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. 2005 Nov 23;5(Spec No A):S89–S96.

ABSTRACTS—SESSIONS 1–3

Tuesday 4 October, 12.00–13.00

PMCID: PMC1665319
Cancer Imaging. 2005 Nov 23;5(Spec No A):S89. doi: 10.1102/1470-7330.2005.0057

Diffusion-weighted imaging with low b factors in prostatic cancer

A Rahmouni *, M Jelali *, L Ruel *, M Bouanane *, P Brugières *, H Kobeiter *, A Luciani *

12.00–13.00

Objectives

To evaluate diffusion-weighted imaging (DWI) with low b factors of the peripheral zone (PZ) of patients with prostatic cancer.

Materials and methods

An EPI diffusion MR sequence (TE=75 ms, TR=4000 ms, slice thickness = 4 mm), with low diffusion factors incremented by 10s/mm2, has been developed on a 1.5 T magnet. Axial T2-weighted images of the prostate were performed on 21 consecutive patients with biopsy-proven prostate cancer. An EPI diffusion sequence with low b factors for the middle part of the prostate was performed at the level showing the lowest T2 signal intensity of the PZ. In both low and normal T2 signal intensity PZ, ADC were computed. A bi-exponential adjustment was performed to extract the slow and fast component values of the apparent diffusion coefficient (ADCslow and ADCfast) as well as the respective fractions of these two compartments (fslow and ffast).

Results

The decrease in signal intensity was bi-exponential for all patients. The mean ADCfast values were 25.70×10−3mm2/s(DS=20.62×10−3) in the low T2 signal intensity PZ and 5.87×10−3mm2/s(DS=2.07×10−3) in normal signal intensity PZ (t-test, p=0.0002).

Conclusion

The significant increase in ADCfast in low T2 signal intensity areas of the PZ when compared to normal signal intensity areas may reflect a difference in microvascular perfusion.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S89. doi: 10.1102/1470-7330.2005.0058

Increased diagnostic performance of prostate cancer staging for contrast-enhanced transrectal ultrasound compared with unenhanced imaging

S W T P J Heijmink *, H van Moerkerk †, J J Fütterer *, T W J Scheenen *, C A Hulsbergen-v d Kaa ‡, J A Witjes †, J G Blickman *, J O Barentsz *

12.00–13.00

Aims

To evaluate whether contrast-enhanced (CE) transrectal ultrasound (TRUS) improves prostate cancer (PC) staging compared with unenhanced TRUS and assess the impact of experience.

Methods

In a prospective study, 58 consecutive patients with biopsy-proven and clinically localised PC underwent TRUS before radical prostatectomy. Axial imaging of the prostate was performed in grey-scale, colour and power Doppler mode. During slow (1 ml /min) intravenous administration of Sonovue ® (sulphur hexafluoride), CE power Doppler images were obtained. Prospectively, two radiologists (one with 1 year’s experience and one with no experience) who were blinded to clinical data, independently reviewed all imaging and determined the disease stage on a five-point scale from definitely stage T2 to T3. Whole-mount section histopathology was the standard of reference. The areas under the receiver operating characteristic curve (AUC) were calculated.

Results

For the more experienced reader the AUCs for grey-scale, colour Doppler, power Doppler and CE power Doppler were 0.68, 0.48, 0.53 and 0.77, respectively. The sensitivity and specificity of the grey-scale imaging were 23% (3 /13) and 96% (43 /45), respectively. CE TRUS increased sensitivity to 62% (8 /13) with 87% (39 /45) specificity. The AUCs for CE TRUS staging of the first and second group of 29 patients increased from 0.66 to 0.85. While the inexperienced reader performed poorly overall and contrast administration did not improve diagnostic performance, a learning curve was also noted.

