A Rare Case of Abnormal Diffuse Brain Uptake on an 123I MIBG Scan in a Patient With High-Risk Neuroblastoma

ABSTRACT

123I-meta-iodobenzylguanidine (123I-MIBG) is extensively used for initial staging and response evaluation in children with neuroblastoma. Physiological uptake of 123I-MIBG occurs in the salivary glands, liver, adrenal gland, myocardium, bowel, and thyroid gland. 123I-MIBG cannot cross an intact blood-brain barrier. We present the rare case of a 3-year-old boy with neuroblastoma and meningeal metastases who underwent an 123I-MIBG scan for disease restaging that showed abnormal brain uptake. Abnormal MIBG uptake in the brain can occur if there is disruption of the blood-brain barrier either secondary to metastases or after damage to blood-brain barrier.

Pearls of Temporal Bone Imaging in Children with Hearing Loss

Hearing loss is one of the most common indications for temporal bone imaging in children. Hearing loss may be congenital or acquired, and it may be conductive, sensorineural, or mixed audiologically. Temporal bone imaging plays an important role in the assessment and management of this condition. An understanding of the embryology of ear structures better enables the radiologist to interpret abnormalities on imaging of the temporal bone. Here, we provide a general review of ear development and a description of known genetic defects that contribute to congenital ear anomalies associated with hearing loss. We provide appropriate imaging techniques for the temporal bone depending on the clinical presentation and a systematic approach to imaging for children with hearing loss. Diagnostic imaging for developmental anomalies of the ear and cholesteatoma will be discussed.

Apparent diffusion coefficient values may help predict which MRI-detected high-risk breast lesions will upgrade at surgical excision

PURPOSE

To investigate whether diffusion-weighted imaging (DWI) features could assist in determining which high-risk lesions identified on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and diagnosed on core needle biopsy (CNB) will upgrade to malignancy on surgical excision.

MATERIALS AND METHODS

This Institutional Review Board (IRB)-approved prospective study included participants with MRI-detected Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 lesions with high-risk pathology on CNB who underwent surgical excision. Twenty-three high-risk lesions detected on 3T breast MRI in 20 women (average age = 54 ± 9 years) were evaluated, of which six lesions (26%) upgraded to malignancy at surgery. DCE, DWI characteristics, and clinical factors were compared between high-risk lesions that upgraded to malignancy on surgical excision and those that did not. Logistic regression modeling was performed to identify features that optimally predicted upgrade to malignancy, with performance described using area under the receiver operating characteristic curve (AUC).

RESULTS

High-risk lesions that upgraded on excision demonstrated lower apparent diffusion coefficient (ADC) than those that did not (median, 1.08 × 10^-3 mm² /s vs.1.39 × 10^-3 mm² /s, P = 0.046), and a trend of greater maximum lesion size (median, 24 mm vs. 8 mm, P = 0.053). There were no significant differences in lesion type (mass vs. nonmass enhancement, P = 1.0) or kinetic features (P = 0.78 for peak initial enhancement; P = 1.0 for worst curve type) among the high-risk cohorts. A model incorporating maximum lesion size and ADC provided optimal performance to predict upgrade to malignancy (AUC = 0.89).

CONCLUSION

ADC and maximum lesion size on MRI show promise for predicting which MRI-detected high-risk lesions will upgrade to malignancy at surgical excision.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1028-1036.

Harnessing the power of crowds: crowdsourcing as a novel research method for evaluation of acne treatments

BACKGROUND

Crowdsourcing is a novel process of data collection that can provide insight into the effectiveness of acne treatments in real-world settings. Little is known regarding the feasibility of crowdsourcing as a means of collecting dermatology research data, the quality of collected data, and how the data compare to the published literature.

OBJECTIVE

The objective of this analysis is to compare acne data collected from a medical crowdsourcing site with high-quality controlled studies from peer-reviewed medical literature.

METHODS

Crowdsourced data was collected from 662 online acne patients. Online patients reported data in a Likert-type format to characterize their symptom severity (740 total responses) and their treatment outcomes (958 total responses). The crowdsourced data were compared with meta-analyses and reviews on acne treatment from August 20, 2010 to August 20, 2011.

RESULTS

We compared topical, oral systemic, alternative, phototherapy, and physical acne treatments of crowdsourced data to published literature. We focused on topical tretinoin due to the large number of online patient responses. While approximately 80% of tretinoin users observed clinical improvement after a 12-week treatment period in clinical trials, 46% of online users reported improvement in an unspecified time period. For most topical treatments, medication with high efficacy in clinical trials did not produce high effectiveness ratings based on the crowdsourced online data.

CONCLUSION

While limitations exist with the current methods of crowdsourced data collection, with standardization of data collection and use of validated instruments, crowdsourcing will provide an important and valuable platform for collecting high-volume patient data in real-world settings.

Crowdsourcing for research data collection in rosacea

Several medical crowdsourcing sites are available to patients online, but few studies in the literature have compared crowdsourced data to clinical trials. Herein, we compare data from rosacea patients from a major medical crowdsourcing site with those from randomized controlled trials.