| 1. |
- Asp, Mihaela, et al.
(author)
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The role of computed tomography in the assessment of tumour extent and the risk of residual disease after upfront surgery in advanced ovarian cancer (AOC)
- 2022
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In: Archives of Gynecology and Obstetrics. - : Springer Science and Business Media LLC. - 1432-0711.
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Journal article (peer-reviewed)abstract
- PurposeEpithelial ovarian cancer is usually diagnosed in the advanced stages. To choose the best therapeutic approach, an accurate preoperative assessment of the tumour extent is crucial. This study aimed to determine whether the peritoneal cancer index (PCI), the amount of ascites, and the presence of cardiophrenic nodes (CPLNs) visualized by computed tomography (CT) can assess the tumour extent (S-PCI) and residual disease (RD) for advanced ovarian cancer (AOC) patients treated with upfront surgery.MethodsIn total, 118 AOC cases were included between January 2016 and December 2018 at Skåne University Hospital, Lund, Sweden. Linear regression and interclass correlation (ICC) analyses were used to determine the relationship between CT-PCI and S-PCI. The patients were stratified in complete cytoreductive surgery (CCS) with no RD or to non-CCS with RD of any size. The amount of ascites on CT (CT-ascites), CA-125 and the presence of radiological enlarged CPLNs (CT-CPLN) were analysed to evaluate their impact on estimating RD.ResultsCT-PCI correlated well with S-PCI (0.397; 95% CI 0.252–0.541; p < 0.001). The risk of RD was also related to CT-PCI (OR 1.069 (1.009–1.131), p < 0.023) with a cut-off of 21 for CT-PCI (0.715, p = 0.000). The sensitivity, specificity, positive predictive value and negative predictive value were 58.5, 70.3, 52.2 and 75.4%, respectively. CT-ascites above 1000 ml predicted RD (OR 3.510 (1.298–9.491) p < 0.013).ConclusionCT is a reliable tool to assess the extent of the disease in advanced ovarian cancer. Higher CT-PCI scores and large volumes of ascites estimated on CT predicted RD of any size.
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| 3. |
- Epstein, Elisabeth, et al.
(author)
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Early-stage cervical cancer: Tumor delineation by magnetic resonance imaging and ultrasound - A European multicenter trial
- 2013
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In: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258. ; 128:3, s. 449-453
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Journal article (peer-reviewed)abstract
- Objective. To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. Patients and methods. Prospective multi-center trial enrolling 209 consecutive women with early-stage cervical cancer (FIGO IA2-IIA) scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology: remaining tumor, size, tumor stromal invasion <2/3 (superficial) or >= 2/3 (deep), and parametrial invasion. Results. Complete data were available for 182 patients. The agreement between US and pathology was excellent for detecting tumors, correctly classifying bulky tumors (>4 cm), and detecting deep stromal invasion (kappa values 0.84, 0.82, and 0.81 respectively); and good for classifying small tumors (<2 cm) and detecting parametrial invasion (kappa values 0.78 and 0.75, respectively). The agreement between MRI and histology was good for classifying tumors as <2 cm, or >4 cm, and detecting deep stromal invasion (kappa values 0.71, 0.76, and 0.77, respectively). It was Moderately accurate in tumor detection, and in assessing parametrial invasion (kappa values 0.52 and 0.45, respectively). The agreement between histology and US was significantly better in assessing residual tumor (p<0.001) and parametrial invasion (p<0.001) than the results obtained by MRI. Imaging methods were not significantly influenced by previous cone biopsy. Conclusion. US and MRI are highly accurate for the preoperative assessment of women with early-stage cervical cancer, although US may be more accurate in detecting residual tumors and assessing parametrial invasion. (C) 2012 Elsevier Inc. All rights reserved.
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| 5. |
- Holtås, Stig, et al.
(author)
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Signal alterations, artifacts and image distortion induced by a superparamagnetic contrast medium. A phantom study in a 0.3 tesla MR system
- 1990
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In: Acta Radiologica. - 1600-0455. ; 31:2, s. 213-216
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Journal article (peer-reviewed)abstract
- In a phantom study using a 0.3 tesla MR system the signal alterations, artifacts and image distortion induced by a bowel contrast medium containing superparamagnetic magnetite particles were evaluated. A concentration of 20 mg iron/l was most useful because it caused a significant signal reduction without disturbing artifacts and image distortion. The signal reduction was most pronounced on long TR/TE spin echo sequences. The appearance and distribution of artifacts are related to the direction of the static magnetic field and frequency encoding gradient. The size of artifacts is related to the concentration of the contrast medium and the band width used.
