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1.
Mario Muto Giulia Frauenfelder Rossana Senese Fabio Zeccolini Emiliano Schena Francesco Giurazza Hans Rolf Jäger 《La Radiologia medica》2018,123(7):545-552
Introduction
Distinction between treatment-related changes and tumour recurrence in patients who have received radiation treatment for brain metastases can be difficult on conventional MRI. In this study, we investigated the ability of dynamic susceptibility contrast (DSC) perfusion in differentiating necrotic changes from pathological angiogenesis and compared measurements of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and K2, using a dedicated software.Methods
Twenty-nine patients with secondary brain tumors were included in this retrospective study and underwent DSC perfusion MRI with a 3-month follow-up imaging after chemo- or radiation-therapy. Region-of-interests were drawn around the contrast enhancing lesions and measurements of rCBV, rCBF and K2 were performed in all patients. Based on subsequent histological examination or clinico-radiological follow-up, the cohort was divided in two groups: recurrent disease and stable disease. Differences between the two groups were analyzed using the Student’s t test. Sensitivity, specificity and diagnostic accuracy of rCBV measurements were analyzed considering three different cut-off values.Results
Between patients with and without disease, only rCBV and rCBF values were significant (p < 0.05). The only cut-off value giving the best diagnostic accuracy of 100% was rCBV = 2.1 (sensitivity = 100%; specificity = 100%). Patients with tumor recurrence showed a higher mean value of rCBV (mean = 4.28, standard deviation = 2.09) than patients with necrotic-related changes (mean = 0.77, standard deviation = 0.44).Conclusion
DSC-MRI appears a clinically useful method to differentiate between tumor recurrence, tumor necrosis and pseudoprogression in patients treated for cerebral metastases. Relative CBV using a cut-off value of 2.1 proved to be the most accurate and reliable parameter.2.
Taro Tsukamoto Taro Shimono Asari Sai Koji Sakai Akira Yamamoto Shinichi Sakamoto Yukio Miki 《Japanese journal of radiology》2016,34(4):277-283
Purpose
To investigate changes in brain temperature according to the menstrual cycle in women using diffusion-weighted imaging (DWI) thermometry and to clarify relationships between brain and body temperatures.Materials and methods
In 20 healthy female volunteers (21.3–38.8 years), DWI of the brain was performed during the follicular and luteal phases to calculate the brain temperature. During DWI, body temperatures were also measured. Group comparisons of each temperature between the two phases were performed using the paired t test. Correlations between brain and body temperatures were analyzed using Pearson’s correlation coefficient test.Results
Mean diffusion-based brain temperature was 36.24 °C (follicular) and 36.96 °C (luteal), showing a significant difference (P < 0.0001). Significant differences were also seen for each body temperature between the two phases. Correlation coefficients between diffusion-based brain and each body temperature were r = 0.2441 (P = 0.1291), –0.0332 (0.8387), and –0.0462 (0.7769), respectively.Conclusions
In women of childbearing age, brain and body temperatures appear significantly higher in the luteal than in the follicular phase. However, brain and body temperatures show no significant correlations.3.
