RESUMEN
AIM: The aim of this study is to investigate anatomical lung variations and vascular patterns using volumetric 3D computed tomography (CT) representations. METHODS & RESULTS: We considered 24 major thoracic surgery performed in our ward. In these, we discovered some interesting anatomical variations of the main pulmonary fissures. These findings were not visible on the plain x-ray or during routine examination of a preoperative CT scan. After re-examination of 3D CT scan reconstruction the anatomical variations were detected. DISCUSSION: General thoracic surgeons must familiarize themselves with anatomical variations in lungs. 3D images may aid the general thoracic surgeon in performing safer surgeries. CONCLUSION: 3D CT scan should be performed before surgery if possible.
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Imagenología Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Procesamiento de Imagen Asistido por Computador , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Neumonectomía/métodos , Cirugía Torácica Asistida por Video/métodosRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the response of biliary tract cancer treated with multidrug chemotherapy using FDG PET in comparison with morphologic and density changes. MATERIALS AND METHODS: In this phase II clinical trial, 28 patients with unresectable or metastatic biliary tract cancers treated with gemcitabine and oxaliplatin combined with bevacizumab (GEMOX-B) underwent FDG PET and contrast-enhanced CT at baseline and after the second cycle of the therapy (8 weeks). A single reviewer recorded tumor maximum standardized uptake value (SUVmax) along with size, volume (3D-sphere), and density. The percentage changes of the parameters were compared with progression-free survival at 7 months. Overall survival was compared with the percentage change of SUVmax. RESULTS: After 8 weeks, measurable reductions (±SD) in size (7.05±4.19 to 5.52±3.28 cm, -21.70%), volume (411.38±540.08 to 212.41±293.45 cm3, -48.36%), and density (60.76±20.65 to 50.68±16.89 HU, -15.59%) were noted along with a substantial drop in SUVmax (5.95±1.95 to 3.36±1.28, -43.52%). The SUVmax change showed positive correlations with tumor size change (R2=0.39, p=0.0004) and volumetric change (R2=0.34, p=0.001). Patients who showed a larger drop in SUVmax at 8 weeks correlated with favorable progression-free survival (p=0.02). ROC analysis showed that a 45% reduction in SUVmax was the best cutoff value to detect favorable progression-free survival patients. When we used this cutoff value, Kaplan-Meier analysis showed that patients with tumors showing greater reduction in SUVmax had favorable progression-free survival and overall survival (p=0.0009, p=0.03). CONCLUSION: In biliary tract cancers treated with GEMOX-B, the reduction of SUVmax after therapy is a better predictor for survival than morphologic and density changes.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Sistema Biliar/tratamiento farmacológico , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Anticuerpos Monoclonales Humanizados/administración & dosificación , Bevacizumab , Neoplasias del Sistema Biliar/diagnóstico por imagen , Neoplasias del Sistema Biliar/patología , Medios de Contraste/farmacocinética , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Progresión de la Enfermedad , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Interpretación de Imagen Radiográfica Asistida por Computador , Radiofármacos/farmacocinética , Tasa de Supervivencia , Resultado del Tratamiento , GemcitabinaRESUMEN
AIM: As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. MATERIALS & METHODS: 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. RESULTS: CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). CONCLUSION: CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases.
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Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Pulmón/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/métodos , Femenino , Humanos , Biopsia Guiada por Imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: To retrospectively investigate the prevalence, MR findings, natural history, and association with other hepatic lesions of focal nodular hyperplasia (FNH)-like lesions in a cohort of consecutive patients with cavernous transformation of the portal vein (CTPV). MATERIALS AND METHODS: This retrospective IRB-approved study comprised 58 patients (32 men, 26 women; average age, 50 years) with CTPV who underwent liver MR imaging between 2000 and 2008. MR images were assessed by two radiologists in consensus for the presence of (a) FNH-like lesions and other liver lesions, and (b) other imaging findings. Patients were assigned to a stable or progressive clinical course based on lesion characteristics at follow-up. RESULTS: Twelve of 58 patients (21%) had 38 FNH-like lesions (average size, 1.3 cm). Common findings of FNH-like lesions were isointensity on T2-weighted images (82%), intense and homogeneous enhancement during the arterial phase, and lack of washout during the hepatic venous and interstitial phases (100%). FNH-like lesions were found with other benign liver lesions (1 hemangioma, 1 adenoma) in two patients. Three (25%) patients with FNH-like lesions showed a progressive clinical course. CONCLUSION: FNH-like lesions are commonly detected in patients with CTPV. Most lesions demonstrate benign imaging findings and stable clinical course.