Journal of Medical Imaging and Radiation Sciences

The Value of PET-CT in Ovarian Epithelial Carcinoma: A Population-Based Study in British Columbia, Canada

In epithelial ovarian cancer (EOC), consensus regarding optimal use of PET/CT is lacking. Limited evidence suggests its accuracy in preoperative staging, investigating recurrence and predicting optimal secondary debulking. This study evaluated indications for PET/CT, impact of PET/CT results on EOC management, and its added value over conventional imaging. Patients with EOC aged 19 years and older who underwent PET/CT at BC Cancer Vancouver between January 2007 and September 2017 were eligible. Medical records were retrospectively reviewed with the following data abstracted: patient demographics, PET/CT indications and results, recent conventional imaging results, and application of PET/CT findings. Basic descriptive analysis was performed to determine most common use of PET/CT and its management impact. 257 PET/CTs in 216 patients were eligible. Most PET/CTs (135/257, 52.6%) were performed for suspected disease recurrence/progression. Management after PET/CT changed in 1/3 of cases with the greatest impact seen when assessing suitability in recurrent disease for focal radiotherapy or secondary surgical debulking. For 106/257 cases with recent conventional imaging available, although differences in disease extent were found in ~50%, clinical conclusions drawn were the same in ~75%. Although PET/CT is most commonly used to investigate suspected recurrence/progression, its impact on management here is low. Greater impact is seen when considering localized therapy in EOC recurrence. When compared with recent conventional imaging, although PET/CT may detect differences in disease extent, clinical conclusions are frequently the same. Impact of PET/CT on management is greatest in EOC recurrence when considering local therapies, beyond which clinical presentation and conventional imaging may suffice.

Living with Long-term Effects of Radiotherapy: A Patient's Perspective

Comparing Setup Errors Using Portal Imaging in Patients With Gynecologic Cancers by Two Methods of Alignment

Alignment tattoos on a lax abdomen contribute to misalignment of patients undergoing abdomino-pelvic radiotherapy (RT). The present study was undertaken to assess setup reproducibility in gynecologic cancer patients positioned identically but aligned for treatment to machine isocenter by two different ways. A prospective study in 35 women treated with radical RT for gynecologic malignancy was undertaken. A RT planning contrast-enhanced computed tomography scan in the supine position using an foot and ankle positioning device was done, and three reference points tattooed on the reference plane, anteriorly at the mons pubis and one on each side laterally at a fixed table top-to-vertical height of 10 cm, whereas a fourth point was tattooed at the xiphoid in the anterior midline. Patients were aligned using either a field center, that is, conventional method (Arm I, n = 18) or by a new setup isocenter (Arm II, n = 17) defined by a cranial offset of 4 cm to the reference plane for daily treatment. Anterior and right lateral digitally reconstructed radiograph setup fields were created at the treatment isocenters and compared with orthogonal megavoltage portal images (PI) taken during initial 3 days of RT and subsequently twice weekly. Setup deviations-rotations and translations were analysed in mediolateral (ML), craniocaudal, and anteroposterior direction. No online and offline corrections were performed. Population systematic error and random error were calculated and planning target volume margins required were estimated using van Herk's formula. Arm I had 209 PI while Arm II had 188 PI. Patients in arm II had a lesser systematic error in the ML direction. Patients with large pelvic girth (>95 cm) were susceptible for greater movements during treatment, more so in Arm I, major shifts (>5 mm) with respect to Arm II in the ML direction (37% vs. 22%, P = .001). A larger planning target volume expansion was required in Arm I (1.6 cm) compared with Arm II (0.9 cm). The margin expansion required from clinical target volume in anteroposterior direction was about 0.6 cm and about a cm in the craniocaudal direction in both the arm. Alignment of patient with anterior tattoo at the relatively immobile portion of lower abdomen (mons pubis) Arm II (setup) is superior to a more cranial location over the flabby abdomen during radiation treatment.

Diagnostic value of T2 and diffusion-weighted imaging (DWI) in local staging of endometrial cancer

Endometrial cancer (EC) is the eighth most prevalent cancer globally. T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) help anatomical localization and local staging of lesions. The present study was performed to assess the diagnostic value of the simultaneous use of T2 and DWI techniques in EC evaluation. Seventy-eight histopathological-proven EC cases were included in this study. Patients were assessed using a complete MRI exam, including T2 and DWI. The myometrial invasion, cervical, serosal or adnexal, vaginal or parametrial, and pelvic lymph node involvements and accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated in each sequence distinctly and was compared with the pathology findings and full standard protocol using post-contrast multiphasic contrast-enhanced series. Deep myometrial invasion in EC cases was detected in 38.5% by T2-DWI and 37.2% by pathology. The pathology diagnosed cervical, serosal, and vaginal involvements and pelvic lymph node metastases in 20.5%, 7.7%, 6.4% and 11.5% of cases respectively, while the numbers for T2-DWI were 26.9%, 7.7%, 7.7%, and 15.4%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of T2-DWI in the diagnosis of myometrial invasion were 93.5%, 93.1%, 93.8%, 90%, and 93.8%, respectively. A slightly higher Kappa coefficient of DWI (0.973) in the diagnosis of myometrial invasion was identified compared to T2 (0.946). The T2-DWI technique had a 52.6% intraclass correlation coefficient in the diagnosis of IA stage. The simultaneous consideration of T2 and DWI technique may signify a noninvasive, rapid, safe, and accurate approach for precisely assessing myometrial invasion and EC staging. Elimination of intravenous contrast material result in prevention of contrast related side effects beside significant cost reduction for health care systems and patients with a comparable result to contrast enhanced MRI.