## Τρίτη, 20 Μαρτίου 2018

### Endovascular trans-jugular occlusion of congenital intrahepatic porto systemic venous shunt using simultaneous fluoroscopy and trans-abdominal ultrasound guidance: Report of two cases

Publication date: Available online 20 March 2018
Author(s): Ujjwal Gorsi, Naveen Kalra, Pankaj Gupta, Karthik Rayasam, Babu Ram Thapa, Hemant Bhagat, Niranjan Khandelwal
Congenital intrahepatic portosystemic venous shunts (CIPVS) are rare anomalies that can be detected before birth or in early infancy or later in life. Symptomatic shunts are treated as they carry high risk of complications like hepatic encephalopathy. Various treatment options include surgery, endovascular embolization and percutaneous closure devices. We treated two infants with CIPVS successfully by endovascular embolization of the shunt using vascular plug through transjugular route. Trans-abdominal ultrasound guidance in addition to fluoroscopy was used at the time of vascular plug placement. We emphasize that the use of transabdominal ultrasound during endovascular occlusion enhances the safety and technical success rate.

### Factors Influencing Choice of Radiology and Relationship to Resident Job Satisfaction

Publication date: Available online 20 March 2018
Author(s): Shanna A. Matalon, Jeffrey P. Guenette, Stacy E. Smith, Jennifer W. Uyeda, Alicia S. Chua, Glenn C. Gaviola, Sara M. Durfee

### Angiomyolipoma of the Kidneys: Current Perspectives and Challenges in Diagnostic Imaging and Image-Guided Therapy

Publication date: Available online 20 March 2018
Author(s): Abdul Razik, Chandan J. Das, Sanjay Sharma
Angiomyolipomas (AML) are benign tumors of the kidneys frequently encountered in radiologic practice in large tertiary centers. In comparison to renal cell carcinomas (RCC), AML are seldom treated unless they are large, undergo malignant transformation or develop complications like acute hemorrhage. The common garden triphasic (classic) AML is an easy diagnosis, however some variants lack macroscopic fat in which case the radiologic differentiation from RCC becomes challenging. Several imaging features, both qualitative and quantitative, have been described in differentiating the two entities. Although minimal fat AML is not entirely a radiologic diagnosis, the suspicion raised on imaging necessitates sampling and potentially avoids an unwanted surgery. Recently a new variant, epitheloid AML has been described which often has atypical imaging features and is at a higher risk for malignant transformation. Apart from the diagnosis, the radiologist also needs to convey information regarding nephrometric scores which help in surgical decision making. Recently, more and more AMLs are managed with selective arterial embolization and percutaneous ablation, both of which lack the amount of morbidity associated with surgery. The purpose of this article is to review the imaging and pathologic features of classic AML as well as the differentiation of minimal fat AML from RCC. In addition, an overview of nephrometric scoring and image-guided interventions is also provided.

### Top 100 Cited articles on Radiation Exposure in Medical Imaging: A Bibliometric Analysis

Publication date: Available online 20 March 2018
Author(s): Jason Kinnin, Tarek N. Hanna, Marc Jutras, Babar Hasan, Rick Bhatia, Faisal Khosa
BackgroundBibliometric analyses by highest number of citations can help researchers and funding agencies in determining the most influential articles in a field. The main objective of this analysis was to identify the top 100 cited articles addressing radiation exposure from medical imaging and assess their characteristics.MethodsRelevant articles were extracted from the Scopus database after a systematic search by researchers using an iteratively defined Boolean search string. Subsequently, exclusion criteria were applied. A list of top 100 articles was prepared, and articles were ranked according to the citations they had received. No time restriction was applied. Descriptive statistics of the data were compiled.ResultsThe top-cited articles were published from 1970–2013, with the most articles published in 2009 and 2010 (12 articles in each year). The citations ranged from 107–1888 with a median of 272. Manuscripts from our top-cited list originated from 20 different countries, with contributions made by 158 authors and 160 organizations. Eighty-eight percent of studies evaluated patient-related radiation exposure, 7% health care workers, and 5% both or were not specified. Thirty-two percent of studies examined adult populations, 14% pediatric, and 54% included both populations or did not specify. Seventy-two percent of studies were dedicated to Computed Tomography, 8% to radiography/fluoroscopy, 9% to interventional procedures, 4% to nuclear medicine, and 7% to a combination of two or more modalities.ConclusionThe top 100 cited articles in medical imaging related to radiation exposure are diverse, originating from many countries with numerous contributing authors. The most common topics covered involve CT and adult patients. The recent peak in the most-highly cited articles (2010) suggests increased attention has been devoted to this field in recent years. Based on these results, it would appear research on radiation exposure in medical imaging is poised to continue expanding.

