Imaging is important for evaluating peritoneal carcinomatosis to determine the extent of disease and select appropriate treatment. Computed tomography and magnetic resonance imaging can detect carcinomatosis by identifying plaques, nodules, masses or infiltration in the peritoneum, fatty areas, visceral serosa, mesentery, and adhesion formations. The peritoneal cancer index score is used to quantify carcinomatosis based on the size and extent of lesions in different abdominal regions. Imaging can also detect extraperitoneal metastases that may alter surgical management or preclude optimal debulking. Pseudomyxoma presents as diffuse intraperitoneal seeding of mucin-secreting cells causing thick ascites.
Comprehensive review of Isolated Axillary lymph nodal metastasis of unknown origin- Clinically unknown primary axilla which includes detailed approach and management of inguinal lymph nodal metastasis also
Radial Margin Positivity as a Poor Prognostic Factor for Colon CancerRamzi Amri
Abstract from 95th Annual Meeting of the New England Surgical Society:
Objective: Radial margin positivity (RMP), defined in colon cancer as primary disease involvement at the cut edge of the mesentery or the non-serosalized side of the ascending or descending colon mesentery, has unclear implications on the prognosis of colon cancer. This study explores the prognostic value of RMP in colon cancer.
Design: Retrospective review of a prospectively maintained, IRB-approved data repository.
Setting: Tertiary care center.
Patients: All colon cancer patients treated surgically at our center from 2004 through 2011 were included.
Main outcome measures: Perioperative and long-term outcomes for all patients were reviewed, assessing for RMP-associated differences
Results: Of 1039 cases with relevant data on surgical margins, 59 (5.6%) had an involved radial margin. All of these cases were AJCC stage II or higher, and were generally associated with higher T, N and M-stage disease (all P<0.001),><0.001)><0.001).><0.001),><0.001)><0.001)><0.001),><0.001) for metastatic disease.
Conclusion: An involved radial margin has strong associations with a constellation of negative histopathological tumor characteristics; even after adjustment for stage, it predicts recurrence, and is strongly associated with death and shorter survival. Albeit occurring infrequently, RMP is an important predictor of mortality and recurrence in colon cancer.
Comprehensive review of Isolated Axillary lymph nodal metastasis of unknown origin- Clinically unknown primary axilla which includes detailed approach and management of inguinal lymph nodal metastasis also
Radial Margin Positivity as a Poor Prognostic Factor for Colon CancerRamzi Amri
Abstract from 95th Annual Meeting of the New England Surgical Society:
Objective: Radial margin positivity (RMP), defined in colon cancer as primary disease involvement at the cut edge of the mesentery or the non-serosalized side of the ascending or descending colon mesentery, has unclear implications on the prognosis of colon cancer. This study explores the prognostic value of RMP in colon cancer.
Design: Retrospective review of a prospectively maintained, IRB-approved data repository.
Setting: Tertiary care center.
Patients: All colon cancer patients treated surgically at our center from 2004 through 2011 were included.
Main outcome measures: Perioperative and long-term outcomes for all patients were reviewed, assessing for RMP-associated differences
Results: Of 1039 cases with relevant data on surgical margins, 59 (5.6%) had an involved radial margin. All of these cases were AJCC stage II or higher, and were generally associated with higher T, N and M-stage disease (all P<0.001),><0.001)><0.001).><0.001),><0.001)><0.001)><0.001),><0.001) for metastatic disease.
Conclusion: An involved radial margin has strong associations with a constellation of negative histopathological tumor characteristics; even after adjustment for stage, it predicts recurrence, and is strongly associated with death and shorter survival. Albeit occurring infrequently, RMP is an important predictor of mortality and recurrence in colon cancer.
Blood-Pressure Management in Patients with Acute Cerebral Hemorrhage
Kontroversi hasil studi ATACH-2 dan dampaknya dalam manajemen hipertensi pada stroke perdarahan intraserebral akut.
