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The evolution of Positron Emission Tomography (PET), culminating in the Total-Body PET (TB-PET) system, represents a paradigm shift in medical imaging. This paper explores the transformative role of Artificial Intelligence (AI) in enhancing clinical and research applications of TB-PET imaging. Clinically, TB-PET's superior sensitivity facilitates rapid imaging, low-dose imaging protocols, improved diagnostic capabilities and higher patient comfort. In research, TB-PET shows promise in studying systemic interactions and enhancing our understanding of human physiology and pathophysiology. In parallel, AI's integration into PET imaging workflows-spanning from image acquisition to data analysis-marks a significant development in nuclear medicine. This review delves into the current and potential roles of AI in augmenting TB-PET/CT's functionality and utility. We explore how AI can streamline current PET imaging processes and pioneer new applications, thereby maximising the technology's capabilities. The discussion also addresses necessary steps and considerations for effectively integrating AI into TB-PET/CT research and clinical practice. The paper highlights AI's role in enhancing TB-PET's efficiency and addresses the challenges posed by TB-PET's increased complexity. In conclusion, this exploration emphasises the need for a collaborative approach in the field of medical imaging. We advocate for shared resources and open-source initiatives as crucial steps towards harnessing the full potential of the AI/TB-PET synergy. This collaborative effort is essential for revolutionising medical imaging, ultimately leading to significant advancements in patient care and medical research., (© 2024. The Author(s).)

GRPR is a type of seven-transmembrane G-protein coupled receptor that belongs to the bombesin protein receptor family. It is highly expressed in various cancers, including prostate cancer, breast cancer, lung cancer, gastrointestinal cancer, and so on. As a result, molecular imaging studies have been conducted using radiolabeled GRPR ligands for tumor diagnosis, as well as monitoring of recurrence and metastasis. In this paper, we provided a comprehensive overview of relevant literature from the past two decades, with a specific focus on the advancements made in radiolabeled GRPR ligands for imaging prostate cancer and breast cancer., (© 2024. The Author(s).)

Neuroendocrine neoplasia (NEN) is an umbrella term that includes a widely heterogeneous disease group including well-differentiated neuroendocrine tumours (NETs), and aggressive neuroendocrine carcinomas (NECs). The site of origin of the NENs is linked to the intrinsic tumour biology and is predictive of the disease course. It is understood that NENs demonstrate significant biologic heterogeneity which ultimately translates to widely varying clinical presentations, disease course and prognosis. Thus, significant emphasis is laid on the pre-therapy evaluation of markers that can help predict tumour behavior and dynamically monitors the response during and after treatment. Most well-differentiated NENs express somatostatin receptors (SSTRs) which make them appropriate for peptide receptor radionuclide therapy (PRRT). However, the treatment outcomes of PRRT depend heavily on the adequacy of patient selection by molecular imaging phenotyping not only utilizing pre-treatment SSTR PET but 18 F-Fluorodeoxyglucose ( 18 F-FDG) PET to provide insights into the intra- or inter-tumoural heterogeneity of the metastatic disease. Molecular imaging phenotyping may go beyond patient selection and provide useful information during and post-treatment for monitoring of temporal heterogeneity of the disease and dynamically risk-stratify patients. In addition, advances in the understanding of genomic-phenotypic classifications of pheochromocytomas and paragangliomas led to an archetypical example in precision medicine by utilizing molecular imaging phenotyping to guide radioligand therapy. Novel non-SSTR based peptide receptors have also been explored diagnostically and therapeutically to overcome the tumour heterogeneity. In this paper, we review the current molecular imaging modalities that are being utilized for the characterization of the NENs with special emphasis on their role in patient selection for radioligand therapy., (© 2022. The Author(s).)

Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non-invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/CT), advanced MRI, optical or ultrasound imaging.This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and, then point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now.Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by advances in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as "data", and - through the wider adoption of advanced analysis, including machine learning approaches and a "big data" concept - move to the next stage of non-invasive tumour phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi-dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging.