Yoshitaka Inui Takashi Ichihara Masaki Uno Masanobu Ishiguro Kengo Ito Katsuhiko Kato Hajime Sakuma Hidehiko Okazawa Hiroshi Toyama 《Annals of nuclear medicine》2018,32(5):311-318
Objective
Statistical image analysis of brain SPECT images has improved diagnostic accuracy for brain disorders. However, the results of statistical analysis vary depending on the institution even when they use a common normal database (NDB), due to different intrinsic spatial resolutions or correction methods. The present study aimed to evaluate the correction of spatial resolution differences between equipment and examine the differences in skull bone attenuation to construct a common NDB for use in multicenter settings.Methods
The proposed acquisition and processing protocols were those routinely used at each participating center with additional triple energy window (TEW) scatter correction (SC) and computed tomography (CT) based attenuation correction (CTAC). A multicenter phantom study was conducted on six imaging systems in five centers, with either single photon emission computed tomography (SPECT) or SPECT/CT, and two brain phantoms. The gray/white matter I-123 activity ratio in the brain phantoms was 4, and they were enclosed in either an artificial adult male skull, 1300 Hounsfield units (HU), a female skull, 850 HU, or an acrylic cover. The cut-off frequency of the Butterworth filters was adjusted so that the spatial resolution was unified to a 17.9 mm full width at half maximum (FWHM), that of the lowest resolution system. The gray-to-white matter count ratios were measured from SPECT images and compared with the actual activity ratio. In addition, mean, standard deviation and coefficient of variation images were calculated after normalization and anatomical standardization to evaluate the variability of the NDB.Results
The gray-to-white matter count ratio error without SC and attenuation correction (AC) was significantly larger for higher bone densities (p?<?0.05). The count ratio error with TEW and CTAC was approximately 5% regardless of bone density. After adjustment of the spatial resolution in the SPECT images, the variability of the NDB decreased and was comparable to that of the NDB without correction.Conclusion
The proposed protocol showed potential for constructing an appropriate common NDB from SPECT images with SC, AC and spatial resolution compensation.4.
Purpose
The use of DSC-MR imaging in pediatric neuroradiology is gradually growing. However, the number of studies listed in the literature remains limited. We propose to assess the perfusion and permeability parameters in pediatric brain tumor grading.Methods
Thirty children with a brain tumor having benefited from a DSC-MR perfusion sequence have been retrospectively explored. Relative CBF and CBV were computed on the ROI with the largest lesion coverage. Assessment of the lesion’s permeability was also performed through the semi-quantitative PSR parameter and the K2 model-based parameter on the whole-lesion ROI and a reduced ROI drawn on the permeability maps. A statistical comparison of high- and low-grade groups (HG, LG) as well as a ROC analysis was performed on the histogram-based parameters.Results
Our results showed a statistically significant difference between LG and HG groups for mean rCBV (p < 10-3), rCBF (p < 10-3), and for PSR (p = 0.03) but not for the K2 factor (p = 0.5). However, the ratio K2/PSR was shown to be a strong discriminating factor between the two groups of lesions (p < 10-3). For rCBV and rCBF indicators, high values of ROC AUC were obtained (> 0.9) and mean value thresholds were observed at 1.07 and 1.03, respectively. For K2/PSR in the reduced area, AUC was also superior to 0.9.Conclusions
The implementation of a dynamic T2* perfusion sequence provided reliable results using an objective whole-lesion ROI. Perfusion parameters as well as a new permeability indicator could efficiently discriminate high-grade from low-grade lesions in the pediatric population.5.
Tanitame K Tani C Nakamura Y Yamasaki W Ishikawa M Kakizawa H Date S Awai K 《Japanese journal of radiology》2012,30(4):370-375
Purpose
Transdermal administration of nitroglycerin (NTG) before arterial puncture may improve puncture success. The objective of this study was to evaluate the vasodilation effect of NTG skin spray on brachial arteries.Materials and methods
We recruited 10 healthy volunteers. On different days and in random order we sprayed their skin above the right or left brachial artery with a solution containing 0.3 mg NTG or above the right brachial artery with physiological saline. A radiologist ultrasonographically measured the cross-sectional area of right brachial artery before and at 5-min intervals for up to 25 min after spraying and calculated the rate of increase of the area.Results
The average vasodilation rate after spraying with NTG above the right brachial arteries of 10 volunteers was 16.4% at 5 min, 23.6% at 10 min, 19.6% at 15 min, and 16.5% at 20 min; spraying with NTG above the left brachial artery or with physiological saline alone elicited few changes. The vasodilation rate 10 min after spraying with NTG above the right brachial artery was significantly higher than for control groups (P < 0.001).Conclusions
Transdermal application of NTG spray dilated the targeted brachial artery. This technique may be a good premedication before artery puncture.6.
Waqas T. Qureshi Zaid Alirhayim Fatima Khalid Mouaz H. Al-Mallah 《Journal of nuclear cardiology》2016,23(6):1266-1274
Background
Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value.Methods
Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality.Results
A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%.Conclusions
This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.7.
