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Brauner JF, Rasul S, Berzaczy D, Beitzke D, Wollenweber T, Beitzke D. Hybrid PET/MRI of large vessel vasculitis : Radiation dose compared to PET/CT with view on cumulative effective dose. Wien Klin Wochenschr 2024:10.1007/s00508-024-02336-2. [PMID: 38456940 DOI: 10.1007/s00508-024-02336-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The diagnosis of large vessel vasculitis (LVV) is often challenging due to the various clinical appearances and the low prevalence. Hybrid imaging by positron emission tomography and computed tomography (PET/CT) is a highly relevant imaging modality for diagnostics and disease surveillance but may be associated with a significant amount of radiation dose especially in patients with complications. OBJECTIVE The aim of this retrospective analysis was to compare the image quality and impact of hybrid imaging methods PET/CT and PET/MRI on the potential for dose reduction. METHODS This retrospective single-center study included a cohort of 32 patients who were referred to PET/MRI for the evaluation of LVV, including graft infections and fever of unknown origin. This cohort was compared to a similar cohort of 37 patients who were examined with PET/CT in the same period. Mean radiation dose as well as image quality to establish a diagnosis were compared between the groups. RESULTS The mean radiation dose applied in PET/MRI was significantly lower when compared to PET/CT (mean 6.6 mSV vs. 31.7 mSV; p < 0.001). This effect was based on the partially multiphasic CT protocols. At the same time, diagnostic image quality using a 4-point scale showed similar results for both imaging modalities in the work-up of LVV. CONCLUSION With PET/MRI, the radiation exposure can be significantly reduced with similar image quality and diagnostic impact. Patients with LVV have a higher risk of receiving a clinically relevant cumulative effective dose (CED) and PET/MRI should be made available to them.
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Affiliation(s)
- Johanna-Felicia Brauner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniela Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- University for Applied Science Wiener Neustadt, Johannes Gutenberg-Straße 3, 2700, Wiener Neustadt, Austria
| | - Tim Wollenweber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Glechner A, Wagner G, Mitus JW, Teufer B, Klerings I, Böck N, Grillich L, Berzaczy D, Helbich TH, Gartlehner G. Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk. Cochrane Database Syst Rev 2023; 3:CD009632. [PMID: 36999589 PMCID: PMC10065327 DOI: 10.1002/14651858.cd009632.pub3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Screening mammography can detect breast cancer at an early stage. Supporters of adding ultrasonography to the screening regimen consider it a safe and inexpensive approach to reduce false-negative rates during screening. However, those opposed to it argue that performing supplemental ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments. OBJECTIVES To assess the comparative effectiveness and safety of mammography in combination with breast ultrasonography versus mammography alone for breast cancer screening for women at average risk of breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up until 3 May 2021. SELECTION CRITERIA For efficacy and harms, we considered randomised controlled trials (RCTs) and controlled non-randomised studies enrolling at least 500 women at average risk for breast cancer between the ages of 40 and 75. We also included studies where 80% of the population met our age and breast cancer risk inclusion criteria. DATA COLLECTION AND ANALYSIS Two review authors screened abstracts and full texts, assessed risk of bias, and applied the GRADE approach. We calculated the risk ratio (RR) with 95% confidence intervals (CI) based on available event rates. We conducted a random-effects meta-analysis. MAIN RESULTS We included eight studies: one RCT, two prospective cohort studies, and five retrospective cohort studies, enrolling 209,207 women with a follow-up duration from one to three years. The proportion of women with dense breasts ranged from 48% to 100%. Five studies used digital mammography; one study used breast tomosynthesis; and two studies used automated breast ultrasonography (ABUS) in addition to mammography screening. One study used digital mammography alone or in combination with breast tomosynthesis and ABUS or handheld ultrasonography. Six of the eight studies evaluated the rate of cancer cases detected after one screening round, whilst two studies screened women once, twice, or more. None of the studies assessed whether mammography screening in combination with ultrasonography led to lower mortality from breast cancer or all-cause mortality. High certainty evidence from one trial showed that screening with a combination of mammography and ultrasonography detects more breast cancer than mammography alone. The J-START (Japan Strategic Anti-cancer Randomised Trial), enrolling 72,717 asymptomatic women, had a low risk of bias and found that two additional breast cancers per 1000 women were detected over two years with one additional ultrasonography than with mammography alone (5 versus 3 per 1000; RR 1.54, 95% CI 1.22 to 1.94). Low certainty evidence showed that the percentage of invasive tumours was similar, with no statistically significant difference between the two groups (69.6% (128 of 184) versus 73.5% (86 of 117); RR 0.95, 95% CI 0.82 to 1.09). However, positive lymph node status was detected less frequently in women with invasive cancer who underwent mammography screening in combination with ultrasonography than in women who underwent mammography alone (18% (23 of 128) versus 34% (29 of 86); RR 0.53, 95% CI 0.33 to 0.86; moderate certainty evidence). Further, interval carcinomas occurred less frequently in the group screened by mammography and ultrasonography compared with mammography alone (5 versus 10 in 10,000 women; RR 0.50, 95% CI 0.29 to 0.89; 72,717 participants; high