The International Association for the Study of Lung Cancer Early Lung Imaging Confederation.

PURPOSE: To improve outcomes for lung cancer through low-dose computed tomography (LDCT) early lung cancer detection. The International Association for the Study of Lung Cancer is developing the Early Lung Imaging Confederation (ELIC) to serve as an open-source, international, universally accessible environment to analyze large collections of quality-controlled LDCT images and associated biomedical data for research and routine screening care. METHODS: ELIC is an international confederation that allows access to efficiently analyze large numbers of high-quality computed tomography (CT) images with associated de-identified clinical information without moving primary imaging/clinical or imaging data from its local or regional site of origin. Rather, ELIC uses a cloud-based infrastructure to distribute analysis tools to the local site of the stored imaging and clinical data, thereby allowing for research and quality studies to proceed in a vendor-neutral, collaborative environment. ELIC's hub-and-spoke architecture will be deployed to permit analysis of CT images and associated data in a secure environment, without any requirement to reveal the data itself (ie, privacy protecting). Identifiable data remain under local control, so the resulting environment complies with national regulations and mitigates against privacy or data disclosure risk. RESULTS: The goal of pilot experiments is to connect image collections of LDCT scans that can be accurately analyzed in a fashion to support a global network using methodologies that can be readily scaled to accrued databases of sufficient size to develop and validate robust quantitative imaging tools. CONCLUSION: This initiative can rapidly accelerate improvements to the multidisciplinary management of early, curable lung cancer and other major thoracic diseases (eg, coronary artery disease and chronic obstructive pulmonary disease) visualized on a screening LDCT scan. The addition of a facile, quantitative CT scanner image quality conformance process is a unique step toward improving the reliability of clinical decision support with CT screening worldwide.

Inter- and intraobserver variability in the postoperative evaluation of transpedicular stabilization: computed tomography versus magnetic resonance imaging.

BACKGROUND CONTEXT: Computed tomography (CT) represents the state of the art for the postoperative verification of the implant position after transpedicular stabilizations. Magnetic resonance imaging (MRI) has not challenged the CT, yet, because of susceptibility artifacts but would be favorable as a diagnostic tool for its excellent soft-tissue qualities. PURPOSE: A study that analyzed if an artifact-reduced MRI could overcome this problem and provide sufficient data for the postoperative assessment was conducted. STUDY DESIGN: The study design was a radiologic comparison of CT and MRI techniques evaluating pedicle screw placement after spinal fusion. PATIENT SAMPLE: Fifty consecutive patients were given an MRI and a CT after a transpedicular stabilization surgery. Thirty-eight patients suffered from degenerative spinal disorders; three surgeries had become necessary because of spondylodiscitis, eight patients suffered from metastatic vertebrae destruction, and one patient experienced a fracture. OUTCOME MEASURES: Any contact of a malpositioned pedicle screw with the dura and/or radicular structures was identified as an implant-associated complication and was compared with postoperative clinical patient findings. METHODS: In total, 338 pedicular screws were analyzed in regard to their intrapedicular position. The double-blind evaluation of MRI and CT data was carried out by two radiologists and two spine surgeons. Accuracy of the CT analysis was calculated based on the interobserver agreement of 100%. Magnetic resonance imaging accuracy was calculated. RESULTS: The interobserver accuracy of the CT data amounted to a median of 89.8% and in the MRI data of 86.7%. Intraobserver comparisons showed a significant difference between CT and magnetic resonance evaluations in one observer (kappa=0.293). In all other observers, the results were concordant with kappa values from kappa=0.328 to kappa=0.702. There was a high degree of agreement regarding the diagnosis of malpositioned pedicle screw and corresponding clinical symptoms between both techniques. CONCLUSIONS: The presented data show that artifact-reduced MRI is equivalent to CT imaging in the postoperative evaluation of titanium spinal rod-screw systems. We therefore conclude that MRI should be considered as an alternative tool for the golden standard CT for postoperative imaging controls for its advantages in soft-tissue analysis.

Mature mediastinal teratoma with subtotal unidirectional pancreatic differentiation.

Tumor-like lesions of the mediastinum consisting exclusively of mature pancreatic tissue are rare. Most authors regard these lesions as developmental abnormalities. We report the case of a 17-year-old male who presented with progressive dyspnea due to a large mediastinal tumor with accompanying pericardial effusion. Percutaneous core needle biopsies showed differentiated pancreatic tissue with chronic inflammation and cystic transformation. On this basis, heterotopic pancreatic tissue of the mediastinum, a lesion occasionally reported in the literature, was suspected and the lesion was excised. The histopathological workup of the surgically excised lesion, in the first place, supported the primary diagnosis. However, after extensive sampling of the lesion, the diagnosis had to be changed to mature teratoma with subtotal unidirectional pancreatic differentiation. We hypothesize that at least some of those cases reported in the literature as "heterotopic pancreatic tissue of the mediastinum" may be in fact unidirectionally differentiated teratomas and should therefore be regarded and treated as true neoplasms rather than developmental abnormalities.

