J. Kwiecinski, P. Slomka, M. Dweck, D. Newby, D. Berman
Positron emission tomography (PET) with 18F-Sodium fluoride (18F-NaF) has emerged as a promising non-invasive imaging modality to identify high-risk and ruptured atherosclerotic plaques. By visualizing microcalcification, 18F-NaF PET holds clinical promise in refining how we evaluate coronary artery disease, shifting our focus from assessing disease burden to atherosclerosis activity. In this review we provide an overview of studies that have utilized 18F-NaF PET for imaging atherosclerosis. We discuss the associations between traditional coronary artery disease measures (risk factors) and 18F-NaF plaque activity. We also present the data on the histological validation as well as show how 18F-NaF uptake is associated with plaque morphology on intravascular and computed tomography imaging. Finally, we discuss the technical challenges associated with 18F-NaF coronary PET highlighting recent advances in this area.
{"title":"Vulnerable plaque imaging using 18F-Sodium fluoride positron emission tomography.","authors":"J. Kwiecinski, P. Slomka, M. Dweck, D. Newby, D. Berman","doi":"10.1259/bjr.20190797","DOIUrl":"https://doi.org/10.1259/bjr.20190797","url":null,"abstract":"Positron emission tomography (PET) with 18F-Sodium fluoride (18F-NaF) has emerged as a promising non-invasive imaging modality to identify high-risk and ruptured atherosclerotic plaques. By visualizing microcalcification, 18F-NaF PET holds clinical promise in refining how we evaluate coronary artery disease, shifting our focus from assessing disease burden to atherosclerosis activity. In this review we provide an overview of studies that have utilized 18F-NaF PET for imaging atherosclerosis. We discuss the associations between traditional coronary artery disease measures (risk factors) and 18F-NaF plaque activity. We also present the data on the histological validation as well as show how 18F-NaF uptake is associated with plaque morphology on intravascular and computed tomography imaging. Finally, we discuss the technical challenges associated with 18F-NaF coronary PET highlighting recent advances in this area.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128140064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mei Chen, P. Yepes, Y. Hojo, F. Poenisch, Yupeng Li, Cheng Xu, Xiao-dong He, Jiayi Chen, G. Gunn, S. Frank, N. Sahoo, Heng Li, X. Zhu, Xiaodong Zhang
OBJECTIVE This study is part of ongoing efforts aiming to transit from measurement-based to combined patient-specific quality assurance (PSQA) in intensity-modulated proton therapy (IMPT). A Monte Carlo (MC) dose-calculation algorithm is used to improve the independent dose calculation and to reveal the beam modeling deficiency of the analytical pencil beam (PB) algorithm. METHODS A set of representative clinical IMPT plans with suboptimal PSQA results were reviewed. Verification plans were recalculated using an MC algorithm developed in-house. Agreements of PB and MC calculations with measurements that quantified by the γ passing rate were compared. RESULTS The percentage of dose planes that met the clinical criteria for PSQA (>90% γ passing rate using 3%/3 mm criteria) increased from 71.40% in the original PB calculation to 95.14% in the MC recalculation. For fields without beam modifiers, nearly 100% of the dose planes exceeded the 95% γ passing rate threshold using the MC algorithm. The model deficiencies of the PB algorithm were found in the proximal and distal regions of the SOBP, where MC recalculation improved the γ passing rate by 11.27% (p < 0.001) and 16.80% (p < 0.001), respectively. CONCLUSIONS The MC algorithm substantially improved the γ passing rate for IMPT PSQA. Improved modeling of beam modifiers would enable the use of the MC algorithm for independent dose calculation, completely replacing additional depth measurements in IMPT PSQA program. For current users of the PB algorithm, further improving the long-tail modeling or using MC simulation to generate the dose correction factor is necessary. ADVANCES IN KNOWLEDGE We justified a change in clinical practice to achieve efficient combined PSQA in IMPT by using the MC algorithm that was experimentally validated in almost all the clinical scenarios in our center. Deficiencies in beam modeling of the current PB algorithm were identified and solutions to improve its dose calculation accuracy were provided.