certainty evidence). False-negative results were less common when ultrasonography was used in addition to mammography than with mammography alone: 9% (18 of 202) versus 23% (35 of 152; RR 0.39, 95% CI 0.23 to 0.66; moderate certainty evidence). However, the number of false-positive results and necessary biopsies were higher in the group with additional ultrasonography screening. Amongst 1000 women who do not have cancer, 37 more received a false-positive result when they participated in screening with a combination of mammography and ultrasonography than with mammography alone (RR 1.43, 95% CI 1.37 to 1.50; high certainty evidence). Compared to mammography alone, for every 1000 women participating in screening with a combination of mammography and ultrasonography, 27 more women will have a biopsy (RR 2.49, 95% CI 2.28 to 2.72; high certainty evidence). Results from cohort studies with methodological limitations confirmed these findings. A secondary analysis of the J-START provided results from 19,213 women with dense and non-dense breasts. In women with dense breasts, the combination of mammography and ultrasonography detected three more cancer cases (0 fewer to 7 more) per 1000 women screened than mammography alone (RR 1.65, 95% CI 1.0 to 2.72; 11,390 participants; high certainty evidence). A meta-analysis of three cohort studies with data from 50,327 women with dense breasts supported this finding, showing that mammography and ultrasonography combined led to statistically significantly more diagnosed cancer cases compared to mammography alone (RR 1.78, 95% CI 1.23 to 2.56; 50,327 participants; moderate certainty evidence). For women with non-dense breasts, the secondary analysis of the J-START study demonstrated that more cancer cases were detected when adding ultrasound to mammography screening compared to mammography alone (RR 1.93, 95% CI 1.01 to 3.68; 7823 participants; moderate certainty evidence), whilst two cohort studies with data from 40,636 women found no statistically significant difference between the two screening methods (RR 1.13, 95% CI 0.85 to 1.49; low certainty evidence). AUTHORS' CONCLUSIONS Based on one study in women at average risk of breast cancer, ultrasonography in addition to mammography leads to more screening-detected breast cancer cases. For women with dense breasts, cohort studies more in line with real-life clinical practice confirmed this finding, whilst cohort studies for women with non-dense breasts showed no statistically significant difference between the two screening interventions. However, the number of false-positive results and biopsy rates were higher in women receiving additional ultrasonography for breast cancer screening. None of the included studies analysed whether the higher number of screen-detected cancers in the intervention group resulted in a lower mortality rate compared to mammography alone. Randomised controlled trials or prospective cohort studies with a longer observation period are needed to assess the effects of the two screening interventions on morbidity and mortality.
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Affiliation(s)
- Anna Glechner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
- Health center of the health insurance fund for civil servants, miners and employees of the federal railroads, Sitzenberg-Reidling, Austria
| | - Gernot Wagner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
| | - Jerzy W Mitus
- Department of Surgical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology in Krakow, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Birgit Teufer
- Department of Business, IMC University of Applied Sciences Krems, Krems, Austria
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
| | - Nina Böck
- General Practitioner, Dr. Robert Milla, Vienna, Austria
| | - Ludwig Grillich
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna/General Hospital AKH, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna/General Hospital AKH, Vienna, Austria
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
- Research Triangle Institute (RTI) International, North Carolina, USA
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Berzaczy D, Haug A, Staber PB, Raderer M, Kiesewetter B, Jaeger U, Kornauth C, Simonitsch-Klupp I, Mayerhoefer ME. RECIL versus Lugano for Treatment Response Assessment in FDG-Avid Non-Hodgkin Lymphomas: A Head-to-Head Comparison in 54 Patients. Cancers (Basel) 2019; 12:cancers12010009. [PMID: 31861433 PMCID: PMC7016710 DOI: 10.3390/cancers12010009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 01/19/2023] Open
Abstract
The response evaluation criteria in lymphoma (RECIL) classification for lymphoma treatment response assessment was introduced in 2017, but it has not yet been compared to the established Lugano classification. Also, the value of the provisional “minor response” (MiR) category of RECIL is unclear. In 54 patients with FDG-avid non-Hodgkin lymphomas (41 diffuse large B-cell lymphomas (DLBCL) and 13 follicular lymphomas), [18F]FDG-PET/CT-based response according to RECIL and Lugano was determined at interim and end-of-treatment (EOT) restaging. Rates of agreement and Cohen’s kappa (κ) coefficients were calculated. The relationship between RECIL and Lugano responses and 2-year complete remission (CR) status of DLBCL patients was determined. At interim restaging, MiR was observed in 14.8%, and at EOT, in 5.6% of patients. When MiR was recoded as partial remission, agreement between RECIL and Lugano was 83.3% at interim restaging (κ = 0.69), and 90.7% at EOT (κ = 0.79). 85.4%, of DLBCL patients with responding disease at interim restaging according to both RECIL and Lugano achieved 2-year CR status; whereas, at EOT, 82.9% of patients with responding disease according to Lugano, and 85.4% of patients with responding disease according to RECIL, achieved 2-year CR status. Thus, RECIL and Lugano classifications show comparable performance for treatment response assessment, and a similar association with 2-year CR status in FDG-avid lymphomas.
