Myometrial invasion and cervical invasion by endometrial carcinoma: evaluation by CO2-volumetric interpolated breathhold examination (VIBE)

PURPOSE: To assess myometrial invasion and cervical invasion by endometrial carcinoma, using CO2-volumetric interpolated breathhold examination (VIBE) enabling more precise evaluation of depth of tumor invasion. MATERIALS AND METHODS: CO2-VIBE was performed in 21 cases of endometrial carcinoma (Stage Ia-IIb) prior to treatment. The images were interpreted by performing multiplanar reconstruction (MPR), and the findings obtained from the images (degree of myometrial invasion and presence or absence of cervical invasion) were assessed in comparison with the histopathological diagnosis. RESULTS: The sites of the endometrial carcinoma lesions were clearly visualized by the CO2-VIBE method. Evaluation of the degree of myometrial invasion enabled a high correct diagnosis rate of 90.5%, and evaluation for the presence of cervical invasion also allowed a high correct diagnosis rate of 90.5%. CONCLUSION: VIBE permits evaluation of any plane desired by means of thin slices, and it is a truly revolutionary method for preoperative evaluation of depth of invasion of endometrial carcinoma that enables highly accurate determination of the extent of lesion sites and degree of invasion before treatment.     

MR of mandibular invasion in patients with oral and oropharyngeal malignant neoplasms.

PURPOSETo investigate whether MR imaging is an accurate means of assessing mandibular invasion in patients with carcinoma.METHODSWe retrospectively studied the MR scans of 22 patients with pathologic or surgical confirmation of mandibular invasion from oral and oropharyngeal cancers. The MR images were blindly analyzed using primary criteria of: (a) cortical breakdown, (b) replacement of bone marrow fat, or (c) gadopentetate dimeglumine enhancement of a mass at the bone marrow defect. Secondary criteria of: (a) contiguous soft-tissue mass, and (b) mass on both sides of the mandibular cortex were also examined. Mandibular invasion was graded as periosteal/cortical, medullary, or no invasion.RESULTSPrimary positive findings of cortical breakdown and abnormal bone marrow signal were highly sensitive (100%) for periosteal/cortical invasion and medullary involvement, respectively. However, a high rate of false-positive studies hampered the MR accuracy, which fell into the 73% to 77% range. A negative MR study was highly predictive, but a positive study was less valuable. Gadolinium enhancement added little to the MR study''s accuracy. False-positive studies mainly occurred in the setting of prior irradiation, osteoradionecrosis, and odontogenic infections.CONCLUSIONSMR imaging is a sensitive method for detecting mandibular invasion but has a low positive predictive value. A negative study virtually excludes cortical/periosteal or bone marrow invasion.     

鼻咽癌侵犯周围结构与肿瘤分期关系的MRI研究

目的 应用MRI探讨鼻咽癌侵犯周围结构的规律及其与肿瘤T分期的关系.方法 回顾性分析1573例经病理证实的鼻咽癌初诊患者,根据2008年鼻咽癌T分期,观察鼻咽癌向周围结构侵犯的MRI表现和规律.对鼻咽癌周围不同方向结构的侵犯率均采用Z检验分析.结果 鼻咽癌对周围结构的侵犯:咽颅底筋膜1299例(82.58%)、咽旁间隙1090例(69.29%)、鼻腔304例(19.33%)、口咽49例(3.12%)、颈动脉间隙514例(32.68%)、翼内肌661例(42.02%)、翼外肌210例(13.35%)、颅底骨质943例(59.95%)、颅神经630例(40.05%)、鼻窦242例(15.38%).T分期分布:T1期为242例(15.38%),T2期为288例(18.31%),T3期为410例(26.06%),T4期为633例(40.24%).鼻腔受累的病例中90.46%(275/304)合并T3以上的结构受累;口咽受累均伴有T3以上结构受累;翼内肌受累的病例中69.14%(457/661)伴有T4结构侵犯;鼻窦受累的病例中92.15%(223/242)伴有T4结构侵犯.鼻咽癌侵犯周围结构的模式为向侧方(1299例)多于向上(943例)侵犯(Z=14.025,P＜0.01);向侧方侵犯多于向下(49例)(Z=45.032,P＜0.01);向上侵犯多于向下(Z=34.301,P＜0.01);向前侵犯(304例)多于向下(Z=14.404,P＜0.01).结论 鼻咽癌侵犯周围结构的模式为向侧方侵犯多于向上;向侧方侵犯多于向下;向上侵犯多于向下;向前侵犯多于向下.     