Nanne P. Kort Yoeri F. L. Bemelmans Martijn G. M. Schotanus 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2659-2667
Purpose
There has been increasing interest in accelerated programs for knee arthroplasty. We examined the efficacy and safety of an outpatient surgery (OS) pathway in patients undergoing unicompartmental knee arthroplasty (UKA).Methods
This case–controlled study evaluates patients operated for UKA in an OS pathway (n = 20) compared to rapid recovery (RR), the current standard (n = 20). We investigated whether patients could be discharged on the day of surgery, resulting in comparable or better outcome by means of adverse events (AEs) in terms of pain (numerical rating scale, NRS), incidences of postoperative nausea and vomiting (PONV) and opiate use (<48 h postoperatively), complication and readmission rates (<3 months postoperatively). Patient-reported outcome measures (PROMS) were obtained preoperatively and 3 months postoperatively.Results
Postoperative pain (NRS > 5) was the most common reason for prolonged hospital stay in the OS pathway. Eighty-five per cent of the patients were discharged on the day of surgery, whereas 95 % of the patients were discharged on postoperative day 3 in the RR pathway. Overall, median pain scores in both pathways did not exceed a NRS score of 5, without significant differences (RR vs. OS) in the number of patients with PONV (4 vs. 2) and opiate use (11 vs. 9) <48 h postoperatively. At 3 months postoperatively, no significant differences were found for AEs and PROMS between both pathways.Conclusion
The results of this study illustrates that an OS pathway for UKA is effective and safe with acceptable clinical outcome. Well-established and adequate standardized protocols, inclusion and exclusion criteria and a change in mindset for both the patient and the multidisciplinary team are the key factors for the implementation of an OS pathway.Level of evidence
Case–control study, Level III.8.
Purpose
In acute cerebral ischemia, the assessment of irreversible injury is crucial for treatment decisions and the patient’s prognosis. There is still uncertainty how imaging can safely differentiate reversible from irreversible ischemic brain tissue in the acute phase of stroke.Methods
We have searched PubMed and Google Scholar for experimental and clinical papers describing the pathology and pathophysiology of cerebral ischemia under controlled conditions.Results
Within the first 6 h of stroke onset, ischemic cell injury is subtle and hard to recognize under the microscope. Functional impairment is obvious, but can be induced by ischemic blood flow allowing recovery with flow restoration. The critical cerebral blood flow (CBF) threshold for irreversible injury is ~15 ml/100 g × min. Below this threshold, ischemic brain tissue takes up water in case of any residual capillary flow (ionic edema). Because tissue water content is linearly related to X-ray attenuation, computed tomography (CT) can detect and measure ionic edema and, thus, determine ischemic brain infarction. In contrast, diffusion-weighted magnetic resonance imaging (DWI) detects cytotoxic edema that develops at higher thresholds of ischemic CBF and is thus highly sensitive for milder levels of brain ischemia, but not specific for irreversible brain tissue injury.Conclusion
CT and MRI are complimentary in the detection of ischemic stroke pathology and are valuable for treatment decisions.9.
Purpose
To report the 3-year results of the MAJESTIC first-in-human study of the Eluvia Drug-Eluting Vascular Stent System for treating femoropopliteal artery lesions.Methods
The prospective, single-arm, multicenter clinical trial enrolled 57 patients with symptomatic lower limb ischemia (Rutherford category 2, 3, or 4) and lesions in the superficial femoral artery or proximal popliteal artery. Mean lesion length was 70.8 ± 28.1 mm, and 46% of lesions were occluded. Efficacy measures at 2 years included primary patency, defined as duplex ultrasound peak systolic velocity ratio of ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Safety monitoring through 3 years included adverse events and TLR.Results
Primary patency was estimated as 83.5% (Kaplan–Meier analysis) at 24 months, and 90.6% (48/53) of patients maintained an improvement in Rutherford class. At 36 months, the Kaplan–Meier estimate of freedom from TLR was 85.3%. No stent fractures were identified, and no major target limb amputations occurred.Conclusion
MAJESTIC results demonstrated long-term treatment durability among patients whose femoropopliteal arteries were treated with the paclitaxel-eluting Eluvia stent.Level of Evidence
Level 2b, cohort study10.