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Affiliation(s)
- Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence:
| | - Alexander Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Philipp B. Staber
- Department of Medicine I, Division of Hematology, Medical University of Vienna, 1090 Vienna, Austria; (P.B.S.); (U.J.)
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Vienna, Austria; (M.R.); (B.K.)
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Vienna, Austria; (M.R.); (B.K.)
| | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology, Medical University of Vienna, 1090 Vienna, Austria; (P.B.S.); (U.J.)
| | - Christoph Kornauth
- Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (C.K.); (I.S.-K.)
| | - Ingrid Simonitsch-Klupp
- Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (C.K.); (I.S.-K.)
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, NY 10065, USA
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Mayerhoefer ME, Prosch H, Beer L, Tamandl D, Beyer T, Hoeller C, Berzaczy D, Raderer M, Preusser M, Hochmair M, Kiesewetter B, Scheuba C, Ba-Ssalamah A, Karanikas G, Kesselbacher J, Prager G, Dieckmann K, Polterauer S, Weber M, Rausch I, Brauner B, Eidherr H, Wadsak W, Haug AR. PET/MRI versus PET/CT in oncology: a prospective single-center study of 330 examinations focusing on implications for patient management and cost considerations. Eur J Nucl Med Mol Imaging 2019; 47:51-60. [PMID: 31410538 PMCID: PMC6885019 DOI: 10.1007/s00259-019-04452-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022]
Abstract
Purpose PET/MRI has recently been introduced into clinical practice. We prospectively investigated the clinical impact of PET/MRI compared with PET/CT, in a mixed population of cancer patients, and performed an economic evaluation of PET/MRI. Methods Cancer patients referred for routine staging or follow-up by PET/CT underwent consecutive PET/CT and PET/MRI, using single applications of [18F]FDG, [68Ga]Ga-DOTANOC, or [18F]FDOPA, depending on tumor histology. PET/MRI and PET/CT were rated separately, and lesions were assessed per anatomic region; based on regions, per-examination and per-patient accuracies were determined. A simulated, multidisciplinary team meeting served as reference standard and determined whether differences between PET/CT and PET/MRI affected patient management. The McNemar tests were used to compare accuracies, and incremental cost-effectiveness ratios (ICERs) for PET/MRI were calculated. Results Two hundred sixty-three patients (330 same-day PET/CT and PET/MRI examinations) were included. PET/MRI was accurate in 319/330 examinations and PET/CT in 277/330 examinations; the respective accuracies of 97.3% and 83.9% differed significantly (P < 0.001). The additional findings on PET/MRI—mainly liver and brain metastases—had implications for patient management in 21/263 patients (8.0%). The per-examination cost was 596.97 EUR for PET/MRI and 405.95 EUR for PET/CT. ICERs for PET/MRI were 14.26 EUR per percent of diagnostic accuracy and 23.88 EUR per percent of correctly managed patients. Conclusions PET/MRI enables more appropriate management than PET/CT in a nonnegligible fraction of cancer patients. Since the per-examination cost is about 50% higher for PET/MRI than for PET/CT, a histology-based triage of patients to either PET/MRI or PET/CT may be meaningful.
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Affiliation(s)
- Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York City, NY, USA.
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian Scheuba
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Kesselbacher
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Bernhard Brauner
- Siemens Healthineers, Siemens Healthcare Diagnostics GmbH, Vienna, Austria
| | - Harald Eidherr
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine-CBmed, Graz, Austria
| | - Alexander R Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
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Berzaczy D, Fueger B, Hoeller C, Haug AR, Staudenherz A, Berzaczy G, Weber M, Mayerhoefer ME. Whole-Body [18F]FDG-PET/MRI vs. [18F]FDG-PET/CT in Malignant Melanoma. Mol Imaging Biol 2019; 22:739-744. [DOI: 10.1007/s11307-019-01413-7] [Citation(s) in RCA: 5] [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: 01/12/2023]
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Mayerhoefer ME, Archibald SJ, Messiou C, Staudenherz A, Berzaczy D, Schöder H. MRI and PET/MRI in hematologic malignancies. J Magn Reson Imaging 2019; 51:1325-1335. [PMID: 31260155 PMCID: PMC7217155 DOI: 10.1002/jmri.26848] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/26/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
The role of MRI differs considerably between the three main groups of hematological malignancies: lymphoma, leukemia, and myeloma. In myeloma, whole‐body MRI (WB‐MRI) is recognized as a highly sensitive test for the assessment of myeloma, and is also endorsed by clinical guidelines, especially for detection and staging. In lymphoma, WB‐MRI is presently not recommended, and merely serves as an alternative technique to the current standard imaging test, [18F]FDG‐PET/CT, especially in pediatric patients. Even for lymphomas with variable FDG avidity, such as extranodal mucosa‐associated lymphoid tissue lymphoma (MALT), contrast‐enhanced computed tomography (CT), but not WB‐MRI, is presently recommended, despite the high sensitivity of diffusion‐weighted MRI and its ability to capture treatment response that has been reported in the literature. In leukemia, neither MRI nor any other cross‐sectional imaging test (including positron emission tomography [PET]) is currently recommended outside of clinical trials. This review article discusses current clinical applications as well as the main research topics for MRI, as well as PET/MRI, in the field of hematological malignancies, with a focus on functional MRI techniques such as diffusion‐weighted imaging and dynamic contrast‐enhanced MRI, on the one hand, and novel, non‐FDG PET imaging probes such as the CXCR4 radiotracer [68Ga]Ga‐Pentixafor and the amino acid radiotracer [11C]methionine, on the other hand. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1325–1335.
