BJR open最新文献

Ultrasound is as accurate as MRI in the detection of most brachial pathologies but tends to be underutilized in clinical practice compared to MRI. The main reason for this under-usage is a relative lack of knowledge regarding how to perform brachial plexus ultrasound and a lack of awareness of the ultrasound appearances of brachial pathologies. This review serves to re-address this imbalance by providing a practical overview on how to perform brachial plexus ultrasound as well as highlighting the ultrasound appearances of common pathologies likely to be encountered in everyday clinical practice.

Objective: Assessing the frequency of ovarian metastasis from nonovarian cancer (N-OC) and evaluate whether any PET-derived parameters can distinguish metastasis from primary ovarian cancer.

Methods: Patients undergoing FDG PET/CT due to suspected ovarian malignancy from 2006 to 2021 with subsequent histologically proven ovarian metastasis from N-OC were included. Exclusion criteria included ovarian metastasis diagnosed prior to PET/CT or >3 months after. Baseline characteristics were collected from electronic medical records, and PET/CT data were analysed using Siemens syngo.via software.

Results: Patients (N =1502) were scanned for suspected ovarian malignancies. Sixty-five patients (4%) were included. The most common origin of metastases was lower gastrointestinal cancer (n = 29, 45%), followed by gynaecological cancer (n = 10, 15%) and breast cancer (n = 9, 14%). Among patients with previous cancer history (n = 26), 18 experienced ovarian metastases from a known cancer. Time from primary diagnosis to ovarian metastasis ranged from 47 days to 11.4 years. There were no differences in maximized standardized uptake value, peak standardized uptake value, or clinical parameters between ovarian metastases and primary ovarian tumours.

Conclusion: The frequency of ovarian metastases from N-OCs was 4%, the most common origin of metastases was lower gastrointestinal tract. Previous cancer history is an important factor in assessing an unknown tumour of the ovary, as metastases can occur several years later. No PET or clinical parameters were useful for separating primary ovarian cancer from ovarian metastases.

Advances in knowledge: The study finds a low frequency of ovarian metastasis from N-OC and indicates that no PET or clinical parameters can distinguish ovarian metastasis from primary ovarian cancer.

Objectives: The purpose of the present study was to evaluate outcomes with radiation therapy (RT) in multimodality treatment for inoperable hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT).

Methods: The present retrospective study included 24 patients without extrahepatic metastases. The patients had received drug eluting beads - transarterial chemoembolization (DEB-TACE) (n = 10) and systemic treatment (n = 14) before RT. The dose fractionation was 12-31.5 Gy in 3-7 fractions of 4-5 Gy to PVTT or PVTT plus the liver parenchymal tumour. All patients were advised systemic treatment with sorafenib, lenvatinib, or nivolumab after RT. After RT, patients had received DEB-TACE within 8 weeks (n = 2) or at 5-10 months (n = 3). Treatment response was evaluated as per mRECIST and PERCIST, and Kaplan-Meier survival analysis was performed.

Results: The disease control rate in PVTT was 50% at 3 months. The median overall survival (OS) was 10.9 months (95% CI, 0.74-21) for all patients. The 6-month, 1-year, 2-year, and 3-year OS rates were 75%, 45.8%, 25%, and 12.5%, respectively. The median OS was 30.4 months (95% CI, 12.1-48.7) versus 18.1 months (0.00-38.8) with complete or partial response versus stable or progressive disease in PVTT (P = .036). Eleven patients had a decline in Child Pugh score of 2 or more points within 3 months after RT. One patient underwent live donor liver transplantation (LDLT) and complete necrosis with no viable tumour was observed in the explant. The patient is cancer- and liver disease-free at 1 year after LDLT.

Conclusions: The present study showed the benefit of radiotherapy with systemic therapy and DEB-TACE in patients with HCC with PVTT.

Advances in knowledge: Radiotherapy as part of the multimodality treatment offers the potential to improve disease control and survival in patients with HCC with PVTT.

Objectives: Determine the incidence, location, and features of insufficiency fractures (IFs) in sacral chordoma patients treated with high-dose radiation therapy (HDR) with(out) resection, relative to radiation therapy type and irradiation plans.

Methods: Clinical data, including details of all surgical procedures and radiotherapies of patients histologically diagnosed with sacral chordoma between 2008 and 2023 available at our database, were retrospectively reviewed. Inclusion criteria were as follows: availability of diagnostic, treatment planning and follow-up magnetic resonance and/or computed tomography scans, and completed treatment. Scans were re-evaluated for the presence and location of IF defined as linear abnormalities with(out) bone marrow oedema (BME)-like changes.

