Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm?

Objectives

To assess the value of secretin during magnetic resonance cholangiopancreatography (MRCP) in demonstrating communication between cystic lesions and the pancreatic duct to help determine the diagnosis of side-branch intraductal papillary mucinous neoplasm (SB-IPMN).

Methods

This is an IRB-approved, HIPAA-compliant retrospective study of 29 SB-IPMN patients and 13 non-IPMN subjects (control) who underwent secretin-enhanced MRCP (s-MRCP). Two readers blinded to the final diagnosis reviewed three randomised image sets: (1) pre-secretin HASTE, (2) dynamic s-MRCP and (3) post-secretin HASTE. Logistic regression, generalised linear models and ROC analyses were used to compare pre- and post-secretin results.

Results

There was no significant difference in median scores for the pre-secretin [reader 1: 1; reader 2: 2 (range -2 to 2)] and post-secretin HASTE [reader 1: 1; reader 2: 1 (range -2 to 2)] in the SB-IPMN group (P?=?0.14), while the scores were lower for s-MRCP [reader 1: 0.5 (range -2 to 2); reader 2: 0 (range -1 to 2); P?=?0.016]. There was no significant difference in mean maximum diameter of SB-IPMN on pre- and post-secretin HASTE, and s-MRCP (P?>?0.05).

Conclusion

Secretin stimulation did not add to MRCP in characterising pancreatic cystic lesions as SB-IPMN.

Key Points

? Magnetic resonance cholangiopancreatography (MRCP) is used to evaluate pancreatic cystic lesions. ? Intraductal papillary mucinous neoplasm (IPMN) is a type of pancreatic cystic neoplasm. ? Secretin administration does not facilitate the diagnosis of IPMN on MRCP.     

Chemical exchange saturation transfer MR imaging of Parkinson’s disease at 3 Tesla

Objectives

To demonstrate the feasibility of using chemical exchange saturation transfer (CEST) imaging to detect Parkinson’s disease (PD) in patients at 3 Tesla.

Methods

Twenty-seven PD patients (17 men and 10 women; age range, 54–77 years) and 22 age-matched normal controls (13 men and 9 women; age range, 55–73 years) were examined on a 3-Tesla MRI system. Magnetization transfer spectra with 31 different frequency offsets (?6 to 6 ppm) were acquired at two transverse slices of the head, including the basal ganglia and midbrain. One-way analysis of variance tests was used to compare the differences in CEST imaging signals between PD patients and normal controls.

Results

Total CEST signal between the offsets of 0 and 4 ppm in the substantia nigra was significantly lower in PD patients than in normal controls (P?=?0.006), which could be associated with the loss of dopaminergic neurons. Protein-based CEST imaging signals at the offset of 3.5 ppm in the globus pallidus, putamen and caudate were significantly increased in PD patients, compared to normal controls (P?P?=?0.003, P?Conclusions CEST imaging signals could potentially serve as imaging biomarkers to aid in the non-invasive molecular diagnosis of PD.

Key Points

? Total CEST signal in substantia nigra decreased in PD patients ? Protein-based CEST signals in basal ganglia increased in PD patients ? CEST could assist with the non-invasive molecular diagnosis for PD patients     

Pretherapy metabolic tumour volume is an independent predictor of outcome in patients with diffuse large B-cell lymphoma

Purpose

We investigated the prognostic value of total metabolic tumour volume (TMTV) in diffuse large B-cell lymphoma (DLBCL).

Methods

TMTV was measured in 114 patients with newly diagnosed DLBCL who underwent ¹⁸F-FDG PET/CT at baseline before immunochemotherapy. TMTV was computed by summing the volumes of all lymphomatous lesions after applying the local SUVmax threshold of 41 % using semiautomatic software. Prognostic value was assessed by Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS).

