Πέμπτη, 22 Μαρτίου 2018

Combining baseline TMTV and gene profiling for a better risk stratification in diffuse large B cell lymphoma



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Preoperative prediction of microvascular invasion of hepatocellular carcinoma using 18 F-FDG PET/CT: a multicenter retrospective cohort study

Abstract

Purpose

The aim of this study was to assess the potential of tumor 18F-fluorodeoxyglucose (FDG) avidity as a preoperative imaging biomarker for the prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC).

Methods

One hundred and fifty-eight patients diagnosed with Barcelona Clinic Liver Cancer stages 0 or A HCC (median age, 57 years; interquartile range, 50–64 years) who underwent 18F-FDG positron emission tomography with computed tomography (PET/CT) before curative surgery at seven university hospitals were included. Tumor FDG avidity was measured by tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor on FDG PET/CT imaging. Logistic regression analysis was performed to identify significant parameters associated with MVI. The predictive performance of TLR and other clinical variables was assessed using receiver operating characteristic (ROC) curve analysis.

Results

MVI was present in 76 of 158 patients with HCCs (48.1%). Multivariable logistic regression analysis revealed that TLR, serum alpha-fetoprotein (AFP) level, and tumor size were significantly associated with the presence of MVI (P < 0.001). Multinodularity was not significantly associated with MVI (P = 0.563). The area under the ROC curve (AUC) for predicting the presence of MVI was best with TLR (AUC = 0.704), followed by tumor size (AUC = 0.685) and AFP (AUC = 0.670). We were able to build an improved prediction model combining TLR, tumor size, and AFP by using multivariable logistic regression modeling (AUC = 0.756).

Conclusions

Tumor FDG avidity measured by TLR on FDG PET/CT is a preoperative imaging biomarker for the prediction of MVI in patients with HCC.



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Prediction of outcome using pretreatment 18 F-FDG PET/CT and MRI radiomics in locally advanced cervical cancer treated with chemoradiotherapy

Abstract

Purpose

The aim of this study is to determine if radiomics features from 18fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) images could contribute to prognoses in cervical cancer.

Methods

One hundred and two patients (69 for training and 33 for testing) with locally advanced cervical cancer (LACC) receiving chemoradiotherapy (CRT) from 08/2010 to 12/2016 were enrolled in this study. 18F-FDG PET/CT and MRI examination [T1, T2, T1C, diffusion-weighted imaging (DWI)] were performed for each patient before CRT. Primary tumor volumes were delineated with the fuzzy locally adaptive Bayesian algorithm in the PET images and with 3D Slicer™ in the MRI images. Radiomics features (intensity, shape, and texture) were extracted and their prognostic value was compared with clinical parameters for recurrence-free and locoregional control.

Results

In the training cohort, median follow-up was 3.0 years (range, 0.43–6.56 years) and relapse occurred in 36% of patients. In univariate analysis, FIGO stage (I–II vs. III–IV) and metabolic response (complete vs. non-complete) were probably associated with outcome without reaching statistical significance, contrary to several radiomics features from both PET and MRI sequences. Multivariate analysis in training test identified Grey Level Non UniformityGLRLM in PET and EntropyGLCM in ADC maps from DWI MRI as independent prognostic factors. These had significantly higher prognostic power than clinical parameters, as evaluated in the testing cohort with accuracy of 94% for predicting recurrence and 100% for predicting lack of loco-regional control (versus ~50–60% for clinical parameters).

Conclusions

In LACC treated with CRT, radiomics features such as EntropyGLCM and GLNUGLRLM from functional imaging DWI-MRI and PET, respectively, are independent predictors of recurrence and loco-regional control with significantly higher prognostic power than usual clinical parameters. Further research is warranted for their validation, which may justify more aggressive treatment in patients identified with high probability of recurrence.



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Value of 18 F–FDG PET/CT for predicting EGFR mutations and positive ALK expression in patients with non-small cell lung cancer: a retrospective analysis of 849 Chinese patients

Abstract

Purpose

Epidermal growth factor receptor (EGFR) mutations and the anaplastic lymphoma kinase (ALK) rearrangement are the two most common druggable targets in non-small cell lung cancer (NSCLC). However, genetic testing is sometimes unavailable. Previous studies regarding the predictive role of 18F–FDG PET/CT for EGFR mutations in NSCLC patients are conflicting. We investigated whether or not 18F–FDG PET could be a valuable noninvasive method to predict EGFR mutations and ALK positivity in NSCLC using the largest patient cohort to date.

Methods

We retrospectively reviewed and included 849 NSCLC patients who were tested for EGFR mutations or ALK status and subjected to 18F–FDG PET/CT prior to treatment. The differences in several clinical characteristics and three parameters based on 18F–FDG PET/CT, including the maximal standard uptake value (SUVmax) of the primary tumor (pSUVmax), lymph node (nSUVmax) and distant metastasis (mSUVmax), between the different subgroups were analyzed. Multivariate logistic regression analysis was performed to identify predictors of EGFR mutations and ALK positivity.

Results

EGFR mutations were identified in 371 patients (45.9%). EGFR mutations were found more frequently in females, non-smokers, adenocarcinomas and stage I disease. Low pSUVmax, nSUVmax and mSUVmax were significantly associated with EGFR mutations. Multivariate analysis demonstrated that pSUVmax < 7.0, female sex, non-smoker status and adenocarcinoma were predictors of EGFR mutations. The receiver operating characteristic (ROC) curve yielded area under the curve (AUC) values of 0.557 and 0.697 for low pSUVmax alone and the combination of the four factors, respectively. ALK-positive patients tended to have a high nSUVmax. Younger age and distant metastasis were the only two independent predictors of ALK positivity.

Conclusion

We demonstrated that low pSUVmax is associated with mutant EGFR status and could be integrated with other clinical factors to enhance the discriminability on the EGFR mutation status in some NSCLC patients whose EGFR testing is unavailable.



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Reply: Interim FDG-PET/CT in primary mediastinal diffuse large B-cell lymphoma: really almost useless procedure?



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H. William Strauss, Giuliano Mariani, Duccio Volterrani, Steven M. Larson (editors): Nuclear Oncology: From Pathophysiology to Clinical Applications, second edition



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Glioblastoma multiforme: another potential application for 68 Ga-PSMA PET/CT as a guide for targeted therapy



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Bone radionuclide therapy and increased survival with radium-223 is the way to go for nuclear medicine: the offer that oncologists cannot refuse



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Yuji Kuge, Tohru Shiga, Nagara Tamaki (editors): Perspectives on nuclear medicine for molecular diagnosis and integrated therapy



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The diagnostic value of 18 F–FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study

Abstract

Purpose

The aim of this study was to determine the diagnostic value of 18F–fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis.

Methods

From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18F–FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others' image interpretation. 18F–FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines.

Results

For 18F–FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F–FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%).

Conclusion

18F–FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18F–FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.



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Solitary testicular metastasis from prostate cancer. A case report diagnosed by PET/CT with PSMA



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Comparison of positron emission tomography/computed tomography and magnetic resonance imaging for posttherapy evaluation in patients with advanced cervical cancer receiving definitive concurrent chemoradiotherapy

Abstract

Purpose

Our purpose was to assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) and pelvic/abdominal magnetic resonance imaging (MRI) after concurrent chemoradiotherapy (CCRT) for posttherapy evaluation in patients with advanced cervical cancer.

