Chuan Xing Li

CT, MRI, and FDG-PET/CT imaging findings of abdominopelvic desmoplastic small round cell tumors: Correlation with histopathologic findings

OBJECTIVE To analyze computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT imaging features of abdominopelvic desmoplastic small round cell tumor (DSRCT) and to improve the diagnostic efficacy of these techniques for the detection of such tumor. METHODS We retrospectively analyzed 7 cases of abdominopelvic DSRCT confirmed by histopathologic analysis. Among the 7 patients, 5 patients had undergone CT scanning, 2 of which were also examined with FDG-PET/CT imaging, and 2 had undergone MRI. Unenhanced and contrast-enhanced examinations were performed in all patients, and 2 patients had also undergone dynamic CT contrast-enhanced examinations. Image characteristics, such as shape, size, number, edge, attenuation, and intensity of each lesion before and after contrast enhancement were analyzed and compared with the pathomorphology of the tumors. RESULTS Multiple large masses in the abdominopelvis were detected in 6 cases, and a large mass in the pelvis was detected in 1 case. Six cases showed largest mass in pelvis, and 1 case in mesentery. None of the masses had a definite organ origin. CT showed soft tissue masses with patchy foci of hypodense areas. MR T1-weighted images revealed lesions with mild hypointense areas and patchy hypointense areas in 2 cases and lesions with patchy hyperintense areas in 1 case. T2-weighted images showed lesions with mixed isointense and hyperintense areas in 1 case and lesions with mixed hypointense, isointense, and hyperintense areas in another. Contrast-enhanced CT and T1-weighted images showed mildly heterogeneous enhancement of the lesions. Other associated findings included peritoneal seeding (n=3), peritoneal effusions (n=3), hepatic metastasis (n=2), bone metastasis (n=1), and mesenteric and retroperitoneal lymphadenopathy (n=4). FDG-PET/CT showed multiple nodular foci of increased metabolic activity in the abdominopelvic masses, in the hepatic and right ilium in 1 case and foci of increased metabolic activity in the pelvic mass in another. CONCLUSION Radiological findings of DSRCT include multiple masses with heterogeneous density/intensity and without an organ origin. Other common associated findings include peritoneal seeding, peritoneal effusion, hepatic metastasis, and retroperitoneal lymphadenopathy. DSRCT should be considered in the differential diagnosis of regional tumors in adolescents and young adults. FDG-PET/CT can provide additional information on the stage of the tumor.

Short- to mid-term evaluation of CT-guided 125I brachytherapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma.

Objective: To evaluate the safety and short- to mid-term efficacy of CT-guided 125I brachytherapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma (HCC). Methods: From November 2004 to May 2008, ten patients with intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for HCC underwent 125I brachytherapy under the guidance of computed tomography. They were followed up for 4 to 44 months after brachytherapy and the treatments efficacy was evaluated. Results: Among the ten patients, one died of liver failure 15 months and one of renal failure 29 months after brachytherapy. All other eight patients survived till the end of the follow-up. Four of them presented good control of local tumor and no systemic recurrence; the other four survived with tumor presence, including three with recurrent tumors undergoing a second 125I brachytherapy and one switching to a biological target drug treatment. The local control rates after 4, 6, 12 and 24 months are 90.3%, 84.0%, 75.6% and 72.7% respectively. Procedure-related complications were minimal. Conclusion: CT-guided 125I brachytherapy is a safe and effective therapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma. It has the advantages of minimal invasion, significant short- to mid-term local control and minimal complications.

Pulmonary mucosa-associated lymphoid tissue lymphoma: Computed tomography and 18F fluorodeoxyglucose-positron emission tomography/computed tomography imaging findings and follow-up

Purpose: The aim of the study was to present the computed tomography (CT) and fluorine 18 (18F) fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT imaging findings of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma and evaluate their roles in the follow-up of this tumor. Methods: Computed tomography and FDG-PET/CT imaging findings of 18 cases of pathologically proven pulmonary MALT lymphoma were reviewed retrospectively. Results: Multiple and solitary lesions were detected in 15 and 3 patients, respectively. Of those patients with multiple pulmonary lesions, 12 were bilateral, and 3 were unilateral. A total of 51 pulmonary lesions were identified in 18 patients, which included lesions with consolidation (31/51), mass and nodule (12/51), and ground-glass attenuation (8/51). 18F fluorodeoxyglucose-PET/CT imaging (n = 8) revealed increased FDG uptake in all lesions in 8 cases. At follow-up, 3 patients experienced complete remission, 10 had partial remission, and 2 remained stable. Conclusions: Computed tomography and FDG-PET/CT images of the pulmonary MALT lymphoma usually reveal multiple, bilateral consolidations, masses, or nodules with air bronchogram and increased FDG uptake. Computed tomography and FDG-PET/CT imaging play important roles in the diagnosis and follow-up of patients with pulmonary MALT lymphoma.

Hepatocellular carcinoma: Clinical study of long-term survival and choice of treatment modalities

AIM To analyze the prognostic factors of 5-year survival and 10-year survival in hepatocellular carcinoma (HCC) patients, and to explore the reasons for long-term survival and provide choice of treatment modalities for HCC patients. METHODS From January 1990 to October 2012, 8450 HCC patients were included in a prospective database compiled by the Information Center after hospital admission. Long-term surviving patients were included in a 10-year survival group (520 patients) and a 5-year survival group (1516 patients) for analysis.The long-term survival of HCC patients was defined as the survival of 5 years or longer. Clinical and biologic variables were assessed using univariate and multivariate analyses. The survival of patients was evaluated by follow-up data. RESULTS The long-term survival of HCC patients was associated with the number of lesions, liver cirrhosis and Child-Pugh classification. It was not found to be associated with tumor diameter, histological stage, and pretreatment level of serum α-fetoprotein. The differences in clinical factors between the 5-year survival and the 10-year survival were found to be the number of lesions, liver cirrhosis, Child-Pugh classification, and time elapsed until first recurrence or metastasis. The survival period of different treatment modalities in the patients who survived for 5 years and 10 years showed significant differences: (in order of significance) surgery alone > surgery-transcatheter arterial chemoembolization (TACE) > TACE-radiofrequency ablation (RFA) > TACE alone > surgery-TACE-RFA. The 10-year survival of HCC patients was not associated with the choice of treatment modality. CONCLUSION This retrospective study elucidated survival outcomes, prognostic factors affecting survival and treatment modalities in HCC patients.