Abdominal and pelvic complications of nonoperative oncologic therapy.

Oncologic patients are treated with a combination of chemotherapy, radiation therapy, and surgery. Advances in therapeutic options have greatly improved the survival of patients with cancer. Examples of these advances are newer chemotherapeutic agents that target the cell receptors and advanced radiation therapy delivery systems. It is imperative that radiologists be aware of the variety of imaging findings seen after therapy in patients with cancer. Complications may occur with classic cytotoxic therapies (eg, 5-fluorouracil), usually at higher or prolonged doses or when administered to radiosensitive areas. Newer targeted systemic agents, such as bevacizumab and imatinib, have associated characteristic toxicities because their effects on cells do not depend on dose. Radiation may induce early and late effects in local normal tissues that may be seen at imaging. Imaging findings after chemotherapy include fatty liver, pseudocirrhosis, hepatic veno-occlusive disease, and splenic rupture. Complications of radiation therapy include large and small bowel strictures and radiation-induced hepatitis and tumors. Awareness of the various therapeutic options and knowledge of the spectrum of posttherapeutic complications allows radiologists to provide a comprehensive report that may impact patient management.

Common and uncommon bilateral adult renal masses.

Masses can involve the kidney unilaterally or bilaterally. The purpose of this article is to review common and uncommon adult renal masses that present bilaterally. Clinical and imaging findings are described. Renal masses that present in a bilateral fashion can have particular clinical and imaging characteristics and knowledge of their presentation enables appropriate diagnosis and management, especially in a multidisciplinary care setting. More commonly found bilateral renal masses that are discussed include metastasis, lymphoproliferative disorders, adult polycystic kidney disease, angiomyolipomas, renal infracts and renal abscesses. Less common bilateral renal masses include transitional cell carcinoma, oncocytoma, and hematomas.

Common and uncommon adult unilateral renal masses other than renal cell carcinoma.

Many different masses can involve the kidney other than the commonly encountered renal cell carcinoma (RCC). The purpose of this article is to review the characteristic clinical and imaging findings of common and uncommon masses that predominantly present unilaterally in the adult patient, other than RCC. Awareness of such lesions and knowing the clinical scenario is important for appropriate diagnosis and management, especially in a multidisciplinary care setting.

Renal cell carcinoma: diagnosis, staging, and surveillance.

OBJECTIVE: This educational review focuses on the staging and radiologic evaluation of renal cell carcinoma. It includes discussion of the epidemiology, pathology, and therapeutic options of renal cell carcinoma and the implications for radiologic follow-up. CONCLUSION: The incidence of renal cell carcinoma has been increasing. Imaging plays a central role in its detection, staging, and treatment evaluation and follow-up.

Imaging in oncology from the University of Texas M. D. Anderson Cancer Center: diagnosis, staging, and surveillance of prostate cancer.

OBJECTIVE: The purpose of this article is to discuss the epidemiology, risk factors, and presentation of prostate cancer. After reviewing the prostate anatomy, the article will show how imaging plays an important role in establishing the diagnosis, staging, and monitoring the therapeutic response in prostate cancer, with a focus on adenocarcinomas. CONCLUSION: Imaging studies, in the appropriate laboratory and clinical context, contribute essential information that enhances the capacity to provide individualized risk stratification, a suitable treatment strategy, and monitoring for the patient with prostate cancer.

Liver metastases: imaging considerations for protocol development with multislice CT (MSCT).

Conventional, single-slice helical computed tomography (SSCT) allowed for scanning the majority of the liver during the critical portal venous phase. This was often referred to as the 'optimal temporal window'. The introduction of current day multislice CT (MSCT) now allows us to acquire images in a much shorter time and more precisely than ever before. This yields increased conspicuity between low attenuation lesions and the enhanced normal liver parenchyma and optimal imaging for the vast majority of hepatic hypovascular metastases. Most importantly, these scanners, when compared to conventional non-helical scanners, avoid impinging upon the 'equilibrium' phase when tumors can become isodense/invisible. MSCT also allows for true multiphase scanning during the arterial and late arterial phases for detection of hypervascular metastases. The MSCT imaging speed has increased significantly over the past years with the introduction of 32- and 64-detector systems and will continue to increase in the future volumetric CT. This provides a number of important gains that are discussed in detail.

