We Should Desist Using RECIST, at Least in GIST

2007 ◽  
Vol 25 (13) ◽  
pp. 1760-1764 ◽  
Author(s):  
Robert S. Benjamin ◽  
Haesun Choi ◽  
Homer A. Macapinlac ◽  
Michael A. Burgess ◽  
Shreyaskumar R. Patel ◽  
...  
Keyword(s):  
Evaluation Criteria ◽  
Response Criteria ◽  
Training Set ◽  
Data Set ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Choi Criteria ◽  
Enhanced Ct ◽  
Response Group

Purpose Response Evaluation Criteria in Solid Tumors (RECIST) are insensitive in evaluating imatinib-treated gastrointestinal stromal tumors (GISTs). Response by Choi criteria, a 10% decrease in size or a 15% decrease in density on contrast-enhanced CT, correlated well in a small training set of patients who showed response as measured by positron emission tomography, and was more predictive of time to tumor progression (TTP) than response by RECIST. This study was designed to validate these observations in an independent data set. Patients and Methods Fifty-eight patients with imatinib-treated GISTs were evaluated by RECIST and Choi criteria. TTP was compared with TTP in the training set. Patients were analyzed initially with follow-up to 28 months, extended to 60 months for survival analysis. Results Patients who met Choi response criteria on CT at 2 months had significantly better TTP than those who did not (P = .0002), whereas response group by RECIST was not significantly correlated with TTP. Even when the 98 patients from both sets were analyzed together, the response group by RECIST did not correlate significantly with TTP, whereas response group by Choi criteria did correlate significantly with TTP. Disease-specific survival (DSS) was also significantly correlated with response group by Choi criteria (P = .04), but not with response group by RECIST. Conclusion Choi response criteria are reproducible, more sensitive, and more precise than RECIST in assessing the response of GISTs to imatinib mesylate. Response by Choi criteria, unlike response by RECIST, correlates significantly with TTP and DSS. Response by Choi criteria should be incorporated routinely into future studies of GIST therapy. We should desist using RECIST, at least in GIST.

Response of gastrointestinal stromal tumors (GISTs) to imatinib by Choi criteria and response evaluation criteria in solid tumors (RECIST) as surrogates for survival and time to progression

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9506-9506 ◽  
Author(s):  
R. S. Benjamin ◽  
H. Choi ◽  
H. A. Macapinlac ◽  
M. A. Burgess ◽  
S. R. Patel ◽  
...  
Keyword(s):  
Tumor Size ◽  
Evaluation Criteria ◽  
Poor Responders ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Choi Criteria ◽  
Enhanced Ct ◽  
Pre Treatment ◽  
Response Group

9506 Background: Recent studies have demonstrated that RECIST is insensitive in evaluating GIST’s treated with imatinib. We have demonstrated in a small group of patients that a good response by Choi Criteria, i.e., a 10% decrease in unidimensional tumor size or a 15% decrease in tumor density on contrast-enhanced CT, correlated well with good response by PET (Proc. ASCO 22:819, 2003) and was more predictive of time to tumor progression (TTP) than response by RECIST (CTOS 2004). The aim of this study was to validate the correlation with disease-specific survival (DSS) and TTP with follow-up updated to 5-years. Methods: We evaluated 98 patients treated with imatinib for recurrent or metastatic GIST at our institution from December 2000 to September 2001 by RECIST and Choi criteria. All patients had pre-treatment and initial 2-monthly follow-up CT’s. DSS and TTP were analyzed by response category. Results: There were 28 (48%) good responders by RECIST and 30 (52%) poor responders. There were 49 (84%) good responders by Choi criteria, and 9 (16%) poor responders. Patients with good response by Choi criteria on CT at 8 weeks after treatment had significantly improved DSS (P = 0.04) in contrast to those with complete or partial response at any time by RECIST (P = 0.45). Similarly, TTP was significantly correlated with Choi response group (P = 0.01) but not with response group by RECIST (P = 0.74). Conclusions: Choi response criteria, incorporating tumor density and using small changes in tumor size on CT, are more sensitive and more accurate than RECIST in assessing the response of GISTs to imatinib mesylate and should be routinely incorporated into future studies of GIST therapy. Good response is detected earlier by Choi criteria and is a valid surrogate for DSS and TTP. We should desist using RECIST, at least in GIST. (Supported in part by NCI contracts U01-CA70172–01 and N01-CM-17003) [Table: see text]

scholarly journals Prospective Study on the Performance of 18F-DOPA Positron Emission Tomography/Computed Tomography in Patients with Medullary Thyroid Carcinoma