Gert Klug Sebastian Johannes Reinstadler Hans-Josef Feistritzer Christian Kremser Johannes P. Schwaiger Martin Reindl Johannes Mair Silvana Müller Agnes Mayr Wolfgang-Michael Franz Bernhard Metzler 《European radiology》2016,26(7):1999-2008
Objectives
Phase-contrast CMR (PC-CMR) might provide a fast and robust non-invasive determination of left ventricular function in patients after ST-segment elevation myocardial infarction (STEMI).Methods
Cine sequences in the left-ventricular (LV) short-axis and free-breathing, retrospectively gated PC-CMR were performed in 90 patients with first acute STEMI and 15 healthy volunteers. Inter- and intra-observer agreement was determined. The correlations of clinical variables (age, gender, ejection fraction, NT pro-brain natriuretic peptide [NT-proBNP] with cardiac index (CI) were calculated.Results
For CI, there was a strong agreement of cine CMR with PC-CMR in healthy volunteers (r: 0.82, mean difference: -0.14 l/min/m2, error?±?23 %). Agreement was lower in STEMI patients (r: 0.61, mean difference: -0.17 l/min/m2, error?±?32 %). In STEMI patients, CI measured with PC-CMR showed lower intra-observer (1 % vs. 9 %) and similar inter-observer variability (9 % vs. 12 %) compared to cine CMR. CI was significantly correlated with age, ejection fraction and NT-proBNP values in STEMI patients.Discussion
The agreement of PC-CMR and cine CMR for the determination of CI is lower in STEMI patients than in healthy volunteers. After acute STEMI, CI measured with PC-CMR decreases with age, LV ejection fraction and higher NT-proBNP.Key Points
? Cine CMR and PC-CMR correlate well in healthy volunteers.? Agreement is lower in STEMI patients.? Cardiac Output should be measured with one method longitudinally.? Cardiac output decreases with age after myocardial infarction.11.
Ulrike Hoeller Thomas Mueller Tina Schubert Volker Budach Pirus Ghadjar Winfried Brenner Felix Kiecker Bernd Schicke Oliver Haase 《Strahlentherapie und Onkologie》2015,191(1):51-58
Purpose
The nodal relapse pattern of surgically staged Merkel cell carcinoma (MCC) with/without elective nodal radiotherapy (RT) was studied in a single institution.Method
A total of 51 patients with MCC, 33?% UICC stage I, 14?% II, 53?% III (4 lymph node metastases of unknown primary) were eligible. All patients had surgical staging: 23 patients sentinel node biopsy (SNB), 22 patients SNB followed by lymphadenectomy (LAD) and 6 patients LAD. In all, 94?% of the primary tumors (PT) were completely resected; 57?% of patients received RT, 51?% of known PT sites, 33?% (8/24 patients) regional RT to snN0 nodes and 68?% (17/27 patients) to pN+ nodes, mean reference dose 51.5 and 50 Gy, respectively. Mean follow-up was 6 years (range 2–14 years).Results
A total of 22?% (11/51) patients developed regional relapses (RR); the 5-year RR rate was 27?%. In snN0 sites (stage I/II), relapse occurred in 5 of 14 nonirradiated vs. none of 8 irradiated sites (p?=?0.054), resulting in a 5-year RR rate of 33?% versus 0?% (p?=?0.16). The crude RR rate was lower in stage I (12?%, 2/17 patients) than for stage II (43?%, 3/7 patients). In stage III (pN+), RR appeared to be less frequent in irradiated sites (18?%, 3/14 patients) compared with nonirradiated sites (33?%, 3/10 patients, p?=?0.45) with 5-year RR rates of 23?% vs. 34?%, respectively.Discussion
Our data suggest that adjuvant nodal RT plays a major role even if the sentinel nodes were negative.Conclusion
Adjuvant RT of the lymph nodes in patients with stage IIa tumors and RT after LAD in stage III tumors is proposed and should be evaluated prospectively.12.