Results

Median follow-up was 39 months. Average pretherapy TMTV was 509?±?568 cm³. The 3-year estimates of PFS were 77 % in the low metabolic burden group (TMTV ≤550 cm³) and 60 % in the high metabolic burden group (TMTV >550 cm³, p?=?0.04), and prediction of OS was even better (87 % vs. 60 %, p?=?0.0003). Cox regression showed independence of TMTV for OS prediction (p?=?0.002) compared with other pretherapy indices of tumour burden, such as tumour bulk and the International Prognostic Index.

Conclusion

Pretherapy TMTV is an independent predictor of outcome in patients with DLBCL.     

Pancreatic neuroendocrine tumours: correlation between MSCT features and pathological classification

Objectives

We aimed to evaluate the multi-slice computed tomography (MSCT) features of pancreatic neuroendocrine neoplasms (P-NENs) and analyse the correlation between the MSCT features and pathological classification of P-NENs.

Methods

Forty-one patients, preoperatively investigated by MSCT and subsequently operated on with a histological diagnosis of P-NENs, were included. Various MSCT features of the primary tumour, lymph node, and distant metastasis were analysed. The relationship between MSCT features and pathologic classification of P-NENs was analysed with univariate and multivariate models.

Results

Contrast-enhanced images showed significant differences among the three grades of tumours in the absolute enhancement (P?=?0.013) and relative enhancement (P?=?0.025) at the arterial phase. Univariate analysis revealed statistically significant differences among the tumours of different grades (based on World Health Organization [WHO] 2010 classification) in tumour size (P?=?0.001), tumour contour (P?P?=?0.001), tumour boundary (P?=?0.003), dilatation of the main pancreatic duct (P?=?0.001), peripancreatic tissue or vascular invasion (P?P?=?0.011), and distant metastasis (P?=?0.012). Multivariate analysis suggested that only peripancreatic tissue or vascular invasion (HR 3.934, 95 % CI, 0.426–7.442, P?=?0.028) was significantly associated with WHO 2010 pathological classification.

Conclusions

MSCT is helpful in evaluating the pathological classification of P-NENs.

Key Points

? P-NENs are potentially malignant, and classification of P-NENs carries important prognostic value. ? MSCT plays an important role in the diagnosis and staging of P-NENs. ? Correlations between classification of P-NENs and imaging findings have not been systematically evaluated. ? MSCT could predict P-NENs classification and may be a useful prognostication tool.     

Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

Purpose

We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural ¹⁸?F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging.

Methods

From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7–15.9 cm; SD, 2.9 cm) in bones (n?=?33), liver (n?=?26), soft tissues (n?=?18), lung (n?=?15) and abdomen (n?=?14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed.

Results

Biopsies were positive for malignancy in 76 cases (71.7 %, 76/106) and for benign tissue in 30 cases (28.3 %, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3 %, 100/106) requiring no further exploration, and for the six others (5.7 %, 6/106) benign diagnoses were confirmed after surgery (n?=?4) or follow-up (n?=?2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100 %. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV?>?4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7 %, 4/106).

Conclusion

Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions.     

Effect of vascular haemoglobin concentrations on ultrasound-guided diffuse optical tomography in differentiating benign from malignant breast lesions

Objectives

Ultrasound-guided diffuse optical tomography (US-DOT) can potentially detect breast carcinomas by measuring total tumour haemoglobin concentrations (TTHC). The purpose of this study was to evaluate whether vascular haemoglobin concentrations (VHC) affect the ability of US-DOT to distinguish breast carcinomas from benign.

Materials and methods

In 85 women (97 palpable lesions) referred for core breast biopsy, we measured VHC with a complete blood count and calculated TTHCs for each lesion with US-DOT. Anaemia was defined as a VHC less than 120.0 g/L.

Results

Mean TTHCs were significantly higher in malignant lesions (n?=?53) than in benign lesions (n?=?44), regardless of whether the lesions were from women with anaemia (TTHC, 248.5 vs. 123.3 μmol/L; P?=?0.001) or from those without (TTHC, 229.7 vs. 173.9 μmol/L; P?=?0.016). A cut-off TTHC of 155.1 μmol/L provided 81.3 % sensitivity, 81.8 % specificity and 81.5 % accuracy for detecting malignant tumours in women with anaemia and 78.4 % sensitivity, 54.5 % specificity and 67.1 % accuracy for women without. There was no significant difference in sensitivity (P?=?0.813), specificity (P?=?0.108) and accuracy (P?=?0.162) between the anaemic group and the non-anaemic group.

