Evaluation of shortened protocol of graph plot method with ¹²³I-IMP

The (123)I-IMP Graph Plot is a convenient method of analyzing cerebral blood flow without blood sampling. Data acquisition requires 45 minutes after the infusion of (123)I-IMP because the method is matched to the protocol of autoradiography (conventional method). However, we think that those protocols do not have to be matched because those theories are different. Therefore, we contrived a protocol for shortening that time by beginning SPECT data acquisition earlier and shortening the acquisition time compared to the conventional method. We compared count ratios of the decreased area to an area of the healthy side, quantitative values, and results of statistical analysis of the shortened protocol and the conventional method for cases of cerebral infarction and of dementia with Lewy bodies (DLB). Some count ratios of the shortened protocol were inferior to those of the conventional method, but the degrees did not affect the clinical diagnosis. In the other areas and cases also, the differences did not affect the clinical diagnosis. In addition to the results of this study, some previous reports have described that early SPECT images after infusion show the true cerebral blood flow. Therefore, we judged that this shortened protocol can be used as a clinical protocol.     

Elite athletes with COVID-19 — Predictors of the course of disease

ObjectivesThe aim of the study was to identify predictors determining the course of COVID-19 and antibody response in elite athletes.DesignObservational study.MethodsRoutine medical screening with physical examination, resting ECG, and laboratory tests including antibody response was performed 12–68 days after the diagnosis of COVID-19 in 111 athletes of different sports.ResultsClinical symptoms were observed in 84% of subjects. The severity of COVID-19 was mild in 82% of athletes and moderate in 2% of cases. Athletes aged above 26 and male were more likely to develop symptomatic COVID-19. Asymptomatic subjects were younger and predominantly female. In 18% of subjects, symptoms were still present 20 (12–68) days (median and range) since positive diagnosis. Antibody response was observed in 88% of athletes, and its magnitude correlated with time since diagnosis of COVID-19 (RT-PCR), fatigue, fever, and conjunctivitis. There were no differences in antibody response between groups distinguished by sports discipline (p = 0.50), and sex (p = 0.59), and antibody response did not correlate with BMI (p = 0.12), age (p = 0.13), the number of symptoms (p = 0.43) or their duration (p = 0.19).ConclusionsThe severity of COVID-19 in elite athletes is predominantly mild and without complications. Athletes can return to sport after two symptom-free weeks and additional heart screening is usually not required. Determination of antibodies has been shown to be a useful indicator of a previous COVID-19 disease, and some symptoms can be used as predictors of antibody response.     

Quantification of liver iron content with CT��added value of dual-energy

Objective  

To evaluate the value of dual-energy CT (DECT) with use of an iron-specific, three-material decomposition algorithm for the quantification of liver iron content (LIC).     

Critical appraisal of volumetric-modulated arc therapy compared with electrons for the radiotherapy of cutaneous Kaposi’s sarcoma of lower extremities with bone sparing

Objective:

To evaluate the use of volumetric-modulated arc therapy [VMAT, RapidArc® (RA); Varian Medical Systems, Palo Alto, CA] for the treatment of cutaneous Kaposi’s sarcoma (KS) of lower extremities with adequate target coverage and high bone sparing, and to compare VMAT with electron beam therapy.

Methods:

10 patients were planned with either RA or electron beams. The dose was prescribed to 30 Gy, 10 fractions, to mean the planning target volume (PTV), and significant maximum dose to bone was limited to 30 Gy. Plans were designed for 6-MV photon beams for RA and 6 MeV for electrons. Dose distributions were computed with AcurosXB® (Varian Medical Systems) for photons and with a Monte Carlo algorithm for electrons.

Results:

V_90% was 97.3±1.2 for RA plans and 78.2±2.6 for electrons; similarly, V_107% was 2.5±2.2 and 37.7±3.4, respectively. RA met coverage criteria. Concerning bone sparing, D_2% was 29.6±1.1 for RA and 31.0±2.4 for electrons. Although acceptable for bone involvement, pronounced target coverage violations were obtained for electron plans. Monitor units were similar for electrons and RA, although for the latter they increased when superior bone sparing was imposed. Delivery times were 12.1±4.0 min for electrons and 4.8±1.3 min for the most modulated RA plans.

