Head and Neck Diseases by Alexandros G.Sfakianakis: Imaging Unread articles

Τρίτη 14 Ιουνίου 2016

Imaging Unread articles

Mediators of Inflammation

Adrenal-Derived Hormones Differentially Modulate Intestinal Immunity in Experimental Colitis

Patrícia Reis De Souza, Helioswilton Sales-campos, Paulo José Basso, Viviani Nardini, Angelica Silva, Fernanda Banquieri, Vanessa Beatriz Freitas Alves, Javier Emílio Lazo Chica, Auro Nomizo, And Cristina Ribeiro De Barros Cardoso · Tuesday, June 14, 2016, 12:12

The adrenal glands are able to modulate immune responses through neuroimmunoendocrine interactions and cortisol secretion that could suppress exacerbated inflammation such as in inflammatory bowel disease (IBD). Therefore, here we evaluated the role of these glands in experimental colitis induced by 3% dextran sulfate sodium (DSS) in C57BL/6 mice subjected to adrenalectomy, with or without glucocorticoid (GC) replacement. Mice succumbed to colitis without adrenals with a higher clinical score and augmented systemic levels of IL-6 and lower LPS. Furthermore, adrenalectomy negatively modulated systemic regulatory markers. The absence of adrenals resulted in augmented tolerogenic lamina propria dendritic cells but no compensatory local production of corticosterone and decreased mucosal inflammation associated with increased IFN-γ and FasL in the intestine. To clarify the importance of GC in this scenario, GC replacement in adrenalectomized mice restored different markers to the same degree of that observed in DSS group. Finally, this is the first time that adrenal-derived hormones, especially GC, were associated with the differential local modulation of the gut infiltrate, also pointing to a relationship between adrenalectomy and the modulation of systemic regulatory markers. These findings may elucidate some neuroimmunoendocrine mechanisms that dictate colitis outcome.

Tags: Imaging

Mediators of Inflammation

Chemokines and Chemokine Receptors in the Development of Lupus Nephritis

Xiaofeng Liao, Tharshikha Pirapakaran, And Xin M. Luo · Tuesday, June 14, 2016, 12:12

Lupus nephritis (LN) is a major cause of morbidity and mortality in the patients with systemic lupus erythematosus (SLE), an autoimmune disease with damage to multiple organs. Leukocyte recruitment into the inflamed kidney is a critical step to promote LN progression, and the chemokine/chemokine receptor system is necessary for leukocyte recruitment. In this review, we summarize recent studies on the roles of chemokines and chemokine receptors in the development of LN and discuss the potential and hurdles of developing novel, chemokine-based drugs to treat LN.

Tags: Imaging

Journal of Medical Imaging and Radiation Oncology

No clinically relevant differences between positron emission tomography (PET) reconstructions based on low-dose or contrast-enhanced CT in combined integrated multiphase 18F-Fluorethylcholine PET/CT for prostate cancer

Florian F Behrendt, Carina Lensing, Sebastian Keil, Felix M Mottaghy, Frederik A Verburg · Tuesday, June 14, 2016, 7:14

Abstract

Objectives

To qualitatively and quantitatively compare the reconstructions of ¹⁸F-Fluorethylcholine (FCH) positron emission tomography (PET) based on the non-enhanced X-ray computed tomography (neCT) and contrast-enhanced CT (ceCT) acquired in integrated PET/CT in prostate cancer (PCA) patients.

Methods

We retrospectively analysed FCH-PET/CTs of 63 PCA patients. PET images were reconstructed using either neCT or ceCT for attenuation correction. Contrast-enhancement (HU) and mean and maximum standardised FDG uptake (SUVmean and SUVmax) were measured at eight anatomical sites, and PET images were evaluated for image quality and patient staging by two independent observers.

Results

At all anatomical sites the HU values were significantly higher in the ceCT than in the neCT. This in turn led to increases in SUVmean and SUVmax that, although small in both absolute and relative terms, were highly consistent and thus statistically highly significant. However, assessment of the FCH-PET images reconstructed using either neCT or ceCT revealed no differences between observers or reconstructions with regard to patient staging (all κ = 1.0: excellent agreement; P = 1.0). Minor visual differences without clinical relevance were seen in 21 scans by observer 1 and in 22 scans by observer 2 (κ = 0.68, P < 0.001).

