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Παρασκευή, 2 Μαρτίου 2018

Correction to: Reducing task-based fMRI scanning time using simultaneous multislice echo planar imaging

Abstract

The original version of this article contained a mistake. The correct Affiliation 2 is Semmelweis University, János Szentágothai PhD School, MR Research Centre, Balassa Street 6, Budapest 1083, Hungary.



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Esophagus toxicity after stereotactic and hypofractionated radiotherapy for central lung tumors: Normal tissue complication probability modeling

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Publication date: Available online 2 March 2018
Source:Radiotherapy and Oncology
Author(s): M. Duijm, H. Tekatli, E. Oomen-de Hoop, W. Verbakel, W. Schillemans, B.J. Slotman, S. Senan, J.J. Nuyttens
PurposeTo correlate esophagus toxicity and dose-volume histogram (DVH) parameters in order to assess risks, and derive a Normal Tissue Complication Probability (NTCP) model.Methods and materialsPatients with a central lung tumor from 2 centers, who underwent stereotactic or hypofractionated radiotherapy (≤12 fractions), were analyzed. Doses were recalculated to an equivalent dose of 2 Gy with an α/β ratio of 10 (EQD210). The esophagus was manually delineated and DVH-parameters (Dmax,EQD2, D1cc,EQD2, D2cc,EQD2, D5cc,EQD2) were analyzed and used for NTCP modeling based on logistic regression analysis.ResultsTwo-hundred-and-thirty-one patients with 252 tumors were eligible. No acute or late grade 3–5 esophageal toxicity was reported. Acute grade 1–2 esophagus toxicity was recorded in 38 patients (17%). All DVH-parameters were significantly higher in patients with toxicity. NTCP models showed a 50% probability of acute grade 1–2 toxicity at a Dmax of 67 Gy EQD210 and D1cc of 42 Gy EQD210. No difference in overall survival was observed between patients with and without toxicity (p = 0.428).ConclusionAs no grade 3–5 esophageal toxicity was observed in our cohort, a Dmax of 56 Gy EQD210 and a D5cc of 35.5 Gy EQD210 could be delivered without high risks of severe toxicity. The NTCP models of this study might be used as practical guidelines for the treatment of central lung tumors with stereotactic radiotherapy.



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Imaging biomarkers of outcome after radiotherapy for pediatric ependymoma

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Publication date: Available online 2 March 2018
Source:Radiotherapy and Oncology
Author(s): Fatima Tensaouti, Anne Ducassou, Léonor Chaltiel, Annick Sevely, Stéphanie Bolle, Laetitia Padovani, Anais Jouin, Claire Alapetite, Stéphane Supiot, Aymeri Huchet, Valérie Bernier, Line Claude, Christine Kerr, Elisabeth Le Prisé, Anne-Isabelle Bertozzi-Salamon, Samuel Liceaga, Jean Albert Lotterie, Patrice Péran, Anne Laprie
Background and purposeEpendymoma is the third most common brain tumor in children. Radiation therapy (RT) is systematically administered after maximum surgical resection, utilizing recent advances in radiation delivery. Imaging can make a significant contribution to improving treatment outcome. This prompted us to look for significant preoperative and postoperative imaging markers for survival.Material and methodsWe undertook a national retrospective review of 121 patients who had undergone resection followed by RT. Preoperative tumor volumes on T1 and FLAIR images were delineated, together with postoperative hyperintense volumes on FLAIR images. Overall survival (OS) and disease-free survival (DFS) analyses included clinical data and volumes extracted from images.ResultsAfter a median follow-up of 38.5 months, 80.2% of patients were alive, but 39.7% had experienced at least one event. Statistically significant differences between patients with and without postoperative FLAIR abnormalities were found for both DFS (71.9% vs. 40.3%; p = 0.006) and OS (93.7% vs. 72.4%; p = 0.023) in the univariate analyses, and for OS (p = 0.049) in the multivariate analyses.ConclusionsPostoperative FLAIR hyperintensities are a negative prognostic factor for intracranial ependymoma and may be a surrogate for residual disease. They could therefore prove helpful in patients' surgical and radiotherapeutic management.



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Optimal image guided radiation therapy strategy for organs at risk sparing in radiotherapy of the prostate including pelvic lymph nodes

Publication date: Available online 2 March 2018
Source:Radiotherapy and Oncology
Author(s): A. van Nunen, P.P.G. van der Toorn, T.C.G. Budiharto, D. Schuring
Background and purposePurpose of this study was to quantify the OAR dose for different position correction strategies, and to determine which strategy is most optimal for treating patients on the prostate and pelvic lymph nodes.Materials and methodsFor 30 patients, four different treatment plans were made reflecting different correction strategies: online correction on bony anatomy; offline correction on bony anatomy; online correction on the prostate fiducials; using 1 cm margins around both CTVs. The dose to the PTVs and OARs was quantified and a pairwise statistical analysis was performed.ResultsNo statistically significant differences were observed in the dose to the PTVs, ensuring that any OAR sparing is not caused by differences in PTV coverage. Dose to the rectum and anal canal was lowest when applying an online correction on prostate fiducials, although the total PTV volume was higher. Dose to the small bowel bag and femoral heads was slightly higher compared to online correction on bony structures, but well within clinically acceptable limits.ConclusionAlthough the total PTV volume is higher when applying an online correction on the prostate, this strategy leads to the most optimal sparing of relevant OARs, at the cost of a slightly higher dose to the femoral heads and small bowel bag.



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Radiotherapy in acromegaly: long-term brain parenchymal and vascular magnetic resonance changes

Publication date: Available online 2 March 2018
Source:Journal of Neuroradiology
Author(s): Laura Milanese, Chiara Martini, Carla Scaroni, Francesca Dassie, Filippo Ceccato, Alessandro Della Puppa, Luca Denaro, Giulia Bommarito, Valentina Citton, Mario Ermani, Pietro Maffei, Renzo Manara
BackgroundRadiation therapy (RT) effectiveness on hormonal reduction is proven in acromegaly; however, collateral long-term effects are still undetermined. This transversal neuroimaging study on a large cohort of acromegalic patients aimed to investigate the rate of parenchymal and vascular changes after RT.Materials and MethodsThirty-six acromegalic patients underwent RT (RT+) after unsuccessful surgery and were compared to RT- acromegalic patients matched for age, gender, adenoma features, clinical and surgical history. All patients underwent magnetic resonance angiography (MRA) to investigate intracranial artery abnormalities and FLAIR sequence to assess white matter changes according to the Wahlund scale.ResultsRT+ acromegalic patients had a higher rate of controlled disease (29/36 vs 12/36, p<0.001). RT+ acromegalic patients had MRI/MRA evaluation 15.3±9.6 years after RT. RT+ acromegalic patients had a significantly higher Wahlund score than RT- acromegalic patients (6.03±6.41 vs 2.53±3.66, p=0.006) due to increased white matter signal abnormalities at the level of the temporal lobes, the basal ganglia (insula) and the infra-tentorial regions, bilaterally. Among RT+ patients one died because of temporo-polar anaplastic astrocytoma, one suffered from a stroke due to right internal carotid artery occlusion, one presented with cystic degeneration of the temporal poles. Long-dated RT (>10 years before MR evaluation) was associated with a higher rate of RT-related white matter changes (p=0.0004).ConclusionsRT seems to have created a cohort of patients with brain parenchymal changes whose clinical and cognitive impact is still unknown. These patients might require a prolonged MRI and MRA follow-up to promptly detect delayed RT-related complications and minimize their clinical consequences.



