UZ Leuven

Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. De Wever W, Ceyssens S, Mortelmans L, Stroobants S, Marchal G, Bogaert J, Verschakelen JA. European Radiology, 2006 May 9. Abstract: Integrated positron emission tomography (PET) and computed tomography (CT) is a new imaging modality offering anatomic and metabolic information. The purpose was to evaluate retrospectively the accuracy of integrated PET-CT in the staging of a suggestive lung lesion, comparing this with the accuracy of CT alone, PET alone and visually correlated PET-CT. Fiftypatients undergoing integrated PET-CT for staging of a suggestive lung lesion were studied. Their tumor, node, metastasis (TNM) statuses were determined with CT, PET, visually correlated PET-CT and integrated PET-CT. These TNM stages were compared with the surgical TNM status. Integrated PET-CT was the most accurate imaging technique in the assessment of the TNM status. Integrated PET-CT predicted correctly the T status, N status, M status and TNM status in, respectively, 86%, 80%, 98%, 70% versus 68%, 66%,88%, 46% with CT, 46%, 70%, 96%, 30% with PET and 72%, 68%, 96%, 54% with visually correlated PET-CT. T status and N status were overstaged, respectively, in 8% and 16% with integrated PET-CT, in 20% and 28% with CT, in 16% and 20% with PET, in 12% and 20% with visually correlated PET-CT and understaged in 6% and 4% with integrated PET-CT, versus 12% and 6% with CT, 38% and 10% with PET and 12% with visually correlated PET-CT. Integrated PET-CT improves the staging of lung cancer through a better anatomic localization and characterization of lesions and is superior to CT alone and PET alone. If this technique is not available, visual correlation of PET and CT can be a valuable alternative.

Evaluation of the larynx for tumour recurrence by diffusion weighted MRI after radiotherapy: initial experience in four cases. Vandecaveye V, De Keyzer F, Vander Poorten V, Deraedt K, Alaerts H, Landuyt W, Nuyts S, Hermans R. Br J Radiology 2006 April 26. Abstract: Radiotherapy-induced changes in the soft tissues of the neck hamper the early detection of persistent or recurrent tumour by clinical examination and imaging procedures. Diffusion-weighted (DW) MRI is a non-invasive technique capable of probing tissue properties by measuring the movement of water. The purpose of the ongoing study is to examine the usefulness of DW-MRI for differentiation of persistent or recurrent tumour from post-radiotherapeutic sequelae or complications. Four patients, suspected of tumour recurrence after radiotherapy for laryngeal squamous cell carcinoma, were examined using a DW-MRI sequence on a clinical 1.5 T MR system prior to surgery. In two patients the DW-MRI images showed an asymmetric hyperintense lesion on b1000 images with low apparent diffusion coefficient (ADC) value, compatible with tumour on histopathology. All surrounding tissue presented high ADC values, and absent signal on the b1000 images, histopathologically correlating to post-radiotherapeutic changes. The images of the third and fourth patient showed absent or minimal symmetric hyper-intensity of the laryngeal soft tissues on the b1000 images and high ADCvalues. In these cases, the histopathological diagnosis of radionecrosis was made and no tumour was found. In all four cases, differentiation of tumoral tissue from radiotherapy-induced tissue alterations was possible with DW-MRI.

Intrahepatic mitomycin C as treatment of breast cancer hepatic metastases. Demey W, Wildiers H, Maleux G, Heye S, Clement P, Debruyne P, Van Oosterom A, Paridaens R.Oral presentation at BSMO, 2006 February 4. Abstract: Introduction : Because of increasing survival due to improving systemic treatment, liver metastasis represents a major and increasing cause of death in women with metastatic breast cancer. Regional treatment is an attractive option in the treatment of liver metastases. We reviewed the tolerability and efficacy of intrahepatic administration of mitomycin C (MMC) performed in our institution. Patients with only or predominant liver metastasis were eligible, independent of previous chemotherapy for metastatic breast cancer. Materials and Methods: In a unicentric protocol we reviewed retrospectively all patients (n=11) who received intrahepatic MMC for liver metastasis of breast cancer between January 2000 and July 2005 in the University Hospital Leuven. MMC was administered as a bolus of 6 mg in 50 ml saline directly into the right and left hepatic arteries by transcatheter technique. The procedure was performed by an interventional radiologist. Patients were hospitalised for 24 hours. In patients with severe liver function disturbances or more than six administrations of MMC, a dose reduction was applied. Results : All treated patients were reviewed. The median age was 52 years (range, 36-61). Most patients were heavily pre-treated with a median of 4 systemic chemotherapy regimens (range, 1-5). Treatment was well tolerated, no grade 3 or 4 adverse events were reported. Only one patient had persistent thrombocytopenia for which interruption of treatment was required. One patient had fatigue. There were no procedure- related complications. Six patients received only 1 or 2 administrations because of rapid disease progression within the first two months. Among the remainders, 4 patients had 6 and 1 patient had 11 administrations. When evaluated by RECIST criteria one patient had a complete remission, two patients had a partial remission and 2 patients remained stable for at least 6 months. Conclusion: In this retrospective analysis intrahepatic administration of MMC was well tolerated and provided clinical benefit (response or at least disease stabilization for 6 months) in 45% of heavily pre-treated patients. This treatment represents a valid therapeutic option for patients with predominant liver metastases of breast cancer after failure of standard systemic treatment.

Dry preparation for virtual CT colonography with faecal tagging using watersoluble contrast medium: initial results. Bielen D, Thomeer M, Vanbeckevoort D, Kiss G, Maes F, Marchal G, Rutgeerts P.  Eur Rad 2003;13:453–458. Abstract: Objective: The purpose was to evaluate the feasibility of a dry bowel preparation, i.e. without laxative fluids, for virtual CT colonography (VCTC) and its impact on patient acceptance compared to conventional colonoscopy (CC).Materials and Methods: A randomly chosen patient population scheduled for CC (n=11) was first submitted to VCTC after a dry preparation, consisting of low residue meals combined with a small amount of a iodinated water-soluble contrast medium during each meal three days before VCTC. In different colon segments and between different persons, the degree of tagging in VCTC was evaluated and graded. Patient acceptance and future preference were assessed for both preparations as well as for both investigations. Results : The mixing of the contrast with the intestinal content results in contrast impregnated stool, the tagged faeces. The degree of faecal tagging was good in the majority of the patients and the colonic segments, especially in the descending colon and sigmoid. Further, patient acceptance and preference were clearly in favour of VCTC compared to CC merely because of the non-invasiveness of the dry preparation. Conclusion: Dry bowel preparation and VCTC is a promising approach towards a patient friendly colon cancer-screening set-up.

Clinical validation of high-resolution fast spin-echo MR colonography after colon distention with air. Bielen DJ, Bosmans HT, De Wever LL, Maes F, Tejpar S, Vanbeckevoort D, Marchal GJ. J Magn Reson Imaging 2005;22:400-405. Abstract: The feasibility of MR colonography (MRC) with air using T1 weighted 2D turbo spin-echo was evaluated in patients scheduled for conventional colonoscopy after classic bowel preparation. The ability to detect colonic lesions was only a secondary goal. Distention was sufficient for diagnosis and the technique provided adequate delineation of the wall in the majority of segments. Residual fluid obscured the wall in different segments, especially in ascending and descending colon (supine position) and in cecum, transverse and sigmoid colon (prone position), findings which were consistent with CT colonography. MRC visualized 3 lesions, missed 1 lesion >10 mm, visualized none of 4 lesions .

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