Conclusion

CE TRUS increased the sensitivity and AUC of PC staging for the more experienced reader and a learning curve was observed. The level of experience of the reader was a factor.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S90. doi: 10.1102/1470-7330.2005.0059

Comparing prostate cancer localisation and staging with body array and endorectal coil MRI at 3T

S W T P J Heijmink *, J J Fütterer *, T W J Scheenen *, S Takahashi *, C A Hulsbergen-vd Kaa †, J A Witjes ‡, J G Blickman *, J O Barentsz *

12.00–13.00

Aim

To assess image quality, localisation and staging accuracies between body array coil (BAC) and endorectal coil (ERC) MR imaging of prostate cancer (PC) at 3T.

Methods

In a prospective study, 18 patients with biopsy-proven and clinically localised PC underwent MR imaging at 3 T prior to radical prostatectomy. Both with a BAC and ERC, T2-weighted images in three planes were obtained for PC localisation and staging. Axial T1-weighted series were used to exclude post-biopsy haemorrhage. The spatial resolution was optimised depending on coil setup. Prospectively, three radiologists with varying experience independently read all imaging. The readers were blinded to the clinical data. BAC and ERC imaging sets were read separately and in random order. Image quality characteristics and disease stage (from definite stage T2 to T3 disease) were determined on a five-point scale. Readers scored each of 14 prostate sections as PC or healthy on a five-point probability scale. Whole-mount section histopathology was the standard of reference. Areas under the receiver operating characteristic curve (AUC) were calculated.

Results

Compared with BAC, anatomical details significantly improved when using an ERC. In all readers, sensitivity for detecting stage T3 disease increased from 0%–50% to 67%–100%, with high specificity (60%–100%). On average, the AUC increased from 0.64 to 0.87. Of the 18 index tumours, BAC imaging found 12 compared to 13 with ERC imaging.

Conclusion

The use of an ERC substantially increased image quality and staging performance. However, 3 T BAC imaging may play a role in PC screening by detecting the index tumour.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S90. doi: 10.1102/1470-7330.2005.0060

An advanced method of CAD applied to breast MRI

J C Vilanova *, J Barceló *

12.00–13.00

Aim

To analyse and compare between a CAD breast MRI system and standard MRI software (SS) analysis for diagnostic accuracy, registration of data to correct patient movement-related artefacts, and the usefulness for the radiologist who interprets MR breast examinations.

Materials and methods

We evaluated 36 subjects from breast cancer MR imaging studies. We performed a comparative study between an automatic CAD system (CADstream) and SS for MRI. For each system analysis, we determined the lesion size, morphology, kinetic enhancement, quality image correction of subtracted images by CAD, time for study analysis on each system, and the presence of additional breast lesions.

Results

CAD’s automatic measurements showed higher tumour size correlation (0.92) with histologic analysis than with the manual SS (0.86). The morphology and kinetic enhancement patterns did not show significant differences between CAD and SS. Both systems detected additional lesions in 10 patients (28%), thus modifying the therapeutic approach. The corrected series from CAD were chosen as better registered data for patient movement-related artefacts than uncorrected subtraction images in 83% of cases. The mean analysis time for breast MRI on the CAD system was 6 min, significantly shorter than the 21 min for the SS.

Conclusions

The CAD system is an accurate diagnostic method for breast cancer evaluation with a high correlation with histology. It shows a significant reduction in artefacts for the subtraction series and is a useful tool for the radiologist in order to save a substantial amount of time for the analysis and interpretation of all MR images.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S91. doi: 10.1102/1470-7330.2005.0061

Breast MRI in breast cancer staging: effect on therapeutic approach in 285 patients

J Camps Herrero *, M Forment Navarro *, M T Loret Martí *, C Martinez Rubio *, V Ricart Selma *, M Sentís Crivellé †, P J Gonzalez Noguera *

12.00–13.00

Aim

The aim of our study was to evaluate the effect of breast MRI on breast cancer patients from the therapeutic approach. We also assessed the outcomes of the work-up of additional lesions seen in breast MRI.

