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Singh A, Hammer MM. Imaging Features Differentiating Between Cardiac Sarcomas and Hematologic Neoplasms. J Comput Assist Tomogr 2025; 49:281-287. [PMID: 39379052 DOI: 10.1097/rct.0000000000001672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
PURPOSE The aim of the study is to assess the efficacy of computed tomography (CT) and positron emission tomography (PET)/CT findings in differentiating between cardiac sarcoma and cardiac hematologic neoplasms, which are rare but potentially lethal primary cardiac malignancies. MATERIALS AND METHODS We searched the electronic medical record for pathology-proven cases from 2012 to 2023, finding 69 patients (46 sarcomas, 23 cardiac hematologic neoplasms). Imaging features including tumor size, atrioventricular (AV) groove involvement, right coronary artery (RCA) encasement by 180°, pericardial effusion, lymphadenopathy, and metabolic activity on fluorodeoxyglucose PET were reviewed by a radiology fellow. Statistical analysis was performed using Fisher exact test and Wilcoxon test. RESULTS Cardiac sarcoma patients were younger (median age 49 years) compared to patients with cardiac hematologic malignancies (66 years, P = 0.006). While tumor size and chamber involvement were similar between the 2 categories, hematologic malignancies exhibited a notable predilection for AV groove involvement (70% vs 43%, P = 0.04) and RCA encasement (52% vs 26%, P = 0.02). Pulmonary metastases were more frequent in sarcoma cases (33% vs 4%, P = 0.006). There was no significant difference in fluorodeoxyglucose uptake. Lymphadenopathy was similar between the 2 disease groups. A decision tree constructed using AV groove involvement and patient age achieved 75% accuracy in predicting the diagnosis of the mass. CONCLUSIONS Overall, there is a substantial overlap in imaging features of cardiac sarcomas and hematologic malignancies involving the heart. Involvement of the AV groove and RCA encasement can allow a radiologist to favor hematologic malignancy. Ultimately, biopsy is required to establish a diagnosis.
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Affiliation(s)
- Aparna Singh
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
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Mashriqi F, Keir G, Vijayashankar A, Glaser JE, Franceschi AM. FDG-PET in HIV-Positive Patient with Extranodal Diffuse Large B-Cell Lymphoma. World J Nucl Med 2024; 23:126-129. [PMID: 38933069 PMCID: PMC11199027 DOI: 10.1055/s-0044-1779751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Extranodal diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease process and an aggressive form of non-Hodgkin's lymphoma. We present a case of multiorgan involvement of DLBCL in a patient with documented risk factors, including [ 18 F] fluorodeoxyglucose positron emission tomography/magnetic resonance imaging findings highlighting striking perineural spread involving intracranial and extracranial segments of the bilateral trigeminal nerves.
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Affiliation(s)
- Faizullah Mashriqi
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
| | - Graham Keir
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
| | - Akarsh Vijayashankar
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
| | - Joseph E. Glaser
- Division of Nuclear Medicine, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Manhasset, New York, United States
| | - Ana M. Franceschi
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
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Trieu H, De Silva S, Manoukian S, Rajan A, Mannan R, Liang Y, Lee JK, Lin J, Kidambi TD. Endoscopic Evaluation of PET/CT Abnormalities in the Gastrointestinal Tract: Yield and Approach. Dig Dis Sci 2024; 69:552-561. [PMID: 38104053 DOI: 10.1007/s10620-023-08231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Unexpected hypermetabolic activity is often encountered in the gastrointestinal tract when PET/CT is performed for various indications, prompting endoscopic evaluation. Our aim was to characterize the types of lesions seen in segments of the gastrointestinal tract with unexpected PET/CT abnormalities as well as clinically significant lesions seen on endoscopy which did not produce a PET/CT abnormality to guide the endoscopist tasked with evaluating these imaging findings. METHODS We retrospectively reviewed a database of endoscopies performed at City of Hope Comprehensive Cancer Center between January 1, 2016 and September 30, 2021 for an indication of "abnormal PET." We divided the gastrointestinal tract into segments and defined categories of endoscopic/histologic findings for each segment. We counted the number of segments with an abnormal PET/CT finding and corresponding endoscopic/histologic abnormality as well as the number of segments with an endoscopic/histologic abnormality but normal PET/CT. RESULTS PET/CT identified 209 segments with hypermetabolic activity, 109 of which had corresponding endoscopic/histologic abnormalities. In the jejunum and ileum, all corresponding lesions were malignant. Seventy-three percent of corresponding lesions in the stomach were H. pylori positive. PET/CT failed to detect 34.7% of clinically significant lesions diagnosed endoscopically, including 1 malignancy in the transverse colon and many inflammatory or low-risk premalignant lesions. CONCLUSION PET/CT abnormalities seen in the small bowel should be evaluated urgently as nearly all correlates were malignant, while abnormalities in the stomach should prompt workup for H. pylori. Most lesions missed by PET/CT were inflammatory or low-risk premalignant yet clinically significant, confirming the need to inspect the entirety of the upper or lower gastrointestinal tract during endoscopy.
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Affiliation(s)
- Harry Trieu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sadie De Silva
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Saro Manoukian
- Department of Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Anand Rajan
- Department of Gastroenterology, University of California San Francisco at Fresno, Fresno, CA, USA
| | - Rifat Mannan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Yu Liang
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - James Lin
- Department of Gastroenterology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Trilokesh D Kidambi
- Department of Gastroenterology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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Fallahpoor M, Chakraborty S, Pradhan B, Faust O, Barua PD, Chegeni H, Acharya R. Deep learning techniques in PET/CT imaging: A comprehensive review from sinogram to image space. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107880. [PMID: 37924769 DOI: 10.1016/j.cmpb.2023.107880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
Positron emission tomography/computed tomography (PET/CT) is increasingly used in oncology, neurology, cardiology, and emerging medical fields. The success stems from the cohesive information that hybrid PET/CT imaging offers, surpassing the capabilities of individual modalities when used in isolation for different malignancies. However, manual image interpretation requires extensive disease-specific knowledge, and it is a time-consuming aspect of physicians' daily routines. Deep learning algorithms, akin to a practitioner during training, extract knowledge from images to facilitate the diagnosis process by detecting symptoms and enhancing images. This acquired knowledge aids in supporting the diagnosis process through symptom detection and image enhancement. The available review papers on PET/CT imaging have a drawback as they either included additional modalities or examined various types of AI applications. However, there has been a lack of comprehensive investigation specifically focused on the highly specific use of AI, and deep learning, on PET/CT images. This review aims to fill that gap by investigating the characteristics of approaches used in papers that employed deep learning for PET/CT imaging. Within the review, we identified 99 studies published between 2017 and 2022 that applied deep learning to PET/CT images. We also identified the best pre-processing algorithms and the most effective deep learning models reported for PET/CT while highlighting the current limitations. Our review underscores the potential of deep learning (DL) in PET/CT imaging, with successful applications in lesion detection, tumor segmentation, and disease classification in both sinogram and image spaces. Common and specific pre-processing techniques are also discussed. DL algorithms excel at extracting meaningful features, and enhancing accuracy and efficiency in diagnosis. However, limitations arise from the scarcity of annotated datasets and challenges in explainability and uncertainty. Recent DL models, such as attention-based models, generative models, multi-modal models, graph convolutional networks, and transformers, are promising for improving PET/CT studies. Additionally, radiomics has garnered attention for tumor classification and predicting patient outcomes. Ongoing research is crucial to explore new applications and improve the accuracy of DL models in this rapidly evolving field.
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Affiliation(s)
- Maryam Fallahpoor
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Subrata Chakraborty
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia; School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351, Australia
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia; Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | - Oliver Faust
- School of Computing and Information Science, Anglia Ruskin University Cambridge Campus, United Kingdom
| | - Prabal Datta Barua
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Australia; School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Australia
| | | | - Rajendra Acharya
- School of Mathematics, Physics and Computing, University of Southern Queensland, Toowoomba, QLD, Australia
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Krishna S, Ravina M, Nanda S, Lukose TT, Moideen A, Bansal H, Dasgupta S, Kote R. Role of 2-(fluorine-18) Fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in Initial Staging and Bone Marrow Involvement Prediction in Patients with Newly Diagnosed Lymphoma in Correlation with Bone Marrow Study. Indian J Nucl Med 2024; 39:10-17. [PMID: 38817719 PMCID: PMC11135373 DOI: 10.4103/ijnm.ijnm_116_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 06/01/2024] Open
Abstract
Background Lymphoma is a common malignant proliferative disease in which bone marrow infiltration will upstage the disease and thus affect prognosis of the disease. As of now bone marrow biopsy is considered as a reference standard to find out bone marrow involvement in lymphoma. Performing an invasive and painful intervention in all newly diagnosed lymphoma patients is controversial. PET-CT is a non-invasive technique that gives functional information about the cells using the glucose metabolism. It can detect early bone marrow and extra medullary organ involvement which can lead to restaging of the disease. These advantages make PET-CT a valuable adjunct in diagnosis of lymphoma. Aims and Objectives Our study aims to evaluate the usefulness of 18 F-FDG PET-CT, a non-invasive, semi quantitative whole body imaging technique for detection of early bone marrow and extra medullary organ involvement in lymphoma patients which in turn can obviate the need for bone marrow study (BMS). The primary objective of study is to categorise FDG uptake in bone marrow as diffuse /unifocal /multifocal / no uptake and to correlate pattern of FDG uptake to bone marrow study. Our study also assesses the role of FDG PET/CT in staging of lymphoma. Materials and Methods Thirty patients with newly diagnosed lymphoma in the age group 18 to 75 years of both sexes within 3 months of diagnosis and who have not been started on any treatment was included in the study. Marrow uptake on FDG PET/CT has been categorized as diffuse, unifocal, multifocal and no uptake. Agreement between bone marrow study and FDG PET/CT has been assessed by reliability analysis using Cohen's kappa. Sensitivity, specificity, PPV, NPV of PET/CT in detecting marrow involvement have been calculated. Results The sensitivity, specificity, PPV, NPV and accuracy of 18 F-FDG PET-CT in detecting marrow involvement of lymphoma cases are 86.6%, 77.7%, 68.4%, 91.3% and 80.9% respectively. 18 F-FDG PET-CT detected bone marrow involvement in 86.6% (13 out of 15 total positive cases) cases of lymphoma which included both HL and NHL. Reliability analysis using Cohen's kappa is used to test the agreement between bone marrow study and 18F-FDG PET/CT. k value of 0.6 was obtained which showed a moderate agreement between bone marrow study and 18F-FDG PET/CT in marrow assessment. Conclusion 18F-FDG PET/CT is a highly sensitive imaging modality which can pick up extra-nodal organ and BMI in patients with lymphoma and can upstage the disease and alter treatment strategies. PET-CT cannot completely replace the bone marrow study. However, being an invasive painful procedure, BMB can be avoided in cases with unifocal or multifocal marrow involvement on PET-CT.
