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The aim of this study was to investigate the diagnostic performance of whole-body [C]acetate PET/CT in less aggressive or indolent lymphomas, wherein [F]FDG PET/CT would exhibit limited sensitivity.Between September 2016 and May 2018, we prospectively evaluated 17 patients (9 men, 8 women; mean age [range], 71 [45-87] years) with pathologically proven less aggressive or indolent lymphomas according to Non-Hodgkin's Lymphoma Classification Project, using both [F]FDG PET/CT and [C]acetate PET/CT (performed on the same day). Detected nodal lesions were recorded according to the Ann Arbor classification. Extranodal (EN) lesions were also evaluated. We compared whole-body lesion detection between [F] FDG PET/CT and [C]acetate PET/CT using the McNemar test.In all patients, significantly more nodal and EN lesions were detected using [C]acetate PET/CT than [F]FDG PET/CT (nodal: 84 vs 64 regions; P0.001; EN: 26 vs 19 regions, P = 0.039). Bone lesions were detected in 8 and 5 patients using [C]acetate PET/CT and [F]FDG PET/CT, respectively (P = 0.25). Among the 14 patients (82.4%) who underwent bone marrow biopsy, bone marrow involvement was detected with sensitivities of 100% (6/6 patients) and 80% (5/6 patients) using [C]acetate PET/CT and [F]FDG PET/CT, respectively. Multiple areas of focal uptake in the spleen of 1 patient were exhibited on [F]FDG PET/CT but not [C]acetate PET/CT.[C]acetate PET/CT exhibited greater sensitivity than [F]FDG PET/CT for lesion detection in patients with less aggressive or indolent lymphomas, thus promising applicability as a physiological tracer in the study of such lesions.

Staging is an important step in the management of bladder cancer as it guides treatment options and surveillance protocols. Accurate staging is highly dependent on diagnostic capabilities and surgical biopsy/resection techniques. Cystoscopy is the mainstay of bladder cancer workup with urine cytology and cystoscopic enhancement serving as adjuncts to cancer detection. After tumor identification, transurethral resection is done to obtain tissue. Recently, newer resection techniques and laser energies have been used to optimize detrusor muscle in the specimen for more accurate staging. To this end, a second-look resection is still recommended in high-risk patients. An important part of clinical staging is obtaining cross-sectional imaging. Classically, CT scan has been used though there may be a role for MRI and PET scan in certain cases. Staging follows the standard TNM classification system and the most recent WHO grading system. Subsequent risk stratification is assigned based on tumor characteristics. Risk tables can provide clinicians and patients with estimates for disease recurrence and progression and further guide surveillance strategies.

In this chapter, an effective computer-aided detection and diagnosis system is proposed which identifies cystic abnormalities in kidneys from 2D abdominal CT scan images. The model differentiates between a normal and abnormal kidney and, if found abnormal, grades the level of cancer in the kidney. This model-based system is developed to assist physicians and radiologists to come to an accurate preliminary diagnosis which would help inappropriate treatment and follow-up. The proposed system can also be used as a preliminary diagnostic tool in rural and underdeveloped areas of the world where quick and easy access to efficient radiologists are limited. Building a classifier to classify the tumor into normal, grade 1, grade 2, grade 3, and grade 4 is the key differentiator of this system compared to the existing tumor identification methodologies available. The concept of Bosniak classification of renal tumors, the most popular preliminary diagnosis methodology preferred by radiologists was used to develop the model using a feed-forward Artificial Neural network (ANN). The neural network was trained using 82 CT images, and the trained network was tested using 30 CT images. The results showed a malignancy classification rate of 93.75% and grading accuracy of 86.67% when compared to the clinical results following biopsy of the tumor.