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Histo-radiological correlations in high-grade glioma with the histone 3.3 G34R mutation

Publication date: Available online 2 March 2018
Source:Journal of Neuroradiology
Author(s): Julien Puntonet, Volodia Dangouloff-Ros, Raphaël Saffroy, Mélanie Pagès, Felipe Andreiuolo, Jacques Grill, Stéphanie Puget, Nathalie Boddaert, Pascale Varlet
Background and PurposeMolecular alterations were recently added to the WHO 2016 classification of central nervous system (CNS) tumors. We correlated the histological and radiological features of G34R-mutant high-grade gliomas, a recently described hemispheric and supratentorial glioma of children and young adults.Materials and MethodsWe performed a retrospective multicenter study on the histopathological and MRI results of 12 patients.ResultsAll tumors were supratentorial. Several radiological aspects were observed. Height over 12 were bulky and well delineated tumors, without visible peritumoral infiltration on MRI, and pathologically characterized by highly cellular tissue associated with a moderate peritumoral infiltrative component. Two tumors were ill-defined and hyperintense on T2 sequences, and pathologically characterized by diffuse tumoral infiltration. Two tumors were bulky and well delineated with an infiltrative component, both radiologically and histopathologically.ConclusionsThese different patterns may correspond to different pathological mechanisms and a potential link with prognosis should be assessed in further studies.



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Encoding and immediate retrieval tasks in patients with epilepsy: a functional MRI study of verbal and visual memory

Publication date: Available online 1 March 2018
Source:Journal of Neuroradiology
Author(s): Najat Saddiki, Sophie Hennion, Romain Viard, Nassima Ramdane, Renaud Lopes, Marc Baroncini, William Szurhaj, Nicolas Reyns, Jean Pierre Pruvo, Christine Delmaire
PurposeMedial lobe temporal structures and more specifically the hippocampus play a decisive role in episodic memory. Most of the memory functional magnetic resonance imaging (fMRI) studies evaluate the encoding phase; the retrieval phase being performed outside the MRI. We aimed to determine the ability to reveal greater hippocampal fMRI activations during retrieval phase.Materials and methodsThirty-five epileptic patients underwent a two-step memory fMRI. During encoding phase, subjects were requested to identify the feminine or masculine gender of faces and words presented, in order to encourage stimulus encoding. One hour after, during retrieval phase, subjects had to recognize the word and face. We used an event-related design to identify hippocampal activations.ResultsThere was no significant difference between patients with left temporal lobe epilepsy, patients with right temporal lobe epilepsy and patients with extra-temporal lobe epilepsy on verbal and visual learning task.For words, patients demonstrated significantly more bilateral hippocampal activation for retrieval task than encoding task and when the tasks were associated than during encoding alone. Significant difference was seen between face encoding alone and face retrieval alone.ConclusionsThis study demonstrates the essential contribution of the retrieval task during a fMRI memory task but the number of patients with hippocampal activations was greater when the two tasks were taken into account.



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Reduced Brain Volumes in Children of Women with Epilepsy: A Neuropsychological and Voxel Based Morphometric ANALYSIS IN Pre-Adolescent Children

Publication date: Available online 2 March 2018
Source:Journal of Neuroradiology
Author(s): Ruma Madhu Sreedharan, R. Sheelakumari, K.M. Anila, Chandrasekharan Kesavadas, Sanjeev V Thomas




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Risk of second malignancies among survivors of pediatric thyroid cancer.

Related Articles

Risk of second malignancies among survivors of pediatric thyroid cancer.

Int J Clin Oncol. 2018 Feb 28;:

Authors: Adly MH, Sobhy M, Rezk MA, Ishak M, Afifi MA, Shafie AE, Ali MA, Zekri W, Alfaar AS, Rashed WM

Abstract
BACKGROUND: Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5-3% of childhood carcinomas in the United States and Europe. We aimed to identify the risk of a second malignancy among pediatric thyroid cancer survivors.
METHODS: The cohort analysis consisted of pediatric cancer patients aged less than 20 years, diagnosed with a primary thyroid cancer, identified by site code ICD-0-3: C739, and reported to the SEER 9 database between 1973 and 2013. They were followed up until December 31, 2013; the end of the study period, or up to death if earlier.
RESULTS: Out of 1769 patients diagnosed primarily with thyroid carcinoma, 42 patients had a total of 45 incidences of subsequent malignancies. The mean age of patients at the initial diagnosis of thyroid cancer was 16 years. Females (90.5%) had a significantly higher incidence of second malignancies (SM) than males (9.5%). The overall Standardized Incidence Ratio (SIR) of SM in the study patients was higher than expected (SIR = 1.48). Some specific sites showed significantly higher incidences: the salivary glands (SIR = 33.95), the gum and other parts of the mouth [excluding the lips, tongue, salivary glands and floor of the mouth] (SIR = 24.53)*** and the kidneys (SIR = 5.72). The overall risk of SM in patients who had received radioactive iodine was higher than expected (SIR = 4.41). The cumulative incidence of SM after treatment of thyroid cancer in children increases steadily over 40 years (11.92%).
CONCLUSIONS: Race, gender, histological subtypes, and radioactive iodine are potentially significant prognostic factors for the development of SM among pediatric thyroid cancer survivors. Identification of underlying mechanisms that raise the risk of SM is important for both treatment and follow-up strategies.

PMID: 29492793 [PubMed - as supplied by publisher]



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Shear Wave Speed of the Lesion in Preoperative Breast Ultrasonography

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Publication date: Available online 2 March 2018
Source:Academic Radiology
Author(s): Youichi Machida, Akiko Shimauchi, Hidemi Okuma, Mitsuhiro Tozaki, Sachiko Isobe, Eisuke Fukuma
Rationale and ObjectivesWe aimed to investigate the relationship between shear wave speed (SWS) of the lesion on preoperative breast ultrasonography (US) and disease-free survival of patients with primary operable invasive breast cancer.Materials and MethodsThis retrospective study was approved by our Institutional Review Board. The requirement for informed consent was waived. A total of 195 consecutive newly diagnosed invasive breast cancer patients (age 33–83 years; mean 54.0 years) with preoperative breast US with SWS measurement of the lesion were identified. They underwent surgery between May 2012 and May 2013. SWS was measured at the center and three marginal zones in the main tumors, and the maximum value was used for analyses. For 35 patients who underwent primary systemic therapy (PST), the maximum SWS before PST was used. Cox proportional hazards modeling was used to identify the relationship between clinical-pathologic factors and disease-free survival.ResultsFourteen recurrences occurred at 6–47 months (mean 22.3 months) after surgery. On multivariate analysis, a positive history of PST (hazard ratio [HR] = 4.93; 95% confidence interval [CI]: 1.66, 14.70; P = .004), adjuvant chemotherapy (HR = 3.67; 95% CI: 1.11, 12.1; P = .033), and higher maximum SWS (HR = 1.55; 95% CI: 1.07, 2.23; P = .020) were associated with poorer disease-free survival.ConclusionHigher maximum SWS on preoperative US, in addition to a positive history of PST and adjuvant chemotherapy, was significantly associated with poorer disease-free survival of patients with invasive breast cancer.



