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Biomedical subjects

Caroline Reinhold

Publications and source records attributed to Caroline Reinhold.

18 recordsLinked to original sources
PubMed2006

Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study.

PURPOSE: To compare magnetic resonance imaging (MRI), computed tomography (CT), and clinical examination for delineating early cervical cancer and for measuring tumor size. PATIENTS AND METHODS: A 25-center study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT before attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist and retrospectively by four independent offsite radiologists, who were all blinded to surgical, histopathologic, and other imaging findings. Likelihood of cervical stromal and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in three axes. Surgical pathology was the standard of reference. RESULTS: Neither MRI nor CT was accurate for evaluating cervical stroma. For uterine body involvement, the area under the receiver operating characteristic curve was higher for MRI than for CT for both prospective (0.80 v 0.66, respectively; P = .01) and retrospective (0.68 v 0.57, respectively; P = .02) readings. Retrospective readers could measure diameter by CT in 35% to 73% of patients and by MRI in 79% to 94% of patients. Prospective readers had the highest Spearman correlation coefficient with pathologic measurement for MRI (r(s) = 0.54), followed by CT (r(s) = 0.45) and clinical examination (r(s) = 0.37; P < .0001 for all). Spearman correlation of multiobserver diameter measurements for MRI (r(s) = 0.58; P < .0001) was double that for CT (r(s) = 0.27; P = .03). CONCLUSION: In patients with cervical cancer, MRI is superior to CT and clinical examination for evaluating uterine body involvement and measuring tumor size, but no method was accurate for evaluating cervical stroma.

Adenocarcinoma↗
PubMed2005

Comparison of qualitative and quantitative measurements on unenhanced T1-weighted fat saturation MR images in predicting pancreatic pathology.

PURPOSE: To evaluate the accuracy of signal intensity (SI) analysis on unenhanced fat-suppressed T1-weighted MR images in the diagnosis of pancreatic disease and to compare subjective interpretation with different quantitative measurements. MATERIALS AND METHODS: The pancreas was evaluated in 159 patients (86 normal and 73 with pancreatic disease) with spoiled gradient echo (GRE) T1-weighted fat saturation MR images. The relative SI of the pancreas to liver and spleen was quantitatively measured using regions of interest (ROIs) and qualitatively assessed by two independent observers. RESULTS: The mean values between a normal and an abnormal pancreas with pancreas-liver ratios of 0.14 +/- 0.37 vs. -0.32 +/- 0.24, respectively, and pancreas-spleen ratios of 0.89 +/- 0.55 vs. 0.02 +/- 0.43, respectively, were significantly different (P < 0.001). The pancreas-liver SI ratio was significantly better than the pancreas-spleen ratio throughout the disease group (area under the receiver operating characteristic (ROC) curve +/- SD; 0.92 +/- 0.02 for pancreas-liver vs. 0.86 +/- 0.03 for pancreas-spleen, P < 0.01), and after excluding cases of acute pancreatitis (0.96 +/- 0.02 for pancreas-liver vs. 0.89 +/- 0.03 for pancreas-spleen, P < 0.01). There was no statistically significant difference between quantitative and qualitative analysis (area under the ROC curve +/- SD; 0.93 +/- 0.02 vs. 0.93 +/- 0.02 for the entire disease group; excluding acute pancreatitis 0.96 +/- 0.02 vs 0.97 +/- 0.02) for the diagnosis of pancreatic disease when using liver as internal standard. The interobserver concordance was very good (kappa > 0.71). The sensitivity of visual liver comparison was 80% in the entire disease group and 91% after the cases of acute pancreatitis were excluded, while specificity was 93%. CONCLUSION: The pancreas-liver ratio is the best quantitative means of distinguishing normal from abnormal pancreas. Visual observation by experienced observers (qualitative measurement) was just as accurate as quantitative measurement. Detection of pancreatic pathology can be made with high accuracy by visually comparing the SI of the pancreas with that of the normal liver.

Adult↗
PubMed2004

Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual.

