Epidural venous thrombosis as differential diagnosis in back pain patients

Abstract

Epidural venous thrombosis is a rare clinical entity with a characteristic constellation of findings in contrast-enhanced MRI, which should be considered in the differential diagnosis in the case of clinical symptoms that are initially indicative of disc herniation. The most important distinctive feature between epidural venous thrombosis and disc herniation is their topographical location in relation to the vertebral venous plexus. Particularly where morphological imaging shows a space-occupying lesion in close proximity to the internal vertebral venous plexus and a central contrast medium defect, epidural venous thrombosis should be taken into consideration.

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How Well Does Dual-energy CT with Fast Kilovoltage Switching Quantify CT Number and Iodine and Calcium Concentrations?

Publication date: Available online 21 December 2017
Source:Academic Radiology
Author(s): Shingo Ohira, Tsukasa Karino, Yoshihiro Ueda, Yuya Nitta, Naoyuki Kanayama, Masayoshi Miyazaki, Masahiko Koizumi, Teruki Teshima
Rationale and ObjectivesBecause it is imperative for understanding the performance of dual-energy computed tomography scanner to determine clinical diagnosis, we aimed to assess the accuracy of quantitative measurements using dual-energy computed tomography with fast kilovoltage switching.Materials and MethodsQuantitative measurements were performed for 16 reference materials (physical density, 0.965–1.550 g/cm³; diameter of rod, 2.0–28.5 mm; iodine concentration, 2–15 mg/mL; and calcium concentration, 50–300 mg/mL) with varying scanning settings, and the measured values were compared to their theoretical values.ResultsFor high-density material, the maximum differences in Hounsfield unit values in the virtual monochromatic images at 50, 70, and 100 keV were −176.2, 61.0, and −35.2 HU, respectively, and the standard deviations over short- and long-term periods were 11.1, 6.1, and 3.5 HU at maximum. The accuracy of the Hounsfield unit measurement at 50 and 70 keV was significantly higher (P < 0.05) with higher radiation output and smaller phantom size. The difference in the iodine and calcium measurements in the large phantom were up to −2.6 and −60.4 mg/mL for iodine (5 mg/mL with 2-mm diameter) and calcium (300 mg/mL) materials, and the difference was improved with a small phantom. Metal artifact reduction software improved subjective image quality; however, the quantitative values were significantly underestimated (P < 0.05) (−49.5, −26.9, and −15.3 HU for 50, 70, and 100 keV, respectively; −1.0 and −17 mg/mL for iodine and calcium concentration, respectively) compared to that acquired without a metal material.ConclusionsThe accuracy of quantitative measurements can be affected by material density and the size of the object, radiation output, phantom size, and the presence of metal materials.



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Breast Imaging Outcomes following Abnormal Thermography

Publication date: Available online 21 December 2017
Source:Academic Radiology
Author(s): Colleen H. Neal, Kelsey A. Flynt, Deborah O. Jeffries, Mark A. Helvie
Rationale and ObjectivesThe study aimed to determine the outcome of patients presenting for evaluation of abnormal breast thermography.Materials and MethodsFollowing Institutional Review Board approval, retrospective search identified 38 patients who presented for conventional breast imaging following a thermography-detected abnormality. Study criteria included women who had mammogram and/or breast ultrasound performed for evaluation of a thermography-detected abnormality between January 1, 2000, and December 31, 2015. Patients whose mammograms and ultrasounds were initiated at an outside institution or who did not have imaging at our institution were excluded. Records were reviewed for clinical history, thermography results, mammogram and/or ultrasound findings, and pathology. Mammograms and ultrasounds were prospectively interpreted by one of 14 Mammography Quality Standards Act–certified breast imaging radiologists with 3–30 years of experience. Patient outcomes were determined by biopsy or at least 1 year of follow-up. Patient ages ranged from 23 to 70 years (mean = 50 years).ResultsNinety-five percent (36 of 38) of patients did not have breast cancer. The two patients diagnosed with breast cancer had suspicious clinical symptoms including palpable mass and erythema. No asymptomatic woman had breast cancer. Negative predictive value was 100%. Of 38 patients, 79% (30 of 38) had Breast Imaging Reporting and Data System (BI-RADS) 1 or 2 assessments; 5% (2 of 38) had BI-RADS 3; and 16% (6 of 38) had BI-RADS 4 (n = 5) or BI-RADS 5 (n = 1) assessments. Two of six patients with biopsy recommendations were diagnosed with breast cancer (Positive predictive value 2 = 33.3%). All findings recommended for biopsy were ipsilateral to the reported thermography abnormality.ConclusionsNo cancer was diagnosed among asymptomatic women. The 5% of patients diagnosed with cancer had co-existing suspicious clinical findings. Mammogram and/or ultrasound were useful in accurately characterizing patients with abnormal thermography.



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Does the Volume of CSF Removed Affect the Response to a Tap in Normal Pressure Hydrocephalus? [LETTERS]

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Reply: [LETTERS]

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Prenatal Factors Associated with Postnatal Brain Injury in Infants with Congenital Diaphragmatic Hernia [PEDIATRICS]

BACKGROUND AND PURPOSE:

Approximately 60% of infants with congenital diaphragmatic hernia have evidence of brain injury on postnatal MR imaging. It is unclear whether any brain injury is present before birth. In this study, we evaluated fetal MR imaging findings of brain injury and the association of congenital diaphragmatic hernia severity with postnatal brain injury.

MATERIALS AND METHODS:

Fetal MR imaging and postnatal brain MR imaging were retrospectively evaluated in 36 cases of congenital diaphragmatic hernia (from 2009 to 2014) by 2 pediatric neuroradiologists. Brain injury on postnatal MR imaging and brain injury and congenital diaphragmatic hernia severity on fetal MR imaging were recorded. Correlations between brain abnormalities on fetal and postnatal brain MR imaging were analyzed. Postnatal brain injury findings correlating with the severity of congenital diaphragmatic hernia were also assessed.

RESULTS:

On fetal MR imaging, enlarged extra-axial spaces (61%), venous sinus distention (21%), and ventriculomegaly (6%) were identified. No maturational delay, intracranial hemorrhage, or brain parenchymal injury was identified on fetal MR imaging. On postnatal MR imaging, 67% of infants had evidence of abnormality, commonly, enlarged extra-axial spaces (44%). Right-sided congenital diaphragmatic hernia was associated with a greater postnatal brain injury score (P = .05). Low observed-to-expected lung volume was associated with postnatal white matter injury (P = .005) and a greater postnatal brain injury score (P = .008). Lack of liver herniation was associated with normal postnatal brain MR imaging findings (P = .03).

CONCLUSIONS:

Fetal lung hypoplasia is associated with postnatal brain injury in congenital diaphragmatic hernia, suggesting that the severity of lung disease and associated treatments affect brain health as well. We found no evidence of prenatal brain parenchymal injury or maturational delay.

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MR Imaging-Based Evaluations of Olfactory Bulb Atrophy in Patients with Olfactory Dysfunction [HEAD & NECK]

BACKGROUND AND PURPOSE:

Although the olfactory bulb volume as assessed with MR imaging is known to reflect olfactory function, it is not always measured during olfactory pathway assessments in clinical settings. We aimed to evaluate the utility of visual olfactory bulb atrophy and neuropathy analyses using MR imaging in patients with olfactory dysfunction.

MATERIALS AND METHODS:

Thirty-four patients who presented with subjective olfactory loss between March 2016 and February 2017 were included. Patients underwent a nasal endoscopic examination, olfactory testing with the Korean Version of the Sniffin' Sticks test, and MR imaging. All patients completed the Sino-Nasal Outcome Test and Questionnaire of Olfactory Disorders. Olfactory bulb atrophy and neuropathy were evaluated on MR images by 2 head and neck radiologists.

RESULTS:

The etiology of olfactory loss was chronic rhinosinusitis with/without nasal polyps in 15 (44.1%) patients, respiratory viral infection in 7 (20.6%), trauma in 2 (5.9%), and idiopathic in 10 (29.4%) patients. Although 10 (29.4%) of the 34 patients were normosmic according to the Sniffin' Sticks test, their scores on the other tests were like those of patients who were hyposmic/anosmic according to the Sniffin' Sticks test. However, the detection rate of olfactory bulb atrophy was significantly higher in patients with hyposmia/anosmia than it was in patients with normosmia (P = .002). No difference in olfactory bulb neuropathy was identified among patients with normosmia and hyposmia/anosmia (P = .395).

CONCLUSIONS:

MR imaging evaluations of olfactory bulb atrophy can be used to objectively diagnose olfactory dysfunction in patients with subjective olfactory loss.

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Pressure Mapping and Hemodynamic Assessment of Intracranial Dural Sinuses and Dural Arteriovenous Fistulas with 4D Flow MRI [ADULT BRAIN]

SUMMARY:

The feasibility of 4D flow MR imaging to visualize flow patterns and generate relative pressure maps in the dural venous sinus in healthy subjects (n = 60) and patients with dural arteriovenous fistulas (n = 7) was investigated. Dural venous drainage was classified based on torcular Herophili anatomy by using 4D flow MR imaging–derived angiograms and magnitude images. Subjects were scanned in a 3T clinical MR imaging system. 4D flow MR imaging enabled noninvasive characterization of dural sinus anatomy and mapping of relative pressure differences.

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White Matter Changes Related to Subconcussive Impact Frequency during a Single Season of High School Football [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period.

MATERIALS AND METHODS:

Seventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis.

RESULTS:

The mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory.

CONCLUSIONS:

Our findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.