Methods

From July 2002 to February 2005 we studied prospectively 285 consecutive patients aged 24–88 years (mean age = 58) with a diagnosis of breast cancer by core needle biopsy, who underwent breast MRI staging. Histopathological results after surgery were considered the gold standard.

Results

The therapeutic approach was changed after breast MRI in 70 patients (25.4%). The change was correct in 58 patients (20.3%) and incorrect in 12 patients (4.2%). In the first group of patients (correct change), 16 out of 58 patients (27.5%) initially scheduled for conservative surgery, underwent mastectomies. Twenty-five patients (43.1%) underwent a wider excision in the same or contralateral breast, 15 patients (25.8%) were re-assigned to the neoadjuvant chemotherapy group and in two patients (3.4%) initially diagnosed with cancer of unknown primary (CUP) the breast cancer was found. In the second group of patients there were ten unnecessary wider excisions as well as two unnecessary mastectomies. The work-up of the additional breast lesions added 81 second-look ultrasound exams, 28 contrast-enhanced ultrasound exams, breast MRI follow-up in BI-RADS 3 lesions in 48 patients and 36 core needle or fine needle aspiration biopsies.

Conclusion

Breast MRI is an effective tool in breast cancer staging, as it changes the therapeutic approach correctly in one out of every five patients.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S91. doi: 10.1102/1470-7330.2005.0062

Contrast-enhanced US (CEUS) in the evaluation of axillary lymph nodes in breast cancer patients

J Camps Herrero *, G Rizzatto †, M Sentís Crivellé ‡, V Ricart Selma *, C Martinez Rubio *, M T Loret Martí *, R Chersevani †, G Ralleigh §

12.00–13.00

Aim

The aim of our study was to evaluate the usefulness of a microbubble contrast in the evaluation of axillary lymph nodes in patients with a diagnosis of breast cancer. The study was carried out within the Perfusion Ultrasound Multicenter European Breast (PUMEB) 2004 protocol.

Methods

Contrast-enhanced US with a microbubble contrast agent (Sonovue) was performed in 20 patients with suspicious findings in axillary US and/or negative fine needle aspiration biopsy (FNAB) in the context of breast cancer staging to confirm or rule out the presence of axillary metastases. In all positive lymph nodes a FNAB was performed. Findings of FNAB, sentinel node procedures or lymphadenectomies were considered the gold standard.

Results

Contrast-enhanced US (CEUS) showed hypoechoic areas consistent with metastastic deposits in 12 patients and homogeneous enhancement consistent with normal reactive lymph nodes in eight patients. The smallest metastatic deposit seen with CEUS was 4 mm. There were two false-positive cases and one false-negative case. Depiction of metastatic deposits with CEUS changed the therapeutic approach in three patients and the absence of positive findings guided sentinel node procedures in eight patients (55%). Sensitivity was 83% and specificity 88%.

Conclusion

Perfusion imaging with CEUS enhances the already high positive predictive value of axillary US and increases diagnostic confidence in negative exams.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S92. doi: 10.1102/1470-7330.2005.0063

Oncological staging in paediatric patients: comparison of whole body MRI and conventional staging

S Ley *, J Schenk *, M Edelhäuser *, J Zaporozhan *, A Kulozik *, E Haufe *, J Tröger *, H-U Kauczor *

12.00–13.00

Goal

Staging of paediatric tumours is done by several modalities representing a great burden for the patients regarding time and radiation. Therefore the goal of this study was to evaluate the usefulness of non-invasive whole body MRI (wb-MRI) staging as a potential substitute for conventional staging.

Material and methods

Eighteen patients (8–18 years) with oncological diseases (such as lymphomas, sarcomas) were included in this prospective study. Wb-MRI (1.5 T, Magnetom Avanto) was performed in comparison to the routinely performed battery of conventional staging procedures (FDG-PET, scintigraphy, CT, ultrasound, bone X-ray). Examinations were performed in a blinded fashion and interpreted during routine. Written reports and images were compared in consensus during tumour board sessions.

