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Biomedical subjects

Jeremy J Erasmus

Publications and source records attributed to Jeremy J Erasmus.

At least 19 recordsLinked to original sources
PubMed2007

Detection of interval distant metastases: clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy.

BACKGROUND: The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy. METHODS: A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses. RESULTS: Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes. CONCLUSIONS: CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.

Adenocarcinoma↗
PubMed2007

The role of integrated computed tomography positron-emission tomography in esophageal cancer: staging and assessment of therapeutic response.

Computed tomography (CT) and endoscopy/endoscopic ultrasonography are usually performed to initially stage patients with esophageal cancer, to determine primary tumor response, and to detect nodal and distant metastases after preoperative therapy. Positron-emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose and integrated CT-PET are useful in the initial staging of patients with esophageal cancer as well as in the prediction of pathologic response, disease-free interval, and overall survival after preoperative therapy. Importantly, integrated CT-PET imaging decreases the number of futile attempts at surgical resection, mainly because of the detection of occult distant metastases. The following sections review the use of integrated CT-PET imaging in determining the T, N, and M descriptors of the American Joint Commission on Cancer's 2002 guidelines for pathologic and clinical staging at initial diagnosis and after chemoradiation therapy in those patients being considered for surgical resection.

Contrast Media↗
PubMed2006

Pitfalls in integrated CT-PET of the thorax: implications in oncologic imaging.

Integrated computed tomography-positron emission tomography (CT-PET) scanners improve localization of regions of increased [18F]-fluoro-2-deoxy-D-glucose (FDG) uptake and staging accuracy by allowing the near-simultaneous acquisition of coregistered, spatially matched functional and morphologic data in the same examination. However, many benign lesions can accumulate FDG and be potential pitfalls in interpretation. With the increased use of CT-PET in oncologic imaging, misinterpretation of these potential pitfalls can have significant clinical ramifications and alter staging and management. In this article, we review the physiologic uptake of FDG, normal variants, and potential pitfalls in the integrated CT-PET imaging of the thorax and their implications in oncologic imaging.

Artifacts↗
PubMed2006

Esophageal cancer: the role of integrated CT-PET in initial staging and response assessment after preoperative therapy.

Esophageal cancer, an uncommon neoplasm, has been increasing in incidence over the past few decades. Optimal management of patients is determined by the stage of disease at presentation, patient performance status, and location of the primary cancer. Recently, there has been increasing use of multimodality therapy in suitable candidates that employs preoperative chemotherapy and/or radiation followed by surgical resection. This evolving treatment strategy together with the substantial morbidity and mortality associated with esophagectomy makes appropriate patient selection critical. Computed tomography (CT) and endoscopy/endoscopic ultrasonography are usually carried out to initially stage patients with esophageal cancer, to determine primary tumor response, and to detect nodal and distant metastases after preoperative therapy. Positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose and integrated CT-PET are useful in the initial staging of patients with esophageal cancer and in the prediction of pathologic response, disease-free interval, and overall survival after preoperative therapy. Importantly, integrated CT-PET imaging decreases the number of futile attempts at surgical resection, mainly because of the detection of occult distant metastases. The following sections review the use of integrated CT-PET imaging in determining the T, N, and M descriptors of the American Joint Commission on Cancer's 2002 guidelines for pathologic and clinical staging at initial diagnosis and after chemoradiation therapy in those patients being considered for surgical resection.

Algorithms↗
PubMed2006

Preoperative evaluation of patients with malignant pleural mesothelioma: role of integrated CT-PET imaging.

