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El Khalfi R, Maupoint E, Chiavassa-Gandois H, Goumarre C, Filliole A, Lapègue F, Fabry V, Acket B, Laforet A, Sans N, Cintas P, Faruch-Bilfeld M. Assessment of whole-body muscle MRI for the early diagnosis of Amyotrophic Lateral Sclerosis. Eur J Radiol 2024; 176:111481. [PMID: 38703513 DOI: 10.1016/j.ejrad.2024.111481] [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: 12/14/2023] [Revised: 03/01/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To evaluate muscle signal abnormalities on whole-body muscle MRI with T2 and diffusion-weighted imaging in early ALS stages. METHODS 101 muscles were analyzed in newly diagnosed ALS patients and healthy controls on a whole-body MRI protocol including four-point T2-Dixon imaging and diffusion-weighted imaging (b0 and b800). Sensitivity and inter-observer agreement were assessed. RESULTS 15 patients (mean age, 64 +/- 12 [SD], 9 men) who met the Awaji-Shima criteria for definite, probable or possible ALS and 9 healthy controls were assessed (mean age, 53 +/- 13 [SD], 2 men). 61 % of the muscles assessed in ALS patients (62/101) showed signal hyperintensities on T2-weighted imaging, mainly in the upper and lower extremities (legs, hands and feet). ALS patients had a significantly higher number of involved muscles compared to healthy controls (p = 0,006). Diffusion-weighted imaging allowed for the detection of additional involvement in 22 muscles, thus improving the sensitivity of whole-body MRI from 60 % (using T2-weighted imaging only) up to 80 % (with the combination of T2-weighted and diffusion-weighted imaging). CONCLUSIONS ALS patients exhibited significant muscle signal abnormalities on T2-weighted and diffusion-weighted imaging in early disease stages. Whole-body MRI could be used for pre-EMG mapping of muscle involvement in order to choose suitable targets, thus improving early diagnosis.
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Affiliation(s)
- Rokia El Khalfi
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
| | - Estelle Maupoint
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Hélène Chiavassa-Gandois
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Céline Goumarre
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Antoine Filliole
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Franck Lapègue
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Vincent Fabry
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Blandine Acket
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Anne Laforet
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Nicolas Sans
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Pascal Cintas
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Marie Faruch-Bilfeld
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
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Aggarwal P, Anwariya A, Kavanal AJ, Sood A, Jena SR, Mittal BR. Hot Embolus Artifact Mimicking Disease Progression in Post-therapy 177Lu-DOTATATE Scan: Incremental Value of SPECT/CT. Nucl Med Mol Imaging 2023; 57:159-161. [PMID: 37187952 PMCID: PMC10172421 DOI: 10.1007/s13139-023-00789-3] [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: 01/07/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/20/2023] Open
Abstract
Peptide receptor radionuclide therapy (PRRT) has become an established treatment for patients with inoperable and/or metastatic, well-differentiated neuroendocrine tumors with overexpression of somatostatin receptor type 2 (SSTR-2). The post-therapy 177Lu-DOTATATE whole-body scan not only assesses the biodistribution of the lesions seen on pre-therapy 68 Ga-SSTR PET/CT scan but also provides a quick assessment of disease status and dosimetry during treatment. Like any other radionuclide scan, the whole-body 177Lu-DOTATATE scan may also show abnormal radiotracer uptake, which may require further imaging to establish its exact etiology. Though radiotracer emboli mimicking focal pulmonary lesions have been described with 18F-FDG and 68 Ga-DOTANOC PET/CT scans, similar artifacts with post-therapy 177Lu-DOTATATE scans have not been described. Herein, we report two cases of hot emboli in the post-therapy 177Lu-DOTATATE scans.
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Affiliation(s)
- Piyush Aggarwal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Anupriya Anwariya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Anwin Joseph Kavanal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Santosh Ranjan Jena
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Abstract
The idea of the global balance of spine stems from Jean Dubousset, who first introduced the concept of cone of economy. Through the compensatory mechanisms, the human body maintains an upright posture and horizontal gaze in the setting of the spinal malalignment. Compensation takes place not only in the mobile spine segments, but also in the pelvis and lower extremities. Patients with a malalignment exhibit compensatory changes in the cervical hyper-lordosis, posterior pelvic shift, knee/ankle flexion, hip extension, and the pelvic retroversion. The advent of whole-body stereo radiography has yielded an improved understanding of global changes among the patients. Deformity-induced compensatory changes in the sagittal alignment could be resolved reciprocally after the surgical correction of the malalignment. Thoracolumbar realignment surgery restores the pathologic compensatory changes in the unfused spinal segments, pelvis, and the lower extremities. Similarly, reciprocal changes in the thoracolumbar spine may harmonize global sagittal alignment after the cervical reconstruction. This study reviews the compensatory mechanisms and reciprocal changes in global sagittal alignment caused by the surgical correction and highlights, the factors that should be considered while assessing a patient's compensatory status.
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Affiliation(s)
- Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Bhaludin BN, Tunariu N, Koh DM, Messiou C, Okines AF, McGrath SE, Ring AE, Parton MM, Sharma B, Gagliardi T, Allen SD, Pope R, Johnston SRD, Downey K. A review on the added value of whole-body MRI in metastatic lobular breast cancer. Eur Radiol 2022; 32:6514-6525. [PMID: 35384456 DOI: 10.1007/s00330-022-08714-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/04/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/01/2022]
Abstract
Invasive lobular breast carcinomas (ILC) account for approximately 15% of breast cancer diagnoses. They can be difficult to diagnose both clinically and radiologically, due to their infiltrative growth pattern. The pattern of metastasis of ILC is unusual, with spread to the serosal surfaces (pleura and peritoneum), retroperitoneum and gastrointestinal (GI)/genitourinary (GU) tracts and a higher rate of leptomeningeal spread than IDC. Routine staging and response assessment with computed tomography (CT) can be undertaken quickly and measurements can be reproduced easily, but this is challenging with metastatic ILC as bone-only/bone-predominant patterns are frequently seen and assessment of the disease status is limited in these scenarios. Functional imaging such as whole-body MRI (WBMRI) allows the assessment of bone and soft tissue disease by providing functional information related to differences in cellular density between malignant and benign tissues. A number of recent studies have shown that WBMRI can detect additional sites of disease in metastatic breast cancer (MBC), resulting in a change in systemic anti-cancer therapy. Although WBMRI and fluorodeoxyglucose-positron-emission tomography-computed tomography (FDG-PET/CT) have a comparable performance in the assessment of MBC, WBMRI can be particularly valuable as a proportion of ILC are non-FDG-avid, resulting in the underestimation of the disease extent. In this review, we explore the added value of WBMRI in the evaluation of metastatic ILC and compare it with other imaging modalities such as CT and FDG-PET/CT. We also discuss the spectrum of WBMRI findings of the different metastatic sites of ILC with CT and FDG-PET/CT correlation. KEY POINTS: • ILC has an unusual pattern of spread compared to IDC, with metastases to the peritoneum, retroperitoneum and GI and GU tracts, but the bones and liver are the commonest sites. • WBMRI allows functional assessment of metastatic disease, particularly in bone-only and bone-predominant metastatic cancers such as ILC where evaluation with CT can be challenging and limited. • WBMRI can detect more sites of disease compared with CT, can reveal disease progression earlier and provides the opportunity to change ineffective systemic treatment sooner.