Methods

Patients with cervical squamous cell carcinoma, either with advanced FIGO stage or with positive pelvic or para-aortic lymph node (PALN), received PET/CT using [18F]fluorodeoxyglucose and MRI including diffusion-weighted imaging between 2 and 3 months after CCRT completion. PET/CT were interpreted independently by two nuclear medicine physicians and MRI by two radiologists using the same scoring system. Active residual tumor was proven by pathological confirmation or disease progression on imaging studies within one year after CCRT and the disease regions were classified as local, regional, PALN, or distant. Patient-based and region-based comparison was performed using the receiver operating characteristic curve analysis.

Results

The study included 55 patients and 15 (27%) patients had active residual tumor. The diagnostic performance of PET/CT is significantly superior to that of MRI in patient-based analysis (P = 0.025) and in the detection of local (P = 0.045) and regional (P = 0.014) disease. The patient-based sensitivity, specificity, and accuracy of PET/CT are 60%, 100%, and 89% while those of MRI are 27%, 100%, and 80%.

Conclusions

PET/CT is superior to MRI for posttherapy evaluation in patients with advanced cervical cancer 2–3 months after definitive CCRT, mainly for the detection of residual local and regional disease. Patients with negative or equivocal results should be followed up regularly due to suboptimal sensitivities of imaging.



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Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe)

Abstract

FDG PET/CT (18F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients.

Materials and methods

Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff's alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease).

Results

Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35–66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff's alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4.

Conclusions

IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.



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Interim FDG PET/CT in primary mediastinal diffuse large B-cell lymphoma: really almost useless procedure?



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Reply to: “All that glitters is not gold – new reconstruction methods using Deauville criteria for patient reporting”



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Liver metastases from prostate cancer at 11C-Choline PET/CT: a multicenter, retrospective analysis

Abstract

Aim

During our daily clinical practice using 11C-Choline PET/CT for restaging patients affected by relapsing prostate cancer (rPCa) we noticed an unusual but significant occurrence of hypodense hepatic lesions with a different tracer uptake. Thus, we decided to evaluate the possible correlation between rPCa and these lesions as possible hepatic metastases.

Materials and methods

We retrospectively enrolled 542 patients diagnosed with rPCa in biochemical relapse after a radical treatment (surgery and/or radiotherapy). Among these, patients with a second tumor or other benign hepatic diseases were excluded. All patients underwent 11C-Choline PET/CT during the standard restaging workup of their disease. We analyzed CT images to evaluate the presence of hypodense lesions and PET images to identify the relative tracer uptake. In accordance to the subsequent oncological history, five clinical scenarios were recognized [Table 1]: normal low dose CT (ldCT) and normal tracer distribution (Group A); evidence of previously unknown hepatic round hypodense areas at ldCT with normal rim uptake (Group B); evidence of previously known hepatic round hypodense areas at ldCT stable over time and with normal rim uptake (Group C); evidence of previously known hepatic round hypodense areas at ldCT, in a previous PET/CT scan, with or without rim uptake and significantly changing over time in terms of size and/or uptake (Group D); evidence of hepatic round hypodense areas at ldCT with or without rim uptake confirmed as prostate liver metastases by histopathology, triple phase ceCT, ce-ultra sound (CEUS) and clinical/biochemical evaluation (Group E). We evaluated the correlation with PSA level at time of scan, rim SUVmax and association with local relapse or non-hepatic metastases (lymph nodes, bone, other parenchyma).

Results

Five hundred and forty-two consecutive patients were retrospectively enrolled. In 140 of the 542 patients more than one 11C-choline PET/CT had been performed. A total of 742 11C-Choline PET/CT scans were analyzed. Of the 542 patients enrolled, 456 (84.1%) had a normal appearance of the liver both at ldCT and PET (Group A). 19/542 (3,5%) belonged to Group B, 13/542 (2.4%) to Group C, 37/542 (6.8%) to Group D and 18/542 (3.3%) to Group E. Mean SUVmax of the rim was: 4.5 for Group B; 4.2 for Group C; 4.8 for Group D; 5.9 for Group E. Mean PSA level was 5.27 for Group A, 7.9 for Group B, 10.04 for Group C, 10.01 for Group D, 9.36 for Group E. Presence of positive findings at 11C-Choline PET/CT in any further anatomical area (local relapse, lymph node, bone, other extra hepatic sites) correlated with an higher PSA (p = 0.0285). In both the univariate and multivariate binary logistic regression analyses. PSA, SUVmax of the rim, local relapse, positive nodes were not associated to liver mets (Groups D-E) (p > 0.05). On the contrary, a significant correlation was found between the presence of liver metG (group D-E) and bone lesions (p= 0.00193).

Conclusion

Our results indicate that liver metastases in relapsing prostate cancer may occur frequently. The real incidence evaluation needs more investigations. In this case and despite technical limitations, Choline PET/CT shows alterations of tracer distribution within the liver that could eventually be mistaken for simple cysts but can be suspected when associated to high trigger PSA, concomitant bone lesions or modification over time. In this clinical setting an accurate analysis of liver tracer distribution (increased or decreased uptake) by the nuclear medicine physician is, therefore, mandatory.



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Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy

Abstract

Purpose

Our purpose was to examine the prognostic value of post-CRT PET based on the presence or absence of FDG-avid metastatic lymph node(s) and metabolic response of the primary tumor in patients with clinically node-positive ESCC treated with definitive chemoradiotherapy (dCRT).

Methods

We identified 108 eligible patients treated by chemoradiotherapy (CRT) with or without resection from our prospectively collected database. Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after initial CRT was defined as the Post-CRT PET favorable group (yPET-F), and otherwise as unfavorable group (yPET-U). The Kaplan-Meier method and Cox regression were performed for survival analyses and multivariable analysis, respectively.

Results

The study cohort was comprised of 59 patients receiving dCRT. Forty-five patients receiving trimodality therapy (TMT) comprised the comparative group and four patients were excluded from further analyses for developing interval distant metastasis detected on post-CRT PET scan. The median follow-up for the study cohort was 41 months. On K-M analysis of the study cohort, yPET-F was found to have significantly better OS (2-year: 72.5% vs 13.7%, p < 0.01) and DMFS (2-year: 71.6% vs 36.6%, p = 0.01) than yPET-U. In multivariable analysis, yPET-F remained as a strong independent favorable prognosticator on both OS (HR 0.08, p < 0.01) and DMFS (HR 0.14, p = 0.02) for the dCRT cohort. Compared with TMT cohort, for yPET-U patients, TMT had better OS (p = 0.03) than dCRT-Operable and dCRT-Operable had superior OS (p = 0.04) than dCRT-Unresectable. For yPET-F patients, there was no difference in both OS (p > 0.99) and DMFS (p = 0.92) between these three groups.

Conclusions

Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after CRT (i.e., yPET-F status) prognosticate for excellent OS and DMFS in cN+ ESCC patients treated with dCRT, and might be comparable to TMT.