2022 ◽  
Author(s):  
Inés Califano ◽  
Fabian Pitoia ◽  
Roxana Chirico ◽  
Alejandra de Salazar ◽  
Maria Bastianello
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Distant Metastases ◽  
Emission Tomography ◽  
Medullary Thyroid ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct

Abstract Purpose 18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, ii) to evaluate changes in disease management secondary to the findings encountered with this methodology. Methods thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/ abdominal 3-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT. Results 77.7% were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in 7 cases (22%) distant metastases were diagnosed, and in 8 additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥ 3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%). Conclusion 18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC and provided helpful information for patient management.

scholarly journals Delayed response to proton beam treatment of hepatocellular carcinoma

2020 ◽  
Vol 6 (1) ◽  
pp. 20180125
Author(s):  
Chee-Wai Cheng ◽  
Mitchell Machtay ◽  
Jennifer Dorth ◽  
Olga Sergeeva ◽  
Hangsheng Xia ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Ct Scan ◽  
Proton Beam ◽  
Arterial Phase ◽  
Delayed Response ◽  
Data Set ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Imaging Response

Hepatocellular carcinoma (HCC) has become one of the leading causes of cancer death worldwide. There has been anecdotal report regarding the effectiveness of proton beam treatment for HCC. In this pre-clinical investigation, the woodchuck model of viral hepatitis infection-induced HCC was used for proton beam treatment experiment. The radiopaque fiducial markers that are biodegradable were injected around the tumor under ultrasound guidance to facilitate positioning in sequential treatments. An α cradle mode was used to ensure reproducibility of animal positioning on the treatment couch. A CT scan was performed first for contouring by a radiation oncologist. The CT data set with contours was then exported for dose planning. Three fractionations, each 750 CcGyE, were applied every other day with a Mevion S250 passive scattering proton therapy system. Multiphase contrast-enhanced CT scans were performed after the treatment and at later times for follow-ups. 3 weeks post-treatment, shrinking of the HCC nodule was detected and constituted to a partial response (30% reduction along the long axis). By week nine after treatment, the nodule disappeared during the arterial phase of multiphase contrast-enhanced CT scan. Pathological evaluation corroborated with this imaging response. A delayed, but complete imaging response to proton beam treatment applied to HCC was achieved with this unique and clinically relevant animal model of HCC.

scholarly journals Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-216948
Author(s):  
Fiona J Gilbert ◽  
Scott Harris ◽  
Kenneth A Miles ◽  
Jonathan R Weir-McCall ◽  
Nagmi R Qureshi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Sensitivity Specificity

IntroductionDynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these.MethodsIn this prospective multicentre trial, 380 participants with an SPN (8–30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model.Results312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred.ConclusionsPET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective.Trial registration numberNCT02013063

Positron Emission Tomography of Cavernous Haemangiomas of the Brain

1986 ◽  
Vol 27 (4) ◽  
pp. 379-383 ◽  
Author(s):  
K. Ericson ◽  
H. von Holst ◽  
M. Mosskin ◽  
M. Bergström ◽  
M. Lindqvist ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Mass Effect ◽  
Emission Tomography ◽  
Low Grade ◽  
Cavernous Haemangioma ◽  
Radionuclide Studies ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Enhanced Ct

Four cases with lesions suspected to be low-grade intracerebral tumours but later proved to be cavernous haemangiomas are described. The patients were examined with contrast enhanced CT and with positron emission tomography (PET). The lesions were partly calcified with a mild or no mass effect and a slight contrast enhancement at CT. There were signs of disrupture of the blood-lesion barrier also on radionuclide studies. PET with 11C-methionine and 11C-glucose showed a normal or decreased accumulation of the tracers. This combination of findings has not been encountered in intracranial tumours. As a comparison, one case of glioblastoma is described. In this patient, the CT findings suggested a cavernous haemangioma. However, PET showed a markedly increased accumulation of 11C-methionine, which is compatible with brain tumour but not with haemangioma.

scholarly journals Computed Tomography-Based Radiomics Model to Preoperatively Predict Microsatellite Instability Status in Colorectal Cancer: A Multicenter Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhi Li ◽  
Qi Zhong ◽  
Liang Zhang ◽  
Minhong Wang ◽  
Wenbo Xiao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Feature Selection ◽  
Clinical Characteristics ◽  
External Validation ◽  
Training Set ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Auc Value ◽  
Validation Set

