Tumor Diagnosis and Treatment: Imaging Assessment

A special issue of Tomography (ISSN 2379-139X).

Deadline for manuscript submissions: closed (15 September 2022) | Viewed by 17827

Special Issue Editor

Institute of Radiology, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy
Interests: MRI; PET; diagnostic imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Imaging is becoming increasingly important in the field of oncology and, nowadays, it is a pivotal tool for clinical decision-making. Imaging is used for cancer screening, diagnosis, staging, restaging, and monitoring for cancer recurrence. For diagnosis and screening, scientific societies are promoting standardized systems of reporting in order to reduce the variability of the reports and to improve the detection of small tumors. These criteria are in a continuous state evolution and improvement since imaging techniques are being continually developed, and it is necessary to improve the accuracy of the reporting systems as much as possible.

In staging and restaging, multiple criteria have been proposed to evaluate the response of the tumors and metastases to neoadjuvant or adjuvant therapies (chemo or radiotherapies), starting from the well-known RECIST criteria up to the volumetric analyses and the evaluation of the image texture. With specific software for texture analysis, it is possible to extract different features from US, CT, and MRI images that are mainly not appreciable by the eye of the radiologist, thus allowing a quantitative evaluation of the tumoral masses that was not possible a few years ago. This technique is illuminating new pathways in the field of diagnostics, and the help of artificial intelligence in evaluating such a large amount of data could become an ordinary application in a few years.

Dr. Filippo Crimi’
Guest Editor

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Keywords

  • CT
  • MRI
  • US
  • PET/CT
  • PET/MRI
  • diagnosis
  • staging
  • texture analysis

Published Papers (9 papers)

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Editorial

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3 pages, 203 KiB  
Editorial
New Frontiers in Oncological Imaging
Tomography 2023, 9(4), 1329-1331; https://doi.org/10.3390/tomography9040105 - 07 Jul 2023
Viewed by 771
Abstract
The more that advances in the medical field are capable of targeted treatments, the more imaging should be tailored to patients [...] Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
3 pages, 212 KiB  
Editorial
Tumor Diagnosis and Treatment: Imaging Assessment
Tomography 2022, 8(3), 1463-1465; https://doi.org/10.3390/tomography8030118 - 30 May 2022
Cited by 1 | Viewed by 1088
Abstract
At present, oncologic imaging is crucial for clinical decision-making [...] Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)

