Clinical relevance of left ventricular volume assessment by gated myocardial SPET in patients with coronary artery disease

Coronary artery disease (CAD) is the leading cause of mortality in the Western world. Multiple parameters have been investigated to predict prognosis in CAD patients. The prognostic value of the left ventricular ejection fraction (LVEF) in patients with CAD is well established. More recently, left ventricular (LV) volumes have also shown prognostic value. Due to the favourable imaging characteristics of technetium-99m (high count density), the development of (99m)Tc-labelled myocardial perfusion tracers has made it possible to perform an electrocardiogram-gated acquisition during routine myocardial perfusion imaging. This enables assessment of LVEF and LV volumes during myocardial perfusion scintigraphy. This review considers the possible prognostic abilities of LV volume assessment by gated cardiac SPET.     

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

The concept of neovascularization in tendinopathy seems to have gained nearly mythological proportions and quasi-religious state: it is considered of diagnostic and prognostic value, related to clinical outcome, and the exclusive target of some therapeutic interventions. However, we question whether these assumptions are based on scientific evidence, and we come to the conclusion that, in the light of recent well-performed research, it seems that detecting neovessels has no additional value for the diagnosis, no firmly confirmed prognostic value, and no proven relation with symptoms. The role of neovascularization in this field should be re-thought. Level of evidence V.     

MR image phenotypes may add prognostic value to clinical features in IDH wild-type lower-grade gliomas

European Radiology - To identify significant prognostic magnetic resonance imaging (MRI) features and their prognostic value when added to clinical features in patients with isocitrate...     

Confirmation of the early prognostic value of bone scanning and pinhole imaging of the hip in Legg-Calvé-Perthes disease.

In about half of all patients with Legg-Calvé-Perthes disease (LCP), severe hip disorders that could be prevented by early surgery will develop. A prognostic test for this complication is also needed as part of routine care to help the surgeon manage LCD. The purpose of this study was to confirm the prognostic value of the bone scanning and pinhole imaging of the hip in LCP that Conway's group proposed in 1997 and to define accurate prognostic scintigraphic patterns. METHODS: Fifty-eight patients with LCP were recruited at initial presentation and followed for 1 y. Each patient underwent bone scanning initially and after 5, 8, and 12 mo of disease. The severity of the disease was assessed by radiography (the Catterall classification), MRI, and arthrography. Retrospectively, initial scintigraphic findings were correlated with severity. RESULTS: Among the 60 hips studied (2 patients had bilateral disease), severe hip disorders developed in 36. The positive predictive value of the scintigraphic classification proposed by Conway's group was 97% for the B pathway (absence of lateral column formation) and 85% for the A pathway (presence of lateral column formation). The hyperactivity of the metaphyseal growth plates was a sign of poor prognosis. The sensitivity was only 33%, but the positive predictive value was 92%. This prognostic information was obtained in as few as 5 mo after initial presentation. CONCLUSION: This study confirms the high prognostic value of bone scanning in LCP as reported by Conway's group not only in terms of the accuracy of the classification but also in terms of the short time in which the prognostic information can be obtained. Thus, we propose that bone scanning be used as part of routine care for the management of LCP.     

CT findings in retinoblastoma.

Computed tomographic (CT) findings in 38 patients with surgically proven retinoblastomas are described. CT is of value in accurately and rapidly assessing the extraocular and intracranial spread of clinically diagnosed retinoblastomas. This information is of prognostic value as patients with tumors that have spread beyond the confines of the globe have a life expectancy of only a few months. Calcification was present in 11 of 23 tumors confined to the globe, but was seen in only two of 15 tumors that had extended beyond the globe. Therefore, the presence of calcification may be a favorable prognostic sign.     

Preoperative CT examination for staging of mediastinal lymph-nodes in patients with (operable) non-small cell lung cancer

In a prospective study of 100 and a retrospective study of 90 patients with non small cell lung cancer, the usefulness of CT in the preoperative staging of mediastinal lymph nodes was examined. The long-term prognostic value of CT was also investigated. Our results suggest that, using 1.5 cm as a criterion of size for malignancy, CT can be useful in the selection of patients for mediastinoscopy. CT can always help the surgeon in the mediastinal exploration but the long-term prognostic value is limited after the surgical-pathologic diagnosis has been made.     

The value of arteriography in the management of aneurysmal bone cyst

The value of arteriography in the management of aneurysmal bone cyst is demonstrated in three cases in which the most vascular area of the tumor was the earliest and/or only one to recur. The prognostic value of arteriography is postulated.     

