Current X-ray diagnosis of stomach cancer (comparison of radiologic and morphological methods of investigation)

By using the principles of wide comparisons of the data of radiation diagnosis (routine X-ray study, ultrasonography (USG), CT, MRI) with the morphological findings of resected gastric specimens from patients with endophytic gastric cancer (EGC) (n = 85), the authors propose some points in the problem associated with its diagnosis. They believe that by taking into account the fact that there is an obvious growth of endophytic parietally growing gastric cancer with the concurrent reduction in its intestinal forms, it is necessary to restore current radiation to its leading place, along with endoscopy, in detecting the cancer. The authors makes a highly positive assessment of USG, CT, MRI in addition to routine X-ray study and endoscopy particularly in those cases when difficulties emerge in histological verification of the existing signs of parietally growing cancer. The paper makes indications for USG, CT, MRI concrete. The authors also show how to stage gastric cancer.     

Cancer of the upper stomach: current problems of its diagnosis

Data on 1248 cases of stomaches radically operated on for cancer at the surgical departments of the Moscow Regional Research Clinical Institute in 1971 to 2000 were used to study a number of problems associated with cancer of the upper stomach, by regarding the present-day role of radiation diagnosis as of paramount importance. The following radiation diagnostic techniques were assessed. Among them there were traditional X-ray studies (in each case), the new radiation diagnostic techniques: ultrasound study and computed tomography (CT) (750 studies), magnetic resonance imaging (MRI) (120 studies). The potentialities of radiation diagnosis and endoscopy performed in all cases are compared. A specially developed procedure for exploring endophytic forms of gastric cancer was employed in the morphological studies of the material. The incidence of cancer of the upper stomach and its association with the esophagus are presented; some aspects of the morphogenesis of cancer of this site are discussed. The relationship of its clinical symptoms and its radiation image has been studied. In the authors' opinion, the past two decades' rise in the incidence of proximal gastric cancer is one of the main problems in diagnosing gastric cancer that continues holding its stand in the general structure of cancer morbidity. The tendency for diffuse and mixed forms to increase in the morphogenesis of gastric cancer provides evidence that radiation techniques should be actively used in its diagnosis. It is necessary to apply classical double-contrasting X-ray study and endoscopy on equal grounds as basic diagnostic methods at early stages. Only their concord use may change the poor situation associated with the diagnosis of cancer at this site. CT and MRI as additional techniques may substantially provide more required diagnostic information. This is first and foremost associated with difficulties in gastric endoscopic study when esophageal cancer is apparently proved.     

Lymphoprostatic scintigraphy in regional lymphatic mapping in patients with prostate cancer

The purpose of the investigation was to upgrade the diagnosis quality for metastatic lesion to the regional lymp nodes in prostate cancer. The results of the most widely used diagnostic techniques (computed tomography (CT), magnetic resonance Imaging, (MRI), radionuclide studies (RNS), and ultrasonography (USG)), which had been compared with those of histology of removed lymph nodes, were assessed. For this, 74 patients with prostate cancer were comprehensively examined and treated at the Central Research X-ray Radiolological Institute. The comparative assessment of radiodiagnostic techniques (USG, CT, MRI, and RNS) showed the high informative value of retroperitoneal lymph nodal MRI in the detection of structural-and-morphological and anatomic-and-topographic changes in the lymph nodes (87.5% sensitivity, 83.3% specificity, and 85.7% accuracy). The developed lymphoprostatic scintigraphy (LPSG) is an informative technique that allows the better diagnosis of prostate metastases to the regional lymph nodes (92.4% sensitivity, 91.7% specificity, and 92.1% accuracy; the prognostic value of a positive result is 90.7%). LPSG is superior in its informative value to small pelvic USG and CT and inferior to indirect lymphoscintigraphy and yields valuable additional information on the physiological function of the small pelvic lymphatic collector.     

