Radiology MOC

Abstract Objective  We evaluated radiation doses, complication rates, and diagnostic accuracy for CT-guided percutaneous needle aspiration biopsy (NAB) procedures of pulmonary lesions performed with or without fluoroscopic guidance. Methods  A total of 142 patients were prospectively enrolled to receive CT-guided NAB with (Group I, n = 72) or without (Group II, n = 70) fluoroscopic guidance. Outcome measurements were patient and doctor radiation dose, and complication rate. Sensitivity, specificity and accuracy were calculated based on 123 NAB results. Results  The mean estimated effective patient radiation dose was 6.53 mSv in Group I and 2.72 mSv in Group II (p < 0.001). The mean estimated effective doctor dose was 0.054 mSv in Group I and 0.029 mSv in Group II (p < 0.001). The complication rate was significantly different between the two groups (13.4% versus 31.4%, p = 0.012). Sensitivity, specificity and accuracy for diagnosing pulmonary lesions were 97.8%, 100% and 98.4% in group I and 95.3%, 100% and 89.5% in group II (p > 0.05). Conclusions  CT fluoroscopy-guided NAB of pulmonary lesions provides high diagnostic accuracy and can be performed with significantly fewer complications. However, radiation exposure to both patient and doctor were significantly higher than conventional CT-guided NAB.

• Content Type Journal Article
• DOI 10.1007/s00330-010-1936-y
• Authors
  • Ga Ram Kim, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Jin Hur, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul 120-752, South Korea
  • Sang Min Lee, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Hye-Jeong Lee, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Yoo Jin Hong, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Ji Eun Nam, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Hua Sun Kim, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Young Jin Kim, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Byoung Wook Choi, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Tae Hoon Kim, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
  • Kyu Ok Choe, Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To evaluate the performance of diffusion-weighted MRI (DWI) in addition to T2-weighted (T2W) MRI for nodal restaging after chemoradiation in rectal cancer. Methods  Thirty patients underwent chemoradiation followed by MRI (1.5 T) and surgery. Imaging consisted of T2W-MRI and DWI (b0, 500, 1000). On T2W-MRI, nodes were scored as benign/malignant by two independent readers (R1, R2). Mean apparent diffusion coefficient (ADC) was measured for each node. Diagnostic performance was compared for T2W-MRI, ADC and T2W+ADC, using a per lesion histological validation. Results  ADC was higher for the malignant nodes (1.43 ± 0.38 vs 1.19 ± 0.27 *10−3 mm2/s, p < 0.001). Area under the ROC curve/sensitivity/specificity were 0.88/65%/93% (R1) and 0.95/71%/91% (R2) using T2W-MRI; 0.66/53%/82% using ADC (mean of two readers); and 0.91/56%/98% (R1) and 0.96/56%/99% (R2) using T2W+ADC. There was no significant difference between T2W-MRI and T2W+ADC. Interobserver reproducibility was good for T2W-MRI (κ0.73) and ADC (intraclass correlation coefficient 0.77). Conclusions  After chemoradiation, ADC measurements may have potential for nodal characterisation, but DWI on its own is not reliable. Addition of DWI to T2W-MRI does not improve accuracy and T2W-MRI is already sufficiently accurate.

• Content Type Journal Article
• DOI 10.1007/s00330-010-1937-x
• Authors
  • Doenja M. J. Lambregts, Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
  • Monique Maas, Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
  • Robert G. Riedl, GROW School for Oncology and Developmental Biology, P.O. Box 616, 6200 MD Maastricht, The Netherlands
  • Frans C. H. Bakers, Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
  • Jan L. Verwoerd, MR Clinical Science Department, Philips Healthcare Benelux, P.O. Box 90050, 5600 PB Eindhoven, The Netherlands
  • Alfons G. H. Kessels, GROW School for Oncology and Developmental Biology, P.O. Box 616, 6200 MD Maastricht, The Netherlands
  • Guido Lammering, GROW School for Oncology and Developmental Biology, P.O. Box 616, 6200 MD Maastricht, The Netherlands
  • Carla Boetes, Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
  • Geerard L. Beets, Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
  • Regina G. H. Beets-Tan, Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

OBJECTIVE. The purpose of this prospective study was to evaluate maintenance of spinal canal size and restoration of vertebral height and wedge angle after percutaneous vertebroplasty.

