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ABSTRACT: The objective of our study was to evaluate the accuracy of integrated PET and CT (PET/CT) using (18)F-FDG in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer, using surgical and histopathologic findings as the reference standard.
Forty patients with clinical stages IA to IIIC underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after FDG PET/CT. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. PET/CT findings were interpreted by two experienced radiologists in consensus and compared with histopathologic results. The criterion for malignancy on PET/CT images was increased radiotracer uptake by a lymph node independent of node size.
In total, 62 pathologically positive nodes were found in 10 patients and 60 of 62 dissected metastatic nodes were identified on the CT component. The overall node-based sensitivity, specificity, and accuracy of PET/CT for detecting nodal metastases were 53.3% (32/60), 99.6% (1,419/1,424), and 97.8% (1,451/1,484), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in diameter was 16.7% (4/24), that for lesions between 5 and 9 mm was 66.7% (14/21), and that for lesions 10 mm or larger was 93.3% (14/15). The overall patient-based sensitivity, specificity, and accuracy were 50% (5/10), 86.7% (26/30), and 77.5% (31/40), respectively.
Integrated FDG PET/CT is superior to conventional imaging techniques, but it is only moderately sensitive in predicting lymph node metastasis preoperatively in patients with endometrial cancer. Even PET/CT should not replace lymphadenectomy.
American Journal of Roentgenology 07/2008; 190(6):1652-8. · 2.78 Impact Factor
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ABSTRACT: The purpose is to evaluate the accuracy of integrated FDG-PET/CT, compared with PET alone, for diagnosis of suspected recurrence of uterine cervical cancer. Fifty-two women who had undergone treatment for histopathologically proven cervical cancer received PET/CT with suspected recurrence. PET-alone and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each investigation. A final diagnosis was confirmed by histopathology, radiological imaging, and clinical follow-up for over 1 year. Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 92.0% (23/25), 92.6% (25/27), and 92.3% (48/52), respectively, while for PET, the corresponding figures were 80.0% (20/25), 77.8% (21/27), and 78.8% (41/52), respectively. PET/CT resolved the false-positive PET results due to hypermetabolic activity of benign/inflammatory lesions and physiological variants, and was able to detect lung metastasis, local recurrence, peritoneal dissemination, para-aortic lymph node metastasis, and pelvic lymph node metastasis missed by PET alone. However, tiny local recurrence and lymph node metastasis could not be detected even by PET/CT. FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with cervical cancer.
European Radiology 05/2008; 18(10):2040-7. · 3.22 Impact Factor
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ABSTRACT: Congenital high airway obstruction syndrome (CHAOS) is a rare life-threatening syndrome. Most cases are diagnosed prenatally by US. We report a fetus with this syndrome that showed a unique course revealed on MRI. Ultrasonography at 22 weeks demonstrated that the fetus had ascites and bilaterally enlarged hyperechoic lungs. Congenital infection, congenital cystic adenomatoid malformation or CHAOS was suspected. Subsequent MRI performed at 24 weeks demonstrated bilaterally enlarged high-signal lungs, dilated bronchi, massive ascites, subcutaneous oedema and polyhydramnios. MRI confirmed the diagnosis of CHAOS. A second MRI at 35 weeks showed that the bilateral lung enlargement, ascites, oedema and polyhydramnios had resolved, but that the appearance of the airway was unchanged. The infant was delivered by caesarean section at 38 weeks of gestation and immediate tracheostomy was performed. This spontaneous regression was explained by a tracheo-oesophageal fistula that may have decreased the intrathoracic pressure.
Pediatric Radiology 04/2008; 38(3):344-7. · 1.67 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using (18)F-fluorodeoxyglucose with IV contrast for depiction of suspected recurrent ovarian cancer and to assess the impact of PET/contrast-enhanced CT findings on clinical management, compared with PET/non-contrast-enhanced CT and CT component.
One hundred thirty-two women previously treated for ovarian cancer underwent PET/CT consisting of non-enhanced and contrast-enhanced CT for suspected recurrence. PET/contrast enhanced CT, PET/non-contrast-enhanced CT, and enhanced CT were interpreted by two experienced radiologists by consensus for each investigation. Lesion status was determined on the basis of histopathology, radiological imaging, and clinical follow-up for longer than 6 months.
Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/contrast-enhanced CT were 78.8% (52 of 66), 90.9% (60 of 66), and 84.8% (112 of 132), respectively, whereas those of PET/non-contrast-enhanced CT were 74.2% (49 of 66), 90.9% (60 of 66), and 82.6% (109 of 132), respectively, and those of enhanced CT were 60.6% (40 of 66), 84.8% (56 of 66), and 72.7% (96 of 132), respectively. Sensitivity, specificity, and accuracy differed significantly among the three modalities (Cochran Q test: p = 0.0001, p = 0.018, and p < 0.0001, respectively). The findings of PET/contrast-enhanced CT resulted in a change of management for 51 of the 132 patients (39%) and had an effect on patient management in 16 patients (12%) diagnosed by enhanced CT alone and three patients (2%) diagnosed by PET/non-contrast-enhanced CT.
Integrated PET/contrast-enhanced CT is an accurate modality for assessing ovarian cancer recurrence and led to changes in the subsequent appropriate therapy.
European journal of nuclear medicine and molecular imaging 04/2008; 35(8):1439-48. · 4.99 Impact Factor
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ABSTRACT: To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18-F-fluorodeoxyglucose (FDG), compared with PET alone, in the diagnosis of suspected endometrial cancer recurrence.
Thirty women who had undergone primary surgery for histopathologically proven endometrial cancer with suspected recurrence because of clinical, cytological, biochemical, and/or radiological findings were enrolled in this study. PET and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each modality. A final diagnosis of recurrence was confirmed by histopathology, other imaging and clinical follow-up for longer than 1 year. The statistical significance of differences between PET and PET/CT was determined by the McNemar test.
Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 93% (14/15), 93% (14/15), and 93% (28/30), respectively, whereas for PET, the corresponding data were 80% (12/15), 80% (12/15), and 80% (24/30), respectively (P=0.479, 0.479, and 0.134, respectively). CT from PET/CT resolved the false-positive PET results because of hyper-metabolic activity of benign inflammatory lesions and physiological variants and moreover detected lung metastasis and para-aortic lymph node metastasis that PET missed. However, tiny para-aortic lymph node metastasis could not be detected even with PET/CT.
Integrated FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with endometrial cancer.
Annals of Nuclear Medicine 03/2008; 22(2):103-9. · 1.50 Impact Factor
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ABSTRACT: To determine whether the apparent diffusion coefficient (ADC) obtained using a high b-value (2,000 s/mm2) is superior to that using a standard b-value (1,000 s/mm2) for discriminating malignant from normal peripheral tissue in the prostate.
Twenty-six patients with biopsy-proven prostate cancer underwent 1.5T magnetic resonance (MR) imaging including single-shot, echo-planar diffusion-weighted imaging (DWI) with repetition time/echo time, 3500/88 ms; 4-mm slice thickness; 1-mm interslice gap; 144x128 matrix; field of view, 250x250 mm; number of excitations, 10; and b-values, 0, 1,000, and 2,000 s/mm2. For each patient, ADC values were obtained for malignant and normal tissue using b=1,000 and 2,000 in a monoexponential model. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios in DWI were also evaluated.
At b=1,000, the mean ADC (x10(-3) mm2/s) for malignant tissue was 0.82+/-0.27 (range 0.43-1.29) and for normal tissue, 1.69+/-0.23 (1.31-2.18). At b=2000, the mean ADC for malignant tissue was 0.61+/-0.19 (0.30-0.94) and for normal tissue, 1.01+/-0.14 (0.73-1.35). Significant ADC overlap between the malignant and normal tissue was recognized at b=2000. As b-value increased, the mean SNR within malignant tissue decreased by 21.6%, and mean CNR decreased 17.3%.
Under the same imaging conditions, measuring ADC using a high b-value (2,000 s/mm2) in a monoexponential model has little diagnostic advantage over using the standard b-value (1,000 s/mm2) in discriminating malignant from normal prostate tissue.
Magnetic Resonance in Medical Sciences 02/2008; 7(2):93-9. · 0.97 Impact Factor
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ABSTRACT: Ovarian fibromas typically exhibit low signal intensity on T(2)-weighted images, which reflects their abundant fibrocollagenous stroma. However, the mass of larger tumors often demonstrates high signal intensity on T(2)-weighted images, which reflects varied degenerative changes, such as cystic degeneration, edematous change, hemorrhagic infarction, or necrosis caused by torsion and myxomatous change. We illustrate typical and atypical magnetic resonance (MR) imaging findings of ovarian fibromas and correlate them with histopathologic findings.
