Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts of limitations of real-time reverse transcription polymerase chain reaction (RT-PCR) assay. Based on a comprehensive literature review and the experience in the frontline, we aim to review the typical and relatively atypical CT manifestations with representative COVID-19 cases at our hospital, and hope to strengthen the recognition of these features with radiologists and help them make a quick and accurate diagnosis.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy. Despite the development of multimodality treatments, including surgical resection, radiotherapy, and chemotherapy, the long-term prognosis of patients with PDAC remains poor. Recently, the introduction of neoadjuvant treatment (NAT) has made more patients amenable to surgery, increasing the possibility of R0 resection, treatment of occult micro-metastasis, and prolongation of overall survival. Imaging plays a vital role in tumor response evaluation after NAT. However, conventional imaging modalities such as multidetector computed tomography have limited roles in the assessment of tumor resectability after NAT for PDAC because of the similar appearance of tissue fibrosis and tumor infiltration. Perfusion computed tomography, using blood perfusion as a biomarker, provides added value in predicting the histopathologic response of PDAC to NAT by reflecting the changes in tumor matrix and fibrosis content. Other imaging technologies, including diffusion-weighted imaging of magnetic resonance imaging and positron emission tomography, can reveal the tumor response by monitoring the structural changes in tumor cells and functional metabolic changes in tumors after NAT. In addition, with the renewed interest in data acquisition and analysis, texture analysis and radiomics have shown potential for the early evaluation of the response to NAT, thus improving patient stratification to achieve accurate and intensive treatment. In this review, we briefly introduce the application and value of NAT in resectable and unresectable PDAC. We also summarize the role of imaging in evaluating the response to NAT for PDAC, as well as the advantages, limitations, and future development directions of current imaging techniques.
Background: The Liver Imaging Reporting and Data System treatment response algorithm (LI-RADS TRA) was developed to evaluate the tumor response of patients with hepatocellular carcinoma (HCC) after locoregional treatments. This study aimed to evaluate the performance of LI-RADS computed tomography (CT) TRA version 2018 in tumor response assessment and survival prediction of patients with single HCC after radiofrequency ablation (RFA). Methods: Forty patients who underwent RFA for single HCC between 2010 and 2016 were included in this retrospective study. The overall survival (OS) data from all the patients after the first therapy was collected. Two readers independently assessed the pretreatment (within 7 d) and posttreatment (within 90 d after RFA) CT manifestations using the LI-RADS version 2018 CT TRA. Inter-reader agreement was assessed. Another radiologist re-evaluated any divergent results and came to the final conclusion. The performance of LI-RADS version 2018 CT TRA for tumor response assessment and predicting survival of patients with single HCC after RFA was evaluated. Results: Interobserver agreement was moderate between the 2 readers [κ=0.602, 95% confidence interval (CI): 0.390-0.814] when using LI-RADS version 2018 TRA to evaluate tumor response for patients with single HCC after RFA. Patients classified as LR-TR viable had significantly lower OS than those classified as LR-TR nonviable (P=0.
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