Malignant pleural mesothelioma (MPM) is an uncommon neoplasm arising from mesothelial cells of the pleura. The prognosis is poor with a median survival of 8 to 18 months after diagnosis. Multimodality regimens combining chemotherapy, radiotherapy, immunotherapy, and surgery are being used more frequently in patient management. Extrapleural pneumonectomy is the surgical treatment of choice in 10% to 15% of patients who present with resectable disease and is reported to prolong survival. Accurate staging is important to distinguish patients who are resectable from those requiring palliative therapy. Integrated computed tomography-positron emission tomography (CT-PET) increases the accuracy of overall staging in patients with MPM and significantly improves the selection of patients for curative surgical resection. Specifically, CT-PET detects more extensive disease involvement than that shown by other imaging modalities and is particularly useful in identifying occult distant metastases. This article reviews aspects of imaging performed in the initial staging of patients with MPM according to the International Mesothelioma Interest Group staging system and will emphasize the appropriate role of CT-PET imaging in determining the T, N, and M descriptors.

Combined Modality Therapy↗
PubMed2006

Quantifying the effect of IV contrast media on integrated PET/CT: clinical evaluation.

OBJECTIVES: The use of IV contrast media in PET/CT can result in an overestimation of PET attenuation factors that potentially can affect interpretation. The objective of this study was to quantify the effect of IV contrast media in PET/CT and assess its impact on patients with intrathoracic malignancies. MATERIALS AND METHODS: Nine patients had CTs performed with and without IV contrast media followed by (18)F-FDG PET. PET images were reconstructed using contrast-enhanced and unenhanced CT. To quantify the effect of contrast media on standardized uptake values (SUV), similar regions of interest (ROIs) were drawn on the subclavian vein, heart, liver, spleen, and site of malignancy on both CT and corresponding reconstructed PET images, and the mean and maximum values were compared. In addition, two physicians blinded to the imaging parameters that were used evaluated the reconstructed PET images to assess whether IV contrast media had an effect on clinical interpretation. RESULTS: For all patient studies, the subclavian vein region on the ipsilateral side of contrast media administration had the highest increase in CT numbers with a corresponding average SUV(max) increase of 27.1%. Similarly, ROIs of the heart and at the site of malignancy showed an increase in the maximum attenuation value with a corresponding average SUV(max) increase of 16.7% and 8.4%, respectively. Other locations had relatively small attenuation value differences with a correspondingly negligible SUV variation. CONCLUSION: Although there is a significant increase in SUV in regions of high-contrast concentration when contrast-enhanced CT is used for attenuation correction, this increase is clinically insignificant. Accordingly, in PET/CT, IV contrast-enhanced CT can be used in combination with the PET to evaluate patients with cancer.

Contrast Media↗
PubMed2006

Truncation artifact on PET/CT: impact on measurements of activity concentration and assessment of a correction algorithm.

OBJECTIVE: Discrepancy between fields of view (FOVs) in a PET/CT scanner causes a truncation artifact when imaging extends beyond the CT FOV. The purposes of this study were to evaluate the impact of this artifact on measurements of 18F-FDG activity concentrations and to assess a truncation correction algorithm. MATERIALS AND METHODS: Two phantoms and five patients were used in this study. In the first phantom, three inserts (water, air, bone equivalent) were placed in a water-filled cylinder containing 18F-FDG. In the second phantom study, a chest phantom and a 2-L bottle fitted with a bone insert were used to simulate a patient's torso and arm. Both phantoms were imaged while positioned centrally (baseline) and at the edge of the CT FOV to induce truncation. PET images were reconstructed using attenuation maps from truncated and truncation-corrected CT images. Regions of interest (ROIs) drawn on the inserts, simulated arm, and background water of the baseline truncated and truncation-corrected PET images were compared. In addition, extremity malignancies of five patients truncated on CT images were reconstructed with and without correction and the maximum standard uptake values (SUVs) of the malignancies were compared. RESULTS: Truncation artifact manifests as a rim of high activity concentration at the edge of the truncated CT image with an adjacent low-concentration region peripherally. The correction algorithm minimizes these effects. Phantom studies showed a maximum variation of -5.4% in the truncation-corrected background water image compared with the baseline image. Activity concentration in the water insert was 6.3% higher while that of air and bone inserts was similar to baseline. Extremity malignancies showed a consistent increase in the maximum SUV after truncation correction. CONCLUSION: Truncation affects measurements of 18F-FDG activity concentrations in PET/CT. A truncation-correction algorithm corrects truncation artifacts with small residual error.

