David T. Fetzer

Does colon cancer ever metastasize to bone first? a temporal analysis of colorectal cancer progression

BackgroundIt is well recognized that colorectal cancer does not frequently metastasize to bone. The aim of this retrospective study was to establish whether colorectal cancer ever bypasses other organs and metastasizes directly to bone and whether the presence of lung lesions is superior to liver as a better predictor of the likelihood and timing of bone metastasis.MethodsWe performed a retrospective analysis on patients with a clinical diagnosis of colon cancer referred for staging using whole-body 18F-FDG PET and CT or PET/CT. We combined PET and CT reports from 252 individuals with information concerning patient history, other imaging modalities, and treatments to analyze disease progression.ResultsNo patient had isolated osseous metastasis at the time of diagnosis, and none developed isolated bone metastasis without other organ involvement during our survey period. It took significantly longer for colorectal cancer patients to develop metastasis to the lungs (23.3 months) or to bone (21.2 months) than to the liver (9.8 months). Conclusion: Metastasis only to bone without other organ involvement in colorectal cancer patients is extremely rare, perhaps more rare than we previously thought. Our findings suggest that resistant metastasis to the lungs predicts potential disease progression to bone in the colorectal cancer population better than liver metastasis does.

Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis.

Abdominal ultrasound fails to detect over one‐fourth of hepatocellular carcinoma (HCC) at an early stage in patients with cirrhosis. Identifying patients in whom ultrasound is of inadequate quality can inform interventions to improve surveillance effectiveness.

The HIPAA privacy rule and protected health information: implications in research involving DICOM image databases.

der Much of the medical imaging community now uses th Digital Imaging and Communication in Medicine (DICOM) format, developed by the American College Radiology and the National Electrical Manufacturers A sociation as a standard system for viewing, archiving, retrieving, and transferring images ( 1). Benefits stem from the fact that a single standard provides physicians pra ing within a variety of fields, for different institutions and working with various technologies the ability to readily share images ( 2,3). As the DICOM image forma was integrated into clinical practice, it was subsequent integrated into clinical research and teaching databases The DICOM format is a multipart document that c tains two layers: the header, typically hidden from vie and the viewable image. Most problematic from the standpoint of patient confidentiality is the identifying i formation saved in the DICOM header ( 4). Such information may include patient name, date and time of the exam, participating physicians (ordering, reading), and on. Image dimensions, pixel spacing, slice thickness, s time, and other scanning protocols are also saved in t header. Each variable is stored under a standardized d group and element number. An example would be 0010,0030, where the group number, in this case 0010 the assigned location for much of the patient’s person information, and the element number, 0030, contains t patient’s date of birth. Other examples are the group-e

Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. The macroscopic growth pattern of HCC is subdivided into three categories: nodular, massive, and infiltrative. Infiltrative HCC accounts for 7%-20% of HCC cases and is confirmed at pathologic analysis on the basis of the spread of minute tumor nodules throughout large regions of the liver. Infiltrative HCC may represent a diagnostic challenge because it is often difficult to distinguish from background changes in cirrhosis at imaging. Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire hepatic lobe or the entire liver, and it is frequently associated with portal vein tumor thrombosis. The tumor is usually ill defined at ultrasonography and shows minimal and inconsistent arterial enhancement and heterogeneous washout at contrast material-enhanced computed tomography and magnetic resonance (MR) imaging. The tumor may be more visible among the surrounding liver parenchyma at diffusion-, T1-, and T2-weighted MR imaging. Several liver diseases can mimic the infiltrative appearance of this malignancy, including focal confluent fibrosis, hepatic fat deposition, hepatic microabscesses, intrahepatic cholangiocarcinoma, and diffuse metastatic disease (pseudocirrhosis). The prognosis for patients with infiltrative HCC is poor because the tumor is often markedly advanced and associated with vascular invasion at presentation. Survival after surgical resection is decreased; thus, infiltrative HCC is a contraindication for resection and transplantation. Knowledge of the key tumor characteristics and imaging findings will help radiologists formulate a correct and timely diagnosis to improve patient management.