We retrospectively compared the diagnostic accuracy of abdominal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) studies performed on the same individual to determine the relative performance of these modalities in the evaluation of disease processes, arising from different intra-abdominal organ systems. We retrospectively reviewed all procedure codes accrued by our abdominal imaging section during a 1-year period to determine how many patients underwent all three imaging procedures in our institution within a 2-week interval. These cases were then further evaluated to determine: (1) the primary organ system of disease involvement, (2) the final diagnosis, and (3) the imaging modality that provided the most accurate information upon which appropriate medical management was based. Imaging findings were determined by review of diagnostic reports, and medical management was determined by chart review. Two thousand six hundred-ninety five patients underwent ultrasound, 4,394 patients underwent CT, and 872 patients underwent MRI for the investigation of abdominal disease. Among these 5,126 patients, 26 underwent sequential US, CT, and MRI evaluation within a two-week interval. Appropriate clinical management was based on the US findings in 12/26 cases (46%; 95% CI: 27-67%), CT findings in 16/26 cases (62%; 95% CI: 41-80%), and MRI findings in 24 cases (92%; 95% CI: 75-99%). Significant differences in directing appropriate clinical management were found when comparing the relative diagnostic accuracies of MRI to US (p = 0.0003) and MRI to CT (p = 0.009). However, differences were not significant when comparing CT to US (p = 0.27). All final diagnoses in a given patient were accurately determined by US in 7/26 cases (27%), by CT in 10/26 cases (38%), and by MRI in 23/26 cases (88%). When analyzed according to individual diagnoses (61 total), US detected 33 of 61 (54%) abnormalities, CT detected 41 (67%) abnormalities, and MRI detected 51 (84%) abnormalities. US correctly characterized 32 (52%) abnormalities, CT correctly characterized 36 (59%) abnormalities, and MRI correctly characterized 49 (80%) abnormalities. Ultrasound, CT, and MR imaging correctly diagnosed the disease process in 3 of 12 (25%), 3 of 12 (25%), and 10 of 12 (83%) patients, respectively, with liver disease; 2 of 9 (22%), 6 of 9 (66%), and 9 of 9 (100%) patients, respectively, with pancreatic disease; 17 of 17 (100%), 8 of 17 (47%), and 10 of 17 (58%) patients, respectively, with gallbladder and biliary disease; 2 of 8 (25%), 5 of 8 (63%), and 5 of 8 (63%) patients, respectively, with renal disease; 0 of 3 (0%), 2 of 3 (66%), and 3 of 3 (100%) patients, respectively, with adrenal disease; and 8 of 12 (75%), 12 of 12 (100%), and 12 of 12 (100%) patients with free intraperitoneal fluid. Our results provide new information, regarding the relative benefits of ultrasound, CT, and MRI for the investigation of abdominal diseases at our institution. This initial data suggests that ultrasound provides the most accurate diagnoses in the investigation of gallbladder disease; MRI provides the most accurate diagnoses in the investigation of hepatic, adrenal, and pancreatic disease; and either CT or MRI may be the most appropriate first imaging study for the detection of renal disease.

Adolescent↗
PubMed2003

Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease.

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is one of many newer noninvasive tests that can image the biliary tree. PURPOSE: To precisely estimate the overall sensitivity and specificity of MRCP in suspected biliary obstruction and to evaluate clinically important subgroups. DATA SOURCES: MEDLINE search (January 1987 to March 2003) for studies in English or French, bibliographies, and subject matter experts. STUDY SELECTION: Studies were included if they allowed construction of 2x2 contingency tables of MRCP compared with a reasonable gold standard for at least 1 of the following: the presence, level, or cause of biliary obstruction. DATA EXTRACTION: Two independent observers graded study quality, which included consecutive enrollment, blinding, use of a single (versus composite) gold standard, and nonselective use of the gold standard. Logistic regression was used to examine the influence of publication year, quality score, proportion of patients having a "direct" gold standard, and clinical context on diagnostic performance. DATA SYNTHESIS: Of 498 studies identified, 67 were included (4711 patients). Mixed-effect models were used to estimate the sensitivity and specificity, and quantitative receiver-operating characteristic analysis was performed. Magnetic resonance cholangiopancreatography had a high overall pooled sensitivity (95% [+/-1.96 SD: spread of SD, 75% to 99%]) and specificity (97% [spread of SD, 86% to 99%]). The procedure was less sensitive for stones (92%; odds ratio, 0.51 [CI, 0.35 to 0.75]) and malignant conditions (88%; odds ratio, 0.28 [CI, 0.18 to 0.44]) than for the presence of obstruction. In addition, diagnostic performance was higher in studies that were larger, did not use consecutive enrollment, and did not use gold standard assessment for some patients. CONCLUSIONS: Magentic resonance cholangiopancreatography is a noninvasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and presence of biliary obstruction; however, it seems less sensitive for detecting stones or differentiating malignant from benign obstruction.