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CT-based Radiomics Signature to Discriminate High-grade From Low-grade Colorectal Adenocarcinoma

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Publication date: Available online 2 March 2018
Source:Academic Radiology
Author(s): Xiaomei Huang, Zixuan Cheng, Yanqi Huang, Cuishan Liang, Lan He, Zelan Ma, Xin Chen, Xiaomei Wu, Yexing Li, Changhong Liang, Zaiyi Liu
Rationale and ObjectivesTo develop and validate a computed tomography-based radiomics signature for preoperatively discriminating high-grade from low-grade colorectal adenocarcinoma (CRAC).Materials and MethodsThis retrospective study was approved by our institutional review board, and the informed consent requirement was waived. This study enrolled 366 patients with CRAC (training dataset: n = 222, validation dataset: n = 144) from January 2008 to August 2015. A radiomics signature was developed with the least absolute shrinkage and selection operator method in training dataset. Mann-Whitney U test was applied to explore the correlation between radiomics signature and histologic grade. The discriminative power of radiomics signature was investigated with the receiver operating characteristics curve. An independent validation dataset was used to confirm the predictive performance. We further performed a stratified analysis to validate the predictive performance of radiomics signature in colon adenocarcinoma and rectal adenocarcinoma.ResultsThe radiomics signature demonstrated discriminative performance for high-grade and low-grade CRAC, with an area under the curve of 0.812 (95% confidence interval [CI]: 0.749–0.874) in training dataset and 0.735 (95%CI: 0.644–0.826) in validation dataset. Stratified analysis demonstrated that radiomics signature also showed distinguishing ability for histologic grade in both colon adenocarcinoma and rectal adenocarcinoma, with area under the curve of 0.725 (95%CI: 0.653–0.797) and 0.895 (95%CI: 0.838–0.952), respectively.ConclusionsWe developed and validated a radiomics signature as a complementary tool to differentiate high-grade from low-grade CRAC preoperatively, which may make contribution to personalized treatment.



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Intravoxel Incoherent Motion Diffusion-weighted MR Imaging for Early Evaluation of the Effect of Radiofrequency Ablation in Rabbit Liver VX2 Tumors

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Publication date: Available online 1 March 2018
Source:Academic Radiology
Author(s): Lian Shanshan, Shi Feng, Wei Kaikai, Zhang Yijun, Liu Huiming, Xie Chuanmiao
Rationale and ObjectivesThis study aims to investigate the value of intravoxel incoherent motion (IVIM)-derived parameters for early evaluation of the efficiency of radiofrequency ablation (RFA) treatment for rabbit liver VX2 tumor.Materials and MethodsEighteen rabbit liver VX2 tumor models were constructed, and computed tomography–guided RFA was performed. One day before and 7 days after RFA, 18 models underwent magnetic resonance imaging, including contrast-enhanced imaging and IVIM diffusion-weighted imaging with 16 b-factors (0–1000 s/mm2). Post-RFA liver tumors were segmented into viable tumor, inflammatory reaction, and ablation necrotic regions according to gross and histopathologic examinations. Parameters derived from IVIM were calculated. One-way analysis of variance and least significant difference test were used for comparisons among the three regions. The diagnostic performance of parameters was evaluated using receiver operating characteristic (ROC) analysis.ResultsADCtotal, D, and f values were significantly lower in viable tumor than in inflammatory reaction regions (all P < .05), but D* showed no significant difference between the two regions. ADCtotal values of viable tumor regions were significantly lower than that of ablation necrotic regions (P = .007), but D* values of necrotic regions were significantly lower than that of viable tumor regions (P = .045). In ROC analysis, ADC showed the highest area under the ROC curve for differentiating inflammatory reaction from viable tumor region.ConclusionsADCtotal, D, and f were valuable discriminating markers for differentiation between regions of viable tumor and inflammatory reaction in post-RFA tumor, especially ADCtotal outperformed the other two parameters with higher diagnostic performance.



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Prevalence and Reporting Rates of Incidental Dental Disease on Head CT Examinations

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Publication date: Available online 2 March 2018
Source:Academic Radiology
Author(s): Khaled Hammoud, Michael Lanfranchi, Daniel Adams, Harprit S. Bedi, William A. Mehan
Rationale and ObjectivesRoutine head computed tomography (CT) examinations often inadvertently include dental pathology which is often overlooked. The purpose of this study is to examine the prevalence of dental disease incidentally present and detected on head CT examinations, and to determine the effect of the institution of a dental disease field or macro in a standardized head CT dictation template on the rate of reporting dental disease.Materials and MethodsHead CT examinations were retrospectively and randomly selected from all examinations performed 6 months before, and 6 months after the institution of a dental disease field in a standardized head CT template. Dental findings were recorded from the initial finalized report. Examination images were subsequently reviewed for the presence of dental disease by two neuroradiologists who were blinded to the original reports and to each other's findings.ResultsOne hundred examinations were reviewed in the analysis. At our institution, 33% of the randomly selected head CT examinations included the level of the teeth (100/307). Dental disease was determined to be present in 40%–41% of these cases. Only 11% of the initial reports mentioned dental disease (P < .01). Addition of a dental disease field in the dictation template resulted in no significant difference in reporting dental disease (14% vs 8%, P = .371).ConclusionsIncidental dental disease is common and frequently underreported. Inclusion of a dental disease field in a standardized template does not significantly improve the rate of reporting dental disease.



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Posterior Inferior Cerebellar Artery Aneurysm

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Publication date: Available online 2 March 2018
Source:Academic Radiology
Author(s): Yuan Zhang, Shiqing Sun, Qi Xu, Weihua Feng, Haisong Chen
Rationale and ObjectivesThe posterior inferior cerebellar artery aneurysm (PICAA), especially distal PICAA, is easily missed by a doctor, leading to misdiagnosis and treatment delays. The objective of this article is to report the computed tomography angiography (CTA) presentations of 30 cases of PICAA proved by digital subtraction angiography (DSA) or surgical operation, and analyze the causes of misdiagnosis of PICAA by CTA.Materials and MethodsThirty cases of patients with PICAA that were proved by DSA or surgical operation were included in this study, all of whom underwent CTA before surgical procedure. The relationship between the locations of PICAA and the rates of missed diagnosis by CTA was analyzed. The detection rates of the PICAA by volume rendering (VR) images and original thin axial images of CTA were compared.ResultsTwelve cases (12 of 30, 40%) of aneurysm lied on the proximal end of posterior inferior cerebellar artery (PICA) (border with vertebral artery) and all of them (12 of 12,100%) were clearly displayed on the VR images of CTA and correctly diagnosed by doctors. Eighteen cases (18 of 30, 60%) of aneurysm lied on the distal part of the PICA, whereas only 2 of them (2/18, 11.1%) were displayed on the VR images and correctly diagnosed before surgical procedure. After surgical operation, the respective review of the CTA images demonstrated that all aneurysms (30 of 30, 100%) can be found on the thin axial images after careful observation and are shown on VR images after adjusting the display threshold when the locations of the PICAA through thin axial images were known, including the distal PICAA.ConclusionsThin axial CT images are most important and reliable for the detection of distal PICAA. Overdependence on three-dimensional VR images of CTA is the main cause of misdiagnosis.



