Detecting young Japanese adults with undetected low skeletal bone density using panoramic radiographs

Objective

The cortical width below the mental foramen of the mandible determined from panoramic radiographs is a useful screening tool for identifying elderly individuals with a low skeletal bone mineral density (BMD). However, whether the mandible cortical width (MCW) is useful for identifying a low skeletal BMD in men and women of 40 years or younger is not known.

Methods

The BMD of the calcaneus was measured by ultrasonography bone densitometry in 158 men and 76 women aged 18–36 years. A logistic regression analysis adjusted for age was used to calculate the odds ratios and 95% confidence interval (CI) of having a low calcaneal BMD, according to the quartiles of the MCW. The areas under the receiver operator characteristic curve (AUC) for identifying participants with a low calcaneal BMD using the MCW were assessed to evaluate the diagnostic efficacy of the MCW.

Results

In men, the adjusted odds ratios of a low calcaneal BMD associated with the second, third and lowest quartiles of MCW were 5.66 (95% CI, 0.61–52.23), 5.43 (95% CI, 0.59–50.18) and 33.22 (95% CI, 3.97–276.94), respectively, compared with the highest quartile, while no significant trend in the adjusted odds ratios was observed in women. The AUC for identifying participants with a low calcaneal BMD based on the MCW was 0.796 (95% CI, 0.702–0.890) in men and 0.593 (95% CI, 0.398–0.788) in women.

Conclusion

MCW determined from panoramic radiographs can be used to identify undetected low calcaneus BMD in young adult men, but not in young adult women.     

The Serum CA-125 Concentration Data Assists in Evaluating CT Imaging Information When Used to Differentiate Borderline Ovarian Tumor from Malignant Epithelial Ovarian Tumors

Objective

We wanted to evaluate the diagnostic value of serum CA-125 concentration, when used in combination with the preoperative contrast-enhanced CT results, to differentiate borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MEOTs).

Materials and Methods

Ninety-eight masses (46 BOTs and 52 stage I MEOTs) from 87 consecutive patients (49 with BOTs and 38 with stage I MEOTs) who had undergone preoperative contrast-enhanced computed tomography (CT) and surgical staging were evaluated retrospectively and independently by two radiologists. The preoperative serum CA-125 concentration was measured in all patients. The utility of analyzing serum CA-125 concentration in combination with the CT results was evaluated by receiver operating characteristic (ROC) curve analysis.

Results

An irregular tumor surface and lymphadenopathy were predictive of a MEOT. ROC analysis showed that the combination of CT data and the serum CA-125 level resulted in a higher diagnostic performance than did using the CT alone for differentiating BOTs from MEOTs. The areas under the curves (AUCs) without and with the use of the serum CA-125 level data were 0.67 (95% confidence interval [CI]: 0.57-0.77) and 0.78 (95% CI: 0.68-0.85), respectively, for reader 1 (p = 0.029) and 0.71 (95% CI: 0.61-0.80) and 0.81 (95% CI: 0.72-0.89), respectively, for reader 2 (p = 0.009).

Conclusion

The serum CA-125 concentration is of additional diagnostic value when used in conjunction with the CT imaging results for differentiating BOTs from MEOTs.     

Imaging Characteristics of Stage I Non-Small Cell Lung Cancer on CT and FDG-PET: Relationship with Epidermal Growth Factor Receptor Protein Expression Status and Survival

Objective

To identify CT and FDG-PET features associated with epidermal growth factor receptor (EGFR) protein overexpression, and to evaluate whether imaging features and EGFR-overexpression can help predict clinical outcome.

Materials and Methods

In 214 patients (M : F = 129 : 85; mean age, 63.2) who underwent curative resection of stage I non-small cell lung cancer, EGFR protein expression status was determined through immunohistochemical analysis. Imaging characteristics on CT and FDG-PET was assessed in relation to EGFR-overexpression. Imaging features and EGFR-overexpression were also evaluated for clinical outcome by using the Cox proportional hazards model.

