/- 3.2) and RF ablation alone (10.0 cm(3) +/- 4.5; P < .05). RF ablation followed by chemoembolization showed larger treatment areas than chemoembolization alone (25.0 cm(3) +/- 9.6 vs 12.1 cm(3) +/- 4.6; P < .001), with chemotherapeutic agent preferentially depositing around the coagulation zone. Histopathologic analysis revealed greater vascular thrombosis and necrosis and reduced islands of viable tumor cells in the chemoembolization/RF ablation group versus the groups treated with chemoembolization alone or bland embolization/RF ablation. Larger treatment volumes were produced when chemoembolization was performed before RF ablation than when RF ablation preceded chemoembolization or when RF ablation or chemoembolization were performed alone. Larger treatment volumes were also produced when chemoembolization rather than bland embolization was performed before RF ablation, indicating the importance and synergy of the chemotherapeutic regimen. These results suggest that the reduction of tumor blood flow combined with the effect of hyperthermia and local chemotherapy

  2. Glutamine Sensitivity Analysis Identifies the xCT Antiporter as a Common Triple Negative Breast Tumor Therapeutic Target

    PubMed Central

    Timmerman, Luika A.; Holton, Thomas; Yuneva, Mariia; Louie, Raymond J.; Padró, Mercè; Daemen, Anneleen; Hu, Min; Chan, Denise A.; Ethier, Stephen P.; van ‘t Veer, Laura J.; Polyak, Kornelia; McCormick, Frank; Gray, Joe W.

    2014-01-01

    SUMMARY A handful of tumor-derived cell lines form the mainstay of cancer therapeutic development, yielding drugs with impact typically measured as months to disease progression. To develop more effective breast cancer therapeutics and more readily understand their clinical impact, we constructed a functional metabolic portrait of 46 independently-derived breast cell lines. Our analysis of glutamine uptake and dependence identified a subset of triple negative samples that are glutamine auxotrophs. Ambient glutamine indirectly supports environmental cystine acquisition via the xCT antiporter, which is expressed on 1/3 of triple negative tumors in vivo. xCT inhibition with the clinically approved anti-inflammatory Sulfasalazine decreases tumor growth revealing a therapeutic target in breast tumors of poorest prognosis, and a lead compound for rapid, effective drug development. PMID:24094812

  3. Single center comparison of laparoscopic cryoablation and CT-guided percutaneous cryoablation for renal tumors.

    PubMed

    Derweesh, Ithaar H; Malcolm, John B; Diblasio, Christopher J; Giem, Andrew; Rewcastle, John C; Wake, Robert W; Patterson, Anthony L; Gold, Robert

    2008-11-01

    Cryoablation has demonstrated therapeutic effectiveness for selected renal tumors. We compared our perioperative and short-term outcomes of laparoscopic (LAP) v percutaneous (PERC) renal cryoablation. Thirty-four patients (18 men/16 women) underwent a LAP and 26 patients (19 men/7 women) underwent a PERC procedure between September1998 and January 2007. LAP cryoablation was performed transperitoneally with ultrasonographic monitoring. PERC cryoablation was performed with CT guidance. Follow-up imaging was obtained at regular intervals. Mean follow-up was 25 months. Average age (years) was 67.0 for the LAP and 69.7 for the PERC procedure (P = 0.307). Mean body mass index (kg/m(2)) was 29.8 for those undergoing LAP and 28.7 for those undergoing PERC procedures (P = 0.543). Mean tumor size (cm) was 2.9 for LAP patients and 3.1 for PERC patients (P = 0.432). Anterior tumors comprised 61.7% of LAP and 15.4% of PERC procedures (P < 0.001). Posterior tumors comprised 32.4% of LAP and 65.4% of PERC procedures (P = 0.01). Mean procedure time (minutes) was 165.7 for LAP and 106.6 for PERC procedures (P < 0.001). Hospital stay (days) was 2.6 for those undergoing LAP and 1.8 for those undergoing PERC procedures (P < 0.001). Both LAP patients (82.4%) and PERC patients (19.2%) needed postoperative narcotics (P < 0.001). Atelectasis developed in 70.6% of LAP patients and 34.6% of PERC patients (P = 0.005). Residual enhancement was seen in 11.5% of PERC patients and 2.9% of LAP patients (P = 0.192). Complications developed in 14.7% of LAP patients and 26.9% of PERC patients (P = 0.248). 1-year, 2-year, and 3-year disease-specific survival for the two groups was 100%. Tumor size > 4 cm and endophytic location were significantly associated with residual enhancement. LAP and PERC renal cryoablation have similar short-term outcomes. Significantly more anterior tumors were approached laparoscopically and significantly more posterior tumors were approached percutaneously. The PERC

  4. Tumor necrosis factor-alpha impairs hepatic insulin signaling and stimulates the overproduction of hepatic apolipoprotein B100-containing very low density lipoproteins

    USDA-ARS?s Scientific Manuscript database

    Mechanisms underlying hepatic overproduction of apolipoprotein B (apoB) 100-containing very low density lipoproteins (VLDL) in insulin resistance induced by tumor necrosis factor (TNF)-a were investigated. In the present study, we examined the potential role of TNF-a in insulin signaling and lipopro...

  5. Tumor necrosis factor-alpha impairs hepatic insulin signaling and stumlates the overproduction of hepatic apolipoprotein B100-containing very low density lipoproteins

    USDA-ARS?s Scientific Manuscript database

    Mechanisms underlying hepatic overproduction of apolipoprotein B (apoB) 100-containing very low density lipoproteins (VLDL) in insulin resistance induced by tumor necrosis factor (TNF)-a were investigated. In the present study, we examined the potential role of TNF-a in insulin signaling and lipopro...

  6. Integrated imaging of hepatic tumors in childhood. Part II. Benign lesions (congenital, reparative, and inflammatory)

    SciTech Connect

    Miller, J.H.; Greenspan, B.S.

    1985-01-01

    The authors have encountered benign liver masses as frequently as malignant lesions in children with hepatomegaly. Lesions studied included abscesses, cavernous hemangioma/hemangioendothelioma, adenoma of glycogen storage disease, choledochal cysts, focal nodular hyperplasia, cystic hepatoblastoma, and hamartoma. An intergrated imaging protocol involving ultrasound, computed tomography, and scintigraphy proved to be more helpful than any one modality in establishing the benign or malignant nature of a hepatic neoplasm and the type of tumor, which is of particular importance when surgical exploration and/or biopsy is contraindicated.

  7. Targeted CT/MR dual mode imaging of tumors using multifunctional dendrimer-entrapped gold nanoparticles.

    PubMed

    Chen, Qian; Li, Kangan; Wen, Shihui; Liu, Hui; Peng, Chen; Cai, Hongdong; Shen, Mingwu; Zhang, Guixiang; Shi, Xiangyang

    2013-07-01

    We report the synthesis and characterization of folic acid (FA)-modified multifunctional dendrimer-entrapped gold nanoparticles (Au DENPs) loaded with gadolinium (Gd) for targeted dual mode computed tomography (CT)/magnetic resonance (MR) imaging of tumors. In this work, amine-terminated generation 5 poly(amidoamine) dendrimers (G5.NH2) modified with Gd(III) chelator, polyethylene glycol (PEG) monomethyl ether, and PEGylated FA were used as templates to entrap gold nanoparticles (AuNPs). Further chelation of Gd(III) ions and acetylation of the remaining dendrimer terminal amines led to the formation of multifunctional FA-targeted Au DENPs loaded with Gd(III) (Gd-Au DENPs-FA). The formed Gd-Au DENPs-FA probes were characterized via different techniques. We show that the Gd-Au DENPs-FA probes with an Au NP core size of 4.0 nm are water dispersible, stable under different pH and temperature conditions, and cytocompatible in the given concentration range. With the co-existence of AuNPs and Gd(III) ions within the single multifunctional particles, Gd-Au DENPs-FA displayed high X-ray attenuation intensity and reasonable r1 relaxivity. These properties of the particles enabled them to be used as dual mode nanoprobes for targeted CT/MR imaging of cancer cells in vitro and xenograft tumor model in vivo via FA receptor-mediated active targeting pathway. The strategy to design multifunctional nanoprobes using the versatile dendrimer nanotechnology may be extended to design various dual mode or multimode imaging agents for accurate diagnosis of different types of cancer. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Defining vascular signatures of malignant hepatic masses: role of MDCT with 3D rendering.

    PubMed

    Ahmed, Sameer; Johnson, Pamela T; Fishman, Elliot K

    2013-08-01

    Malignant hepatic masses, both primary and metastatic lesions, have characteristic CT appearances and enhancement patterns. Owing to advances in CT resolution, high-quality vascular maps can be generated with 3D rendering tools to aid hepatic mass evaluation. These renderings enable identification of neovascularity, which is critical for distinguishing malignant from benign lesions, and facilitate identification of small hyperenhancing malignant hepatic tumors. In this review, CT features of malignant hepatic masses are discussed in conjunction with a demonstration of the role for 3D vascular mapping.

  9. Feasibility of Preoperative FDG PET/CT Total Hepatic Glycolysis in the Remnant Liver for the Prediction of Postoperative Liver Function.

    PubMed

    Cho, Arthur; Chung, Yong Eun; Choi, Jin Sub; Kim, Kyung Sik; Choi, Gi Hong; Park, Young Nyun; Kim, Myeong-Jin

    2017-03-01

    The objective of our study was to investigate the prognostic value of total glycolysis of the remnant liver, which reflects both metabolic and anatomic liver function, for predicting postoperative hepatic insufficiency. Patients who underwent (18)F-FDG PET/CT and abdominal CT within 1 month of major hepatectomy were retrospectively analyzed. Total liver volume, remnant liver volume, the ratio of the remnant hepatic volume to the preoperative hepatic volume (RFRHV), and mean standardized uptake value (SUVmean) were measured, and total glycolysis of the remnant liver was calculated. Clinical hepatic function reserve values, including the indocyanine green retention rate at 15 minutes, the model for end-stage liver disease (MELD) score, and aspartate aminotransferase to platelet ratio index (APRI), were calculated. Univariate and multivariate analyses were performed, and an optimal model for predicting hepatic insufficiency was developed. ROC curves were used to compare diagnostic performance. Of 149 patients, seven patients had hepatic insufficiency. The SUVmean showed the highest sensitivity (100%; specificity, 31.7%) for predicting hepatic insufficiency, and total glycolysis of the remnant liver showed the highest specificity (96.5%; sensitivity, 57.1%) for predicting hepatic insufficiency. On multivariate analysis, the odds ratio of APRI (> 5.4) and total glycolysis of the remnant liver (≤ 625.6) was 46.3 and 82.9, respectively, for predicting hepatic insufficiency. On ROC curve analysis, a new model composed of APRI and total glycolysis of the remnant liver showed a higher area under the ROC curve (Az) value (Az = 0.899) than SUVmean (0.659), MELD score (0.618), APRI (0.693), RFRHV (0.797), and remnant liver volume (0.762). The total glycolysis of the remnant liver has moderate sensitivity and high specificity for predicting hepatic insufficiency. Combining the total glycolysis of the remnant liver and APRI yielded the best diagnostic performance for predicting

  10. A black adrenal adenoma difficult to be differentiated from a malignant adrenal tumor by CT, MRI, scintigraphy and FDG PET/CT examinations.

    PubMed

    Nakajo, Masatoyo; Nakajo, Masayuki; Kajiya, Yoriko; Tani, Atsushi; Tsuruta, Masashi; Sugita, Satoshi; Fushitani, Shunsaku; Umekita, Yoshihisa

    2011-12-01

    Black adrenal adenoma (BAA) is an adrenal adenoma which contains lipofuscin and has a black or brown appearance. Preoperative diagnosis of BAA is difficult because it is diagnosed by pathologic findings. We report a case of an incidentally discovered non-hyperfunctioning BAA in the left adrenal gland of a 58-year-old man. It showed an oval lipid-poor mass, 3 cm × 2 cm in size on computed tomography (CT) and magnetic resonance imaging (MRI), no avid uptake of (131)I-norcholesterol and (123)I-meta-iodobenzylguanidine (MIBG) on scintigraphy, and intense avid uptake of (18)F-fluorodeoxyglucose (FDG) on positron emission tomography-CT (PET/CT). FDG PET/CT showed that it was a hypermetabolic lesion, more intense than the activity of the liver, and the maximum standardized uptake value was 5.6 on 1-h early imaging and 8.3 on 2-h delayed imaging, suggesting a malignant tumor. BAA is a clinically rare benign adrenal adenoma, but it should be kept in mind that BAA may exhibit false-positive results for malignancy or inconclusive results for benignity with modern imaging modalities including CT, MRI, adrenal scintigraphy with radiolabelled cholesterol and radiolabelled MIBG, and FDG-PET like this case.

  11. Genomic Profiling Reveals an Alternate Mechanism for Hepatic Tumor Promotion by Perfluorooctanoic Acid in Rainbow Trout

    PubMed Central

    Tilton, Susan C.; Orner, Gayle A.; Benninghoff, Abby D.; Carpenter, Hillary M.; Hendricks, Jerry D.; Pereira, Cliff B.; Williams, David E.

    2008-01-01

    Background Perfluorooctanoic acid (PFOA) is a potent hepatocarcinogen and peroxisome proliferator (PP) in rodents. Humans are not susceptible to peroxisome proliferation and are considered refractory to carcinogenesis by PPs. Previous studies with rainbow trout indicate they are also insensitive to peroxisome proliferation by the PP dehydroepiandrosterone (DHEA), but are still susceptible to enhanced hepatocarcinogenesis after chronic exposure. Objectives In this study, we used trout as a unique in vivo tumor model to study the potential for PFOA carcinogenesis in the absence of peroxisome proliferation compared with the structurally diverse PPs clofibrate (CLOF) and DHEA. Mechanisms of carcinogenesis were identified from hepatic gene expression profiles phenotypically anchored to tumor outcome. Methods We fed aflatoxin B1 or sham-initiated animals 200–1,800 ppm PFOA in the diet for 30 weeks for tumor analysis. We subsequently examined gene expression by cDNA array in animals fed PFOA, DHEA, CLOF, or 5 ppm 17β-estradiol (E2, a known tumor promoter) in the diet for 14 days. Results PFOA (1,800 ppm or 50 mg/kg/day) and DHEA treatments resulted in enhanced liver tumor incidence and multiplicity (p < 0.0001), whereas CLOF showed no effect. Carcinogenesis was independent of peroxisome proliferation, measured by lack of peroxisomal β-oxidation and catalase activity. Alternately, both tumor promoters, PFOA and DHEA, resulted in estrogenic gene signatures with strong correlation to E2 by Pearson correlation (R = 0.81 and 0.78, respectively), whereas CLOF regulated no genes in common with E2. Conclusions These data suggest that the tumor-promoting activities of PFOA in trout are due to novel mechanisms involving estrogenic signaling and are independent of peroxisome proliferation. PMID:18709148

  12. Localization of Unknown Primary Site with (68)Ga-DOTATOC PET/CT in Patients with Metastatic Neuroendocrine Tumor.

    PubMed

    Menda, Yusuf; O'Dorisio, Thomas M; Howe, James R; Schultz, Michael; Dillon, Joseph S; Dick, David; Watkins, G Leonard; Ginader, Timothy; Bushnell, David L; Sunderland, John J; Zamba, Gideon K D; Graham, Michael; O'Dorisio, M Sue

    2017-07-01

    Localization of the site of the unknown primary tumor is critical for surgical treatment of patients presenting with neuroendocrine tumor (NET) with metastases. Methods: Forty patients with metastatic NET and unknown primary site underwent (68)Ga-DOTATOC PET/CT in a single-site prospective study. The (68)Ga-DOTATOC PET/CT was considered true-positive if the positive primary site was confirmed by histology or follow-up imaging. The scan was considered false-positive if no primary lesion was found corresponding to the (68)Ga-DOTATOC-positive site. All negative scans for primary tumor were considered false-negative. A scan was classified unconfirmed if (68)Ga-DOTATOC PET/CT suggested a primary, however, no histology was obtained and imaging follow-up was not confirmatory. Results: The true-positive, false-positive, false-negative, and unconfirmed rates for unknown primary tumor were 38%, 7%, 50%, and 5%, respectively. Conclusion:(68)Ga-DOTATOC PET/CT is an effective modality in the localization of unknown primary in patients with metastatic NET. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

  13. Paraneoplastic pemphigus as a first sign of metastatic retroperitoneal inflammatory myofibroblastic tumor: (18)F-FDG PET/CT findings.

    PubMed

    Dhull, V S; Passah, A; Rana, N; Arora, S; Mallick, S; Kumar, R

    2016-01-01

    A 30-year-old female presented with a 3-month history of erosive stomatitis and bullous lesions, along with recurrent episodes of abdominal pain. She was found to have a retroperitoneal lump in left lumbar region. Skin biopsy revealed bullous disorder. CT guided biopsy of the retroperitoneal mass was suggestive of inflammatory myofibroblastic tumor (IMT). She was started on oral steroids and supportive care, and surgery was being planned when she developed respiratory failure. CT chest revealed vertebral metastases. PET/CT for whole body work up revealed a left para-aortic mass along with multiple skeletal metastases. The patient was kept on conservative management. After 3 months, the patient has shown clinical improvement, and an exploratory laparotomy is now being planned for the excision of the tumor, followed by chemotherapy. This case of retroperitoneal IMT is rare in terms of skeletal metastases with paraneoplastic pemphigus.

  14. SU-D-202-03: Statistical Segmentation On Quantitative CT for Assessing Spatial Tumor Response During Radiation Therapy Delivery

    SciTech Connect

    Schott, D; Chen, X; Klawikowski, S; Noid, G; Dalah, E; Li, X; Schmidt, T

    2016-06-15

    Purpose: Develop a method to segment regions of interest (ROIs) in tumor with statistically similar Hounsfield unit (HU) values and/or HU changes during chemoradiation therapy (CRT) delivery, to assess spatial tumor treatment response based on daily CTs during CRT delivery. Methods: Generate a three region map of ROIs with differential HUs, by sampling neighboring voxels around a selected voxel and comparing to the mean of the entire ROI using a t-test. The cumulative distribution function, P, is calculated from the t-test. The P value is assigned to be the value at the selected voxel, and this is repeated over all voxels in the initial ROI. Three regions are defined as: (1-P) < 0.00001 (mid region), and 0.00001 < (1-P) (mean greater than baseline and mean lower than baseline). The test is then expanded to compare daily CT sets acquired during routine CT-guided RT delivery using a CT-on-rails. The first fraction CT is used as the baseline for comparison. We tested 15 pancreatic head tumor cases undergoing CRT, to identify the ROIs and changes corresponding to normal, fibrotic, and tumor tissue. The obtained ROIs were compared with MRI-ADC maps acquired pre- and post-CRT. Results: The ROIs in 13 out of 15 patients’ first fraction CTs and pre-CRT MRIs matched the general region and slices covered, as well as in 6 out of the 9 patients with post-CRT MRIs. The high HU region designated by the t-test was seen to correlate with the tumor region in MR, and these ROIs are positioned within the same region over the course of treatment. In patients with poorly delineated tumors in MR, the t-test was inconclusive. Conclusion: The proposed statistical segmentation technique shows the potential to identify regions in tumor with differential HUs and HU changes during CRT delivery for patients with pancreas head cancer.

  15. A Case Series of Liver Abscess Formation after Transcatheter Arterial Chemoembolization for Hepatic Tumors

    PubMed Central

    Sun, Wei; Xu, Fei; Li, Xiao; Li, Chen-Rui

    2017-01-01

    Background: Liver abscess is a serious complication following transcatheter arterial chemoembolization (TACE). Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches. Methods: From June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess after TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records. Results: These five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. After percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures. Conclusions: TACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration. PMID:28524831

  16. A Case Series of Liver Abscess Formation after Transcatheter Arterial Chemoembolization for Hepatic Tumors.

    PubMed

    Sun, Wei; Xu, Fei; Li, Xiao; Li, Chen-Rui

    2017-06-05

    Liver abscess is a serious complication following transcatheter arterial chemoembolization (TACE). Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches. From June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess after TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records. These five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. After percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures. TACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration.

  17. Bitargeted microemulsions based on coix seed ingredients for enhanced hepatic tumor delivery and synergistic therapy.

    PubMed

    Qu, Ding; Sun, Wenjie; Liu, Mingjian; Liu, Yuping; Zhou, Jing; Chen, Yan

    2016-04-30

    A hepatic tumor bitargeted microemulsions drug delivery system using coix seed oil and coix seed polysaccharide (CP) acting as anticancer components, as well as functional excipients, was developed for enhanced tumor-specific accumulation by CP-mediated enhancement on passive tumor targeting and modification of galactose stearate (tumor-targeted ligand). In the physicochemical characteristics studies, galactose stearate-modified coix seed multicomponent microemulsions containing 30% CP (w%) (Gal-C-MEs) had a well-defined spherical shape with a small size (47.63 ± 1.41 nm), a narrow polydispersity index (PDI, 0.101 ± 0.002), and a nearly neutral surface charge (-4.37 ± 1.76 mV). The half-maximal inhibitory concentration (IC50) of Gal-C-MEs against HepG2 cells was 70.2 μg/mL, which decreased by 1.8-fold in comparison with that of coix seed multicomponent microemulsions (C-MEs). The fluorescence intensity of fluorescein isothiocyanate (FITC)-loaded Gal-C-MEs (FITC-Gal-C-MEs) internalized by HepG2 cells was 1.8-fold higher than that of FITC-loaded C-MEs (FIT C-C-MEs), but the cellular uptake of the latter became reduce by 1.6-fold when the weight ratio of CP decreased up to 10%. In the cell apoptosis studies, C-MEs (containing 30% CP) did not show a significant difference with Gal-C-MEs, but exhibited 3.3-fold and 1.5-fold increase relative to C-MEs containing 10% CP and 20% CP, respectively. In the in vivo tumor targeting studies, Cy5-loaded Gal-C-MEs (Cy5-Gal-C-MEs), notably distributed in the tumor sites and still found even at 48 h post-administration, displayed the strongest capability of tumor tissue accumulation and retention among all the test groups. Most importantly, Gal-C-MEs had stronger inhibition of tumor growth, prolonged survival time and more effectively tumor cell apoptosis induction in comparison with C-MEs containing different amounts of CP, which further confirmed that a certain amount of CP and tumor-targeted ligand were of great importance to

  18. Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors.

    PubMed

    Ichida, Hirofumi; Ishizawa, Takeaki; Tanaka, Masayuki; Terasawa, Muga; Watanabe, Genki; Takeda, Yoshinori; Matsuki, Ryota; Matsumura, Masaru; Hata, Taigo; Mise, Yoshinori; Inoue, Yosuke; Takahashi, Yu; Saiura, Akio

    2017-03-01

    The aim of this study was to demonstrate the detailed surgical techniques of laparoscopic hepatectomy using intercostal transthoracic trocars for subcapsular tumors located in segment VII or VIII. Intercostal transthoracic trocars were used in patients undergoing laparoscopic hepatectomy for tumors located in segment VII or VIII. Following establishment of pneumoperitoneum and placement of abdominal trocars, balloon-tipped trocars were inserted into the abdominal cavity from the intercostal space and through the pleural space and diaphragm. Upon placement of the intercostal trocars, the lung edge was confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hemispherical wedge resection of segment VII or VIII was performed using the intercostal trocars as a camera port or for the forceps of the surgeon's left hand. After the hepatectomy, the holes in the diaphragm were sutured closed. Among the 79 patients who underwent laparoscopic hepatectomy, intercostal trocars were used in 14 patients for resection of tumors located in segment VII (4 nodules) or VIII (10 nodules). The median (range) operation time and amount of blood loss for hepatectomy were 225 (109-477) min and 60 (20-310) mL, respectively. No postoperative complications associated with hepatectomy or the use of intercostal trocars occurred. Use of intercostal transthoracic trocars is safe and effective not only for complicated laparoscopic hepatectomy but also for hemispherical wedge resections of subcapsular hepatic tumors located in segment VII or VIII.

  19. Evaluating dynamic contrast-enhanced and photoacoustic CT to assess intra-tumor heterogeneity in xenograft mouse models

    NASA Astrophysics Data System (ADS)

    Stantz, Keith M.; Liu, Bo; Cao, Minsong; Reinecke, Dan; Dzemidzic, Mario; Liang, Yun; Kruger, Robert

    2006-03-01

    Purpose: To evaluate photoacoustic CT spectroscopy (PCT-S) and dynamic contrast-enhanced CT (DCE-CT) ability to measure parameters - oxygen saturation and vascular physiology - associated with the intra-tumor oxygenation status. Material and Methods: Breast (VEGF165 enhance MCF-7) and ovarian (SKOV3x) cancer cells were implanted into the fat pads and flanks of immune deficient mice and allowed to grow to a diameter of 8-15 mm. CT was used to determine physiological parameters by acquiring a sequence of scans over a 10 minute period after an i.v. injection of a radio-opaque contrast agent (Isovue). These time-dependent contrast-enhanced curves were fit to a two-compartmental model determining tumor perfusion, fractional plasma volume, permeability-surface area produce, and fractional interstitial volume on a voxel-by-voxel basis. After which, the tumors were imaged using photoacoustic CT (Optosonics, Inc., Indianapolis, IN 46202). The near infrared spectra (700-910 nm) within the vasculature was fit to linear combination of measured oxy- and deoxy-hemoglobin blood samples to obtain oxygen saturation levels (SaO II). Results: The PCT-S scanner was first calibrated using different samples of oxygenated blood, from which a statistical error ranging from 2.5-6.5% was measured and a plot of the hemoglobin dissociation curve was consistent with empirical formula. In vivo determination of tumor vasculature SaO II levels were measurably tracked, and spatially correlated to the periphery of the tumor. Tumor depend variations in SaO II - 0.32 (ovarian) and 0.60 (breast) - and in vascular physiology - perfusion, 1.03 and 0.063 mL/min/mL, and fractional plasma volume, 0.20 and 0.07 - were observed. Conclusion: Combined, PCT-S and CED-CT has the potential to measure intra-tumor levels of tumor oxygen saturation and vascular physiology, key parameters associated with hypoxia.

  20. CT, MRI, and (18)F-FDG PET/CT findings of malignant peripheral nerve sheath tumor of the head and neck.

    PubMed

    Kim, Ha Youn; Hwang, Ji Young; Kim, Hyung-Jin; Kim, Yi Kyung; Cha, Jihoon; Park, Gyeong Min; Kim, Sung Tae

    2017-10-01

    Background Malignant peripheral nerve sheath tumor (MPNST) is a highly malignant tumor and rarely occurs in the head and neck. Purpose To describe the imaging features of MPNST of the head and neck. Material and Methods We retrospectively analyzed computed tomography (CT; n = 14), magnetic resonance imaging (MRI; n = 16), and (18)F-FDG PET/CT (n = 5) imaging features of 18 MPNSTs of the head and neck in 17 patients. Special attention was paid to determine the nerve of origin from which the tumor might have arisen. Results All lesions were well-defined (n = 3) or ill-defined (n = 15) masses (mean, 6.1 cm). Lesions were at various locations but most commonly the neck (n = 8), followed by the intracranial cavity (n = 3), paranasal sinus (n = 2), and orbit (n = 2). The nerve of origin was inferred for 11 lesions: seven in the neck, two in the orbit, one in the cerebellopontine angle, and one on the parietal scalp. Attenuation, signal intensity, and enhancement pattern of the lesions on CT and MRI were non-specific. Necrosis/hemorrhage/cystic change within the lesion was considered to be present on images in 13 and bone change in nine. On (18)F-FDG PET/CT images, all five lesions demonstrated various hypermetabolic foci with maximum standard uptake value (SUVmax) from 3.2 to 14.6 (mean, 7.16 ± 4.57). Conclusion MPNSTs can arise from various locations in the head and neck. Though non-specific, a mass with an ill-defined margin along the presumed course of the cranial nerves may aid the diagnosis of MPSNT in the head and neck.

  1. Temporal change analysis for improved tumor detection in dedicated CT breast imaging using affine and free-form deformation

    NASA Astrophysics Data System (ADS)

    Dey, Joyoni; O'Connor, J. Michael; Chen, Yu; Glick, Stephen J.