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EANM guideline for radionuclide therapy with radium-223 of metastatic castration-resistant prostate cancer

Abstract

Radium Ra-223 dichloride (radium-223, Xofigo®) is a targeted alpha therapy approved for the treatment of castration-resistant prostate cancer (CRPC) with symptomatic bone metastases and no known visceral metastatic disease. Radium-223 is the first targeted alpha therapy in this indication providing a new treatment option, with evidence of a significant survival benefit, both in overall survival and in the time to the first symptomatic skeletal-related event. The skeleton is the most common metastatic site in patients with advanced prostate cancer. Bone metastases are a clinically significant cause of morbidity and mortality, often resulting in bone pain, pathologic fracture, or spinal cord compression necessitating treatment. Radium-223 is selectively accumulated in the bone, specifically in areas of high bone turnover, by forming complexes with the mineral hydroxyapatite (the inorganic matrix of the bone). The alpha radiation generated during the radioactive decay of radium-223 produces a palliative anti-tumour effect on the bone metastases. The purpose of this guideline is to assist nuclear medicine specialists in evaluating patients who might be candidates for treatment using radium-223, planning and performing this treatment, understanding and evaluating its consequences, and improving patient management during therapy and follow-up.



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Life is not black and white, nor just Shades of Gray



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EANM guidelines for radionuclide therapy of bone metastases with beta-emitting radionuclides

Abstract

The skeleton is the most common metastatic site in patients with advanced cancer. Pain is a major healthcare problem in patients with bone metastases. Bone-seeking radionuclides that selectively accumulate in the bone are used to treat cancer-induced bone pain and to prolong survival in selected groups of cancer patients. The goals of these guidelines are to assist nuclear medicine practitioners in: (a) evaluating patients who might be candidates for radionuclide treatment of bone metastases using beta-emitting radionuclides such as strontium-89 (89Sr), samarium-153 (153Sm) lexidronam (153Sm-EDTMP), and phosphorus-32 (32P) sodium phosphate; (b) performing the treatments; and ©) understanding and evaluating the treatment outcome and side effects.



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3D Deep Learning Angiography (3D-DLA) from C-arm Conebeam CT [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Deep learning is a branch of artificial intelligence that has demonstrated unprecedented performance in many medical imaging applications. Our purpose was to develop a deep learning angiography method to generate 3D cerebral angiograms from a single contrast-enhanced C-arm conebeam CT acquisition in order to reduce image artifacts and radiation dose.

MATERIALS AND METHODS:

A set of 105 3D rotational angiography examinations were randomly selected from an internal data base. All were acquired using a clinical system in conjunction with a standard injection protocol. More than 150 million labeled voxels from 35 subjects were used for training. A deep convolutional neural network was trained to classify each image voxel into 3 tissue types (vasculature, bone, and soft tissue). The trained deep learning angiography model was then applied for tissue classification into a validation cohort of 8 subjects and a final testing cohort of the remaining 62 subjects. The final vasculature tissue class was used to generate the 3D deep learning angiography images. To quantify the generalization error of the trained model, we calculated the accuracy, sensitivity, precision, and Dice similarity coefficients for vasculature classification in relevant anatomy. The 3D deep learning angiography and clinical 3D rotational angiography images were subjected to a qualitative assessment for the presence of intersweep motion artifacts.

RESULTS:

Vasculature classification accuracy and 95% CI in the testing dataset were 98.7% (98.3%–99.1%). No residual signal from osseous structures was observed for any 3D deep learning angiography testing cases except for small regions in the otic capsule and nasal cavity compared with 37% (23/62) of the 3D rotational angiographies.

CONCLUSIONS:

Deep learning angiography accurately recreated the vascular anatomy of the 3D rotational angiography reconstructions without a mask. Deep learning angiography reduced misregistration artifacts induced by intersweep motion, and it reduced radiation exposure required to obtain clinically useful 3D rotational angiography.



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The New Low-Profile WEB 17 System for Treatment of Intracranial Aneurysms: First Clinical Experiences [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

The Woven EndoBridge (WEB) is an intrasaccular flow diverter intended to treat wide-neck aneurysms. The latest generation WEBs needed a 0.021-inch microcatheter in the small sizes. Recently, a lower profile range of WEBs compliant with a 0.017-inch microcatheter (WEB 17) has been introduced. We present the first clinical results of treatment of both ruptured and unruptured aneurysms with the WEB 17.

MATERIALS AND METHODS:

Between December 2016 and September 2017, forty-six aneurysms in 40 patients were treated with the WEB 17. No supporting stents or balloons were used. Twenty-five aneurysms were ruptured (54%). There were 6 men and 34 women (mean age, 62 years; median, 63 years; range, 46–87 years). The mean aneurysm size was 4.9 mm (median, 5 mm; range, 2–7 mm).

RESULTS:

There were 2 thromboembolic procedural complications without clinical sequelae and no ruptures. The overall permanent procedural complication rate was 0% (0 of 40; 97.5% CI, 0%–10.4%). Imaging follow-up at 3 months was available in 33 patients with 39 aneurysms (97.5% of 40 eligible aneurysms). In 1 aneurysm, the detached WEB was undersized and the remnant was additionally treated with coils after 1 week. This same aneurysm reopened at 3 months and was again treated with a second WEB. One other aneurysm showed persistent WEB filling at 3 months. Complete occlusion was achieved in 28 of 39 aneurysms (72%), and 9 aneurysms (23%) showed a neck remnant.

CONCLUSIONS:

The WEB 17 is safe and effective for both ruptured and unruptured aneurysms. The WEB 17 is a valuable addition to the existing WEB size range, especially for very small aneurysms.



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Endovascular Management of Acute Stroke in the Elderly: A Systematic Review and Meta-Analysis [ADULT BRAIN]

Background:

Acute ischemic stroke occurs more frequently, presents with more severe symptoms, and has worse outcomes in elderly patients. The safety and efficacy of endovascular therapy for acute stroke in this age group has not been fully established.

Purpose:

We present the results of a systematic review and meta-analysis examining clinical, procedural, and radiologic outcomes of endovascular therapy for acute stroke in patients older than 80 years of age.

Data Sources:

We searched PubMed, MEDLINE, and EMBASE from 1992 to week 35 of 2017 for studies evaluating endovascular therapy for acute stroke in the elderly.

Study Selection:

Two independent reviewers selected studies and abstracted data. The primary end point was good functional outcome at 3 months defined as modified Rankin Scale score of ≤2.

Data Analysis:

Data were analyzed using random-effects meta-analysis.

Data Synthesis:

Seventeen studies reporting on 860 patients were included. The rate of good functional outcome at 3 months was 27% (95% CI, 21%–32%). Mortality at 3 months was 34% (95% CI, 23%–44%). Successful recanalization was achieved in 78% of patients (95% CI, 72%–85%). Procedure-related complications occurred in 11% (95% CI, 4%–17%). The incidence of intracranial hemorrhage was 24% (95% CI, 15%–32%), and for symptomatic intracranial hemorrhage, it was 8% (95% CI, 5%–10%). The mean time to groin was 251 minutes (95% CI, 224–278 minutes). Procedure time was 99 minutes (95% CI, 67–131 minutes).

Limitations:

I2 values were above 50% for all outcomes, indicating substantial heterogeneity.

Conclusions:

Good functional recovery in octogenarians treated with endovascular therapy for acute stroke can be achieved in a high proportion of patients despite the higher incidence of comorbidity in this cohort. Outcomes are inferior to those reported for younger patients; however, endovascular therapy can allow at least 1 in 4 patients older than 80 years of age to regain independent function at 3 months. More research is required to improve patient selection in the elderly, but age should not be a discriminator when deciding to offer endovascular therapy for patients with acute stroke.