Publication date: Available online 20 March 2018
Author(s): Rajiv N. Srinivasa, Jeffrey Forris Beecham Chick, Kyle Cooper, Ravi N. Srinivasa
Interventional radiology-operated endoscopy is an underutilized technique which may have a significant impact on the ability to treat patients with a variety of conditions. Interventional radiologists are in a unique position to implement endoscopy into routine practice given the manual dexterity and hand-eye coordination already required to perform other image-guided interventions. When used in combination, endoscopy adds an entirely new dimension to the fluoroscopic-guided procedures of which interventional radiologists are accustomed. A number of new and innovative interventions may be performed in the biliary, genitourinary, and gastrointestinal systems through percutaneous access that interventional radiologists already create. Although other specialists traditionally have performed endoscopic interventions and local politics often dictate referral patterns, a collaborative relationship amongst these specialists and interventional radiology will allow for improved patient care. A concerted effort is needed by interventional radiologists to learn the techniques and equipment required in order to successfully incorporate endoscopy into practice. The article presents the setup, equipment, and potential clinical uses of interventional radiology-operated endoscopy.

### Assessment of dosimetric errors induced by deformable image registration methods in 4D pencil beam scanned proton treatment planning for liver tumours

Publication date: Available online 20 March 2018
Author(s): Cássia O. Ribeiro, Antje Knopf, Johannes A. Langendijk, Damien C. Weber, Antony J. Lomax, Ye Zhang
PurposeRespiratory impacts in pencil beam scanned proton therapy (PBS-PT) are accounted by extensive 4D dose calculations, where deformable image registration (DIR) is necessary for estimating deformation vector fields (DVFs). We aim here to evaluate the dosimetric errors induced by different DIR algorithms in their resulting 4D dose calculations by using ground truth(GT)-DVFs from 4DMRI.Materials and methodsSix DIR methods: ANACONDA, Morfeus, B-splines, Demons, CT Deformable, and Total Variation, were respectively applied to nine 4DCT-MRI liver data sets. The derived DVFs were then used as input for 4D dose calculation. The DIR induced dosimetric error was assessed by individually comparing the resultant 4D dose distributions to those obtained with GT-DVFs. Both single-/three-field plans and single/rescanned strategies were investigated.ResultsDifferences in 4D dose distributions among different DIR algorithms, and compared to the results using GT-DVFs, were pronounced. Up to 40 % of clinically relevant dose calculation points showed dose differences of 10 % or more between the GT. Differences in V95(CTV) reached up to 11.34 ± 12.57 %. The dosimetric errors became in general less substantial when applying multiple-field plans or using rescanning.ConclusionIntrinsic geometric errors by DIR can influence the clinical evaluation of liver 4D PBS-PT plans. We recommend the use of an error bar for correctly interpreting individual 4D dose distributions.

### Editorial Board

Publication date: April 2018
Source:European Journal of Radiology, Volume 101

### Risk factors and aetiopathogenesis of potentially premalignant oral epithelial lesions

Potentially malignant oral mucosal disease has some ability to give rise to malignancy of the oral epithelium i.e. oral squamous cell carcinoma (OSCC). The present article provides a succinct review of the possible or probable causes of potentially premalignant oral epithelial lesions (PPOEL). There is a focus upon studies that examined the causes or aetiological associations with clinically likely or histopathologically detectable oral epithelial dysplasia.

### Assessment of dosimetric errors induced by deformable image registration methods in 4D pencil beam scanned proton treatment planning for liver tumours

Respiratory impacts in pencil beam scanned proton therapy (PBS-PT) are accounted by extensive 4D dose calculations, where deformable image registration (DIR) is necessary for estimating deformation vector fields (DVFs). We aim here to evaluate the dosimetric errors induced by different DIR algorithms in their resulting 4D dose calculations by using ground truth(GT)-DVFs from 4DMRI.