Results

EGFR-overexpression was found in 51 patients (23.8%). It was significantly more frequent in tumors with an SUV_max > 5.0 (p < 0.0001), diameter > 2.43 cm (p < 0.0001), and with ground glass opacity ≤ 50% (p = 0.0073). SUV_max > 5.0 (OR, 3.113; 95% CI, 1.375-7.049; p = 0.006) and diameter > 2.43 cm (OR, 2.799; 95% CI, 1.285-6.095; p = 0.010) were independent predictors of EGFR overexpression. Multivariate analysis showed that SUV_max > 4.0 (hazard ratio, 10.660; 95% CI, 1.370-82.966; p = 0.024), and the presence of cavitation within a tumor (hazard ratio, 3.122; 95% CI, 1.143-8.532; p = 0.026) were factors associated with poor prognosis.

Conclusion

EGFR-overexpression is associated with high SUV_max, large tumor diameter, and small GGO proportion. CT and FDG-PET findings, which are closely related to EGFR overexpression, can be valuable in the prediction of clinical outcome.     

Proposal of new upper airway margins in children assessed by CBCT

Objectives:

Recently, studies have performed three-dimensional analyses of upper airways in children. However, there was a lack of airway delineation according to anatomical boundaries and/or easily mobile soft-tissue landmarks were used. The aim of the present study was to define new upper airway margins in children on CBCT according to anatomical bony landmarks and to validate the method.

Methods:

25 scans were randomly selected from a larger database containing CBCT scans of children prior to orthodontic treatment (14 girls and 11 boys; mean age, 10.9 ± 2.5 years). Scans were evaluated by two observers. Specific head positioning and virtual orientation protocols were adopted and greyscale thresholding was established for each patient. Volume and minimum cross-sectional area of the oropharynx were calculated. Intra- and interobserver reliability were assessed by reassessment of the CBCTs 2 weeks later.

Results:

The new airway margins were defined superiorly by a line passing through the palatal plane (anterior nasal spine to posterior nasal spine) extending to the posterior wall of the pharynx, inferiorly by a line passing from the anterosuperior edge of C4 to menton, anteriorly by a line passing from the soft palate to menton, posteriorly and laterally by the respective pharyngeal walls. Method error for airway volume and minimal cross-sectional area was ≤2.00%, and intra- and interobserver reliability ranged from 0.99 to 1.00.

Conclusions:

The proposed protocol utilizes easily identifiable bony landmarks to delineate the upper airway on cone beam scans of children and was found to be reliable and reproducible.     

FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications

Objective

We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and Methods

Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results

Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion

The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.     

Multiplanar 3D ultrasound imaging to assess the anatomy of the upper airway and measure the subglottic and tracheal diameters in adults

Objective:

To evaluate the feasibility of using three-dimensional (3D) ultrasound to assess the anatomy of the airway.

Methods:

11 young volunteers were recruited for 3D ultrasound and MRI of the airway. 3D ultrasound data were obtained from the level of the true vocal cords, cricoid cartilage and upper trachea. Multiplanar 3D ultrasound images were rendered and compared visually with corresponding MRI and cadaver anatomical sections. The anteroposterior (AP) and transverse diameter of the subglottic space and transverse diameter of the upper trachea were also measured in the 3D ultrasound and MR images and compared.

Results:

The airway anatomy was clearly delineated in the multiplanar 3D ultrasound images. It was also possible to identify the cricothyroid junction, and a simple method to measure the AP diameter of the subglottic space using this landmark is described. We were also able to accurately measure the transverse diameter of the upper trachea, but the transverse diameter of the subglottic space was overestimated using ultrasound. There was a strong correlation for the AP diameter measurement (r=0.94, p<0.05) and moderate correlation for the transverse diameter measurement (r=0.82, p=0.002) of the subglottic space, and a strong correlation for the transverse diameter measurement (r=0.91, p<0.05) of the upper trachea, in the ultrasound and MR images.

Conclusion:

The anatomy of the adult airway can be assessed using 3D ultrasound. It can also be used to accurately measure the AP diameter of the subglottic space and the transverse diameter of the upper trachea.

