ABSTRACT
Imaging plays a vital role in the evaluation of peritoneal malignancies. The presence of peritoneal metastases (PM) alters tumor staging, with direct implications in treatment choice and prognosis. Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) as a combined modality treatment have led to prolonged survival and even cure in selected patients with PM. Better outcomes are seen in patients with limited disease spread. Therefore, early diagnosis of peritoneal tumor seeding is essential. Despite significant advancement of technology, assessment of the origin of PM is often difficult, due partly to the complex peritoneal anatomy and partly due to the complex overlap of imaging features. Multidetector CT (MDCT) is the main stay due to its wide availbility, rapid evaluation, robust technique and good resolution. Imaging plays a vital role in selecting patients for the combined modality treatment. MRI is not as popular as CT due to limited availability, time required for the study and lack of experience with interpreting the results. PET-CT is useful in ruling out extra peritoneal disease and it is the CT component that is more reliable for predicting the disease extent. This article reviews the current use of various imaging modalities in various stages of treatment of patients with PM especially those undergoing CRS and HIPEC.
ABSTRACT
A 22 year old female presented with vasculitic skin rash. She was incidentally found to be hypertensive and had proteinuria. Skin biopsy showed leuco-cytoclastic vasculitis. On Imaging, there was left hydronephrosis, hydroureter with bilateral multiple foci of ureteric stenosis and micro-aneurysms in relation to interlobar arteries of kidney. A diagnosis of classical Polyarteritis Nodosa (cPAN) with multi-level ureteric stenosis was made. She was treated with Glucocorticoids, Cyclophosphamide, following which Azathioprine was given.
Subject(s)
Polyarteritis Nodosa/complications , Polyarteritis Nodosa/diagnosis , Ureteral Diseases/diagnosis , Vasculitis/diagnosis , Adult , Azathioprine/therapeutic use , Cyclophosphamide/therapeutic use , Drug Therapy, Combination , Female , Glucocorticoids/therapeutic use , Humans , Polyarteritis Nodosa/drug therapy , Treatment Outcome , Ureteral Diseases/drug therapy , Ureteral Diseases/etiology , Vasculitis/drug therapy , Vasculitis/etiologyABSTRACT
Brain source localization accuracy in magnetoencephalography (MEG) requires accuracy in both digitizing anatomical landmarks and coregistering to anatomical magnetic resonance images (MRI). We compared the source localization accuracy and MEG-MRI coregistration accuracy of two head digitization systems-a laser scanner and the current standard electromagnetic digitization system (Polhemus)-using a calibrated phantom and human data. When compared using the calibrated phantom, surface and source localization accuracy for data acquired with the laser scanner improved over the Polhemus by 141% and 132%, respectively. Laser scan digitization reduced MEG source localization error by 1.38 mm on average. In human participants, a laser scan of the face generated a 1000-fold more points per unit time than the Polhemus head digitization. An automated surface-matching algorithm improved the accuracy of MEG-MRI coregistration over the equivalent manual procedure. Simulations showed that the laser scan coverage could be reduced to an area around the eyes only while maintaining coregistration accuracy, suggesting that acquisition time can be substantially reduced. Our results show that the laser scanner can both reduce setup time and improve localization accuracy, in comparison to the Polhemus digitization system.