Potentialities of new radiation technologies (ultrasonography, computed tomography, magnetic resonance imaging) in the diagnosis of endocrine diseases

In the paper providing the data available in the literature and many years' experience gained by the Department of the Moscow Regional Clinical Research Institute, the authors describe the potentialities of the currently available radiation techniques in the diagnosis of surgical endocrine diseases. The incidence of various organ dysfunctions is presented. The authors also consider the introscopic symptoms of various endocrinopathies and outline the common specific features of the ultrasound, computed tomographic, and magnetic resonance imaging pattern of individual masses (including adipose tissue cysts and tumors). Emphasis is laid on the leading role of ultrasonography (USG) in the diagnosis of thyroid and parathyroid diseases and on the priorities of computed tomography (CT) and magnetic resonance imaging (MRI) in visualIzing the abnormal thymus, mediastinally ectopic glands, and pituitary tumors. The capacities of each technique in the diagnosis of endocrine space lesions of the pancreas and adrenals are defined. The increase in the frequency of endocrine abnormalities accidentally identified at USG, CT, and MRI, which is noted in the paper, fosters the development of new trends in endocrinology and points to the need for screening surveys (particularly patients who live in poor environmental areas).     

Possibilities of CT and US in the diagnosis of colonic cancer

The data of examination of 59 patients with colonic cancer were used to consider the potentialities of transabdominal, transrectal ultrasonography and X-ray computed tomography and to assess their value in diagnosing colonic cancer, including its "minor" forms. The paper describes the ultrasound and computed tomographic semiotics of colonic cancer and determines a place of the above techniques in the algorithm of radiation and instrumental studies. Inclusion of these techniques into the diagnostic algorithm may solve a range of differentially diagnostic problems and allows a preliminary analysis to be made in a tumor lesion according to the International TNM classification. Ultrasonography and X-ray computed tomography should be included into a range of basic methods for diagnosis of colonic cancer.     

Potentialities of ultrasound study in diagnosis of endophytic carcinoma of stomach

The data of studies of 45 patients with gastric cancer are used to consider the potentialities of ultrasonography (USG) in the diagnosis of its endophytic forms. Its use in the diagnosis of "small" gastric carcinomas is evaluated. The USG semiotics of endophytic tumors of the stomach, including its "small" and early forms, is presented. The place of USG in the diagnostic algorithmic of gastric cancer is specified. In the authors' opinion, gastric USG along with traditional X-ray and endoscopic studies should take an appropriate place as it is beneficial in solving a great deal of differential diagnostic problems associated with the intramural spread of tumors.     

Quantification of the Iodine Content of Perigastric Adipose Tissue by Dual-Energy CT: A Novel Method for Preoperative Diagnosis of T4-Stage Gastric Cancer

This study investigated the utility of quantifying iodine concentration (IC) in perigastric adipose tissue, using dual-energy computed tomography (DECT), for the detection of T4a-stage gastric cancer. Fifty-four patients with gastric cancer were enrolled at the Fourth Hospital of Hebei Medical University between January and June 2013. Patients were imaged preoperatively with conventional computed tomography (CT) scans and DECT, and the IC in perigastric fat adjacent to the tumor calculated from arterial phase (AP) and portal venous phase (PVP) images. The patients subsequently received surgical treatment (gastrectomy), and histologic analysis of resected specimens was used as a ‘gold standard’ reference for cancer staging. Receiver operating characteristic (ROC) curve analysis was employed to assess the utility of DECT for identifying T4a-stage gastric cancer, with optimal IC thresholds determined from the area under the ROC curve (AUC). Postoperative histology revealed that 32 patients had serosal invasion (group A), and 22 did not (group B). The accuracy of conventional CT for distinguishing stage T4 from non-T4 stages was 68.5% (37/54). IC was significantly higher in group A than in group B (AP: 0.60±0.34 vs. 0.09±0.19 mg/mL, p<0.001; PVP: 0.83±0.41 vs. 0.27±0.21 mg/mL, p<0.001). The sensitivity, specificity and AUC for detecting serosal invasion were 77.1%, 79.2% and 0.89 at an IC threshold of 0.25 mg/mL for AP images; and 80.0%, 79.2% and 0.90 at an IC threshold of 0.45 mg/mL for PVP images. These results indicated that Iodine quantification in perigastric fat using DECT is an accurate method for detecting serosal invasion by gastric cancer.     