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Affiliation(s)
- Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria.,Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, USA
| | | | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Anton Staudenherz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, USA
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Berzaczy D, Haug AR, Raderer M, Kiesewetter B, Berzaczy G, Weber M, Mayerhoefer ME. Is there a reliable size cut-off for splenic involvement in lymphoma? A [18F]FDG-PET controlled study. PLoS One 2019; 14:e0213551. [PMID: 30849131 PMCID: PMC6407760 DOI: 10.1371/journal.pone.0213551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/22/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose Aim of present study was to determine whether the currently recommended 13-cm cranio-caudal diameter cut-off on CT for assessment of splenic involvement in lymphoma offers adequate sensitivity and specificity. Materials and Methods Patients with histologically proven lymphoma who had undergone [18F]FDG-PET/CT before therapy were included. Cranio-caudal diameters of the spleen were measured on the CT component of PET/CT, and ROC analyses with calculation of respective areas under the curve (AUC) were used to determine cut-off values of cranio-caudal measurements with their respective sensitivities and specificities, using [18F]FDG-PET as the reference standard. Results In 93 patients, we found a sensitivity of 74.1% and a specificity of 47% for the 13-cm splenic diameter cut-off. Conclusions Our results show reasonable, though far from perfect sensitivities and specificities for the currently recommend 13-cm splenic diameter cut-off.
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Affiliation(s)
- Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Alexander R. Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gundula Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
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Berzaczy D, Staudenherz A, Raderer M, Weber M, Mayerhoefer ME. DWI-MRI vs CT in gastric MALT lymphoma-preliminary results in 19 patients. Br J Radiol 2019; 92:20180263. [PMID: 30040435 PMCID: PMC6435076 DOI: 10.1259/bjr.20180263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess the diagnostic performance of [F18] fluoro-2-desoxy-D-glucose positron emission tomography/CT [(18F) FDG-PET/CT] compared to diffusion-weighted imaging (DWI)-MRI of lesion detection in patients with non-FDG avid gastric mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS 19 patients with histologically proven gastric MALT lymphoma were included in this prospective Institutional Review Board-approved study. Patients underwent [18F]-FDG-PET/CT and consecutive MRI/DWI. Images were evaluated for the presence of gastric lesions in two anatomically defined groups (region 1: cardia, body, fundus; region 2: antrum, pyloric region) by two senior board-certified radiologists, in an observer-blinded manner. Overall accuracy relative to the reference standard (histology obtained by biopsy) was calculated for each reader and a consensus rating. RESULTS We found a statistically significant higher accuracy of lesion detection for lesions in region 1 (p = 0.030) and 2 (p = 0.070) for DWI-MRI (100%/78.9%) than for CT (68.4%/42.1%). CONCLUSION DWI-MRI seems to be superior accurate to CT for lesion detection in non-FDG avid gastric MALT lymphoma. ADVANCES IN KNOWLEDGE DWI-MRI seems to be an alternative reliable imaging method for locoregional disease evaluation of non-FDG avid gastric MALT lymphoma.
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Affiliation(s)
- Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Anton Staudenherz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
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Mayerhoefer ME, Raderer M, Jaeger U, Staber P, Kiesewetter B, Senn D, Gallagher FA, Brindle K, Porpaczy E, Weber M, Berzaczy D, Simonitsch-Klupp I, Sillaber C, Skrabs C, Haug A. Ultra-early response assessment in lymphoma treatment: [ 18F]FDG PET/MR captures changes in glucose metabolism and cell density within the first 72 hours of treatment. Eur J Nucl Med Mol Imaging 2018; 45:931-940. [PMID: 29480328 PMCID: PMC5915494 DOI: 10.1007/s00259-018-3937-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/04/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE To determine whether, in patients with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL), [18F]FDG PET/MR can capture treatment effects within the first week after treatment initiation, and whether changes in glucose metabolism and cell density occur simultaneously. METHODS Patients with histologically proven HL or NHL were included in this prospective IRB-approved study. Patients underwent [18F]FDG PET/MR before, and then 48-72 h after (follow-up 1, FU-1) and 1 week after (FU-2) initiation of the first cycle of their respective standard chemotherapy (for HL) or immunochemotherapy (for NHL). Standardized [18F]FDG uptake values (SUVmax, SUVmean) and apparent diffusion coefficients (ADCmin, ADCmean) based on diffusion-weighted MRI, and metabolic and morphological tumour volumes (MTV, VOL) were assessed at each time-point. Multilevel analyses with an unstructured covariance matrix, and pair-wise post-hoc tests were used to test for significant changes in SUVs, ADCs, MTVs and VOLs between the three time-points. RESULTS A total of 58 patients (11 with HL and 47 with NHL) with 166 lesions were analysed. Lesion-based mean rates of change in SUVmax, SUVmean, ADCmin, ADCmean, MTV and VOL between baseline and FU-1 were -46.8%, -33.3%, +20.3%, +14%, -46% and -12.8%, respectively, and between baseline and FU-2 were -65.1%, -49%, +50.7%, +32.4%, -61.1% and -24.2%, respectively. These changes were statistically significant (P < 0.01) except for the change in VOL between baseline and FU-1 (P = 0.079). CONCLUSION In lymphoma patients, [18F]FDG PET/MR can capture treatment-induced changes in glucose metabolism and cell density as early as 48-72 h after treatment initiation.
