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Biomedical subjects

Reginald F Munden

Publications and source records attributed to Reginald F Munden.

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↗
PubMed2007

Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases.

OBJECTIVE: The purpose of this study was to determine whether there are clinical or sonographic findings that can be used to differentiate benign self-limited small-bowel intussusception from pathologic small-bowel intussusception that necessitates surgical intervention. MATERIALS AND METHODS: A retrospective search was performed of abdominal sonograms obtained at two institutions between January 1996 and June 2005. Sonographic findings were correlated with medical and surgical records. RESULTS: A total of 35 cases of isolated small-bowel intussusception were found. Thirteen (37%) of these cases necessitated surgical intervention, and 22 (63%) of the cases were benign and self-limiting. Patients with self-limiting intussusception were younger than patients with intussusception necessitating surgical intervention (mean, 4.2 vs 7.5 years; p = 0.0327). Abdominal sonograms depicted ascites and small-bowel obstruction significantly more frequently in patients with small-bowel intussusception necessitating surgery (n = 7 [54%] for each finding) than in patients with self-limiting intussusception (n = 2 [9%], n = 0) (p = 0.006 and p = 0.0003, respectively). At sonography, patients who later underwent surgical intervention had small-bowel intussusception of significantly greater length (mean, 7.3 cm) than those treated conservatively (mean length, 1.9 cm) (p < 0.0001). Intussusception length greater than 3.5 cm was considered a sensitive and specific independent predictor of the need for surgery (sensitivity, 93%; specificity, 100%). CONCLUSION: When small-bowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3.5 cm is a strong independent predictor of the need for surgical intervention.

Adolescent↗
PubMed2006

Incidental pulmonary emboli in oncology patients: prevalence, CT evaluation, and natural history.

PURPOSE: To retrospectively determine the prevalence and natural history of incidental pulmonary emboli in oncology patients, the number of such cases reported at initial thoracic computed tomographic (CT) image interpretation, and the factors that contribute to underdiagnosis. MATERIALS AND METHODS: Institutional review board approval, which included HIPAA-compliant access to protected health information and waived patient consent requirements, was obtained for this retrospective study. Four hundred three consecutive oncology patients (199 male, 204 female; age range, 14-87 years; mean age, 55 years) in whom adequate-quality multidetector thoracic CT was performed within a 10-day period for indications other than pulmonary emboli assessment were identified. There were 31 (7.7%) inpatients at the time of imaging. Each imaging case was reviewed by two independent radiologists, and all pulmonary emboli were confirmed by a panel of three thoracic radiologists. Clinical charts were reviewed for demographic data, embolus detection, and outcomes up to 2 years after the initial examination. Patient groups were compared by using chi2 and one-sided binomial tests. RESULTS: Sixteen (4.0%) of the 403 patients had pulmonary emboli. The highest prevalences were in patients with gynecologic malignancies (two of 13, 15%) and in those with melanoma (four of 41, 10%). Four (25%) of the 16 patients with emboli were identified at initial clinical CT image interpretation, and all had multiple emboli involving at least the lobar arteries. Missed emboli typically were solitary and involved smaller arteries; no other confounding factors were identified. Six (60%) of 10 patients with emboli who underwent any lower extremity imaging had deep vein thrombosis. With the exception of one patient, who was transferred back to the referring physician and lost to follow-up, all patients with reported pulmonary emboli were treated. Two patients had subsequent embolic events: one death despite treatment and one recurrent embolus in a nontreated patient. CONCLUSION: Incidental pulmonary emboli were seen in 16 (4%) oncology patients but were initially reported in only four of them. The small size of involved arteries contributes to the failed detection at initial CT image interpretation, and patients with emboli in these small vessels may have deep vein thrombosis or recurrent emboli.

Adolescent↗
PubMed2006

PET/CT imaging of lung cancer.

