Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy: a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and 1H-MR spectroscopy compared with histology (subgroup in the RAXO trial)

BACKGROUND

Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival.

PATIENTS AND METHODS

We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusion-weighted imaging and 1H-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and Kaplan-Meier estimates of overall survival (OS).

RESULTS

In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). 1H-MRS revealed steatohepatosis induced by systemic therapy.

CONCLUSIONS

Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.

The Accuracy of the Computed Tomography Diagnosis of Acute Appendicitis: Does the Experience of the Radiologist Matter?

Background and Aims:

To assess the accuracy of computed tomography in diagnosing acute appendicitis with a special reference to radiologist experience.

Material and Methods:

Data were collected prospectively in our randomized controlled trial comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (APPAC trial, NCT01022567). We evaluated 1065 patients who underwent computed tomography for suspected appendicitis. The on-call radiologist preoperatively analyzed these computed tomography images. In this study, the radiologists were divided into experienced (consultants) and inexperienced (residents) ones, and the comparison of interpretations was made between these two radiologist groups.

Results:

Out of the 1065 patients, 714 had acute appendicitis and 351 had other or no diagnosis on computed tomography. There were 700 true-positive, 327 true-negative, 14 false-positive, and 24 false-negative cases. The sensitivity and the specificity of computed tomography were 96.7% (95% confidence interval, 95.1–97.8) and 95.9% (95% confidence interval, 93.2–97.5), respectively. The rate of false computed tomography diagnosis was 4.2% for experienced consultant radiologists and 2.2% for inexperienced resident radiologists (p = 0.071). Thus, the experience of the radiologist had no effect on the accuracy of computed tomography diagnosis.

Conclusion:

The accuracy of computed tomography in diagnosing acute appendicitis was high. The experience of the radiologist did not improve the diagnostic accuracy. The results emphasize the role of computed tomography as an accurate modality in daily routine diagnostics for acute appendicitis in all clinical emergency settings.

Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration

STUDY DESIGN

Prospective cohort study.

OBJECTIVES

Dysphagia is a relatively common secondary complication in patients with traumatic cervical spinal cord injuries (TCSCI). The purpose of this study was to determine the incidence of aspiration and penetration in patients with acute TCSCI.

SETTING

Tampere University Hospital, Tampere, Finland.

METHODS

A total of 46 patients with TCSCI were evaluated with a videofluoroscopic swallowing study (VFSS). Rosenbek's penetration-aspiration scale (PAS) was used to classify the degree of penetration or aspiration. The medical records of each patient were systematically reviewed.

RESULTS

Of the 46 patients, 85% were male. The mean age at the time of the injury was 62.1 years. Most patients had an incomplete injury (78%), and most of them due to a fall (78%). In the VFSS 19 (41%) patients penetrated and 15 (33%) aspirated. Only 12 (26%) of the patients had a PAS score of 1 indicating that swallowed material did not enter the airway. Of the patients who aspirated, 73% had silent aspiration.

CONCLUSION

The incidence of penetration or aspiration according to VFSS is high in this cohort of patients with TCSCI. Therefore, the swallowing function of patients with acute TCSCI should be routinely evaluated before initiating oral feeding. VFSS is highly recommended, particularly to rule out the possibility of silent aspiration and to achieve information on safe nutrition consistency.

Pregnancy-associated recurrent liver necrosis in patient with antiphospholipid syndrome

The presence of antiphospholipid antibodies is associated with thromboembolic events, thrombocytopenia and numerous pregnancy complications such as recurrent miscarriage, preeclampsia and HELLP syndrome. This condition is known as the antiphospholipid syndrome (APS). We describe a rare case of recurrent liver necrosis postpartum in two consecutive pregnancies of woman with systemic lupus erythematosus (SLE) and positive antiphospholipid antibodies (aPL) who underwent complete recovery.

Intermediate-term clinical and radiographic results of Synatomic and AGC knee prostheses

This study compared two total knee prostheses to determine whether the clinical and radiographic outcomes were different, focusing primarily on the patellofemoral articulation. The study group was comprised of 75 Synatomic (short-stemmed, anatomic VF type) and 79 AGC 2000 (universal, nonanatomic) prostheses. Patients underwent follow-up for an average of 63 and 50 months, respectively. At latest follow-up, the mean knee joint score was 84.4 in the Synatomic and 86.5 in the AGC group. Mean knee function scores were 63.5 and 63.4, respectively. No statistically significant difference was noted between the two prostheses.

The clinical and radiological outcome of the rotating hinged knee prostheses in the long-term

BACKGROUND AND AIMS

Opinions about hinged knee prostheses vary a lot in different studies. We wanted to examine our series in order to gain long-term information about this kind of knee prosthesis.

MATERIAL AND METHODS

Forty-eight (18 Kinematic Hinge and 30 Link Endo Model) rotating hinged knee prostheses were implanted in the Hospital of Invalid Foundation. All knees were retrospectively followed up for an average of 66.3 months and examined for clinical or radiological factors indicating the overall outcome.

RESULTS

In the latest review there were 10 patients (20.8%) regarded as having unsatisfactory and 35 patients (79.2%) satisfactory results. Eighty-four per cent of the patients were subjectively satisfied with the operation, mostly because of the painless result.

CONCLUSIONS

Taking into account the very poor initial status of these patients, we recommend the rotating hinged prostheses still to be used in severely instable knees awaiting revision.

Clinical results and survival of cementless revisions after 49 to 93 months

The results of 93 unselected consecutive cementless revision hip arthroplasties are reported. The patients' average age was 67 years, and the average follow-up was 62 months. The preoperative modified Merle d'Aubigne hip score averaged 9.7 (range 4-17) and the latest postoperative score was 13.7 (range 9-18). Twenty-five hips were rerevised and two await rerevision. Survivals of acetabular and femoral components at five years were 77 and 76% correspondingly. Radiographic examinations revealed migration in three acetabular components and seven femoral components (not yet rerevised). The results of the revisions with threaded acetabular components and with femoral components with madreporic or macrotextured surface were especially poor.