### Risk factors and aetiopathogenesis of potentially premalignant oral epithelial lesions

Publication date: Available online 20 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Luiz Alcino Gueiros, Jair Carneiro Leão, Stefano Fedele, Stephen Porter
Potentially malignant oral mucosal disease has some ability to give rise to malignancy of the oral epithelium i.e. oral squamous cell carcinoma (OSCC). The present article provides a succinct review of the possible or probable causes of potentially premalignant oral epithelial lesions (PPOEL). There is a focus upon studies that examined the causes or aetiological associations with clinically likely or histopathologically detectable oral epithelial dysplasia.

### Detection of major histocompatibility complex molecules in processed allogeneic bone blocks for use in alveolar ridge reconstruction

Publication date: Available online 20 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Tobias Fretwurst, Lames M. Gad, Thorsten Steinberg, Hagen Schmal, Robert Zeiser, Anna-K. Amler, Katja Nelson, Brigitte Altmann
ObjectivesBecause processed allogenic bone blocks contain remnants of cells and other organic material, the present study examined the putative presence of major histocompatibility complex (MHC) molecules in protein extracts derived from processed allogeneic bone blocks.Study DesignProtein content and the immunogenic potential of 3 different processed allografts (Osteograft, DIZG, Berlin, Germany; Caput femoris, DIZG, Berlin, Germany; Human Spongiosa, Charité Tissue Bank, Berlin, Germany) were assessed by protein extraction and analysis of the presence of MHC class 1 and 2 molecules prior to grafting. MHC concentration was measured by using enzyme-linked immunosorbent assay.ResultsProtein content in the allograft materials varied between 0.87 and 1.61 µg protein/mg. In the allograft Human Spongiosa, no MHC was detected, whereas in the allogeneic bone blocks Osteograft and Caput femoris MHC 1 (0.04–0.037 ng/mg graft material) and in Osteograft MHC class 2 molecules were detectable.ConclusionsThe results of the present study suggest that despite thorough processing, a potential antigenicity of allografts is not eliminated. MHC molecules in allografts may sensitize the immune system.

### Morphometric analysis of the frontal sinus: application of industrial digital radiography and virtual endocast

Publication date: March 2018
Source:Journal of Forensic Radiology and Imaging, Volume 12
Author(s): Silviya Nikolova, Diana Toneva, Ivan Georgiev, Angel Dandov, Nikolai Lazarov
BackgroundThe morphology and dimensions of the frontal sinus (FS) are significant in the forensic, surgical and population context.PurposeThe study aimed to compare linear FS measurements taken both on radiographs and virtual endocasts and to assess the impact of the skull angulation on the FS dimensions.Material and MethodsThirteen intact dry skulls of contemporary adult males were radiographed using industrial digital radiography while they were inclined in the Frankfurt plane, through the Caldwell's view up to the Water's view by angular steps of 5°. The width and height of both frontal lobes were measured in each projection. To verify the measurements on the radiographs, ten of the skulls were µCT-scanned and virtual endocasts of the FS were generated.ResultsThe concordance between the measurements on the virtual endocasts and the radiographs in the Caldwell's view showed almost perfect concurrence for the width (0.998) and height on the left side (0.990), and substantial one for the height on the right side (0.961). Since the width is more sensitive compared to the height, any inclination from the initial position at the Caldwell's view caused a significant distortion of the FS measurements.ConclusionThe industrial µCT-systems support both 2D and 3D imaging and could generate images with a high resolution. Therefore, if the industrial digital radiography is selected as an eligible imaging modality for FS investigation and documentation in conformity with the research goals, the appropriate skull positioning ensures reliable readings of the linear FS dimensions.

### Differentiated thyroid cancer and selenium supplements for protection of salivary glands from 131I treatment.

Differentiated thyroid cancer and selenium supplements for protection of salivary glands from 131I treatment.

