ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost – GEC-ESTRO Breast Cancer Working Group practical recommendations

This consensus statement from the Breast Cancer Working Group of Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) aims at generating practical guidelines for multi-catheter image-guided brachytherapy in the conservative management of breast cancer patients used for either Accelerated Partial Breast Irradiation (APBI) or for a breast boost.

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REPLY.

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REPLY.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Vanjare HA, Mani S

PMID: 29674418 [PubMed - as supplied by publisher]

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Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke.

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Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Boers AMM, Sales Barros R, Jansen IGH, Berkhemer OA, Beenen LFM, Menon BK, Dippel DWJ, van der Lugt A, van Zwam WH, Roos YBWEM, van Oostenbrugge RJ, Slump CH, Majoie CBLM, Marquering HA, MR CLEAN investigators

Abstract
BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.
MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.
RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.
CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

PMID: 29674417 [PubMed - as supplied by publisher]

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Altered White Matter Microstructure in the Corpus Callosum and Its Cerebral Interhemispheric Tracts in Adolescent Idiopathic Scoliosis: Diffusion Tensor Imaging Analysis.

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Altered White Matter Microstructure in the Corpus Callosum and Its Cerebral Interhemispheric Tracts in Adolescent Idiopathic Scoliosis: Diffusion Tensor Imaging Analysis.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Xue C, Shi L, Hui SCN, Wang D, Lam TP, Ip CB, Ng BKW, Cheng JCY, Chu WCW

Abstract
BACKGROUND AND PURPOSE: Neural system was one of the important contributors to the etiopathogenesis of adolescent idiopathic scoliosis; additionally, the morphology of corpus callosum interconnecting both hemispheres of the brain was found to be altered morphologically. Our aim was to evaluate and compare the microstructural changes of the corpus callosum and its interhemispheric white matter fiber tracts interconnecting both cerebral hemispheres in patients with adolescent idiopathic scoliosis and matched controls using diffusion tensor imaging.
MATERIALS AND METHODS: Brain DTI was performed in 69 patients with adolescent idiopathic scoliosis (female, right thoracic/thoracolumbar curve) and 40 age-matched controls without adolescent idiopathic scoliosis (female). 2D and 3D segmentation of the corpus callosum were performed using a region-growing method, and the corpus callosum was further divided into 6 regions, including the rostrum, genu, anterior and posterior midbodies, isthmus, and splenium. The laterality index was calculated to quantify the asymmetry of the corpus callosum. Interhemispheric fiber tractography were performed using the Brodmann atlas.
RESULTS: 2D ROI analysis revealed reduced fractional anisotropy in the genu and splenium (P = .075 and P = .024, respectively). Consistently reduced fractional anisotropy on the left sides of the genu and splenium was also found in 3D ROI analysis (P = .03 and P = .012, respectively). The laterality index analysis revealed a pseudo-right lateralization of the corpus callosum in adolescent idiopathic scoliosis. Interhemispheric fibers via the splenium interconnecting Brodmann 3, 1, and 2; Brodmann 17; and Brodmann 18 (corresponding to the primary somatosensory cortex and primary and secondary visual cortices) were also found to have reduced fractional anisotropy (P ≤ .05).
CONCLUSIONS: Reduced fractional anisotropy was found in the genu and splenium of the corpus callosum and corresponding interhemispheric fiber tracts interconnecting the somatosensory and visual cortices via the splenium. Our results are suggestive of altered white matter microstructure within the brain of those with adolescent idiopathic scoliosis, which could be related to abnormal brain maturation during adolescence in adolescent idiopathic scoliosis and could possibly explain the previously documented somatosensory function impairment and visuo-oculomotor dysfunction in this condition.

PMID: 29674416 [PubMed - as supplied by publisher]

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Noninvasive Assessment of Hemodynamic Stress Distribution after Indirect Revascularization for Pediatric Moyamoya Vasculopathy.