FDG PET/CT and diffusion-weighted imaging for breast cancer: prognostic value of maximum standardized uptake values and apparent diffusion coefficient values of the primary lesion

Purpose  

To correlate both primary lesion ¹⁸F-fluorodeoxyglucose (FDG) maximum standardized uptake value (SUVmax) and diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) with clinicopathological prognostic factors and compare the prognostic value of these indexes in breast cancer.     

PET/CT与临床预后因素在弥漫大B细胞淋巴瘤疗效评价及预后评估中的应用

弥漫大B细胞淋巴瘤（DLBCL）是最常见的侵袭性非霍奇金淋巴瘤（NHL）。应用美罗华联合环磷酰胺、阿霉素、长春新碱、甲泼尼龙化疗方案后,DLBCL患者的治愈率可达60%~80%。由于DLBCL在分子病理等方面具有明显的异质性,不同患者的疗效和预后不同,因此如何正确评价其疗效及预后是目前研究的热点。18F-FDG PET/CT是DLBCL患者常用的疗效评价及预后评估的影像学工具。国际预测预后指数（IPI）以及美国国立综合癌症网络-国际预后指标（NCCN-IPI）是广泛应用于临床的恶性淋巴瘤预后评分系统。近年来,一些新的临床及分子病理因素的预后价值也先后被探索。笔者将对PET/CT、临床预后评分系统、不同的临床及分子病理预后因素在DLBCL患者的疗效评价及预后评估中的应用、研究进展以及发展趋势进行综述。     

Systematic review of the prognostic effectiveness of SPECT myocardial perfusion scintigraphy in patients with suspected or known coronary artery disease and following myocardial infarction

OBJECTIVES: In patients with suspected or known coronary artery disease (CAD), or following myocardial infarction (MI), assessing the degree of ischaemia is important from a prognostic and therapeutic point of view. Single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) is a non-invasive technique that allows the presence, location and extent of ischaemia to be determined. The aim of this systematic review was to assess the prognostic effectiveness of SPECT MPS. METHODS: We sought prognostic studies involving SPECT, exercise tolerance testing (ETT) and/or coronary angiography (CA) in people with suspected or known CAD, or following MI. Outcomes included cardiac death, non-fatal MI and revascularization. We searched the following databases: MEDLINE, PREMEDLINE, EMBASE, BIOSIS, Science Citation Index, the Cochrane Library, the Health Management Information Consortium and the Health Technology Assessment Database. RESULTS: Twenty-one observational studies enrolling 53,762 people reported the general prognostic value of SPECT MPS. In multivariate analysis, SPECT MPS variables yielded both independent and incremental value to combinations of clinical, ETT and angiographic variables in predicting cardiac death or non-fatal MI. Three comparative studies reported lower revascularization rates following a SPECT MPS-CA strategy (6-21%) compared with direct CA (16-44%). Four observational studies enrolling 2106 people reported the prognostic value of SPECT for patients following MI. In multivariate analysis including clinical history, ETT, SPECT MPS and angiographic variables, strategies involving SPECT MPS provided independent and incremental prognostic performance in predicting future cardiac events. CONCLUSIONS: SPECT MPS provides important additional information to that from ETT and/or CA that helps to risk-stratify patients with suspected or known CAD or following MI, enabling them to be managed more appropriately. Increasing the use of strategies involving SPECT MPS may identify lower risk patients for whom invasive CA might be avoided.     

Hodgkin's disease: a quantitative evaluation by computed tomography of tumor burden

A direct method for the evaluation by computed tomography (CT) of the neoplastic mass (tumor burden [TB]) has been adopted in 34 patients diagnosed with Hodgkin's disease in the early stage. Stressed are its prognostic value, and its correlation with the clinical and laboratory parameters usually adopted in the staging of the disease and in its follow-up. It is concluded that the CT-calculated TB is a reliable index showing good correlation with other commonly used prognostic parameters.     

3种血清肿瘤标记物在判断非小细胞肺癌患者预后中的价值

 目的 分析血清MMP-9、endostatin、VEGF水平及临床因素对非小细胞肺癌患者预后的意义.方法 根据112例非小细胞肺癌患者的临床及随访资料,采用Kaplan Meier和Cox模型回归法,分析非小细胞肺癌患者的预后影响因素,包括临床常规因素和基质金属蛋白酶9(MMP-9)、血管内皮生长因子(VEGF)和内皮抑素(ES)等3种肿瘤标记物.结果 单因素分析显示,血清MMP-9、ES水平高低与预后有关,同时男性,PS评分≥3分,临床分期晚,未行系统治疗的患者预后较差.多因素分析表明,治疗前血清MMP-9水平、临床分期、是否行系统治疗是预后的独立影响因素.结论 非小细胞肺癌患者治疗前血清MMP-9水平是预后的独立影响因素,检测治疗前血清MMP-9水平对于临床估计非小细胞肺癌患者预后有着重要意义.     