Conclusions

Vascular haemoglobin concentrations did not affect the ability of US-DOT to differentiate breast carcinomas from benign lesions.

Key Points

? US-DOT can differentiate benign from malignant breast lesions by measuring TTHC. ? No difference in TTHC between the anaemia and non-anaemia group. ? Vascular haemoglobin concentrations do not affect the diagnostic ability of US-DOT.     

Tumour volume doubling time of molecular breast cancer subtypes assessed by serial breast ultrasound

Objectives

The aim of our study was to evaluate the tumour volume doubling time (TVDT) of molecular breast cancer subtypes by serial ultrasound (US).

Methods

Sixty-six patients (mean age, 50 years; range, 29–78 years) with invasive breast cancer underwent initial and follow-up breast US examinations (at least three months apart) with no intervention. TVDT was determined using the tumours’ greatest dimensions in two orthogonal planes. The results were compared with clinical, imaging, and tumour variables and molecular subtypes (oestrogen receptor [ER]-positive, human epidermal growth factor receptor 2 [HER2]-positive, and triple negative) using a multiple linear regression analysis.

Results

TVDT exhibited a wide range (46–825 days; median, 141 days) with an overall mean of 193?±?141 days and mean values of 241?±?166 days for ER-positive tumours (n?=?37), 162?±?60 days for HER2-positive tumours (n?=?12), and 103?±?43 days for triple-negative tumours (n?=?17) (P?P?Conclusions TVDT differed significantly among the three molecular breast cancer subtypes, with the triple-negative tumours showing the fastest growth.

Key Points

? Knowledge of tumour volume doubling time provides clues for improving screening. ? TVDT assessed by serial US differed significantly between breast cancer subtypes. ? Triple-negative tumours had 2.4-fold shorter TVDT compared to ER-positive tumours. ? Tumours classified as BI-RADS 3 had shorter TVDT than BI-RADS 4.     

Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size

Objectives

To assess the contrast-enhanced ultrasound (CEUS) frequencies of centrifugal enhancement, spoke-wheel sign and central scar in focal nodular hyperplasia (FNH) as a function of lesion size.

Methods

Ninety-four FNHs were retrospectively reviewed to assess their largest diameter and enhancement pattern, including centrifugal enhancement from one central artery, spoke-wheel sign, diffuse or centripetal enhancement, central scar and late-phase washout.

Results

Mean FNH-lesion size was 3.7?±?2.1 cm. Only 43.6 % of FNHs had centrifugal enhancement, with a spoke-wheel pattern (23.4 %) or without (20.2 %), while 56.4 % showed diffuse or centripetal enhancement. Centrifugal enhancement was observed in 73.9 % of FNHs ≤3.1 cm and 14.6 % of FNHs >3.1 cm (P?–4). Size and frequency of centrifugal enhancement were negatively correlated (r?=?–0.57, P?–4). The spoke-wheel pattern was also seen more frequently in smaller (37 %) than in larger FNHs (10.4 %) (P?–3). Late-phase washout was described in 5.3 % of FNHs and was not size-dependent. Lesions with a central scar were larger than those without, respectively, 5.7?±?1.7 and 3.6?±?2.0 cm (P?=?0.012).

Conclusions

Typical centrifugal enhancement yielding a confident FNH diagnosis is seen significantly more frequently when the lesion is ≤3.1 cm.

