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Li W, Ma L, Li F, Li K, Zhang Y, Ren H, Bao X, Guo Y, Guo Y, Wang M, Li D, Duan Y, Ma X, Wang Z, Wang Y, Yin R. Effects of bone marrow sparing radiotherapy on acute hematologic toxicity for patients with locoregionally advanced cervical cancer: a prospective phase II randomized controlled study. Radiat Oncol 2024; 19:46. [PMID: 38594678 PMCID: PMC11005132 DOI: 10.1186/s13014-024-02432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE To evaluate effects of bone marrow sparing (BMS) radiotherapy on decreasing the incidence of acute hematologic toxicity (HT) for locoregionally advanced cervical cancer (LACC) patients treated by pelvic irradiation. MATERIALS AND METHODS LACC patients were recruited prospectively from May 2021 to May 2022 at a single center and were evenly randomized into the BMS group and the control group. All patients received pelvic irradiation with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy and BM V40 < 25% in the BMS group was additionally prescribed. Acute HT was assessed weekly. Binary logistic regression model and receiver operating characteristic (ROC) curve were used for predictive value analysis. The trial was registered with Chinese clinical trial registry (ChiCTR2200066485). RESULTS A total of 242 patients were included in the analysis. Baseline demographic, disease and treatment characteristics were balanced between the two groups. In the intention-to-treat population, BMS was associated with a lower incidence of grade ≥ 2 and grade ≥ 3 acute HT, leukopenia and neutropenia s(72.70% v 90.90%, P < 0.001*; 16.50% vs. 65.30%, P < 0.001*; 66.10% vs. 85.10%, P = 0.001*; 13.20% vs. 54.50%, P < 0.001*; 37.20% vs. 66.10%, P < 0.001*; 10.70% vs. 43.80%, P < 0.001*). BMS also resulted in decreased dose delivered to the organs at risk (OARs) including rectum, bladder and left and right femoral head. Univariate and multivariate analyses showed that BM V40 was an independent risk factor for grade ≥ 3 acute HT (odds ratio [OR] = 2.734, 95% confidence interval [CI] = 1.959-3.815, P < 0.001*). Cutoff value was 25.036% and area under the curve (AUC) was 0.786. The nomogram was constructed, which was rigorously evaluated and internally cross-validated, showing good predictive performance. CONCLUSIONS Receiving BMS pelvic irradiation could reduce the incidence of acute HT in LACC patients, and BM V40 < 25% may be a significant factor in reducing the risks of acute HT.
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Affiliation(s)
- Wen Li
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China
| | - Lan Ma
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Fang Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Kemin Li
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China
| | - Yang Zhang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Hongtao Ren
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Xing Bao
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Yuyan Guo
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Ya Guo
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Mincong Wang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Dan Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Yuanqiong Duan
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China
| | - Xiulong Ma
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Zhongwei Wang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Yali Wang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China.
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China.
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Habib DS, Azimi-Shooshtari A, Sarva ST, Kesavan R, Jayaraman G. A Case of Vanishing Bronchus Syndrome in a Non-lung Transplant Patient. Cureus 2023; 15:e50168. [PMID: 38186408 PMCID: PMC10771747 DOI: 10.7759/cureus.50168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Vanishing bronchus syndrome (VBS) is the most severe form of bronchial stenosis. It has been described as a complication following a lung transplant (LT). We present a case of VBS in a patient with non-Hodgkin lymphoma in remission status post chemotherapy and radiation therapy and no history of a lung transplant.
