paywalled: MR Imaging of Malignancies Arising in Endometriomas and Extraovarian Endometriosis

MR Imaging of Malignancies Arising in Endometr... [Radiographics. 2012] - PubMed - NCBI

Radiographics. 2012 May

Abstract: 

Cancers that arise in ovarian or extraovarian endometriosis are a distinct disease category with a histologic profile different from that of the more common epithelial ovarian cancers and with a better prognosis.

Because the malignant transformation of endometriomas is rarely associated with lymphadenopathy or peritoneal carcinomatosis, a high index of suspicion on the part of the radiologist is necessary to establish a timely diagnosis of endometriosis-related ovarian cancers and allow appropriate oncologic management. Although imaging is not currently performed for surveillance of endometriosis, magnetic resonance (MR) imaging is often performed when surgical treatment is under consideration................. For definitive diagnosis, histopathologic analysis is required.

paywalled: Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: A meta-analysis

Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: A meta-analysis

Abstract 

Objectives

To compare the diagnostic performances of computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET or PET/CT) for detection of metastatic lymph nodes in patients with ovarian cancer.

Methods

Relevant studies were identified with MEDLINE and EMBASE from January 1990 to July 2010. We estimated the weighted summary sensitivities, specificities, OR (odds ratio), and summary receiver operating characteristic (sROC) curves of each imaging technique and conducted pair-wise comparisons using the two-sample Z-test. Meta-regression, subgroup analysis, and funnel plots were also performed to explain the between-study heterogeneity.

Results

Eighteen eligible studies were included, with a total of 882 patients. PET or PET/CT was a more accurate modality (sensitivity, 73.2%; specificity, 96.7%; OR [odds ratio], 90.32). No significant difference was detected between CT (sensitivity, 42.6%; specificity, 95.0%; OR, 19.87) and MR imaging (sensitivity, 54.7%; specificity, 88.3%; OR, 12.38). Meta-regression analyses and subgroup analyses revealed no statistical difference. Funnel plots with marked asymmetry suggested a publication bias.

Conclusion

FDG-PET or FDG-PET/CT is more accurate than CT and MR imaging in the detection of lymph node metastasis in patients with ovarian cancer.

paywalled: (March 2012) Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach.

Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach

Abstract

The most definitive role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) at present is surveillance and detecting recurrence in patients who have completed primary therapy but demonstrate a rising serum tumor marker (e.g., CA-125 levels). In this scenario, PET/CT demonstrates high sensitivity and accuracy in detecting lesions that are otherwise challenging, and appears superior (with less interobserver variability) compared with CT alone. Despite the fact that peritoneal deposits may be missed by PET/CT, the overall performance is better than CT alone. FDG-PET does not play a significant additional role in the primary diagnosis of ovarian cancers; however, the role of combined PET/CT modality has recently begun to be re-explored for initial disease staging, particularly because PET/CT can pick up small unsuspected lesions and thereby provide a better disease assessment of the whole body in a single examination. The baseline PET/CT also subserves an important role for future monitoring of therapy response. Therapy monitoring by PET could help to optimize neoadjuvant therapy protocols and to avoid ineffective therapy in nonresponders early in its course, although PET/CT has cost-effectiveness issues that need further evaluation. The prognostic value of FDG-PET/CT has been investigated in the following areas: in the preoperative setting to predict optimal cytoreduction; to assess the value of a positive FDG-PET following primary surgery; and when employed as a replacement for second-look laparotomy following completion of primary surgery and chemotherapy. The data, although promising, are still sparse in all the three domains for a definite recommendation.

 

paywalled: PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

PET/CT scanning guided intensity-modulated radi... [Eur J Radiol. 2012] - PubMed - NCBI

Abstract

OBJECTIVE:

This study was undertaken to evaluate the clinical contribution of positron emission tomography using (18)F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer.

MATERIALS AND METHODS:

Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated.

RESULTS:

Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P=0.021; PR: 25.0% vs. 13.3%, P=0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P=0.014).

CONCLUSIONS:

PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

paywalled: Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT scans for diagnosing ovarian cancer recurrence

Low-dose non-enhanced CT versus full-dose contr... [Eur J Radiol. 2012] - PubMed - NCBI

 Abstract

OBJECTIVE:

To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated (18)F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer.

MATERIALS AND METHODS:

One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months.