Adult↗
PubMed2005

Extended surgical staging for potentially resectable malignant pleural mesothelioma.

BACKGROUND: Extrapleural pneumonectomy for malignant pleural mesothelioma (MPM) is a high-risk procedure, and patients require careful preoperative staging to exclude advanced disease. Computed tomography, magnetic resonance imaging, and positron emission tomography are useful staging modalities, but do not reliably identify contralateral mediastinal involvement or transdiaphragmatic invasion. We evaluated the role of extended surgical staging procedures, which generally includes a combination of laparoscopy, peritoneal lavage, and mediastinoscopy, to more precisely stage patients with MPM. METHODS: One hundred eighteen patients with MPM, deemed clinically and radiologically resectable, underwent extended surgical staging. Mediastinoscopy was performed in 111 patients, laparoscopy in 109 patients, and peritoneal lavage in 78 patients. RESULTS: Ten (9.2%) patients had gross evidence of transdiaphragmatic or peritoneal involvement. Peritoneal lavage was positive for metastatic MPM in 2 (2.6%) patients, neither of whom had obvious transdiaphragmatic invasion. Ipsilateral mediastinal nodes contained metastatic tumor in 10 of 62 (16.1%) patients. Contralateral nodes were positive in 4 of 111 (3.6%) patients. Of the patients who underwent biopsy of both ipsilateral and contralateral mediastinal nodes, and who had complete pathologic staging after extrapleural pneumonectomy (n = 46), 14 (30.4%) had N2-positive nodes. Only 5 of these patients were correctly identified by mediastinoscopy (sensitivity 36%, accuracy 80%). Extended surgical staging identified 16 (13.6%) patients who had contralateral nodal involvement, transdiaphragmatic invasion, or positive peritoneal cytology. CONCLUSIONS: Extended surgical staging defines an important subset of patients with unresectable MPM not identified by imaging. Because of the potential morbidity associated with extrapleural pneumonectomy, we advocate that extended surgical staging be performed in all patients with MPM before resection.

Adult↗
PubMed2005

Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: Staging implications.

BACKGROUND: Integrated computed tomography-positron emission tomography imaging with coregistration of anatomic and functional imaging data may improve the accuracy of malignant pleural mesothelioma staging. We evaluate the use of integrated computed tomography-positron emission tomography in patients with malignant pleural mesothelioma who are being considered for extrapleural pneumonectomy. METHODS: Twenty-nine patients with malignant pleural mesothelioma who were judged to be candidates for extrapleural pneumonectomy after clinical and conventional radiologic evaluation underwent whole-body integrated computed tomography-positron emission tomography and pathologic staging. Two reviewers blinded to the results of clinical and pathologic staging retrospectively evaluated computed tomography, positron emission tomography, and coregistered computed tomography-positron emission tomography images. Staging was performed according to the International Mesothelioma Interest Group TNM staging system. Histopathology and/or results of further radiologic evaluation or follow-up served as the reference standard. RESULTS: Integrated computed tomography-positron emission tomography provided additional information in 11 of 29 patients that precluded extrapleural pneumonectomy. The overall tumor stage was correctly classified in 21 of 29 patients. The tumor stage was correctly determined in 15 of 24 patients, 6 of whom had T4 (nonresectable) disease. The node stage was accurately determined in 6 of 17 patients. Extrathoracic metastases not identified by routine clinical and conventional radiologic evaluation were detected in 7 of 29 patients and were found to be diffuse (n = 2) or solitary (n = 5). CONCLUSIONS: Integrated computed tomography-positron emission tomography increases the accuracy of malignant pleural mesothelioma staging and is important in determining the appropriate therapy in patients being considered for extrapleural pneumonectomy.

Adult↗
PubMed2005

Cystic bronchioloalveolar cell carcinoma.

