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Vezakis I, Vezakis A, Gourtsoyianni S, Koutoulidis V, Polydorou AA, Matsopoulos GK, Koutsouris DD. An Automated Prognostic Model for Pancreatic Ductal Adenocarcinoma. Genes (Basel) 2023; 14:1742. [PMID: 37761882 PMCID: PMC10530933 DOI: 10.3390/genes14091742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) constitutes a leading cause of cancer-related mortality despite advances in detection and treatment methods. While computed tomography (CT) serves as the current gold standard for initial evaluation of PDAC, its prognostic value remains limited, as it relies on diagnostic stage parameters encompassing tumor size, lymph node involvement, and metastasis. Radiomics have recently shown promise in predicting postoperative survival of PDAC patients; however, they rely on manual pancreas and tumor delineation by clinicians. In this study, we collected a dataset of pre-operative CT scans from a cohort of 40 PDAC patients to evaluate a fully automated pipeline for survival prediction. Employing nnU-Net trained on an external dataset, we generated automated pancreas and tumor segmentations. Subsequently, we extracted 854 radiomic features from each segmentation, which we narrowed down to 29 via feature selection. We then combined these features with the Tumor, Node, Metastasis (TNM) system staging parameters, as well as the patient's age. We trained a random survival forest model to perform an overall survival prediction over time, as well as a random forest classifier for the binary classification of two-year survival, using repeated cross-validation for evaluation. Our results exhibited promise, with a mean C-index of 0.731 for survival modeling and a mean accuracy of 0.76 in two-year survival prediction, providing evidence of the feasibility and potential efficacy of a fully automated pipeline for PDAC prognostication. By eliminating the labor-intensive manual segmentation process, our streamlined pipeline demonstrates an efficient and accurate prognostication process, laying the foundation for future research endeavors.
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Affiliation(s)
- Ioannis Vezakis
- Biomedical Engineering Laboratory, School of Electrical & Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou St., 15780 Athens, Greece; (I.V.); (D.D.K.)
| | - Antonios Vezakis
- 2nd Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 76 Vas. Sophias Ave., 11528 Athens, Greece; (A.V.); (A.A.P.)
| | - Sofia Gourtsoyianni
- 1st Department of Radiology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 76 Vas. Sophias Ave., 11528 Athens, Greece; (S.G.); (V.K.)
| | - Vassilis Koutoulidis
- 1st Department of Radiology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 76 Vas. Sophias Ave., 11528 Athens, Greece; (S.G.); (V.K.)
| | - Andreas A. Polydorou
- 2nd Department of Surgery, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 76 Vas. Sophias Ave., 11528 Athens, Greece; (A.V.); (A.A.P.)
| | - George K. Matsopoulos
- Biomedical Engineering Laboratory, School of Electrical & Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou St., 15780 Athens, Greece; (I.V.); (D.D.K.)
| | - Dimitrios D. Koutsouris
- Biomedical Engineering Laboratory, School of Electrical & Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou St., 15780 Athens, Greece; (I.V.); (D.D.K.)
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Gourtsoyianni S, Laniado M, Ros-Mendoza L, Mansueto G, Zamboni GA. The Spectrum of Solitary Benign Splenic Lesions-Imaging Clues for a Noninvasive Diagnosis. Diagnostics (Basel) 2023; 13:2120. [PMID: 37371015 DOI: 10.3390/diagnostics13122120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/03/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Cross-sectional imaging of the upper abdomen, especially if intravenous contrast has been administered, will most likely reveal any acute or chronic disease harbored in the spleen. Unless imaging is performed with the specific purpose of evaluating the spleen or characterizing a known splenic lesion, incidentally discovered splenic lesions pose a small challenge. Solitary benign splenic lesions include cysts, hemangiomas, sclerosing angiomatous nodular transformation (SANT), hamartomas, and abscesses, among others. Sarcoidosis and tuberculosis, although predominantly diffuse micronodular disease processes, may also present as a solitary splenic mass lesion. In addition, infarction and rupture, both traumatic and spontaneous, may take place in the spleen. This review aims to describe the imaging features of the most common benign focal splenic lesions, with emphasis on the imaging findings as these are encountered on routine cross-sectional imaging from a multicenter pool of cases that, coupled with clinical information, can allow a definite diagnosis.
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Affiliation(s)
- Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Ave., 11528 Athens, Greece
| | - Michael Laniado
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Luis Ros-Mendoza
- Department of Radiology, Miguel Servet University Hospital, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - Giancarlo Mansueto
- Istituto di Radiologia, DAI Patologia e Diagnostica, Policlinico GB Rossi, AOUI Verona, 37134 Verona, Italy
| | - Giulia A Zamboni
- Istituto di Radiologia, DAI Patologia e Diagnostica, Policlinico GB Rossi, AOUI Verona, 37134 Verona, Italy
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Triantopoulou C, Gourtsoyianni S, Karakaxas D, Delis S. Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Challenging Diagnosis. Diagnostics (Basel) 2023; 13:2015. [PMID: 37370909 DOI: 10.3390/diagnostics13122015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Intraductal papillary mucinous neoplasm of the pancreas (IPMN) was classified as a distinct entity from mucinous cystic neoplasm by the WHO in 1995. It represents a mucin-producing tumor that originates from the ductal epithelium and can evolve from slight dysplasia to invasive carcinoma. In addition, different aspects of tumor progression may be seen in the same lesion. Three types are recognized, the branch duct variant, the main duct variant, which shows a much higher prevalence for malignancy, and the mixed-type variant, which combines branch and main duct characteristics. Advances in cross-sectional imaging have led to an increased rate of IPMN detection. The main imaging characteristic of IPMN is the dilatation of the pancreatic duct without the presence of an obstructing lesion. The diagnosis of a branch duct IPMN is based on the proof of its communication with the main pancreatic duct on MRI-MRCP examination. Early identification by imaging of the so-called worrisome features or predictors for malignancy is an important and challenging task. In this review, we will present recent imaging advances in the diagnosis and characterization of different types of IPMNs, as well as imaging tools available for early recognition of worrisome features for malignancy. A critical appraisal of current IPMN management guidelines from both a radiologist's and surgeon's perspective will be made. Special mention is made of complications that might arise during the course of IPMNs as well as concomitant pancreatic neoplasms including pancreatic adenocarcinoma and pancreatic endocrine neoplasms. Finally, recent research on prognostic and predictive biomarkers including radiomics will be discussed.