Magnetic resonance imaging in the diagnosis of gastric cancer: X-ray versus MRI anatomic findings

The paper assesses the present-day role of MRI in the diagnosis of gastric cancer. The authors consider the major prerequisites for the main aim of their study to be: 1) a dramatic incidence of diffuse (endophytic) gastric carcinoma, which requires significant correction of today's approaches to its diagnosis and 2) a rather biased and, in the authors' opinion, present-day mainly negative attitude towards MRI of the stomach as a diagnostic method for its tumor lesions. By applying the X-ray-MRI anatomic principle to the comparative study of MRI findings in 50 patients with predominantly gastric intramural carcinoma and in 25 patients without gastric tumors (controls), the authors present their methods for gastric MRI, the MRI semiotics of gastric cancer by concurrently touching upon a variety of problems that characterize the potentialities of MRI of the stomach in the diagnosis of its tumor lesions, including their differential diagnosis. As a result, the authors highly appreciate gastric MRI and consider this method to be included into the diagnostic algorithm of radiation techniques used in the diagnosis of gastric cancer, which should occupy its definite diagnostic place.     

The use of ultrasound and computed tomography for the diagnosis of a squamous cell carcinoma of the oesophago-cardial region of the stomach in a rhesus monkey

A 5-year-old female rhesus macaque (Macaca mulatta) suddenly began suffering from anorexia, dysphagia, vomiting, diarrhoea, and anaemia. Clinical examination and conventional radiography were uneventful. Additionally an ultrasound (US) and computed tomography (CT) were performed which revealed a large tumorous mass in the upper abdomen and a lung metastasis. Using sonographic guidance, a biopsy of the abdominal masse was taken. Histopathological analysis revealed the diagnosis of a squamous cell carcinoma. At autopsy, an advanced gastric carcinoma, which originated from the cardia, was found with infiltration of the retroperitoneum, and metastatic involvement of the mesenterial lymph nodes as well as metastasis in the lung parenchyma. This case illustrates the usefulness of modern non-invasive imaging techniques, including US and CT, in enabling a quick and accurate diagnosis in laboratory animals.     

Expression of UDP-N-acetyl-D-galactosamine: polypeptide N-acetylgalactosaminyltransferase-6 in gastric mucosa, intestinal metaplasia, and gastric carcinoma

Aberrant mucin O-glycosylation is often observed in cancer and is characterized by the expression of immature simple mucin-type carbohydrate antigens. UDP-N-acetyl-d-galactosamine:polypeptide N-acetylgalactosaminyltransferase-6 (ppGalNAc-T6) is one of the enzymes responsible for the initial step in O-glycosylation. This study evaluated the expression of ppGalNAc-T6 in human gastric mucosa, intestinal metaplasia, and gastric carcinomas. Our results showed that ppGalNAc-T6 is expressed in normal gastric mucosa and in intestinal metaplasia. A heterogeneous expression and staining pattern for this enzyme was observed in gastric carcinomas. ppGalNAc-T6 was expressed in 79% of the cases, and its expression level was associated with the presence of venous invasion. Our results provide evidence that ppGalNAc-T6 is an IHC marker associated with venous invasion in gastric carcinoma and may contribute to the understanding of the molecular mechanisms that underlie aberrant glycosylation in gastric carcinogenesis and in gastric carcinoma.     

Computed tomography and magnetic resonance imaging in the diagnosis of accessory nasal sinuses, upper jaw and nasal cavity tumors

Radiation studies, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed that these techniques can accurately determine the site of a tumor, the borders of its spread to the adjacent anatomic structures. They also revealed the features of CT in detecting osseous structural destruction and the advantage of MRI in visualizing the soft tissue component of a neoplasm and in distinguishing the degree of contrast of tumor tissue and concurrent secondary inflammation. The accuracy of CT and MRI for small tumors is 45-80 and 29% higher than that of X-ray study and traditional tomography, respectively. The potentialities of all radiation diagnostic techniques for over 3.0-cm tumors are equal.     