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Affiliation(s)
- Sarin Krishna
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mudalsha Ravina
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Siddhartha Nanda
- Department of Radiation Oncology, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Amal Moideen
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Himanshu Bansal
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subhajit Dasgupta
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Rutuja Kote
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Dai N, Cai R, Deng S, Sang S. Analysis of Positive Results of 18F-FDG PET/CT Imaging after Hematopoietic Stem Cell Transplantation in Lymphoma. Diagnostics (Basel) 2023; 13:2027. [PMID: 37370922 DOI: 10.3390/diagnostics13122027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE The purpose of this study was to differentiate between false-positive and true-positive positron emission tomography (PET) results after hematopoietic stem cell transplantation (SCT) for lymphoma involvement by analyzing several clinical variables and specific imaging features. PATIENTS AND METHODS Patients with lymphoma who received SCT and underwent post-transplantation 18F-FDG PET/CT scans between January 2013 and April 2021 at our institution were included. Associations between PET positivity and related clinical information were assessed using t-tests and χ2 tests. The significance of variables differentiating benign lesions from malignant FDG-avid lesions was evaluated by logistic regression analysis. Survival probabilities were derived from Kaplan-Meier curves and compared using the log-rank test. RESULTS A total of 185 patients (235 post-transplantation PET/CT scans) were enrolled in our present study. Compared with those with true-positive PET results, patients with false-positive PET results exhibited a better prognosis. For the autologous SCT group, false-positive cases were more commonly seen when FDG-avid foci appeared outside the sites of the original disease (p = 0.004), and the integrated CT imaging showed negative results (p = 0.000). In multivariate logistic regression analysis, integrated CT results were the only significant factor. For the allogeneic SCT group, false-positive cases were significantly more commonly seen when DS = 4 (p = 0.046), FDG-avid foci appeared outside the sites of the original disease (p = 0.022), and the integrated CT imaging showed negative results (p = 0.001). In a multivariate logistic regression analysis, whether FDG-avid foci were in the sites of the original disease and integrated CT results were both significant factors. CONCLUSION False-positive FDG uptake in post-transplantation PET was not uncommon. Several variables could provide an important reference to differentiate false-positive from true-positive post-SCT PET results for lymphoma involvement. TRIAL REGISTRATION NUMBER ChiCTR2300067355.
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Affiliation(s)
- Na Dai
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Rongcui Cai
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Shibiao Sang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Murad V, Kulanthaivelu R, Ortega C, Veit-Haibach P, Metser U. Standardized classification schemes in reporting oncologic PET/CT. Front Med (Lausanne) 2023; 9:1051309. [PMID: 36777163 PMCID: PMC9909469 DOI: 10.3389/fmed.2022.1051309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
The imaging report is essential for the communication between physicians in patient care. The information it contains must be clear, concise with evidence-based conclusions and sufficient to support clinical decision-making. In recent years, several classification schemes and/or reporting guidelines for PET have been introduced. In this manuscript, we will review the classifications most frequently used in oncology for interpreting and reporting 18F-FDG PET imaging in lymphoma, multiple myeloma, melanoma and head and neck cancers, PSMA-ligand PET imaging for prostate cancer, and 68Ga-DOTA-peptide PET in neuroendocrine tumors (NET).
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Affiliation(s)
- Vanessa Murad
- Molecular Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
| | - Roshini Kulanthaivelu
- Molecular Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
| | - Claudia Ortega
- Molecular Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Molecular Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
| | - Ur Metser
- Molecular Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
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Sjöholm T, Korenyushkin A, Gammelgård G, Sarén T, Lövgren T, Loskog A, Essand M, Kullberg J, Enblad G, Ahlström H. Whole body FDG PET/MR for progression free and overall survival prediction in patients with relapsed/refractory large B-cell lymphomas undergoing CAR T-cell therapy. Cancer Imaging 2022; 22:76. [PMID: 36575477 PMCID: PMC9793670 DOI: 10.1186/s40644-022-00513-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To find semi-quantitative and quantitative Positron Emission Tomography/Magnetic Resonance (PET/MR) imaging metrics of both tumor and non-malignant lymphoid tissue (bone marrow and spleen) for Progression Free Survival (PFS) and Overall Survival (OS) prediction in patients with relapsed/refractory (r/r) large B-cell lymphoma (LBCL) undergoing Chimeric Antigen Receptor (CAR) T-cell therapy. METHODS A single-center prospective study of 16 r/r LBCL patients undergoing CD19-targeted CAR T-cell therapy. Whole body 18F-fluorodeoxyglucose (FDG) PET/MR imaging pre-therapy and 3 weeks post-therapy were followed by manual segmentation of tumors and lymphoid tissues. Semi-quantitative and quantitative metrics were extracted, and the metric-wise rate of change (Δ) between post-therapy and pre-therapy calculated. Tumor metrics included maximum Standardized Uptake Value (SUVmax), mean SUV (SUVmean), Metabolic Tumor Volume (MTV), Tumor Lesion Glycolysis (TLG), structural volume (V), total structural tumor burden (Vtotal) and mean Apparent Diffusion Coefficient (ADCmean). For lymphoid tissues, metrics extracted were SUVmean, mean Fat Fraction (FFmean) and ADCmean for bone marrow, and SUVmean, V and ADCmean for spleen. Univariate Cox regression analysis tested the relationship between extracted metrics and PFS and OS. Survival curves were produced using Kaplan-Meier analysis and compared using the log-rank test, with the median used for dichotomization. Uncorrected p-values < 0.05 were considered statistically significant. Correction for multiple comparisons was performed, with a False Discovery Rate (FDR) < 0.05 considered statistically significant. RESULTS Pre-therapy (p < 0.05, FDR < 0.05) and Δ (p < 0.05, FDR > 0.05) total tumor burden structural and metabolic metrics were associated with PFS and/or OS. According to Kaplan-Meier analysis, a longer PFS was reached for patients with pre-therapy MTV ≤ 39.5 ml, ΔMTV≤1.35 and ΔTLG≤1.35. ΔSUVmax was associated with PFS (p < 0.05, FDR > 0.05), while ΔADCmean was associated with both PFS and OS (p < 0.05, FDR > 0.05). ΔADCmean > 0.92 gave longer PFS and OS in the Kaplan-Meier analysis. Pre-therapy bone marrow SUVmean was associated with PFS (p < 0.05, FDR < 0.05) and OS (p < 0.05, FDR > 0.05). For bone marrow FDG uptake, patient stratification was possible pre-therapy (SUVmean ≤ 1.8). CONCLUSIONS MTV, tumor ADCmean and FDG uptake in bone marrow unaffected by tumor infiltration are possible PET/MR parameters for prediction of PFS and OS in r/r LBCL treated with CAR T-cells. TRIAL REGISTRATION EudraCT 2016-004043-36.
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Affiliation(s)
- Therese Sjöholm
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Gustav Gammelgård
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tina Sarén
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tanja Lövgren
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Angelica Loskog
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Magnus Essand
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Joel Kullberg
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.511796.dAntaros Medical AB, Mölndal, Sweden
| | - Gunilla Enblad
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.511796.dAntaros Medical AB, Mölndal, Sweden
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Eisazadeh R, Mirshahvalad SA. 18F-FDG PET/CT prognostic role in predicting response to salvage therapy in relapsed/refractory Hodgkin's lymphoma. Clin Imaging 2022; 92:25-31. [PMID: 36179394 DOI: 10.1016/j.clinimag.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the response predictors, both clinical and 18F-FDG PET/CT parameters, in Hodgkin's lymphoma (HL) patients diagnosed with refractory/relapsed disease who were planned to receive salvage therapy. METHODS In this retrospective study, all HL patients referred to our center between March 2015 and July 2021 were reviewed. Patients with refractory/relapsed disease who were candidates for salvage therapy were included. 18F-FDG PET/CT measurements at the time of diagnosis were extracted as the predictors, and the lesions' response at the end of the salvage therapy was considered the outcomes. The Kaplan-Meier method and multiple Cox regression were utilized to find the significant parameters to predict the time to reach the complete response. The statistical significance level was set at a two-sided p-value <0.05. RESULTS A total of 303 tumoral lesions from 64 patients were included. Regarding the factors associated with the response, B symptoms (p-value < 0.01), pathologic subtype (p-value < 0.001), and patient stage (p-value < 0.01) were the significant clinical parameters. In addition, SUVmax (p-value = 0.03), SUVmax/hepatic background SUVmax (p-value = 0.04), SUVmean (in all thresholds; 41% p-value = 0.02, 51% p-value = 0.04, 61% p-value = 0.01), and MTV (in all thresholds; 41% p-value = 0.04, 51% p-value = 0.04, 61% p-value = 0.05) were the significant parameters in the 18F-FDG PET/CT scans. At the median follow-up of 9 months, we found that pathologic subtype (p-value < 0.01), patient stage (p-value = 0.03), SUVmax (p-value = 0.02), SUVmax/hepatic background SUVmax (p-value = 0.03), SUVmean (in all thresholds; 41% p-value = 0.01, 51% p-value = 0.02, 61% p-value = 0.02), and MTV ≥ 41% (p-value = 0.02) were significant predictive factors. Multiple Cox regression showed the pathologic subtype (p-value = 0.02), SUVmax (p-value = 0.02), and MTV ≥ 41% (p-value = 0.04) were the most significant predictors. CONCLUSION Our study demonstrated that by knowing the histopathology of the lesions, the pre-treatment 18F-FDG PET/CT might be able to predict response after salvage therapy in the relapsed/refractory HL.
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Affiliation(s)
- Roya Eisazadeh
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran; Joint Department of Medical Imaging, University Health Network, University of Toronto, Canada.