Conclusion:

High plan quality was shown for KS in the lower extremities using VMAT, and this might simplify their management in comparison with the more conventional usage of electrons, particularly in institutes with limited staff resources and heavy workloads.

Advances in knowledge:

VMAT is also dosimetrically extremely advantageous in a typology of treatments where electron beam therapy is mainly considered to be effective owing to the limited penetration of the beams.Kaposi’s sarcoma (KS) is frequently demonstrated in patients infected by human immunodeficiency virus (HIV)([1], epidemic form) and can be manifested in the mouth, lymphatic system, gastro-intestinal system, lungs and skin. KS can be considered as generally responsive to radiation therapy, and good palliative (and cosmetic) results were demonstrated with doses higher than 20 Gy [2–4]. In 1996, Stein et al [5] demonstrated that, in South Africa, all types of KS were present and that response rates as high as 90% were achieved for the epidemic form. In addition, the study proved that radiation therapy allowed better symptomatic control than chemotherapy. The randomised trial of Singh et al [4] demonstrated the feasibility of hypofractionation in terms of recurrence-free survival, toxicity and local control. Even a single fraction of 8 Gy [6, 7] showed to be feasible in patients with limited median life expectancy. Conill et al [8] suggested that the range from 8 Gy in a single fraction to 30 Gy in ten fractions, tailored to individual patient needs, permits the achievement of local control with minimal toxicity. Although conventional photon therapy can be applied to most of the cases, for cutaneous lesions, electron beam therapy is considered to be effective because of the limited penetration of the beams, and it would also allow the risk of radiation-induced oedema of the legs as a consequence of reduced lymphatic drainage to be minimised. Geara et al [9] showed that, with electrons of 4–8 MeV, the main toxicity was dry epidermitis with limited frequency of skin ulcerations. The obvious limit of electrons is that when extensive KS is treated, the large number of treatment fields necessary to cover the target and the complex positioning of the same lead to very long treatment times and risk of under- or overirradiation of the skin (when field matching is needed and because of the convexity of the target), requiring very careful patient positioning procedures. In busy clinics with heavy patient loads, the usage of electrons for cutaneous KS could therefore be problematic for a smooth workflow.RapidArc® (RA; Varian Medical Systems, Palo Alto, CA) is a relatively new volumetric-modulated arc therapy (VMAT) technique based on simultaneous optimisation of the multileaf collimator (MLC) shape, dose rate and gantry rotation speed [10]. The technology was investigated in several studies, showing a general improvement in organs at risk and healthy tissue sparing, similarly good target coverage, reduced beam-on time and lower number of monitor units (MUs) compared with other intensity-modulated radiotherapy approaches with fixed gantry entrances. Many indications can benefit from the RA technology, and, regarding sarcomas, little has been published to date. Llacer-Moscardo et al [11] investigated the potential of this VMAT approach for huge retroperitoneal sarcoma, this being the seminal study for the application of the new treatment technique to this class of tumours. A more recent study [12] assessed the positive role of RA in the case of soft-tissue sarcoma in the legs with the possibility of significantly sparing the femurs. Given the anatomical analogy, a similar planning approach was mimicked in the present study, with the main difference given by the fact that, here, target volumes are extended over the entire lower legs but are limited to a relatively superficial layer. In this context, the role of RA for superficial targets has not been extensively studied. An investigation [13] demonstrated that, with the first generation of the optimisation engine, it was possible to achieve the desired target homogeneity using multiple arcs. In that study, the clinical case (a paediatric brain tumour) was quite different from the problem under investigation here, but it was encouraging as a proof of principle.The aim of this work is to present a comparative planning study on a group of patients to be treated for cutaneous KS of the lower extremities, comparing dose distributions achieved with RA against the more conventional approach based on electron fields. The planning challenge was to achieve a high degree of bone and normal tissue sparing to minimise the risk of fractures and other disease-related morbidities, which prevented the use of simple and straightforward techniques such as opposed photon fields. In addition to dosimetric plan quality, treatment efficiency was also scored. This was mostly determined by treatment time, and was assessed to clarify the possibility of using a high technology treatment modality like RA in institutes with limited staff resources and heavy patient load, as in Africa.     