Di?Ningning Pang?Haopeng Dang?Xuefei Cheng?Wenna Ren?Yan Wu?Jingsong Yao?Chengjun Yao?Zhenwei Feng?Xiaoyuan
Introduction
This study was designed to determine if cerebral blood flow (CBF) derived from arterial spin labeling (ASL) perfusion imaging could be used to quantitatively evaluate the microvascular density (MVD) of brain gliomas on a “point-to-point” basis by matching CBF areas and surgical biopsy sites as accurate as possible.Methods
The study enrolled 47 patients with treatment-naive brain gliomas who underwent preoperative ASL, 3D T1-weighted imaging with gadolinium contrast enhancement (3D T1C+), and T2 fluid acquisition of inversion recovery (T2FLAIR) sequences before stereotactic surgery. We histologically quantified MVD from CD34-stained sections of stereotactic biopsies and co-registered biopsy locations with localized CBF measurements. The correlation between CBF and MVD was determined using Spearman’s correlation coefficient. P ≤ .05 was considered statistically significant.Results
Of the 47 patients enrolled in the study, 6 were excluded from the analysis because of brain shift or poor co-registration and localization of the biopsy site during surgery. Finally, 84 biopsies from 41 subjects were included in the analysis. CBF showed a statistically significant positive correlation with MVD (ρ = 0.567; P = .029).Conclusion
ASL can be a useful noninvasive perfusion MR method for quantitative evaluation of the MVD of brain gliomas.13.
Timothy M. Brock Paul N. Baker Steven Rushton Michelle Bardgett David Deehan 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2676-2681
Purpose
The aim was to investigate the interplay between patient characteristics and (1) length of hospital stay and (2) one-year patient-reported outcome following total knee and hip arthroplasty.Methods
Event (survival) analysis and structural equation modelling were performed for 1001 patients undergoing knee (n = 566) and hip (n = 435) arthroplasty in a single institution.Results
Age, body mass index and co-morbidities were independent predictors of length of stay in both event analysis and structural equation modelling. These patient characteristics and type of arthroplasty had both small direct and indirect effects on patient-reported outcome measures at one year. Length of stay had a small effect (<2 %) in SF-36 scores at one year.Conclusion
Predictors that influence length of stay also impact on one-year post-operative outcome and therefore should be taken into account during patient selection and discharge planning.Level of evidence
Retrospective cohort study, Level III.14.
Purpose
A pseudo-normalization of infarcted brain parenchyma, similar to the “fogging effect” which usually occurs after 2–3 weeks, can be observed on CT performed immediately after endovascular stroke treatment (EST). Goal of this study was to analyze the incidence of this phenomenon and its evolution on follow-up imaging.Methods
One hundred fifty-two patients in our database of 949 patients, who were treated for acute stroke between January 2010 and January 2015, fulfilled the inclusion criteria of (a) EST for an acute stroke in the anterior circulation, (b) an ASPECT-score < 10 on pre-interventional CT, and (c) postinterventional CT imaging within 4.5 h after the procedure. Two independent reviewers analyzed imaging data of these patients.Results
Transformation of brain areas from hypoattenuated on pre-interventional CT to isodense on postinterventional CT was seen in 37 patients in a total of 49 ASPECTS areas (Cohen’s kappa 0.819; p < 0.001). In 17 patients, the previously hypoattenuated brain areas became isodense, but appeared swollen. In 20 patients (13%), the previously hypodense brain area could not be distinguished from normal brain parenchyma. On follow-up imaging, all isodense brain areas showed signs of infarction.Conclusion
Pseudo-normalization of infarct hypoattenuation on postinterventional CT is not infrequent. It is most likely caused by contrast leakage in infarcted parenchyma and does not represent salvage of ischemic brain parenchyma.15.