Hell J Nucl Med. 2017 Mar 20;:

Authors: Mazokopakis E

Abstract
Dear Editor, I read with great interest the article by Son et al about the radioprotective effect of selenium (Se) supplementation for the salivary glands from 131I treatment in patients with differentiated thyroid cancer (DTC). In this study, 8 patients received 300μg of Se (as inorganic sodium selenite; selenase®) orally for 10 days, 3 days before to 6 days after 131I treatment. On the occasion of the use of Se among these patients, I want with this letter to remind the differences among the prescribed Se supplements in clinical practice, such as the possible health consequences of Brazil nut consumption as another choice for the preparation of DTC patients for radioactive iodine (RAI) therapy. Selenium is an essential element with many pleiotropic effects that can be found in foods and supplements in organic form (as selenomethionine, selenocysteine, γ-glutamyl-Se-methylselenocysteine) or/and in inorganic form (as sodium selenate and sodium selenite). Selenium in multivitamin/multimineral supplements or in a stand-alone supplement is often available in the forms of L-selenomethionine, Se-enriched yeast (grown in a high-Se medium), mustard seed-derived Se, or as sodium selenite or sodium selenate. Because these two (organic and inorganic) forms of Se are absorbed and metabolized differently, it is very important for the physicians, when prescribe a Se supplement, to know the contained form of Se. Inorganic forms of Se are easily absorbed through the intestine but poorly retained. Once they reach the blood, inorganic Se is quickly filtered out by the kidneys and excreted in the urine. So, the consumption of supplements with inorganic forms of Se does not offer the maximum health benefits of the element. Conversely, Se-containing amino acids, such as selenomethionine and selenocysteine, are introduced directly into proteins, including muscle proteins. These organic proteins-bound Se (selenoproteins) are better retained, utilized, and incorporated by the human body. About 90% of the received selenomethionine is actually absorbed in the intestinal tract, and about half of that remains in the body. The higher degree of absorption of selenomethionine against selenite was described in a recently published systematic review and meta-analysis by Wichman et al. In this review, a significant decrease in serum thyroid peroxidase antibodies (TPO-Ab) levels was found among patients receiving 200μg selenomethionine, but not among those receiving 200μg sodium selenite. In another investigation, 10 groups of Se-replete subjects were randomly assigned to receive a placebo or either 200 or 400 or 600μg/day Se as selenomethionine, sodium selenite, or high-selenium yeast (in which an estimated 75% of Se was in the form of selenomethionine) for 16 weeks. Selenium bioavailability, based on urinary excretion, was greatest for selenomethionine and lowest for selenite. However, supplementation with any of these forms only affected plasma Se levels and not glutathione peroxidase activity or selenoprotein P concentration, suggesting that study participants were selenium replete before they began taking Se supplements. Because the absorption of selenite was approximately two-thirds of the absorption of selenomethionine in this study, we can assume that the daily dose of 300μg of sodium selenite in the study of Son et al corresponded to 200μg of selenomethionine which is the most frequently used dose in intervention trials. However, in our opinion, the prescription of supplements with organic forms of Se must be preferred, when required. It is also worth mentioning that the prescribed Se supplements should not contain iodine considering that for a successful RAI therapy after thyroidectomy, DTC patients must, not only increase their thyroid-stimulating hormone (TSH) levels, but also deplete the whole body iodine pool through a low-iodine diet (low-quality evidence). One of the richest known food sources of bioavailable Se, in the organic form of selenomethionine, are the Brazil nuts. Brazil nuts grow on massive tropical trees, the Bertholletia excelsa of the Lecythidaceae family, some reaching heights over 45m. The average Se content of each Brazil nut in most elemental analyses varies ranging from 2.7 to 11μg Se/g, and the average weight of each nut varies between 3 and 4 g. Their consumption can increase the likelihood of Se toxicity, regardless of the quantity of the nuts consumed, and thus is not be a safe dietary choice. Moreover, Brazil nuts may be infected externally by aflatoxins or can trigger allergic reactions in sensitive people. However, raw Brazil nuts don't contain iodine and thus their consumption would not undermine the dietary efforts of DTC patient in the framework of the required low-iodine diet. The consumption of 2-3 unshelled and raw (unsalted) Brazil nuts daily could be another choice for the post-thyroidectomy period up to 10 days after RAI therapy among DTC patients who do not want to receive supplements as source of Se. We must emphasize that some patients having DTC and also Hashimoto's thyroiditis may had previously received Se supplements or Brazil nuts for a long period of time before DTC was diagnosed and thyroidectomy had followed. In conclusion, the prescription of supplements with organic forms of Se must be preferred against of supplements with inorganic forms of Se among DTC patients for the protection of their salivary glands from 131I treatment and Brazil nuts could be another choice.

