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Kedves A, Akay M, Akay Y, Kisiván K, Glavák C, Miovecz Á, Schiffer Á, Kisander Z, Lőrincz A, Szőke A, Sánta B, Freihat O, Sipos D, Kovács Á, Lakosi F. Predictive value of magnetic resonance imaging diffusion parameters using artificial intelligence in low-and intermediate-risk prostate cancer patients treated with stereotactic ablative radiotherapy: A pilot study. Radiography (Lond) 2024; 30:986-994. [PMID: 38678978 DOI: 10.1016/j.radi.2024.03.015] [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: 09/12/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION To investigate the predictive value of the pre-treatment diffusion parameters of diffusion-weighted magnetic resonance imaging (DW-MRI) using artificial intelligence (AI) for prostate-specific antigen (PSA) response in patients with low- and intermediate-risk prostate cancer (PCa) treated with stereotactic ablative radiotherapy (SABR). METHODS Retrospective evaluation was performed for 30 patients using pre-treatment multi-parametric MR image datasets between 2017 and 2021. MR-based mean- and minimum apparent diffusion coefficients (ADCmean, ADCmin) were calculated for the intraprostatic dominant lesion. Therapeutic response was assessed using PSA levels. Predictive performance was assessed by the receiver operating characteristic (ROC) analysis. Statistics performed with a significance level of p ≤ 0.05. RESULTS No biochemical relapse was detected after a median follow-up of twenty-three months (range: 3-50), with a median PSA of 0.01 ng/ml (range: 0.006-2.8) at the last examination. Significant differences were observed between the pre-treatment ADCmean, ADCmin parameters, and the group averages of patients with low and high 1-year-PSA measurements (p < 0.0001, p < 0.0001). In prediction, the random forest (RF) model outperformed the decision tree (DT) and support vector machine (SVM) models by yielding area under the curves (AUC), with 0.722, 0.685, and 0.5, respectively. CONCLUSION Our findings suggest that pre-treatment MR diffusion data may predict therapeutic response using the novel approach of machine learning in PCa patients treated with SABR. IMPLICATIONS FOR PRACTICE Clinicians shall measure and implement the evaluation of the suggested parameters (ADCmin, ADCmean) to provide the most accurate therapy for the patient.
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Affiliation(s)
- A Kedves
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Institute of Information and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary; Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - M Akay
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Y Akay
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - K Kisiván
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - C Glavák
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - Á Miovecz
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Á Schiffer
- Institute of Information and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - Z Kisander
- Department of Electrical Networks, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - A Lőrincz
- Institute of Information and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - A Szőke
- 3D Printing and Visualization Centre, Medical School, University of Pécs, Pécs, Hungary
| | - B Sánta
- Röntgenpraxis Dr. Thomas Trieb, Innsbruck, Austria
| | - O Freihat
- College of Health Sciences, Abu Dhabi University, Abu Dhabi, UAE
| | - D Sipos
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Institute of Diagnostics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Á Kovács
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; Institute of Diagnostics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary; Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Lakosi
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; Institute of Diagnostics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
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Baasan O, Freihat O, Nagy DU, Lohner S. Change over Five Years in Important Measures of Methodological Quality and Reporting in Randomized Cardiovascular Clinical Trials. J Cardiovasc Dev Dis 2023; 11:2. [PMID: 38276655 PMCID: PMC10816801 DOI: 10.3390/jcdd11010002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES The aim of our current study was to analyze whether the use of important measures of methodological quality and reporting of randomized clinical trials published in the field of cardiovascular disease research haschanged over time. A furtheraim was to investigate whether there was an improvement over time in the ability of these trials to provide a good estimate of the true intervention effect. METHODS We conducted two searches in the Cochrane Central Register of Controlled Trials (CENTAL) database to identify randomized cardiovascular clinical trials published in either 2012 or 2017. Randomized clinical trials (RCTs) trials in cardiovascular disease research with adult participants were eligible to be included. We randomly selected 250 RCTs for publication years 2012 and 2017. Trial characteristics, data on measures of methodological quality, and reporting were extracted and the risk of bias for each trial was assessed. RESULTS As compared to 2012, in 2017 there were significant improvements in the reporting of the presence of a data monitoring committee (42.0% in 2017 compared to 34.4% in 2012; p < 0.001), and a positive change in registering randomized cardiovascular disease research in clinical trial registries (78.4% in 2017 compared to 68.9% in 2012; p = 0.03). We also observed that significantly more RCTs reported sample size calculation (60.4% in 2017 compared to 49.6% in 2012; p < 0.01) in 2017 as compared to 2012. RCTs in 2017 were more likely to have a low overall risk of bias (RoB) than in 2012 (29.2% in 2017 compared to 21.2% in 2012; p < 0.01). However, fewer 2017 RCTs were rated low (50.8% compared to 65.6%; p < 0.001) risk for blinding of participants and personnel, for blinding of outcome assessors (82.4% compared to 90.8%; p < 0.001), and selective outcome reporting (62.8% compared to 80.0%; <0.001). CONCLUSIONS As compared to 2012, in 2017 there were significant improvements in some, but not all, the important measures of methodological quality. Although more trials in the field of cardiovascular disease research had a lower overall RoB in 2017, the improvement over time was not consistently perceived in all RoB domains.