MRI-detected skull-base invasion

Purpose

With advances in imaging and radiotherapy, the prognostic value of skull-base invasion in nasopharyngeal carcinoma (NPC) needs to be reassessed. We aimed to define a classification system and evaluate the prognostic value of the classification of magnetic resonance imaging (MRI)-detected skull-base invasion in NPC treated with intensity-modulated radiotherapy (IMRT).

Patients and materials

We retrospectively reviewed 749 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated NPC and treated with IMRT.

Results

MRI-detected skull-base invasion was not found to be an independent prognostic factor for overall survival (OS), distant metastasis-free survival (DMFS), local relapse-free survival (LRFS), or disease-free survival (DFS; p?>?0.05 for all). Skull-base invasion was classified according to the incidence of each site (type I sites inside pharyngobasilar fascia and clivus vs. type II sites outside pharyngobasilar fascia). The 5-year OS, DMFS, LRFS, and DFS rates in the classification of skull-base invasion in NPC were 83 vs. 67?%, 85 vs.75?%, 95 vs. 88?%, and 76 vs. 62?%, respectively (p?Conclusion MRI-detected skull-base invasion is not an independent prognostic factor in patients with NPC treated with IMRT. However, classification according to the site of invasion has prognostic value. Therefore, patients with various subclassifications of stage T3 disease may receive treatment with different intensities; however, further studies are warranted to prove this.     

Parametrial invasion in carcinoma of cervix: role of MRI measured tumour volume

The aim of the study was to determine the correlation between MRI measured tumour volume and parametrial invasion on histology in the evaluation of carcinoma of the cervix showing full thickness stromal invasion (FTSI). Original MR images of 159 surgical cases of carcinoma of the cervix retrieved from the MR image bank of the department were analysed retrospectively. Tumour volume from the maximum tumour diameters in each case was computed using the standard formula for an ellipse and correlated with parametrial invasion on histology. Of 105 cases showing FTSI on axial T(2) weighted MRI, tumour volume between the two groups of cases, with parametrial invasion (n=27) and without parametrial invasion (n=78), shows a statistically significant difference (p=0.006). Best accuracy of 60.95%, sensitivity 59.26% and specificity 61.54% was found for tumour volume of 36.39 cm(3). The study concludes that MRI measured tumour volume is associated with low accuracy in the evaluation of parametrial invasion in carcinoma of cervix showing FTSI in axial T(2) weighted MR images and may not help as an additional diagnostic criterion to predict parametrial invasion pre-operatively.     