Key Points

? CEUS yields confident diagnoses of FNHs ≤3.1 cm ? The larger the FNH, the lower the diagnostic sensitivity of CEUS ? Final diagnosis of FNHs >3.1 cm should be obtained with MRI not CEUS     

Inverse prognostic impact of ErbB2 mRNA and protein expression level in tumors of soft tissue sarcoma patients

Background

Human epidermal growth factor receptor 2 (ErbB2) is overexpressed in a variety of human malignancies. Moreover, ErbB2 has been reported to influence cancer patient survival and progression of different tumor entities. However, information regarding the prognostic impact of ErbB2 in soft tissue sarcoma (STS) patients is limited and conflicting.

Material and methods

ErbB2 mRNA and protein levels were defined by quantitative real-time PCR and enzyme-linked immunosorbent assay (ELISA), and the prognostic impact of ErbB2 mRNA and protein levels in tumor tissue of 124 soft tissue sarcoma patients were investigated.

Results

The median ErbB2 mRNA expression level in tumor tissue was decreased 3.9-fold compared to non-neoplastic surrounding tissue (p?=?0.001). Furthermore, an increased ErbB2 mRNA expression level was associated with an improved tumor-specific survival (p?=?0.01, log rank test). Multivariate Cox’s proportional hazard regression analyses revealed an increased ErbB2 mRNA expression level as an independent favorable prognostic factor for tumor-specific survival of STS patients (n?=?124; RR?=?3.0; 95?% CI?=?1.6–5.7; p?n?=?47; RR?=?9.9; 95?% CI?=?1.7–59.7; p?=?0.012), in particular for STS patients who received postoperative radiotherapy (n?=?27; RR?=?17.9; 95?% CI?=?1.3–247.7; p?=?0.031).

Conclusion

This study suggests an inverse prognostic value of ErbB2 mRNA and protein expression level.     

Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma

Purpose

The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC).

Methods and materials

A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) Results Overall, treatment was well tolerated, with no grade >?3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7?%) than patients in the HD group (p?p?=?0.039) and 2-year LPFS (85.7 vs. 59?%, p?=?0.119), RFS (38.1 vs. 7.3?%, p?=?0.063), and OS (83.3 vs. 44.3?%, p?=?0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS.

Conclusion

SIB-IMRT is feasible and safe for patients with inoperable HCC.     

Prognostic value of 18 F-FDG uptake by regional lymph nodes on pretreatment PET/CT in patients with resectable colorectal cancer

Purpose

We evaluated the ability of pretreatment ¹⁸?F-FDG uptake by regional lymph nodes to predict the survival of patients with resectable colorectal cancer.

Methods

The records of 78 patients with AJCC stage III colorectal cancer (pathologically confirmed node-positive disease without evidence of distant metastasis) treated with surgery and adjuvant chemotherapy were retrospectively reviewed. The maximum standardized uptake values of the primary tumor (SUVp) and regional lymph nodes (SUVn) were measured by pretreatment ¹⁸?F-FDG PET/CT. The ROC curve analyses and the Cox proportional hazard model were used to analyze whether SUVp, SUVn, and clinicopathologic parameters could predict disease-free survival.

Results

Although there were no significant differences between the median SUVp in the event group and that in the non-event group, the median SUVn was significantly higher in the event group (1.7) than in the non-event group (0.8, p?=?0.023). Based on the ROC curve analysis, SUVn predicted the event for disease-free survival (AUC?=?0.668, p?=?0.02) with the optimal criterion, sensitivity, specificity, and accuracy of?>?1.2, 71 %, 63 %, and 65 %, respectively. However, SUVp did not predict disease-free survival (AUC?=?0.570, p?=?0.349). Univariate analysis revealed that SUVn (p?=?0.011) and venous invasion (p?=?0.016) were associated with disease-free survival, but pathologic N stage was not (p?=?0.09). By multivariate analysis, only SUVn?>?1.2 independently shortened the disease-free survival (relative risk, 2.97; 95 % CI, 1.14–7.74, p?=?0.026).

Conclusion

SUVn before surgery may be a useful prognostic marker in patients with AJCC stage III colorectal cancer.     