Fluoro-deoxyglucose positron emission tomography (PET) imaging has a diagnostic and prognostic value in the initial staging, restaging, and surveillance of non-small-cell lung cancer (NSCLC). When used in conjunction with conventional radiologic imaging, PET imaging has been shown to result in significant changes in clinical management of NSCLC. Specifically, baseline PET imaging can improve initial staging and guide surgical and radiotherapy planning, whereas repeat PET imaging after the initiation of chemoradiotherapy can predict tumor response and help tailor therapy. After the end of definitive treatment, PET has greater diagnostic accuracy than other imaging modalities for the detection of tumor recurrence. The recent development of fused PET/CT imaging has improved the radiologic evaluation of NSCLC patients by combining metabolic and anatomic imaging; however, this has resulted in more complexity in the image interpretation. It is important for the interpreting physician to understand the role PET/CT plays in the staging, assessment of treatment, and follow-up after therapy in the multidisciplinary management of patients with NSCLC.

Adenocarcinoma↗
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

Interobserver and intraobserver variability of standardized uptake value measurements in non-small-cell lung cancer.

OBJECTIVES: To assess interobserver and intraobserver variabilities in measuring the maximal standardized uptake value (SUV) of non-small-cell lung cancer. METHODS: Positron emission tomography-computed tomography examinations of 20 consecutive patients referred for initial evaluation of newly diagnosed non-small-cell lung cancer were retrospectively reviewed by 5 experienced positron emission tomography-computed tomography readers, who independently measured the maximal SUV/body weight of the primary tumors. Interobserver and intraobserver variabilities were assessed by using 4 statistical methods: correlation, regression analysis, Bland-Altman analysis, and analysis of variance. The SUV measurements derived in the study were compared with the SUV measurements documented in the original reports using correlation and regression analysis. The percentages of tumors whose retrospective SUV measurements were more than 20% different and more than 25% different from those in the original report were assessed. RESULTS: Both interobserver and intraobserver SUV measurements were highly reproducible. Pearson correlation coefficients were greater than 0.95 and 0.94, respectively. Good interobserver and intraobserver agreement was shown with regression analysis (F test P value >0.05), the Bland-Altman analysis, and analysis of variance (F test P value >0.95). The mean original SUV was much less than the mean study SUV (P<0.05). The study SUV differed from the SUV of the original report by more than 20% in 50% of the tumors, and by more than 25% in 45% of the tumors. CONCLUSIONS: There was excellent interobserver and intraobserver agreement in SUVs measured in the study environment but poor agreement between study SUVs and those documented in original reports, which can affect treatment decisions substantially.

Aged↗
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

Incidental findings on integrated PET/CT that do not accumulate 18F-FDG.

OBJECTIVE: The purpose of this study was to report the prevalence of abnormalities that do not show increased 18F-FDG uptake on the CT component of integrated PET/CT in patients with non-small cell lung cancer. MATERIALS AND METHODS: Images from all PET/CT studies performed consecutively between April and October 2003 on patients with non-small cell lung cancer were retrospectively reviewed. All abnormalities present on the CT component of the PET/CT scans that did not show abnormally increased 18F-FDG uptake were documented. RESULTS: Three hundred twenty-one patients with non-small cell lung cancer (179 men, 142 women; mean age, 67 years; age range, 38-91 years) underwent initial staging (198/321 [62%]) or restaging (123/321 [38%]) PET/CT imaging during the study period. In 263 (82%) of the patients, CT showed 1,231 abnormalities that were not 18F-FDG avid. The abnormalities were located in the thorax (n = 650), abdomen and pelvis (n = 444), head and neck (n = 69), and bony skeleton (n = 68). In total, 298 (24%) of the abnormalities that were not 18F-FDG avid were located outside the range of a standard thoracic CT scan. The clinical importance of these abnormalities was classified as major (n = 48 [4%]), moderate (n = 465 [38%]), or minor (n = 718 [58%]). Four (1%) of the patients had findings of major clinical importance that did not show increased 18F-FDG uptake and were previously unsuspected. CONCLUSION: Among patients with non-small cell lung cancer undergoing PET/CT, there is a high prevalence of CT abnormalities that do not show correlative 18F-FDG avidity but that may be clinically important.

Adult↗
PubMed2006

Detection of Richter's transformation of chronic lymphocytic leukemia by PET/CT.