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Better Than Nothing: A Rational Approach for Minimizing the Impact of Outflow Strategy on Cerebrovascular Simulations [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Computational fluid dynamics simulations of neurovascular diseases are impacted by various modeling assumptions and uncertainties, including outlet boundary conditions. Many studies of intracranial aneurysms, for example, assume zero pressure at all outlets, often the default ("do-nothing") strategy, with no physiological basis. Others divide outflow according to the outlet diameters cubed, nominally based on the more physiological Murray's law but still susceptible to subjective choices about the segmented model extent. Here we demonstrate the limitations and impact of these outflow strategies, against a novel "splitting" method introduced here.

MATERIALS AND METHODS:

With our method, the segmented lumen is split into its constituent bifurcations, where flow divisions are estimated locally using a power law. Together these provide the global outflow rate boundary conditions. The impact of outflow strategy on flow rates was tested for 70 cases of MCA aneurysm with 0D simulations. The impact on hemodynamic indices used for rupture status assessment was tested for 10 cases with 3D simulations.

RESULTS:

Differences in flow rates among the various strategies were up to 70%, with a non-negligible impact on average and oscillatory wall shear stresses in some cases. Murray-law and splitting methods gave flow rates closest to physiological values reported in the literature; however, only the splitting method was insensitive to arbitrary truncation of the model extent.

CONCLUSIONS:

Cerebrovascular simulations can depend strongly on the outflow strategy. The default zero-pressure method should be avoided in favor of Murray-law or splitting methods, the latter being released as an open-source tool to encourage the standardization of outflow strategies.

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Systematic Radiation Dose Reduction in Cervical Spine CT of Human Cadaveric Specimens: How Low Can We Go? [PATIENT SAFETY]

BACKGROUND AND PURPOSE:

While the use of cervical spine CT in trauma settings has increased, the balance between image quality and dose reduction remains a concern. The purpose of our study was to compare the image quality of CT of the cervical spine of cadaveric specimens at different radiation dose levels.

MATERIALS AND METHODS:

The cervical spine of 4 human cadavers (mean body mass index; 30.5 ± 5.2 kg/m²; range, 24–36 kg/m²) was examined using different reference tube current–time products (45, 75, 105, 135, 150, 165, 195, 275, 355 mAs) and a tube voltage of 120 kV(peak). Data were reconstructed with filtered back-projection and iterative reconstruction. Qualitative image noise and morphologic characteristics of bony structures were quantified on a Likert scale. Quantitative image noise was measured. Statistics included analysis of variance and the Tukey test.

RESULTS:

Compared with filtered back-projection, iterative reconstruction provided significantly lower qualitative (mean noise score: iterative reconstruction = 2.10/filtered back-projection = 2.18; P = .003) and quantitative (mean SD of Hounsfield units in air: iterative reconstruction = 30.2/filtered back-projection = 51.8; P < .001) image noise. Image noise increased as the radiation dose decreased. Qualitative image noise at levels C1–4 was rated as either "no noise" or as "acceptable noise." Any shoulder position was at level C5 and caused more artifacts at lower levels. When we analyzed all spinal levels, scores for morphologic characteristics revealed no significant differences between 105 and 355 mAs (P = .555), but they were worse in scans at 75 mAs (P = .025).

CONCLUSIONS:

Clinically acceptable image quality of cervical spine CTs for evaluation of bony structures of cadaveric specimens with different body habitus can be achieved with a reference mAs of 105 at 120 kVp with iterative reconstruction. Pull-down of shoulders during acquisition could improve image quality but may not be feasible in trauma patients with unknown injuries.

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A new time-resolved 3D angiographic technique (4D DSA): description, and assessment of its reliability in Spetzler-Martin grading of cerebral arteriovenous malformations

Publication date: Available online 20 December 2017
Source:Journal of Neuroradiology
Author(s): Julien Ognard, Elsa Magro, Jildaz Caroff, Douraied Ben Salem, Sebastien Andouard, Michel Nonent, Jean-Christophe Gentric
Background and Purpose: The Spetzler and Martin (SM) cerebral arteriovenous malformation (AVM) classification is a widely used 5-tier classification. This common language allows specialists to exchange about AVMs and must be reliably characterized by the imaging methods. We presented an agreement study on a new method of digital subtracted 3D rotational angiography resolved in time (four-dimensional DSA: 4D DSA) compared to the gold standard (two-dimensional digital DSA: 2D DSA) in AVM grading using the SM classification. Methods: Ten patients with AVMs were included during one year, they had an angiographic exploration with both 4D DSA and 2D DSA. Three readers assessed the SM classification. One reader conducted a second reading. The inter-, intra-observer and inter-modality agreements were calculated by Kappas. Dose to patient was reported. Results: Considering the SM grade, the interobserver agreement between 4D DSA and 2D DSA was equivalent (κ = 0.45 and 0.46), and calculated as substantial κ = 0.76 between the 2 methods. The agreement between 4D DSA and 2D DSA was calculated as moderate κ = 0.46 assessing the size of the nidus, slight κ = 0.18 analyzing the drainage and almost perfect κ = 0.95 depicting the localization. 4D DSA performed during a standard initial angiographic assessment of AVM represented approximately 6% of the total dose. Conclusion: The addition of this new technique 4D DSA could be performed regularly in addition to the 2D DSA if available, to assess SM grading, with an acceptable exposure to ionizing radiation cost.



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T2 Mapping for Noninvasive Assessment of Interstitial Edema in Acute Cardiac Allograft Rejection in a Mouse Model of Heterotopic Heart Transplantation.

Objectives: Heart transplantation (HTX) in mice is used to characterize gene-deficient mice and to test new treatment strategies. The purpose was to establish noninvasive magnetic resonance imaging techniques in mice to monitor pathophysiological changes of the allograft during rejection. Materials and Methods: Magnetic resonance imaging was performed at baseline and days 1 and 6 after isogenic (n = 10, C57BL/6) and allogenic (n = 12, C57BL/6 to BALB/c) heterotopic HTX on a 7 T small animal scanner. Respiratory- and electrocardiogram-gated multislice multi-echo spin echo sequences were acquired, and parameter maps of T2 relaxation time were generated. T2 times in septal, anterior, lateral, and posterior myocardial segments as well as global T2 times were calculated and compared between groups. At day 7 animals were sacrificed and graft pathology was assessed by semiquantitative regional analysis and correlated with magnetic resonance imaging results. Results: Myocardial T2 relaxation time was significantly increased in allogenic (33.4 +/- 0.1 ms) and isogenic cardiac grafts (31.8 +/- 1.8 ms) on day 1 after HTX compared with healthy donor hearts at baseline (23.1 +/- 0.3 ms, P

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Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography: A Systematic Preclinical Approach.

Objectives: Low peak kilovoltage (kVp) protocols in computed tomography angiography (CTA) demand a review of contrast media (CM) administration practices. The aim of this study was to systematically evaluate different iodine concentrations of CM in a porcine model. Materials and Methods: Dynamic 70 kVp CTA was performed on 7 pigs using a third-generation dual-source CT system. Three CM injection protocols (A-C) with an identical total iodine dose and iodine delivery rate (150 mg I/kg, 12 s, 0.75 g I/s) differed in iodine concentration and flow rate (protocol A: 400 mg I/mL, 1.9 mL/s; B: 300 mg I/mL, 2.5 mL/s; C: 150 mg I/mL, 5 mL/s). All protocols were applied in a randomized order and compared intraindividually. Arterial enhancement at different locations in the pulmonary artery, the aorta, and aortic branches was measured over time. Time attenuation curves, peak enhancement, time to peak, and bolus tracking delay times needed for static CTA were calculated. The reproducibility of optimal parameters was tested in single-phase CTA. Results: The heart rates of the pigs were comparable for all protocols (P > 0.7). The injection pressure was significantly higher for protocol A (64 +/- 5 psi) and protocol C (55 +/- 3 psi) compared with protocol B (39 +/- 2 psi) (P

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90Sr specific activity of teeth of abandoned cattle after the Fukushima accident – teeth as an indicator of environmental pollution

Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): Kazuma Koarai, Yasushi Kino, Atsushi Takahashi, Toshihiko Suzuki, Yoshinaka Shimizu, Mirei Chiba, Ken Osaka, Keiichi Sasaki, Yusuke Urushihara, Tomokazu Fukuda, Emiko Isogai, Hideaki Yamashiro, Toshitaka Oka, Tsutomu Sekine, Manabu Fukumoto, Hisashi Shinoda
⁹⁰Sr specific activity in the teeth of young cattle that were abandoned in Kawauchi village and Okuma town located in the former evacuation areas of the Fukushima-Daiichi Nuclear Power Plant (FNPP) accident were measured. Additionally, specific activity in contaminated surface soils sampled from the same area was measured. (1) All cattle teeth examined were contaminated with ⁹⁰Sr. The specific activity, however, varied depending on the developmental stage of the teeth during the FNPP accident; teeth that had started development before the accident exhibited comparatively lower values, while teeth developed mainly after the accident showed higher values. (2) Values of ⁹⁰Sr-specific activity in teeth formed after the FNPP accident were higher than those of the bulk soil but similar to those in the exchangeable fraction (water and CH3COONH4 soluble fractions) of the soil. The findings suggest that ⁹⁰Sr was incorporated into the teeth during the process of development, and that ⁹⁰Sr in the soluble and/or leachable fractions of the soil might migrate into teeth and contribute to the amount of ⁹⁰Sr in the teeth. Thus, the concentration of ⁹⁰Sr in teeth formed after the FNPP accident might reflect the extent of ⁹⁰Sr pollution in the environment.