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Affiliation(s)
- Basrull N Bhaludin
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK.
| | - Nina Tunariu
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Alicia F Okines
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Sophie E McGrath
- Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK
| | - Alistair E Ring
- Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK
| | - Marina M Parton
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Bhupinder Sharma
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Tanja Gagliardi
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Steven D Allen
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Romney Pope
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Stephen R D Johnston
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Kate Downey
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
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Heo YM, Kim TK, Jang MG, Choi JK. Sagittal Parameters of Spine and Pelvis in Young Adults Using the EOS Imaging System: Prospective Study of 92 Asymptomatic Subjects. Asian Spine J 2022; 16:732-739. [PMID: 35184522 DOI: 10.31616/asj.2021.0111] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design This study adopted a prospective study design to evaluate the sagittal parameters of the spine and pelvis in young adults using the EOS imaging system. Purpose This study was designed to analyze spinopelvic sagittal alignment measurement values obtained using the EOS imaging system in asymptomatic young adults. Overview of Literature Sagittal alignment of the spine and pelvis is important in diagnosing and treating spinal diseases. We usually take sagittal images using whole-spine standing lateral radiography. Recently, the EOS imaging system, which uses a low-dose radiation in a weight-bearing state, was developed. So, we studied the sagittal parameters of the spine and pelvis in young adults by using the EOS imaging system. Methods We recruited young adults aged 20-30 years and explained the EOS imaging system. They voluntarily participated in the study. We took full-body standing orthogonal anteroposterior and lateral images using the EOS imaging system (EOS imaging, Paris, France). Then, we measured the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), T1/T12 kyphosis, and L1/S1 lordosis. We analyzed each parameter using Student t-test, paired t-test, and Pearson's correlation coefficient. Results Ninety-two patients were enrolled in the study. The average PI and SS were 47.18° and 36.03°, respectively. Moreover, PT and SVA were 11.17° and -10.15 mm, respectively. T1/T12 kyphosis was 37.37°, while L1/S1 lordosis was 46.64°. All parameters were enough for normal distribution. Pearson correlation coefficient analysis showed a meaningful correlation between PI and SS and PI and PT (R>0.6, p<0.05). Conclusions Measuring spinal and pelvic sagittal values is important. Sagittal parameters could help decide how to operate patients with spinal diseases. We attempted to obtain sagittal values using the EOS imaging system. These parameters could help preoperatively estimate the lumbar lordosis restoration and could also be used as guidelines for spinopelvic sagittal balance.
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Affiliation(s)
- Youn Moo Heo
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea.,Konyang University Myunggok Research Institute for Medical Scienece, Konyang University College of Medicine, Daejeon, Korea
| | - Tae Kyun Kim
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea.,Konyang University Myunggok Research Institute for Medical Scienece, Konyang University College of Medicine, Daejeon, Korea
| | - Min Gu Jang
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea.,Konyang University Myunggok Research Institute for Medical Scienece, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Kyu Choi
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea.,Konyang University Myunggok Research Institute for Medical Scienece, Konyang University College of Medicine, Daejeon, Korea
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Sachpekidis C, Goldschmidt H, Dimitrakopoulou-Strauss A. [Positron emission tomography/computed tomography (PET/CT) in multiple myeloma]. Radiologe 2021; 62:20-29. [PMID: 34921323 DOI: 10.1007/s00117-021-00948-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Imaging plays a pivotal role in the management of multiple myeloma (MM). Besides morphological imaging methods, such as whole-body X‑ray, computed tomography (CT) and magnetic resonance imaging (MRI), the hybrid modality positron emission tomography/CT (PET/CT) using the glucose analogue 18F‑fluorodeoxyglucose (18F‑FDG) as radiotracer is increasingly used. OBJECTIVES Aim of this review article is to outline the major applications of PET/CT in the diagnosis and management of MM, and to provide hints on the reading and interpretation. MATERIALS AND METHODS Background knowledge and guideline recommendations on imaging of MM are outlined and complemented by recent study results. RESULTS Although 18F‑FDG PET/CT is not currently considered a standard method for the diagnosis of MM, it is a very powerful diagnostic tool for the detection of medullary and extramedullary disease, a reliable predictor of survival and the most robust modality for treatment response evaluation. Moreover, it plays a significant role in minimal residual disease (MRD) assessment. On the other hand, practical considerations on local availability and costs limit the widespread use of PET/CT. In addition, false-negative and the seldom false-positive results and the heterogeneity of MM presentation inevitably make interpretation of PET/CT images challenging. CONCLUSIONS PET/CT has a high value in the diagnosis, prognosis, and assessment of treatment response in patients with MM. Therefore, the role of the modality in the management of the disease is expected to increase in the near future.
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Affiliation(s)
- Christos Sachpekidis
- Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Deutschland.
| | - Hartmut Goldschmidt
- Sektion Multiples Myelom, Klinik für Hämatologie, Onkologie, Rheumatologie Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland
| | - Antonia Dimitrakopoulou-Strauss
- Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Deutschland
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Abstract
CLINICAL/METHODOLOGICAL ISSUE Lymphoma is the third most common neoplasm in children. Detection, accurate staging, and restaging are important for all radiologists involved in the diagnosis of children. STANDARD RADIOLOGICAL METHODS Magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT), CT, ultrasound, X‑ray. METHODOLOGICAL INNOVATIONS Whole-body imaging (MRI and PET-MRI or PET-CT) play a key role in diagnostics and for therapy selection in Hodgkin lymphoma. PERFORMANCE In particular, hybrid imaging using 18F‑FDG PET is proving to be a powerful method for staging and restaging. ACHIEVEMENTS Standardization of imaging and inclusion in therapy studies (e.g. within the framework of the EuroNet-PHL-C2 study) improves diagnostics and simultaneously reduces therapy-related side effects. PRACTICAL RECOMMENDATIONS In Hodgkin lymphoma, deviations from the prescribed diagnostic procedure should be avoided. In clinically very heterogeneous non-Hodgkin lymphoma (NHL), on the other hand, the diagnostic procedure should be adapted to the actual clinical condition of the child. The role of interim PET in NHL is currently still the subject of clinical discussion.
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Yoshida S, Takahara T, Arita Y, Toda K, Yamada I, Tanaka H, Yokoyama M, Matsuoka Y, Yoshimura R, Fujii Y. Genuine- and induced-oligometastatic castration-resistant prostate cancer: clinical features and clinical outcomes after progressive site-directed therapy. Int Urol Nephrol 2021; 53:1119-1125. [PMID: 33452956 DOI: 10.1007/s11255-020-02762-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/03/2020] [Accepted: 12/15/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the clinical characteristics of genuine- and induced-oligometastatic castration-resistant prostate cancer (OM-CRPC) and assess the therapeutic effect of progressive-site directed therapy (PSDT). METHODS We performed a retrospective analysis of 45 patients with OM-CRPC. Whole-body diffusion-weighted MRI (WB-DWI) was used to diagnose oligo-progressive disease. Based on the clinical and radiological findings, the OM-CRPCs were classified as genuine or induced. PSDT was performed with the intent to ablate all the progressive sites detected on WB-DWI with radiotherapy. Systemic therapy remained unchanged during and after PSDT. RESULTS A total of 31 (69%) and 14 (31%) patients were diagnosed with genuine- and induced-OM-CRPC, respectively. The genuine-OM-CRPC group had significantly fewer patients treated with taxane-based chemotherapy and new hormonal drugs than the induced-OM-CRPC group. Of these, 26 OM-CRPC patients were treated with PSDT, and a 50% PSA decline was observed in 14 (93%) of 15 patients with genuine-OM-CRPC and 4 (36%) of 11 patients with induced-OM-CRPC (P = 0.033). Further, the duration of PSA-progression-free survival was significantly longer in the genuine-OM-CRPC group than in the induced-OM-CRPC group (8.7 vs. 5.8 months, P = 0.040). CONCLUSIONS PSDT can be a promising treatment option for genuine-OM-CRPC. The procedure might also be considered effective for induced-OM-CRPC, although there was less therapeutic benefit of PSDT in patients with induced-OM-CRPC than in patients with genuine-OM-CRPC.