Magnetic Resonance in Medical Sciences 02/2008; 7(1):43-8. · 0.97 Impact Factor
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ABSTRACT: The aim of this study was to assess the physiological uptake of 18F-fluoro-2-deoxyglucose (FDG) by an apparently normal testis with combined positron emission tomography-computed tomography (PET/CT) and its correlation with age, blood glucose level, and testicular volume.
The testicular uptake of 18F-FDG, expressed as the standardized uptake value (SUV), was measured on PET/CT images in 203 men. The correlation between SUV and age, blood glucose level, and testicular volume was assessed.
The SUV in the total of 406 testes was 2.44 +/- 0.45 (range 1.23-3.85). The SUV was 2.81 +/- 0.43 (2.28-3.85) for 30-39 years (n = 12), 2.63 +/- 0.45 (1.77-3.75) for 40-49 years (n = 64), 2.46 +/- 0.35 (1.44-3.15) for 50-59 years (n = 82), 2.51 +/- 0.41 (1.50-3.46) for 60-69 years (n = 86), 2.43 +/- 0.47 (1.42-3.29) for 70-79 years (n = 86), and 2.18 +/- 0.45 (1.23-3.03) for 80-89 years (n = 76). When we calculated the mean SUV of bilateral testes in each patient, there were significant statistical differences between those in the age group of 30-39 years and 80-89 years, 40-49 years and 80-89 years, and 50-60 years and 80-89 years, when using an unpaired test with Bonferroni correction. The laterality index (|L - R|/(L + R) x 2) in 203 men was 0.066 +/- 0.067 (0-0.522). There was a mild correlation between the mean SUV and age (r = -0.284, P < 0.001) as well as between the mean SUV and mean volume (r = +0.368, P < 0.001). There was no correlation between the mean SUV and glucose blood level (r = -0.065, P = 0.358).
Some uptake of FDG is observed in the normal testis and declines slightly with age. Physiological FDG uptake in the testis should not be confused with pathological accumulation.
Annals of Nuclear Medicine 09/2007; 21(7):405-10. · 1.50 Impact Factor
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ABSTRACT: OBJECTIVE: Our objective was to describe the MRI findings of uterine lipoleiomyoma and to correlate them with histopathologic findings. CONCLUSION: Uterine lipoleiomyoma typically presents as a well-demarcated mass showing hyperintensity with hypointense amorphous bundles on T1- and T2-weighted images with chemical shift artifacts. The hyperintense region suppressed on chemical shift fat-suppressed sequences and the hypointense bundles enhanced by contrast material pathologically correspond to mature fat tissue and smooth muscle tissue, respectively. Even in an atypical case with a small volume of fat tissue in the mass, a fat-suppression MRI sequence is especially useful for the diagnosis.
American Journal of Roentgenology 09/2007; 189(2):W100-4. · 2.78 Impact Factor
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ABSTRACT: We assessed magnetic resonance imaging (MRI) features and clinical characteristics of ovarian endometrioid adenocarcinoma.
A total of 31 patients with 39 surgically proven ovarian endometrioid adenocarcinomas were analyzed retrospectively. Histologically, 13 lesions in 12 patients arose from proven endometriomas (group A), and 26 lesions in 19 patients did not coexist with endometrioma (group B). The morphological pattern of the lesion on MRI was classified as a solid or a cystic type: A solid type was defined as a solid component occupying more than half of the lesion; and a cystic type was a cystic lesion with one or more mural nodules.
Altogether, 11 lesions in group A were the cystic type on MRI, whereas 24 lesions in group B were the solid type (P < 0.0001). Among the 11 cystic-type lesions in group A, the cysts of 5 lesions were hypointense on T1-weighted images, and the cysts of 6 lesions were hyperintense on T1- and T2-weighted images without "shading." The nuclear grade was higher (P = 0.0028) and the clinical stage more advanced (P = 0.0018) in group B compared to group A.
MRI of ovarian endometrioid adenocarcinomas revealed two types: a solid type and a cystic type. The lesions arising from endometriomas tended to be the cystic type on MRI and have a good prognosis. Preexisting endometrioma in this entity rarely showed "shading" on T2-weighted images.
Radiation Medicine 08/2007; 25(7):346-54.