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Affiliation(s)
- Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Markus Raderer
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jaeger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philipp Staber
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Daniela Senn
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ferdia A Gallagher
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Edit Porpaczy
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Christian Sillaber
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexander Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Berzaczy D. [Borderline and malignant mesenchymal tumors of the abdomen]. Radiologe 2017; 58:60-67. [PMID: 29242953 DOI: 10.1007/s00117-017-0335-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Soft tissue sarcomas are most common mesenchymal malignancies in the abdomen. Their radiologic features are often unspecific and establishing a differential diagnosis to other pathologies can be difficult. OBJECTIVES This review presents a selection of the most common mesenchymal abdominal tumors and their imaging characteristics, as well as the associated differential diagnoses. Knowledge of fundamental pathologic, anatomic and radiologic features of these malignancies is crucial for the differential diagnosis and key in clinical decision making and subsequent selection of an appropriate therapeutic regimen.
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Affiliation(s)
- D Berzaczy
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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11
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Berzaczy D, Mayerhoefer ME, Azizi AA, Haug AR, Senn D, Beitzke D, Weber M, Traub-Weidinger T. Does elevated glucose metabolism correlate with higher cell density in Neurofibromatosis type 1 associated peripheral nerve sheath tumors? PLoS One 2017; 12:e0189093. [PMID: 29206885 PMCID: PMC5716584 DOI: 10.1371/journal.pone.0189093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate whether elevated glucose metabolism in neurofibroma, determined by [F18]-FDG-PET, is correlated with cell density in MRI, as expressed through the apparent diffusion coefficient. Materials and methods Patients diagnosed with neurofibromatosis type 1 and peripheral nerve sheath tumors (PNST) were enrolled in this prospective, IRB-approved study. After a single [F18]-FDG injection, patients consecutively underwent [F18]-FDG-PET/CT and [F18]-FDG-PET/MRI on the same day. Maximum and mean standardized uptake values (SUVmax, SUVmean) on [F18]-FDG-PET/CT and [F18]-FDG-PET/MRI were compared, and correlated with minimum and mean apparent diffusion coefficients (ADCmean, ADCmin). Results A total of 12 (6 male/6 female, mean age was 16.2 ± 5.2 years) patients were prospectively included and analyzed on a per-lesion (n = 39) basis. The SUVmean of examined PNST showed a moderate negative correlation with the ADCmean (r = -.441) and ADCmin (r = -.477), which proved to be statistically significant (p = .005 and p = .002). The SUVmax of the respective lesions, however, showed a weaker negative correlation for ADCmean (r: -.311) and ADCmin (r: -.300) and did not reach statistical significance (p = .054 and p = .057). Lesion-based correlation between [F18]-FDG-PET/MRI and [F18]-FDG-PET/CT showed a moderate correlation for SUVmax (r = .353; p = .027) and a strong one for SUVmean (r = .879; p = .001)). Patient-based liver uptake (SUVmax and mean) of [F18]-FDG-PET/MRI and [F18]-FDG-PET/CT were strongly positively correlated (r = .827; p < .001 and r = .721; p < .001) but differed significantly (p < .001). Conclusions We found a statistically significant, negative correlation between glucose metabolism and cell density in PNST. Thus, ADCmean and ADCmin could possibly add complimentary information to the SUVmax and SUVmean and may serve as a potential determinant of malignant transformation of PNST.
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Affiliation(s)
- Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
- * E-mail:
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Amedeo A. Azizi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Alexander R. Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Daniela Senn
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria, E.U
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Sardanelli F, Bashir H, Berzaczy D, Cannella G, Espeland A, Flor N, Helbich T, Hunink M, Malone DE, Mann R, Muzzupappa C, Petersen LJ, Riklund K, Sconfienza LM, Serafin Z, Spronk S, Stoker J, van Beek EJR, Vorwerk D, Leo GD. The Role of Imaging Specialists as Authors of Systematic Reviews on Diagnostic and Interventional Imaging and Its Impact on Scientific Quality: Report from the EuroAIM Evidence-based Radiology Working Group. Radiology 2014; 272:533-40. [DOI: 10.1148/radiol.14131730] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Mayerhoefer ME, Karanikas G, Kletter K, Prosch H, Kiesewetter B, Skrabs C, Porpaczy E, Weber M, Pinker-Domenig K, Berzaczy D, Hoffmann M, Sillaber C, Jaeger U, Müllauer L, Simonitsch-Klupp I, Dolak W, Gaiger A, Ubl P, Lukas J, Raderer M. Evaluation of Diffusion-Weighted MRI for Pretherapeutic Assessment and Staging of Lymphoma: Results of a Prospective Study in 140 Patients. Clin Cancer Res 2014; 20:2984-93. [DOI: 10.1158/1078-0432.ccr-13-3355] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gartlehner G, Thaler KJ, Chapman A, Kaminski A, Berzaczy D, Van Noord MG, Helbich TH. Adjunct ultrasonography for breast cancer screening in women at average risk: a systematic review. INT J EVID-BASED HEA 2014; 11:87-93. [PMID: 23750571 DOI: 10.1111/1744-1609.12022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. AIMS The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. METHODS We searched multiple electronic databases and the Cochrane Breast Cancer Group's Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. RESULTS We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98%. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. CONCLUSIONS No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. IMPLICATIONS FOR PRACTICE Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.