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ERDOĞAN EB, GÜNER Ş, SÖNMEZOĞLU K. The Role of Post-treatment FDG-PET/CT Scanning after the First-line Chemotherapy in Predicting Prognosis in Patients with Hodgkin Disease and High-grade Non-Hodgkin Lymphoma: A Comparative Study with Clinical Prognostic Risk Scoring Data. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.5981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Etchebehere E, Andrade R, Camacho M, Lima M, Brink A, Cerci JJ, Nadel H, Bal C, Rangarajan V, Pfluger T, Kagna O, Alonso O, Begum FK, Mir KB, Magboo VP, Menezes LJ, Paez D, Pascual T. VALIDATION OF CONVOLUTIONAL NEURAL NETWORK FOR FAST DETERMINATION OF WHOLE-BODY METABOLIC TUMOR BURDEN IN PEDIATRIC LYMPHOMA. J Nucl Med Technol 2022; 50:256-262. [PMID: 35440476 DOI: 10.2967/jnmt.121.262900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION: 18F-FDG PET/CT whole-body tumor burden in lymphoma is not routinely performed due to the lack of fast quantification methods. Although the semi-automatic method is fast, it still lacks the necessary speed required to quantify tumor burden in daily clinical practice. PURPOSE: To evaluate the performance of the convolutional neural networks (CNN) software to localize neoplastic lesions in whole-body 18F-FDG PET/CT images of pediatric lymphoma patients. METHODS: This retrospective image data set, derived from the data pool under the IAEA (CRP# E12017), included 102 baseline staging 18F-FDG PET/CTs of pediatric lymphoma patients (mean age 11 yrs). Images were quantified to determine the whole-body (wb) tumor burden (wbMTV and wbTLG) using a semi-automatic (SEMI) software and an CNN-based software. Both were displayed as wbMTVSEMI & wbTLGSEMI and wbMTVCNN & TLGCNN. The intraclass correlation coefficient (ICC) was applied to evaluate concordance between the CNN-based software and the SEMI software. RESULTS: Twenty-six patients were excluded from the analyses because the software was unable to perform calculation. In the remaining 76 patients, wbMTVCNN and wbMTVSEMI whole-body tumor burden metrics were highly correlated (ICC=0.993; 95%CI: 0.989 -0.996; p-value<0.0001) as were wbTLGCNN and wbTLGSEMI (ICC=0.999; 95%CI: 0.998-0.999; p-value<0.0001). However, the time spent calculating these metrics was significantly (<0.0001) faster by CNN (mean = 19 seconds; 11 - 50 seconds) compared to the semi-automatic method (mean = 21.6 minutes; 3.2 - 62.1 minutes), especially in patients with advanced disease. CONCLUSION: Determining whole-body tumor burden in pediatric lymphoma patients using CNN is fast and feasible in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Omar Alonso
- Clinical Hospital of the University of Uruguay, Uruguay
| | - Fatima K Begum
- National Institute of Nuclear Medicine and Allied Sciences, Bangladesh
| | | | | | | | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Austria
| | - Thomas Pascual
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Austria
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12
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Nawwar AA, Searle J, Hodby K, Chavda ND, Qamhia N, Lyburn ID. [18F]FDG-PET/CT Demonstration of Young Adult Onset Stills Disease Mimicking Lymphoma. BJR Case Rep 2022; 8:20210195. [PMID: 36101734 PMCID: PMC9461729 DOI: 10.1259/bjrcr.20210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
Adult-onset Still’s disease (AOSD) is an inflammatory disease of unknown aetiology, with no specific diagnostic tests. A 17-year-old female presented with fevers, night sweats and weight loss. Markedly FDG avid lymphadenopathy, and diffuse marrow and splenic uptake were demonstrated on [18F]FDG-PET/CT, most suggestive of lymphoma. After extensive investigations, the working diagnosis of AOSD was made. Other conditions, such AOSD, in addition to lymphoproliferative disorders, should be considered in the differential diagnosis of widespread avid lymphadenopathy in a teenager/young adult
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Affiliation(s)
- Ayah Adel Nawwar
- Cobalt Medical Charity, Cheltenham, UK
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, UK
- Clinical Oncology and Nuclear Medicine department, Cairo University, Cairo, Egypt
| | - Julie Searle
- Cobalt Medical Charity, Cheltenham, UK
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Katherine Hodby
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, UK
| | | | | | - Iain Douglas Lyburn
- Cobalt Medical Charity, Cheltenham, UK
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- Cranfield University, Bedford, UK
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13
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Zhang J, He B, Wang J, Ying C, Zeng L, Zheng S. Differential Diagnosis of Hemophagocytic Syndrome by 18F-FDG PET/CT: A Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4448993. [PMID: 35132359 PMCID: PMC8817876 DOI: 10.1155/2022/4448993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022]
Abstract
Hemophagocytic syndrome (HPS) is a rare disease in clinical practice, and there are often cases of delayed diagnosis. At present, researchers have applied 18F-FDG PET/CT in the differential diagnosis of HPS, but no consensus has been formed. Therefore, this study aims to systematically evaluate the application value of 18F-FDG PET/CT in the diagnosis of HPS patients. PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wangfang database (Wangfang), and Chinese Biomedical Network (CBM) were searched to collect the relevant studies of 18F-FDG PET/CT in the diagnosis of HPS. Data from the articles were screened and extracted for meta-analysis using Stata16.0 software. A total of 10 retrospective studies, including 300 patients, were included in this meta-analysis. The meta-analysis results showed that the pooled sensitivity was 0.82 (95% CI: 0.67-0.95), specificity was 0.72 (95% CI: 0.51-0.86), positive likelihood ratio was 2.89 (95% CI: 1.46-5.75), positive likelihood ratio was 0.25 (95% CI: 0.12-0.54), diagnostic odds ratio was 2.89 (95% CI: 1.46-5.75), and AUC was 0.84 (95% CI: 0.81-0.87). The SUVmax in the liver, spleen, lymph nodes, and bone marrow of HPS patients was greater than 2.5, and the SUVmax in the spleen, lymph nodes, and bone marrow of malignant HPS patients was higher than that of benign HPS patients. The difference was statistically significant (P < 0.05). According to the existing literature evidence, 18F-FDG PET/CT is an effective method for diagnosing HPS.
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Affiliation(s)
- Jun Zhang
- Department of Neurology, Chengdu Xindu District People's Hospital, Chengdu, Sichuan, China
| | - Bang He
- Department of Neurology, Chengdu Xindu District People's Hospital, Chengdu, Sichuan, China
| | - Jian Wang
- Department of Nuclear Medicine Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Caiyun Ying
- Department of Radiology, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Lingfeng Zeng
- Department of Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shiyi Zheng
- Department of Radiology, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
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14
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Yang X, Lu X, Liu J, Kan Y, Wang W, Zhang S, Liu L, Li J, Yang J. Development and Validation of 18F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis. Korean J Radiol 2022; 23:466-478. [PMID: 35289150 PMCID: PMC8961016 DOI: 10.3348/kjr.2021.0733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/28/2021] [Accepted: 12/26/2021] [Indexed: 11/15/2022] Open
Abstract
Objective 18F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of 18F-FDG PET/CT in identifying malignancy in patients with HLH by combining 18F-FDG PET/CT and clinical parameters. Materials and Methods Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment 18F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson’s chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH). Results The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686–0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of 18F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity. Conclusion 18F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using 18F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of 18F-FDG PET/CT images.
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Affiliation(s)
- Xu Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xia Lu
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Liu
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Kan
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuxin Zhang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Liu
- Sinounion Medical Technology (Beijing) Co., Ltd., Beijing, China
| | - Jixia Li
- Department of Laboratory Medicine, School of Medicine, Foshan University, Foshan, China
- Department of Molecular Medicine and Pathology, School of Medical Science, The University of Auckland, Auckland, New Zealand
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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15
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Husseini JS, Amorim BJ, Torrado-Carvajal A, Prabhu V, Groshar D, Umutlu L, Herrmann K, Cañamaque LG, Garzón JRG, Palmer WE, Heidari P, Shih TTF, Sosna J, Matushita C, Cerci J, Queiroz M, Muglia VF, Nogueira-Barbosa MH, Borra RJH, Kwee TC, Glaudemans AWJM, Evangelista L, Salvatore M, Cuocolo A, Soricelli A, Herold C, Laghi A, Mayerhoefer M, Mahmood U, Catana C, Daldrup-Link HE, Rosen B, Catalano OA. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 2021; 48:1522-1537. [PMID: 33619599 PMCID: PMC8240455 DOI: 10.1007/s00259-021-05198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use. METHODS We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered. RESULTS Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies. CONCLUSION PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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Affiliation(s)
- Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bárbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lina García Cañamaque
- Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Cristina Matushita
- Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliano Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil
| | - Marcelo Queiroz
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Evangelista
- Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
| | - Alberto Cuocolo
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Andrea Soricelli
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Laghi
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | - Marius Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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16
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Li S, Jiang H, Li H, Yao YD. AW-SDRLSE: Adaptive Weighting and Scalable Distance Regularized Level Set Evolution for Lymphoma Segmentation on PET Images. IEEE J Biomed Health Inform 2021; 25:1173-1184. [PMID: 32841130 DOI: 10.1109/jbhi.2020.3017546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate lymphoma segmentation on Positron Emission Tomography (PET) images is of great importance for medical diagnoses, such as for distinguishing benign and malignant. To this end, this paper proposes an adaptive weighting and scalable distance regularized level set evolution (AW-SDRLSE) method for delineating lymphoma boundaries on 2D PET slices. There are three important characteristics with respect to AW-SDRLSE: 1) A scalable distance regularization term is proposed and a parameter q can control the contour's convergence rate and precision in theory. 2) A novel dynamic annular mask is proposed to calculate mean intensities of local interior and exterior regions and further define the region energy term. 3) As the level set method is sensitive to parameters, we thus propose an adaptive weighting strategy for the length and area energy terms using local region intensity and boundary direction information. AW-SDRLSE is evaluated on 90 cases of real PET data with a mean Dice coefficient of 0.8796. Comparative results demonstrate the accuracy and robustness of AW-SDRLSE as well as its performance advantages as compared with related level set methods. In addition, experimental results indicate that AW-SDRLSE can be a fine segmentation method for improving the lymphoma segmentation results obtained by deep learning (DL) methods significantly.
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17
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Pickhardt PJ, Perez AA, Elmohr MM, Elsayes KM. CT imaging review of uncommon peritoneal-based neoplasms: beyond carcinomatosis. Br J Radiol 2021; 94:20201288. [PMID: 33353398 DOI: 10.1259/bjr.20201288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pathologic involvement of the peritoneum can result from a wide variety of conditions, including both neoplastic and non-neoplastic entities. Neoplastic involvement of the peritoneal ligaments, mesenteries, and spaces from malignant spread of epithelial cancers, termed peritoneal carcinomatosis, is frequently encountered at CT evaluation. However, a host of other more unusual benign and malignant neoplasms can manifest with peritoneal disease, including both primary and secondary peritoneal processes, many of which can closely mimic peritoneal carcinomatosis at CT. In this review, we discuss a wide array of unusual peritoneal-based neoplasms that can resemble the more common peritoneal carcinomatosis. Beyond reviewing the salient features for each of these entities, particular emphasis is placed on any specific clinical and CT imaging clues that may allow the interpreting radiologist to appropriately narrow the differential diagnosis and, in some cases, make an imaging-specific diagnosis.
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Affiliation(s)
- Perry J Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Alberto A Perez
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Huynh KN, Nguyen BD. Histiocytosis and Neoplasms of Macrophage-Dendritic Cell Lineages: Multimodality Imaging with Emphasis on PET/CT. Radiographics 2021; 41:576-594. [PMID: 33606566 DOI: 10.1148/rg.2021200096] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Histiocytosis is a rare inflammatory process characterized by pathologic infiltration and accumulation of cells derived from the monocytic lineage in normal tissue. It encompasses more than 100 different subtypes of disorders that were recently classified into five main groups: (a) Langerhans-related histiocytosis, (b) Rosai-Dorfman histiocytosis, (c) cutaneous and mucocutaneous histiocytosis, (d) malignant histiocytosis, and (e) hemophagocytic lymphohistiocytosis and macrophage activation syndrome. Langerhans cell histiocytosis is the most common histiocytic disorder. Less common types include Erdheim-Chester disease, Rosai-Dorfman disease, adult and juvenile xanthogranuloma, necrobiotic xanthogranuloma, histiocytic sarcoma, interdigitating dendritic cell sarcoma, Langerhans cell sarcoma, and hemophagocytic lymphohistiocytosis. Although the pathogenesis of these disorders may be attributable to mutations in the oncogenic driver, recent discoveries have shown that inflammation and fibrosis secondary to mutated histiocytes, rather than a proliferative cell mechanism, result in manifestation of the disease. Diagnosis, which relies on a multidisciplinary approach, is challenging and often delayed because clinical findings are nonspecific and may mimic malignant processes at radiologic evaluation. Compared with conventional imaging, PET/CT allows detection of the increased metabolic activity in histiocytes. Diagnostic algorithms for histiocytic disorders should include functional imaging with fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT, which provides a comprehensive whole-body evaluation of their potential involvement with multiple organ systems and allows monitoring of therapeutic response. The most recent revised classification, pathophysiologic and clinical manifestations, sites of involvement, and imaging features of histiocytosis are described in this review and a multimodality approach is used, with emphasis on 18F-FDG PET/CT evaluation. ©RSNA, 2021.