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ABSTRACT: We report the magnetic resonance (MR) imaging findings of proliferative trichilemmal tumor (PTT), a rare benign tumor of the scalp. MR imaging showed a well-margined mass with isointense signal on T(1)-weighted images and heterogeneous mixed intensity signal on T(2)-weighted images After i.v. administration of contrast material, the mass showed significant enhancement, with small portions remaining unenhanced. It was considered that these findings reflected the pathological characteristics of PTT, which consists of solid lobules and cystic cavities.
Neuroradiology 07/2005; 47(6):406-10. · 2.82 Impact Factor
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ABSTRACT: Hepatic metastases are generally known to be composed of three structures (central necrosis, viable tumor cells, and peritumoral changes such as edema or congestion). We experienced a case of hepatic metastasis that was examined with ferucarbotran-enhanced magnetic resonance (MR) imaging, dynamic MR imaging using Gd-DTPA, and CT during arterial portography (CTAP), and was confirmed pathologically. MR imaging of this case vividly described the three pathological structures of the hepatic metastasis.
Radiation Medicine 03/2005; 23(1):75-9.
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ABSTRACT: Malignant fibrous histiocytoma (MFH) arising from the renal capsule is a rare tumor. We report a case of 55-year-old man with this tumor. Radiological imaging, including magnetic resonance (MR) imaging, was helpful in the differential diagnosis between MFH of the renal capsule and other renal tumors. In particular, a hypo-intense area identified on T(2)-weighted images reflecting the fibrous component was identified as an important characteristic of renal MFH.
Magnetic Resonance in Medical Sciences 01/2004; 2(4):199-202. · 0.97 Impact Factor
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ABSTRACT: This article presents an extremely rare case of solitary metastasis in the choroid plexus of the inferior horn of the right lateral ventricle three years after a colectomy for colon cancer. We discuss the current literature on this tumor together with the magnetic resonance (MR) imaging and computed tomography (CT) findings.
Magnetic Resonance in Medical Sciences 11/2003; 2(3):155-8. · 0.97 Impact Factor
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ABSTRACT: The magnetic resonance imaging findings in 2 patients pathologically proven to have pure leiomyoma of the prostate are reported.
Journal of Computer Assisted Tomography 30(6):910-2. · 1.22 Impact Factor
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ABSTRACT: The magnetic resonance imaging findings in 2 patients pathologically proven to have endometrial tuberculosis are reported.
Journal of Computer Assisted Tomography 30(1):62-4. · 1.22 Impact Factor
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ABSTRACT: We report the magnetic resonance (MR) imaging findings of ovarian transitional cell carcinoma (TCC), a rare subtype of ovarian surface epithelial-stromal cancer. MR imaging showed large solid mass including various amounts of cystic components and necrosis, vividly describing this entity's pathological structures.
European Journal of Radiology Extra.
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ABSTRACT: To study the magnetic resonance imaging findings of typical polypoid adenomyoma and correlate radiological findings with histopathologic findings.
Magnetic resonance imaging and histopathologic findings were retrospectively reviewed in 8 patients. The size, location, polyp's shape, and signal intensity of magnetic resonance imaging findings were evaluated.
The polyp's shape of 8 cases is pedunculated in 7 and sessile in 1, and all 8 cases are well circumscribed. Four cases (50%) show an isointense mass relative to the myometrium with small or large hyperintense foci on T1-weighted imaging (T1WI) or T2-weighted imaging (T2WI), reflecting the fascicle of smooth muscle with islands of hemorrhagic endometrial tissue. One case forms a large hemorrhagic cavity, being hyperintense on T1WI and hypointense on T2WI. Three cases (37%) show almost homogeneous isointense or hyperintense mass on T2WI.
When there is a well-defined polypoid mass protrusion into the uterine endometrial cavity that is isointense relative to the myometrium with small or large foci of high signal on T1WI or T2WI in a premenopausal woman, typical polypoid adenomyoma can be considered in the differential diagnosis.
Journal of Computer Assisted Tomography 31(3):463-8. · 1.22 Impact Factor
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ABSTRACT: We report a rare case of large cell neuroendocrine carcinoma of the uterine cervix as revealed by MR imaging and histologic findings.
European Journal of Radiology Extra.
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ABSTRACT: This report concerns a 40-year-old woman case of ovarian dysgerminoma presenting the MRI findings of predominantly hemorrhagic multilocules with papillary projections and irregular septa.
European Journal of Radiology Extra 61(1):23-25.
