Improved stratification of stage-specific survival for cervical uterine cancer by integrating FDG-PET/CT and MRI for lymph node staging in 2018 FIGO classification.

OBJECTIVE: Staging carcinoma of the uterine cervix (CCU) by FIGO-2018 suggests stage migration of FIGO-2009 stage I-III patients with lymph node metastasis into FIGO-2018 stage IIIC. We aimed to investigate the prognostic value of lymph node metastases identified by imaging. METHODS: We enrolled all patients with biopsy-verified CCU from 2007 to 2016 at Odense University Hospital, Denmark. FDG-PET/CT and MRI were performed before clinical examination in general anesthesia. Disease-specific mortality was compared between women with lymph node-positive and lymph node-negative imaging. RESULTS: In total, 488 patients underwent clinical staging according to FIGO-2009. Lymph node-positive imaging was identified in 146 (30%) patients: 0/36 (0%) in stage IA, 22/195 (11%) in IBI, 14/30 (47%) in IB2, 70/164 (43%) in II and 40/63 (63%) in III. The 5-year cumulative incidence of death due to CCU lymph node-negative vs. lymph node-positive patients was 0.8% vs. 7.1% (p = 0.034) in stage IBI, 0% vs. 34.5% (p = 0.003) in stage IB2, 15.1% vs. 41.4% (p < 0.0001) in stage II, and 33.3% vs. 46.6% (p = 0.28) in stage III by FIGO-2009. CONCLUSIONS: One of three women with FIGO-2009 stage I-III CCU had suspected lymph node metastasis on imaging and is upstaged to stage IIIC according to FIGO-2018. The cancer-specific mortality by CCU was significantly lower in the lymph node-negative women stages IBI-II, thus supporting stage migration due to suspected lymph node metastasis. However, the exact prognostic value within stage IIIC is challenged, and future revision of FIGO stages may include new sub-stages.

[Positron emission tomography/computed tomography for diagnosing a rare genetic disease in an infant].

Generalized arterial calcification of infancy is a very rare genetic disorder characterized by arterial calcifications. The symptoms are apparent within the first few weeks of life and the disease shows high mortality rates. This case report describes the clinical presentation, the radiological findings and the treatments challenges.

Can the CT planning image determine whether a kidney stone is radiopaque on a plain KUB?

Almost all kidney stones are CT positive. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB) but with reduced quality. It has been used as a guide, assuming that if the kidney stone could be seen on the CTI the kidney stone also would be visible on a conventional plain KUB (radiopaque). From the perspective of diagnosis and treatment as well as follow-up it is of importance to know whether a kidney stone is radiopaque or not. The aim of this study was to evaluate whether the CTI actually can predict radiopacity. CT scans and corresponding KUB's were analysed in 76 consecutive kidney stone patients. The CT scan and the KUB were performed on the same day. All patients were examined with the same CT scanner (64 slice GE light speed VCT). Three radiologists evaluated the images in plenum. The following was recorded regarding the kidney stones: X-ray positive (radiopaque on KUB), CTI positive (radiopaque on CTI), location (a kidney, b upper two-thirds of ureter and c lower one-thirds of ureter including the bladder), size and Hounsfield units (HU). We also measured the patient's 'anterior-posterior depth' (APD) at the kidney stone level in axial plane, and whether the stone was homogeneous/inhomogeneous. 54 of the 76 patients (71%) had radiopaque stones on KUB. 43 (57%) of these also could be seen on the CTI, resulting in a positive predicting value (PPV) of 100% and a negative predictive value (NPV) of 67%. In the 54 KUB positive kidney stones the mean kidney stone diameter was 7 mm (2-30 mm), mean HU's 1,007 (294-1,782 HU), location: a:32, b:9 and c:13 patients. APD was mean 23.6 cm (13-39 cm). In the KUB positive and CTI negative kidney stones (11 patients) mean kidney stone diameter was 4 mm (2-9 mm), mean HU's 742 (294-1,253 HU), location: a:32, b:9 and c:13 patients. APD in this group was mean 26.1 cm (13-37 cm). If the kidney stone can be seen on the CTI it is also visible on a plain KUB (PPV 100%). The CTI do, however, underestimate the radiopacity of a stone on a plain KUB (NPV 67%). Kidney stone HU > 742, stone location in the kidney and proximal ureter and APD < 26 cm independently predict agreement between CTI and KUB with regard to radiopacity.