The Past, Present and Future of Diagnostic Imaging in Ovarian Cancer

Ovarian cancers (OC) include a group of diseases with variable prognoses. While most conventional imaging techniques rely on the detection of tumour burden and distant spread to identify treatment plans, more emphasis is now being placed on screening for early detection and also for more accurate staging using molecular imaging techniques. It is generally accepted that there are some incremental benefits of using serum CA125 levels coupled with cross-sectional diagnostic imaging to aid in the diagnosis, staging and treatment planning of OC. This chapter provides a review of tests and diagnostic imaging modalities that aid in the detection and staging of OC with a particular focus on F18-Fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) imaging. This chapter also proposes a diagnostic algorithm for the management of ovarian cancer. F18-FDG PET/CT imaging can act as a catalyst for the development of personalised medicine by stimulating advancements in targeted therapy. In conclusion, diagnostic imaging with particular focus in molecular imaging has the potential for altering management plans, which can ultimately help improve the prognosis of ovarian cancer

Gorham's disappearing bone disease: a rare cause of extensive bone destruction

Osteolytic disease of the bones have a myriad range of aetiology. One rare cause is Gorham’s disease or disappearing bone disease. This disease is a diagnosis by exclusion using correlation made with clinical presentation, radiological findings and histopathological confirmation. Although many different therapies have been advocated, none have been successful in fully controlling this disease. We present a case that was detected in a Chinese lady using diagnostic imaging, confirmed with computed tomography guided biopsy and successfully treated with joint reconstruction using endoprosthesis

Systematic review of the utility of functional MRI to investigate internet addiction disorder: recent updates on resting state and task-based fMRI

Introduction: Internet addiction disorder (IAD) particularly the internet gaming disorder (IGD) is recognized as a type of addiction similar to substance abuse. This addiction carries similar social impact as the latter, as it can cause serious impairment of interpersonal relationship, and even deterioration of academic or occupational performances. Functional magnetic resonance imaging (fMRI) is able to act as a non-invasive objective biomarker to detect functional neuronal connectivity in areas of the brain affected by IAD by utilizing blood oxygenation level dependent (BOLD) imaging. Methods: A systematic review was conducted from original articles published from January 2014 to January 2017 that had the keywords “internet addiction” and fMRI. Results: Initial data collection had 170 articles, however after applying the inclusion and exclusion criteria, there were 34 articles in the final analysis (17 resting-state fMRI studies and 18 task-based fMRI studies). The striatal nucleus and dopaminergic system demonstrated impaired functioning in subjects with IAD. Conclusion: Task-based and resting-state fMRI are able to detect areas of the brain that are activated in subjects with internet addiction, similar to those observed in subjects with substance abuse and other addictions. This review also introduces a newly arising subtype which is smartphone addiction disorder

Electroencephalography-detected neurophysiology of internet addiction disorder and internet gaming disorder in adolescents- a review

Introduction: Internet Addiction Disorder (IAD) is an umbrella term for various types of Internet-based behavioural addiction, whereas Internet Gaming Disorder (IGD) addresses a specific type of IAD that is postulated to be due to a lack of control in impulse inhibition. IGD is an area of concern in the Diagnostic and Statistics Manual of Mental Disorders (DSM-5), which can be objectively assessed by dysfunctional behaviour and the increasing time of being online, particularly during the COVID-19 pandemic. Electroencephalography (EEG) identifies amplitude changes in the evoked response potential (ERP) among IGDs, correlated with underlying comorbidities. Materials and methods: A scoping review was performed to elaborate on the research regarding resting-state EEG and task-based EEG, particularly for Go/No-go paradigms pertaining to subjects with IAD or specifically IGD. The role of EEG was identified in its diagnostic capability to identify the salient changes that occurred in the response to reward network and the executive control network, using restingstate and task-based EEG. The implication of using EEG in monitoring the therapy for IAD and IGD was also reviewed. Results: EEG generally revealed reduced beta waves and increased theta waves in addicts. IGD with depression demonstrated increased theta and decreased alpha waves. Whereas increased P300, a late cognitive ERP component, was frequently associated with impaired excessive allocation of attentional resources of the IAD towards addiction-specific cues. IGD had increased whole brain delta waves at baseline, which showed significant reduction post therapy. Conclusion: EEG can identify distinct neurophysiological changes among Internet Addiction Disorder and Internet Gaming Disorder that are akin to substance abuse disorders

The who, when, why, and how of PET Amyloid imaging in management of Alzheimer’s disease-review of literature and interesting images

Amyloid imaging using positron emission tomography (PET) has an emerging role in the management of Alzheimer’s disease (AD). The basis of this imaging is grounded on the fact that the hallmark of AD is the histological detection of beta amyloid plaques (Aβ) at post mortem autopsy. Currently, there are three FDA approved amyloid radiotracers used in clinical practice. This review aims to take the readers through the array of various indications for performing amyloid PET imaging in the management of AD, particularly using 18F-labelled radiopharmaceuticals. We elaborate on PET amyloid scan interpretation techniques, their limitations and potential improved specificity provided by interpretation done in tandem with genetic data such as apolipiprotein E (APO) 4 carrier status in sporadic cases and molecular information (e.g., cerebral spinal fluid (CSF) amyloid levels). We also describe the quantification methods such as the standard uptake value ratio (SUVr) method that utilizes various cutoff points for improved accuracy of diagnosing AD, such as a threshold of 1.122 (area under the curve 0.894), which has a sensitivity of 92.3% and specificity of 90.5%, whereas the cutoff points may be higher in APOE ε4 carriers (1.489) compared to non-carriers (1.313). Additionally, recommendations for future developments in this field are also provided

