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Oncology imaging in the abdomen and pelvis: where cancer hides
Abstract
As the incidence of cancer continues to increase, imaging will play an ever more important role in the detection, diagnosis,
staging, surveillance, and therapeutic monitoring of cancer. Diagnostic errors in the initial discovery of cancer or at follow-up
assessments can lead to missed opportunities for curative treatments or altering or reinitiating therapies, as well as adversely
impact clinical trials. Radiologists must have an understanding of cancer biology, treatments, and imaging appearance of therapeutic
effects and be mindful that metastatic disease can involve virtually any organ system. Knowledge of patient history and tumor
biology allows for optimizing imaging protocols. The majority of cancer imaging utilizes computed tomography, where contrast
enhancement characteristics of lesions can be exploited and detection of subtle lesions can involve manipulation of window
width and level settings, multiplanar reconstruction, and maximum intensity projections. For magnetic resonance imaging, diffusion-weighted
imaging can render lesions more conspicuous, improve characterization, and help assess therapeutic response. Positron emission
tomography with 18F-labeled fluorodeoxyglucose and sodium fluoride are invaluable in detecting occult existing and new cancerous lesions, characterizing
indeterminate lesions, and assessing treatment effects. The most common anatomic "hiding places" for cancer include metastases
to solid organs, such as the kidneys and pancreas, gastrointestinal tract, peritoneum and retroperitoneum, neural axis, muscular
body wall, and bones. Consistent work habits, employment of appropriate technologies, and particular attention to the above
anatomic areas can enhance detection, staging, and reassessments of these complex and often stealthy diseases, ensuring the
radiologists' integral role in the cancer care team.
staging, surveillance, and therapeutic monitoring of cancer. Diagnostic errors in the initial discovery of cancer or at follow-up
assessments can lead to missed opportunities for curative treatments or altering or reinitiating therapies, as well as adversely
impact clinical trials. Radiologists must have an understanding of cancer biology, treatments, and imaging appearance of therapeutic
effects and be mindful that metastatic disease can involve virtually any organ system. Knowledge of patient history and tumor
biology allows for optimizing imaging protocols. The majority of cancer imaging utilizes computed tomography, where contrast
enhancement characteristics of lesions can be exploited and detection of subtle lesions can involve manipulation of window
width and level settings, multiplanar reconstruction, and maximum intensity projections. For magnetic resonance imaging, diffusion-weighted
imaging can render lesions more conspicuous, improve characterization, and help assess therapeutic response. Positron emission
tomography with 18F-labeled fluorodeoxyglucose and sodium fluoride are invaluable in detecting occult existing and new cancerous lesions, characterizing
indeterminate lesions, and assessing treatment effects. The most common anatomic "hiding places" for cancer include metastases
to solid organs, such as the kidneys and pancreas, gastrointestinal tract, peritoneum and retroperitoneum, neural axis, muscular
body wall, and bones. Consistent work habits, employment of appropriate technologies, and particular attention to the above
anatomic areas can enhance detection, staging, and reassessments of these complex and often stealthy diseases, ensuring the
radiologists' integral role in the cancer care team.
- Journal Abdominal Imaging
- Online ISSN 1432-0509
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