External beam radiation therapy to hepatocellular carcinoma involving inferior vena cava and/or right atrium: A meta-analysis and systemic review

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): Chai Hong Rim, Chul Yong Kim, Dae Sik Yang, Won Sup Yoon
PurposeHepatocellular carcinoma (HCC) involving inferior vena cava (IVC) and/or right atrium (RA) is a very rare but serious disease. The objective of this meta-analysis was to assess efficacy and safety of external beam radiotherapy (EBRT) for HCC involving IVC and/or RA.Materials and methodsSystematic search of Pubmed, MEDLINE, EMBASE, and Cochrane library published was performed. Primary endpoints were 1-year overall survival (OS) rate and 2-year OS rates. Secondary endpoints were response rate, local control (LC) rate, and grade ≥3 toxicities. According to heterogeneity evaluated with Cochran Q test and I² statistics, meta-analysis was performed using either random or fixed model.ResultsA total of 8 studies and 9 cohorts were included, encompassing 164 patients. Pooled 1- and 2-year OS rates were 53.6% (95% CI: 45.7–61.3%) and 36.9% (95% CI: 27.2–42.4%), respectively. Pooled response rate and LC rate were 59.2% (95% CI: 39.0–76.7%) and 83.8% (95% CI: 78.8–97.1%), respectively. Only one study reported 2 grade ≥3 toxicities, an esophageal rupture and a pulmonary embolism cases. The overall rate of possible grade ≥3 complications was 1.2% (2 of 164).ConclusionsEBRT is a feasible and safe option to palliate HCC with IVC and/or RA invasion.



from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2E5OBqA

Influence of deformable image registration on 4D dose simulation for extracranial SBRT: A multi-registration framework study

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): Nik Mogadas, Thilo Sothmann, Tobias Knopp, Tobias Gauer, Cordula Petersen, René Werner
Background and purposeTo evaluate the influence of deformable image registration approaches on correspondence model-based 4D dose simulation in extracranial SBRT by means of open source deformable image registration (DIR) frameworks.Material and methodsEstablished DIR algorithms of six different open source DIR frameworks were considered and registration accuracy evaluated using freely available 4D image data. Furthermore, correspondence models (regression-based correlation of external breathing signal measurements and internal structure motion field) were built and model accuracy evaluated. Finally, the DIR algorithms were applied for motion field estimation in radiotherapy planning 4D CT data of five lung and five liver lesion patients, correspondence model formation, and model-based 4D dose simulation. Deviations between the original, statically planned and the 4D-simulated VMAT dose distributions were analyzed and correlated to DIR accuracy differences.ResultsRegistration errors varied among the DIR approaches, with lower DIR accuracy translating into lower correspondence modeling accuracy. Yet, for lung metastases, indices of 4D-simulated dose distributions widely agreed, irrespective of DIR accuracy differences. In contrast, liver metastases 4D dose simulation results strongly vary for the different DIR approaches.ConclusionsEspecially in treatment areas with low image contrast (e.g. the liver), DIR-based 4D dose simulation results strongly depend on the applied DIR algorithm, drawing resulting dose simulations and indices questionable.



from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2GWyxu7

Radiotherapy quality assurance for the RTOG 0834/EORTC 26053-22054/NCIC CTG CEC.1/CATNON intergroup trial “concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic glioma”: Individual case review analysis

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): André N. Abrunhosa-Branquinho, Raquel Bar-Deroma, Sandra Collette, Enrico Clementel, Yan Liu, Coen W. Hurkmans, Loïc Feuvret, Karen Van Beek, Martin van den Bent, Brigitta G. Baumert, Damien C. Weber
BackgroundThe EORTC phase III 26053-22054/ RTOG 0834/NCIC CTG CEC.1/CATNON intergroup trial was designed to evaluate the impact on concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic gliomas. The primary endpoint was overall survival.We report the results of retrospective individual case reviews (ICRs) for the first patient randomized per institution to detect the compliance with the study protocol.Material and methodsSixty-nine institutions were required to submit the radiotherapy plan of their first randomized patient. Full digital datasets uploaded to the EORTC server were assessed by three independent and blinded reviewers through the EORTC radiotherapy quality assurance platform.ResultsSixty-two (90%) of sixty-nine ICRs were received and assessable. Of the 62 cases, 22 were evaluated as per protocol (35.5%), 11 as acceptable variation (17.7%) and 29 were classified as unacceptable variations (46.8%). Most common unacceptable variations were related to the PTV dose (n = 19, 31%) and delineation (n = 17, 27%) processes.ConclusionsThe ICR analysis showed a significant number of unacceptable variations with potential impact on tumor control and/or toxicity profile. Prospective ICRs are encouraged for future studies to prevent and correct protocol violations before start of treatment.