Striated abrasions from a knife with non-serrated blade—identification of the instrument of crime on the basis of an experiment with material evidence

This paper presents an experiment with a knife seized as material evidence in a homicide case. The reason for the experiment was the necessity to determine whether the injuries of the deceased could have been inflicted with this instrument since in the course of the investigation doubt arose as to the origin of linear, parallel scratches around one of the wounds and on the abdominal integuments suggesting a serrated blade. The knife found near the crime scene had a smooth blade and small serrations only on the borderline between its blade and hilt. However, the performed experiment showed that if the knife is directed towards the integuments of the body in a special way, its serrations, even though not located on the blade itself, may leave such striated marks on the body, as those found during the autopsy, suggesting their origin from a serrated blade.     

Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

Objectives

To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome.

Method and Materials

Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n?=?4), small (n?=?68) and/or large bowel (n?=?96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome.

Results

The most frequent cause of PI was intestinal ischemia (n?=?80,53.7 %), followed by infection (n?=?18,12.1 %), obstructive (n?=?12,8.1 %) and non-obstructive (n?=?10,6.7 %) bowel dilatation, unknown aetiologies (n?=?8,5.4 %), drugs (n?=?8,5.4 %), inflammation (n?=?7,4.7 %), and others (n?=?6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n?=?62), mostly related to intestinal ischemia (p?=?0.003). Associated PMVG significantly correlated with underlying ischemia (p?=?0.009), as did the anatomical distribution of PMVG (p?=?0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p?<?0.001). Elevated white blood count significantly correlated with ischemia (p?=?0.03).

Conclusion

In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia.

Key Points

? In emergency patients, PI may be caused by various disorders.? Intestinal ischemia remains the most common cause of PI in acute situations.? PI associated with decreased mural contrast-enhancement indicates acute intestinal ischemia.? PI associated with PMVG should alert the radiologist to possible underlying ischemia.

     

Does the accuracy of single reading with CAD (computer-aided detection) compare with that of double reading?: A review of the literature

AIM: To examine current evidence to determine whether the accuracy of single reading with computed-aided detection (CAD) compares with that of double reading. METHODS: We performed a literature review to identify studies where both protocols had been investigated and compared. We identified eight studies that compared single reading with CAD against double reading, of which six reported on comparisons of both sensitivity and specificity. RESULTS: Of the six studies identified, three showed no differences in either sensitivity or specificity. One showed single reading with CAD had a higher sensitivity at the same specificity, another that single reading with CAD had a higher specificity at the same sensitivity. However, one study, in a real-life setting, showed that single reading with CAD had a higher sensitivity but a lower specificity. CONCLUSION: As the majority of the studies were not in a real-life setting, used test sets, lacked sufficient training in the use of CAD and simulated double reading (using a protocol of recall if one suggests), current evidence is therefore limited as to the accuracy, in terms of sensitivity and specificity, of single reading with CAD in comparison with the most common practice in the UK of double reading using a protocol of consensus or arbitration.     

Successful treatment of a rare case of ameloblastic fibrosarcoma with radiation therapy

Sarcomas are rare diseases of the head and neck region, representing around 1% of all malignancies. Amongst them, ameloblastic fibrosarcoma (AFS) is of even greater rarity, with less than 100 cases reported in the literature. Consequently, no standard treatment or guidelines have been made available. Surgery is often performed as primary therapy, but may be limited due to anatomical or functional reasons. We present a case of AFS successfully treated by postoperative radiation therapy. A detailed case study is provided, followed by a review of the English-language literature focusing on the role of radiation therapy.     