PMID: 29550852 [PubMed - as supplied by publisher]

### Exophytic swelling of the buccal mucosa in a young female patient.

Exophytic swelling of the buccal mucosa in a young female patient.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 21;:

Authors: Martínez R, Marín C, Niklander S, Marshall M, González-Arriagada WA

PMID: 29551257 [PubMed - as supplied by publisher]

### Pentoxifylline, tocopherol, and clodronate for the treatment of mandibular osteoradionecrosis: a systematic review.

Pentoxifylline, tocopherol, and clodronate for the treatment of mandibular osteoradionecrosis: a systematic review.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 14;:

Authors: Martos-Fernández M, Saez-Barba M, López-López J, Estrugo-Devesa A, Balibrea-Del-Castillo JM, Bescós-Atín C

Abstract
OBJECTIVE: The purpose of this study was to evaluate the healing benefit provided by the antioxidant and antifibrotic properties of pentoxifylline-tocopherol or pentoxifylline-tocopherol-clodronate in combination therapy for osteoradionecrosis.
STUDY DESIGN: We searched for relevant reports in PubMed by using a combination of "osteoradionecrosis" and the following keywords: "pentoxifillyne," "tocopherol," "vitamin E," or "clodronate." We considered articles in English or Spanish, with no limitations on the publication date.
RESULTS: The combination of pentoxifylline plus tocopherol with or without clodronate was found to be effective for the treatment of mandibular osteoradionecrosis, although data were generally scarce and mostly came from retrospective case series.
CONCLUSIONS: This drug therapy is well tolerated and could be promising for the treatment of mandibular osteoradionecrosis, but prospective randomized controlled clinical trials are needed for further clarification.

PMID: 29550081 [PubMed - as supplied by publisher]

### Expression of cyclin D1 correlates with p27KIP1 and regulates the degree of oral dysplasia and squamous cell carcinoma differentiation.

Expression of cyclin D1 correlates with p27KIP1 and regulates the degree of oral dysplasia and squamous cell carcinoma differentiation.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 01;:

Authors: Guan G, Bakr MM, Firth N, Love RM

Abstract
OBJECTIVES: The aim of this study was to identify an association or link between cyclin D1 and p27KIP1 protein expression and dysplastic changes or progression.
STUDY DESIGN: Oral mucosal biopsies with a diagnosis of non-neoplastic tissue (gingivitis) (n = 10), mild to moderate oral epithelial dysplasia (n = 12), and oral squamous cell carcinoma (n = 11) were evaluated by using immunohistochemistry. Scanning software was used to determine cyclin D1 and p27KIP1 intensity of expression, location, and pattern.
RESULTS: A significant increase in expression of cyclin D1 and a decrease in expression of p27KIP1 proteins were identified in oral epithelial dysplasia and less differentiated oral squamous cell carcinoma (OSCC). There was a more diffuse distribution of cyclin D1 protein expression extending from the basal cell layer into the prickle cell layers in epithelial dysplasia and extending within all epithelial layers in OSCC. Cases of oral epithelial dysplasia had moderate infrequent expression of p27KIP1. There were no p27KIP1-positive cells in OSCC. The percentage of cells with both nuclear and cytoplasmic cyclin D1 staining was higher in OSCC specimens than control groups and oral epithelial dysplasia.
CONCLUSIONS: The expression of both cyclin D1 and p27KIP1 correlated with the grade of oral epithelial dysplasia and degree of OSCC differentiation. The results obtained will be verified through a basic follow-up of the cases to determine the prognosis/progression of oral dysplasia.

PMID: 29550080 [PubMed - as supplied by publisher]

### Vitamin D deficiency and periodontal clinical attachment loss in HIV-seropositive women: A secondary analysis conducted in the Women's Interagency HIV Study (WIHS).