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Affiliation(s)
- Diane S Habib
- Internal Medicine, Hospital Corporation of America (HCA) Houston Healthcare-Kingwood/ University of Houston College of Medicine, Kingwood, USA
| | | | - Siva T Sarva
- Pulmonary and Critical Care Medicine, Hospital Corporation of America (HCA) Houston Healthcare-Kingwood/ University of Houston College of Medicine, Kingwood, USA
| | - Ramesh Kesavan
- Pulmonary and Critical Care Medicine, Hospital Corporation of America (HCA) Houston Healthcare-Kingwood/ University of Houston College of Medicine, Kingwood, USA
| | - Gnananandh Jayaraman
- Pulmonary and Critical Care Medicine, Hospital Corporation of America (HCA) Houston Healthcare-Kingwood/ University of Houston College of Medicine, Kingwood, USA
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3
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Chen Y, Wu M. Exploration of molecular mechanism underlying protective effect of astragaloside IV against radiation-induced lung injury by suppressing ferroptosis. Arch Biochem Biophys 2023; 745:109717. [PMID: 37573925 DOI: 10.1016/j.abb.2023.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
In this study, we aimed to investigate the pharmacological effects and underlying mechanisms of astragaloside IV (AS IV) against radiation-induced lung injury. We established experimental models of radiation-induced lung injury and observed the effect of AS IV on cell viability, cell death, inflammatory responses and ferroptosis. Accordingly, we found that AS IV restored the suppressed cell viability and promoted cell death induced by X-ray irradiation. Moreover, radiation-induced up-regulation of lactate dehydrogenase (LDH) release, ferroptosis, reactive oxygen species (ROS) and inflammatory responses were also restored by AS IV in a dose-dependent manner. Besides, in radiation-induced lung injury C57BL/6 mice, AS IV evidently alleviated lung injury and promoted the survival rate of lung-injured mice. And the ferroptosis level in mice lung tissues were also alleviated by the administration of AS IV in a dose-dependent manner. As a conclusion, by comparing the changes of ferroptosis, ROS and inflammatory responses in the experimental models, we validated that AS IV could inhibit inflammatory responses and cell injury in the treatment of radiation-induced lung injury by suppressing ferroptosis. This finding not only find potentially effective treatments to mitigate radiation-induced lung injury, but also provides supporting evidence for clinical application of AS IV to improve the management of radiation-treated patients and minimize the associated lung complications or other adverse effects. Moreover, as inflammation and ROS are key contributors to tissue damage in various diseases, our study suggested the potential application of AS IV in the treatments for other diseases.
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Affiliation(s)
- Yunlong Chen
- Department of Oncology, Rudong County Hospital of Traditional Chinese Medicine, Rudong, Jiangsu, 226400, China
| | - Mianhua Wu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210046, China.
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Latgé A, Boisson F, Ouadi A, Averous G, Thomas L, Imperiale A, Brasse D. 64CuCl 2 PET Imaging of 4T1-Related Allograft of Triple-Negative Breast Cancer in Mice. Molecules 2022; 27:4869. [PMID: 35956819 DOI: 10.3390/molecules27154869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
64CuCl2 is an economic radiotracer for oncologic PET investigations. In the present study, we characterized the uptake of 64CuCl2 in vivo by µPET/CT in an allograft 4T1-related mouse model (BALB/c) of advanced breast cancer. 18F-FDG was used as a comparator. Twenty-two animals were imaged 7–9 days following 4T1-cell implantation inside mammary glands. Dynamic 64CuCl2 µPET/CT acquisition or iterative static images up to 8 h p.i. were performed. Animal biodistribution and tumor uptake were first evaluated in vivo by µPET analysis and then assessed on tissue specimens. Concerning 18F-FDG µPET, a static acquisition was performed at 15 min and 60 min p.i. Tumor 64CuCl2 accumulation increased from 5 min to 4 h p.i., reaching a maximum value of 5.0 ± 0.20 %ID/g. Liver, brain, and muscle 64CuCl2 accumulation was stable over time. The tumor-to-muscle ratio remained stable from 1 to 8 h p.i., ranging from 3.0 to 3.7. Ex vivo data were consistent with in vivo estimations. The 18F-FDG tumor accumulation was 8.82 ± 1.03 %ID/g, and the tumor-to-muscle ratio was 4.54 ± 1.11. 64CuCl2 PET/CT provides good characterization of the 4T1-related breast cancer model and allows for exploration of non-glycolytic cellular pathways potentially of interest for theragnostic strategies.
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5
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Albano D, Benenati M, Bruno A, Bruno F, Calandri M, Caruso D, Cozzi D, De Robertis R, Gentili F, Grazzini I, Micci G, Palmisano A, Pessina C, Scalise P, Vernuccio F, Barile A, Miele V, Grassi R, Messina C. Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe. Insights Imaging 2021; 12:76. [PMID: 34114094 PMCID: PMC8192650 DOI: 10.1186/s13244-021-01017-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Further, advancements in oncology research have increased life expectancy of patients as well as the frequency of long-term therapy-related side effects that once could not be observed. This pictorial will help radiologists tasked to detect therapy-related complications and to differentiate expected changes of normal tissues from tumor relapse.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università Degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy. .,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy.