QCT定量评估癌症病人身体组分的应用进展

癌症病人身体组分定量对其预后评估和指导临床干预至关重要。定量CT（QCT）可在提供常规的影像诊断信息同时,定量反映骨密度和肌肉、脂肪含量,现已逐步应用于癌症病人的综合营养状况评估、恶病质诊断和预后风险评估等方面。就QCT在癌症病人身体组分定量评估中的应用进展和临床价值予以综述。     

幽门螺杆菌粪便抗原检测对诊断儿童幽门螺杆菌感染的价值

目的评价酶联免疫法检测幽门螺杆菌粪便抗原(HpAg)在诊断儿童幽门螺杆菌(Hp)感染及治疗后复查的价值。方法采用快速尿素酶试验,组织切片染色法,酶联免疫分析法,细菌分离培养Hp。结果ELISA检测粪便HpAg阳性率(85.2%)与其他3种方法差异无显著性(P>0.05)。HpAg的敏感度为98.1%,特异性为84.2%,阳性预测值为97.1%,阴性预测值为88.9%,总有效率为95.1%。结论HpAg具有简便、经济、无创伤性等特点,可用于儿童Hp感染的诊断和观察治疗后Hp的转阴情况。     

Incremental prognostic value of RNA ejection fraction measurements during pharmacologic stress testing: a comparison with clinical and perfusion variables.

This investigation examined the prognostic power of first-pass radionuclide angiocardiography (RNA) ejection fraction compared with clinical information and myocardial perfusion imaging in patients undergoing pharmacologic stress testing. The value of RNA and myocardial perfusion imaging in predicting death or nonfatal myocardial infarction (MI) is well established. However, limited information exists on the usefulness of combined myocardial perfusion imaging and RNA to predict prognosis, especially in patients undergoing pharmacologic stress testing. METHODS: We identified 240 patients who underwent pharmacologic stress testing with myocardial perfusion imaging and combined RNA. The patients were followed for a mean of 1.4 y. Cox proportional hazards models were used to assess the value in predicting death and MI. Multivariable models were generated to assess the independent incremental predictive value of clinical and nuclear imaging variables. Kaplan-Meier survival and event-free survival estimates were examined in patients with low (< or = 45%) versus high (>45%) ejection fractions. RESULTS: Clinical information, myocardial perfusion imaging, and RNA ejection fraction were significant predictors of the death/MI composite outcome (chi(2) = 7.4, 14.0, and 21.8, respectively). The addition of myocardial perfusion imaging to the clinical information provided incremental prognostic information (chi(2) = 15.2). The addition of RNA ejection fraction provided further predictive information (chi(2) = 22.5). However, when RNA ejection fraction was first added to the clinical information, myocardial perfusion imaging had no incremental prognostic value. CONCLUSION: For hard cardiac events, RNA ejection fraction provides prognostic information besides that provided by clinical and myocardial perfusion imaging. In patients who cannot exercise and are undergoing noninvasive evaluation with pharmacologic stress testing and myocardial perfusion imaging, ejection fraction should be measured simultaneously for risk assessment optimization.     

Advantages of electrocardiographic monitoring in top level athletes.

We used continuous electrocardiographic monitoring according to Holter's method for a tentative evaluation of the prognostic value of the main electrocardiographic peculiarities of the "athlete's heart". Five hundred and eighty-seven Holter recordings were performed in 164 top athletes divided into three groups: dynamic, static and mixed. Selection criteria were either clinical or electrical (resting-ECG). The prognostic value of arrhythmia is variable: unworrying junctional rhythm (JR) and auriculo-ventricular blocks (AVB) that disappeared under strain, which in our study interested mostly the dynamic group. No pejorative prognostic criteria were found related to supraventricular premature beats (SVPB). Ventricular premature beats (VPB) of recent occurrence were predominantly found, in our study, in the static athletes; their occurrence was not always accounted for and their prognosis, at least as regards sports, was uncertain. Holters repeated throughout the sports season made it possible to establish a relationship between some peculiarities and the training intensiveness: auriculo-ventricular block and junction rhythm culminated during intensive periods. Unusual sinus tachycardia would be indicative of over-training.     