    2008-03-01

    Preliminary evidence has suggested that computerized tomographic (CT) imaging of the breast using a cone-beam, flat-panel detector system dedicated solely to breast imaging has potential for improving detection and diagnosis of early-stage breast cancer. Hypothetically, a powerful mechanism for assisting in early stage breast cancer detection from annual screening breast CT studies would be to examine temporal changes in the breast from year-to-year. We hypothesize that 3D image registration could be used to automatically register breast CT volumes scanned at different times (e.g., yearly screening exams). This would allow radiologists to quickly visualize small changes in the breast that have developed during the period since the last screening CT scan, and use this information to improve the diagnostic accuracy of early-stage breast cancer detection. To test our hypothesis, fresh mastectomy specimens were imaged with a flat-panel CT system at different time points, after moving the specimen to emulate the re-positioning motion of the breast between yearly screening exams. Synthetic tumors were then digitally inserted into the second CT scan at a clinically realistic location (to emulate tumor growth from year-to-year). An affine and a spline-based 3D image registration algorithm was implemented and applied to the CT reconstructions of the specimens acquired at different times. Subtraction of registered image volumes was then performed to better analyze temporal change. Results from this study suggests that temporal change analysis in 3D breast CT can potentially be a powerful tool in improving the visualization of small lesion growth.

  2. Targeting xCT, a cystine-glutamate transporter induces apoptosis and tumor regression for KSHV/HIV-associated lymphoma

    PubMed Central

    2014-01-01

    Kaposi’s sarcoma-associated herpesvirus (KSHV) is the etiological agent of primary effusion lymphoma (PEL), which represents a rapidly progressing malignancy arising in HIV-infected patients. Conventional chemotherapy for PEL treatment induces unwanted toxicity and is ineffective — PEL continues to portend nearly 100% mortality within a period of months, which requires novel therapeutic strategies. The amino acid transporter, xCT, is essential for the uptake of cystine required for intracellular glutathione (GSH) synthesis and for maintaining the intracellular redox balance. Inhibition of xCT induces growth arrest in a variety of cancer cells, although its role in virus-associated malignancies including PEL remains unclear. In the current study, we identify that xCT is expressed on the surface of patient-derived KSHV+ PEL cells, and targeting xCT induces caspase-dependent cell apoptosis. Further experiments demonstrate the underlying mechanisms including host and viral factors: reducing intracellular GSH while increasing reactive oxygen species (ROS), repressing cell-proliferation-related signaling, and inducing viral lytic genes. Using an immune-deficient xenograft model, we demonstrate that an xCT selective inhibitor, Sulfasalazine (SASP), prevents PEL tumor progression in vivo. Together, our data provide innovative and mechanistic insights into the role of xCT in PEL pathogenesis, and the framework for xCT-focused therapies for AIDS-related lymphoma in future. PMID:24708874

  3. Ectopic ACTH and CRH co-secreting tumor localized by 68Ga-DOTA-TATE PET/CT

    PubMed Central

    Papadakis, Georgios Z.; Bagci, Ulas; Sadowski, Samira M.; Patronas, Nicholas J.; Stratakis, Constantine A.

    2015-01-01

    Diagnosis of ectopic adrenocorticotropic hormone (ACTH) and corticotropin releasing hormone (CRH) co-secreting tumors causing Cushing syndrome (CS) is challenging, since these tumors are rare and their diagnosis is frequently confused with Cushing disease (CD), due to the effect of CRH on the pituitary. We report a case of a 21-year-old male who was referred to our institution with persistent hypercortisolemia and CS after undergoing unnecessary transsphenoidal surgery (TSS). 68Ga-DOTA-TATE PET/CT revealed increased tracer uptake in the thymus which was histologically proved to be neuroendocrine tumor (NET) staining positive for ACTH and CRH. Imaging with 18F-FDG PET/CT was not diagnostic. PMID:26018709

  4. Ectopic ACTH and CRH Co-secreting Tumor Localized by 68Ga-DOTA-TATE PET/CT.

    PubMed

    Papadakis, Georgios Z; Bagci, Ulas; Sadowski, Samira M; Patronas, Nicholas J; Stratakis, Constantine A

    2015-07-01

    Diagnosis of ectopic adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) co-secreting tumors causing Cushing syndrome (CS) is challenging because these tumors are rare and their diagnosis is frequently confused with Cushing disease (CD), caused by the effect of CRH on the pituitary. We report a case of a 21-year-old male patient who was referred to our institution with persistent hypercortisolemia and CS after undergoing unnecessary transsphenoidal surgery (TSS). ⁶⁸Ga-DOTA-TATE PET/CT revealed increased tracer uptake in the thymus, which was histologically proven to be a neuroendocrine tumor (NET) that stained positive for ACTH and CRH. Imaging with ¹⁸F-FDG PET/CT was not diagnostic.

  5. FDG-Avid Portal Vein Tumor Thrombosis from Hepatocellular Carcinoma in Contrast-Enhanced FDG PET/CT

    PubMed Central

    Nguyen, Xuan Canh; Nguyen, Dinh Song Huy; Ngo, Van Tan; Maurea, Simone

    2015-01-01

    Objective(s): In this study, we aimed to describe the characteristics of portal vein tumor thrombosis (PVTT), complicating hepatocellular carcinoma (HCC) in contrast-enhanced FDG PET/CT scan. Methods: In this retrospective study, 9 HCC patients with FDG-avid PVTT were diagnosed by contrast-enhanced fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), which is a combination of dynamic liver CT scan, multiphase imaging, and whole-body PET scan. PET and CT DICOM images of patients were imported into the PET/CT imaging system for the re-analysis of contrast enhancement and FDG uptake in thrombus, the diameter of the involved portal vein, and characteristics of liver tumors and metastasis. Results: Two patients with previously untreated HCC and 7 cases with previously treated HCC had FDG-avid PVTT in contrast-enhanced FDG PET/CT scan. During the arterial phase of CT scan, portal vein thrombus showed contrast enhancement in 8 out of 9 patients (88.9%). PET scan showed an increased linear FDG uptake along the thrombosed portal vein in all patients. The mean greatest diameter of thrombosed portal veins was 1.8 ± 0.2 cm, which was significantly greater than that observed in normal portal veins (P<0.001). FDG uptake level in portal vein thrombus was significantly higher than that of blood pool in the reference normal portal vein (P=0.001). PVTT was caused by the direct extension of liver tumors. All patients had visible FDG-avid liver tumors in contrast-enhanced images. Five out of 9 patients (55.6%) had no extrahepatic metastasis, 3 cases (33.3%) had metastasis of regional lymph nodes, and 1 case (11.1%) presented with distant metastasis. The median estimated survival time of patients was 5 months. Conclusion: The intraluminal filling defect consistent with thrombous within the portal vein, expansion of the involved portal vein, contrast enhancement, and linear increased FDG uptake of the thrombus extended from liver tumor are findings of FDG

  6. Association between textural and morphological tumor indices on baseline PET-CT and early metabolic response on interim PET-CT in bulky malignant lymphomas.

    PubMed

    Ben Bouallègue, Fayçal; Tabaa, Yassine Al; Kafrouni, Marilyne; Cartron, Guillaume; Vauchot, Fabien; Mariano-Goulart, Denis

    2017-09-01

    We investigated whether metabolic, textural, and morphological tumoral indices evaluated on baseline PET-CT were predictive of early metabolic response on interim PET-CT in a cohort of patients with bulky Hodgkin and non-Hodgkin malignant lymphomas. This retrospective study included 57 patients referred for initial PET-CT examination. In-house dedicated software was used to delineate tumor contours using a fixed 30% threshold of SUV max and then to compute tumoral metabolic parameters (SUV max, mean, peak, standard deviation, skewness and kurtosis, metabolic tumoral volume (MTV), total lesion glycolysis, and area under the curve of the cumulative histogram), textural parameters (Moran's and Geary's indices, energy, entropy, contrast, correlation derived from the gray-level co-occurrence matrix, area under the curve of the power spectral density, auto-correlation distance, and granularity), and shape parameters (surface, asphericity, convexity, surfacic extension, and 2D and 3D fractal dimensions). Early metabolic response was assessed on interim PET-CT using the Deauville 5-point scale and patients were ranked according to the Lugano classification as complete or not complete metabolic responders. The impact of the segmentation method (alternate threshold at 41%) and image resolution (Gaussian postsmoothing of 3, 5, and 7 mm) was investigated. The association of the proposed parameters with early response was assessed in univariate and multivariate analyses. Their added predictive value was explored using supervised classification by support vector machines (SVM). We evaluated in leave-one-out cross-validation three SVMs admitting as input features (a) MTV, (b) MTV + histological type, and (c) MTV + histology + relevant texture/shape indices. Features associated with complete metabolic response were low MTV (P = 0.01), low TLG (P = 0.003), high power spectral density AUC (P = 0.007), high surfacic extension (P = 0.006), low 2D fractal dimension (P

  7. [Detection of tumors in the central zone of the prostate with 11C-Choline PET/CT].

    PubMed

    Garcia, J R; Soler, M; Moragas, M; Ponce, A; Moreno, C; Riera, E

    2014-01-01

    Prostate tumors originate 68% in the peripheral region and 24% in the transitional region where tumors originating in the central zone are rare (8%). However, diagnosis of the tumors in the central zone is important since they exhibit greater aggressiveness conditioned by their location and different biological behavior. Magnetic resonance imaging shows problems in identifying lesions in the central prostate zone, since this region has a heterogeneous signal, mainly after the primary treatment. Ultrasound guided sextant biopsy shows a negative result in 28% of prostate tumors. Therefore, it is advisable to repeat or even to perform saturation biopsies. We present two patients, one of them with suspected biochemical prostate cancer and one with biochemical recurrence after radical treatment. In both, (11)C-Choline PET/CT allowed detection of the tumor focus in the central zone of the prostate, with negative complementary diagnostic test and biopsies. Copyright © 2013 Elsevier España, S.L. y SEMNIM. All rights reserved.

  8. Resistance exercise prevents impaired homocysteine metabolism and hepatic redox capacity in Walker-256 tumor-bearing male Wistar rats.

    PubMed

    Deminice, Rafael; Padilha, Camila de Souza; Borges, Fernando; da Silva, Lilian Eslaine Costa Mendes; Rosa, Flávia Troncon; Robinson, Jason Lorne; Cecchini, Rubens; Guarnier, Flávia Alessandra; Frajacomo, Fernando Trevisan

    2016-10-01

    The aim of this study was to investigate changes in homocysteine (Hcy) metabolism and redox balance in response to exercise treatment in a tumor-bearing rat model. Male Wistar rats were exposed, or not, to a resistance exercise program 6 wk before inoculation with Walker-256 tumor cells or vehicle. After application, rats maintained their routine for 12 d and were then sacrificed for plasma and liver analyses. Impaired Hcy metabolism was evident after 12 d of tumor cell inoculation as demonstrated by significantly increased (P < 0.05) plasma total homocysteine (tHcy) concentration (53%) and decreased plasma cysteine, methionine, and vitamin B12 concentrations. Decreased hepatic cystathionine β-synthase (CBS) and betaine-homocysteine S-methyltransferase mRNA levels were found in tumor-bearing rats but not in controls. Tumor inoculation also decreased levels of liver reduced glutathione (GSH) and increased hepatic oxidative stress compared with non-tumor controls. However, resistance exercise prevented the tumor-impaired transsulfuration pathway as demonstrated by the decreased plasma tHcy, hepatic CBS expression, and increased GSH in tumor-exercised versus tumor-sedentary rats. Remarkably, all measures of liver oxidative stress were suppressed by exercise training. Tumor weight was unchanged between groups. Resistance exercise prevented tHcy accumulation and liver oxidative damage caused by Walker-256 tumor cell inoculation; the modulatory effects of resistance exercise on Hcy metabolism appear to be at the level of transsulfuration pathway. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Automated detection and delineation of lung tumors in PET-CT volumes using a lung atlas and iterative mean-SUV threshold

    NASA Astrophysics Data System (ADS)

    Ballangan, Cherry; Wang, Xiuying; Eberl, Stefan; Fulham, Michael; Feng, Dagan

    2009-02-01

    Automated segmentation for the delineation of lung tumors with PET-CT is a challenging task. In PET images, primary lung tumors can have varying degrees of tracer uptake, which sometimes does not differ markedly from normal adjacent structures such as the mediastinum, heart and liver. In addition, separation of tumor from adjacent soft tissues and bone in the chest wall is problematic due to limited resolution. For CT, the tumor soft tissue density can be similar to that in the blood vessels and the chest wall; and although CT provides better boundary definition, exact tumor delineation is also difficult when the tumor density is similar to adjacent structures. We propose an innovative automated adaptive method to delineate lung tumors in PET-CT images in conjunction with a lung atlas in which an iterative mean-SUV (Standardized Uptake Value) threshold is used to gradually define the tumor region in PET. Tumor delineation in the CT data is performed using region growing and seeds obtained autonomously from the PET tumor regions. We evaluated our approach in 13 patients with non-small cell lung cancer (NSCLC) and found it could delineate tumors of different size, shape and location, even when when the NSCLC involved the chest wall.

  10. Ultrastable polyethyleneimine-stabilized gold nanoparticles modified with polyethylene glycol for blood pool, lymph node and tumor CT imaging.

    PubMed

    Zhang, Yongxing; Wen, Shihui; Zhao, Lingzhou; Li, Du; Liu, Changcun; Jiang, Wenbin; Gao, Xiang; Gu, Wentao; Ma, Nan; Zhao, Jinhua; Shi, Xiangyang; Zhao, Qinghua

    2016-03-14

    Development of new long-circulating contrast agents for computed tomography (CT) imaging of different biological systems still remains a great challenge. Here, we report the design and synthesis of branched polyethyleneimine (PEI)-stabilized gold nanoparticles (Au PSNPs) modified with polyethylene glycol (PEG) for blood pool, lymph node, and tumor CT imaging. In this study, thiolated PEI was first synthesized and used as a stabilizing agent to form AuNPs. The formed Au PSNPs were then grafted with PEG monomethyl ether via PEI amine-enabled conjugation chemistry, followed by acetylation of the remaining PEI surface amines. The formed PEGylated Au PSNPs were characterized via different methods. We show that the PEGylated Au PSNPs with an Au core size of 5.1 nm have a relatively long half-decay time (7.8 h), and display a better X-ray attenuation property than conventionally used iodine-based CT contrast agents (e.g., Omnipaque), and are hemocompatible and cytocompatible in a given concentration range. These properties of the Au PSNPs afford their uses as a contrast agent for effective CT imaging of the blood pool and major organs of rats, lymph node of rabbits, and the xenografted tumor model of mice. Importantly, the PEGylated Au PSNPs could be excreted out of the body with time and also showed excellent in vivo stability. These findings suggest that the formed PEGylated Au PSNPs may be used as a promising contrast agent for CT imaging of different biological systems.

  11. Comparison of manual vs. automated multimodality (CT-MRI) image registration for brain tumors

    SciTech Connect

    Sarkar, Abhirup; Santiago, Roberto J.; Smith, Ryan; Kassaee, Alireza . E-mail: Kassaee@xrt.upenn.edu

    2005-03-31

    Computed tomgoraphy-magnetic resonance imaging (CT-MRI) registrations are routinely used for target-volume delineation of brain tumors. We clinically use 2 software packages based on manual operation and 1 automated package with 2 different algorithms: chamfer matching using bony structures, and mutual information using intensity patterns. In all registration algorithms, a minimum of 3 pairs of identical anatomical and preferably noncoplanar landmarks is used on each of the 2 image sets. In manual registration, the program registers these points and links the image sets using a 3-dimensional (3D) transformation. In automated registration, the 3 landmarks are used as an initial starting point and further processing is done to complete the registration. Using our registration packages, registration of CT and MRI was performed on 10 patients. We scored the results of each registration set based on the amount of time spent, the accuracy reported by the software, and a final evaluation. We evaluated each software program by measuring the residual error between 'matched' points on the right and left globes and the posterior fossa for fused image slices. In general, manual registration showed higher misalignment between corresponding points compared to automated registration using intensity matching. This error had no directional dependence and was, most of the time, larger for a larger structure in both registration techniques. Automated algorithm based on intensity matching also gave the best results in terms of registration accuracy, irrespective of whether or not the initial landmarks were chosen carefully, when compared to that done using bone matching algorithm. Intensity-matching algorithm required the least amount of user-time and provided better accuracy.

  12. Exploring Variability in CT Characterization of Tumors: A Preliminary Phantom Study1

    PubMed Central

    Zhao, Binsheng; Tan, Yongqiang; Tsai, Wei Yann; Schwartz, Lawrence H; Lu, Lin

    2014-01-01

    PURPOSE: To explore the effects of computed tomography (CT) slice thickness and reconstruction algorithm on quantification of image features to characterize tumors using a chest phantom. MATERIALS AND METHODS: Twenty-two phantom lesions of known sizes (10 and 20 mm), shapes (spherical, elliptical, lobulated, and spiculated), and densities [-630, -10, and +100 Hounsfield Unit (HU)] were inserted into an anthropomorphic thorax phantom and scanned three times with relocations. The raw data were reconstructed using six imaging settings, i.e., a combination of three slice thicknesses of 1.25, 2.5, and 5 mm and two reconstruction kernels of lung and standard. Lesions were segmented and 14 image features representing lesion size, shape, and texture were calculated. Differences in the measured image features due to slice thickness and reconstruction algorithm were compared using linear regression method by adjusting three confounding variables (size, density, and shape). RESULTS: All 14 features were significantly different between 1.25 and 5 mm slice images. The 1.25 and 2.5 mm slice thicknesses were better than 5 mm for volume, density mean, density SD gray-level co-occurrence matrix (GLCM) energy and homogeneity. As for the reconstruction algorithm, there was no significant difference in uni-dimension, volume, shape index 9, and compactness. Lung reconstruction was better for density mean, whereas standard reconstruction was better for density SD. CONCLUSIONS: CT slice thickness and reconstruction algorithm can significantly affect the quantification of image features. Thinner (1.25 and 2.5 mm) and thicker (5 mm) slice images should not be used interchangeably. Sharper and smoother reconstructions significantly affect the density-based features. PMID:24772211

  13. Evaluation of the tumor registration error in biopsy procedures performed under real-time PET/CT guidance.

    PubMed

    Fanchon, Louise M; Apte, Adytia; Schmidtlein, C Ross; Yorke, Ellen; Hu, Yu-Chi; Dogan, Snjezana; Hatt, Mathieu; Visvikis, Dimitris; Humm, John L; Solomon, Stephen B; Kirov, Assen S

    2017-10-01

    The purpose of this study is to quantify tumor displacement during real-time PET/CT guided biopsy and to investigate correlations between tumor displacement and false-negative results. 19 patients who underwent real-time (18) F-FDG PET-guided biopsy and were found positive for malignancy were included in this study under IRB approval. PET/CT images were acquired for all patients within minutes prior to biopsy to visualize the FDG-avid region and plan the needle insertion. The biopsy needle was inserted and a post-insertion CT scan was acquired. The two CT scans acquired before and after needle insertion were registered using a deformable image registration (DIR) algorithm. The DIR deformation vector field (DVF) was used to calculate the mean displacement between the pre-insertion and post-insertion CT scans for a region around the tip of the biopsy needle. For 12 patients one biopsy core from each was tracked during histopathological testing to investigate correlations of the mean displacement between the two CT scans and false-negative or true-positive biopsy results. For 11 patients, two PET scans were acquired; one at the beginning of the procedure, pre-needle insertion, and an additional one with the needle in place. The pre-insertion PET scan was corrected for intraprocedural motion by applying the DVF. The corrected PET was compared with the post-needle insertion PET to validate the correction method. The mean displacement of tissue around the needle between the pre-biopsy CT and the postneedle insertion CT was 5.1 mm (min = 1.1 mm, max = 10.9 mm and SD = 3.0 mm). For mean displacements larger than 7.2 mm, the biopsy cores gave false-negative results. Correcting pre-biopsy PET using the DVF improved the PET/CT registration in 8 of 11 cases. The DVF obtained from DIR of the CT scans can be used for evaluation and correction of the error in needle placement with respect to the FDG-avid area. Misregistration between the pre-biopsy PET and the CT acquired with

  14. Percutaneous CT-Guided Ablation in the Hepatic Dome: Artificially Induced Pneumothorax for Safe Transpleural Access

    PubMed Central

    Valle, Leonardo Guedes Moreira; Rochal, Rafael Dahmer; Rahal, Antônio; Garcia, Rodrigo Gobbo

    2015-01-01

    Ablative therapies have become a great alternative to surgical treatment of hepatic nodules. Some technical difficulties may negatively influence the effectiveness of this therapy, such as lesions located near the diaphragm. The transthoracic approach is commonly used to access these lesions. However, it is associated with an increased risk of complications, such as pneumothorax, hemothorax, alveolar bleeding, and others. We report a case of a radiofrequency ablation of a lesion in the hepatic dome, where an artificially induced pneumothorax was performed to guarantee a safe and effective access. The air was easily injected by a spinal needle and later aspirated by a single-lumen catheter. Induced pneumothorax shoud be considered in ablation of hepatic dome lesions, mainly when the transhepatic access is not appropriate. PMID:26713179

  15. Radiological prediction of tumor invasiveness of lung adenocarcinoma on thin-section CT

    PubMed Central

    Yanagawa, Masahiro; Johkoh, Takeshi; Noguchi, Masayuki; Morii, Eiichi; Shintani, Yasushi; Okumura, Meinoshin; Hata, Akinori; Fujiwara, Maki; Honda, Osamu; Tomiyama, Noriyuki

    2017-01-01

    Abstract To evaluate thin-section computed tomography (CT) (TSCT) features that differentiate adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IVA), and to determine the size of solid portion on CT that correlates to pathological invasive components. Forty-eight patients were included. Nodules were classified into ground-glass nodule (GGN), part-solid, solid, and heterogeneous. Visual density of GGNs was subjectively evaluated using reference standard images: faint GGN (Ga), <−700 Hounsfield unit (HU); intermediate GGN (Gb), from −700 to −400 HU; dense GGN (Gc), >−400 HU; and mixed (Ga + Gb, Ga + Gc, and Gb + Gc). The evaluated TSCT findings included margin of nodule, distribution of solid portion, distribution of air bronchiologram, and pleural indentation. The longest diameters of the solid portion and the entire tumor were measured. Invasive diameters were measured in pathological specimens. Twenty-two AISs (16 GGNs [7 Ga, 5 Gb, 2 Gc, 1 Ga + Gc, 1 Gb + Gc], 4 part-solids, and 2 heterogeneous), 6 MIAs (1 GGN [Gb + Gc], 3 part-solids, and 2 solids), and 20 IVAs (1 GGN [Gb], 3 part-solids, and 16 solid) were found. The longest diameter (mean ± standard deviation) of the solid portion and total tumor were 9.7 ± 9.7 and 18.9 ± 5.6 mm, respectively. Significant differences in TSCT findings between AIS and IVA were margin of nodule (Pearson chi-squared test, P = 0.004), distribution of air bronchiologram (P = 0.0148), and pleural indentation (P = 0.0067). A solid portion >5.3 mm on TSCT indicated MIA or IVA, and >7.3 mm indicated IVA (receiver operating characteristic analysis, P < 0.0001). Irregular margin, air bronchiologram with disruption and/or irregular dilatation, and pleural indentation may distinguish IVA from AIS. A 5.3 to 7.3 mm solid portion on TSCT indicates MIA/IVA, and a solid portion >7.3 mm on TSCT indicates IVA. PMID:28296757

  16. Hybrid gold-gadolinium nanoclusters for tumor-targeted NIRF/CT/MRI triple-modal imaging in vivo

    NASA Astrophysics Data System (ADS)

    Hu, De-Hong; Sheng, Zong-Hai; Zhang, Peng-Fei; Yang, Da-Zhi; Liu, Shu-Hui; Gong, Ping; Gao, Du-Yang; Fang, Sheng-Tao; Ma, Yi-Fan; Cai, Lin-Tao

    2013-01-01

    Multimodal imaging is highly desirable for accurate diagnosis because it can provide complementary information from each imaging modality. In this study, we prepared hybrid gold-gadolinium nanoclusters (NCs), which are ultrasmall, stable, biocompatible, and suitable for triple-modal NIRF/CT/MRI imaging. Upon intravenously injected, the hybrid NCs are effectively accumulated in tumor tissues and quickly clear by renal excretion, indicating their capacity of tumor targeting and low body residues. Notably, the ultrasmall hybrid NCs would penetrate into the solid tumor for capturing its heterostructure and do not induce potential toxicity in vivo. Hence, the well-defined hybrid gold-gadolinium NCs provide a versatile nanoprobe for cancer targeted imaging and diagnosis in vivo.Multimodal imaging is highly desirable for accurate diagnosis because it can provide complementary information from each imaging modality. In this study, we prepared hybrid gold-gadolinium nanoclusters (NCs), which are ultrasmall, stable, biocompatible, and suitable for triple-modal NIRF/CT/MRI imaging. Upon intravenously injected, the hybrid NCs are effectively accumulated in tumor tissues and quickly clear by renal excretion, indicating their capacity of tumor targeting and low body residues. Notably, the ultrasmall hybrid NCs would penetrate into the solid tumor for capturing its heterostructure and do not induce potential toxicity in vivo. Hence, the well-defined hybrid gold-gadolinium NCs provide a versatile nanoprobe for cancer targeted imaging and diagnosis in vivo. Electronic supplementary information (ESI) available. See DOI: 10.1039/c2nr33543c

  17. rs10499194 polymorphism in the tumor necrosis factor-α inducible protein 3 (TNFAIP3) gene is associated with type-1 autoimmune hepatitis risk in Chinese Han population.

    PubMed

    Xu, Enbin; Cao, Hailian; Lin, Liming; Liu, Honglong

    2017-01-01

    Previous studies have found that the polymorphisms of tumor necrosis factor-α induced protein 3 (TNFAIP3) were associated with several autoimmune diseases. However, the role of TNFAIP3 polymorphisms in type-1 autoimmune hepatitis (AIH-1) remained unclear. The present study aimed to clarify the association of TNFAIP3 polymorphisms with AIH-1 risk in a Chinese Han population. The TaqMan SNP genotyping assay was used to determine the distribution of TNFAIP3 polymorphisms in 432 AIH-1 patients and 500 healthy controls. The association of TNFAIP3 polymorphisms and clinical characteristic was further evaluated. Five TNFAIP3 polymorphisms (rs2230926, rs5029939, rs10499194, rs6920220, rs582757) were analyzed in the present study. No significant association could be observed between rs2230926, rs5029939, rs6920220, rs582757 and the susceptibility to AIH-1 in Chinese Han population. Compared with wild-type genotype CC at rs10499194, individuals carrying CT genotype had a significantly increased risk for developing AIH-1 (OR = 2.32, 95%CI 1.44-3.74). Under a dominant model, CT/TT carriers have a 140% increased risk of AIH-1 than CC carriers (OR = 2.40, 95%CI 1.50-3.87). The rs10499194 T allele was also found to be significantly associated with AIH-1 risk (OR = 2.41, 95%CI 1.51-3.82). In addition, higher serum ALT, AST levels and more common cirrhosis were observed in AIH-1 patients with T allele (CT/TT) than those with CC genotype. In conclusion, TNFAIP3 rs10499194 T allele and CT genotype were associated with an increased risk for AIH-1, suggesting rs10499194 polymorphism as a candidate of susceptibility locus to AIH-1.

  18. Histopathological characteristics of glutamine synthetase-positive hepatic tumor lesions in a mouse model of spontaneous metabolic syndrome (TSOD mouse).

    PubMed

    Takahashi, Tetsuyuki; Nishida, Takeshi; Baba, Hayato; Hatta, Hideki; Imura, Johji; Sutoh, Mitsuko; Toyohara, Syunji; Hokao, Ryoji; Watanabe, Syunsuke; Ogawa, Hirohisa; Uehara, Hisanori; Tsuneyama, Koichi

    2016-08-01

    We previously reported that Tsumura-Suzuki obese diabetic (TSOD) mice, a polygenic model of spontaneous type 2 diabetes, is a valuable model of hepatic carcinogenesis via non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). One of the characteristics of tumors in these mice is the diffuse expression of glutamine synthetase (GS), which is a diagnostic marker for hepatocellular carcinoma (HCC). In this study, we performed detailed histopathological examinations and found that GS expression was diffusely positive in >70% of the hepatic tumors from 15-month-old male TSOD mice. Translocation of β-catenin into nuclei with enhanced membranous expression also occurred in GS-positive tumors. Small lesions (<1 mm) in GS-positive cases exhibited dysplastic nodules, with severe nuclear atypia, whereas large lesions (>3 mm) bore the characteristics of human HCC, exhibiting nuclear and structural atypia with invasive growth. By contrast, the majority of GS-negative tumors were hepatocellular adenomas with advanced fatty change and low nuclear grade. In GS-negative tumors, loss of liver fatty acid-binding protein expression was observed. These results suggest that the histological characteristics of GS-positive hepatic tumors in TSOD mice resemble human HCC; thus, this model may be a useful tool in translational research targeting the NAFLD/NASH-HCC sequence.