SUBJECTS AND METHODS. This study included 27 patients (19 women, eight men) with osteoporotic compression fractures (52 vertebrae). MDCT with multiplanar reformation was performed within 1 day before and 1 hour after the procedure and 1 year after the procedure on a routine or as-needed basis. The degree of retropulsion, smallest size of the spinal canal, and vertebral height and wedge angle were measured. Statistical analyses were performed with the paired Student's t and Mann-Whitney U tests.

RESULTS. There were no statistically significant differences in degree of retropulsion or size of the spinal canal before and after treatment and at the follow-up evaluation (p > 0.05). Even in the 36 vertebrae with spinal canal compromise before the procedure, there was no significant change in spinal stenosis (p > 0.05). Vertebral height and wedge angle were restored immediately after treatment (1.2 mm and 2.8°, p < 0.05). These restorations were more prominent in vertebrae with fracture clefts than in those without clefts (p < 0.05). Restoration of vertebral height and wedge angle were diminished, but the preprocedure results were maintained in follow-up (0.4 mm and 1.1°, p > 0.05).

CONCLUSION. Vertebroplasty can maintain vertebral height and wedge angle and spinal canal size at least 1 year after treatment.

OBJECTIVE. The purpose of this study was to evaluate the equivalence of CT pulmonary angiography and perfusion scanning in terms of diagnostic quality and negative predictive value in the imaging of pulmonary embolism (PE) in pregnancy.

MATERIALS AND METHODS. Between 2000 and 2007 at a university hospital and a large private hospital, 199 pregnant patients underwent 106 CT pulmonary angiographic examinations and 99 perfusion scans. Image quality was evaluated, and the findings were reread by radiologists and compared with the original clinical readings. Three-month follow-up findings of PE and deep venous thrombosis were recorded.

RESULTS. PE was found in four of the 106 patients (3.7%) who underwent CT pulmonary angiography. The overall image quality was poor in 5.6% of cases, acceptable in 17.9%, and good in 76.4%. Fourteen CT and nine radiographic studies showed other clinically significant abnormalities. Six patients had indeterminate CT pulmonary angiographic findings, three had normal perfusion scans, and none underwent anticoagulation. All perfusion scan findings were normal. There was one incomplete study, and follow-up CT pulmonary angiography performed the same day showed PE. Two of 99 studies (2.02%) showed intermediate probability of the presence of PE; PE was not found at CT pulmonary angiography, but pneumonia was found. PE was found in one postpartum patient 9 weeks after she had undergone CT pulmonary angiography and ultrasound with normal findings. None of the patients died.

CONCLUSION. CT pulmonary angiography and perfusion scanning have equivalent clinical negative predictive value (99% for CT pulmonary angiography; 100% for perfusion scanning) and image quality in the care of pregnant patients. Therefore, the choice of study should be based on other considerations, such as radiation concern, radiographic results, alternative diagnosis, and equipment availability. Reducing the amount of radiation to the maternal breast favors use of perfusion scanning when the radiographic findings are normal and there is no clinical suspicion of an alternative diagnosis.

OBJECTIVE. The purpose of this article is to compare the recently published revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (version 1.1) to the original guidelines (RECIST 1.0) for advanced non–small cell lung cancer (NSCLC) after erlotinib therapy and to evaluate the impact of the new CT tumor measurement guideline on response assessment.

MATERIALS AND METHODS. Forty-three chemotherapy-naive patients with advanced NSCLC treated with erlotinib in a single-arm phase 2 multicenter open-label clinical trial were retrospectively studied. CT tumor measurement records using RECIST 1.0 that were generated as part of the prospective clinical trial were reviewed. A second set of CT tumor measurements was generated from the records to meet RECIST 1.1 guidelines. The number of target lesions, best response, and time to progression were compared between RECIST 1.1 and RECIST 1.0.

RESULTS. The number of target lesions according to RECIST 1.1 decreased in 22 patients (51%) and did not change in 21 patients (49%) compared with the number according to RECIST 1.0 (p < 0.0001, paired Student's t test). Almost perfect agreement was observed between best responses using RECIST 1.1 and RECIST 1.0 (weighted = 0.905). Two patients with stable disease according to RECIST 1.0 had progressive disease according to RECIST 1.1 criteria because of new lesions found on PET/CT. There was no significant difference in time to progression between RECIST 1.1 and RECIST 1.0 (p = 1.000, sign test).