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Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access [SPINE]

SUMMARY:

Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1–2 level was used in 2; the L2–3 level, in 10; the L3–4 level, in 12; and the L4–5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture.



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Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

One-stop management of mechanical thrombectomy–eligible patients with large-vessel occlusion represents an innovative approach in acute stroke treatment. This approach reduces door-to-reperfusion times by omitting multidetector CT, using flat detector CT as pre-mechanical thrombectomy imaging. The purpose of this study was to compare the diagnostic performance of the latest-generation flat detector CT with multidetector CT.

MATERIALS AND METHODS:

Prospectively derived data from patients with ischemic stroke with large-vessel occlusion and mechanical thrombectomy were analyzed in this monocentric study. All included patients underwent multidetector CT before referral to our comprehensive stroke center and flat detector CT in the angiography suite before mechanical thrombectomy. Diagnosis of early ischemic signs, quantified by the ASPECTS, was compared between modalities using cross tables, the Pearson correlation, and Bland-Altman plots. The predictive value of multidetector CT– and flat detector CT–derived ASPECTS for functional outcome was investigated using area under the receiver operating characteristic curve analysis.

RESULTS:

Of 25 patients, 24 (96%) had flat detector CT with sufficient diagnostic quality. Median multidetector CT and flat detector CT ASPECTSs were 7 (interquartile range, 5.5–9 and 4.25–8, respectively) with a mean period of 143.6 ± 49.5 minutes between both modalities. The overall sensitivity was 85.1% and specificity was 83.1% for flat detector CT ASPECTS compared with multidetector CT ASPECTS as the reference technique. Multidetector CT and flat detector CT ASPECTS were strongly correlated (r = 0.849, P < .001) and moderately predicted functional outcome (area under the receiver operating characteristic curve, 0.738; P = .007 and .715; P = .069, respectively).

CONCLUSIONS:

Determination of ASPECTS on flat detector CT is feasible, showing no significant difference compared with multidetector CT ASPECTS and a similar predictive value for functional outcome. Our findings support the use of flat detector CT for emergency stroke imaging before mechanical thrombectomy to reduce door-to-groin time.



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Brain MRI Characteristics of Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Associations with 2-Year Clinical Outcome [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Anti-N-methyl-D-aspertate receptor encephalitis is an autoimmune-mediated disease without specific brain MRI features. Our aim was to investigate the brain MR imaging characteristics of anti-N-methyl-D-aspartate receptor encephalitis and their associations with clinical outcome at a 2-year follow-up.

MATERIALS AND METHODS:

We enrolled 53 patients with anti-N-methyl-D-aspartate receptor encephalitis and performed 2-year follow-up. Brain MRIs were acquired for all patients at the onset phase. The brain MR imaging manifestations were classified into 4 types: type 1: normal MR imaging findings; type 2: only hippocampal lesions; type 3: lesions not involving the hippocampus; and type 4: lesions in both the hippocampus and other brain areas. The modified Rankin Scale score at 2-year follow-up was assessed, and the association between the mRS and onset brain MR imaging characteristics was evaluated.

RESULTS:

Twenty-eight (28/53, 53%) patients had normal MR imaging findings (type 1), and the others (25/53, 47%) had abnormal MRI findings: type 2: 7 patients (13%); type 3: seven patients (13%); and type 4: eleven patients (21%). Normal brain MRI findings were more common in female patients (P = .02). Psychiatric and behavioral abnormalities were more common in adults (P = .015), and autonomic symptoms (P = .025) were more common in pediatric patients. The presence of hippocampal lesions (P = .008, OR = 9.584; 95% CI, 1.803–50.931) and relapse (P = .043, OR = 0.111; 95% CI, 0.013–0.930) was associated with poor outcome.

CONCLUSIONS:

Normal brain MRI findings were observed in half of the patients. Lesions in the hippocampus were the most common MR imaging abnormal finding. The presence of hippocampal lesions is the main MR imaging predictor for poor prognosis in patients with anti-N-methyl-D-aspartate receptor encephalitis.



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Cerebellar Growth Impairment Characterizes School-Aged Children Born Preterm without Perinatal Brain Lesions [PEDIATRICS]

BACKGROUND AND PURPOSE:

Infants born preterm are commonly diagnosed with structural brain lesions known to affect long-term neurodevelopment negatively. Yet, the effects of preterm birth on brain development in the absence of intracranial lesions remain to be studied in detail. In this study, we aim to quantify long term consequences of preterm birth on brain development in this specific group.

MATERIALS AND METHODS:

Neonatal cranial sonography and follow-up T1-weighted MR imaging and DTI were performed to evaluate whether the anatomic characteristics of the cerebrum and cerebellum in a cohort of school-aged children (6–12 years of age) were related to gestational age at birth in children free of brain lesions in the perinatal period.

RESULTS:

In the cohort consisting of 36 preterm (28–37 weeks' gestational age) and 66 term-born infants, T1-weighted MR imaging and DTI at 6–12 years revealed a reduction of cerebellar white matter volume (β = 0.387, P < .001), altered fractional anisotropy of cerebellar white matter (β = –0.236, P = .02), and a reduction of cerebellar gray and white matter surface area (β = 0.337, P < .001; β = 0.375, P < .001, respectively) in relation to birth age. Such relations were not observed for the cerebral cortex or white matter volume, surface area, or diffusion quantities.

CONCLUSIONS:

The results of our study show that perinatal influences that are not primarily neurologic are still able to disturb long-term neurodevelopment, particularly of the developing cerebellum. Including the cerebellum in future neuroprotective strategies seems therefore essential.



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Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.

MATERIALS AND METHODS:

Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.

RESULTS:

Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, "very certain"). Confidence was statistically significantly higher in cases that were generally rated as "worse." The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.

CONCLUSIONS:

Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.



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Triage in the Angiography Suite for Mechanical Thrombectomy in Acute Ischemic Stroke: Not Such a Good Idea [LETTERS]



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Three-dimensional magnetic resonance pelvimetry: A new technique for evaluating the female pelvis in pregnancy

Publication date: May 2018
Source:European Journal of Radiology, Volume 102
Author(s): K.D. Liao, Y.H. Yu, Y.G. Li, L. Chen, C. Peng, P. Liu, C.L. Chen, R.Y. Chen, M. Zhong, Y. Wang
ObjectiveTo describe three-dimensional (3D) magnetic resonance imaging (MRI) pelvimetry methods and to establish the pelvimetric reference in a large population of Chinese females at term pregnancy.MethodsThree-hundred one pregnant women at term who underwent MRI were included. Three-dimensional pelvic models were reconstructed using Mimics. 10.0 software based on MRI data sets, and measurements of these models were made. Pelvimetric results according to delivery modality were presented. Additionally, the previously described CT 3D pelvimetry method for predicting cephalopelvic disproportion (CPD) was used to validate its accuracy.ResultsTwo hundred ten women underwent vaginal delivery, and 13 underwent caesarean delivery for CPD. 3D modelling of the pelvis of pregnant women was feasible using MR data sets. Pelvimetric parameters in the vaginal delivery group were as follows: transverse diameter, 134.7 mm ± 7.5; obstetric conjugate, 126.9 mm ± 8.3; interspinous distance, 113.4 mm ± 8.2; sagittal midpelvis, 117.8 mm ± 8.1; intertuberous distance, 127.1 mm ± 10.4; sagittal outlet, 110.2 mm ± 8.9, and posterior sagittal outlet, 59.7 mm ± 8.1. According to the previously described CT 3D pelvimetry method for predicting CPD, 67.6% (142/210) of women in the vaginal delivery group were diagnosed with CPD.Conclusion3D MR pelvimetry is a novel method for determining pelvic dimensions at term pregnancy. A prospective trial is needed to establish a useful value for predicting CPD in Chinese females at high risk of CPD.