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Bruno
- Diagnostic and Interventional Radiology Unit, Maggiore Hospital "C. A. Pizzardi", 40133, Bologna, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy.,Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Marco Calandri
- Radiology Unit, A.O.U. San Luigi Gonzaga di Orbassano, Department of Oncology, University of Torino, 10043, Turin, Italy
| | - Damiano Caruso
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy.,Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Riccardo De Robertis
- U.O.C. Radiologia BT, Ospedale Civile Maggiore - Azienda Ospedaliera Universitaria Integrata Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Giuseppe Micci
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università Degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy
| | - Anna Palmisano
- Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, via Olgettina 58, 20132, Milan, Italy
| | - Carlotta Pessina
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Paola Scalise
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Federica Vernuccio
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università Degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy.,Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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Itani M, Menias CO, Mellnick VM, El Zakhem A, Elsayes K, Katabathina V, Revzin MV. Imaging of abdominal and pelvic infections in the cancer patient. Abdom Radiol (NY) 2021; 46:2920-41. [PMID: 33386914 DOI: 10.1007/s00261-020-02896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/01/2022]
Abstract
Infections are the most commonly encountered complications in patients with cancer. The classical signs and symptoms of infections are often not present in this patient population, which makes the diagnosis more challenging. Host factors play a major role in the development and prognosis of infections in cancer patients; these can be related to the underlying type of malignancy (solid organ versus hematological), tumor burden, anatomic obstruction, altered integrity of barriers (skin or mucosa), treatment-related factors (from chemotherapy, radiation treatment, surgery, interventional procedures, and/or medical device placement) and the degree of immunosuppression. This article reviews common, as well as less common, imaging manifestations of infections and their potential mimics in the abdomen and pelvis in cancer patients and discusses their differentiating features, with the role of imaging in various organs in the abdomen and pelvis taking into consideration relevant clinical background information and the main risk factors.
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Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC Pulm Med 2021; 21:9. [PMID: 33407290 PMCID: PMC7788688 DOI: 10.1186/s12890-020-01376-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Chemo-radiotherapy and systemic therapies have proven satisfactory outcomes as standard treatments for various thoracic malignancies; however, adverse pulmonary effects, like pneumonitis, can be life-threatening. Pneumonitis is caused by direct cytotoxic effect, oxidative stress, and immune-mediated injury. Radiotherapy Induced Lung Injury (RILI) encompasses two phases: an early phase known as Radiation Pneumonitis (RP), characterized by acute lung tissue inflammation as a result of exposure to radiation; and a late phase called Radiation Fibrosis (RF), a clinical syndrome that results from chronic pulmonary tissue damage. Currently, diagnoses are made by exclusion using clinical assessment and radiological findings. Pulmonary function tests have constituted a significant step in evaluating lung function status during radiotherapy and useful predictive tools to avoid complications or limit toxicity. Systemic corticosteroids are widely used to treat pneumonitis complications, but its use must be standardized, and consider in the prophylaxis setting given the fatal outcome of this adverse event. This review aims to discuss the clinicopathological features of pneumonitis and provide practical clinical recommendations for prevention, diagnosis, and management.
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Affiliation(s)
- Marisol Arroyo-Hernández
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Federico Maldonado
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Francisco Lozano-Ruiz
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Wendy Muñoz-Montaño
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Mónica Nuñez-Baez
- Departamento de Radioncología, Hospital Universitario HM Sanchinarro, Caracas, Venezuela
| | - Oscar Arrieta
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México.
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Hasan HF, Elgazzar EM, Mostafa DM. Diminazene aceturate extenuate the renal deleterious consequences of angiotensin-II induced by γ-irradiation through boosting ACE2 signaling cascade. Life Sci 2020; 253:117749. [PMID: 32380079 DOI: 10.1016/j.lfs.2020.117749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
AIM This work aims to explore the role of diminazene aceturate (DIZE) in the enhancement of angiotensin-converting enzyme-2 (ACE2) to prevent the inflammatory and fibrotic response induced by γ-irradiation through activating the protective axis ACE2/angiotensin (1-7)/Mas receptor (ACE2/Ang(1-7)/Mas). METHODS Male rats were injected i.p. with 15 mg/kg DIZE daily for 7 days pre and post-irradiation, where 7.5 Gy of γ-radiation as a single dose was used. KEY FINDINGS Gamma radiation induced a significant elevation of renal biochemical parameters: urea, creatinine and blood urea nitrogen (BUN) in serum with a significant disturbance in oxidative stress markers: elevation in malondialdehyde (MDA) associated with a depletion of reduced glutathione (GSH) and superoxide dismutase (SOD). Beside elevation in the level of angiotensin II (AngII) that lead to remarkably increases in the levels of the renal inflammatory mediators: tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB) and interleukin-1β (IL-1β) as well as renal fibrogenic markers: transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), and hydroxyproline content in the renal tissues. DIZE caused marked expansion in the expression of ACE2 consequently decreased the expression of AngII and increased the expression of Ang(1-7) which through its Mas receptor ameliorates the biochemical and histopathological damage induced by radiation. SIGNIFICANCE DIZE-induced stimulation of ACE2 subdues the renal deleterious consequences induced by γ-radiation via activation of ACE2/Ang(1-7)/Mas axis in rats.