{"title":"Transitioning from measurement-based to combined patient-specific quality assurance for intensity-modulated proton therapy.","authors":"Mei Chen, P. Yepes, Y. Hojo, F. Poenisch, Yupeng Li, Cheng Xu, Xiao-dong He, Jiayi Chen, G. Gunn, S. Frank, N. Sahoo, Heng Li, X. Zhu, Xiaodong Zhang","doi":"10.1259/bjr.20190669","DOIUrl":"https://doi.org/10.1259/bjr.20190669","url":null,"abstract":"OBJECTIVE\u0000This study is part of ongoing efforts aiming to transit from measurement-based to combined patient-specific quality assurance (PSQA) in intensity-modulated proton therapy (IMPT). A Monte Carlo (MC) dose-calculation algorithm is used to improve the independent dose calculation and to reveal the beam modeling deficiency of the analytical pencil beam (PB) algorithm.\u0000\u0000\u0000METHODS\u0000A set of representative clinical IMPT plans with suboptimal PSQA results were reviewed. Verification plans were recalculated using an MC algorithm developed in-house. Agreements of PB and MC calculations with measurements that quantified by the γ passing rate were compared.\u0000\u0000\u0000RESULTS\u0000The percentage of dose planes that met the clinical criteria for PSQA (>90% γ passing rate using 3%/3 mm criteria) increased from 71.40% in the original PB calculation to 95.14% in the MC recalculation. For fields without beam modifiers, nearly 100% of the dose planes exceeded the 95% γ passing rate threshold using the MC algorithm. The model deficiencies of the PB algorithm were found in the proximal and distal regions of the SOBP, where MC recalculation improved the γ passing rate by 11.27% (p < 0.001) and 16.80% (p < 0.001), respectively.\u0000\u0000\u0000CONCLUSIONS\u0000The MC algorithm substantially improved the γ passing rate for IMPT PSQA. Improved modeling of beam modifiers would enable the use of the MC algorithm for independent dose calculation, completely replacing additional depth measurements in IMPT PSQA program. For current users of the PB algorithm, further improving the long-tail modeling or using MC simulation to generate the dose correction factor is necessary.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000We justified a change in clinical practice to achieve efficient combined PSQA in IMPT by using the MC algorithm that was experimentally validated in almost all the clinical scenarios in our center. Deficiencies in beam modeling of the current PB algorithm were identified and solutions to improve its dose calculation accuracy were provided.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128504604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is growing in incidence and prevalence. However, it is frequently overlooked as a differential diagnosis by both clinicians and radiologists alike due to its non-specific clinical features, wide spectrum of radiological findings and difficulty in isolating the causative organism. The aim of this article is to illustrate the spectrum and follow-up of the radiological findings of NTM-PD and the challenges involved in making a diagnosis.
{"title":"Diagnosis of Non-Tuberculous mycobacterial pulmonary disease (NTM-PD): Modern Challenges.","authors":"B. Musaddaq, J. Cleverley","doi":"10.1259/bjr.20190768","DOIUrl":"https://doi.org/10.1259/bjr.20190768","url":null,"abstract":"Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is growing in incidence and prevalence. However, it is frequently overlooked as a differential diagnosis by both clinicians and radiologists alike due to its non-specific clinical features, wide spectrum of radiological findings and difficulty in isolating the causative organism. The aim of this article is to illustrate the spectrum and follow-up of the radiological findings of NTM-PD and the challenges involved in making a diagnosis.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115698536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Contegiacomo, E. M. Amodeo, A. Cina, C. Di Stasi, R. Iezzi, D. Coppolino, Nico Attempati, R. Manfredi
OBJECTIVES Evaluate the efficacy and safety of Renal Artery Embolization (RAE) for Iatrogenic Renal Vascular Injuries (IRVI) management at our institution in the last 5 years. METHODS Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. RESULTS 28 RAE procedures performed on 28 patients (21 Males; 7 Females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI.The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028).Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with three patient requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016).No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at one week from the procedure were significantly lower (p = 0.04). CONCLUSIONS RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. ADVANCES IN KNOWLEDGE Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.