  19. Histopathological characteristics of glutamine synthetase-positive hepatic tumor lesions in a mouse model of spontaneous metabolic syndrome (TSOD mouse)

    PubMed Central

    Takahashi, Tetsuyuki; Nishida, Takeshi; Baba, Hayato; Hatta, Hideki; Imura, Johji; Sutoh, Mitsuko; Toyohara, Syunji; Hokao, Ryoji; Watanabe, Syunsuke; Ogawa, Hirohisa; Uehara, Hisanori; Tsuneyama, Koichi

    2016-01-01

    We previously reported that Tsumura-Suzuki obese diabetic (TSOD) mice, a polygenic model of spontaneous type 2 diabetes, is a valuable model of hepatic carcinogenesis via non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). One of the characteristics of tumors in these mice is the diffuse expression of glutamine synthetase (GS), which is a diagnostic marker for hepatocellular carcinoma (HCC). In this study, we performed detailed histopathological examinations and found that GS expression was diffusely positive in >70% of the hepatic tumors from 15-month-old male TSOD mice. Translocation of β-catenin into nuclei with enhanced membranous expression also occurred in GS-positive tumors. Small lesions (<1 mm) in GS-positive cases exhibited dysplastic nodules, with severe nuclear atypia, whereas large lesions (>3 mm) bore the characteristics of human HCC, exhibiting nuclear and structural atypia with invasive growth. By contrast, the majority of GS-negative tumors were hepatocellular adenomas with advanced fatty change and low nuclear grade. In GS-negative tumors, loss of liver fatty acid-binding protein expression was observed. These results suggest that the histological characteristics of GS-positive hepatic tumors in TSOD mice resemble human HCC; thus, this model may be a useful tool in translational research targeting the NAFLD/NASH-HCC sequence. PMID:27446562

  20. (18)F-FDG PET/CT Volumetric Parameters are Associated with Tumor Grade and Metastasis in Pancreatic Neuroendocrine Tumors in von Hippel-Lindau Disease.

    PubMed

    Satoh, Kei; Sadowski, Samira M; Dieckmann, William; Quezado, Martha; Nilubol, Naris; Kebebew, Electron; Patel, Dhaval

    2016-12-01

    Approximately 8-17 % of patients with von Hippel-Lindau (VHL) syndrome develop pancreatic neuroendocrine tumors (PNETs), with 11-20 % developing metastases. Tumor grade is predictive of prognosis. The aim of this study was to determine if preoperative metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were associated with metastatic disease and tumor grade. Sixty-two patients with VHL-associated PNETs prospectively underwent (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT). MTV, TLG, and maximum standardized uptake value (SUVmax) were measured using a semi-automatic method. Surgically resected PNETs were classified according to 2010 World Health Organization tumor grade classification. MTV, TLG, and SUVmax were analyzed by metastatic disease and tumor grade using the Mann-Whitney test. A total of 88 PNETs were identified by CT and (18)F-FDG PET/CT, 10 of which were non-FDG-avid. Histologic grading was available for 20 surgical patients. Patients with metastatic PNETs had a higher TLG (median 25.9 vs. 7.7 mean SUV [SUVmean]*mL; p = 0.0092) compared with patients without metastasis, while patients with grade 2 PNETs had a higher MTV (median 6.9 vs. 2.6 mL; p = 0.034) and TLG (median 41.2 vs. 13.1 SUVmean*mL; p = 0.0035) compared with patients with grade 1 PNETs. No difference in tumor size or SUVmax was observed between the groups. Patients with metastatic PNETs have a higher TLG compared with patients without metastasis. Grade 2 PNETs have a higher MTV and TLG compared with grade 1 PNETs. Tumor size and SUVmax were not associated with grade. Volumetric parameters on (18)F-FDG PET/CT may be useful in detecting higher grade PNETs with a higher malignant potential that may need surgical intervention.

  1. Unusual association of alveolar rhabdomyosarcoma with pancreatic metastasis: emerging role of PET-CT in tumor staging

    PubMed Central

    Jha, Priyanka; Frölich, Andreas M. J.; McCarville, Beth; Navarro, Oscar M.; Babyn, Paul; Goldsby, Robert

    2010-01-01

    Background Pancreatic metastases in childhood cancer have been rarely reported in the radiology literature although ample evidence exists in pathology reports for its occurrence in patients with alveolar rhabdomyosarcomas (RMS). Objective Assess the occurrence of pancreatic metastases in alveolar rhabdomyosarcomas, increase awareness of this association and reassess current staging protocols. Materials and methods Three major oncology centers reviewed their records and imaging examinations. Patients’ history and demographics, primary tumor site and histology, presence of tumor recurrence, and presence and location of other metastases were reviewed. Results Pancreatic metastases occurred in eight patients with alveolar RMS. Four of these presented at diagnosis and four with disease recurrence. In recurrent disease, the duration between the diagnosis of the primary tumor and pancreatic metastases varied from 8 months to 6 years (mean ± SD: 2.38 ± 2.49 years). In all patients who received PET scans, pancreatic metastases showed a marked FDG-uptake, but had variable detectability with CT. Pancreatic metastases were not associated with certain primary tumor locations or presence of other metastases, mandating an evaluation of the pancreas in all cases of alveolar rhabdomyosarcomas. Conclusion Radiologists should be sensitized and actively evaluate the pancreas in patients with alveolar RMS. Optimizing CT and PET-CT protocols may increase the diagnostic yield. PMID:20180103

  2. Vasculature segmentation for radio frequency ablation of non-resectable hepatic tumors

    NASA Astrophysics Data System (ADS)

    Hemler, Paul F.; McCreedy, Evan S.; Cheng, Ruida; Wood, Brad; McAuliffe, Matthew J.

    2006-03-01

    In Radio Frequency Ablation (RFA) procedures, hepatic tumor tissue is heated to a temperature where necrosis is insured. Unfortunately, recent results suggest that heating tumor tissue to necrosis is complicated because nearby major blood vessels provide a cooling effect. Therefore, it is fundamentally important for physicians to perform a careful analysis of the spatial relationship of diseased tissue to larger liver blood vessels. The liver contains many of these large vessels, which affect the RFA ablation shape and size. There are many sophisticated vasculature detection and segmentation techniques reported in the literature that identify continuous vessels as the diameter changes size and it transgresses through many bifurcation levels. However, the larger blood vessels near the treatment area are the only vessels required for proper RFA treatment plan formulation and analysis. With physician guidance and interaction, our system can segment those vessels which are most likely to affect the RFA ablations. We have found that our system provides the physician with therapeutic, geometric and spatial information necessary to accurately plan treatment of tumors near large blood vessels. The segmented liver vessels near the treatment region are also necessary for computing isolevel heating profiles used to evaluate different proposed treatment configurations.

  3. Frequency of interleukin 28B rs12979860 C>T variants in Filipino patients chronically infected with hepatitis B virus.

    PubMed

    Baclig, Michael O; Reyes, Karen G; Mapua, Cynthia A; Gopez-Cervantes, Juliet; Natividad, Filipinas F

    2015-03-01

    Hepatitis B virus (HBV) is one of the most prevalent viral infections worldwide. Nearly 400 million individuals are chronic carriers of HBV. The aim of the present study was to determine the frequency of human interleukin 28B (IL28B) variants among treatment naive Filipino patients clinically diagnosed with chronic hepatitis B (CHB), and to compare the IL28B frequency distribution with various ethnic populations. Fifty-seven CHB patients and 43 normal controls were enrolled in this study. Real-time PCR was performed using the TaqMan genotyping assay for IL28B rs12979860. The allelic frequencies among normal controls were 0.94 and 0.06 for the IL28B rs12979860 C and T alleles, respectively. Eighty-eight percent were identified as homozygous for the IL28B C/C genotype and 12% were identified as heterozygous for the IL28B C/T genotype. Among CHB patients, the allelic frequencies were 0.90 for the IL28B C allele and 0.10 for the IL28B T allele. No IL28B T/T genotype was observed between the two groups. No significant difference in the distribution of IL28B genotypes was observed between normal controls and CHB patients. Allelic frequencies of IL28B among Filipinos were similar with other Asian populations but significantly different from Caucasians. The frequency of rs12979860 C>T variants among Filipino CHB patients has not yet been reported. These data provided new insight into the geographical frequency distribution of IL28B variants. Further studies are needed to determine the possible association between IL28B variants and response to pegylated-interferon-α plus ribavirin combination therapy among Filipino patients chronically infected with HBV.

  4. Glycogen storage disease type Ia mice with less than 2% of normal hepatic glucose-6-phosphatase-α activity restored are at risk of developing hepatic tumors.

    PubMed

    Kim, Goo-Young; Lee, Young Mok; Kwon, Joon Hyun; Cho, Jun-Ho; Pan, Chi-Jiunn; Starost, Matthew F; Mansfield, Brian C; Chou, Janice Y

    2017-03-01

    Glycogen storage disease type Ia (GSD-Ia), characterized by impaired glucose homeostasis and chronic risk of hepatocellular adenoma (HCA) and carcinoma (HCC), is caused by a deficiency in glucose-6-phosphatase-α (G6Pase-α or G6PC). We have previously shown that G6pc-/- mice receiving gene transfer mediated by rAAV-G6PC, a recombinant adeno-associated virus (rAAV) vector expressing G6Pase-α, and expressing 3-63% of normal hepatic G6Pase-α activity maintain glucose homeostasis and do not develop HCA/HCC. However, the threshold of hepatic G6Pase-α activity required to prevent tumor formation remained unknown. In this study, we constructed rAAV-co-G6PC, a rAAV vector expressing a codon-optimized (co) G6Pase-α and showed that rAAV-co-G6PC was more efficacious than rAAV-G6PC in directing hepatic G6Pase-α expression. Over an 88-week study, we showed that both rAAV-G6PC- and rAAV-co-G6PC-treated G6pc-/- mice expressing 3-33% of normal hepatic G6Pase-α activity (AAV mice) maintained glucose homeostasis, lacked HCA/HCC, and were protected against age-related obesity and insulin resistance. Of the eleven rAAV-G6PC/rAAV-co-G6PC-treated G6pc-/- mice harboring 0.9-2.4% of normal hepatic G6Pase-α activity (AAV-low mice), 3 expressing 0.9-1.3% of normal hepatic G6Pase-α activity developed HCA/HCC, while 8 did not (AAV-low-NT). Finally, we showed that the AAV-low-NT mice exhibited a phenotype indistinguishable from that of AAV mice expressing ≥3% of normal hepatic G6Pase-α activity. The results establish the threshold of hepatic G6Pase-α activity required to prevent HCA/HCC and show that GSD-Ia mice harboring <2% of normal hepatic G6Pase-α activity are at risk of tumor development. Published by Elsevier Inc.

  5. /sup 133/Xe uptake in focal hepatic fat accumulation: CT correlation

    SciTech Connect

    Patel, S.; Sandler, C.M.; Rauschkolb, E.N.; McConnell, B.J.

    1982-03-01

    Irregular fatty infiltration of the liver appears as focal areas of decreased attenuation on computed tomography (CT) and often cannot be distinguished from other, clinically more significant space-occupying lesions. Six patients with CT and clinical findings suggestive of fatty infiltration had xenon-133 ventilation scans of the liver. Four of these patients showed uptake and retention of 133Xe in the corresponding area of the liver, confirming the presence of fatty infiltration. The two patients in whom there was no uptake or retention of xenon by the liver were subsequently proven to have liver abscess and metastatic adenocarcinoma, respectively.

  6. Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

    PubMed Central

    Naranjo, Arlene; Hoffer, Fredric; Mullen, Elizabeth; Geller, James; Gratias, Eric J.; Ehrlich, Peter F.; Perlman, Elizabeth J.; Rosen, Nancy; Grundy, Paul; Dome, Jeffrey S.

    2013-01-01

    Purpose: To retrospectively determine the diagnostic performance of computed tomography (CT) in identifying the presence or absence of preoperative Wilms tumor rupture. Materials and Methods: The cohort was derived from the AREN03B2 study of the Children’s Oncology Group. The study was approved by the institutional review board and was compliant with HIPAA. Written informed consent was obtained before enrollment. The diagnosis of Wilms tumor rupture was established by central review of notes from surgery and/or pathologic examination. Seventy Wilms tumor cases with rupture were matched to 70 Wilms tumor controls without rupture according to age and tumor weight (within 6 months and 50 g, respectively). CT scans were independently reviewed by two radiologists, and the following CT findings were assessed: poorly circumscribed mass, perinephric fat stranding, peritumoral fat planes obscured, retroperitoneal fluid (subcapsular vs extracapsular), ascites beyond the cul-de-sac, peritoneal implants, ipsilateral pleural effusion, and intratumoral hemorrhage. All fluids were classified as hemorrhagic or nonhemorrhagic by using a cutoff of 30 HU. The relationship between CT findings and rupture was assessed with logistic regression models. Results: The sensitivity and specificity for detecting Wilms tumor rupture were 54% (36 of 67 cases) and 88% (61 of 69 cases), respectively, for reviewer 1 and 70% (47 of 67 cases) and 88% (61 of 69 cases), respectively, for reviewer 2. Interobserver agreement was substantial (ĸ = 0.76). All imaging signs tested, except peritoneal implants, intratumoral hemorrhage, and subcapsular fluid, showed a significant association with rupture (P ≤ .02). The attenuation of ascitic fluid did not have a significant correlation with rupture (P = .9990). Ascites beyond the cul-de-sac was the single best indicator of rupture for both reviewers, followed by perinephric fat stranding and retroperitoneal fluid for reviewers 1 and 2, respectively (P

  7. Tumor suppressor Menin acts as a corepressor of LXRα to inhibit hepatic lipogenesis.

    PubMed

    Cheng, Peng; Li, Gang; Yang, Sheng Sheng; Liu, Rui; Jin, Gang; Zhou, Xu Yu; Hu, Xian Gui

    2015-10-07

    Menin, encoded by the MEN1 gene, was initially identified as a tumor suppressor for endocrine neoplasia. Our previous report showed that Menin enhances PPARα transactivity preventing triglyceride accumulation in the liver. Here, we further explore the role of Menin in liver steatosis. Transient transfection assays demonstrate that Menin inhibits the transcriptional activity of nuclear receptor liver X receptor α (LXRα). Accordingly, Menin overexpression results in reduced expression of LXRα target genes, such as lipogenic enzymes including SREBP-1c, FASN and SCD-1. Co-immunoprecipitation assays revealed physical interaction between Menin and LXRα. Collectively, our data suggest that Menin acts as a novel corepressor of LXRα and functions as a negative regulator of hepatic lipogenesis. Copyright © 2015. Published by Elsevier B.V.

  8. Multimodality therapy for a case of neuroendocrine tumor in the hilum with multiple hepatic metastases

    PubMed Central

    Li, Yuan; Huang, Zhen; Zhang, Yefan

    2016-01-01

    This article reports a male mid-aged patient with a rare neuroendocrine tumor in hepatic hilum who finally received surgical treatment after multidisciplinary treatment (MDT). After the condition was confirmed, the patient received sandostatin treatment based on MDT consultations and his family’s willingness due to the high surgical risk. One year later, follow-up examinations showed “stable disease” (SD), and sandostatin was withdrawn due to economic consideration. One year after drug withdrawal, liver metastases were found. Sutent treatment was then applied after a second MDT consultation. Four months later, further examinations showed a partial response (PR). Finally, the patient received surgical treatment in the department of surgery. PMID:28138646

  9. Optimizing a head-tracked stereo display system to guide hepatic tumor ablation.

    PubMed

    Fuchs, Henry; State, Andrei; Yang, Hua; Peck, Tabitha; Lee, Sang Woo; Rosenthal, Michael; Bulysheva, Anna; Burke, Charles

    2008-01-01

    Radio frequency ablation is a minimally invasive intervention that introduces -- under 2D ultrasound guidance and via a needle-like probe -- high-frequency electrical current into non-resectable hepatic tumors. These recur mostly on the periphery, indicating errors in probe placement. Hypothesizing that a contextually correct 3D display will aid targeting and decrease recurrence, we have developed a prototype guidance system based on a head-tracked 3D display and motion-tracked instruments. We describe our reasoning and our experience in selecting components for, designing and constructing the 3D display. Initial candidates were an augmented reality see-through head-mounted display and a virtual reality "fish tank" system. We describe the system requirements and explain how we arrived at the final decision. We show the operational guidance system in use on phantoms and animals.

  10. Serum alpha-fetoprotein subfractions identified by Ricinus communis agglutinin I in hepatic malignancies, yolk sac tumor, benign hepatic diseases, and fetal stage.

    PubMed

    Ishiguro, T; Takahashi, Y

    1989-01-01

    Using Ricinus communis agglutinin I (RCA-I) affinity crossed-line immunoelectrophoresis, alpha-fetoprotein (AFP) subfractions were studied in sera from patients with primary hepatic cancer (PHC), hepatic metastasis of gastric cancer (HMGC), yolk sac tumor (YST), acute or chronic hepatitis or hepatic cirrhosis. Fetal AFP subfractions were also examined in amniotic fluids or in culture fluids of fetal tissues. RCA-I non-reactive subfraction was commonly found in PHC, HMGC, YST, benign hepatic diseases, and fetal stage. RCA-I weakly reactive (WR) or strongly reactive (SR) subfraction was noted only in malignant diseases. RCA-I has a specific affinity to terminal galactose in oligosaccharide, and the presence of sialic acid on galactose residue(s) inhibits the affinity with RCA-I. Therefore, common AFP subfraction non-reactive with RCA-I was assumed to be galactosialyl form, while RCA-I WR and SR subfractions found only in malignancies were monogalactosyl and digalactosyl, respectively. Clinically this approach to detect the RCA-I WR or SR subfraction facilitates a differential diagnosis of AFP-producing malignancies and benign conditions.

  11. Tumor-induced CD11b(+) Gr-1(+) myeloid-derived suppressor cells exacerbate immune-mediated hepatitis in mice in a CD40-dependent manner.

    PubMed

    Kapanadze, Tamar; Medina-Echeverz, José; Gamrekelashvili, Jaba; Weiss, Jonathan M; Wiltrout, Robert H; Kapoor, Veena; Hawk, Nga; Terabe, Masaki; Berzofsky, Jay A; Manns, Michael P; Wang, Ena; Marincola, Francesco M; Korangy, Firouzeh; Greten, Tim F

    2015-04-01

    Immunosuppressive CD11b(+) Gr-1(+) myeloid-derived suppressor cells (MDSCs) accumulate in the livers of tumor-bearing (TB) mice. We studied hepatic MDSCs in two murine models of immune-mediated hepatitis. Unexpectedly, treatment of TB mice with Concanavalin A (Con A) or α-galactosylceramide resulted in increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) serum levels in comparison to tumor-free mice. Adoptive transfer of hepatic MDSCs into naïve mice exacerbated Con A induced liver damage. Hepatic CD11b(+) Gr-1(+) cells revealed a polarized proinflammatory gene signature after Con A treatment. An IFN-γ-dependent upregulation of CD40 on hepatic CD11b(+) Gr-1(+) cells along with an upregulation of CD80, CD86, and CD1d after Con A treatment was observed. Con A treatment resulted in a loss of suppressor function by tumor-induced CD11b(+) Gr-1(+) MDSCs as well as enhanced reactive oxygen species (ROS)-mediated hepatotoxicity. CD40 knockdown in hepatic MDSCs led to increased arginase activity upon Con A treatment and lower ALT/AST serum levels. Finally, blockade of arginase activity in Cd40(-/-) tumor-induced myeloid cells resulted in exacerbation of hepatitis and increased ROS production in vivo. Our findings indicate that in a setting of acute hepatitis, tumor-induced hepatic MDSCs act as proinflammatory immune effector cells capable of killing hepatocytes in a CD40-dependent manner.

  12. Classification of Hepatic Lesions From CT Images Using Texture Features and Neural Networks

    DTIC Science & Technology

    2001-10-25

    forward selection, neural network, classification, liver CT images I. INTRODUCTION The use of medical imaging and tissue characterisation...implemented with NN techniques. NN�s have been applied successfully in classification problems in the field of medical imaging . In the current application

  13. A pilot study of the prognostic significance of metabolic tumor size measurements in PET/CT imaging of lymphomas

    NASA Astrophysics Data System (ADS)

    Kallergi, Maria; Botsivali, Maria; Politis, Nikolaos; Menychtas, Dimitrios; Georgakopoulos, Alexandros; Chatziioannou, Sofia

    2015-03-01

    This study explores changes in metabolic tumor volume, metabolic tumor diameter, and maximum standardized uptake value (SUVmax), for earlier and more accurate identification of lymphomas' response to treatment using 18F- FDG PET/CT. Pre- and post-treatment PET/CT studies of 20 patients with Hodgkin disease (HL) and 7 patients with non- Hodgkin lymphoma (NHL) were retrospectively selected for this study. The diameter and volume of the metabolic tumor was determined by an in-house developed adaptive local thresholding technique based on a 50% threshold of the maximum pixel value within a region. Statistical analysis aimed at exploring associations between metabolic size measurements and SUVmax and the ability of the three biomarkers to predict the patients' response to treatment as defined by the four classes in the European Organization for Research and Treatment of Cancer (EORTC) guidelines. Results indicated moderate correlations between % change in metabolic tumor volume and % change in metabolic tumor maximum diameter (R=0.51) and between % change in maximum diameter and % change in SUVmax (R=0.52). The correlation between % change in tumor volume and % change in SUVmax was weak (R=0.24). The % change in metabolic tumor size, either volume or diameter, was a "very strong" predictor of response to treatment (R=0.89), stronger than SUVmax (R=0.63). In conclusion, metabolic tumor volume could have important prognostic value, possibly higher than maximum metabolic diameter or SUVmax that are currently the standard of practice. Volume measurements, however, should be based on robust and standardized segmentation methodologies to avoid variability. In addition, SUV-peak or lean body mass corrected SUV-peak may be a better PET biomarker than SUVmax when SUV-volume combinations are considered.

  14. Hypoxia-activated cytotoxic agent tirapazamine enhances hepatic artery ligation-induced killing of liver tumor in HBx transgenic mice.

    PubMed

    Lin, Wei-Hsiang; Yeh, Shiou-Hwei; Yeh, Kun-Huei; Chen, Kai-Wei; Cheng, Ya-Wen; Su, Tung-Hung; Jao, Ping; Ni, Lin-Chun; Chen, Pei-Jer; Chen, Ding-Shinn

    2016-10-18

    Transarterial chemoembolization (TACE) is the main treatment for intermediate stage hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer classification because of its exclusive arterial blood supply. Although TACE achieves substantial necrosis of the tumor, complete tumor necrosis is uncommon, and the residual tumor generally rapidly recurs. We combined tirapazamine (TPZ), a hypoxia-activated cytotoxic agent, with hepatic artery ligation (HAL), which recapitulates transarterial embolization in mouse models, to enhance the efficacy of TACE. The effectiveness of this combination treatment was examined in HCC that spontaneously developed in hepatitis B virus X protein (HBx) transgenic mice. We proved that the tumor blood flow in this model was exclusively supplied by the hepatic artery, in contrast to conventional orthotopic HCC xenografts that receive both arterial and venous blood supplies. At levels below the threshold oxygen levels created by HAL, TPZ was activated and killed the hypoxic cells, but spared the normoxic cells. This combination treatment clearly limited the toxicity of TPZ to HCC, which caused the rapid and near-complete necrosis of HCC. In conclusion, the combination of TPZ and HAL showed a synergistic tumor killing activity that was specific for HCC in HBx transgenic mice. This preclinical study forms the basis for the ongoing clinical program for the TPZ-TACE regimen in HCC treatment.

  15. The role of 68Ga-DOTA-NOC PET/CT in evaluating neuroendocrine tumors: real-world experience from two large neuroendocrine tumor centers.

    PubMed

    Haidar, Mohamad; Shamseddine, Ali; Panagiotidis, Emmanouil; Jreige, Mario; Mukherji, Deborah; Assi, Rita; Abousaid, Rayan; Ibrahim, Toni; Haddad, Marwan M; Vinjamuri, Sobhan

    2017-02-01

    Our aim was to assess the role of Ga-DOTA-NOC PET/CT as a tool for the management of neuroendocrine tumors (NETs), evaluating the clinical impact on patients from two large NET centers in different geopolitical settings. This is a retrospective study of patients with NETs who underwent Ga-DOTA-NOC PET/CT at Royal Liverpool University Hospital (UK) and at Mount Lebanon Hospital (Lebanon). Indications for imaging and findings of the PET/CT along with demographic and clinical outcome data were recorded and evaluated. Four hundred and forty-five patients fulfilled the inclusion criteria, with a median age at the time of diagnosis of 56 (range: 3-90) years; 248 (55.7%) patients were male.Ga-DOTA-NOC PET/CT was indicated for staging in 193 (43.4%) patients, for diagnosis in 124 (27.9%) patients, for follow-up in 97 (21.7%) patients, and for identification of a primary NET site in 31 (7%) patients.One hundred and four (27.9%) patients underwent Ga-DOTA-NOC PET/CT for the primary diagnosis of NET, of whom 66 (52.7%) patients presented with a clinical suspicion of NET, 10 (8.3%) patients presented with a biochemical suspicion of NET only, and 48 (38.8%) patients presented with a suspicious NET lesion discovered on another imaging modality. The most common clinical presentation was typical carcinoid syndrome [4 (33%) patients].Results on the basis of histology were used as the gold standard for the diagnosis in 57% of patients and the remaining on the basis of follow-up as per established clinical consensus. Sensitivity, specificity, negative-predictive value, and positive-predictive value of PET/CT were 87.1, 97.7, 79.6, and 98.7%, respectively, for the entire sample. Accuracy was measured using the receiver operating characteristic curve analysis with an area under the curve of 0.924 (95% confidence interval: 0.874-0.974). Ga-DOTA-NOC PET/CT is a highly sensitive and specific study for the diagnosis and follow-up of patients with neuroendocrine tumors. These results

  16. Graphics Processing Unit-Accelerated Nonrigid Registration of MR Images to CT Images During CT-Guided Percutaneous Liver Tumor Ablations.