from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2E6QQd8

Economic data for particle therapy: Dealing with different needs in a heterogeneous landscape

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): Yolande Lievens, Klaus Nagels
BackgroundIn the light of scarce resources to be allocated for cancer care and a steady stream of costly innovations in all modalities applied to treat cancer, particle therapy needs to demonstrate its cost-utility balance to allow its positioning in the context of competing modalities. In the continuous evolving particle therapy landscape, the timely availability of appropriate economic data is crucial.MethodsEconomic data collection and compilation for particle therapy needs to follow health economic standards. Costing related analyses particularly need attention as clinical outcome data follow international standards to provide comparability. Among others, perspective, time horizons and cost categories are critical.ResultsIn this report from the "Health Economics Work Package" of the European Particle Therapy Network, the approaches commonly applied in health economic assessments are described and tailored to the specific needs of particle therapy. Data collection for cost calculation, economic evaluation and budget impact analysis are discussed.ConclusionThe presented data are intended to serve as a guidance for economic data collection, bearing in mind that in each specific case, the heterogeneous requirements of national health systems will need to be considered and assessments adapted accordingly.



from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2H0xo53

Submandibular Gland Transfer: A Potential Imaging Pitfall [HEAD & NECK]

BACKGROUND AND PURPOSE:

The Seikaly and Jha submandibular gland transfer surgery is performed to facilitate gland shielding during radiation therapy for head and neck tumors to circumvent radiation-induced xerostomia. It results in an asymmetric postsurgical appearance of the submandibular and submental spaces. Our purpose was to characterize the morphologic and enhancement characteristics of the transferred submandibular gland and identify potential pitfalls in postoperative radiologic interpretation.

MATERIALS AND METHODS:

This retrospective study identified patients with head and neck cancer who had undergone the submandibular gland transfer procedure at our institution. Chart reviews were performed to identify relevant oncologic histories and therapies. CT and MR neck imaging was reviewed to characterize morphologic and enhancement characteristics of the pre- and postoperative submandibular glands, as well as interpretive accuracy.

RESULTS:

Eleven patients with oropharyngeal and nasopharyngeal squamous cell carcinomas who underwent submandibular gland transfer were identified. The transferred glands were significantly lengthened in the anteroposterior dimension compared with contralateral glands (P < .001) and displaced anteriorly and inferiorly within the submandibular and submental spaces. Enhancement patterns of the transferred submandibular glands varied, depending on the time of imaging relative to the operation and radiation therapy. Submandibular gland transfer was acknowledged in the postoperative report in 7/11 cases. Errors in interpretation were present in 2/11 reports.

CONCLUSIONS:

After the submandibular gland transfer procedure, the submandibular and submental spaces lose their symmetric appearances as the transferred submandibular glands become lengthened and located more anteriorly and inferiorly, with variable enhancement characteristics. Familiarity with the postsurgical appearance of the transferred submandibular glands is key to accurate imaging interpretation.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2pPCBnW

Aneurysmal Parent Artery-Specific Inflow Conditions for Complete and Incomplete Circle of Willis Configurations [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Hemodynamics are thought to play a role in intracranial aneurysm growth and rupture. Computational fluid dynamics is frequently performed to assess intra-aneurysmal hemodynamics, using generalized flow waveforms of healthy volunteers as inflow boundary conditions. The purpose of this study was to assess differences in inflow conditions for different aneurysmal parent artery locations and variations of circle of Willis configurations.