Results

Wb-MRI including post contrast sequences took less than 90 min and was well tolerated by all patients. All lesions visualised during conventional work-up were detected and correctly classified by MRI. MRI showed a higher sensitivity in the case of small bone metastases with a diameter less than 1.0 cm. Tumour staging was correct by MRI alone, compared to all other modalities together. Furthermore, MRI offers a first assessment of whole body tumour burden, which might be of great value for follow-up studies.

Conclusion

Wb-MRI is a feasible technique for fast and sensitive detection of oncological diseases in paediatric patients with bone and soft tissue metastases. It outperforms conventional staging in the case of small lesions. Therefore, MRI might be used as a single staging modality leading to a reduction of techniques associated with radiation.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S92. doi: 10.1102/1470-7330.2005.0064

Efficacy of 16-row multidetector CT (MDCT) in the preoperative staging of oesophageal cancer in comparison to endoscopic ultrasonography (EUS) using the histopathological findings as the gold standard

W K Matzek *, A Ba-Ssalamah *, K Pinker *, J Zacherl *, A Püspök *, W Schima *

12.00–13.00

Purpose

To evaluate the preoperative staging of oesophageal carcinoma with contrast enhanced 16-row multidetector CT and compare the findings with the results by EUS, in correlation with histopathological findings.

Materials and methods

Forty-two patients with oesophageal carcinoma proven by endoscopic biopsy were examined preoperatively with MDCT in a prone position. After distending the oesophagus (gas granules) and stomach (1.5 l water), the thorax and neck were subjected to MDCT scanning with 16×0.5 mm, the abdomen with 16×1.5 mm, using an individualised contrast injection protocol based on a bolus tracking technique. EUS was performed using a fibre-optic endoscope with a 5–10 MHz electronic array at a 360 degree scanning angle. Our MDCT staging criteria were drawn from a careful review of the literature and from personal experience and we used the TNM classification by the AJCC.

Results

Both modalities detected all tumours with a sensitivity of 100%. T staging by MDCT and EUS reached accuracies of 66% and 75%. The diagnosis of local node involvement by MDCT was correct in 81%, by EUS in 75%. The evaluation of distant node involvement and other metastases reached an accuracy of 92% with MDCT and 65% with EUS.

Conclusion

Non-invasive MDCT is an important tool in the preoperative staging of oesophageal carcinoma and is complementary to EUS.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S93. doi: 10.1102/1470-7330.2005.0065

Diffusion-weighted MRI-based differentiation of tumour recurrence after radiotherapy for head and neck squamous cell carcinoma

V Vandecaveye *, F De Keyzer *, S Nuyts *, V Vander Poorten *, P Delaere *, R Hermans *

12.00–13.00

Purpose

To examine the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) to discriminate persisting or recurring tumour from non-tumoral tissue in head and neck squamous cell carcinoma (SCC) after radiotherapy.

Materials and methods

In 15 patients with suspicion of persistent or recurrent SCC after radiotherapy (seven at a primary site, eight with persisting adenopathies), MRI was performed on a 1.5 T system before salvage surgery. T2- and T1-weighted turbo spin-echo sequences (before and after contrast injection) were acquired, as well as an echo-planar DW-MRI sequence, using a large range of b-values (0–1000 s/mm2). Apparent diffusion coefficient (ADC) maps were calculated for the suspect areas, as well as for the surrounding tissue; this was done separately for the entire b-value range (ADCavg) and for high b-values only (b≥500s/mm2, ADChigh). Imaging results were correlated with the histopathology.