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Affiliation(s)
| | - Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece
| | - Dimitriοs Karakaxas
- Department of Surgery, Konstantopouleio General Hospital, 14233 Athens, Greece
| | - Spiros Delis
- Department of Surgery, Konstantopouleio General Hospital, 14233 Athens, Greece
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Bonanno N, Cioni D, Caruso D, Cyran CC, Dinkel J, Fournier L, Gourtsoyianni S, Hoffmann RT, Laghi A, Martincich L, Mayerhoefer ME, Zamboni GA, Sala E, Schlemmer HP, Neri E, D’Anastasi M. Attitudes and perceptions of radiologists towards online (virtual) oncologic multidisciplinary team meetings during the COVID-19 pandemic-a survey of the European Society of Oncologic Imaging (ESOI). Eur Radiol 2023; 33:1194-1204. [PMID: 35986772 PMCID: PMC9391636 DOI: 10.1007/s00330-022-09083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/03/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To explore radiologists' opinions regarding the shift from in-person oncologic multidisciplinary team meetings (MDTMs) to online MDTMs. To assess the perceived impact of online MDTMs, and to evaluate clinical and technical aspects of online meetings. METHODS An online questionnaire including 24 questions was e-mailed to all European Society of Oncologic Imaging (ESOI) members. Questions targeted the structure and efficacy of online MDTMs, including benefits and limitations. RESULTS A total of 204 radiologists responded to the survey. Responses were evaluated using descriptive statistical analysis. The majority (157/204; 77%) reported a shift to online MDTMs at the start of the pandemic. For the most part, this transition had a positive effect on maintaining and improving attendance. The majority of participants reported that online MDTMs provide the same clinical standard as in-person meetings, and that interdisciplinary discussion and review of imaging data were not hindered. Seventy three of 204 (35.8%) participants favour reverting to in-person MDTs, once safe to do so, while 7/204 (3.4%) prefer a continuation of online MDTMs. The majority (124/204, 60.8%) prefer a combination of physical and online MDTMs. CONCLUSIONS Online MDTMs are a viable alternative to in-person meetings enabling continued timely high-quality provision of care with maintained coordination between specialties. They were accepted by the majority of surveyed radiologists who also favoured their continuation after the pandemic, preferably in combination with in-person meetings. An awareness of communication issues particular to online meetings is important. Training, improved software, and availability of support are essential to overcome technical and IT difficulties reported by participants. KEY POINTS • Majority of surveyed radiologists reported shift from in-person to online oncologic MDT meetings during the COVID-19 pandemic. • The shift to online MDTMs was feasible and generally accepted by the radiologists surveyed with the majority reporting that online MDTMs provide the same clinical standard as in-person meetings. • Most would favour the return to in-person MDTMs but would also accept the continued use of online MDTMs following the end of the current pandemic.
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Affiliation(s)
- Nathania Bonanno
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, MSD 2090 Malta
| | - Dania Cioni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Clemens C. Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Laure Fournier
- Radiology Department, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, 20 Rue Leblanc, F-75015 Paris, France
| | - Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ralf-Thorsten Hoffmann
- Diagnostische und Interventionelle Radiologie Universitätsklinikum Dresden, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Laura Martincich
- Ospedale Cardinal Massaia Asti, Unit of Radiology, Corso Dante Alighieri, 202, 14100, Asti, Italy
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria ,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Giulia A. Zamboni
- Department of Diagnostics and Public Health, Institute of Radiology, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134 Verona, Italy
| | - Evis Sala
- Department of Radiology Box 218, Cambridge Biomedical Campus Cambridge, Cambridge, CB2 0QQ UK
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, MSD 2090 Malta
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Bourgioti C, Zafeiropoulou K, Tzavara C, Daskalakis G, Fotopoulos S, Theodora M, Nikolaidou ME, Konidari M, Gourtsoyianni S, Panourgias E, Koutoulidis V, Martzoukos EA, Konstantinidou AE, Moulopoulos LA. Comparison between 1.5-T and 3.0-T MRI for the diagnosis of placenta accreta spectrum disorders. Diagn Interv Imaging 2022; 103:408-417. [PMID: 35568666 DOI: 10.1016/j.diii.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Accurate antenatal diagnosis of placenta accreta spectrum (PAS) is important for optimal management. The purpose of this study was to compare the respective capabilities of 1.5-T and 3.0-T MRI in the diagnosis of PAS. MATERIALS AND METHODS Between March 2016-March 2021, 190 pregnant women at high risk for PAS underwent dedicated prenatal MRI with either 1.5-T or 3.0-T units at a tertiary imaging center. Cesarian section and MRI were performed less than 6 weeks from each other. Prospectively collected data were evaluated by two experienced genitourinary radiologists for presence and extent of PAS. A comparative study was designed to investigate differences in predictive ability between 1.5-T and 3.0-T MRI groups. Sensitivity, specificity, accuracy, negative and positive prognostic values relative to intraoperative/histological findings, were computed for both groups and were compared with chi-square (χ 2) test. Interobserver agreement was estimated using Kappa test. RESULTS One hundred-eighty-two gravid women were included in the study; of these, 91/182 (50%) women were evaluated with 1.5-T (mean age, 35 ± 5.1 [SD] years; mean gestational age: 32.5 weeks) and 91/182 (50%) with 3.0-T MRI (mean age, 34.9 ± 4.9 [SD] years; mean gestational age, 32.1 weeks). 1.5-T MRI yielded 95.7% sensitivity (95% CI: 87.8-99.1) and 81.8% specificity (95% CI: 59.8) and 3.0-T MRI 93.8% sensitivity (95% CI: 86.0-97.9) and 83.3% specificity (95% CI: 48.2-97.7) for PAS identification, with no differences between the two groups (P = 0.725 and P >0.999, respectively). MRI showed excellent predictive ability for detecting extrauterine placental spread with 100% sensitivity (95% CI: 89.4-100.0), 96.7% specificity (95% CI: 88.1-99.6) for 1.5-T and 97% sensitivity (95% CI: 84.2-99.9), 96.7% specificity (95% CI: 88.1-99.6) for 3.0-T without differences between the two groups (P > 0.999). Interobserver agreement was excellent for both groups. The most frequently detected MRI signs of PAS for both 1.5-T and 3.0-T groups were placental heterogeneity (n = 85, 93.5% vs. n = 90, 98.9%; P = 0.413), and intraplacental fetal vessels (n = 64, 70.3% vs. n = 65, 71.4%; P = 0.870). CONCLUSION This study suggests that 3.0-T MRI and 1.5-T MRI are equivalent for the diagnosis of PAS.
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Affiliation(s)
- Charis Bourgioti
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece.
| | - Konstantina Zafeiropoulou
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Chara Tzavara
- Department of Health, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - George Daskalakis
- Department of Fetal and Maternal Medicine, First Department of Gynaecology and Obstetrics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Stavros Fotopoulos
- Department of Gynaecology and Obstetrics, IASO Maternity Hospital, Athens 15123, Greece
| | - Marianna Theodora
- Department of Fetal and Maternal Medicine, First Department of Gynaecology and Obstetrics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | | | - Marianna Konidari
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Evangelia Panourgias
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Vassilis Koutoulidis
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | | | | | - Lia Angela Moulopoulos
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
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Fournier L, de Geus-Oei LF, Regge D, Oprea-Lager DE, D’Anastasi M, Bidaut L, Bäuerle T, Lopci E, Cappello G, Lecouvet F, Mayerhoefer M, Kunz WG, Verhoeff JJC, Caruso D, Smits M, Hoffmann RT, Gourtsoyianni S, Beets-Tan R, Neri E, deSouza NM, Deroose CM, Caramella C. Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group - ESOI Joint Paper. Front Oncol 2022; 11:800547. [PMID: 35083155 PMCID: PMC8784734 DOI: 10.3389/fonc.2021.800547] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required.