Diffuse bone metastases on 68 Ga-PSMA PET-CT in a patient with prostate cancer and normal bone scan

Tuesday, June 14, 2016, 4:11

Abstract

A 75-year-old patient was diagnosed with a Gleason 9 prostate carcinoma. His PSA level was 50.4 ng/ml. Routine bone scintigraphy was negative for metastasis (a). Due to the high tumour grading and relatively high PSA level, ⁶⁸Ga-PSMA PET-CT was ordered to rule out distant metastases. This scan showed numerous skeletal lesions with high tracer accumulation as sign of diffuse osseous metastases (b). On low-dose CT there were no signs of sclerosis (c). ⁶⁸Ga-PSMA PET-CT also showed high uptake in the prostate and in para-iliac and para-aortal lymph nodes, without lymph node enlargement. No bone biopsy was obtained to confirm the metastases. Due to this result, the treatment plan was changed to systemic therapy, instead of local therapy.

Tags: Imaging

European Journal of Nuclear Medicine and Molecular Imaging

FDG PET/CT texture analysis for predicting the outcome of lung cancer treated by stereotactic body radiation therapy

Tuesday, June 14, 2016, 4:11

Abstract

Introduction

With ¹⁸F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether ¹⁸F-FDG uptake intensity, volume or heterogeneity could predict the outcome in patients with non-small cell lung cancers (NSCLC) treated by stereotactic body radiation therapy (SBRT).

Methods

Sixty-three patients with NSCLC treated by SBRT underwent a ¹⁸F-FDG PET/CT before treatment. Maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), as well as 13 global, local and regional textural features were analysed. The predictive value of these parameters, along with clinical features, was assessed using univariate and multivariate analysis for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Cutoff values were obtained using logistic regression analysis, and survivals were compared using Kaplan-Meier analysis.

Results

The median follow-up period was 27.1 months for the entire cohort and 32.1 months for the surviving patients. At the end of the study, 25 patients had local and/or distant recurrence including 12 who died because of the cancer progression. None of the clinical variables was predictive of the outcome, except age, which was associated with DFS (HR 1.1, P = 0.002). None of the ¹⁸F-FDG PET/CT or clinical parameters, except gender, were associated with OS. The univariate analysis showed that only dissimilarity (D) was associated with DSS (HR = 0.822, P = 0.037), and that several metabolic measurements were associated with DFS. In multivariate analysis, only dissimilarity was significantly associated with DSS (HR = 0.822, P = 0.037) and with DFS (HR = 0.834, P < 0.01).

Conclusion

The textural feature dissimilarity measured on the baseline ¹⁸F-FDG PET/CT appears to be a strong independent predictor of the outcome in patients with NSCLC treated by SBRT. This may help selecting patients who may benefit from closer monitoring and therapeutic optimization.

Tags: Imaging

European Journal of Nuclear Medicine and Molecular Imaging

Molecular imaging using PSMA PET/CT versus multiparametric MRI for initial staging of prostate cancer: comparing apples with oranges?

Tuesday, June 14, 2016, 4:11

Tags: Imaging

European Journal of Nuclear Medicine and Molecular Imaging

The reproducibility and prognostic value of serial measurements of heart rate response to regadenoson during myocardial perfusion imaging

Tuesday, June 14, 2016, 4:11

Abstract

Purpose

The heart rate response (HRR, percentage change from baseline) to regadenoson during myocardial perfusion imaging (MPI) can provide incremental prognostic value in patients with known or suspected coronary artery disease. Our purpose was to evaluate the variability and prognostic value of HRR on serial measurements.

Methods

We studied 648 consecutive patients (61 ± 11 years, 48 % with diabetes) who underwent two regadenoson MPI studies (16 ± 9 months between studies). HRR <30 % was defined as abnormal. All-cause mortality was determined by chart review and verified using the US Social Security Death Master File.

Results

Five recently published clinical trials showed dramatically higher rates of favorable functional outcome and a satisfying safety profile of endovascular treatment compared with the previous standard of care in acute ischemic stroke with proximal anterior circulation artery occlusion. Eligibility criteria within these trials varied by age, stroke severity, imaging, treatment-time window, and endovascular treatment devices. This focused review provides an overview of the trial results and explores the heterogeneity in imaging techniques, workflow, and endovascular techniques used in these trials and the consequent impact on practice. Using evidence from these trials and following a case from start to finish, this review recommends strategies that will help the appropriate patient undergo a fast, focused clinical evaluation, imaging, and intervention.