Results

In the seven patients with suspected primary tumour recurrence, six were positive on histology. In the eight patients with suspected neck recurrence, 25 lymph nodes were found in neck-dissection specimens; 7 /25 were positive. All confirmed tumoral lesions (both primary and adenopathies) showed low ADC values and hyperintensity on b1000 images, while non-tumoral tissue showed high ADC values and no signal on b1000 images. Mean ADCavg (mm2/s) for tumoral tissue was 0.00099±0.00017 vs. 0.00179±0.00035 for surrounding normal irradiated tissue (P<0.0001). Mean ADChigh values (mm2/s) were 0.00084±0.00023 and 0.00135±0.00030 for tumoral and normal tissue, respectively (P<0.0001).

Conclusion

DW-MRI differentiates persistent or recurrent head and neck cancer from non-tumoral tissue changes after radiotherapy.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S93. doi: 10.1102/1470-7330.2005.0066

Dexamethasone alters cerebral perfusion and blood-tumour barrier kinetics on MR in patients with intracranial masses

F L Giesel *,†, H von Tengg-Kobligk *, D A Jellinek †, D Levy †, B A Miller †, P D Griffiths †, I D Wilkinson †

12.00–13.00

Objectives

Dexamethasone is commonly administered following initial diagnosis of an intracranial tumour. The clinical effects of this steroid can be dramatic. However, the underlying physiological response that gives rise to this often rapid symptom resolution remains unclear. This study sought to investigate localised vascular perfusion plus brain–tumour barrier (BTB) and blood–brain barrier (BBB) integrity via two dynamic MRI methods before and after administration of glucocorticoids in patients with enhancing cerebral mass lesions.

Study design

Seventeen patients (11 astrocytoma IV, 1 sarcoma, 1 anaplastic oligodendroglioma, 4 unknowns) underwent MRI at 1.5 T (Eclipse, PMS) before and 3 days after initiation of high-dose dexamethasone. Contrast ‘uptake’ time curves were calculated from dynamic, T1-weighted, RF-spoiled FAST datasets (50 frames over 162 s, 10 ml bolus of Gadovist). Regional CBV and transit time (TTFM) were assessed using a dynamic, T2*-weighted EPI technique (70 frames over 98 s; 10 ml bolus Gadovist).

Results

Following initiation of steroid treatment: tumour rCBV was reduced (p<0.005); contralateral normal appearing white matter rCBV was reduced (p<0.05); contralateral TTFM reduced (p<0.05) and maximum uptake of tumour contrast was found to have decreased (p<0.005).

Conclusions

Suggested mechanisms underlying symptom resolution following glucocorticoid therapy include a decrease in vasogenic oedema following tightening of the BTB or changes in rCBV with subsequent lowering of ICP. Our results indicate that rCBF within normal appearing white matter as well as tumour are lowered following drug initiation in addition to alterations in BTB permeability. This work highlights the need to control for steroid therapy in MR studies involving cerebral neoplasms.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S94. doi: 10.1102/1470-7330.2005.0067

MR staging of rectal cancer after long course neo-adjuvant chemo radiotherapy

M J Dobson *, V Rudralingam *

12.00–13.00

Neo-adjuvant chemo-irradiation is often used to attempt ‘down-staging’ of patients with locally advanced rectal cancer, with a view to subsequent total meso-rectal excision (TME). This paper addresses the MR scanning appearance of 20 patients post-long course radiotherapy, with histological correlation for 16 patients. Patients were scanned on a 1.5 T system (Siemens Symphony, Erlanghen, Germany), using flexible pelvic phased array surface coils; 3 mm high-resolution T2-weighted images were acquired perpendicular and parallel to the rectal tumour. Four patients were considered inoperable due to either advanced loco-regional disease or metastasis. Fourteen patients showed a variable reduction in tumour bulk post-therapy. MR staging was correct in all cases (T4 n=1, T3 n=10, T2 n=2, T0 n=1). MR correctly predicted all patients (n=5) with a negative circumferential resection margin (CRM). Four of six patients predicted on scan to be CRM positive (tumour within 1 mm of the mesorectal fascia) were confirmed at histology. Two false-positive cases had tumour extending to 3 mm and 4 mm from the meso-rectal fascia. Two patients were incorrectly staged post-therapy. Both had bulky mucinous tumours, with clear evidence of residual mucinous change post-therapy. However, histology showed only microscopic tumour foci in one case, and no tumour in the other, the staging error due to the presence of residual inert mucin. In this small series, MR imaging accurately assessed the presence and stage of residual tumour post-radiotherapy, and the proximity of residual disease to the CRM. A larger study is ongoing.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S94. doi: 10.1102/1470-7330.2005.0068