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Affiliation(s)
- Hesham Farouk Hasan
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Atomic Energy Authority, Egypt.
| | - Eman M Elgazzar
- Health Radiation Research Department, National Center for Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt
| | - Dalia M Mostafa
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Atomic Energy Authority, Egypt
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Abstract
BACKGROUND Peritumoral normal tissue is inevitably also irradiated during radiotherapy, depending on the location and size of the target volume as well as the cumulative dose. Depending on the temporal course after irradiation acute, subacute, and chronic alterations are described in co-irradiated normal tissue that can be detected by imaging. Radiation damage can be transient or persistent. OBJECTIVE This article gives an overview of the most important signs of radiation-induced radiogenic alterations to tissue in various organ systems. FINDINGS Frequent radiation-induced tissue alterations found by imaging are pneumonitis, disturbance of the blood-brain barrier, radionecrosis of brain tissue, radiogenic liver damage, mucositis, colitis, osteitis, osteoradionecrosis and myositis. The combination with systemic chemotherapy or immunotherapy can increase the severity of radiogenic reactions of normal tissue. RECOMMENDATIONS FOR AFTERCARE The most important differential diagnosis for radiogenic alterations to normal tissue is post-therapeutic tumor recurrence. Besides typical latency periods, location and matching with the radiation field are important differentiation criteria, depending on the tumor biology and the radiation technique. The follow-up schedule should follow the current guidelines and the clinical condition of the patient should be additionally considered. The radiologist needs to be familiar with the typical imaging morphology of radiogenic tissue changes to avoid false interpretation during follow-up investigations.
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Song SH, Jeong WK, Choi D, Kim YK, Park HC, Yu JI. Evaluation of early treatment response to radiotherapy for HCC using pre- and post-treatment MRI. Acta Radiol 2019; 60:826-835. [PMID: 30282483 DOI: 10.1177/0284185118805253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- So Hee Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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12
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Erlichman DB, Kanmaniraja D, Kobi M, Chernyak V. MRI anatomy and pathology of the anal canal. J Magn Reson Imaging 2019; 50:1018-1032. [PMID: 31115134 DOI: 10.1002/jmri.26776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018-1032.
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Affiliation(s)
- David B Erlichman
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
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13
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Veiga C, Landau D, Devaraj A, Doel T, White J, Ngai Y, Hawkes DJ, McClelland JR. Novel CT-Based Objective Imaging Biomarkers of Long-Term Radiation-Induced Lung Damage. Int J Radiat Oncol Biol Phys 2018; 102:1287-1298. [PMID: 29908943 DOI: 10.1016/j.ijrobp.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Recent improvements in lung cancer survival have spurred an interest in understanding and minimizing long-term radiation-induced lung damage (RILD). However, there are still no objective criteria to quantify RILD, leading to variable reporting across centers and trials. We propose a set of objective imaging biomarkers for quantifying common radiologic findings observed 12 months after lung cancer radiation therapy. METHODS AND MATERIALS Baseline and 12-month computed tomography (CT) scans of 27 patients from a phase 1/2 clinical trial of isotoxic chemoradiation were included in this study. To detect and measure the severity of RILD, 12 quantitative imaging biomarkers were developed. The biomarkers describe basic CT findings, including parenchymal change, volume reduction, and pleural change. The imaging biomarkers were implemented as semiautomated image analysis pipelines and were assessed against visual assessment of the occurrence of each change. RESULTS Most of the biomarkers were measurable in each patient. The continuous nature of the biomarkers allows objective scoring of severity for each patient. For each imaging biomarker, the cohort was split into 2 groups according to the presence or absence of the biomarker by visual assessment, testing the hypothesis that the imaging biomarkers were different in the 2 groups. All features were statistically significant except for rotation of the main bronchus and diaphragmatic curvature. Most of the biomarkers were not strongly correlated with each other, suggesting that each of the biomarkers is measuring a separate element of RILD pathology. CONCLUSIONS We developed objective CT-based imaging biomarkers that quantify the severity of radiologic lung damage after radiation therapy. These biomarkers are representative of typical radiologic findings of RILD.