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Affiliation(s)
- Laure Fournier
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Université de Paris, Assistance Publique–Hôpitaux de Paris (AP-HP), Hopital europeen Georges Pompidou, Department of Radiology, Paris Cardiovascular Research Center (PARCC) Unité Mixte de Recherche (UMRS) 970, Institut national de la santé et de la recherche médicale (INSERM), Paris, France
| | - Lioe-Fee de Geus-Oei
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Daniele Regge
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-Istituto Di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Turin, Italy
| | - Daniela-Elena Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers [Vrije Universiteit (VU) University], Amsterdam, Netherlands
| | - Melvin D’Anastasi
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, United Kingdom
| | - Tobias Bäuerle
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Egesta Lopci
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine Unit, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) – Humanitas Research Hospital, Milan, Italy
| | - Giovanni Cappello
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-Istituto Di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Turin, Italy
| | - Frederic Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marius Mayerhoefer
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang G. Kunz
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Joost J. C. Verhoeff
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Damiano Caruso
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Marion Smits
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Brain Tumour Centre, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, Netherlands
| | - Ralf-Thorsten Hoffmann
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl-Gustav-Carus Technical University Dresden, Dresden, Germany
| | - Sofia Gourtsoyianni
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Regina Beets-Tan
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- School For Oncology and Developmental Biology (GROW) School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Emanuele Neri
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Nandita M. deSouza
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, United States
| | - Christophe M. Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Caroline Caramella
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Radiology Department, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph Centre International des Cancers Thoraciques, Université Paris-Saclay, Le Plessis-Robinson, France
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7
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Bourgioti C, Konidari M, Gourtsoyianni S, Moulopoulos LA. Imaging during pregnancy: What the radiologist needs to know. Diagn Interv Imaging 2021; 102:593-603. [PMID: 34059484 DOI: 10.1016/j.diii.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022]
Abstract
During the last decades, there has been a growing demand for medical imaging in gravid women. Imaging of the pregnant woman is challenging as it involves both the mother and the fetus and, consequently, several medical, ethical, or legal considerations are likely to be raised. Theoretically, all currently available imaging modalities may be used for the evaluation of the pregnant woman; however, in practice, confusion regarding the safety of the fetus often results in unnecessary avoidance of useful diagnostic tests, especially those involving ionizing radiation. This review article is focused on the current safety guidelines and considerations regarding the use of different imaging modalities in the pregnant population; also presented is an imaging work-up for the most common medical conditions of pregnant women, with emphasis on fetal and maternal safety.
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Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece.
| | - Marianna Konidari
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece
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8
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Neri E, Gabelloni M, Bäuerle T, Beets-Tan R, Caruso D, D'Anastasi M, Dinkel J, Fournier LS, Gourtsoyianni S, Hoffmann RT, Mayerhöfer ME, Regge D, Schlemmer HP, Laghi A. Involvement of radiologists in oncologic multidisciplinary team meetings: an international survey by the European Society of Oncologic Imaging. Eur Radiol 2020; 31:983-991. [PMID: 32833089 PMCID: PMC7813742 DOI: 10.1007/s00330-020-07178-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/30/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Objectives Multidisciplinary tumour boards (MTBs) play an increasingly important role in managing cancer patients from diagnosis to treatment. However, many problems arise around the organisation of MTBs, both in terms of organisation-administration and time management. In this context, the European Society of Oncologic Imaging (ESOI) conducted a survey among its members, aimed at assessing the quality and amount of involvement of radiologists in MTBs, their role in it and related issues. Methods All members were invited to fill in a questionnaire consisting of 15 questions with both open and multiple-choice answers. Simple descriptive analyses and graphs were performed. Results A total of 292 ESOI members in full standing for the year 2018 joined the survey. Most respondents (89%) declared to attend MT-Bs, but only 114 respondents (43.9%) review over 70% of exams prior to MTB meetings, mainly due to lack of time due to a busy schedule for imaging and reporting (46.6%). Perceived benefits (i.e. surgical and histological feedback (86.9%), improved knowledge of cancer treatment (82.7%) and better interaction between radiologists and referring clinicians for discussing rare cases (56.9%)) and issues (i.e. attending MTB meetings during regular working hours (71.9%) and lack of accreditation with continuing medical education (CME) (85%)) are reported. Conclusions Despite the value and benefits of radiologists’ participation in MTBs, issues like improper preparation due to a busy schedule and no counterpart in CME accreditation require efforts to improve the role of radiologists for a better patient care. Key Points • Most radiologists attend multidisciplinary tumour boards, but less than half of them review images in advance, mostly due to time constraints. • Feedback about radiological diagnoses, improved knowledge of cancer treatment and interaction with referring clinicians are perceived as major benefits. • Concerns were expressed about scheduling multidisciplinary tumour boards during regular working hours and lack of accreditation with continuing medical education.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Michela Gabelloni
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Damiano Caruso
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Sant'Andrea University Hospital, Rome, Italy
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Valletta, Malta
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Laure S Fournier
- Radiology Department, Hôpital européen Georges Pompidou, AP-HP, Université de Paris, 20 Rue Leblanc, F-75015, Paris, France
| | - Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ralf-Thorsten Hoffmann
- Diagnostische und Interventionelle Radiologie Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Marius Erik Mayerhöfer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Vienna, Austria
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, University of Torino, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Heinz Peter Schlemmer
- German Cancer Research Center (DKFZ) Foundation Under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Andrea Laghi
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Sant'Andrea University Hospital, Rome, Italy
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9
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Sotirova I, Gklavas A, Papalouka D, Gourtsoyianni S, Christodoulou D, Papaconstantinou I. Multiple Small Bowel Diverticula Were an Unexpected Finding During Laparoscopic Enterectomy for Crohn's Disease. Med Arch 2020; 74:142-145. [PMID: 32577058 PMCID: PMC7296412 DOI: 10.5455/medarh.2020.74.142-145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn’s disease (CD) is rarely reported in the current literature. Aim: We present a rare case of concomitant Crohn’s disease (CD) and SBD in a male patient, where multiple jejunal diverticula were an incidental intraoperative finding. Preoperative evaluation with magnetic resonance enterography (MRE) failed to recognize the coexistence of these two entities. Surgeons should be aware of the possibility of this rare situation. Case report: A 52-year-old Caucasian male diagnosed with CD was referred to our department for surgical intervention due to an ileal stricture. The patient reported no past medical history, except for a few episodes of bloody diarrhoea during a three-year period. The index colonoscopy revealed luminal narrowing in the ileum at approximately 70 cm proximal to the ileocaecal valve, and biopsies revealed findings compatible with CD. Clinical examination and laboratory tests were unremarkable one day before surgery. The patient underwent laparoscopic segmental resection of the affected part of the ileum. Intraoperatively, multiple non-inflamed diverticula along the jejunum extending from the Treitz ligament to the proximal ileum were recognized. Our patient had an uncomplicated post-operative course and was discharged on the fifth post-operative day. Pathological examination revealed features compatible with CD in the active phase. The patient was referred to his gastroenterological team for further consultation regarding the appropriate post-operative management. Conclusion: Concomitant CD and SBD is a rare condition, and the differential diagnosis may be challenging due to overlapping symptoms.