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Affiliation(s)
- Gerald Gartlehner
- Department of Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
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15
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Berzaczy D, Domenig CM, Beitzke D, Bodner G. Imaging of a case of benign carotidynia with ultrasound, MRI and PET-CT. Wien Klin Wochenschr 2013; 125:719-20. [PMID: 24146331 DOI: 10.1007/s00508-013-0436-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
We present a case of carotidynia that we believe supports its classification as a distinct inflammatory disease entity. Doppler sonography and cervical magnetic resonance imaging are appropriate imaging modalities for diagnosing presumed carotidynia.
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Affiliation(s)
- Dominik Berzaczy
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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Moritz T, Prosch H, Berzaczy D, Happak W, Lieba-Samal D, Bernathova M, Auff E, Bodner G. Common anatomical variation in patients with idiopathic meralgia paresthetica: a high resolution ultrasound case-control study. Pain Physician 2013; 16:E287-E293. [PMID: 23703427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) characterized by pain, numbness or paresthesia on the anterolateral aspect of the thigh. Though several contributing factors have been identified, the cause of its idiopathic form still remains unclear. Anatomic and clinical studies have demonstrated a variable course for the LFCN and have suggested a contribution to the pathogenesis of MP. OBJECTIVE It was the aim of the present case-control study to assess the anatomical course and compression site of the LFCN using high resolution ultrasound (HRUS) in patients suffering from idiopathic MP, and compare the anatomical course in these patients to an asymptomatic control group. STUDY DESIGN Case-control study. SETTING Nerve imaging center at a large university hospital in Austria. METHODS Twenty-eight patients with a diagnosis of MP were included in this study (20 men, 8 women; mean age 54 years). The diagnosis was established by clinical history, physical examination, and diagnostic anesthetic block. Fifteen age- and gender-matched healthy volunteers served as the control group. Standardized HRUS examinations were performed by one experienced radiologist from June 2004 through April 2012. Two experienced radiologists reviewed the patients' standardized HRUS examinations and performed examinations in the control group to measure the minimal distance between the LFCN and the anterior superior iliac spine (ASIS). OUTCOMES The minimal distance between the ASIS and the LFCN was measured using HRUS. RESULTS The LFCN could be seen in all patients and volunteers. In MP patients, the mean distance between the LFCN and the ASIS was 0.52 cm (SD 0.46 cm), compared to a mean distance of 1.79 cm (SD 1.48 cm) in the control group (P < 0.001). LIMITATIONS Limited sample size, retrospective design. CONCLUSIONS The results of this study demonstrate a significantly different course of the LFCN, closer to the ASIS in patients with idiopathic MP.
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Affiliation(s)
- Thomas Moritz
- Department of Radiology, Medical University of Vienna A-1090 Vienna, Austria.
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Gartlehner G, Thaler K, Chapman A, Kaminski-Hartenthaler A, Berzaczy D, Van Noord MG, Helbich TH. Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk. Cochrane Database Syst Rev 2013; 2013:CD009632. [PMID: 23633376 PMCID: PMC6464804 DOI: 10.1002/14651858.cd009632.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Breast cancer is the most common malignant disease diagnosed in women worldwide. Screening with mammography has the ability to detect breast cancer at an early stage. The diagnostic accuracy of mammography screening largely depends on the radiographic density of the imaged breasts. In radiographically dense breasts, non-calcified breast cancers are more likely to be missed than in fatty breasts. As a consequence, some cancers are not detected by mammography screening. Supporters of adjunct ultrasonography to the screening regimen for breast cancer argue that it might be a safe and inexpensive approach to reduce the false negative rates of the screening process. Critics, however, are concerned that performing supplemental ultrasonography on women at average risk will also increase the rate of false positive findings and can lead to unnecessary biopsies and treatments. OBJECTIVES To assess the comparative effectiveness and safety of mammography in combination with breast ultrasonography versus mammography for breast cancer screening for women at average risk of breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, MEDLINE (via OvidSP) and EMBASE up until February 2012.To detect ongoing or unpublished studies, we searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the National Cancer Institute's clinical trial database until June 2012. In addition, we conducted grey literature searches using the following sources: OpenGrey; National Institute of Health RePORTER; Health Services Research Projects in Progress (HSRPROJ); Hayes, Inc. Health Technology Assessment; The New York Academy of Medicine's Grey Literature Index and Conference Papers Index. SELECTION CRITERIA For efficacy, we considered randomised controlled trials (RCTs), with either individual or cluster randomisation, and prospective, controlled non-randomised studies with a low risk of bias and a sample size of at least 500 participants.In addition to studies eligible for efficacy, we considered any controlled, non-randomised study with a low risk of bias and a study size of at least 500 participants for the assessment of harms.Our population of interest were women between the ages of 40 and 75 years who were at average risk for breast cancer. DATA COLLECTION AND ANALYSIS Two review authors screened abstracts and full-text publications against the inclusion criteria. None of the studies met our inclusion criteria. MAIN RESULTS Our review did not detect any controlled studies on the use of adjunct ultrasonography for screening in women at average risk for breast cancer. One ongoing randomised controlled trial was identified (J-START, Japan). AUTHORS' CONCLUSIONS Presently, there is no methodologically sound evidence available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer.