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Noninvasive Assessment of Hemodynamic Stress Distribution after Indirect Revascularization for Pediatric Moyamoya Vasculopathy.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Tortora D, Severino M, Pacetti M, Morana G, Mancardi MM, Capra V, Cama A, Pavanello M, Rossi A

Abstract
BACKGROUND AND PURPOSE: Indirect revascularization surgery is an effective treatment in children with Moyamoya vasculopathy. In the present study, we hypothesized that DSC-PWI may reliably assess the evolution of CBF-related parameters after revascularization surgery, monitoring the outcome of surgical pediatric patients with Moyamoya vasculopathy. Thus, we aimed to evaluate differences in DSC-PWI parameters, including the hemodynamic stress distribution, in surgical and nonsurgical children with Moyamoya vasculopathy and to correlate them with long-term postoperative outcome.
MATERIALS AND METHODS: Pre- and postoperative DSC parameters of 28 patients (16 females; mean age, 5.5 ± 4.8 years) treated with indirect revascularization were compared with those obtained at 2 time points in 10 nonsurgical patients (6 females; mean age, 6.9 ± 4.7 years). We calculated 4 normalized CBF-related parameters and their percentage variance: mean normalized CBF of the MCA territory, mean normalized CBF of the proximal MCA territory, mean normalized CBF of cortical the MCA territory, and hemodynamic stress distribution. The relationship between perfusion parameters and postoperative outcomes (poor, fair, good, excellent) was explored using 1-way analysis of covariance (P < .05).
RESULTS: A significant decrease of the mean normalized CBF of the proximal MCA territory and hemodynamic stress distribution and an increase of the mean normalized CBF of the cortical MCA territory were observed after revascularization surgery (P < .001). No variations were observed in nonsurgical children. Postoperative hemodynamic stress distribution and its percentage change were significantly different in outcome groups (P < .001).
CONCLUSIONS: DSC-PWI indices show postoperative hemodynamic changes that correlate with clinical outcome after revascularization surgery in children with Moyamoya disease.

PMID: 29674415 [PubMed - as supplied by publisher]

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Volumetric Brain MRI Study in Fetuses with Congenital Heart Disease.

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Volumetric Brain MRI Study in Fetuses with Congenital Heart Disease.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Olshaker H, Ber R, Hoffman D, Derazne E, Achiron R, Katorza E

Abstract
BACKGROUND AND PURPOSE: It is well-established that a high prevalence of infants with congenital heart defects surviving to childhood have neurodevelopmental abnormalities. The etiology is not clear. In this study, we aimed to find prenatal neuroanatomic changes in fetuses with congenital heart disease to better understand the pathophysiology behind these sequelae.
MATERIALS AND METHODS: A retrospective study of 46 fetal brain MR imaging scans was performed at a tertiary medical center during a 4-year period. Clinical data were collected from electronic medical charts. Volumes of the supratentorial brain, right hemisphere, left hemisphere, and cerebellum were measured using a semiautomated method and were compared with the normal growth percentiles.
RESULTS: We found that cerebellar volume and the cerebellar-supratentorial volume ratio were significantly lower among fetuses with congenital heart disease. Supratentorial and hemisphere volumes showed no difference between groups. This difference was not observed in fetuses with septation defects.
CONCLUSIONS: Fetuses with congenital heart disease have smaller cerebellar volumes than healthy fetuses. Additional research is needed to assess this finding as a radiologic marker for long-term outcome.

PMID: 29674414 [PubMed - as supplied by publisher]

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Neuroimaging in Dengue Seropositive Cases.

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Neuroimaging in Dengue Seropositive Cases.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Sookaromdee P, Wiwanitkit V

PMID: 29674413 [PubMed - as supplied by publisher]

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Comparison of 3T Intracranial Vessel Wall MRI Sequences.

