- Email: [email protected]
CT for detection of focal splenic lesions in paediatric and adolescent lymphoma at initial staging
Abstracts / Clinical Radiology 66 (2011) S1eS12 Monday 12 September following the Carcinoma of unknown primary session 12.10 - 12.20pm Presenting Author Mr Sriram Vaidyanathan, Glasgow Royal Infirmary Positron emission tomography in the evaluation of paraneoplastic syndromes: experience at a regional oncology centre
Monday 12 September following the Carcinoma of unknown primary session 12.20 - 12.30pm Presenting Author Dr Shonit Punwani, University College London Hospital Evaluation of pre-treatment MR derived ADC as a predictive biomarker of response to first line chemotherapy for childhood and adolescent lymphoma Purpose: To evaluate if pre-treatment MR derived apparent diffusion coefficient (ACD) can predict response to first line chemotherapy for childhood and adolescent lymphoma. Materials and Methods: Thirty-two patients (¼18 years) with histological confirmed lymphoma underwent PET-CT and contrast enhanced chest Ct and additional whole body and diffusion weighted (b0, 300 and 500) MRI (within 7 days of the PET-CT) prior to commencing treatment. All patients received two cycles of vincristine, etoposide, prednisolone and doxorubicin (OEPA). Early response to treatment at 3 months was evaluated by PET-CT, contrast enhanced chest CT and repeat MRI. All nodal tissue at the anatomical site of greatest nodal disease was selected using the Jim 5.0 region of interest (ROI) toolkit on and total pre-treatment nodal volume within the anatomical location recorded. The process was repeated for post-treatment nodal tissue volume assessment. Pre-treatment ROIs were transferred to corresponding ADC maps allowing calculation of mean pretreatment ADC. For the initial seventeen patients pre-treatment ADC was correlated with percentage residual nodal volume following treatment. For the subsequent fifteen pre-treatment ADC prediction of residual volume was assessed. Results: There was a strong positive linear correlation between pretreatment ADC and percentage residual tissue volume following 2 cycles of chemotherapy (Group 1 R2 ¼ 0.70). Using a pre- treatment ADC cut-off of 1.43 x10-3 mm2s-1 MRI had a 100% sensitivity and specificity for differentiating complete (¼25% residual volume) from incomplete response (>25 residual volume) to chemotherapy within the validation group. Conclusion: Pre-treatment ADC maybe useful in predicting response to first line chemotherapy. Contributing Authors Dr Stuart Taylor Dr Stephen Daw Dr Ananth Shankar Dr Paul Humphries
Monday 12 September 12.30 - 12.40pm Presenting Author Dr Shonit Punwani, University College London Hospital MRI vs. PET/CT for detection of focal splenic lesions in paediatric and adolescent lymphoma at initial staging Purpose: Compare MRI (Short TI Inversion Recovery Half Fourier Single Shot Turbo Spin Echo [STIR-HASTE] Dynamic Contrast Enhanced [DCE] Imaging) and PET/CT for detection of focal spleen involvement at initial staging of lymphoma
S5
Materials and Methods: Coronal STIR-HASTE images of the neck, chest, abdomen and pelvis were acquired for 44 patient (<18 years) with known lymphoma, using a Siemens 1.5T MR system. Twenty-three of the 44 patients underwent additional DCE-MR imaging of the spleen using axial 3D Fast Low Angle SHot technique (FLASH). FDG PET/CT data were acquired by using a dedicated combined in-line GE system. Anonymous STIR-HASTE images of the spleen were first evaluated independently, then in consensus by two radiologists (n¼21). For patients with DCE-MR (n¼23), radiologists independently assessed STIR-HASTE, then DCE-MR images, followed by a final consensus of combined MR datasets. PET-CT images of the spleen were independently and then in consensus assessed by two nuclear medicine physicians (n¼44). At each assessment readers recorded presence or absence of focal splenic disease. An independent expert multi-disciplinary panel derived reference based on all concurrent imaging, clinical details and follow-up formed the reference standard for MRI and PET/CT assessment. Results: Sensitivity and specificity for detecting focal splenic disease was 100% for STIR-HASTE and STIR-HASTE+DCE-MR, and 83.3% and 87.5% for PET/CT at consensus. Reader concordance was 88.6% for STIR-HASTE MRI (?¼0.73), 95.7% for STIR-HASTE+DCE (?¼0.90) and 84.1% for PET/CT (?¼0.63). Conclusion: STIR-HASTE MR imaging accurately detects focal splenic involvement by lymphoma and compares favorably with PET/CT. Addition of DCE-MR to STIR-HASTE improves overall reader concordance. Contributing Authors Dr Kenneth Cheung Dr Sharon Hain Dr Simona Ben-Haim Dr Paul Humphries
