Radiology and Oncology最新文献

Background: Whole-body positron emission tomography/magnetic resonance imaging (WB-PET/MRI) is increasingly used in the initial evaluation of oncology patients. The purpose of this study was to compare the diagnostic performance of WB MRI sequences, attenuation-corrected raw data positron-emission tomography (AC PET), and PET/MRI fused images to detect bone metastases.

Patients and methods: We included 765 consecutive oncologic patients who received WB-PET/MRI from between January 2017 and September 2023. The presence of bone metastases was assessed using the individual sequences by two radiologists. Interobserver agreement was calculated. A receiver operating characteristic (ROC) analysis was performed to assess the performance of each individual sequence and fused images.

Results: Interobserver agreement for the detection of bone metastases on all sequences ranged from good to very good. The reading of the combination of MRI sequences with PET images showed statistically significantly better performance than the reading of individual MRI sequences and PET component only. Contrast enhanced T1 W Volume-interpolated breath-hold examination (CE T1W VIBE) sequence superior to PET for the detection of bone metastasis, but the statistical significance was not as high as with T1W-PET and CE T1W-PET fused images. The highest performance was achieved by the fused CE T1W-PET images with sensitivity of 100%, specificity of 92%, PPV of 96%, and NPV of 100%.

Conclusions: The combination of these CE T1W VIBE sequences with PET images have the highest diagnostic performance in detecting bone metastases in oncologic patients. This sequence should be integrated in WB-PET/MRI acquisitions for initial staging of cancer.

Background: To compare the diagnostic accuracy and predictive value of aneurysm sac volume measurement versus maximum diameter measurement of abdominal aortic aneurysm sac after endovascular aneurysm repair (EVAR) in patients with type II endoleak.

Patients and methods: Retrospective study on a cohort of 103 patients who presented with a type II endoleak after EVAR for infrarenal abdominal aortic aneurysm. Maximum diameter and volumetric measurements were calculated on computed tomography follow-up scans at 3 months and 1 year after index surgery. Pearson correlation coefficient was used to determine linear association between diameter and volume; Mann-Whitney U test was used to compare patients with and without later intervention for type II endoleak with regard to diameter and volume change.

Results: The correlation between diameter and volume measurement was high (Rho: 0.890-0.980 with P < 0.0001). In 38 out of 103 patients (37%) with type II endoleak, a later intervention for endoleak management was performed; early diameter (P = 0.097), or volume (P = 0.387) change could not predict risk for later intervention.

Conclusions: Both diameter and volume measurements can be used in the imaging follow-up of patients with endoleak type II after EVAR; however early changes in diameter or volume of the aneurysm sac cannot predict late intervention for type II endoleak.

Background: The aim of our study was to assess the inter-observer variability in delineation of the gross tumour volume (GTV) of oesophageal cancer on magnetic resonance (MR) in comparison to computed tomography (CT) and positron emission tomography and CT (PET/CT).

Patients and methods: Twenty-three consecutive patients with oesophageal cancer treated with chemo-radiotherapy were enrolled. All patients had PET/CT and MR imaging in treatment position. Five observers independently delineated the GTV on CT alone, MR alone, CT with co-registered MR, PET/CT alone and MR with co-registered PET/CT. Volumes of GTV were measured per patient and imaging modality. Inter-observer agreement, expressed in generalized conformity index (CIgen), volumetric conformity index (VCI), planar conformity index (PCI) and inter-delineation distance (IDD) were calculated per patient and imaging modality. Linear mixed models were used for statistical analysis.

Results: GTV volume was significantly lower on MR (33.03 cm³) compared to CT (37.1 cm³; p = 0.002) and on PET/CT MR (35.2 cm³; p = 0.018) compared to PET/CT (39.1 cm³). The CIgen was lowest on CT (0.56) and highest on PET/CT MR (0.67). The difference in CIgen between MR (0.61) and CT was borderline significant (p = 0.048). The VCI was significantly higher on MR (0.71; p = 0.007) and on CT MR (0.71; p = 0.004) compared to CT (0.67). The PCI was significantly higher on CT MR (0.67; p = 0.031) compared to CT (0.64). The largest differences were observed in the cranio-caudal direction.

Conclusions: The highest inter-observer agreement was found for PET/CT MR and the lowest for CT. MR could reduce the difference in delineation between observers and provide additional information about the local extent of the tumour.