The combination of FDG PET and dynamic contrast-enhanced MRI improves the prediction of disease-free survival in patients with advanced breast cancer after the first cycle of neoadjuvant chemotherapy

Purpose

The aim of this study was to investigate the potential of FDG PET/CT and MRI in predicting disease-free survival (DFS) after neoadjuvant chemotherapy (NAC) and surgery in patients with advanced breast cancer.

Methods

The analysis included 54 women with advanced breast cancer. All patients received three cycles of NAC, underwent curative surgery, and then received three cycles of additional chemotherapy. Before and after the first cycle of NAC, all patients underwent sequential PET/CT and MRI. All patients were analysed using a diverse range of parameters. including maximal standardized uptake value (SUV), percent change in SUV (ΔSUV), initial slope of the enhancement curve (MRslope), apparent diffusion coefficient (ADC), tumour size, change in MRslope (ΔMRslope), change in ADC (ΔADC), change in tumour size (Δsize) and other clinicopathological parameters]. The relationships between covariates and DFS after surgery were analysed using the Kaplan-Meier method and the multivariate Cox proportional hazards model. Time-dependent receiver operating characteristic curves were used to determine the optimal cut-off values of imaging parameters for DFS.

Results

Of the 54 patients, 13 (24 %) experienced recurrence at a median follow-up of 38 months (range 25 – 45 months). Univariate and multivariate analyses showed that a lesser decline in SUV, a lesser decline in MRslope, a lesser increase in ADC, and ER negativity were significantly associated with a poorer DFS (P?=?0.0006, ΔSUV threshold ?41 %; P?=?0.0016, ΔMRslope threshold ?6 %; P?=?0.011, ΔADC threshold 11 %; and P?=?0.0086, ER status, respectively). Patients with a combination of ΔSUV >?41 % and ΔMRslope >?6 % showed a significantly higher recurrence rate (77.8 %) than the remaining of patients (13.3 %, P?Conclusion Functional parameters of both FDG PET and MRI after the first cycle of NAC are useful for predicting DFS in patients with advanced breast cancer. This approach could lead to an improvement in patient care because ineffective NAC agents could be avoided and more aggressive therapy could be used in high-risk patients.     

Brain core temperature of patients with mild traumatic brain injury as assessed by DWI-thermometry

Introduction

The aim of this study was to assess the brain core temperature of patients with mild traumatic brain injury (mTBI) using a noninvasive temperature measurement technique based on the diffusion coefficient of the cerebrospinal fluid.

Methods

This retrospective study used the data collected from April 2008 to June 2011. The patient group comprised 20 patients with a Glasgow Coma Scale score of 14 or 15 who underwent magnetic resonance imaging within 30 days after head trauma. The normal control group comprised 14 subjects who volunteered for a brain checkup (known in Japan as “brain dock”). We compared lateral ventricular (LV) temperature between patient and control groups. Follow-up studies were performed for four patients.

Results

LV temperature measurements were successfully performed for both patients and controls. Mean (±standard deviation) measured LV temperature was 36.9?±?1.5 °C in patients, 38.7?±?1.8 °C in follow-ups, and 37.9?±?1.2 °C in controls, showing a significant difference between patients and controls (P?=?0.017). However, no significant difference was evident between patients and follow-ups (P?=?0.595) or between follow-ups and controls (P?=?0.465).

Conclusions

A reduction in brain core temperature was observed in patients with mTBI, possibly due to a global decrease in metabolism.     

Court decisions on medical malpractice

Background

Recent studies on court cases dealing with medical malpractice are few and far between. This retrospective study, therefore, undertakes an analysis of medical malpractice lawsuits brought before regional courts in two judicial districts of the federal state of Hesse.

Methods

Over a 5-year period (2006–2010), 232 court decisions on medical malpractice taken by the regional courts (Landgericht) of Kassel and Marburg were evaluated according to medical discipline, diagnosis, therapy, relevant level of care, charge of neglect of duty by the claimant party, outcome of the lawsuit, and further criteria.