MATERIALS AND METHODS:

In a series of 96 patients with 103 aneurysms, velocity measurements were acquired using 2D phase-contrast MR imaging perpendicular to the aneurysmal parent arteries in the circle of Willis. Circle of Willis configurations were inspected for variations using multiple overlapping thin-slab-acquisition MRAs. Flow rates, velocity magnitudes, and pulsatility indices were calculated for each parent artery location in subgroups of complete and incomplete circle of Willis configurations.

RESULTS:

Flow rates, velocity magnitudes, and pulsatility indices were significantly different among aneurysmal parent arteries. Incomplete circle of Willis configurations were observed in 24% of the cases. Significantly lower basilar artery flow rates were observed in configurations with hypoplastic P1 segments. Significantly higher A1 flow rates were observed in configurations with a hypoplastic contralateral A1 segment.

CONCLUSIONS:

Inflow conditions vary substantially between aneurysmal parent arteries and circle of Willis configurations. We have created a collection of parent artery–specific inflow conditions tailored to the patient-specific circle of Willis configuration that can be used in future computational fluid dynamics studies analyzing intra-aneurysmal hemodynamics.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2J60IYm

Blood Flow Mimicking Aneurysmal Wall Enhancement: A Diagnostic Pitfall of Vessel Wall MRI Using the Postcontrast 3D Turbo Spin-Echo MR Imaging Sequence [ADULT BRAIN]

SUMMARY:

Our aim was to compare the detectability of aneurysmal wall enhancement in unruptured intracranial aneurysms between conventional and motion-sensitized driven equilibrium–prepared postcontrast 3D T1-weighted TSE sequences (sampling perfection with applicationoptimized contrasts by using different flip angle evolution, SPACE). Twenty-two patients with 30 unruptured intracranial aneurysms were scanned at 3T. Aneurysmal wall enhancement was more significantly detected using conventional compared with motion-sensitized driven equilibrium–prepared SPACE sequences (10/30 versus 2/30, P < .0001). Contrast-to-noise ratio measurements did not differ between conventional and motion-sensitized driven equilibrium–prepared sequences (P = .51). Flowing blood can mimic aneurysmal wall enhancement using conventional SPACE sequences with potential implications for patient care.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2pPCB7q

Signal Change of Acute Cortical and Juxtacortical Microinfarction on Follow-Up MRI [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Although the clinical importance of cortical microinfarcts has become well-recognized recently, the evolution of cortical microinfarcts on MR imaging is not fully understood. The aim of this study was to examine the temporal changes in acute cortical microinfarcts using susceptibility-weighted imaging and conventional MR imaging.

MATERIALS AND METHODS:

Patients with acute infarcts located in the cortical and/or juxtacortical region measuring ≤10 mm in axial diameter based on diffusion-weighted imaging who had a follow-up 3T MR imaging were retrospectively included in the study. All lesions did not show hypointensity on initial T2*WI. For cortical and/or juxtacortical microinfarcts detected on initial DWI, 2 neuroradiologists evaluated the follow-up MR imaging (T2WI, FLAIR, T2*WI, and SWI) and assessed lesion signal intensities and locations (cortical microinfarcts or microinfarcts with juxtacortical white matter involvement).

RESULTS:

On initial DWI, 2 radiologists observed 180 cortical and/or juxtacortical microinfarcts in 35 MR imaging examinations in 25 patients; on follow-up, the neuroradiologists identified 29 cortical microinfarcts (16%) on T2WI, 9 (5%) on FLAIR, 4 (2%) on T2*, and 97 (54%) on SWI. All cortical microinfarcts detected with any follow-up MR imaging showed hyperintensity on T2WI/FLAIR and/or hypointensity on T2*WI and SWI.

CONCLUSIONS:

SWI revealed conversion (paramagnetic susceptibility changes) of acute cortical microinfarcts, suggesting that a substantial number of cortical microinfarcts may contain hemorrhagic components.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2J2a9bc

An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

The safety and efficacy of the PulseRider for the treatment of wide-neck, bifurcation aneurysms at the basilar and carotid terminus locations were studied in a prospective trial, the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction (ANSWER) trial, reporting on initial 6-month angiographic and clinical results. This report provides insight into the longer term durability and safety with 12-month data.

MATERIALS AND METHODS:

Aneurysms treated with the PulseRider among enrolled sites were prospectively studied. Updated 12-month data on clinical and imaging end points are included.