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Affiliation(s)
- Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.
| | - David Landau
- Department of Oncology, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Department of Oncology, University College London Hospital, London, United Kingdom
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom
| | - Tom Doel
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Jared White
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom
| | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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14
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Najafi M, Motevaseli E, Shirazi A, Geraily G, Rezaeyan A, Norouzi F, Rezapoor S, Abdollahi H. Mechanisms of inflammatory responses to radiation and normal tissues toxicity: clinical implications. Int J Radiat Biol 2018; 94:335-356. [DOI: 10.1080/09553002.2018.1440092] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Elahe Motevaseli
- Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Geraily
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolhasan Rezaeyan
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Norouzi
- Science and Research Branch, Azad University, Tehran, Iran
| | - Saeed Rezapoor
- Department of Radiology, Faculty of Paramedical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Abdollahi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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15
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Veiga C, Landau D, McClelland JR, Ledermann JA, Hawkes D, Janes SM, Devaraj A. Long term radiological features of radiation-induced lung damage. Radiother Oncol 2018; 126:300-306. [PMID: 29191458 DOI: 10.1016/j.radonc.2017.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To describe the radiological findings of radiation-induced lung damage (RILD) present on CT imaging of lung cancer patients 12 months after radical chemoradiation. MATERIAL AND METHODS Baseline and 12-month CT scans of 33 patients were reviewed from a phase I/II clinical trial of isotoxic chemoradiation (IDEAL CRT). CT findings were scored in three categories derived from eleven sub-categories: (1) parenchymal change, defined as the presence of consolidation, ground-glass opacities (GGOs), traction bronchiectasis and/or reticulation; (2) lung volume reduction, identified through reduction in lung height and/or distortions in fissures, diaphragm, anterior junction line and major airways anatomy, and (3) pleural changes, either thickening and/or effusion. RESULTS Six patients were excluded from the analysis due to anatomical changes caused by partial lung collapse and abscess. All remaining 27 patients had radiological evidence of lung damage. The three categories, parenchymal change, shrinkage and pleural change were present in 100%, 96% and 82% respectively. All patients had at least two categories of change present and 72% all three. GGOs, reticulation and traction bronchiectasis were present in 44%, 52% and 37% of patients. CONCLUSIONS Parenchymal change, lung shrinkage and pleural change are present in a high proportion of patients and are frequently identified in RILD. GGOs, reticulation and traction bronchiectasis are common at 12 months but not diagnostic.
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Affiliation(s)
- Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK.
| | - David Landau
- Department of Oncology, Guy's & St. Thomas' NHS Trust, London, UK; Department of Oncology, University College London Hospital, London, UK
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Jonathan A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - David Hawkes
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
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Kashyap R, Agrawal K, Singh H, Mittal BR. Disease- and Treatment-related Complication on F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Oncology Practice: A Pictorial Review. Indian J Nucl Med 2017; 32:304-315. [PMID: 29142347 PMCID: PMC5672751 DOI: 10.4103/ijnm.ijnm_78_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
F-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is routinely performed in oncology patients for various indications including staging, restaging, recurrence detection, and treatment response evaluation. Many disease- and treatment-related complications can be incidentally detected on PET/CT, which may be due to the complication of radiotherapy, chemotherapy, intervention, or primary tumor itself. Some of these complications could be life threatening and need urgent intervention. Therefore, these incidental findings should be recognized on PET/CT and immediately informed to the treating physicians if required urgent intervention.
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Affiliation(s)
- Raghava Kashyap
- Department of Nuclear Medicine and Positron Emission Tomography, Mahatma Gandhi Cancer Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Harmandeep Singh
- Department of Nuclear Medicine and Positron Emission Tomography, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and Positron Emission Tomography, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nguyen D, Maheshwary R, Rajput A, Tran C, Kudithipudi V. PET-CT Post–Hepatic Radiation Changes in Gastroesophageal Adenocarcinoma. Clin Nucl Med 2017; 42:e54-5. [DOI: 10.1097/rlu.0000000000001404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ganguly A, Meredith S, Probert C, Kraecevic J, Anosike C. Colorectal cancer mimics: a review of the usual suspects with pathology correlation. Abdom Radiol (NY) 2016; 41:1851-66. [PMID: 27178338 DOI: 10.1007/s00261-016-0771-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Colorectal cancer is the third most commonly diagnosed cancer in men and second most commonly diagnosed cancer in women worldwide. Initial diagnosis of colorectal malignancy is generally made on colonoscopy, sigmoidoscopy or digital rectal examination; however, with increased use of CT as primary investigation in patients with lower gastrointestinal symptoms, the diagnosis of colon cancer is often first apparent to a radiologist prior to more invasive tests. CT can demonstrate a discrete soft-tissue mass that narrows the colonic lumen or focal nodular wall thickening/stricture and a variety of pericolonic changes. Pattern of wall thickening has been described as an aid to differential diagnosis; however, significant overlap remains between primary colonic tumor and non-colonic tumors or benign conditions. Imaging is non-specific, and appropriate clinical history, direct inspection, histological analysis, and sometimes discussion at MDT are essential for accurate diagnosis and treatment planning. In this article, we will review the imaging features of some of these benign and malignant mimics of colorectal cancer, with accompanying histology slides where appropriate.