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| 6. |
- Liedberg, Fredrik, et al.
(author)
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Preoperative staging of locally advanced bladder cancer before radical cystectomy using 3 tesla magnetic resonance imaging with a standardized protocol
- 2013
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In: Scandinavian Journal of Urology. - : Informa UK Limited. - 2168-1813 .- 2168-1805. ; 47:2, s. 108-112
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Journal article (peer-reviewed)abstract
- Objective. The correlation between clinical tumour stage and pathological tumour stage in radical cystectomy specimens in locally advanced bladder cancer is suboptimal. Radiological methods have so far been of limited value in preoperative staging; however, the resolution with magnetic resonance imaging (MRI) has improved with further technical developments of the method. The aim of this study was to compare tumour stage at MRI with pathological tumour stage in the cystectomy specimen. Material and methods. Prospectively, 53 patients with invasive bladder cancer were preoperatively investigated with 3 tesla (3T) MRI using a standardized protocol. 3T MRI was performed at a standardized bladder volume. Clinical tumour stage, tumour stage at MRI and pathological tumour stage groups (Ta, Cis, T1/T2a, T2b/T3a, T3b/T4a), were compared, and sensitivity and specificity for organ-confined and non-organ-confined disease (stage T3a or above or lymph-node metastases) were analysed. Results. MRI overestimated tumour stage in 23 out of 47 patients (49%), whereas six patients (13%) were understaged. In the three groups of patients (those with the same stage group at MRI as in the cystectomy specimen, overestimated tumour stage and understaged patients), the time interval between transurethral resection of the bladder (TURB) and MRI did not differ significantly. Conclusions. Preoperative MRI overestimated tumour stage in almost half of the patients investigated in this study. Postoperative changes could have contributed to such overstaging with MRI.
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| 7. |
- Plana, Alba, et al.
(author)
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Radiologically enlarged cardiophrenic lymph nodes and CA-125 in relation to diaphragmatic carcinomatosis, surgical outcome, and overall survival in advanced ovarian cancer
- 2023
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In: Acta Oncologica. - 1651-226X. ; 62:5, s. 451-457
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Journal article (peer-reviewed)abstract
- BackgroundWe primarily aimed to determine whether the presence of enlarged cardiophrenic lymph nodes (CPLNs), visualized by computed tomography (CT), and CA-125 can be used to assess diaphragmatic carcinomatosis and residual disease (RD) in advanced ovarian cancer (AOC) patients treated with upfront surgery. The secondary aim was to determine the prognostic role of CT-CPLNs in overall survival (OS).Material and methodsA single-center, retrospective, population-based study was conducted of patients who underwent surgery for AOC from January 1, 2014-December 31, 2018. Suspicious CT-CPLNs were defined as having a short axis ≥5 mm. The median survival and rate of survival were calculated with the Kaplan–Meier method using multivariate Cox regression analyses, including comparisons of complete cytoreductive surgery (CCS; defined as the complete removal of all intra-abdominal tumor) versus noncomplete cytoreductive surgery (non-CCS) and analyses related to CT-CPLN status and preoperative CA-125 values.ResultsWe included 208 patients. CT-CPLNs correlated with both diaphragmatic carcinomatosis (OR 3.59, 95% CI 1.81–7.16, p ConclusionEnlarged CPLNs on CT scans and CA-125 levels correlate with diaphragmatic carcinomatosis and RD at the end of the surgery. The strongest prognostic factor for OS remains CCS, regardless of the CT-CPLN status.
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| 8. |
- Wallengren, Nils-Olof
(author)
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Double-contrast MRI for the staging of rectal carcinoma: Technical aspects and clinical experience.