RESULTS:

Thirty-four patients were enrolled (29 women, 5 men) with a mean age of 60.9 years. The mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range, 2.3–11.6 mm). At 1 year, there were no device migrations or symptomatic in-stent stenoses. Raymond-Roy I occlusion was achieved in 53% of cases at the time of treatment and progressed to 61% and 67% at 6 and 12 months, respectively. Adequate occlusion (Raymond-Roy I/II) progressed from 88% at 6 months to 90% at 12 months. No recanalizations were observed. There was 1 delayed ischemic event. Good outcome (mRS 0–2) was achieved in 90% of patients.

CONCLUSIONS:

The updated 1-year results from the ANSWER trial demonstrate aneurysm stability and an acceptable safety profile for aneurysms treated at the basilar apex and carotid terminus. Prospective data from a larger set of aneurysms treated at other locations are required to assess how treatment with PulseRider compares with alternatives for treating wide-neck bifurcation aneurysms.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2pUh1hU

Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT) [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Although flow diverters have been reported with favorable clinical and angiographic outcomes in various literatures, randomized trials determining their true effectiveness and safety are still in lack. The Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter (PARAT) trial was designed to evaluate the safety and efficacy of the Tubridge flow diverter in the treatment of large or giant aneurysms in comparison with Enterprise stent-assisted coiling.

MATERIALS AND METHODS:

This prospective, multicenter, randomized trial was conducted at 12 hospitals throughout China. Enrolled adults with unruptured large/giant intracranial aneurysms were randomly assigned (1:1) to receive either Enterprise stent-assisted coiling or Tubridge flow diverter implantation. The primary end point was complete occlusion at 6-month follow-up, while secondary end points included technical success, mortality, target vessel–related stroke, aneurysm bleeding, in-stent stenosis, parent artery occlusion, and the frequency of all adverse events.

RESULTS:

Among 185 enrolled subjects, 41 withdrew before procedure initiation. Overall, 82 subjects underwent Tubridge implantation, and 62 subjects were primarily treated with stent-assisted coiling. The results of 6-month follow-up imaging included complete occlusion rates of 75.34% versus 24.53% for the Tubridge and stent-assisted coiling groups, respectively, with a calculated common odds ratio of 9.4 (95% confidence interval, 4.14–21.38; P < .001). There was a higher, nonsignificant frequency of complications for Tubridge subjects. Multivariate analysis showed a decreased stroke rate at the primary investigational site, with a marginal P value (P = .051).

CONCLUSIONS:

This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2J29Yg2

Combined hyperpolarized 13C-pyruvate MRS and 18F-FDG PET (hyperPET) estimates of glycolysis in canine cancer patients

Publication date: June 2018
Source:European Journal of Radiology, Volume 103
Author(s): Adam E. Hansen, Henrik Gutte, Pernille Holst, Helle H. Johannesen, Sofie Rahbek, Andreas E. Clemmensen, Majbritt M.E. Larsen, Christina Schøier, Jan Ardenkjaer-Larsen, Thomas L. Klausen, Annemarie T. Kristensen, Andreas Kjaer
¹³C Magnetic Resonance Spectroscopy (MRS) using hyperpolarized ¹³C-labeled pyruvate as a substrate offers a measure of pyruvate-lactate interconversion and is thereby a marker of the elevated aerobic glycolysis (Warburg effect) generally exhibited by cancer cells. Here, we aim to compare hyperpolarized [1-¹³C]pyruvate MRS with simultaneous ¹⁸F-2-fluoro-2-deoxy-d-glucose (FDG) PET in a cross-sectional study of canine cancer patients.MethodsCanine cancer patients underwent integrated PET/MRI using a clinical whole-body system. Hyperpolarized [1-¹³C]pyruvate was obtained using dissolution-DNP. ¹⁸F-FDG PET, dynamic ¹³C MRS, ¹³C MRS Imaging (MRSI) and anatomical ¹H MRI was acquired from 17 patients. Apparent pyruvate-to-lactate rate constants were estimated from dynamic ¹³C MRS. ¹⁸F-FDG Standard Uptake Values and maximum [1-¹³C]lactate-to-total-¹³C ratios were obtained from tumor regions of interest. Following inspection of data, patients were grouped according to main cancer type and linear regression between measures of lactate generation and ¹⁸F-FDG uptake were tested within groups. Between groups, the same measures were tested for group differences.ResultsThe main cancer types of the 17 patients were sarcoma (n = 11), carcinoma (n = 5) and mastocytoma (n = 1). Significant correlations between pyruvate-to-lactate rate constants and ¹⁸F-FDG uptake were found for sarcoma patients, whereas no significant correlations appeared for carcinoma patients. The sarcoma patients showed a non-significant trend towards lower ¹⁸F-FDG uptake and higher lactate generation than carcinoma patients. However, the ratio of lactate generation to ¹⁸F-FDG uptake was found to be significantly higher in sarcoma as compared to carcinoma. The results were found both when lactate generation was estimated as an apparent pyruvate-to-lactate rate constant from dynamic ¹³C MRS and as an [1-¹³C]lactate to total ¹³C ratio from ¹³C MRSI.ConclusionsA comparison of hyperpolarized [1-¹³C]pyruvate MRS with simultaneous ¹⁸F-FDG PET indicate that lactate generation and ¹⁸F-FDG uptake in cancers can be related and that their relation depend on cancer type. This finding could be important for the interpretation and eventual clinical implementation of hyperpolarized ¹³C. In addition, the differences between the two modalities may allow for better metabolic phenotyping performing hybrid imaging in the form of hyperPET.