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Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Taro Takahara
- Department of Biomedical Engineering, Tokai University School of Engineering, Kanagawa, 259-1292, Japan
- Department of Radiology, Advanced Imaging Center Yaesu Clinic, Tokyo, 113-0027, Japan
| | - Yuki Arita
- Departments of Diagnostic Radiology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Kazuma Toda
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Ichiro Yamada
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Schlett CL, Rospleszcz S, Korbmacher D, Lorbeer R, Auweter S, Hetterich H, Selder S, Heier M, Linkohr B, Weckbach S, Ertl-Wagner B, Peters A, Bamberg F. Incidental findings in whole-body MR imaging of a population-based cohort study: Frequency, management and psychosocial consequences. Eur J Radiol 2020; 134:109451. [PMID: 33279799 DOI: 10.1016/j.ejrad.2020.109451] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Management of incidental findings (IF) remains controversial but highly relevant. Our aim was to assess the frequency, management and psychosocial consequences of IF reporting in a population-based cohort study undergoing whole-body MR imaging. METHODS The study was nested in a prospective cohort from a longitudinal, population-based cohort (KORA-FF4) in southern Germany. All MR obtained on 3 T MR scanner were reviewed by board-certified radiologists regarding clinically relevant IF. A baseline and follow-up questionnaires including PHQ-9 were completed prior to and 6-month after to the scan. RESULTS Of 400 participants (56.3 ± 9.2years, 58 % male) undergoing whole-body MR, IF were found in 22 % of participants (n = 89); most frequently located in the abdominal sequences. In the pre-scan survey, most participants stated as the motivation that they wanted to "contribute to a scientific purpose" (91 %), while "knowing whether I'm healthy" was the most frequent motivation reported 6 months post-scan (88 %). The desire for IF reporting increased over time (pre- vs. 6-months-post-scan), also for clinically less important IF (72 % vs. 84 %, p = 0.001). Regarding psychosocial impact, a small portion (3.4 %) reported that awaiting the IF report added "definitely" or "very probably" additional stress burden. Of participants with reported IF, 56.8 % classified the results as "very helpful". In the post-scan survey moderate depression was observed in 3.3 % and severe depression in 1.2 %. This did not differ between participants with and without reported IF. CONCLUSION In a cohort with whole-body MR imaging, the prevalence of IF was high. Participants considered reporting of IF highly important and added only minor psychological burden.
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Affiliation(s)
- Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dorina Korbmacher
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sigrid Auweter
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Holger Hetterich
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sonja Selder
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Sabine Weckbach
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Birgit Ertl-Wagner
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Preez HD, Lasker I, Rajakulasingam R, Saifuddin A. Whole-body magnetic resonance imaging: Incidental findings in paediatric and adult populations. Eur J Radiol 2020; 130:109156. [PMID: 32645680 DOI: 10.1016/j.ejrad.2020.109156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/31/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the prevalence and characterise the significance of incidental findings on whole-body MRI in paediatric and adult populations. METHODS A retrospective, single-institution study over a period of 8 years. The study population comprised 325 paediatric (0-18 yrs) patients and 148 adults (19-40 yrs) referred to a specialist musculoskeletal oncology centre, who underwent whole-body MRI for a range of pathological indications. Incidental findings were recorded according to pathology (musculoskeletal or non-musculoskeletal), site and clinical relevance. RESULTS Eighty-seven of 325 (26.8 %) paediatric patients and 51 of 148 (35.8 %) adults had incidental findings detected on whole-body MRI. The most common site was the musculoskeletal system, and within this location the lower limbs. Eighty-nine percent of incidental findings in paediatric patients and 79 % of incidental findings in adults were classified as being of either minor or no clinical significance. CONCLUSION Incidental findings are common in paediatric and adult patients undergoing whole-body MRI, and are most frequently found in the lower limbs. The overwhelming majority are of minor clinical significance.
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Buus TW, Sivesgaard K, Jensen AB, Pedersen EM. Simultaneous multislice diffusion-weighted imaging with short tau inversion recovery fat suppression in bone-metastasizing breast cancer. Eur J Radiol 2020; 130:109142. [PMID: 32619754 DOI: 10.1016/j.ejrad.2020.109142] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/02/2020] [Accepted: 06/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare image quality and ADC values of simultaneous multislice diffusion-weighted imaging (mb-DWI) with that of conventional DWI (c-DWI) using short tau inversion recovery fat saturation (STIR) in women with bone-metastasizing breast cancer. METHOD c-DWI and mb-DWI were acquired at 1.5 T in 23 breast cancer patients from skull base to mid thighs. mb-DWI was compared to c-DWI in terms of subjective image quality, artefacts and bone metastasis lesion conspicuity assessed on a 5-point Likert scale. ADC values of different organs as well as bone metastasis ADC values were compared between c-DWI and mb-DWI. RESULTS mb-DWI reduced scan time by 48 % compared with c-DWI (1 min 58 s vs. 3 min 45 s per station). mb-DWI provided similar subjective image quality (3.8 vs. 3.7, p = 0.70), number of artefacts (50 vs. 56), severity of these (4.6 vs. 4.7, p = 0.11), and lesion conspicuity (4.2 vs. 4.4, p = 0.31) compared to c-DWI. mb-DWI showed lower mean ADC values in liver (0.5 × 10-3 mm2/s vs. 0.7 × 10-3 mm2/s, p = 0.002) and erector spine muscle (1.3 × 10-3 mm2/s vs. 1.5 × 10-3 mm2/s, p < 0.001). Bone metastasis ADC values from mb-DWI were 6.4 % lower than c-DWI (95 % confidence interval: 5.4%-7.4%, p < 0.001). CONCLUSIONS mb-DWI provides similar subjective image quality to c-DWI with the same level of artefacts. Although bone metastasis ADC values were lower, mb-DWI can substantially reduce scan times of whole-body DWI in women with bone-metastasizing breast cancer.
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Affiliation(s)
- Thomas Winther Buus
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Anders Bonde Jensen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Erik Morre Pedersen
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Treskes K, Russchen MJAM, Beenen LFM, de Jong VM, Kolkman S, de Bruin IGJM, Dijkgraaf MGW, Van Lieshout EMM, Saltzherr TP, Goslings JC. Early detection of severe injuries after major trauma by immediate total-body CT scouts. Injury 2020; 51:15-19. [PMID: 31493846 DOI: 10.1016/j.injury.2019.08.040] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Evaluation of immediate total-body CT (iTBCT) scouts during primary trauma care could be clinically relevant for early detection and treatment of specific major injuries. The aim of this study was to determine the diagnostic usefulness of TBCT scouts in detecting life-threatening chest and pelvic injuries. METHODS All patients who underwent an iTBCT during their primary trauma assessment in one trauma center between April 2011 and November 2014 were retrospectively included. Two experienced trauma surgeons and two emergency radiologists evaluated iTBCT scouts with structured questionnaires. Inter-observer agreement and diagnostic properties were calculated for endotracheal tube position and identification of pneumo- and/or hemothorax and pelvic fractures. Diagnostic properties of iTBCT scouts for indication for chest tube placement and pelvic binder application were calculated in comparison to decision based on iTBCT. RESULTS In total 220 patients with a median age of 37 years (IQR 26-59) were selected with a median Injury Severity Score of 18 (IQR 9-27). There was moderate to substantial inter-observer agreement and low false positive rates for pneumo- and/or hemothorax and for severe pelvic fractures by iTBCT scouts. For 19.8%-22.5% of the endotracheal intubated patients trauma surgeons stated that repositioning of the tube was indicated. Positive predictive value and sensitivity were respectively 100% (95%CI 52%-100%) and 50% (95%CI 22%-78%) for decisions on chest tube placement by trauma surgeon 1 and 67% (95%CI 13%-98%) and 22% (95%CI 4%-60%) for decisions by trauma surgeon 2. Only in one of 14 patients the pelvic binder was applied after iTBCT acquisition. CONCLUSIONS iTBCT scouts can be useful for early detection of pneumo- and/or hemothorax and severe pelvic fractures. Decision for chest tube placement based on iTBCT scouts alone is not recommended.