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

BACKGROUND The survival benefit in maximizing resection in glioblastomas (GBMs) has been demonstrated by numerous studies. The true limit of infiltration of GBMs has been an overwhelming obstacle, and several technological advances have been introduced to improve the identification of residual tumors. OBJECTIVE To evaluate whether the integration of 5-aminolevulinic acid (5-ALA) with microbubble contrast-enhanced ultrasound (CEUS) improves residual tumor identification and has an impact on the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS). METHODS A total of 230 GBM procedures were retrospectively studied. Cases were stratified according to the surgical procedure into 4 groups: 5-ALA- and CEUS-guided surgeries, 5-ALA-guided surgeries, CEUS-guided surgeries, and conventional microsurgical procedures. RESULTS Patients undergoing conventional microsurgical procedures showed the worst EORs compared to the assisted techniques (5-ALA and CEUS procedures). Both 5-ALA and CEUS techniques improved the EOR compared to conventional microsurgical procedures. However, their combination gave the best results in terms of the EOR (P = .0003). The median EOR% and the number of supramarginal resections are hence superior in the 5-ALA + CEUS + group compared to the others; this observation had consequences on PFS and OS in our series. CONCLUSION In terms of the EOR, the best results can be achieved through a combination of both techniques, where the 5-ALA-guided procedure is followed by a final survey with CEUS. Compared with other intraoperative imaging techniques, CEUS is a real-time, readily repeatable, safe, and inexpensive technique that provides valuable information to the surgeon before, during, and after resection.

The integration of fluorescence guidance techniques into minimally invasive surgery (MIS) has transformative potential and is well adapted to existing laparoscopic equipment. Current clinical applications include sentinel lymph node mapping in gastric and uterine cancers, identification of important structures such as the ureter in pelvic surgery, evaluation of perfusion in bowel anastomoses, and liver tumor localization. Preclinical studies with tumor-targeting agents in rodent studies have shown benefit in tumor identification, resection margins, and survival. Translation of these benefits into the clinic requires successful development of tumor-targeting agents for humans and remains the key challenge to overcome to realize the potential of fluorescence-guided techniques in MIS.

Background and Objective Over the last decade, an increasing effort has been put towards the implementation of optical guidance techniques to aid surgeons during cancer surgery. Diffuse reflectance spectroscopy (DRS) and fluorescence spectroscopy (FS) are two of these new techniques. The objective of this study is to investigate whether in vivo optical spectroscopy is able to accurately discriminate colorectal liver metastases (CRLM) from normal liver tissue in vivo. Materials and Methods DRS and FS were incorporated at the tip of a needle and were used for in vivo tissue differentiation during resection of CRLM. Measurements were taken in and around the tumor lesions and measurement sites were marked and correlated to histology (i.e., normal liver tissue or tumor tissue). Patients with and without neoadjuvant systemic chemotherapy were included into the study. Results Four hundred and eighty-four measurements were taken in and near 19 liver lesions prior to resection. Overall sensitivity and specificity for DRS was 95% and 92%, respectively. Bile was the most discriminative parameter. The addition of FS did not improve the overall accuracy. Sensitivity and specificity was not hampered by neo-adjuvant chemotherapy; sensitivity and specificity after neo-adjuvant chemotherapy were 92% and 100%, respectively. Conclusion We have successfully integrated spectroscopy technology into a disposable 15 Gauge optical needle and we have shown that DRS and FS can accurately discriminate CRLM from normal liver tissue in the in vivo setting regardless of whether the patient was pre-treated with systemic therapy. This technique makes in vivo guidance accessible for common surgical practice. Lasers Surg. Med. 48:820–827, 2016. © 2016 Wiley Periodicals, Inc.