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Britton T, Robinson N. Pitfalls and Pearls of Wisdom in 18F-FDG PET Imaging of Tumors. J Nucl Med Technol 2016; 44:59-64. [PMID: 27102663 DOI: 10.2967/jnmt.115.170803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
(18)F-FDG PET imaging of tumors has pitfalls and pearls of wisdom that begin at the point of scheduling and continue through the patient interview, the resting phase, the scan itself, and the image review. Interviewing the patient at the time of scheduling, followed by placing a reminder phone call shortly before the appointment, can save a nuclear medicine department the financial loss of wasted doses and missed appointment slots in the schedule. The pitfalls and pearls of wisdom in tumor imaging are ever changing, and the technologist is in a constant state of inquiry about the patient's disease process and ability to comply. Consideration of each item on the worksheets in this article affects every scan. On completing this article, the reader will be able to identify questions that should be asked in the scheduling and preinjection patient interviews, interpret the answers to those questions, determine how the images may be affected, and adapt the scan.
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Affiliation(s)
- Tracey Britton
- Nuclear Medicine Service, Birmingham Veterans Administration Medical Center, Birmingham, Alabama; and
| | - Nicholas Robinson
- Department of Nuclear Medicine, Memorial Health University Medical Center, Savannah, Georgia
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Papadopoulou I, Stewart V, Barwick TD, Park WHE, Soneji N, Rockall AG, Bharwani N. Post–Radiation Therapy Imaging Appearances in Cervical Carcinoma. Radiographics 2016; 36:538-53. [DOI: 10.1148/rg.2016150117] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Chin JL, Chan G, Ryan JD, McCormick PA. Spleen stiffness can non-invasively assess resolution of portal hypertension after liver transplantation. Liver Int 2015; 35:518-23. [PMID: 25074281 DOI: 10.1111/liv.12647] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 07/25/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Spleen stiffness can be measured by transient elastography. Recent studies have shown that spleen stiffness correlates with hepatic venous pressure gradient and can predict oesophageal varices. Elevated spleen stiffness in cirrhosis has been attributed to splenic tissue hyperplasia and fibrosis, portal hypertension and its consequent hyperdynamic circulation. The aim of this study was to investigate changes to spleen stiffness after orthotopic liver transplantation (OLT) when portal hypertension resolves. METHODS Twenty-one patients awaiting OLT were studied prospectively, while 11 post-transplant patients were recruited as controls. Spleen and liver stiffness were measured with Fibroscan before and at 2-8 weeks after OLT. Criteria applied for spleen stiffness measurement were similar to liver stiffness (≥10 measurements; ≥60% success rate; interquartile range, IQR <30% of median). RESULTS Spleen stiffness was significantly higher before OLT compared to post-transplant patients [75.0 (63.9-75.0) kPa vs. 28.4 (22.0-37.5) kPa; P < 0.0001]. For patients awaiting OLT, 90% (19/21) had oesophageal varices (endoscopically or radiologically). In patients who underwent liver transplantation, spleen stiffness decreased significantly from a median of 75.0 (62.0-75.0) kPa before OLT, to 41.9 (27.0-47.4) kPa at 2 weeks after transplant and 32.9 (29.1-38.0) kPa in the subsequent 4-8 weeks after OLT (P < 0.0001). As expected, liver stiffness measurements reduced from 39.3 (24.9-75.0) kPa to 8.6 (6.8-11.8) kPa in patients receiving OLT (P = 0.0004). CONCLUSIONS Spleen stiffness can non-invasively assess changes in portal pressure after liver transplantation and decreases significantly when portal hypertension resolves.
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Affiliation(s)
- Jun Liong Chin
- Liver Unit, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
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Tran LK, Maturen KE, Feng MU, Wizauer EJ, Watcharotone K, Parker RA, Ellis JH. Renal remodeling after abdominal radiation therapy: parenchymal and functional changes. AJR Am J Roentgenol 2014; 203:W192-8. [PMID: 25055293 DOI: 10.2214/AJR.13.12149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify changes in renal length, volume, and function over time after upper abdominal radiation therapy. MATERIALS AND METHODS Imaging and clinical data were retrospectively reviewed for 27 adults with abdominal radiation therapy between 2001 and 2012. All had two kidneys, radiation exposure to one kidney, and survival of at least 1 year after therapy. Mean prescribed dose was 52 ± 9 Gy to extrarenal targets. Length and volume of exposed and unexposed kidneys were measured on CT scans before treatment (baseline) and at intervals 0-3, 3-6, 6-12, 12-24, 24-36, and more than 36 months after completion of radiotherapy. Serum creatinine was correlated at each interval. Mixed-models ANOVA was used to test renal length and volume, serum creatinine, and time against multiple models to assess for temporal effects; specific time intervals were compared in pairwise manner. RESULTS Mean follow-up duration was 35 months (range, 5-94 months). Exposed kidney length and volume progressively decreased from baseline throughout follow-up, with mean loss of 23% (p < 0.001) and 47% (p < 0.001), respectively. Slight increase in unexposed kidney length was not significant. Mean serum creatinine increased from 0.86 ± 0.18 mg/dL at baseline to 1.12 ± 0.27 mg/dL at 12-24 months (p < 0.001), then stabilized. CONCLUSION Kidneys exposed to radiation during therapy of adjacent malignancies exhibited continuous progressive atrophy for the entire follow-up period, nearly 8 years. Volume changes were twice as great as length changes. Renal function also declined. To accurately interpret follow-up studies in cancer survivors, radiologists should be aware of the potential for progressive renal atrophy, even many years after radiation therapy.