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Affiliation(s)
- Kenneth N Huynh
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259
| | - Ba D Nguyen
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259
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19
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Hong GS, Chae EJ, Ryu JS, Chae SY, Lee HS, Yoon DH, Suh C. Assessment of naive indolent lymphoma using whole-body diffusion-weighted imaging and T2-weighted MRI: results of a prospective study in 30 patients. Cancer Imaging 2021; 21:5. [PMID: 33413685 PMCID: PMC7791993 DOI: 10.1186/s40644-020-00371-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Background We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients. Methods This prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow. Results In the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88–1.00), high sensitivity (93.4–95.1%), and high specificity (99.0–99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9–96.8% vs. 79.6–86.3%, P = 0.058). Conclusion WB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.
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Affiliation(s)
- Gil-Sun Hong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea.
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Sun Young Chae
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Hyo Sang Lee
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, 38, Bangdong-gil, Sacheon-myeon, Gangneung, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Cheolwon Suh
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
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20
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Latifoltojar A, Duncan MKJ, Klusmann M, Sidhu H, Bainbridge A, Neriman D, Fraioli F, Lambert J, Ardeshna KM, Punwani S. Whole Body 3.0 T Magnetic Resonance Imaging in Lymphomas: Comparison of Different Sequence Combinations for Staging Hodgkin's and Diffuse Large B Cell Lymphomas. J Pers Med 2020; 10:E284. [PMID: 33339372 PMCID: PMC7765916 DOI: 10.3390/jpm10040284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
To investigate the diagnostic value of different whole-body magnetic resonance imaging (WB-MRI) protocols for staging Hodgkin and diffuse-large B-cell lymphomas (HL and DLBCL), twenty-two patients (M/F 12/10, median age 32, range 22-87, HL/DLBCL 14/8) underwent baseline WB-MRI and 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) fused with computed tomography (CT) scan 18F-FDG-PET-CT. The 3.0 T WB-MRI was performed using pre-contrast modified Dixon (mDixon), T2-weighted turbo-spin-echo (TSE), diffusion-weighted-imaging (DWI), dynamic-contrast-enhanced (DCE) liver/spleen, contrast-enhanced (CE) lung MRI and CE whole-body mDixon. WB-MRI scans were divided into: (1) "WB-MRI DWI+IP": whole-body DWI + in-phase mDixon (2) "WB-MRI T2-TSE": whole-body T2-TSE (3) "WB-MRI Post-C": whole-body CE mDixon + DCE liver/spleen and CE lung mDixon (4) "WB-MRI All ": the entire protocol. Two radiologists evaluated WB-MRIs at random, independently and then in consensus. Two nuclear-medicine-physicians reviewed 18F-FDG PET-CT in consensus. An enhanced-reference-standard (ERS) was derived using all available baseline and follow-up imaging. The sensitivity and specificity of WB-MRI protocols for nodal and extra-nodal staging was derived against the ERS. Agreement between the WB-MRI protocols and the ERS for overall staging was assessed using kappa statistic. For consensus WB-MRI, the sensitivity and specificity for nodal staging were 75%, 98% for WB-MRI DWI+IP, 76%, 98% for WB-MRI Post-C, 83%, 99% for WB-MRI T2-TSE and 87%, 100% for WB-MRI All. The sensitivity and specificity for extra-nodal staging were 67% 100% for WB-MRI DWI+IP, 89%, 100% for WB-MRI Post-C, 89%, 100% for WB-MRI T2-TSE and 100%, 100% for the WB-MRI All. The consensus WB-MRI All read had perfect agreement with the ERS for overall staging [kappa = 1.00 (95% CI: 1.00-1.00)]. The best diagnostic performance is achieved combining all available WB-MRI sequences.
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Affiliation(s)
- Arash Latifoltojar
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; (A.L.); (H.S.)
- The Royal Marsden Hospital, Downs road, Sutton, Surrey SM2 5PT, UK
| | - Mark K. J. Duncan
- Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (M.K.J.D.); (M.K.)
| | - Maria Klusmann
- Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (M.K.J.D.); (M.K.)
| | - Harbir Sidhu
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; (A.L.); (H.S.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (M.K.J.D.); (M.K.)
| | - Alan Bainbridge
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK;
| | - Deena Neriman
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (D.N.); (F.F.)
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (D.N.); (F.F.)
| | - Jonathan Lambert
- Department of Haematology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (J.L.); (K.M.A.)
| | - Kirit M. Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (J.L.); (K.M.A.)
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; (A.L.); (H.S.)
- Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (M.K.J.D.); (M.K.)
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El Bakouri A, Ballati A, Bouali M, Elhattabi K, Bensardi F, Fadil A. Primary appendiceal Burkitt's lymphoma presenting as acute appendicitis: An extremely rare case report and review of the literatture. Ann Med Surg (Lond) 2020; 61:16-18. [PMID: 33363721 PMCID: PMC7750439 DOI: 10.1016/j.amsu.2020.11.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022] Open
Abstract
Primary lymphomas of appendix are extremely rare tumors. The incidence is 0.015% out of all gastrointestinal lymphomas; furthermore, limited data is available in literature. The appendiceal neoplasms are most commonly presented as acute appendicitis followed intestinal obstruction, intussusception or perforation. We present a case of a 22 year-old male patient who presented with acute appenditis and underwent emergency laparotomy. On abdominal exploration, swollen and enlarged appendix measured 3cm was present for which appendectomy were performed. The histopathological examination of appendectomy specimen revealed a Burkitt's Lymphoma. The patient received R-COPADEM protocol of chemotherapy. Primary gastrointestinal lymphoma is a extremely rare neoplasm without guidelines for therapy. Burkitt lymphoma is an aggressive non-hodgkin b-cell lymphoma. The occurrence of primary Burkitt's lymphoma of appendix is extremely rare. The appendiceal neoplasms are most commonly presented as acute appendicitis. The diagnosis of kimura disease is confirmed by surgical biopsy. The diagnostic of Burkitt's lymphoma was only made after histopathological examination, so should be done. The surgery and chemotheray constitue a best traitement for burkitt's lymphoma of appendix presenting as acute appendicitis.
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Affiliation(s)
- Abdelilah El Bakouri
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.,Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ahmed Ballati
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.,Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mounir Bouali
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.,Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Khalid Elhattabi
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.,Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Fatimazahra Bensardi
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.,Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abdelaziz Fadil
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.,Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
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22
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Abdelmohsen MA, Omar WM. The added value of positron emission tomography/computed tomography (PET/CT) in assessment of treatment response of secondary malignant osseous lesions: our experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bone metastasis can be noted in the course of many primary malignant neoplastic lesions; breast and prostate cancers are the most frequent, but lung, kidney, and thyroid malignancies frequently metastasize to bones. Secondary osseous lymphomatous infiltrations is relatively uncommon and mainly noted in patients with non-Hodgkin lymphoma (NHL). By adding the metabolic changes to the conventional CT morphologic changes, combined positron emission tomography (PET) and computed tomography (CT) may offer clinically useful addition in assessment of treatment response of these lesions and offer helpful judgment for the different oncologic therapeutic regimens.
Results
The study included 45 patients, 24 females (53.33%) and 21 males (46.66%). Showing bone dominant or isolated bony secondary malignant infiltrations. The study included 24 patients with history of breast cancer (53.33%), 12 patients with history of lymphoma (26.66%), and 9 patients (20%) with history of lung cancer. All the bony lesions included in the study were multiple lesions in each patient, classified into mixed lytic and sclerotic bony lesions in 21 patients (46.66%), sclerotic lesions in 12 patients (26.66%), and radiologically occult lesions or osteopenic areas in 12 patients (26.66%). The most accurate SUV max cut-off value among studied cases was 4, taking the lesion with highest SUV max value as the reference standard, with measurements taken before and after the medical regimen with six months interval. Confirmation of PET/CT results was done by serial post management follow up at 6 months interval and 1 year interval.
Conclusion
PET/CT study is an effective tool for assessment of treatment response for ossoues secondary malignant lesions.
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Abdelmohsen MA, Omar WM. Abdominal extranodal lymphoma detection: positron emission tomography/computed tomography can help. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lymphoid neoplasms that present with masses are broadly referred to as lymphomas, and they can be classified to two main groups: Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL); they are mainly characterized by enlargement of lymph nodes (nodal disease) although any organ in the body can be involved in different settings of the disease (extranodal disease). Adequate staging, which has a direct impact on prognosis, is essential to properly plan therapy. Stage IV disease with extranodal dissemination should be treated by long-term systemic chemotherapy.
By adding the metabolic changes to the conventional CT morphologic changes, combined positron emission tomography (PET) and computed tomography (CT) may offer clinically useful addition in staging of lymphomas and detection of extranodal lesions.
Results
The study included thirty nine patients, with forty-eight extranodal sites with lymphomatous infiltration, twenty-four males (61.5%), and fifteen females (38.4%). The patients showed forty-eight extranodal abdominal lymphomatous infiltration.
The study included twelve gastric lymphomatous lesions (25%), twelve splenic lymphomatous lesion (25%), three ileo-caecal lymphomatous lesions (6.25%), three patients (6.25%) with skin infiltration, three adrenal lymphomatous lesions (6.25%), three patients with hepatic lymphoma, and twelve bone marrow infiltrations (25%).
The most accurate SUV max cutoff value among studied cases was 3.5, the highest SUV max value noted was 21 in gastric lesions, and the lowest SUV max noted was 4.1 in adrenal lesions.
Confirmation of PET/CT results was done by histopathological assessment and post-management follow-up.
Conclusion
PET/CT study is an effective tool for evaluation of extranodal lymphomas. PET/CT fusion images can affect the clinical management plan by detection of extranodal lymphomas with lymphoma staging modification.
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Yassin A, El Sheikh RH, Ali MM. PET/CT vs CECT in assessment of therapeutic response in lymphoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lymphoma incorporates histologically variable cancers derived from the immune system cells. The distinctive feature of lymphoma is the rapid increase in size and number of lymph nodes and/or secondary lymphoid tissues.
The aim of the work is to evaluate the accuracy of PET/CT vs CECT in the assessment of response to therapy in lymphoma patients: both early and late therapeutic response assessment.
This retrospective study was conducted on 80 patients with different types of lymphoma recruited and enrolled from a university hospital. All 80 patients underwent pre-treatment, during the course of chemotherapy and at the end of planned treatment contrast-enhanced СT (СEСT) and PET-СT. Interpretation of the СEСT and the fusion images PET/СT each was done separately and comparison of the results was achieved.