RESULTS:

Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods ...... The scales of detecting 104 recurrent lesion sites were N:14, E:6, P:84 for PET/ceCT, and N:15, E:17, P:72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT.

CONCLUSION:

PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT.

PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

Abstract

OBJECTIVE: This study was undertaken to evaluate the clinical contribution of positron emission tomography using (18)F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer.

MATERIALS AND METHODS: Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated.

RESULTS: Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P=0.021; PR: 25.0% vs. 13.3%, P=0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P=0.014).

CONCLUSIONS: PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

abstract: Relationship among glycolytic phenotype, grade, and histological subtype in ovarian carcinoma - F-18 FDG PET/CT imaging

Relationship among glycolytic phenotype, grade, and histological subtype in ovarian carcinoma.

Abstract

PURPOSE:

Knowing the glycolytic phenotype of cancers is important for the appropriate use of F-18 FDG PET/CT imaging. This study was performed to determine the influence of tumor grade and histology on the glycolytic phenotype of epithelial ovarian cancer patients.

MATERIALS AND METHODS:

Only histopathologically confirmed epithelial ovarian cancer patients, with no other concurrent malignancies, who had F-18 FDG PET/CT either before or at least 3 months after any therapeutic intervention and had confirmed measurable disease of >1 cm were included. The F-18 FDG PET/CT uptake was determined as maximum standard uptake value (SUVmax) at the pathologically confirmed site of disease or in the most active lesion. SUVmax was correlated to tumor grade and histology.

RESULTS:

Of 171 ovarian cancer patients, 42 referred for F-18 FDG PET/CT scans between January 2003 and December 2010 were eligible for inclusion. Histologic diagnosis most frequently revealed the serous subtype (n = 32) and grade III (n = 28) epithelial ovarian cancer. Overall, ovarian carcinomas exhibited a strong glycolytic phenotype (average SUVmax, 7.6 g/mL). The SUVmax averaged 7.76 g/mL, 6.76 g/mL, and 7.95 g/mL for Grade I, II, and III, respectively. There was no statistically significant correlation between tumor SUVmax and the histologic tumor grade (P = 0.74). No statistically significant differences were found between the tumor SUVmax of serous and endometrioid subtypes (P = 0.53). For other histology subtypes, no statistic evaluation was possible due to the low number of cases.

CONCLUSIONS:

The glycolytic phenotype in epithelial ovarian cancer, expressed as SUVmax, is strong. However, tumor FDG uptake is unrelated to tumor grade and histologic subtype implying that F-18 FDG PET/CT cannot be used to predict tumor aggressiveness or histology.

abstract: Preoperative PET/CT in early-stage breast cancer (including ovarian cancer primary/metastases)

Preoperative PET/CT in early-stage breast cancer

Abstract

Background: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer. 

Patients and methods: A total of 103 consecutive patients with newly diagnosed operable breast cancer with tumors ≥2 cm were independently examined preoperatively with conventional assessment (mammography, breast/axillary ultrasound, chest X-ray and blood samples) and PET/CT with no prior knowledge of the other. 

Results: PET/CT identified a primary tumor in all but three patients (97%). PET/CT solely detected distant metastases (ovary, bones and lung) in 6 patients and new primary cancers (ovary, lung) in another two patients, as well as 12 cases of extra-axillary lymph node involvement. In 15 patients (15%), extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 14% (14/103) and ultimately a modification of planned treatment in 8% (8/103) of patients. 

Conclusions: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative ¹⁸F-fluorodeoxyglucose–PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer with tumors ≥2 cm.

open access: Causes and imaging features of false positives and false negatives on 18F-PET/CT in oncologic imaging

fulltext.pdf (application/pdf Object)

open access: Cancer risks associated with external radiation from diagnostic imaging procedures - 2012 - CA: A Cancer Journal for Clinicians

Cancer risks associated with external radiation from diagnostic imaging procedures -  2012 - CA: A Cancer Journal for Clinicians

abstract: Common patterns in 558 diagnostic radiology errors

Common patterns in 558 diagnostic radiology errors:

Abstract

Introduction: As a Quality Improvement initiative our department has held regular discrepancy meetings since 2003. We performed a retrospective analysis of the cases presented and identified the most common pattern of error.