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Advanced Modeled Iterative Reconstruction (ADMIRE) Facilitates Radiation Dose Reduction in Abdominal CT

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Publication date: Available online 1 March 2018
Source:Academic Radiology
Author(s): Stephan Ellmann, Ferdinand Kammerer, Thomas Allmendinger, Matthias Hammon, Rolf Janka, Michael Lell, Michael Uder, Manuel Kramer
Rationale and ObjectivesThis study aimed to determine the potential degree of radiation dose reduction achievable using Advanced Modeled Iterative Reconstruction (ADMIRE) in abdominal computed tomography (CT) while maintaining image quality. Moreover, this study compared differences in image noise reduction of this iterative algorithm with radiation dose reduction.MethodsEleven consecutive patients scheduled for abdominal CT were scanned according to our institute's standard protocol (100 kV, 289 reference mAs). Using a proprietary reconstruction software, CT images of these patients were reconstructed as either full-dose weighted filtered back projections or with simulated radiation dose reductions down to 10% of the full-dose level and ADMIRE at either strength 3 or strength 5. Images were marked with arrows pointing on anatomic structures of the abdomen, differing in their contrast to the surrounding tissue. Structures were grouped into high-, medium-, and low-contrast subgroups. In addition, the intrinsic noise of these structures was measured. That followed, image pairs were presented to observers, with five readers assessing image quality using two-alternative-forced-choice comparisons. In total, 3000 comparisons were performed that way.ResultsBoth ADMIRE 3 and 5 decreased noise of the anatomic structures significantly compared to the filtered back projection, with an additional significant difference between ADMIRE 3 and 5. Radiation dose reduction potential for ADMIRE ranged from 29.0% to 53.5%, with no significant differences between ADMIRE 3 and 5 within the contrast subgroups.The potential levels of radiation dose reduction for ADMIRE 3 differed significantly between high-, medium-, and low-contrast structures, whereas for ADMIRE 5, there was only a significant difference between the high- and the medium-contrast subgroups.ConclusionAlthough ADMIRE 5 permits significantly higher noise reduction potential than ADMIRE 3, it does not facilitate higher levels of radiation dose reduction. ADMIRE nonetheless holds remarkable potential for radiation dose reduction, which features a certain dependency on the contrast of the structure of interest. Applying ADMIRE with a strength of 3 in abdominal CT may permit radiation dose reduction of about 30%.



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Canceled MRI-guided Breast Biopsies Due to Nonvisualization

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Publication date: Available online 1 March 2018
Source:Academic Radiology
Author(s): Niveditha Pinnamaneni, Linda Moy, Yiming Gao, Amy N. Melsaether, James S. Babb, Hildegard K. Toth, Samantha L. Heller
Rationale and ObjectiveThe objective of this study was to evaluate breast lesion outcomes in patients after canceled MRI-guided breast biopsy due to lesion nonvisualization.Materials and MethodsElectronic medical records (January 2007–December 2014) were searched for patients with canceled magnetic resonance imaging (MRI)-guided breast biopsies due to lesion nonvisualization. A total of 1403 MRI-detected lesions were scheduled for MRI-guided biopsy and 89 were canceled because of nonvisualization. Imaging studies and medical records were reviewed for patient demographics, lesion characteristics, and subsequent malignancy. Patients without adequate MRI follow-up imaging were excluded. Statistical analysis was employed to determine if patient demographics or lesion characteristics were predictive of lesion resolution or lesion biopsy after subsequent follow-up.ResultsEighty-nine (6.3% [89/1403]; 95% confidence interval, 5.2%–7.7%) biopsies in 89 women were canceled because of nonvisualization. Follow-up MRIs greater than 5.5 months were available for 60.7% (54/89) of women. In 74.1% (40/54) of these patients, the lesions completely resolved on follow-up. In 25.9% (14/54) of the patients, the lesion persisted on follow-up; 42.9% (6/14) of these patients underwent biopsy. One case (1.9% [1/54]) yielded ductal carcinoma in situ with microinvasion at the 6-month follow-up. No patient demographics or lesion features were associated with lesion resolution or lesion biopsy.ConclusionsThe majority of canceled MRI-guided biopsy lesions resolved on later follow-up; however, because of the small possibility of a missed malignancy, follow-up MRI imaging at 6 months is recommended.



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Teaching and Assessing Professionalism in Radiology

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Publication date: Available online 1 March 2018
Source:Academic Radiology
Author(s): Aine Marie Kelly, Patricia B. Mullan
Teaching and assessing trainees' professionalism now represents an explicit expectation for Accreditation Council Graduate Medical Education–accredited radiology programs. Challenges to meeting this expectation include variability in defining the construct of professionalism; limits of traditional teaching and assessment methods, used for competencies historically more prominent in medical education, for professionalism; and emerging expectations for credible and feasible professionalism teaching and assessment practices in the current context of health-care training and practice.This article identifies promising teaching resources and methods that can be used strategically to augment traditional teaching of the cognitive basis for professionalism, including role modeling, case-based scenarios, debriefing, simulations, narrative medicine (storytelling), guided discussions, peer-assisted learning, and reflective practice. This article also summarizes assessment practices intended to promote learning, as well as to inform how and when to assess trainees as their professional identities develop over time, settings, and autonomous practice, particularly in terms of measurable behaviors. This includes assessment tools (including mini observations, critical incident reports, and appreciative inquiry) for authentic assessment in the workplace; engaging multiple sources (self-, peer, other health professionals, and patients) in assessment; and intentional practices for trainees to take responsibility for seeking our actionable feedback and reflection. This article examines the emerging evidence of the feasibility and value added of assessment of medical competency milestones, including professionalism, coordinated by the Accreditation Council Graduate Medical Education in radiology and other medical specialties. Radiology has a strategic opportunity to contribute to scholarship and inform policies in professionalism teaching and assessment practices.



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Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events

Abstract

Objectives

To evaluate the clinical significance of discrepant lesions between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) in a longitudinal study.

Methods

In 220 patients with suspected coronary artery disease (CAD) who underwent both 256-row CCTA and ICA, the obstructive CAD (≥ 50% stenosis) on CCTA was compared with that on ICA as the reference standard. We analysed the causes of the discrepancy between CCTA and ICA. During a 40-month follow-up period, major adverse cardiac events (MACE) were assessed.

Results

Discordance between CCTA and ICA was observed in 121 of the 3166 coronary artery segments (3.8%). Common causes were calcification (45.9%) and positive remodelling (PR) (29.6%) in 83 false positive lesions, and noise (40.0%) and motion artefact (37.8%) in 38 false negative lesions. MACE occurred in seven lesions among the discrepant lesions; six among the 29 PR lesions (20.7%) and one among the 53 calcified lesions (1.9%). With respect to the prediction power of MACE in an intermediate stenosis, the CCTA-related value including PR was higher than the ICA-related value.

Conclusions

PR was a frequent cause of MACE among the false positive lesions on CCTA. Therefore, the presence of PR on CCTA may suggest clinical significance, although it can be missed by ICA.

Key Points

• Compared to ICA, PR in CCTA may be cause of false positive lesion.

• CCTA-related value including PR shows higher prediction power of MACE than ICA-related value.

• PR reflects atherosclerotic burden that can be related to cardiac events.

• PR in CCTA should be observed carefully, even if it is false positive.



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Image quality and radiation dose of coronary CT angiography performed with whole-heart coverage CT scanner with intra-cycle motion correction algorithm in patients with atrial fibrillation

Abstract

Objectives

To evaluate image quality, coronary evaluability and radiation exposure of coronary CT angiography (CCTA) performed with whole-heart coverage cardiac-CT in patients with atrial fibrillation (AF).

Materials and methods

We prospectively enrolled 164 patients with AF who underwent a clinically indicated CCTA with a 16-cm z-axis coverage scanner. In all patients CCTA was performed using prospective ECG-triggering with targeted RR interval. We evaluated image quality, coronary evaluability and effective dose (ED). Patients were divided in two subgroups based on heart rate (HR) during imaging. Group 1: 64 patients with low HR (<75 bpm), group 2: 100 patients with high HR (≥75 bpm). Written informed consent was obtained from all patients and the institutional ethics committee approved the study protocol.