PET/CT诊断恶性淋巴瘤对肝和(或)脾的侵犯

目的 根据恶性淋巴瘤侵犯肝和(或)脾的PET/CT影像学表现,总结肝和(或)脾内病变累及的特点,为以后正确诊断提供依据.方法 41例累及肝和(或)脾的恶性淋巴瘤患者,共进行52例次全身PET/CT检查,追踪分析这些患者的临床资料及PET/CT影像表现,以期发现恶性淋巴瘤侵犯肝和(或)脾的规律.所有病例均由组织病理学检查证实,其中包括非霍奇金淋巴瘤(NHL)38例,霍奇金淋巴瘤(HL)2例,胃黏膜相关淋巴组织淋巴瘤1例.静脉注射18F-脱氧葡萄糖(FDG) 222～555 MBq 1h后行PET/CT显像.测定肿瘤体积和平均标准摄取值(SUVavg),并与PET/CT检查中单纯CT平扫(41例)结果进行对照.结果 淋巴瘤侵犯肝和脾的表现形式明显不同.(1)有30例(30/41)患者肝受累及,肝侵犯以肝实质内结节或肿块状病变和肝门部淋巴结受累,并形成体积较大的肿块压迫和侵犯邻近的肝实质最为常见.(2)有23例(23/41)患者脾受侵犯,脾侵犯以脾体积明显增大,PET显示整个脾代谢弥漫性均匀性增高为主要表现.(3)除全身淋巴结组织和肝、脾侵犯以外,还有一些少见部位的累及:肺内13例、骨皮质和骨髓内12例、胃9例、胸膜6例、皮下软组织5例等.结论 PET/CT可以较准确地发现恶性淋巴瘤对肝、脾的侵犯,并准确显示病灶大小、形态和分布,为淋巴瘤的诊断和准确分期提供帮助.     

Impact of cartilage invasion on treatment and prognosis of laryngeal cancer

Invasion of laryngeal cartilage has long been considered as a contraindication to radiation treatment and to all types of conservation surgery. With the advent of axial imaging techniques clarification of the submucosal extent of disease became possible. However, controversies regarding diagnosis (preferred modality, accuracy of detection of cartilage invasion) and treatment of cartilage invasion (Is cartilage invasion really a contraindication for irradiation treatment?) arose. Based on currently accepted criteria, CT appears to be more specific in detecting neoplastic cartilage invasion than MRI, but tends to underestimate invasion and may therefore result in undertreatment. Magnetic resonance has a higher sensitivity than CT for detection of cartilage invasion. The superiority of MRI lies in its ability to detect intracartilaginous tumor spread. Unfortunately, MR findings suggesting neoplastic cartilage invasion may be false positive in a considerable number of instances. Two MRI-dependent parameters appear to be significant as a prognostic factor for success of radiation therapy: tumor volume and abnormal MR signal pattern in cartilage. Minimal abnormal MR signal patterns in cartilage in patients with small tumors (under 5 cc) does not appear to be a very ominous finding for tumor recurrence after radiation therapy. On the other hand, abnormal MR signal pattern in cartilage combined with large tumor volume (above 5 cc) appears to worsen the prognosis significantly. If voice conservation surgery is being considered, MR imaging is useful for assesing those structures (such as cartilages) whose involvement would contraindicate partial laryngectomy. Magnetic resonance imaging appears to be the optimal method of examination in cooperative patients. If MRI fails or if it is contraindicated, CT may still be recommended. The radiologist's experience with CT or MRI also determines the choice between the two modalities.     

Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation

The computed tomographic (CT) scans of 80 patients with bronchogenic carcinoma classified as indeterminate for direct mediastinal invasion were retrospectively reviewed after the patients had undergone thoracotomy. Forty-eight (60%) of the masses were resectable, without invasion of the mediastinum, 18 (22%) focally invaded the mediastinum but were technically resectable, and 14 (18%) invaded the mediastinum and were not technically resectable. Although in most circumstances in this relatively small subset of patients CT was not helpful in differentiating masses with and without mediastinal invasion, CT was able to separate a large group of masses that were likely to be technically resectable. Thirty-six (97%) of 37 masses with one or more of these CT findings were considered technically resectable: contact of 3 cm or less with mediastinum, less than 90 degrees of contact with aorta, and mediastinal fat between mass and mediastinal structures. Of these 36 masses, 28 were resectable without mediastinal invasion, and eight were resectable with focal limited mediastinal invasion.     

Jugular vein invasion rate in surgically operated paragangliomas: a multimodality retrospective study

PurposeTo assess the rate of jugular vein (JV) invasion by paragangliomas and imaging's ability to predict invasion.MethodsImaging studies of patients with paragangliomas were evaluated for JV invasion. Rates of invasion by different paragangliomas and each modality's accuracy were determined.ResultsJV invasion occurred in 11/11 glomus jugulares (GJs), 3/5 glomus vagales, and 2/8 carotid body tumors. Accuracy for magnetic resonance imaging (92.3%), computed tomography (92.3%), and digital subtraction angiography (94.1%) was comparable.ConclusionsJV invasion is characteristic of but not specific to GJs. All modalities show high accuracy in detecting invasion.     

Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging

The purpose of this study was to determine the accuracy of magnetic resonance imaging (MRI) for evaluating the depth of myometrial invasion, potential sources of pitfalls, and the usefulness of contrast-enhanced series. Eighty-five patients with a pathologic diagnosis of endometrial carcinoma underwent preoperative MRI (plain and contrast-enhanced). Grade of myometrial invasion, presence of junctional zone (JZ), fibromyomas, and tumoral thickness were evaluated by two groups of radiologists blinded to pathologic results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI in determining the depth of myometrial invasion were evaluated. The sensitivity/specificity for plain MR was 64.1-64.1/93.5-100 for both observers. Assessing deep myometrial invasion, sensitivity, and NPV improved significantly (P = 0.002, P = 0.003 for both observers) when comparing plain and whole study series. Tumoral thickness (P = 0.16, P = 0.13, for the two observers) and presence or absence of JZ (P = 0.41, P = 0.14) did not influence myometrial invasion assessment. Gadolinium-enhanced series improve the assessment of deep myometrial invasion in endometrial carcinoma. J. Magn. Reson. Imaging 2000;12:460-466.     

Esophageal invasion by thyroid carcinomas: prediction using magnetic resonance imaging

PURPOSE: We evaluated the accuracy of magnetic resonance imaging (MRI) in predicting esophageal invasion by thyroid carcinomas and established an optimal criterion for diagnosing esophageal invasion. METHOD: The MRI findings (size and margins of tumor, ratio of tumor contact to the esophagus, shape and displacement of the esophagus, and tumor invasion to the outer and inner layers of the esophagus) in 67 patients with thyroid carcinomas were retrospectively reviewed and correlated with surgical and pathologic findings. Logistic modeling was used to determine the significant factors for predicting esophageal invasion. RESULTS: Seventeen (34%) of the 67 patients had pathologically or surgically verified esophageal invasion. The logistic modeling revealed that outer layer invasion (P < 0.001) and poorly defined margins (P = 0.001) were the significant factors. The outer layer invasion showed the highest accuracy of 91%, with 82% sensitivity and 94% specificity. The addition of poorly defined margins to this criterion did not improve its accuracy. CONCLUSION: Esophageal invasion by thyroid carcinoma was accurately predicted with MRI, and an MRI finding of outer layer invasion was optimal for diagnosing esophageal invasion.     

Tumor invasion of the chest wall and mediastinum in lung cancer: evaluation with pneumothorax CT

For preoperative evaluation of chest wall and mediastinal invasion by lung cancer, computed tomography (CT), combined with artificial pneumothorax (pneumothorax CT), was performed in 43 patients with lung cancer in whom conventional CT scans showed that the mass was contiguous to the chest wall (n = 30) and/or mediastinum (n = 25) but without evidence of definite tumor invasion. Invasion was diagnosed on the basis of whether an air space existed between the mass and the adjacent structures. In three patients pneumothorax was not produced. After the procedure, four patients developed symptomatic pneumothorax, and one, subcutaneous emphysema. Comparison of diagnoses based on findings at pneumothorax CT, surgery, and pathologic examination showed that pneumothorax CT is 100% accurate for chest wall invasion and 76% accurate for mediastinal invasion. The authors conclude that this procedure is helpful in accurate evaluation of the T criterion in lung cancer, especially for patients in whom findings at conventional CT suggest tumor invasion of the chest wall and mediastinum.     