Methods: A total of 558 cases were referred for discussion over 92 months, and errors were classified as perceptual or interpretative. The most common patterns of error for each imaging modality were analysed, and the misses were scored by consensus as subtle or non-subtle.

Results: Of 558 diagnostic errors, 447 (80%) were perceptual and 111 (20%) were interpretative errors. Plain radiography and computed tomography (CT) scans were the most frequent imaging modalities accounting for 246 (44%) and 241 (43%) of the total number of errors, respectively. In the plain radiography group 120 (49%) of the errors occurred in chest X-ray reports with perceptual miss of a lung nodule occurring in 40% of this subgroup. In the axial and appendicular skeleton missed fractures occurred most frequently, and metastatic bone disease was overlooked in 12 of 50 plain X-rays of the pelvis or spine. The majority of errors within the CT group were in reports of body scans with the commonest perceptual errors identified including 16 missed significant bone lesions, 14 cases of thromboembolic disease and 14 gastrointestinal tumours. Of the 558 errors, 312 (56%) were considered subtle and 246 (44%) non-subtle.

Conclusion: Diagnostic errors are not uncommon and are most frequently perceptual in nature. Identification of the most common patterns of error has the potential to improve the quality of reporting by improving the search behaviour of radiologists.

Clinical value of 18F-FDG PET-CT in detecting primary tumor for patients with carcinoma of unknown primary

Clinical value of 18F-FDG PET-CT in detecting primary tumor for patients with carcinoma of unknown primary: Publication year: 2012


Objective: 
To investigate the clinical value in detecting occult primary tumors with ¹⁸F-FDG PET-CT whole body imaging.

Methods: 
120 patients with unknown primary origin were referred for ¹⁸F-FDG PET-CT whole body imaging. All patients were performed ¹⁸F-FDG PET-CT whole body scan. PET-CT images were interpreted by visual inspection and semi-quantitative analysis (standardized uptake value, SUV). Histopathological and formal clinical follow-up findings were used to assess the value of FDG PET-CT.

Results: 
FDG PET-CT was able to detect the primary tumor in 54/120 patients (42.5%). The primary tumors were confirmed by histopathologic and formal clinical follow-up findings, and located in the head and neck (n =17), the lung (n =19), the breast (n =2), the esophagus (n =1), the stomach (n =2), the bile ducts (n =1), the pancreas (n =3), the co1on (n =3), the ovary (n =2), the prostate (n =l), others (n =3). FDG PET results were proved false positive in 9 patients (7.5%), which were located in the head and neck (n =3), the lung (n =1), the gastric (n =1), the colon (n =2), the ovary (n =1), the prostate (n =l).

During the clinical follow-up of median 32months (range, 2–45months), primary tumor was found in only 5 patients of 60 cases unidentified by PET-CT (breast cancer, gastric cancer, co1on cancer, prostate cancer and urinary tumors, respectively). The sensitivity, specificity, and accuracy of ¹⁸F-FDG PET-CT in the detection of the primary tumor site were 91.5%, 85.2%, and 88.3%, respectively.

Conclusion:
¹⁸F-FDG PET-CT whole body imaging is both a noninvasive and a very sensitive tomographic whole-body imaging modality, allowing for the detection of a primary tumor and complete tumor staging in single examination, which can contribute substantially to selecting appropriate therapeutic methods and evaluating prognosis. Perhaps ¹⁸F-FDG PET-CT whole body imaging should be used as a first-line imaging modality for patients with carcinoma of unknown primary rather than using it after other diagnostic procedures have failed to identify a primary tumor.

abstract: Preoperative assessment of peritoneal carcinomatosis: intraindividual comparison of 18F-FDG PET/CT and MRI

Preoperative assessment of peritoneal carcinomatosis: intraindividual comparison of 18F-FDG PET/CT and MRI:

Conclusion  

With high diagnostic accuracy for PC of both, MRI and PET/CT, PET/CT provides better diagnostic accuracy and especially better NPV.