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The severity of denture stomatitis as related to risk factors and different candida spp.

i) to select patients with Candida denture related stomatitis (DS) and to study possible risk factors associated with DS; ii) to evaluated the severity of DS according to Newton's Classification; iii) to investigated the association between the presence of Candida non-albicans spp. (NAC) or mixed Candida spp. and the severity of DS.

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Dr. Herbert H. Frommer, 1933-2018

The American Academy of Oral and Maxillofacial Radiology (AAOMR) mourns the death of Dr. Herbert H. Frommer, who passed away peacefully on February 1, 2018. Dr. Frommer was born in Manhattan in 1933 and grew up in Queens, New York. After earning his DDS degree from Columbia University School of Dental and Oral Surgery, he embarked on a career in dental practice and education that spanned 40 years. Herb taught for many decades at New York University College of Dentistry, where he was highly respected by students, staff, and fellow faculty members.

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Alterations in the expression of DNA damage response-related molecules in potentially preneoplastic oral epithelial lesions

To evaluate the expression levels of DNA damage response (DDR) markers in potentially preneoplastic oral epithelial lesions (PPOELs).

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Evaluation of the diagnostic value of immunoglobulin clonal gene rearrangements in patients with parotid gland MALT lymphoma using BIOMED-2 protocol

Publication date: Available online 21 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yamin Zhang, Dan Yu, Ke Huang, Chongshang Huang, Hangfei Liu, Xiafei Sun, Jiaxiong Wang, Huiyong Zhu
ObjectivesTo evaluate the diagnostic value of immunoglobulin (Ig) clonal gene rearrangements for mucosa-associated lymphoid tissue (MALT) lymphoma of the parotid gland.MethodsWe collected and retrospectively analyzed clinical data of 21 patients referred to our institution between 2009 and 2017. Eight patients were primarily diagnosed MALT lymphoma of the parotid gland, the remaining patients diagnosed lymphoepithelial lesion (LEL). The paraffin-embedded tissues were chosen for extracting genomic DNA and multiplex primer PCR amplification using BIOMED-2 primers. PCR amplification products were analyzed by heteroduplex analysis (HA).ResultsGenerally, seventeen patients were identified to be parotid gland MALT lymphoma; 47.06% of them had Sjögren's syndrome (SS). The sensitivity of IGH VH-JH FR1, FR2, FR3, IGK Vκ-Jκ and IGK (Vκ-Kde and intron-Kde) as targets was 76.47%, 82.35%, 88.24%, 29.41% and 35.29% respectively. The sensitivity of combined application of the above three IGH primers as targets was 100%. The sensitivity of combined application of the above two IGK primers as targets was 58.82%.ConclusionIg clonal gene rearrangements assays using BIOMED-2 protocol, could be a highly-reliable diagnostic method for parotid gland MALT lymphoma. For patients with SS, along with histologically benign lymphoepithelial lesion (BLL), Ig clonal gene rearrangements is important for routine differential diagnosis.



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The severity of denture stomatitis as related to risk factors and different candida spp.

Publication date: Available online 22 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mirjana Perić, Rade Živković, Aleksandra Milić Lemić, Milena Radunović, Biljana Miličić, Valentina Arsić Arsenijević
Objectivesi) to select patients with Candida denture related stomatitis (DS) and to study possible risk factors associated with DS; ii) to evaluated the severity of DS according to Newton's Classification; iii) to investigated the association between the presence of Candida non-albicans spp. (NAC) or mixed Candida spp. and the severity of DS.Study design82 subjects with Candida positive DS have undergone: i) filling in the questionnaire-interview, ii) clinical examination and iii) microbiological examination.ResultsA total number of 113 Candida spp. isolates were obtained from Candida positive DS patients: C. albicans (as a single species) in 47/82 (57%) (SG_A patients) and NAC/mixed Candida spp. in 35/82 (43%) (SG_B patients). Univariate logistic regression analysis showed that older age, age of the mandibular denture, and ex-smokers associated with SG_A. Multivariate model revealed no significant predictor of DS severity. Patients from SG_A group were 3 times more likely to have DS type I, while patients from SG_B group were 4.9 times more likely to have DS type III.ConclusionOur results showed the association between type III of DS (by Newton's Classification) and presents of NAC or mixed Candida spp. in denture wearers.



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Alterations in the expression of DNA damage response-related molecules in potentially preneoplastic oral epithelial lesions

Publication date: Available online 22 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nikolaos G. Nikitakis, George Z. Rassidakis, Jason Tasoulas, Ioannis Gkouveris, Georgios Kamperos, Argyrios Daskalopoulos, Alexandra Sklavounou
ObjectivesTo evaluate the expression levels of DNA damage response (DDR) markers in potentially preneoplastic oral epithelial lesions (PPOELs).Study designImmunohistochemical expression of DDR markers (γΗ2ΑΧ, pChk2, 53BP1, p53 and phosphorylated at Ser 15 p53) was assessed in 41 oral leukoplakias ranging from hyperplasia (H) to dysplasia (D), and compared with oral squamous cell carcinoma (OSCC) and normal mucosa (NM). Statistical and ROC curve analysis were performed.ResultsγH2AX immunoexpression demonstrated a gradual increase and upper layer extension from NM to H to higher D degrees to OSCC. pChk2 expression was minimal in NM, relatively low in PPOELs with an increasing tendency from H to D, and higher in OSCC. 53BP1 demonstrated higher levels in OSCC than NM, while its expression in PPOELs was heterogeneous, gradually increasing according to D. p53 demonstrated progressively higher levels and upper layer extension from H to D to OSCC. Phosphorylated p53 was absent in NM and relatively low in PPOELs and OSCC.ConclusionsDDR markers' expression is variable in PPOELs showing a tendency to increase along with dysplasia. Activated DDR mechanisms may play an important protective role at early stages of oral carcinogenesis, but probably suffer progressive deregulation, eventually failing to suppress malignant transformation.



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Dr. Herbert H. Frommer, 1933-2018

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Publication date: Available online 22 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): James R. Geist




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Technologies which will Impact the Future of Healthcare


  • What technologies are going to impact the way we practice medicine in future?
  • Should we talk at future with apprehension or with anticipation? 
  • Let me answer in a short video.