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Affiliation(s)
- Odgerel Baasan
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Dávid U. Nagy
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7624 Pécs, Hungary
- Institute of Geobotany/Plant Ecology, Martin-Luther-University, 06108 Halle, Germany
| | - Szimonetta Lohner
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, 7624 Pécs, Hungary
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
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Sipos D, Biro AA, Busa F, Freihat O, Tollár J, Pandur AA, Kovács Á, Deutsch K, Csima MP. Reduced burnout in medical and health science students during the pandemic COVID-19 - a follow-up study of a single institution in Hungary. BMC Med Educ 2023; 23:893. [PMID: 37993921 PMCID: PMC10666327 DOI: 10.1186/s12909-023-04867-0] [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] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The coronavirus pandemic has significantly impacted lives worldwide, especially of medical and health science students. In Hungary, education has been relegated to the online space, with a substantial proportion of students having to attend medical secondments. Increased stress, uncertainty, and the presence of medical secondments can have an impact on students' premature burnout. METHODS In 2021, we conducted a follow-up survey among students of the University of Pécs studying medicine and health sciences in two data collection periods (from March to May and September to November). Our online questionnaire consisted of the Maslach Burnout Inventory General Survey for Students and our self-designed questionnaire. We used descriptive and paired two-sample t-tests for data analysis at a 95% confidence interval (p ≤ 0.05). RESULTS We excluded from our survey respondents whose data we could not follow-up; finally, 183 students' responses were analyzed. The majority of students were female (n = 148; 80.9%). Overall, there was a significant decrease in both exhaustion (EX) and cynicism (CY) scores (p = 0.001; p = 0.004). Female respondents had higher EX scores, but a significant decrease was observed for both genders (p ≤ 0.05). Excluding paramedic students, a significant decrease in EX scores was observed for the specialties we studied (p ≤ 0.05). General medicine students' CY scores decreased; physiotherapy students' profesisonal efficacy (PE) scores increased significantly (p ≤ 0.05). Students who were on medical secondments (n = 127; 69. 4%) were found to be more affected by burnout, but in all cases, these scores significantly improved (p ≤ 0.05). Students serving in the National Ambulance Service (n = 76; 41.5%), Hospitals (n = 44; 24.0%), or both (n = 7; 3.8%) had a significant decrease in their burnout score (p ≤ 0.05). Students who served in either a hospital or a hospital and National Ambulance Service had significantly improved CY and PE scores (p ≤ 0.05). Students concerned about their health had elevated EX and CY scores, which also improved (p ≤ 0.05). CONCLUSIONS In conclusion, medical secondments positively affected student burnout scores for medicine and health sciences students at our institution. This fact implies that it is necessary to have more internships in real-life settings during the training. TRIAL REGISTRATION Our survey has been approved by the Medical Research Council (Case No IV/4573-1/2021/ECU).
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Affiliation(s)
- David Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary.