Results: From 48 included patients (29 male, median age 66, range 27-85), 22 were diagnosed with 56 IF (45.8%). IF occurred 3-266 months following the treatment. All sacral and iliac bone IF had vertical components parallel to the SI joint. Twenty patients had bilateral and 16 unilateral IF. BME-like changes were visible in 46 IF (82.1%, 0.80, P ≤ .001). In 13/56 IF (23.2%), BME-like changes were seen prior to IF diagnosis; in only 1 patient, BME-like changes did not develop into an IF. Thirty-nine IF (84.7%) occurred within low-dose volume and 7 (15.3%) outside of irradiated volume in 16/44 irradiated patients. Six IF occurred in 1 patient treated with surgery only.

Conclusions: Pelvic IFs are common in sacral chordoma patients treated with definitive or (neo)adjuvant HDR, occurring months to years following treatment. Not all IF occur in the irradiated volume.

Advances in knowledge: When present, BME-like changes indicate risk of IF developing. IF do not heal over time.

Objectives: To establish a link between radiation dosimetry and disability-adjusted life-years (DALY) with the aim of quantifying the justification of medical exposures.

Methods: The health detriment, defined as lifetime loss of DALY at age of exposure to ionizing radiation for a US-European population was calculated. A simple model of the relationship was fitted to the results. Apart from in late life within the latency period for radiation-induced cancers, most of the relationship can be adequately fitted to a straight line of negative gradient. The gradient of this line corresponds to a loss of DALY per year following exposure to radiation and is therefore equivalent to a disability weight (DW) used in the calculation of DALY.

Results: Radiation dose-dependent DWs for radiation exposure to a US-European population are estimated as 0.020 DALY/yr/Sv for males and 0.022 DALY/yr/Sv for females.

Conclusions: By comparing a range of 66 radiological examinations in terms of the DWs of the disease or injury states with the DWs resulting from the associated radiological exposures, it is demonstrated graphically that the resulting benefit is far greater than the detriment in every case.

Advances in knowledge: The definition of a DW for ionizing radiation, proportional to effective dose as currently defined, can link radiation exposure to the existing large body of data on the DALY burden and DWs for a wide range of diseases and injuries, providing a means for the quantitative justification of the benefit-detriment balance of medical exposures.

[This corrects the article DOI: 10.1093/bjro/tzae034.].

Objectives: To evaluate the outcome of patients with cranial (C) and extra-cranial (EC) oligometastases treated with stereotactic radiosurgery (SRS)/stereotactic body radiotherapy (SBRT) and standard of care systemic therapy.

Methods: During the period 2018-2022, patients who received SBRT or SRS for oligometastases (≤5 lesions) in addition to systemic therapy were evaluated. PET-CT was done to categorize them as C or EC oligometastases. Local control, distant progression, progression-free survival (PFS), overall survival (OS), and toxicity of the treatment were recorded.

Results: 43 patients received SBRT/SRS to 88 oligometastatic lesions. Eighteen patients had C metastases, 23 had EC metastases and 2 patients had both. 40/43 patients had received systemic therapy. At a median follow-up of 13 months, median PFS was 14 months and 1 and 2 years OS was 83.2% and 67.4%. Local control with SRS was 92.8% and with SBRT was 86.3%. Distant failure in C vs EC oligometastases was seen in 12/14 vs 7/20 patients (P = 0.03). Median PFS was 30 months for EC and 6 months for C oligometastases (P = 0.003). 1 and 2 years OS was 89.6% and 82.7% for EC and 77.6% and 48.5% for C oligometastases (P = 0.21). One patient had grade 3 and 3 patients had grade 1 toxicity.

Conclusions: SRS and SBRT yielded high rates of local control with low toxicity. Compared to EC, patients with C oligometastases had higher distant relapses, poorer PFS, and a trend towards worse survival. More studies with separate enrolment of patients with C and EC oligometastases are needed.

Advances in knowledge: Outcome of patients with C oligometastases is poorer than EC metastases and hence the studies should be separately done in these 2 groups to assess the benefit of SRS/SBRT.

Objective: There is a lack of recent meta-analyses and systematic reviews on the use of ultra-low-dose CT (ULDCT) for the detection, measurement, and diagnosis of lung nodules. This review aims to summarize the latest advances of ULDCT in these areas.

Methods: A systematic review of studies in PubMed and Web of Science was conducted, using search terms specific to ULDCT and lung nodules. The included studies were published in the last 5 years (January 2019-August 2024). Two reviewers independently selected articles, extracted data, and assessed the risk of bias and concerns using the Quality Assessment of Diagnostic Accuracy Studies-II (QUADAS-II) tool. The standard-dose, low-dose, or contrast-enhanced CT served as the reference-standard CT to evaluate ULDCT.