Results
PET/CT and contrast-enhanced computed tomography were concurrent in results in 55% of cases during treatment and 75% at the end of treatment with CT sensitivity of 61.1%, specificity of 92.2%, and accuracy of 76.2% during treatment in comparison to 100% sensitivity and specificity of PET/CT. Sensitivity of CT at end of treatment was 57.5%, specificity 86.7%, and accuracy 71.6% as compared to 100% sensitivity and specificity of PET/CT.
Conclusion
PET/СT using 2-deoxy-2-[18F] fluoro-d-glucose is considered one of the best oncologic imaging modalities at the time being with valuable applications in lymphoma. It is very efficient with least possible pitfalls and false results compared to either of its components alone and to side by side reading of separately acquired PET and СT. PET/CT can detect both anatomical information as well as metabolical information providing more data and thus giving more accurate results than CECT. It is becoming а standard modality for lymphoma providing а new vision to management and treatment plan.
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25
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Bermo MS, Koppula B, Kumar M, Leblond A, Matesan MC. The Peritoneum: What Nuclear Radiologists Need to Know. Semin Nucl Med 2020; 50:405-418. [PMID: 32768005 DOI: 10.1053/j.semnuclmed.2020.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The peritoneum is the largest and most complex serous membrane in the human body. The peritoneal membrane is composed of a layer of mesothelium supported by a thin layer of connective tissue. The peritoneum is one continuous sheet, forming two layers and a potential space between them - the peritoneal cavity- which is subdivided into multiple communicating spaces containing small amount of serous fluid that facilitates frictionless movement of mobile intraabdominal viscera. Peritoneum also contributes to fluid exchange mechanism and plays a role in immune response. The peritoneum is subject to many neoplastic and non-neoplastic processes including infections, trauma, developmental and inflammatory processes. Different Nuclear Medicine imaging techniques can be used to diagnose peritoneal diseases, most of these techniques can be customized depending on the clinical scenario and expected findings. Peritoneal scintigraphy can detect abnormal peritoneal communication or compartmentalization. Several nuclear medicine techniques can help characterize intraperitoneal fluid collections and differentiate sterile from infected fluid. PET imaging plays an important role in imaging of different neoplastic and non-neoplastic peritoneal pathologies. Nuclear radiologists need to be familiar with peritoneal anatomy and pathology to interpret peritoneal findings in dedicated peritoneal nuclear medicine imaging studies, as part of more general nuclear medicine scans, or on CT or MRI component of hybrid imaging studies. The purpose of this article is to review the normal peritoneal anatomy, various pathologic processes involving the peritoneum, and different nuclear medicine and hybrid imaging techniques that can help detect, characterize, and follow up peritoneal pathology.
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Affiliation(s)
- Mohammed S Bermo
- Department of Radiology, Texas Tech University Health Science Center, El Paso, TX.
| | - Bhasker Koppula
- Department of Radiology, University of Utah, Salt Lake City, UT
| | - Meena Kumar
- Diagnostic Imaging Service, VA Puget Sound Health Care System, Seattle, WA
| | - Antoine Leblond
- Department of Radiology, University of Montreal, Montreal, Quebec, Canada
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26
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Ozaki K, Ikeno H, Koneri K, Higuchi S, Hosono N, Kosaka N, Goi T, Gabata T, Kimura H. Primary hepatic diffuse large B-cell lymphoma presenting unusual imaging features. Clin J Gastroenterol 2020; 13:1265-1272. [PMID: 32794156 DOI: 10.1007/s12328-020-01203-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022]
Abstract
Primary hepatic lymphomas are frequently misdiagnosed, due to their rarity and non-specific clinical manifestations. As these tumors can be successfully treated with chemotherapy and/or radiotherapy, early recognition on imaging is essential to avoid unnecessary surgery. We report a case of primary hepatic lymphoma in a 73-year-old woman presenting with a 1-week history of persistent fever and elevated hepatobiliary enzymes. Ultrasound showed a hypoechoic hepatic mass in the anterior segment. Dynamic contrast-enhanced computed tomography (CT) revealed an ill-defined solitary mass showing peripherally dominant slight-to-moderate enhancement contrasting with a hypovascular central area. On magnetic resonance imaging, the mass showed moderate hyperintensity on T2-weighted imaging, hypointensity on T1-weighted imaging, doughnut-like hyperintensity on diffusion-weighted imaging, and an obviously low apparent diffusion coefficient (ADC). The pattern of enhancement resembled that of CT. Neither calcification nor any fat component was observed. Doughnut-like accumulation was seen on 18F-fluorodeoxyglucose (FDG)-positron emission tomography/CT without other FDG-avid lesions. Imaging findings suggested the possibility of cholangiocellular carcinoma, but the low ADC and extremely high FDG accumulation were suggestive of malignant lymphoma, and diffuse large B-cell lymphoma was pathologically confirmed from percutaneous biopsy. The mass disappeared after radiochemotherapy, and no recurrence has been observed for 3 years.
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Affiliation(s)
- Kumi Ozaki
- Departments of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Hiroshi Ikeno
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Koneri
- Departments of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shohei Higuchi
- Departments of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Nahoko Hosono
- Departments of Pathology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Nobuyuki Kosaka
- Departments of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Takanori Goi
- Departments of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hirohiko Kimura
- Departments of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
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27
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Melendez PE, Nguyen TT, Bhatt AA, Kaproth-Joslin K. Neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging. Insights Imaging 2020; 11:82. [PMID: 32643039 PMCID: PMC7343701 DOI: 10.1186/s13244-020-00879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/24/2020] [Indexed: 11/10/2022] Open
Abstract
The thoracic inlet is located at the crossroads between imaging of the neck and the chest. Its location is an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many critical body systems, including the respiratory, lymphatic, neurologic, enteric, musculoskeletal, endocrine, and vascular systems, are located within this region. Neoplasms, both benign and malignant, can arise in any of the body systems located in this area. Due to the small size of this anatomic location, pathology is easily overlooked and imagers should be aware of the imaging appearance of these neoplasms, as well as which imaging modality is the most appropriate for neoplasm evaluation. This article will present an image rich, system-based discussion of the neoplastic pathology that can occur in this region. The anatomy of the thoracic inlet and the non-neoplastic pathology of the thoracic inlet have been covered in our companion article.
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Affiliation(s)
- Patricia E Melendez
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA.
| | - Trinh T Nguyen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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28
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Paltiel O, Raviv Sharabi G, Tzemach R, Rechavi T, Trachtenberg E, Goldschmidt N, Dann EJ, Bar-Shalom R. Limiting surveillance imaging for patients with lymphoma in remission: a mixed methods study leading to a Choosing Wisely recommendation. BMJ Qual Saf 2020; 30:300-310. [PMID: 32467340 DOI: 10.1136/bmjqs-2019-010756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/17/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Under the 'Choosing Wisely' (CW) framework, professional organisations internationally have advocated limiting imaging for asymptomatic patients following curative cancer therapy, based on limited value and high cost. F18-fluorodeoxyglucose (FDG) positron emission tomography-CT (PET/CT) was widely adopted locally for surveillance lymphoma imaging after 2004. OBJECTIVES Prior to ratification of a local CW recommendation to limit surveillance imaging in lymphoma, we aimed to assess: (A) performance characteristics of surveillance FDG-PET/CT; (B) rates, clinical consequences and costs of false positives (FP); and (C) patients and professionals' attitudes towards overuse. METHODS Mixed methods (quantitative and qualitative) study. We analysed surveillance FDG-PET/CT results of two patient cohorts (n1=215 Hodgkin lymphoma and non-Hodgkin lymphoma; n2=203 Hodgkin lymphoma only). FPs were defined by negative biopsy or clinical follow-up. We held focus group discussions and in-depth interviews eliciting attitudes of 26 patients and 11 clinicians, respectively. RESULTS FPs were observed in 25.1% (95% CI 20.5 to 30.5) per scan-cohort 1, and 41.7% (95% CI 37.9 to 45.6) per patient-cohort 2, engendering frequent additional testing. Specific characteristics and location of findings altered the FP rate. The estimated cost per relapse detected was $50 000 (cohort 2). Patients sought reassurance via surveillance imaging, which they considered highly accurate, yet stressful. Aware of radiation risks, they were largely unconcerned about consequences of FPs. Confidence in the treating physicians was an important factor in patients' acceptance of forgoing imaging. Clinicians, frequently under patient pressure to order imaging, generally believed that it did not affect prognosis (with important exceptions), welcomed professional guidelines, but rejected regulatory restrictions on its use. CONCLUSION Acceptance of CW recommendations to limit overuse may be enhanced by quantitative data on consequences and costs of surveillance imaging, supplemented by qualitative data on patient and physician attitudes.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University of Jerusalem, Jerusalem, Israel .,Hematology, Hadassah Medical Center, Jerusalem, Israel
| | | | - Reut Tzemach
- Rheumatology, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
| | - Talya Rechavi
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University of Jerusalem, Jerusalem, Israel
| | - Estherina Trachtenberg
- Hematology, Rambam Hospital, Haifa, Israel.,Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | | | - Eldad J Dann
- Hematology, Rambam Hospital, Haifa, Israel.,Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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29
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Ozaki K, Harada K, Terayama N, Kosaka N, Kimura H, Gabata T. FDG-PET/CT imaging findings of hepatic tumors and tumor-like lesions based on molecular background. Jpn J Radiol 2020; 38:697-718. [PMID: 32246350 DOI: 10.1007/s11604-020-00961-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
The usefulness of whole-body 18-fluoro-2-deoxyglucose (FDG)-fluorodeoxyglucose positron emission (PET)/computed tomography (CT) is established for assessment of disease staging, detection of early disease recurrence, therapeutic evaluation, and predicting prognosis in various malignancies; and for evaluating the spread of inflammation. However, the role of FDG-PET/CT for the liver is limited because CT and magnetic resonance imaging (MRI) can provide an accurate diagnosis of most tumors. In addition, in other potentially useful roles there are several pitfalls in the interpretation of FDG uptake in PET/CT imaging. Accurate evaluation demands knowledge of the FDG uptake of each lesion, including potential negative and positive uptakes, and requires an understanding of the underlying background of the molecular mechanisms. The degree of FDG uptake is dependent on cellular metabolic rate and the expression of glucose transporter, hexokinase, and glucose-6-phosphatase, which in turn are closely affected by biological characteristics such as pathological category (e.g., adenocarcinoma, squamous cell carcinoma, small cell cancer, transitional cell cancer, neuroendocrine tumor, sarcoma, lymphoma), tumor differentiation, histological behavior (e.g., solid, cystic, mucinous), and intratumoral alterations (e.g., necrosis, degeneration, hemorrhage). Correlation with the CT and MRI findings, which also precisely depict the pathological findings, is important to avoid misdiagnosis.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Kenichi Harada
- Department of Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Noboru Terayama
- Department of Radiology, Takaoka City Hospital, Takaoka, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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30
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Major A, Hammes A, Schmidt MQ, Morgan R, Abbott D, Kamdar M. Evaluating Novel PET-CT Functional Parameters TLG and TMTV in Differentiating Low-grade Versus Grade 3A Follicular Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2020; 20:39-46. [PMID: 31761712 PMCID: PMC9040515 DOI: 10.1016/j.clml.2019.09.609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/02/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Follicular lymphoma (FL) grading, low-grade 1-2 (LG) versus grade 3A (3A), informs management. However, accurate grading is challenging owing to disease heterogeneity and inter-reader variability. The [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) parameter maximum standardized uptake value (SUVmax) has utility in differentiating LG from 3A FL, but the utility of novel parameters total lesion glycolysis (TLG) and total metabolic tumor volume (TMTV) is unknown. PATIENTS AND METHODS Retrospective review of diagnostic pre-treatment PET-CTs of patients aged > 18 years with FL grades 1-3A from 2009-2017 was performed. PET-CT parameters SUVmax, TLG, and TMTV values were generated using manual (MW) and semi-automated workflows (SW). Poisson regression and receiver operating characteristic curves were used to compare PET-CT parameters between LG and 3A. RESULTS A total of 49 patients with FL were identified: 38 LG and 11 3A. PET-CT parameters were significantly higher in 3A as compared with LG in both workflows. The cutoff values, sensitivities, and specificities were as follows: SUVmax: 10.4, 64%, and 74% in MW and 11.9, 73%, and 76% in SW; TLG: 543, 82%, and 74% in MW and 371, 73%, and 74% in SW; and TMTV: 141, 73%, and 76% in MW and 93, 64%, and 76% in SW. SUVmax had identical cutoff, sensitivity, and specificity across all 3 SWs, whereas TLG and TMTV had considerable variance across all 3 SWs. CONCLUSIONS TLG and TMTV are comparable to SUVmax in differentiating LG versus 3A FL. Cutoffs, sensitivities, and specificities varied in MW versus SW. Novel PET-CT parameters serve as reproducible adjuncts but not replacements for biopsy in differentiating grades of FL.