Vitamin D deficiency and periodontal clinical attachment loss in HIV-seropositive women: A secondary analysis conducted in the Women's Interagency HIV Study (WIHS).

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 19;:

Authors: Dragonas P, Kaste LM, Nunn M, Gajendrareddy PK, Weber KM, Cohen M, Adeyemi OM, French AL, Sroussi HY

Abstract
OBJECTIVE: The aim of this study was to test a hypothesized positive association between low vitamin D (VitD) serum levels and the severity of periodontal disease in women with HIV infection.
STUDY DESIGN: This was a cross-sectional secondary analysis of data from an oral substudy conducted within the Chicago site of the Women's Interagency HIV Study. Serum VitD levels and clinical attachment loss (CAL) measurements were available for 74 women with HIV infection. VitD levels were treated as both continuous and categorical variables in bivariate and multivariate analyses. Mean clinical attachment loss (mCAL) was determined for each subject by obtaining the averages of measurements taken at 4 sites in each measured tooth.
RESULTS: Average age of study participants (n = 74) was 39.6 years (standard deviation 7.2), and the majority were African Americans (70.3%) with VitD deficiency (58.1%). VitD deficiency was positively associated with higher mCAL (P = .012). After adjustment for race, age, smoking, and HIV viral load, an association was found between VitD deficiency and mCAL (Beta 0.438; P = .036).
CONCLUSIONS: We identified a previously unreported association between VitD deficiency and mCAL in women with HIV infection. Larger and more inclusive, multisite, longitudinal studies are warranted to investigate whether these findings can be generalized to all individuals with HIV infection in the current treatment era and to determine causality.

PMID: 29550079 [PubMed - as supplied by publisher]

### Oral manifestations of lipoid proteinosis in a 10-year-old female: A case report and literature update.

Oral manifestations of lipoid proteinosis in a 10-year-old female: A case report and literature update.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 14;:

Authors: Lee KC, Peters SM, Ko YCK, Kunkle TC, Perrino MA, Yoon AJ, Philipone EM

Abstract
Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. Here, we present a case of LP with significant oral, dermatologic, and neurologic manifestations occurring in a 10 year-old female of Asian descent. In addition to the more typical oral findings of restricted tongue movement and labial and buccal mucosal involvement, this case highlights an unusual pattern of gingival enlargement infrequently reported in the literature. As LP almost always involves the oral cavity, often before the onset of cutaneous lesions, it is important for dental providers to be familiar with the oral manifestations of this disease. Early detection and diagnosis of LP by the dental practitioner can help expedite proper multidisciplinary care and lead to significant reductions in patient morbidity and mortality.

PMID: 29548668 [PubMed - as supplied by publisher]

### Objective

The identification of cardiac sarcoidosis is challenging as there is no gold standard consensually admitted for its diagnosis. The aim of this study was to evaluate the diagnostic value of the assessment of cardiac dynamic 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET/CT) and net influx constant (Ki) in patients suspected of cardiac sarcoidosis.

### Methods

Data obtained from 30 biopsy-proven sarcoidosis patients suspected of cardiac sarcoidosis who underwent a 50-min list-mode cardiac dynamic 18F-FDG PET/CT after a 24 h high-fat and low-carbohydrate diet were analyzed. A normalized coefficient of variation of quantitative glucose influx constant, calculated as the ratio: standard deviation of the segmental Ki (min−1)/global Ki (min−1) was determined using a validated software (Carimas® 2.4, Turku PET Centre). Cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare criteria. Receiving operating curve analysis was performed to determine sensitivity and specificity of cardiac dynamic 18F-FDG PET/CT analysis to diagnose cardiac sarcoidosis.

### Results

Six out of 30 patients (20%) were diagnosed as having cardiac sarcoidosis. Myocardial glucose metabolism was significantly heterogeneous in patients with cardiac sarcoidosis who showed significantly higher normalized coefficient of variation values compared to patients without cardiac sarcoidosis (0.513 ± 0.175 vs. 0.205 ± 0.081; p = 0.0007). Using ROC curve analysis, we found a cut-off value of 0.38 for the diagnosis of cardiac sarcoidosis with a sensitivity of 100% and a specificity of 91%.

### Conclusions

Our results suggest that quantitative analysis of cardiac dynamic 18F-FDG PET/CT could be a useful tool for the diagnosis of cardiac sarcoidosis.