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Affiliation(s)
- Ira Sotirova
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Antonios Gklavas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitra Papalouka
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- First Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitrios Christodoulou
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina and Medical School of Ioannina, Ioannina 45110, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
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10
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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11
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Douridas GN, Fountoulakis A, Souglakos J, Gourtsoyianni S, Vini L, Levidou G, Liakakos T, Agalianos C, Dervenis C, Kalogeridi MA, Karavokyros I, Koumarianou A, Kountourakis P, Oikonomopoulos G, Economopoulou P, Sgouros J, Sgouros SN, Stamou K, Triantopoulou C, Zacharoulis D, Gouvas N, Xynos E. Consensus statement of the Hellenic and Cypriot Gastric Cancer Study Group on the diagnosis, staging and management of gastric cancer. Updates Surg 2020; 72:1-19. [PMID: 32112342 DOI: 10.1007/s13304-020-00723-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/11/2020] [Indexed: 12/15/2022]
Abstract
Gastric Cancer epidemics have changed over recent decades, declining in incidence, shifting from distal to proximal location, transforming from intestinal to diffuse histology. Novel chemotherapeutic agents combined with modern surgical operations hardly changed overall disease related survival. This may be attributed to a substantial inherent geographical variation of disease genetics, but also to a failure to standardize and implement treatment protocols in clinical practice. To overcome these drawbacks in Greece and Cyprus, a Gastric Cancer Study Group under the auspices of the Hellenic Society of Medical Oncology (HeSMO) and Gastrointestinal Cancer Study Group (GIC-SG) merged their efforts to produce a consensus considering ethnic parameters of healthcare system and the international proposals as well. Utilizing structured meetings of experts, a consensus was reached. To achieve further consensus, statements were subjected to the Delphi methodology by invited multidisciplinary national and international experts. Sentences were considered of high or low consensus if they were voted by ≥ 80%, or < 80%, respectively; those obtaining a low consensus level after both voting rounds were rejected. Forty-five statements were developed and voted by 71 experts. The median rate of abstention per statement was 9.9% (range: 0-53.5%). At the end of the process, one statement was rejected, another revised, and all the remaining achieved a high consensus. Forty-four recommendations covering all aspects of the management of gastric cancer and concise treatment algorithms are proposed by the Hellenic and Cypriot Gastric Cancer Study Group. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and individualization are emphasized.
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Affiliation(s)
| | | | - John Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, Crete, Greece
| | | | - Louiza Vini
- Department of Radiotherapy, Iatriko Medical Center, Athens, Greece
| | | | - Theodoros Liakakos
- 1st Department of General Surgery, Laikon University Hospital, Athens, Greece
| | | | - Christos Dervenis
- General Surgery, Faculty of Medicine, University of Cyprus, Nicosia, Cyprus
| | | | - Ioannis Karavokyros
- 1st Department of General Surgery, Laikon University Hospital, Athens, Greece
| | - Anna Koumarianou
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | | | | | | | - Joseph Sgouros
- Department of Medical Oncology, Agioi Anargyroi Hospital, Athens, Greece
| | | | | | | | | | - Nikolaos Gouvas
- Department of General Surgery, Medical School, University of Nicosia, Nicosia, Cyprus
| | - Evangelos Xynos
- Department of General Surgery, Creta Interclinic Hospital, Heraklion, Crete, Greece
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12
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Fountoulakis A, Souglakos J, Vini L, Douridas GN, Koumarianou A, Kountourakis P, Agalianos C, Alexandrou A, Dervenis C, Gourtsoyianni S, Gouvas N, Kalogeridi MA, Levidou G, Liakakos T, Sgouros J, Sgouros SN, Triantopoulou C, Xynos E. Consensus statement of the Hellenic and Cypriot Oesophageal Cancer Study Group on the diagnosis, staging and management of oesophageal cancer. Updates Surg 2019; 71:599-624. [DOI: 10.1007/s13304-019-00696-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
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13
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Prezzi D, Mandegaran R, Gourtsoyianni S, Owczarczyk K, Gaya A, Glynne-Jones R, Goh V. The impact of MRI sequence on tumour staging and gross tumour volume delineation in squamous cell carcinoma of the anal canal. Eur Radiol 2018; 28:1512-1519. [PMID: 29134349 PMCID: PMC5834548 DOI: 10.1007/s00330-017-5133-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/30/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare maximum tumour diameter (MTD) and gross tumour volume (GTV) measurements between T2-weighted (T2-w) and diffusion-weighted (DWI) MRI in squamous cell carcinoma of the anal canal (SCCA) and assess sequence impact on tumour (T) staging. Second, to evaluate interobserver agreement and reader delineation confidence. METHODS The staging MRI scans of 45 SCCA patients (25 females) were assessed retrospectively by two independent radiologists (0 and 5 years' experience of anal cancer MRI). MTD and GTV were delineated on both T2-w and high-b-value DWI images and compared between sequences; T staging was derived from MTD. Interobserver agreement was assessed and delineation confidence scored (1 to 5) by each observer. RESULTS GTV and MTD were significantly and systematically lower on DWI versus T2-w sequences by 14.80%/9.98% (MTD) and 29.70%/12.25% (GTV) for each reader, respectively, causing T staging discordances in approximately a quarter of cases. Bland-Altman limits of agreement were narrower and intraclass correlation coefficients higher for DWI. Delineation confidence was greater on DWI: 40/42 cases were scored confidently (4 or 5) by each reader, respectively, versus 31/36 cases based on T2-w images. CONCLUSIONS Sequence selection affects SCCA measurements and T stage. DWI yields higher interobserver agreement and greater tumour delineation confidence. KEY POINTS • MTD and GTV measurements are significantly lower on DWI than on T 2 -w MRI. • Such differences cause T staging discordances in up to a quarter of cases. • DWI results in higher agreement between inexperienced and experienced observers. • DWI offers greater tumour delineation confidence to inexperienced readers.