Spectrum of imaging findings in the abdomen after radiotherapy.

OBJECTIVE: The objective of this article is to describe the imaging appearances of radiation injury to normal tissues in the abdomen that may be seen during imaging surveillance of oncology patients. CONCLUSION: Therapeutic radiation is used to treat various malignant conditions in the abdomen. Radiation damages normal surrounding tissues as well as the intended tumor. Radiation changes vary based on the target organ and the time from completion of therapy. Familiarity with the spectrum of changes that may be seen on follow-up imaging studies should help in the differentiation of radiation injury from other causes such as recurrent malignancy.

Lymph node imaging: multidetector CT (MDCT).

Advances in cross-sectional imaging, including conventional and helical (spiral) CT and multidetector (MDCT) and MR imaging, now allow detailed evaluation of the anatomy and pathology of the neck and thoracic inlet. The major structures are identified by their appearance and that of contrasting fatty tissue planes surrounding the soft tissues. These structures include the larynx, trachea, thyroid, and parathyroid glands as well as the vessels, lymph node chains, nerves, and supporting muscles. A thorough understanding of the normal cross-sectional anatomy is fundamental to properly interpret pathologic processes. Pathologic processes include both solid and cystic masses. Most solid masses are enlarged lymph nodes. In contrast, cystic masses are of variable pathology, and their characteristic appearances and locations with respect to normal neck anatomy allow a confident diagnosis to be made from a brief differential diagnostic spectrum.

Controversies in imaging of hepatocellular carcinoma: multidetector CT (MDCT).

Primary hepatocellular carcinoma (HCC) is a significant tumor worldwide and represents the most common primary hepatic neoplasm. Staging criteria are important for appreciation of timely work up of these neoplasms in contradiction with surgical colleagues. This article demonstrates the appearance of HCC on multiphasic, multidetector CT (MDCT) and relates these findings to current staging criteria. The variable appearance on different planes of contrast is critical to appreciate in staging this neoplasm. The hypervascular nature of the primary tumor makes MDCT and three-phase imaging a critical feature in the detection and characterization of this tumor. This is especially critical in the patients who are candidates for surgical resection. Additionally, MDCT has allowed arterial phase imaging to define the vascular supply of the tumor. An accurate representation of the size and number of lesions is critical in not only the initial staging but also the follow-up of hepatocellular carcinoma. The post-treatment features including the appearance post-surgically and after radiofrequency ablation can be well appreciated on MDCT.

Impact of multislice CT on imaging of acute abdominal disease.

The increased speed, greater coverage, and thinner slices of MSCT are exciting developments in radiology, and these feature should only improve with newer generation multislice scanners. The impact of this technology on abdominal imaging has just begun.

Evaluation of the patient with flank pain and possible ureteral calculus.

Flank pain due to urolithiasis is a common problem in patients presenting to emergency departments. Radiology plays a vital role in the work-up of these patients. Many modalities can be used, including ultrasonography, nuclear medicine, and the traditionally used techniques of intravenous urography and conventional radiography. The development of nonenhanced computed tomography (CT) (single- or multi-detector row helical) has provided a means to enable detection and characterization of urolithiasis with unprecedented sensitivity, specificity, and accuracy while yielding important information for treatment planning, including the size and location of calculi. This technique can also help detect causes for flank pain outside the genitourinary tract. However, close attention must be paid to all aspects of the CT study to prevent misdiagnoses.

The subperitoneal space: mechanisms of tumour spread in the peritoneal cavity, mesentery, and omentum.

The subperitoneal space consists of fatty tissue, blood vessels, lymphatics, and lymph nodes enveloped by a serosal lining. This provides a complex interconnecting space which is an important conduit for pathology within the peritoneal cavity. The anatomy and pathology of the subperitoneal space and the surrounding cavity is discussed in its relationship to tumor spread.