ObjectivesTo establish and validate a combined radiomics model based on radiomics features and clinical characteristics, and to predict microsatellite instability (MSI) status in colorectal cancer (CRC) patients preoperatively.MethodsA total of 368 patients from four hospitals, who underwent preoperative contrast-enhanced CT examination, were included in this study. The data of 226 patients from a single hospital were used as the training dataset. The data of 142 patients from the other three hospitals were used as an independent validation dataset. The regions of interest were drawn on the portal venous phase of contrast-enhanced CT images. The filtered radiomics features and clinical characteristics were combined. A total of 15 different discrimination models were constructed based on a feature selection strategy from a pool of 3 feature selection methods and a classifier from a pool of 5 classification algorithms. The generalization capability of each model was evaluated in an external validation set. The model with high area under the curve (AUC) value from the training set and without a significant decrease in the external validation set was final selected. The Brier score (BS) was used to quantify overall performance of the selected model.ResultsThe logistic regression model using the mutual information (MI) dimensionality reduction method was final selected with an AUC value of 0.79 for the training set and 0.73 for the external validation set to predicting MSI. The BS value of the model was 0.12 in the training set and 0.19 in the validation set.ConclusionThe established combined radiomics model has the potential to predict MSI status in CRC patients preoperatively.

scholarly journals Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin’s ulcer: a short report focused on preoperative imaging

2014 ◽  
Vol 3 (1) ◽  
pp. 204798161351661 ◽  
Author(s):  
Signe Muus Steffensen ◽  
Anders Thomassen ◽  
Jesper Poul Naested Jensen ◽  
Jens Ahm Soerensen
Keyword(s):  
Lymph Nodes ◽  
Ct Scan ◽  
Preoperative Imaging ◽  
Short Report ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Pet Ct Scan

We present a case of a 56-year-old man with a giant carcinoma in the abdominal wall. Based on positron emission tomography/computed tomography (PET/CT) scan there were FDG-avid lymph nodes in the ipsilateral axillary and groin, suspicious for metastases. At contrast-enhanced CT the parietal peritoneum seemed free of tumor invasion, which was essential to radical surgery planning. The tumor was completely removed with clear margins of resection and no metastasis in the resected lymph nodes. The PET/CT scan was repeated after 4 months, showing no signs of recurrence.

[18F]Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET)/Computed Tomography (CT) in Suspected Recurrent Breast Cancer: A Prospective Comparative Study of Dual-Time-Point FDG-PET/CT, Contrast-Enhanced CT, and Bone Scintigraphy

2016 ◽  
Vol 34 (16) ◽  
pp. 1889-1897 ◽  
Author(s):  
Malene Grubbe Hildebrandt ◽  
Oke Gerke ◽  
Christina Baun ◽  
Kirsten Falch ◽  
Jeanette Ansholm Hansen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fdg Pet ◽  
Distant Recurrence ◽  
Receiver Operating Curve ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Fdg Pet Ct

Purpose To prospectively investigate the diagnostic accuracy of [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) with dual-time-point imaging, contrast-enhanced CT (ceCT), and bone scintigraphy (BS) in patients with suspected breast cancer recurrence. Patients and Methods One hundred women with suspected recurrence of breast cancer underwent 1-hour and 3-hour FDG-PET/CT, ceCT, and BS within approximately 10 days. The study was powered to estimate the precision of the individual imaging tests. Images were visually interpreted using a four-point assessment scale, and readers were blinded to other test results. The reference standard was biopsy along with treatment decisions and clinical follow-up (median, 17 months). Results FDG-PET/CT resulted in no false negatives and fewer false positives than the other imaging techniques. Accuracy of results were similar for 1-hour and 3-hour FDG-PET/CT. For distant recurrence, the area under the receiver operating curve was 0.99 (95% CI, 0.97 to 1) for FDG-PET/CT, 0.84 (95% CI, 0.73 to 0.94) for ceCT, and 0.86 (95% CI, 0.77 to 0.94) for the combined ceCT+BS. Of 100 patients, 22 (22%) were verified with distant recurrence, and 18 of these had bone involvement. Nineteen patients (19%) had local recurrence only. In exploratory analyses, diagnostic accuracy of FDG-PET/CT was better than ceCT alone or ceCT combined with BS in diagnosing distant, bone, and local recurrence, shown by a greater area under the receiver operating curve and higher sensitivity, specificity, and superior likelihood ratios. Conclusion FDG-PET/CT was accurate in diagnosing recurrence in breast cancer patients. It allowed for distant recurrence to be correctly ruled out and resulted in only a small number of false-positive cases. Exploratory findings suggest that FDG-PET/CT has greater accuracy than conventional imaging technologies in this patient group.

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