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Comparison of 3T Intracranial Vessel Wall MRI Sequences.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Lindenholz A, Harteveld AA, Zwanenburg JJM, Siero JCW, Hendrikse J

Abstract
BACKGROUND AND PURPOSE: Intracranial vessel wall MR imaging plays an increasing role in diagnosing intracranial vascular diseases. For a complete assessment, pre- and postcontrast sequences are required, and including other sequences, these result in a long scan duration. Ideally, the scan time of the vessel wall sequence should be reduced. The purpose of this study was to evaluate different intracranial vessel wall sequence variants to reduce scan duration, provided an acceptable image quality can be maintained.
MATERIALS AND METHODS: Starting from the vessel wall sequence that we use clinically (6:42 minutes), 6 scan variants were tested (scan duration ranging between 4:39 and 8:24 minutes), creating various trade-offs among spatial resolution, SNR, and contrast-to-noise ratio. In total, 15 subjects were scanned on a 3T MR imaging scanner: In 5 subjects, all 7 variants were performed precontrast-only, and in 10 other subjects, the fastest variant (4:39 minutes) and our clinically used variant (6:42 minutes) were performed pre- and postcontrast.
RESULTS: The fastest variant (4:39 minutes) had higher or comparable SNRs/contrast-to-noise ratios of the intracranial vessel walls compared with the reference sequence (6:42 minutes). Qualitative assessment showed that the contrast-to-noise ratio was most suppressed in the fastest variant of 4:39 minutes and the variant of 6:42 minutes pre- and postcontrast. SNRs/contrast-to-noise ratios of the fastest variant were all, except one, higher compared with the variant of 6:42 minutes (P < .008). Furthermore, the fastest variant (4:39 minutes) detected all vessel wall lesions identified on the 6:42-minute variant.
CONCLUSIONS: A 30% faster vessel wall sequence was developed with high SNRs/contrast-to-noise ratios that resulted in good visibility of the intracranial vessel wall.

PMID: 29674412 [PubMed - as supplied by publisher]

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Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma.

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Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma.

AJNR Am J Neuroradiol. 2018 Apr 19;:

Authors: Chen IE, Swinburne N, Tsankova NM, Hefti MM, Aggarwal A, Doshi AH, Hormigo A, Delman BN, Nael K

Abstract
BACKGROUND AND PURPOSE: Early and accurate identification of tumor progression in patients with low-grade gliomas is challenging. We aimed to assess the role of quantitative ADC analysis in the sequential follow-up of patients with low-grade gliomas as a potential imaging marker of tumor stability or progression.
MATERIALS AND METHODS: In this retrospective study, patients with a diagnosis of low-grade glioma with at least 12 months of imaging follow-up were retrospectively reviewed. Two neuroradiologists independently reviewed sequential MR imaging in each patient to determine tumor progression using the Response Assessment in Neuro-Oncology criteria. Normalized mean ADC (ADCmean) and 10th percentile ADC (ADC10) values from FLAIR hyperintense tumor volume were calculated for each MR image and compared between patients with stable disease versus tumor progression using univariate analysis. The interval change of ADC values between sequential scans was used to differentiate stable disease from progression using the Fisher exact test.
RESULTS: Twenty-eight of 69 patients who were evaluated met our inclusion criteria. Fifteen patients were classified as stable versus 13 patients as having progression based on consensus reads of MRIs and the Response Assessment in Neuro-Oncology criteria. The interval change of ADC values showed greater concordance with ultimate lesion disposition than quantitative ADC values at a single time point. The interval change in ADC10 matched the expected pattern in 12/13 patients with tumor progression (overall diagnostic accuracy of 86%, P <.001). On average, the ADC10 interval change predicted progression 8 months before conventional MR imaging.
CONCLUSIONS: The interval change of ADC10 values can be used to identify progression versus stability of low-grade gliomas with a diagnostic accuracy of 86% and before apparent radiologic progression on conventional MR imaging.

PMID: 29674411 [PubMed - as supplied by publisher]

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Blindness after facial trauma: epidemiology, incidence and risk factors: a 27-year cohort study of 5708 patients.