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Affiliation(s)
- K Treskes
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - M J A M Russchen
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - L F M Beenen
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - V M de Jong
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - S Kolkman
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - I G J M de Bruin
- Trauma Unit, Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - M G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - E M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - T P Saltzherr
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, Den Haag, the Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
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Lind L, Strand R, Michaelsson K, Kullberg J, Ahlström H. Relationship between endothelium-dependent vasodilation and fat distribution using the new "imiomics" image analysis technique. Nutr Metab Cardiovasc Dis 2019; 29:1077-1086. [PMID: 31377180 DOI: 10.1016/j.numecd.2019.06.017] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/09/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We investigated how vasoreactivity in the brachial artery and the forearm resistance vessels were related to fat distribution and tissue volume, using both traditional imaging analysis and a new technique, called "Imiomics", whereby vasoreactivity was related to each of the >2M 3D image elements included in the whole-body magnetic resonance imaging (MRI). METHODS AND RESULTS In 326 subjects in the Prospective investigation of Obesity, Energy and Metabolism (POEM) study (all aged 50 years), endothelium-dependent vasodilation was measured by acetylcholine infusion in the brachial artery (EDV) and flow-mediated vasodilation (FMD). Fat distribution was evaluated by dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). EDV, but not FMD, was significantly related to total fat mass, liver fat, subcutaneous (SAT) and visceral (VAT) adipose tissue in a negative fashion in women, but not in men. Using Imiomics, an inverse relationship was seen between EDV and a local tissue volume of SAT in both the upper part of the body, as well as the gluteo-femoral part and the medial parts of the legs in women. Also the size of the liver, heart and VAT was inversely related to EDV. In men, less pronounced relationships were seen. FMD was also significantly related to local tissue volume of upper-body SAT and liver fat in women, but less so in men. CONCLUSION EDV, and to a lesser degree also FMD, were related to liver fat, SAT and VAT in women, but less so in men. Imiomics both confirmed findings from traditional methods and resulted in new, more detailed results.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Robin Strand
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Karl Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joel Kullberg
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Antaros Medical AB, BioVenture Hub, Mölndal, Sweden
| | - Håkan Ahlström
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Antaros Medical AB, BioVenture Hub, Mölndal, Sweden.
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Millor M, Bartolomé P, Pons MJ, Bastarrika G, Beloqui Ó, Cano D, González I, Vivas I. Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients. Radiol Med 2019; 124:1199-211. [PMID: 31407223 DOI: 10.1007/s11547-019-01068-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.
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Abstract
BACKGROUND Extranodal manifestations occur in up to 40% of non-Hodgkin lymphomas. The prevalence of extranodal involvement has increased. OBJECTIVES A comprehensive overview on lymphoma involvement in the parenchymatous abdominal organs, the gastrointestinal tract, and the peritoneal cavity under due consideration of clinical implications is given. MATERIALS AND METHODS A selective literature search with analysis of dedicated original research articles and reviews was carried out. Clinical guidelines are discussed. RESULTS Extranodal abdominal lymphoma involvement usually occurs secondarily in advanced disease. Sites involved most frequently are the liver and the gastrointestinal tract. Extranodal abdominal lymphoma involvement is more common in the immunocompromised patient. CONCLUSION Imaging findings of extranodal abdominal lymphoma are variable. Lymphoma is an important differential diagnosis to be considered in unclear tumor diseases.
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Affiliation(s)
- T F Weber
- Radiologische Klinik, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - S Dietrich
- Medizinische Klinik, Abteilung Innere Medizin V, Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - J Nattenmüller
- Radiologische Klinik, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
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Derlin T. [Positron emission tomography/computed tomography in rheumatology]. Z Rheumatol 2017; 76:566-73. [PMID: 28664283 DOI: 10.1007/s00393-017-0345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Combined positron emission tomography/computed tomography (PET/CT) is a whole-body imaging procedure, which enables sensitive detection of inflammatory changes. It may be used to simultaneously obtain both precise anatomical and molecular information in order to comprehensively characterize diseases. The glucose analogue 18F-fluorodeoxyglucose (FDG) represents a universally applicable radiotracer for imaging of inflammatory processes. Its accumulation in tissues can be semiquantitatively characterized by use of standardized uptake values (SUV). In principle, a broad spectrum of infectious and non-infectious inflammatory and malignant diseases can be imaged. 18F-FDG PET/CT has become a valuable modality and is increasingly being used for evaluation of large vessel vasculitis and for evaluation of elevated systemic inflammatory markers without known cause. Beside the radiotracer 18F-FDG, other radiopharmaceuticals enable a non-invasive analysis of additional parameters of inflammatory disorders, such as other metabolic pathways or the expression of surface receptors.
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Kim SB, Heo YM, Hwang CM, Kim TG, Hong JY, Won YG, Ham CU, Min YK, Yi JW. Reliability of the EOS Imaging System for Assessment of the Spinal and Pelvic Alignment in the Sagittal Plane. Clin Orthop Surg 2018; 10:500-507. [PMID: 30505420 PMCID: PMC6250964 DOI: 10.4055/cios.2018.10.4.500] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/04/2018] [Indexed: 11/06/2022] Open
Abstract
Background The sagittal alignment of the spine and pelvis is not only closely related to the overall posture of the body but also to the evaluation and treatment of spine disease. In the last few years, the EOS imaging system, a new low-dose radiation X-ray device, became available for sagittal alignment assessment. However, there has been little research on the reliability of EOS. The purpose of this study was to evaluate the intrarater and interrater reliability of EOS for the sagittal alignment assessment of the spine and pelvis. Methods Records of 46 patients were selected from the EOS recording system between November 2016 and April 2017. The exclusion criteria were congenital spinal anomaly and deformity, and previous history of spine and pelvis operation. Sagittal parameters of the spine and pelvis were measured by three examiners three times each using both manual and EOS methods. Means comparison t-test, Pearson bivariate correlation analysis, and reliability analysis by intraclass correlation coefficients (ICCs) for intrarater and interrater reliability were performed using R package "irr." Results We found excellent intrarater and interrater reliability of EOS measurements. For intrarater reliability, the ICC ranged from 0.898 to 0.982. For interrater reliability, the ICC ranged from 0.794 to 0.837. We used a paired t-test to compare the values measured by manual and EOS methods: there was no statistically significant difference between the two methods. Correlation analysis also showed a statistically significant positive correlation. Conclusions EOS showed excellent reliability for assessment of the sagittal alignment of the spine and pelvis.