abstract: Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders

Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders

Abstract

"Several advances in imaging have become part of the work-up for localization, diagnosis, and management of infectious diseases and inflammatory disorders. Utility of multiple imaging modalities is a time-consuming step, and significant numbers of patients remain undiagnosed despite utilization of series of tests. Inflammatory cells have avidity for fluorine 18–labeled fluorodeoxyglucose (¹⁸F-FDG), and thus positron emission tomographic–computed tomographic (PET-CT) hybrid imaging provides anatomical and metabolic information that can be used to define the extent of infectious and inflammatory diseases and assess response to treatment. PET-CT provides a “one-stop test” in which use of hybrid imaging provides anatomical and metabolic information. The extent of disease is defined quickly, and response to treatment can be assessed. This modality also helps define the metastatic and/or septic foci where there is lack of localizing symptoms. More recently, there is increasing awareness among clinicians regarding the ability of PET-CT to help in diagnosing, characterizing, and assessing inflammatory disorders. This article reviews the usefulness of this imaging modality."

abstract: Evaluation of 2-Deoxy-2-[18F]Fluoro-D-glucose- and 3′-Deoxy-3′-[18F]Fluorothymidine–Positron Emission Tomography as Biomarkers of Therapy Response in Platinum-Resistant Ovarian Cancer

Molecular Imaging and Biology, Online First™ 

Abstract

Purpose  

We evaluated whether 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) and 3′-deoxy-3′-[¹⁸F]fluorothymidine ([¹⁸F]FLT) positron emission tomography (PET) could be used as imaging biomarkers of platinum resensitization in ovarian cancer.

Procedures  

Paired platinum-sensitive and platinum-resistant ovarian cancer cells from the same patient, PEO1 and PEO4, grown as tumor xenografts in nude mice, were assessed by PET.

Results  

The AKT inhibitor, API-2, resensitized platinum-resistant PEO4 tumors to cisplatin, leading to a markedly lower Ki67 labeling index (p ≤ 0.006, n = 6 per group). [¹⁸F]FDG-PET and [¹⁸F]FLT-PET imaging variables were lower after combination treatment compared with vehicle treatment (p ≤ 0.006, n = 6 per group). No changes were seen with either drug alone. PRAS40 phosphorylation status was a sensitive biochemical marker of pathway inhibition, whereas reductions thymidine kinase 1 expression defined the [¹⁸F]FLT response.

Conclusions  

Therapeutic inhibition of AKT activation in acquired platinum-resistant disease can be imaged noninvasively by [¹⁸F]FDG-PET and [¹⁸F]FLT-PET warranting further assessment. 

abstract: HE4 combined with MDCT imaging is a good marker in the evaluation of disease extension in advanced epithelial ovarian carcinoma.

HE4 combined with MDCT imaging is a good marker in the evaluation of disease extension in advanced epithelial ovarian carcinoma

Abstract

The purpose of the study was to evaluate the expression of the biomarkers CA125 and HE4 combined with imaging, in patients with advanced epithelial ovarian cancer (EOC). Forty-six women with EOC were included in the study all affected with peritoneal carcinomatosis. ................The availability of biomarkers, particularly HE4, together with sophisticated imaging techniques, strengthens the clinical relevance of this study, for the follow-up of patients with peritoneal carcinomatosis.

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carcinomatosis - definition of carcinomatosis in the Medical ...

medical-dictionary.thefreedictionary.com/carcinomatosis

carcinomatosis /car·ci·no·ma·to·sis/ (kahr″sĭ-no-mah-to´sis) the condition of widespread dissemination of cancer throughout the body.

Picture this: The new imaging techniques that can help doctors select the right treatment at the right time - Cutting Edge - Cancer World (eg. MRI/PET/CT/therapies/biomarkers....)

Blogger's Note: worth reading

abstract: Spectrum of (FDG-PET/CT) fluorodeoxyglucose-positron emission tomography/computed tomography and magnetic resonance imaging findings of ovarian tumors.

Abstract

The purpose of this article is to review fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) findings in a variety of benign, malignant, and borderline malignant ovarian tumors. It is advantageous to become familiar with the wide variety of FDG-PET/CT findings of this entity. Benign ovarian tumors generally have faint uptake, whereas endometriomas, fibromas, and teratomas show mild to moderate uptake. Malignant ovarian tumors generally have intense uptake, whereas tumors with a small solid component often show minimal uptake.

open access: MRI, CT, and PET/CT for Ovarian Cancer Detection and Adnexal Lesion Characterization February 2010

OBJECTIVE. The purpose of this article is to describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions.

Future Oncology - Review Imaging assessment of tumor response: past, present and future

Summary
Future Oncology
May 2011

Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.