Results

In a segment-based analysis, coronary evaluability was 98.4 % (2,577/2,620 segments) in the whole population, without significant differences between groups (1,013/1,024 (98.9 %) and 1,565/1,596 (98.1 %), for groups 1 and 2, respectively, p=0.15). Mean ED was similar in both groups (3.8±1.9 mSv and 3.9±2.1 mSv in groups 1 and 2, respectively, p=0.75)

Conclusions

The whole-heart-coverage scanner could evaluate coronary arteries with high image quality and without increase in radiation exposure in AF patients, even in the high HR group.

Key points

• Last-generation CT scanner improves coronary artery assessment in AF patients.

• The new CT scanner enables low radiation exposure in AF patients.

• Diagnostic ICA maybe avoided in AF patients with suspected CAD.

• Whole-heart coverage CT scanner enables low radiation exposure in AF patients.



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The impact of MRI sequence on tumour staging and gross tumour volume delineation in squamous cell carcinoma of the anal canal

Abstract

Objectives

To compare maximum tumour diameter (MTD) and gross tumour volume (GTV) measurements between T2-weighted (T2-w) and diffusion-weighted (DWI) MRI in squamous cell carcinoma of the anal canal (SCCA) and assess sequence impact on tumour (T) staging. Second, to evaluate interobserver agreement and reader delineation confidence.

Methods

The staging MRI scans of 45 SCCA patients (25 females) were assessed retrospectively by two independent radiologists (0 and 5 years' experience of anal cancer MRI). MTD and GTV were delineated on both T2-w and high-b-value DWI images and compared between sequences; T staging was derived from MTD. Interobserver agreement was assessed and delineation confidence scored (1 to 5) by each observer.

Results

GTV and MTD were significantly and systematically lower on DWI versus T2-w sequences by 14.80%/9.98% (MTD) and 29.70%/12.25% (GTV) for each reader, respectively, causing T staging discordances in approximately a quarter of cases. Bland-Altman limits of agreement were narrower and intraclass correlation coefficients higher for DWI. Delineation confidence was greater on DWI: 40/42 cases were scored confidently (4 or 5) by each reader, respectively, versus 31/36 cases based on T2-w images.

Conclusions

Sequence selection affects SCCA measurements and T stage. DWI yields higher interobserver agreement and greater tumour delineation confidence.

Key Points

MTD and GTV measurements are significantly lower on DWI than on T 2 -w MRI.

Such differences cause T staging discordances in up to a quarter of cases.

DWI results in higher agreement between inexperienced and experienced observers.

DWI offers greater tumour delineation confidence to inexperienced readers.



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Apparent diffusion coefficient of vertebral haemangiomas allows differentiation from malignant focal deposits in whole-body diffusion-weighted MRI

Abstract

Objectives

The aim of this study was to identify apparent diffusion coefficient (ADC) values for typical haemangiomas in the spine and to compare them with active malignant focal deposits.

Methods

This was a retrospective single-institution study. Whole-body magnetic resonance imaging (MRI) scans of 106 successive patients with active multiple myeloma, metastatic prostate or breast cancer were analysed. ADC values of typical vertebral haemangiomas and malignant focal deposits were recorded.

Results

The ADC of haemangiomas (72 ROIs, median ADC 1,085×10-6mm2s-1, interquartile range 927–1,295×10-6mm2s-1) was significantly higher than the ADC of malignant focal deposits (97 ROIs, median ADC 682×10-6mm2s-1, interquartile range 583–781×10-6mm2s-1) with a p-value < 10-6. Receiver operating characteristic (ROC) analysis produced an area under the curve of 0.93. An ADC threshold of 872×10-6mm2s-1 separated haemangiomas from malignant focal deposits with a sensitivity of 84.7 % and specificity of 91.8 %.

Conclusions

ADC values of classical vertebral haemangiomas are significantly higher than malignant focal deposits. The high ADC of vertebral haemangiomas allows them to be distinguished visually and quantitatively from active sites of disease, which show restricted diffusion.

Key Points

• Whole-body diffusion-weighted MRI is becoming widely used in myeloma and bone metastases.

• ADC values of vertebral haemangiomas are significantly higher than malignant focal deposits.

• High ADCs of haemangiomas allows them to be distinguished from active disease.



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Intraprocedural 3D perfusion measurement during chemoembolisation with doxorubicin-eluting beads in liver metastases of malignant melanoma

Abstract

Objectives

To study feasibility and validity of a new software application for intraprocedural assessment of perfusion during chemoembolisation of melanoma metastases.

Methodology

In a prospective phase-II trial, ten melanoma patients with liver-only metastases underwent chemoembolisation with doxorubicin-eluting beads (DEBDOX-TACE). Tumour perfusion was evaluated immediately before and after treatment at cone beam computer tomography (CBCT) using a new software application. For control and comparison, patients underwent perfusion measurement via contrast-enhanced multidetector CT (MDCT) before and after treatment.

Results

CBCT showed 94.7 % reduction in perfusion in metastases after DEBDOX-TACE, whereas MDCT showed 96.8 %. Reduction in perfusion after treatment was statistically significant (p < 0.01) for both methods. The additional time needed for data acquisition during treatment was 5 min per case or less; the post-processing data analysis was 10 min or less. Perfusion imaging was associated with additional contrast agent and patient exposure to radiation (dose-length product [DLP]): 18 ml and 394 mGy*cm in CBCT and 100 ml and 446 mGy*cm in MDCT, respectively.

Conclusions

Reduction in perfusion of melanoma metastases after DEBDOX-TACE can be reliably assessed during the intervention via perfusion software at CBCT. Data acquisition and analysis require additional time but can be easily performed during the treatment.

Key Points

Tumour perfusion of melanoma metastases can be assessed at cone beam CT.

The software shows a significant decrease of tumour perfusion after DEBDOX-TACE.

Data acquisition and analysis require an acceptable additional time during the procedure.

CBCT requires less radiation exposure and contrast for perfusion study than MSCT.

This software can monitor the course of DEBDOX-TACE in melanoma metastases.



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Conventional and synthetic MRI in multiple sclerosis: a comparative study

Abstract

Objectives

To compare the assessment of patients with multiple sclerosis (MS) using synthetic and conventional MRI.

Materials and methods

Synthetic and conventional axial images were prospectively acquired for 52 patients with diagnosed MS. Quantitative MRI (qMRI) was used for measuring proton density and relaxation times (T1, T2) and then, based on these parameters, synthetic T1W, T2W and FLAIR images were calculated. Image stacks were reviewed blindly, independently and in random order by two radiologists. The number and location for all lesions were documented and categorised. A combined report of lesion load and presence of contrast-enhancing lesions was compiled for each patient. Agreement was evaluated using kappa statistic.

Results

There was no significant difference in lesion detection using synthetic and conventional MRI in any anatomical region or for any of the three image types. Inter- and intra-observer agreements were mainly higher (p < 0.05) using conventional images but there was no significant difference in any specific region or for any image type. There was no significant difference in the outcome of the combined reports.

Conclusion

Synthetic MR images show potential to be used in the assessment of MS dissemination in space (DIS) despite a slightly lower inter- and intra-observer agreement compared to conventional MRI.

Key Points

• Synthetic MR images may potentially be useful in the assessment of MS.

