1
|
Schnapp W, Martiatu K, Delcroix GJR. Basivertebral nerve ablation for the treatment of chronic low back pain in a community practice setting: 6 Months follow-up. N Am Spine Soc J 2023; 14:100201. [PMID: 36926532 PMCID: PMC10011817 DOI: 10.1016/j.xnsj.2023.100201] [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] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
Background Strong innervation of the vertebral endplates by the basivertebral nerve makes it an ideal target for ablation in the treatment of vertebrogenic low back pain with Modic changes. This data represents the clinical outcomes for 16 consecutively treated patients in a community practice setting. Methods Basivertebral nerve ablations were performed on 16 consecutive patients by a single surgeon (WS) utilizing the INTRACEPT® device (Relievant Medsystems, Inc.). Evaluations were performed at baseline, 1 month, 3 months, and 6 months. The Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and SF-36 were recorded in Medrio electronic data capture software. All patients (n = 16) completed the baseline, 1 month, 3 months, and 6 months follow-up. Results The ODI, VAS, and SF-36 Pain Component Summary showed statistically significant improvements above minimal clinically important differences at 1 month, 3 months, and 6 months (all p values <0.05). Change in ODI pain impact declined 13.1 points [95% CI: 0.01,27.2] at one month from baseline, 16.5 points [95% CI: 2.5,30.6] at three months from baseline, and 21.1 points [95% CI: 7.0,35.2] six-months from baseline. SF-36 Mental Component Summary also showed some improvements, but with significance only at 3 months (p = 0.0091). Conclusions Basivertebral nerve ablation appears to be a durable, minimally invasive treatment for the relief of chronic low back pain that can be successfully implemented in a community practice setting. To our knowledge, this is the first independently funded US study on basivertebral nerve ablation.
Collapse
Affiliation(s)
| | | | - Gaëtan J-R Delcroix
- Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, FL, USA.,Neuroscience Associates, Key West, FL, USA
| |
Collapse
|
2
|
Fierens G, Standaert N, Peeters R, Glorieux C, Verhaert N. Safety of active auditory implants in magnetic resonance imaging. J Otol 2021; 16:185-198. [PMID: 34220987 PMCID: PMC8241703 DOI: 10.1016/j.joto.2020.12.005] [Citation(s) in RCA: 3] [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: 10/16/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become the gold standard for the diagnosis of many pathologies. Using MRI in patients with auditory implants can however raise concerns due to mutual interactions between the implant and imaging device, resulting in potential patient risks. Several implant manufacturers have been working towards more MRI safe devices. Older devices are however often labelled for more stringent conditions, possibly creating confusion with patients and professionals. With this myriad of different devices that are implanted in patients for lifetimes of at least 20 years, it is crucial that both patients and professionals have a clear understanding of the safety of their devices. This work aims at providing an exhaustive overview on the MRI safety of active auditory implants. The available industry standards that are followed by manufacturers are outlined and an overview of the latest scientific developments focusing on the last five years is provided. In addition, based on the analysis of the adverse events reported to the Food and Drug Administration (FDA) and in literature within the past ten years, a systematic review of the most commonly occurring issues for patients with auditory implants in the MRI environment is provided. Results indicate that despite the release of more MRI conditional active hearing implants on the market, adverse events still occur. An extensive overview is provided on the MRI safety of active auditory implants, aiming to increase the understanding of the topic for healthcare professionals and contribute to safer scanning conditions for patients.