386 Background: Laparoscopic surgery for gastrointestinal tumors requires fast and precise tumor localization. As tumor palpation is not possible during laparoscopic surgery, tumor identification is often difficult for some cases. Despite various methods, such as tattooing or endo-clipping, have been introduced for the localization of tumors, these methods own clear limitations. To overcome the drawbacks of these conventional marking methods, we designed a magnetic marking device linked to an endo-clip(MMC, Magnetic Marking Clip) for endoscopy. We performed preoperative endoscopic clipping with MMC and analyzed the intraoperative localization efficacy and safety during laparoscopic surgery. Methods: Study enrolled 30 patients with gastric and colorectal neoplasms scheduled to undergo endoscopic clipping before laparoscopic surgery at the Korea University Medical Center, Korea, between August 2017 and June 2019. A silicone-coated high-power neodymium marking device (ring or rod type) was fixed together with an endo-clip and applied on the center of the lesion during preoperative endoscopy. During laparoscopic surgery, a detecting magnetic body was inserted through a laparoscopic trocar and was used to localize the tumor that is marked with MMC. The time needed for endoscopists to place MMC at the lesion, laparoscopic clip detection time and success rate were studied. Results: Endoscopists placed MMC within 30 seconds. It was possible to find MMC in all cases of laparoscopic surgery. Time needed to find the MMC laparoscopically was relatively shorter than the time conventionally taken just with an endo-clip itself. There was no reported dislodgement of the clip before the surgery or any other adverse events associated with the MMC procedure. Conclusions: The MMC method enabled simple and fast tumor localization and showed excellent outcomes in efficacy of tumor localization. The MMC method may help surgeons localize GI tumor lesions easily and safely during laparoscopic surgery.

Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors derived from adrenal or extra-adrenal locations, respectively. Upon suspicion of PPGL, specific metabolomic, molecular, biochemical, imaging, and histopathologic studies are performed to prove, localize, treat, and monitor disease progression. Improved diagnostic tools allow physicians to accurately diagnose PPGL, even in patients presenting with small (1 cm) or biochemically silent tumors, which previously delayed proper detection and treatment.This review outlines the most updated approach to PPGL patients and presents a new diagnostic protocol for physicians to increase earlier tumor identification and accurately assess metastatic behavior.We present the most recent advances in genetics, epigenetics, metabolomics, biochemical, and imaging diagnoses of this rare tumor to properly assess disease, decide treatment options, and manage follow-up. We also elaborate on new therapeutic perspectives in these very rare neoplastic entities.ATRX = ATRX chromatin remodeler; ccRCC = clear cell renal cell carcinoma; c-MYC = MYC proto oncognene; CT = computed tomography; DOTATATE = DOTA-octreotate; EGLN1/2 = egl-9 family hypoxia inducible factor 1/2; EGLN2/PHD1 = egl-9 family hypoxia inducible factor 2; EPAS1/HIF2A = endothelial PAS domain protein 2/hypoxia-inducible factor 2α; ERK = extracellular signal-regulated kinase; HIFs = hypoxia-inducible factors; HIF-α = hypoxia-inducible factor alpha; HNPGLs = head and neck paragangliomas

Lung cancer is the most critical reason for death. To enhance cancer detection the radiologists using distinctive scans and X-ray’s. Consequently, we use CT scan images for inspecting the interiors of the body. An automatic cancer detection system proposed to distinguish cancerous tumor from the CT scan images. The cancer detection scheme consists of four stages. They are preprocessing, segmentation, feature extraction and classification. These four levels are used in image processing to enhance the tumor identification precision. The final outcome of this paper is to find cancer tumor as benign (or) malignant.

Summary:. Pediatric mandible tumors are rare and generally benign but can be locally aggressive. Diagnosis and treatment involve tumor identification, excision, and subsequent reconstruction. Successful reconstruction should address form and function of the mandible while minimizing morbidity. The authors review the diagnosis and treatment of a benign pediatric mandible tumor and the use of nonvascularized rib graft for mandible reconstruction. The subject of interest is an 8-year-old boy who presented with progressive left-sided facial swelling and examination findings concerning for a mandibular neoplasm. A large bony tumor of the left mandibular ramus and condyle was identified on computed tomography scan. Needle aspiration was performed but was nondiagnostic. The patient underwent en bloc resection and immediate reconstruction utilizing nonvascularized rib graft. Pathologic analysis demonstrated a benign fibro-osseous lesion consistent with fibrous dysplasia, ossifying fibroma, or aneurysmal bone cyst. The patient had excellent recovery of jaw function and resumption of solid diet 5 weeks after reconstruction. Mandibular defects >6 cm in length often require free vascularized bone flaps for reconstruction; however, these procedures can have greater morbidity in the skeletally immature patient. Nonvascularized rib graft is a viable alternative that also allows for reconstruction of the mandibular condyle using the costocartilagenous cap of the harvested rib. The authors present this case as an example of a rare pediatric head and neck tumor and review of the approach to diagnosis and treatment, including special considerations for complex pediatric mandibular reconstruction.