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Affiliation(s)
- Sang Bum Kim
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Cheol Mog Hwang
- Department of Radiology, Konyang University Hospital, Daejeon, Korea
| | - Tae Gyun Kim
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Jee Young Hong
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - You Gun Won
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Chang Uk Ham
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Young Ki Min
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Jin Woong Yi
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea
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Larbi A, Omoumi P, Pasoglou V, Michoux N, Triqueneaux P, Tombal B, Cyteval C, Lecouvet FE. Whole-body MRI to assess bone involvement in prostate cancer and multiple myeloma: comparison of the diagnostic accuracies of the T1, short tau inversion recovery (STIR), and high b-values diffusion-weighted imaging (DWI) sequences. Eur Radiol 2018; 29:4503-4513. [PMID: 30413957 DOI: 10.1007/s00330-018-5796-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 07/10/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare the diagnostic accuracy of whole-body T1, short tau inversion recovery (STIR), high b-value diffusion-weighted imaging (DWI), and sequence combinations to detect bone involvement in prostate cancer (PCa) and multiple myeloma (MM) patients. MATERIALS AND METHODS We included 50 consecutive patients with PCa at high risk for metastasis and 47 consecutive patients with a histologically confirmed diagnosis of MM who received whole-body MRI at two institutions from January to December 2015. Coronal T1, STIR, and reconstructed coronal high b-values DWI were obtained for all patients. Two musculoskeletal radiologists read individual sequences, pairs of sequences (T1-DWI, T1-STIR, and STIR-DWI), and all combined (T1-STIR-DWI) to detect bone involvement. Receiver operating characteristic curve analysis was used to assess diagnostic performance according to a "best valuable comparator" combining baseline and 6-month imaging and clinical and biological data. Interobserver agreement was calculated. RESULTS Interobserver agreement for individual and combined MRI sequences was very good in the PCa group and ranged from good to very good in the MM group (0.76-1.00). In PCa patients, T1-DWI, T1-STIR, and T1-STIR-DWI showed the highest performance (sensitivity = 100% [95% CI = 90.5-100%], specificity = 100% [75.3-100%]). In MM patients, the highest performance was achieved by T1-STIR-DWI (sensitivity = 100% [88.4-100%], specificity = 94.1% [71.3-100%]). T1-STIR-DWI significantly outperformed all sequences (p < 0.05) except T1-DWI (p = 0.49). CONCLUSION In PCa patients, a combination of either T1-DWI or T1-STIR sequences is not inferior to a combination of three sequences to detect bone metastases. In MM, T1-STIR-DWI and T1-DWI had the highest diagnostic performance for detecting bone involvement. KEY POINTS • The sequences used in Whole Body MRI studies to detect bone involvement in prostate cancer and myeloma were evaluated. • In prostate cancer, any pairwise combinations of T1, STIR, and DWI have high diagnostic value. • In myeloma, the combinations T1-STIR-DWI or T1-DWI sequences should be used.
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Affiliation(s)
- Ahmed Larbi
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | | | - Vassiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nicolas Michoux
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Perrine Triqueneaux
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Bertrand Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Catherine Cyteval
- Department of Radiology, Faculté de médecine de Montpellier/Nîmes, Hôpital Lapeyronie, Montpellier, France
| | - Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium.
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Tordjman M, Dabaj I, Laforet P, Felter A, Ferreiro A, Biyoukar M, Law-Ye B, Zanoteli E, Castiglioni C, Rendu J, Beroud C, Chamouni A, Richard P, Mompoint D, Quijano-Roy S, Carlier RY. Muscular MRI-based algorithm to differentiate inherited myopathies presenting with spinal rigidity. Eur Radiol 2018; 28:5293-5303. [PMID: 29802573 DOI: 10.1007/s00330-018-5472-5] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/01/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Inherited myopathies are major causes of muscle atrophy and are often characterized by rigid spine syndrome, a clinical feature designating patients with early spinal contractures. We aim to present a decision algorithm based on muscular whole body magnetic resonance imaging (mWB-MRI) as a unique tool to orientate the diagnosis of each inherited myopathy long before the genetically confirmed diagnosis. METHODS This multicentre retrospective study enrolled 79 patients from referral centres in France, Brazil and Chile. The patients underwent 1.5-T or 3-T mWB-MRI. The protocol comprised STIR and T1 sequences in axial and coronal planes, from head to toe. All images were analyzed manually by multiple raters. Fatty muscle replacement was evaluated on mWB-MRI using both the Mercuri scale and statistical comparison based on the percentage of affected muscle. RESULTS Between February 2005 and December 2015, 76 patients with genetically confirmed inherited myopathy were included. They were affected by Pompe disease or harbored mutations in RYR1, Collagen VI, LMNA, SEPN1, LAMA2 and MYH7 genes. Each myopathy had a specific pattern of affected muscles recognizable on mWB-MRI. This allowed us to create a novel decision algorithm for patients with rigid spine syndrome by segregating these signs. This algorithm was validated by five external evaluators on a cohort of seven patients with a diagnostic accuracy of 94.3% compared with the genetic diagnosis. CONCLUSION We provide a novel decision algorithm based on muscle fat replacement graded on mWB-MRI that allows diagnosis and differentiation of inherited myopathies presenting with spinal rigidity. KEY POINTS • Inherited myopathies are rare, diagnosis is challenging and genetic tests require specialized centres and often take years. • Inherited myopathies are often characterized by spinal rigidity. • Whole body magnetic resonance imaging is a unique tool to orientate the diagnosis of each inherited myopathy presenting with spinal rigidity. • Each inherited myopathy in this study has a specific pattern of affected muscles that orientate diagnosis. • A novel MRI-based algorithm, usable by every radiologist, can help the early diagnosis of these myopathies.
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Affiliation(s)
- Mickael Tordjman
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France.
| | - Ivana Dabaj
- Pôle Pédiatrie, Hôpital Raymond Poincaré, Garches, France - Centre de Référence Maladies Neuromusculaires GNMH, FILNEMUS, Garches, France
| | - Pascal Laforet
- Département de Neurologie, Unité Clinique de Pathologie Neuromusculaire, Institut de Myologie, CHU La Pitié Salpêtrière, APHP, Paris, France
| | - Adrien Felter
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
| | - Ana Ferreiro
- Service de Génétique, Hôpital Raymond Poincaré, APHP, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
| | - Moustafa Biyoukar
- Unité de Recherche Clinique, Hôpital Saint-Antoine, APHP, Paris, Hôpitaux Universitaires Est Parisien, Garches, France
| | - Bruno Law-Ye
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
| | - Edmar Zanoteli
- Department of Neurology, Medical School of the University of São Paulo, São Paulo, Brazil
| | - Claudia Castiglioni
- Neuromuscular and Motor Disorders Program Clinica Las Condes, Pediatric Neurology, Santiago, Chile
| | - John Rendu
- Département de Biochimie, Toxicologie, Pharmacologie et Génétique Moléculaire, CHU Grenoble Alpes, Grenoble, France
| | - Christophe Beroud
- Département de Génétique Médicale, AP-HM, Hôpital Timone Enfants, Marseille, France
| | | | - Pascale Richard
- UF de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, Centre de Génétique Moléculaire et Chromosomique, CHU La Pitié Salpêtrière, APHP, Paris, France
| | - Dominique Mompoint
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
| | - Susana Quijano-Roy
- Pôle Pédiatrie, Hôpital Raymond Poincaré, Garches, France - Centre de Référence Maladies Neuromusculaires GNMH, FILNEMUS, Garches, France
| | - Robert-Yves Carlier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
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Albano D, Patti C, Matranga D, Lagalla R, Midiri M, Galia M. Whole-body diffusion-weighted MR and FDG-PET/CT in Hodgkin Lymphoma: Predictive role before treatment and early assessment after two courses of ABVD. Eur J Radiol 2018; 103:90-98. [PMID: 29803392 DOI: 10.1016/j.ejrad.2018.04.014] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/03/2018] [Accepted: 04/10/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate whether imaging features of pathologic lymph nodes on whole-body diffusion-weighted MR have a predictive role before treatment and may assess the response after two courses of chemotherapy in comparison to FDG-PET/CT in Hodgkin Lymphoma. MATERIALS AND METHODS We reviewed the whole-body MR and FDG-PET/CT performed on 41 patients with Hodgkin Lymphoma before and after two Doxorubicin-Bleomycin-Vinblastine-Dacarbazine (ABVD). Responder and non-responder lesions were identified on interim-FDG-PET/CT performed after two ABVD. We used Multivariate Generalized Estimating Equations model to assess statistical association between being-responder and baseline-Maximum Standard Uptake Value (SUVmax), baseline and interim-Apparent Diffusion Coefficient (ADC) and size, ADC and size changes during chemotherapy, site of disease, bulky, and stage. RESULTS 10/41 (24%) patients were positive on interim-FDG-PET/CT. The interim-FDG-PET/CT positivity was associated with worse cumulative survival rate at 24 months in comparison to interim-FDG-PET/CT negativity (P < .05); 3/10 patients with positive interim-FDG-PET/CT and 1/31 with negative interim-FDG-PET/CT experienced disease progression. Baseline-SUVmax was 11.18 ± 5.58 (3.1-28.0) and baseline-ADC was 0.70 ± 0.14 × 10-3 mm2/s (0.39-0.98). There was a significant difference between responder and non-responder lesions based on interim-ADC (1.83 ± 0.34 × 10-3 mm2/s vs. 1.01 ± 0.27 × 10-3 mm2/s;p <.001), interim-size (3.1 cm2 vs. 9.4 cm2;p = .009), and bulky (8.2% vs. 66.7%;p = .002). There was no significant difference between responder and non-responder lesions based on baseline-SUVmax (p = .713), baseline-ADC (p = .253), ADC changes (p = .058), size changes (p = .085), site (p = .209), stage (p = .290), baseline-size (p = .064). CONCLUSIONS Interim-ADC is helpful for identifying non-responder lesions, while size changes are not useful. Baseline-SUVmax and ADC have no predictive role. Bulky is the most useful imaging parameter to predict suboptimal response to chemotherapy.