Collapse
Affiliation(s)
- Guy Fierens
- Laboratory of Soft Matter and Biophysics, Department of Physics and Astronomy, KU Leuven, Celestijnenlaan 200D, B-3001, Heverlee, Belgium
- Cochlear Technology Centre, Schaliënhoevedreef 20I, B-2800, Mechelen, Belgium
- KU Leuven, Department of Neurosciences, Research Group Experimental Otorhinolaryngology, Herestraat 49, B-3000, Leuven, Belgium
| | - Nina Standaert
- University Hospitals Leuven, Department of Otorhinolaryngology, Herestraat 49, B-3000, Leuven, Belgium
| | - Ronald Peeters
- University Hospitals Leuven, Department of Radiology, Herestraat 49, B-3000, Leuven, Belgium
| | - Christ Glorieux
- Laboratory of Soft Matter and Biophysics, Department of Physics and Astronomy, KU Leuven, Celestijnenlaan 200D, B-3001, Heverlee, Belgium
| | - Nicolas Verhaert
- KU Leuven, Department of Neurosciences, Research Group Experimental Otorhinolaryngology, Herestraat 49, B-3000, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Herestraat 49, B-3000, Leuven, Belgium
| |
Collapse
|
3
|
Fatima K, Dasgupta A, DiCenzo D, Kolios C, Quiaoit K, Saifuddin M, Sandhu M, Bhardwaj D, Karam I, Poon I, Husain Z, Sannachi L, Czarnota GJ. Ultrasound delta-radiomics during radiotherapy to predict recurrence in patients with head and neck squamous cell carcinoma. Clin Transl Radiat Oncol 2021; 28:62-70. [PMID: 33778174 PMCID: PMC7985224 DOI: 10.1016/j.ctro.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study investigated the use of quantitative ultrasound (QUS) obtained during radical radiotherapy (RT) as a radiomics biomarker for predicting recurrence in patients with node-positive head-neck squamous cell carcinoma (HNSCC). METHODS Fifty-one patients with HNSCC were treated with RT (70 Gy/33 fractions) (±concurrent chemotherapy) were included. QUS Data acquisition involved scanning an index neck node with a clinical ultrasound device. Radiofrequency data were collected before starting RT, and after weeks 1, and 4. From this data, 31 spectral and related-texture features were determined for each time and delta (difference) features were computed. Patients were categorized into two groups based on clinical outcomes (recurrence or non-recurrence). Three machine learning classifiers were used for the development of a radiomics model. Features were selected using a forward sequential selection method and validated using leave-one-out cross-validation. RESULTS The median follow up for the entire group was 38 months (range 7-64 months). The disease sites involved neck masses in patients with oropharynx (39), larynx (5), carcinoma unknown primary (5), and hypopharynx carcinoma (2). Concurrent chemotherapy and cetuximab were used in 41 and 1 patient(s), respectively. Recurrence was seen in 17 patients. At week 1 of RT, the support vector machine classifier resulted in the best performance, with accuracy and area under the curve (AUC) of 80% and 0.75, respectively. The accuracy and AUC improved to 82% and 0.81, respectively, at week 4 of treatment. CONCLUSION QUS Delta-radiomics can predict higher risk of recurrence with reasonable accuracy in HNSCC.Clinical trial registration: clinicaltrials.gov.in identifier NCT03908684.
Collapse
Key Words
- AAC, Average acoustic concentration
- ACE, Attenuation co-efficient estimate
- ASD, Average scatterer diameter
- AUC, Area under the curve
- Acc, Accuracy
- CON, Contrast
- COR, Correlation
- CR, Complete responders
- CT, Computed tomography
- Delta-radiomics
- EBV, Epstein-Barr virus
- ENE, Energy
- FDG-PET, 18F-fluorodeoxyglucose positron emission tomography
- FLD, Fisher’s linear discriminant
- FN, False negative
- FP, False positive
- GLCM, Grey level co-occurrence matrix
- HN, Head and neck
- HNSCC, Head and neck squamous cell carcinoma
- HOM, Homogeneity
- HPV, Human papillomavirus
- Head and neck malignancy
- IGRT, Image-guided radiation therapy
- IMRT, Intensity-modulated radiation therapy
- MBF, Mid-band fit
- MRI, Magnetic resonance imaging
- Machine learning
- NR, Non-recurrence
- PET, Positron emission tomography
- PR, Partial responders
- QUS, Quantitative ultrasound
- Quantitative ultrasound
- R, Recurrence
- RF, Radiofrequency
- RFS, Recurrence-free survival
- ROI, Region of interest
- RT, Radiotherapy
- Radiomics
- Radiotherapy squamous cell carcinoma
- Recurrence
- SAS, Spacing among scatterers
- SI, Spectral intercept
- SP, Specificity
- SS, Spectral slope
- SVM, Support vector machine
- Sn, Sensitivity
- TN, True negative
- TP, True positive
- US, Ultrasound
- kNN, k nearest neighbors
Collapse
Affiliation(s)
- Kashuf Fatima
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Archya Dasgupta
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Daniel DiCenzo
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Karina Quiaoit
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Michael Sandhu
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Divya Bhardwaj
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | | | - Gregory J. Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Wheatley-Guy CM, Sajgalik P, Cierzan BS, Wentz RJ, Johnson BD. Validation of radiofrequency determined lung fluid using thoracic CT: Findings in acute decompensated heart failure patients. Int J Cardiol Heart Vasc 2020; 30:100645. [PMID: 33024812 PMCID: PMC7528183 DOI: 10.1016/j.ijcha.2020.100645] [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: 07/28/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
