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Zhao W, Qin S, Wang Q, Chen Y, Liu K, Xin P, Lang N. Assessment of Hidden Blood Loss in Spinal Metastasis Surgery: A Comprehensive Approach with MRI-Based Radiomics Models. J Magn Reson Imaging 2024; 59:2023-2032. [PMID: 37578031 DOI: 10.1002/jmri.28954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Patients undergoing surgery for spinal metastasis are predisposed to hidden blood loss (HBL), which is associated with poor surgical outcomes but unpredictable. PURPOSE To evaluate the role of MRI-based radiomics models for assess the risk of HBL in patients undergoing spinal metastasis surgery. STUDY TYPE Retrospective. SUBJECTS 202 patients (42.6% female) operated on for spinal metastasis with a mean age of 58 ± 11 years were divided into a training (n = 162) and a validation cohort (n = 40). FIELD STRENGTH/SEQUENCE 1.5T or 3.0T scanners. Sagittal T1-weighted and fat-suppressed T2-weighted imaging sequences. ASSESSMENT HBL was calculated using the Gross formula. Patients were classified as low and high HBL group, with 1000 mL as the threshold. Radiomics models were constructed with radiomics features. The radiomics score (Radscore) was obtained from the optimal radiomics model. Clinical variables were accessed using univariate and multivariate logistic regression analyses. Independent risk variables were used to build a clinical model. Clinical variables combined with Radscore were used to establish a combined model. STATISTICAL TESTS Predictive performance was evaluated using area under the curve (AUC), accuracy, sensitivity, specificity, and F1 score. Calibration curves and decision curves analyses were produced to evaluate the accuracy and clinical utility. RESULTS Among the radiomics models, the fusion (T1WI + FS-T2WI) model demonstrated the highest predictive efficacy (AUC: 0.744, 95% confidence interval [CI]: 0.576-0.914). The Radscore model (AUC: 0.809, 95% CI: 0.664-0.954) performs slightly better than the clinical model (AUC: 0.721, 95% CI: 0.524-0.918; P = 0.418) and the combined model (AUC: 0.752, 95% CI: 0.593-0.911; P = 0.178). DATA CONCLUSION A radiomics model may serve as a promising assessment tool for the risk of HBL in patients undergoing spinal metastasis surgery, and guide perioperative planning to improve surgical outcomes. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Weili Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Siyuan Qin
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yongye Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ke Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Peijin Xin
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Zamanian M, Treglia G, Abedi I. Diagnostic Accuracy of PET with Different Radiotracers versus Bone Scintigraphy for Detecting Bone Metastases of Breast Cancer: A Systematic Review and a Meta-Analysis. J Imaging 2023; 9:274. [PMID: 38132692 PMCID: PMC10744045 DOI: 10.3390/jimaging9120274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/05/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Due to the importance of correct and timely diagnosis of bone metastases in advanced breast cancer (BrC), we performed a meta-analysis evaluating the diagnostic accuracy of [18F]FDG, or Na[18F]F PET, PET(/CT), and (/MRI) versus [99mTc]Tc-diphosphonates bone scintigraphy (BS). The PubMed, Embase, Scopus, and Scholar electronic databases were searched. The results of the selected studies were analyzed using pooled sensitivity and specificity, diagnostic odds ratio (DOR), positive-negative likelihood ratio (LR+-LR-), and summary receiver-operating characteristic (SROC) curves. Eleven studies including 753 BrC patients were included in the meta-analysis. The patient-based pooled values of sensitivity, specificity, and area under the SROC curve (AUC) for BS (with 95% confidence interval values) were 90% (86-93), 91% (87-94), and 0.93, respectively. These indices for [18F]FDG PET(/CT) were 92% (88-95), 99% (96-100), and 0.99, respectively, and for Na[18F]F PET(/CT) were 96% (90-99), 81% (72-88), and 0.99, respectively. BS has good diagnostic performance in detecting BrC bone metastases. However, due to the higher and balanced sensitivity and specificity of [18F]FDG PET(/CT) compared to BS and Na[18F]F PET(/CT), and its advantage in evaluating extra-skeletal lesions, [18F]FDG PET(/CT) should be the preferred multimodal imaging method for evaluating bone metastases of BrC, if available.
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Affiliation(s)
- Maryam Zamanian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (M.Z.); (I.A.)
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Iraj Abedi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (M.Z.); (I.A.)
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Rodriguez A, Nunez L, Timaran-Montenegro D, Riascos R. Imaging of Common and Infrequent Extradural Tumors. Neuroimaging Clin N Am 2023; 33:443-457. [PMID: 37356861 DOI: 10.1016/j.nic.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Spinal extradural tumors, although uncommon, have high morbidity and mortality rates. Radiographs and computed tomography scans are typically used to assess and determine the characteristics of these tumors. However, MR imaging is the preferred method for the evaluation of complications that can increase morbidity, such as spinal cord and nerve compression. Imaging features, such as type of matrix, cortical involvement, and margins, aid in determining the diagnosis. This article discusses common and infrequent extradural spinal tumors, their imaging characteristics, and how age, location, and clinical presentation help in diagnosing these neoplasms.