Gianvincenzo Sparacia Koji Sakai Kei Yamada Giovanna Giordano Rosalia Coppola Massimo Midiri Luigi Maria Grimaldi 《Japanese journal of radiology》2017,35(4):168-171
Purpose
To assess the brain core temperature of Alzheimer disease (AD) patients in comparison with healthy volunteers using diffusion-weighted thermometry.Materials and methods
Fourteen AD patients (3 men, 11 women; age range 60–81 years, mean age 73.8 ± 6.1 years) and 14 healthy volunteers, age and sex-matched (mean age 70.1 ± 6.9 years; range 62–84 years; 5 men, 9 women) underwent MR examination between February 2014 and March 2016. MR imaging studies were performed with a 1.5-T MR scanner. Brain core temperature (T: °C) was calculated using the following equation from the diffusion coefficient (D) in the lateral ventricular (LV) cerebrospinal fluid: T = 2256.74/ln (4.39221/D) ? 273.15 using a standard DWI single-shot echo-planar pulse sequence (b value 1000 s/mm2). Statistical analysis was performed using a nonparametric Wilcoxon rank-sum test to compare the patient and control groups regarding LV temperatures.Results
There was no significant difference (P = 0.1937) in LV temperature between patients (mean 37.9 ± 1.1 °C, range 35.8–39.2 °C) and control group (38.7 ± 1.4 °C, range 36.9–42.7 °C).Conclusions
Brain core temperature in AD patients showed no significant alterations compared to healthy volunteers.16.
Early versus late prophylactic cranial irradiation in patients with extensive small cell lung cancer
Objective
Previous studies demonstrated that prophylactic cranial irradiation (PCI) significantly reduced the incidence of brain metastases in patients with extensive disease small cell lung cancer (ED-SCLC). However, the appropriate timing for PCI in treating ED-SCLC is still unclear. This study aimed to compare the effect and safety of early versus late PCI.Methods
Between November 2011 and July 2016, 103 patients with ED-SCLC were reviewed, receiving appropriate imaging tests to exclude brain metastases prior to cranial irradiation. Of these 103 patients, early PCI was performed in 47 patients and the other 56 patients received late PCI. The primary endpoint was the incidence of brain metastases. The progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were also assessed.Results
Early PCI significantly lowered the risk of brain metastases, as compared to late PCI (p?=?0.024). Additionally, multivariate analyses demonstrated that early PCI was a favorable independent predictor of the incidence of brain metastases. The PFS and OS of patients in the early and late PCI groups were comparable (PFS: 8.4 months vs. 7.5 months, p?=?0.234; OS: 16.1 months vs. 15.2 months, p?=?0.753). The AEs were generally acceptable in both groups.Conclusion
To reduce the incidence of brain metastases, early PCI is more effective than late PCI for ED-SCLC patients.17.
Yuichi?Nishiyama Hidekazu?Kanayama Hiroshi?Mori Keiji?Tada Yasushi?Yamamoto Takashi?Katsube Haruo?Takeshita Kazunori?Kawakami Hajime?Kitagaki
Objectives
This study examined the usefulness of statistical parametric mapping (SPM) for investigating postmortem changes on brain computed tomography (CT).Methods
This retrospective study included 128 patients (23???100 years old) without cerebral abnormalities who underwent unenhanced brain CT before and after death. The antemortem CT (AMCT) scans and postmortem CT (PMCT) scans were spatially normalized using our original brain CT template, and postmortem changes of CT values (in Hounsfield units; HU) were analysed by the SPM technique.Results
Compared with AMCT scans, 58.6 % and 98.4 % of PMCT scans showed loss of the cerebral sulci and an unclear grey matter (GM)–white matter (WM) interface, respectively. SPM analysis revealed a significant decrease in cortical GM density within 70 min after death on PMCT scans, suggesting cytotoxic brain oedema. Furthermore, there was a significant increase in the density of the WM, lenticular nucleus and thalamus more than 120 min after death.Conclusions
The SPM technique demonstrated typical postmortem changes on brain CT scans, and revealed that the unclear GM–WM interface on early PMCT scans is caused by a rapid decrease in cortical GM density combined with a delayed increase in WM density. SPM may be useful for assessment of whole brain postmortem changes.Key Points
? The original brain CT template achieved successful normalization of brain morphology.? Postmortem changes in the brain were independent of sex.? Cortical GM density decreased rapidly after death.? WM and deep GM densities increased following cortical GM density change.? SPM could be useful for assessment of whole brain postmortem changes.18.