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Affiliation(s)
- Davide Prezzi
- Division of Imaging Sciences & Biomedical Engineering, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Clinical Imaging, Guy's and St Thomas' NHS Foundation Trust, 1st Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Imaging 2, Level 1, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Ramin Mandegaran
- Clinical Imaging, Guy's and St Thomas' NHS Foundation Trust, 1st Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sofia Gourtsoyianni
- Division of Imaging Sciences & Biomedical Engineering, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Clinical Imaging, Guy's and St Thomas' NHS Foundation Trust, 1st Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Katarzyna Owczarczyk
- Division of Imaging Sciences & Biomedical Engineering, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew Gaya
- Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Robert Glynne-Jones
- Mount Vernon Cancer Centre, East and North Herts NHS Trust, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | - Vicky Goh
- Division of Imaging Sciences & Biomedical Engineering, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Clinical Imaging, Guy's and St Thomas' NHS Foundation Trust, 1st Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Mount Vernon Cancer Centre, East and North Herts NHS Trust, Rickmansworth Rd, Northwood, HA6 2RN, UK
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14
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Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, Fenlon HM, Gollub MJ, Gourtsoyianni S, Halligan S, Hoeffel C, Kim SH, Laghi A, Maier A, Rafaelsen SR, Stoker J, Taylor SA, Torkzad MR, Blomqvist L. Correction to: Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 2018; 28:2711. [PMID: 29322331 DOI: 10.1007/s00330-017-5204-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting, written by [§§§ AuthorNames §§§].
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Affiliation(s)
- Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | | | | | | | - Helen M Fenlon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marc J Gollub
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | | | - Seung Ho Kim
- Inje University Haeundae Paik Hospital, Busan, South Korea
| | | | | | | | - Jaap Stoker
- Academic Medical Centre, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Lennart Blomqvist
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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15
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Gourtsoyianni S, Doumou G, Prezzi D, Taylor B, Stirling JJ, Taylor NJ, Siddique M, Cook GJR, Glynne-Jones R, Goh V. Primary Rectal Cancer: Repeatability of Global and Local-Regional MR Imaging Texture Features. Radiology 2017; 284:552-561. [PMID: 28481194 PMCID: PMC6150741 DOI: 10.1148/radiol.2017161375] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Purpose To assess the day-to-day repeatability of global and local-regional magnetic resonance (MR) imaging texture features derived from primary rectal cancer. Materials and Methods After ethical approval and patient informed consent were obtained, two pretreatment T2-weighted axial MR imaging studies performed prospectively with the same imaging unit on 2 consecutive days in 14 patients with rectal cancer (11 men [mean age, 61.7 years], three women [mean age, 70.0 years]) were analyzed to extract (a) global first-order statistical histogram and model-based fractal features reflecting the whole-tumor voxel intensity histogram distribution and repeating patterns, respectively, without spatial information and (b) local-regional second-order and high-order statistical texture features reflecting the intensity and spatial interrelationships between adjacent in-plane or multiplanar voxels or regions, respectively. Repeatability was assessed for 46 texture features, and mean difference, 95% limits of agreement, within-subject coefficient of variation (wCV), and repeatability coefficient (r) were recorded. Results Repeatability was better for global parameters than for most local-regional parameters. In particular, histogram mean, median, and entropy, fractal dimension mean and standard deviation, and second-order entropy, homogeneity, difference entropy, and inverse difference moment demonstrated good repeatability, with narrow limits of agreement and wCVs of 10% or lower. Repeatability was poorest for the following high-order gray-level run-length (GLRL) gray-level zone size matrix (GLZSM) and neighborhood gray-tone difference matrix (NGTDM) parameters: GLRL intensity variability, GLZSM short-zone emphasis, GLZSM intensity nonuniformity, GLZSM intensity variability, GLZSM size zone variability, and NGTDM complexity, demonstrating wider agreement limits and wCVs of 50% or greater. Conclusion MR imaging repeatability is better for global texture parameters than for local-regional texture parameters, indicating that global texture parameters should be sufficiently robust for clinical practice. Online supplemental material is available for this article.
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Affiliation(s)
- Sofia Gourtsoyianni
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Georgia Doumou
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Davide Prezzi
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Benjamin Taylor
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - J. James Stirling
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - N. Jane Taylor
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Musib Siddique
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Gary J. R. Cook
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Robert Glynne-Jones
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
| | - Vicky Goh
- From the Department of Radiology (S.G., D.P., V.G.) and PET Centre (J.J.S., G.J.R.C.), Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH; Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, England (G.D., D.P., B.T., J.J.S., M.S., G.J.R.C., V.G.); and the Cancer Centre, Mount Vernon Hospital, Northwood, England (N.J.T., R.G.)
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Abstract
New-generation magnetic resonance imaging (MRI) scanners with optimal phased-array body coils have contributed to obtainment of high-resolution T2-weighted turbo spin echo images in which visualization of anatomical details such as the mesorectal fascia and the bowel wall layers is feasible. Preoperative, locoregional staging of rectal cancer with MRI, considered standard of care nowadays, relies on these images for stratification of high-risk patients for local recurrence, patients most likely to benefit from neoadjuvant therapy, as well as patients who exhibit imaging features indicative of a high risk of metastatic disease. Functional imaging, including optimized for rectal cancer diffusion-weighted imaging and more recently use of dynamic contrast-enhanced MRI, combined with radiologists׳ rising level of familiarity regarding the assessment of reactive changes postchemoradiation treatment, have shown to increase MRI staging accuracy after neoadjuvant treatment. Our intention is to review already established standard protocols for primary rectal cancer and go through potential additional promising imaging tools.
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Affiliation(s)
- Sofia Gourtsoyianni
- Department of Radiology, Guy׳s and St Thomas׳ NHS Foundation Trust, London, UK.
| | - Nickolas Papanikolaou
- Department of Radiology, Champalimaud Foundation, Centre for the Unknown, Lisbon, Portugal
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Patel KR, Parikh J, Hussain Z, Gourtsoyianni S, Griffin N. The diagnostic and technical quality of magnetic resonance cholangiopancreatography (MRCP). Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Regini F, Gourtsoyianni S, Cardoso De Melo R, Charles-Edwards GD, Griffin N, Parikh J, Rottenberg G, Leslie M, Gaya A, Goh V. Rectal tumour volume (GTV) delineation using T2-weighted and diffusion-weighted MRI: Implications for radiotherapy planning. Eur J Radiol 2014; 83:768-72. [PMID: 24646719 DOI: 10.1016/j.ejrad.2014.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the rectal tumour gross target volume (GTV) delineated on T2 weighted (T2W MRI) and diffusion weighted MRI (DWI) images by two different observers and to assess if agreement is improved by DWI. MATERIAL AND METHODS 27 consecutive patients (15 male, range 27.1-88.8 years, mean 66.9 years) underwent 1.5T MRI prior to chemoradiation (45Gy in 25 fractions; oral capecitabine 850mg/m(2)), including axial T2W MRI (TR=6600ms, TE=90ms) and DWI (TR=3000ms, TE=77ms, b=0, 100, 800s/mm(2)). 3D tumour volume (cm(3)) was measured by volume of interest (VOI) analysis by two independent readers for the T2W MRI and b800 DWI axial images, and the T2W MRI and DWI volumes compared using Mann-Whitney test. Observer agreement was assessed using Bland-Altman statistics. Significance was at 5%. RESULTS Artefacts precluded DWI analysis in 1 patient. In the remaining 26 patients evaluated, median (range) T2W MRI MRI and DWI (b=800s/mm(2)) 3D GTVin cm(3) were 33.97 (4.44-199.8) and 31.38 (2.43-228), respectively, for Reader One and 43.78 (7.57-267.7) and 42.45 (3.68-251) for Reader Two. T2W MRI GTVs were slightly larger but not statistically different from DWI volumes: p=0.52 Reader One; p=0.92 Reader Two. Interobserver mean difference (95% limits of agreement) for T2W MRI and DWI GTVs were -9.84 (-54.96 to +35.28) cm(3) and -14.79 (-54.01 to +24.43) cm(3) respectively. CONCLUSION Smaller DWI volumes may result from better tumour conspicuity but overall observer agreement is not improved by DWI.