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Do Tumor Shrinkage Patterns at Breast MR Imaging Predict Survival?

Do Tumor Shrinkage Patterns at Breast MR Imaging Predict Survival?

Radiology. 2018 Jan;286(1):58-59

Authors: Moy L

PMID: 29261475 [PubMed - in process]

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Vijay M. Rao, MD, President, Radiological Society of North America, 2018.

Vijay M. Rao, MD, President, Radiological Society of North America, 2018.

Radiology. 2018 Jan;286(1):9-10

Authors: Levin DC

PMID: 29261474 [PubMed - in process]

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Editor's Note: January 2018.

Editor's Note: January 2018.

Radiology. 2018 Jan;286(1):7-8

Authors: Bluemke DA

PMID: 29261473 [PubMed - in process]

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Case 253.

Case 253.

Radiology. 2018 Jan;286(1):350-352

Authors: Sandberg JK, Hulett-Bowling R, Khanna G

PMID: 29261472 [PubMed - in process]

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Using Computer Analysis to Predict Likelihood of Cancer in Lung Nodules.

Using Computer Analysis to Predict Likelihood of Cancer in Lung Nodules.

Radiology. 2018 Jan;286(1):296-297

Authors: MacMahon H

PMID: 29261471 [PubMed - in process]

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Science to Practice: Can Functional MR Imaging Be Useful in the Evaluation of Cardiorenal Syndrome?

Science to Practice: Can Functional MR Imaging Be Useful in the Evaluation of Cardiorenal Syndrome?

Radiology. 2018 Jan;286(1):1-3

Authors: Pursnani A, Prasad PV

Abstract
Functional magnetic resonance (MR) imaging of the kidneys has gained interest recently, especially in the detection of early changes in acute kidney injury or to predict progression of chronic kidney disease (CKD). The application of these methods to cardiorenal syndrome (CRS) is novel. CRS is widely accepted as a complex clinical problem routinely faced by clinicians. In this issue, Chang et al ( 1 ) present their preliminary experience applying blood oxygen level-dependent (BOLD) MR imaging to the kidneys in mice with experimental myocardial infarction. They showed that R2* in the kidney increases after induced myocardial infarction and that the response was higher in animals with larger infarcts and over time. The authors also for the first time correlated the BOLD MR imaging findings against hypoxia-inducible factor-1α (HIF-1α) expression, an independent marker of renal hypoxia. In addition, they showed evidence for renal injury by using a kidney injury marker, kidney injury molecule-1 (KIM-1). The results of their study support the use of renal BOLD MR imaging in subjects with heart failure, in whom the risk of subsequent renal ischemia and/or hypoxia is known to exist. These results, along with those of other recent reports ( 2 ), suggest that functional imaging methods could play a key role in evaluating changes in both the primary and secondary organs involved in complex disease processes such as CRS. Availability of such methods could facilitate translation to the clinic and improve the mechanistic understanding of the complicated and interrelated pathophysiology.

PMID: 29261470 [PubMed - in process]

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The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It.

The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It.

Radiology. 2018 Jan;286(1):12-28

Authors: Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J

Abstract
Intracranial vessel wall magnetic resonance (MR) imaging has gained much attention in the past decade and has become part of state-of-the-art MR imaging protocols to assist in diagnosing the cause of ischemic stroke. With intracranial vessel wall imaging, vessel wall characteristics have tentatively been described for atherosclerosis, vasculitis, dissections, Moyamoya disease, and aneurysms. With the increasing demand and subsequently increased use of intracranial vessel wall imaging in clinical practice, radiologists should be aware of the choices in imaging parameters and how they affect image quality, the clinical indications, methods of assessment, and limitations in the interpretation of these images. In this How I do It article, the authors will discuss the technical requirements and considerations for vessel wall image acquisition in general, describe their own vessel wall imaging protocol at 3 T and 7 T, show a step-by-step basic assessment of intracranial vessel wall imaging as performed at their institution-including commonly encountered artifacts and pitfalls-and summarize the commonly reported imaging characteristics of various intracranial vessel wall diseases for direct clinical applicability. Finally, future technical and clinical considerations for full implementation of intracranial vessel wall imaging in clinical practice, including the need for histologic validation and acquisition time reduction, will be discussed.

PMID: 29261469 [PubMed - in process]

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Can Dual-Energy CT Challenge MR Imaging in the Diagnosis of Focal Infiltrative Bone Marrow Lesions?

Can Dual-Energy CT Challenge MR Imaging in the Diagnosis of Focal Infiltrative Bone Marrow Lesions?

Radiology. 2018 Jan;286(1):214-216

Authors: Palmer WE, Simeone FJ

PMID: 29261468 [PubMed - in process]

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Editor's Recognition Awards.

Editor's Recognition Awards.

Radiology. 2018 Jan;286(1):5-6

Authors: Bluemke DA

PMID: 29261467 [PubMed - in process]

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Case 249: Intramuscular Mycetoma.

Case 249: Intramuscular Mycetoma.

Radiology. 2018 Jan;286(1):353-359

Authors: Neyaz Z, Mohindra N, Bhatnagar A, Marak RSK

Abstract
History A 21-year-old man presented with swelling of the medial aspect of the left thigh of 1-month duration. There was no history of fever or penetrating injury in the left thigh. The patient had undergone renal transplantation 7 years earlier and had been taking immunosuppressants since transplantation. He had undergone two surgeries at the same site in the medial aspect of the left thigh in the past 3 years for a similar problem. At physical examination, there was swelling in the medial aspect of the left thigh, with mild tenderness. A surgical scar was noted anterior to the swelling ( Fig 1 ). No redness or discharging sinus was present. Laboratory results were as follows: hemoglobin level, 11.3 g/dL (normal range, 13.8-17.2 g/dL); white blood cell count, 9.7 × 109/L (normal range, [4-11] × 109/L); neutrophil, 75% (normal range, 48%-77%); lymphocyte, 22% (normal range, 10%-24%); eosinophil, 1% (normal range, 0.3%- 7%); monocyte, 1% (normal range, 0.6%-10%); serum creatinine level, 1.3 mg/dL (114.9 μmol/L) (normal range, 0.5-1.6 mg/dL [44.2-141.4 μmol/L]); and serum glucose (random) level, 82 mg/dL (4.5 mmol/L) (normal range, 79-140 mg/dL [4.4-7.8 mmol/L]). Radiography of the left thigh showed soft-tissue swelling in the medial aspect of the left thigh, without underlying bone involvement (not shown). Ultrasonography (US) and magnetic resonance (MR) imaging of the left thigh were performed. [Figure: see text].

PMID: 29261466 [PubMed - in process]

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John Rousseau Thornbury, MD.

John Rousseau Thornbury, MD.

Radiology. 2018 Jan;286(1):368

Authors: Lee FT

PMID: 29261465 [PubMed - in process]

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Frederick J. Bonte, MD.

Frederick J. Bonte, MD.

Radiology. 2018 Jan;286(1):366

Authors: Rofsky NM

PMID: 29261464 [PubMed - in process]

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Increased Rather than Decreased Small Vessel Pulsatility in Patients with Progressing Cerebral White Matter Hyperintensities.

Increased Rather than Decreased Small Vessel Pulsatility in Patients with Progressing Cerebral White Matter Hyperintensities.

Radiology. 2018 Jan;286(1):363-364

Authors: Zwanenburg JJM

PMID: 29261463 [PubMed - in process]

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Contrast Media for Coronary CT Angiography: Should an Iso-osmolar Agent Be Used?

Contrast Media for Coronary CT Angiography: Should an Iso-osmolar Agent Be Used?

Radiology. 2018 Jan;286(1):81-82

Authors: Schoepf UJ

PMID: 29261462 [PubMed - in process]

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An Imaging Glimpse into the Autistic Brain.

An Imaging Glimpse into the Autistic Brain.

Radiology. 2018 Jan;286(1):227-228

Authors: Rollins NK

PMID: 29261461 [PubMed - in process]

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Radiology Editorial Board 2018.

Radiology Editorial Board 2018.

Radiology. 2018 Jan;286(1):4

Authors: Bluemke DA

PMID: 29261460 [PubMed - in process]

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Abbreviated Biparametric Prostate MR Imaging: Is It Really an Alternative to Multiparametric MR Imaging?

Abbreviated Biparametric Prostate MR Imaging: Is It Really an Alternative to Multiparametric MR Imaging?

Radiology. 2018 Jan;286(1):360-361

Authors: Scialpi M, Martorana E, Aisa MC, Rondoni V, D'Andrea A, Brunese L

PMID: 29261459 [PubMed - in process]

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James G. Kereiakes, PhD.

James G. Kereiakes, PhD.

Radiology. 2018 Jan;286(1):367

Authors: Thomas SR, Hendee W, Simmons G, Pomeranz SJ

PMID: 29261458 [PubMed - in process]

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Erik Boijsen, PhD.

Erik Boijsen, PhD.

Radiology. 2018 Jan;286(1):365

Authors: Ekberg O, Aspelin P, Baum S

PMID: 29261457 [PubMed - in process]

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Diagnostic Ability of CT to Help Differentiate Stenosis of 30% in Patients with Atrial Fibrillation.

Diagnostic Ability of CT to Help Differentiate Stenosis of 30% in Patients with Atrial Fibrillation.

Radiology. 2018 Jan;286(1):361-363

Authors: Xing X

PMID: 29261456 [PubMed - in process]

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The performance of 3D ABUS versus HHUS in the visualisation and BI-RADS characterisation of breast lesions in a large cohort of 1,886 women

Abstract

Objectives

This study aimed to evaluate automated breast ultrasound (ABUS) compared to hand-held traditional ultrasound (HHUS) in the visualisation and BIRADS characterisation of breast lesions.