Research

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11 pages, 1214 KiB  
Article
Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis
Tomography 2022, 8(6), 2828-2838; https://doi.org/10.3390/tomography8060236 - 25 Nov 2022
Cited by 14 | Viewed by 2185
Abstract
Background: Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest [...] Read more.
Background: Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0–60% incidence) and pulmonary hemorrhage (4–27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. Materials and Methods: Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. Results: There was sensitivity of 90.07% (95% CI 86.05–93.25%), accuracy of 98.87% (95% CI 98.12–99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23–99.10%). Specificity settled at 100% (93.84–100%). The AUC was 0.952 (95% CI 0.924–0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. Conclusions: The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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12 pages, 1368 KiB  
Article
FDG-PET/MRI for Nonoperative Management of Rectal Cancer: A Prospective Pilot Study
Tomography 2022, 8(6), 2723-2734; https://doi.org/10.3390/tomography8060227 - 09 Nov 2022
Cited by 6 | Viewed by 1636
Abstract
Nonoperative management (NOM) is increasingly utilized for rectal cancer patients with a clinical complete response (cCR) following total neoadjuvant therapy (TNT). The objective of this pilot study was to determine whether FDG-PET/MRI alters clinical response assessments among stage I-III rectal cancer patients undergoing [...] Read more.
Nonoperative management (NOM) is increasingly utilized for rectal cancer patients with a clinical complete response (cCR) following total neoadjuvant therapy (TNT). The objective of this pilot study was to determine whether FDG-PET/MRI alters clinical response assessments among stage I-III rectal cancer patients undergoing TNT followed by NOM, relative to MRI alone. This prospective study included 14 subjects with new rectal cancer diagnoses. Imaging consisted of FDG-PET/MRI for initial staging, post-TNT restaging, and surveillance during NOM. Two independent readers assessed treatment response on MRI followed by FDG-PET/MRI. Inter-reader differences were resolved by consensus review. The reference standard for post-TNT restaging consisted of surgical pathology or clinical follow-up. 7/14 subjects completed post-TNT restaging FDG-PET/MRIs. 5/7 subjects had evidence of residual disease and underwent total mesorectal excision; 2/7 subjects had initial cCR with no evidence of disease after 12 months of NOM. FDG-PET/MRI assessments of cCR status at post-TNT restaging had an accuracy of 100%, compared with 71% for MRI alone, as FDG-PET detected residual tumor in 2 more subjects. Inter-reader agreement for cCR status on FDG-PET/MRI was moderate (kappa, 0.56). FDG-PET provided added value in 82% (9/11) of restaging/surveillance scans. Our preliminary data indicate that FDG-PET/MRI can detect more residual disease after TNT than MRI alone, with the FDG-PET component providing added value in most restaging/surveillance scans. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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9 pages, 3381 KiB  
Article
Contrast-Enhanced CT Texture Analysis in Colon Cancer: Correlation with Genetic Markers
Tomography 2022, 8(5), 2193-2201; https://doi.org/10.3390/tomography8050184 - 31 Aug 2022
Cited by 4 | Viewed by 2022
Abstract
Background: The purpose of the study was to determine whether contrast-enhanced CT texture features relate to, and can predict, the presence of specific genetic mutations involved in CRC carcinogenesis. Materials and methods: This retrospective study analyzed the pre-operative CT in the venous phase [...] Read more.
Background: The purpose of the study was to determine whether contrast-enhanced CT texture features relate to, and can predict, the presence of specific genetic mutations involved in CRC carcinogenesis. Materials and methods: This retrospective study analyzed the pre-operative CT in the venous phase of patients with CRC, who underwent testing for mutations in the KRAS, NRAS, BRAF, and MSI genes. Using a specific software based on CT images of each patient, for each slice including the tumor a region of interest was manually drawn along the margin, obtaining the volume of interest. A total of 56 texture parameters were extracted that were compared between the wild-type gene group and the mutated gene group. A p-value of <0.05 was considered statistically significant. Results: The study included 47 patients with stage III-IV CRC. Statistically significant differences between the MSS group and the MSI group were found in four parameters: GLRLM RLNU (area under the curve (AUC) 0.72, sensitivity (SE) 77.8%, specificity (SP) 65.8%), GLZLM SZHGE (AUC 0.79, SE 88.9%, SP 65.8%), GLZLM GLNU (AUC 0.74, SE 88.9%, SP 60.5%), and GLZLM ZLNU (AUC 0.77, SE 88.9%, SP 65.8%). Conclusions: The findings support the potential role of the CT texture analysis in detecting MSI in CRC based on pre-treatment CT scans. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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10 pages, 583 KiB  
Article
Prostate Cancer Detection with mpMRI According to PI-RADS v2 Compared with Systematic MRI/TRUS-Fusion Biopsy: A Prospective Study
Tomography 2022, 8(4), 2020-2029; https://doi.org/10.3390/tomography8040169 - 16 Aug 2022
Cited by 2 | Viewed by 1967
Abstract
Background: mpMRI assesses prostate lesions through their PI-RADS score. The primary goal of this prospective study was to demonstrate the correlation of PI-RADS v2 score and the volume of a lesion with the presence and clinical significance of prostate cancer (PCa). The secondary [...] Read more.
Background: mpMRI assesses prostate lesions through their PI-RADS score. The primary goal of this prospective study was to demonstrate the correlation of PI-RADS v2 score and the volume of a lesion with the presence and clinical significance of prostate cancer (PCa). The secondary goal was to determine the extent of additionally PCa in inconspicuous areas. Methods: All 157 patients underwent a perineal MRI/TRUS-fusion prostate biopsy. Targeted biopsies as well as a systematic biopsy were performed. The presence of PCa in the probes was specified by the ISUP grading system. Results: In total, 258 lesions were biopsied. Of the PI-RADS 3 lesions, 24% were neoplastic. This was also true for 36.9% of the PI-RADS 4 lesions and for 59.5% of the PI-RADS 5 lesions. Correlation between ISUP grades and lesion volume was significant (p < 0.01). In the non-suspicious mpMRI areas carcinoma was revealed in 19.7% of the patients. Conclusions: The study shows that the PI-RADS v2 score and the lesion volume correlate with the presence and clinical significance of PCa. However, there are two major points to consider: First, there is a high number of false positive findings. Second, inconspicuous mpMRI areas revealed PCa. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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12 pages, 2618 KiB  
Article
Predictors of Metastatic Lymph Nodes at Preoperative Staging CT in Gastric Adenocarcinoma
Tomography 2022, 8(3), 1196-1207; https://doi.org/10.3390/tomography8030098 - 22 Apr 2022
Cited by 1 | Viewed by 2820
Abstract
Background. The aim of this study was to identify the most accurate computed-tomography (CT) dimensional criteria of loco-regional lymph nodes (LNs) for detecting nodal metastases in gastric cancer (GC) patients. Methods. Staging CTs of surgically resected GC were jointly reviewed by two radiologists, [...] Read more.
Background. The aim of this study was to identify the most accurate computed-tomography (CT) dimensional criteria of loco-regional lymph nodes (LNs) for detecting nodal metastases in gastric cancer (GC) patients. Methods. Staging CTs of surgically resected GC were jointly reviewed by two radiologists, considering only loco-regional LNs with a long axis (LA) ≥ 5 mm. For each nodal group, the short axis (SA), volume and SA/LA ratio of the largest LN, the sum of the SAs of all LNs, and the mean of the SA/LA ratios were plotted in ROC curves, taking the presence/absence of metastases at histopathology for reference. On a per-patient basis, the sums of the SAs of all LNs, and the sums of the SAs, volumes, and SA/LA ratios of the largest LNs in all nodal groups were also plotted, taking the presence/absence of metastatic LNs in each patient for reference. Results. Four hundred and forty-three nodal groups were harvested during surgery from 107 patients with GC, and 173 (39.1%) were metastatic at histopathology. By nodal group, the sum of the SAs showed the best Area Under the Curve (AUC), with a sensitivity/specificity of 62.4/72.6% using Youden’s index with a >8 mm cutoff. In the per-patient analysis, the sum of the SAs of all LNs in the loco-regional nodal groups showed the best AUC with a sensitivity/specificity of 65.6%/83.7%, using Youden’s index with a >39 mm cutoff. Conclusion. In patients with GC, the sum of the SAs of all the LNs at staging CT is the best predictor among dimensional LNs criteria of both metastatic invasion of the nodal group and the presence of metastatic LNs. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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Review