### Purpose of Review

The substantia nigra pars compacta (SNc) and its projection to the striatum undergo profound degeneration in Parkinson's disease (PD). Literature on imaging PD-related changes in the nigrostriatal system using iron-sensitive and diffusion-sensitive MRI contrasts has been contentious, with both negative and positive results reported in each contrast. These incompatible findings may be due to the inaccurate placement of regions of interest for the SNc.

### Recent Findings

Histologically, SNc is characterized by the presence of melanized dopamine neurons, whereas the substantia nigra pars reticulata is characterized by high iron content. Despite this histology, previous studies have frequently relied upon iron-sensitive MRI contrast when segmenting the SNc. This is also problematic since recent work found iron-sensitive and neuromelanin-sensitive contrasts are largely non-overlapping in substantia nigra. Since neuromelanin-sensitive MRI contrast colocalizes with the melanized dopamine neurons of the SNc upon radiologic–histologic correlation, the use of neuromelanin-sensitive MRI will allow for accurate localization of SNc and better capture parkinsonian pathobiology than iron-sensitive MRI.

### Summary

This article outlines iron-sensitive and diffusion-sensitive MRI contrasts, and provides an overview of neuromelanin-sensitive MRI techniques. The application of these techniques to image parkinsonian pathobiology in substantia nigra is then reviewed, with a focus on neuromelanin-sensitive imaging methods for the accurate and reproducible study of PD-related changes in SNc. These advances may help resolve current controversies surrounding MRI investigations of substantia nigra in PD and related disorders.

### Purpose

Deep brain stimulation (DBS) is a procedure requiring accurate targeting and electrode placement. The two key elements for successful planning are preserving patient safety by ensuring a safe trajectory and creating treatment efficacy through optimal selection of the stimulation point. In this work, we present the first approach of computer-assisted preoperative DBS planning to automatically optimize both the safety of the electrode's trajectory and location of the stimulation point so as to provide the best clinical outcome.

### Methods

Building upon the findings of previous works focused on electrode trajectory, we added a set of constraints guiding the choice of stimulation point. These took into account retrospective data represented by anatomo-clinical atlases and intersections between the stimulation region and sensitive anatomical structures causing side effects. We implemented our method into automatic preoperative planning software to assess if the algorithm was able to simultaneously optimize electrode trajectory and the stimulation point.

### Results

Leave-one-out cross-validation on a dataset of 18 cases demonstrated an improvement in the expected outcome when using the new constraints. The distance to critical structures was not reduced. The intersection between the stimulation region and structures sensitive to stimulation was minimized.

### Conclusions

Introducing these new constraints guided the planning to select locations showing a trend toward symptom improvement, while minimizing the risks of side effects, and there was no cost in terms of trajectory safety.

### Coping with loss of ability vs. emotional control and self-esteem in women after mastectomy

Publication date: May–June 2018
Source:Reports of Practical Oncology & Radiotherapy, Volume 23, Issue 3
Author(s): Katarzyna Cieślak, Wojciech Golusiński
AimDoes coping with the loss of ability depend on self-esteem and emotional control?BackgroundPersons who experience losses in two dimensions, i.e. health and ability can deal with the loss by physical therapy, and also by mental and socio-professional rehabilitation. But far and foremost, it is the personality of the person who experiences the loss that matters most.Materials and methodsThe study included 37 patients after mastectomy. They were divided into two groups according to the time elapsed from cancer diagnosis. The study was conducted using the Questionnaire on Coping With Ability Loss (P. Wolski), Self-Esteem Loss (M. Rosenberg,) and the Courtauld Emotional Control Scale – CECS.ResultsIn Group I, the higher level of acceptance in the QCAL test, the higher self-esteem. The more depression experienced by individuals, the lower is their level of self-esteem or the less depression experienced, the higher the self-esteem. In Group II, the higher the level of depression, the lower the level of anger. The greater the struggle, the lower level of anger. The lower the level of depression and struggle, the higher the level of emotion control.ConclusionsWomen diagnosed no longer than five years back do not differ from those diagnosed further back in terms of copying with the loss of ability, self-esteem and emotional control.

### Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients?