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Affiliation(s)
- Andres Rodriguez
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA
| | - Luis Nunez
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA
| | - David Timaran-Montenegro
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA
| | - Roy Riascos
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSB 2130B, Houston, TX 77030, USA.
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Al-Smadi MW, Kozma I, Aslan S, Bölöni B, Viola Á. Percutaneous Superimposed O-Arm-MRI-Navigated Biopsy for Spinal Column Pathologies. Diagnostics (Basel) 2023; 13:2252. [PMID: 37443649 DOI: 10.3390/diagnostics13132252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Classifying spinal tumors can be challenging due to nonspecific clinical and radiological qualities, and a precise biopsy is crucial for an accurate diagnosis and treatment planning. This study aimed to enhance the accuracy and efficiency of spinal biopsies integrating Cone Beam Computed Tomography (CBCT) and magnetic resonance imaging (MRI) modalities using an O-arm CT navigation system. Eighteen patients with different spinal lesions underwent 18 biopsies following the Stealth Station navigation system Spine 8 protocol. Preoperative MRI scans were merged with intraoperative CT navigation systems for continuous monitoring during the biopsy process. The combined imaging technique accurately identified the diseased lesion type in all biopsies, demonstrating 100% sensitivity and specificity. In conclusion, combining MRI and CT imaging modalities significantly improved spinal biopsy accuracy and efficiency, differentiating between pathological entities. However, large-scale studies are desired to validate these findings and investigate potential benefits in different clinical scenarios. Although this method requires general anesthesia, its potential profits in avoiding misdiagnosed lesions and decreasing the need for further invasive procedures make it a promising approach for improving spinal biopsy accuracy and efficiency.
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Affiliation(s)
- Mohammad W Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institution, 1081 Budapest, Hungary
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Department of Neurosurgery, Andras Josa Teaching Hospital, 4400 Nyiregyhaza, Hungary
| | - István Kozma
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institution, 1081 Budapest, Hungary
| | - Siran Aslan
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institution, 1081 Budapest, Hungary
| | - Balázs Bölöni
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institution, 1081 Budapest, Hungary
| | - Árpád Viola
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institution, 1081 Budapest, Hungary
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
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Tsukamoto S, Kido A, Tanaka Y, Facchini G, Peta G, Rossi G, Mavrogenis AF. Current Overview of Treatment for Metastatic Bone Disease. Curr Oncol 2021; 28:3347-3372. [PMID: 34590591 PMCID: PMC8482272 DOI: 10.3390/curroncol28050290] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
The number of patients with bone metastasis increases as medical management and surgery improve the overall survival of patients with cancer. Bone metastasis can cause skeletal complications, including bone pain, pathological fractures, spinal cord or nerve root compression, and hypercalcemia. Before initiation of treatment for bone metastasis, it is important to exclude primary bone malignancy, which would require a completely different therapeutic approach. It is essential to select surgical methods considering the patient’s prognosis, quality of life, postoperative function, and risk of postoperative complications. Therefore, bone metastasis treatment requires a multidisciplinary team approach, including radiologists, oncologists, and orthopedic surgeons. Recently, many novel palliative treatment options have emerged for bone metastases, such as stereotactic body radiation therapy, radiopharmaceuticals, vertebroplasty, minimally invasive spine stabilization with percutaneous pedicle screws, acetabuloplasty, embolization, thermal ablation techniques, electrochemotherapy, and high-intensity focused ultrasound. These techniques are beneficial for patients who may not benefit from surgery or radiotherapy.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
- Correspondence: ; Tel.: +81-744-22-3051
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
| | - Giancarlo Facchini
- Department of Radiology and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.F.); (G.P.); (G.R.)
| | - Giuliano Peta
- Department of Radiology and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.F.); (G.P.); (G.R.)
| | - Giuseppe Rossi
- Department of Radiology and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.F.); (G.P.); (G.R.)
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Athens, Greece;
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Current Concepts in the Treatment of Giant Cell Tumors of Bone. Cancers (Basel) 2021; 13:cancers13153647. [PMID: 34359548 PMCID: PMC8344974 DOI: 10.3390/cancers13153647] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary According to the 2020 World Health Organization classification, a giant cell tumor of bone is an intermediate malignant bone tumor. Denosumab treatment before curettage should be avoided due to the increased risk of local recurrence. Administration of denosumab before en bloc resection of the giant cell tumors of the pelvis and spine facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for giant cell tumors of the sacrum. Denosumab therapy with or without embolization is indicated for inoperable giant cell tumors of the pelvis, spine, and sacrum. A wait-and-see approach is recommended for lung metastases at first, then denosumab should be administered to the growing lesions. Radiotherapy is not recommended owing to the risk of malignant transformation. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant giant cell tumors of bone. Abstract The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.
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