Advances in knowledge:

This is the first report to describe the use of 3D ultrasound to evaluate the anatomy of the upper airway and accurately measure the AP diameter of the subglottic space and the transverse diameter of the upper trachea.Ultrasound imaging of the airway has been described [1–6], but the majority of the published data involve the use of two-dimensional (2D) ultrasound, which allows examination of the airway in only the transverse or sagittal axis [2,7,8]. There is also a paucity of data correlating the sonoanatomy of the airway [2,7] with an alternative imaging modality [2]. Three-dimensional (3D) ultrasound imaging is currently available and provides simultaneous images of an area of interest (volume) in multiple orthogonal (perpendicular) planes [9]. Preliminary experience with 3D ultrasound suggests that the spatial anatomical information obtained is more detailed [9] than with 2D ultrasound, and the same may apply for imaging of the airway. Currently, there are no published data on 3D ultrasound imaging of the airway. The aim of this pilot study was to evaluate the feasibility of using 3D ultrasound to delineate the anatomy of the upper airway and correlate the sonoanatomy with cadaver anatomical sections and volunteer MR images of the airway. A secondary objective was to measure the subglottic and tracheal diameters in the multiplanar 3D ultrasound images.     

Hyperfunction Thyroid Nodules: Their Risk for Becoming or Being Associated with Thyroid Cancers

Objective

To retrospectively evaluate the risk of thyroid cancer in patients with hyperfunctioning thyroid nodules through ultrasonographic-pathologic analysis.

Materials and Methods

Institutional review board approval was obtained and informed consent was waived. From 2003 to 2007, 107 patients consecutively presented with hot spots on thyroid scans and low serum thyroid-stimulating hormone levels. Among them, 32 patients who had undergone thyroid ultrasonography were analyzed in this study. Thyroid nodules depicted on ultrasonography were classified based on size and categorized as benign, indeterminate, or suspicious malignant nodules according to ultrasonographic findings. The thyroid nodules were determined as either hyperfunctioning or coexisting nodules and were then correlated with pathologic results.

Results

In 32 patients, 42 hyperfunctioning nodules (mean number per patient, 1.31; range, 1-6) were observed on thyroid scans and 68 coexisting nodules (mean, 2.13; range, 0-7) were observed on ultrasonography. Twenty-five patients (78.1%) had at least one hyperfunctioning (n = 17, 53.1%) or coexisting (n = 16, 50.0%) nodule that showed a suspicious malignant feature larger than 5 mm (n = 8, 25.0%), or an indeterminate feature 1 cm or greater (n = 20, 62.5%) in diameter, which could have been indicated by using fine needle aspiration (FNA). Seven patients were proven to have 11 thyroid cancers in 3 hyperfunctioning and 8 coexisting nodules. All of these had at least one thyroid cancer, which could have been indicated by using FNA. The estimated minimal risk of thyroid cancer was 6.5% (7/107).

Conclusion

Patients with hyperfunctioning nodules may not be safe from thyroid cancer because hyperfunctioning nodules can coexist with thyroid cancer nodules. To screen out these cancers, ultrasonography should be performed.     

Percutaneous Unilateral Biliary Metallic Stent Placement in Patients with Malignant Obstruction of the Biliary Hila and Contralateral Portal Vein Steno-Occlusion

Objective

To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion.

Materials and Methods

Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients.

Results

A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days).

Conclusion

Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.     

Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures

Objectives

The aim of this study is to compare ultrasonography with CT in the diagnosis of nasal bone fractures.

Methods

40 patients (9 female and 31 male) with mid-facial fractures, which were suspected nasal bone fractures, were included. All of the patients had mid-facial CT images. Ultrasonography with a 7.5 MHz transducer (Aloka 3500, Tokyo, Japan) was used to evaluate the nasal bone fractures. All of the sonograms were compared with CT findings for sensitivity, specificity and predictive values. A χ² test was applied to the data to assess statistical significance.

Results

CT diagnosed nasal bone fractures in 24 of the 40 patients (9 unilateral fractures and 15 bilateral fractures) while ultrasonography diagnosed the fractured bones in 23 patients (9 unilateral fractures and 14 bilateral fractures). Ultrasonography missed one fractured bone in a bilateral fractured case and a unilateral fracture was also missed (two false-negative results). The sensitivity and specificity of ultrasonography in assessing nasal bone fracture in comparison with CT were 94.9% and 100%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) of ultrasonographic evaluation of the nasal bone fractures were 100% and 95.3%, respectively. The χ² test did not show any significant difference between CT and ultrasonography in diagnosis of nasal bone fractures (P = 0.819).