- Radiation Oncology, Research, and Teaching Center, Dr. József Baka Diagnostic, "Moritz Kaposi" Teaching Hospital, Guba Sándor street 40, Kaposvár, 7400, Hungary.
| | - Anett Anna Biro
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary
| | - Flora Busa
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary
| | - Omar Freihat
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary
- College of Health Science, Abu Dhabi University, Department of Public Health, Abu Dhabi, United Arab Emirates
| | - József Tollár
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary
- Radiation Oncology, Research, and Teaching Center, Dr. József Baka Diagnostic, "Moritz Kaposi" Teaching Hospital, Guba Sándor street 40, Kaposvár, 7400, Hungary
| | - Attila András Pandur
- Department of Oxyology, Emergency Care, Faculty of Health Sciences, University of Pécs, Vörösmarty 4, Pécs, 7621, Hungary
| | - Árpád Kovács
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Nagyerdei 98, Debrecen, 4032, Hungary
| | - Krisztina Deutsch
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Street 4, Pécs, 7621, Hungary
| | - Melinda Petőné Csima
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre street 14/B, Kaposvár, 7400, Hungary
- Institute of Education, MATE - Hungarian University of Agriculture and Life Sciences, Guba Sándor street 40, Kaposvár, 7400, Hungary
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Sipos D, Jenei T, Kövesdi OL, Novák P, Freihat O, Tollár J, András Pandur A, Kovács Á, Repa I, Petőné Csima M. Burnout and occupational stress among Hungarian radiographers working in emergency and non-emergency departments during COVID-19 pandemic. Radiography (Lond) 2023; 29:466-472. [PMID: 36871472 PMCID: PMC9939395 DOI: 10.1016/j.radi.2023.02.013] [Citation(s) in RCA: 2] [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: 08/01/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The increased workload caused by the coronavirus pandemic may have had a significant impact on the mental health of radiographers. The aim of our study was to investigate burnout and occupational stress in radiographers working in emergency departments (ED) and non-emergency departments (NED). METHODS Quantitative, cross-sectional, descriptive research was carried out among radiographers working in the public health sector in Hungary. Due to the cross-sectional nature of our survey, there was no overlap between the ED and NED groups. For data collection, we used simultaneously the Maslach Burnout Inventory (MBI), the Effort-Reward Imbalance questionnaire (ERI), and our self-designed questionnaire. RESULTS We excluded incomplete questionnaires from our survey; finally, 439 responses were evaluated. Significantly higher scores for depersonalisation (DP; 8.43 (SD = 6.69) vs. 5.63 (SD = 4.21) and emotional exhaustion (EE; 25.07 (SD = 11.41) vs. 19.72 (SD = 11.72)) were observed in radiographers working in ED (p = 0.001; p = 0.001) when compared to NED. Male radiographers working in ED aged 20-29 and 30-39 years with experience of 1-9 years were more affected by DP (p ≤ 0.05). Worrying about one's own health had a negative effect on DP and EE (p ≤ 0.05). Having close friend with a COVID-19 infection had a negative effect on EE (p ≤ 0.05); not being infected with coronavirus, not being quarantined and relocating within the workplace had a positive effect on personal accomplishment (PA); radiographers who were 50 years or older with 20-29 years of experience were more affected by depersonalisation (DP); and those who worried about their health had significantly higher stress scores (p ≤ 0.05) in both ED and NED settings. CONCLUSION Male radiographers at the beginning of their careers were more affected by burnout. Employment in EDs had a negative impact on DP and EE. IMPLICATIONS FOR PRACTICE Our results support the implementation of interventions to counter the effects of occupational stress and burnout among radiographers working in ED.