This is a detailed presentation on the management of rectal cancer. this presentation commenced with the definition of the rectum by rigid sigmoidoscopy followed by definition of high, middle and low rectum. this was follwed by the pathology and pathogenesis of colorectal cancer. I went further to discuss the various clinical presentations of rectal cancers either as emergency or elective cases. Finally, the presentation discussed on the various approaches to the treatment of rectal cancer, whether high, middle or low rectal tumor. furthermore, the discussion went to the local therapy for early rectal cancer. Finally, prognostic factors and follow up modality was discussed.
Common: 200 000 TC/an, 12 000 death
Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury
CT: first-line of imaging
MR imaging being recommended in specific settings
MR imaging DTI, blood oxygen level–dependent fMRI, MR spectroscopy, perfusion imaging are of particular interest in identifying further injury CT and MRI are normal, as well as for prognostication in patients with persistent symptoms
However, it is an invasive procedure that is not straightforward to perform so is often reserved as a problem-solving tool when both the aortic root and valve are the prime source of interest.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
C Hoeffel, P Rousset imaging of peritoneal carcinomatosis jfim hanoi 2015
1. Imaging
of
peritoneal
carcinomatosis
C.HOEFFEL,
Reims
P.ROUSSET,
Lyon
HANOI,
NOV
2015
2. ObjecHves
• Understand
why
evaluaHon
of
carcinomatosis
is
necessary
• Understand
where
to
look
for
and
how
to
quanHfy
carcinomatosis
• Know
the
protocol
of
CT
and
MR
examinaHons
for
evaluaHon
of
carcinomatosis
• Know
the
role
and
added
value
of
involved
imaging
modaliHes
in
evaluaHon
of
carcinomatosis
3. General
consideraHons
• Primary
– GI
:
colo-‐rectal,
pancreaHc,
gastric
– Ovary/Breast
• Outcome
– Median
survival:
7
months,
OS-‐2
years
:
15%
– Limited
penetraHon
of
systemic
chemotherapy
4. • New
agressive
treatment=
standard
[
for
paHents
with
disease
confined
to
peritoneum
and
CRC
– Removal
of
macroscopical
– HIPEC:
high
local
concentraHon
of
chemotherapy,
increased
in
drug
toxicity
with
heat,
for
microscopical
– OS-‐3
years:
53
%
and
OS-‐5
years:
48.5
%
– 30
%
morbidity,
4
%
mortality
General
consideraHons
5. ROLE
OF
IMAGING
• Not
only
Diagnosis
but
• Extension
for
strategy
–
selecHon
of
paHents
for
surgery
+++,
even
if
perop
evaluaHon=
ref
– PCI
=
peritoneal
cancer
index=>
score
0
to
39
(12
regions),
ex
Sugarbaker
score
• Diameter
:
score
1
=
0-‐5
mm,
score
2=
5
mm-‐5
cm,
score
3
>
5
cm
– Probability
to
obtain
R0
surgery
and
taken
into
account
as
CI
to
surgery
when
too
high
for
a
type
of
cancer
Sugarbaker PH, De Bree E., Jour Surg Oncol, 2004
6. • Extension
necessitaHng
expert
centre:
– ResecHon
of
diaphragm
for
diaphragmaHc
nodule
– HepaHc
parenchymal
invasion
from
implants,
Bowel
implants
– Bladder
or
ureteral
invasion
• Idea
of
length
and
morbidity
• No
current
consensus
on
criteria
for
subopHmal
resecHon
but
some
lesions
suggest
non
resectability
ROLE
OF
IMAGING
Low AJR 2008 Low. Ann Surg Oncolo.2013 Nougaret.
Radiographics
2013
7.
Alert
surgeons
to
to
the
presence
of
disease
that
may
complicate
surgery
or
may
preclude
opHmal
debulking
.
Extensive
involvement
of
small
bowel-‐
diffuse
mesenteric
infiltraHon
or
retracHon
of
the
root
of
mesentery
8.
9. • Bulky
hepatoduodenal-‐
involved
node
sup
to
celiac
axis
• Involvement
of
vesical
trigone
-‐
pelvic
sidewall
Non
mucinous
CRC-‐
not
resectable
because
involvement
of
duodenal
extension
10. • IdenHfy
extraperitoneal
lesions
– Liver
small
or
central
mets
in
liver
,
spleen
not
seen
with
lap
– Lymph
nodes
– Abdominal
wall
– Pleura
– Bone
Role
of
Imaging
12.