Background: During a nuclear accident, numerous products of nuclear fission are released, including isotopes of radioactive iodine. Among them is iodine-131, with a half-life of 8.02 days, which emits β radiation. For decades, it has been effectively and safely used in medicine. However, in the event of a nuclear accident, uncontrolled exposure can have harmful biological effects. The main sources of internal contamination with iodine-131 are contaminated air, food and water. The most exposed organ is the thyroid gland, where radioactive iodine accumulates via the Na+/I- symporter (NIS). NIS does not distinguish between radioactive iodine isotopes and the stable isotope iodine-127, which is essential for the synthesis of thyroid hormones. Exposure to radioactive iodine during a nuclear accident is primarily associated with papillary thyroid cancer, whose incidence begins to increase a few years after exposure. Children and adolescents are at the highest risk, and the risk is particularly significant for individuals living in iodine-deficient areas.

Conclusions: Ensuring an adequate iodine supply is therefore crucial for lowering the risk of the harmful effects of exposure to radioactive iodine at the population level. Protecting the thyroid with potassium iodide tablets significantly reduces radiation exposure, as stable iodine prevents the entry of radioactive iodine into the thyroid. Such protection is effective only within a narrow time window - a few hours before and after the exposure and is recommended only for those under 40 years of age, as the risks of excessive iodine intake outweigh the potential benefits in older individuals.

Background: To analyze the contribution of two non-standard magnetic resonance imaging (MRI) techniques the chemical-shift image (CSI), and diffusion-weighted imaging (DWI) in distinguishing malignant and benign vertebral bone marrow lesions (VBMLs).

Patients and methods: Conventional spine MRI protocol, followed by CSI and DWI was performed with a 1.5 T system on 102 oncologic patients between January 2020 and December 2023. From the identified 325 VBMLs, 102 representative lesions (one per patient) were selected. VBMLs were divided into malignant (n = 74) and benign (n = 28) based on histopathology, or imaging follow-up. The quantitative parameters for VBMLs assessment were signal intensity ratio (SIR) derived from CSI and apparent diffusion coefficient (ADC) derived from DWI.

Results: The malignant VBMLs had significantly higher SIR values (p < 0.05) and lower ADC values compared to benign VBMLs (p < 0.05). The area under the curve (AUC) was 0.953 (p < 0.001) for SIR, and 0.894 for ADC (p < 0.001) (cut-off at > 0.82, and ≤ 1.57x10^-3 mm²/s, respectively). The sensitivity and specificity for SIR were 93.6%, and 88.5%, while for ADC were 88.2% and 92.3% (respectively). The combined use of SIR and ADC improved the diagnostic accuracy to AUC of 0.988 (p < 0.001, cut-off at > 0.19), sensitivity, and specificity of 100.0% and 90.9% (respectively).

Conclusions: Quantitative parameters, SIR and ADC, derived from two non-standard MRI techniques, CSI, and DWI, showed diagnostic strength in differentiating malignant and benign VBMLs. Combining both methods can further enhance the diagnostic performance and accuracy of spine MRI in clinical practice.

Background: Transarterial chemoembolization (TACE) is the treatment of choice for the intermediate stage hepatocellular carcinoma (HCC). Doxorubicin remains the most used chemotherapeutic agent in TACE, although in vitro screening has demonstrated that idarubicin exhibits greater cytotoxicity against HCC. This study aimed to evaluate safety, efficacy, and pharmacokinetics of idarubicin-loaded drug-eluting microspheres TACE (DEMIDA-TACE) in intermediate stage HCC patients.

Patients and methods: Between September 2019 and December 2021, 31 consecutive intermediate stage HCC patients (96.8% cirrhotic) were included to this study. 2 mL of LifePearl™ microspheres (100 μm) loaded with 10 mg of 1 mg/mL idarubicin were used for treatment. The adverse events, objective response rate (ORR), progression free survival (PFS), time to TACE untreatable progression (TTUP), median overall survival (mOS), and pharmacokinetics were evaluated.

Results: There were 68 TACE procedures performed. Adverse events grade ≥ 3 were noted after 29.4% procedures. The ORR was 83.9%, median PFS and TTUP were 10.5 months (95% CI: 6.8-14.3 months) and 24.6 months (95% CI: 11.6-37.6 months), respectively. Median OS was 36.0 months (95% CI: 21.1-50.9 months). Significant differences between patients achieving objective response (OR) and those with progressive disease were observed regarding idarubicinol and combined idarubicin-idarubicinol plasma concentrations at 72 hours post-procedure, higher plasma concentrations were observed in patients achieving OR (p = 0.014 and 0.014; cut-off values 1.2 and 1.29 ng/mL, respectively).