Diagnostic dilemma of reactive arthritis aided by multimodality imaging using MRI, CECT and 18F-FDG PET/CT scans

Reactive arthritis can be an elusive diagnosis especially in the elderly. A 77-year-old lady, presented with recent history of hip pain. She had been treated for urinary tract infection caused by Chlamydia sp. and had associated weight loss. She was also investigated for possible tuberculosis and occult malignancy. CT scan abdomen/pelvis and MRI revealed peri-articular muscle inflammation. Biopsy of her hip joint failed to find the causative factor. Whole-body 18F-FDG PET/CT scan revealed increased FDG uptake at bilateral hip and shoulder joints. She recovered after an intensive course of antibiotics. Thus, she was diagnosed with reactive arthritis. Reactive arthritis is usually a diagnosis of exclusion made by a high index of suspicion and positive serology test. Molecular imaging can be an alternative investigation for joint pains in the elderly, which enables excellent anatomical and functional information to exclude more sinister conditions such as malignancy

Characterization of adnexal masses using multidetector contrast-enhanced CT scan - recognising common pitfalls that masquerade as ovarian cancer

Adnexal masses are growths that form near the uterus; the majority being ovarian tumours. Although there is no established population-screening tool for detecting ovarian cancer, ultrasound and contrast-enhanced computed tomography (CECT) are useful imaging tools in the management of adnexal masses. Our study aimed to determine the characteristics of malignant adnexal masses on CECT scan and to describe common pitfalls in diagnosis of ovarian cancer when interpreting images. We also determined the sensitivity and specificity of diagnosing ovarian cancer using CECT. A retrospective study was conducted in Hospital Serdang using data from all patients who underwent CECT scan and detected with adnexal masses, and had histopathological examination correlation from January 2013 until January 2015. Out of the 64 cases analysed; the majority of malignant lesions were serous carcinoma of the ovary (40%). The CECT scan characteristics, tumour consistency of mixed type, presence of wall enhancement, septations, ascites and peritoneal nodule/omental caking were significantly associated with ovarian malignancy (p<0.05). The sensitivity, specificity, PPV and NPV of CECT scan was 95.45%, 71.43%, 63.63% and 96.77% respectively. Contrast-enhanced computed tomography scan is a good, non-invasive method to diagnose ovarian cancer. By using a pro-forma document as a guide, good results can be achieved to help differentiate between benign and malignant lesions. Nevertheless, caution needs to be exercised in interpreting cases that mimic features of malignancy

Mapping 18F-fluorodeoxyglucose metabolism using PET/CT for the assessment of treatment response in non-small cell lung cancer patients undergoing epidermal growth factor receptor inhibitor treatment: a single-centre experience

Introduction: Specific mutations in the epidermal growth factor receptor (EGFR) characterize a subgroup of non-small cell lung cancer (NSCLC) patients that may be highly responsive to receptor inhibitor therapy. 18F-FDG PET/CT scans can map the glucose metabolism and treatment response of NSCLC. Therefore, we aimed to assess the pattern of metabolic response and outcome of inoperable NSCLC treated with epidermal growth factor receptor (EGFR) inhibitors, using 18F-FDG PET/CT scan. Methods: A retrospective study of inoperable NSCLC patients on EGFR inhibitor treatment that were referred for wholebody18F-FDG PET/CT scans was conducted based on cases scanned from January 2011 to June 2014. Comparison was made among serial attenuation-corrected fused PET/CT images for all study patients throughout the course of their treatment. Comparison based on PERCIST criteria was categorized into 4 levels ie. complete response (CMR), partial response (PMR), stable disease (SMD), progressive metabolic disease (PMD). Results: Overall, there were 5 patients identified, mean age: 57.4 years old +/- 2.9 years; The median survival time from initiation of EGFR inhibitor treatment to death was 17 months. Two patients showed initial partial metabolic response (PMR), two had progressive metabolic disease (PMD) and one had complete metabolic response (CMR) after the initiation of treatment. The patient with initial CMR had relapse and PMD 5 months later. Majority of patients eventually succumbed to their illness. Conclusions: Wholebody18F-FDG PET/CT is able to assess metabolic treatment response of NSCLC towards EGFR inhibitor treatment

Doctor, there's a lump in my mouth!: imaging aspects of torus palatinus; a case report

This is a case report of a 36-year-old lady who presented with a swelling on the hard palate of her mouth. She had undergone computed tomography (CT) scan of the oropharynx and paranasal sinuses and the diagnosis of torus palatinus, a normal anatomical variant of the hard palate was made. The authors discuss about the appearance of torus palatinus in various imaging modalities, specifically dental radiograph, CT scan and magnetic resonance imaging (MRI)

Main methods to detect Multiple Sclerosis (MS) lesions in patients with MS

The aim of the study is to investigate the main methodsto detect Multiple Sclerosis (MS) Lesions in patientswith MS. This study was a systematic review to detect main methods to detect of MS lesion in patients with MS. As a result, we found that MRI is the most accuracy and powerful tool for diagnosing a MS especially in early phase. In conclusion, the McDonald criteria is the best criteria that it has been proposed and revised in recently years to diagnose of MS based on clinical presentation and MRI