Materials and methods

From January 2016 to January 2017, 1,886 women with breast density category C or D (aged 48.6±10.8 years) were recruited. All participants underwent ABUS and HHUS examination; a subcohort of 1,665 women also underwent a mammography.

Results

The overall agreement between HHUS and ABUS was 99.8 %; kappa=0.994, p<0.0001. Two cases were graded as BI-RADS 1 in HHUS, but were graded as BIRADS 4 in ABUS; biopsy revealed a radial scar. Three carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 4 in ABUS; two additional carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 5 in ABUS. Two carcinomas, appearing as a well-circumscribed mass or developing asymmetry in mammography, were graded as BI-RADS 4 in mammography but BI-RADS 5 in ABUS.

Conclusions

ABUS could be successfully used in the visualisation and characterisation of breast lesions. ABUS seemed to outperform HHUS in the detection of architectural distortion on the coronal plane and can supplement mammography in the detection of non-calcified carcinomas in women with dense breasts.

Key Points

• The new generation of ABUS yields comparable results to HHUS.

• ABUS seems superior to HHUS in detecting architectural distortions.

• In dense breasts, supplemental ABUS to mammography detects additional cancers.

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Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy

Abstract

Objectives

To investigate the relationship between the level of collateral circulation and perfusion territory normalisation after carotid endarterectomy (CEA).

Methods

This study enrolled 22 patients with severe carotid stenosis that underwent CEA and 54 volunteers without significant carotid stenosis. All patients were scanned with ASL and t-ASL within 1 month before and 1 week after CEA. Collateral circulation was assessed on preoperative ASL images based on the presence of ATA. The postoperative flow territories were considered as back to normal if they conformed to the perfusion territory map in a healthy population. Neuropsychological tests were performed on patients before and within 7 days after surgery.

Results

ATA-based collateral score assessed on preoperative ASL was significantly higher in the flow territory normalisation group (n=11, 50 %) after CEA (P < 0.0001). The MMSE (mean change=1.36±0.96) and MOCA (mean change=1.18±0.95) test scores showed a significant postoperative (7 days after CEA) improvement in the flow territory normalisation group [>mean differences+2SD among control (MMSE=1.35, MOCA=1.02)].

Conclusions

This study demonstrated that effective collateral flow in carotid stenosis patients was associated with normalisation of t-ASL perfusion territory after CEA. The perfusion territory normalisation group tends to have more cognitive improvement after CEA.

Key Points

• Evaluation of collaterals before CEA is helpful for avoiding ischaemia during clamping.

• There was good agreement on ATA-based ASL collateral grading.

• Perfusion territories in carotid stenosis patients are altered.

• Patients have better collateral circulation with perfusion territory back to normal.

• MMSE and MOCA test scores improved more in the territory normalisation group.

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Erratum to: Effects of radiation dose reduction in volume perfusion CT imaging of acute ischaemic stroke

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Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines

Abstract

Objectives

Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR Contrast Media Safety Committee performed a systematic review of the incidence of post-contrast acute kidney injury (PC-AKI) in these patients.

Methods

A systematic search in Medline and Scopus databases was performed for renal function deterioration studies in patients with MM or MG following administration of iodine-based contrast media. Data collection and analysis were performed according to the PRISMA statement 2009. Eligibility criteria and methods of analysis were specified in advance. Cohort and case-control studies reporting changes in renal function were included.

Results

Thirteen studies were selected that reported 824 iodine-based contrast medium administrations in 642 patients with MM or MG, in which 12 unconfounded cases of PC-AKI were found (1.6 %). The majority of patients had intravenous urography with high osmolality ionic contrast media after preparatory dehydration and purgation.

Conclusions

MM and MG alone are not risk factors for PC-AKI. However, the risk of PC-AKI may become significant in dehydrated patients with impaired renal function. Hypercalcaemia may increase the risk of kidney damage, and should be corrected before contrast medium administration. Assessment for Bence-Jones proteinuria is not necessary.

Key Points

• Monoclonal gammopathies including multiple myeloma are a large spectrum of disorders.

• In monoclonal gammopathy with normal renal function, PC-AKI risk is not increased.

• Renal function is often reduced in myeloma, increasing the risk of PC-AKI.

• Correction of hypercalcaemia is necessary in myeloma before iodine-based contrast medium administration.

• Bence-Jones proteinuria assessment in myeloma is unnecessary before iodine-based contrast medium administration.

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Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings

Abstract

Purpose

To evaluate serial computed tomography (CT) findings of pulmonary mucormycosis correlated with peripheral blood absolute neutrophil count (ANC).

Materials and methods

Between February 1997 and June 2016, 20 immunocompromised patients (10 males, 10 females; mean age, 48.9 years) were histopathologically diagnosed as pulmonary mucormycosis. On initial (n=20) and follow-up (n=15) CT scans, the patterns of lung abnormalities and their changing features on follow-up scans were evaluated, and the pattern changes were correlated with ANC changes.

Results

All patients were immunocompromised. On initial CT scans, nodule (≤3cm)/mass (>3cm) or consolidation with surrounding ground-glass opacity halo (18/20, 90%)) was the most common pattern. On follow-up CT, morphologic changes (13/15, 87%) could be seen and they included reversed halo (RH) sign, central necrosis, and air-crescent sign. Although all cases did not demonstrate the regular morphologic changes at the same timeline, various combinations of pattern change could be seen in all patients. Sequential morphologic changes were related with recovering of ANC in 13 of 15 patients.

Conclusion

Pulmonary mucormycosis most frequently presents as consolidation or nodule/mass with halo sign at CT. Morphologic changes into RH sign, central necrotic cavity or air-crescent sign occur with treatment and recovery of ANC.

Key points

• Pulmonary mucormycosis showed various CT-morphology including CT halo sign

• Pulmonary mucormycosis had trends of serial morphologic changes on follow-ups

• Recovery of absolute neutrophil count changed CT-morphology of mucormycosis in immune-compromised patients

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Prostate cancer detection among readers with different degree of experience using ultra-high b-value diffusion-weighted Imaging: Is a non-contrast protocol sufficient to detect significant cancer?

Abstract

Aim

To evaluate the accuracy of a T2-weighted (T2w) – and a parallel transmit zoomed b = 2000 s/mm2 (b2000) – diffusion-weighted imaging sequence among three readers with different degrees of experience for prostate cancer (Pca) detection.

Methods

Ninety-three patients with suspected Pca were enrolled. For b2000 a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory was applied, and the field of view (FOV) was reduced to one-third. All three readers (Reader A: 7, B 4 and C <1 years of experience in prostate MRI) independently evaluated b2000 with regard to the presence of suspicious lesions that displayed increased signal. The results were compared to histopathology obtained by real-time MR/ultrasound fusion and systematic biopsy.

Results

In 62 patients Pca was confirmed. One significant Pca (Gleason score (GS) 7b) was missed by Reader C. Overall, sensitivity/specificity/positive predictive value/negative predictive value were 90/71/86/79% for Reader A, 87/84/92/76% for Reader B and 85/74/87/72% for Reader C, respectively. Detection rates for significant Pca (GS >7a) were 100/100/94% for Readers A/B/C, respectively. Inter-reader agreement was generally good (Kappa A/B: 0.8; A/C: 0.82; B/C: 0.74).

Conclusion

B2000 in combination with a T2w could be useful to detect clinically significant Pca.

Key Points

• Significant prostate cancer using zoomed ultra-high b-value DWI was detected.

• Diagnostic performance among readers with different degrees of experience was good.

• mp- MRI of the prostate using a comprehensive non-contrast protocol is clinically feasible.

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Multispectral optoacoustic tomography of the human breast: characterisation of healthy tissue and malignant lesions using a hybrid ultrasound-optoacoustic approach

Abstract

Background and aim

Multispectral optoacoustic tomography (MSOT) represents a new in vivo imaging technique with high resolution (~250 μm) and tissue penetration (>1 cm) using the photoacoustic effect. While ultrasound contains anatomical information for lesion detection, MSOT provides functional information based on intrinsic tissue chromophores. We aimed to evaluate the feasibility of combined ultrasound/MSOT imaging of breast cancer in patients compared to healthy volunteers.

Methods

Imaging was performed using a handheld MSOT system for clinical use in healthy volunteers (n = 6) and representative patients with histologically confirmed invasive breast carcinoma (n = 5) and ductal carcinoma in situ (DCIS, n = 2). MSOT values for haemoglobin and oxygen saturation were assessed at 0.5, 1.0 and 1.5 cm depth and selected wavelengths between 700 and 850 nm.

Results

Reproducible signals were obtained in all wavelengths with consistent MSOT signals in superficial tissue in breasts of healthy individuals. In contrast, we found increased signals for haemoglobin in invasive carcinoma, suggesting a higher perfusion of the tumour and tumour environment. For DCIS, MSOT values showed only little variation compared to healthy tissue.

Conclusions

This preliminary MSOT breast imaging study provided stable, reproducible data on tissue composition and physiological properties, potentially enabling differentiation of solid malignant and healthy tissue.

Key Points

• A handheld MSOT probe enables real-time molecular imaging of the breast.

• MSOT of healthy controls provides a reproducible reference for pathology identification.

• MSOT parameters allows for differentiation of invasive carcinoma and healthy tissue.