    PubMed

    Tokuda, Junichi; Plishker, William; Torabi, Meysam; Olubiyi, Olutayo I; Zaki, George; Tatli, Servet; Silverman, Stuart G; Shekher, Raj; Hata, Nobuhiko

    2015-06-01

    Accuracy and speed are essential for the intraprocedural nonrigid magnetic resonance (MR) to computed tomography (CT) image registration in the assessment of tumor margins during CT-guided liver tumor ablations. Although both accuracy and speed can be improved by limiting the registration to a region of interest (ROI), manual contouring of the ROI prolongs the registration process substantially. To achieve accurate and fast registration without the use of an ROI, we combined a nonrigid registration technique on the basis of volume subdivision with hardware acceleration using a graphics processing unit (GPU). We compared the registration accuracy and processing time of GPU-accelerated volume subdivision-based nonrigid registration technique to the conventional nonrigid B-spline registration technique. Fourteen image data sets of preprocedural MR and intraprocedural CT images for percutaneous CT-guided liver tumor ablations were obtained. Each set of images was registered using the GPU-accelerated volume subdivision technique and the B-spline technique. Manual contouring of ROI was used only for the B-spline technique. Registration accuracies (Dice similarity coefficient [DSC] and 95% Hausdorff distance [HD]) and total processing time including contouring of ROIs and computation were compared using a paired Student t test. Accuracies of the GPU-accelerated registrations and B-spline registrations, respectively, were 88.3 ± 3.7% versus 89.3 ± 4.9% (P = .41) for DSC and 13.1 ± 5.2 versus 11.4 ± 6.3 mm (P = .15) for HD. Total processing time of the GPU-accelerated registration and B-spline registration techniques was 88 ± 14 versus 557 ± 116 seconds (P < .000000002), respectively; there was no significant difference in computation time despite the difference in the complexity of the algorithms (P = .71). The GPU-accelerated volume subdivision technique was as accurate as the B-spline technique and required significantly less processing time. The GPU

  17. Graphics processing unit-accelerated non-rigid registration of MR images to CT images during CT-guided percutaneous liver tumor ablations

    PubMed Central

    Tokuda, Junichi; Plishker, William; Torabi, Meysam; Olubiyi, Olutayo I; Zaki, George; Tatli, Servet; Silverman, Stuart G.; Shekhar, Raj; Hata, Nobuhiko

    2015-01-01

    Rationale and Objectives Accuracy and speed are essential for the intraprocedural nonrigid MR-to-CT image registration in the assessment of tumor margins during CT-guided liver tumor ablations. While both accuracy and speed can be improved by limiting the registration to a region of interest (ROI), manual contouring of the ROI prolongs the registration process substantially. To achieve accurate and fast registration without the use of an ROI, we combined a nonrigid registration technique based on volume subdivision with hardware acceleration using a graphical processing unit (GPU). We compared the registration accuracy and processing time of GPU-accelerated volume subdivision-based nonrigid registration technique to the conventional nonrigid B-spline registration technique. Materials and Methods Fourteen image data sets of preprocedural MR and intraprocedural CT images for percutaneous CT-guided liver tumor ablations were obtained. Each set of images was registered using the GPU-accelerated volume subdivision technique and the B-spline technique. Manual contouring of ROI was used only for the B-spline technique. Registration accuracies (Dice Similarity Coefficient (DSC) and 95% Hausdorff Distance (HD)), and total processing time including contouring of ROIs and computation were compared using a paired Student’s t-test. Results Accuracy of the GPU-accelerated registrations and B-spline registrations, respectively were 88.3 ± 3.7% vs 89.3 ± 4.9% (p = 0.41) for DSC and 13.1 ± 5.2 mm vs 11.4 ± 6.3 mm (p = 0.15) for HD. Total processing time of the GPU-accelerated registration and B-spline registration techniques was 88 ± 14 s vs 557 ± 116 s (p < 0.000000002), respectively; there was no significant difference in computation time despite the difference in the complexity of the algorithms (p = 0.71). Conclusion The GPU-accelerated volume subdivision technique was as accurate as the B-spline technique and required significantly less processing time. The GPU

  18. Monitoring glioma growth and tumor necrosis with the U-SPECT-II/CT scanner by targeting integrin αvβ3.

    PubMed

    Shao, Guoqiang; Zhou, Yang; Wang, Feng; Liu, Shuang

    2013-01-01

    The purpose of this study was to validate (99m)Tc-3P-RGD(2) single-photon emission computed tomography/computed tomography (SPECT/CT) as an imaging tool to monitor α(v)β(3) expression and tumor necrosis. The animal model was established by subcutaneous injection of 5 × 10(6) U87MG cells into the shoulder flank of each mouse. Imaging was performed using the U-SPECT-II/CT scanner (Milabs, Utrecht, the Netherlands). Tumor volumes were determined, and the tumor uptake of (99m)Tc-3P-RGD(2) was calculated on the basis of SPECT/CT and compared to that from biodistribution. Immunohistochemistry was performed to determine CD31 and α(v)β(3) expression levels. We found that the tumor detection limit was ≈ 0.5 mm(3) by (99m)Tc-3P-RGD(2) SPECT/CT. The tumor uptake of (99m)Tc-3P-RGD(2) from SPECT/CT was almost identical to that from biodistribution. The α(v)β(3) was expressed mainly on blood vessels for the tumors of 0.2 to 0.5 cm(3). In larger tumors, tumor α(v)β(3) expression increased due to more contribution from glioma cells. When tumors were > 0.5 cm(3), the %ID/cm(3) uptake of (99m)Tc-3P-RGD(2) decreased because of necrosis. The overall relationship between the tumor size and %ID of (99m)Tc-3P-RGD(2) was modeled as a quadratic polynomial fitting curve, with R(2) being > .95. (99m)Tc-3P-RGD(2) SPECT/CT is excellent for monitoring α(v)β(3) expression and tumor necrosis during tumor growth and may become a screening tool for patient selection before anti-α(v)β(3) therapy.

  19. Case Report of Contrast-Enhanced Ultrasound Features of Primary Hepatic Neuroendocrine Tumor

    PubMed Central

    Li, Wei; Zhuang, Bo-wen; Wang, Zhu; Liao, Bing; Hong, Ling-yao; Xu, Ming; Lin, Xiao-na; Xie, Xiao-yan; Lu, Ming-de; Chen, Li-da; Wang, Wei

    2016-01-01

    Abstract Primary hepatic neuroendocrine tumors (PHNETs) are very rare and their clinical features and treatment outcomes are not well understood. It is difficult to reach a proper diagnosis before biopsy or resection. The aim of this study was to analyze the imaging features of PHNETs on contrast-enhanced ultrasound (CEUS). The clinical characteristics, CEUS findings, pathological features, treatment and prognosis of 6 patients with PHNET treated in our hospital were retrospectively analyzed. Most PHNETs occurred in middle-aged patients, and the most common clinical manifestation was right upper quadrant palpable mass and abdominal pain. Multiple small anechoic intralesional cavities occurred frequently in PHNET. Multilocular cystic with internal septation or monolocular with wall nodule could also be detected. On contrast-enhanced ultrasonography (CEUS), heterogeneous hyperenhancement in the arterial phase and wash-out hypoenhancement were observed in most patients, while computed tomography scanning yielded similar results. Diagnosis of PHNET was confirmed by immunohistochemical result and follow-up with the absence of extrahepatic primary sites. Five patients received surgical resection and 2 cases exhibited recurrence. Transcatheter arterial chemoembolization was performed in 1 patient with recurrence. Only 1 patient received conservative care. The median overall survival in 5 patients who underwent surgical treatment was 27 months (18–36 months). PHNET is a rare tumor, and its diagnosis is difficult. The CEUS features reported in this series may enrich the knowledge base for characterization of PHNET. PMID:27227910

  20. Hepatocellular carcinoma mouse models: Hepatitis B virus-associated hepatocarcinogenesis and haploinsufficient tumor suppressor genes

    PubMed Central

    Teng, Yuan-Chi; Shen, Zhao-Qing; Kao, Cheng-Heng; Tsai, Ting-Fen

    2016-01-01

    The multifactorial and multistage pathogenesis of hepatocellular carcinoma (HCC) has fascinated a wide spectrum of scientists for decades. While a number of major risk factors have been identified, their mechanistic roles in hepatocarcinogenesis still need to be elucidated. Many tumor suppressor genes (TSGs) have been identified as being involved in HCC. These TSGs can be classified into two groups depending on the situation with respect to allelic mutation/loss in the tumors: the recessive TSGs with two required mutated alleles and the haploinsufficient TSGs with one required mutated allele. Hepatitis B virus (HBV) is one of the most important risk factors associated with HCC. Although mice cannot be infected with HBV due to the narrow host range of HBV and the lack of a proper receptor, one advantage of mouse models for HBV/HCC research is the numerous and powerful genetic tools that help investigate the phenotypic effects of viral proteins and allow the dissection of the dose-dependent action of TSGs. Here, we mainly focus on the application of mouse models in relation to HBV-associated HCC and on TSGs that act either in a recessive or in a haploinsufficient manner. Discoveries obtained using mouse models will have a great impact on HCC translational medicine. PMID:26755878

  1. Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful?

    PubMed

    Kakigi, Takahide; Okada, Tomohisa; Kanagaki, Mitsunori; Yamamoto, Akira; Fushimi, Yasutaka; Sakamoto, Ryo; Arakawa, Yoshiki; Mikami, Yoshiki; Shimono, Taro; Takahashi, Jun C; Togashi, Kaori

    2014-04-01

    Quantitative values of CT attenuation, apparent diffusion coefficient (ADC), and standardized uptake value (SUV) were investigated for differentiation between pineal parenchymal tumors (PPTs) and germinomas. Differences in age, sex, and calcification pattern were also evaluated. Twenty-three patients with PPTs and germinomas in 20 years were retrospectively enrolled under the approval of the institutional review board. CT attenuation, ADC, and SUV (20, 13, and 10 patients, respectively) were statistically compared between the two tumors. Differences in sex and patterns of calcification ("exploded" or "engulfed") were also examined. Mean patient ages were compared among three groups of pineoblastoma, pineal parenchymal tumor of intermediate differentiation, (PPTID) and pineocytoma and germinoma. None of the quantitative values of CT attenuation, ADC, and SUV showed significant differences between PPTs and germinomas (p > .05). However, there was a significant difference in age (p < .05) among the three groups of pineoblastoma (mean age ± standard deviation 7.0 ± 8.7 years), PPTID, and pineocytoma (53.7 ± 11.4 years) and germinoma (19.1 ± 8.1 years). Sex also showed significant differences between PPTs and germinomas (p = .039). Exploded pattern of calcification was found in 9 of 11 PPT patients and engulfed pattern in 7 of 9 patients with germinomas. No reverse pattern was observed, and the patterns of calcification were considered highly specific of tumor types. None of the quantitative imaging values could differentiate PPTs from germinomas. Age, sex, and calcification patterns were confirmed useful in differentiating these tumors to some degree.

  2. Tumor Factors Associated with Clinical Outcomes in Patients with Hepatitis B Virus Infection and Hepatocellular Carcinoma

    PubMed Central

    Siripongsakun, Surachate; Stanford-Moore, Gaelen; Hsu, Leeyen; Chang, Patrick Weijen; Blatt, Lawrence Mitchell

    2012-01-01

    Background and aims: Hepatitis B virus (HBV) infection is a common cause of hepatocellular carcinoma (HCC) in the United States. This study evaluated the impact of surveillance and treatment on HBV-infected HCC patients and identified factors associated with survival. Methods: From 1981 to 2010, 166 hepatitis B surface antigen (HBsAg)-positive HCC patients were evaluated. Fifty-eight patients had HCC detected by surveillance, while 108 patients presented with HCC. Results: Compared to patients detected by surveillance, those presenting with HCC had more symptoms (65.7% vs 41.4%; P=.002), were more frequently outside of Milan criteria (73.7% vs 29.6%; P<.001), more often presented with diffuse tumors (23.2% vs 1.9%; P<.001), and had a shortened median survival time (9.5 months vs 18.7 months; P=.003). Patients who presented with diffuse tumors were younger and more often male (P=.002-.007), had a higher alpha-fetoprotein (AFP) level (P=.023), and had a median survival time of only 1.68 months. By multivariate analysis, factors that were significantly associated with mortality included diffuse tumors (hazard ratio [HR], 6.30; 95% confidence interval [CI], 3.14-12.66; P<.001), being outside of Milan criteria (HR, 2.02; 95% CI, 1.26-3.23; P=.005), albumin level (HR per 1 standard deviation decrease, 1.4; 95% CI, 1.15-1.72; P=.001), AFP level (HR per 1 log standard deviation increase, 1.38; 95% CI, 1.13-1.67; P=.001), and receiving liver transplantation versus other treatments (HR, 0.08-0.38; 95% CI, 0.03-0.87; P<.001 to P=.022). Conclusion: In the United States, HBV-related HCC is a common malignancy, especially among Asian immigrants. Identification of HBsAgpositive subjects and routine HCC surveillance are essential for improving survival in these patients. PMID:24693270

  3. [Relief effect of CT-guided (125)I seed implantation on patients with spinal and paraspinal osteolytic metastatic tumors].

    PubMed

    Huang, H; Li, F S; Wang, L; Du, Z G; Xu, S N

    2017-03-23

    Objective: To evaluate the clinical value of computed tomography (CT)-guided (125)I seed implantation in the treatment of patients with spinal and/or paraspinal osteolytic metastatic tumors. Methods: The radiation dose distribution was planned for 27 patients with 35 spinal and paraspinal osteolytic metastatic tumors by a treatment planning system (TPS). CT-guided (125)I seed implantation was carried out in the patients, and the quality of treatment was evaluated based on CT-imaging follow-up. Results: All the 27 patients underwent CT-guided (125)I seed implantation successfully. 12 to 50 (125)I seeds were injected into each spinal or paraspinal metastatic tumor, 39.15 on average, and the specific radioactive activity of the particles ranged from 0.60 to 0.80 mCi, 0.73 mCi on average. The minimal percentage of the dose received by 90% of the target volume (D(90)) of the spinal and paraspinal metastatic tumors ranged from 90 to 165 Gy, 115.03 Gy on average. Among the 27 patients, 21 (77.8%) had partial remission (PR) and 6(22.2%)had stable disease (SD). The Numerical Rating Scale (NRS) scores before implantation and at postoperative 3 and 6 months were 7.81±0.74, 2.04±1.10 and 1.81±0.79, respectively, (P<0.05). The assessment of pain intensity before (125)I seed implantation and at 3 postoperative months showed obvious improvements in the patients evaluated according to the American Spinal Injury Association (ASIA) impairment scale: 12 (44.4%) patients with ASIA grade C were changed to grade D, 3 (11.1%) from grade C to grade E, 8 (29.6%) from grade D to grade E, 3 (11.1%) with a stable grade D, and 1 (3.7%)with a stablegrade C. The Karnovsky performance scale (KPS) scores before treatment and at 3 months and 6 months postoperatively were 66.30±6.88, 85.93±9.31 and 87.91±8.56, respectively (P<0.05). Their local control rate (LCR) at 3 months, 6 months and 1 year postoperatively were 100%, 92.6% and 51.9%, respectively, and the overall survival rates(OSR) were

  4. Enhanced Ablation of High Intensity Focused Ultrasound with Microbubbles: An Experimental Study on Rabbit Hepatic VX2 Tumors

    SciTech Connect

    He Wei; Wang Wei Zhou Ping; Wang, Yixiang J.; Zhou Peng; Li Ruizhen; Wang Jinsheng; Ahuja, Anil T.

    2011-10-15

    Purpose: This study was designed to assess the enhanced effect of high intensity focused ultrasound (HIFU) ablation with microbubbles on rabbit hepatic VX2 tumors and to compare the detection sensitivity of CEUS and CECT to determine the residual viable tissue after ablation of HIFU. Methods: Forty rabbits with hepatic VX2 tumors were randomly separated into two groups (20 animals per group) before HIFU ablation. A bolus of 0.2 mL of saline or a microbubble-based ultrasound (US) contrast agent was injected intravenously to group I rabbits and group II rabbits, respectively. The HIFU ablation procedure was started 15 s after the injection. Tumors were examined with grayscale contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) immediately before and after HIFU ablation. Histopathologic assessment was performed immediately after treatment imaging. Results: Before ablation, intense contrast enhancement during arterial phase was observed at the whole tumors or the periphery of the tumors by CEUS and CECT. Lower HIFU energy was used in group II than in group I (P < 0.001). Histopathologic assessment revealed local residual viable tumor tissues due to incomplete ablation in 47.4% (9/19) of tumors in group I and 10% (2/20) of tumors in group II (P < 0.05). The concordance rate of CEUS (90.9%) with histopathology on residual tumor detection was higher than that of CECT (27.3%, P < 0.05). Conclusions: Introduction of the microbubble agent enhances HIFU therapeutic efficacy. CEUS proves to have high sensitivity in assessment of residual viable rabbit VX2 tumor after HIFU.

  5. Ultrastable polyethyleneimine-stabilized gold nanoparticles modified with polyethylene glycol for blood pool, lymph node and tumor CT imaging

    NASA Astrophysics Data System (ADS)

    Zhang, Yongxing; Wen, Shihui; Zhao, Lingzhou; Li, Du; Liu, Changcun; Jiang, Wenbin; Gao, Xiang; Gu, Wentao; Ma, Nan; Zhao, Jinhua; Shi, Xiangyang; Zhao, Qinghua

    2016-03-01

    Development of new long-circulating contrast agents for computed tomography (CT) imaging of different biological systems still remains a great challenge. Here, we report the design and synthesis of branched polyethyleneimine (PEI)-stabilized gold nanoparticles (Au PSNPs) modified with polyethylene glycol (PEG) for blood pool, lymph node, and tumor CT imaging. In this study, thiolated PEI was first synthesized and used as a stabilizing agent to form AuNPs. The formed Au PSNPs were then grafted with PEG monomethyl ether via PEI amine-enabled conjugation chemistry, followed by acetylation of the remaining PEI surface amines. The formed PEGylated Au PSNPs were characterized via different methods. We show that the PEGylated Au PSNPs with an Au core size of 5.1 nm have a relatively long half-decay time (7.8 h), and display a better X-ray attenuation property than conventionally used iodine-based CT contrast agents (e.g., Omnipaque), and are hemocompatible and cytocompatible in a given concentration range. These properties of the Au PSNPs afford their uses as a contrast agent for effective CT imaging of the blood pool and major organs of rats, lymph node of rabbits, and the xenografted tumor model of mice. Importantly, the PEGylated Au PSNPs could be excreted out of the body with time and also showed excellent in vivo stability. These findings suggest that the formed PEGylated Au PSNPs may be used as a promising contrast agent for CT imaging of different biological systems.Development of new long-circulating contrast agents for computed tomography (CT) imaging of different biological systems still remains a great challenge. Here, we report the design and synthesis of branched polyethyleneimine (PEI)-stabilized gold nanoparticles (Au PSNPs) modified with polyethylene glycol (PEG) for blood pool, lymph node, and tumor CT imaging. In this study, thiolated PEI was first synthesized and used as a stabilizing agent to form AuNPs. The formed Au PSNPs were then grafted with PEG

  6. Hepatitis

    MedlinePlus

    ... low because of routine testing of donated blood. Sexual transmission and transmission among family members through close contact ... associated with drinking contaminated water. Hepatitis Viruses ... B Blood, needles, sexual 10% of older children develop chronic infection. 90% ...

  7. Activated Hepatic Stellate Cells Induce Tumor Progression of Neoplastic Hepatocytes in a TGF-β Dependent Fashion

    PubMed Central

    MIKULA, M.; PROELL, V.; FISCHER, A.N.M.; MIKULITS, W.

    2010-01-01

    The development of hepatocellular carcinomas from malignant hepatocytes is frequently associated with intra- and peritumoral accumulation of connective tissue arising from activated hepatic stellate cells. For both tumorigenesis and hepatic fibrogenesis, transforming growth factor (TGF)-β signaling executes key roles and therefore is considered as a hallmark of these pathological events. By employing cellular transplantation we show that the interaction of neoplastic MIM-R hepatocytes with the tumor microenvironment, containing either activated hepatic stellate cells (M1-4HSCs) or myofibroblasts derived thereof (M-HTs), induces progression in malignancy. Cotransplantation of MIM-R hepatocytes with M-HTs yielded strongest MIM-R generated tumor formation accompanied by nuclear localization of Smad2/3 as well as of β-catenin. Genetic interference with TGF-β signaling by gain of antagonistic Smad7 in MIM-R hepatocytes diminished epithelial dedifferentiation and tumor progression upon interaction with M1-4HSCs or M-HTs. Further analysis showed that tumors harboring disrupted Smad signaling are devoid of nuclear β-catenin accumulation, indicating a crosstalk between TGF-β and β-catenin signaling. Together, these data demonstrate that activated HSCs and myofibroblasts directly govern hepatocarcinogenesis in a TGF-β dependent fashion by inducing autocrine TGF-β signaling and nuclear β-catenin accumulation in neoplastic hepatocytes. These results indicate that intervention with TGF-β signaling is highly promising in liver cancer therapy. PMID:16883581

  8. Synthesis and characterization of PEGylated polyethylenimine-entrapped gold nanoparticles for blood pool and tumor CT imaging.

    PubMed

    Zhou, Benqing; Zheng, Linfeng; Peng, Chen; Li, Du; Li, Jingchao; Wen, Shihui; Shen, Mingwu; Zhang, Guixiang; Shi, Xiangyang

    2014-10-08

    The synthesis and characterization of gold nanoparticles (AuNPs) entrapped within polyethylene glycol (PEG)-modified polyethylenimine (PEI) for blood pool and tumor computed tomography (CT) imaging are reported. In this approach, partially PEGylated PEI was used as a template for AuNP synthesis, followed by acetylating the PEI remaining surface amines. The synthesized PEGylated PEI-entrapped AuNPs (Au PENPs) were characterized via different methods. Our results reveal that the synthesized Au PENPs can be tuned to have an Au core size in a range of 1.9-4.6 nm and to be water-soluble, stable, and noncytotoxic in a studied concentration range. With a demonstrated better X-ray attenuation property than that of clinically used iodinated small molecular contrast agent (e.g., Omnipaque) and the prolonged half-decay time (11.2 h in rat) confirmed by pharmacokinetics studies, the developed PEGylated Au PENPs enabled efficient and enhanced blood pool CT imaging with imaging time up to 75 min. Likewise, thanks to the enhanced permeability and retention effect, the PEGylated Au PENPs were also able to be used as a contrast agent for effective CT imaging of a tumor model. With the proven organ biocompatibility by histological studies, the designed PEGylated Au PENPs may hold great promise to be used as contrast agents for CT imaging of a variety of biological systems. The significance of this study is that rather than the use of dendrimers as templates, cost-effective branched polymers (e.g., PEI) can be used as templates to generate functionalized AuNPs for CT imaging applications.

  9. Whole-tumor perfusion CT in patients with advanced lung adenocarcinoma treated with conventional and antiangiogenetic chemotherapy: initial experience.

    PubMed

    Fraioli, Francesco; Anzidei, Michele; Zaccagna, Fulvio; Mennini, Maria Luisa; Serra, Goffredo; Gori, Bruno; Longo, Flavia; Catalano, Carlo; Passariello, Roberto

    2011-05-01

    To determine whether wide-volume perfusion computed tomography (CT) performed with a new generation scanner can allow evaluation of the effects of chemotherapy combined with antiangiogenetic treatment on the whole tumor mass in patients with locally advanced lung adenocarcinoma and to determine if changes in CT numbers correlate with the response to therapy as assessed by conventional response evaluation criteria in solid tumors (RECIST). Forty-five patients with unresectable lung adenocarcinoma underwent perfusion CT before and 40 and 90 days after chemotherapy and antiangiogenetic treatment. RECIST measurements and calculations of blood flow, blood volume, time to peak, and permeability were performed by two independent blinded radiologists. Pearson correlation coefficient was used to assess the correlation between baseline CT numbers. Baseline and follow-up perfusion parameters of the neoplastic lesions were tested overall for statistically significant differences by using the repeated-measures analysis of variance and then were also compared on the basis of the therapy response assessed according to the RECIST criteria. Pearson correlation coefficient showed a significant correlation between baseline values of blood flow and blood volume (ρ = 0.48; P = .001), time to peak and permeability (ρ = 0.31; P = .04), time to peak and blood flow (ρ = -0.66; P < .001), and time to peak and blood volume (ρ = -0.39; P = .007). Blood flow, blood volume, and permeability values were higher in responding patients than in the other patients, with a significant difference at second follow-up for blood flow (P = .0001), blood volume (P = .02), and permeability (P = .0001); time to peak was higher in nonresponding patients (P = .012). Perfusion CT imaging may allow evaluation of lung cancer angiogenesis demonstrating alterations in vascularity following treatment. RSNA, 2011

  10. Radiation dose during CT-guided percutaneous cryoablation of renal tumors: Effect of a dose reduction protocol.

    PubMed

    Levesque, Vincent M; Shyn, Paul B; Tuncali, Kemal; Tatli, Servet; Nawfel, Richard D; Olubiyi, Olutayo; Silverman, Stuart G

    2015-11-01

    To estimate and compare the radiation dose using a standard protocol and that of a dose reduction protocol in patients undergoing CT-guided percutaneous cryoablation of renal tumors. An IRB-approved, HIPAA-compliant retrospective study of 97 CT-guided cryoablation procedures to treat a solitary renal tumor in each of 97 patients (64 M, 33 F; range 31-84 yrs) was performed. Fifty patients were treated using a standard dose protocol (kVp=120, mean mAs=180, monitoring scans every 3 min during freezes), and an additional 47 patients were treated using a dose reduction protocol (kVp=100, mean mAs=100, monitoring scans less frequently than every 3 min during freezes). Multiple Wilcoxon Mann-Whitney (rank-sum) tests were used to compare dose-length product (DLP) between the two groups. Fisher's exact test was used to compare technique effectiveness at 12 months post ablation between the two groups. Median DLP for the standard protocol group was 4833.5 mGy*cm (range, 1667-8267 mGy*cm); median DLP for the dose reduction group was 2648 mGy*cm (range, 850-7169 mGy*cm), significantly less than that of the standard protocol group (p<0.01). The technique effectiveness for the dose reduction group was not significantly different from that of the standard protocol group at 12 month follow up (p=0.434). The radiation dose during percutaneous CT-guided cryoablation of renal tumors was substantial in both the standard and the dose reduction groups; however, it was significantly lower with the protocol change that reduced dose parameters and decreased the number of CT scans. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. CD39/ENTPD1 expression by CD4+Foxp3+ regulatory T cells promotes hepatic metastatic tumor growth in mice

    PubMed Central

    SUN, XIAOFENG; WU, YAN; GAO, WENDA; ENJYOJI, KEIICHI; CSIZMADIA, EVA; MÜLLER, CHRISTA E.; MURAKAMI, TAKASHI; ROBSON, SIMON C.

    2010-01-01

    Background & Aims Adenosine mediates immune suppression and is generated by the ectonucleotidases CD39 (ENTPD1) and CD73 that are expressed on vascular endothelial cells and regulatory T cells (Treg). Although tumor-infiltrating immune cells include Foxp3+ Treg, it is not clear whether local adenosine generation by Treg promotes tumor growth in a CD39-dependent manner. In this study, we have examined the impact of CD39 expression by Treg on effector immune cell responses to hepatic metastases in vivo. Methods and Results A model of hepatic metastatic cancer was developed with portal vein infusion of luciferase-expressing melanoma B16/F10 cells and MCA38 colon cancer cells in wild type and mutant mice null for Cd39. Chimeric mice were generated by bone marrow transplantation (BMT) using Cd39 null or wild type (wt) C57BL6 donors and irradiated recipient mice. We demonstrate that hepatic growth of melanoma metastatic tumors was strongly inhibited in mice with Cd39 null vasculature or in wild type mice with circulating Cd39 null bone marrow-derived cells. We show functional CD39 expression on CD4+Foxp3+ Treg suppressed anti-tumor immunity mediated by NK cells in vitro and in vivo. Lastly, inhibition of CD39 activity by POM-1 (polyoxometalate-1), a pharmacological inhibitor of NTPDase activity, significantly inhibited tumor growth (P < .001). Conclusions CD39 expression on Treg inhibits NK activity and is permissive for metastatic growth. Pharmacological or targeted inhibition of CD39 enzymatic activity may find utility as an adjunct therapy for secondary hepatic malignancies. PMID:20546740

  12. Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain.

    PubMed

    Andreano, Anita; Galimberti, Stefania; Franza, Elvira; Knavel, Erica M; Sironi, Sandro; Lee, Fred T; Meloni, Maria Franca

    2014-01-01

    To prospectively investigate the frequency and severity of postablation syndrome (PAS) and postprocedural pain in a cohort of patients undergoing hepatic microwave ablation. From March 2009 to November 2011, 54 consecutive patients undergoing microwave ablation for liver tumors were enrolled. A questionnaire was administered to investigate PAS and pain at 1, 7, and 40 days after ablation. Four patients did not complete all three questionnaires and were excluded from the analysis. Additionally, laboratory tests with results known to significantly increase or decrease after ablation were performed, and ablation parameters were recorded. Potential predictors of PAS and pain at 1 and 7 days were evaluated by a logistic regression model. Fifty patients underwent a single microwave ablation session, 33 for hepatocellular carcinoma (HCC) and 17 for liver metastasis. Median ablation volumes on computed tomography were 31 cm(3) for HCC and 42 cm(3) for metastasis. Sixty percent of patients experienced PAS in the first week. Aspartate aminotransferase (AST) levels after ablation were significantly associated with PAS during postprocedure days 1-7. Median visual analog scale scores for pain at the puncture site were 1 and 0.24 at 1 and 7 days, respectively. The risk of having at least moderate pain in the first week was significantly related to ablation volume and time and postablation increase in AST level. The incidence and severity of PAS with hepatic microwave ablation is similar to that reported for radiofrequency ablation, with the best predictive factor being postablation AST level elevation. Postablation pain was best predicted by total ablation volume and AST level. © 2013 The Society of Interventional Radiology Published by SIR All rights reserved.