Famous Radiology Blog http://ift.tt/1MM2hKr TeleRad Providers at http://ift.tt/1NgppuI Mail us at sales@teleradproviders.com


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ESR paper on the proper use of mobile devices in radiology

Abstract

Mobile devices (smartphones, tablets, etc.) have become key methods of communication, data access and data sharing for the population in the past decade. The technological capabilities of these devices have expanded very rapidly; for example, their in-built cameras have largely replaced conventional cameras. Their processing power is often sufficient to handle the large data sets of radiology studies and to manipulate images and studies directly on hand-held devices. Thus, they can be used to transmit and view radiology studies, often in locations remote from the source of the imaging data. They are not recommended for primary interpretation of radiology studies, but they facilitate sharing of studies for second opinions, viewing of studies and reports by clinicians at the bedside, etc. Other potential applications include remote participation in educational activity (e.g. webinars) and consultation of online educational content, e-books, journals and reference sources. Social-networking applications can be used for exchanging professional information and teaching. Users of mobile device must be aware of the vulnerabilities and dangers of their use, in particular regarding the potential for inappropriate sharing of confidential patient information, and must take appropriate steps to protect confidential data.

Key Points

• Mobile devices have revolutionized communication in the past decade, and are now ubiquitous.

• Mobile devices have sufficient processing power to manipulate and display large data sets of radiological images.

• Mobile devices allow transmission & sharing of radiologic studies for purposes of second opinions, bedside review of images, teaching, etc.

• Mobile devices are currently not recommended as tools for primary interpretation of radiologic studies.

• The use of mobile devices for image and data transmission carries risks, especially regarding confidentiality, which must be considered.



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ABCs of the degenerative spine

Abstract

Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents.

Teaching Points

• The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit.

Degenerative change is a response to insults, such as mechanical or metabolic injury.

Spine degeneration is a biomechanically related continuum of alterations evolving over time.



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Radiologische Bildgebung akuter infektiöser und nichtinfektiöser Enterokolitiden

Zusammenfassung

Hintergrund

In der Abklärung entzündlicher und nichtentzündlicher Enterokolitiden wird oft frühzeitig eine Computertomographie (CT) indiziert. So breit wie das Spektrum der möglichen infektiösen, nichtinfektiösen und vaskulären Ursachen sind die verschiedenen Therapieoptionen. Wenngleich Labor- und Stuhldiagnostik oder Endoskopie häufig die Diagnose sichern, kann der Radiologe anhand der Bildbefunde bei der Eingrenzung des Diagnosespektrums helfen.

Fragestellung

Dieser Beitrag gibt einen Überblick über Darmwandmuster und ordnet diese dem Spektrum der in Frage kommenden Erkrankungen aus dem Formenkreis der infektiösen und nichtinfektiösen Enterokolitiden zu.

Material und Methode

Wichtige extramurale Begleitbefunde und Pathologien werden ebenso beleuchtet wie Besonderheiten, die sich aus Lokalisation und Verteilung von Darmwandveränderungen oder als Folge einer Therapienebenwirkung ergeben.

Ergebnisse

Infektiöse Enterokolitiden zeigen in Abhängigkeit der Auslöser (bakteriell, viral, parasitär) eine Lokalisationspräferenz. Die pseudomembranöse Kolitis manifestiert sich häufig als Pankolitis mit dem relativ spezifischen Giraffenfellzeichen in der CT. Nichtinfektiöse Enterokolitiden sind primärer (chronisch-entzündliche Darmerkrankungen, Vaskulitis) oder sekundärer (Bestrahlung, Graft-versus-Host-Reaktion) Genese. Die ischämische Mesenteriitis oder ischämische Kolitis ist okklusiver und nichtokklusiver Genese. Das CT-Erscheinungsbild variiert nach Ursache, Dauer und Grad der Reperfusion.

Schlussfolgerung

Bei akuten infektiösen und nichtinfektiösen Enterokolitiden erlauben die Zuordnung zu einem Darmwandmuster sowie die Berücksichtigung von Lokalisationsbesonderheiten, Therapienebenwirkungen und extramuralen Begleitbefunden eine differenzialdiagnostische Eingrenzung.



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Posterior Circulation Occlusions May Be Associated with Distal Emboli During Thrombectomy

Abstract

Background

Distal embolization or movement of the thrombus to previously uninvolved vasculature are feared complications during stroke thrombectomy. We looked at associated factors in a consecutive series of patients who underwent thrombectomy with the same endovascular device.

Methods

We included all patients with acute ischemic stroke in the anterior or posterior circulation, who underwent thrombectomy with the same thrombectomy device for acute stroke from 2013 to 2016. Distal embolization was defined as any movement of the thrombus into a previously uninvolved portion of the cerebral vasculature or the presence of thrombotic material further downstream in the affected vessel, which occurred after the initial angiogram. We studied patient-related as well as technical factors to determine their association with distal emboli.

Results

In this study 167 consecutive acute stroke patients treated with the emboTrap® device (Cerenovus, Irvine, CA, USA) were included with a median National Institutes of Health Stroke Scale (NIHSS) of 15 (range 2–30) and mean age of 67 years (SD 13.1 years). Of the patients in our cohort 20 (11.9%) experienced distal emboli, with 2.3% into a new territory and 9.6% into a territory distal to the primary occlusion. On univariate analysis, age, intravenous tissue plasminogen activator (tPA), posterior circulation occlusions, and general anesthesia were associated with distal emboli. On multivariate analysis, only posterior circulation occlusions (odds ratio OR 4.506 95% confidence interval CI 1.483–13.692, p = 0.008) were significantly associated with distal emboli. Distal embolization was not significantly associated with worse functional outcomes at 3 months, increased mortality or increased bleeding risk.

Conclusion

Posterior circulation occlusions were significantly associated with distal emboli during thrombectomy, possibly due to the lack of flow arrest during such procedures. New techniques and devices should be developed to protect against embolic complications during posterior circulation stroke thrombectomy.



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CT features of diffuse lung disease in infancy

Abstract

Diffuse lung disease in infancy includes a wide range of very rare and peculiar pulmonary conditions usually not seen in older children, in whom diffuse lung disease has much greater overlap with adult disorders. The acronym chILD (childhood Interstitial Lung Disease) commonly defines these disorders, although air spaces, airways, alveolar epithelium, vasculature, pleura, and pleural spaces can also be involved, besides the pulmonary interstitium. chILD can be caused by diffuse developmental disorders, alveolar growth abnormalities, surfactant dysfunction disorders, and other specific conditions of poorly understood etiology. Chest CT imaging studies play a pivotal role in the evaluation of chILD. In some conditions CT findings can be specific, and thus make it possible avoiding further testing. In other disorders, findings are nonspecific, although they may suggest a diagnostic pattern and guide further testing. Nevertheless, chILD disorders often remain unrecognized on imaging studies, as they are very rare. The aim of this article is to review the CT patterns of lung involvement in a series of infants with chILD.



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Focal breast lesion characterization according to the BI-RADS US lexicon: role of a computer-aided decision-making support



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MRI evaluation of peripheral vascular anomalies using time-resolved imaging of contrast kinetics (TRICKS) sequence

Abstract

Introduction

We describe the use of time-resolved imaging of contrast kinetics (TRICKS) sequence in the diagnosis of Peripheral Vascular Anomalies. In case of suspected vascular malformations time-resolved MR angiography might add important information for therapeutic decisions and follow-up.

Objective

The objective of our study was to assess the usefulness and diagnostic performance of time-resolved imaging of contrast kinetics sequence in the evaluation of peripheral vascular anomalies.