During the last decade, there is an increasing usage of quantitative methods in Radiology in an effort to reduce the diagnostic variability associated with a subjective manner of radiological interpretation. Combined approaches where visual assessment made by the radiologist is augmented by quantitative imaging biomarkers are gaining attention. Advances in machine learning resulted in the rise of radiomics that is a new methodology referring to the extraction of quantitative information from medical images. Radiomics are based on the development of computational models, referred to as "Radiomic Signatures", trying to address either unmet clinical needs, mostly in the field of oncologic imaging, or to compare radiomics performance with that of radiologists. However, to explore this new technology, initial publications did not consider best practices in the field of machine learning resulting in publications with questionable clinical value. In this paper, our effort was concentrated on how to avoid methodological mistakes and consider critical issues in the workflow of the development of clinically meaningful radiomic signatures.

Background: In clinical practice, there is the need to optimize imaging usage in MM patients. Accordingly, the aim of this paper was to develop a simple computed tomography (CT) scoring method for MM, able to shorten and simplify the interpretation time with good intra- and inter-reader reliability. This method, named MSBDS (Myeloma Spine and Bone Damage Score) was developed with the final aim to use standard total-body CT in the routine practice of MM centres as a complement of standard evaluations in patients undergoing stem cells transplantation., Methods: We used a widely accepted consensus formation method and literature research during three structured face-to-face meetings specifically designed to combine opinions from a group of experts with proven experience in multiple myeloma care and/or musculoskeletal CT to facilitate the consensus on the field of study topics and the contents of the MSBDS score. Seven practical requisites for the MSBDS score were agreed. A total of 70 MM patients (mean age, 60 years ±9.2 [standard deviation]; range, 35-70 years) undergoing total-body CT was included to develop MSBDS scores. Patients data were already stored in the Radiological database for other Research studies IRB approved (054/2019). Readers to test the MSDMS were radiologists and clinicians involved in MM care or expert in bone damage scores with different level of experience in musculoskeletal and total body CT. Readers were blinded to the clinical data of the patients., Results: The MSBDS scores based on the consensus work described above and literature analysis was finalized. MSBDS is based on an additive scale with assessment of a total body CT with the bone window one time and includes indicators of structural bone damage and instability or fracture risk. The total score is given by the sum of item scores for abnormalities detected. Its values range from 0 (minimum) to values > 10 where 10 is represented by high-risk patients. In high-risk patients immediate surgical or radiation oncologist consultation is suggested., Conclusions: The MSBDS descriptive criteria are easy, highly reproducible and can be considered as a strong base for harmonizing total body CT interpretation in multiple myeloma patients undergoing stem cell transplantation.

Finding a soft tissue mass in the superficial regions is a common event in daily clinical practice. Correct management of the diagnostic process is crucial to avoid blunders. Diagnosis is posed by pathology, although both imaging and a better understanding of the cellular and molecular mechanisms play an important a role in the characterization, staging and follow-up of soft tissue masses. Cellular and molecular mechanisms can explain either the development of chemo-resistance and the underlying pre- and post-surgery metastasis formation. These are mandatory to improve prognosis and unveil novel parameters predicting therapeutic response. Imaging mainly involves ultrasound and MR and is fundamental not only in diagnosis but also in the first step of therapy: the biopsy. Novel imaging techniques like Ultrasound Elastosonography, Dynamic Contrast-Enhanced MR imaging (DCE), Diffusion Weighted MR imaging (DWI) and MR Spectroscopy (MRS) are discussed. This paper aims at reviewing and discussing pathological methods and imaging in the diagnosis of soft tissue masses underscoring that the most appropriate treatment depends on advanced molecular and radiological studies.

Neuroblastoma (NBL) is the most common extra-cranial tumour in childhood. It can present as an abdominal mass, but is usually metastatic at diagnosis so the symptomatology can be varied. Nephroblastoma, also more commonly known as a Wilms tumour, is the commonest renal tumour in childhood and more typically presents as abdominal pathology with few constitutional symptoms, although rarely haematuria can be a presenting feature. The pathophysiology and clinical aspects of both tumours including associated risk factors and pathologies are discussed. Oncogenetics and chromosomal abnormalities are increasingly recognised as important prognostic indicators and their impact on initial management is considered. Imaging plays a pivotal role in terms of diagnosis and recent imaging advances mean that radiology has an increasingly crucial role in the management pathway. The use of image defined risk factors in neuroblastoma has begun to dramatically change how this tumour is characterised pre-operatively. The National Wilms Tumour Study Group have comprehensively staged Wilms tumours and this is reviewed as it impacts significantly on management. The use of contrast-enhanced MRI and diffusion-weighted sequences have further served to augment the information available to the clinical team during initial assessment of both neuroblastomas and Wilms tumours. The differences in management strategies are outlined. This paper therefore aims to provide a comprehensive update on these two common paediatric tumours with a particular emphasis on the current crucial role played by imaging.