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Affiliation(s)
- Ajay Major
- Department of Medicine, Internal Medicine Residency Training Program, University of Colorado School of Medicine, Aurora, CO.
| | - Andrew Hammes
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | | | - Rustain Morgan
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO
| | - Diana Abbott
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Manali Kamdar
- Department of Medicine, Division of Hematology, University of Colorado School of Medicine, Aurora, CO
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Gupta M, Gupta T, Purandare N, Rangarajan V, Puranik A, Moiyadi A, Shetty P, Epari S, Sahay A, Mahajan A, Janu A, Bagal B, Menon H, Kannan S, Krishnatry R, Sastri GJ, Jalali R. Utility of flouro-deoxy-glucose positron emission tomography/computed tomography in the diagnostic and staging evaluation of patients with primary CNS lymphoma. CNS Oncol 2019; 8:CNS46. [PMID: 31779471 PMCID: PMC6912853 DOI: 10.2217/cns-2019-0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To prospectively assess the clinical utility of pretreatment flouro-deoxy-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with primary central nervous system (CNS) lymphoma (PCNSL). Materials & methods: Patients with suspected/proven PCNSL underwent baseline whole-body 18F-FDG-PET/CT. Maximum standardized uptake value and tumor/normal tissue ratios were compared between CNS lymphoma and other histological diagnoses. Results: The mean maximum standardized uptake value (27.5 vs 18.2; p = 0.001) and mean tumor/normal tissue ratio (2.34 vs 1.53; p < 0.001) of CNS lymphoma was significantly higher than other histologic diagnoses. Five of 50 (10%) patients with biopsy-proven CNS lymphomas had pathologically increased FDG-uptake at extraneuraxial sites uncovering systemic lymphoma. Conclusion: Pretreatment whole-body 18F-FDG-PET/CT provides valuable complementary information in the diagnostic and staging evaluation of patients with PCNSL to guide therapeutic decision-making.
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Affiliation(s)
- Meetakshi Gupta
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Tejpal Gupta
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Nilendu Purandare
- Department of Nuclear Medicine & Molecular Imaging, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine & Molecular Imaging, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Ameya Puranik
- Department of Nuclear Medicine & Molecular Imaging, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Aliasgar Moiyadi
- Department of Neuro-surgery, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Prakash Shetty
- Department of Neuro-surgery, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Sridhar Epari
- Department of Pathology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Ayushi Sahay
- Department of Pathology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Abhishek Mahajan
- Department of Radio-diagnosis, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Amit Janu
- Department of Radio-diagnosis, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Hari Menon
- Department of Medical Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Sadhana Kannan
- Department of Clinical Research Secretariat, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Goda Jayant Sastri
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Rakesh Jalali
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
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Yang M, Rosenthal AC, Ashman JB, Craig FE. The Role and Pitfall of F18-FDG PET/CT in Surveillance of High Grade Pulmonary Lymphomatoid Granulomatosis. Curr Probl Diagn Radiol 2019; 50:443-449. [PMID: 30826140 DOI: 10.1067/j.cpradiol.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 11/22/2022]
Abstract
Lymphomatoid granulomatosis (LYG) is an uncommon angiocentric and angiodestructive T-cell rich, Epstein-Barr virus (EBV) positive B-cell multisystem lymphoproliferative disorder, predominately affecting the lungs. Since both clinical presentation and radiographic imaging findings, including X-ray and computed tomographic (CT), are nonspecific, the ultimate diagnosis of LYG relies on lung tissue sample diagnosis with its WHO grading based on the degree of cytologic atypia, necrosis and density of EBV positive B-cells. In addition, its histopathologic grading is correlated with clinical manifestation with high grade LYG mimicking aggressive B-cell lymphoma. Discordant grading between pulmonary and cutaneous LYG lesion has have been observed and might be a potential diagnostic and prognostic pitfall. F18-FDG PET/CT has been used to monitor disease progression and treatment response. In this study, we reviewed and summarized the clinical role of F18-FDG PET/CT in the surveillance of high grade pulmonary LYG, and examined its limitations in grading multisystem LYG.
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Affiliation(s)
- Ming Yang
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ..
| | - Allison C Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Fiona E Craig
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ
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Magnetic Resonance Imaging of the Perirenal Space and Retroperitoneum. Magn Reson Imaging Clin N Am 2019; 27:77-103. [PMID: 30466914 DOI: 10.1016/j.mric.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Post-therapy lesions in patients with non-Hodgkin's lymphoma characterized by 18F-FDG PET/CT-guided biopsy using automated robotic biopsy arm. Nucl Med Commun 2018; 39:74-82. [PMID: 29189443 DOI: 10.1097/mnm.0000000000000780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this study was to analyse the positive predictive value (PPV) of post-therapy fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT performed for response or recurrence evaluation in patients with non-Hodgkin's lymphoma (NHL) and to appraise the diagnostic utility of F-FDG PET/CT-guided biopsy in this setting. PATIENTS AND METHODS A total of 17 patients with NHL showing F-FDG avid lesions in F-FDG PET/CT performed for response or recurrence assessment underwent F-FDG PET/CT-guided biopsy using automated robotic biopsy arm needle navigation technique. The objectives were analysed in reference to histopathology. RESULTS In all, 15 of the 17 (88.5%) procedures yielded adequate representative tissue samples. Nine out of 15 lesions were positive for residual disease and the remaining revealed benign findings on histopathology. One patient with inconclusive biopsy underwent surgical resection and histopathology confirmed the presence of residual disease. PPV of theF-FDG PET/CT was observed to be 62.5% (10/16). CONCLUSION F-FDG PET/CT for response evaluation in NHL possesses a low PPV and hence warrants histopathological correlation when F-FDG PET/CT findings influence management decision. Diagnostic yield of F-FDG PET/CT-guided biopsy is high and has the potential to reduce sampling errors.
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Martin SS, Czwikla R, Wichmann JL, Albrecht MH, Lenga L, Savage RH, Arendt C, Hammerstingl R, Vogl TJ, Kaltenbach B. Dual-energy CT-based iodine quantification to differentiate abdominal malignant lymphoma from lymph node metastasis. Eur J Radiol 2018; 105:255-260. [PMID: 30017291 DOI: 10.1016/j.ejrad.2018.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/10/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the value of dual-energy computed tomography (DECT)-derived iodine and fat quantification in differentiating malignant abdominal lymphoma from lymph node metastasis. MATERIALS AND METHODS In this retrospective study, 59 patients (39 men; mean age, 62.7 years) with histopathologically-confirmed diagnosis of either malignant lymphoma or lymph node metastasis were included. For each lesion, contrast-enhanced attenuation, as well as DECT-derived iodine density and fat fraction measurements were recorded. Mean attenuation and material density values were compared between malignant lymphomas and lymph node metastases. The receiver operating characteristic (ROC) curve analysis was adopted to estimate the optimal threshold for discriminating between both entities. A control group (n = 60) was analyzed for comparison of attenuation and material density values of normal abdominal lymph nodes. RESULTS Assessment of DECT-derived iodine density and fat fraction values revealed significant differences between lymph node metastases (1.7 ± 0.4 mg/ml and 15.5 ± 7.3%) and malignant lymphomas (2.5 ± 0.5 mg/ml and 26.7 ± 12.2%) as well as normal lymph nodes (2.4 ± 0.8 mg/ml and 24.1 ± 10.8%) (P ≤ 0.013). An iodine concentration of 2.0 mg/ml represented the optimal threshold to discriminate between lymphoma and lymph node metastasis (sensitivity, 87%; specificity, 89%). Moreover, a significant correlation was found between iodine concentration and fat fraction for both lymphomas and lymph node metastases (P = 0.001). CONCLUSION DECT enables characterization of abdominal masses as derived iodine and fat fraction values differ significantly between malignant abdominal lymphomas and lymph node metastases.
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Affiliation(s)
- Simon S Martin
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Rouben Czwikla
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Julian L Wichmann
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Moritz H Albrecht
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lukas Lenga
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Rock H Savage
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Christophe Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Renate Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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Wang D, Huo Y, Chen S, Wang H, Ding Y, Zhu X, Ma C. Whole-body MRI versus 18F-FDG PET/CT for pretherapeutic assessment and staging of lymphoma: a meta-analysis. Onco Targets Ther 2018; 11:3597-3608. [PMID: 29950864 PMCID: PMC6016278 DOI: 10.2147/ott.s148189] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is the reference standard in staging of 18F-FDG-avid lymphomas; however, there is no recommended functional imaging modality for indolent lymphomas. Therefore, we aimed to compare the performance of whole-body magnetic resonance imaging (WB-MRI) with that of 18F-FDG PET/CT for lesion detection and initial staging in patients with aggressive or indolent lymphoma. Materials and methods We searched the MEDLINE, EMBASE, and CENTRAL databases for studies that compared WB-MRI with 18F-FDG PET/CT for lymphoma staging or lesion detection. The methodological quality of the studies was assessed using version 2 of the “Quality Assessment of Diagnostic Accuracy Studies” tool. The pooled staging accuracy (μ) of WB-MRI and 18F-FDG PET/CT for initial staging and for assessing possible heterogeneity (χ2) across studies were calculated using commercially available software. Results Eight studies comprising 338 patients were included. In terms of staging, the meta-analytic staging accuracies of WB-MRI and 18F-FDG PET/CT for Hodgkin lymphoma and aggressive non-Hodgkin lymphoma (NHL) were 98% (95% CI, 94%–100%) and 98% (95% CI, 94%–100%), respectively. The pooled staging accuracy of 18F-FDG PET/CT dropped to 87% (95% CI, 72%–97%) for staging in patients with indolent lymphoma, whereas that of WB-MRI remained 96% (95% CI, 91%–100%). Subgroup analysis indicated an even lower staging accuracy of 18F-FDG PET/CT for staging of less FDG-avid indolent NHLs (60%; 95% CI, 23%–92%), in contrast to the superior performance of WB-MRI (98%; 95% CI, 88%–100%). Conclusion WB-MRI is a promising radiation-free imaging technique that may serve as a viable alternative to 18F-FDG PET/CT for staging of 18FDG-avid lymphomas, where 18F-FDG PET/CT remains the standard of care. Additionally, WB-MRI seems a less histology-dependent functional imaging test than 18F-FDG PET/CT and may be the imaging test of choice for staging of indolent NHLs with low 18F-FDG avidity.
