Journal of Medical Imaging and Radiation Oncology最新文献

Introduction: The purpose of this study was to understand the clinical indications and utility of a barium swallow study in patients who have already been investigated with an upper gastrointestinal (UGI) endoscopy. It would be useful to determine the additional diagnostic information provided by a barium swallow study given endoscopy is considered the gold standard for examining the UGI tract.

Methods: This retrospective study examined all barium swallow studies performed at a single tertiary hospital and identified patients who had been investigated with an UGI endoscopy in the preceding 6 months. The radiology request forms, barium swallow reports, UGI endoscopy reports and clinic letters were reviewed to determine the most frequent clinical indications, quantify and characterise new findings on barium swallow and determine the proportion of patients with alteration in management.

Results: Between 1 January 2023 and 30 September 2023, 105 of 318 patients investigated with barium swallow studies had received a recent UGI endoscopy. Over half of the study requests were non-specific, aimed at identifying the cause of dysphagia. A total of 59 studies (56.2%) demonstrated findings that were not apparent on UGI endoscopy. The most common new finding was dysmotility (n = 53, 89.8%). Of the patients with new findings, 24 (40.7%) experienced no change in management, nine (15.2%) were offered lifestyle advice, seven (11.9%) were referred to speech and language therapy and seven (11.9%) were started on medication.

Conclusion: A barium swallow study is a helpful adjunct to UGI endoscopy, especially in the diagnosis of dysmotility.

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy and remains one of the most common causes of cancer-related death in children and adolescents. It is characterised by the proliferation of immature lymphoid cells capable of infiltrating bone marrow, blood and extramedullary sites. Five-year overall survival rates exceed 90% with current multidrug chemotherapeutic regimens. This manuscript reviews the abdominal imaging features of leukaemic infiltration in children with ALL at the time of initial diagnosis and following relapse.

Introduction: This retrospective single-institution study evaluated the safety, efficacy and durability of stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) and related facial pain syndromes-including TN1, TN2, multiple sclerosis (MS) associated-TN and atypical facial pain (AFP).

Methods: We included 192 patients treated with Gamma Knife SRS between 2015 and 2022 at Australia's only publicly funded GK centre. Outcomes included Barrow Neurological Institute (BNI) pain scores, time to response and relapse. Kaplan-Meier and Cox regression analyses were performed.

Results: Median follow-up was 5 years. Treatment response occurred in 88.5%, with a relapse rate of 30%. Faster response was seen with 85 Gy (p = 0.004) and prior SRS (p = 0.02). MS-related TN relapsed earlier than vascular, tumour, idiopathic or stroke-related causes (p = 0.027) and TN1/TN2/AFP (p < 0.0001). On multivariable analysis, prior balloon compression (HR 3.02, 95% CI 1.07-8.51, p = 0.036) and 85 Gy (HR 2.07, 95% CI 1.29-3.33, p = 0.003) were associated with faster response. Patients with vascular TN (HR 0.32, 95% CI 0.13-0.79, p = 0.013), tumour/stroke/idiopathic aetiology (HR 0.36, 95% CI 0.14-0.91, p = 0.031) had utilised prior medication only (HR 0.18, 95% CI 0.06-0.48, p = 0.001) and had undergone prior MVD alone (HR 0.11, 95% CI 0.03-0.5, p = 0.004) were less likely to relapse.

Conclusion: SRS remains a valuable option for refractory facial pain, including redo SRS in select patients.

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.