Spleen metastasis from thyroid carcinoma. Report of a case with diagnosis by fine needle aspiration cytology

BACKGROUND: Lymphoreticular malignancies are the most common neoplasms involving the spleen. Metastasis can be caused by direct invasion from surrounding tumors or from hematogenous spread. Spleen metastases from thyroid carcinoma are unusual, and only 1 case has been reported; none have been diagnosed by fine needle aspiration cytology (FNAC). CASE: A 75-year-old female was diagnosed 6 months earlier with a poorly differentiated thyroid carcinoma with wide lymphatic and vascular invasion. Abdominal computed tomography (CT) and magnetic resonance imaging showed several spleen nodules. FNAC was performed under CT guidance. Cytologic examination showed atypical epithelial cells with thyroidal characteristics. CONCLUSION: This case had the cytologic findings of a poorly differentiated carcinoma of the thyroid metastatic to spleen. We confirmed the rarity of this pathology and the efficacy of splenic FNAC in the diagnosis.     

Use of radiothermometry in the screening of nonpalpable breast neoplasms

As compared with other types of malignancies, breast cancer is one of the commonest causes of female death. Mammography used for screening is associated with radiation exposure and it is of low informative value in women less than 35 years of age. Breast ultrasonography (USG) cannot be used for screening of women less than 35 years of age in whom a glandular component is prevalent in the breast structure as it takes much time and should be performed by a qualified specialist. The purpose of our study was to estimate the diagnostic capacities of microwave radiothermometry (RTM) and to determine its place in the early diagnosis of nonpalpable breast neoplasms in medical practice. An integrated study, including RTM, USG, and mammography, was conducted in women at the District Mammology Department, Diagnostic Center Five, and at Branch One of the Female Health Clinic Diagnostic Center in March 2003 to October 2006. The study covered 200 women aged 35 to 71 years who had neither complaints nor clinical signs of a breast nodule and had been found to have neoplasms after undergoing the above diagnostic studies. The studies performed showed that the sensitivity of RMT diagnosis, USG, and mammography was 86.7, 75.8, and 88.3%, respectively. The precision of these techniques was 75.2, 80.0, and 83%.     

Capacities of diagnostic volumetric multislice spiral computed tomography in the diagnosis of gastric cancer

In the period 2009 to 2010, diagnostic multislice spiral computed tomography (MSCT) was carried out in 49 patients with gastric cancer. The efficiency of dynamic MSCT in detecting a tumor and determining its locoregional extent was evaluated. The results of dynamic MSCT were compared with those of postoperative histological examination. The possibility of detecting gastric cancer by dynamic MSCT was ascertained to depend on the depth of tumor invasion and to average 29, 71, 72, and 77% for T1, T2, T3, and T4, respectively. Dynamic MSCT showed a correlation between the frequency of metastatic lesion and the sizes of lymph nodes (r = 0.54; p = 0.0001) and their number (r = 0.82; p < 0.0001).     

Prediction of Nodal Involvement in Primary Rectal Carcinoma without Invasion to Pelvic Structures: Accuracy of Preoperative CT,MR, and DWIBS Assessments Relative to Histopathologic Findings

Objective

To investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.

Methods and Materials

Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings.

Results

The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.

Conclusion

MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.     

Current problems in the diagnosis of gastric cancer

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.     

Intérêt complémentaire de la TEP/TDM au FDG et de l’imagerie conventionnelle dans le bilan initial et le suivi post-thérapeutique des cancers des VADS : recommandations et perspectives

Functional imaging by ¹⁸fluorodesoxyglucose (FDG) positron emission tomography (PET) and morphological imaging by computed tomography (CT) and magnetic resonance imaging (MRI) hold an important and complementary role in characterization of head and neck squamous cell carcinoma (HNSCC). Based on an exhaustive literature, the recommendations and perspectives of their use in the initial assessment and the post-therapeutic management of HNSCC are presented.     