Heinz?Schmidberger Matthias?Rapp Anne?Ebersberger Silla?Hey-Koch Carmen?Loquai Stephan?Grabbe Arnulf?Mayer
Purpose
Since the introduction of ipilimumab (IPI) for the treatment of patients with metastatic malignant melanoma, we have observed remarkable responses after hypofractionated whole brain irradiation (WBRT) or stereotactic radiotherapy (STX) for brain metastases of malignant melanoma. We sought to investigate the impact of the sequence of these treatment modalities.Methods
We retrospectively evaluated the survival of melanoma patients with brain metastases who were treated with WBRT or STX and received IPI in close temporal relation between October 2010 and March 2015. Follow-up was obtained until November 2016. A total of 27 patients with advanced melanoma and brain metastases who were treated with WBRT before 2010, and who had not received IPI, served as historical controls.Results
We identified a total of 41 patients of whom 15 were treated with STX, 7 with a combination of STX and WBRT and 19 with WBRT alone. All patients received at least 2 doses of IPI. The median time interval between radiotherapy and IPI was 2 months. Patients treated with IPI after radiotherapy had a censored median survival of 11 months, compared with 3 months for the patients who received IPI prior to radiotherapy. Patients who received IPI before radiotherapy showed a similar survival as historical controls, who had not received IPI. We observed long-term survivors after radiotherapy of brain metastases followed by IPI.Conclusions
These data suggest that the sequence of RT and immune checkpoint inhibition with IPI may be crucial for the success of combined modality treatment of melanoma brain metastases.19.
Young-Do Kim Hyeonseok S. Jeong In-Uk Song Yong-An Chung Eun Namgung Yong-Duk Kim 《Annals of nuclear medicine》2016,30(10):731-737
Objective
Although Parkinson’s disease (PD) is frequently accompanied by depression, brain perfusion deficits in PD with depression remain unclear. This study aimed to assess alterations in regional cerebral blood flow (rCBF) in depressed PD patients using 99mTc hexamethyl-propylene-amine-oxime single-photon emission computed tomography (SPECT).Methods
Among 78 patients with PD, 35 patients were classified into the depressed PD group, while the rest (43 patients) was assigned to the nondepressed PD group based on the scores of the Geriatric Depressive Scale (GDS). All participants underwent brain SPECT imaging. The voxel-wise whole-brain analysis and region-of-interest (ROI) analysis of the limbic areas were conducted to compare rCBF between the depressed and nondepressed PD groups.Results
The depressed PD patients demonstrated higher GDS scores than nondepressed patients, whereas between-group differences in the PD severity and cognitive function were not significant. Perfusion in the left cuneus was increased, while that in the right superior temporal gyrus and right medial orbitofrontal cortex was reduced in the depressed PD patients as compared with nondepressed PD patients. In addition, the ROI analysis demonstrated rCBF decreases in the amygdala, anterior cingulate cortex, hippocampus, and parahippocampal gyrus in the depressed PD group. A positive correlation was found between the GDS scores and rCBF in the left cuneus cluster in the depressed PD patients.Conclusion
This study identified the regional pattern of brain perfusion that distinguished depressed from nondepressed PD patients. Hyperperfusion in the occipital areas and hypoperfusion in the fronto-temporo-limbic regions may be potential imaging biomarkers for depression in PD.20.
W. Fitz S. Jäger J. S. Rieger E. Seebach R. G. Bitsch 《Knee surgery, sports traumatology, arthroscopy》2017,25(6):1712-1719