{"title":"Renal artery embolization for iatrogenic renal vascular injuries management: 5 years' experience.","authors":"A. Contegiacomo, E. M. Amodeo, A. Cina, C. Di Stasi, R. Iezzi, D. Coppolino, Nico Attempati, R. Manfredi","doi":"10.1259/bjr.20190256","DOIUrl":"https://doi.org/10.1259/bjr.20190256","url":null,"abstract":"OBJECTIVES\u0000Evaluate the efficacy and safety of Renal Artery Embolization (RAE) for Iatrogenic Renal Vascular Injuries (IRVI) management at our institution in the last 5 years.\u0000\u0000\u0000METHODS\u0000Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated.\u0000\u0000\u0000RESULTS\u000028 RAE procedures performed on 28 patients (21 Males; 7 Females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI.The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028).Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with three patient requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016).No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at one week from the procedure were significantly lower (p = 0.04).\u0000\u0000\u0000CONCLUSIONS\u0000RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127546582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Jiang, A. Kelekis, Qiyu Zhao, A. Mazioti, Jia Liu, N. Kelekis, G. Tian, D. Filippiadis
OBJECTIVES To review safety and efficacy of percutaneous microwave ablation (MWA) for post-procedural haemostasis. METHODS Institutional databases retrospective research identified 10 cases of iatrogenic bleeding who underwent percutaneous microwave ablation for post-procedural haemostasis. Ultrasound examination with Doppler and contrast enhancement identified a source of active bleeding prior to ablation; additionally they were used as guiding modality for antenna insertion whilst, post ablation, assessed the lack of active extravasation. Target locations included liver intercostal space spleen and thyroid gland. Technical success was defined as positioning of the antenna on the desired location. Treatment endpoint was considered the disappearance of active extravasation in both Doppler imaging and CEUS. RESULTS Technical success (i.e., positioning of the antenna on the desired location) was achieved in all cases. No complications were noted. All patients post microwave ablation remained hemodynamically stable with no need for transfusion and were discharged from the hospital the next morning. Imaging and clinical follow-up in all patients before exiting the hospital did not depict any sign of active extravasation or bleeding. CONCLUSION Our limited experience reports preliminary data showing that microwave ablation could be added in the armamentarium of percutaneous therapies for iatrogenic bleeding. More prospective studies with larger patient samples are necessary for verification of this technique as well as for drawing broader conclusions in order to evaluate the place of percutaneous ablation in the treatment algorithm of haemorrhage. ADVANCES IN KNOWLEDGE Percutaneous ablation might have a role in hemostasis in well selected cases.