Conclusion

Ultrasonography can be used as a first line of diagnostic imaging for evaluating nasal bone fractures, especially in children and pregnant women.     

Does the Oropharyngeal Fat Tissue Influence the Oropharyngeal Airway in Snorers? Dynamic CT Study

Objective

The aim of this study was to determine if snorers have a narrower oropharyngeal airway area because of fat infiltration, and an elevated body mass index.

Materials and Methods

Ten control subjects and 19 patients that snored were evaluated. We obtained 2-mm-thick axial CT scan images every 0.6 seconds during expiration and inspiration at the same level of the oropharynx. We selected the largest and the smallest oropharyngeal airway areas and found the differences. From the slice that had the smallest oropharyngeal airway area, the thickness of the parapharyngeal and subcutaneous fat was measured. The measurements from the left and right side were added together and single values for parapharyngeal and subcutaneous fat tissue thickness were then found.

Results

The conventional measure of body mass index was significantly higher in the snorers (p < 0.05). The difference in the smallest oropharyngeal airway area between snorers and the controls was statistically significant (p < 0.01). The average difference between the largest and the smallest oropharyngeal area in the control group and the snorer group was statistically significant (p < 0.05). There was no significant difference in the largest oropharyngeal airway area, the total subcutaneous fat width and the total parapharyngeal fat width between snorers and control subjects (p > 0.05).

Conclusion

We concluded that the oropharyngeal fat deposition in snorers is not an important factor, and it does not predispose a person to the upper airway narrowing.     

Efficacy of Barium-Based Fecal Tagging for CT Colonography: a Comparison between the Use of High and Low Density Barium Suspensions in a Korean Population - a Preliminary Study

Objective

This preliminarily study was designed to determine and to compare the efficacy of two commercially available barium-based fecal tagging agents for CT colonography (CTC) (high-density [40% w/v] and low-density [4.6% w/v] barium suspensions) in a population in Korea.

Materials and Methods

In a population with an identified with an average-risk for colorectal cancer, 15 adults were administered three doses of 20 ml 40% w/v barium for fecal tagging (group I) and 15 adults were administered three doses of 200 ml 4.6% w/v barium (group II) for fecal tagging. Excluding five patients in group I and one patient in group II that left the study, ten patients in group I and 14 patients in group II were finally included in the analysis. Two experienced readers evaluated the CTC images in consensus regarding the degree of tagging of stool pieces 6 mm or larger. Stool pieces were confirmed with the use of standardized CTC criteria or the absence of matched lesions as seen on colonoscopy. The rates of complete fecal tagging were analyzed on a per-lesion and a per-segment basis and were compared between the patients in the two groups.

Results

Per-lesion rates of complete fecal tagging were 52% (22 of 42; 95% CI, 37.7-66.6%) in group I and 78% (28 of 36; 95% CI, 61.7-88.5%) in group II. The difference between the two groups did not reach statistical significance (p = 0.285). The per-segment rates of complete tagging were 33% (6 of 18; 95% CI, 16.1%-56.4%) in group I and 60% (9 of 15; 95% CI, 35.7%-80.3%) in group II; again, the difference between the two groups did not reach statistical significance (p = 0.171).

Conclusion

Barium-based fecal tagging using both the 40% w/v and the 4.6% w/v barium suspensions showed moderate tagging efficacy. The preliminary comparison did not demonstrate a statistically significant difference in the tagging efficacy between the use of the two tagging agents, despite the tendency toward better tagging with the use of the 4.6% w/v barium suspension.     

The Usefulness of Pulsatile Flow Detection in Measuring Resistive Index in Renal Doppler US

Objective

To assess the usefulness of pulsatile flow detection (PFD), a newly developed function of color Doppler US, in measuring resistive index (RI) in renal Doppler US and to compare it with conventional color Doppler (CCD).

Materials and Methods

Fifty-six kidneys in 31 patients were randomly selected and divided into two groups. In group A, RI was measured first with the aid of CCD, and then with PFD. In group B, data were obtained in the reverse order. The time required for each RI measurement was recorded in seconds. The quality of the Doppler spectral waveform was subjectively graded as 0, 1, or 2 and examination time and waveform quality were compared between PFD and CCD.