  13. Comparison of Fusion Imaging Using a Combined SPECT/CT System and Intra-arterial CT: Assessment of Drug Distribution by an Implantable Port System in Patients Undergoing Hepatic Arterial Infusion Chemotherapy

    SciTech Connect

    Ikeda, Osamu Kusunoki, Shinichiroh; Nakaura, Takeshi; Shiraishi, Shinya; Kawanaka, Kouichi; Tomiguchi, Seiji; Yamashita, Yasuyuki; Takamori, Hiroshi; Chikamoto, Akira; Kanemitsu, Keiichiro

    2006-06-15

    Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinoma of the liver. We compared the perfusion patterns of HAI chemotherapy on intra-arterial port-catheter computed tomography (iapc-CT) and fused images obtained with a combined single-photon emission computed tomography/computed tomography (SPECT/CT) system. We studied 28 patients with primary or metastatic carcinoma of the liver who bore an implantable HAI port system. All underwent abdominal SPECT using Tc-99m-MAA (185 Mbq); the injection rate was 1 mL/min, identical to the chemotherapy infusion rate, and 0.5 mL/sec for iapc-CT. Delivery was through an implantable port. We compared the intrahepatic perfusion (IHP) and extrahepatic perfusion (EHP) patterns of HAI chemotherapy on iapc-CT images and fused images obtained with a combined SPECT/CT system. In 23 of 28 patients (82%), IHP patterns on iapc-CT images and fused images were identical. In 5 of the 28 patients (18%), IHP on fusion images was different from IHP on iapc-CT images. EHP was seen on fused images in 12 of the 28 patients (43%) and on iapc-CT images in 8 patients (29%). In 17 patients (61%), upper gastrointestinal endoscopy revealed gastroduodenal mucosal lesions. EHP was revealed on fused images in 10 of these patients; 9 of them manifested gastroduodenal toxicity at the time of subsequent HAI chemotherapy. Fusion imaging using the combined SPECT/CT system reflects the actual distribution of the infused anticancer agent. This information is valuable not only for monitoring adequate drug distribution but also for avoiding potential extrahepatic complications.

  14. [Effect of lipiodol emulsion and local hyperthermia on hepatic tissue blood flow in rabbits with VX-2 liver tumor].

    PubMed

    Suzuki, K; Tada, I; Okada, K; Kim, Y I; Kobayashi, M

    1988-08-01

    The effect of intra-arterial infusion of lipiodol-emulsion and local hyperthermia on tissue blood flow was examined in experimental hepatic tumor and normal liver of rabbits. VX-2 tumor was implanted in liver of rabbit. The tissue blood flow was estimated by hydrogen gas clearance method when the tumor grew to about 2 cm. Tissue blood flow in tumor (64.5 ml/min/100 g) was significantly less than in normal liver (90.8 ml/min/100 g) (p less than 0.005). The intra-arterial infusion of lipiodol-emulsion did not alter the flow in either tissue. However, the addition of hyperthermia induced a substantial rise of tissue blood flow in normal liver (35% increase, from 93.8 to 127 ml/min/100 g) when compared with in VX-2 tumor (8.9% increase, from 65.1 to 71.8 ml/min/100 g). These were accompanied by a selective heating of liver tumor; the tumor temperature rose to 43 degrees C, although that of normal liver remained at 38 degrees C. Our results suggested that a specific temperature rise of liver tumor after infusion of lipiodol-emulsion and local heating might be related to a different response of microcirculation in tumor and normal liver to the hyperthermia.

  15. Contribution of 18-FDG PET/CT to brown tumor detection in a patient with primary hyperparathyroidism.

    PubMed

    Gahier Penhoat, Mélanie; Drui, Delphine; Ansquer, Catherine; Mirallie, Eric; Maugars, Yves; Guillot, Pascale

    2017-03-01

    We report the case of a patient who presented with multiple brown tumors as the inaugural manifestation of primary hyperparathyroidism. Tc-99m hexakis methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy demonstrated increased radiotracer uptake by the bone lesions. The patient was a 65-year-old male who sought advice for a swelling on his right shin. An osteolytic lesion was visible on the radiograph. A bone biopsy showed a benign tumor containing abundant osteoclastic cells. Laboratory abnormalities included hypercalcemia (3.63mmol/L with 1.91mmol/L ionized calcium), hypophosphatemia (0.38mmol/L), and parathyroid hormone elevation (880.8pg/mL; N: 10-70). Serum 25-OH Vitamin D level was lower than 4ng/mL (N: 30-60). An 18-FDG PET/CT scan identified numerous high-uptake bone lesions. By 99mTc-MIBI scintigraphy, a large high-uptake mass was seen in the left parathyroid gland, as well as high-uptake lesions throughout the skeleton, which were less numerous than those seen by 18-FDG PET/CT. Ultrasonography of the neck visualized a mass consistent with an adenoma in the left parathyroid gland. Brown tumors are bone lesions whose diagnosis should be considered in patients with clinical and laboratory evidence of hyperparathyroidism, once a malignant disease is ruled out. Our case report suggests that 18-FDG PET/CT may be more sensitive than whole-body 99mTc-MIBI scintigraphy in detecting brown tumors.

  16. Tumor Tracking Method Based on a Deformable 4D CT Breathing Motion Model Driven by an External Surface Surrogate

    SciTech Connect

    Fassi, Aurora; Schaerer, Joël; Fernandes, Mathieu; Riboldi, Marco; Sarrut, David; Baroni, Guido

    2014-01-01

    Purpose: To develop a tumor tracking method based on a surrogate-driven motion model, which provides noninvasive dynamic localization of extracranial targets for the compensation of respiration-induced intrafraction motion in high-precision radiation therapy. Methods and Materials: The proposed approach is based on a patient-specific breathing motion model, derived a priori from 4-dimensional planning computed tomography (CT) images. Model parameters (respiratory baseline, amplitude, and phase) are retrieved and updated at each treatment fraction according to in-room radiography acquisition and optical surface imaging. The baseline parameter is adapted to the interfraction variations obtained from the daily cone beam (CB) CT scan. The respiratory amplitude and phase are extracted from an external breathing surrogate, estimated from the displacement of the patient thoracoabdominal surface, acquired with a noninvasive surface imaging device. The developed method was tested on a database of 7 lung cancer patients, including the synchronized information on internal and external respiratory motion during a CBCT scan. Results: About 30 seconds of simultaneous acquisition of CBCT and optical surface images were analyzed for each patient. The tumor trajectories identified in CBCT projections were used as reference and compared with the target trajectories estimated from surface displacement with the a priori motion model. The resulting absolute differences between the reference and estimated tumor motion along the 2 image dimensions ranged between 0.7 and 2.4 mm; the measured phase shifts did not exceed 7% of the breathing cycle length. Conclusions: We investigated a tumor tracking method that integrates breathing motion information provided by the 4-dimensional planning CT with surface imaging at the time of treatment, representing an alternative approach to point-based external–internal correlation models. Although an in-room radiograph-based assessment of the

  17. MicroCT for high-resolution imaging of ectopic pheochromocytoma tumors in the liver of nude mice.

    PubMed

    Ohta, Shoichiro; Lai, Edwin W; Morris, John C; Bakan, Douglas A; Klaunberg, Brenda; Cleary, Susannah; Powers, James F; Tischler, Arthur S; Abu-Asab, Mones; Schimel, Daniel; Pacak, Karel

    2006-11-01

    Successful outcomes for patients with cancer often depend on the early detection of tumor and the prompt initiation of active therapy. Despite major advances in the treatment of many cancers, early-stage lesions often go undetected due to the suboptimal resolution of current anatomical and functional imaging modalities. This limitation also applies to preclinical animal tumor models that are crucial for the evaluation and development of new therapeutic approaches to cancer. We report a new mouse model of metastatic pheochromocytoma, generated using tail vein injection of the mouse pheochromocytoma cell (MPC) line that reproducibly generated multiple liver tumors in the animals. Furthermore, we show that in vivo microCT imaging enhanced using a hepatobiliary-specific contrast agent, glyceryl-2-oleyl-1,3-di-7-(3-amino-2,4,6-triiodophenyl)-heptanoate (DHOG), detected tumors as small as 0.35 mm as early as 4 weeks after the injection of the tumor cells. This model may be useful for in vivo studies of tumor biology and for development of new strategies to treat metastatic pheochromocytoma.

  18. MicroCT for high-resolution imaging of ectopic pheochromocytoma tumors in the liver of nude mice

    PubMed Central

    Ohta, Shoichiro; Lai, Edwin W.; Morris, John C.; Bakan, Douglas A.; Klaunberg, Brenda; Cleary, Susannah; Powers, James F.; Tischler, Arthur S.; Abu-Asab, Mones; Schimel, Daniel; Pacak, Karel

    2008-01-01

    Successful outcomes for patients with cancer often depend on the early detection of tumor and the prompt initiation of active therapy. Despite major advances in the treatment of many cancers, early-stage lesions often go undetected due to the suboptimal resolution of current anatomical and functional imaging modalities. This limitation also applies to preclinical animal tumor models that are crucial for the evaluation and development of new therapeutic approaches to cancer. We report a new mouse model of metastatic pheochromocytoma, generated using tail vein injection of the mouse pheochromocytoma cell (MPC) line that reproducibly generated multiple liver tumors in the animals. Furthermore, we show that in vivo microCT imaging enhanced using a hepatobiliary-specific contrast agent, glyceryl-2-oleyl-1,3-di-7-(3-amino-2,4,6-triiodophenyl)-heptanoate (DHOG), detected tumors as small as 0.35 mm as early as 4 weeks after the injection of the tumor cells. This model may be useful for in vivo studies of tumor biology and for development of new strategies to treat metastatic pheochromocytoma. PMID:16841334

  19. Exposure (mAs) optimisation of a multi-detector CT protocol for hepatic lesion detection: Are thinner slices better?

    PubMed

    Dobeli, Karen Leigh; Lewis, Sarah Jane; Meikle, Steven Richard; Thiele, David Lewis; Brennan, Patrick Christopher

    2014-04-01

    The purpose of this work was to determine the exposure-optimised slice thickness for hepatic lesion detection with CT. A phantom containing spheres (diameter 9.5, 4.8 and 2.4 mm) with CT density 10 HU below the background (50 HU) was scanned at 125, 100, 75 and 50 mAs. Data were reconstructed at 5-, 3- and 1-mm slice thicknesses. Noise, contrast-to-noise ratio (CNR), area under the curve (AUC) as calculated using receiver operating characteristic analysis and sensitivity representing lesion detection were calculated and compared. Compared with the 125 mAs/5 mm slice thickness setting, significant reductions in AUC were found for 75 mAs (P < 0.01) and 50 mAs (P < 0.05) at 1- and 3-mm thicknesses, respectively; sensitivity for the 9.5-mm sphere was significantly reduced for 75 (P < 0.05) and 50 mAs (P < 0.01) at 1-mm thickness; sensitivity for the 4.8-mm sphere was significantly lower for 100, 75 and 50 mAs at all three slice thicknesses (P < 0.05). The 2.4-mm sphere was rarely detected. At each slice thickness, noise at 100, 75 and 50 mAs exposures was approximately 10, 30 and 50% higher, respectively, than that at 125 mAs exposure. CNRs decreased in an irregular manner with reductions in exposure and slice thickness. This study demonstrated no advantage to using slices below 5 mm thickness, and consequently thinner slices are not necessarily better. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists.

  20. Skeletal Tumor Burden on Baseline 18F-Fluoride PET/CT Predicts Bone Marrow Failure After 223Ra Therapy.

    PubMed

    Etchebehere, Elba C; Araujo, John C; Milton, Denái R; Erwin, William D; Wendt, Richard E; Swanston, Nancy M; Fox, Patricia; Macapinlac, Homer A; Rohren, Eric M

    2016-04-01

    Determine if skeletal tumor burden on 18F-fluoride PET/CT (fluoride PET/CT) predicts the risk of bone marrow failure (BMF) after 223Ra dichloride therapy (223Ra). Forty-one metastatic prostate cancer patients (43-89 years old; mean, 71 ± 9 years.) underwent fluoride PET/CT prior to 223Ra. Bone marrow failure was the primary end point and was defined as (1) development of hematologic toxicity (World Health Organization grade 3 or 4) associated with no recovery after 6 weeks or (2) death due to BMF after the last 223Ra dose. Bone marrow failure was correlated to fluoride PET/CT skeletal tumor burden (TLF10 [total lesion on fluoride PET/CT with SUVmax of 10 or greater]), use of chemotherapy, serum hemoglobin concentration, serum ALP, and serum prostate-specific antigen. The number of 223Ra cycles ranged from 2 to 6 (mean, 5). Of the 41 patients, 16 developed BMF (G3 = 12; G4 = 4). A significantly increased risk of developing BMF was observed in patients with TLF10 of 12,000 or greater (hazard ratio [HR], 11.09; P < 0.0001), hemoglobin of less than 10 g/dL (HR, 7.35; P = 0.0002), and AP > 146 UI/L (HR, 4.52; P = 0.0100). Neither concomitant (HR, 0.91; P = 0.88) nor subsequent use of chemotherapy (HR, 0.14; P = 0.84) increased the risk of BMF, nor was prostate-specific antigen greater than 10 μg/L (HR, 0.90; P = 0.86). Moreover, in a multivariable analysis, TLF10 was the only independent predictor of BMF (HR, 6.66; P = 0.0237). 223Ra was beneficial and reduced the risk of death even in patients with a high skeletal tumor burden. Fluoride PET/CT is able to determine which patients will benefit from 223Ra and which will develop BMF.

  1. Treatment of hepatic tumors by thermal versus mechanical effects of pulsed high intensity focused ultrasound in vivo

    NASA Astrophysics Data System (ADS)

    Peng, Song; Zhou, Ping; He, Wei; Liao, Manqiong; Chen, Lili; Ma, C.-M.

    2016-09-01

    The purpose of this study is to comparatively assess the thermal versus mechanical effects of pulsed high intensity focused ultrasound (HIFU) treatment on hepatic tumors in vivo. Forty-five rabbits with hepatic VX2 tumors were randomly separated into three groups (15 animals per group) before HIFU ablation. The total HIFU energy (in situ) of 1250 J was used for each tumor for three groups. In groups I and II, animals were treated with 1 MHz pulsed ultrasound at 1 Hz pulsed repetition frequency (PRF), 0.5 duty cycle (0.5 s on and 0.5 s off) and10 s duration for one spot sonication. For group II, in addition to HIFU treatment, microbubbles (SonoVue, Bracco, Milan, Italy) were injected via vein before sonication acting as a synergist. In group III, animals were treated with 1 MHz pulsed ultrasound at 10 Hz PRF, 0.1 duty cycle (0.1 s on and 0.9 s off) and 10 s duration for one sonication. The total treatment spots were calculated according to the tumor volume. Tumors were examined with contrast-enhanced computed tomography (CECT) immediately prior to and post HIFU treatment. Histopathologic assessment was performed 3 h after treatment. Our study showed that all animals tolerated the HIFU treatment well. Our data showed that mechanical HIFU could lead to controlled injury in rabbit hepatic tumors with different histological changes in comparison to thermal HIFU with or without microbubbles.

  2. Histogram Analysis of CT Perfusion of Hepatocellular Carcinoma for Predicting Response to Transarterial Radioembolization: Value of Tumor Heterogeneity Assessment

    SciTech Connect

    Reiner, Caecilia S. Gordic, Sonja; Puippe, Gilbert; Morsbach, Fabian; Wurnig, Moritz; Schaefer, Niklaus; Veit-Haibach, Patrick; Pfammatter, Thomas; Alkadhi, Hatem

    2016-03-15

    PurposeTo evaluate in patients with hepatocellular carcinoma (HCC), whether assessment of tumor heterogeneity by histogram analysis of computed tomography (CT) perfusion helps predicting response to transarterial radioembolization (TARE).Materials and MethodsSixteen patients (15 male; mean age 65 years; age range 47–80 years) with HCC underwent CT liver perfusion for treatment planning prior to TARE with Yttrium-90 microspheres. Arterial perfusion (AP) derived from CT perfusion was measured in the entire tumor volume, and heterogeneity was analyzed voxel-wise by histogram analysis. Response to TARE was evaluated on follow-up imaging (median follow-up, 129 days) based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results of histogram analysis and mean AP values of the tumor were compared between responders and non-responders. Receiver operating characteristics were calculated to determine the parameters’ ability to discriminate responders from non-responders.ResultsAccording to mRECIST, 8 patients (50 %) were responders and 8 (50 %) non-responders. Comparing responders and non-responders, the 50th and 75th percentile of AP derived from histogram analysis was significantly different [AP 43.8/54.3 vs. 27.6/34.3 mL min{sup −1} 100 mL{sup −1}); p < 0.05], while the mean AP of HCCs (43.5 vs. 27.9 mL min{sup −1} 100 mL{sup −1}; p > 0.05) was not. Further heterogeneity parameters from histogram analysis (skewness, coefficient of variation, and 25th percentile) did not differ between responders and non-responders (p > 0.05). If the cut-off for the 75th percentile was set to an AP of 37.5 mL min{sup −1} 100 mL{sup −1}, therapy response could be predicted with a sensitivity of 88 % (7/8) and specificity of 75 % (6/8).ConclusionVoxel-wise histogram analysis of pretreatment CT perfusion indicating tumor heterogeneity of HCC improves the pretreatment prediction of response to TARE.

  3. CT features of nonfunctioning islet cell carcinoma

    SciTech Connect

    Eelkema, E.A.; Stephens, D.H.; Ward, E.M.; Sheedy, P.F. II

    1984-11-01

    To determine the computed tomographic (CT) characteristics of nonfunctioning islet cell carcinoma of the pancreas, the CT scans of 27 patients with that disease were reviewed. The pancreatic tumor was identified as a mass in 26 patients (96%) Of the 25 tumors evaluated with contrast enhancement, 20 became partially diffusely hyperdense relative to nearby normal pancreatic tissue. Hepatic metastases were identified in 15 patients (56%), regional lymphadenopathy in 10 (37%), atrophy of the gland proximal to the tumor in six (22%), dilatation of the biliary ducts in five (19%), and dilatation of the pancreatic duct in four (15%). The CT appearances of the nonfunctioning islet cell tumors were compared with those of 100 ordinary (ductal) pancreatic adenocarcinomas. Although the two types of tumors were sometimes indistinguishable, features found to be more characteristic of islet cell carcinoma included a pancreatic mass of unusually large size, calcification within the tumor, and contrast enhancement of either the primary tumor or hepatic metastases. Involvement of the celiac axis or proximal superior mesenteric artery was limited to ductal carcinoma.

  4. SU-E-I-84: Accuracy Comparison of Multi-Modality Image-Based Volumes of Rodent Solid Tumors Using In-Air Micro-CT Image Volume

    SciTech Connect

    Lee, Y; Fullerton, G; Goins, B

    2015-06-15

    Purpose: Tumor volume is considered as a better predictor for therapy response monitoring and tumor staging over Response Evaluation Criteria In Solid Tumors (RECIST) or World Health Organization (WHO) criteria. In this study, the accuracy of subcutaneous rodent tumor volumes using preclinical magnetic resonance imaging (MRI), micro-computed tomography (micro-CT) and ultrasound (US) equipment and with an external caliper was compared using in-air micro-CT image volume of excised tumors determined as reference tumor volume in our prior study. Methods: MR, US and micro-CT images of subcutaneous SCC4 head and neck tumor xenografts were acquired 4, 6, 9, 11 and 13 days after tumor cell inoculation. Before MR and US scans, caliper measurements were made. After tumors were excised, in-air micro-CT imaging and ex vivo caliper measurements were performed. Tumor volumes were calculated using formula V = (π/6)*a*b*c where a, b and c are the maximum diameters in three perpendicular dimensions determined by the three image modalities and caliper, and compared with reference tumor volume by linear regression analysis as well as Bland-Altman plots. A one-way Analysis of Variance (ANOVA) test was also performed to compare volumes among caliper measurements. Results: The correlation coefficients (R2) of the regression lines for tumor volumes measured by the three imaging modalities and caliper were 0.9939, 0.9669, 0.9806, 0.9274, 0.9619 and 0.9819 for MRI, US and micro-CT, caliperbeforeMRI, caliperbeforeUS and ex vivo caliper respectively. In Bland-Altman plots, the average of tumor volume difference from reference tumor volume (bias) was significant for caliper and micro- CT, but not for MRI and US. Comparison of caliper measurements showed a significant difference (p < 0.05). Conclusion: Using the in-air micro-CT image volume, tumor volume measured by MRI was the most accurate among the three imaging modalities. In vivo caliper volume measurements showed unreliability while ex

  5. Down-regulation of the cancer/testis antigen 45 (CT45) is associated with altered tumor cell morphology, adhesion and migration

    PubMed Central

    2013-01-01

    Background Due to their restricted expression in male germ cells and certain tumors, cancer/testis (CT) antigens are regarded as promising targets for tumor therapy. CT45 is a recently identified nuclear CT antigen that was associated with a severe disease score in Hodgkin’s lymphoma and poor prognosis in multiple myeloma. As for many CT antigens, the biological function of CT45 in developing germ cells and in tumor cells is largely unknown. Methods CT45 expression was down-regulated in CT45-positive Hodgkin’s lymphoma (L428), fibrosarcoma (HT1080) and myeloma (U266B1) cells using RNA interference. An efficient CT45 knock-down was confirmed by immunofluorescence staining and/or Western blotting. These cellular systems allowed us to analyze the impact of CT45 down-regulation on proliferation, cell cycle progression, morphology, adhesion, migration and invasive capacity of tumor cells. Results Reduced levels of CT45 did not coincide with changes in cell cycle progression or proliferation. However, we observed alterations in cell adherence, morphology and migration/invasion after CT45 down-regulation. Significant changes in the distribution of cytoskeleton-associated proteins were detected by confocal imaging. Changes in cell adherence were recorded in real-time using the xCelligence system with control and siRNA-treated cells. Altered migratory and invasive capacity of CT45 siRNA-treated cells were visualized in 3D migration and invasion assays. Moreover, we found that CT45 down-regulation altered the level of the heterogeneous nuclear ribonucleoprotein syncrip (hnRNP-Q1) which is known to be involved in the control of focal adhesion formation and cell motility. Conclusions Providing first evidence of a cell biological function of CT45, we suggest that this cancer/testis antigen is involved in the modulation of cell morphology, cell adherence and cell motility. Enhanced motility and/or invasiveness of CT45-positive cells could contribute to the more severe

  6. A hybrid approach for fusing 4D-MRI temporal information with 3D-CT for the study of lung and lung tumor motion

    SciTech Connect

    Yang, Y. X.; Van Reeth, E.; Poh, C. L.; Teo, S.-K.; Tan, C. H.; Tham, I. W. K.

    2015-08-15

    Purpose: Accurate visualization of lung motion is important in many clinical applications, such as radiotherapy of lung cancer. Advancement in imaging modalities [e.g., computed tomography (CT) and MRI] has allowed dynamic imaging of lung and lung tumor motion. However, each imaging modality has its advantages and disadvantages. The study presented in this paper aims at generating synthetic 4D-CT dataset for lung cancer patients by combining both continuous three-dimensional (3D) motion captured by 4D-MRI and the high spatial resolution captured by CT using the authors’ proposed approach. Methods: A novel hybrid approach based on deformable image registration (DIR) and finite element method simulation was developed to fuse a static 3D-CT volume (acquired under breath-hold) and the 3D motion information extracted from 4D-MRI dataset, creating a synthetic 4D-CT dataset. Results: The study focuses on imaging of lung and lung tumor. Comparing the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, accurate results (average error <2 mm) were achieved using the authors’ proposed approach. Their hybrid approach achieved a 40% error reduction (based on landmarks assessment) over using only DIR techniques. Conclusions: The synthetic 4D-CT dataset generated has high spatial resolution, has excellent lung details, and is able to show movement of lung and lung tumor over multiple breathing cycles.

  7. A hybrid approach for fusing 4D-MRI temporal information with 3D-CT for the study of lung and lung tumor motion.

    PubMed

    Yang, Y X; Teo, S-K; Van Reeth, E; Tan, C H; Tham, I W K; Poh, C L

    2015-08-01

    Accurate visualization of lung motion is important in many clinical applications, such as radiotherapy of lung cancer. Advancement in imaging modalities [e.g., computed tomography (CT) and MRI] has allowed dynamic imaging of lung and lung tumor motion. However, each imaging modality has its advantages and disadvantages. The study presented in this paper aims at generating synthetic 4D-CT dataset for lung cancer patients by combining both continuous three-dimensional (3D) motion captured by 4D-MRI and the high spatial resolution captured by CT using the authors' proposed approach. A novel hybrid approach based on deformable image registration (DIR) and finite element method simulation was developed to fuse a static 3D-CT volume (acquired under breath-hold) and the 3D motion information extracted from 4D-MRI dataset, creating a synthetic 4D-CT dataset. The study focuses on imaging of lung and lung tumor. Comparing the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, accurate results (average error <2 mm) were achieved using the authors' proposed approach. Their hybrid approach achieved a 40% error reduction (based on landmarks assessment) over using only DIR techniques. The synthetic 4D-CT dataset generated has high spatial resolution, has excellent lung details, and is able to show movement of lung and lung tumor over multiple breathing cycles.

  8. Confounding of the Association between Radiation Exposure from CT Scans and Risk of Leukemia and Brain Tumors by Cancer Susceptibility Syndromes.

    PubMed

    Meulepas, Johanna M; Ronckers, Cécile M; Merks, Johannes; Weijerman, Michel E; Lubin, Jay H; Hauptmann, Michael

    2016-01-01

    Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of CT scans performed in children. We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk estimates. Because there is virtually no empirical evidence in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about the current and previous patterns of CT scans among CSS patients. We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome, or other CSS. In contrast, RRs for brain tumors may be overestimated due to confounding by tuberous sclerosis complex (TSC) while von Hippel-Lindau disease, neurofibromatosis type 1, or other CSS do not meaningfully confound. Empirical data on the use of CT scans among CSS patients are urgently needed. Our assessment indicates that associations with leukemia reported in previous studies are unlikely to be substantially confounded by unmeasured CSS, whereas brain tumor risks might have been overestimated due to confounding by TSC. Future studies should identify TSC patients in order to avoid overestimation of brain tumor risks due to radiation exposure from CT scans. ©2015 American Association for Cancer Research.

  9. The Long-term Benefit of Liver Transplantation for Hepatic Metastases from Neuroendocrine Tumors.

    PubMed

    Mazzaferro, V; Sposito, C; Coppa, J; Miceli, R; Bhoori, S; Bongini, M; Camerini, T; Milione, M; Regalia, E; Spreafico, C; Gangeri, L; Buzzoni, R; de Braud, F G; De Feo, T; Mariani, L

    2016-05-01

    Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors (NETs) remains uncertain. Eighty-eight consecutive patients with metastatic NETs eligible for liver transplantation according to Milan-NET criteria were offered transplant (n.42) vs. non-transplant options (n.46) depending on list dynamics, patient disposition and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p<0.001). Long-term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival-benefit was the difference in mean survival between transplant vs. non-transplant options. No patients were lost or died without recurrence. Median follow-up was 122 months. Transplant group showed significant advantage over non-transplant strategies at 5 and 10-yrs in survival (97.2% and 88.8% vs. 50.9% and 22.4% respectively; p<0.001) and time-to-progression (13.1% and 13.1% vs. 83.5% and 89%; p<0.001). After adjustment for propensity score, survival advantage of transplant group was significant (HR=7.4; 95%CI: 2.4-23.0; p=0.001). Adjusted transplant-related survival-benefit was 6.82 months (95%CI: 1.10-12.54; p=0.019) and 38.43 months (95%CI: 21.41-55.45; p<0.001) at 5 and 10-yrs respectively. Liver transplantation for metastatic NETs under restrictive criteria provides excellent long-term outcome. Transplant-related survival-benefit increases over time and maximizes after 10 yrs. This article is protected by copyright. All rights reserved.