Conclusions: DEMIDA-TACE emerges as a safe and effective method of treatment for the intermediate stage HCC with low rates of adverse events alongside high tumor response, favourable disease control and overall survival. Idarubicinol and combined idarubicin-idarubicinol plasma concentrations at 72 hours post-procedure may serve as prognostic factors for achieving OR.

Background: Prostate cancer (PCa) is a prevalent male malignancy globally. Prolonged diagnostic intervals are associated with poorer outcomes, emphasizing the need to optimize this process. This study aimed to evaluate the doctor and primary care interval, research their impact on patient survival and explore opportunities to improve PCa diagnostic pathway in primary care.

Patients and methods: A retrospective cohort study using cancer patients' anonymised primary care data and data of the Slovenian Cancer Registry.

Results: The study found that the doctor interval had a median duration of 0 days (interquartile range ([IQR] 0-6) and primary care interval a median duration of 5 days (IQR 0-58). Longer intervals were observed in patients with more than two comorbidities, where general practitioners didn't have access to laboratory diagnostic tests within their primary health care centre and when patients first presented with symptoms (reported symptoms at first presentation: dysuria, lower urinary tract symptoms [LUTS], abdominal pain). The analysis also revealed a statistically significant association between lower 5-year survival rate and the accessibility of laboratory and ultrasound diagnostics in primary healthcare centres and a shorter 5-year survival of symptomatic patients in comparison to patients who were identified by elevated levels of prostate specific antigen (PSA).

Conclusions: This study shows that treating suspected PCa in primary care has a significant impact on 5-year survival. Several factors contribute to better survival, including easy access to laboratory and abdominal ultrasound in primary care centres. The study highlights the complex array of factors shaping PCa diagnosis, beyond individual clinicians' skills, encompassing test and service availability.

Background: JAK2 V617F (JAK2) mutation is associated with clonal hemopoiesis in myeloproliferative neoplasms as well as with faster progression of cardiovascular diseases. Little is known about the relationship between allele burden and the degree of atherosclerotic alteration of coronary vasculature. We previously reported that carotid artery stiffness progressed faster in patients with JAK2 positive essential thromocythemia (ET) patients. After a four-year follow-up we investigated whether mutation burden of a JAK2 allele correlates with a higher coronary calcium score.

Patients and methods: Thirty-six patients with JAK2 positive ET and 38 healthy matched control subjects were examined twice within four years. At each visit clinical baseline characteristics and laboratory testing were performed, JAK2 mutation burden was determined, and coronary calcium was measured.

Results: JAK2 allele burden decreased in 19 patients, did not change in 5 patients, and increased in 4 patients. The coronary calcium Agatston score increased slightly in both groups. Overall, there was no correlation between JAK2 allele burden and calcium burden of coronary arteries. However, in patients with the JAK2 mutation burden increase, the coronary calcium score increased as well.

Conclusions: The average JAK2 allele burden decreased in our patients with high-risk ET during the four-year period. However, in the small subgroup whose JAK2 mutation burden increased the Agatston coronary calcium score increased as well. This finding, which should be interpreted with caution and validated in a larger group, is in line with emerging evidence that JAK2 mutation accelerates atherosclerosis and can be regarded as a non-classical risk factor for cardiovascular disease.

Background: Posterior interosseous nerve lesion is a rare mononeuropathy of the upper limb. Atraumatic posterior interosseous nerve lesions are commonly caused by lipomas of the forearm, manifesting as slow-progressing wrist and finger drop.

Patients and methods: In this review and case report study, we present a systematic review of the literature for patients presenting with posterior interosseous palsy due to lipomas and a rare case of patient with acute posterior interosseous nerve lesion caused by a lipoma. Our primary interest was in the timing of clinical presentation. For the review process, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: After reviewing the literature, we identified thirty patients with posterior interosseous nerve lesions caused by lipomas. In 28 patients, the symptoms presented progressively, ranging from 1 month to a maximum of 240 months. We found only one case of a patient with acute presentation and another patient with acute worsening of chronic weakness due to trauma.

Conclusions: Atraumatic posterior interosseous nerve lesions are frequently secondary to forearm lipomas. In the majority of cases, the symptoms will develope progressively. However, in this study, we also report a rare case of a patient presenting with acute posterior interosseous nerve lesion due to a lipoma.