Results

The time required to measure RI with PFD (PFD time) was less than with CCD (CCD time) (mean 42.7 secs vs. mean 70.3 secs; p = 0.031). There was no significant difference in PFD time between group A and B, but CCD time was shorter in group B (70.3 secs vs. 24.6 secs; p = 0.0004). Spectral waveform quality was not significantly different between PFD and CCD.

Conclusion

The time required to measure RI in kidneys can be shortened with the aid of the PFD function in color Doppler US without affecting the quality of the examination.     

Computer-Aided Classification of Visual Ventilation Patterns in Patients with Chronic Obstructive Pulmonary Disease at Two-Phase Xenon-Enhanced CT

Objective

To evaluate the technical feasibility, performance, and interobserver agreement of a computer-aided classification (CAC) system for regional ventilation at two-phase xenon-enhanced CT in patients with chronic obstructive pulmonary disease (COPD).

Materials and Methods

Thirty-eight patients with COPD underwent two-phase xenon ventilation CT with resulting wash-in (WI) and wash-out (WO) xenon images. The regional ventilation in structural abnormalities was visually categorized into four patterns by consensus of two experienced radiologists who compared the xenon attenuation of structural abnormalities with that of adjacent normal parenchyma in the WI and WO images, and it served as the reference. Two series of image datasets of structural abnormalities were randomly extracted for optimization and validation. The proportion of agreement on a per-lesion basis and receiver operating characteristics on a per-pixel basis between CAC and reference were analyzed for optimization. Thereafter, six readers independently categorized the regional ventilation in structural abnormalities in the validation set without and with a CAC map. Interobserver agreement was also compared between assessments without and with CAC maps using multirater κ statistics.

Results

Computer-aided classification maps were successfully generated in 31 patients (81.5%). The proportion of agreement and the average area under the curve of optimized CAC maps were 94% (75/80) and 0.994, respectively. Multirater κ value was improved from moderate (κ = 0.59; 95% confidence interval [CI], 0.56-0.62) at the initial assessment to excellent (κ = 0.82; 95% CI, 0.79-0.85) with the CAC map.

Conclusion

Our proposed CAC system demonstrated the potential for regional ventilation pattern analysis and enhanced interobserver agreement on visual classification of regional ventilation.     

Visually stratified CT honeycombing as a survival predictor in combined pulmonary fibrosis and emphysema

Objective:

To determine whether visually stratified CT findings and pulmonary function variables are helpful in predicting mortality in patients with combined pulmonary fibrosis and emphysema (CPFE).

Methods:

We retrospectively identified 113 patients with CPFE who underwent high-resolution CT between January 2004 and December 2009. The extent of emphysema and fibrosis on CT was visually assessed using a 6- or 5-point scale, respectively. Univariate and multivariate Cox proportional regression analyses were performed to determine the prognostic value of visually stratified CT findings and pulmonary function variables in patients with CPFE. Differences in 5-year survival rates in patients with CPFE according to the extent of honeycombing were calculated using Kaplan–Meier analysis.

Results:

An increase in the extent of visually stratified honeycombing on CT [hazard ratio (HR), 1.95; p = 0.018; 95% confidence interval (CI), 1.12–3.39] and reduced diffusing capacity of lung for carbon monoxide (DLCO) (HR, 0.97; p = 0.017; 95% CI, 0.94–0.99) were independently associated with increased mortality. In patients with CPFE, the 5-year survival rate was 78.5% for <5% honeycombing, 55.7% for 5–25% honeycombing, 32% for 26–50% honeycombing and 33.3% for >50% honeycombing on CT.

Conclusion:

The >50% honeycombing on CT and reduced DLCO are important prognostic factors in CPFE.

Advances in knowledge:

Visual estimation of honeycombing extent on CT can help in the prediction of prognosis in CPFE.     

Doping prevalence among preadolescent athletes: a 4-year follow-up

Objective

To describe the prevalence of doping and its progression in a cohort of preadolescent athletes during a 4‐year follow‐up.

Design and settings

Prospective cohort study. Self‐questionnaire survey.

Participants

All of the pupils entering the first year of secondary school (sixth grade) in the Vosges Département (east France) and followed for 4 years.

Main outcome measurements

Drug use (prohibited substances, tobacco, alcohol, cannabis), intention to use, reported health hazards, perceived drug effectiveness, self‐esteem, trait anxiety.