混合磨玻璃结节肺腺癌胸膜侵犯的HRCT表现

目的 探讨与胸膜毗邻的混合磨玻璃密度结节(mGGN)(Ⅰ期)肺腺癌胸膜侵犯的高分辨率CT(HRCT)表现.方法 回顾性分析经手术病理证实的20例mGGN型肺腺癌与胸膜的毗邻关系,分析最大径与胸膜侵犯的关系. 结果 (1) mGGN与胸膜毗邻关系分型:Ⅰ型,典型及不典型胸膜凹陷征,10枚,均未见胸膜侵犯;Ⅱa型,mGGN与胸膜相贴处为磨玻璃密度成分,4枚,均未见胸膜侵犯;Ⅱb型,mGGN与胸膜相贴处为实性成分,6枚,均见胸膜侵犯.(2) mGGN胸膜侵犯与未侵犯组病灶最大径差异无统计学意义(P=0.694).结论 与胸膜毗邻的mGGN型肺腺癌与胸膜相贴处为实性成分是诊断胸膜侵犯的可靠征象.     

鼻咽癌颅底侵犯的CT与MRI征象对比分析

目的:探讨CT及MRI在鼻咽癌颅底侵犯诊断中的应用价值.方法:回顾性分析经病理证实的52例鼻咽癌的CT及MRI图像,并以放疗后6个月的影像资料和临床资料为参考依据,比较CT与MRI在鼻咽癌颅底受侵诊断中的应用价值.结果:52例放疗6个月后定性诊断结果为颅底受侵41例,其中颅底骨质受侵39例,颅底肌肉受侵41例.52例中...     

Myometrial invasion by endometrial carcinoma: sonographic assessment

The depth of myometrial invasion by endometrial carcinoma was evaluated using real-time sonography (US) in 20 patients with histologically proved adenocarcinoma of the endometrium. In 14 of 20 (70%) cases, US-based estimation of the depth of myometrial invasion was within 10% of the actual measurement in the gross specimen. The US-based estimation of tumor invasion was low in seven patients, high in four patients, and agreed with pathologic findings (+/- 5%) in nine patients. In four patients with polypoid intraluminal extension of tumor, a deeply invasive tumor was suspected on US but was not found on pathologic examination. In 12 superficially invasive tumors, the continuity of the demarcating subendometrial halo was intact in nine and incomplete in three. In six patients with deeply invasive tumors, this zone was partially disrupted in four, totally disrupted in one, and intact in one. Errors of estimation of the depth of myometrial invasion on US most frequently occurred when a tumor had a significant intraluminal polypoid extension. Demonstration of a subendometrial halo usually indicated superficial invasion, whereas the absence of a halo was frequently associated with deep invasion.     

早期胃癌内镜、病理检查特征及其浸润深度相关性研究

 目的 回顾性分析早期胃癌(early gastric cancer,EGC)内镜、病理检查特征及其与浸润深度的关系。方法 选择经胃镜下诊断+活组织病理检查及手术后病理确诊为EGC的72例患者资料,分析内镜诊断及其临床病理特征,探讨EGC的内镜、临床病理特征及其与浸润深度相关性。结果 EGC患者的性别、年龄、主要症状、分化程度、内镜下形态学分型均与浸润深度无相关性。病灶大小直径≥2 cm者,15例侵及黏膜下层,占60.0%,病灶大小与浸润深度存在统计学关联(χ²＝22.273,P=0.000, Cramer’s V=0.556);病灶部位与浸润深度存在统计学关联(χ²＝17.743,P=0.000,Cramer’s V =0.496),上部侵及黏膜下层占77.78%,而中部及下部仅12例侵及黏膜下层(19.05%)。结论 EGC的病灶部位、病变大小与肿瘤浸润深度密切相关,探索EGC浸润深度相关的内镜及病理表现规律,可为EGC的检出、治疗与预后判断提供进一步指导依据。     

Diagnosis of chest wall invasion by lung cancer: useful criteria for exclusion of the possibility of chest wall invasion with MR imaging