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Affiliation(s)
- F Regini
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Experimental and Clinical Biomedical Sciences - Radiodiagnostic Unit 2 - University of Florence- Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| | - S Gourtsoyianni
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
| | - R Cardoso De Melo
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - G D Charles-Edwards
- Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK; Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - N Griffin
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
| | - J Parikh
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - G Rottenberg
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - M Leslie
- Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - A Gaya
- Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - V Goh
- Department of Radiology,Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK.
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Mendiratta-Lala M, Sheiman R, Brook OR, Gourtsoyianni S, Mahadevan A, Siewert B. CT-guided core biopsy and percutaneous fiducial seed placement in the lung: Can these procedures be combined without an increase in complication rate or decrease in technical success? Eur J Radiol 2014; 83:720-5. [DOI: 10.1016/j.ejrad.2014.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/26/2013] [Accepted: 01/03/2014] [Indexed: 11/30/2022]
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Abstract
Anal cancer is an uncommon malignancy of the gastrointestinal tract but has a relatively good prognosis with an 80% 5-year overall survival. In this article, we review the role of MRI for assessing treatment response in anal cancer after completion of definitive chemoradiotherapy. New generation MRI scanners with optimal-phased array body coils, resulting in better signal to noise and improved contrast and spatial resolution, have contributed to high-resolution imaging in clinical practice enabling visualization of relevant anatomy including the sphincter complex, adjacent structures, mesorectal and pelvic lymph nodes with a diameter down to 2 mm. Multiplanar, high-resolution T2-weighted and diffusion-weighted sequences have a role in initial locoregional staging of anal SCC, assisting radiotherapy planning, as well as in assessing response to treatment and treatment-related complications.
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Affiliation(s)
- S Gourtsoyianni
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, Imaging 2, Level 1, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK,
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21
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Brook OR, Gourtsoyianni S, Brook A, Siewert B, Kent T, Raptopoulos V. Split-Bolus Spectral Multidetector CT of the Pancreas: Assessment of Radiation Dose and Tumor Conspicuity. Radiology 2013; 269:139-48. [DOI: 10.1148/radiol.13121409] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Caseiro-Alves F, Curvo-Semedo L, Fenlon HM, Gollub MJ, Gourtsoyianni S, Halligan S, Hoeffel C, Kim SH, Laghi A, Maier A, Rafaelsen SR, Stoker J, Taylor SA, Torkzad MR, Blomqvist L. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 2013; 23:2522-31. [PMID: 23743687 DOI: 10.1007/s00330-013-2864-4] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/12/2013] [Accepted: 03/30/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. METHODS A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. RESULTS Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. CONCLUSIONS These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. KEY POINTS • These guidelines recommend standardised imaging for staging and restaging of rectal cancer. • The guidelines were constructed through consensus amongst 14 abdominal imaging experts. • Consensus was reached by in 88 % of 236 items discussed.
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Abstract
Anatomical-based imaging is used widely for the evaluation of diffuse and focal liver, including detection, characterization, and therapy response assessment. However, a limitation of anatomical-based imaging is that structural changes may occur relatively late in a disease process. By applying conventional anatomical-imaging methods in a more functional manner, specific pathophysiologic alterations of the liver may be assessed and quantified. There has been an increasing interest in both the clinical and research settings, with the expectation that functional-imaging techniques may help solve common diagnostic dilemmas that conventional imaging alone cannot. This review considers the most common functional magnetic resonance imaging, computed tomography, and ultrasound imaging techniques that may be applied to the liver.
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Affiliation(s)
- Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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Gourtsoyianni S, Hwang S, Panicek DM, Zheng J, Moskowitz C, Scher H, Morris M, Hricak H. Reproducibility and clinical correlations of post-treatment changes on CT of prostate cancer bone metastases treated with chemotherapy. Br J Radiol 2012; 85:1243-9. [PMID: 22919006 DOI: 10.1259/bjr/27266976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine whether, in patients with prostate cancer (PCa) bone metastases receiving chemotherapy, early post-treatment changes on CT are reproducible and associated with clinical outcomes. METHODS Blinded to outcomes, two radiologists with 1 year and 5 years of experience independently reviewed CTs obtained before and 3 months after chemotherapy initiation in 38 patients with bone metastases from castration-resistant PCa, recording the size, matrix and attenuation of ≤5 lesions; presence of new lesions, extraosseous components, periosteal reactions and cortical thickening; and overall CT assessment (improved, no change or worse). Kappa statistics were used to assess inter-reader agreement; the Kruskal-Wallis test and Cox regression model were used to evaluate associations. RESULTS Inter-reader agreement was low/fair for size change (concordance correlation coefficient=0.013), overall assessment and extraosseous involvement (κ=0.3), moderate for periosteal reaction and cortical thickening (κ=0.4-0.5), and substantial for CT attenuation (κ=0.7). Most metastases were blastic (Reader 1, 58%; Reader 2, 67%) or mixed lytic-blastic (Reader 1, 42%; Reader 2, 34%). No individual CT features correlated with survival. Readers 1 and 2 called the disease improved in 26% and 5% of patients, unchanged in 11% and 21%, and worse in 63% and 74%, respectively, with 64% interreader agreement. Overall CT assessment did not correlate with percentage change in prostate-specific antigen level. For the more experienced reader (Reader 2), patients with improved or unchanged disease had significantly longer median survival (p=0.036). CONCLUSIONS In PCa bone metastases, interreader agreement is low in overall CT post-treatment assessment and varies widely for individual CT features. Improved or stable disease identified by an experienced reader is statistically associated with longer survival.