UNLABELLED: Our objective was to evaluate the accuracy of PET/CT for the diagnosis of Richter's transformation of chronic lymphocytic leukemia (CLL) to diffuse large cell lymphoma. METHODS: A retrospective study was performed of 37 patients with CLL who underwent 18F-FDG PET/CT at our institution between March 2003 and July 2005. All PET/CT scans were reviewed in consensus by 2 diagnostic radiologists. Sites of abnormal 18F-FDG uptake with a maximum standardized uptake value (SUVmax) of greater than 5 were considered highly suggestive of Richter's transformation. The PET/CT findings were correlated with histologic findings from bone marrow or lymph node biopsy performed within 6 wk of PET/CT and with clinical follow-up. RESULTS: The 37 patients (26 men and 11 women; mean age, 61 y, range, 40-82 y) underwent 57 PET/CT scans. In 10 (91%) of 11 patients with Richter's transformation, PET/CT detected sites of abnormal 18F-FDG uptake having an SUVmax of greater than 5. Richter's transformation was missed in 1 patient who had only low-grade 18F-FDG uptake (SUVmax < 5). Nine patients had false-positive PET/CT findings; in 3 of these patients, alternative malignancies were diagnosed (Hodgkin's disease; metastatic neuroendocrine carcinoma; non-small cell lung cancer). In all remaining patients, PET/CT correctly excluded Richter's transformation. For the specific diagnosis of Richter's transformation of CLL to diffuse large B-cell lymphoma, PET/CT had overall sensitivity, specificity, and positive and negative predictive values of 91%, 80%, and 53% and 97%, respectively. CONCLUSION: PET/CT can detect Richter's transformation of CLL to diffuse large B-cell lymphoma with a high sensitivity and a high negative predictive value.

Adult↗
PubMed2005

Imaging of the patient with non-small cell lung cancer.

Lung cancer is the most common type of cancer and is the leading cause of cancer deaths in the United States for both men and women. Even though the 5-year survival rate of patients with lung cancer remains dismal at 14% for all cancer stages, treatments are improving and newer agents for lung cancer appear promising. Therefore, an accurate assessment of the extent of disease is critical to determine whether the patient is treated with surgical resection, radiation therapy, chemotherapy, or a combination of these modalities. Radiologic imaging plays an important role in the staging evaluation of the patient; however, radiologists need to be aware that there are also important differences in what each specialist needs from imaging to provide appropriate treatment. This article reviews the role of imaging in patients with non-small cell lung cancer, with an emphasis on the radiologic imaging findings relevant for each specialty.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Phase II study of the farnesyltransferase inhibitor lonafarnib with paclitaxel in patients with taxane-refractory/resistant nonsmall cell lung carcinoma.

BACKGROUND: The authors evaluated the safety, tolerability, and efficacy of treatment using lonafarnib, a novel farnesyltransferase inhibitor (FTI), in combination with paclitaxel in patients with metastatic (Stage IIIB/V), taxane-refractory/resistant nonsmall cell lung carcinoma (NSCLC). METHODS: Patients with NSCLC who experienced disease progression while receiving previous taxane therapy or who had disease recurrence within 3 months after taxane therapy cessation were treated with continuous lonafarnib 100 mg orally twice per day beginning on Day 1 and paclitaxel 175 mg/m(2) intravenously over 3 hours on Day 8 of each 21-day cycle. RESULTS: A total of 33 patients were enrolled, 29 of whom were evaluable for response. Partial responses (PR) and stable disease (SD) were observed in 3 (10%) and 11 patients (38%), respectively. Thus, 48% (14 of 29) experienced clinical benefit (PR or SD). The updated and final median overall survival time was 39 weeks and the median disease progression-free survival time was 16 weeks. The combination of lonafarnib and paclitaxel was well tolerated with minimal toxicity. Grade 3 toxicities included fatigue (9%), diarrhea (6%), and dyspnea (6%). Grade 3 neutropenia occurred in only 1 patient (3%). Grade 4 adverse events included respiratory insufficiency in 2 patients (6%) and acute respiratory failure in 1 patient (3%). CONCLUSIONS: Lonafarnib plus paclitaxel demonstrated clinical activity in patients with taxane-refractory/resistant metastatic NSCLC. In addition, the combination of lonafarnib and paclitaxel was well tolerated with minimal toxicity. Evaluation of this combination therapy in additional clinical trials is warranted.

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

Imaging of non-small cell lung cancer.