Liver transplantation arrests and reverses muscle wasting

Muscle wasting, sarcopenia, is common in advanced cirrhosis and predicts adverse outcomes while awaiting and following liver transplantation. Frequent post‐transplant worsening of sarcopenia has attracted recent interest. It is unknown whether this serious problem is an expected metabolic consequence of transplantation or results from confounding conditions such as recurrent allograft liver disease or avoidable post‐transplant complications. To clarify this question, we studied pre‐ and post‐transplant muscle mass in a retrospective cohort of 40 patients transplanted for three diseases – alcoholic cirrhosis, non‐alcoholic steatohepatitis cirrhosis, and primary sclerosing cholangitis cirrhosis – in whom allograft disease recurrence was monitored and excluded, and who lacked common post‐transplant muscle wasting complications such as sepsis, renal failure, ischemia, and cholestasis. We measured skeletal muscle index (SMI) using computed tomography before and 12–48 months after transplant. SMI as a categorical variable significantly improved, from 18 patients above the normal cutoff pre‐transplant to 28 post‐transplant (p = 0.008). SMI increases were greatest in patients with the lowest pre‐transplant SMI (p < 0.01). As a continuous variable, mean SMI remained stable, with a non‐significant trend toward improvement. We conclude that after liver transplantation sarcopenia does not progress but is arrested and frequently improves in the absence of confounding conditions.

Assessing response to treatment in non--small-cell lung cancer: role of tumor volume evaluated by computed tomography.

INTRODUCTION We set out to investigate whether volumetric tumor measurements allow for a prediction of treatment response, as measured by patient survival, in patients with advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS Patients with nonresectable NSCLC (stage III or IV, n = 100) who were repeatedly evaluated for treatment response by computed tomography (CT) were included in a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. Tumor response was measured by comparing tumor volumes over time. Patient survival was compared with Response Evaluation Criteria in Solid Tumors (RECIST) using Kaplan-Meier survival statistics and Cox regression analysis. RESULTS The median overall patient survival was 553 days (standard error, 146 days); for patients with stage III NSCLC, it was 822 days, and for patients with stage IV disease, 479 days. The survival differences were not statistically significant (P = .09). According to RECIST, 5 patients demonstrated complete response, 39 partial response, 44 stable disease, and 12 progressive disease. Patient survival was not significantly associated with RECIST class, the change of the sum of tumor diameters (P = .98), nor the change of the sum of volumetric tumor dimensions (P = .17). CONCLUSION In a group of 100 patients with advanced-stage NSCLC, neither volumetric CT measurements of changes in tumor size nor RECIST class significantly predicted patient survival. This observation suggests that size response may not be a sufficiently precise surrogate marker of success to steer treatment decisions in individual patients.

Imaging of Neurologic Conditions During Pregnancy and the Perinatal Period

Throughout pregnancy and the puerperium, a variety of hormonal and physiologic changes occur that are associated with pregnancy-specific neurologic conditions, which may also influence known preexisting medical conditions or bring previously unknown neurologic conditions to clinical attention. This article reviews the imaging of a spectrum of neurologic conditions that may be encountered in the pregnant or puerperal patient, the key physiologic changes that are most germane to the imaging of neurologic conditions, and the important safety considerations that are made when choosing and performing a diagnostic imaging test for the pregnant and puerperal patient.

Screening and Surveillance of Hepatocellular Carcinoma: An Introduction to Ultrasound Liver Imaging Reporting and Data System

Given the high prevalence, increasing incidence, and significant morbidity and mortality related to hepatocellular carcinoma (HCC), a robust and cost-effective screening and surveillance program is needed. Most societies recommend ultrasound for HCC screening, despite lack of standardization in imaging acquisition, reporting content and language, and follow-up recommendations. The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) fills this unmet need by providing standardization in the use of US in at-risk patients. It is anticipated that US LI-RADS will improve the performance of ultrasound for HCC screening and surveillance and unify management recommendations.

Practical advantages of contrast-enhanced ultrasound in abdominopelvic radiology

Computed tomography (CT) and magnetic resonance imaging (MRI) are two of the workhorse modalities of abdominopelvic radiology. However, these modalities are not without patient- and technique-specific limitations that may prevent a timely and accurate diagnosis. Contrast-enhanced ultrasound (CEUS) is an effective, rapid, and cost-effective imaging modality with expanding clinical utility in the United States. In this pictorial essay, we provide a case-based discussion demonstrating the practical advantages of CEUS in evaluating a variety of pathologies in which CT or MRI was precluded or insufficient. Through these advantages, CEUS can serve a complementary role with CT and MRI in comprehensive abdominopelvic radiology.

Artifacts in contrast-enhanced ultrasound: a pictorial essay

Although contrast-enhanced ultrasound (CEUS) has become a widely utilized and accepted modality in much of the world, the associated contrast agents have only recently received approval in the United States. As with all radiological techniques, image artifacts are encountered in CEUS, some of which relate to commonly encountered ultrasound artifacts, while others are unique to this technique. Image artifacts must be recognized when performing and interpreting examinations to improve technique and diagnostic accuracy. In this article, we review artifacts that may be encountered in CEUS, and where possible discuss how to minimize them or mitigate their effect on image quality and interpretation.