Diagnosis of bone metastasis with whole body MRI?

Ohne Zusammenfassung     

MRI of cortical dysplasia – correlation with pathological findings

Cortical dysplasia (CD) is the most epileptogenic structural lesion associated with epilepsy and patients with intractable seizures caused by this condition are good surgical candidates. MRI plays an important role in detecting the abnormalities of CD. We clarified the MRI characteristics of CD by comparing imaging and histological findings in 20 patients with intractable seizures who underwent surgical resection. There were 12 males and eight females, mean age at operation was 15 years. MRI was performed at 1.5 tesla; T1-weighted, T2- and proton density-weighted spin-echo and fluid-attenuated inversion-recovery (FLAIR) images were obtained. The lesions were in the frontal lobe in nine cases, temporal in two, occipital in another two, insular in one and multilobar in six. Blurring of the grey/white matter junction was seen in all patients, and T2 prolongation in white matter and/or at the grey/white matter junction in 19. Abnormal signal intensity was more frequent in the white matter or at the grey/white matter junction than in the grey matter. FLAIR images made this abnormal high signal easier to appreciate, and we thought them very useful in this context. In areas of T2 prolongation, we saw dysplastic neurones and/or balloon cells, dysmyelination, and ectopic neuronal clustering histologically; glial proliferation played an important role in prolonging T2. Received: 24 November 2000/Accepted: 6 February 2001     

Usefulness of whole PTH assay in patients with renal osteodystrophy —Correlation with bone scintigraphy

OBJECTIVE: Intact parathyroid hormone (PTH) assay has recently been reported to be effective in evaluating both 1-84 PTH (whole PTH) and inactive 7-84 PTH. Inactive 7-84 PTH is considered to be increased in hemodialysis patients and to prevent the effects of 1-84 PTH, and intact PTH is considered to overestimate the PTH activity in these patients. As such, a whole PTH assay has recently been developed. The purpose of this study was to examine the usefulness of a whole PTH assay using the bone to soft tissue (B/ST) ratio on bone scintigraphy. METHOD: Twenty-five hemodialysis patients were included in our study. In all patients, bone scintigraphy and a blood test [whole PTH, intact PTH, alkaline phosphatase (ALP), calcium (Ca), and phosphorus (P)] were performed. Regions of interest (ROIs) were drawn around the cranium, lumbar vertebrae, left femoral neck, and soft tissue of the medial left thigh to obtain the B/ST ratio. RESULTS: The B/ST ratio of the cranium and left femoral neck correlated with whole PTH and intact PTH. In particular, the B/ST ratio of the cranium correlated most significantly with the value of whole PTH. Whole PTH levels correlated with intact PTH levels (r = 0.891, p < 0.0001). CONCLUSION: Our data indicate that a whole PTH assay may be useful in evaluating PTH activity using the B/ST ratio. The B/ST ratio of the cranium may reflect the bone metabolism of hemodialysis patients.     

Is Grading of Breast Fibrosis with Mammography Feasible?