Bile Duct Neoplasms↗
PubMed2003

Benign myometrial conditions: leiomyomas and adenomyosis.

Leiomyomas and adenomyosis are common benign myometrial conditions. Although their symptoms overlap, traditional treatment of these two entities differs; thus, making the correct diagnosis is critical. Specifically, uterine-conserving therapy is well established for many women with symptomatic leiomyomas, whereas hysterectomy is the treatment for debilitating adenomyosis. Magnetic resonance imaging (MRI) is the most accurate modality for identifying leiomyomas and adenomyosis. T2-weighted sequences often are diagnostic. For leiomyomas, MRI reliably identifies their number, size, and location. These features help triage patients to appropriate therapy. For adenomyosis, MRI establishes the diagnosis in cases of equivocal or nondiagnostic ultrasounds. MRI also has been used to confirm an ultrasound diagnosis of adenomyosis when curative surgery is being considered. Intravenous gadolinium chelates are not necessary to make the diagnosis of either adenomyosis or leiomyomas, but it provides useful information about vascularity of lesions, a factor that may impact the type of treatment undertaken.

Contrast Media↗
PubMed2002

Streamlined flow in the portal vein: demonstration with MR angiography.

PURPOSE: To demonstrate whether streamlining of the portal vein flow exists by evaluating the relative distribution of blood flowing from the superior mesenteric vein (SMV) and splenic vein (SV) into the portal venous system. MATERIALS AND METHODS: Fifteen healthy adult volunteers underwent MR angiography of the main portal vein (PV) and portal vein branches after an overnight fast. Transverse two dimension time-of-flight gradient echo sequences were obtained three times, in suspended expiration and inspiration, respectively, as follows: 1) No presaturation slab, 2) presaturation slab across the SMV, 3) presaturation slab across the SV. Signal intensity (SI) measurements were obtained for all acquisitions. using regions of interest traced manually within the PV and portal branches. RESULTS: After presaturation of the SMV and SV during expiration, the overall SI average in the PV decreased by 47% +/- 8 (mean +/- SD) and 17% +/- 9, respectively. Right to left portal branch SI ratio and right-anterior to left-posterior SI ratio in the PV were 0.91 +/- 0.09 and 1.02 +/- 0.08 at baseline, respectively. They decreased significantly (P < 0.05) to 0.87 +/- 0.09 and to 0.95 +/- 0.09 after saturation of the SMV, and increased significantly to 0.95 +/- 0.08 and to 1.07 +/- 0.10 after saturation of the SV. CONCLUSION: MR angiography with selective saturation of the SMV and SV provided reproducible assessment of the respective contributions of the SMV and SV to portal flow, and allows demonstration that streamlining of splanchnic blood occurs in the portal vein of normal subjects.

Adult↗
PubMed2002

Conformal preoperative endorectal brachytherapy treatment for locally advanced rectal cancer: early results of a phase I/II study.