- 2001
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Doctoral thesis (other academic/artistic)abstract
- Aim of the study Today´s methods for the staging of rectal carcinoma: ultrasonography with transrectal probe, CT, MRI or MRI with a rectal coil, all have limitations. The aim was therefore to develop a new, double-contrast MRI method for evaluation of rectal carcinoma. The idea was that a rectally applied contrast medium causing distension and signal void of the rectal lumen and an intravenous injection of contrast medium containing gadolinium to increase the signal from the mucosa would facilitate tumor staging and allow assessment of the rectal wall. Material, Methods and Results In a phantom study, using a 0.3T MR system, the signal alterations, artifacts and distorsion induced by the super-paramagnetic bowel contrast medium, Ferristene, were evaluated. A concentration of 20 mg iron/liter gave the best results. In a study of 12 patients, using a 0.3T MR system, the double-contrast MRI made possible the evaluation of the normal rectal wall and could be used for staging of rectal carcinoma. In a study of 29 patients, using a 0.3T MR system, the double-contrast MRI had a sensitivity of 100%, a specificity of 70% and an accuracy of 90% in distinguishing tumor stages more advanced than Dukes´ A. In a prospective, multicenter study using 1.0 or 1.5T MR systems, it was shown that the method had a sensitivity of 97%, a specificity of 50% and an accuracy of 82% for staging rectal carcinoma more advanced than stage T2. The possibility of replacing Ferristene by air in the double-contrast method was evaluated in ten patients. Ferristene was superior, mainly because the patients were unable to keep the air in the rectum. Conclusion The study has shown that double-contrast MRI is a robust and reliable method for staging of rectal carcinoma.
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| 9. |
- Wallengren, Nils-Olof, et al.
(author)
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Preoperative staging of rectal carcinoma using double-contrast MR imaging. Technical aspects and early clinical experiences
- 1996
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In: Acta Radiologica. - 1600-0455. ; 37:5, s. 791-798
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Journal article (peer-reviewed)abstract
- PURPOSE: To improve preoperative staging of rectal carcinoma with MR imaging, using a double-contrast technique. MATERIAL AND METHODS: Imaging was performed in 12 patients before and after i.v. injection of Gd-DTPA and rectal administration of a superparamagnetic contrast medium, mainly containing magnetite. The diagnostic information was evaluated and compared with findings at surgery and histopathological analysis. RESULTS: The superparamagnetic contrast medium enema caused a distension of the rectum and intraluminal signal void, whereas Gd-DTPA enhanced the mucosa in T1-weighted images. This allowed an evaluation of the normal rectal wall and separation of the mucosa, tunica muscularis and perirectal space in all cases, which was not possible in T1- or T2-weighted precontrast images. The rectal carcinoma could be delineated and tumor invasion to the rectal wall determined in all cases. The findings in postcontrast MR corresponded with the findings at histopathological examination in 11 of 12 patients. The histopathological examination in one patient revealed metastases (< 1 cm) in regional lymph nodes, too small to be identified in pre- or postcontrast MR images. CONCLUSION: Double-contrast-enhanced MR imaging allows evaluation of the normal rectal wall and preoperative staging of rectal carcinoma.
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| 10. |
- Wallengren, Nils-Olof, et al.
(author)
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Rectal carcinoma: double-contrast MR imaging for preoperative staging
- 2000
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In: Radiology. - 1527-1315. ; 215:1, s. 108-114
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Journal article (peer-reviewed)abstract
- PURPOSE: To evaluate and compare the imaging findings and staging of rectal carcinoma by using conventional magnetic resonance (MR) imaging, MR imaging with an enema of superparamagnetic ferristene-based contrast material, and MR imaging with an enema of ferristene solution plus intravenous injection of gadodiamide. MATERIALS AND METHODS: Twenty-nine patients (17 women, 12 men; age range, 39-91 years) referred with a diagnosis of rectal carcinoma were examined. Analysis of the rectal wall and staging of the tumor were performed. In all patients, the MR imaging findings were correlated with the histopathologic findings. RESULTS: The contrast material enema caused distention of the rectum and an intraluminal signal void, whereas the gadodiamide injection caused enhancement of the mucosa on T1-weighted images. This enhancement enabled evaluation of the normal rectal wall and differentiation of the mucosa, tunica muscularis, and perirectal space, which was not possible on the nonenhanced images. Double-contrast (ferristene solution plus gadodiamide) MR imaging was superior to imaging with only ferristene-based contrast material and had a sensitivity of 100%, specificity of 70%, and accuracy of 90% in distinguishing tumor stages worse than Dukes A. CONCLUSION: Double contrast material-enhanced MR imaging enables accurate rectal carcinoma staging, which is not possible at nonenhanced imaging.
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