Prognostic utility of FDG PET/CT in advanced ovarian, fallopian and primary peritoneal high-grade serous cancer patients before and after neoadjuvant chemotherapy.

OBJECTIVES: In patients with advanced ovarian, fallopian and primary peritoneal carcinoma, complete interval debulking surgery (IDS) is often performed after neoadjuvant chemotherapy (NAC) to achieve long progression-free survival (PFS) and overall survival (OS). We aimed to investigate the utility of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) PET/CT in patients with these malignancies who underwent complete IDS. METHODS: Between 2009 and 2017, twenty-two patients underwent FDG PET/CT scans before and after NAC. The highest SUVmax/peak (standardized uptake value), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) for whole lesions were defined as target SUVmax/peak, tMTV and tTLG, respectively. We also calculated these reduction rates during NAC. These parameters were compared between the groups with platinum-free interval (PFI) > 12 months (n = 10) and those with PFI ≤ 12 months (n = 12). The PFS and OS were evaluated using these quantitative parameters, and in terms of the presence of visually detectable residual lesions after NAC. RESULTS: The target SUVmax/peak before NAC, the reduction rates in the target SUVmax, tMTV and tTLG were significantly higher in the group with PFI > 12 months than the shorter PFI group (p < 0.05). Especially in PFS, the higher reduction rates in the target SUVmax/peak, tMTV, and tTLG had an excellent prognostic stratification (p < 0.05) and the FDG visually negative group after NAC had a significantly better prognosis than the other group (p < 0.01). CONCLUSIONS: The reduction rate of FDG PET-based quantitative values and visual analysis after NAC demonstrated prognostic potential, especially in PFS.

Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management.

Acute mesenteric ischemia is a rare life-threatening condition that accounts for approximately one in 1000 hospital admissions. The mortality rate is 50%-69% owing to the absence of specific symptoms and laboratory data, which makes early detection of this condition difficult. If the use of contrast material is possible, biphasic contrast material-enhanced multidetector computed tomography (CT) is the first-line imaging test for early diagnosis of the disease and for differentiation from other causes of acute abdomen. Multidetector CT can depict mesenteric ischemia, its underlying causes, and its severity. Mesenteric ischemia is classified as either acute or chronic. The causes of AMI include arterial embolism, arterial thrombosis, venous thrombosis, and nonocclusive mesenteric ischemia, among which arterial causes are far more common than venous causes. Recently, endovascular procedures such as thrombolysis, thrombectomy, thrombus fragmentation, and stent placement have been successfully and safely performed when the ischemia is reversible. Online DICOM image stacks are available for this article. ©RSNA, 2018.

Clinical value of FDG-PET for preoperative evaluation of endometrial cancer.

OBJECTIVE: Whole body positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) has been widely used in various malignancies, but the clinical value of FDG-PET for endometrial cancer has not been fully investigated. The purpose of this study was to evaluate the usefulness of FDG-PET for preoperative evaluation of endometrial cancer. METHODS: Forty female patients suspected of having endometrial cancer were included in this study. All patients underwent an FDG-PET or PET/CT scan, and images were interpreted visually. The diagnostic performance in detecting the primary tumor, regional nodal status, and distant metastasis was determined. In addition, the usefulness of PET was assessed in terms of additional information and clinical impact for therapeutic management. RESULTS: Of 40 patients, 30 were histologically confirmed to have endometrial cancer. The patient-based sensitivity and specificity of FDG-PET for primary tumors were 83 and 100%, respectively, and 100 and 100%, respectively, for nodal metastases. There were 12 distant metastases in 6 patients and two second primary cancers in two patients, which were all accurately diagnosed by PET on a patient-basis. PET yielded 12 additional findings in 10 patients, and had a bearing on the therapeutic management of four patients, including one patient with recurrent breast cancer. CONCLUSIONS: FDG-PET had a reasonably high diagnostic accuracy in endometrial cancer. Although the number of cases with clinical impact was limited, additional information by PET was obtained in one-third of the cases.

Radiological findings in total colon aganglionosis and allied disorders.

OBJECTIVE: The aim of this study was to review the radiological findings of three cases of total colon aganglionosis (TCA), hypoganglionosis, and immature ganglionosis, and to compare the differences in diagnosis and follow-up of these three disease entities. MATERIALS AND METHODS: Three neonates with neonatal onset of abdominal distension with vomiting were investigated, and the cases were diagnosed as TCA, hypoganglionosis, and immature ganglionosis, respectively. Radiological examination of each neonate was performed during the neonatal period and at follow-up. RESULTS: A plain abdominal radiograph showed massive abdominal bowel gas and multiple air-fluid levels in all cases. Barium enema findings including no transition zone, normal rectosigmoid index, reflux of barium into a dilated ileum, and retention of barium on delayed film were observed in all three cases. In aganglionosis and hypoganglionosis, a normal-sized colon, irregular contraction, shortening of the colon, and lack of redundancy were observed. In immature ganglionosis, microcolon was present but there was no shortening of the colon or loss of redundancy. Barium studies following ileostomy during childhood revealed no efficient peristalsis after the neonatal period in patients with aganglionosis and hypoganglionosis. Conversely, the patient with immature ganglionosis showed maturity of colonic function on barium studies after infancy. CONCLUSION: The clinical and radiological findings of TCA and allied disorders are similar in neonates. Sequential contrast intestinal studies could reveal peristalsis of the colon wall, suggesting maturity of the ganglion cells.