PURPOSE: To establish a grading system for mammographic fibrosis and correlate it with clinical fibrosis. PATIENTS AND METHODS: Analogous to the LENT/SOMA scale a four-tiered scoring scale of breast fibrosis in mammography (G0 = absent, G1 = barely increased density, G2 = definitely increased density to G3 = very marked density) was established by two observers in a group of 16 patients. Reference mammograms were selected. Independently and blinded to clinical results, three observers scored the fibrosis in mammograms of further 31 patients examined by one radiation oncologist in a cross-sectional follow-up study. Pretreatment parenchyma density was judged according to the American College of Radiology (ACR). Interobserver correlation of mammography scoring as well as correlation of mammography and clinical findings were calculated with Cohen's weighted kappa. All patients had breast-conserving surgery and axillary resection for breast carcinoma T1-2N0-1. The breast was irradiated to a median reference dose of 55 Gy (range 50-60 Gy) with 2 Gy five times weekly or 2.5 Gy four times weekly. Two patients received chemotherapy, 14 patients tamoxifen. Median age was 55 years, median follow-up 8 years (4-15 years). RESULTS: 14 of 31 patients had clinical fibrosis, twelve G1 and two G2. In mammography, mild fibrosis (G1) was seen in 12/12/18 patients (observer 1/2/3) and moderate fibrosis (G2) in 9/10/2 patients. Interobserver correlation for observers 1 and 2 who had developed the score was fair (Cohen's weighted kappa 0.64, 95% confidence interval 0.4-0.88). However, it was weak for observer 3 (0.36 and 0.42, respectively) who relied on reference mammograms only. Independent interobserver correlation of pretreatment breast density was good for all observers (Cohen's weighted kappa 0.73-0.8). The correlation of fibrosis by mammography and palpation was weak (Cohen's weighted kappa 0.32-0.42). CONCLUSION: Grading fibrosis as depicted by mammography is possible, especially if observers prepare by jointly analyzing a training group. It may be useful to study treatment effects, e. g., of fractionation or drugs, because retrospective and repeated analysis is possible. The correlation of mammography with clinical grading should be further evaluated with more objective clinical reference tools.     

Proton therapy of iris melanoma with 50 CGE

Purpose

The aim of this study was to evaluate local tumour control, incidence of radiation-induced glaucoma and associated interventions of sector-based and whole anterior segment proton beam therapy (PBT) for the treatment of iris melanoma.

Patients and methods

We retrospectively analysed the data of 77 patients with iris melanoma who underwent PBT applied as 50 CGE in four daily fractions. Of the patients, 47 received PBT with a circular-shaped collimator and 30 with a conformal sector-shaped target volume. Local control, eye preservation and secondary glaucoma were evaluated.

Results

Median follow-up time was 54.9 months. Local tumour control was 100% in patients receiving whole anterior segment irradiation. Two patients developed pigment dispersion in the non-irradiated area after sector-based PBT and received whole anterior segment salvage PBT. The mean volume of ciliary body irradiated was 89.0% and 34.9% for whole anterior segment and lesion-based irradiation, respectively. At the end of follow-up, secondary glaucoma was found in 74.3% of the patients with whole anterior segment irradiation and in 19.2% with sector-based irradiation. Patients with sector-based PBT had a stable visual acuity of logMAR 0.1, while it declined from logMAR 0.1 to 0.4 after whole anterior segment irradiation.

Conclusion

We found a significant reduction in radiation-induced secondary glaucoma and glaucoma-associated surgical interventions and stable visual acuity after sector-based irradiation compared with whole anterior segment irradiation. Sector-based irradiation revealed a higher risk for local recurrence, but selected patients with well-circumscribed iris melanoma benefit from applying a lesion-based target volume when treated with sector-based PBT.

     

The effect of short-term treatment with lithium carbonate on the outcome of radioiodine therapy in patients with long-lasting Graves’ hyperthyroidism

Objective

The outcome of radioiodine therapy (RIT) in Graves’ hyperthyroidism (GH) mainly depends on radioiodine (¹³¹I) uptake and the effective half-life of ¹³¹I in the gland. Studies have shown that lithium carbonate (LiCO₃) enhances the ¹³¹I half-life and increases the applied thyroid radiation dose without affecting the thyroid ¹³¹I uptake. We investigated the effect of short-term treatment with LiCO₃ on the outcome of RIT in patients with long-lasting GH, its influence on the thyroid hormones levels 7 days after RIT, and possible side effects.

Methods

Study prospectively included 30 patients treated with LiCO₃ and ¹³¹I (RI-Li group) and 30 patients only with ¹³¹I (RI group). Treatment with LiCO₃ (900 mg/day) started 1 day before RIT and continued 6 days after. Anti-thyroid drugs withdrawal was 7 days before RIT. Patients were followed up for 12 months. We defined a success of RIT as euthyroidism or hypothyroidism, and a failure as persistent hyperthyroidism.