PURPOSE: To compare the accuracy of thin-section CT, conventional static MR imaging (conventional MRI), and breathing dynamic echo planar magnetic resonance imaging (BDEPI) in evaluating lung cancer invasion to the chest wall. MATERIALS AND METHODS: Thin-section CT, conventional MRI, and BDEPI were performed preoperatively in 20 patients suspected of having primary lung cancers adjacent to the chest wall on conventional CT. The results of imaging findings were compared with those of surgical and histopathological findings. RESULTS: All patients were confirmed to have no chest wall invasion after surgery. By thin-section CT, 10 of 20 patients were correctly diagnosed as having no chest wall invasion (50% specificity). Two of the 20 patients were incorrectly diagnosed as having chest wall invasion by conventional MRI and BDEPI (90% specificity). CONCLUSION: When chest wall invasion is suspected on CT scans, static and breathing dynamic MRI are recommended to avoid false positive interpretations.     

Helical CT with CT angiography in assessing periampullary neoplasms: identification of vascular invasion

PURPOSE: To determine the accuracy of helical computed tomography (CT) with CT angiography in identifying vascular invasion by periampullary neoplasms and to assess the added value of CT angiography. MATERIALS AND METHODS: Sixty-nine patients suspected of having periampullary neoplasms were examined. Images from dual phase helical CT with CT angiography were compared with surgical findings in 36 patients. Arterial and venous invasion were assessed separately. Accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined for CT alone and for CT supplemented with CT angiography. RESULTS: The accuracy, PPV, and NPV of helical CT with CT angiography in identifying venous invasion was 92% (33 of 36 patients), 86% (12 of 14 patients), and 95% (21 of 22 patients), respectively. When transverse CT images alone were analyzed, accuracy decreased to 69% (25 of 36 patients) (P =.005); PPV and NPV were 63% (five of eight patients) and 71% (20 of 28 patients), respectively. When identifying arterial invasion, the accuracy of CT with CT angiography and of CT alone was 86% (31 of 36 patients). PPV and NPV also were identical at 71% (five of seven patients) and 90% (26 of 29 patients), respectively. CONCLUSION: CT angiography significantly increases the ability to identify venous invasion when compared with CT alone but does not improve detection of arterial invasion.     

Long-term results of celiac Ganglia block: correlation of grade of tumoral invasion and pain relief

OBJECTIVE: We evaluated the long-term results and response rates of celiac ganglia block to the level of tumor invasion of the celiac region. SUBJECTS AND METHODS. Forty-one patients each with an inoperable intraabdominal carcinoma who were referred to our department for celiac ganglia block were included in this study. Tumor invasion of the celiac ganglia region was graded on a four-point scale according to CT features (grade I = no invasion, grade II = invasion < 50%, grade III = invasion > 50%, and grade IV = complete invasion). Subjective pain levels (0 = no pain, 10 = worst pain) were obtained from the patients, and objective criteria (change in daily analgesic doses) were noted before the procedure and during the follow-up to determine effectiveness of the celiac ganglia block. RESULTS: Celiac ganglia block was successfully performed in all 41 patients (100%). In 39 (95%) of 41 patients, pain decreased significantly after the procedure, and the pain level did not change in the remaining two patients. Major complications were not encountered in any of the patients. Minor complications were observed in 35 patients (85%). Mean pain intensity and mean daily analgesic consumption significantly decreased after the procedure in all four groups. The amount of pain decrease for these two parameters was inversely related to degree of invasion. Responses of the patients were obtained at the end of the first week after the procedure and remained unchanged during long-term follow-up. CONCLUSION: Percutaneous celiac ganglia block, particularly when performed in earlier stages of ganglia invasion, is an effective, easy, and safe procedure with successful long-term results.     

Venous invasion in renal cell carcinoma: A correlative clinical and radiologic study

Angiography, cavography, ultrasound (US), computed tomography (CT), and low-field magnetic resonance imaging (MRI) were used to explore venous tumor invasion in 86 patients with renal cell carcinoma. The findings confirm previous experience that ultrasound and dynamic CT are reliable methods for the evaluation of venous invasion. Low-field magnetic resonance imaging does not improve tumor staging. In case of equivocal findings, vena cavography should be used as a complementary examination.