Graphical abstract

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2If345U

Radiotherapy quality assurance for the RTOG 0834/EORTC 26053-22054/NCIC CTG CEC.1/CATNON intergroup trial “concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic glioma”: Individual case review analysis

The EORTC phase III 26053-22054/ RTOG 0834/NCIC CTG CEC.1/CATNON intergroup trial was designed to evaluate the impact on concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic gliomas. The primary endpoint was overall survival.We report the results of retrospective individual case reviews (ICRs) for the first patient randomized per institution to detect the compliance with the study protocol.

from Imaging via alkiviadis.1961 on Inoreader http://bit.ly/2Ihb0n1

Influence of deformable image registration on 4D dose simulation for extracranial SBRT: A multi-registration framework study

To evaluate the influence of deformable image registration approaches on correspondence model-based 4D dose simulation in extracranial SBRT by means of open source deformable image registration (DIR) frameworks.

from Imaging via alkiviadis.1961 on Inoreader http://bit.ly/2GU4wew

External beam radiation therapy to hepatocellular carcinoma involving inferior vena cava and/or right atrium: A meta-analysis and systemic review

Hepatocellular carcinoma (HCC) involving inferior vena cava (IVC) and/or right atrium (RA) is a very rare but serious disease. The objective of this meta-analysis was to assess efficacy and safety of external beam radiotherapy (EBRT) for HCC involving IVC and/or RA.

from Imaging via alkiviadis.1961 on Inoreader http://bit.ly/2IgZUP3

Economic data for particle therapy: Dealing with different needs in a heterogeneous landscape

In the light of scarce resources to be allocated for cancer care and a steady stream of costly innovations in all modalities applied to treat cancer, particle therapy needs to demonstrate its cost-utility balance to allow its positioning in the context of competing modalities. In the continuous evolving particle therapy landscape, the timely availability of appropriate economic data is crucial.

from Imaging via alkiviadis.1961 on Inoreader http://bit.ly/2GUQg5a

Radiation exposure for intraoperative 3D scans in a hybrid operating room: how to reduce radiation exposure for the surgical team

Abstract

Background

Hybrid operating rooms are used in different fields of surgery. In orthopedic surgery, the possibility of a 3D scan of difficult anatomical regions (spine, pelvis) showed promising results not only in navigated screw placement. The associated exposure to radiation raises questions regarding potential risks for the operating room personal and the patient. The present study focuses on scatter radiation during 3D scans in a hybrid operating room, the adjacent rooms, and methods to reduce radiation exposure.

Material and Methods

\(\hbox {RaySafe}^{\mathrm{TM}}\) i2 dosimeters were used to measure scatter radiation during 3D scans of different anatomical regions in different distances and heights in a hybrid operating room. The 3D scans were performed with a floor-based flat-panel robotic C-arm with 3D scan capability (Artis Zeego, Siemens; Germany). The 3D scans were performed using a human cadaver. The 3D scans were performed using a standard and a dose reduction protocol (DRP).