胶质瘤中TRP基因家族预后模型的开发和验证

 目的 探讨采用生物信息学方法,构建胶质瘤患者瞬时受体电位(TRP)基因家族表达的预后模型并进行验证。方法 从UCSC Xena数据库的TCGA target GTEx数据集中,提取癌症基因组图谱(TCGA)数据库523例低级别胶质瘤,171例高级别胶质瘤及基因组织表达(GTEx)数据库中105例正常脑皮质的RNA测序数据,使用R语言评估胶质瘤样本和正常脑皮质中TRP基因家族的表达差异;使用Lasso回归模型分析并构建TRP基因家族预后模型,并在中国脑胶质瘤图谱数据库(CGGA)中对该模型的预后效能进行验证,同时对高低风险评分的亚组进行免疫浸润分析。结果 TRP基因家族在胶质瘤中存在广泛的异常表达且与胶质瘤患者预后相关,并建立TRP基因家族相关的预后模型,在TCGA训练集中该模型的1,3,5年曲线下面积(AUC)值均大于0.8,在CCGA验证集中该模型的1,3,5年AUC值均大于0.6,证实该模型具有较好的预测价值。免疫浸润分析提示高风险评分组中患者免疫活性较差。结论 采用TCGA数据库成功构建TRP基因家族的预后模型,可为判断胶质瘤患者预后及指导临床治疗提供帮助。     

血清甲状腺激素监测对急性重型脑血管病预后判断

 为研究血清甲状腺素对急性重型脑血管病的预后诊断价值,对42例急性重型脑血管病患者血清T3T4进行监测,并与30例健康人作对照.结果表明,观察组病初血清T3T4均下降,明显低于对照组;观察组中的死亡组(20例)死前较病初血清T3T4明显下降,有非常显著性差异(P<0.01);存活组(22例)好转时较病初血清T3T3明显上升,有非常显著性差异(P<0.01),且随着病情好转,T3T4逐渐上升,随着病情恶化,T3T4逐渐下降.提示动态观察血清T3T4水平,对急性重型脑血管病预后早期判断具有较高价值.     

FDG-PET after radiotherapy is a good prognostic indicator of rectal cancer

In the management of rectal cancer after the combined therapy of the radiation and surgical operation, the evaluation of the prognosis is important. Although fluoro- 18-deoxyglucose positron emission tomography (FDG-PET) is considered as a useful tool for evaluation of therapeutic effect of this cancer as well as the other cancers, however, there are few articles that clearly describe the appropriate procedure of the FDG-PET in order to obtain the best prognostic value. The purpose of the present study is to compare several variations of a semi-quantification method, the Standardized Uptake Values (SUV) and to determine the most appropriate parameter, for the prognostic prediction and to propose the quantitative guideline of the FDG-PET. Especially, the authors focused on the SUV after radiotherapy, which had not been considered as a key quantitative value, as it was rather taken as a mere indicator of the therapeutic (radiotherapeutic) effect, not a direct indicator of the prognosis for the cancer itself. METHODS: Forty patients with rectal cancer in the lower rectal region underwent two series of FDG-PET study before and after pre-operative radiotherapy. Their SUVs were calculated from FDG-PET data and compared with the results of the long-term follow-up of the patients as well as with histopathological outcomes. Results: All 40 patients had high FDG uptake before radiotherapy. The mean value of SUV before radiotherapy (SUV1) was 7.6. After radiotherapy, the mean value of SUV (SUV2) decreased to 4.2. There was a significant difference in SUV2 between the groups with and without recurrence (p < 0.05), however, SUVI or SUV ratio (SUV2/SUV1) displayed no significant difference with the incidence of recurrence. CONCLUSION: SUV2 was considered to be a good prognostic indicator for long-term prognosis of rectal cancer patients. SUV1 nor SUV ratio SUV2/SUV1 did not have the equivalent prognostic usefulness. Subsets of patients with SUV2 greater than 3.2 should be observed closely.     

The value of multi-slice-computed tomography coronary angiography for risk stratification

Multi-slice-computed tomography coronary angiography (CTA) provides direct non-invasive anatomic assessment of the coronary arteries allowing for early identification of coronary artery disease (CAD). This information is useful for diagnosis of CAD, particularly the rule out of CAD. In addition, early identification of CAD with CTA may also be useful for risk stratification. The purpose of this review is to provide an overview of the current literature on the prognostic value of CTA and to discuss how the prognostic information obtained with CTA can be used to further integrate the technique into clinical practice. Non-invasive anatomic assessment of plaque burden, location, composition, and remodeling using CTA may provide prognostically relevant information. This information has been shown to be incremental to the Framingham risk score, coronary artery calcium scoring, and myocardial perfusion imaging. Characterization of atherosclerosis non-invasively has the potential to provide important prognostic information enabling a more patient-tailored approach to disease management. Future studies assessing outcome after CTA-based risk adjustments are needed to further understand the value of detailed non-invasive anatomic imaging.