Dynamic contrast enhanced CT (dceCT) parameters in carcinoid liver metastases undergoing anti-VEGF versus interferon therapy

C S Ng *, S C Faria *, J C Yao *, X Wang *, C Charnsangavej *

12.00–13.00

Aim

To assess differences in dceCT perfusion parameters in patients with liver metastases from carcinoid undergoing targeted anti-VEGF therapy (Bevacizumab, BEV), vs. pegylated interferon (PEGI).

Methods

DceCT was undertaken in a randomised Phase II trial of BEV vs. PEGI in patients with carcinoid liver metastases. Scans were performed at baseline, at 48 h, and 18 weeks after starting BEV (Avastin), and at 9 weeks and 18 weeks after PEGI. Tumour regions of interest were evaluated for tumour blood flow (TBF), blood volume (TBV), and permeability (PS) utilising CT perfusion software (GE Medical Systems). Changes in perfusion parameters between time points and between therapies, for 37 lesions in 25 patients, were evaluated.

Results

TBF and TBV fell significantly after 48 h and 18 weeks of therapy with BEV compared to baseline (% change (range)): −48% (−73%, −21%) [p=0.0006], −40% (−63%, −20%) [p=0.0009], and −39% (−68%, 8%) [p=0.01], −34% (−75%, −40%) [p=0.04], respectively. TBF and TBV also fell after 9 and 18 weeks of PEGI, but not significantly. PS was lower at all time points for both therapies, but not significantly, except for BEV at 48 h [p=0.02]. All three perfusion parameters were significantly lower at 18 weeks with BEV compared to PEGI [all p<0.05].

Conclusion

Bevacizumab appears to mediate a more potent effect on perfusion in carcinoid liver metastases than PEGI. DceCT is able to detect such changes as early as 48 h after therapy, and may be a valuable non-invasive technique for assessing the early efficacy of anti-angiogenic therapies in tumours.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S95. doi: 10.1102/1470-7330.2005.0069

Can the non-invasive hydro-multidetector row CT replace endoscopic ultrasound in preoperative staging of gastric cancer?

A Ba-Ssalamah *, W K Matzek *, K Pinker *, A Püspök *, J Zacherl *, W Schima *

12.00–13.00

Purpose

To assess the usefulness of hydro-multidetector CT (HMCT) in the preoperative staging of gastric cancer in comparison to the endoscopic ultrasound (EUS) and post-operative histopathological correlation.

Materials and methods

HMCT and EUS examinations were performed in 79 patients of gastric cancer diagnosed by biopsy prior to surgery on two different days. Distention of the stomach was achieved with 1–1.5 l of water. The HMCT and EUS findings were analysed prospectively. Each case was staged according to the TNM classification and correlated with histopathological findings. HMCT scans were performed using either a 4- or 16-channel scanner. EUS was performed using a fibre-optic endoscope with a 5–10 MHz electronic array at a 360^ scanning angle. Accuracy of TNM staging was calculated for each modality and the findings of EUS and HMCT were directly compared to each other and were correlated with histopathological findings.

Results

The accuracy for T staging with HMCT was 84%, for N staging 72% and for M staging 97%. The results of EUS were 79%, 61%, and 43%, respectively.