Magnetic resonance imaging (MRI) has an established role in imaging pelvic gynaecological malignancies. It is routinely used in staging endometrial and cervical cancer, characterizing adnexal masses, selecting optimal treatment, monitoring treatment and detecting recurrent disease. MRI has also been shown to have an excellent performance and an evolving role in surveillance of patients after chemoradiotherapy in cervical cancer, post-trachelectomy, detecting early recurrence and planning exenterative surgery in isolated central recurrences in both cervical and endometrial cancer and in young patients on surveillance for medically managed endometrial cancer. However, conventional MRI still has limitations when the morphological appearance of early recurrent or residual disease overlaps with normal pelvic anatomy or treatment effects in the pelvis. In particular, after chemoradiotherapy for cervical cancer, distinguishing between radiotherapy changes and residual or early recurrent disease within the cervix or the vaginal vault can be challenging on conventional MRI alone. Therefore, there is an emerging need for functional imaging to overcome these limitations. The purpose of this paper is to discuss the emerging functional MRI techniques and their applications in predicting treatment response, detecting residual disease and early recurrent disease to optimize the treatment options available using diffusion-weighted imaging and dynamic contrast enhancement particularly in cervical and endometrial cancer.

The National Lung Cancer Screening Trial has recently demonstrated that screening of high-risk populations with the use of low-dose computed tomography (LDCT) reduces lung cancer mortality. Based on this encouraging result, the National Comprehensive Cancer Network guidelines recommended LDCT for selected patients at high risk of lung cancer. This suggests that an increasing number of CT screening examinations will be performed. The LDCT technique is relatively simple but some CT parameters are important and should be accurately defined in order to achieve good diagnostic quality and minimize the delivered dose. In addition, LDCT examinations are not as easy to read as they may initially appear; different approaches and tools are available for nodule detection and measurement. Moreover, the management of positive results can be a complex process and can differ significantly from routine clinical practice. Therefore this paper deals with the LDCT technique, reading methods and interpretation in lung cancer screening, particularly for those radiologists who have little experience of the technique.

The purpose of this study was to systemically review the available literature regarding the diagnostic performance of positron emission tomography (PET) using 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) in patients with thymic epithelial tumors. We reviewed 13 studies that evaluated the diagnostic role of thymic epithelial tumors with [18F]FDG-PET. [18F]FDG-PET is a useful radiological modality for differentiating between thymomas and thymic carcinoma. However, [18F]FDG-PET may not be useful for differentiating low-risk thymoma and high-risk thymoma. One paper reported that [18F]FDG-PET has a predictive significance for treatment and prognosis in thymic epithelial tumors. Two papers reported that the degree of [18F]FDG uptake in thymic epithelial tumors is based on glucose metabolism. [18F]FDG-PET may have a further use for radiological differential diagnosis of thymomas and thymic carcinomas.

At diagnosis 10-25% of patients with colorectal liver metastases (CRLM) present as resectable disease. Liver resection is the gold standard treatment, resulting in a 5-year overall survival (OS) of 22-58%, local recurrence rates of 1.2-10.4% and a perioperative mortality of less than 5%. Multiple attempts have been made to assess the possible contribution of radiofrequency ablation (RFA) to improve OS and progression-free survival (PFS) in patients with unresectable colorectal liver metastases. The aim of this paper is to review the RFA literature in the setting of colorectal liver metastases: RFA with and without chemotherapy, RFA with and without resection, RFA for solitary unresectable CRLM, surgical and percutaneous imaging-guided RFA, RFA compared with chemotherapy. The reported OS, PFS, local recurrence rates, morbidity and mortality in these different settings are analyzed. This paper reflects on a possible role of RFA in resectable CRLM.