Results

At the beginning of the study, 1.2% (95% CI 0.8 to 1.6) stated that they had taken doping agents at least once in the preceding 6 months, and this had risen to 3.0% (95% CI 2.3–3.7) 4 years later (p<0.001). Of those who had used doping agents, 4% reported that they had experienced a health problem related to doping, and 44% reported that they had won at least one sports event as a result of using the drug. Use of doping agents is linked to the number of hours of practice per week, intention to use, use of other drugs, self‐esteem and trait anxiety.

Conclusions

The results show that doping does exist in preadolescent athletes who train every day. This fact should to be taken into account in preventive actions.     

Correlation between anthropometric parameters and acute skin toxicity in breast cancer radiotherapy patients: a pilot assessment study

Objective:

The objective of the present study was to identify acute skin toxicity risk factors linked to the anthropometric characteristics of patients with breast cancer treated with radiation therapy.

Methods:

Consecutive patients with breast cancer were enrolled after breast-conserving surgery and before radiotherapy course. Acute skin toxicity was assessed weekly during the 7 weeks of radiotherapy with the International Classification from National Cancer Institute. Grade 2 defined acute skin toxicity. Patient characteristics and anthropometric measurements were collected.

Results:

54 patients were enrolled in 2013. Eight patients (14.8%) had grade ≥2 toxicity. The average weight and chest size were 65.5 kg and 93.6 cm, respectively. Bra cup size is significantly associated with a risk of grade 2 dermatitis [odds ratio (OR) 3.46, 95% confidence interval (CI) (1.29–11.92), p = 0.02]. Anthropometric breast fat mass measurements, such as thickness of left [OR 2.72, 95% CI (1.08–8.26), p = 0.04] and right [OR 2.45, 95% CI (0.99–7.27), p = 0.05] axillary fat, are correlated with an increased risk. Distance between the pectoral muscle and nipple is a reproducible measurement of breast size and is associated with acute skin toxicity with significant tendency (OR = 2.21, 95% CI (0.97–5.98), p = 0.07).

Conclusion:

Breast size and its different anthropometric measurements (thickness of left and right axillary fat, nipple-to-pectoral muscle distance) are correlated with the risk of skin toxicity.

Advances in knowledge:

The present article analyses several characteristics and anthropomorphic measurements of breast in order to assess breast size. A standardized and reproducible protocol to measure breast volume is described.     

Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions

Objective:

This meta-analysis is to determine the overall diagnostic yield of CT-guided transthoracic needle biopsy (TNB) of ground-glass opacity (GGO) lesions.

Methods:

A PubMed search was performed using “ground-glass opacity” crossed with “core biopsy” and “needle biopsy”. Test performance characteristics with the use of forest plots, summary receiver operating characteristic curves and bivariate random effects models were summarized. Adverse events, if reported, were recorded.

Results:

Our search identified 52 citations, of which 6 diagnostic studies evaluated 341 patients. Pooled specificity estimates were 0.94 [95% confidence interval (CI), 0.84–0.98] and sensitivity estimates were 0.92 (95% CI, 0.88–0.95), respectively. The positive likelihood ratio was 11.27 (95% CI, 4.2–30.6), the negative likelihood ratio was 0.1 (95% CI, 0.06–0.19), the diagnostic odds ratio was 131.38 (95% CI, 39.6–436.0) and the area under the curve was 0.97.

Conclusion:

Our data suggest that the CT-guided TNB is likely to be a useful tool for tissue diagnosis and may serve as an alternative for further patient management with GGO lesions. However, considering the limited studies and patients included, large scale studies are needed to verify these findings.