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Affiliation(s)
- Danyang Wang
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanlei Huo
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Suyun Chen
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingli Ding
- Department of Nuclear Medicine, Affiliated Third People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochun Zhu
- Department of Nuclear Medicine, Affiliated Ninth People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao Ma
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Nuclear Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
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Reinert CP, Hinterleitner C, Fritz J, Nikolaou K, Horger M. Diagnosis of diffuse spleen involvement in haematological malignancies using a spleen-to-liver attenuation ratio on contrast-enhanced CT images. Eur Radiol 2018; 29:450-457. [DOI: 10.1007/s00330-018-5556-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/20/2018] [Accepted: 05/21/2018] [Indexed: 01/14/2023]
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Mayerhoefer ME, Raderer M, Jaeger U, Staber P, Kiesewetter B, Senn D, Gallagher FA, Brindle K, Porpaczy E, Weber M, Berzaczy D, Simonitsch-Klupp I, Sillaber C, Skrabs C, Haug A. Ultra-early response assessment in lymphoma treatment: [ 18F]FDG PET/MR captures changes in glucose metabolism and cell density within the first 72 hours of treatment. Eur J Nucl Med Mol Imaging 2018; 45:931-940. [PMID: 29480328 PMCID: PMC5915494 DOI: 10.1007/s00259-018-3937-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/04/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE To determine whether, in patients with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL), [18F]FDG PET/MR can capture treatment effects within the first week after treatment initiation, and whether changes in glucose metabolism and cell density occur simultaneously. METHODS Patients with histologically proven HL or NHL were included in this prospective IRB-approved study. Patients underwent [18F]FDG PET/MR before, and then 48-72 h after (follow-up 1, FU-1) and 1 week after (FU-2) initiation of the first cycle of their respective standard chemotherapy (for HL) or immunochemotherapy (for NHL). Standardized [18F]FDG uptake values (SUVmax, SUVmean) and apparent diffusion coefficients (ADCmin, ADCmean) based on diffusion-weighted MRI, and metabolic and morphological tumour volumes (MTV, VOL) were assessed at each time-point. Multilevel analyses with an unstructured covariance matrix, and pair-wise post-hoc tests were used to test for significant changes in SUVs, ADCs, MTVs and VOLs between the three time-points. RESULTS A total of 58 patients (11 with HL and 47 with NHL) with 166 lesions were analysed. Lesion-based mean rates of change in SUVmax, SUVmean, ADCmin, ADCmean, MTV and VOL between baseline and FU-1 were -46.8%, -33.3%, +20.3%, +14%, -46% and -12.8%, respectively, and between baseline and FU-2 were -65.1%, -49%, +50.7%, +32.4%, -61.1% and -24.2%, respectively. These changes were statistically significant (P < 0.01) except for the change in VOL between baseline and FU-1 (P = 0.079). CONCLUSION In lymphoma patients, [18F]FDG PET/MR can capture treatment-induced changes in glucose metabolism and cell density as early as 48-72 h after treatment initiation.
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Affiliation(s)
- Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Markus Raderer
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jaeger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philipp Staber
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Daniela Senn
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ferdia A Gallagher
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Edit Porpaczy
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Christian Sillaber
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexander Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Caristo G, Griseri G, Fornaro R, Langone A, Franceschi A, Errigo V, Ferrari C, Casaccia M, Frascio M, Schirru A. Primary lymphoma of appendix presenting as acute appendicitis: A case report. Int J Surg Case Rep 2018; 48:30-33. [PMID: 29778032 PMCID: PMC6026685 DOI: 10.1016/j.ijscr.2018.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/17/2018] [Accepted: 04/29/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary lymphomas of appendix are extremely rare tumors. The incidence is 0.015% of all gastrointestinal lymphomas. PRESENTATION OF CASE We present a case of a 75 year-old male patient who presented with acute abdominal pain in the lower right quadrant and fever. DISCUSSION The patient received laparotomic appendectomy. The definitive histopathological examination revealed the presence of diffuse large cell B-lymphoma of the appendix. The neoplasms of appendix usually manifest clinically with sign and symptoms of acute appendicitis from luminal obstruction (30-50%). Preoperative diagnosis is difficult and often occurs through histopathological examination. CONCLUSION Primary appendiceal lymphoma is rare and there are no clear guidelines for therapy. Primary surgical resection followed by post-operative chemotherapy showed high efficacy. The histopathological examination of all appendectomy is essential.
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Affiliation(s)
| | - Guido Griseri
- San Paolo Hospital, Via Genova 30, Savona, 17100, Italy.
| | - Rosario Fornaro
- University of study of Genoa (Italy), Policlinico San Martino Largo Benzi 10, 16132 Genova, Italy.
| | | | | | | | | | - Marco Casaccia
- University of study of Genoa (Italy), Policlinico San Martino Largo Benzi 10, 16132 Genova, Italy.
| | - Marco Frascio
- University of study of Genoa (Italy), Policlinico San Martino Largo Benzi 10, 16132 Genova, Italy.
| | - Angelo Schirru
- San Paolo Hospital, Via Genova 30, Savona, 17100, Italy.
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Salvatore B, Fonti R, De Renzo A, Pellegrino S, Ferrara IL, Mainolfi CG, Marano L, Selleri C, Pane F, Del Vecchio S, Pace L. 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography in primary extranodal lymphomas: treatment response evaluation and prognosis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:219-225. [PMID: 29697219 DOI: 10.23736/s1824-4785.18.03043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We evaluated the role of [18F]FDG PET/CT in tumor response assessment and prognosis of primary extranodal lymphoma (PEL) patients. METHODS We examined retrospectively, 56 PEL patients: 31 with aggressive diffuse large B cell lymphoma (DLBCL) and 25 with indolent lymphoma (20 mucosa-associated lymphoid tissue lymphoma and five follicular lymphoma). All patients had undergone [18F]FDG PET/CT at diagnosis (PET-I) and 50 of them also after therapy (PET-II). Moreover, 52 patients were subjected to a mean follow-up period of 76 months. RESULTS PET-I was positive in 50 (89%) patients (mean SUVmax 10.3±6.7). In the assessment of tumor response, according to Lugano classification, 45 patients showed complete metabolic response (CMR), four patients had partial metabolic response (PMR) and one had progressive metabolic disease (PMD). Based on 66% ΔSUVmax cut-off, among CMR patients, 41 showed a ΔSUVmax>66% whereas among non-responders, four patients showed a ΔSUVmax<66%. At follow-up, univariate analysis showed that age, performance status, prognostic index, ΔSUVmax and Lugano classification predicted progression-free survival (PFS) (P<0.05), while, performance status, prognostic index, ΔSUVmax and Lugano classification predicted overall survival (OS) (P<0.05). At multivariate analysis only Lugano classification was retained in the model for prediction of both PFS (P<0.05) and OS (P<0.05). By Kaplan-Meier analysis and log-rank testing both PFS and OS were significantly better in patients in CMR as compared to patients in PMR or PMD according to Lugano classification (P<0.01). CONCLUSIONS [18F]FDG PET/CT represents a useful tool in the detection of disease response and in the evaluation of outcome in PEL patients.
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Affiliation(s)
- Barbara Salvatore
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Rosa Fonti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy -
| | - Amalia De Renzo
- Department of Surgery and Clinical Medicine, Federico II University, Naples, Italy
| | - Sara Pellegrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ida L Ferrara
- Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Ciro G Mainolfi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Luana Marano
- Department of Surgery and Clinical Medicine, Federico II University, Naples, Italy
| | - Carmine Selleri
- Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Fabrizio Pane
- Department of Surgery and Clinical Medicine, Federico II University, Naples, Italy
| | - Silvana Del Vecchio
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Leonardo Pace
- Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
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Abdel-Sattar MH, Abdelaziz O, Othman AO, El-Refaei SM. The use of Deauville criteria in follow-up assessment of response to therapy in extra-nodal Non-Hodgkin's lymphoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Radhakrishnan RK, Mittal BR, Reddy Gorla AK, Malhotra P, Bal A, Varma S. Unilateral Primary Adrenal Lymphoma: Uncommon Presentation of a Rare Disease Evaluated Using 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. World J Nucl Med 2018; 17:46-48. [PMID: 29398965 PMCID: PMC5778714 DOI: 10.4103/1450-1147.222288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Primary adrenal lymphoma (PAL) is a relatively rare disease entity with only fewer than 200 cases reported till date. PAL frequently presents with bilateral adrenal involvement and shows male preponderance. We here present a case of PAL in a 65-year-old female with a relatively uncommon unilateral adrenal involvement. The present case depicts that 18F-fluorodeoxyglucose positron emission tomography/computed tomography had decisive role in the treatment management of this patient suggesting its potential utility in the management of this rare disease.
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Affiliation(s)
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Reddy Gorla
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ehman EC, Johnson GB, Villanueva-Meyer JE, Cha S, Leynes AP, Larson PEZ, Hope TA. PET/MRI: Where might it replace PET/CT? J Magn Reson Imaging 2017; 46:1247-1262. [PMID: 28370695 PMCID: PMC5623147 DOI: 10.1002/jmri.25711] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/06/2017] [Indexed: 12/13/2022] Open
Abstract
Simultaneous positron emission tomography and MRI (PET/MRI) is a technology that combines the anatomic and quantitative strengths of MR imaging with physiologic information obtained from PET. PET and computed tomography (PET/CT) performed in a single scanning session is an established technology already in widespread and accepted use worldwide. Given the higher cost and complexity of operating and interpreting the studies obtained on a PET/MRI system, there has been question as to which patients would benefit most from imaging with PET/MRI versus PET/CT. In this article, we compare PET/MRI with PET/CT, detail the applications for which PET/MRI has shown promise and discuss impediments to future adoption. It is our hope that future work will prove the benefit of PET/MRI to specific groups of patients, initially those in which PET/CT and MRI are already performed, leveraging simultaneity and allowing for greater degrees of multiparametric evaluation. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:1247-1262.