Background: Intraoperative ultrasonography has proven to be a useful tool for tumor identification during robot-assisted laparoscopic partial nephrectomy (RALPN). However, its utility is limited in renal tumors that are completely endophytic and isoechoic in nature. We present a novel approach to intraoperative tumor identification using preoperative percutaneous intratumoral embolization coil placement that may be utilized in the management of such cases. Case Presentation: A 42-year-old Caucasian male was referred with an incidentally discovered right renal mass that was posterior and completely endophytic. He desired a RALPN; however, preoperative renal ultrasound demonstrated an isoechoic lesion. Thus, the patient underwent preoperative image-guided placement of an embolization coil within the tumor. This facilitated identification of the tumor intraoperatively using intracorporeal ultrasound centered on the coil and enabled resection with negative margins. Conclusion: Utilizing a novel approach analogous to preoperative localization of other solid malignancies, such as breast cancer, we were able to effectively identify and resect an isoechoic renal mass during RALPN.

Magnetic resonance plays a leading role in the management of oncology patients, providing superior contrast resolution and greater sensitivity compared with other techniques, which enables more accurate tumor identification, characterization and staging. Contrast agents are widely used in clinical magnetic resonance imaging; approximately 40–50% of clinical scans are contrast enhanced. Most contrast agents are based on the paramagnetic gadolinium ion Gd3+, which is chelated to avoid the toxic effects of free gadolinium. Multiple factors such as molecule structure, molecule concentration, dose, field strength and temperature determine the longitudinal and transverse relaxation rates (R1 and R2, respectively) and thus the T1- and T2-relaxivities of these chelates. These T1- and T2-relaxivities, together with their pharmacokinetic properties (i.e. distribution and concentration in the area of interest), determine the radiologic efficacy of the gadolinium-based contrast agents.

Objectives: Accurate tumor identification during partial nephrectomy is essential for successful tumor control. Intraoperative laparoscopic ultrasonography is useful for tumor localization, but the ultrasound probe is controlled by the assistant rather than the surgeon. We evaluated our initial experience using a robotic ultrasound probe that is controlled by the console surgeon. Methods: Partial nephrectomy was carried out in 22 consecutive patients between November 2010 and March 2011. A robotic ultrasound probe under console surgeon control was used in all the cases. All patients had at least 1 year follow up. Results: Mean patient age was 59 years and mean tumor size was 2.7 cm. There were six hilar tumors (27%) and 21 (95%) endophytic tumors. Mean R.E.N.A.L. nephrometry score was 6.9 (range 6–9). Mean operative time was 205.7 min and mean warm ischemia time was 17.9 min (range 6–28 min). All patients had negative tumor margins and were free of disease recurrence at a mean follow up of 13 months. Conclusion: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure.

Near-infrared indocyanine green (ICG) fluorescence application in liver cancer surgery have been reported in the literature since 2008. To date, most reports emphasized not only to the safety, feasibility and reproducibility, but also the potential benefits of its clinical applications in term of demarcating segmentation for an anatomical resection, tumor identification to achieve tumor free resection margin, detection of small unidentifiable subcapsular nodules as well as extrahepatic metastatic lesions, and fluorescence cholangiography. The purpose of this review is to present the fundamental concept of the interpretation of fluorescence enhancement by different timing through intravascular ICG distribution to liver and biliary washout; to describe step-by-step technical aspects of its use in different purposes, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver cancer surgery.