This paper summarises the current status of PET/CT in relation to breast cancer.

The glucose analogue fluorodeoxyglucose (FDG) has demonstrated enhanced uptake in the majority of tumours as a result of increased uptake and fixation by phosphorylation. It is the most widely used radiotracer in positron emission tomography (PET), being used in >90% of scans, and is useful for diagnosis, staging and detection of residual/recurrent cancer. However, there are limits to the utility of FDG, particularly in certain tumour types. The development of new radiotracers to study molecular processes such as proliferation, apoptosis, angiogenesis and hypoxia will complement FDG by providing additional information on the cell biology of tumours. The aim of this paper is to consider how the availability of new tracers, or new applications for existing PET/CT technologies, could deliver clinical benefit in cancer, using breast cancer as a paradigm.

Adolescent cancers are treated with a host of chemotherapy agents, radiotherapy and stem cell transplantation. The complications of these treatments may contribute significantly to the morbidity and mortality in this age group, with imaging playing a role in identifying some of these complications. This second article reviews the imaging of acute and early complications relating to adolescent cancer treatment, many of which may also be seen in the treatment of paediatric patients. Late effects involving endocrine and reproductive systems or psychosocial considerations are not discussed in this paper, although these are clearly important issues in long-term survivors.

Imaging plays a crucial role in the management of a child with a suspected liver tumor. There are various important differences between pediatric and adult practice, and in particular several liver tumor types that are almost never seen in adults are not uncommon in children. The radiologist makes important contributions to the diagnosis through non-invasive imaging and often biopsy. This paper describes imaging tips for the radiologist, including a discussion of the PRETEXT system for staging primary malignant tumors.

Low-dose computed tomography (ld-CT) for lung cancer screening in high-risk subjects is performed within clinical trials and has started to be used in routine clinical practice. The technique is well defined, even if some methodological problems are still debated, such as the measurements of pulmonary nodules, the size to define them as clinically significant, the management of small or non-solid nodules and the best diagnostic work-up to optimize diagnostic accuracy. The data derived from an IEO observational study, started in 2000, shows a high prevalence and incidence of early stage lung cancer detected at ld-CT, demonstrating the need to prolong observation for a long period of time. The high survival rate of patients with screening-detected cancer has recently been debated in a number of papers using statistical models, but the advantage of the yearly ld-CT for the individuals is unquestionable; its benefit on the population base has still to be demonstrated by ongoing randomized trials.

The last few years have seen a rapid expansion in the use and availability of ablation techniques with hundreds of papers published. Radiofrequency remains the front-runner in terms of cost, ease of set-up, versatility and flexibility but other techniques are catching up. Ablation with cryotherapy and microwave, which were previously only available at open laparotomy due to the large size of the probes, are now readily performed percutaneously, with a predictable reduction in morbidity. Ablation is now accepted as the first line of treatment in patients with limited volume hepatocellular carcinoma who are not candidates for transplantation. There is continuing debate in most other areas but the evidence is increasing for an important role in liver metastases, renal carcinoma, inoperable lung tumours and some bone tumours.

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The last few years have seen a rapid expansion in the use and availability of ablation techniques with hundreds of papers published. Radiofrequency remains the front-runner in terms of cost, ease of set-up, versatility and flexibility but other techniques are catching up. Ablation with cryotherapy and microwave, which were previously only available at open laparotomy due to the large size of the probes, are now readily performed percutaneously, with a predictable reduction in morbidity. Ablation is now accepted as the first line of treatment in patients with limited volume hepatocellular carcinoma who are not candidates for transplantation. There is continuing debate in most other areas but the evidence is increasing for an important role in liver metastases, renal carcinoma, inoperable lung tumours and some bone tumours.

Aggressive treatment of patients with colorectal liver metastases can improve treatment outcome. In this paper, we review current management of patients with colorectal liver metastases and discuss the critical questions that the radiologist should consider when reviewing the imaging of these patients, so as to provide information that is important for formulating treatment strategies by the multidisciplinary management team.