Advances in knowledge:

Some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. To our knowledge, our study is the first systematic analysis about CT-guided TNB of GGO lesions.Owing to the prevalence of lung cancer screening with low-dose CT, an increase in the detection of ground-glass opacity (GGO) lesions has been noted.^1–3 GGO is a finding on thin-section CT that is defined as “hazy increased attenuation of the lung with preservation of bronchial and vascular margins”.⁴ These characteristics may be caused by partial filling of air spaces, interstitial thickening, partial collapse of alveoli, normal expiration or increased capillary blood volume. It is known that GGO is a non-specific finding that may be caused by various disorders, including inflammatory disease, pulmonary fibrosis, alveolar haemorrhage or neoplasm.^5,6 The clinical significance of localized GGO is its high incidence of malignancy compared with solid nodules.^7,8 Kim et al⁹ reported that approximately 75% of focal pure GGO lesions are adenocarcinoma. Although it has been reported that the morphologic classification is helpful to differentiate malignant GGO lesions from benign conditions,⁸ it is generally considered very difficult based on CT findings alone.⁹ CT-guided biopsy is an established diagnostic technique that has high diagnostic yield and is used mainly for solid lung lesions.^10,11 Although some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. Figure 6 shows the procedure of CT-guided TNB for GGO lesions. The aim of this study was to systemically and quantitatively assess the diagnostic performance of CT-guided transthoracic needle biopsy (TNB) of GGO lesions.Open in a separate windowFigure 6.CT-guided core biopsy in 76-year-old male with ground-glass opacity (GGO) lesion in left lower lobe. CT scan obtained during biopsy shows biopsy needle targeting GGO lesion. Histologic diagnosis of core biopsy and surgical resection was adenocarcinoma.     

Application of contrast-enhanced ultrasonography in the diagnosis of skeletal muscle crush injury in rabbits

Objective:

To explore the diagnostic value of quantitative contrast-enhanced (CE) ultrasonography for crush injury in the hind limb muscles of rabbits.

Methods:

A total of 120 New Zealand white rabbits were randomized to receive compression on the left hind limb for either 2 h (n = 56) or 4 h (n = 56) to induce muscle crush injury. Another eight animals were not injured and served as normal controls. CE ultrasonography parameters such as peak intensity (PI), ascending slop, descending slop and area under curve (AUC) were measured at 0.5, 2, 6 and 24 h and 3, 7 and 14 days after decompression.

Results:

Compared with the uninjured muscles, reperfusion of the injured muscles showed early and high enhancement in CE ultrasonography images. The time-intensity curve showed a trend of rapid lift and gradual drop. The PI and AUC values differed significantly among the three groups and were positively correlated with serum and tissue biomarkers. Rabbits of the 4-h compression group showed significantly higher PI and AUC values, and serum and tissue parameters than the 2-h compression group at each time points.

Conclusion:

CE ultrasonography can effectively detect muscle crush injury and monitor dynamic changes of the injured muscles in rabbits. PI and AUC are promising diagnostic parameters for this disease.

Advances in knowledge:

CE ultrasonography might play an important role in the pre-hospital and bedside settings for the diagnosis of muscle crush injury.Muscle crush injury usually occurs during earthquakes, collapse of buildings and heavy whip beatings, and often induces crush syndrome if not treated promptly. Crush injury is estimated to account for 3–20% of all injuries during natural disasters, and the lower limbs are the most frequently affected.¹ Limb crush injury and its complications are life threatening and the most frequent cause of disability and death after earthquakes.²The mortality rate in patients with crush syndrome can be as high as 21%, which is the most dangerous complication of all injuries during disasters.³ Crush syndrome can cause acute kidney injury and acute osteofascial compartment syndrome (AOCS), which are the most life-threatening complications. AOCS has a 47% mortality, and unrecognized AOCS can leave a patient with non-viable limbs requiring amputation.⁴ Severe muscle crush injury can also result in multiple organ dysfunction syndrome, acute respiratory distress syndrome, disseminated intravascular coagulation and severe arrhythmia.⁵ Early diagnosis of muscle crush injury and correct assessment of its severity are critical for good prognosis of patients. However, bedside and pre-hospital diagnosis of crush injury still lacks effective methods.Typical muscle crush injury and related AOCS are usually diagnosed with clinical symptoms, but the sensitivity of this method is very low.^6,7 Impaired microcirculation is the initial pathological change of crushed muscles.⁴ A variety of imaging methods have been used to examine reperfusion of the extremities and therefore detect the presence of muscle crush injury, such as CT, MRI and ultrasonography.^8–11 However, the equipment of CT and MRI is large and inconvenient for bedside or pre-hospital settings or in situ care at the trauma scene. On the contrary, ultrasonography devices can be light, portable and convenient for bedside or traumatic scenes. Ultrasonography also has no radiation. Conventional ultrasonography has been used to determine limb muscle crush injury, rhabdomyolysis and AOCS during the 2008 Sichuan earthquake in China.¹² However, the sensitivity of conventional ultrasonography is low for the diagnosis of extremity crush injury, and its detecting ability of microvascular perfusion is also very poor.¹³Gas-filled microbubbles can significantly augment the back scattered signals and do not leak out of the blood vessel and therefore are used as a contrast agent for Doppler ultrasonography to trace the bloodstream. Contrast-enhanced (CE) ultrasonography has been successfully used to measure microcirculation of the skeletal muscles, such as measurement of muscle perfusion after exercise, and evaluation of muscle perfusion in inflammatory myopathy or peripheral arterial disease.^14–16 However, application of CE ultrasonography in the assessment of microcirculation perfusion in muscle crush injury has rarely been reported.¹⁷In this study, microcirculation of extremities that underwent crush injury were evaluated using CE ultrasonography to investigate the values of CE ultrasonography in diagnosing limb crush injury.     