This paper primarily focuses on to employ a novel approach to classify the brain tumor and its area. The Tumor is an uncontrolled enlargement of tissues in any portion of the human body. Tumors are of several types and have some different characteristics. According to their characteristics some of them are avoidable and some are unavoidable. Brain tumor is serious and life threatening issues now days, because of today’s hectic lifestyle. Medical imaging play important role to diagnose brain tumor .In this study an automated system has been proposed to detect and calculate the area of tumor. For proposed system the experiment carried out with 150 T1 weighted MRI images. The edge based segmentation, watershed segmentation has applied for tumor, and watershed segmentation has used to extract abnormal cells from the normal cells to get the tumor identification of involved and noninvolved areas so that the radiologist differentiate the affected area. The experiment result shows tumor extraction and area of tumor find the weather it is benign and malignant.

OBJECTIVE: The purpose of this study was to investigate the ability of the apparent diffusion coefficient (ADC) ratio of tumor to normal prostate tissue to overcome inherent variability based on choice of b values, with whole-mount histopathologic analysis as the reference standard for tumor identification. MATERIALS AND METHODS: Thirty-nine patients with prostate cancer underwent 3-T MRI, including DWI with b values of 0, 150, 750, and 1000 s/mm(2). ADC maps were derived from four b value combinations. Histologically derived ROIs were defined for prostate tumor and benign prostate tissue to generate a ratio. The concordance correlation coefficient was used to evaluate agreement and reproducibility at different b values. Bland-Altman plots were used to evaluate the pattern of relative measurement difference between b value combinations. The relationship between ADC values and Gleason score was tested by Spearman rank correlation. RESULTS: ADC values varied depending on the b value combination selected. The concordance correlation coefficient was higher for ADC ratios (0.883; 95% CI, 0.816-0.927) compared with absolute ADC values for normal tissue (0.873; 95% CI, 0.799-0.921) and tumor (0.792; 95% CI, 0.688-0.864). The ADC ratio concordance correlation coefficient for transition zone tumors was considerably higher than that for the peripheral zone in all cases. Bland-Altman analysis showed higher variation for ADC maps incorporating a b value of zero for both ratio and absolute values. There was a stronger inverse relationship to Gleason score for ADC ratios (rho, -0.354 to -0.456) compared with absolute ADC values (rho, -0.117 to -0.379). CONCLUSION: The use of a simple ratio of prostate tumor ADC to normal tissue ADC improved the concordance between different b value combinations and could provide a more robust means of assessing restricted diffusion in the prostate.

Purpose: To investigate the feasibility of a biomechanical-based deformable image registration technique for the integration of multimodality imaging, image guided treatment, and response monitoring. Methods and Materials: A multiorgan deformable image registration technique based on finite element modeling (FEM) and surface projection alignment of selected regions of interest with biomechanical material and interface models has been developed. FEM also provides an inherent method for direct tracking specified regions through treatment and follow-up. Results: The technique was demonstrated on 5 liver cancer patients. Differences of up to 1 cm of motion were seen between the diaphragm and the tumor center of mass after deformable image registration of exhale and inhale CT scans. Spatial differences of 5 mm or more were observed for up to 86% of the surface of the defined tumor after deformable image registration of the computed tomography (CT) and magnetic resonance images. Up to 6.8 mm of motion was observed for the tumor after deformable image registration of the CT and cone-beam CT scan after rigid registration of the liver. Deformable registration of the CT to the follow-up CT allowed a more accurate assessment of tumor response. Conclusions: This biomechanical-based deformable image registration technique incorporates classification, targeting, and monitoring of tumor and normal tissue using one methodology.