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Affiliation(s)
- S Gourtsoyianni
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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25
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Brook OR, Gourtsoyianni S, Brook A, Mahadevan A, Wilcox C, Raptopoulos V. Spectral CT with metal artifacts reduction software for improvement of tumor visibility in the vicinity of gold fiducial markers. Radiology 2012; 263:696-705. [PMID: 22416251 DOI: 10.1148/radiol.12111170] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate spectral computed tomography (CT) with metal artifacts reduction software (MARS) for reduction of metal artifacts associated with gold fiducial seeds. MATERIALS AND METHODS Thirteen consecutive patients with 37 fiducial seeds implanted for radiation therapy of abdominal lesions were included in this HIPAA-compliant, institutional review board-approved prospective study. Six patients were women (46%) and seven were men (54%). The mean age was 61.1 years (median, 58 years; range, 29-78 years). Spectral imaging was used for arterial phase CT. Images were reconstructed with and without MARS in axial, coronal, and sagittal planes. Two radiologists independently reviewed reconstructions and selected the best image, graded the visibility of the tumor, and assessed the amount of artifacts in all planes. A linear-weighted κ statistic and Wilcoxon signed-rank test were used to assess interobserver variability. Histogram analysis with the Kolmogorov-Smirnov test was used for objective evaluation of artifacts reduction. RESULTS Fiducial seeds were placed in pancreas (n = 5), liver (n = 7), periportal lymph nodes (n = 1), and gallbladder bed (n = 1). MARS-reconstructed images received a better grade than those with standard reconstruction in 60% and 65% of patients by the first and second radiologist, respectively. Tumor visibility was graded higher with standard versus MARS reconstruction (grade, 3.7 ± 1.0 vs 2.8 ± 1.1; P = .001). Reduction of blooming was noted on MARS-reconstructed images (P = .01). Amount of artifacts, for both any and near field, was significantly smaller on sagittal and coronal MARS-reconstructed images than on standard reconstructions (P < .001 for all comparisons). Far-field artifacts were more prominent on axial MARS-reconstructed images than on standard reconstructions (P < .01). Linear-weighted κ statistic showed moderate to perfect agreement between radiologists. CT number distribution was narrower with MARS than with standard reconstruction in 35 of 37 patients (P < .001). CONCLUSION Spectral CT with use of MARS improved tumor visibility in the vicinity of gold fiducial seeds.
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Affiliation(s)
- Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
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Brodoefel H, Tognolini A, Zamboni GA, Gourtsoyianni S, Claussen CD, Raptopoulos V. Standardisation of liver MDCT by tracking liver parenchyma enhancement to trigger imaging. Eur Radiol 2011; 22:812-20. [PMID: 22057214 DOI: 10.1007/s00330-011-2310-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/15/2011] [Accepted: 08/31/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess parenchymal bolus-triggering in terms of liver enhancement, lesion-to-liver conspicuity and inter-image variability across serial follow-up MDCTs. METHODS We reviewed MDCTs of 50 patients with hepatic metastases who had a baseline CT and two follow-up examinations. In 25 consecutive patients CT data acquisition was initiated by liver parenchyma triggering at a 50-HU enhancement threshold. In a matched control group, imaging was performed with an empirical delay of 65 s. CT attenuation values were assessed in vessels, liver parenchyma and metastasis. Target lesions were classified according to five enhancement patterns. RESULTS Compared with the control group, liver enhancement was significantly higher with parenchyma triggering (59.8 ± 7.6 HU vs. 48.8 ± 11.2 HU, P = 0.0002). The same was true for conspicuity (liver parenchyma - lesion attenuation) of hypo-enhancing lesions (72.2 ± 15.9 HU vs. 52.7 ± 19.4 HU, P = 0.0006). Liver triggering was associated with reduced variability for liver enhancement among different patients (P = 0.035) and across serial follow-up examinations in individual patients (P < 0.0001). The number of patients presenting with uniform lesion enhancement pattern across serial examinations was significantly higher in the triggered group (20 vs. 11; P = 0.018). CONCLUSION Liver parenchyma triggering provides superior lesion conspicuity and improves standardisation of image quality across follow-up examinations with greater uniformity of enhancement patterns. KEY POINTS Liver parenchyma tracking improves liver enhancement and lesion-to-liver conspicuity in abdominal CT. In serial CT studies this technique reduces variability of conspicuity and enhancement patterns. Higher liver-to-lesion conspicuity is a prerequisite for reliable detection of liver lesions. Stabilisation of enhancement permits more accurate follow-up of oncology patients.
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Affiliation(s)
- H Brodoefel
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Gourtsoyianni S, Hudolin T, Sala E, Goldman D, Bochner B, Hricak H. MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration. Clin Radiol 2011; 66:1072-8. [DOI: 10.1016/j.crad.2011.07.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/14/2011] [Accepted: 07/05/2011] [Indexed: 11/15/2022]
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Magkanas E, Detorakis E, Nikolakopoulos I, Gourtsoyianni S, Linardakis M, Sidiropoulos P, Boumpas D, Gourtsoyiannis N. Air trapping in Wegener’s granulomatosis: an additional finding on expiratory chest HRCT. Radiol Med 2011; 116:858-67. [DOI: 10.1007/s11547-011-0675-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 11/24/2010] [Indexed: 01/15/2023]
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Abstract
The clinical problems raised in patients presenting with all forms of gynecological malignancy are currently addressed using conventional cross-sectional imaging, usually MRI. In general, F-18 FDG PET-CT has not been shown to have a clinical role in any of these cancers at presentation, although studies are under way to use this form of metabolic imaging to predict prognosis and the response to treatment. Although F-18 FDG PET-CT is superior to conventional imaging techniques, it is only moderately sensitive in demonstrating lymph node metastasis preoperatively, and is inadequate for local staging of patients with endometrial cancer. In ovarian cancer, F-18 FDG PET-CT provides an accurate assessment of the extent of disease, particularly in areas difficult to assess for metastases by CT and MRI such as the abdomen and pelvis, mediastinum, and supraclavicular region. F-18 FDG PET-CT is a sensitive method of detecting pelvic and para-aortic lymph nodal disease in cervical cancer, and appears to be superior to MRI and CT despite the limitations in identifying small foci of disease. In the main, as elsewhere in patients with cancer, the value of PET-CT is in identifying and defining the extent of recurrent disease, in distinguishing between posttreatment fibrosis and recurrence, and possibly in monitoring response to therapy.
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Affiliation(s)
- Norbert Avril
- Department of Nuclear Medicine, Barts and The London School of Medicine, Queen Mary, University of London, London, UK.
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Taflampas P, Christodoulakis M, Gourtsoyianni S, Leventi K, Melissas J, Tsiftsis DD. The effect of preoperative chemoradiotherapy on lymph node harvest after total mesorectal excision for rectal cancer. Dis Colon Rectum 2009; 52:1470-4. [PMID: 19617762 DOI: 10.1007/dcr.0b013e3181a0e6ac] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate whether preoperative chemoradiotherapy reduces the number of lymph nodes harvested after total mesorectal excision of rectal cancer. METHODS From January 1995 to December 2007, 168 consecutive patients with rectal cancer underwent total mesorectal excision in the Department of Surgical Oncology at the University of Crete. The patients were divided into three groups (Group A, no chemoradiotherapy; Group B, short course of chemoradiotherapy; Group C, long course of chemoradiotherapy). The primary end points were the number of lymph nodes examined and the percentage of patients with fewer than 12 lymph nodes removed. RESULTS The overall number of lymph nodes retrieved was not significantly reduced by the use of preoperative chemoradiotherapy. The percentage of patients with fewer than 12 lymph nodes examined, however, was significantly higher in Group C. The leakage rate and the duration of hospital stay were not affected. The rate of wound infections was higher in Group C. CONCLUSION Preoperative chemoradiotherapy did not significantly decrease the overall number of lymph nodes retrieved but did increase the percentage of patients with fewer than 12 lymph nodes examined.
