Optimization of follow-up MRI protocol for malignant neoplasms of the female pelvis

Introduction. MRI is widely used to follow-up malignant neoplasms of the female pelvis. Aim. To optimize the use of MRI sequences for follow-up of female patients with malignant pelvic neoplasms. Materials and methods. Retrospective analysis of female pelvic MRI has been performed on 1.5 T MR scanner. This study includes 530 protocols. Results. The authors describe different protocols for assessment and differential diagnosis of recurrence, postradiation and postoperative changes. It includes applicable sequences, axis and the structure which require evaluation. In all cases, dynamic follow-up has to include analysis of patient's previous studies, anamnesis, previous treatment, as well as the end of chemotherapy and radiotherapy. All of the above, combined with the oncologist's treatment of choice determines the objective of this study. Nowadays, MRI is the method which most accurately characterizes postoperative and postradiation structural changes. MRI is useful in detection of pelvic lymph nodes. The role of MRI has high potential in assessing the effectiveness of chemotherapy and radiation therapy. Conclusion. In order to make the optimal scan protocol, follow-up of malignant neoplasms of the pelvic organs in women require the use of clinical and anamnestic data along with the results of patient's previous studies. The combined use of various sequences and techniques can improve the diagnostic significance of pelvic MRI at follow-up. Contrast enhancement has additional role in diagnostics of recurrent of pelvic organs in women. The use of different contrast enhancement techniques has proven effective in case of postradiation and postoperative complications.

Imaging Findings in Late-Onset Rectal and Vesical Bleed in Patients Who Have Undergone Radiation Therapy for Pelvic Neoplasms

Radiation-induced vessel injury is described more than a century ago and remains a persistent clinical problem, despite advances in the field of radiation oncology. Treatment of pelvic neoplasms with radiotherapy may result in chronic radiation toxicity, especially Haemorrhagic radiation cystitis and chronic radiation proctitis. We discussed the computed tomography (CT) findings of three cases with a history of radiotherapy to the pelvis presenting with hematuria and hematochezia. Contrast-enhanced CT could diagnose the cause and site of bleed. All these patients were managed successfully by endoscopic coagulation.

Characteristics of abdomen and pelvis CT scan's evaluation of patients with malignancies

According to the American Cancer Center, cancer causes about 1 in 6 deaths worldwide, more than AIDS, tuberculosis and malaria taken together, it is the second leading cause of death, after cardiovascular disease. Imaging examinations to examine the abdomen and pelvis are the methods of choice in detecting neoplastic formations with the provision of information that is essential for the subsequent management of these patients. From the PubMed databases and the Google Scholar search engine, the articles published during 2010-2020 were selected, according to the keywords: oncology statistics, oncology imaging, computed tomography, abdominal neoplasms, pelvic neoplasms, oncology staging, post-processing programs in computed tomography, follow-up of cancer patients, diagnostic algorithms. Information on international scientific studies on oncological pathology statistics has been selected and processed globally, according to data from the American Cancer Center and the International Agency for Research on Cancer, innovative methods for assessing the staging of patients with abdominal and pelvic neoplasms, and modern post processing in the case of examination by computed tomography of abdominal and pelvic neoplasms patients. After processing the information in the Google Scholar and PubMed database, according to the search criteria, 346 articles on the proposed topic were found. The final bibliography contains 176 relevant sources, of which 77 were considered representative for the elaboration of this synthesis article. We must aim to justify, optimize and customize each imaging procedure for patients with neoplasms, as they are frequently exposed to imaging examinations.

Assessment of Quality of Life Related to Radiation Proctitis in Patients Who Received Pelvic Radiotherapy

Background: Radiotherapy is widely used in the treatment of several pelvic neoplasms, Radiation-related adverse events may result in intestinal, urinary, sexual, bone and dermatological disorders, impacting quality of life. The prevalence of radiation proctitis is probably underestimated. The aim of this study is to assess the quality of life associated with radiation proctitis in patients undergoing pelvic radiotherapy.Methods: A cohort of 40 consecutive patients from an academic institution in Brazil who received pelvic radiotherapy was analyzed. Patients completed questionnaires EORTC QLQ-C30 and EORTC QLQ-PRT20 at the beginning and at the end of treatment. Clinico-pathological features were also collected using standard templates. Results: Thirty-seven patients were included in the analysis. Thirty-two patients (80%) were male and had prostate cancer. Pelvic radiotherapy was associated with worsening bowel control (p=0.0171) leakage (p=0.0542) and pain (p=0.0074) in EORTC QLQ-PRT20. Patients had increased number of bowel movements per day after treatment (p=0.0036). Fatigue (p=0.0176) and diarrhea (p=0.0103) increased after radiation therapy. There was no statistical difference in global quality of life in patients who received radiotherapy. Conclusion: EORTC QLQ-PRT20 questionnaire is suitable for assessing the quality of life related to radiation proctitis in patients undergoing pelvic radiotherapy. This tool may help clinicians in the management and monitoring of treatment-related adverse events of this treatment modality.