Monday 12 September 12.40 - 12.50pm Presenting Author Dr Alexandra Hutchings, Queen Alexandra Hospital, Portsmouth Long term peritoneal drainage for the management of treatment resistant ascites of malignant aetiology Purpose: 1. To report on our experience of indwelling tunnelled cuffed peritoneal catheter (TCPC) insertion in patients with refractory malignant ascites, with an emphasis on long term outcomes and complication rates. 2. To compare its cost-effectiveness compared to recurrent paracentesis. Methods and Materials: Patients in whom a TCPC was inserted at our institution over the past 6 years were identified by local database. The majority suffered from advanced cancer with refractory malignant ascites. We conducted a retrospective review of patient records to determine postprocedure outcomes, including infection, catheter blockage and removal. Records were also reviewed for anecdotal evidence of improvements to patients' quality of life (QOL) following TCPC insertion. Total cost of TCPC placement and aftercare was compared with recurrent paracenteses. Results: 34 successful TCPC placements were recorded in 32 patients. Mean duration of catheter placement was 52 days. Mean interval between recurrent peritoneal paracentesis prior to TCPC was 2.5 weeks. 4 patients suffered from catheter-related infection, of which 2 necessitated catheter removal. Accidental removal occurred in 2 patients. TCPC placement costs less overall than recurrent paracentesis in managing refractory malignant ascites, an important consideration with current pressures on the global health economy. Whilst formal targeted studies are currently in progress within the UK, anecdotal evidence we have obtained suggests that TCPC placement improves QOL in terminally ill patients. Conclusion: TCPC placement is a safe treatment option in selected terminally-ill patients suffering from refractory malignant ascites. Furthermore, we demonstrate additional benefits in terms of cost and patient QOL. Contributing Authors Dr Ken Tung Ms Alison Keen
Monday 12 September following the Carcinoma of unknown primary session 12.20 - 12.30pm Presenting Author Dr Shonit Punwani, University College London Hospital Evaluation of pre-treatment MR derived ADC as a predictive biomarker of response to first line chemotherapy for childhood and adolescent lymphoma Purpose: To evaluate if pre-treatment MR derived apparent diffusion coefficient (ACD) can predict response to first line chemotherapy for childhood and adolescent lymphoma. Materials and Methods: Thirty-two patients (¼18 years) with histological confirmed lymphoma underwent PET-CT and contrast enhanced chest Ct and additional whole body and diffusion weighted (b0, 300 and 500) MRI (within 7 days of the PET-CT) prior to commencing treatment. All patients received two cycles of vincristine, etoposide, prednisolone and doxorubicin (OEPA). Early response to treatment at 3 months was evaluated by PET-CT, contrast enhanced chest CT and repeat MRI. All nodal tissue at the anatomical site of greatest nodal disease was selected using the Jim 5.0 region of interest (ROI) toolkit on and total pre-treatment nodal volume within the anatomical location recorded. The process was repeated for post-treatment nodal tissue volume assessment. Pre-treatment ROIs were transferred to corresponding ADC maps allowing calculation of mean pretreatment ADC. For the initial seventeen patients pre-treatment ADC was correlated with percentage residual nodal volume following treatment. For the subsequent fifteen pre-treatment ADC prediction of residual volume was assessed. Results: There was a strong positive linear correlation between pretreatment ADC and percentage residual tissue volume following 2 cycles of chemotherapy (Group 1 R2 ¼ 0.70). Using a pre- treatment ADC cut-off of 1.43 x10-3 mm2s-1 MRI had a 100% sensitivity and specificity for differentiating complete (¼25% residual volume) from incomplete response (>25 residual volume) to chemotherapy within the validation group. Conclusion: Pre-treatment ADC maybe useful in predicting response to first line chemotherapy. Contributing Authors Dr Stuart Taylor Dr Stephen Daw Dr Ananth Shankar Dr Paul Humphries