Subjects and methods

Sixty-six patients (23 pediatric, 43 adult; mean age 26) affected by upper or lower limb vascular anomalies and studied using time-resolved imaging of contrast kinetics sequence were prospectively evaluated. All studies were performed on a 1.5-T whole-body MR system. Two independent readers tried to categorized the suspected vascular anomalies in pre-contrast and post-contrast MR sequences and assessed the overall TRICKS image quality. In 11 patients, the diagnostic performance comparability between TRICKS sequence and digital subtraction angiography was evaluated.

Results

On the basis of time-resolved imaging of contrast kinetics, 31 of the vascular anomalies were classified as high-flow vascular malformations, 29 as low-flow vascular lesions and 6 as hemangiomas. There was no significant difference in image quality evaluation and vascular anomaly classification between the two observers. The vascular anomalies characteristics provided by moderate, good or excellent quality TRICKS images were confirmed by digital subtraction angiography.

Conclusion

Time-resolved imaging of contrast kinetics sequence let the radiologist to acquire useful temporal information to correctly evaluate vascular anomalies components, adding more data to those provided by conventional MR sequences, especially in case of arteriovenous malformation. Therefore, both in pediatric and adult population, TRICKS could be used as an additional initial diagnostic tool to rightly classify these lesions and evaluate if a treatment is needed and which.



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Teaching Radiology Trainees From the Perspective of a Millennial

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Publication date: Available online 21 March 2018
Source:Academic Radiology
Author(s): Po-Hao Chen, Mary H. Scanlon
The millennial generation consists of today's medical students, radiology residents, fellows, and junior staff. Millennials' comfort with immersive technology, high expectations for success, and desire for constant feedback differentiate them from previous generations. Drawing from an author's experiences through radiology residency and fellowship as a millennial, from published literature, and from the mentorship of a long-time radiology educator, this article explores educational strategies that embrace these characteristics to engage today's youngest generation both in and out of the reading room.



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Diagnostic Radiology Resident Recruitment Part II

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Publication date: Available online 21 March 2018
Source:Academic Radiology
Author(s): Mark E. Mullins, Arash Anavim, Lori A. Deitte, Theresa C. McLoud, Charles S. Resnik
Applicants to diagnostic radiology residencies often obtain advice regarding the process, typically from local individuals. Materials available on the Internet contribute to this process as well. We are a group of current and former Diagnostic Radiology Residency Program Directors and current Vice Chairs for Education who commonly advise medical students, including regarding radiology as a career. This work is meant to provide a "plain talk" resource for those considering a career in radiology via a radiology residency, written from the point of view of an advisor with lots of experience.



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Accuracy of Dual-Energy Virtual Monochromatic CT Numbers

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Publication date: Available online 21 March 2018
Source:Academic Radiology
Author(s): Takashi Ueguchi, Ryota Ogihara, Sachiko Yamada
Rationale and ObjectivesTo investigate the accuracy of dual-energy virtual monochromatic computed tomography (CT) numbers obtained by two typical hardware and software implementations: the single-source projection-based method and the dual-source image-based method.Materials and MethodsA phantom with different tissue equivalent inserts was scanned with both single-source and dual-source scanners. A fast kVp-switching feature was used on the single-source scanner, whereas a tin filter was used on the dual-source scanner. Virtual monochromatic CT images of the phantom at energy levels of 60, 100, and 140 keV were obtained by both projection-based (on the single-source scanner) and image-based (on the dual-source scanner) methods. The accuracy of virtual monochromatic CT numbers for all inserts was assessed by comparing measured values to their corresponding true values. Linear regression analysis was performed to evaluate the dependency of measured CT numbers on tissue attenuation, method, and their interaction.ResultsRoot mean square values of systematic error over all inserts at 60, 100, and 140 keV were approximately 53, 21, and 29 Hounsfield unit (HU) with the single-source projection-based method, and 46, 7, and 6 HU with the dual-source image-based method, respectively. Linear regression analysis revealed that the interaction between the attenuation and the method had a statistically significant effect on the measured CT numbers at 100 and 140 keV.ConclusionsThere were attenuation-, method-, and energy level-dependent systematic errors in the measured virtual monochromatic CT numbers. CT number reproducibility was comparable between the two scanners, and CT numbers had better accuracy with the dual-source image-based method at 100 and 140 keV.



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Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography

Publication date: Available online 21 March 2018
Source:Academic Radiology
Author(s): Adriana Gregory, Mahdi Bayat, Viksit Kumar, Max Denis, Bae Hyung Kim, Jeremy Webb, Duane D. Meixner, Mabel Ryder, John M. Knudsen, Shigao Chen, Mostafa Fatemi, Azra Alizad
Rationale and ObjectivesLow specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented.Materials and MethodsA total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5–68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained.ResultsMeasurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively.ConclusionsThe elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P < .0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.



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Comparison of Local Injection of Fresh Frozen Plasma to Traditional Methods of Hemostasis in Minimally Invasive Procedures

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Publication date: Available online 22 March 2018
Source:Academic Radiology
Author(s): John Haaga, Shiraz Rahim, Victor Kondray, Jon Davidson, Indravadan Patel, Dean Nakamoto
Rationale and ObjectivesTo evaluate different techniques for reducing hemorrhagic complications in coagulopathic patients with elevated international normalized ratio having an image-guided percutaneous invasive procedure; techniques included systemic transfusion of fresh frozen plasma (FFP), local injection of FFP, percutaneous injection of gelatin sponge, and percutaneous placements of angiographic coils.Materials and MethodsRetrospective review of 232 consecutive patients with known coagulopathy undergoing image-guided minimally invasive procedures were selected. Ninety-one patients had local FFP injected, 40 patients underwent local synthetic gelatin injection, 16 patients had percutaneous coil embolization, and 85 patients received systemic FFP. The number of bleeds, complications related to bleeds, and systemic complications were recorded. A 30 cc threshold was used to delineate significant bleeding.ResultsNo patients experienced clinically significant or insignificant bleeding with local FFP injection (P value <.05). Other local hemostatic methods (Gelfoam, systemic FFP, and coil embolization) were associated with higher levels of bleeding (12.5%, 17.1%, 37.5%, respectively) and complications (7.5%, 31.4%, 37.5%, respectively). Systemic FFP infusion was associated with respiratory, infectious, and mortal complications.ConclusionsLocal injection of blood products provides a safe and efficacious hemostatic agent to reduce the incidence of postprocedural bleeding. The technique is associated with lower rates of bleeding and systemic complications when compared to other local and systemic techniques. Further randomized prospective studies with a larger patient cohort need to be performed to corroborate these initial findings.



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Diagnostic performance of PET in thyroid cancer with elevated anti-Tg Ab.

Diagnostic performance of PET in thyroid cancer with elevated anti-Tg Ab.

Endocr Relat Cancer. 2018 Mar 20;:

Authors: Kim SJ, Lee SW, Pak K, Shim SR

Abstract
We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for the detection of recurrent and/or metastatic diseases in differentiated thyroid cancer (DTC) patients with progressively and/or persistently elevated TgAb levels and negative radioactive iodine whole body scan (RI-WBS) through a systematic review and meta-analysis. The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-). Across 9 studies (515 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.84 (95% CI; 0.77-0.89) a pooled specificity of 0.78 (95% CI; 0.67-0.86). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.8 (95% CI; 2.5-5.7) and negative likelihood ratio (LR-) of 0.21 (95% CI; 0.14-0.30). The pooled diagnostic odds ratio (DOR) was 18 (95% CI; 10-34). The area (AUC) under the hierarchical summary receiver operating characteristic (HCROC) curve was 0.88 (95% CI: 0.85-0.90). F-18 FDG PET or PET/CT demonstrated moderate sensitivity and specificity for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS.