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Affiliation(s)
- David Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary; Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Guba Sándor Street 40, 7400 Kaposvár, Hungary.
| | - Timea Jenei
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary
| | - Orsolya L Kövesdi
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary
| | - Pál Novák
- Faculty of Health Sciences, University of Pécs, Vörösmarty 4, 7621 Pécs, Hungary
| | - Omar Freihat
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary
| | - József Tollár
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary; Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Guba Sándor Street 40, 7400 Kaposvár, Hungary
| | - Attila András Pandur
- Department of Oxyology, Emergency Care, Faculty of Health Sciences, University of Pécs, Vörösmarty 4, 7621 Pécs, Hungary
| | - Árpád Kovács
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary; Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Nagyerdei 98, 4032 Debrecen, Hungary
| | - Imre Repa
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary; Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Guba Sándor Street 40, 7400 Kaposvár, Hungary
| | - Melinda Petőné Csima
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Street 14/B, 7400 Kaposvár, Hungary; Institute of Education, MATE - Hungarian University of Agriculture and Life Sciences, Guba Sándor Street 40, 7400 Kaposvár, Hungary
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Baasan O, Freihat O, Nagy DU, Lohner S. Methodological Quality and Risk of Bias Assessment of Cardiovascular Disease Research: Analysis of Randomized Controlled Trials Published in 2017. Front Cardiovasc Med 2022; 9:830070. [PMID: 35369336 PMCID: PMC8968023 DOI: 10.3389/fcvm.2022.830070] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background All randomized-controlled trials (RCTs) are required to follow high methodological standards. In this study, we aimed to assess the methodological quality of published cardiovascular clinical research trials in a representative sample of RCTs published in 2017. Methods Cochrane Central Register of Controlled Trials was used to identify cardiovascular clinical research trials with adult participants published in 2017. Overall, 250 (10%) RCTs were randomly selected from a total of 2,419 studies. Data on general trial characteristics were extracted and the risk of bias (RoB) was determined. Results Overall, 86% of RCTs have reported at least one statistically significant result, with the primary outcome significant in 69%, treatment favored in 55%, and adverse events reported in 68%. Less than one-third (29%) of trials were overall low RoB, while the other two-thirds were rated unclear (40%) or with high RoB (31%). Sequence generation, allocation concealment, and selective reporting were the domains most often rated with high RoB. Drug trials were more likely to have low RoB than non-drug trials. Significant differences were found in RoB for the allocation concealment and blinding of participants and personnel between industry-funded and non-industry-funded trials, with industry-funded trials more often rated at low RoB. Conclusion Almost two-thirds of RCTs in the field of cardiovascular disease (CVD) research, were at high or unclear RoB, indicating a need for more rigorous trial planning and conduct. Prospective trial registration is a factor predicting a lower risk of bias.
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Affiliation(s)
- Odgerel Baasan
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - David U. Nagy
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
- Institute of Geobotany/Plant Ecology, Martin-Luther-University, Halle, Germany
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
- *Correspondence: Szimonetta Lohner,
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Freihat O, Zoltán T, Pinter T, Kedves A, Sipos D, Repa I, Kovács Á, Zsolt C. Correlation between Tissue Cellularity and Metabolism Represented by Diffusion-Weighted Imaging (DWI) and 18F-FDG PET/MRI in Head and Neck Cancer (HNC). Cancers (Basel) 2022; 14:cancers14030847. [PMID: 35159115 PMCID: PMC8833888 DOI: 10.3390/cancers14030847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/17/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/02/2023] Open
Abstract
Simple Summary We report on the correlation between the diffusion-weighted imaging (DWI) and the metabolic volume parameters derived from a PET scan, to determine the correlation between these parameters and the tumor cellularity in head and neck primary tumors. Our findings implied that there was no correlation between the information derived from the DWI and the information derived from the FDG metabolic parameters. Thus, both imaging techniques might play a complementary role in HNC diagnosis and assessment. This is significant because the treatment plan of patients with HNC should be well evaluated by using all the available diagnosis techniques, for a better understanding of how the tumor will react. Abstract Background: This study aimed to assess the association of 18F-Fluorodeoxyglucose positron-emission-tomography (18F-FDG/PET) and DWI imaging parameters from a primary tumor and their correlations with clinicopathological factors. Methods: We retrospectively analyzed primary tumors in 71 patients with proven HNC. Primary tumor radiological parameters: DWI and FDG, as well as pathological characteristics were analyzed. Spearman correlation coefficient was used to assess the correlation between DWI and FDG parameters, ANOVA or Kruskal–Wallis, independent sample t-test, Mann–Whitney test, and multiple regression were performed on the clinicopathological features that may affect the 18F- FDG and apparent-diffusion coefficient (ADC) of the tumor. Results: No significant correlations were observed between DWI and any of the 18F-FDG parameters (p > 0.05). SUVmax correlated with N-stages (p = 0.023), TLG and MTV correlated with T-stages (p = 0.006 and p = 0.001), and ADC correlated with tumor grades (p = 0.05). SUVmax was able to differentiate between N+ and N− groups (p = 0.004). Conclusions: Our results revealed a non-significant correlation between the FDG-PET and ADC-MR parameters. FDG-PET-based glucose metabolic and DWI-MR-derived cellularity data may represent different biological aspects of HNC.