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The influence of microvascular injury on native T1 and T2* relaxation values after acute myocardial infarction: implications for non-contrast-enhanced infarct assessment

Abstract

Objectives

Native T1 mapping and late gadolinium enhancement (LGE) imaging offer detailed characterisation of the myocardium after acute myocardial infarction (AMI). We evaluated the effects of microvascular injury (MVI) and intramyocardial haemorrhage on local T1 and T2* values in patients with a reperfused AMI.

Methods

Forty-three patients after reperfused AMI underwent cardiovascular magnetic resonance imaging (CMR) at 4 [3-5] days, including native MOLLI T1 and T2* mapping, STIR, cine imaging and LGE. T1 and T2* values were determined in LGE-defined regions of interest: the MI core incorporating MVI when present, the core-adjacent MI border zone (without any areas of MVI), and remote myocardium.

Results

Average T1 in the MI core was higher than in the MI border zone and remote myocardium. However, in the 20 (47%) patients with MVI, MI core T1 was lower than in patients without MVI (MVI 1048±78ms, no MVI 1111±89ms, p=0.02). MI core T2* was significantly lower in patients with MVI than in those without (MVI 20 [18-23]ms, no MVI 31 [26-39]ms, p<0.001).

Conclusion

The presence of MVI profoundly affects MOLLI-measured native T1 values. T2* mapping suggested that this may be the result of intramyocardial haemorrhage. These findings have important implications for the interpretation of native T1 values shortly after AMI.

Key points

• Microvascular injury after acute myocardial infarction affects local T1 and T2* values.

• Infarct zone T1 values are lower if microvascular injury is present.

• T2* mapping suggests that low infarct T1 values are likely haemorrhage.

• T1 and T2* values are complimentary for correctly assessing post-infarct myocardium.

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Comparison between free-breathing radial VIBE on 3-T MRI and endoscopic ultrasound for preoperative T staging of resectable oesophageal cancer, with histopathological correlation

Abstract

Objectives

To compare the T staging of resectable oesophageal cancer (OC) using radial VIBE (r-VIBE) and endoscopic ultrasound (EUS) with pathological confirmation of the T stage.

Methods

Forty-three patients with endoscopically proven OC and indeterminate T1/T2/T3/T4a stage by computed tomography (CT) and EUS were imaged on a 3-T magnetic resonance imaging (MRI) scanner. T stage was scored on MRI and EUS by two independent radiologists and one endoscopist, respectively, and compared with postoperative pathological findings. T staging agreement between r-VIBE and EUS with postoperative pathological T staging was analysed by a kappa test.

Results

EUS and pathological T staging showed agreement of 69.8% (30/43). Radial VIBE and pathological T staging agreement was 86.0% (37/43) and 90.7% (39/43) for readers 1 and 2, respectively. High accuracy for T1/T2 stage was obtained for both r-VIBE readers (90.5% and 100% for reader 1 and reader 2, respectively) and EUS reader (100%). For T3/T4, r-VIBE showed accuracy of 81.8% and 90.9% for reader 1 and reader 2, respectively, while for EUS, accuracy was only 68.2% compared with pathological T staging.

Conclusions

Contrast-enhanced r-VIBE is comparable to EUS in T staging of resectable OC with stage of T1/T2, and is superior to EUS in staging of T3/T4 lesions.

Key Points

• Radial VIBE may be useful in preoperative T staging of OC

• Accuracy of staging on r-VIBE is higher in T1/2 than in T3/4

• Accuracy of EUS was 100% and 68.2% for T1/T2 and T3/T4 stage

• Inter-reader agreement of T staging for r-VIBE was good

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Erratum to: Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results

Abstract

The original version of this article, published on 12 July 2017, unfortunately contained mistakes. The following corrections have therefore been made in the original:

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Accurate late gadolinium enhancement prediction by early T1- based quantitative synthetic mapping

Abstract

Objectives

Early synthetic gadolinium enhancement (ESGE) imaging from post-contrast T1 mapping after adenosine stress-perfusion cardiac magnetic resonance (CMR) was compared to conventional late gadolinium enhancement (LGE) imaging for assessing myocardial scar.

Methods

Two hundred fourteen consecutive patients suspected of myocardial ischaemia were referred for stress-perfusion CMR. Myocardial infarct volume was quantified on a per-subsegment basis in both synthetic (2–3 min post-gadolinium) and conventional (9 min post-gadolinium) images by two independent observers. Sensitivity, specificity, PPV and NPV were calculated on a per-patient and per-subsegment basis.

Results

Both techniques detected 39 gadolinium enhancement areas in 23 patients. The median amount of scar was 2.0 (1.0–3.1) g in ESGE imaging and 2.2 (1.1–3.1) g in LGE imaging (p=0.39). Excellent correlation (r=0.997) and agreement (mean absolute difference: -0.028±0.289 ml) were found between ESGE and LGE images. Sensitivity, specificity, PPV and NPV of ESGE imaging were 96 (78.9–99.9), 99 (97.1–100.0)%, 96 (76.5–99.4) and 99.5 (96.6–99.9) in patient-based and 99 (94.5–100.0), 100 (99.9–100.0)%, 97.0 (91.3–99.0) and 100.0 (99.8–100.0) in subsegment-based analysis.

Conclusion

ESGE based on post-contrast T1 mapping after adenosine stress-perfusion CMR imaging shows excellent agreement with conventional LGE imaging for assessing myocardial scar, and can substantially shorten clinical acquisition time.

Key Points

• Synthetic gadolinium enhancement images can be used for detection of myocardial scar.

• Early synthetic gadolinium enhancement images can substantially shorten clinical acquisition time.

• ESGE has high diagnostic accuracy as compared to conventional late gadolinium enhancement.

• Quantification of myocardial scar with ESGE closely correlates with conventional LGE.

• ESGE after stress perfusion CMR avoids need for additional gadolinium administration.

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Repeat biopsy of patients with acquired resistance to EGFR TKIs: implications of biopsy-related factors on T790M mutation detection

Abstract

Objectives

To find predictors of non-diagnostic repeat biopsy specimen acquisition for mutational analysis and detection of epidermal growth factor receptor (EGFR) T790M mutation.

Methods

We retrospectively reviewed 90 non-small cell lung cancer patients harbouring EGFR mutations who underwent repeat cone-beam CT-guided transthoracic needle biopsy. Clinical characteristics as well as biopsy-related factors were compared between patients with and without diagnostic specimen acquisition and between patients with and without T790M mutation. After univariate analysis, multivariate logistic regression analysis was performed to reveal independent predictors.

Results

Diagnostic biopsy specimens for mutational test were obtained in 90% (81/90) of patients, of which 62% (50/81) possessed T790M mutation. None of the analysed variables were significantly associated with non-diagnostic specimen acquisition. For T790M detection, duration of EGFR tyrosine kinase inhibitor treatment (p = 0.066), duration of total chemotherapy (p = 0.026), tumour size (p = 0.066), and metastatic lung lesion as a biopsy target (p = 0.029) showed p values less than 0.10. Multivariate analysis revealed that target tumour size (odds ratio, 0.765; p = 0.031) was an independent predictor of T790M mutation. Metastatic lesions as biopsy targets (odds ratio, 4.194; p = 0.050) showed marginal statistical significance.

Conclusions

Non-diagnostic repeat biopsy specimen acquisition was not related to the clinical or technical factors. However, detection of T790M at repeat biopsy might be associated with smaller target tumour size and selection of metastatic lesions as biopsy targets.

Key Points

• Cone-beam CT-guided repeat biopsy yielded high diagnostic specimen acquisition rate.

• Biopsy-related features were associated with the detection of T790M mutation.

• Target tumour size was an independent predictor of the T790M detection.

• Biopsy targeting metastatic lung nodules might help detect the T790M mutation.

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Reperfusion facilitates reversible disruption of the human blood–brain barrier following acute ischaemic stroke

Abstract

Objectives

We aimed to detect early changes of the blood–brain barrier permeability (BBBP) in acute ischaemic stroke (AIS), with or without reperfusion, and find out whether BBBP can predict clinical outcomes.

Methods

Consecutive AIS patients imaged with computed tomographic perfusion (CTP) before and 24 h after treatment were included. The relative permeability–surface area product (rPS) was calculated within the hypoperfused region (rPS_hypo-i), non-hypoperfused region of ischaemic hemisphere (rPS_nonhypo-i) and their contralateral mirror regions (rPS_hypo-c and rPS_nonhypo-c). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome.

Results

Fifty-six patients were included in the analysis, median age was 76 (IQR 62–81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPS_hypo-i, rPS_nonhypo-i and rPS_hypo-c all decreased significantly. The decreases in rPS_hypo-i and rPS_hypo-c were larger in the reperfusion group than non-reperfusion group. The rPS_hypo-i at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018–1.256; P = 0.022).

Conclusion

Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome.

Key points

• Early disruption of blood–brain barrier (BBB) in stroke is reversible after treatment.

• The reversibility of BBB permeability is associated with reperfusion.

• Unfavourable outcome is associated with BBB permeability at 24 h after treatment.

• Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.

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An open-label, prospective, observational study of the efficacy of bisphosphonate therapy for painful osteoid osteoma

Abstract

Objectives

To assess the efficacy of bisphosphonate therapy on bone pain in patients with osteoid osteoma (OO) (main objective), and to describe bisphosphonate-induced changes in nidus mineralisation and regional bone-marrow oedema (BMO).

Methods

A prospective, observational study was conducted from 2011 to 2014. Patients with risk factors for complications of percutaneous or surgical ablation or recurrence after ablation, were offered once monthly intravenous bisphosphonate treatment until significant pain alleviation was achieved.