{"title":"Safety and efficacy of percutaneous microwave ablation for post-procedural hemostasis: a bi-central retrospective study focusing on safety and efficacy.","authors":"T. Jiang, A. Kelekis, Qiyu Zhao, A. Mazioti, Jia Liu, N. Kelekis, G. Tian, D. Filippiadis","doi":"10.1259/bjr.20190615","DOIUrl":"https://doi.org/10.1259/bjr.20190615","url":null,"abstract":"OBJECTIVES\u0000To review safety and efficacy of percutaneous microwave ablation (MWA) for post-procedural haemostasis.\u0000\u0000\u0000METHODS\u0000Institutional databases retrospective research identified 10 cases of iatrogenic bleeding who underwent percutaneous microwave ablation for post-procedural haemostasis. Ultrasound examination with Doppler and contrast enhancement identified a source of active bleeding prior to ablation; additionally they were used as guiding modality for antenna insertion whilst, post ablation, assessed the lack of active extravasation. Target locations included liver intercostal space spleen and thyroid gland. Technical success was defined as positioning of the antenna on the desired location. Treatment endpoint was considered the disappearance of active extravasation in both Doppler imaging and CEUS.\u0000\u0000\u0000RESULTS\u0000Technical success (i.e., positioning of the antenna on the desired location) was achieved in all cases. No complications were noted. All patients post microwave ablation remained hemodynamically stable with no need for transfusion and were discharged from the hospital the next morning. Imaging and clinical follow-up in all patients before exiting the hospital did not depict any sign of active extravasation or bleeding.\u0000\u0000\u0000CONCLUSION\u0000Our limited experience reports preliminary data showing that microwave ablation could be added in the armamentarium of percutaneous therapies for iatrogenic bleeding. More prospective studies with larger patient samples are necessary for verification of this technique as well as for drawing broader conclusions in order to evaluate the place of percutaneous ablation in the treatment algorithm of haemorrhage.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Percutaneous ablation might have a role in hemostasis in well selected cases.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128402819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Monti, M. Codari, C. D. De Cecco, F. Secchi, F. Sardanelli, A. Stillman
Epicardial adipose tissue (EAT) is a metabolically activated beige adipose tissue, non-homogeneously surrounding the myocardium. Physiologically, EAT regulates toxic fatty acids, protects the coronary arteries against mechanical strain, regulates proinflammatory cytokines, stimulates the production of nitric oxide, reduces oxidative stress, and works as a thermogenic source against hypothermia. Conversely, EAT has pathologic paracrine interactions with the surrounded vessels, and might favour the onset of atrial fibrillation. In addition, initial atherosclerotic lesions can promote inflammation and trigger the EAT production of cytokines increasing vascular inflammation, which, in turn, may help the development of collateral vessels but also of self-stimulating, dysregulated inflammatory process, increasing coronary artery disease severity. Variations in EAT were also linked to metabolic syndrome. Echocardiography firstly estimated EAT measuring its thickness on the free wall of the right ventricle but does not allow accurate volumetric EAT estimates. Cardiac CT (CCT) and cardiac MR (CMR) allow for three-dimensional EAT estimates, the former showing higher spatial resolution and reproducibility but being limited by radiation exposure and long segmentation times, the latter being radiation-free but limited by lower spatial resolution and reproducibility, higher cost, and difficulties for obese patients. EAT radiodensity at CCT could to be related to underlying metabolic processes. The correlation between EAT and response to certain pharmacological therapies has also been investigated, showing promising results. In the future, semi-automatic or fully automatic techniques, machine/deep-learning methods, if validated, will facilitate research for various EAT measures and may find a place in CCT/CMR reporting.