• Examination times may be shortened.

• Inter- and intra-observer agreement is generally higher using conventional MRI.



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Extracellular contrast agent-enhanced MRI: 15-min delayed phase may improve the diagnostic performance for hepatocellular carcinoma in patients with chronic liver disease

Abstract

Objectives

To determine the value of a 15-min delayed phase in extracellular contrast agent (ECA)-enhanced magnetic resonance imaging (MRI) for evaluation of hepatocellular carcinoma (HCC) in patients with chronic liver disease.

Methods

Between 2014 and 2015, 103 patients with chronic liver disease underwent ECA-enhanced MRI; 133 lesions consisting of 107 HCCs, 23 benign lesions and three non-HCC malignancies were identified with pathological or clinical diagnosis. MRI images were reviewed by two abdominal radiologists independently using the European Association for the Study of the Liver (EASL) and Liver Imaging Reporting and Data System (LI-RADS) criteria. Imaging features observed in the 15-min delayed phase were recorded.

Results

Of 107 HCCs, three or four additional HCCs were diagnosed according to the EASL criteria by adding the 15-min delayed phase, increasing sensitivity (Reviewer 1, from 69.2–72.0 % [P = 0.072]; Reviewer 2, from 75.7–79.4 % [P = 0.041]). Reviewers 1 and 2 upgraded one and four HCCs from LR-4 to LR-5 based on the LI-RADS, respectively. Among 23 benign lesions, no additional findings were observed in the 15-min delayed phase.

Conclusions

Including the 15-min delayed phase in ECA-enhanced MRI may improve the diagnostic performance for HCC in patients with chronic liver disease.

Key Points

• Additional acquisition of 15-min delayed phase (FDP) requires approximately 20 s.

• About 5 % of HCCs show washout or capsule appearance only in FDP.

• Including FDP improves the sensitivity of extracellular contrast agent-enhanced MRI for HCC.

• These results are applicable only to patients with chronic liver disease.



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Medial temporal lobe atrophy ratings in a large 75-year-old population-based cohort: gender-corrected and education-corrected normative data

Abstract

Objectives

To find cut-off values for different medial temporal lobe atrophy (MTA) measures (right, left, average, and highest), accounting for gender and education, investigate the association with cognitive performance, and to compare with decline of cognitive function over 5 years in a large population-based cohort.

Methods

Three hundred and ninety 75-year-old individuals were examined with magnetic resonance imaging of the brain and cognitive testing. The Scheltens's scale was used to assess visually MTA scores (0–4) in all subjects. Cognitive tests were repeated in 278 of them after 5 years. Normal MTA cut-off values were calculated based on the 10th percentile.

Results

Most 75-year-old individuals had MTA score ≤2. Men had significantly higher MTA scores than women. Scores for left and average MTA were significantly higher in highly educated individuals. Abnormal MTA was associated with worse results in cognitive test and individuals with abnormal right MTA had faster cognitive decline.

Conclusion

At age 75, gender and education are confounders for MTA grading. A score of ≥2 is abnormal for low-educated women and a score of ≥2.5 is abnormal for men and high-educated women. Subjects with abnormal right MTA, but normal MMSE scores had developed worse MMSE scores 5 years later.

Key Points

Gender and education are confounders for MTA grading.

We suggest cut-off values for 75-year-olds, taking gender and education into account.

Males have higher MTA scores than women.

Higher MTA scores are associated with worse cognitive performance.



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In memoriam Prof. Erik Boijsen



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Detection of lung carcinoma with predominant ground-glass opacity on CT using temporal subtraction method

Abstract

Purpose

To evaluate the usefulness of the CT temporal subtraction (TS) method for the detection of the lung cancer with predominant ground-glass opacity (LC-pGGO).

Materials and methods

Twenty-five pairs of CT and their TS images in patients with LC-pGGO (31 lesions) and 25 pairs of those in patients without nodules were used for an observer performance study. Eight radiologists participated and the statistical significance of differences with and without the CT-TS was assessed by JAFROC analysis.

Results

The average figure-of-merit (FOM) values for all radiologists increased to a statistically significant degree, from 0.861 without CT-TS to 0.912 with CT-TS (p < .001). The average sensitivity for detecting the actionable lesions improved from 73.4 % to 85.9 % using CT-TS. The reading time with CT-TS was not significantly different from that without.

Conclusion

The use of CT-TS improves the observer performance for the detection of LC-pGGO.

Key Points

CT temporal subtraction can improve the detection accuracy of lung cancer.

Reading time with temporal subtraction is not different from that without.

CT temporal subtraction improves observer performance for ground-glass/subsolid nodule detection.



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Management of subcentimetre arterially enhancing and hepatobiliary hypointense lesions on gadoxetic acid-enhanced MRI in patients at risk for HCC

Abstract

Objectives

To investigate the significance of subcentimetre (≤1 cm) arterially enhancing and hepatobiliary hypointense lesions (SAELs) observed on gadoxetic acid-enhanced magnetic resonance imaging (MRI) of patients at risk of hepatocellular carcinoma (HCC).

Methods

A SAEL was defined as a subcentimetre hypervascular nodule exhibiting a hepatobiliary phase defect on gadoxetic acid-enhanced MRI. We included 52 SAELs from 46 patients in a HCC surveillance population. The HCC reference standard was pathologic confirmation or a nodule >1 cm with typical imaging features of HCC at follow-up imaging. The malignancy rate and HCC-favourable imaging findings of SAELs were evaluated.

Results

The malignancy rate among SAELs was 57.7% (30/52). At diagnosis, all SAELs that progressed to overt HCC were treatable with curative intention. Venous or late dynamic phase washout was more frequently observed with malignant SAELs than with benign SAELs (57.7% vs. 30.6%; P = 0.01). If SAELs exhibiting washout were considered as HCC, sensitivity, specificity, and positive predictive value was 83.3%, 50%, and 69.4%, respectively.

Conclusion

Among patients at risk of HCC, SAELs on gadoxetic acid-enhanced MRI exhibited high malignant potential. However, close observation may be an appropriate strategy for isolated SAELs. A washout appearance may be helpful for predicting malignancy.

Key Points

Gadoxetic acid-enhanced MRI provides hepatobiliary phase (HBP) images.

Screening frequently detects subcentimetre arterially enhancing and hepatobiliary hypointense lesions (SAELs).

A majority of SAELs progressed to overt HCC within 2 years.

A venous-phase washout appearance correlated significantly with malignancy in SAELs.



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CAD-RADS – a new clinical decision support tool for coronary computed tomography angiography

Abstract

Coronary computed tomography angiography (CTA) has been established as an accurate method to non-invasively assess coronary artery disease (CAD). The proposed 'Coronary Artery Disease Reporting and Data System' (CAD-RADS) may enable standardised reporting of the broad spectrum of coronary CTA findings related to the presence, extent and composition of coronary atherosclerosis. The CAD-RADS classification is a comprehensive tool for summarising findings on a per-patient-basis dependent on the highest-grade coronary artery lesion, ranging from CAD-RADS 0 (absence of CAD) to CAD-RADS 5 (total occlusion of a coronary artery). In addition, it provides suggestions for clinical management for each classification, including further testing and therapeutic options. Despite some limitations, CAD-RADS may facilitate improved communication between imagers and patient caregivers. As such, CAD-RADS may enable a more efficient use of coronary CTA leading to more accurate utilisation of invasive coronary angiograms. Furthermore, widespread use of CAD-RADS may facilitate registry-based research of diagnostic and prognostic aspects of CTA.