This paper evaluates the imaging appearance of radiation injury in the liver on positron emission tomography (PET)/computed tomography (CT) in patients with distal esophageal cancer who underwent pre-operative chemoradiation therapy. Twenty-six patients with distal esophageal cancer who received chemoradiotherapy before esophagectomy were included. All patients had baseline and follow-up PET/CT. Fluorodeoxyglucose (FDG) uptake in both left and right lobes of the liver was evaluated. CT findings suggesting radiation damage were documented. Abnormal FDG uptake in the liver was observed in 5 (19%) patients after therapy. These abnormalities were in the left lobe (12%) and right lobe (12%) of the liver. In the irradiated left lobe, FDG uptake increased focally greater than 50% over baseline in two patients (54% and 133%); in one of these patients, biopsy confirmed radiation injury. In the non-irradiated right lobe, standard uptake values (SUV) increased diffusely in two different patients. In one patient, SUV decreased by at least 50% in both the right and left lobes. In the remaining patients, there were no significant changes in FDG uptake. Atrophy and attenuation changes of irradiated liver on CT were found in 15 (58%) patients. In patients receiving chemoradiotherapy, PET/CT may identify metabolic abnormalities in irradiated liver. Such abnormalities should be correlated with other imaging, clinical and laboratory findings to avoid confusion with hepatic metastases.

Most patients with colorectal cancer undergo treatment with curative intent and subsequently enter a surveillance programme. The primary aim of surveillance is to identify patients with disease relapse at a resectable stage. However, the identification of local recurrence and metachronous carcinoma are also important aspects of follow up. Patients under observation may be referred for imaging either because regular imaging forms part of the surveillance strategy, or because tumour relapse is suggested by the development of new symptoms or a rise in tumour markers. This paper reviews the use of new and existing imaging techniques during surveillance following resection of primary colorectal cancer. The use of imaging for this surveillance is an application of cancer imaging that is supported by evidence-based clinical guidelines. Computed tomography provides the mainstay modality on grounds of good overall diagnostic performance combined with high availability and low cost. Improvements in survival with more aggressive follow up and treatment are likely to demand more accurate imaging techniques in the future.

Tumour volume is a significant prognostic factor in the treatment of malignant head and neck tumours. Studies of laryngeal and pharyngeal tumours have shown tumour volume to be an important predictor for tumour recurrence. Some studies (for instance nasopharyngeal carcinoma) have shown through multivariate modelling that tumour volume is a dominant covariate that overwhelms T stage, N stage and stage group. The results of these studies have prompted several investigators to suggest the inclusion of tumour volume as an additional prognostic factor in future revisions of the TNM staging system. This paper briefly reviews the TNM system as a staging tool, the measurement of tumour volume and how tumour volume could possibly be incorporated in the system or used as an additional prognostic factor.

Until recently it was believed that extracellular gadolinium based contrast agents were safe for both the kidneys and all other organs within the dose range up to 0.3 mmol/kg body weight. However, in 2006, it was demonstrated that some gadolinium based contrast agents may trigger the development of nephrogenic systemic fibrosis, a generalised fibrotic disorder, in renal failure patients. Accordingly, the use of gadodiamide and gadopentate dimeglumine for renal failure patients was banned in Europe in spring 2007. The same two compounds should only be used cautiously in patients with moderate renal dysfunction. The current paper reviews the situation (July 2007) regarding gadolinium based contrast agent and the severe delayed reaction to some of these agents. The fear of nephrogenic systemic fibrosis should not lead to a denial of a well indicated enhanced magnetic resonance imaging examination.

The optimal definition of the size, shape and location of gross tumour volume is one of the most important steps in the planning of radiation therapy, and necessitates a proper understanding of the procedure from both the oncologic radiologist and the radiation oncologist. This overview reports on the different terms and concepts that have been recommended in the ICRU Reports for this purpose; the latest Report 71 focuses on both previously given recommendations, and especially on electron beam therapy. This paper also highlights some of the problems that are encountered in the use of the International Commission on Radiation Units and Measurements (ICRU) recommendations in clinical practice, and at the interface between the radiation oncologist and the diagnostic oncologist.