Radiologic evaluation is an important component of the clinical staging evaluation of lung cancer and can greatly influence whether the patient is treated with surgical resection, radiation therapy, chemotherapy, or a combination of these modalities. In addition to staging, the radiologic evaluation of the patient undergoing treatment and subsequent follow-up is important to the clinician for assessing treatment effects and complications. This article discusses the imaging of patients with non-small cell lung cancer and its use in management of these patients.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Focal uptake of fluorodeoxyglucose by the thyroid in patients undergoing initial disease staging with combined PET/CT for non-small cell lung cancer.

PURPOSE: To retrospectively evaluate the prevalence of focal fluorodeoxyglucose (FDG) uptake by the thyroid gland on combined positron emission tomographic (PET) and computed tomographic (CT) scans in patients undergoing staging of newly diagnosed non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Institutional review board approval was obtained, informed consent was waived, and the study was Health Insurance Portability and Accountability Act-compliant. Whole-body PET/CT scans and medical records of 140 consecutive patients with newly diagnosed NSCLC (80 men, 60 women; mean age, 66 years; range, 39-89 years) were retrospectively reviewed by two experienced PET/CT scan readers. Maximum standardized uptake value (SUV) was calculated for FDG-avid thyroid foci. Corresponding thyroid CT findings were recorded in patients with focal increased FDG thyroid uptake. RESULTS: PET results showed that six patients (4.3%) had seven foci of increased FDG uptake in the thyroid. Five of the seven foci (in four patients) corresponded to a low-attenuation thyroid lesion on the non-enhanced CT scan. Lesions ranged in diameter from 0.8 to 2.5 cm. Four of the lesions were found to be papillary thyroid cancers at fine-needle aspiration biopsy. The fifth lesion was found to be benign at thyroidectomy. The remaining two patients did not have histologic confirmation of their thyroid lesion because no specific biopsy site was visualized on CT or sonographic images and lesions were considered benign. Maximum SUV of the thyroid cancers ranged from 3.0 to 32.9 (mean, 13.7). Maximum SUV of benign thyroid lesions ranged from 4.6 to 6.2 (mean, 5.4). CONCLUSION: Focal thyroid FDG uptake found during the initial staging of NSCLC at PET/CT indicates a high likelihood of primary thyroid cancer.

Adult↗
PubMed2005

Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome.

PURPOSE: To retrospectively identify radiographic characteristics of stage I non-small cell lung cancer (NSCLC) that may correlate with epidermal growth factor receptor (EGFR) or HER2 expression or with prognosis. MATERIALS AND METHODS: This study was approved by the institutional review board, with waiver of informed consent, and was in compliance with HIPAA regulations. Findings of chest computed tomography (CT) were retrospectively evaluated in 72 patients who underwent resection of pathologic stage I NSCLC; tumor diameter, presence of calcifications, type of contour, type of margins, attenuation of the nodule, presence of a halo, presence of cavitation, and tumor location were documented. Immunohistochemical studies were performed in surgical specimens. Imaging and molecular data were correlated with patient outcome. Cox proportional hazards regression models were used to correlate biologic and radiographic variates with clinical outcome. RESULTS: There were 38 men (53%) and 34 women (47%) (median age, 65.5 years). Median follow-up was 56.3 months; median overall survival, 76.3 months. A strong correlation was found between tumor diameter measured by radiologists and that measured by pathologists (P < .001; Pearson correlation coefficient, 0.81). EGFR overexpression was found in 48 (67%) tumors; significantly more was found in squamous cell carcinomas than was found in adenocarcinomas (P = .028), and more was found in T2 tumors than was found in T1 tumors (P = .001). HER2 overexpression was found in 13 (18%) tumors; cavitation, in 16 (22%) tumors. Cavitary lesions were significantly more common in squamous cell carcinomas than were in adenocarcinomas (P = .013) and in EGFR-overexpressing tumors (P = .012) than in tumors that did not overexpress EGFR. Cavitary lesions were significantly associated with shorter disease-free survival time (P = .01) and shorter overall survival time (P < .007). CONCLUSION: Patients who have stage I NSCLC with cavitary lesions have an adverse prognosis and are likely to have tumor EGFR overexpression.

Adenocarcinoma↗