PURPOSE: Downstaging rectal carcinoma by preoperative radiotherapy decreases local recurrence, and recent phase II studies suggest that, in the lower one-third lesions, sphincter-preserving surgery can be considered. The purpose of the current study was to assess the efficacy and the toxicity of endorectal high dose-rate brachytherapy as a preoperative downstaging treatment modality. METHODS: Patients with newly diagnosed invasive rectal adenocarcinoma, T2 to very early T4, operable tumors were eligible. A dose of 26 Gy was given over four consecutive daily treatments of 6.5 Gy prescribed at the tumor radial margin using endorectal brachytherapy with high dose-rate delivery system. Surgery as planned initially was done four to eight weeks later to allow for tumor downstaging. Patients found to have pathologic positive nodes received postoperative external beam (45 Gy/25 fractions) to the pelvis and systemic 5-fluorouracil-leucovorin chemotherapy. RESULTS: Forty-nine patients entered the study. Tumors were in the lower one-third in 24 patients, middle one-third in 22, and upper one-third in 3. With preoperative endorectal ultrasound and magnetic resonance imaging, the clinical staging of the tumors was: 3 T2, 42 T3, 4 T4, and 16 N1-2. Acute toxicity related to brachytherapy was limited to a moderate proctitis (Radiation Therapy Oncology Group acute toxicity scoring system, Grade 2) in all patients, with two patients with tumors extending into the anal canal having Grade 3 dermatitis. Forty-seven patients underwent surgery. Two patients refused their operation based on a normal endoscopic rectal ultrasound after treatment. A complete clinical response was obtained in 32 of 47 (68 percent) patients with 32 percent pathologically pT0N0-1, and 36 percent had only residual microfoci of carcinoma. The surgical approaches did not yield more complications than expected. CONCLUSION: Preoperative high dose-rate endorectal brachytherapy seems to be safe, because acute toxicity was mainly local, with moderate proctitis (Grade 2) and occasional dermatitis (Grade 3) for very low tumors. Finally, this modality, by providing high rate of tumor downstaging and downsizing especially for patients with lesions in the lower one-third of the rectum, represents a definite potential for sphincter-preserving surgery for investigation in future studies.

Adenocarcinoma↗
PubMed2002

Postmenopausal bleeding: value of imaging.

Endovaginal sonography in combination with HSG is an effective screening tool in evaluating patients with postmenopausal bleeding. Endovaginal sonography is highly sensitive for detecting endometrial carcinoma and can identify patients at low risk for endometrial disease obviating the need for endometrial sampling in this subgroup of patients. In patients with abnormal findings at sonography, a detailed morphologic analysis can be used to determine which patients can undergo blind endometrial sampling successfully versus those who would benefit from hysteroscopic guidance. In patients in whom endovaginal sonography and HSG are inadequate, MRI may provide additional information on the appearance of the endometrium, particularly in patients in whom endometrial sampling is difficult (eg, patients with cervical stenosis).

Biopsy↗
PubMed2002

Imaging of cancer of the endometrium.

Transvaginal US is often the initial imaging examination for women with dysfunctional (postmenopausal or intermenstrual) uterine bleeding. However, once the diagnosis of endometrial cancer has been made, contrast-enhanced MRI should be performed in patients who require multifactorial assessment (eg, depth of myometrial invasion, cervical involvement, lymph node metastasis). The results of contrast-enhanced MRI help distinguish patients who need more aggressive therapy and referral to a gynecologic oncologist from those who will do well treated by a community gynecologist.

Endometrial Neoplasms↗
PubMedDate not supplied

Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT--a multicenter trial.

OBJECTIVE: In our multi center trial we compared the potentials of biphasic contrast-enhanced computed tomography (CT) and a novel tissue-specific magnetic resonance imaging (MRI) contrast agent gadoxetic acid disodium in liver lesion characterization. METHODS: A total of 176 patients with 252 liver lesions were analyzed. There were 104 malignant and 148 benign lesions. High-field strength (1.0 T or 1.5 T) MR systems with T1-and T2-weighted sequences were used with and without fat suppression. After gadoxetic acid disodium injection, dynamic imaging and hepatocyte phase MR imaging were performed. Biphasic with 150 mg I/kg of body weight (100-200 mL) spiral CT was also performed. Image reading consisted of on-site (by study investigators) and fully blinded off-site (by E.S.P; C.R; and A.S) evaluations. The classification (benign or malignant) and characterization (lesion type) outcomes of both techniques were assessed. All imaging results were verified against a standard of reference. RESULTS: Both on-site and off-site evaluations demonstrated increases in the lesion classification accuracy with gadoxetic acid disodium-enhanced MRI when compared with spiral CT. This improvement was also shown for characterization. Gadoxetic acid disodium was well tolerated. CONCLUSIONS: Gadoxetic acid disodium offers a safe and diagnostically powerful tool for the evaluation of patients with focal liver lesions with a reliable assessment of lesion classification and characterization.

Gadolinium DTPA↗