Background Noninvasive outpatient monitoring for heart failure (HF) has significant opportunity to reduce patient morbidity and the costs associated with recurrent hospitalization. The purpose of this study was to validate the ability of radiofrequency (RF) to assess lung fluid via a wearable patch device compared to thoracic CT in order to characterize volume overload. Methods 120 subjects were studied: 66 acute heart failure (AHF) inpatients and 54 subjects without AHF (Control – 44 healthy and 10 stable HF). All underwent supine thoracic CT scans and supine RF readings from the wearable patch device placed on the left mid-axillary line (age = 74 ± 16 vs. 57 ± 15 yrs.; female = 38 vs. 44%; BMI = 33.2 ± 9.0 vs. 27.3 ± 5.1, AHF vs. Control respectively). Reflected RF signals and subject-specific anthropometric data were used to calculate the RF-determined lung fluid content. CT Lung fluid was reported as percentage of lung volume. Classification analyses were used to compare RF and CT performance. Results AHF presented with higher lung fluid than controls by both CT and RF (CT: 20.1 ± 4.2% vs. 15.4 ± 2.4%; RF: 20.7 ± 5.6% vs. 15.6 ± 3.3%; p < 0.05 for all). The correlation between lung fluid measured by CT vs. RF was r = 0.7 (p < 0.001). RF determined lung fluid performed as well as CT in distinguishing AHF from control subjects: Sensitivity: 70% vs. 86%; Specificity: 82% vs. 83%; Positive Predictive Value: 82% vs. 86%; Negative Predictive Value: 69% vs. 83%, CT vs. RF respectively. Conclusions Noninvasive nonionizing RF determined lung fluid provides a potential alternative to other measures for diagnosing and monitoring pulmonary fluid overload.
Collapse
|
5
|
Abi-Saleh B, Skouri H, Cantillon DJ, Fowler J, Wazni O, Tchou P, Saliba W. Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter. J Arrhythm 2015; 31:359-63. [PMID: 26702315 PMCID: PMC4672076 DOI: 10.1016/j.joa.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 12/03/2022] Open
Abstract
Background Left atrial flutter following atrial fibrillation (AF) ablation is increasingly common and difficult to treat. We evaluated the safety and efficacy of ablation of the anteroseptal line connecting the right superior pulmonary vein (RSPV) to the anteroseptal mitral annulus (MA) for the treatment of perimitral flutter (PMF). Methods We systematically studied patients who were previously treated with AF ablation and who presented to the electrophysiology laboratory with atrial tachyarrhythmias between January 2000 and July 2010. The diagnosis of PMF was confirmed by activation mapping and/or entrainment. After re-isolation of any recovered pulmonary vein, a linear radiofrequency (RF) ablation was performed on the line that connected the RSPV to the anteroseptal MA. In this analysis, we included only patients who were treated with an anteroseptal line for their PMF. Results Ablation was performed at the anteroseptal line in 27 PMF patients (63±13 years; 9 women) who had undergone prior ablation for paroxysmal (n=3) or persistent (n=24) AF, using electroanatomic activation mapping (70% CARTO, 30% NavX). The anteroseptal ablation line was effective in 22/27 (81.5%) patients in the acute-care setting. Termination of AF to sinus rhythm occurred in 15/22 (68.2%) patients, and 7/22 (31.8%) patients׳ AF converted to another right or left atrial flutter. At the 6-month follow-up, 20% of patients demonstrated recurrent left atrial tachyarrhythmia. Only one patient required repeat ablation, and the remaining patients׳ condition was controlled with antiarrhythmic medications. No major procedural complications or heart block occurred. Conclusion Ablation at the left atrial anteroseptal line is safe and efficacious for the treatment of PMF. Unlike ablation at the traditional mitral isthmus line, ablation at the left atrial anteroseptal line does not require ablation in the coronary sinus.
Collapse
Key Words
- AAD, Antiarrhythmic drug
- AF, Atrial fibrillation
- Ablation
- Atrial fibrillation
- CS, Coronary sinus
- CTI, Cavotricuspid isthmus
- ICE, Intracardiac echocardiography
- LA, Left atrium
- LAA, Left atrial appendage
- Left atrial anteroseptal line
- MA, Mitral annulus
- PMF, Perimitral flutter
- PVI, Pulmonary vein isolation
- Perimitral flutter
- RF, Radiofrequency
- RSVP, Right superior pulmonary vein
Collapse
Affiliation(s)
- Bernard Abi-Saleh
- Department of Internal Medicine (Cardiology Division/Cardiac Electrophysiology Section), American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Hadi Skouri
- Department of Internal Medicine (Cardiology Division/Cardiac Electrophysiology Section), American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Daniel J Cantillon
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffery Fowler
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama Wazni
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Tchou
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA
| | - Walid Saliba
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|