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Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA. Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 2011; 22:901-9; quiz 909. [PMID: 21570318 DOI: 10.1016/j.jvir.2011.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/10/2011] [Accepted: 03/14/2011] [Indexed: 11/19/2022] Open
Abstract
During the past 10 years, uterine artery embolization (UAE) has been investigated as a possible therapy for adenomyosis. All publications available from 1999 through 2010 are included in this report. Levels of evidence and trial classifications were evaluated according to the guidelines developed by the United States Preventive Services Task Force. Long-term data are available from 511 affected women from 15 studies. Improvements were reported by 387 patients (75.7%). The median follow-up was 26.9 months. UAE as treatment for adenomyosis shows significant clinical and symptomatic improvements on a short- and long-term basis.
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Affiliation(s)
- Martin Popovic
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Funovics PT, Edelhauser G, Funovics MA, Laux C, Berzaczy D, Kubista B, Kotz RI, Dominkus M. Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma. Int Orthop 2011; 35:1529-36. [PMID: 21249357 DOI: 10.1007/s00264-011-1208-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/04/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate (a) whether pre-operative serum CRP is a predictor of survival in patients with high-grade osteosarcoma, (b) whether post-operative infection is a predictor of survival in these patients and (c) whether CRP is a predictor of post-operative infection, and especially deep prosthetic infection. METHODS In this retrospective single-centre study, pre-operative serum CRP levels in 79 patients (37 females, 42 males; average age, 18 years; mean follow-up, 46 months) undergoing resection of an osteosarcoma were correlated with clinical data and survival. RESULTS The mean pre-operative serum CRP level of all 79 patients was 0.53 mg/dl (SD, 1.27 mg/dl). Patients dying of their underlying disease had significantly higher CRP levels compared to patients surviving throughout the follow-up period (1.09 mg/dl ± 2.02 mg/dl versus 0.32 mg/dl ± 0.75 mg/dl, respectively; p = 0.015). CRP levels were significantly correlated with survival (Pearson's correlation coefficient = -0.25; p = 0.026) and histological subtype (Pearson's correlation coefficient = -0.42; p < 0.001), but not with sex, age, histological response, tumour size or metastatic disease. In uni- and multivariate survival analysis, age, response to chemotherapy and serum CRP were associated with disease-specific survival. Patients with a CRP level over 1 mg/dl had a significantly lower disease-specific five-year survival of 36.7% compared to 73.8% in patients with normal CRP values (p = 0.020). Infection was not correlated with disease-specific survival. Pre-operative serum CRP levels were not correlated with post-operative infection or deep prosthetic infection. CONCLUSIONS Pre-operative serum CRP seems to be an independent predictor of survival in patients with high-grade osteosarcoma. Further studies are needed to confirm these results on a large-scale basis.
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Affiliation(s)
- Philipp T Funovics
- Medical University of Vienna Department of Orthopaedic Surgery, Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Berzaczy D, Popovic M, Reiter M. Quality of Life in Patients with Idiopathic Subclavian Vein Thrombosis. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Popovic M, Berzaczy D, Puchner S, Lammer J, Bucek RA. Long-term Quality of Life after Uterine Artery Embolization in Women with Adenomyosis and Fibroids versus Women with Fibroids Alone. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA. Uterine Artery Embolization for the Treatment of Adenomyosis. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Klug C, Berzaczy D, Voracek M, Nell C, Ploder O, Millesi W, Ewers R. Preoperative radiochemotherapy in the treatment of advanced oral cancer: Outcome of 276 patients. J Craniomaxillofac Surg 2009; 37:344-7. [PMID: 19525119 DOI: 10.1016/j.jcms.2008.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 11/09/2008] [Accepted: 11/20/2008] [Indexed: 10/20/2022] Open
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Berzaczy D, Popovic M, Reiter M, Puchner S, Weber M, Minar E, Bucek RA. Quality of life in patients with idiopathic subclavian vein thrombosis. Thromb Res 2009; 125:25-8. [PMID: 19476976 DOI: 10.1016/j.thromres.2009.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 04/26/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Idiopathic subclavian vein thrombosis (SVT) is a rare disease but these otherwise healthy patients often suffer from prolonged clinical manifestations. The aim of this retrospective study was to assess the range and severity of thrombosis-related disability of the upper extremity in patients after an episode of documented idiopathic SVT in the long-term follow-up. MATERIALS AND METHODS The quality of life (QoL) of 37 patients with documented idiopathic SVT was assessed by two standardized questionnaires (DASH and SF 36). The DASH and SF-36 questionnaire each use a 100 point scale. 0 stands for uncompromised functioning, 100 for maximum limitation in the DASH, while in the SF-36 0 marks the lowest rating of QoL and 100 indicates the best imaginable quality of life. RESULTS Mean follow-up time was 120+/-80.1 months (range: 14 to 286 months). The mean DASH score was 10.7+/-12 and the mean scores for the SF-36 dimensions Physical Component Summary (PCS) and Mental Component System (MCS) were 52+/-9.3 and 46.3+/-9.5, respectively. CONCLUSIONS Patients suffering from idiopathic SVT report good overall QoL judged by the mean DASH and satisfactory QoL by the SF-36 score in the long-term follow-up. These patients deal well with their physical limitations.
