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Massive abdominopelvic masses usually arise from the female reproductive organs. However, these masses may also arise from the gastrointestinal system, urinary system, adjacent soft tissues, peritoneum, retroperitoneum or be metastatic. Differential diagnosis is very important in these huge masses and imaging techniques are usually the best method of assessing, but in some cases, they cannot provide conclusive results and a definitive diagnosis is only achieved after surgical resection. We present three cases of giant abdominopelvic tumors with different etiologies and outcomes. We intend to highlight the importance of early detection, preoperative evaluation, and subsequent surgical management with a multidisciplinary approach to decrease pre and postoperative complications and to improve the quality of live.

Objectives: To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution. Methods: First, we performed a literature search (2009–2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution. Results: Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data. Conclusions: The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice. Advances in knowledge: The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology.

Background: RECIST 1.1 presents challenges when evaluating treatment response to angiogenesis inhibitors. The objective response rate, when evaluating the treatment effect of regorafenib, using RECIST 1.1, is < 2% and beneficial treatment could erroneously be terminated. Dynamic contrast-enhanced computed tomography (DCE-CT) has potential as a non-invasive functional imaging biomarker, by quantifying the treatment effect of this targeted therapy. Purpose: To evaluate three-dimensional (3D) tumor dynamic parameters representing tumor microcirculation assessed by DCE-CT during the treatment with regorafenib in a cohort of patients with treatment-refractory metastatic colorectal cancer. Material and Methods: Thirty-three patients with colorectal metastases (27 liver lesions, three abdominal lesions, and three pulmonary lesions) were treated with regorafenib and evaluated using DCE-CT. A total of 112 DCE-CT scans were analyzed using Advanced Perfusion and Permeability Application and correlated to standard contrast-enhanced computed tomography (CE-CT) evaluated using RECIST 1.1. Results: A significant decrease in most DCE-CT parameters, a simultaneous decrease in tumor attenuation and an increase in tumor volume were detected during treatment. However, no associations were found between the DCE-CT parameters and PFS or OS using simple COX proportional hazards regression. Conclusion: In this exploratory study, a significant decrease in most dynamic parameters suggests an overall treatment effect of regorafenib in tumor vasculature. DCE-CT may assist in an objective evaluation of these responses compared to RECIST. The anti-angiogenic changes could not be associated with treatment outcome in terms of PFS and OS, which might be due to the small cohort or a rather limited survival benefit in this pre-medicated treatment-refractory group of patients.

The purpose of this study was to develop a method enabling synthetic computed tomography (sCT) generation of the whole abdomen using magnetic resonance imaging (MRI) images of pediatric patients with abdominal tumors. The proposed method relies on an automatic atlas-based segmentation of bone and lungs followed by an MRI intensity to synthetic Hounsfield unit conversion. Separate conversion algorithms were used for bone, lungs and soft-tissue. Rigidly registered CT and T2-weighted MR images of 30 patients in treatment position and with the same field of view were used for the evaluation of the atlas and the conversion algorithms. The dose calculation accuracy of the generated sCTs was verified for volumetric modulated arc therapy (VMAT) and pencil beam scanning (PBS). VMAT and PBS plans were robust optimized on an internal target volume (ITV) against a patient set-up uncertainty of 5 mm. Average differences between CT and sCT dose calculations for the ITV V95% were 0.5% (min 0.0%; max 5.0%) and 0.0% (min -0.1%; max 0.1%) for VMAT and PBS dose distributions, respectively. Average differences for the mean dose to the organs at risk were

Objective: To evaluate the performance of computed tomography (CT)-guided percutaneous biopsy of abdominal lesions. Materials and Methods: This retrospective, single-center study evaluated patients submitted to CT-guided percutaneous biopsy of abdominal lesions at a cancer center, between January 2014 and June 2015. The images and patient medical records were reviewed using a standardized data collection form. Results: We included 225 procedures performed in 212 patients, of whom 143 (63.5%) had a prior diagnosis of cancer. Of the 225 lesions biopsied, 88 (39.1%) had a suspected primary origin and 137 (60.9%) were suspected metastatic lesions. Complications occurred in only 14 (6.2%), the most common being self-limited bleeding, which occurred in 12 (85.7%) of the 14. The occurrence of complications was not found to be significantly associated with the lesion location, age of the patient, presence of comorbidities, use of a supplementary technique, vascularization pattern, or proximity of the lesion to large vessels. The pathology findings were sufficient for making the diagnosis in 202 cases (89.8%), and the diagnosis was consistent with the clinical suspicion in 132 (58.6%). Conclusion: The procedure demonstrated a high (approximately 90%) rate of providing a sufficient sample for the diagnosis and a low complication rate, the most common complication being self-limiting bleeding. Resumo Objetivo: Avaliar a performance das biópsias percutâneas de lesões abdominais guiadas por tomografia computadorizada (TC). Materiais e Métodos: Estudo retrospectivo, unicêntrico, com pacientes submetidos a biópsias percutâneas de lesões abdominais guiadas por TC em um centro de referência oncológico, no período de janeiro de 2014 a junho de 2015. Foram avaliados as imagens dos procedimentos e os prontuários dos pacientes, sendo preenchida uma ficha de coleta de dados padronizada. Resultados: Foram incluídos 225 procedimentos em 212 pacientes, dos quais 143 (63,5%) tinham história prévia de câncer. Das lesões submetidas a biópsia, 88 (39,1%) apresentavam suspeita de lesão primária e 137 (60,9%), de lesão metastática. Apenas 14 (6,2%) lesões evoluíram com alguma complicação, sendo a mais comum o sangramento autolimitado (n = 12; 85,7%). Todos os procedimentos foram realizados com técnica coaxial. Não houve diferença na incidência de complicações em relação a localização da lesão, idade, comorbidades, técnica utilizada, padrão de vascularização e proximidade de grandes vasos. O resultado do exame patológico foi suficiente para o diagnóstico em 89,8% (202) do total. O diagnóstico foi concordante com a suspeita em 58,6% dos casos. Conclusão: Os resultados demonstraram um índice de amostra suficiente para o diagnóstico de aproximadamente 90%, com uma taxa de complicação pequena, sendo a mais frequente o sangramento autolimitado.