Results

We included 23 patients. The first two patients received pamidronate and the next 21 zoledronic acid (mean, 2.95 infusions per patient). Bisphosphonate therapy was successful in 19 patients (83%), whose mean pain visual analogue scale score decreased by 76.7%; this pain-relieving effect persisted in 17 patients (74%) with a mean follow-up time of 36 months. Computed tomography (CT) demonstrated a mean nidus density increase of 177.7% (p = 0.001). By magnetic resonance imaging (MRI), mean decreases were 38.4% for BMO surface area and 30.3% for signal intensity (p = 0.001 and p = 0.000, respectively).

Conclusions

In 17/23 patients with painful OO managed conservatively with bisphosphonates, long-term final success was achieved. Bisphosphonates may accelerate the spontaneous healing of OO.

Key points

• 19/23 patients with OO managed with bisphosphonates experienced significant pain relief

• Pain relief was sustained in 17/23 patients, mean follow-up of 36 months

• CT demonstrated a significant increase in nidus mineralisation

• MRI demonstrated a significant decrease in bone marrow oedema

• Bisphosphonate therapy may accelerate the spontaneous healing of OO

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How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings

Abstract

Purpose

To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome.

Materials and methods

This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated.

Results

The median patient age was 28 years (interquartile range, 22–39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96–99.4).

Conclusion

Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA.

Key points

• Appendiceal diameter and marked left tubal thickening allow differentiating PID from AA.

• PID should be considered if appendiceal diameter is < 7 mm.

• Marked left tubal diameter indicates PID rather than AA when enlarged appendix.

• No pathological CT findings were identified in 5 % of PID patients.

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Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results

Abstract

Objective

To assess the feasibility of greater occipital nerve (GON) intermediate site infiltration with MRI guidance.

Methods

Eleven consecutive patients suffering from chronic refractory cranio-facial pain who underwent 16 GON infiltrations were included in this prospective study. All of the procedures were performed on an outpatient basis in the research facility of our institution, with a 1.5 T scanner. The fatty space between inferior obliquus and semispinalis muscles at C1-C2 level was defined as the target. Technical success was defined as the ability to accurately inject the products at the target, assessed by post-procedure axial and sagittal proton density-weighted sequences. Clinical success was defined as a 50% pain decrease at 1 month.

Results

Technical success was 100%. GON was depicted in 6/11 cases on planning MRI sequences. Mean duration of procedure was 22.5 min (range 16–41). Clinical success was obtained in 7/11 included patients (63.6%) with a mean self-reported improvement of 78%.

Conclusion

Interventional MR-guidance for GON infiltration is a feasible technique offering similar results to an already established effective procedure. It may appear as a useful tool in specific populations, such as young patients and repeat infiltrations, and should be considered in these settings.

Key Points

• MR guidance for GON infiltration is a feasible technique.

• Preliminary results are in agreement with other guidance modalities.

• MR guidance may be seen as a useful tool in specific populations.

• Specific populations include young patients and repeat infiltrations.

• Target patients may also include patients with potentionally previously reported complications (torticollis).

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Gadoxetate disodium-induced tachypnoea and the effect of dilution method: a proof-of-concept study in mice

Abstract

Objectives

To directly investigate the rapid respiratory effect of gadoxetate disodium in an experimental study using mice.

Methods

After confirming the steady respiratory state under general anaesthesia, eight mice were injected with all test agents in the following order: phosphate-buffered saline (A, control group), 1.25 mmol/kg of gadoteridol (B) or gadopentetate dimeglumine (C), or 0.31 mmol/kg of gadoxetate disodium (D, E). The experimenter was not blinded to the agents. The injection dose was fixed as 100 μL for Groups A-D and 50 μL for Group E. We continuously monitored and recorded respiratory rate (RR), peripheral oxygen saturation (SpO₂), and heart rate. The time-series changes from 0 to 30 s were compared by the linear mixed method

Results

Groups D and E showed the largest RR increase (20.6 and 20.3 breaths/min, respectively) and were significantly larger compared to Group A (3.36 breaths/min, both P<0.001). RR change of Groups D and E did not differ. RR change of Groups B and C was smaller (0.72 and 12.4 breaths/min, respectively) and did not differ statistically with Group A. Significant bradycardia was observed only in Group C (P<0.001). SpO₂ was constant in all groups.

Conclusions

Gadoxetate disodium causes a rapid tachypnoea without significant change of SpO₂ and heart rate regardless of the dilution method.

Key Points

• Injection of gadoxetate disodium causes tachypnoea.

• Dilution method did not alter the rapid respiratory effect of gadoxetate disodium.

• The respiratory effect of gadoxetate disodium was larger than other contrast agents.

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Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis

Abstract

Objectives

To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis.

Methods

Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48–74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA.

Results

After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0–318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10–20 mm in 27, 20–50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54–84), even in 17/29 nodules with 10–20 mm diameter (58.6%, CI: 39–76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22–47) (p= 0.0007). MVI did not correlate with history of previous HCC.

Conclusions

HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients.

Key Points

• In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy.

• HCC presents imaging features of microvascular invasion, predictive of more aggressive progression.

• Cirrhotic patients need aggressive and close monitoring after direct-acting antiviral therapy.

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Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America.

Related Articles

Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America.

Rev Invest Clin. 2017 Mar-Apr;69(2):103-113

Authors: Lambertini M, Goldrat O, Barragan-Carrillo R, Viglietti G, Demeestere I, Villarreal-Garza C

Abstract
Thanks to the improved survival outcomes observed in recent years, a growing attention has been given to the quality of life issues faced by young women with breast cancer such as fertility preservation and concerns related to future pregnancies. However, several challenges remain for young women with breast cancer considering undergoing fertility preservation strategies. Further specific issues on this regard should be taken into account in Latin America, where patients and physicians face particular barriers that hinder the routine adoption of this practice. Hence, further efforts are needed to overcome these deficiencies and improve the correct referral of breast cancer patients to fertility preservation strategies. The aim of the present review is to focus on the risk of anticancer treatment-related premature ovarian failure and infertility in young breast cancer patients, to summarize the current knowledge on the available options for fertility preservation, and to discuss the safety issues of pregnancy in breast cancer survivors. Furthermore, this review aims to highlight the specific clinical challenges in this field encountered by healthcare providers and young breast cancer patients from Latin American countries.

PMID: 28453508 [PubMed - indexed for MEDLINE]

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Editorial: inflammatory bowel disease risk reduction after migration - are early life events important?

Related Articles

Editorial: inflammatory bowel disease risk reduction after migration - are early life events important?

Aliment Pharmacol Ther. 2017 05;45(10):1367-1368

Authors: Lamba MJ, Tharayil VS, Gearry RB

PMID: 28417499 [PubMed - indexed for MEDLINE]

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Awareness and attitudes of the Lebanese population with regard to physician-pharmaceutical company interaction: a survey study.

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Awareness and attitudes of the Lebanese population with regard to physician-pharmaceutical company interaction: a survey study.

BMJ Open. 2017 Mar 31;7(3):e013041

Authors: Ammous A, Bou Zein Eddine S, Dani A, Dbaibou J, El-Asmar JM, Sadder L, Akl EA

Abstract
OBJECTIVE: To assess the awareness and attitudes of the general public in Lebanon regarding the interactions between physicians and pharmaceutical companies.
SETTING: Primary healthcare clinics and shopping malls in the Greater Beirut Area.
PARTICIPANTS: 263 participants completed the questionnaire, of whom 62% were female and 38% were male. Eligible participants were Arabic-speaking or English-speaking adults (age≥18 years) residing in Lebanon for at least 5 years.
PRIMARY AND SECONDARY OUTCOME MEASURES: Awareness, attitudes and beliefs of the general public.
RESULTS: 263 out of 295 invited individuals (89% completion rate) completed the questionnaire. While the majority of participants were aware of pharmaceutical company presence (or absence) in physicians' offices (range of 71-76% across questions), smaller percentages were aware of gift-related practices of physicians (range of 26-69% across questions). 40% thought that the acceptance of small gifts or meals by physicians is wrong/unethical. The percentage of participants reporting lower trust in physicians due to their participation in various pharmaceutical company-related activities ranged from 12% to 45% (the highest percentage being for large gifts). Participants who reported receiving free medication samples were significantly more likely to consider physicians' acceptance of small gifts as 'not a problem' than 'unethical' (OR=1.53; p=0.044).
CONCLUSIONS: Participants in our survey were generally more aware of pharmaceutical company presence (or absence) in physicians' offices than of gift-related practices of physicians. While the level of trust was not affected for the majority of participants for various types of interactions, it was affected the most for accepting large gifts.

PMID: 28363922 [PubMed - indexed for MEDLINE]

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Correlates of quality of life among individuals with epilepsy enrolled in self-management research: From the US Centers for Disease Control and Prevention Managing Epilepsy Well Network.

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Correlates of quality of life among individuals with epilepsy enrolled in self-management research: From the US Centers for Disease Control and Prevention Managing Epilepsy Well Network.