– Liver
– Lymph
nodes
– Abdominal
wall
– Pleura-‐
inaccessible
with
lap
– Bone
13. Where
to
look
for
carcinosis?
– Gravity
dependent
areas
or
of
arrested
flows
• Pelvic
recesses
(rectouterine,
lateral
paravesical,
RLQ),
Right
paracolic
gu[er
(phrenicocolic
lig
upward
on
the
lel),
ACE,
Morisson’s
recess,
Right
subdiaphragmaHc
space
• RS
J,
Ileocaecal
juncHon,
pylorus
– Peritoneal
folds
containing
fat
• Ligaments
:
reflexion
area
between
visceral
and
parietal
p
• Mesos
:
mesentery,
transverse
meso
colon,
mesosigmoïd
• Omentum
Nougaret
et
al.
RadioGraphics
2012.
32,
No.
6:
1775-‐1800
14. PCI
SCORE-‐Features
•
Involvement
of
parietal
serosa
:
peritoneal
thickening-‐
nodules
•
Involvement
of
fa[y
areas
(omental
cake)
Nougaret
et
al.
RadioGraphics
2012
Vol.
32,
No.
6:
1775-‐1800
plaques
infiltration
Reticulonodular lesions
Mass (confluent nodules)
15. •
Involvement
of
visceral
serosa
– Extrinsic
tumoral
infiltraHon
(ileocaecal,
right
colonic
angle,
RSJ)
– Distorsion
SB
(retracHon
of
mesentery)-‐
Thickening
– ObstrucHon
17.
Adhesions=
deviaHon
of
a
structure
to
another
or
thickening
between
two
structures
without
fat
interface.
18.
nodules
of
the
mesentery
if
>7mm,
and/if
irregular
hypodense
nodules
and/if
numerous
:
grouped
and
>
8
on
one
slice
19. Other
signs
• Ureteral
dilataHon
without
any
obstacle
• Cardiophrenic
lymph
node
– 550
pts
with
CRC
– 30
%
proven
PC
– VPN
85
%/VPP
49
%
Caramella.
Eur
J
Cancer
2013
Two years after surgery for CRC.
Ureteral dilatation due to carcinomatosis
20. Pseudomyxoma
• Intraperitoneal
seeding
of
mucin
secreHng
cells
responsible
for
mucin
in
the
peritoneum
– Low
grade
and
high
grade
according
to
OMS
2010
– From
mucinous
appendicular,
ovary
• Features:
– Diffuse
involvement
– Thick
asciHs
with
scalloping
or
septas
– Possibility
of
calcificaHons
– Rarely
nodules
and
masses,
associated
organ
involvement
or
extent
to
pleura
21. ROLE
of
CT
• Reference
imaging
for
staging
and
restaging
of
paHents:
>90
%
/paHent
• Easily
available,
quick,
large
FOV
– SpaHal
resoluHon
(1
mm
thick
slices)
and
3D
reformats:
reconstrucHon
using
3
mm
slices-‐
– Anayze
coronal
reformats
:
Nodule
in
at
least
two
planes
increases
confidence
in
diagnosis
• Protocol:
IV
+±1
l
water
IV-‐
for
ovary
and
CRC
(30
%
with
calcificaHons)
Chandrashekhara.
BJR.2011
Mazzei
2013.
Abdominal
imaging
22.
• PCI:
underscores
staging
compared
with
surgery
• Depends
on
size
– Se
<
15%
for
T<
0.5
cm
(miliary
in
liniHs)
– Se
<
25%
for
T
<
1
cm
– Se
around
40%
for
T
=
0.5
-‐
5
cm
– Se
60
to
94%
for
T
>
5
cm
De
Bree.
JSO
2004
Koh
Ann.
Surg
Oncol
.2009
Esquivel.
JSO
2010
Sala.
Radiology.