Results

The highest scatter radiation was measured during 3D scans of the pelvis on the side of the surgical assistant (39.5 Sv in height of 1 m) compared to the side of the main surgeon (23 Sv in height of 1 m). Scatter radiation was less on the position of the scrub nurse (6.8 Sv in height of 1 m) and during 3D scans of the other anatomical regions. The radiation dosage was about 66% less with the DRP. Low values of scatter radiation were measured behind a radiation protection wall and with open doors in the adjacent rooms.

Conclusion

While performing a scan scatter radiation was measured everywhere in the operating room especially during 3D scans of the pelvic girdle. Therefore, settings with lower dosage should be used whenever possible. Personnel should stand behind a radiation safety wall or leave the operating room and close the doors. For this study, six behavioral rules to avoid radiation in a hybrid operating room were established.

from Imaging via alkiviadis.1961 on Inoreader http://bit.ly/2E4g4c4

Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women.

Related Articles

Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women.

Surg Radiol Anat. 2018 Mar 27;:

Authors: Chantalat E, Vaysse C, Delchier MC, Bordier B, Game X, Chaynes P, Cavaignac E, Roumiguié M

Abstract
OBJECTIVE: In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy.
PATIENTS AND METHODS: We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre- and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries.
RESULTS: The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin.
CONCLUSION: The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.

PMID: 29589145 [PubMed - as supplied by publisher]

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2IdH6QQ

[Influence of glucocorticoid therapy on intratherapeutic biodistribution of 131I radioiodine therapy in Graves' disease].

[Influence of glucocorticoid therapy on intratherapeutic biodistribution of 131I radioiodine therapy in Graves' disease].

Nuklearmedizin. 2018 Apr;57(2):43-49

Authors: Halstenberg J, Kranert WT, Korkusuz H, Mayer A, Ackermann H, Grünwald F, Happel C

Abstract
AIM: Radioiodine therapy (RIT) is an important therapeutic method in the definitive treatment of Graves' disease (GD). However, RIT may trigger development of Graves' ophthalmopathy (GO) or exacerbate a pre-existing GO. Therefore, the procedure recommendation of the DGN (German Society of Nuclear Medicine) for RIT of benign thyroid diseases recommends an additional glucocorticoid therapy for patients with pre-existing GO. Aim of this study was to analyze the influence of a protective glucocorticoid therapy on 131I biokinetics during RIT of patients with GD.
MATERIAL AND METHODS: In this retrospective analysis 211 patients with GD who underwent RIT without additional thyreostatic medication were examined. To analyze 131I biokinetics the extrapolated maximum uptake (EMU) and the effective half-life of 131I in the thyroid were determined. Patients suffering from GO received glucocorticoids according to a fixed scheme starting one day prior to RIT, patients without GO did not receive glucocorticoids. Subsequently the ratios of values measured during RIT and those measured during radioactive iodine uptake test were compared among the groups. To take into account other factors, the groups were also compared regarding age, weight, TSH, TRAb, TgAb and TPOAb.
RESULTS: In patients with additional glucocorticoid therapy, a reduction of the median EMU from 44 % in radioiodine uptake test to 35 % during RIT was observed. The pretherapeutic (47 %) and intratherapeutic (46 %) EMU of the control group without glucocorticoids remained constant. Comparison of the change in the EMU showed a statistically significant difference between both groups (p < 0.001). Comparison of all other parameters including the effective half-life of 131I (p = 0.79) did not show any statistically significant difference.
CONCLUSION: The present study suggests that glucocorticoids affect the biokinetics of 131I by reducing its thyroidal uptake. As a result of this study, for patients without antithyroid medication undergoing glucocorticoid therapy, an adjustment of therapeutic 131I activity determined in radioiodine uptake test could be considered.

PMID: 29590674 [PubMed - in process]

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2GGfFC6

Evaluation and Management of the Child with Thyrotoxicosis.

Evaluation and Management of the Child with Thyrotoxicosis.