Bronchioloalveolar cell carcinomas (BACs), a subset of primary lung adenocarcinomas, are uncommon. Similar to other non-small cell lung cancers, patients with BAC are usually 40-70 years of age. Distinguishing features relative to other non-small cell lung cancers include occurrence in young patients, a higher relative predominance in women, and weaker association with smoking. Histologically, they are a diverse group of malignancies that grow in a lepidic manner. Common radiologic presentations of BAC include a solitary nodule, airspace disease, and multiple nodules. Rare manifestations include cystic and cavitary disease. We report a case of a young woman with BAC that manifested as a chronic cough and bilateral air-containing opacities, initially misinterpreted as infection. Knowledge of the spectrum of radiologic manifestations of BAC and correlation with clinical history are important in suggesting the diagnosis and preventing misinterpretation.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2005

Radiation injury to the liver after intensity-modulated radiation therapy in patients with mesothelioma: an unusual CT appearance.

OBJECTIVE: We sought to report the unusual distribution of radiation-induced injury to the liver in patients with mesothelioma after extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). CONCLUSION: Abnormal hepatic enhancement after extrapleural pneumonectomy and IMRT is common in patients with mesothelioma. Knowledge of the early occurrence and typical location and appearance of IMRT-induced injury can be useful in preventing misinterpretation as metastatic disease or recurrent tumor.

Aged↗
PubMed2004

Evaluation of cardiac tumors with magnetic resonance imaging.

Primary cardiac neoplasms are rare, and are more commonly benign than malignant. However, metastases are by far the most common cardiac neoplasms. MRI allows evaluation of myocardial infiltration, pericardial involvement and/or extracardiac extension. MRI overcomes the usual limitations of echocardiography and assesses more accurately changes in cardiac function. Specific tumoral characterization is only possible in cases of myxoma, lipoma, fibroma and hemangioma. Suggestive features of malignancy are right side location, extracardiac extension, inhomogeneity in signal intensity of the tumor and pericardial effusion. The use of intravenous contrast material improves tumor characterization and depiction of tumor borders. MRI also allows differentiation of tumor from other nontumoral masses such as intracavitary tumors or fibromuscular elements of the posterior wall of the right atrium.

Contrast Media↗
PubMed2004

Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer.

BACKGROUND: This study evaluates the utility of positron emission tomography (PET), endoscopic ultrasonography (EUS), and computed tomographic (CT) scans to predict pathologic response and survival following preoperative chemoradiation (CRT) in esophageal cancer. METHODS: One hundred three sequential patients with locoregionally advanced esophageal cancer, who were treated with CRT and esophageal resection between May 2001 and November 2003 at the University of Texas M.D. Anderson Cancer Center, were retrospectively reviewed. PET, EUS, and CT were performed before (pre) or after (post) CRT and before surgical resection. PET standardized uptake value (SUV) was defined as maximal uptake in primary tumor. RESULTS: Most patients were male (91 [88%]) with adenocarcinoma (90 [87%]). Pretreatment clinical stages were: IIA (42 [41%]), IIB (5 [5%]), III (50 [49%]), and IVA (6 [6%]). At the time of surgery, 58 patients (56%) had a pathologic response to CRT (< or =10% viable cells). Post-CRT measurements that correlated with pathologic response were: CT esophageal wall thickness (13.3 vs 15.3 mm, p = 0.04), EUS mass size (0.7 vs 1.7 cm, p = 0.01) and PET SUV (3.1 vs 5.8, p = 0.01). Post-CRT PET SUV equal to or greater than 4 had the highest accuracy for pathologic response (76%). Univariate and multivariate Cox regression analysis demonstrated that a post-CRT PET SUV equal to or greater than 4 was an independent predictor of survival (HR, 3.5, p = 0.04). CONCLUSIONS: The FDG-PET SUV is the most accurate noninvasive test to predict long-term survival after preoperative CRT and before surgical resection. Post-CRT FDG-PET cannot, however, rule out residual microscopic disease so esophagectomy should remain a therapeutic option even if the post-CRT imaging modalities are normal.

Adenocarcinoma↗