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14 pages, 776 KiB  
Review
Imaging or Adrenal Vein Sampling Approach in Primary Aldosteronism? A Patient-Based Approach
Tomography 2022, 8(6), 2735-2748; https://doi.org/10.3390/tomography8060228 - 09 Nov 2022
Cited by 3 | Viewed by 1746
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, associated with an increased risk of cardiovascular and cerebral disease, compared to essential hypertension. Therefore, it is mandatory to promptly recognize the disease and offer to the patient the correct diagnostic–therapeutic process [...] Read more.
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, associated with an increased risk of cardiovascular and cerebral disease, compared to essential hypertension. Therefore, it is mandatory to promptly recognize the disease and offer to the patient the correct diagnostic–therapeutic process in order to reduce new-onset cardiovascular events. It is fundamental to define subtype classification (unilateral or bilateral disease), in order to provide the best treatment (surgery for unilateral and medical treatment for bilateral disease). Here, we report five clinical cases of different subtypes of PA (patients with monolateral or bilateral PA, nondiagnostic AVS, allergy to iodinated contrast, and patients not suitable for surgery), with particular attention to the diagnostic–therapeutic process and the different approaches tailored to a single case. Since PA is a spectrum of various diseases, it needs a personalized diagnostic–therapeutic process, customized for the individual patient, depending on previous medical history, suitability for the surgery and patient’s preferences. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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Other

6 pages, 1367 KiB  
Case Report
18F-FES PET/CT Improves the Detection of Intraorbital Metastases in Estrogen-Receptor-Positive Breast Cancer: Two Representative Cases and Review of the Literature
Tomography 2022, 8(2), 1060-1065; https://doi.org/10.3390/tomography8020086 - 07 Apr 2022
Cited by 2 | Viewed by 2840
Abstract
Orbital metastases are a rare but life-altering complication in cancer. Most commonly seen in breast cancer, metastases to the optic nerves or extraocular muscles can have a devastating impact on visual acuity and quality of life. Hormone receptor status plays a central role [...] Read more.
Orbital metastases are a rare but life-altering complication in cancer. Most commonly seen in breast cancer, metastases to the optic nerves or extraocular muscles can have a devastating impact on visual acuity and quality of life. Hormone receptor status plays a central role in metastatic breast cancer treatment, with endocrine therapy often representing first-line therapy in hormone-receptor-positive cancers. Staging and treatment response evaluation with positron emission tomography (PET) computed tomography (CT) imaging with 18F-fluorodeoxyglucose (18F-FDG) is limited by high physiologic uptake in the intracranial and intraorbital compartments. Thus, traditional staging scans with 18F-FDG PET/CT may under-detect intraorbital and intracranial metastatic disease and inaccurately evaluate active metastatic disease burden. In comparison, 18F-fluoroestradiol (18F-FES) is a novel estrogen-receptor-specific PET radiotracer, which more accurately assesses the intracranial and intraorbital compartments in patients with estrogen-receptor-positive (ER+) cancers than 18F-FDG, due to lack of physiologic background activity in these regions. We present two cases of breast cancer patients with orbital metastases confirmed on MR imaging who underwent PET/CT imaging with 18F-FES and 18F-FDG. Multimodality imaging with 18F-FES PET/CT offers higher detection sensitivity of orbital metastases, compared with traditional 18F-FDG PET/CT imaging, and can improve the assessment of treatment response in patients with estrogen-receptor-positive (ER+) cancers. Full article
(This article belongs to the Special Issue Tumor Diagnosis and Treatment: Imaging Assessment)
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