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Affiliation(s)
- Domenico Albano
- Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
| | - Caterina Patti
- Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello, Viale Trabucco 180, 90146 Palermo, Italy.
| | - Domenica Matranga
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127 Palermo, Italy.
| | - Roberto Lagalla
- Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
| | - Massimo Midiri
- Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
| | - Massimo Galia
- Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
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Winfield JM, Poillucci G, Blackledge MD, Collins DJ, Shah V, Tunariu N, Kaiser MF, Messiou C. Apparent diffusion coefficient of vertebral haemangiomas allows differentiation from malignant focal deposits in whole-body diffusion-weighted MRI. Eur Radiol 2018; 28:1687-1691. [PMID: 29134357 PMCID: PMC5834553 DOI: 10.1007/s00330-017-5079-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/25/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to identify apparent diffusion coefficient (ADC) values for typical haemangiomas in the spine and to compare them with active malignant focal deposits. METHODS This was a retrospective single-institution study. Whole-body magnetic resonance imaging (MRI) scans of 106 successive patients with active multiple myeloma, metastatic prostate or breast cancer were analysed. ADC values of typical vertebral haemangiomas and malignant focal deposits were recorded. RESULTS The ADC of haemangiomas (72 ROIs, median ADC 1,085×10-6mm2s-1, interquartile range 927-1,295×10-6mm2s-1) was significantly higher than the ADC of malignant focal deposits (97 ROIs, median ADC 682×10-6mm2s-1, interquartile range 583-781×10-6mm2s-1) with a p-value < 10-6. Receiver operating characteristic (ROC) analysis produced an area under the curve of 0.93. An ADC threshold of 872×10-6mm2s-1 separated haemangiomas from malignant focal deposits with a sensitivity of 84.7 % and specificity of 91.8 %. CONCLUSIONS ADC values of classical vertebral haemangiomas are significantly higher than malignant focal deposits. The high ADC of vertebral haemangiomas allows them to be distinguished visually and quantitatively from active sites of disease, which show restricted diffusion. KEY POINTS • Whole-body diffusion-weighted MRI is becoming widely used in myeloma and bone metastases. • ADC values of vertebral haemangiomas are significantly higher than malignant focal deposits. • High ADCs of haemangiomas allows them to be distinguished from active disease.
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Affiliation(s)
- Jessica M Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Gabriele Poillucci
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Matthew D Blackledge
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Vallari Shah
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Martin F Kaiser
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Department of Haematology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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Bolt C, O'Keeffe F, Finnegan P, Dickson K, Smit V, Fitzgerald MC, Mitra B. Straight leg elevation to rule out pelvic injury. Injury 2018; 49:279-83. [PMID: 29132904 DOI: 10.1016/j.injury.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/12/2017] [Accepted: 10/07/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury. METHODS We conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable. RESULTS Of the 328 participants, 35 had pelvic fractures, and of these 32 were either unable to straight leg raise, or had pain on doing so, with a sensitivity of 91.43% (95% CI: 76.94-98.2%) and a negative predictive value of 98.57% (95% CI: 95.88-99.70%). The 3 participants with a pelvic fracture who could straight leg raise with no pain, all had a GCS of less than 15, and therefore, among the sub-group of patients with GCS15, a 100% sensitivity and 100% negative predictive value for straight leg raise with no pain to rule out pelvic fracture was demonstrated. CONCLUSION Among awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients.
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Pothmann CEM, Sprengel K, Alkadhi H, Osterhoff G, Allemann F, Jentzsch T, Jukema G, Pape HC, Simmen HP, Neuhaus V. [Abdominal injuries in polytraumatized adults : Systematic review]. Unfallchirurg 2018; 121:159-173. [PMID: 29350250 DOI: 10.1007/s00113-017-0456-5] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal injuries are potentially life-threatening and occur in 20-25% of all polytraumatized patients. Blunt trauma is the main mechanism. The liver and spleen are most commonly injured and much less often the intestines. The clinical evaluation proves equivocal in many cases; therefore, the gold standard is computed tomography (CT), which has been increasingly used even in hemodynamically weakly stable or sometimes even unstable patients because it promptly provides precise diagnostic findings, which present the basis for successful therapy. Hemodynamically unstable patients always need an exploratory laparotomy (EL). An EL should also be carried out with a positive focused assessment with sonography for trauma (FAST) or CT for severe parenchymal lesions, hollow organ lesions, intraperitoneal bladder lesions, peritonitis and organ evisceration, impalement injuries and lesions of the abdominal fascia. Hemodynamically stable patients without signs of peritonitis and a lack of such findings can often be treated conservatively irrespective of the extent of an injury. Angiography (and if needed embolization) can additionally be diagnostically and therapeutically utilized.
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Affiliation(s)
- C E M Pothmann
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - K Sprengel
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - H Alkadhi
- Institut für Diagnostische und Interventionelle Radiologie, UniversitätsSpital Zürich, Zürich, Schweiz
| | - G Osterhoff
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - F Allemann
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - T Jentzsch
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - G Jukema
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - H C Pape
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - H-P Simmen
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.
| | - V Neuhaus
- Klinik für Traumatolgie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
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Galia M, Albano D, Tarella C, Patti C, Sconfienza LM, Mulè A, Alongi P, Midiri M, Lagalla R. Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now. Eur Radiol 2017; 28:1187-1193. [PMID: 29018927 DOI: 10.1007/s00330-017-5071-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/29/2017] [Revised: 07/26/2017] [Accepted: 09/11/2017] [Indexed: 12/26/2022]
Abstract
ᅟ: The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in i-NHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used. In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging. KEY POINTS • Watchful waiting is a reasonable option in patients with indolent non-Hodgkin lymphomas. • Imaging is crucial to monitor patients with indolent non-Hodgkin lymphomas. • CT and 18 F-FDG-PET/CT are commonly used, implying a substantial radiation exposure. • WB-MRI is highly reliable in lymphoma staging. • WB-MRI may be considered to monitor indolent non-Hodgkin lymphomas under watchful waiting.