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Abstract
Radiation injuries often occur during or after radiation therapy in the abdomen or pelvis. Although any organ in the abdomen or pelvis may be exposed to and injured by radiation therapy directed to a nearby organ, this article focuses on more frequently encountered imaging findings of inadvertent radiation damage. It is important for the radiologist to be familiar with the imaging appearances of inadvertent radiation damage to abdominopelvic viscera in order to sustain clinical relevance and not mistake radiation injuries for other entities.
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Affiliation(s)
| | - Christine O Menias
- Mayo Clinic LL Radiology, 13400 East Shea Blvd, Scottsdale, AZ 85259, USA; Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA; State University of New York at Stony Brook, Stony Brook, NY 11794, USA
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Domachevsky L, Jacene HA, Sakellis CG, Kim CK. Postradiation changes in tissues: evaluation by imaging studies with emphasis on fluorodeoxyglucose-PET/computed tomography and correlation with histopathologic findings. PET Clin 2014; 9:217-35. [PMID: 25030284 DOI: 10.1016/j.cpet.2013.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Efforts have been made to minimize the damage to adjacent normal tissues during radiotherapy, primarily by shifting from the use of conventional radiotherapy to more advanced techniques. Reviewing the overall pattern on combined anatomic and functional imaging can enhance diagnostic accuracy. Several radiotracers can be used; [(18)F]fluorodeoxyglucose is the most common. Familiarity with the type and timing of previous radiation therapy, the spectrum of imaging findings after radiation injury, and the appropriate use of the different radiotracers can be crucial. This article summarizes postradiation histologic findings and multimodality imaging findings, with emphasis on PET/computed tomography.
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Affiliation(s)
- Liran Domachevsky
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chun K Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Hedgire SS, Mino-Kenudson M, Elmi A, Thayer S, Fernandez-del Castillo C, Harisinghani MG. Enhanced primary tumor delineation in pancreatic adenocarcinoma using ultrasmall super paramagnetic iron oxide nanoparticle-ferumoxytol: an initial experience with histopathologic correlation. Int J Nanomedicine 2014; 9:1891-6. [PMID: 24790431 PMCID: PMC4000182 DOI: 10.2147/ijn.s59788] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate the role of ferumoxytol-enhanced magnetic resonance imaging (MRI) in delineating primary pancreatic tumors in patients undergoing preoperative neoadjuvant therapy. Materials and methods Eight patients with pancreatic adenocarcinoma were enrolled in this study, and underwent MRI scans at baseline, immediate post, and at the 48 hour time point after ferumoxytol injection with quantitative T2* sequences. The patients were categorized into two groups; group A received preoperative neoadjuvant therapy and group B did not. The T2* of the primary pancreatic tumor and adjacent parenchyma was recorded at baseline and the 48 hour time point. After surgery, the primary tumors were assessed histopathologically for fibrosis and inflammation. Results The mean T2* of the primary tumor and adjacent parenchyma at 48 hours in group A were 22.11 ms and 16.34 ms, respectively; in group B, these values were 23.96 ms and 23.26 ms, respectively. The T2* difference between the tumor and adjacent parenchyma in group A was more pronounced compared to in group B. The tumor margins were subjectively more distinct in group A compared to group B. Histopathologic evaluation showed a rim of dense fibrosis with atrophic acini at the periphery of the lesion in group A. Conversely, intact tumor cells/glands were present at the periphery of the tumor in group B. Conclusion Ferumoxytol-enhanced MRI scans in patients receiving preoperative neoadjuvant therapy may offer enhanced primary tumor delineation, contributing towards achieving disease-free margin at the time of surgery, and thus improving the prognosis of pancreatic carcinomas.