Prognostic significance of SUV on PET/CT in patients with localised oesophagogastric junction cancer receiving neoadjuvant chemotherapy/chemoradiation:a systematic review and meta-analysis

Objective

The objective of this study was to comprehensively review the evidence for use of pre-treatment, post-treatment and changes in tumour glucose uptake that were assessed by 18-fludeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) early, during or immediately after neoadjuvant chemotherapy/chemoradiation to predict prognosis of localised oesophagogastric junction (AEG) cancer.

Methods

We searched for articles published in English; limited to AEG; ¹⁸F-FDG uptake on PET performed on a dedicated device; dealt with the impact of standard uptake value (SUV) on survival. We extracted an estimate of the log hazard ratios (HRs) and their variances and performed meta-analysis.

Results

798 patients with AEG were included. And the scan time for ¹⁸F-FDG-PET was as follows: prior to therapy (PET1, n=646), exactly 2 weeks after initiation of neoadjuvant therapy (PET2, n=245), and pre-operatively (PET3, n=278). In the two meta-analyses for overall survival, including the studies that dealt with reduction of tumour maximum SUV (SUV_max) (from PET1 to PET2/PET3 and from PET1 to PET2), the results were similar, with the overall HR for non-responders being 1.83 [95% confidence interval (CI), 1.41–2.36] and 2.62 (95% CI, 1.61–4.26), respectively; as for disease-free survival, the combined HR was 2.92 (95% CI, 2.08–4.10) and 2.39 (95% CI, 1.57–3.64), respectively. The meta-analyses did not attribute significant prognostic values to SUV_max before and during therapy in localised AEG.

Conclusion

Relative changes in FDG-uptake of AEG are better prognosticators. Early metabolic changes from PET1 to PET2 may provide the same accuracy for prediction of treatment outcome as late changes from PET1 to PET3.It is known from several studies that the outcome of patients with adenocarcinomas of the oesophagogastric junction (AEG) treated with pre-operative chemotherapy/chemoradiation is heterogeneous. To the best of our knowledge, the reasons for this unpredictability in clinical outcome are not entirely clear but could be attributed to the differences in molecular compositions of cancers [1-5] and/or patient genetics [6,7]. Two Phase III studies indicated that pre-operative chemotherapy improved survival in patients with oesophageal adenocarcinoma and AEG [8,9]. However, a systematic review did show only marginal effects of pre-operative chemotherapy for resectable intrathoracic oesophageal cancer [10]. Of note, in non-responders, survival seems to be similar or even worse than after surgical resection alone [11]. Therefore, early identification of patients likely to have an unfavourable outcome after pre-operative therapy is highly important for the future use of neoadjuvant therapy in AEG.The use of 18-fludeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) as a metabolism-based imaging technique has been increased steadily during the last decade in most malignant tumours. The prognostic values of FDG uptake before and after chemotherapy/chemoradiotherapy were reported, and other studies have been conducted to evaluate the prognostic value of a decrease in tumour metabolic activity on the survival of patients with AEG. However, the sample size of most studies was rather small and the results of the prognostic value of standardised uptake value (SUV) remained undetermined. Therefore, we performed a meta-analysis to assess the prognostic value of SUV for survival of patients with AEG receiving neoadjuvant chemotherapy/chemoradiation.