Results

With certain overlaps, the disciplines most frequently confronted with claims of medical malpractice were accident surgery and orthopedics (30.2 %; n?=?70), dentistry (16.4 %; n?=?38), surgery (12.1 %; n?=?28), and gynecology and obstetrics (7.8 %; n?=?18), followed by the remaining medical disciplines (38.8 %; n?=?90). Malpractice allegations were brought against the practice-based sector in 35.8 % (n?=?83) of cases, the hospital-based sector in 63.3 % (n?=?147) of cases, and other sectors in 0.9 % (n?=?2) of cases. The allegation grounds included false administration of treatment (67.2 %; n?=?156), false indication of treatment (37.1 %; n?=?86), false diagnosis (31.5 %; n?=?73), and/or organizational negligence (13.8 %; n?=?32). A breach of duty to inform was given as grounds for the claim in 38.8 % (n?=?90) of cases. A significant majority of 65.6 % (n?=?152) of cases ended in a court settlement. Of the cases, 18.9 % (n?=?44) were concluded by claim withdrawal, 11.2 % (n?=?26) by claim dismissal and 2.6 % (n?=?6) by criminal sentence. Of the cases, 1.7 % (n?=?4) were for purposes of securing evidence.

Conclusion

Although there was no conclusive evidence of malpractice, two thirds of the cases ended in a court settlement. On the one hand, this outcome reduces the burden on the courts, but on the other, it can in the long term give rise to expectations that doctors will accept liability even in cases of inevitable deterioration following due and proper treatment.     

The usefulness of diffusion-weighted/fluid-attenuated inversion recovery imaging in the diagnostics and timing of lacunar and nonlacunar stroke

Introduction

The DWI/FLAIR mismatch is a potential radiological marker for the timing of stroke onset. The aim of the study was to assess if the DWI/FLAIR mismatch can help to identify patients with both lacunar and nonlacunar acute ischemic stroke within 4.5 h of onset.

Methods

A retrospective study was performed in which the authors analysed data from 86 ischemic lacunar and nonlacunar stroke patients with a known time of symptom onset, imaged within the first 24 h from stroke onset (36 patients <4.5 h, 14 patients 4.5–6 h, 15 patients 6–12 h, and 21 patients 12–24 h). Patients underwent the admission CT and MR scan. The presence of lesions was assessed in correlation with the duration of the stroke.

Results

The time from stroke onset to neuroimaging was significantly shorter in patients with an ischemic lesion visible only in the DWI (mean 2.78 h, n?=?24) as compared to patients with signs of ischemia also in other modalities (mean 8.6 h, n?=?62) (p?=?0.0001, Kruskal–Wallis ANOVA). The DWI/FLAIR mismatch was characterised by a global sensitivity of 58 %, specificity 94 %, PPV 87.5 %, and NPV 76 % in identifying patients in the 4.5 h thrombolysis time window. For lacunar strokes (n?=?20), these parameters were as follows: sensitivity 50 %, specificity 92.8 %, PPV 75 %, and NPV 81.2 %.

Conclusions

The presence of acute ischemic lesions only in DWI can help to identify both lacunar and nonlacunar stroke patients who are in the 4.5 h time window for intravenous thrombolysis with high specificity.     

Postprandial changes in secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP with a spatially selective inversion-recovery (IR) pulse

Purpose

To evaluate the influence of oral ingestion on the secretory flow dynamics of physiological pancreatic juice within the main pancreatic duct in healthy subjects by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively.

Materials and methods

Thirty-eight healthy subjects were investigated. MRCP with spatially-selective IR pulse was repeated every 15 s for 5 min to acquire a total of 20 images (cine-dynamic MRCP). A set of 20 MRCP images was repeatedly obtained before and after liquid oral ingestion every 7 min (including 2-min interval) for 40 min (a total of seven sets). Secretion grade of pancreatic juice on cine-dynamic MRCP was compared before and after oral ingestion using the nonparametric Wilcoxon signed-rank test.