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Affiliation(s)
- Omar Freihat
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Correspondence: (O.F.); (Á.K.); Tel.: +36-52-411-600 (Á.K.)
| | - Tóth Zoltán
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, 7400 Kaposvár, Hungary
| | - Tamas Pinter
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
| | - András Kedves
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
- Institute of Information Technology and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, 7621 Pécs, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
| | - Imre Repa
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
| | - Árpád Kovács
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence: (O.F.); (Á.K.); Tel.: +36-52-411-600 (Á.K.)
| | - Cselik Zsolt
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Csolnoky Ferenc County Hospital, 8200 Veszprém, Hungary
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Freihat O, Tóth Z, Pintér T, Kedves A, Sipos D, Cselik Z, Lippai N, Repa I, Kovács Á. Pre-treatment PET/MRI based FDG and DWI imaging parameters for predicting HPV status and tumor response to chemoradiotherapy in primary oropharyngeal squamous cell carcinoma (OPSCC). Oral Oncol 2021; 116:105239. [PMID: 33640578 DOI: 10.1016/j.oraloncology.2021.105239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/17/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the feasibility of pre-treatment primary tumor FDG-PET and DWI-MR imaging parameters in predicting HPV status and the second aim was to assess the feasibility of those imaging parameters to predict response to therapy. MATERIAL AND METHODS We retrospectively analyzed primary tumors in 33 patients with proven OPSCC. PET/MRI was performed before and 6 months after chemo-radiotherapy for assessing treatment response. PET Standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and apparent diffusion coefficient (ADC) from pre-treatment measurements were assessed and compared to the clinicopathological characteristics (T stages, N stages, tumor grades, HPV and post-treatment follow up). HPV was correlated to the clinicopathological characteristics. RESULTS ADCmean was significantly lower in patients with HPV+ve than HPV-ev, (P = 0.001), cut off value of (800 ± 0.44*10-3mm2/s) with 76.9% sensitivity, and 72.2% specificity is able to differentiate between the two groups. No significant differences were found between FDG parameters (SUVmax, TLG, and MTV), and HPV status, (P = 0.873, P = 0.958, and P = 0.817), respectively. Comparison between CR and NCR groups; ADCmean, TLG, and MTV were predictive parameters of treatment response, (P = 0.017, P = 0.013, and P = 0.014), respectively. HPV+ve group shows a higher probability of lymph nodes involvement, (P = 0.006) CONCLUSION: Our study found that pretreatment ADC of the primary tumor can predict HPV status and treatment response. On the other hand, metabolic PET parameters (TLG, and MTV) were able to predict primary tumor response to therapy.
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Affiliation(s)
- Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.