  10. Imaging Intratumoral Nanoparticle Uptake after Combining Nanoembolization with Various Ablative Therapies in Hepatic VX2 Rabbit Tumors

    PubMed Central

    Tam, Alda L; Melancon, Marites P.; Abdelsalam, Mohamed; Figueira, Tomas Appleton; Dixon, Katherine; McWatters, Amanda; Zhou, Min; Huang, Qian; Mawlawi, Osama; Dunner, Kenneth; Li, Chun; Gupta, Sanjay

    2016-01-01

    Combining image-guided therapy techniques for the treatment of liver cancers is a strategy that is being used to improve local tumor control rates. Here, we evaluate the intratumoral uptake of nanoparticles used in combination with radiofrequency ablation (RFA), irreversible electroporation (IRE), or laser induced thermal therapy (LITT). Eight rabbits with VX2 tumor in the liver underwent one of four treatments: (i) nanoembolization (NE) with radiolabeled, hollow gold nanoparticles loaded with doxorubicin (64Cu-PEG-HAuNS-DOX); (ii) NE+RFA; (iii) NE+IRE; (iv) NE+LITT. Positron emission tomography/computed tomography (PET/CT) imaging was obtained 1-hr or 18-hrs after intervention. Tissue samples were collected for autoradiography and transmission electron microscopy (TEM) analysis. PET/CT imaging at 1-hr showed focal deposition of oil and nanoparticles in the tumor only after NE+RFA but at 18-hrs, all animals had focal accumulation of oil and nanoparticles in the tumor region. Autoradiograph analysis demonstrated nanoparticle deposition in the tumor and in the ablated tissues adjacent to the tumor when NE was combined with ablation. TEM results showed the intracellular uptake of nanoparticles in tumor only after NE+IRE. Nanoparticles demonstrated a structural change, suggesting direct interaction, potentially leading to drug release, only after NE+LITT. The findings demonstrate that a combined NE and ablation treatment technique for liver tumors is feasible, resulting in deposition of nanoparticles in and around the tumor. Depending on the ablative energy applied, different effects are seen on nanoparticle localization and structure. These effects should be considered when designing nanoparticles for use in combination with ablation technologies. PMID:27305763

  11. Hepatitis B viral reactivation secondary to imatinib treatment in a patient with gastrointestinal stromal tumor.

    PubMed

    Walker, Evan J; Simko, Jeffry P; Ko, Andrew H

    2014-07-01

    Hepatitis B virus (HBV) reactivation is a known risk in cancer patients receiving cytotoxic or immunosuppressive therapy; however, the risk associated with newer molecularly-targeted agents has not been well-quantified. Imatinib, a small molecule inhibitor directed against BCR-ABL, CKIT, and other tyrosine kinases, has been associated with HBV reactivation primarily in patients treated for chronic myelogenous leukemia. Herein we present the first reported case of a patient who developed HBV reactivation while receiving imatinib therapy for a gastrointestinal stromal tumor (GIST) in the adjuvant setting. This eventually resulted in fulminant liver failure and was effectively treated with living-related donor liver transplant and anti-viral medication. Currently, no guidelines exist for HBV screening prior to imatinib therapy. This report emphasizes the need for such guidelines and supports the idea that viral reactivation is a risk in all imatinib-treated patients, regardless of the underlying disease. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  12. Observer Performance in the Detection and Classification of Malignant Hepatic Nodules and Masses with CT Image-Space Denoising and Iterative Reconstruction

    PubMed Central

    Yu, Lifeng; Li, Zhoubo; Manduca, Armando; Blezek, Daniel J.; Hough, David M.; Venkatesh, Sudhakar K.; Brickner, Gregory C.; Cernigliaro, Joseph C.; Hara, Amy K.; Fidler, Jeff L.; Lake, David S.; Shiung, Maria; Lewis, David; Leng, Shuai; Augustine, Kurt E.; Carter, Rickey E.; Holmes, David R.; McCollough, Cynthia H.

    2015-01-01

    Purpose To determine if lower-dose computed tomographic (CT) scans obtained with adaptive image-based noise reduction (adaptive nonlocal means [ANLM]) or iterative reconstruction (sinogram-affirmed iterative reconstruction [SAFIRE]) result in reduced observer performance in the detection of malignant hepatic nodules and masses compared with routine-dose scans obtained with filtered back projection (FBP). Materials and Methods This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from patients for the retrospective use of medical records for research purposes. CT projection data from 33 abdominal and 27 liver or pancreas CT examinations were collected (median volume CT dose index, 13.8 and 24.0 mGy, respectively). Hepatic malignancy was defined by progression or regression or with histopathologic findings. Lower-dose data were created by using a validated noise insertion method (10.4 mGy for abdominal CT and 14.6 mGy for liver or pancreas CT) and images reconstructed with FBP, ANLM, and SAFIRE. Four readers evaluated routine-dose FBP images and all lower-dose images, circumscribing liver lesions and selecting diagnosis. The jackknife free-response receiver operating characteristic figure of merit (FOM) was calculated on a per–malignant nodule or per-mass basis. Noninferiority was defined by the lower limit of the 95% confidence interval (CI) of the difference between lower-dose and routine-dose FOMs being less than −0.10. Results Twenty-nine patients had 62 malignant hepatic nodules and masses. Estimated FOM differences between lower-dose FBP and lower-dose ANLM versus routine-dose FBP were noninferior (difference: −0.041 [95% CI: −0.090, 0.009] and −0.003 [95% CI: −0.052, 0.047], respectively). In patients with dedicated liver scans, lower-dose ANLM images were noninferior (difference: +0.015 [95% CI: −0.077, 0.106]), whereas lower-dose FBP images were not (difference −0.049 [95% CI:

  13. Tumor and normal tissue motion in the thorax during respiration: Analysis of volumetric and positional variations using 4D CT

    SciTech Connect

    Weiss, Elisabeth . E-mail: eweiss@mcvh-vcu.edu; Wijesooriya, Krishni; Dill, S. Vaughn; Keall, Paul J.

    2007-01-01

    Purpose: To investigate temporospatial variations of tumor and normal tissue during respiration in lung cancer patients. Methods and Materials: In 14 patients, gross tumor volume (GTV) and normal tissue structures were manually contoured on four-dimensional computed tomography (4D-CT) scans. Structures were evaluated for volume changes, centroid (center of mass) motion, and phase dependence of variations relative to inspiration. Only volumetrically complete structures were used for analysis (lung in 2, heart in 8, all other structures in >10 patients). Results: During respiration, the magnitude of contoured volumes varied up to 62.5% for GTVs, 25.5% for lungs, and 12.6% for hearts. The range of maximum three-dimensional centroid movement for individual patients was 1.3-24.0 mm for GTV, 2.4-7.9 mm for heart, 5.2-12.0 mm for lungs, 0.3-5.5 mm for skin markers, 2.9-10.0 mm for trachea, and 6.6-21.7 mm for diaphragm. During respiration, the centroid positions of normal structures varied relative to the centroid position of the respective GTV by 1.5-8.1 mm for heart, 2.9-9.3 mm for lungs, 1.2-9.2 mm for skin markers, 0.9-7.1 mm for trachea, and 2.7-16.4 mm for diaphragm. Conclusion: Using 4D-CT, volumetric changes, positional alterations as well as changes in the position of contoured structures relative to the GTV were observed with large variations between individual patients. Although the interpretation of 4D-CT data has considerable uncertainty because of 4D-CT artifacts, observer variations, and the limited acquisition time, the findings might have a significant impact on treatment planning.

  14. Obtaining quantitative global tumoral state indicators based on whole-body PET/CT scans: a breast cancer case study.

    PubMed

    Sampedro, Frederic; Domenech, Anna; Escalera, Sergio

    2014-04-01

    In this work we address the need for the computation of quantitative global tumoral state indicators from oncological whole-body PET/computed tomography scans. The combination of such indicators with other oncological information such as tumor markers or biopsy results would prove useful in oncological decision-making scenarios. From an ordering of 100 breast cancer patients on the basis of oncological state through visual analysis by a consensus of nuclear medicine specialists, a set of numerical indicators computed from image analysis of the PET/computed tomography scan is presented, which attempts to summarize a patient's oncological state in a quantitative manner taking into consideration the total tumor volume, aggressiveness, and spread. Results obtained by comparative analysis of the proposed indicators with respect to the experts' evaluation show up to 87% Pearson's correlation coefficient when providing expert-guided PET metabolic tumor volume segmentation and 64% correlation when using completely automatic image analysis techniques. Global quantitative tumor information obtained by whole-body PET/CT image analysis can prove useful in clinical nuclear medicine settings and oncological decision-making scenarios. The completely automatic computation of such indicators would improve its impact as time efficiency and specialist independence would be achieved.

  15. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI

    PubMed Central

    Dietrich, Christoph F; Kratzer, Wolfgang; Strobel, Deike; Danse, Etienne; Fessl, Robert; Bunk, Alfred; Vossas, Udo; Hauenstein, Karlheinz; Koch, Wilhelm; Blank, Wolfgang; Oudkerk, Matthijs; Hahn, Dietbert; Greis, Christian

    2006-01-01

    AIM: To evaluate contrast-enhanced ultrasonography (CEUS) using SonoVue® in the detection of liver metastases in patients with known extrahepatic primary tumors versus the combined gold standard comprising CT, MRI and clinical/histological data. METHODS: It is an international multicenter study, and there were 12 centres and 125 patients (64 males, 61 females, aged 59 ± 11 years) involved, with 102 patients per protocol. Primary tumors were colorectal in 35 %, breast in 27 %, pancreatic in 17 % and others in 21 %. CEUS using SonoVue® was employed with a low-mechanical-index technique and contrast-specific software using Siemens Elegra, Philips HDI 5000 and Acuson Sequoia; continuous scanning for at least five minutes. RESULTS: CEUS with SonoVue® increased significantly the number of focal liver lesions detected versus unenhanced sonography. In 31.4 % of the patients, more lesions were found after contrast enhancement. The total numbers of lesions detected were comparable with CEUS (55), triple-phase spiral CT (61) and MRI with a liver-specific contrast agent (53). Accuracy of detection of metastatic disease (i.e. at least one metastatic lesion) was significantly higher for CEUS (91.2 %) than for unenhanced sonography (81.4 %) and was similar to that of triple-phase spiral CT (89.2 %). In 53 patients whose CEUS examination was negative, a follow-up examination 3-6 mo later confirmed the absence of metastatic lesions in 50 patients (94.4 %). CONCLUSION: CEUS is proved to be reliable in the detection of liver metastases in patients with known extrahepatic primary tumors and suspected liver lesions. PMID:16586537

  16. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI.

    PubMed

    Dietrich, Christoph F; Kratzer, Wolfgang; Strobe, Deike; Danse, Etienne; Fessl, Robert; Bunk, Alfred; Vossas, Udo; Hauenstein, Karlheinz; Koch, Wilhelm; Blank, Wolfgang; Oudkerk, Matthijs; Hahn, Dietbert; Greis, Christian

    2006-03-21

    To evaluate contrast-enhanced ultrasonography (CEUS) using SonoVue in the detection of liver metastases in patients with known extrahepatic primary tumors versus the combined gold standard comprising CT, MRI and clinical/histological data. It is an international multicenter study, and there were 12 centres and 125 patients (64 males, 61 females, aged 59+/-11 years) involved, with 102 patients per protocol. Primary tumors were colorectal in 35%, breast in 27%, pancreatic in 17% and others in 21%. CEUS using SonoVue was employed with a low-mechanical-index technique and contrast-specific software using Siemens Elegra, Philips HDI 5000 and Acuson Sequoia; continuous scanning for at least five minutes. CEUS with SonoVue increased significantly the number of focal liver lesions detected versus unenhanced sonography. In 31.4% of the patients, more lesions were found after contrast enhancement. The total numbers of lesions detected were comparable with CEUS (55), triple-phase spiral CT (61) and MRI with a liver-specific contrast agent (53). Accuracy of detection of metastatic disease (i.e. at least one metastatic lesion) was significantly higher for CEUS (91.2%) than for unenhanced sonography (81.4%) and was similar to that of triple-phase spiral CT (89.2%). In 53 patients whose CEUS examination was negative, a follow-up examination 3-6 mo later confirmed the absence of metastatic lesions in 50 patients (94.4%). CEUS is proved to be reliable in the detection of liver metastases in patients with known extrahepatic primary tumors and suspected liver lesions.

  17. Prognostic value of FDG PET/CT-based metabolic tumor volumes in metastatic triple negative breast cancer patients

    PubMed Central

    Marinelli, Brett; Espinet-Col, Carina; Ulaner, Gary A; McArthur, Heather L; Gonen, Mithat; Jochelson, Maxine; Weber, Wolfgang A

    2016-01-01

    FDG PET/CT-based measures of tumor burden show promise to predict survival in patients with metastatic breast cancer, but the patient populations studied so far are heterogeneous. The reports may have been confounded by the markedly different prognosis of the various subtypes of breast cancer. The purpose of this study is to evaluate the correlation between tumor burden on FDG PET/CT and overall survival (OS) in patients within a defined population: metastatic triple negative breast cancer (MTNBC). FDG PET/CT scans of 47 consecutive MTNBC patients (54±12 years-old) with no other known malignancies were analyzed. A total 393 lesions were identified, and maximum standardized uptake value (SUVmax), mean SUV, metabolic tumor volume (MTV), total lesion number (TLN) and total lesion glycolysis (TLG), were measured and correlated with patient survival by Mantel-Cox tests and Cox regression analysis. At a median follow-up time of 12.4 months, 41 patients died with a median OS of 12.1 months. Patients with MTV less than 51.5 ml lived nearly three times longer (22 vs 7.1 months) than those with a higher MTV (χ2=21.3, P<0.0001). In a multivariate Cox regression analysis only TLN and MTV were significantly correlated with survival. Those with an MTV burden in the 75th percentile versus the 25th percentile had a hazard ratio of 6.94 (p=0.001). In patients with MTNBC, MTV appears to be a strong prognostic factor. If validated in prospective studies, MTV may be a valuable tool for risk stratification of MTNBC patients in clinical trials and to guide patient management. PMID:27186439

  18. Ga-68 DOTATOC PET/CT Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia

    PubMed Central

    Maybody, Majid; Grewal, Ravinder K; Healey, John H; Antonescu, Cristina R; Fanchon, Louise; Hwang, Sinchun; Carrasquillo, Jorge A; Kirov, Assen; Farooki, Azeez

    2017-01-01

    Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by small benign tumors of mesenchymal origin also known as phosphaturic mesenchymal tumors mixed connective tissue variant. Excellent prognosis is expected with eradication of the culprit tumor. These small tumors are notoriously difficult to localize with conventional radiographic studies; this often leads to an extensive work up and prolonged morbidity. We report a patient with clinical diagnosis of TIO whose culprit tumor was localized with Ga-68 DOTATOC PET/CT and MRI. Biopsy and cryoablation were performed under Ga-68 DOTATOC PET/CT guidance. Autoradiography of the biopsy specimen was performed and showed in situ correlation between Ga-68 DOTATOC uptake and histopathology with millimeter resolution. PMID:27150801

  19. Simulation of dosimetric consequences of 4D-CT-based motion margin estimation for proton radiotherapy using patient tumor motion data

    NASA Astrophysics Data System (ADS)

    Koybasi, Ozhan; Mishra, Pankaj; St. James, Sara; Lewis, John H.; Seco, Joao

    2014-02-01

    For the radiation treatment of lung cancer patients, four-dimensional computed tomography (4D-CT) is a common practice used clinically to image tumor motion and subsequently determine the internal target volume (ITV) from the maximum intensity projection (MIP) images. ITV, which is derived from short pre-treatment 4D-CT scan (<6 s per couch position), may not adequately cover the extent of tumor motion during the treatment, particularly for patients that exhibit a large respiratory variability. Inaccurate tumor localization may result in under-dosage of the tumor or over-dosage of the surrounding tissues. The purpose of this study is therefore to assess the degree of tumor under-dosage in case of regular and irregular breathing for proton radiotherapy using ITV-based treatment planning. We place a spherical lesion into a modified XCAT phantom that is also capable of producing 4D images based on irregular breathing, and move the tumor according to real tumor motion data, which is acquired over multiple days by tracking gold fiducial markers implanted into the lung tumors of patients. We derive ITVs by taking the union of all tumor positions during 6 s of tumor motion in the phantom using the first day patient tumor tracking data. This is equivalent to ITVs generated clinically from cine-mode 4D-CT MIP images. The treatment plans created for different ITVs are then implemented on dynamic phantoms with tumor motion governed by real tumor tracking data from consecutive days. By comparing gross tumor volume dose distribution on days of ‘treatment’ with the ITV dose distribution, we evaluate the deviation of the actually delivered dose from the predicted dose. Our results have shown that the proton treatment planning on ITV derived from pre-treatment cine-mode 4D-CT can result in under-dosage (dose covering 95% of volume) of the tumor by up to 25.7% over 3 min of treatment for the patient with irregular respiratory motion. Tumor under-dosage is less significant for

  20. In vivo Tumor Grading of Prostate Cancer using Quantitative 111In-Capromab Pendetide SPECT/CT

    PubMed Central

    Seo, Youngho; Aparici, Carina Mari; Cooperberg, Matthew R.; Konety, Badrinath R.; Hawkins, Randall A.

    2010-01-01

    We have developed an in vivo antibody uptake quantification method using 111In-capromab pendetide single photon emission computed tomography combined with computed tomography (SPECT/CT) technology. Our goal is to evaluate this noninvasive antibody quantification method for potential prostate tumor grading. Methods Our phantom experiments focused on the robustness of an advanced iterative reconstruction algorithm that involves corrections for photon attenuation, scatter, and geometric blurring caused by radionuclide collimators. The conversion factors between image values and tracer concentrations (in Bq/ml) were calculated from uniform phantom filled with aqueous solution of 111InCl3 using the same acquisition protocol and reconstruction parameters as for patient studies. In addition, the spatial resolution of the reconstructed images was measured from a point source phantom. The measured spatial resolution was modeled into a point spread function (PSF), and the PSF was implemented in a deconvolution-based partial volume error (PVE) correction algorithm. The recovery capability to correctly estimate true tracer concentration values was tested using prostate-like and bladder-like lesion phantoms fitted in the modified NEMA/IEC body phantom. Patients with biopsy-proven prostate cancer (n=10) who underwent prostatectomy were prospectively enrolled in the preoperative SPECT/CT studies at the San Francisco VA Medical Center. The CT portion of SPECT/CT was used for CT-based attenuation map generation as well as an anatomical localization tool for clinical interpretation. Pathologic Gleason grades were compared with in vivo “antibody uptake value” (AUV) normalized by injected dose, effective half-life, and injection-scan time difference. AUVs were calculated in each lobe of prostate gland with cylindrical volumes of interest (VOIs) having dimensions of 1.5 cm both in diameter and height. Results Reconstructed SPECT images further corrected by the deconvolution

  1. Attenuation correction of PET images with interpolated average CT for thoracic tumors

    NASA Astrophysics Data System (ADS)

    Huang, Tzung-Chi; Mok, Greta S. P.; Wang, Shyh-Jen; Wu, Tung-Hsin; Zhang, Geoffrey

    2011-04-01

    To reduce positron emission tomography (PET) and computed tomography (CT) misalignments and standardized uptake value (SUV) errors, cine average CT (CACT) has been proposed to replace helical CT (HCT) for attenuation correction (AC). A new method using interpolated average CT (IACT) for AC is introduced to further reduce radiation dose with similar image quality. Six patients were recruited in this study. The end-inspiration and -expiration phases from cine CT were used as the two original phases. Deformable image registration was used to generate the interpolated phases. The IACT was calculated by averaging the original and interpolated phases. The PET images were then reconstructed with AC using CACT, HCT and IACT, respectively. Their misalignments were compared by visual assessment, mutual information, correlation coefficient and SUV. The doses from different CT maps were analyzed. The misalignments were reduced for CACT and IACT as compared to HCT. The maximum SUV difference between the use of IACT and CACT was ~3%, and it was ~20% between the use of HCT and CACT. The estimated dose for IACT was 0.38 mSv. The radiation dose using IACT could be reduced by 85% compared to the use of CACT. IACT is a good low-dose approximation of CACT for AC.

  2. Slip-ring and conventional dynamic hepatic CT: contrast material and timing considerations.

    PubMed

    Berland, L L

    1995-04-01

    advantages have come with new challenges, which can be overcome by knowing underlying principles and by attending to detail. Although we have learned much over the past 15 years about proper performance of abdominal CT examinations, we have much yet to learn about the effects of such examinations on the improved health of our patients and on the economic costs to society of providing this form of health care. Opinions on techniques have converged recently, as summarized herein. Therefore, we hope that some centers will now redirect their CT research toward the profoundly difficult, timely, and important issues of examination appropriateness, the value of quality improvement programs, clinical outcomes, and cost-effectiveness.

  3. Cervical neuroblastoma in eleven infants--a tumor with favorable prognosis. Clinical and radiologic (US, CT, MRI) findings.

    PubMed

    Abramson, S J; Berdon, W E; Ruzal-Shapiro, C; Stolar, C; Garvin, J

    1993-01-01

    Cervical neuroblastoma, a disease primarily of infants, has a favorable prognosis. Eleven patients are reported. Clinical presentations (other than mass) included stridor and swallowing problems. Masses when felt were commonly mistaken for infectious adenitis. Imaging studies (US, CT, MRI) showed solid masses with vascular displacement and narrowing; intraspinal extension was absent though extension into the adjacent sites of mediastinum and skull occurred. Horner syndrome was seen in five patients with accompanying heterochromia iridis in one. Five tumors had calcification. A high index of suspicion will lead to biopsy and less delay in diagnosis once a mass is felt or imaged.

  4. Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

    SciTech Connect

    Panizza, Pedro Sergio Brito; Albuquerque Cavalcanti, Conrado Furtado de; Yamaguchi, Nise Hitomi; Leite, Claudia Costa; Cerri, Giovanni Guido; Menezes, Marcos Roberto de

    2016-02-15

    A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

  5. The utility of 18F-FDG PET/CT in solitary fibrous tumors of the pleura.

    PubMed

    Tazeler, Z; Tan, G; Aslan, A; Tan, S

    2016-01-01

    To demonstrate the utility of (18)F-FDG PET/CT in the differentiation of benign and malignant solitary fibrous tumors of the pleura (SFTP). A retrospective review was performed on the (18)F-FDG PET/CT data from 17 patients with histopathologically diagnosed benign or malignant SFTP. The size, side of SFTP, presence of necrosis, calcification, pleural effusion, hilar lymphadenopathy (LAP), density on CT images (Hounsfield unit-HU), and (18)F-FDG uptake (SUVmax) were recorded and compared in order to detect malignant SFTP. Statistical significance was set as p<0.05. The difference in size, presence of necrosis, and hilar LAP on CT images were statistically significant (p=0.004, p<0.001, p=0.015, respectively) in a comparison of benign and malignant SFTPs. The mean HU of benign SFTP was 46.16±5.52HU, and for malignant SFTP it was 35.03±4.61HU (p=0.003). The mean SUVmax was 3.02±1.02 for benign SFTP and 4.89±2.12 for malignant SFTP (p=0.021). A cut-off value of ≥7cm for size, ≤39.81HU for density, and ≥3.47 for SUVmax was obtained by ROC analysis for detecting malignant SFTP. (18)F-FDG PET/CT may have a limited role in diagnosing malignant SFTP in suspected patients. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  6. The role of FDG PET/CT in evaluation of mediastinal masses and neurogenic tumors of chest wall

    PubMed Central

    Tatci, Ebru; Ozmen, Ozlem; Dadali, Yeliz; Biner, Inci Uslu; Gokcek, Atila; Demirag, Funda; Incekara, Funda; Arslan, Nuri

    2015-01-01

    We evaluated the efficiency of FDG PET/CT for the differentiation of malignant from benign mediastinal masses and neurogenic tumors of chest-wall. Methods: The 88 patients with chest wall-mediastinal masses who underwent examination before operation were retrospectively reviewed. Size, CT density (HU mean) and SUVmax of mediastinal and chest wall lesions were determined. Statistical differences of these parameters were compared between groups by Mann-Whitney U test. Receiver-operating characteristic curve (ROC) analysis with respect to SUVmax was performed to determine the best cutoff value for differentiating benign from malignant masses. Results: The overall sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT in detection of malignancy were 90%, 55.17%, 67%, 50.94% and 91.43%, respectively. The SUVmax, HU mean and size were higher in malignant cases (P < 0.05). To distinguish benign and malignant lesions, the cut off value of SUVmax was 4.67. The lesion SUVmax was significantly associated with the lesion size and lesion HU mean values (P < 0.05). The value of SUVmax and HU mean were higher in solid benign lesions than those of cystic benign lesions (P < 0.05). The lesion size was higher in cystic lesions (P = 0.000). The mean SUVmax was significantly higher in invasive thymomas than those of non-invasive forms (P = 0.029). Conclusion: FDG PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall masses. PET/CT may reduce unnecessary invasive investigations for diagnosis in patients with nonavid or low avid FDG lesions. However confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis. PMID:26379916

  7. Tumor necrosis factor-alpha induced by hepatitis B virus core mediating the immune response for hepatitis B viral clearance in mice model.

    PubMed

    Tzeng, Horng-Tay; Tsai, Hwei-Fang; Chyuan, I-Tsu; Liao, Hsiu-Jung; Chen, Chun-Jen; Chen, Pei-Jer; Hsu, Ping-Ning

    2014-01-01

    Persistent hepatitis B viral (HBV) infection results in chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). An efficient control of virus infections requires the coordinated actions of both innate and adaptive immune responses. In order to define the role of innate immunity effectors against HBV, viral clearance was studied in a panel of immunodeficient mouse strains by the hydrodynamic injection approach. Our results demonstrate that HBV viral clearance is not changed in IFN-α/β receptor (IFNAR), RIG-I, MDA5, MYD88, NLRP3, ASC, and IL-1R knock-out mice, indicating that these innate immunity effectors are not required for HBV clearance. In contrast, HBV persists in the absence of tumor necrosis factor-alpha (TNF-α) or in mice treated with the soluble TNF receptor blocker, Etanercept. In these mice, there was an increase in PD-1-expressing CD8+ T-cells and an increase of serum HBV DNA, HBV core, and surface antigen expression as well as viral replication within the liver. Furthermore, the induction of TNF-α in clearing HBV is dependent on the HBV core, and TNF blockage eliminated HBV core-induced viral clearance effects. Finally, the intra-hepatic leukocytes (IHLs), but not the hepatocytes, are the cell source responsible for TNF-α production induced by HBcAg. These results provide evidences for TNF-α mediated innate immune mechanisms in HBV clearance and explain the mechanism of HBV reactivation during therapy with TNF blockage agents.

  8. Clinical implications of defining the gross tumor volume with combination of CT and {sup 18}FDG-positron emission tomography in non-small-cell lung cancer

    SciTech Connect

    Grills, Inga S. . E-mail: igrills@beaumont.edu; Yan Di; Black, Quinten C.; Wong, Ching-Yee O.; Martinez, Alvaro A.; Kestin, Larry L.

    2007-03-01

    Purpose: To compare the planning target volume (PTV) definitions for computed tomography (CT) vs. positron emission tomography (PET) in non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 21 patients with NSCLC underwent three-dimensional conformal radiotherapy planning. All underwent a staging F-18 fluorodeoxyglucose-position emission tomography ({sup 18}FDG-PET) scan and underwent treatment simulation using CT plus a separate planning {sup 18}FDG-PET scan. Three sets of target volumes were defined: Set 1, CT volumes (CT tumor + staging PET nodal disease); Set 2, PET volumes (planning PET tumor {l_brace}gross tumor volume (GTV) = [(0.3069 x mean standardized uptake value) + 0.5853]){r_brace}; Set 3, composite CT-PET volumes (fused CT-PET tumor). Sets 1 and 2 were compared using a matching index. Three-dimensional conformal radiotherapy plans were created using the Set 1 (CT) volumes; and coverage of the Set 3 (composite) volumes was evaluated. Separate three-dimensional conformal radiotherapy plans were designed for the Set 3 volumes. Results: For the primary tumor GTV, the Set 1 (CT) volume was larger than the Set 2 (PET) volume in 48%, smaller in 33%, and equal in 19%. The mean matching index was 0.65 (35% CT-PET mismatch). Although quantitatively similar, the volumes differed qualitatively. The Set 3 (composite) volume was larger than either CT or PET alone in 62%, smaller in 24%, and equal in 14%. The dose-volume histogram parameters did not differ among the plans for Set 1 (CT) vs. Set 3 (composite) volumes. Small portions of the Set 3 PTV were significantly underdosed in 40% of cases using the CT-only plan. Conclusion: Computed tomography and PET are complementary and should be obtained in the treatment position and fused to define the GTV for NSCLC. Although the quantitative absolute target volume is sometimes similar, the qualitative target locations can be substantially different, leading to underdosage of the target when planning is

  9. Confounding of the association between radiation exposure from CT scans and risk of leukemia and brain tumors by cancer susceptibility syndromes.

    PubMed

    Meulepas, Johanna M; Ronckers, Cécile M; Merks, Johannes; Weijerman, Michel E; Lubin, Jay H; Hauptmann, Michael

    2016-12-01

    Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of pediatric CT scans. We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk. Since empirical evidence is lacking in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about patterns of CT scans among CSS patients. We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome and other CSS. Moreover, tuberous sclerosis complex, von Hippel-Lindau disease, neurofibromatosis type 1 and other CSS do not meaningfully confound RRs for brain tumors. Empirical data on the use of CT scans among CSS patients is urgently needed. Our assessment indicates that associations with radiation exposure from pediatric CT scans and leukemia or brain tumors reported in previous studies are unlikely to be substantially confounded by unmeasured CSS.

  10. (18)F-FDG-PET/CT versus panendoscopy for the detection of synchronous second primary tumors in patients with head and neck squamous cell carcinoma.