Recent Pat Endocr Metab Immune Drug Discov. 2018 Mar 26;:

Authors: Leung AKC, Leung AAC

Abstract
BACKGROUND: Uncontrolled thyrotoxicosis, especially in early infancy, may cause irreversible damage to the central nervous system as well as profound effects on the function of many organs. Thyrotoxicosis has multiple etiologies and treatment depends on the underlying etiology. An accurate diagnosis is essential so that appropriate treatment can be initiated without undue delay.
OBJECTIVE: To review in depth the evaluation, diagnosis, and treatment of children with thyrotoxicosis.
METHODS: A PubMed search was completed in Clinical Queries using the key terms "thyrotoxicosis" and "hyperthyroidism". The search strategy included meta-analysis, randomized controlled trials, clinical trials, observational studies, and reviews. Patents were searched using the key terms "thyrotoxicosis" and "hyperthyroidism" from https://ift.tt/N1R7MD and www.google.com/patents.
RESULTS: Graves' disease accounts for approximately 96% of pediatric cases of thyrotoxicosis. Other causes include Hashitoxicosis, toxic adenoma, toxic multinodular goiter, subacute granulomatous thyroiditis, acute suppurative thyroiditis, pituitary thyroid-stimulating hormone-secreting adenoma, pituitary thyroid hormone resistance, iodine-induced thyrotoxicosis, and drug-induced thyrotoxicosis. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment. The underlying cause of thyrotoxicosis should be treated if possible. Treatment options for Graves' disease include antithyroid medications, radioiodine therapy, and surgery. Recent patents related to the management of thyrotoxicosis are discussed.
CONCLUSION: Currently, antithyroid medications are considered to be the initial treatment of choice for Graves' disease in the pediatric age group. Radioactive iodine treatment is generally used for children with poor compliance with antithyroid medications, children not in remission after 1 to 2 years of antithyroid medications, and children with a major adverse effect while receiving an antithyroid medication. Total or near-total thyroidectomy should be considered in children younger than 5 years of age who do not respond to or experience a major adverse effect to antithyroid medications. Surgery should also be considered in those with very large goiter, severe ophthalmopathy, pregnancy, persistent hyperthyroidism in spite of treatment with antithyroid medications and radioactive iodine, and personal preference.

PMID: 29589552 [PubMed - as supplied by publisher]

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2E3YKnm

Dissolution of studtite [UO2(O2)(H2O)4] in various geochemical conditions

Publication date: September 2018
Source:Journal of Environmental Radioactivity, Volume 189
Author(s): Jungjin Kim, HyunJu Kim, Won-Seok Kim, Wooyong Um
This study determined the dissolution rate of studtite, (UO2)O2(H2O)4, which can be formed by reaction between H2O2 and UO2²⁺ that leaks from spent nuclear fuel (SNF) in deep geological repositories. The batch dissolution experiments were conducted using synthesized studtite under different solution conditions with varying pHs and concentrations of HCO3⁻ and [H2O2] in synthetic groundwater. The experimental results suggested that carbonate ligand and H2O2 in groundwater accelerated the dissolution of studtite and uranium (U) release. Above 10⁻⁵ M of H2O2 initial concentration, the released uranium concentration in solution decreased, possibly as a result of reprecipitation of studtite due to reaction between uranium and H2O2. The results will be useful to assess the comprehensive transport of uranium from both nuclear waste and SNF stored in deep geological repositories.

Graphical abstract

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2Gj5Oi8

Possible Balo concentric sclerosis : MRI

Case Report: 23 year old left hemiparesis. Clinical diagnosis MS. CSF OCB positive . Poor response to steroid. CEMR images are provided.MRI images  reveal rounded lesion with alternating layers of increased and reduced signal, along with diffusion restriction.  Case Submitted by Dr Rahul Rajeev, DM (Neurology std)

Quick Notes: Balo concentric sclerosis  is a rare and severe monophasic demyelinating disease, considered a subtype of multiple sclerosis, appearing as a rounded lesion with alternating layers of increased and reduced signal giving it a characteristic 'bulls eye or 'onion bulb' appearance

FLAIR AXIAL MRI

DW-MRI AXIAL

CEMR

AXIAL T2 WI

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

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2pQV4QX