Conclusion

Accuracies for T- and N-staging can be achieved substantially better with CT than with endosonography, especially in advanced gastric cancer.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S95. doi: 10.1102/1470-7330.2005.0070

Contrast-enhanced ultrasound in staging and follow-up of splenic lymphomas

F Sandomenico *, O Catalano *, M Mattace Raso *, P Vallone *, A Siani *

12.00–13.00

Purpose

To illustrate our experience in the evaluation of splenic haematological malignancies with a real-time, CE-US mode.

Materials and methods

We studied 27 patients (10 Hodgkin’s disease, 17 non-Hodgkin’s lymphoma): 16 M, 11 F; 28–79 years. After a baseline US study we injected 2.4–4.8 ml of second-generation contrast-agent SonoVue ® (Bracco). Contrast-enhanced studies were carried out with contrast-specific software (CnTI-Esaote) using harmonic acquisition and low acoustic pressure. US studies were retrospectively correlated with the results of standard tools, including CT (15 cases), MRI (1), US follow-up (10) and FNAB (4).

Results

Among 17 cases with focal involvement, contrast-enhanced US detected 50 /55 lesions demonstrated by reference tools. Conventional US recognised 37 /55 lesions. Lesion extent defined by CE-US correlated with standard tools: similar (81%), underestimated (13%), and overestimated (6%). Baseline US defined the lesion size correctly in 56%, underestimating (31%) and overestimating (13%).

Lesion-to-parenchyma contrast of CE-US was low (11%), intermediate (62%), and high (27%). Conspicuity at conventional US was low (52%), intermediate (33%), and high (15%).

Lesions appeared hypoechoic and better definable during the intermediate-delayed phase of enhancement. Arteries were visible around the lesion and perpendicularly entering along intralesional septa. Intralesional microcirculation was visible. Among nine subjects studied after chemotherapy, loss of microcirculation and marked lesion hypoechogenicity were visible in the case of response. Hence, disease activity could be assessed. In 10 patients with diffuse disease we recognised a slightly less intense and persistent parenchymal opacification.

Conclusion

Contrast-enhanced, grey-scale US is a simple and non-invasive tool in morphological and functional imaging of splenic lymphomatous disease.

Cancer Imaging. 2005 Nov 23;5(Spec No A):S96. doi: 10.1102/1470-7330.2005.0071

MRI appearances of rectal carcinoma before and after radiotherapy

A E T Wenaden *, M Alijani *, J Hughes *, S Barber *, J Chin-Aleong *, S Dorudi *, A Rockall *, R H Reznek *

12.00–13.00

Aim

In patients with advanced rectal cancer, neo-adjuvant long course radiotherapy (RT) may reduce tumour size or result in down-staging. In patients with primary resectable disease short course RT, proven to reduce local recurrence rates, is not thought to alter tumour size. We aimed to assess change in tumour size and stage on MRI pre- and post-long or short course RT.

Method

Nineteen patients with rectal carcinoma underwent MRI before and after neo-adjuvant RT. Tumour length, size (using RECIST criteria) and stage were documented and numbers and size of locoregional lymph nodes recorded. Total mesorectal excision was performed in 15 patients and MR findings correlated with histology.

Results

Ten patients received short course RT and nine long course RT plus chemotherapy. Tumour length reduced by 19% overall (16% following short course, 23% following long course). Significant reduction in tumour thickness of 31% overall was seen (26% following short course, 36% following long course). Greater than 30% reduction (partial response) in maximum tumour thickness was seen in 4 /10 (40%) following short course and 5 /9 (56%) following long course RT. Overall T stage accuracy was 60% (n=15). One patient was down-staged following short course RT. The total number of visible nodes reduced by 31% following long course and 10% following short course RT.

Conclusion

Significant reduction in tumour size can be achieved with preoperative long course chemoradiotherapy and short course RT. In addition, short course RT resulted in tumour down-staging in one case. This unexpected finding has not been previously described.

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