Objectives

Defining locally advanced carcinoma gall bladder

Current Guidelines for staging and management of locally advanced carcinoma gall bladder

Demonstrate pathways of dissemination in locally advanced carcinoma gall bladder

Key Imaging Features of locally advanced carcinoma gall bladder with implication on management and outcomes.

Predicting patterns of recurrence in locally advanced carcinoma gall bladder

Background

Carcinoma of the gall bladder is the most common biliary tract malignancy with very poor outcomes and 5-year survival <12 %.

Locally advanced Ca GB implies involvement of adjacent organs with patterns of dissemination including locoregional, nodal, vascular and distant metastasis. Surgery is the most potential curative therapy for locally advanced early T3 disease.

Unresectable cases are treated palliatively with local disease control in the form of chemotherapy or radiotherapy. Imaging is an essential tool in optimising management, detecting recurrence and predicting outcomes.

Imaging findings OR Procedure findings

Review NCCN guidelines for management of locally advanced Ca GB

Discuss patterns of disseminations in locally advanced Ca GB

Discuss role of imaging in identifying these patterns of spread, and, the implications of these findings in management

Role of post-operative imaging in understanding patterns of recurrence

Conclusion

•Locally advanced carcinoma gall bladder has poor prognosis, with stage-adjusted therapy being the cornerstone for improving survival.

•Only potentially curative therapy for early T3 disease is surgical resection.

•Radiologists should be conversant with the key features of locally advanced carcinoma gall bladder and patterns of spread to improve patient management and clinical outcomes.

Objectives

After reviewing this exhibit, participants will know following-

•Review the Updated Bosniak Classification Of Cystic Renal Masses, Version 2019.

•Review major modifications to previous version of Bosniak classification.

•Pearls to understand newer terminologies and categories in the proposed update using pictorial presentation.

•Knowledge gaps not addressed by the updated classification

Background

•Radiological classification of renal cysts popularly known as Bosniak classification, stratifies the risk of malignancy in cystic renal masses.

•It is the most commonly adopted system by both Radiologists and Urologists.

•There are certain limitations in the currently used classification systems leading to inter-reader variability and variable reported malignancy rates.

•The latest update version 2019 addresses these issues with notable changes like incorporation of MRI in addition to CT, establishment of definitions for previously vague imaging terms, and enabling greater proportion of masses to enter lower risk classes.

Imaging findings OR Procedure findings

•Discuss in brief about key modifications to previous versions of Bosniak classification.

•Pictorial review of modified terminologies.

•Pictorial review of the cyst categories and subcategories.

•Pitfalls of the updated classification

Conclusion

•The updated version 2019 though not yet fully validated, aims to expand the number of cystic masses to which Bosniak classification can be applied while improving its precision and accuracy for the occurrence of cancer in each class.

•Radiologist should understand key imaging features of the updated Bosniak classification helping in improved communication with the clinicians and more precise management of renal cysts.

Objectives

To describe pathways of dissemination of CA prostate

To review atypical locations of metastasis of CA prostate

To highlight prognostic impactions of atypical metastasis

To Illustrate the key imaging findings of atypical metastasis with emphasis on PSMA PET/CT findings

Background

Carcinoma of prostate [Ca prostate] most commonly metastases to lymph nodes [pelvic and retroperitoneal] and bones [spine]. Any dissemination beyond these sites is usually less common and considered as atypical metastasis. Since last few decades, there is increase in lifespan of CA prostate patients due to better treatment options and optimal imaging modalities which in turn has resulted into increase in the detection rates of the atypical sites of metastasis. PSMA PET/CT is current modality of choice in the metastatic work up of CA prostate.

Imaging findings OR Procedure findings

Discuss lymphatic and haematogenous pathways of dissemination of CA prostate

Discuss atypical nodal and extra nodal locations of metastasis of CA prostate

Discuss prognostic impact of atypical metastasis on patient survival

Discuss key imaging findings of atypical metastasis using PSMA PET/CT as primary imaging modality

Discuss pitfalls in interpretation of PSMA PET/CT for metastatic work up

Conclusion

Atypical patterns of the metastasis in CA prostate are on rise due to longer survival of these patients in the current era. The radiologist should be familiar with the pearls and pitfalls in the diagnosis of the atypical metastasis which will help in better patient management.

Objectives

After viewing this exhibit, the participants will know the following:

The normal imaging findings after Whipple’s surgery

Sites and patterns of post - operative recurrence in pancreatic cancer and their imaging mimics

Background

Despite an R0 resection surgery in pancreatic adenocarcinoma, local recurrence is frequently seen within 2 years from surgery and the median survival in resectable pancreatic cancer is reported to range from 11 months for surgery alone to 20 months for surgery in combination with adjuvant chemotherapy.

A critical problem in post-operative imaging of patients with pancreatic cancer is that extensive surgical changes with scar tissue formation as well as lymphadenopathy may be mistaken for disease recurrence.

Early identification of local recurrence can help in timely institution of chemo-radiotherapy and in appropriate situations, a potentially curative surgical approach for liver metastasis or local tumor recurrence may be advocated.

Imaging findings OR Procedure findings

Discuss the normal post -operative imaging findings after the

Whipples’ procedure

To identify the predilection sites of local recurrence of pancreatic

cancer.

Impact of apparently worrisome imaging findings on eventual

patient survival.

Conclusion

Pancreatic cancer has a dismally poor prognosis with a 5 year survival rate of about 6% and despite R0 resection, the high chances of early local recurrence and metastases make it a matter of serious concern. Its therefore imperative for an abdominal radiologist to look for a pattern to detect early signs of recurrence in order to facilitate an appropriate therapeutic plan.