PMID: 29559552 [PubMed - as supplied by publisher]



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The seasonal fluctuations and accumulation of iodine-129 in relation to the hydrogeochemistry of the Wolf Creek Research Basin, a discontinuous permafrost watershed.

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The seasonal fluctuations and accumulation of iodine-129 in relation to the hydrogeochemistry of the Wolf Creek Research Basin, a discontinuous permafrost watershed.

Sci Total Environ. 2016 Nov 01;569-570:1212-23

Authors: Herod MN, Li T, Pellerin A, Kieser WE, Clark ID

Abstract
The long lived radioisotope (129)I is a uranium fission product, and an environmental contaminant of the nuclear age. Consequently, it can trace anthropogenic releases of (129)I in watersheds, and has been identified as a potential means to distinguish water sources in discharge (Nimz, 1998). The purpose of this work was to identify the sources and mass input of (129)I and trace the transport, partitioning and mass balance of (129)I over time in a remote watershed. We monitored (129)I and other geochemical and isotope tracers (e.g. δ(14)CDIC, δ(13)CDIC, δ(2)H, δ(18)O, etc.) in precipitation and discharge from the Wolf Creek Research Basin (WCRB), a discontinuous permafrost watershed in the Yukon Territory, Canada, and evaluated the use of (129)I as a water end-member tracer. Radiocarbon and geochemical tracers of weathering show that discharge is comprised of (i) groundwater baseflow that has recharged under open system conditions, (ii) spring freshet meltwater that has derived solutes through closed-system interaction with saturated soils, and (iii) active layer drainage. The abundance of (129)I and the (129)I/(127)I ratio correlated with geochemical tracers suggests varying contributions of these three water end-members to discharge. The (129)I concentration was highest at the onset of freshet, reaching 17.4×10(6) atoms/L, and likely reflects the lack of interaction between meltwater and organic matter at that time. This peak in (129)I was followed by a decline over the summer to its lowest value. Mass balance calculations of the (129)I budget show that the input to the watershed via precipitation is nearly one order of magnitude higher than the output suggesting that such arctic watersheds accumulate nearly 90% of the annual input, primarily in soil organic matter. Temporal variations in discharge (129)I concentrations correlated with changes in discharge water sources suggesting that (129)I is a promising hydrologic tracer, particularly when used in concert with other stable and radioisotopes.

PMID: 27387807 [PubMed - indexed for MEDLINE]



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Dosimetric effect of limited aperture multileaf collimator on VMAT plan quality: A study of prostate and head-and-neck cancers

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Publication date: May–June 2018
Source:Reports of Practical Oncology & Radiotherapy, Volume 23, Issue 3
Author(s): Ghulam Murtaza, Shahid Mehmood, Shahid Rasul, Imran Murtaza, Ehsan Ullah Khan
AimThe aim of study was to evaluate the dosimetric effect of collimator-rotation on VMAT plan quality, when using limited aperture multileaf collimator of Elekta Beam Modulator™ providing a maximum aperture of 21cm×16cm.BackgroundThe increased use of VMAT technique to deliver IMRT from conventional to very specialized treatments present a challenge in plan optimization. In this study VMAT plans were optimized for prostate and head and neck cancers using Elekta Beam-ModulatorTM, whereas previous studies were reported for conventional Linac aperture.Materials and methodsVMAT plans for nine of each prostate and head-and-neck cancer patients were produced using the 6MV photon beam for Elekta-SynergyS® Linac using Pinnacle3 treatment planning system. Single arc, dual arc and two combined independent-single arcs were optimized for collimator angles (C) 0°, 90° and 0°–90° (0°–90°; i.e. the first-arc was assigned C0° and second-arc was assigned C90°). A treatment plan comparison was performed among C0°, C90° and C(0°–90°) for single-arc dual-arc and two independent-single-arcs VMAT techniques to evaluate the influence of extreme collimator rotations (C0° and 90°) on VMAT plan quality. Plan evaluation criteria included the target coverage, conformity index, homogeneity index and doses to organs at risk. A 'two-sided student t-test' (p≤0.05) was used to determine if there was a significant difference in dose volume indices of plans.ResultsFor both prostate and head-and-neck, plan quality at collimator angles C0° and C(0°–90°) was clinically acceptable for all VMAT-techniques, except SA for head-and-neck. Poorer target coverage, higher normal tissue doses and significant p-values were observed for collimator angle 90° when compared with C0° and C(0°–90°).ConclusionsA collimator rotation of 0° provided significantly better target coverage and sparing of organs-at-risk than a collimator rotation of 90° for all VMAT techniques.



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Determination of the proton RBE in the rat spinal cord: Is there an increase towards the end of the spread-out Bragg peak?

To determine the relative biological effectiveness (RBE) of protons in the rat spinal cord as a function of linear energy transfer (LET) and dose.

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Evaluation of the diagnostic value of immunoglobulin clonal gene rearrangements in patients with parotid gland MALT lymphoma using BIOMED-2 protocol

To evaluate the diagnostic value of immunoglobulin (Ig) clonal gene rearrangements for mucosa-associated lymphoid tissue (MALT) lymphoma of the parotid gland.

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Numerical modeling of the sources and behaviors of 222Rn, 220Rn and their progenies in the indoor environment—A review

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Publication date: September 2018
Source:Journal of Environmental Radioactivity, Volume 189
Author(s): Jun Hu, Guosheng Yang, Miklós Hegedűs, Kazuki Iwaoka, Masahiro Hosoda, Shinji Tokonami
222Rn, 220Rn and their short-lived progenies are well known radioactive indoor pollutants, identified as the leading environmental cause of lung cancer next to smoking. Apart from the conventional measurement methods, numerical modeling methods are developed to simulate their physical and decay processes in 222Rn and 220Rn's life cycle, estimate their levels, concentration distributions, as well as effects of control strategies in the indoor environment. In this article, we summarized the numerical models used to illustrate the physical processes of each source of 222Rn and 220Rn entry into the indoor environment, and the application of Jacobi room models and CFD (Computational Fluid Dynamic) models used to present the behaviors of indoor 222Rn, 220Rn and their progenies. Furthermore, we consider that the development of numerical modeling of 222Rn and 220Rn would have a bright prospect in the directions of stochastic methods based on a steady-state model, the fine simulation of the time-dependent model as well as the multi-dimension model.



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Whole organism to tissue concentration ratios derived from an Australian tropical dataset

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Publication date: September 2018
Source:Journal of Environmental Radioactivity, Volume 189
Author(s): Che Doering, Peter Medley, Blake Orr, David Urban
Whole organism to tissue concentration ratios (CRwo-tissue) were derived for six wildlife groups (freshwater birds, freshwater bivalves, freshwater fishes, freshwater reptiles, freshwater vascular plants and terrestrial mammals). The wildlife groups and data represented species common to tropical northern Australia. Values of CRwo-tissue were derived for between 6 and 34 elements, depending upon wildlife group. The values were generally similar to international reference values. However, differences for some element-tissue combinations could affect radiation dose estimates for wildlife in certain environmental exposure situations, including uranium mining, where these data are intended to be applied.



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