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

PREVENTION AND TREATMENT OF VENOUS THROMBOSIS AND THROMBOEMBOLISM IN SURGICAL TREATMENT PELVIC NEOPLASMS

Summary. Venous thromboembolic complications — a collective concept that combines thrombosis of the saphenous and deep veins, as well as pulmonary thromboembolism. In the clinical practice of a doctor of any specialty, especially surgical, the possibility of timely diagnosis, treatment and preventive measures for deep vein thrombosis and pulmonary embolism are extremely important. Purpose. To study the most informative measures for the prevention and treatment of venous thrombosis and thromboembolism in the surgical treatment of pelvic neoplasms. Materials and methods. The analysis of the results of the examination and treatment of 112 patients observed for tumors of the pelvic organs and tumors of the retroperitoneal space is presented. Results and discussion. When studying the initial state of the hemostasis system in 48 patients, a significant shortening of activated partial thromboplastin time (APTT), a 1.5-fold increase in the concentration of fibrinogen, which indicates activation of the procoagulant link, as well as an increase in platelet aggregation by 20.0 %, were established. Studies of the hemostatic system showed that surgical interventions and injuries contribute to increased hypercoagulation. Conclusions. The most informative methods for determining thrombosis in the system of the inferior vena cava and the optimal examination algorithm are: ultrasonic dynamic angioscanning, determination of the amount of D-dimer, computer, magnetic resonance bolus venography and retrograde ileocavagography. The use of unfractionated and low molecular weight heparins effectively prevents the development of thrombosis and thromboembolism before and after surgery and does not cause bleeding. Nonspecific and specific prophylaxis of venous thrombosis and embolism allowed a 2.8-fold reduction in their number in patients of the main group.

Diagnostic Efficiency of Magnetic Resonance Imaging and Positron Emission Tomography/ Computed Tomography for Pelvic Neoplasms

Objective: To evaluate the clinical diagnosis value of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for pelvic neoplasms, and make comparisons between them, thereby to provide necessary references for health informatics. Methods: This retrospective analysis was carried out on the basis of 169 medical records of patients suffering from pelvic neoplasms in our hospital from February 2011 to February 2017. The definitive diagnosis was made by postoperative pathologic examinations, and all the participants ever reveiwed MRI or/and PET/CT examinations prior to surgery. The coincidence rates between MRI (or/and PET/CT) and pathological examinations were compared, respectively. The parameters of diagnostic efficiency including sensitivity, specitivity, accuracy, positive predictive value and negative predictive value were calculated, respectively. In further, we then made comprehensive comparison between MRI and PET/CT to provide references for clinical practice. The informed consents of patients were obtained beforehand, and this research protocol was approved by institutional review board in our hospital. Results: The total number of identified patients was 386, and the age range of these incuded participants was 37–84 (mean age: 68.3 years old). 124 patients ever underwent MRI, and 137 patients underwent PET/CT, and 125 patients underwent MRI and PET/CT. The resection specimens of 386 patients with pelvic neoplasms were subjected to pathological examinations, and it could be confirmed that 38 patients suffered from fibroid, 121 suffered from cervical cancer, 93 suffered from endometrial cancer, 105 suffered from ovarian cancer, 29 suffered from benign ovarian tumor. The accuracy rate of MRI in detecting pelvic malignancies was 81.55%, PET/CT was 94.74%, and MRI combined with PET/CT was 97.06%. PET/CT is superior in staging pelvic malignancies and detecting distant metastasis, when compared with CT. But the combination of PET/CT and MRI could not obviously improve the accuracy rate of pelvic malignancies diagnosis. Conclusions: The primary pelvic neoplasms included fibroid, cervical cancer, endometrial cancer, ovarian cancer, and benign ovarian tumor. The total accuracy rate of MRI diagnosis was lower than PET/CT and the combination of MRI and PET/CT. Nevertheless, the combination of MRI and PET/CT resulted in additional medical costs, which could not bring more benefits for patients with pelvic malignancies. Whether the combination of MRI and PET/CT should be adopted needs further randomized controlled trials and economic evaluation to evaluate.