Key points

• CAD-RADS is a tool for standardising coronary CTA reports.

• CAD-RADS includes clinical treatment recommendations based on CTA findings.

• CAD-RADS has the potential to reduce variability of CTA reports.



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Histogram analysis of diffusion kurtosis imaging derived maps may distinguish between low and high grade gliomas before surgery

Abstract

Objective

To investigate the value of histogram analysis of diffusion kurtosis imaging (DKI) maps in the evaluation of glioma grading.

Methods

A total of 39 glioma patients who underwent preoperative magnetic resonance imaging (MRI) were classified into low-grade (13 cases) and high-grade (26 cases) glioma groups. Parametric DKI maps were derived, and histogram metrics between low- and high-grade gliomas were analysed. The optimum diagnostic thresholds of the parameters, area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were achieved using a receiver operating characteristic (ROC).

Result

Significant differences were observed not only in 12 metrics of histogram DKI parameters (P<0.05), but also in mean diffusivity (MD) and mean kurtosis (MK) values, including age as a covariate (F=19.127, P<0.001 and F=20.894, P<0.001, respectively), between low- and high-grade gliomas. Mean MK was the best independent predictor of differentiating glioma grades (B=18.934, 22.237 adjusted for age, P<0.05). The partial correlation coefficient between fractional anisotropy (FA) and kurtosis fractional anisotropy (KFA) was 0.675 (P<0.001). The AUC of the mean MK, sensitivity, and specificity were 0.925, 88.5% and 84.6%, respectively.

Conclusions

DKI parameters can effectively distinguish between low- and high-grade gliomas. Mean MK is the best independent predictor of differentiating glioma grades.

Key points

DKI is a new and important method.

DKI can provide additional information on microstructural architecture.

Histogram analysis of DKI may be more effective in glioma grading.



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Subtraction multiphase CT angiography: A new technique for faster detection of intracranial arterial occlusions

Abstract

Objective

To describe and evaluate a novel technical development to improve detection of intracranial vessel occlusions using multiphase CT angiography (MPCTA).

Materials and methods

The institutional ethics committee approved the study. Fifty patients (30 consecutive distal (M2 or smaller) anterior circulation occlusions, ten M1 occlusions, ten cases without occlusion) presenting with suspected AIS who underwent MPCTA were included. Post-processing of MPCTA studies created "subtraction" and "delayed enhancement" (DE) datasets. Initially, non-contrast CT and MPCTA studies for each patient were evaluated. Readers' confidence, speed and sensitivity of detection of intracranial vessel occlusions were recorded. After an interval of at least 4 weeks, readers were provided with post-processed images and studies were re-evaluated.

Results

While the sensitivity of detection of intracranial vessel occlusions was equal for both conventional MPCTA and subMPCTA, the mean time taken to identify a vessel occlusion decreased by 64 % using subMPCTA (16 s vs. 45 s with conventional MPCTA) (p<0.001). In addition, confidence in interpretation improved (from 4.4 to 4.9) using subMPCTA (p<0.001).

Conclusion

SubMPCTA is a novel technique that aids in identifying small intracranial vessel occlusions in the suspected AIS patient. SubMPCTA increases confidence in interpretation and reduces the time taken to detect intracranial vessel occlusions.

Key Points

• SubMPCTA processes MPCTA data to better demonstrate intracranial arterial occlusions.

• SubMPCTA increases confidence and speed of interpretation of MPCTA studies.

• SubMPCTA may aid in rapidly differentiating acute ischaemic stroke from stroke mimics.



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Secretin-stimulated ultrasound estimation of pancreatic secretion in cystic fibrosis validated by magnetic resonance imaging

Abstract

Objectives

Secretin-stimulated magnetic resonance imaging (s-MRI) is the best validated radiological modality assessing pancreatic secretion. The purpose of this study was to compare volume output measures from secretin-stimulated transabdominal ultrasonography (s-US) to s-MRI for the diagnosis of exocrine pancreatic failure in cystic fibrosis (CF).

Methods

We performed transabdominal ultrasonography and MRI before and at timed intervals during 15 minutes after secretin stimulation in 21 CF patients and 13 healthy controls. To clearly identify the subjects with reduced exocrine pancreatic function, we classified CF patients as pancreas-sufficient or -insufficient by secretin-stimulated endoscopic short test and faecal elastase.

Results

Pancreas-insufficient CF patients had reduced pancreatic secretions compared to pancreas-sufficient subjects based on both imaging modalities (p < 0.001). Volume output estimates assessed by s-US correlated to that of s-MRI (r = 0.56–0.62; p < 0.001). Both s-US (AUC: 0.88) and s-MRI (AUC: 0.99) demonstrated good diagnostic accuracy for exocrine pancreatic failure.

Conclusions

Pancreatic volume-output estimated by s-US corresponds well to exocrine pancreatic function in CF patients and yields comparable results to that of s-MRI. s-US provides a simple and feasible tool in the assessment of pancreatic secretion.

Key points

• Cystic fibrosis patients with affected pancreas have reduced pancreatic secretions.

Secretin-stimulated sonography is a simple and feasible method to assess pancreatic output.

Secretin-simulated MRI is a more precise method to assess pancreatic secretions.

The sonographic and MRI methods yielded comparable pancreatic secretory output estimates.



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Early US findings of biliary atresia in infants younger than 30 days

Abstract

Purpose

To investigate and compare ultrasound (US) findings for the diagnosis of biliary atresia (BA) in infants younger than 30 days with those of infants older than 30 days.

Materials and Methods

From 2000 to 2015, we reviewed hepatobiliary US images in 12 BA infants younger than 30 days (younger BA group) and 62 BA infants older than 30 days (older BA group) before Kasai procedure. Eight (67%) of younger BA group underwent follow-up US examinations before Kasai procedure. Our review of the images focused on triangular cord sign, gallbladder (GB) abnormalities, vascular changes, and signs of portal hypertension.

Results

The triangular cord sign was present in 17% of younger BA group and in 56% of older BA group (P=.024). GB abnormalities were commonly identified in both groups. The hepatic artery diameter was significantly smaller in younger BA group than in older BA group (P<.001). Signs of portal hypertension were less common in younger BA group (17%) than in older BA group (84%) (P<.001). Follow-up US of two infants in younger BA group showed a new appearance of the triangular cord sign.

Conclusion

BA infants younger than 30 days showed atypical US findings compared with those older than 30 days.

Key Points

BA infants younger than 30 days show atypical US findings.

GB abnormalities were common in both younger and older BA group.

Subsequent US examination may be helpful to diagnose BA in young infants.



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Accuracy of apparent diffusion coefficient in differentiating pancreatic neuroendocrine tumour from intrapancreatic accessory spleen

Abstract

Objectives

To evaluate and compare the accuracy of absolute apparent diffusion coefficient (ADC) and normalised ADC (lesion-to-spleen ADC ratio) in differentiating pancreatic neuroendocrine tumour (NET) from intrapancreatic accessory spleen (IPAS).

Methods

Study included 62 patients with the diagnosis of pancreatic NET (n=51) or IPAS (n=11). Two independent reviewers measured ADC on all lesions and spleen. Receiver operating characteristics (ROC) analysis to differentiate NET from IPAS was performed and compared for absolute and normalised ADC. Inter-reader reliability for the two methods was assessed.