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Affiliation(s)
- Massimo Galia
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Corrado Tarella
- Hemato-Oncology Division, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Caterina Patti
- Department of Hematology I, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Viale Trabucco 180, 90146, Palermo, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Antonino Mulè
- Department of Hematology I, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Viale Trabucco 180, 90146, Palermo, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015, Cefalù, Italy
| | - Massimo Midiri
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Guimarães MD, Noschang J, Teixeira SR, Santos MK, Lederman HM, Tostes V, Kundra V, Oliveira AD, Hochhegger B, Marchiori E. Whole-body MRI in pediatric patients with cancer. Cancer Imaging 2017; 17:6. [PMID: 28187778 PMCID: PMC5303228 DOI: 10.1186/s40644-017-0107-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 09/30/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
Cancer is the leading cause of natural death in the pediatric populations of developed countries, yet cure rates are greater than 70% when a cancer is diagnosed in its early stages. Recent advances in magnetic resonance imaging methods have markedly improved diagnostic and therapeutic approaches, while avoiding the risks of ionizing radiation that are associated with most conventional radiological methods, such as computed tomography and positron emission tomography/computed tomography. The advent of whole-body magnetic resonance imaging in association with the development of metabolic- and function-based techniques has led to the use of whole-body magnetic resonance imaging for the screening, diagnosis, staging, response assessment, and post-therapeutic follow-up of children with solid sporadic tumours or those with related genetic syndromes. Here, the advantages, techniques, indications, and limitations of whole-body magnetic resonance imaging in the management of pediatric oncology patients are presented.
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Affiliation(s)
- Marcos Duarte Guimarães
- Department of Imaging, AC Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, São Paulo/SP, 01509-010, Brazil.,Universidade Federal do Vale do São Francisco (UNIVASF), Av. José de Sá Maniçoba, Petrolina, PE, 56304-917, Brazil
| | - Julia Noschang
- Department of Imaging, AC Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, Sao Paulo/SP, 01509-010, Brazil.
| | - Sara Reis Teixeira
- Division of Radiology, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900, Ribeirao Preto/ SP, 14049-090, Brazil
| | - Marcel Koenigkam Santos
- Division of Radiology, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900, Ribeirao Preto/ SP, 14049-090, Brazil
| | - Henrique Manoel Lederman
- Universidade Federal de São Paulo, Departamento de Diagnóstico Por Imagem, Disciplina de Diagnóstico por Imagem em Pediatria, Rua Napoleão de Barros, 800, Vila Clementino, Sao Paulo/SP, 04024002, Brazil
| | - Vivian Tostes
- Universidade Federal de São Paulo, Centro de Diagnóstico por Imagem do Instituto de Oncologia Pediátrica e Médica Radiologista do Centro de Diagnóstico por Imagem do Instituto de Oncologia Pediátrica, Rua Napoleão de Barros, 800, Vila Clementino, Sao Paulo/SP, 04024002, Brazil
| | - Vikas Kundra
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Alex Dias Oliveira
- Department of Imaging, AC Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, Sao Paulo/SP, 01509-010, Brazil
| | - Bruno Hochhegger
- Department of Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Professor Anes Dias, 285, Centro Histórico, Porto Alegre/RS, 90020-090, Brazil
| | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaíso, Petrópolis/RJ, 25685-129, Brazil
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Arnoldi AP, Schlett CL, Douis H, Geyer LL, Voit AM, Bleisteiner F, Jansson AF, Weckbach S. Whole-body MRI in patients with Non-bacterial Osteitis: Radiological findings and correlation with clinical data. Eur Radiol 2016; 27:2391-2399. [PMID: 27663226 DOI: 10.1007/s00330-016-4586-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 10/23/2015] [Revised: 05/29/2016] [Accepted: 08/29/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To correlate clinical findings of Non-bacterial Osteitis (NBO) with whole-body MRI (WB-MRI) findings and determine a radiologic index for NBO (RINBO) which allows standardized reporting of WB-MRI. METHODS AND MATERIALS In a prospective study, 40 patients with diagnosis of NBO underwent clinical examination and WB-MRI in which STIR- and T1- weighted images were assessed for NBO-typical lesions. Parameters of interest for RINBO were: number of radiologically active lesions (RAL), size of the patients' maximum RAL presence of extramedullary and spinal involvement. Results were tested for statistical agreement of clinical and MR-based lesion detection. RINBO was tested for correlation with clinical activity. RESULTS 62/95 clinically/radiologically active lesions were found in 30/33 patients. In 45 % of the cohort, more active lesions were detected by WB-MRI than by clinical examination. RINBO was a significant predictor for the presence of clinically active lesions. CONCLUSION WB-MRI is a powerful diagnostic tool for patients with NBO which can reveal asymptomatic disease activity. With RINBO a standardized evaluation approach is proposed which helps assessing radiologic disease burden and predicts clinical disease activity. KEY POINTS • Whole body MRI is a powerful diagnostic tool for patients with non-bacterial Osteitis. • Whole body MRI can reveal asymptomatic disease activity. • The radiologic index RINBO offers a standardized evaluation approach.
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Affiliation(s)
- A P Arnoldi
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Nussbaumstrasse 20, 80336, Munich, Germany.
| | - C L Schlett
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - H Douis
- Department of Radiology, University Hospital Birmingham, Birmingham, B15 2TH, United Kingdom
| | - L L Geyer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Nussbaumstrasse 20, 80336, Munich, Germany
| | - A M Voit
- Department of Rheumatology & Immunology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - F Bleisteiner
- Department of Rheumatology & Immunology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - A F Jansson
- Department of Rheumatology & Immunology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S Weckbach
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Albano D, Patti C, La Grutta L, Grassedonio E, Mulè A, Brancatelli G, Lagalla R, Midiri M, Galia M. Osteonecrosis detected by whole body magnetic resonance in patients with Hodgkin Lymphoma treated by BEACOPP. Eur Radiol 2017; 27:2129-36. [PMID: 27519911 DOI: 10.1007/s00330-016-4535-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 07/09/2016] [Accepted: 07/27/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of our retrospective review of prospectively acquired Whole Body Magnetic Resonance (WB-MRI) scans was to assess the incidence of osteonecrosis in patients who received different chemotherapies. METHODS We evaluated the WB-MRI scans performed on 42 patients with Hodgkin Lymphoma treated by three chemotherapy regimens (6ABVD, 2ABVD + 4BEACOPP, 2ABVD + 8BEACOPP), excluding patients with the main risk factors for osteonecrosis. RESULTS Six out of seven patients (86 %) who received eight BEACOPP and one out of five patients (20 %) treated by four BEACOPP presented osteonecrosis, with a statistically significant difference of frequency between the two groups of patients (p < 0.05); no injury has been reported in patients treated by only ABVD. Among a total of 48 osteonecrotic lesions observed, 48 % were detected in the knee; multifocal osteonecrosis were detected in six out of seven patients (86 %). CONCLUSIONS The development of osteonecrosis is strictly related to the chemotherapy protocol adopted and the number of cycles received, with a strong correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows detecting earlier osteonecrotic lesions in patients treated with corticosteroids. KEY POINTS • Osteonecrosis is a possible complication of patients with Lymphoma treated by chemotherapy. • Osteonecrosis is related to the corticosteroids included within the BEACOPP protocol. • WB-MRI allows detecting osteonecrotic lesions in patients treated with corticosteroids.
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Treskes K, Saltzherr TP, Luitse JSK, Beenen LFM, Goslings JC. Indications for total-body computed tomography in blunt trauma patients: a systematic review. Eur J Trauma Emerg Surg 2016; 43:35-42. [PMID: 27435196 PMCID: PMC5306321 DOI: 10.1007/s00068-016-0711-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/16/2015] [Accepted: 07/12/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Total-body CT scanning (TBCT) could improve the initial in-hospital evaluation of severe trauma patients. Indications for TBCT, however, differ between trauma centers, so more insight in how to select patients that could benefit from TBCT is required. The aim of this review was to give an overview of currently used indications for total-body CT in trauma patients and to describe mortality and Injury Severity Scores of patient groups selected for TBCT. METHODS A systematic review was performed by searching MEDLINE and Embase databases. Studies evaluating or describing criteria for selection of patients with potentially severe injuries for TBCT during initial trauma care were included. Also, studies comparing total-body CT during the initial assessment of injured patients with conventional imaging and selective CT in specific patient groups were included. RESULTS Thirty eligible studies were identified. Three studies evaluated indications for TBCT in trauma with divergent methods. Combinations of compromised vital parameters, severe trauma mechanisms and clinical suspicion on severe injuries are often used indications; however, clinical judgement is used as well. Studies describing TBCT indications selected patients in different ways and were difficult to compare regarding mortality and injury severity. CONCLUSIONS Indications for TBCT in trauma show a wide variety in structure and cut-off values for vital parameters and trauma mechanism dimensions. Consensus on indications for TBCT in trauma is lacking.