The lack of functional information and targeted imaging in conventional white-light endoscopy leads to a high miss-rate of gastrointestinal tumor. The combination of near-infrared fluorescence imaging and endoscopy presents a promising approach. Here we introduce a new endoscopy method employing a home-made flexible wide-field epi-fluorescence endoscope, that can be inserted through the biopsy channel of a gastrointestinal endoscope, with the glucose analogue 2- DeoxyGlucosone as the near-infrared fluorescent probe. System characterization indicates a good sensitivity and linearity over a large field of view. Its capability of tumor identification and location is demonstrated with in-vivo imaging of xenografted tumor model.

Purpose: PET can be useful in determining the progression of malignant disease over time as well as the response to therapy. To achieve this, the physician must be able to unambiguously identify and characterize individual tumors among several different scans.Methods: We have developed a coordinate system for identifying individual tumor sites on PET scans, selecting the carina on the transmission scan as a point of origin. Using this system, each tumor is given a set of spherical coordinates that identifies its position: a rho (rho, displacement from carina), a theta (theta;, angle between the A-P axis and the tumor), and a phi (phi;, angle between the polar axis and the tumor). We tested this method on a patient with metastatic thyroid cancer, who underwent 18FDG and 124I-Iodide PET scans in the same week. This sytem was also used on a patient with metastatic prostate cancer, who had two FDG scans done 7 weeks apart. The patient underwent chemotherapy treatment during this period, and the scans were performed to assess therapy response.Results: The patient with thyroid cancer had a total of 90 tumors, 82 of them identified in the 18FDG scan and 35 in the 124I-Iodide scan, with 27 tumors identified in both. For rho,theta;, andphi; among the 27 matching pairs of tumors, the mean differences were 6.80 +/- 5 mm, 6.22 +/- 4.54 degrees, and 5.51 +/- 5.81 degrees, respectively. The disparity in coordinate values between corresponding tumors can be explained by the distinctive uptake patterns of the radiopharmaceuticals. The patient with prostate cancer had 9 tumors identifiable in both the pre- and post-therapy scans. The mean differences for rho,theta;, andphi; among the 9 pairs of tumors were 1.93 +/- 1.65 mm, 6.67 +/- 5.53 degrees, and 2.04 +/- 2.02 degrees, respectively. After thorough analysis, we have determined that corresponding tumors with rho15 mm,theta; andphi;15 degrees difference usually indicate a match.Conclusion: This coordinate system facilitates the identification and characterization of individual tumors among multiple scans, thus aiding in both the assessment of diagnostic capabilities of different tracers, and the tracking of tumors following therapy.

To evaluate and compare perioperative outcomes of robotic partial nephrectomy (RPN) using robotic and laparoscopic ultrasound probe for tumor identification.Data from 75 consecutive RPN procedures using a laparoscopic ultrasound probe (January 2009- November 2010) and 75 consecutive RPN procedures using a robotic ultrasound probe (November 2010- November 2011) were collected. Perioperative outcomes of the two groups were retrospectively analyzed.A total of 72 patients underwent 75 consecutive RPN using the laparoscopic ultrasound probe followed by 73 patients who underwent 75 consecutive RPNs using the robotic ultrasound probe. Characteristics were similar between groups, and tumors had a similar complexity (mean nephrometry score 6.6 vs. 6.8, p=0.534), mean operating room time (234 vs. 218 min, p=0.095), mean console time (173 vs. 156 min, p=0.071), mean blood loss (171 mL vs. 164 mL, p=0.79), and positive tumor margin rates (1.2% vs. 2.2%, p=1) did not achieve significance. All patients are free of cancer recurrence after a mean follow up of 25.7 months in the laparoscopic probe group and of 10.2 months in the robotic probe group.Robotic ultrasound probes for tumor identification during RPN had comparable perioperative outcomes and surgical margin rates as a laparoscopic ultrasound probe, but with the advantage of surgeon autonomy.