Results

In RI-Li group, a serum level of Li was 0.571?±?0.156 mmol/l before RIT. Serum levels of TT₄ and FT₄ increased while TSH decreased only in RI group 7 days after RIT. No toxic effects were noticed during LiCO₃ treatment. After 12 months, a success of RIT was 73.3% in RI and 90.0% in RI-Li group (P?<?0.01). Hypothyroidism was achieved faster in RI-Li (1st month) than in RI group (3rd month). Euthyroidism slowly decreased in RI-Li group, and not all patients became hypothyroid for 12 months. In contrast, euthyroidism rapidly declined in RI group, and all cured patients became hypothyroid after 6 months.

Conclusion

The short-term treatment with LiCO₃ as an adjunct to ¹³¹I improves efficacy of RIT in patients with long-lasting GH. A success of RIT achieves faster in lithium-treated than in RI group. Treatment with LiCO₃ for 7 days prevents transient worsening of hyperthyroidism after RIT. Short-term use of LiCO₃ shows no toxic side effects.

     

High-intensity interval training with probiotic supplementation decreases gene expression of NF-κβ and CXCL2 in small intestine of rats with steatosis

Sport Sciences for Health - The aim of this study was to investigate the effects of high-intensity interval training (HIIT) with probiotic supplementation (Lactobacillus rhamnosus GG) on gene...     

An In Vitro Evaluation of Four Types of Drug-Eluting Embolics Loaded with Idarubicin

PurposeThis study compared loading, elution, and stability of drug-eluting embolic beads (DEBs) loaded with idarubicin.Materials and MethodsDC Bead (100–300 μm), HepaSphere (30–60 μm), LifePearl (200 μm), and Tandem (100 μm) DEBs were loaded with 5 mg/mL idarubicin. Loading, elution, diameter changes, loading stability over 2 weeks in storage, and time in suspension were determined for each of the DEBs.ResultsLoading of more than 99% of idarubicin was achieved within 15 minutes for LifePearl, DC Bead, and Tandem beads. LifePearl, DC Bead, HepaSphere, and Tandem beads eluted 75% of the total idarubicin released in 13, 24, 42, and 91 minutes, respectively. In vitro elution was completed in 2 hours with 73% ± 3%, 74% ± 3%, 65% ± 6%, and 7% ± 0% of the loaded idarubicin eluted for LifePearl, DC Bead, HepaSphere, and Tandem, respectively. Statistically significant differences were observed at every time point between at least 2 of the products. Overall, in vitro idarubicin elution was rapid and nearly complete for LifePearl, DC Bead, and HepaSphere beads but was minimal and slow from Tandem beads. The average diameter of DEBs after loading was reduced by 5% for LifePearl, whereas it was increased by 9% and 1% for DC Bead and Tandem, respectively. After loading, time in suspension was 11 ± 4 and 10 ± 2 minutes for LifePearl and HepaSphere, respectively, whereas DC Bead and Tandem beads were held in suspension for greater than 20 minutes.ConclusionsAlthough all 4 DEBs loaded idarubicin within 15 minutes with minimal changes in diameter, the elution amounts, rates of release, and time in suspension varied.     

An unusual case of Erdheim–Chester disease with features of Langerhans cell histiocytosis

Erdheim–Chester disease (ECD) and Langerhans cell histiocytosis (LCH) are both exceedingly rare histiocytic proliferations that can involve the skeletal system. We report on a case of ECD with some features suggestive of LCH. Radiographs demonstrated a large lytic lesion in the left femur, with multiple lesions of sclerosis involving both distal femurs and tibias. Both the lytic lesion and a sclerotic lesion were biopsied and demonstrated distinctive histologic features characteristic of ECD in the tibia and features of LCH in the femur. The clinical/radiologic and pathologic features that distinguish ECD and LCH as distinct entities are reviewed, and the underlying biological connection between them is discussed.     

The Role of Platelet Activating Factor in the Hemodynamic Disorders of Rabbits with Endotoxemia

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