{"title":"Novel imaging biomarkers: epicardial adipose tissue evaluation.","authors":"C. Monti, M. Codari, C. D. De Cecco, F. Secchi, F. Sardanelli, A. Stillman","doi":"10.1259/bjr.20190770","DOIUrl":"https://doi.org/10.1259/bjr.20190770","url":null,"abstract":"Epicardial adipose tissue (EAT) is a metabolically activated beige adipose tissue, non-homogeneously surrounding the myocardium. Physiologically, EAT regulates toxic fatty acids, protects the coronary arteries against mechanical strain, regulates proinflammatory cytokines, stimulates the production of nitric oxide, reduces oxidative stress, and works as a thermogenic source against hypothermia. Conversely, EAT has pathologic paracrine interactions with the surrounded vessels, and might favour the onset of atrial fibrillation. In addition, initial atherosclerotic lesions can promote inflammation and trigger the EAT production of cytokines increasing vascular inflammation, which, in turn, may help the development of collateral vessels but also of self-stimulating, dysregulated inflammatory process, increasing coronary artery disease severity. Variations in EAT were also linked to metabolic syndrome. Echocardiography firstly estimated EAT measuring its thickness on the free wall of the right ventricle but does not allow accurate volumetric EAT estimates. Cardiac CT (CCT) and cardiac MR (CMR) allow for three-dimensional EAT estimates, the former showing higher spatial resolution and reproducibility but being limited by radiation exposure and long segmentation times, the latter being radiation-free but limited by lower spatial resolution and reproducibility, higher cost, and difficulties for obese patients. EAT radiodensity at CCT could to be related to underlying metabolic processes. The correlation between EAT and response to certain pharmacological therapies has also been investigated, showing promising results. In the future, semi-automatic or fully automatic techniques, machine/deep-learning methods, if validated, will facilitate research for various EAT measures and may find a place in CCT/CMR reporting.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122954239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Tsang, D. Vignarajah, A. McWilliam, H. Tharmalingam, G. Lowe, A. Choudhury, P. Hoskin
OBJECTIVES A cohort of HDR monotherapy patients was analysed to (i) establish the frequency of non-malignant urethral stricture; (ii) explore the relation between stricture formation with the dose distribution along the length of the urethra, and MRI radiomics features of the prostate gland. METHODS A retrospective review of treatment records of patients who received 19 Gy single fraction of HDR BT was carried out. A matched pair analysis used one control for each stricture case matched with pre-treatment IPSS score, number of needles used and clinical target volume (CTV) volume for each stricture case identified.For all data sets, pre-treatment T2-weighted MRI images were used to define regions-of-interests along the urethra and within the whole prostate gland. MRI textural radiomics features - energy, contrast and homogeneity were selected. Wilcoxon signed-rank test was performed to investigate significant differences in dosimetric parameters and MRI radiomics feature values between cases and controls. RESULTS From Nov 2010 to July 2017, there were 178 patients treated with HDR BT delivering 19 Gy in a single dose. With a median follow up of 28.2 months, a total of 5/178 (3%) strictures were identified.ten patients were included in the matched pair analysis. The urethral dosimetric parameters investigated were not statistically different between cases and controls (p > 0.05). With regards to MRI radiomics feature analysis, significant differences were found in contrast and homogeneity between cases and controls (p < 0.05). However, this did not apply to the energy feature (p = 0.28). CONCLUSIONS In this matched pair analysis, no association between post-treatment stricture and urethral dosimetry was identified. Our study generated a preliminary clinical hypothesis suggesting that the MRI radiomics features of homogeneity and contrast of the prostate gland can potentially identify patients who develop strictures after HDR BT. Although the sample size is small, this warrants further validation in a larger patient cohort. ADVANCES IN KNOWLEDGE Urethral stricture has been reported as a specific late effect with prostate HDR brachytherapy. Our study reported a relatively low stricture rate of 3% and no association between post-treatment stricture and urethral dosimetry was identified. MRI radiomics features can potentially identify patients who are more prone to develop strictures.