| | - Zoltán Tóth
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; Medicopus Healthcare Provider and Public Nonprofit Ltd., Somogy County Mór Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Tamás Pintér
- KMOK Hospital, Dr. József Baka Diagnostic Center, Radiation Oncology, Hungary; Medicopus Healthcare Provider and Public Nonprofit Ltd., Somogy County Mór Kaposi Teaching Hospital, Kaposvár, Hungary
| | - András Kedves
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; KMOK Hospital, Dr. József Baka Diagnostic Center, Radiation Oncology, Hungary; University of Pecs, Faculty of Health Sciences, Department of Diagnostics, Hungary
| | - Dávid Sipos
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; KMOK Hospital, Dr. József Baka Diagnostic Center, Radiation Oncology, Hungary; University of Pecs, Faculty of Health Sciences, Department of Diagnostics, Hungary
| | - Zsolt Cselik
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | | | - Imre Repa
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; KMOK Hospital, Dr. József Baka Diagnostic Center, Radiation Oncology, Hungary; Medicopus Healthcare Provider and Public Nonprofit Ltd., Somogy County Mór Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Árpád Kovács
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; University of Pecs, Faculty of Health Sciences, Department of Diagnostics, Hungary; Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Cselik Z, Tóth Z, Kedves A, Sipos D, Freihat O, Vecsera T, Lukács G, Emri M, Bajzik G, Hadjiev J, Repa I, Moizs M, Kovács Á. Predictive value of PET/CT based metabolic information in the modern 3D based radiotherapy treatment of head and neck can-cer patients - single institute study. Hell J Nucl Med 2020; 23:290-295. [PMID: 33306758 DOI: 10.1967/s002449912207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the predictive value of pretreatment positron emission tomography (PET) standardized uptake value (SUVmax), standardized uptake value corrected for lean body mass (SULpeak) value, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) parameters of the primary tumour assessed with PET/computed tomography (CT) in the clinical out-come in patients diagnosed with histopathologically confirmed head and neck squamous cell carcinoma. MATERIALS AND METHODS Retrospective evaluation was performed using PET/CT image datasets of 52 histologically proven head and neck cancer patients in 4 weeks' prior receiving definitive chemo-radiotherapy (CRT). Positron emission tomography /CT was performed before the CRT and 12 weeks after it for response evaluation. Image data was used for target volume delineation and for specify SUVmax, SULpeak, MTV and TLG parameters of the primary tumour. According to the results of the therapeutic response evaluation two patient subgroups were created in relation to the presence or absence of viable tumour. Metabolic data from pre-treatment PET/CT and therapeutic response were correlated using Kruskal-Wallis test. RESULTS After completion of the CRT in 24/52 (46%) cases viable residual tumour was detected on restaging PET/CT, while in 28/52 (54%) patients showed complete remission. For the therapeutic success prediction assessment, we could not find any significant correlation with pre-treatment SUVmax and SULpeak values (P>0.44, P>0.33). Total lesion glycolysis provided nearly significant difference (P=0.052) and MTV had shown significant difference (P=0.001) between the two patient subgroups statistically. CONCLUSION Simple metabolic data (SUVmax and SULpeak) from pretreatment fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT were unable to predict therapeutic response, while volumetric information containing MTV and TLG parameters proved to be more useful, thus their inclusion to risk stratification may also have additional value.
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Affiliation(s)
- Zsolt Cselik
- Oncoradiology, Csolnoky Ferenc County Hospital, Veszprém, Hungary.
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Kedves A, Tóth Z, Emri M, Fábián K, Sipos D, Freihat O, Tollár J, Cselik Z, Lakosi F, Bajzik G, Repa I, Kovács Á. Predictive Value of Diffusion, Glucose Metabolism Parameters of PET/MR in Patients With Head and Neck Squamous Cell Carcinoma Treated With Chemoradiotherapy. Front Oncol 2020; 10:1484. [PMID: 32983984 PMCID: PMC7492555 DOI: 10.3389/fonc.2020.01484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/27/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose: This study aims to evaluate the predictive value of the pretreatment, metabolic, and diffusion parameters of a primary tumor assessed with PET/MR on patient clinical outcomes. Methods: Retrospective evaluation was performed using PET/MR image data sets acquired using the single tracer injection dual imaging of 68 histologically proven head and neck cancer patients 4 weeks before receiving definitive chemoradiotherapy (CRT). PET/MR was performed before the CRT and 12 weeks after the CRT for response evaluation. Image data (PET and MRI diffusion-weighted imaging [DWI]) was used to specify the maximum standard uptake value, the peak lean body mass corrected, SUVmax, the metabolic tumor volume, the total lesion glycolysis (SUVmax, SULpeak, MTV, and TLG), and the mean apparent diffusion coefficient (ADCmean) of the primary tumor. Based on the results of the therapeutic response evaluation, two patient subgroups were created: one with a viable tumor and another without. Metabolic and diffusion data, from the pretreatment PET/MR and the therapeutic response, were correlated using Spearman's correlation coefficient and Wilcoxon's test. Results: After completing the CRT, a viable residual tumor was detected in 36/68 (53%) cases, and 32/68 (47%) patients showed complete remission. However, no significant correlation was found between the pretreatment parameter, ADCmean (p = 0.88), and the therapeutic success. The PET parameters, SUVmax and SULpeak, MTV, and TLG (p = 0.032, p = 0.01, p < 0.0001, p = 0.0004) were statistically significantly different between the two patient subgroups. Conclusion: This study found that MRI-based (ADCmean) data from FDG PET/MR pretreatment could not be used to predict therapeutic response although the PET parameters SUVmax, SULpeak, MTV, and TLG proved to be more useful; thus, their inclusion in risk stratification may also be of additional value.