Tags: Imaging, Neurology

American Journal of Neuroradiology current issue

Radiation Dose Reduction by Indication-Directed Focused z-Direction Coverage for Neck CT [PEDIATRICS]

Parikh, A. K., Shah, C. C. · Monday, June 13, 2016, 23:11

BACKGROUND AND PURPOSE:

The American College of Radiology–American Society of Neuroradiology–Society for Pediatric Radiology Practice Parameter for a neck CT suggests that coverage should be from the sella to the aortic arch. It also recommends using CT scans judiciously to achieve the clinical objective. Our purpose was to analyze the potential dose reduction by decreasing the scan length of a neck CT and to assess for any clinically relevant information that might be missed from this modified approach.

MATERIALS AND METHODS:

This retrospective study included 126 children who underwent a neck CT between August 1, 2013, and September 30, 2014. Alteration of the scan length for the modified CT was suggested on the topographic image on the basis of the indication of the study, with the reader blinded to the images and the report. The CT dose index volume of the original scan was multiplied by the new scan length to calculate the dose-length product of the modified study. The effective dose was calculated for the original and modified studies by using age-based conversion factors from the American Association of Physicists in Medicine Report No. 96.

RESULTS:

Decreasing the scan length resulted in an average estimated dose reduction of 47%. The average reduction in scan length was 10.4 cm, decreasing the overall coverage by 48%. The change in scan length did not result in any missed findings that altered management. Of the 27 abscesses in this study, none extended to the mediastinum. All of the lesions in question were completely covered.

CONCLUSIONS:

Decreasing the scan length of a neck CT according to the indication provides a significant savings in radiation dose, while not altering diagnostic ability or management.

Tags: Imaging, Neurology

American Journal of Neuroradiology current issue

How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center [PEDIATRICS]

Tekes, A., Jackson, E. M., Ogborn, J., Liang, S., Bledsoe, M., Durand, D. J., Jallo, G., Huisman, T. A. G. M. · Monday, June 13, 2016, 23:11

BACKGROUND AND PURPOSE:

Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months.

MATERIALS AND METHODS:

We applied a Lean Six Sigma methodology using a multidisciplinary team at a quaternary care academic children's center. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system. Data collection continued postintervention and during the control phase (each for 3 months). The percentage of neuroimaging per technique (head CT, head ultrasound, ultrafast brain MR imaging, and routine brain MR imaging) was recorded during each phase.

RESULTS:

The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases (Z-test, P = .0001).

CONCLUSIONS:

Our lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders and increased use of ultrafast brain MR imaging.

Tags: Imaging, Neurology

American Journal of Neuroradiology current issue

Myelography CPT Coding Updates: Effects of 4 New Codes and Unintended Consequences [INTERVENTIONAL]

Chokshi, F. H., Tu, R. K., Nicola, G. N., Hirsch, J. A. · Monday, June 13, 2016, 23:11

SUMMARY:

The Current Procedural Terminology of the American Medical Association has recently introduced coding changes for myelography with the introduction of new bundled codes. The aim of this review was to help neuroradiologists understand these code changes and their unintended consequences and to discuss various scenarios in which permutations of various codes could occur in clinical practice.

Tags: Imaging, Neurology

American Journal of Neuroradiology current issue

Same-Day Sinus and Brain CT Imaging in the Medicare Population: Are Practice Patterns Changing in Association with Medicare Policy Initiatives? [ADULT BRAIN]

Kroll, H., Duszak, R., Hemingway, J., Hughes, D., Wintermark, M. · Monday, June 13, 2016, 23:11

BACKGROUND AND PURPOSE:

Monitoring the frequency of same-day sinus and brain CT (Outpatient Measure 14, "OP-14") is part of a recent large Centers for Medicare and Medicaid Services hospital outpatient quality initiative to improve imaging efficiency. This study investigates patient-level claims data in the Medicare population focusing on where same-day sinus and brain CT imaging is performed and how the frequency of same-day studies changed with time before and during OP-14 measure program implementation.

MATERIALS AND METHODS:

Research Identifiable Files were used to identify all sinus and brain CT examinations from 2004 through 2012 for a 5% random patient sample of Medicare fee-for-service beneficiaries. Overall and site of service use rates were calculated for same- and non-same-day examinations. Changes were mapped to policy initiative timetables.