Regional variations in tumor blood flow and necrosis are commonly observed in cross sectional imaging of clinical cancers. We hypothesize that radiologically-defined regional variations in tumor characteristics can be used to define distinct “habitats” that reflect the underlying evolutionary dynamics. Here we present an experimental framework to extract spatially-explicit variations in tumor features (habitats) from multiple MRI sequences performed on patients with Glioblastoma Multiforme (GBM). The MRI sequences consist of post gadolinium T1-weighted, FLAIR, and T2-weighted images from The Cancer Genome Atlas (TCGA). Our strategy is to identify spatially distinct, radiologically-defined intratumoral habitats by characterizing each small tumor regions based on their combined properties in 3 different MRI sequences. Initial tumor identification was performed by manually drawing a mask on a T1-weighted post contrast image slice. The extracted tumor was segmented into an enhancing and non-enhancing region by the Otsu segmentation algorithm, followed by a mask mapping procedure onto the corresponding FLAIR and T2-weighted images. Then Otsu was applied on the FLAIR and T2 images separately. We find that tumor heterogeneity measured through Distance Features (DF) can be used as a strong predictor of survival time. In an initial cohort of 16 cases slow progressing tumors have lower DF values (are less heterogeneous) compared to those with fast progression and short survival times.

Brain tumors are the second leading cause of cancer death in children under 15 years and young adults up to the age of 34, early detection and correct treatments based on accurate diagnosis are important steps to improve disease outcome. In this paper, a new method for brain tumors identification based on quantitative three-dimensional shape analysis is proposed. According to the character of magnetic resonance imaging (MRI) data and doctor’s clinical experience, we defined three two-dimensional shape descriptors correlating with tumor type from different points of view; on this basis, four three-dimensional shape descriptors were defined to realize the automatic classification of brain tumors. The experiment result demonstrates that these shape descriptors can well represent the tumor character. The classification accuracy of regular/irregular tumor is 93.93% and that of benign/malignant tumor is 87.14%. To regular benign (RB)/regular malignant (RM)/irregular benign (IB)/irregular malignant (IM), the classification accuracy is 86.43%. This method can be used as a clinical image analysis tool for doctors or radiologists to tumor identification.

Multidetector CT (MDCT) examination with multiphasic acquisition should be advocated as routine study in patient investigated for pancreatic adenocarcinoma. The application of a biphasic protocol gives the best results, using a pancreatic phase for tumor identification and arterial infiltration, and portal phase for the assement of venous infiltration and liver metastasis. Pancreatic adenocarcinoma is classically visualized as an ill-defined solid mass, not capsulated, isodense to the pancreatic parenchyma in pre-contrast scan and hypo-attenuating in the pancreatic-portal phases. Ancillary signs can be helpful in the diagnosis of small tumors (< 2 cm) and isoattenuating adenocarcinoma. Several benign and malignant condition can mimick adenocarcinoma, in this case magnetic resonance and endoscopic ultrasonography biopsy can be helpful in diagnosis. MDCT enables an accurate tumor staging and presents a positive predictive values for unresectability between 89% to 100%; it also allows a complete preoperative planning and presents high accuracy both in surgical complications and tumor recurrence detection.

Background. Few reports indicate the potential of transcranial sonography (TCS) in detecting human brain tumors. Methods. With an Agilent Sonos 2500 ultrasound device, the authors studied 4 brain tumor phantoms and compared the findings with magnetic resonance imaging (MRI). TCS was performed on 40 patients with intracranial tumors in a follow-up design. Sonographic tumor volume and affection of the ventricular system were compared with MRI findings. Results. The authors found a good correlation between TCS and MRI volumetry in the in vitro study. TCS showed good intraobserver and interobserver reliability. A new volumetric formula for TCS measurement was determined. TCS detection rate of brain tumors in vivo was 40%. When the investigators were given access to radiological findings, the rate of tumor identification was 80%. Despite a sufficient acoustic window, 40% of gliomas grade II and III were not detected. One glioblastoma was not identified owing to an insufficient temporal acoustic window. Tumor volumes measured with MRI and TCS correlated well. MRI volumes exceeded TCS volumes by 41%. In the postoperative examinations (mean = 8 days postoperative, n= 15), the resection cavity was displayed as hyperechogenic. It appeared impossible to differentiate between residual tumor tissue and normal repair mechanisms or blood. In the follow-up examination (mean = 99 days postoperative, n= 15) in 5 patients, neither MRI nor TCS showed tumor regrowth. Ten patients had residual tumors that were detected by sonography. Conclusions. The value of TCS for the diagnostics of brain tumors is at present limited. Once the tumor has been identified, sonographic results match well with those of MRI.