Results: The literature search yielded 15 high-quality articles on a total of 1889 patients, of which 10, 3, and 2 dealt with the detection, measurement, and diagnosis of lung nodules. QUADAS-II showed a generally low risk of bias. The mean radiation dose for ULDCT was 0.22 ± 0.10 mSv (7.7%) against 2.84 ± 1.80 mSv for reference-standard CT. Nodule detection rates ranged from 86.1% to 100%. The variability of diameter measurements ranged from 2.1% to 14.4% against contrast-enhanced CT and from 3.1% to 8.29% against standard CT. The diagnosis rate of malignant nodules ranged from 75% to 91%.

Conclusions: ULDCT proves effective in detecting lung nodules while substantially reducing radiation exposure. However, the use of ULDCT for the measurement and diagnosis of lung nodules remains challenging and requires further research.

Advances in knowledge: When ULDCT reduces radiation exposure to 7.7%, it detects lung nodules at a rate of 86.1%-100%, with a measurement variance of 2.1%-14.4% and a diagnostic accuracy for malignancy of 75%-91%, suggesting the potential for safe and effective lung cancer screening.

The use of artificial intelligence (AI) holds great promise for radiation oncology, with many applications being reported in the literature, including some of which are already in clinical use. These are mainly in areas where AI provides benefits in efficiency (such as automatic segmentation and treatment planning). Prediction models that directly impact patient decision-making are far less mature in terms of their application in clinical practice. Part of the limited clinical uptake of these models may be explained by the need for broader knowledge, among practising clinicians within the medical community, about the processes of AI development. This lack of understanding could lead to low commitment to AI research, widespread scepticism, and low levels of trust. This attitude towards AI may be further negatively impacted by the perception that deep learning is a "black box" with inherently low transparency. Thus, there is an unmet need to train current and future clinicians in the development and application of AI in medicine. Improving clinicians' AI-related knowledge and skills is necessary to enhance multidisciplinary collaboration between data scientists and physicians, that is, involving a clinician in the loop during AI development. Increased knowledge may also positively affect the acceptance and trust of AI. This paper describes the necessary steps involved in AI research and development, and thus identifies the possibilities, limitations, challenges, and opportunities, as seen from the perspective of a practising radiation oncologist. It offers the clinician with limited knowledge and experience in AI valuable tools to evaluate research papers related to an AI model application.

Objectives: To quantify the stage-shift with prostate-specific membrane antigen (PSMA) PET/CT imaging in metastatic prostate cancer and explore treatment implications.

Methods: Single-centre, retrospective analysis of patients with newly diagnosed [¹⁸F]PSMA-1007 or [⁶⁸Ga]Ga-PSMA-11 PET/CT-detected metastatic prostate cancer who had baseline bone scintigraphy between January 2015 and May 2021. Patients were subclassified into oligometastatic and polymetastatic disease utilizing the STAMPEDE2 trial (ISRCTN66357938/NCT06320067) definition. Patient, tumour, and treatment characteristics were collected. PSMA PET/CT concordance with conventional imaging (bone scintigraphy and low-dose CT of PET) was identified by number and site of metastases, and subgroup assigned. Spearman's rank correlation and linear regression modelling determined the association between the imaging modalities.

Results: We analysed 62 patients with a median age was 72 years (range 48-86). On PSMA PET/CT, 31/62 (50%) patients had oligometastatic disease, and 31/62 (50%) had polymetastatic disease. Prostate radiotherapy was delivered in 20/31 (65%) patients with oligometastatic disease and 17/31 (55%) with polymetastatic disease. 23/62 (37%) patients were reclassified as M0 on conventional imaging. PSMA PET/CT had a 2.9-fold increase in detecting bone metastases. Bone metastases concordance was found in 10/50 (20%) by number and 30/33 (91%) by site. PSMA PET/CT had a 2.2-fold increase in detecting nodal metastases. Nodal metastases concordance was found in 5/46 (11%) by number and 25/26 (96%) by site. There was significant positive correlation between PSMA PET/CT and conventional imaging for detecting bone [R ² = 0.25 (P < 0.001)] and nodal metastases [R ² = 0.19 (P < 0.001)]. 16/31 (52%) had oligometastatic disease concordance.

Conclusion: The magnitude of PSMA PET/CT-driven stage-shift is highly variable and unpredictable with implications on treatment decisions, future trial design, and potentially clinical outcomes.

Advances in knowledge: The magnitude of "frame-shift" with PSMA PET/CT imaging is highly variable and unpredictable which may unreliably change treatment decisions dependent on image-defined disease extent. Prospective randomized trials are required to determine the relationship between PSMA PET/CT-guided treatment choices and outcomes.