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Affiliation(s)
- Eric C. Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Andrew Palmera Leynes
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Peder Eric Zufall Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Thomas A. Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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Bligh MP, Borgaonkar JN, Burrell SC, MacDonald DA, Manos D. Spectrum of CT Findings in Thoracic Extranodal Non-Hodgkin Lymphoma. Radiographics 2017; 37:439-461. [PMID: 28287948 DOI: 10.1148/rg.2017160077] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Non-Hodgkin lymphoma (NHL) frequently manifests in extranodal structures in the chest, often in the form of secondary involvement but occasionally as primary disease. Because staging and treatment are affected by the presence of extranodal disease at imaging, radiologists' interpretation and management of suspicious findings are critical to patient care. Unfortunately, owing to considerable imaging overlap with other diseases, primary extranodal lymphoma is difficult to diagnose with imaging alone. Radiologists should have a heightened degree of suspicion in patients at risk (including patients with immune compromise, autoimmune diseases, or a history of stem cell or solid organ transplant) or with particular imaging appearances (including the vertebral wraparound sign, nonresolving consolidation, an infiltrative soft-tissue mass, and lesions demonstrating vascular encasement without invasion). For patients with known NHL, positron emission tomography/computed tomography (PET/CT) using fluorine 18 (18F)-labeled fluorodeoxyglucose (FDG) is now preferred for routine staging in most cases. CT remains heavily used, and identification of subtle extranodal involvement with CT can be improved with use of intravenous contrast material and careful review of multiplanar images. Pericardial effusion, pleural soft tissue (even when mild), mass-like consolidation, perilymphatic nodularity, and new lytic bone lesions are particularly suggestive of secondary involvement in a patient with known NHL. Magnetic resonance imaging is a helpful problem-solving tool when equivocal findings would change staging and treatment. This comprehensive review illustrates the spectrum of CT manifestations of extranodal NHL in the chest, including the pleura, lung, airways, heart, pericardium, esophagus, chest wall, and breast. ©RSNA, 2017.
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Affiliation(s)
- Mathew P Bligh
- From the Department of Diagnostic Radiology (M.P.B., J.N.B., S.C.B., D.M.) and Division of Hematology, Department of Medicine (D.A.M.), Dalhousie University, Room 307, Victoria Building, 1276 S Park St, Halifax, NS, Canada B3H 2Y9
| | - Joy N Borgaonkar
- From the Department of Diagnostic Radiology (M.P.B., J.N.B., S.C.B., D.M.) and Division of Hematology, Department of Medicine (D.A.M.), Dalhousie University, Room 307, Victoria Building, 1276 S Park St, Halifax, NS, Canada B3H 2Y9
| | - Steven C Burrell
- From the Department of Diagnostic Radiology (M.P.B., J.N.B., S.C.B., D.M.) and Division of Hematology, Department of Medicine (D.A.M.), Dalhousie University, Room 307, Victoria Building, 1276 S Park St, Halifax, NS, Canada B3H 2Y9
| | - David A MacDonald
- From the Department of Diagnostic Radiology (M.P.B., J.N.B., S.C.B., D.M.) and Division of Hematology, Department of Medicine (D.A.M.), Dalhousie University, Room 307, Victoria Building, 1276 S Park St, Halifax, NS, Canada B3H 2Y9
| | - Daria Manos
- From the Department of Diagnostic Radiology (M.P.B., J.N.B., S.C.B., D.M.) and Division of Hematology, Department of Medicine (D.A.M.), Dalhousie University, Room 307, Victoria Building, 1276 S Park St, Halifax, NS, Canada B3H 2Y9
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Mayerhoefer ME, Haug A. [Hemato-oncological imaging : Importance of hybrid procedures]. Radiologe 2017; 56:597-604. [PMID: 27335021 DOI: 10.1007/s00117-016-0126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE Biomedical imaging procedures play a major role in hemato-oncological diseases with respect to pre-therapeutic staging and assessment of treatment response. STANDARD RADIOLOGICAL METHODS Originally, the therapeutic management was the domain of computed tomography (CT) and whole-body magnetic resonance imaging (MRI). METHODICAL INNOVATIONS Over the last decade these purely morphological techniques have gradually been replaced by hybrid imaging techniques, such as positron emission tomography-CT (PET/CT) and PET/MRI, which also provide metabolic and functional information. PERFORMANCE For lymphomas, the PET tracer 18F-fluorodeoxyglucose (18 F-FDG) is meanwhile so well-established that its use is a cornerstone of the Lugano classification; however, for multiple myeloma the search for an optimal PET tracer that can also detect early disease stages is still ongoing. Functional MRI techniques, such as diffusion-weighted imaging (DWI), perfusion-weighted imaging and dynamic contrast-enhanced imaging have shown promising results for both lymphomas and multiple myelomas. ACHIEVEMENTS The PET/MRI technique can combine the different types of information due to its truly multiparametric approach. PRACTICAL RECOMMENDATIONS In the future PET/MRI could possibly become the hybrid imaging technique of choice for hemato-oncological diseases.
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Affiliation(s)
- M E Mayerhoefer
- Abteilung für Allgemeine und Kinderradiologie, Medizinische Universität Wien, Univ.-Klinik für Radiologie und Nuklearmedizin, Waehringer Guertel 18-20, 1090, Wien, Österreich.
| | - A Haug
- Abteilung für Nuklearmedizin, Medizinische Universität Wien, Univ.-Klinik für Radiologie und Nuklearmedizin, Wien, Österreich
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46
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Bates JE, Dhakal S, Mazloom A, Casulo C, Constine LS. Benefit from the inclusion of radiation therapy in the treatment of patients with stage III classical Hodgkin lymphoma: A propensity matched analysis of the Surveillance, Epidemiology, and End Results database. Radiother Oncol 2017; 124:325-330. [PMID: 28778348 DOI: 10.1016/j.radonc.2017.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND While stage III and IV classical Hodgkin lymphoma (HL) patients are often combined and defined as "advanced stage," there are significant differences in disease distribution and burden between the two stages. This may obscure advantages of radiotherapy (RT) in a combined modality therapy strategy in stage III disease due to the relative lack of benefit in stage IV patients. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER) database, restricting our search to patients with stage III classical HL diagnosed from 2004 to 2012, to examine the difference in overall and cause-specific survival (OS and CSS) between patients who did or did not receive RT. RESULTS Patients treated with RT had improved OS and CSS relative to those treated without RT (5-year OS 91.6% with RT compared to 71.4% without RT, HR=0.34, p<0.001) and CSS (5-year OS 95.4% with RT compared to 84.7% without RT, HR=0.32, p<0.001). A benefit in OS and/or CSS was seen in all patient subgroups except for older adults (>64years). CONCLUSION These data support at least a cautionary approach to omitting RT from treatment strategies for patients with advanced stage HL.
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Affiliation(s)
- James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, USA
| | - Sughosh Dhakal
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Ali Mazloom
- Tacoma Valley Radiation Oncology Center, USA
| | - Carla Casulo
- Department of Medicine, Division of Medical Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA.
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47
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Cardenas ML, Spencer CR, Markovina S, DeWees TA, Mazur TR, Weiner AA, Parikh PJ, Olsen JR. Quantitative FDG-PET/CT predicts local recurrence and survival for squamous cell carcinoma of the anus. Adv Radiat Oncol 2017; 2:281-287. [PMID: 29114593 PMCID: PMC5605304 DOI: 10.1016/j.adro.2017.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/10/2017] [Accepted: 04/20/2017] [Indexed: 12/22/2022] Open
Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) positron emission tomography-(PET)/computed tomography (CT) imaging is used for staging and treatment planning of patients with anal cancer. Quantitative pre- and posttreatment metrics that are predictive of recurrence are unknown. We evaluated the association between pre- and posttreatment FDG-PET/CT parameters and outcomes for patients with squamous cell carcinoma of the anus (SCCA). METHODS AND MATERIALS The records of 110 patients treated between 2003 and 2013 with definitive radiation therapy for SCCA were reviewed under an institutional review board-approved protocol. The median radiation therapy dose was 50.4 Gy (range, 35-60 Gy). Concurrent chemotherapy was administered for 109 of 110 patients and generally consisted of 5-fluorouracil and mitomycin C (n = 94). All patients underwent pretreatment FDG-PET/CT and 101 of 110 underwent posttreatment FDG-PET/CT 3 months after completion of radiation therapy. The maximum standard uptake value (SUVmax) was analyzed, in addition to multiple patient and treatment factors, by univariate and multivariate Cox regression for correlation with local recurrence (LR) and overall survival (OS). RESULTS The median follow-up was 28.6 months. LR occurred in 1 of 15 (6.7%), 5 of 47 (10.6%), and 6 of 48 (12.5%) patients with stage I, II, and III disease, respectively. On univariate analysis, a significant association was observed between reduced LR and posttreatment SUVmax <6.1 (P = .0095) and between increased OS and posttreatment SUVmax <6.1 (P = .0086). On multivariate analysis, a significant association was observed between reduced LR and posttreatment SUVmax <6.1 (P = .0013) and the use of intensity modulated radiation therapy (P < .001). A significant multivariate association was observed between increased OS and posttreatment SUVmax <6.1 (P = .0373) and the use of 5-fluorouracil/mitomycin C chemotherapy (P = .001). CONCLUSION Posttreatment SUVmax <6.1 is associated with reduced LR and increased OS after chemoradiation therapy for SCCA independent of T and N stage on multivariate analysis. Greater follow-up is required to confirm this association with late patterns of failure.
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Affiliation(s)
- Michael L. Cardenas
- Department of Radiation Oncology, University of California, Davis, California
| | - Christopher R. Spencer
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Todd A. DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas R. Mazur
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Ashley A. Weiner
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Parag J. Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey R. Olsen
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, Colorado
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48
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Correlation of PET/CT and Image-Guided Biopsies of Pediatric Malignancies. AJR Am J Roentgenol 2017; 208:656-662. [DOI: 10.2214/ajr.15.15914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rohena-Quinquilla IR, Lattin GE, Wolfman D. Imaging of Extranodal Genitourinary Lymphoma. Radiol Clin North Am 2017; 54:747-64. [PMID: 27265606 DOI: 10.1016/j.rcl.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed.
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Affiliation(s)
- Iván R Rohena-Quinquilla
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Radiology, Martin Army Community Hospital, 6600 Van Aalst Boulevard, Fort Benning, GA 31905-5637, USA
| | - Grant E Lattin
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA
| | - Darcy Wolfman
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA; Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA.
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50
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Park HS, McIntosh L, Braschi-Amirfarzan M, Shinagare AB, Krajewski KM. T-Cell Non-Hodgkin Lymphomas: Spectrum of Disease and the Role of Imaging in the Management of Common Subtypes. Korean J Radiol 2017; 18:71-83. [PMID: 28096719 PMCID: PMC5240486 DOI: 10.3348/kjr.2017.18.1.71] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/24/2016] [Indexed: 11/15/2022] Open
Abstract
T-cell non-Hodgkin lymphomas (NHLs) are biologically diverse, uncommon malignancies characterized by a spectrum of imaging findings according to subtype. The purpose of this review is to describe the common subtypes of T-cell NHL, highlight important differences between cutaneous, various peripheral and precursor subtypes, and summarize imaging features and the role of imaging in the management of this diverse set of diseases.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Lacey McIntosh
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marta Braschi-Amirfarzan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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