RESULTS:

The number of same-day sinus and brain CT studies from 2004 to 2012 increased 67% from 1.85 (95% CI, 1.78–1.91) per 1000 Medicare beneficiaries in 2004 to 3.08 (95% CI, 3.00–3.15) in 2012. The biggest driver of increased same-day studies was the emergency department setting, from 0.56 (95% CI, 0.53–0.60) per 1000 to 1.78 (95% CI, 1.72–1.84; +215.7%). Overall use of brain CT from 146.0 (95% CI, 145.1–146.9) per 1000 to 176.3 (95% CI, 175.4–177.2; +21%) and sinus CT from 12.6 (95% CI, 12.4–12.8) per 1000 to 15.4 (95% CI, 15.2–15.6; +22%) increased until 2009 and remained stable through 2012.

CONCLUSIONS:

Previously increasing same-day sinus and brain CT in Medicare beneficiaries plateaued in 2009, coinciding with the implementation of targeted measures by the Centers for Medicare and Medicaid Services. Same-day imaging continues to increase in the emergency department setting.

Tags: Imaging, Neurology

American Journal of Neuroradiology current issue

We identified 12 patients representing 14 cases of Langerhans cell histiocytosis, and 9 patients representing 9 cases of rhabdomyosarcoma. For patients with Langerhans cell histiocytosis, mastoid involvement was rated 23/28 (82%) compared with 6/18 (33%) with rhabdomyosarcoma (P = .001). Langerhans cell histiocytosis was present in only the anterior portion of the temporal bone (petrous apex and middle ear) in 1 case (7.1%) and in the anterior portion of the temporal bone only in 5/9 (55%) cases of rhabdomyosarcoma (P = .018). The cortical bone was more commonly involved in Langerhans cell histiocytosis, 11/28 (39%) of cases compared with 2/18 (11%) cases in rhabdomyosarcoma (P < .05).

CONCLUSIONS:

These results indicate that lesions involving only the anterior portion of the temporal bone (petrous apex and middle ear) are more likely to be rhabdomyosarcoma. Lesions involving the mastoid are more likely to be Langerhans cell histiocytosis. This difference in primary location may be helpful in predicting the pathology of these lesions on the basis of imaging.

Tags: Imaging, Neurology

Clinical Imaging

Isolated fallopian tube torsion: two case reports of a rare entity

Monday, June 13, 2016, 21:12

Seki, H., Ohi, H., Ozaki, T., Yabusaki, H. · Monday, June 13, 2016, 19:59

Background

For patients with liver metastases from gastric cancer (LMGC), combination chemotherapy with fluoropyrimidines and platinum agents has been recognized as standard treatment. However, the prognosis of hepatic progression after first-line treatment failure remains poor. When hepatic progression occurs, hepatic arterial infusion (HAI) chemotherapy may be helpful for preventing disease progression.

Purpose

To retrospectively assess the feasibility and efficacy of HAI chemotherapy using 5-fluorouracil, epirubicin, and mitomycin C (FEM) for patients with LMGC after failure of systemic S-1 plus cisplatin.

Material and Methods

We reviewed the records of patients who received HAI chemotherapy using FEM for LMGC that progressed during systemic S-1 plus cisplatin treatment while extrahepatic disease was decreased or did not appear. HAI chemotherapy was given as second-line therapy using 5-fluorouracil (330 mg/m² weekly), epirubicin (30 or 40 mg/m² every 4 weeks), and mitomycin C (2.7 mg/m² biweekly).

Results

Fourteen patients were analyzed. Toxicity of HAI chemotherapy was generally mild. The objective response rate was 42.9%, including a complete response rate of 14.3%. Median times to hepatic and extrahepatic progression were 9.2 and 7.4 months, respectively. Of 12 patients with documented progression after HAI chemotherapy, 10 patients (83.3%) received additional treatment, including irinotecan or taxanes. Overall, median survival was 12.7 months.

Conclusion

Our findings suggest that HAI chemotherapy using FEM is a feasible and effective treatment for patients with LMGC after failure of systemic S-1 plus cisplatin. HAI chemotherapy employed in the second-line setting is useful for achieving long-term disease control of LMGC.

Tags: Imaging

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Τρίτη 14 Ιουνίου 2016

Imaging Unread articles

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