Results

Pancreatic NET had significantly higher absolute ADC (1.431x10-3 vs 0.967x10-3 mm2/s; P<0.0001) and normalised ADC (1.59 vs 1.09; P<0.0001) compared to IPAS. An ADC value of ≥1.206x10-3 mm2/s was 70.6% sensitive and 90.9% specific for the diagnosis of NET vs. IPAS. Lesion to spleen ADC ratio of ≥1.25 was 80.4% sensitive, and 81.8% specific while ratio of ≥1.29 was 74.5% sensitive and 100% specific in the differentiation. The area under the curve (AUCs) for two methods were similar (88.2% vs. 88.8%; P=0.899). Both methods demonstrated excellent inter-reader reliability with ICCs for absolute ADC and ADC ratio being 0.957 and 0.927, respectively.

Conclusion

Both absolute and normalised ADC allow clinically relevant differentiation of pancreatic NET and IPAS.

Key points

• Imaging overlaps between IPASs and pancreatic-NETs lead to unnecessary procedures including pancreatectomy.

• Uniquely low ADC of spleen allows differentiating IPASs from pancreatic NETs.

• Both absolute-ADC and normalised-ADC (lesion-to-spleen ADC-ratio) demonstrate high accuracy in differentiating IPASs from NETs.

• Both methods demonstrate excellent inter-reader reliability.



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Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients

Abstract

Objectives

To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC).

Methods

The study population comprised 271 patients (mean age, 72 years; range, 22–97 years, male, n=169) with AAC treated with PC with or without subsequent cholecystectomy. Clinical data from total 271 patients were analysed, and outcomes were assessed according to whether the catheter was removed or remained indwelling. Patient survival and recurrence rates were calculated.

Results

Symptom resolution and significant improvement of laboratory test values were achieved in 235 patients (86.7%) within 4 days after PC. Complications occurred in six patients (2.2%). Interval elective cholecystectomy was performed in 127 (46.8%) patients. Among the remaining 121 patients, successful removal of the PC catheter was achieved in 88 patients (72.7%) at a mean of 30 days (range, 4–365 days). Of the catheter removal group, 86/88 (97.7%) were successfully treated with the initial PC, whereas two (2.3%) experienced recurrence of cholecystitis. Cumulative recurrence rates were 1.1%, 2.7%, and 2.7% at 1, 2, and 8 years, respectively.

Conclusions

The good therapeutic outcomes of PC and low recurrence rate suggest that PC can be a definitive treatment option in the majority of AAC patients.

Key Points

Many patients with AAC are too ill to undergo cholecystectomy.

PC in AAC patients shows low complication and recurrence rate.

PC solely can be a definitive treatment option in the majority of AAC patients



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Correlation between the availability of dopamine transporter and olfactory function in healthy subjects

Abstract

Objectives

Olfactory dysfunction in Parkinson's disease is usually prodromal to other symptoms. In this study, we aimed to explore the association of olfactory function with the availabilities of striatal dopamine transporter (DAT) in healthy subjects.

Methods

Data used in the preparation of this article were obtained from Parkinson's Progression Markers Initiative database (www.ppmi-info.org/data). The study population consisted of healthy controls with screening 123I-FP-CIT single photon emission tomography (SPECT). University of Pennsylvania Smell Identification Test (UPSIT) was assessed to evaluate the olfactory function. Results: Totally, 181 healthy subjects (117 male, 64 female) with 123I-FP-CIT SPECT data were included in this study. Specific binding ratios (SBRs) of the caudate nucleus (rho = -0.4217, p < 0.0001), putamen (rho = -0.2292, p = 0.0019), and striatum (rho=-0.3425, p < 0.0001) showed a reduction with ageing. SBRs of the caudate nucleus, putamen, and striatum were positively correlated with UPSIT (rho = 0.3716, p < 0.0001; rho = 0.3655, p < 0.0001; rho = 0.3880, p < 0.0001). After controlling for age by partial correlation, SBRs of the caudate nucleus, putamen, and striatum showed an influence on UPSIT (rho = 0.3288, p < 0.0001; rho = 0.3374, p < 0.0001; rho = 0.3511, p < 0.0001).

Conclusion

Olfactory function is associated with the availability of striatal DAT independent of age in healthy subjects.

Key Points

Olfactory dysfunction in Parkinson's disease is prodromal to other symptoms.

The availability of dopamine transporter showed a reduction with ageing.

Olfactory function is associated with the availability of dopamine transporter.



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Commentary on "The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea".

Commentary on "The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea".

Otolaryngol Head Neck Surg. 2018 Mar;158(3):581

Authors: Lou ZC

PMID: 29494318 [PubMed - in process]



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Highlights from the Current Issue: March 2018.

Highlights from the Current Issue: March 2018.

Otolaryngol Head Neck Surg. 2018 Mar;158(3):403-404

Authors: Krouse JH

PMID: 29494317 [PubMed - in process]



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Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary.

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary.

Otolaryngol Head Neck Surg. 2018 Mar;158(3):409-426

Authors: Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis CCW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC

Abstract
Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Differences from Prior Guideline (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.

PMID: 29494316 [PubMed - in process]



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Plain Language Summary: Hoarseness (Dysphonia).

Plain Language Summary: Hoarseness (Dysphonia).

Otolaryngol Head Neck Surg. 2018 Mar;158(3):427-431

Authors: Krouse HJ, Reavis CCW, Stachler RJ, Francis DO, O'Connor S

Abstract
This plain language summary for patients serves as an overview in explaining hoarseness (dysphonia). The summary applies to patients in all age groups and is based on the 2018 "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)." The evidence-based guideline includes research to support more effective identification and management of patients with hoarseness (dysphonia). The primary purpose of the guideline is to improve the quality of care for patients with hoarseness (dysphonia) based on current best evidence.

PMID: 29494315 [PubMed - in process]



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Distinct alterations of CD68+CD163+ M2-like macrophages and myeloid-derived suppressor cells in newly diagnosed primary immune thrombocytopenia with or without CR after high-dose dexamethasone treatment

Although impaired myeloid-derived suppressor cells (MDSCs) recently have been studied in immune thrombocytopenia (ITP), another myeloid-derived cell population signified as M2 macrophages has not been investig...

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Leon Kaufman

bmj;360/mar02_10/k960/FAF1faA lifelong love of reading, a hugely retentive memory, and a keen interest in research enabled Leon Kaufman to place the new academic department of anaesthesia at...
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Prassankumar Valabhji

bmj;360/mar02_9/k971/FAF1faPrassankumar Valabhji (“Val”) was born and grew up in the Seychelles. At age 17 he travelled to London to study for his A levels. He qualified from Cardiff in 1960. As a...
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John Bernard Hawkins

bmj;360/mar02_8/k958/FAF1faJohn Bernard Hawkins entered Birmingham medical school in 1958 after national service in the Royal Navy and training as a timber merchant in the family firm. Appointed...
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Magnitude of institutional delivery service utilization and associated factors among women in pastoral community of Awash Fentale district Afar Regional State, Ethiopia

Reduction of maternal mortality is a global priority particularly in developing countries like Ethiopia where maternal mortality ratio is one of the highest in the world. Most deliveries in developing countrie...

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Validation of the Orebro musculoskeletal pain screening questionnaire in patients with chronic neck pain

To validate the German version of OMPSQ (OMPSQ-G) for patients with chronic neck pain.

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Nicola Best

bmj;360/mar02_7/k957/FAF1faNicola Best (née Bird) was a paediatric registrar at Pembury Hospital. As a clinician she was compassionate and caring towards her patients, their families, and colleagues....
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