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Affiliation(s)
- Dominik Berzaczy
- Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA. Long-Term Quality of Life Assessment in Patients Undergoing Uterine Fibroid Embolization. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nell C, Berzaczy D, Millesi W, Ewers R, Klug C. O.495 Multimodal therapy of 276 patients with advanced oral cancer. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Klug C, Berzaczy D, Voracek M, Millesi W. Preoperative chemoradiotherapy in the management of oral cancer: a review. J Craniomaxillofac Surg 2008; 36:75-88. [PMID: 18222699 DOI: 10.1016/j.jcms.2007.06.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 06/05/2007] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Multi-modality treatment concepts involving preoperative radiotherapy (RT) or chemoradiotherapy (CRT) and subsequent radical resection are used much less frequently than postoperative treatment for oral and oropharyngeal squamous cell carcinomas. In some centres, however, the preoperative approach has been established for several years. MATERIAL The present review is a compilation of the existing evidence on this subject. METHODS In a literature-based meta-analysis, the survival data of 1927 patients from 32 eligible publications were analysed. RESULTS The calculated survival rates of documented patients show remarkably good results with preoperative CRT and radical surgery. However, the findings of this analysis are based on data with a large proportion of studies using consecutive patient series. CONCLUSION Hard evidence providing sufficient data from prospective randomised studies is as yet missing for preoperative CRT. Prospective randomised studies are mandatory in this area.
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Affiliation(s)
- Clemens Klug
- Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, AKH, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Klug C, Berzaczy D, Reinbacher H, Voracek M, Rath T, Millesi W, Ewers R. Influence of Previous Radiotherapy on Free Tissue Transfer in the Head and Neck Region: Evaluation of 455 Cases. Laryngoscope 2006; 116:1162-7. [PMID: 16826053 DOI: 10.1097/01.mlg.0000227796.41462.a1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/HYPOTHESIS The aim of this retrospective cohort study was to investigate the effect of prior radiotherapy (XRT) on the outcome of microvascular free tissue transfer in the head and neck region. METHODS Four hundred fifty-five patients, subdivided into three groups, were analyzed. Groups I (no previous XRT, n=110), II (previous radiochemotherapy with 50 Gy focus dosage in the primary treatment regime for oral cancer, n=322), and III (secondary reconstruction after XRT-induced complications, n=23) were compared regarding flap success rate, postoperative complications, postoperative mortality, duration of intensive care (DOIC), and hospitalization (DOH). RESULTS Flap success did not differ significantly across groups (I: 95.5%, II: 93.2%, III: 91.3%. Risk of postoperative complications was significantly lower for group I (12.7%) compared with groups II (23.9%) and III (39.1%). DOIC and DOH were significantly shorter for patients in group I than for those in groups II and III. CONCLUSIONS XRT before free tissue transfer does not significantly increase flap loss or postoperative mortality but does increase postoperative complications and length of hospitalization.
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Affiliation(s)
- Clemens Klug
- Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
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Klug C, Berzaczy D, Voracek M, Enislidis G, Rath T, Millesi W, Ewers R. Experience with microvascular free flaps in preoperatively irradiated tissue of the oral cavity and oropharynx in 303 patients. Oral Oncol 2005; 41:738-46. [PMID: 15978858 DOI: 10.1016/j.oraloncology.2005.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 03/29/2005] [Indexed: 11/18/2022]
Abstract
This study examined free flap reconstruction of surgical defects of the oral cavity and oropharynx after preoperative radiochemotherapy. Included in this analysis are 303 prospectively followed patients who underwent a multimodal treatment regime for advanced oral and oropharyngeal carcinoma. All patients received preoperative radiochemotherapy (Mitomycin C, 5-FU, 50 Gy), ablative surgery, and primary free flap reconstruction. Patient characteristics, surgical parameters like duration of surgery and ischaemia, size of defect, type of transplant, and clinical outcome parameters like duration of intensive care and hospitalization, type of complications, necessity and type of revision surgery were statistically evaluated. Overall flap success rate was 93.1%. Sixty seven patients required revision and 21 flaps (6.9%) were lost. Overall complication rate was 22.1%. Mean duration of intensive care (DOIC) and duration of overall postoperative hospitalization (DOH) were 11.0+/-9.6 days and 35.9+/-26.3 days, respectively. Flap success and flap related complications after 50 Gy focal radiation dosage were found in a comparable range as in published series of reconstructions in uncompromised tissue.
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Affiliation(s)
- Clemens Klug
- Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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