{"title":"A pilot study on dosimetric and radiomics analysis of urethral strictures following HDR brachytherapy as monotherapy for localised prostate cancer.","authors":"Y. Tsang, D. Vignarajah, A. McWilliam, H. Tharmalingam, G. Lowe, A. Choudhury, P. Hoskin","doi":"10.1259/bjr.20190760","DOIUrl":"https://doi.org/10.1259/bjr.20190760","url":null,"abstract":"OBJECTIVES\u0000A cohort of HDR monotherapy patients was analysed to (i) establish the frequency of non-malignant urethral stricture; (ii) explore the relation between stricture formation with the dose distribution along the length of the urethra, and MRI radiomics features of the prostate gland.\u0000\u0000\u0000METHODS\u0000A retrospective review of treatment records of patients who received 19 Gy single fraction of HDR BT was carried out. A matched pair analysis used one control for each stricture case matched with pre-treatment IPSS score, number of needles used and clinical target volume (CTV) volume for each stricture case identified.For all data sets, pre-treatment T2-weighted MRI images were used to define regions-of-interests along the urethra and within the whole prostate gland. MRI textural radiomics features - energy, contrast and homogeneity were selected. Wilcoxon signed-rank test was performed to investigate significant differences in dosimetric parameters and MRI radiomics feature values between cases and controls.\u0000\u0000\u0000RESULTS\u0000From Nov 2010 to July 2017, there were 178 patients treated with HDR BT delivering 19 Gy in a single dose. With a median follow up of 28.2 months, a total of 5/178 (3%) strictures were identified.ten patients were included in the matched pair analysis. The urethral dosimetric parameters investigated were not statistically different between cases and controls (p > 0.05). With regards to MRI radiomics feature analysis, significant differences were found in contrast and homogeneity between cases and controls (p < 0.05). However, this did not apply to the energy feature (p = 0.28).\u0000\u0000\u0000CONCLUSIONS\u0000In this matched pair analysis, no association between post-treatment stricture and urethral dosimetry was identified. Our study generated a preliminary clinical hypothesis suggesting that the MRI radiomics features of homogeneity and contrast of the prostate gland can potentially identify patients who develop strictures after HDR BT. Although the sample size is small, this warrants further validation in a larger patient cohort.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Urethral stricture has been reported as a specific late effect with prostate HDR brachytherapy. Our study reported a relatively low stricture rate of 3% and no association between post-treatment stricture and urethral dosimetry was identified. MRI radiomics features can potentially identify patients who are more prone to develop strictures.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124955099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zongqiong Sun, Shudong Hu, Jie Li, Teng Wang, Zhihui Xie, Lin-fang Jin
OBJECTIVES To assess metastatic involvement of perigastric lymph nodes (PLNs) in patients with T1 gastric cancer by using CT perfusion imaging (CTPI). METHODS A total of 82 annotated PLNs of 33 patients with T1 gastric cancer confirmed by endoscopic ultrasonography (EUS) underwent CTPI and portal Phase CT scan before operation. The scan data were postprocessed to acquire perfusion maps and calculate perfusion parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short axis diameters and perfusion parameters of PLNs. According to the post-operative pathology result, PLNs were divided into two groups: metastatic and inflammatory LNs. Perfusion parameters values and the size of PLNs between two groups were respectively compared statistically by t test, and a receiver-operating characteristic (ROC) curve analysis was used to determine the optimal diagnostic cutoff value with sensitivity, specificity and area under the curve (AUC). RESULTS Examined 82 PLNs were metastatic in 45 (54.9%) and inflammatory in 37 (45.1%). The mean values of perfusion parameters and the short axis diameters in metastatic and inflammatory PLNs, respectively, were BF of 97.48 vs 81.21 ml/100 mg /min (p < 0.001), PS of 45.11 vs 36.80 ml/100 mg /min (p < 0.001), and the size of 1.51 cm vs 1.29 cm (p = 0.059). The sensitivity of 84.4%, specificity of 67.6% and AUC of 0.826 for BF with cutoff value of 88.89 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of PLNs (p < 0.001). CONCLUSIONS CT perfusion parameters values were different between metastatic and inflammatory PLNs in T1 gastric cancer. BF value may be the most reliable diagnostic marker of metastatic PLNs, and it is helpful for clinicians to choose treatment modality or management plan in T1 gastric cancer patients. ADVANCES IN KNOWLEDGE CTPI gives information on vascularization of LNs.BF value might be a more effective marker than PS or the size of LNs for differentiating metastatic from inflammatory LNs in patients with T1 gastric cancer.