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Affiliation(s)
- András Kedves
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Zoltán Tóth
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Miklós Emri
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Krisztián Fábián
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Dávid Sipos
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - József Tollár
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Cselik
- Oncoradiology, Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Ferenc Lakosi
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Gábor Bajzik
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Árpád Kovács
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Freihat O, Pinter T, Kedves A, Sipos D, Cselik Z, Repa I, Kovács Á. Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Cancer Imaging 2020; 20:56. [PMID: 32771060 PMCID: PMC7414722 DOI: 10.1186/s40644-020-00334-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/29/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To determine the usefulness of Diffusion Weighted Imaging (DWI) derived from PET/MRI in discriminating normal from metastatic lymph nodes and the correlation between the metastatic lymph nodes with the grade and the localization of the primary tumor. METHODS Retrospective study of 90 lymph nodes from 90 subjects; 65 patients who had proven histopathological metastatic lymph nodes from (HNSCC) who had undergone 18F- PET/MRI for clinical staging and assessment and twenty-five lymph nodes were chosen from 25 healthy subjects. Apparent Diffusion Coefficient (ADC) map was generated from DWI with b values (0 and 800 s/mm2). ADC values of the metastatic lymph nodes were calculated and compared to the normal lymph nodes ADC values, ROC was used to determine the best cut-off values to differentiate between the two group. Metastatic lymph nodes ADC mean values were compared to primary tumor grade and localization. RESULTS ADCmean value of the metastatic lymph nodes in the overall sample (0.899 ± 0.98*10- 3 mm2/sec) was significantly lower than the normal lymph nodes' ADCmean value (1.267 ± 0.88*10- 3 mm2/sec); (P = 0.001). The area under the curve (AUC) was 98.3%, sensitivity and specificity were 92.3 and 98.6%, respectively, when using a threshold value of (1.138 ± 0.75*10- 3 mm2/sec) to differentiate between both groups. Significant difference was found between metastatic lymph nodes (short-axis diameter < 10 mm), ADCmean (0.898 ± 0.72*10- 3 mm2/sec), and the benign lymph nodes ADCmean, (P = 0.001). No significant difference was found between ADCmean of the metastatic lymph nodes < 10 mm and the metastatic lymph nodes > 10 mm, ADCmean (0.899 ± 0.89*10- 3 mm2/sec), (P = 0.967). No significant differences were found between metastatic lymph nodes ADCmean values and different primary tumor grades or different primary tumor localization, (P > 0.05). CONCLUSION DWI-ADC is an effective and efficient imaging technique in differentiating between normal and malignant lymph nodes, and might be helpful to discriminate sub-centimeters lymph nodes. TRIAL REGISTRATION The trial is registered in clinical trials under ID: NCT04360993 , registration date: 17/04/2020.
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Affiliation(s)
- Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
| | - Tamas Pinter
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Medicopus Non-Profit Ltd., “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
| | - András Kedves
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Dávid Sipos
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Zsolt Cselik
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Oncoradiology, Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Imre Repa
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
- Medicopus Non-Profit Ltd., “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Árpád Kovács
- Doctoral School of Health Sciences, University of Pécs, P.O. Box: 7621, Vorosmarty 4, Pecs, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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