Among mediastinal tumors requiring operative treatment endothoracic goiters have to be considered as common cause (13.7%) in differential diagnostic aspects next to dysontogenetic and neurogenic tumors. Final diagnosis is best established by chest x-rays in two directions, perhaps with additional barium swallow and a scintigraphy (131I or technetium). Angiography is of no valuable further information concerning tumor identification or operability. The disadvantage refers to unwanted iodine load in case of thyroid malignancy. The operative approach for real mediastinal goiter necessitates partial or total sternotomy or occasionally lateral thoracotomy.

Positive contrast examination of the cerebellopontine cisterns with ethyl iodophenylundecylate (Pantopaque) injected via the lumbar route is a simple and effective method of demonstrating masses. The presence of a tumor may be proved in the absence of plain skull changes. The procedure would appear to be no more formidable than cervical myelography. Special equipment is not required, although fluoroscopy with image intensification and a television monitor is desirable. Fluoroscopic spot-films are usually adequate for diagnosis. An accurate comparison of positive contrast cerebellopontine cisternography and pneumoencephalography is not the purpose of this article. Rather, it is to stress that limited posterior fossa cisternography with Pantopaque represents a practical method of tumor identification. The clinical and roentgen features in the following four cases emphasize the simplicity of method and the criteria for the identification of lesions involving the cerebellopontine angle. Method Pantopaque exam...

The accurate identification of eye tumors continues to be a difficult medical diagnostic problem. The several non-nuclear clinical diagnostic techniques that have been used, such as direct and indirect ophthalmoscopy, slit lamp examination, transillumination, fluorescein angiograph, ultrasonography and direct analysis of the subretinal fluid, have all resulted in a high percentage of misdiagnoses. This has resulted in eyes being enucleated that did not contain malignant melanomas, but more tragically, eyes with malignant tumors were not enucleated, resulting in the death of the patient due to the metastatic spread of the tumor. At the present state of development, the 32p uptake test offers the best diagnostic method. For tumors of the uveal tract both G. M. and semiconductor detectors can be used. Detectors more sensitive to lower energy betas are needed to diagnose deeper lying tumors and to study the possible correlation between percent 32p uptake and the particular cell type of the tumor.

Ewing's sarcoma in the infant and young child is rare, highly malignant, and can be difficult to identify. An erroneous diagnosis of osteomyelitis may be considered first because the presentation may be similar to that of Ewing's sarcoma, and routine laboratory evaluation may not distinguish between these entities. Two such cases are presented, one involving the tibia in a 16-month-old child and another a finger phalanx in a 7-month-old child. In both cases the correct diagnosis of Ewing's sarcoma was delayed because of initial misdiagnosis of osteomyelitis. This diagnostic dilemma is summarized, and the literature reviewed. Special attention is given to recent advances in histochemistry and cytogenetics that assist in tumor identification. The conclusion highlights areas of remaining controversies for which additional study may facilitate distinction between osteomyelitis and Ewing's sarcoma.

In Reply .—It is refreshing to see others thinking creatively about improving our ability to trace and excise tumor. There is very little doubt that a major cause of local recurrence is incomplete tumor excision. Parallel histologic sectioning is time-consuming. The idea proposed by Jako et al would greatly simplify tumor identification and excision and is therefore worth pursuing. I am hopeful that others will also apply their ingenuity to develop techniques for detecting, tracing, and excising microscopic extensions of locally aggressive neoplasms.