    PubMed

    Haerle, Stephan K; Strobel, Klaus; Hany, Thomas F; Sidler, Daniel; Stoeckli, Sandro J

    2010-03-01

    This study assesses the additional value of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/CT ((18)F-FDG-PET/CT) with respect to synchronous primaries in patients undergoing panendoscopy for staging of head and neck squamous cell carcinoma. In all, 311 patients underwent both modalities. Cytology, histology, and/or clinical/imaging follow-up served as reference standard. The prevalence of second primary tumors detected by panendoscopy was 4.5%, compared with 6.1% detected by (18)F-FDG-PET/CT. The sensitivity for panendoscopy was 74%, the specificity was 99.7%, the positive predictive value (PPV) was 93%, and the negative predictive value (NPV) was 98%. The sensitivity for (18)F-FDG-PET/CT was 100%, the specificity was 95.7%, the PPV was 59%, and the NPV was 100%. (18)F-FDG-PET/CT is superior to panendoscopy. With a negative (18)F-FDG-PET/CT, the extent of endoscopy can be reduced to the area of the primary tumor. Due to the costs, (18)F-FDG-PET/CT is recommended only in advanced disease to assess potential distant disease. In early-stage cancer, panendoscopy is accurate enough to rule out secondary tumors.

  11. Correlation of pre-operative CT findings with surgical & histological tumor dissemination patterns at cytoreduction for primary advanced and relapsed epithelial ovarian cancer: A retrospective evaluation.

    PubMed

    Nasser, S; Lazaridis, A; Evangelou, M; Jones, B; Nixon, K; Kyrgiou, M; Gabra, H; Rockall, A; Fotopoulou, C

    2016-11-01

    Computed tomography (CT) is an essential part of preoperative planning prior to cytoreductive surgery for primary and relapsed epithelial ovarian cancer (EOC). Our aim is to correlate pre-operative CT results with intraoperative surgical and histopathological findings at debulking surgery. We performed a systematic comparison of intraoperative tumor dissemination patterns and surgical resections with preoperative CT assessments of infiltrative disease at key resection sites, in women who underwent multivisceral debulking surgery due to EOC between January 2013 and December 2014 at a tertiary referral center. The key sites were defined as follows: diaphragmatic involvement(DI), splenic disease (SI), large (LBI) and small (SBI) bowel involvement, rectal involvement (RI), porta hepatis involvement (PHI), mesenteric disease (MI) and lymph node involvement (LNI). A total of 155 patients, mostly with FIGO stage IIIC disease (65%) were evaluated (primary=105, relapsed=50). Total macroscopic cytoreduction rates were: 89%. Pre-operative CT findings displayed high specificity across all tumor sites apart from the retroperitoneal lymph node status, with a specificity of 65%. The ability however of the CT to accurately identify sites affected by invasive disease was relatively low with the following sensitivities as relating to final histology: 32% (DI), 26% (SI), 46% (LBI), 44% (SBI), 39% (RI), 57% (PHI), 31% (MI), 63% (LNI). Pre-operative CT imaging shows high specificity but low sensitivity in detecting tumor involvement at key sites in ovarian cancer surgery. CT findings alone should not be used for surgical decision making. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  12. In vivo characterization of tumor vasculature using iodine and gold nanoparticles and dual energy micro-CT

    NASA Astrophysics Data System (ADS)

    Clark, Darin P.; Ghaghada, Ketan; Moding, Everett J.; Kirsch, David G.; Badea, Cristian T.

    2013-03-01

    Tumor blood volume and vascular permeability are well established indicators of tumor angiogenesis and important predictors in cancer diagnosis, planning and treatment. In this work, we establish a novel preclinical imaging protocol which allows quantitative measurement of both metrics simultaneously. First, gold nanoparticles are injected and allowed to extravasate into the tumor, and then liposomal iodine nanoparticles are injected. Combining a previously optimized dual energy micro-CT scan using high-flux polychromatic x-ray sources (energies: 40 kVp, 80 kVp) with a novel post-reconstruction spectral filtration scheme, we are able to decompose the results into 3D iodine and gold maps, allowing simultaneous measurement of extravasated gold and intravascular iodine concentrations. Using a digital resolution phantom, the mean limits of detectability (mean CNR = 5) for each element are determined to be 2.3 mg mL-1 (18 mM) for iodine and 1.0 mg mL-1 (5.1 mM) for gold, well within the observed in vivo concentrations of each element (I: 0-24 mg mL-1, Au: 0-9 mg mL-1) and a factor of 10 improvement over the limits without post-reconstruction spectral filtration. Using a calibration phantom, these limits are validated and an optimal sensitivity matrix for performing decomposition using our micro-CT system is derived. Finally, using a primary mouse model of soft-tissue sarcoma, we demonstrate the in vivo application of the protocol to measure fractional blood volume and vascular permeability over the course of five days of active tumor growth.

  13. New orally active DNA minor groove binding small molecule CT-1 acts against breast cancer by targeting tumor DNA damage leading to p53-dependent apoptosis.

    PubMed

    Saini, Karan Singh; Hamidullah; Ashraf, Raghib; Mandalapu, Dhanaraju; Das, Sharmistha; Siddiqui, Mohd Quadir; Dwivedi, Sonam; Sarkar, Jayanta; Sharma, Vishnu Lal; Konwar, Rituraj

    2017-04-01

    Targeting tumor DNA damage and p53 pathway is a clinically established strategy in the development of cancer chemotherapeutics. Majority of anti-cancer drugs are delivered through parenteral route for reasons like severe toxicity, lack of stability, and poor enteral absorption. Current DNA targeting drugs in clinical like anthracycline suffers from major drawbacks like cardiotoxicity. Here, we report identification of a new orally active small molecule curcumin-triazole conjugate (CT-1) with significant anti-breast cancer activity in vitro and in vivo. CT-1 selectively and significantly inhibits viability of breast cancer cell lines; retards cells cycle progression at S phase and induce mitochondrial-mediated cell apoptosis. CT-1 selectively binds to minor groove of DNA and induces DNA damage leading to increase in p53 along with decrease in its ubiquitination. Inhibition of p53 with pharmacological inhibitor as well as siRNA revealed the necessity of p53 in CT-1-mediated anti-cancer effects in breast cancer cells. Studies using several other intact p53 and deficient p53 cancer cell lines further confirmed necessity of p53 in CT-1-mediated anti-cancer response. Pharmacological inhibition of pan-caspase showed CT-1 induces caspase-dependent cell death in breast cancer cells. Most interestingly, oral administration of CT-1 induces significant inhibition of tumor growth in LA-7 syngeneic orthotropic rat mammary tumor model. CT-1 treated mammary tumor shows enhancement in DNA damage, p53 upregulation, and apoptosis. Collectively, CT-1 exhibits potent anti-cancer effect both in vitro and in vivo and could serve as a safe orally active lead for anti-cancer drug development. © 2016 Wiley Periodicals, Inc.

  14. Feasibility of using single photon counting X-ray for lung tumor position estimation based on 4D-CT.

    PubMed

    Aschenbrenner, Katharina P; Guthier, Christian V; Lyatskaya, Yulia; Boda-Heggemann, Judit; Wenz, Frederik; Hesser, Jürgen W

    2017-09-01

    In stereotactic body radiation therapy of lung tumors, reliable position estimation of the tumor is necessary in order to minimize normal tissue complication rate. While kV X-ray imaging is frequently used, continuous application during radiotherapy sessions is often not possible due to concerns about the additional dose. Thus, ultra low-dose (ULD) kV X-ray imaging based on a single photon counting detector is suggested. This paper addresses the lower limit of photons to locate the tumor reliably with an accuracy in the range of state-of-the-art methods, i.e. a few millimeters. 18 patient cases with four dimensional CT (4D-CT), which serves as a-priori information, are included in the study. ULD cone beam projections are simulated from the 4D-CTs including Poisson noise. The projections from the breathing phases which correspond to different tumor positions are compared to the ULD projection by means of Poisson log-likelihood (PML) and correlation coefficient (CC), and template matching under these metrics. The results indicate that in full thorax imaging five photons per pixel suffice for a standard deviation in tumor positions of less than half a breathing phase. Around 50 photons per pixel are needed to achieve this accuracy with the field of view restricted to the tumor region. Compared to CC, PML tends to perform better for low photon counts and shifts in patient setup. Template matching only improves the position estimation in high photon counts. The quality of the reconstruction is independent of the projection angle. The accuracy of the proposed ULD single photon counting system is in the range of a few millimeters and therefore comparable to state-of-the-art tumor tracking methods. At the same time, a reduction in photons per pixel by three to four orders of magnitude relative to commercial systems with flatpanel detectors can be achieved. This enables continuous kV image-based position estimation during all fractions since the additional dose to the

  15. [Clinical evaluation of 18F-FDE PET-CT in detecting malignant liver tumors].

    PubMed

    Yao, Shu-zhan; Zhang, Cheng-qi; Chen, Jing; Liu, Qing-wei; Li, Qing-guo

    2003-11-01

    To evaluate the clinical value of (18)F-fluorodeoxyglucose ((18)F-FDG) positron-emission tomography (PET) combined with computer tomography (PET-CT) in the diagnosis and clinical staging of liver cancer. (18)F-FDG PET-CT was performed preoperatively in 16 cases of primary and 8 metastatic liver cancers. The imaging features of the primary foci were analyzed, followed by measurement of standardized (18)F-FDG uptake. For the metastatic foci, the abnormal metabolism of (18)F-FDG was observed and CT, PET and PET-CT fusion images were obtained for accurate localization of these foci. (18)F-FDG uptake occurred in the supraclavicular region in 6 (37.5%) of the 16 patients with primary liver cancer, but was detected in the 8 patients with metastatic liver cancer. Fourteen metastatic nodules were found in 5 of the 16 patients with primary liver cancer, located in the lungs (2 cases) or the abdominal cavity (3 cases). Negative results of (18)F-FDG PET-CT imaging should be carefully evaluated for diagnosing primary liver cancers, considering the very low sensitivity (37.5%) of this imaging modality in this study. But in the cases of metastatic liver cancers this imaging modality may exhibit high sensitivity, and can also be of great value in clinical staging of the primary liver cancers.

  16. FUSE Binding Protein 1 Facilitates Persistent Hepatitis C Virus Replication in Hepatoma Cells by Regulating Tumor Suppressor p53

    PubMed Central

    Dixit, Updesh; Pandey, Ashutosh K.; Liu, Zhihe; Kumar, Sushil; Neiditch, Matthew B.; Klein, Kenneth M.

    2015-01-01

    ABSTRACT Hepatitis C virus (HCV) is a leading cause of chronic hepatitis C (CHC), liver cirrhosis, and hepatocellular carcinoma (HCC). Immunohistochemistry of archived HCC tumors showed abundant FBP1 expression in HCC tumors with the CHC background. Oncomine data analysis of normal versus HCC tumors with the CHC background indicated a 4-fold increase in FBP1 expression with a concomitant 2.5-fold decrease in the expression of p53. We found that FBP1 promotes HCV replication by inhibiting p53 and regulating BCCIP and TCTP, which are positive and negative regulators of p53, respectively. The severe inhibition of HCV replication in FBP1-knockdown Huh7.5 cells was restored to a normal level by downregulation of either p53 or BCCIP. Although p53 in Huh7.5 cells is transcriptionally inactive as a result of Y220C mutation, we found that the activation and DNA binding ability of Y220C p53 were strongly suppressed by FBP1 but significantly activated upon knockdown of FBP1. Transient expression of FBP1 in FBP1 knockdown cells fully restored the control phenotype in which the DNA binding ability of p53 was strongly suppressed. Using electrophoretic mobility shift assay (EMSA) and isothermal titration calorimetry (ITC), we found no significant difference in in vitro target DNA binding affinity of recombinant wild-type p53 and its Y220C mutant p53. However, in the presence of recombinant FBP1, the DNA binding ability of p53 is strongly inhibited. We confirmed that FBP1 downregulates BCCIP, p21, and p53 and upregulates TCTP under radiation-induced stress. Since FBP1 is overexpressed in most HCC tumors with an HCV background, it may have a role in promoting persistent virus infection and tumorigenesis. IMPORTANCE It is our novel finding that FUSE binding protein 1 (FBP1) strongly inhibits the function of tumor suppressor p53 and is an essential host cell factor required for HCV replication. Oncomine data analysis of a large number of samples has revealed that overexpression of

  17. Hepatic Thermal Ablation: Effect of Device and Heating Parameters on Local Tissue Reactions and Distant Tumor Growth.

    PubMed

    Velez, Erik; Goldberg, S Nahum; Kumar, Gaurav; Wang, Yuanguo; Gourevitch, Svetlana; Sosna, Jacob; Moon, Tyler; Brace, Christopher L; Ahmed, Muneeb

    2016-12-01

    Purpose To determine whether variable hepatic microwave ablation (MWA) can induce local inflammation and distant pro-oncogenic effects compared with hepatic radiofrequency ablation (RFA) in an animal model. Materials and Methods In this institutional Animal Care and Use Committee-approved study, F344 rats (150 gm, n = 96) with subcutaneous R3230 breast adenocarcinoma tumors had normal non-tumor-bearing liver treated with RFA (70°C × 5 minutes), rapid higher-power MWA (20 W × 15 seconds), slower lower-power MWA (5 W × 2 minutes), or a sham procedure (needle placement without energy) and were sacrificed at 6 hours to 7 days (four time points; six animals per arm per time point). Ablation settings produced 11.4 mm ± 0.8 of coagulation for all groups. Distant tumor growth rates were determined to 7 days after treatment. Liver heat shock protein (HSP) 70 levels (at 72 hours) and macrophages (CD68 at 7 days), tumor proliferative indexes (Ki-67 and CD34 at 7 days), and serum and tissue levels of interleukin 6 (IL-6) at 6 hours, hepatocyte growth factor (HGF) at 72 hours, and vascular endothelial growth factor (VEGF) at 72 hours after ablation were assessed. All data were expressed as means ± standard deviations and were compared by using two-tailed t tests and analysis of variance for selected group comparisons. Linear regression analysis of tumor growth curves was used to determine pre- and posttreatment growth curves on a per-tumor basis. Results At 7 days, hepatic ablations with 5-W MWA and RFA increased distant tumor size compared with 20-W MWA and the sham procedure (5-W MWA: 16.3 mm ± 1.1 and RFA: 16.3 mm ± 0.9 vs sham: 13.6 mm ± 1.3, P < .01, and 20-W MWA: 14.6 mm ± 0.9, P < .05). RFA and 5-W MWA increased postablation tumor growth rates compared with the 20-W MWA and sham arms (preablation growth rates range for all arms: 0.60-0.64 mm/d; postablation: RFA: 0.91 mm/d ± 0.11, 5-W MWA: 0.91 mm/d ± 0.14, P < .01 vs pretreatment; 20-W MWA: 0.69 mm/d ± 0

  18. Computed tomography of infantile hepatic hemangioendothelioma

    SciTech Connect

    Lucaya, J.; Enriquez, G.; Amat, L.; Gonzalez-Rivero, M.A.

    1985-04-01

    Computed tomography (CT) was performed on five infants with hepatic hemangioendothelioma. Precontrast scans showed solitary or multiple, homogeneous, circumscribed areas with reduced attenuation values. Tiny tumoral calcifications were identified in two patients. Serial scans, after injection of a bolus of contrast material, showed early massive enhancement, which was either diffuse or peripheral. On delayed scans, multinocular tumors became isodense with surrounding liver, while all solitary ones showed varied degrees of centripetal enhancement and persistent central cleftlike unenhanced areas. The authors believe that these CT features are characteristic and obviate arteriographic confirmation.

  19. Early prediction of tumor recurrence based on CT texture changes after stereotactic ablative radiotherapy (SABR) for lung cancer.

    PubMed

    Mattonen, Sarah A; Palma, David A; Haasbeek, Cornelis J A; Senan, Suresh; Ward, Aaron D

    2014-03-01

    Benign computed tomography (CT) changes due to radiation induced lung injury (RILI) are common following stereotactic ablative radiotherapy (SABR) and can be difficult to differentiate from tumor recurrence. The authors measured the ability of CT image texture analysis, compared to more traditional measures of response, to predict eventual cancer recurrence based on CT images acquired within 5 months of treatment. A total of 24 lesions from 22 patients treated with SABR were selected for this study: 13 with moderate to severe benign RILI, and 11 with recurrence. Three-dimensional (3D) consolidative and ground-glass opacity (GGO) changes were manually delineated on all follow-up CT scans. Two size measures of the consolidation regions (longest axial diameter and 3D volume) and nine appearance features of the GGO were calculated: 2 first-order features [mean density and standard deviation of density (first-order texture)], and 7 second-order texture features [energy, entropy, correlation, inverse difference moment (IDM), inertia, cluster shade, and cluster prominence]. For comparison, the corresponding response evaluation criteria in solid tumors measures were also taken for the consolidation regions. Prediction accuracy was determined using the area under the receiver operating characteristic curve (AUC) and two-fold cross validation (CV). For this analysis, 46 diagnostic CT scans scheduled for approximately 3 and 6 months post-treatment were binned based on their recorded scan dates into 2-5 month and 5-8 month follow-up time ranges. At 2-5 months post-treatment, first-order texture, energy, and entropy provided AUCs of 0.79-0.81 using a linear classifier. On two-fold CV, first-order texture yielded 73% accuracy versus 76%-77% with the second-order features. The size measures of the consolidative region, longest axial diameter and 3D volume, gave two-fold CV accuracies of 60% and 57%, and AUCs of 0.72 and 0.65, respectively. Texture measures of the GGO appearance

  20. TU-F-17A-05: Calculating Tumor Trajectory and Dose-Of-The-Day for Highly Mobile Tumors Using Cone-Beam CT Projections

    SciTech Connect

    Jones, B; Miften, M

    2014-06-15

    Purpose: Cone-beam CT (CBCT) projection images provide anatomical data in real-time over several respiratory cycles, forming a comprehensive picture of tumor movement. We developed a method using these projections to determine the trajectory and dose of highly mobile tumors during each fraction of treatment. Methods: CBCT images of a respiration phantom were acquired, where the trajectory mimicked a lung tumor with high amplitude (2.4 cm) and hysteresis. A template-matching algorithm was used to identify the location of a steel BB in each projection. A Gaussian probability density function for tumor position was calculated which best fit the observed trajectory of the BB in the imager geometry. Two methods to improve the accuracy of tumor track reconstruction were investigated: first, using respiratory phase information to refine the trajectory estimation, and second, using the Monte Carlo method to sample the estimated Gaussian tumor position distribution. 15 clinically-drawn abdominal/lung CTV volumes were used to evaluate the accuracy of the proposed methods by comparing the known and calculated BB trajectories. Results: With all methods, the mean position of the BB was determined with accuracy better than 0.1 mm, and root-mean-square (RMS) trajectory errors were lower than 5% of marker amplitude. Use of respiratory phase information decreased RMS errors by 30%, and decreased the fraction of large errors (>3 mm) by half. Mean dose to the clinical volumes was calculated with an average error of 0.1% and average absolute error of 0.3%. Dosimetric parameters D90/D95 were determined within 0.5% of maximum dose. Monte-Carlo sampling increased RMS trajectory and dosimetric errors slightly, but prevented over-estimation of dose in trajectories with high noise. Conclusions: Tumor trajectory and dose-of-the-day were accurately calculated using CBCT projections. This technique provides a widely-available method to evaluate highly-mobile tumors, and could facilitate better

  1. Tumor doubling time of renal cell carcinoma measured by CT: collaboration of Japanese Society of Renal Cancer.

    PubMed

    Ozono, Seiichiro; Miyao, Noriomi; Igarashi, Tatsuo; Marumo, Ken; Nakazawa, Hayakazu; Fukuda, Momokuni; Tsushima, Tomoyasu; Tokuda, Noriaki; Kawamura, Juichi; Murai, Masaru

    2004-02-01

    This study was conducted to examine the natural history of renal cell carcinoma (RCC). Inclusion criteria were the following: (1) patients who received diagnostic imaging of the kidney (CT, MRI) at two points in time before the diagnosis of RCC or patients who were followed, without treatment, after a diagnosis of RCC; and (2) patients in whom changes in tumor size were followed by the same modality of diagnostic imaging and who did not receive any treatment which could exert anti-tumor activity on the primary or metastatic lesions. The tumor doubling time (DT) and the growth rate of maximum tumor diameter (R) were determined. DT was calculated using the equation DT = (T - T(0)) x log2/logV - logV(0) (where T - T(0) indicates the length of time between two measurements and V(0) and V denote the tumor volume at two points of measurement). R was calculated using the equation R = (phi - f(0))/(T - T(0)) x 100 (where phi(0) and f indicate the maximum diameter at two points). Fifty-six cases registered with the Japanese Society of Renal Cancer were included in the evaluation. DT was 603.1 +/- 510.1 days, which did not correlate with V(0). R was 0.263 +/- 0.346 cm/day x 100. In cases where the tumor diameter was >/=4 cm, a significant correlation was noted between f(0) and R. Elucidation of the natural history of RCC will contribute to facilitation of differential diagnosis and determination of optimum therapeutic strategy.

  2. Histologic evaluation and treatment outcome after sequential radiofrequency ablation and hepatic resection for primary and metastatic tumors.

    PubMed

    Hoffman, Allen L; Wu, Sandy S; Obaid, Amal K; French, Samuel W; Lois, Juan; McMonigle, Michael; Ramos, Hector C; Sher, Linda S; Lopez, Richard R

    2002-12-01

    Operative manipulation during hepatic resection (HR) causes tumor cell shedding which is a factor in disease recurrence. Radiofrequency ablation (RFA) causes coagulative necrosis and was used to destroy the tumor before HR. We evaluated tumor necrosis and recurrence of hepatic malignancies treated by sequential RFA/HR. A retrospective review of patients treated with sequential RFA/HR from April 1999 to January 2002 was performed. A Radionics 500-kW RF generator was used to ablate lesions via H2O-cooled electrodes under ultrasound guidance. Segmental HR was performed after RFA. Resected specimens were reviewed with hematoxylin and eosin staining and for apoptosis. Patient follow-up ranged from 10 to 33 months with evaluation of salient clinical, radiologic, and laboratory parameters. Seven patients (four male and three female) ages 62.1 +/- 10.3 years had sequential RFA/HR. Four patients had hepatocellular carcinoma (HCC) and three had colorectal metastases (CRm). The tumors were unifocal right-lobe lesions measuring 4.1 +/- 0.9 cm with a resection margin of 0.4 to 2.5 cm. Extensive necrosis was noted but intact nests of tumor cells occurred in all specimens with minimal apoptosis. Three of seven patients (two HCC and one CRm) developed pulmonary metastases at 3 to 20 months with one HCC patient developing concurrent liver metastases. Two deaths occurred in the HCC group. Sequential RFA/HR may minimize local recurrence; however, the high incidence of pulmonary metastases raises concern of transvenous migration. The histologic findings demonstrate foci of intact tumor cells after RFA. Controlled study of additional patients with long-term follow-up is necessary to better understand these findings.

  3. Pericardial, But Not Hepatic, Fat by CT Is Associated With CV Outcomes and Structure: The Multi-Ethnic Study of Atherosclerosis.

    PubMed

    Shah, Ravi V; Anderson, Amanda; Ding, Jingzhong; Budoff, Matthew; Rider, Oliver; Petersen, Steffen E; Jensen, Majken Karoline; Koch, Manja; Allison, Matthew; Kawel-Boehm, Nadine; Wisocky, Jessica; Jerosch-Herold, Michael; Mukamal, Kenneth; Lima, João A C; Murthy, Venkatesh L

    2017-09-01

    The study sought to determine the associations between local (pericardial) fat and incident cardiovascular disease (CVD) events and cardiac remodeling independent of markers of overall adiposity. The impact of pericardial fat-a local fat depot encasing the heart-on myocardial function and long-term CV prognosis independent of systemic consequences of adiposity or hepatic fat is an area of active debate. We studied 4,234 participants enrolled in the MESA (Multi-Ethnic Study of Atherosclerosis) study with concomitant cardiac magnetic resonance imaging and computed tomography (CT) measurements for pericardial fat volume and hepatic attenuation (a measure of liver fat). Poisson and Cox regression were used to estimate the annualized risk of incident hard atherosclerotic CVD (ASCVD), all-cause death, heart failure, all-cause CVD, hard coronary heart disease, and stroke as a function of pericardial and hepatic fat. Generalized additive models were used to assess the association between cardiac magnetic resonance indices of left ventricular (LV) structure and function and pericardial fat. Models were adjusted for relevant clinical, demographic, and cardiometabolic covariates. MESA study participants with higher pericardial and hepatic fat were more likely to be older, were more frequently men, and had a higher prevalence of cardiometabolic risk factors (including dysglycemia, dyslipidemia, hypertension), as well as adiposity-associated inflammation. Over a median 12.2-year follow-up (interquartile range: 11.6 to 12.8 years), pericardial fat was associated with a higher rate of incident hard ASCVD (standardized hazard ratio: 1.22; 95% confidence interval: 1.10 to 1.35; p = 0.0001). Hepatic fat by CT was not significantly associated with hard ASCVD (standardized hazard ratio: 0.96; 95% confidence interval: 0.86 to 1.08; p = 0.52). Higher pericardial fat was associated with greater indexed LV mass (37.8 g/m(2.7) vs. 33.9 g/m(2.7), highest quartile vs. lowest quartile; p

  4. Metabolic Tumor Burden Assessed by Dual Time Point [(18)F]FDG PET/CT in Locally Advanced Breast Cancer: Relation with Tumor Biology.

    PubMed

    Garcia-Vicente, Ana María; Pérez-Beteta, Julián; Pérez-García, Víctor Manuel; Molina, David; Jiménez-Londoño, German Andrés; Soriano-Castrejón, Angel; Martínez-González, Alicia

    2017-08-01

    The aim of the study was to investigate the influence of dual time point 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) positron emission tomography/x-ray computed tomography (PET/CT) on the standard uptake value (SUV) and volume-based metabolic variables of breast lesions and their relation with biological characteristics and molecular phenotypes. Retrospective analysis including 67 patients with locally advanced breast cancer (LABC). All patients underwent a dual time point [(18)F]FDG PET/CT, 1 h (PET-1) and 3 h (PET-2) after [(18)F]FDG administration. Tumors were segmented following a three-dimensional methodology. Semiquantitative metabolic variables (SUVmax, SUVmean, and SUVpeak) and volume-based variables (metabolic tumor volume, MTV, and total lesion glycolysis, TLG) were obtained. Biologic prognostic parameters, such as the hormone receptors status, p53, HER2 expression, proliferation rate (Ki-67), and grading were obtained. Molecular phenotypes and risk-classification [low: luminal A, intermediate: luminal B HER2 (-) or luminal B HER2 (+), and high: HER2 pure or triple negative] were established. Relations between clinical and biological variables with the metabolic parameters were studied. The relevance of each metabolic variable in the prediction of phenotype risk was assessed using a multivariate analysis. SUV-based variables and TLG obtained in the PET-1 and PET-2 showed high and significant correlations between them. MTV and SUV variables (SUVmax, SUVmean, and SUVpeak) where only marginally correlated. Significant differences were found between mean SUV variables and TLG obtained in PET-1 and PET-2. High and significant associations were found between metabolic variables obtained in PET-1 and their homonymous in PET-2. Based on that, only relations of PET-1 variables with biological tumor characteristics were explored. SUV variables showed associations with hormone receptors status (p < 0.001 and p = 0.001 for estrogen and progesterone receptor

  5. Bilateral glomus tumor treated with PET-CT based conformal radiotherapy: a case report

    PubMed Central

    Yuksel, Oznur; Topkan, Erkan; Pehlivan, Berrin

    2009-01-01

    Introduction Glomus tumors are benign, slow growing tumors originating from paraganglionic tissue, mostly located at the carotid bifurcation, jugular foramen, cervical portion vagus nerve, and middle ear cavity. Radiotherapy is treatment of choice for patients with intracranial extension, and patients with bilateral and multiple tumors, or patients who are inoperable. Case presentation We present a 53-year-old female patient with a glomus tumor treated with positron emission tomography computed tomography planning and 3D conformal radiotherapy, and the patient has remained free of disease progression 2 years after. Conclusion It is suggested that radiotherapy is a good treatment modality in patients with glomus tumor, and metabolic imaging and treatment planning with positron emission tomography computed tomography is superior to other imaging modalities. PMID:19918426

  6. 18F-fluorothymidine PET/CT as an early predictor of tumor response to treatment with cetuximab in human lung cancer xenografts.