2010
ROLE
OF
CT-‐
Limits
small lesion on mesentery
plaque like lesion
23. ROLE
OF
CT-‐
Limits
• Depends
on
site
–
Se<
20%
for
small
bowel
and
mesentery
– Se
poor
for
diaphragmaHc
lesions
– Se
variable
for
pelvis
• Depends
on
level
of
experience
• Depends
on
type
of
lesion
:
nodule
(k=0.8)/
thickening
(k=0.4)/distorsion
(k=0.2)
• Depends
on
amount
of
fat
De
Bree.
JSO.
2004
24. ROLE
OF
CT-‐
Limits
•
CharacterizaHon
of
nodules
and
of
asciHs
26. ROLE
OF
MRI
• Few
studies
available,
parHcularly
in
paHents
without
neoadjuvant
treatment
• MRI
versus
CT
– Qayyum.
Gynecol
oncol
2005:
137
pts,
CT
=
MRI
– Torkzad.
JSO
2015:
39
pts,
PCI
radio
CT
=
MRI,
EXCEPT
junior
– Low.
Ann
surg
oncol.
2015:
22
pts:
Acc
=
85
vs
63%
• MRI
versus
PET
– Soussan.
Eur
radiol
2012:
30
pts
(13/33
(43%
opérés)
Ac
=
83
vs
80%
per
p[
per
site
MRI
+
per
lesion
– Klumpp.
abdo
imaging
2012:
15
pts:
88
vs
94%.
MRI
without
diffusion
• MRI
alone
–
pseudomyxoma
– Low.
Ann
Surg
Oncol
2012:
33
p[s
(25
PMP)
Acc
0.84
27. MR
PROTOCOL
• Fast/PEG
500
cc?
• AnHperistalHc
agents
before
gadolinium
injecHon
=
glucagon
• MRI
of
abdomen
and
pelvis
-‐
2
stacks
to
cover
the
whole
peritoneal
cavity
– Axial
T2
single
shot
FSE
(trigger
free
breathing,
not
as
good
with
echo
nav),
5-‐6
mm,
sans
Fatsat
– Axial
Diffusion
(b
0-‐800)
– Axial
post
gadolinium-‐enhanced
T1-‐weighted
art/
portal/late
phase
(5
minutes).
28. T2
:
Added
value
for
PCI
assessment
•
limited
added
value
in
non
mucinous
lesions
29. T2
:
Added
value
for
PCI
assessment
•
added
value
++
for
mucinous
lesions
40. Diffusion-‐Limits
• Limits
of
diffusion
sequences
– T2
shine
through
effect=>
ADC
– RestricHon
of
diffusion
from
less
cellular
some
lesion:
mucin,
adhesions,
confluent
areas,
fibrosis
– Lesions
with
blood,
mucoid
content
41. MR
Technique-‐Limits
• PaHent-‐dependent
• PeristalHsm
• Black
hole
effect-‐
get
rid
of
the
asciHs
before
MRI
• ParHal
volume
effect-‐spaHal
resoluHon
• Interobserver
Variability
(per
site)-‐
learning
curve
42. PET
CT-‐
Main
IndicaHons
• Strong
Clinical
suspicion
of
PC
or
increase
in
markers
level
with
normal
CT
• DetecHon
of
recurrence
versus
fibrosis
• Assessment
before
HIPEC
– Underscores
PCI
but
complementary
to
CT/MRI
– Rules
out
extraperitoneal
lesions
contraindicaHng
surgery
44. PET
CT-‐
Limits
• False
negaHve
– Size
<
1cm
– Hidden
lesions
by
respiratory
and
GI
movements
• False
posiHve:
specificity
<
CT
– Inflammatory
reacHon
of
peritoneum
around
large
or
numerous
implants
– Foreign
body
or
inflammatory
reacHon
related
to
previous
surgery
– Physiological
uptake
of
bowel
and
vessels
Pierandrea
de
Iaco.
EJR.
2011
45. Conclusion
– CT=
reference
imaging
– Before
deciding
upon
treatment
MRI
±PET
scanner
needed
• For
assessment
of
PCI
• Detect
lesions
needing
expert
center
• Detect
non
resectable
disease
– Added
value
of
diffusion
for
small
bowel,
pelvis
,
hepaHc
hilum,
pseudomyxoma
++
– PET/CT
for
extraperitoneal
disease
– COMBINE
modaliHes