Epilepsy Behav. 2017 Apr;69:177-180

Authors: Sajatovic M, Tatsuoka C, Welter E, Friedman D, Spruill TM, Stoll S, Sahoo SS, Bukach A, Bamps YA, Valdez J, Jobst BC

Abstract
RATIONALE: Epilepsy is a chronic neurological condition that causes substantial burden on patients and families. Quality of life may be reduced due to the stress of coping with epilepsy. For nearly a decade, the Centers for Disease Control (CDC) Prevention Research Center's Managing Epilepsy Well (MEW) Network has been conducting research on epilepsy self-management to address research and practice gaps. Studies have been conducted by independent centers across the U.S. Recently, the MEW Network sites, collaboratively, began compiling an integrated database to facilitate aggregate secondary analysis of completed and ongoing studies. In this preliminary analysis, correlates of quality of life in people with epilepsy (PWE) were analyzed from pooled baseline data from the MEW Network.
METHODS: For this analysis, data originated from 6 epilepsy studies conducted across 4 research sites and comprised 459 PWE. Descriptive comparisons assessed common data elements that included gender, age, ethnicity, race, education, employment, income, seizure frequency, quality of life, and depression. Standardized rating scales were used for quality of life (QOLIE-10) and for depression (Patient Health Questionnaire, PHQ-9).
RESULTS: While not all datasets included all common data elements, baseline descriptive analysis found a mean age of 42 (SD 13.22), 289 women (63.0%), 59 African Americans (13.7%), and 58 Hispanics (18.5%). Most, 422 (92.8%), completed at least high school, while 169 (61.7%) were unmarried, divorced/separated, or widowed. Median 30-day seizure frequency was 0.71 (range 0-308). Depression at baseline was common, with a mean PHQ-9 score of 8.32 (SD 6.04); 69 (29.0%) had depression in the mild range (PHQ-9 score 5-9) and 92 (38.7%) had depression in the moderate to severe range (PHQ-9 score >9). Lower baseline quality of life was associated with greater depressive severity (p<.001), more frequent seizures (p<.04) and lower income (p<.05).
CONCLUSIONS: The MEW Network Integrated Database offers a unique opportunity for secondary analysis of data from multiple community-based epilepsy research studies. While findings must be tempered by potential sample bias, i.e. a relative under-representation of men and relatively small sample of some racial/ethnic subgroups, results of analyses derived from this first integrated epilepsy self-management database have potential to be useful to the field. Associations between depression severity and lower QOL in PWE are consistent with previous studies derived from clinical samples. Self-management efforts that focus on mental health comorbidity and seizure control may be one way to address modifiable factors that affect quality of life in PWE.

PMID: 28139451 [PubMed - indexed for MEDLINE]

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Development and evaluation of a generic education program for chronic diseases in childhood.

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Development and evaluation of a generic education program for chronic diseases in childhood.

Patient Educ Couns. 2017 Jun;100(6):1153-1160

Authors: Ernst G, Menrath I, Lange K, Eisemann N, Staab D, Thyen U, Szczepanski R, ModuS Study Group

Abstract
OBJECTIVE: To support families with a chronically ill child, a modular curriculum and new healthcare structures (trainer education, quality management) for a group self-management program (ModuS) were developed. ModuS focuses on common psychosocial aspects of chronic conditions and comprises generic and disease-specific modules. A pilot test was conducted for asthma by comparing ModuS with an established asthma-specific education program (CAE).
METHODS: Under routine care conditions, 491 children (6-17 years) with asthma and their parents participated in a multi-center prospective study (265 ModuS; 226 CAE). Families' program satisfaction, disease-specific knowledge, health-related quality of life (HRQoL), life satisfaction, and burden of disease were assessed before, directly following and six weeks after participation.
RESULTS: The families were highly satisfied with the program. CAE and ModuS were associated with improved disease-specific knowledge, childreńs HRQoL and life satisfaction and decreased the families' burden. This demonstrates comparability of existing care with the modular approach.
CONCLUSION: The ModuS approach offers a structure for effective patient education programs aiming to improve self-management. As it focused on the similarities of chronic conditions, it provides the opportunity to establish education programs for a wide range of chronic childhood diseases.
PRACTICE IMPLICATIONS: ModuS facilitates the development of new patient education programs.

PMID: 28109650 [PubMed - indexed for MEDLINE]

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Sleep and its associations with perceived and objective cognitive impairment in individuals with multiple sclerosis.

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Sleep and its associations with perceived and objective cognitive impairment in individuals with multiple sclerosis.

J Sleep Res. 2017 Aug;26(4):428-435

Authors: Hughes AJ, Parmenter BA, Haselkorn JK, Lovera JF, Bourdette D, Boudreau E, Cameron MH, Turner AP

Abstract
Problems with sleep and cognitive impairment are common among people with multiple sclerosis (MS). The present study examined the relationship between self-reported sleep and both objective and perceived cognitive impairment in MS. Data were obtained from the baseline assessment of a multi-centre intervention trial (NCT00841321). Participants were 121 individuals with MS. Nearly half (49%) of participants met the criteria for objective cognitive impairment; however, cognitively impaired and unimpaired participants did not differ on any self-reported sleep measures. Nearly two-thirds (65%) of participants met the criteria for 'poor' sleep, and poorer sleep was significantly associated with greater levels of perceived cognitive impairment. Moreover, the relationships between self-reported sleep and perceived cognitive impairment were significant beyond the influence of clinical and demographic factors known to influence sleep and cognitive functioning (e.g. age, sex, education level, disability severity, type of MS, disease duration, depression and fatigue). However, self-reported sleep was not associated with any measures of objective cognitive impairment. Among different types of perceived cognitive impairment, poor self-reported sleep was most commonly related to worse perceived executive function (e.g. planning/organization) and prospective memory. Results from the present study emphasize that self-reported sleep is significantly and independently related to perceived cognitive impairment in MS. In terms of clinical implications, interventions focused on improving sleep may help improve perceived cognitive function and quality of life in this population; however, the impact of improved sleep on objective cognitive function requires further investigation.

PMID: 28093823 [PubMed - indexed for MEDLINE]

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Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults.

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Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults.

Patient Educ Couns. 2017 Jun;100(6):1177-1184

Authors: Goedendorp MM, Kuiper D, Reijneveld SA, Sanderman R, Steverink N

Abstract
OBJECTIVE: The Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity.
METHODS: In the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants' baseline characteristics. Professionals completed questions regarding program fidelity.
RESULTS: No significant differences were found on effect outcomes and adherence between IMP and RCT (all p≥0.135). Intervention effect sizes were equal (0.47-0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations.
CONCLUSION: The effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity.
PRACTICE IMPLICATIONS: The SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.

PMID: 28089311 [PubMed - indexed for MEDLINE]

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Trajectories of mental and physical functioning among spouse caregivers of cancer survivors over the first five years following the diagnosis.

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Trajectories of mental and physical functioning among spouse caregivers of cancer survivors over the first five years following the diagnosis.

Patient Educ Couns. 2017 Jun;100(6):1213-1221

Authors: Lambert S, Girgis A, Descallar J, Levesque JV, Jones B

Abstract
OBJECTIVE: Identify the trajectories of physical and mental functioning among spouse caregivers of patients with cancer over the first five years post-diagnosis and variables associated with low or deteriorating functioning.
METHODS: Caregivers completed a survey at 6 months and 1, 2, 3.5, and 5 years post-patient diagnosis, including the SF-12 for quality of life (QOL). SF-12 Mental Component Summary (MCS, n=299) and Physical Component Summary (PCS, n=300) scores were analyzed using SAS.
RESULTS: Five trajectories for PCS were identified, the top three were: (a) high PCS (53.0%); (b) steady decline in PCS (17.0%); and (c) steady increase, but remaining below population norm (16.7%). Five trajectories for MCS were also identified, the top two being: (a) high MCS (45.8%) and (b) MCS comparable to population norm (27.8%). Variables associated with low or deteriorating QOL included depression, social support, coping, burden, and/or unmet needs.
CONCLUSIONS: This is the first study to document spouse caregivers' QOL over the first five years post-patient diagnosis. Although many participants experienced high functioning, almost a third reported low or deteriorating mental or physical functioning.
PRACTICE IMPLICATIONS: Variables associated with low or deteriorating mental and physical functioning can be targeted in future interventions.

PMID: 28089132 [PubMed - indexed for MEDLINE]

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Quality of life in patients with an idiopathic rapid eye movement sleep behaviour disorder in Korea.

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Quality of life in patients with an idiopathic rapid eye movement sleep behaviour disorder in Korea.

J Sleep Res. 2017 Aug;26(4):422-427

Authors: Kim KT, Motamedi GK, Cho YW

Abstract
There have been few quality of life studies in patients with idiopathic rapid eye movement sleep behaviour disorder. We compared the quality of life in idiopathic rapid eye movement sleep behaviour disorder patients to healthy controls, patients with hypertension, type 2 diabetes mellitus without complication and idiopathic restless legs syndrome. Sixty patients with idiopathic rapid eye movement sleep behaviour disorder (24 female; mean age: 61.43 ± 8.99) were enrolled retrospectively. The diagnosis was established based on sleep history, overnight polysomnography, neurological examination and Mini-Mental State Examination to exclude secondary rapid eye movement sleep behavior disorder. All subjects completed questionnaires, including the Short Form 36-item Health Survey for quality of life. The total quality of life score in idiopathic rapid eye movement sleep behaviour disorder (70.63 ± 20.83) was lower than in the healthy control group (83.38 ± 7.96) but higher than in the hypertension (60.55 ± 24.82), diabetes mellitus (62.42 ± 19.37) and restless legs syndrome (61.77 ± 19.25) groups. The total score of idiopathic rapid eye movement sleep behaviour disorder patients had a negative correlation with the Pittsburg Sleep Quality Index (r = -0.498, P < 0.001), Insomnia Severity Index (r = -0.645, P < 0.001) and the Beck Depression Inventory-2 (r = -0.694, P < 0.001). Multiple regression showed a negative correlation between the Short Form 36-item Health Survey score and the Insomnia Severity Index (β = -1.100, P = 0.001) and Beck Depression Inventory-2 (β = -1.038, P < 0.001). idiopathic rapid eye movement sleep behaviour disorder had a significant negative impact on quality of life, although this effect was less than that of other chronic disorders. This negative effect might be related to a depressive mood associated with the disease.