    PubMed

    Takeuchi, Satoshi; Zhao, Songji; Kuge, Yuji; Zhao, Yan; Nishijima, Ken-Ichi; Hatano, Toshiyuki; Shimizu, Yasushi; Kinoshita, Ichiro; Tamaki, Nagara; Dosaka-Akita, Hirotoshi

    2011-09-01

    We investigated whether 18F-fluorothymidine-positron-emission tomography/computed tomography (18F-FLT-PET/CT) is useful for the evaluation of the very early response to anti-epidermal growth factor receptor (EGFR) antibody cetuximab therapy in human lung cancer xenografts. A human tumor xenograft model was established with a human non-small cell lung cancer cell line. The mice were randomly assigned to four groups: tumor growth follow-up, ex vivo study, PET/CT imaging and non-treated control. Mice were administered saline as control or cetuximab on day 1. An immunohistochemical study with Ki-67 was performed. Tumor volume treated with cetuximab was kept significantly smaller than control after day 8, although there was no difference on day 3. On day 3, 18F-FLT distribution was higher in the tumor than in other tissues, and was significantly decreased by treatment with cetuximab. On PET/CT imaging, 18F-FLT distribution in the tumor was clearly visualized, and the maximum standardized uptake value (SUV) was significantly decreased after treatment with cetuximab (p<0.01). Ki-67 expression was also significantly decreased on day 3 (p=0.01). These results suggest that 18F-FLT-PET/CT can be a useful predictor to determine the response to molecular targeted drugs such as cetuximab at an earlier time point than the change of tumor size.

  7. Towards respiration management in radiation treatment of lung tumors: transferring regions of interest from planning CT to kilovoltage X-ray images.

    PubMed

    Ataer-Cansizoglu, Esra; Bas, Erhan; Yousuf, M; You, Sheng; D'Souza, Warren D; Erdogmus, Deniz

    2010-01-01

    Tracking of lung tumors is imperative for improved radiotherapy treatment. However, the motion of the thoracic organs makes it a complicated task. 4D CT images acquired prior to treatment provide valuable information regarding the motion of organs and tumor, since it is manually annotated. In order to track tumors using treatment-day X-ray images (kV images), we need to find the correspondence with CT images so that projection of tumor region of interest will provide a good estimate about the position of the tumor on the X-ray image. In this study, we propose a method to estimate the alignment and respiration phase corresponding to X-ray images using 4D CT data. Our approach generates Digitally Reconstructed Radiographs (DRRs) using bilateral filter smoothing and computes rigid registration with kV images since the position and orientation of patient might differ between CT and treatment-day image acquisition processes. Instead of using landmark points, our registration method makes use of Kernel Density Estimation over the edges that are not affected much by respiration. To estimate the phase of X-ray, we apply template matching techniques between the lung regions of X-ray and registered DRRs. Our approach gives accurate results for rigid registration and provides a starting point to track tumors using the X-ray images during the treatment.

  8. Evaluation of tumor localization in respiration motion-corrected cone-beam CT: Prospective study in lung

    SciTech Connect

    Dzyubak, Oleksandr; Kincaid, Russell; Hertanto, Agung; Hu, Yu-Chi; Pham, Hai; Yorke, Ellen; Zhang, Qinghui; Mageras, Gig S.; Rimner, Andreas

    2014-10-15

    Purpose: Target localization accuracy of cone-beam CT (CBCT) images used in radiation treatment of respiratory disease sites is affected by motion artifacts (blurring and streaking). The authors have previously reported on a method of respiratory motion correction in thoracic CBCT at end expiration (EE). The previous retrospective study was limited to examination of reducing motion artifacts in a small number of patient cases. They report here on a prospective study in a larger group of lung cancer patients to evaluate respiratory motion-corrected (RMC)-CBCT ability to improve lung tumor localization accuracy and reduce motion artifacts in Linac-mounted CBCT images. A second study goal examines whether the motion correction derived from a respiration-correlated CT (RCCT) at simulation yields similar tumor localization accuracy at treatment. Methods: In an IRB-approved study, 19 lung cancer patients (22 tumors) received a RCCT at simulation, and on one treatment day received a RCCT, a respiratory-gated CBCT at end expiration, and a 1-min CBCT. A respiration monitor of abdominal displacement was used during all scans. In addition to a CBCT reconstruction without motion correction, the motion correction method was applied to the same 1-min scan. Projection images were sorted into ten bins based on abdominal displacement, and each bin was reconstructed to produce ten intermediate CBCT images. Each intermediate CBCT was deformed to the end expiration state using a motion model derived from RCCT. The deformed intermediate CBCT images were then added to produce a final RMC-CBCT. In order to evaluate the second study goal, the CBCT was corrected in two ways, one using a model derived from the RCCT at simulation [RMC-CBCT(sim)], the other from the RCCT at treatment [RMC-CBCT(tx)]. Image evaluation compared uncorrected CBCT, RMC-CBCT(sim), and RMC-CBCT(tx). The gated CBCT at end expiration served as the criterion standard for comparison. Using automatic rigid image

  9. Evaluation of tumor localization in respiration motion-corrected cone-beam CT: Prospective study in lung

    PubMed Central

    Dzyubak, Oleksandr; Kincaid, Russell; Hertanto, Agung; Hu, Yu-Chi; Pham, Hai; Rimner, Andreas; Yorke, Ellen; Zhang, Qinghui; Mageras, Gig S.

    2014-01-01

    Purpose: Target localization accuracy of cone-beam CT (CBCT) images used in radiation treatment of respiratory disease sites is affected by motion artifacts (blurring and streaking). The authors have previously reported on a method of respiratory motion correction in thoracic CBCT at end expiration (EE). The previous retrospective study was limited to examination of reducing motion artifacts in a small number of patient cases. They report here on a prospective study in a larger group of lung cancer patients to evaluate respiratory motion-corrected (RMC)-CBCT ability to improve lung tumor localization accuracy and reduce motion artifacts in Linac-mounted CBCT images. A second study goal examines whether the motion correction derived from a respiration-correlated CT (RCCT) at simulation yields similar tumor localization accuracy at treatment. Methods: In an IRB-approved study, 19 lung cancer patients (22 tumors) received a RCCT at simulation, and on one treatment day received a RCCT, a respiratory-gated CBCT at end expiration, and a 1-min CBCT. A respiration monitor of abdominal displacement was used during all scans. In addition to a CBCT reconstruction without motion correction, the motion correction method was applied to the same 1-min scan. Projection images were sorted into ten bins based on abdominal displacement, and each bin was reconstructed to produce ten intermediate CBCT images. Each intermediate CBCT was deformed to the end expiration state using a motion model derived from RCCT. The deformed intermediate CBCT images were then added to produce a final RMC-CBCT. In order to evaluate the second study goal, the CBCT was corrected in two ways, one using a model derived from the RCCT at simulation [RMC-CBCT(sim)], the other from the RCCT at treatment [RMC-CBCT(tx)]. Image evaluation compared uncorrected CBCT, RMC-CBCT(sim), and RMC-CBCT(tx). The gated CBCT at end expiration served as the criterion standard for comparison. Using automatic rigid image

  10. Evaluation of tumor localization in respiration motion-corrected cone-beam CT: prospective study in lung.

    PubMed

    Dzyubak, Oleksandr; Kincaid, Russell; Hertanto, Agung; Hu, Yu-Chi; Pham, Hai; Rimner, Andreas; Yorke, Ellen; Zhang, Qinghui; Mageras, Gig S

    2014-10-01

    Target localization accuracy of cone-beam CT (CBCT) images used in radiation treatment of respiratory disease sites is affected by motion artifacts (blurring and streaking). The authors have previously reported on a method of respiratory motion correction in thoracic CBCT at end expiration (EE). The previous retrospective study was limited to examination of reducing motion artifacts in a small number of patient cases. They report here on a prospective study in a larger group of lung cancer patients to evaluate respiratory motion-corrected (RMC)-CBCT ability to improve lung tumor localization accuracy and reduce motion artifacts in Linac-mounted CBCT images. A second study goal examines whether the motion correction derived from a respiration-correlated CT (RCCT) at simulation yields similar tumor localization accuracy at treatment. In an IRB-approved study, 19 lung cancer patients (22 tumors) received a RCCT at simulation, and on one treatment day received a RCCT, a respiratory-gated CBCT at end expiration, and a 1-min CBCT. A respiration monitor of abdominal displacement was used during all scans. In addition to a CBCT reconstruction without motion correction, the motion correction method was applied to the same 1-min scan. Projection images were sorted into ten bins based on abdominal displacement, and each bin was reconstructed to produce ten intermediate CBCT images. Each intermediate CBCT was deformed to the end expiration state using a motion model derived from RCCT. The deformed intermediate CBCT images were then added to produce a final RMC-CBCT. In order to evaluate the second study goal, the CBCT was corrected in two ways, one using a model derived from the RCCT at simulation [RMC-CBCT(sim)], the other from the RCCT at treatment [RMC-CBCT(tx)]. Image evaluation compared uncorrected CBCT, RMC-CBCT(sim), and RMC-CBCT(tx). The gated CBCT at end expiration served as the criterion standard for comparison. Using automatic rigid image registration, each CBCT was

  11. Evaluation of (68)Ga-DOTA-TOC PET/CT for the detection of duodenopancreatic neuroendocrine tumors in patients with MEN1.

    PubMed

    Morgat, Clément; Vélayoudom-Céphise, Fritz-Line; Schwartz, Paul; Guyot, Martine; Gaye, Delphine; Vimont, Delphine; Schulz, Jürgen; Mazère, Joachim; Nunes, Marie-Laure; Smith, Denis; Hindié, Elif; Fernandez, Philippe; Tabarin, Antoine

    2016-07-01

    Somatostatin receptor scintigraphy with (111)In-pentetreotide (SRS) is used to detect duodenopancreatic neuroendocrine tumors (dpNETs) in multiple endocrine neoplasia type 1 (MEN1). However, SRS has limited sensitivity for this purpose. Positron emission tomography/computed tomography (PET/CT) with (68)Ga-DOTA-TOC has a higher rate of sporadic dpNETs detection than SRS but there is little data for dpNETs detection in MEN1. To compare the performances of (68)Ga-DOTA-TOC PET/CT, SRS and contrast-enhanced computed tomography (CE-CT) to diagnose dpNETs in MEN1. Single-institution prospective comparative study Nineteen consecutive MEN1 patients (aged 47 ± 13 years) underwent (68)Ga-DOTA-TOC PET/CT, SRS, and CE-CT within 2 months in random order. Blinded readings of images were performed separately by experienced physicians. Unblinded analysis of CE-CT, combined with additional magnetic resonance imaging, endoscopic-ultrasound, (18)F-2-fluoro-deoxy-D-glucose ((18)F-FDG) PET/CT or histopathology results served as reference standard for dpNETs diagnosis. The sensitivity of (68)Ga-DOTA-TOC PET/CT, SRS, and CE-CT was 76, 20, and 60 %, respectively (p < 0.0001). All the true-positive lesions detected by SRS were also depicted on (68)Ga-DOTA-TOC PET/CT. (68)Ga-DOTA-TOC PET/CT detected lesions of smaller size than SRS (10.7 ± 7.6 and 15.2 ± 5.9 mm, respectively, p < 0.03). False negatives of (68)Ga-DOTA-TOC PET/CT included small dpNETs (<10 mm) and (18)F-FDG PET/CT positive aggressive dpNETs. No false positives were recorded. In addition, whole-body mapping with (68)Ga-DOTA-TOC PET/CT identified extra-abdominal MEN1-related tumors including one neuroendocrine thymic carcinoma identified by the three imaging procedures, one bronchial carcinoid undetected by CE-CT and three meningiomas undetected by SRS. Owing to higher diagnostic performance, (68)Ga-DOTA-TOC PET/CT (or alternative (68)Ga-labeled somatostatin analogues) should replace (111)In

  12. SU-E-J-190: Characterization of Radiation Induced CT Number Changes in Tumor and Normal Lung During Radiation Therapy for Lung Cancer

    SciTech Connect

    Yang, C; Liu, F; Tai, A; Gore, E; Johnstone, C; Li, X

    2014-06-01

    Purpose: To measure CT number (CTN) changes in tumor and normal lung as a function of radiation therapy (RT) dose during the course of RT delivery for lung cancer using daily IGRT CT images and single respiration phase CT images. Methods: 4D CT acquired during planning simulation and daily 3D CT acquired during daily IGRT for 10 lung cancer cases randomly selected in terms of age, caner type and stage, were analyzed using an in-house developed software tool. All patients were treated in 2 Gy fractions to primary tumors and involved nodal regions. Regions enclosed by a series of isodose surfaces in normal lung were delineated. The obtained contours along with target contours (GTVs) were populated to each singlephase planning CT and daily CT. CTN in term of Hounsfield Unit (HU) of each voxel in these delineated regions were collectively analyzed using histogram, mean, mode and linear correlation. Results: Respiration induced normal lung CTN change, as analyzed from single-phase planning CTs, ranged from 9 to 23 (±2) HU for the patients studied. Normal lung CTN change was as large as 50 (±12) HU over the entire treatment course, was dose and patient dependent and was measurable with dose changes as low as 1.5 Gy. For patients with obvious tumor volume regression, CTN within the GTV drops monotonically as much as 10 (±1) HU during the early fractions with a total dose of 20 Gy delivered. The GTV and CTN reductions are significantly correlated with correlation coefficient >0.95. Conclusion: Significant RT dose induced CTN changes in lung tissue and tumor region can be observed during even the early phase of RT delivery, and may potentially be used for early prediction of radiation response. Single respiration phase CT images have dramatically reduced statistical noise in ROIs, making daily dose response evaluation possible.

  13. Desmoplastic small round cell tumor in the abdomen and pelvis: report of CT findings in 11 affected children and young adults.

    PubMed

    Bellah, Richard; Suzuki-Bordalo, Lisa; Brecher, Eric; Ginsberg, Jill P; Maris, John; Pawel, Bruce R

    2005-06-01

    Our objective was to evaluate the CT features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis in pediatric and young adult patients. Characteristic CT features of DSRCT include bulky intraabdominal soft-tissue masses that involve omental and serosal surfaces, without a distinct organ of origin; solid, dominant, heterogeneous pelvic masses in the retrovesical or rectouterine spaces; and concurrent metastases, common at the time of diagnosis, particularly those involving lymph nodes and liver.

  14. [Imaging techniques in the preoperative diagnosis of soft tissue tumors. A comparison of MRT, CT, sonography, angiography and conventional x-rays].

    PubMed

    Roeren, T; Gindele, A; Grosspietsch, C; Dueck, M; Kauffmann, G W

    1992-12-01

    In a study on 51 patients with histologically confirmed soft tissue tumors (STT), we retrospectively evaluated the preoperative use of imaging procedures (MRI, CT, ultrasound, angiography, plain film) for identification of tumor size, delineation, and determination of malignancy and tissue type. The findings were correlated with intraoperative findings and histological diagnosis. The overall diagnostic method of choice for preoperative imaging of STT is MRI, followed by CT. Ultrasound, although sensitive, lacks the required specificity. Angiography and plain film can only be used for specific indications, as they generally do not make it possible to stage the tumor. Combining our results with those from the more recent literature, we propose a diagnostic algorithm according to which MRI would generally be performed for preoperative staging of STT. CT and plain film should only be used if bony infiltration is suspected; angiography is indicated for planning intraarterial chemotherapy or embolization or if vascular infiltration is probable.

  15. Observer variation in contouring gross tumor volume in patients with poorly defined non-small-cell lung tumors on CT: the impact of 18FDG-hybrid PET fusion.

    PubMed

    Caldwell, C B; Mah, K; Ung, Y C; Danjoux, C E; Balogh, J M; Ganguli, S N; Ehrlich, L E

    2001-11-15

    To quantify interobserver variation in gross tumor volume (GTV) localization using CT images for patients with non-small-cell lung carcinoma and poorly defined tumors on CT and to determine whether variability would be reduced if coregistered 2-[18F]fluoro-2-deoxy-d-glucose (FDG)-hybrid positron emission tomography (PET) with CT images were used. Prospectively, 30 patients with non-small-cell lung carcinoma had CT and FDG-hybrid PET examinations in radiation treatment position on the same day. Images were coregistered using eight fiducial markers. Guidelines were established for contouring GTVs. Three radiation oncologists performed localization independently. The coefficient of variation was used to assess interobserver variability. The size of the GTV defined showed great variation among observers. The mean ratios of largest to smallest GTV were 2.31 and 1.56 for CT only and for CT/FDG coregistered data, respectively. The addition of PET reduced this ratio in 23 of 30 cases and increased it in 7. The mean coefficient of variation for GTV based on the combined modalities was significantly smaller (p < 0.01) than that for CT data only. High observer variability in CT-based definition of the GTV can occur. A more consistent definition of the GTV can often be obtained if coregistered FDG-hybrid PET images are used.

  16. Effective localization in tumor-induced osteomalacia using 68Ga-DOTATOC-PET/CT, venous sampling and 3T-MRI

    PubMed Central

    Kawai, Shintaro; Furukawa, Yasushi; Yamamoto, Reika; Uraki, Shinsuke; Takeshima, Ken; Warigaya, Kenji; Nakamoto, Yuji; Akamizu, Takashi

    2017-01-01

    Summary Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by renal phosphate wasting leading to hypophosphatemia due to excessive actions of fibroblast growth factor 23 (FGF23) produced by the tumors. Although the best way of curing TIO is complete resection, it is usually difficult to detect the culprit tumors by general radiological modalities owing to the size and location of the tumors. We report a case of TIO in which the identification of the tumor by conventional imaging studies was difficult. Nonetheless, a diagnosis was made possible by effective use of multiple modalities. We initially suspected that the tumor existed in the right dorsal aspect of the scapula by 68Ga-DOTATOC positron emission tomography/computed tomography (68Ga-DOTATOC-PET/CT) and supported the result by systemic venous sampling (SVS). The tumor could also be visualized by 3T-magnetic resonance imaging (MRI), although it was not detected by 1.5T-MRI, and eventually be resected completely. In cases of TIO, a stepwise approach of 68Ga-DOTATOC-PET/CT, SVS and 3T-MRI can be effective for confirmation of diagnosis. Learning points: TIO shows impaired bone metabolism due to excessive actions of FGF23 produced by the tumor. The causative tumors are seldom detected by physical examinations and conventional radiological modalities. In TIO cases, in which the localization of the culprit tumors is difficult, 68Ga-DOTATOC-PET/CT should be performed as a screening of localization and thereafter SVS should be conducted to support the result of the somatostatin receptor (SSTR) imaging leading to increased diagnosability. When the culprit tumors cannot be visualized by conventional imaging studies, using high-field MRI at 3T and comparing it to the opposite side are useful after the tumor site was determined. PMID:28469928

  17. Combined Evaluation of AFP, CA15-3, CA125, CA19-9, and CEA Tumor Markers in Patients with Hepatitis B and C

    PubMed Central

    ASSMAR, Mehdi; YEGANEH, Sara; MANSOURGHANAEI, Fariborz; AMIRMOZAFARI, Nour

    2016-01-01

    Background: This study aimed to determine the role of tumor markers AFP, CA15-3, CA125, CA19-9 and CEA in patients with hepatitis B and C. Methods: This descriptive cross-sectional study was performed from Oct 2012 to Oct 2014. Serum samples of 129 patients with hepatitis B and C referred to Guilan Liver and Digestive Disease Research Center in Rasht, Iran were collected and checked for the existence of the listed tumor markers by ELISA. Results: No increase in serum levels of tumor marker CA19-9, CEA and CA15-3 were seen in patients with hepatitis (P>0.05). In patients with hepatitis B, increase in CA125 were observed (P=0.03). In hepatitis C patients, there was an increase in AFP levels (P=0.03). Conclusion: The levels of AFP and CA125 markers were high in hepatitis C and hepatitis B, respectively. However, the increased levels were not seen is malignancy. Due to the small sample size, further study is necessary to find the reasons of the increase. PMID:28053931

  18. Combined Evaluation of AFP, CA15-3, CA125, CA19-9, and CEA Tumor Markers in Patients with Hepatitis B and C.

    PubMed

    Assmar, Mehdi; Yeganeh, Sara; Mansourghanaei, Fariborz; Amirmozafari, Nour

    2016-12-01

    This study aimed to determine the role of tumor markers AFP, CA15-3, CA125, CA19-9 and CEA in patients with hepatitis B and C. This descriptive cross-sectional study was performed from Oct 2012 to Oct 2014. Serum samples of 129 patients with hepatitis B and C referred to Guilan Liver and Digestive Disease Research Center in Rasht, Iran were collected and checked for the existence of the listed tumor markers by ELISA. No increase in serum levels of tumor marker CA19-9, CEA and CA15-3 were seen in patients with hepatitis (P>0.05). In patients with hepatitis B, increase in CA125 were observed (P=0.03). In hepatitis C patients, there was an increase in AFP levels (P=0.03). The levels of AFP and CA125 markers were high in hepatitis C and hepatitis B, respectively. However, the increased levels were not seen is malignancy. Due to the small sample size, further study is necessary to find the reasons of the increase.

  19. Gastric large cell neuroendocrine carcinoma with venous tumor thrombus: the value of PET/CT and contrast-enhanced computed tomography.

    PubMed

    Song, Le; Jin, Zhu; Zhang, Weifang; Zhang, Yanyan

    2015-01-01

    Venous involvement is commonly detected microscopically on gastric neuroendocrine carcinomas (NECs), but related imaging studies have been rarely documented. We report a rare case of gastric large cell NEC with tumor thrombi in gastric and splenic veins, elevated serum alpha fetoprotein, and multiple hepatic nodules. In this case, (18)F-fluorodeoxyglucose positron emission tomography combined with contrast-enhanced computed tomography provided valuable information on tumor staging. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Filter paper-assisted cell transfer (FaCT) technique: A novel cell-sampling technique for intraoperative diagnosis of central nervous system tumors.

    PubMed

    Kawamura, Jumpei; Kamoshida, Shingo; Shimakata, Takaaki; Hayashi, Yurie; Sakamaki, Kuniko; Denda, Tamami; Kawai, Kenji; Kuwao, Sadahito

    2017-04-01

    Intraoperative diagnosis of central nervous system (CNS) tumors provides critical guidance to surgeons in the determination of surgical resection margins and treatment. The techniques and preparations used for the intraoperative diagnosis of CNS tumors include frozen sectioning and cytologic methods (squash smear and touch imprint). Cytologic specimens, which do not have freezing artifacts, are important as an adjuvant tool to frozen sections. However, if the amount of submitted tissue samples is limited, then it is difficult to prepare both frozen sections and squash smears or touch imprint specimens from a single sample at the same time. Therefore, the objective of this study was to derive cells directly from filter paper on which tumor samples are placed. The authors established the filter paper-assisted cell transfer (FaCT) smear technique, in which tumor cells are transferred onto a glass slide directly from the filter paper sample spot after the biopsy is removed. Cell yields and diagnostic accuracy of the FaCT smears were assessed in 40 CNS tumors. FaCT smears had ample cell numbers and well preserved cell morphology sufficient for cytologic diagnosis, even if the submitted tissues were minimal. The overall diagnostic concordance rates between frozen sections and FaCT smears were 90% and 87.5%, respectively (no significant differences). When combining FaCT smears with frozen sections, the diagnostic concordance rate rose to 92.5%. The current results suggest that the FaCT smear technique is a simple and effective processing method that has significant value for intraoperative diagnosis of CNS tumors. Cancer Cytopathol 2017;125:277-282. © 2016 American Cancer Society. © 2017 American Cancer Society.

  1. Oncocytic carcinoid tumor of the lung with intense F-18 fluorodeoxyglucose (FDG) uptake in positron emission tomography-computed tomography (PET/CT).

    PubMed

    Tanabe, Yuki; Sugawara, Yoshifumi; Nishimura, Rieko; Hosokawa, Kohei; Kajihara, Makoto; Shimizu, Teruhiko; Takahashi, Tadaaki; Sakai, Shinya; Sawada, Shigeki; Yamashita, Motohiro; Ohtani, Haruhiko

    2013-10-01

    The present report describes a case of typical carcinoid tumor with intense fluorodeoxyglucose (FDG) uptake. The most of tumor cells were characterized by eosinophilic cytoplasm resulting from accumulation of mitochondria, which was called an oncocytic carcinoid tumor. Glucose transporter type 1 (GLUT-1) was expressed in a membranous pattern in the oncocytic component. Oncocytic carcinoid tumors could show intense FDG uptake due to the numerous intracellular mitochondria and the membranous overexpression of GLUT-1. Thus, it could be a potential pitfall of interpreting FDG-PET/CT image.

  2. Mesenteric inflammatory myofibroblastic tumor: MRI and CT imaging correlated to anatomical pathology.

    PubMed

    Kirchgesner, Th; Danse, E; Sempoux, Ch; Annet, L; Dragean, Ch Anca; Trefois, P; Abbes Orabi, N; Kartheuser, A

    2014-01-01

    Inflammatory myofibroblastic tumor (IMT) is a rare tumor, classified by WHO of intermediate biological potential with tendency for local recurrence and small risk for distant metastasis. Histologically IMT is a mixture of inflamma- tory cells and myofibroblastic spindle cells proliferation. To our knowledge there is no MRI description of mesenteric IMT in the literature. We would like to emphasize the correlation between medical imaging and anatomical pathology based on our experience of a mesenteric IMT in a 28-year-old patient.

  3. Hepatic arterial administration of sorafenib and iodized oil effectively attenuates tumor growth and intrahepatic metastasis in rabbit VX2 hepatocellular carcinoma model

    PubMed Central

    Zhang, Lin; Liu, Feng-Yong; Fu, Jin-Xin; Duan, Feng; Fan, Qing-Sheng; Wang, Mao-Qiang

    2014-01-01

    Aim: To investigate the therapeutic effect of the hepatic arterial administration of sorafenib in rabbit VX-2 hepatocellular carcinoma (HCC) model. Methods: Rabbit VX-2 HCC models were established via implanting VX-2 tumors into the livers, and randomly divided into four groups, respectively treated with (1) The hepatic arterial administration of iodized oil alone (TACE-i), (2) The hepatic arterial administration of iodized oil and pharmorubicin (TACE-ip), (3) The hepatic arterial administration of iodized and cis-DDP (TACE-ic), (4) The hepatic arterial administration of iodized and sorafenib (TACE-is). The growth rate and intrahepatic metastasis of implanted VX-2 tumor in each rabbit were measured. Microvessel density (MVD) in the adjacent tissues of implanted VX-2 tumor were estimated by detecting the expression of CD34 and VEGF level in tumor adjacent tissues were also examined by Immunohistochemistry. Results: Compared with other groups, TACE-is treatment group presented a better effect on inhibiting tumor growth rate and intrahepatic metastasis in rabbit VX-2 HCC model. The angiogenesis (assessed by MVD) in the adjacent tissues were suppressed more dramatically in TACE-is treated group. Moreover, TACE-is treatment did not significantly increase the levels of alanine transaminase and creatinine compared to the group with TACE-i treatment. Conclusion: The hepatic arterial administration of sorafenib and iodized oil (TACE-is) effectively attenuates tumor growth and intrahepatic metastasis in rabbit VX-2 HCC model without obvious hepatic and renal toxicity. One of the related mechanisms may be due to the inhibition of angiogenesis in the adjacent tissues. Our data indicated that TACE-is may be a secure and effective treatment for HCC. PMID:25550815

  4. Comparative Effects of CT Imaging Measurement on RECIST End Points and Tumor Growth Kinetics Modeling

    PubMed Central

    Li, CH; Bies, RR; Wang, Y; Sharma, MR; Karovic, S; Werk, L; Edelman, MJ; Miller, AA; Vokes, EE; Oto, A; Ratain, MJ; Schwartz, LH

    2016-01-01

    Quantitative assessments of tumor burden and modeling of longitudinal growth could improve phase II oncology trials. To identify obstacles to wider use of quantitative measures we obtained recorded linear tumor measurements from three published lung cancer trials. Model‐based parameters of tumor burden change were estimated and compared with similarly sized samples from separate trials. Time‐to‐tumor growth (TTG) was computed from measurements recorded on case report forms and a second radiologist blinded to the form data. Response Evaluation Criteria in Solid Tumors (RECIST)‐based progression‐free survival (PFS) measures were perfectly concordant between the original forms data and the blinded radiologist re‐evaluation (intraclass correlation coefficient = 1), but these routine interrater differences in the identification and measurement of target lesions were associated with an average 18‐week delay (range, −20 to 55 weeks) in TTG (intraclass correlation coefficient = 0.32). To exploit computational metrics for improving statistical power in small clinical trials will require increased precision of tumor burden assessments. PMID:26790562

  5. Impact of (18)F-FDG PET/CT imaging in therapeutic decisions for malignant solitary fibrous tumor of the pelvis.