Malignant melanoma metastasis as a cause of small-bowel perforation.

BACKGROUND: Malignant melanoma is a disease with an increasing rate of incidence, currently at 10 cases per 100,000. In most cases, malignant melanoma metastasizes over the lymph vessels to parenchymal organs. Symptomatic metastases are found in the gastrointestinal tract in only about 2% of the patients. CASE REPORT: A 43-year-old patient with a known metastasized malignant melanoma (brain, liver, bones) was admitted to the department of dermatology due to fatigue, headache and unspecified abdominal symptoms. Because of persistent abdominal symptoms, a computed tomography (CT) scan of the abdomen was performed, showing a perforation of the ileum with an abscess on the basis of multiple small-bowel metastases. A segmental small-bowel resection with primary anastomosis was performed. The postoperative course of the patient was complicated by a subcutaneous wound infection and a prolonged period of convalescence (due to multiple brain metastases). CONCLUSIONS: Novel therapy concepts and medication in the treatment of patients with malignant melanoma have improved life expectancy. These patients are therefore expected to suffer more frequently from complications of the primary disease. Interdisciplinary management and cooperation is required to adequately diagnose and handle such cases.

A case of Erdheim-Chester disease initially mistaken for Ormond's disease.

BACKGROUND: A 54-year-old man presented with fever, abdominal pain, anemia, elevated C-reactive protein level and decreased renal function. Idiopathic retroperitoneal fibrosis (Ormond's disease) had been diagnosed in the past, leading to surgical ureterolysis. Re-evaluation of the CT scans and histological biopsy samples revealed unusual sclerosis of the long bones and diffuse infiltrates of foamy histiocytes in the bone marrow and the retroperitoneum. INVESTIGATIONS: Physical examination, laboratory tests including hemoglobin concentration, erythrocyte sedimentation rate, C-reactive protein level, beta2-microglobulin level, creatinine level, CT of the chest and abdomen, bone scintigraphy, bone marrow and soft tissue biopsies and immunohistochemistry. DIAGNOSIS: Erdheim-Chester disease with retroperitoneal fibrosis and bone sclerosis. MANAGEMENT: Treatment with glucocorticoids failed. The patient's symptoms improved significantly after initiation of interferon-alpha therapy.

Prevention of disease progression in a patient with a gastric cancer-re-recurrence. Outcome after intravenous treatment with the novel antineoplastic agent taurolidine. Report of a case.

BACKGROUND: Taurolidine (TRD) is a novel agent with multimodal antineoplastic effects. We present the case of a tumor remission after intravenous administration of taurolidine in a patient with gastric cancer re-recurrence. CASE PRESENTATION: A 58 years old male patient suffering from a gastric adenocarcinoma was submitted to partial gastrectomy and partial liver resection (pT2, pN1, pM1L (liver segment 2), N0, V0). 24 months later a local recurrence was diagnosed and the patient was reoperated. Postoperatively the patient underwent a palliative chemotherapy with eloxatin, FU, and leucovorin. A subsequent CT-revealed a liver metastasis and a recurrence adjacent to the hepatic artery. After successful radiofrequency ablation of the liver metastasis the patient was intravenously treated with 2% taurolidine. The patient endured the therapy well and no toxicity was observed. CT-scans revealed a stable disease without a tumor progression or metastatic spread. After 39 cycles the patient was submitted to left nephrectomy due to primary urothelial carcinoma and died 2 days later due to myocardial infarction. Postmortem histology of the esophageal-jejunal anastomosis and liver revealed complete remission of the known metastasized gastric adenocarcinoma. CONCLUSION: The intravenous treatment with 2% taurolidine led to a histological remission of the tumor growth without any toxicity for the patient.

Application of the three-dimensional maximum mode in prenatal diagnosis of Apert syndrome.

Apert syndrome is a rare disorder characterized by coronal craniosynostosis, syndactyly, brachycephaly, midfacial hypoplasia, and central nervous system anomalies, among other malformations. We present a case of Apert syndrome examined at 22 + 0 weeks' gestation. Three-dimensional maximum mode was decisive for the correct prenatal diagnosis by demonstrating the cranial deformities.

Tenecteplase for the treatment of massive and submassive pulmonary embolism.

BACKGROUND: Data on thrombolytic therapy disclose benefits from thrombolytic therapy in patients with massive and submassive pulmonary embolism (PE). Previously published case reports have described the successful use of tenecteplase under these conditions. METHODS: Four patients with massive and submassive PE received a weight-optimized dosing regimen of tenecteplase, administered as an intravenous bolus. RESULTS: All patients experienced clinically relevant improvement of dyspnea following thrombus regression. Regression of right ventricular enlargement was documented in three cases. Tenecteplase was well tolerated and did not cause bleeding complications. Thirty-day mortality was zero. CONCLUSIONS: These data support the use of this new thrombolytic agent in patients with massive and submassive PE; however, sufficiently powered, randomized trials have not yet taken place for these indications.