PMID: 28019055 [PubMed - indexed for MEDLINE]

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Singing for Lung Health-a systematic review of the literature and consensus statement.

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Singing for Lung Health-a systematic review of the literature and consensus statement.

NPJ Prim Care Respir Med. 2016 12 01;26:16080

Authors: Lewis A, Cave P, Stern M, Welch L, Taylor K, Russell J, Doyle AM, Russell AM, McKee H, Clift S, Bott J, Hopkinson NS

Abstract
There is growing interest in Singing for Lung Health (SLH), an approach where patients with respiratory disease take part in singing groups, intended to improve their condition. A consensus group was convened in early 2016 to address issues including: the specific features that make SLH distinct from other forms of participation in singing; the existing evidence base via a systematic review; gaps in the evidence base including the need to define value-based outcome measures for sustainable commissioning of SLH; defining the measures needed to evaluate both individuals' responses to SLH and the quality of singing programmes. and core training, expertise and competencies required by singing group leaders to deliver high-quality programmes. A systematic review to establish the extent of the evidence base for SLH was undertaken. Electronic databases, including Pubmed, OVID Medline and Embase, Web of Science, Cochrane central register of controlled trials and PEDro, were used. Six studies were included in the final review. Quantitative data suggest that singing has the potential to improve health-related quality of life, particularly related to physical health, and levels of anxiety without causing significant side effects. There is a significant risk of bias in many of the existing studies with small numbers of subjects overall. Little comparison can be made between studies owing to their heterogeneity in design. Qualitative data indicate that singing is an enjoyable experience for patients, who consistently report that it helps them to cope with their condition better. Larger and longer-term trials are needed.

PMID: 27906158 [PubMed - indexed for MEDLINE]

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Psychometric Characteristics of the Hebrew Version of the Professional Quality-of-Life Scale.

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Psychometric Characteristics of the Hebrew Version of the Professional Quality-of-Life Scale.

J Pain Symptom Manage. 2016 Oct;52(4):575-581.e1

Authors: Samson T, Iecovich E, Shvartzman P

Abstract
CONTEXT: Exposure to human suffering may have ramifications for the professional quality of life (ProQol) of palliative care teams. The ProQol scale was designed to assess both negative and positive work-related outcomes and has been used recently for the evaluation of work-related outcomes among palliative care workers. However, the assessment of ProQol among Israeli hospice workers is scant.
OBJECTIVES: The aim of this study was to assess the psychometric properties and the factor structure of the Hebrew version of the 30-item ProQol questionnaire.
METHODS: The study population included 1100 health care providers including physicians, nurses, and social workers in primary health care and palliative care settings.
RESULT: A total of 380 workers participated in the study, representing a response rate of 34.5%. The confirmatory factor analysis did not show an adequate "goodness to fit." Using a factor coefficient of 0.35 or greater for inclusion, the exploratory factor analysis revealed a 23-item solution, loaded onto three factors: compassion satisfaction, secondary traumatic stress, and burnout (BU). The internal consistency subscales were 0.87, 0.82, and 0.69, respectively. The subscales showed good convergent and exploratory validity because of significant correlations with measures that examine BU, work engagement, and peritraumatic dissociative experiences.
CONCLUSIONS: Although the findings are consistent with those from studies in other languages, they are different from the original 30-item three-factor structure reported by Stamm. The Hebrew version of the compassion satisfaction subscale was found to be reliable and valid for studies among health care professionals, but further research is needed to improve the BU and secondary traumatic stress subscales.

PMID: 27660084 [PubMed - indexed for MEDLINE]

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Dignity Through Integrated Symptom Management: Lessons From the Breathlessness Support Service.

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Dignity Through Integrated Symptom Management: Lessons From the Breathlessness Support Service.

J Pain Symptom Manage. 2016 Oct;52(4):515-524

Authors: Gysels M, Reilly CC, Jolley CJ, Pannell C, Spoorendonk F, Moxham J, Bausewein C, Higginson IJ

Abstract
CONTEXT: Dignity is poorly conceptualized and little empirically explored in end-of-life care. A qualitative evaluation of a service offering integrated palliative and respiratory care for patients with advanced disease and refractory breathlessness uncovered an unexpected outcome, it enhanced patients' dignity.
OBJECTIVES: To analyze what constitutes dignity for people suffering from refractory breathlessness with advanced disease, and its implications for the concept of dignity.
METHODS: Qualitative study of cross-sectional interviews with 20 patients as part of a Phase III evaluation of a randomized controlled fast-track trial. The interviews were transcribed verbatim, imported into NVivo, and analyzed through constant comparison. The findings were compared with Chochinov et al.'s dignity model. The model was adapted with the themes and subthemes specific to patients suffering from breathlessness.
RESULTS: The findings of this study underscore the applicability of the conceptual model of dignity for patients with breathlessness. There were many similarities in themes and subthemes. Differences specifically relevant for patients suffering from severe breathlessness were as follows: 1) physical distress and psychological mechanisms are interlinked with the disability and dependence breathlessness causes, in the illness-related concerns, 2) stigma is an important component of the social dignity inventory, 3) conditions and perspectives need to be present to practice self-care in the dignity-conserving repertoire.
CONCLUSION: Dignity is an integrated concept and can be affected by influences from other areas such as illness-related concerns. The intervention shows that targeting the symptom holistically and equipping patients with the means for self-care realized the outcome of dignity.

PMID: 27650009 [PubMed - indexed for MEDLINE]

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[Progress in diagnosis and treatment of radioactive iodine-refractory differentiated thyroid carcinoma].

[Progress in diagnosis and treatment of radioactive iodine-refractory differentiated thyroid carcinoma].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Dec 07;52(12):956-960

Authors: Zhao Z, Shen GH, Li YH, Zhou K, Cai HW

Abstract
The radioactive iodine-refractory differentiated thyroid carcinoma (RIR-DTC) is a complex process that involves multiple genetic changes and multiple signaling pathways.Radionuclide imaging, genomics and proteomics are effective to clarify the mechanism and helpful in clinical diagnosis and therapy.The treatment of RIR-DTC includes the removal of distant metastases, drug therapy, external radiotherapy and radiofrequency ablation.This review mainly focuses on the pathogenesis, diagnosis and treatment of RIR-DTC.

PMID: 29262462 [PubMed - in process]

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Prenatal Diagnosis of Trisomy 2p due to Terminal 2p Duplication including Interstitial Telomeric Sequences

We report on a prenatally diagnosed unusual case of inverted terminal duplication of the short arm of chromosome 2, leading to interstitial telomeric sequences (ITSs) and partial trisomy 2p. To our knowledge, there are only 4 further cases of pure partial trisomy 2p reported prenatally. Here, the mother was referred at 22 weeks of gestation for isolated fetal congenital heart malformation at ultrasound. The karyotype of amniotic fluid cells displayed a large duplication of the short arm of chromosome 2 that was further investigated by array-CGH, which detected a 1-copy gain of 43.75 Mb in chromosome 2 at 2p21p25.3. FISH confirmed the presence of an inverted duplication in the short arm of chromosome 2 involving the region 2p21pter and revealed the presence of ITSs at the breakpoint in chromosome 2p21. This report contributes to the prenatal description of the syndrome. We also discuss the possible mechanisms leading to this duplication and the formation of ITSs which are rarely described in constitutional rearrangements.
Cytogenet Genome Res

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The economic value of long-lasting insecticidal nets and indoor residual spraying implementation in Mozambique

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Are public-private partnerships the solution to tackle neglected tropical diseases? A systematic review of the literature

Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available preventive and curative interventions for NTDs mostly rely on old technologies and products that are often not adequate. Moreover, NTDs mostly affect populations living in remote rural areas and conflict zones, thereby hampering access to healthcare. The challenges posed by NTDs have led to the proliferation of a variety of public-private partnerships (PPPs) in the last decades. We conducted a systematic review to assess the functioning and impact of these partnerships on the development of and access to better technologies for NTDs. Our systematic review revealed a clear lack of empirical assessment of PPPs: we could not find any impact evaluation analyses, while these are crucial to realize the full potential of PPPs and to progress further towards NTDs elimination.

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Cytosolic high-mobility group box protein 1 (HMGB1) and/or PD-1+ TILs in the tumor microenvironment may be contributing prognostic biomarkers for patients with locally advanced rectal cancer who have undergone neoadjuvant chemoradiotherapy

Abstract

Rectal cancer, which comprises 30% of all colorectal cancer cases, is one of the most common forms of cancer in the world. Patients with locally advanced rectal cancer (LARC) are often treated with neoadjuvant chemoradiotherapy (neoCRT) followed by surgery. However, after neoCRT treatment, approximately one-third of the patients progress to local recurrence or distant metastasis. In these studies, we found that patients with tumors that exhibited cytosolic HMGB1(Cyto-HMGB1) translocation and/or the presence of PD-1+ tumor-infiltrating lymphocytes (TILs) before treatment had a better clinical outcome. The better outcome is likely due to the release of HMGB1, which triggers the maturation of dendritic cells (DCs) via TLR4 activation, and the subsequent recruitment of PD-1+ tumor-infiltrating lymphocytes to the tumor site, where they participate in immune-scavenging. In conclusion, our results provide evidence that cyto-HMGB1 and/or PD-1+TIL are not only predictive biomarkers before treatment, but they can also potentially designate patients for personalized oncological management including immunotherapy.

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