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Blindness after facial trauma: epidemiology, incidence and risk factors: a 27-year cohort study of 5708 patients.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 23;:

Authors: Stathopoulos P, Igoumenakis D, Mezitis M, Rallis G

Abstract
OBJECTIVES: This was a 27-year study of a cohort of 5708 patients who had sustained maxillofacial fractures. Our purpose was to present the etiology, mechanism of trauma, site, and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high-energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included.
STUDY DESIGN: The study included 5708 patients who had sustained a maxillofacial fracture during the years 1985-2012. Patients' records were reviewed for gender, age, fracture site, etiology of trauma, concomitant injuries, method of treatment, length of hospital stay, and cause of blindness. The relationship of the above variables to blindness was investigated.
RESULTS: The incidence of loss of vision was 0.34%. A very strong association between firearm injuries and blindness was observed (P < .001). These patients spent much longer time in hospital (P < .01) and suffered serious concomitant injuries involving the brain.
CONCLUSIONS: Retrobullbar hemorrhage should be treated with lateral canthotomy, whereas in traumatic optic neuropathy, observation seems to be the safest thing to do. In patients with penetrating injuries of the globe, the immediate involvement of an ophthalmic surgeon is of paramount importance.

PMID: 29673800 [PubMed - as supplied by publisher]

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Clinical features and presentation of oral potentially malignant disorders.

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Clinical features and presentation of oral potentially malignant disorders.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Apr 04;:

Authors: Warnakulasuriya S

Abstract
Oral potentially malignant disorders (OPMDs) are conditions that precede the onset of invasive cancers of the oral cavity. The term embraces precancerous lesions and conditions referred to in earlier World Health Organization (WHO) definitions. Leukoplakia is the most common OPMD; erythroplakia, although rare, is more serious. Several variants of leukoplakia are recognized, and clinical subtyping may help determine the prognosis to a limited extent. Biopsy is essential to confirm the provisional clinical diagnosis, and timely referral to a specialist is indicated. Certain OPMDs, such as oral submucous fibrosis, are encountered particularly in population groups from Asia with specific lifestyle habits. This review provides clinical descriptions of the wide range of potentially malignant disorders encountered in the oral cavity as a prelude to the topics discussed in this focus issue.

PMID: 29673799 [PubMed - as supplied by publisher]

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Anthropometric and clinical analysis of the distal ulna and extensor carpi ulnaris tendon using MRI.

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Anthropometric and clinical analysis of the distal ulna and extensor carpi ulnaris tendon using MRI.

Surg Radiol Anat. 2018 Apr 19;:

Authors: Toprak U, Turkoglu S

Abstract
OBJECTIVE: To investigate the ulnar groove (UG), extensor carpi ulnaris (ECU) tendon, and ulnar styloid process (USP) parameters in asymptomatic individuals without ulnar-sided wrist abnormalities, to determine whether these values can be anthropometric markers of age and gender and identify their correlations for use in clinical decision-making.
MATERIALS AND METHODS: The MRI T1W axial, T2W sagittal, coronal PW and DESS sequences were evaluated in 100 cases (62 women). The UG width, depth and groove opening angle (GOA), ECU tendon width and thickness, and USP base width and length were measured.
RESULTS: For gender, the cut-off, sensitivity, specificity and accuracy values were 8.58 mm, 67, 68 and 66%, respectively, for UG width; 5.3 mm, 53, 68 and 62%, respectively, for ECU width; and 6.4 mm, 55, 74, and 67%, respectively, for USP length. There was no difference concerning age. The tendon width was 63% of the UG width and depth was approximately 51% out of the UG. UG depth was correlated with GOA and tendon thickness (p < 0.001 and 0.03, respectively); UG width with GOA, tendon thickness, and USP base width and length (p = 0.005, 0.01, 0.016, and 0.02, respectively); tendon width-thickness with USP base width and length (p = 0.05); and US base width with US length (p < 0.001).
CONCLUSION: The gender differences in distal ulnar measurements can be beneficial for surgery and forensic science. UG is wider than ECU tendon, and this is the cause of normal subluxation. Therefore, rather than deepening UG, surgeons should focus on tendon sheath abnormalities as a physiological solution.