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Affiliation(s)
- K Treskes
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - T P Saltzherr
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Tan TH, Hassan SZA. A Rare Case of Isolated Pericardial Effusion Detected by SPECT/CT on a Post-Therapeutic Radioiodine Whole-Body Scan. Nucl Med Mol Imaging 2015; 49:246-7. [PMID: 26279701 DOI: 10.1007/s13139-015-0330-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/27/2014] [Revised: 02/22/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022] Open
Abstract
We reported a rare finding of isolated pericardial uptake detected by SPECT/CT on posttherapeutic radioiodine whole body scan. This case highlights the usefulness of hybrid SPECT/CT, with subsequent correlation with biochemical results, in ruling out metastatic pericardial effusion in the postsurgical radioiodine remnant ablation setting. The effusion was resolved after reinstituted thyroid replacement therapy. Recombinant thyrotropin is recommended to avoid such rare but life-threatening complication.
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Affiliation(s)
- Teik Hin Tan
- Department of Nuclear Medicine, National Cancer Institute, No. 4, Jalan P7, Presint 7, 62550 Putrajaya, Malaysia
| | - Siti Zarina Amir Hassan
- Department of Nuclear Medicine, Kuala Lumpur Hospital, Jalan Pahang 50586 Kuala Lumpur, Malaysia
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30
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Park HS, Shin DS, Cho DH, Jung YW, Park JS. Improved sectioned images and surface models of the whole dog body. Ann Anat 2014; 196:352-9. [PMID: 24986152 DOI: 10.1016/j.aanat.2014.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/21/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
The objective of this research was to produce high-quality sectioned images of a whole dog which can be used to create sectional anatomy atlases and three-dimensional (3D) models. A year old female beagle was sacrificed by potassium chloride injection and frozen. The frozen dog was then serially ground using a cryomacrotome. Sectioned surfaces were photographed using a digital camera to create 3555 sectioned images of whole dog body (intervals, 0.2 mm; pixel size, 0.1 mm; 48 bit color). In a sectioned image, structures of dimension greater than 0.1mm could be identified in detail. Photoshop was used to make segmented images of 16 structures. Sectioned and segmented images were stored in browsing software to allow easy access. Segmented images were reconstructed to make surface models of 16 structures using Mimics software and stored in portable document format (PDF) using Adobe 3D Reviewer software. In this research, state-of-art sectioned images and surface models were produced for the dog. The authors hope that the sectioned images produced will become a useful source of software for basic and clinical veterinary medicine, and therefore, are distributing the sectioned images and surface models through browsing software and PDF file available free of charge.
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Affiliation(s)
- Hyo Seok Park
- Department of Anatomy, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Daegu 704-701, Republic of Korea.
| | - Dong Sun Shin
- Department of Anatomy, Ajou University School of Medicine, Suwon 443-749, Republic of Korea.
| | - Dai Hai Cho
- Department of Emergency Medicine, Dongguk University School of Medicine, Gyeongju 780-350, Republic of Korea.
| | - Yong Wook Jung
- Department of Anatomy, Dongguk University School of Medicine, 87 Dongdae-ro, Gyeongju 780-350, Republic of Korea.
| | - Jin Seo Park
- Department of Anatomy, Dongguk University School of Medicine, 87 Dongdae-ro, Gyeongju 780-350, Republic of Korea.
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31
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Lee JH, Kim SY, Lee JE, Cho EY, Choi YL, Choi JY, Han SW, Kim SW, Kil WH, Nam SJ. Polyostotic fibrous dysplasia mimicking multiple bone metastases in a patient with ductal carcinoma in situ. J Breast Cancer 2014; 17:83-7. [PMID: 24744802 PMCID: PMC3988348 DOI: 10.4048/jbc.2014.17.1.83] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/31/2013] [Indexed: 11/30/2022] Open
Abstract
Whole-body bone scans and whole body 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic scans are sensitive for detecting bone metastasis in patients with breast cancer. However, it is often difficult to discriminate between bone metastasis and other nonmalignant bone lesions. Polyostotic fibrous dysplasia is a rare disorder characterized by the osteoid medullary cavity filling with fibrous tissue causing bony expansion. We report the case of a 42-year-old female patient with ductal carcinoma in situ, which appeared to have multiple bone metastases on initial work-up images. Subsequently, the bone metastases were identified as polyostotic fibrous dysplasia. The patient underwent modified radical mastectomy and subsequently visited for a second opinion regarding the bony metastases. She underwent right ilium computed tomography-guided biopsy. Pathology was consistent with fibrous dysplasia. This patient received only adjuvant tamoxifen, and 1.5 years later, there was no evidence of recurrence.
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Affiliation(s)
- Jun Ho Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Han
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seok Won Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Ho Kil
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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32
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Dutoit JC, Vanderkerken MA, Verstraete KL. Value of whole body MRI and dynamic contrast enhanced MRI in the diagnosis, follow-up and evaluation of disease activity and extent in multiple myeloma. Eur J Radiol 2013; 82:1444-52. [PMID: 23726124 DOI: 10.1016/j.ejrad.2013.04.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 01/29/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the significance of dynamic contrast enhanced MRI (DCE-MRI) and whole body MRI (WB-MRI) in the diagnosis, prognosis and assessment of therapy for patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). MATERIALS AND METHODS The retrospective study includes 219 patients providing 463 WB-MRI and DCE-MRI investigations for the subgroups MGUS (n=70), MM active disease (n=126; this includes 70 patients with new diagnosis of MM, according to the International Staging System (ISS): 41.4% ISS stage I, 20.0% ISS stage II, 7.1% ISS stage III, 31.4% insufficient for staging; and 56 patients with '(re-)active disease': 16.07% relapse, 32.14% progressive disease and 51.79% stable disease) and MM remission (n=23; 60.87% complete remission, 17.39% very good partial remission and 21.74% partial remission). Investigations of patients with hereditary multiple exostoses (n=5), neurofibromatosis (n=7) and healthy persons (n=9) were added as control subjects (n=21). WB-MRI evaluation was done by evaluating thirteen skeletal regions, providing a 'skeletal score'. DCE-MRI images of the spine, were analyzed with regions-of-interest and time-intensity-curves (TIC). RESULTS All TIC parameters can significantly differentiate between the predefined subgroups (p<0.001). One hundred days after autologous stem cell transplantation a 75% decrease of the slope wash-in value (p<0.001) can be seen. A cubic regression trend between 'skeletal score' and slope wash-in (adj.R(2)=0.412) could demonstrate a significant increase bone marrow perfusion if MM affects more than 10 skeletal regions (p<0.001), associated with a poorer prognosis (p<0.001). CONCLUSION DCE-MRI evaluation of the spine is useful for diagnosis of MM, follow-up after stem cell transplantation and evaluation of disease activity. A combined evaluation with WB-MRI and DCE-MRI provides additional micro-vascular information on the morphologic lesions and could help categorize patients with MM in two different groups to offer useful therapeutic and prognostic advise.
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Affiliation(s)
- Julie C Dutoit
- Department of Radiology, MR-1K12, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium.
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