CONCLUSION. RECIST 1.1 provided almost perfect agreement in response assessment after erlotinib therapy compared with RECIST 1.0. Assessment with PET/CT was a major factor that influenced the difference in best response assessment between RECIST 1.1 and RECIST 1.0.

OBJECTIVE. Peritoneal sarcomatosis is an entity analogous to the better known peritoneal carcinomatosis. The purpose of this article is to discuss the imaging findings of peritoneal sarcomatosis versus peritoneal carcinomatosis.

CONCLUSION. Sarcomatosis is most commonly seen in gastrointestinal stromal tumor, liposarcoma, and leiomyosarcoma. A few distinguishing features of peritoneal sarcomatosis include heterogeneous bulky masses, hypervascularity with or without hemoperitoneum, and variable presence of ascites.

OBJECTIVE. The purpose of this study was to determine the diagnostic accuracy of CT for detecting extrathyroidal invasion of thyroid cancer to adjacent structures.

MATERIALS AND METHODS. Eighty-four patients (19 men, 65 women; age range, 19–84 years; mean, 54.2 ± 15.4 years) with 86 malignant tumors of the thyroid with extracapsular extension (37 T3, 49 T4) were retrospectively enrolled in this study. Two radiologists independently evaluated the CT findings of invasion of thyroid cancer into the trachea, esophagus, common carotid artery, internal jugular vein, and recurrent laryngeal nerve. These results were compared with the surgical and histopathologic findings.

RESULTS. The mean sensitivity, specificity, and accuracy of CT were as follows: 59.1%, 91.4%, and 83.2% for tracheal invasion; 28.6%, 96.2%, and 90.7% for esophageal invasion; 75.0%, 99.4%, and 98.8% for invasion of the common carotid artery; 33.3%, 98.8%, and 97.1% for invasion of the internal jugular vein; and 78.2%, 89.8%, and 85.5% for invasion to the recurrent laryngeal nerve. Interobserver agreement was moderate to good in the five categories of extrathyroidal invasion with a mean kappa value of 0.65 (range, 0.49–0.77).

CONCLUSION. Although the effectiveness is limited by low sensitivity, CT may be a valuable tool for evaluation of extrathyroidal invasion of thyroid cancer to adjacent structures.

OBJECTIVE. The aim of this study was to evaluate the safety and efficacy of ultrasound-guided high-intensity focused ultrasound therapeutic ablation of solid tumors in difficult locations.

SUBJECTS AND METHODS. A procedure was performed with a focused ultrasound tumor therapeutic system which provides real-time ultrasound guidance. All patients underwent MDCT or MRI, and some patients underwent PET/CT. From November 2007 through April 2009, 31 patients with 38 lesions of the liver and pancreas in difficult locations were treated. Six patients had hepatocellular carcinoma, 13 patients had hepatic metastasis from colorectal cancer, two had hepatic metastases of breast cancer, two had hepatic metastasis of neuroendocrine tumors, one patient had lymph node metastasis of breast cancer at the hepatic hilum, six patients had pancreatic cancer, and one patient had a neuroendocrine tumor. Difficult location was defined as tumor adjacent to a main blood vessel, the heart, the gallbladder and bile ducts, the bowel, or the stomach.

RESULTS. The mean diameter of tumors was 2.7 ± 1.4 cm. PET/CT, MDCT, or both on the day after one session of high-intensity focused ultrasound treatment showed complete response in all six patients with hepatocellular carcinoma, the patient with lymph node metastasis, and 22 of 24 patients with hepatic metastasis. The symptoms of all seven patients with pancreatic caner or neuroendocrine tumors were palliated, and PET/CT or MRI showed complete response of six of seven lesions. Portal vein thrombosis occurred after high-intensity focused ultrasound ablation in one patient with pancreatic cancer. No other side effects were detected in a median follow-up period of 12 months.

CONCLUSION. According to our short- and long-term follow-up results, ultrasound-guided high-intensity focused ultrasound ablation can be considered a safe and feasible approach to the management of solid tumors in difficult locations.