PMID: 29675678 [PubMed - as supplied by publisher]

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Quantitative anatomy of the ilium's primary ossification center in the human fetus.

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Quantitative anatomy of the ilium's primary ossification center in the human fetus.

Surg Radiol Anat. 2018 Apr 19;:

Authors: Baumgart M, Wiśniewski M, Grzonkowska M, Badura M, Biernacki M, Siedlecki Z, Szpinda A, Szpinda M, Pawlak-Osińska K

Abstract
PURPOSE: An understanding of the development of the ilium's primary ossification center may be useful in both determining the fetal stage and maturity, and for detecting congenital disorders. This study was performed to quantitatively examine the ilium's primary ossification center with respect to its linear, planar and volumetric parameters.
MATERIALS AND METHODS: Using methods of CT, digital-image analysis and statistics, the size of the ilium's primary ossification center in 42 spontaneously aborted human fetuses of crown-rump length (CRL) ranged from 130 to 265 mm (aged 18-30 weeks) was studied.
RESULTS: With no sex and laterality differences, the best fit growth dynamics for the ilium's primary ossification center was modelled by the following functions: y = - 63.138 + 33.413 × ln(CRL) ± 1.609 for its vertical diameter, y = - 59.220 + 31.353 × ln(CRL) ± 1.736 for its transverse diameter, y = - 105.681 + 1.137 × CRL ± 16.035 for its projection surface area, and y = 478.588 + 4.035 × CRL ± 14.332 for its volume. The shape of the ilium's primary ossification center did not change over the study period, because its transverse -to- vertical diameter ratio was stable at the level of 0.94 ± 0.07. Conclusions The size of the ilium's primary ossification center displays neither sex nor laterality differences. The ilium's primary ossification center grows logarithmically with respect to its vertical and transverse diameters, and linearly with respect to its projection surface area and volume. The shape of the ilium's primary ossification center does not change throughout the examined period. The obtained quantitative data of the ilium's primary ossification center is considered normative for respective prenatal weeks and may contribute to the prenatal ultrasound diagnostics of congenital defects.

PMID: 29675677 [PubMed - as supplied by publisher]

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Assessment of Chemotherapy Response in Ewing Sarcoma: Response

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Assessment of Chemotherapy Response in Ewing Sarcoma: Response

Radiology. 2016 Nov;281(2):647-649

Authors: Daldrup-Link HE, DuBois SG, Aghighi M, Marina N, Petit P

PMID: 29672009 [PubMed - in process]

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A Suggestion to Radiological Hazards Characterization of 226Ra, 232Th, 40K and 137Cs: Spatial Distribution Modelling

Publication date: Available online 20 April 2018
Source:Journal of Hazardous Materials
Author(s): Serpil Aközcan, Fatih Külahcı, Yeliz Mercan
Spatial distribution modelling has been proposed to characterize the radiological hazards associated with concentration of natural ²²⁶Ra, ²³²Th, ⁴⁰K and artificial ¹³⁷Cs radionuclides in the nature. These elements have been determined for the sediment samples of the Bafa Lake with the aim of radiation hazard evaluation via a high purity germanium detector gamma spectrometry. Their activity concentrations in sediments are in the ranges of 29.87 ± 2.2–72.56 ± 11 Bq kg^{− 1} dry weight (dw), 31.57 ± 3.5–66.48 ± 8.3 Bq kg^{− 1} (dw), 332.01 ± 12–1092.37 ± 21 and 0.65 ± 0.04–3.96 ± 0.78 Bq kg^{− 1} (dw), respectively. In order to determine the radiological hazard associated with the radioactivity in the samples, the external terrestrial gamma dose rate in air, annual effective dose rate, the radium equivalent activity and the external hazard index are calculated and compared with the data from literature. Moreover, the spatial modelling distributions are obtained visually for radiological hazards characterization of these elements, which are very dangerous in terms of radiological and environmental pollution in the nature. These visual distributions give meaningful information for future researches on the migration of radionuclides in the environment.

Graphical abstract

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