The necessity of complex use of radiation and endoscopic techniques in the differential diagnosis of gastric ulcerations

The results of examination of 156 patients were used to consider whether radiation and endoscopic techniques might be used in the differential diagnosis of gastric ulcerations. The necessity of their complex use is shown. Evidence is provided for that the understanding of intramural changes at the site of ulceration should underlie the interpretation of visual changes in the gastric mucosa. An algorithm has been developed for the rational and effective use of radiation and endoscopic techniques in the differential diagnosis of gastric ulcerations. The algorithm is shown to be highly effective in the correct interpretation of the pattern of an identified ulceration (98.4% specificity). Ultrasound and computed tomographic semiotics of benign and malignant gastric ulcerations is presented.     

Overexpression of ZEB1 associated with metastasis and invasion in patients with gastric carcinoma

The aim of this study was to investigate the expression of ZEB1 in gastric carcinoma, its correlation with the clinicopathology of gastric carcinoma, and the role of ZEB1 in invasion and metastasis in gastric carcinoma. ZEB1 expression was analyzed by immunohistochemistry and Western blot in 45 gastric carcinoma tissue samples that contained the adjacent gastric mucosa. The correlation between ZEB1 expression, the occurrence and development of gastric cancer, and clinical pathology was investigated. ZEB1 expression in the human gastric carcinoma cell line AGS was downregulated by RNA interference, and changes in ZEB1 expression corresponded with changes in the invasive and metastatic ability of AGS cells. Immunohistochemistry revealed that ZEB1 protein expression in gastric carcinoma tissues was significantly higher than in normal gastric mucosa tissues (p < 0.001). A lower degree of differentiation of gastric cancer (p = 0.009), a higher TNM (tumor, node, and metastasis) stage (p = 0.010), and a larger scope of invasion were correlated with higher expression of ZEB1 (p = 0.041, 0.002). However, the expression of ZEB1 in gastric carcinoma tissue was independent of gender, age, and tumor size (p > 0.05). Western blot results also showed that ZEB1 protein expression was significantly higher in gastric carcinoma tissue than in the adjacent normal gastric mucosa tissue (p = 0.008). A lower degree of differentiation of the gastric carcinoma correlated with a higher TNM stage, and a larger scope of invasion correlated with increased ZEB1 expression (p = 0.023). Transfection of ZEB1 siRNA in AGS cells significantly decreased the expression level of ZEB1 protein (p = 0.035). Furthermore, the number of cells that could pass through the Transwell chamber was significantly lower in the transfected group than in the non-transfected control group (p = 0.039), indicating that the suppression of ZEB1 expression could significantly reduce the invasive and metastatic ability of AGS cells (p = 0.005). Concluding, in gastric carcinoma tissue, overexpression of ZEB1 may be related to the occurrence and development as well as invasion and metastasis of gastric carcinoma.     

Imaging lung perfusion

From the first measurements of the distribution of pulmonary blood flow using radioactive tracers by West and colleagues (J Clin Invest 40: 1-12, 1961) allowing gravitational differences in pulmonary blood flow to be described, the imaging of pulmonary blood flow has made considerable progress. The researcher employing modern imaging techniques now has the choice of several techniques, including magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET), and single photon emission computed tomography (SPECT). These techniques differ in several important ways: the resolution of the measurement, the type of contrast or tag used to image flow, and the amount of ionizing radiation associated with each measurement. In addition, the techniques vary in what is actually measured, whether it is capillary perfusion such as with PET and SPECT, or larger vessel information in addition to capillary perfusion such as with MRI and CT. Combined, these issues affect quantification and interpretation of data as well as the type of experiments possible using different techniques. The goal of this review is to give an overview of the techniques most commonly in use for physiological experiments along with the issues unique to each technique.