Monday 12 September 12.30 - 12.40pm Presenting Author Dr Shonit Punwani, University College London Hospital MRI vs. PET/CT for detection of focal splenic lesions in paediatric and adolescent lymphoma at initial staging Purpose: Compare MRI (Short TI Inversion Recovery Half Fourier Single Shot Turbo Spin Echo [STIR-HASTE] Dynamic Contrast Enhanced [DCE] Imaging) and PET/CT for detection of focal spleen involvement at initial staging of lymphoma
S5
Materials and Methods: Coronal STIR-HASTE images of the neck, chest, abdomen and pelvis were acquired for 44 patient (<18 years) with known lymphoma, using a Siemens 1.5T MR system. Twenty-three of the 44 patients underwent additional DCE-MR imaging of the spleen using axial 3D Fast Low Angle SHot technique (FLASH). FDG PET/CT data were acquired by using a dedicated combined in-line GE system. Anonymous STIR-HASTE images of the spleen were first evaluated independently, then in consensus by two radiologists (n¼21). For patients with DCE-MR (n¼23), radiologists independently assessed STIR-HASTE, then DCE-MR images, followed by a final consensus of combined MR datasets. PET-CT images of the spleen were independently and then in consensus assessed by two nuclear medicine physicians (n¼44). At each assessment readers recorded presence or absence of focal splenic disease. An independent expert multi-disciplinary panel derived reference based on all concurrent imaging, clinical details and follow-up formed the reference standard for MRI and PET/CT assessment. Results: Sensitivity and specificity for detecting focal splenic disease was 100% for STIR-HASTE and STIR-HASTE+DCE-MR, and 83.3% and 87.5% for PET/CT at consensus. Reader concordance was 88.6% for STIR-HASTE MRI (?¼0.73), 95.7% for STIR-HASTE+DCE (?¼0.90) and 84.1% for PET/CT (?¼0.63). Conclusion: STIR-HASTE MR imaging accurately detects focal splenic involvement by lymphoma and compares favorably with PET/CT. Addition of DCE-MR to STIR-HASTE improves overall reader concordance. Contributing Authors Dr Kenneth Cheung Dr Sharon Hain Dr Simona Ben-Haim Dr Paul Humphries
Monday 12 September 12.40 - 12.50pm Presenting Author Dr Alexandra Hutchings, Queen Alexandra Hospital, Portsmouth Long term peritoneal drainage for the management of treatment resistant ascites of malignant aetiology Purpose: 1. To report on our experience of indwelling tunnelled cuffed peritoneal catheter (TCPC) insertion in patients with refractory malignant ascites, with an emphasis on long term outcomes and complication rates. 2. To compare its cost-effectiveness compared to recurrent paracentesis. Methods and Materials: Patients in whom a TCPC was inserted at our institution over the past 6 years were identified by local database. The majority suffered from advanced cancer with refractory malignant ascites. We conducted a retrospective review of patient records to determine postprocedure outcomes, including infection, catheter blockage and removal. Records were also reviewed for anecdotal evidence of improvements to patients' quality of life (QOL) following TCPC insertion. Total cost of TCPC placement and aftercare was compared with recurrent paracenteses. Results: 34 successful TCPC placements were recorded in 32 patients. Mean duration of catheter placement was 52 days. Mean interval between recurrent peritoneal paracentesis prior to TCPC was 2.5 weeks. 4 patients suffered from catheter-related infection, of which 2 necessitated catheter removal. Accidental removal occurred in 2 patients. TCPC placement costs less overall than recurrent paracentesis in managing refractory malignant ascites, an important consideration with current pressures on the global health economy. Whilst formal targeted studies are currently in progress within the UK, anecdotal evidence we have obtained suggests that TCPC placement improves QOL in terminally ill patients. Conclusion: TCPC placement is a safe treatment option in selected terminally-ill patients suffering from refractory malignant ascites. Furthermore, we demonstrate additional benefits in terms of cost and patient QOL. Contributing Authors Dr Ken Tung Ms Alison Keen