Magnetic resonance imaging (MRI) is the best technique for bone marrow imaging. The MRI signal of bone marrow depends on the quantity of fat it contains and on its cellularity. Evaluation of marrow of patients treated for cancer is complicated by age and osseous site related changes in the distribution of normal haematopoietic (red) and fatty (yellow) marrow and by the changes induced by treatments: decrease in pathological cellularity, increase in fat proportion, conversion of red marrow to fatty marrow or, conversely, reconversion of fatty marrow in normal haematopoietic red marrow. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. These modifications may be focal or diffuse, homogeneous or patchy and symmetrical or asymmetric. The knowledge of bone marrow physiological status and post-therapeutic patterns is important for the interpretation of marrow disorders and effects of therapy and to avoid false-positive diagnosis of marrow metastases and tumour progression. The aim of this paper is to recall the MRI patterns of normal bone marrow and normal variations and to show the effects of treatments on bone tissue and normal bone marrow and treatment-related modifications on pathological marrow., ((c) International Cancer Imaging Society.)

Primary malignant lesions in the orbit are relatively uncommon. However, the orbits are frequently involved in haematogeneous metastasis or by direct extension from malignancies originating from the adjacent nasal cavity or paranasal sinuses. This paper focuses on the more commonly encountered primary orbital malignancies and the mapping of tumour spread into the orbits., ((c) International Cancer Imaging Society.)

Novel technology has made dynamic magnetic resonance imaging (MRI) of lung motion and lung tumour mobility during continuous respiration feasible. This might be beneficial for planning of radiotherapy of lung tumours, especially when using high precision techniques. This paper describes the recent developments to analyze and visualize pulmonary nodules during continuous respiration using MRI. Besides recent dynamic two-dimensional approaches to quantify motion of pulmonary nodules during respiration novel three-dimensional techniques are presented. Beyond good correlation to pulmonary function tests MRI also provides regional information about differences between tumour-bearing and non-tumour bearing lung and the restrictive effects of radiotherapy as well as the compensation by the contralateral lung., ((c) International Cancer Imaging Society.)

This paper reviews the potential of ultrasound for assessing the viability and biological behavior of tumors. Unlike color Doppler sonography, modern techniques for contrast-enhanced ultrasound permit the measurement of tissue perfusion irrespective of vessel size or flow velocity. Perfusion can also be assessed quantitatively, using replenishment kinetics or derivates thereof. The perfusion of tumors is a surrogate parameter of their viability and may mirror their response to therapy. Furthermore, the degree of vascularity in a tumor may express its aggressiveness and help to predict its response to treatment. In animal models, a decrease in blood flow has been shown to precede a shrinkage of tumors treated with anti-angiogenic compounds. In liver metastases, arterial and portal blood supply can be assessed separately, and a response to stereotactic radiotherapy was found to go along with a decrease in arterial perfusion. Moreover, a relatively high arterial perfusion of liver metastases may predict a response to chemotherapy. Contrast-enhanced ultrasound may be a potent tool for assessing the effects of anti-angiogenic treatment in patients., ((c) International Cancer Imaging Society.)

In vivo proton magnetic resonance spectroscopy (1HMRS) can substantially improve the non-invasive categorization of human brain tumors, especially for gliomas. It provides greater information concerning tumor activity and characterization of the tumor tissue than is possible with MRI techniques alone. Moreover, 1HMRS may ultimately prove to be a highly beneficial modality in the post-irradiation care of patients with brain gliomas. This paper reviews the current status of 1HMRS with the emphasis on its clinical utility in the diagnosis of active tumor processes of gliomas, and its use in planning surgical and radiation therapy interventions and monitoring tumor treatment paradigms., ((c) International Cancer Imaging Society.)

The incidence of hepatocellular carcinoma has been rising in the USA in the past two decades. Hepatocellular carcinoma primarily affects older people and reaches its highest prevalence among those aged between 50 and 70 years. Chronic infection by the hepatitis B virus is the most common cause of this disease. Since hepatocellular carcinoma is an indolent tumor, it has a low life expectancy. In patients with suspected hepatocellular carcinoma, CT, MRI, and ultrasound techniques are useful for formulating the diagnosis based on vascularity and specific enhancement features. In this paper we will discuss the multimodal approach for diagnosis and surveillance of hepatocellular carcinoma. We will also furnish the latest staging and treatment, epidemiology, clinical presentation, pathology and laboratory findings in hepatocellular carcinoma.

