Contrast enhanced MR angiography with parallel imaging in the early period after renal transplantation.

PURPOSE: To evaluate renal allograft vessels in the early period after kidney transplantation with three-dimensional (3D) contrast-enhanced MR angiography (3D CE MRA) using a parallel imaging technique. MATERIALS AND METHODS: Sixty-three consecutive patients were examined with 3D CE MRA and integrated SENSE technique (Sensitivity Encoding) 2 to 21 days after renal transplantation. MR angiography studies were analyzed for the presence of arterial stenosis. The degree of renal transplant artery stenosis was graded qualitatively as <50% = mild, 50-70% = moderate, 70-99% = severe, and occlusion. Four patients (6.3%) with moderate (n = 1) or severe (n = 3) arterial stenoses on CE MRA underwent selective intra-arterial digital subtraction angiography. In two patients, selective intravenous digital subtraction angiography (DSA) was performed. RESULTS: Twenty-seven (42.9%) of the 63 patients had normal CE MR angiograms, 29 (46%) showed mild, 3 patients (4.8%) moderate, and 4 patients (6.3%) severe stenoses of the donor artery. In three patients, the severe stenosis of the graft artery was confirmed by surgery or intra-arterial DSA. One patient with suspicion of severe arterial stenosis on MRA had moderate vessel narrowing on DSA. Twelve months after kidney transplantation, serum creatinine levels were not significantly different in patients with mild and moderate stenoses from those without (P > 0.19) but significantly different from those with severe stenoses (P < 0.05). CONCLUSION: The incidence of mild and moderate vessel narrowing at the arterial anastomosis is unexpectedly high in the early period after kidney transplantation and is most likely due to surgery-related tissue edema.

Fuzzy logic-based tumor marker profiles including a new marker tumor M2-PK improved sensitivity to the detection of progression in lung cancer patients.

In lung cancer patients tumor markers are used for disease monitoring. The goal of this study was to improve diagnostic efficiency in the detection of tumor progression in lung cancer patients by using fuzzy logic modeling in combination with a tumor marker panel (Tumor M2-PK, CYFRA 21-1, CEA, NSE and SCC). Thirty-three small cell lung cancers (SCLC) and 69 consecutive inoperable patients (40 squamous and 29 adenocarcinomas) were included in a prospective study. The changes of blood levels of tumor markers as well as their analysis by fuzzy logic modelling were compared to the clinical evaluation of response vs. non-response to therapy. Clinical monitoring was evaluated according to the standard criteria of the WHO. Tumor M2-PK was measured in plasma with an ELISA (ScheBo Biotech, Germany) and all other markers in sera (Roche, Germany). At a 90% specificity, the respective best single marker found the following fraction of all patients who had tumor progression clinically detected: in SCLC with NSE 52%, in adenocarcinoma with CYFRA 21-1 89% and in squamous carcinoma with SCC 65%. A fuzzy logic rule-based system employing a tumor marker panel increased the sensitivity in small cell carcinomas to 73% with the marker combination NSE/CEA and to 63% with the marker combination NSE/Tumor M2-PK, respectively. In squamous carcinomas an improvement of sensitivity is also observed using the marker combination of SCC/Tumor M2-PK (Sensitivity: 81%) or SCC/CEA (Sensitivity: 71%). By using the fuzzy logic method and the marker combination CYFRA 21-1/CEA as well as CYFRA 21-1/Tumor M2-PK, the detection of lung cancer progression was possible in all adenocarcinomas. With the fuzzy logic method and a tumor marker panel (including the new marker Tumor M2-PK), a useful diagnostic tool for the detection of progression in lung cancer patients is available.

Tumor M2-pyruvate kinase in the follow-up of inoperable lung cancer patients: a pilot study.

Tumor markers were used for disease monitoring in lung cancer patients. The goal of this pilot study was to determine the diagnostic efficiency of a new tumor metabolic marker, Tumor M2-pyruvate kinase (Tumor M2-PK) for the detection of tumor growth in inoperable lung cancer patients.Fifty-seven consecutive and primary inoperable lung cancer patients were included in this prospective study. Changes in plasma levels of Tumor M2-PK were compared to the clinical course of the disease. Clinical monitoring was evaluated according to the standard criteria of the WHO. Of the 57 patients, 19 were in remission, 18 showed signs of stable disease and there were 20 tumor progressions under therapy. In the further follow-up after treatment, tumor relapse occurred in 30 patients. Tumor M2-PK was measured in plasma before and after treatment as well as at time of relapse. During tumor remission Tumor M2-PK levels decreased significantly under treatment (P=0.0004). As might be expected, pre- and post-treatment marker concentrations did not differ significantly in patients with stable disease. In progressive lung cancer patients a significant increase in Tumor M2-PK was detectable (P=0.0094). Overall, a decrease of Tumor M2-PK was seen in 17 (89%) of all responders, while an increase could be detected in 16 (80%) of the patients experiencing tumor progression. After treatment tumor relapse occurred in 30 patients. Tumor M2-PK increased significantly (P=0.0201) at time of relapse in 17 patients with non-small cell lung cancers and exceeded the cut-off in 11 of the 17 (65%). In conclusion, Tumor M2-PK proved useful as a diagnostic aid for therapy control in lung cancer patients. This marker can also be used to detect tumor relapse after treatment. Tumor M2-PK could be well suited to complete the present diagnostic panel for monitoring of inoperable lung cancer patients.

Tumor M2-pyruvate kinase in lung cancer patients: immunohistochemical detection and disease monitoring.

BACKGROUND: Lung cancer is one of the main causes for cancer death. A reliable diagnosis and follow-up of patients is important support for a successful therapy. The diagnostic efficiency of a new marker Tumor M2-pyruvate kinase (Tumor M2-PK) is evaluated. MATERIALS AND METHODS: In this report immunohistochemical detection of pyruvate kinase M2 in tissue sections of lung cancer specimens is presented. Furthermore Tumor M2-PK was quantified in EDTA plasma of lung cancer patients in order to monitor the disease, especially under chemotherapy. RESULTS: Immunohistochemical detection of pyruvate kinase M2 in tissue sections of lung cancer specimens showed selective staining of tumor cells, independent of the histological classification of the tumor. In EDTA plasma of lung cancer patients, the marker concentrations correlated well with the tumor load during follow-up, showing significantly increasing concentrations with progressive tumor stages and decreased concentrations during tumor remission. Again, this effect was independent of the histological tumor type. CONCLUSION: The present data indicate that Tumor M2-PK in EDTA-plasma could be a valuable tumor marker for monitoring lung cancer.