目的应用CT灌注成像(CTPI)评价T1期胃癌患者胃周淋巴结(PLNs)转移情况。方法33例经超声内镜(EUS)确诊的T1期胃癌患者，术前行CTPI和门静脉期CT扫描，共82例带注释的pln。对扫描数据进行后处理，获得灌注图，计算血流(BF)、通透面(PS)等灌注参数。放射科医生测量了pln的短轴直径和灌注参数。根据术后病理结果，将pln分为转移性和炎性两组。采用t检验对两组灌注参数值及pln大小进行统计学比较，采用受试者-工作特征(ROC)曲线分析，结合敏感性、特异性和曲线下面积(AUC)确定最佳诊断截断值。结果82例pln转移45例(54.9%)，炎性37例(45.1%)。转移性和炎症性PLNs灌注参数均值和短轴直径均值分别为:BF 97.48 vs 81.21 ml/100 mg /min (p < 0.001)， PS 45.11 vs 36.80 ml/100 mg /min (p < 0.001)，大小1.51 cm vs 1.29 cm (p = 0.059)。BF鉴别炎性淋巴结转移的敏感性为84.4%，特异性为67.6%，AUC为0.826，临界值为88.89 ml/100 mg /min，高于PS和PLNs大小(p < 0.001)。结论T1期胃癌转移性与炎性pln的sct灌注参数值存在差异。BF值可能是转移性pln最可靠的诊断指标，有助于临床医生在T1胃癌患者中选择治疗方式或管理方案。知识进展:pi提供了LNs血管化的信息。在T1胃癌患者中，BF值可能是鉴别转移性和炎性LNs更有效的标志物，而不是PS或LNs的大小。
{"title":"An application study of CT perfusion imaging in assessing metastatic involvement of perigastric lymph nodes in patients with T1 gastric cancer.","authors":"Zongqiong Sun, Shudong Hu, Jie Li, Teng Wang, Zhihui Xie, Lin-fang Jin","doi":"10.1259/bjr.20190790","DOIUrl":"https://doi.org/10.1259/bjr.20190790","url":null,"abstract":"OBJECTIVES\u0000To assess metastatic involvement of perigastric lymph nodes (PLNs) in patients with T1 gastric cancer by using CT perfusion imaging (CTPI).\u0000\u0000\u0000METHODS\u0000A total of 82 annotated PLNs of 33 patients with T1 gastric cancer confirmed by endoscopic ultrasonography (EUS) underwent CTPI and portal Phase CT scan before operation. The scan data were postprocessed to acquire perfusion maps and calculate perfusion parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short axis diameters and perfusion parameters of PLNs. According to the post-operative pathology result, PLNs were divided into two groups: metastatic and inflammatory LNs. Perfusion parameters values and the size of PLNs between two groups were respectively compared statistically by t test, and a receiver-operating characteristic (ROC) curve analysis was used to determine the optimal diagnostic cutoff value with sensitivity, specificity and area under the curve (AUC).\u0000\u0000\u0000RESULTS\u0000Examined 82 PLNs were metastatic in 45 (54.9%) and inflammatory in 37 (45.1%). The mean values of perfusion parameters and the short axis diameters in metastatic and inflammatory PLNs, respectively, were BF of 97.48 vs 81.21 ml/100 mg /min (p < 0.001), PS of 45.11 vs 36.80 ml/100 mg /min (p < 0.001), and the size of 1.51 cm vs 1.29 cm (p = 0.059). The sensitivity of 84.4%, specificity of 67.6% and AUC of 0.826 for BF with cutoff value of 88.89 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of PLNs (p < 0.001).\u0000\u0000\u0000CONCLUSIONS\u0000CT perfusion parameters values were different between metastatic and inflammatory PLNs in T1 gastric cancer. BF value may be the most reliable diagnostic marker of metastatic PLNs, and it is helpful for clinicians to choose treatment modality or management plan in T1 gastric cancer patients.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000CTPI gives information on vascularization of LNs.BF value might be a more effective marker than PS or the size of LNs for differentiating metastatic from inflammatory LNs in patients with T1 gastric cancer.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"40 23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128478383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachita Khot, Melissa McGettigan, J. Patrie, S. Feuerlein
OBJECTIVES To test the hypothesis that there is a measureable upward motion of the diaphragm during prolonged breath holds that could have a detrimental effect on image quality in liver MRI and to identify factor that potentially influence the magnitude of this motion. METHODS 15 healthy volunteers underwent MRI examination using prolonged breath holds in the maximum inspiratory position and a moderate inspiratory position. Coronal T1-weighted 3D gradient echo sequences of the entire thorax were acquired every 6 sec during breath holding allowing the calculation of total lung volume and the measurement of the absolute position of the dome of the liver. The potential impact of subject's gender, BMI, and total lung capacity on the change in lung volume/diaphragmatic motion was assessed using random coefficient regression. RESULTS All volunteers demonstrated a slow reduction of the total lung volume during prolonged breath holding up to 123 ml. There was a measurable associated upward shift of the diaphragm, measuring up to 5.6 mm after 24 sec. There was a positive correlation with female gender (p = 0.037) and total lung volume (p = 0.005) and a negative association with BMI (p = 0.012) for the maximum inspiratory position only. CONCLUSIONS There is a measureable reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath holding which likely contributes to motion artifacts in liver MRI. ADVANCES IN KNOWLEDGE There is a measureable gas exchange-related reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath holding which likely contributes to motion artifacts in liver MRI. Correcting for this predictable upward shift has potential to improve image quality.The magnitude of this effect does not seem to be related to gender, BMI or total lung capacity if a moderate inspiratory position is used.
