Journal of Medical Imaging and Radiation Oncology最新文献

Aim: To evaluate the incidence of pseudoprogression on ¹⁸F-FDG PET/CT scans in metastatic melanoma patients commencing immune checkpoint inhibitor therapy and to determine the average time to confirmed ¹⁸F-FDG PET/CT response in the pseudoprogression cohort identified.

Methods: Patients with metastatic melanoma who underwent baseline and follow-up ¹⁸F-FDG PET/CT scans after commencing immune checkpoint inhibitor therapy at Alfred Hospital (2012-2023) were retrospectively reviewed. Cases of pseudoprogression were identified by a keyword search of reports and confirmed on image review by a nuclear medicine physician. Data on timing of confirmed response, immune-related adverse events, and autoimmune history were also collected.

Results: 10/401 (2.49%) metastatic melanoma patients were confirmed as having pseudoprogression on PET/CT. 8/10 (80%) had new FDG-avid lesions and 2/10 (20%) had an increase in size and SUVmax of original disease. 8/10 (80%) of patients achieved complete metabolic remission on subsequent PET/CT scans with an average time to confirmed reduction of disease on PET/CT of 28.4 weeks. 4/10 (40%) received dual agent immunotherapy. 8/10 (80%) developed irAEs of varying types and severity. 2/10 (20%) had a history of pre-existing autoimmune disease. 9/10 (90%) of pseudoprogression patients are alive at last review.

Conclusion: Pseudoprogression on ¹⁸F-FDG PET/CT occurred in approximately 2.5% of metastatic melanoma patients commencing immunotherapy with an average time to subsequent confirmed response of ~6 months. This highlights the importance of not ceasing immunotherapy prematurely based on early ¹⁸F-FDG PET/CT findings.

Introduction: Cancer is the current leading cause of death in Australia, with a mortality and morbidity burden that is expected to rise with the aging population. Despite radiotherapy being indicated in 52% of cancer cases and contributing to 40% of cancer survival, radiation oncology (RO) research has not been prioritised by domestic or international research funding groups.

Methods: This study reviewed the past 5 years of publicly available oncology grant funding data from Australia's largest funding organisations, including commonwealth, individual state and territory governments, and philanthropic organisations. Data were retrieved from individual organisations' websites and GrantConnect. Grants for potential RO projects were identified using search terms. Additional descriptive information was retrieved using search engines. The combined data were assessed to determine inclusion/exclusion from the final RO grant pool. Descriptive statistics were generated using Microsoft Excel.

Results: Our analysis identified 1660 oncology grants, of which 74 (4.5%) were deemed to be RO grants. The total value of oncology grants was AUD$1.89 B, and RO grants was $60 M (3.2%). Of the RO grants, 39% were provided by philanthropic organisations, 39% by the Commonwealth Government and 22% by state and territory governments. Only 9% of RO grants were awarded to radiation oncologists.

Conclusions: This study demonstrates the low proportion of Australian oncology research funding awarded to RO projects. The gap between the clinical importance of RO and the funding it receives risks delays in more effective and less toxic radiation therapy reaching Australian cancer patients.

Objective: To evaluate the correlation between cardiac MRI and FDG-PET/CT findings in the diagnosis of cardiac sarcoidosis (CS) and assess their complementary roles in clinical decision-making.

Methods: A retrospective study was conducted on patients referred for both FDG-PET/CT and cardiac MRI for suspected CS at a single tertiary Australian hospital between January 2022 and June 2024. Imaging studies were categorised as 'negative', 'equivocal' or 'probable/positive' for CS. Clinical diagnosis was determined based on imaging, histopathology, and multidisciplinary assessment. Concordance between MRI, FDG-PET/CT and final clinical diagnosis was analysed.

Results: Twenty patients met inclusion criteria (mean age 55.6 ± 13.8 years, 70% male). MRI identified eight positive, seven equivocal, and five negative cases, whereas FDG-PET/CT detected eight positive and 12 negative cases. Clinical diagnosis confirmed CS in eight patients, with nine deemed negative and one equivocal. Direct concordance between MRI and FDG-PET/CT was observed in 9 of 20 cases (45%), with positive agreement in five and negative agreement in four cases. Imaging findings correlated with clinical diagnosis in seven of eight confirmed CS cases. Discordant imaging findings occurred in four cases, including MRI-positive but FDG-PET/CT-negative cases, later diagnosed as myocarditis or non-ischaemic cardiomyopathy.

Conclusion: Cardiac MRI and FDG-PET/CT demonstrate a complementary role in CS evaluation, with MRI excelling in detecting fibrosis and structural abnormalities, while FDG-PET/CT identifies active inflammation. Concordant imaging findings strongly correlated with clinical diagnosis, reinforcing the need for a multimodal approach in CS assessment and management.

Introduction: Recurrent urinary tract infections (rUTI) are a known complication following urogynaecology surgery, including anti-incontinence suburethral sling (SUS) insertion. Pelvic Floor Ultrasound (PFUS) can be used to accurately assess SUS characteristics, including position, configuration and tension. The purpose of this study is to investigate potential associations of these parameters with the occurrence of rUTI, as this knowledge could help guide clinical management.

Methods: A retrospective observational study of 283 consecutive pelvic floor ultrasounds was completed at a single large tertiary centre in Auckland, New Zealand. Following exclusions, a total of 204 women were included. Comparisons were performed using statistical analysis as appropriate.

Results: 125 women had a single intact SUS, and 79 women had no pelvic mesh or sling. rUTI was more common in patients with a SUS (21.6%) than those without SUS or other pelvic mesh (5.1%) (p = 0.001). Almost a quarter of patients (22.4%) had a SUS with an SPG < 8 mm, a marker of increased tension, and this was associated with a significantly higher frequency of rUTI (39.3% compared to 16.5% with SPG ≥ 8 mm) (p = 0.017). Women with SUS and PVR > 100 mL were more likely to have rUTI than those with a SUS and PVR < 100 mL (p = 0.007). No significant association was found between an abnormal SUS configuration and rUTI, or between the type of SUS and rUTI.

Conclusion: Recurrent UTI is more common in women with a SUS, even in this symptomatic cohort. More frequent rUTIs occur when SPG is < 8 mm and/or a PVR > 100 mL. Women with rUTI in the context of SUS may benefit from PFUS assessment to guide management. Further studies to clarify the significance of PFUS findings are needed.