Parameters that significantly influence results in radiation treatment of gynaecological malignancies are mainly related to the tumour characteristics and the radiotherapy technique used. High-dose radiotherapy requires accurate localisation of the tumour volume and its relationship to surrounding normal tissues. For many years the standard technique used for irradiation of the pelvic area was the four-field box technique which offered the potential benefit of the lateral fields to shield the rectum and small bowel. However, this conventional technique was designed according to bony landmarks and offered limited information regarding the topography of the tumour and the flexion of the uterus which are influenced by the tumour burden and bladder and rectal filling. CT and MRI enable the visualisation of the cervix, uterus, vagina, iliac vessels and organs at risk, but MRI allows tumour depiction in all planes. In the early 1990s, several studies reported on the value of pelvic MRI in designing the lateral fields of the box technique. They demonstrated that conventional lateral portals would have resulted in a marginal tumour miss and incomplete coverage of the uterine fundus in more than 50% of cases, thus leading to the conclusion that if a box technique is used its design should be based on sagittal MRI. CT-based 3D planning systems are now routinely used in the vast majority of radiotherapy departments. Target volumes and organs at risk are delineated by the physician on each CT slice in order to conform the radiotherapy fields to the tumour volume. For several reasons, such as distortion and lack of electron density which is essential for dose calculation, the implementation of MRI into radiation treatment planning has its limitations. However, MRI can still be used if planning systems integrate tools for CT/MR image registration. There is little experience in the literature for gynaecological malignancies demonstrating that image fusion allows an improvement of the definition of the target and the organ at risk compared to CT alone. Only a few papers in the literature report on the use of CT/MR image registration in planning the external irradiation of gynaecological tumours. Most demonstrate feasibility, but they fail to quantify the improvement for volume definition compared to the use of CT alone. Finally, recent possibilities offered by MRI technology are promising in the area of brachytherapy planning as the full potential of individually defining and evaluating GTV and CTV based on tumour extent and anatomical structures is exploited.

The management of thyroid nodules is multi-disciplinary and involves head and neck surgeons, pathologists and radiologists. Ultrasound is easy to perform, widely available, does not involve ionizing radiation and is readily combined with fine needle aspiration cytology (FNAC). It is therefore an ideal investigation of choice for evaluating thyroid nodules. It evaluates specific features that help in identifying the nature of the nodule and FNAC helps in diagnostic accuracy. In addition, following treatment for thyroid cancer ultrasound provides a safe tool for disease surveillance. This paper discusses the role of ultrasound in the management of patients with thyroid cancer., (International Cancer Imaging Society.)

Imaging plays a crucial role in the staging of oral cancers. Imaging information is essential for determining tumour resectibility, post resection surgical reconstruction and radiation therapy planning. The aim of this paper is to highlight the natural history of oral cancer spread and how malignant infiltration can be accurately mapped. It focuses on buccal mucosa, hard palate, tongue and floor of mouth carcinoma., (International Cancer Imaging Society.)

Metastatic cervical lymphadenopathy is a common problem in head and neck oncology. The appropriate management of the cervical lymph nodes requires a good understanding of the incidence, patterns, and prognostic implications of nodal metastasis. This paper correlates the anatomical and the simplified level classification systems of cervical lymph nodes, examines the clinical significance of nodal metastasis, and evaluates the criteria for nodal metastasis.

The cranial nerves are often involved in head and neck malignancies. Some malignancies have a strong propensity to show perineural spread. Cranial nerve palsy may be the presenting sign of metastatic disease to the skull base. Like metastatic disease to the lungs or liver, the cranial nerves themselves may be the site of metastatic disease. In addition, cranial nerves can be injured by radiation therapy or sacrificed during surgical treatment. This paper focuses on the imaging features of perineural infiltration, skull base neural foramen involvement and metastatic disease in the cranial nerves. It will also highlight the complications of radiation therapy, in particular radiation - induced optic neuritis.