{"title":"Quantification of gas exchange-related upward motion of the liver during prolonged breathholding - potential reduction of motion artifacts in abdominal MRI.","authors":"Rachita Khot, Melissa McGettigan, J. Patrie, S. Feuerlein","doi":"10.1259/bjr.20190549","DOIUrl":"https://doi.org/10.1259/bjr.20190549","url":null,"abstract":"OBJECTIVES\u0000To test the hypothesis that there is a measureable upward motion of the diaphragm during prolonged breath holds that could have a detrimental effect on image quality in liver MRI and to identify factor that potentially influence the magnitude of this motion.\u0000\u0000\u0000METHODS\u000015 healthy volunteers underwent MRI examination using prolonged breath holds in the maximum inspiratory position and a moderate inspiratory position. Coronal T1-weighted 3D gradient echo sequences of the entire thorax were acquired every 6 sec during breath holding allowing the calculation of total lung volume and the measurement of the absolute position of the dome of the liver. The potential impact of subject's gender, BMI, and total lung capacity on the change in lung volume/diaphragmatic motion was assessed using random coefficient regression.\u0000\u0000\u0000RESULTS\u0000All volunteers demonstrated a slow reduction of the total lung volume during prolonged breath holding up to 123 ml. There was a measurable associated upward shift of the diaphragm, measuring up to 5.6 mm after 24 sec. There was a positive correlation with female gender (p = 0.037) and total lung volume (p = 0.005) and a negative association with BMI (p = 0.012) for the maximum inspiratory position only.\u0000\u0000\u0000CONCLUSIONS\u0000There is a measureable reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath holding which likely contributes to motion artifacts in liver MRI.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000There is a measureable gas exchange-related reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath holding which likely contributes to motion artifacts in liver MRI. Correcting for this predictable upward shift has potential to improve image quality.The magnitude of this effect does not seem to be related to gender, BMI or total lung capacity if a moderate inspiratory position is used.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131048856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is growing evidence supporting the use of stereotactic ablative radiotherapy (SABR) on the treatment of localized stage non-small-cell Lung cancer (NSCLC). Distinctive imaging challenges are posed post-SABR treatment. Thus, it is imperative to provide guidance on assessing treatment response, especially for new adopters. This commentary is about filling a gap in response evaluation after SABR for localized NSCLC.
{"title":"Response evaluation after stereotactic ablative radiotherapy for localized non-small-cell lung cancer - an equipoise of available resource and accuracy.","authors":"Andre G. Gouveia, O. Zalay, K. Chua, F. Moraes","doi":"10.1259/bjr.20190647","DOIUrl":"https://doi.org/10.1259/bjr.20190647","url":null,"abstract":"There is growing evidence supporting the use of stereotactic ablative radiotherapy (SABR) on the treatment of localized stage non-small-cell Lung cancer (NSCLC). Distinctive imaging challenges are posed post-SABR treatment. Thus, it is imperative to provide guidance on assessing treatment response, especially for new adopters. This commentary is about filling a gap in response evaluation after SABR for localized NSCLC.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115284813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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