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Gourtsoyianni S, Papanikolaou N, Amanakis E, Bourikas L, Roussomoustakaki M, Grammatikakis J, Gourtsoyiannis N. Crohn's disease lymphadenopathy: MR imaging findings. Eur J Radiol 2009; 69:425-8. [DOI: 10.1016/j.ejrad.2008.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
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Myronakis M, Perisinakis K, Tzedakis A, Gourtsoyianni S, Damilakis J. Evaluation of a patient-specific Monte Carlo software for CT dosimetry. Radiat Prot Dosimetry 2009; 133:248-255. [PMID: 19329513 DOI: 10.1093/rpd/ncp051] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim was to validate the ImpactMC computed tomography (CT) dosimetry software that allows patient-specific dose determination. Measured values of head- and body-weighted CT dose index (CTDI(w)) were compared with corresponding values derived using ImpactMC software. A physical anthropomorphic phantom simulating the average adult was employed to study the effect of exposure parameters used to produce the input image set on a normalised dose output and the relationship between exposure parameters selected for simulation on the dose output. The difference between CTDI(w) values obtained through measurements and simulations were found to be up to 12.8 and 18.3% for head and body phantoms, respectively. Exposure parameters of the image set used as input were found to have a minor impact on the normalised dose output. Simulations confirmed the expected linear relationship between dose and tube load and the power law relationship between dose and tube potential. Results demonstrate that ImpactMC may be capable of providing reliable CT dose estimates.
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Affiliation(s)
- Marios Myronakis
- Faculty of Medicine, Department of Medical Physics, University of Crete, PO Box 2208, Heraclion 71003, Crete, Greece
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Papanikolaou N, Gourtsoyianni S, Yarmenitis S, Maris T, Gourtsoyiannis N. Comparison between two-point and four-point methods for quantification of apparent diffusion coefficient of normal liver parenchyma and focal lesions. Value of normalization with spleen. Eur J Radiol 2008; 73:305-9. [PMID: 19091503 DOI: 10.1016/j.ejrad.2008.10.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 10/15/2008] [Accepted: 10/23/2008] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare two quantification techniques of apparent diffusion coefficient (ADC), both in normal liver parenchyma and focal lesions, and to investigate any potential value of normalization. MATERIALS AND METHODS Fifty-six consecutive patients underwent MRI examination of the liver, including a single shot spin-echo echo planar imaging diffusion sequence with four b-values (0, 50, 500 and 1000s/mm(2)). ADC maps were reconstructed based on a two-point method (b-values: 500 and 1000s/mm(2)) and a four-point method (b-values: 0, 50, 500 and 1000s/mm(2)). Comparison of absolute ADC measurements of the liver, benign and malignant focal lesions was performed between the two- and four-point techniques. The same analysis was done on normalized ADC values (absolute ADC values divided by spleen ADC values). RESULTS The difference between mean two-point and four-point ADC values of normal liver (absolute: 1.237x10(-3), 1.615x10(-3)mm(2)/s, normalized: 1.40, 1.52, respectively) was statistically significant (p<0.0001 and p=0.0061). Significantly higher absolute ADC values of benign and malignant lesions were recorded with the four-point method (2.860x10(-3) and 1.307x10(-3)mm(2)/s) over the two-point method (2.243x10(-3), and 1.011x10(-3)mm(2)/s) (p<0.0001 in both) while the same differences in normalized values were proven statistically non-significant for benign lesions (p=0.788) and statistically significant for malignant lesions (p=0.015). Both differences in absolute and normalized ADC values of benign versus malignant lesions based on two- and four-point methods were found to be significant (p<0.0001). CONCLUSION ADC quantification of the liver may be performed with a two-point method (b-values of 500 and 1000s/mm(2)), while normalization of ADC measurements with the spleen is not further improving lesion characterization.
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Affiliation(s)
- Nickolas Papanikolaou
- Dept of Radiology, University Hospital of Heraklion, Medical School, University of Crete, Greece
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Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N. Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 2007; 18:486-92. [PMID: 17994317 DOI: 10.1007/s00330-007-0798-4] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 07/03/2007] [Accepted: 09/26/2007] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to measure apparent diffusion coefficient values of normal liver parenchyma and focal liver lesions utilizing a respiratory gated diffusion sequence with multiple b-values and to investigate whether apparent diffusion coefficient (ADC) measurements may be utilized to characterize and differentiate between malignant and benign focal hepatic lesions. Thirty-eight consecutive patients underwent MRI of the liver including diffusion-weighted imaging (DWI). A single-shot echo planar imaging sequence was applied in coronal orientation with multiple b-values (0, 50, 500, 1,000 s/mm2) and respiratory gating. ADC values were recorded on corresponding maps utilizing region of interest measurements in patients with benign (group A), malignant (group B) focal lesions and liver parenchyma (group C). Statistical analysis was applied to check whether differences in mean ADC values were significant (p<0.05). No focal lesions were detected in 11 patients, with a mean ADC value (CI 95%) of liver parenchyma 1.25x10(-3) mm2/s (1.21x10(-3) mm2/s-1.29x10(-3) mm2/s). Differences in mean ADC of liver parenchyma between group A and B were not significant (p=0.054, 1.30x10(-3) mm2/s and 1.31x10(-3) mm2/s, respectively). Mean ADC value (95% CI) of 22 benign lesions found in 18 patients was 2.55x10(-3) mm2/s (2.35x10(-3) mm2/s-2.74x10(-3) mm2/s), while the mean ADC value (95% CI) of 16 malignant lesions recorded in 9 patients was 1.04x10(-3) mm2/s (0.9x10(-3) mm2/s-1.17x10(-3) mm2/s). The difference between mean ADC values of benign and malignant focal lesions was statistically significant (p<0.0001). Respiratory gated diffusion-weighted imaging in the liver is technically feasible. Apparent diffusion coefficient measurements can be useful in differentiating malignant from benign focal liver lesions.
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Affiliation(s)
- Sofia Gourtsoyianni
- Department of Radiology, University Hospital of Heraklion, 71110 Stavrakia, Heraklion/Crete, Greece
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Abstract
Magnetic resonance cholangio-pancreaticograpy (MRCP) is a non-invasive imaging modality of the pancreatico-biliary system which plays an increasingly important role in the clinical and diagnostic workup of patients with biliary or pancreatic diseases. The present review is designed to give an overview of the currently available and appropriate sequences, their technical background, as well as new developments and their relevance to the various clinical issues and challenges. The impact of the latest technical innovations, such as integrated parallel imaging techniques and navigator-based respiratory triggering, on the diagnostic capacities of MRCP is discussed. In this context, the individual value of RARE, T2w single shot turbo/fast spin echo (SSFSE) and the recently introduced 3D T2w turbo/fast spin echo sequences (T2w 3D-T/FSE) is reviewed. RARE imaging may be preferred in severely ill patients with limitations in cooperation, SSFSE is particularly effective in differentiating benign and malignant stenosis, and 3D-FSE offers additional advantages in the detection of small biliary concrements.
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Affiliation(s)
- A M Wallnoefer
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilian-Universität München.
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