Publication date: May–June 2018
Source:Reports of Practical Oncology & Radiotherapy, Volume 23, Issue 3
Author(s): Annamaria Didona, Valentina Lancellotta, Claudio Zucchetti, Bianca Moira Panizza, Alessandro Frattegiani, Martina Iacco, Anna Concetta Di Pilato, Simonetta Saldi, Cynthia Aristei
BackgroundIntensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer.Methods and materialsStep and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle3 TPS (v 9.8) using 6MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66Gy, 60Gy and 54Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs (Dmean, D2%, D50%, D95%, D98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times.ResultsCompared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D98% and D95%. It significantly spared parotid and submandibular glands and was associated with a lower Dmean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better Dmean, to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the Dmean to the larynx was also worse. Compared with SS-IMRT and VDR-VMAT, CDR-VMAT was associated with higher average monitor unit values and significantly shorter average delivery times.ConclusionsCDR-VMAT appeared to be a valid option in Radiation Therapy Centers that lack a dedicated linear accelerator for volumetric arc therapy with variable dose-rates and gantry velocities, and are unwilling or unable to sanction major expenditure at present but want to adopt volumetric techniques.

### Volumetric Textural Analysis of Colorectal Masses at CT Colonography

Publication date: Available online 19 March 2018
Author(s): B. Dustin Pooler, Meghan G. Lubner, Jake R. Theis, Richard B. Halberg, Zhengrong Liang, Perry J. Pickhardt
Rationale and ObjectivesTo (1) apply a quantitative volumetric textural analysis (VTA) to colorectal masses at CT colonography (CTC) for the differentiation of malignant and benign lesions and to (2) compare VTA with human performance.Materials and MethodsA validated, quantitative VTA method was applied to 63 pathologically proven colorectal masses (mean size, 4.2 cm; range, 3–8 cm) at noncontrast CTC in 59 adults (mean age, 66.5 years; range, 45.9–91.6 years). Fifty-one percent (32/63) of the masses were invasive adenocarcinoma, and the remaining 49% (31/63) were large benign adenomas. Three readers with CTC experience independently assessed the likelihood of malignancy using a 5-point scale (1 = definitely benign, 2 = probably benign, 3 = indeterminate, 4 = probably malignant, 5 = definitely malignant). Areas under the curve (AUCs) and accuracy levels were compared.ResultsVTA achieved optimal sensitivity of 83.6% vs 91.7% for human readers (P = .034), with specificities of 87.5% and 77.4%, respectively (P = .007). No significant difference in overall accuracy was seen between VTA and human readers (85.5% vs 84.7%, P = .753). The AUC for differentiating benign and malignant lesions was 0.936 for VTA and 0.917 for human readers. Intraclass correlation coefficient among the human readers was 0.76, indicating good to excellent agreement.ConclusionVTA demonstrates excellent performance for distinguishing benign from malignant colorectal masses (≥3 cm) at CTC, comparable yet potentially complementary to experienced human performance.

### Purpose

We present a hybrid 2D–3D ultrasound (US) rigid registration method for navigated prostate biopsy that enables continuous localization of the biopsy trajectory during the exam.

### Methods

Current clinical computer-assisted biopsy systems use either sensor-based or image-based approaches. We combine the advantages of both in order to obtain an accurate and real-time navigation based only on an approximate localization of the US probe. Starting with features extracted in both 2D and 3D images, our method introduces a variant of the iterative closest point (ICP) algorithm. Among other differences to ICP, a combination of both the euclidean distance of feature positions and the similarity distance of feature descriptors is used to find matches between 2D and 3D features. The evaluation of the method is twofold. First, an analysis of variance on input parameters is conducted to estimate the sensitivity of our method to their initialization. Second, for a selected set of their values, the target registration error (TRE) was calculated on 29,760 (resp. 4000) registrations in two different experiments. It was obtained using manually identified anatomical fiducials.

### Results

For 160 US volumes, from 20 patients, recorded during routine biopsy procedures performed in two hospitals by six operators, the mean TRE was $$3.91\pm 3.22$$  mm (resp. $$4.37\pm 2.62$$  mm).

### Conclusion

This work allows envisioning further developments for prostate navigation and their clinical transfer.