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Affiliation(s)
- Sandeep S Hedgire
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Azadeh Elmi
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Thayer
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mukesh G Harisinghani
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
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Park HJ, Kim SH, Jang KM, Lim S, Kang TW, Park HC, Choi D. Added value of diffusion-weighted MRI for evaluating viable tumor of hepatocellular carcinomas treated with radiotherapy in patients with chronic liver disease. AJR Am J Roentgenol. 2014;202:92-101. [PMID: 24370133 DOI: 10.2214/ajr.12.10212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the added value of diffusion-weighted imaging (DWI) to the diagnostic performance of conventional MRI in diagnosing viable hepatocellular carcinoma (HCC) tumors treated with radiotherapy in patients with chronic liver disease. MATERIALS AND METHODS Twenty-nine patients with viable tumor and 35 patients without viable tumor were enrolled. We assessed the signal intensity of viable tumor compared with irradiated liver on MRI and DWI. Signal intensity ratios and apparent diffusion coefficient (ADC) ratios of viable tumor to nonirradiated liver were also assessed on DWI with ADC maps. Two observers reviewed conventional MRI and combined MRI and DWI and rated them using a 5-point scale. Diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. RESULTS Viable tumors showed hyperintensity on T2-weighted and arterial phase images (16/29 [55.2%]) and hypointensity on portal (22/29 [75.9%]), 3-minute late (19/29 [65.5%]), and hepatobiliary phase (23/29 [79.3%]) images. Twenty-seven (93.1%) viable tumors showed hyperintensity on DWI and hypointensity on ADC maps. Mean signal intensity ratios and ADC ratios of viable tumor on DWI with ADC maps were significantly higher and lower than those of irradiated liver. Diagnostic performance (area under the ROC curve) improved significantly after adding DWI, and interobserver agreement was moderate for conventional MRI (κ = 0.450) and good after adding DWI (κ = 0.748). CONCLUSION Adding DWI to conventional MRI can improve the detection of viable HCC tumors treated with radiotherapy compared to conventional MRI alone.
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Sponseller P, Lenards N, Kusano A, Patel S. Radiation treatment for newly diagnosed esophageal cancer with prior radiation to the thoracic cavity. Med Dosim 2014; 39:251-5. [DOI: 10.1016/j.meddos.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/03/2014] [Accepted: 03/26/2014] [Indexed: 11/30/2022]
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Maturen KE, Feng MU, Wasnik AP, Azar SF, Appelman HD, Francis IR, Platt JF. Imaging Effects of Radiation Therapy in the Abdomen and Pelvis: Evaluating “Innocent Bystander” Tissues. Radiographics 2013; 33:599-619. [DOI: 10.1148/rg.332125119] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ganeshan DM, Salem U, Viswanathan C, Balachandran A, Garg N, Silverman P, Bhosale P. Complications of oncologic therapy in the abdomen and pelvis: a review. ACTA ACUST UNITED AC 2013; 38:1-21. [DOI: 10.1007/s00261-012-9899-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Morris MF, Maleszewski JJ, Suri RM, Burkhart HM, Foley TA, Bonnichsen CR, Anavekar NS, Young PM, Williamson EE, Glockner JF, Araoz PA. CT and MR imaging of the mitral valve: radiologic-pathologic correlation. Radiographics 2011; 30:1603-20. [PMID: 21071378 DOI: 10.1148/rg.306105518] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging are increasingly important adjuncts to echocardiography for the evaluation of mitral valve disease. The mitral valve may be involved in various acquired or congenital conditions with resultant regurgitation or stenosis, and many of these conditions can be identified with CT or MR imaging. In addition, CT is useful for detecting and monitoring postoperative complications after mitral valve repair or replacement. As the use of CT and MR imaging increases, awareness of the CT and MR imaging appearances of the normal mitral valve and the various disease processes that affect it may foster recognition of unsuspected mitral disease in patients undergoing imaging for other purposes. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.306105518/-/DC1.
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Affiliation(s)
- Michael F Morris
- Department of Radiology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Abstract
Cancer in the elderly represents a major public health topic and its importance will increase in the future because of increased life expectancy and ageing. Cancer prognosis is worse due to late diagnosis, frequent comorbidities and treatment often considered as suboptimal. Reference treatments were primarily validated for younger or selected elderly patients and experimental data collected on most vulnerable are rare. Oncogeriatrics development for 15 years made it possible to consider two fundamental aspects, which are the geriatric evaluation, from the most simple to the complete one, and the development of specific trials. In addition, a strong institutional policy allowed promotion, on the French national territory, of regional experiments thanks to Pilot Units of Oncogeriatrics Coordination (UPCOG). The question of the interest of a geriatric evaluation in radiotherapy is related mainly to the difficulties of tolerance and observance of this treatment, but also with its effectiveness and this review explores the main curative, adjuvant and palliative indications as well as research perspectives.
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