Results

Median secretion grades of pancreatic juice at 5 min (score?=?2.15), 12 min (score?=?1.95) and 19 min (score?=?2.05) after ingestion were significantly higher than that before ingestion (score?=?1.40) (P?=?0.004, P?=?0.032, P?=?0.045, respectively). Secretion grade of pancreatic juice showed a maximum peak of 2.15 at 5 min after ingestion. Thereafter, the secretion grade of pancreatic juice tended to gradually decline.

Conclusion

Non-invasive cine-dynamic MRCP using spatially-selective IR pulse showed potential for evaluating postprandial changes in the secretory flow dynamics of pancreatic juice as a physiological reaction.

Key Points

? Secretion grade of pancreatic juice at cine-dynamic MRCP after ingestion was evaluated. ? Secretion grade was significantly increased within 19 min after liquid meal ingestion. ? Secretion grade showed maximum peak of 2.15 at 5 min after ingestion. ? Postprandial changes in pancreatic juice flow can be assessed by cine-dynamic MRCP.

     

Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head

Objectives

To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture.

Methods

Thirty-seven symptomatic hips of 27 consecutive patients (53 % women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification.

Results

On MR imaging a fracture line could be identified in 19/37 (51 %) cases, which were classified as ARCO stage 3 (n?=?15) and stage 4 (n?=?4). The remaining 18/37 (49 %) cases were classified as ARCO stage 2. However, in all 37/37 (100 %) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P?Histopathological analysis confirmed bone necrosis and subchondral fractures.

Conclusions

In patients with AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease.

Key Points

? BME on MRI in AVN of femoral head indicates a subchondral fracture. ? BME in AVN of the femoral head represents ARCO stage 3/4 disease. ? CT identifies subchondral fractures and femoral head collapse better than MR imaging. ? This knowledge helps to avoid understaging and to trigger adequate treatment.     

Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma

Purpose

The safety and efficacy of using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with esophageal squamous cell carcinoma were evaluated in a single-institution phase II setting.

Methods and materials

Between June 2007 and October 2009, 45 patients underwent concurrent chemoradiotherapy (n?=?27) or radiotherapy alone (n?=?18). Two planning target volumes (PTV) were defined for the SIB: PTV_C and PTV_G, with prescribed doses of 50.4 Gy to the PTV_C (1.8 Gy/fraction) and 63 Gy to the PTV_G (2.25 Gy/fraction), both given in 28 fractions.

Results

At a median follow-up interval of 20.3 months, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 42.2 and 40.7?%, respectively. The median overall survival time was 21 months; locoregional control rates were 83.3?% at 1 year and 67.5?% at 3 years. According to CTCAE (version 3.0) criteria, none of the patients developed grade 4–5 toxicity. The most common grade 2 and 3 radiation-related toxicity was radiation esophagitis, occurring in 64?% of all patients (but only 13?% as grade 3). No patient developed grade >?2 pulmonary complications.

Conclusion

SIB-IMRT is a feasible therapeutic approach for esophageal carcinoma patients and provides encouraging locoregional control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.     

18F-FDG PET of the hands with a dedicated high-resolution PEM system (arthro-PET): correlation with PET/CT,radiography and clinical parameters

Purpose

The aim of this study was to prospectively determine the feasibility and compare the novel use of a positron emission mammography (PEM) scanner with standard PET/CT for evaluating hand osteoarthritis (OA) with ¹⁸F-FDG.

Methods

Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study in which 14 adults referred for oncological ¹⁸F-FDG PET/CT underwent dedicated hand PET/CT followed by arthro-PET using the PEM device. Hand radiographs were obtained and scored for the presence and severity of OA. Summed qualitative and quantitative joint glycolytic scores for each modality were compared with the findings on plain radiography and clinical features.

Results

Eight patients with clinical and/or radiographic evidence of OA comprised the OA group (mean age 73?±?7.7 years). Six patients served as the control group (53.7?±?9.3 years). Arthro-PET quantitative and qualitative joint glycolytic scores were highly correlated with PET/CT findings in the OA patients (r?=?0.86. p??=?0.007; r?=?0.94, p?=?0.001). Qualitative arthro-PET and PET/CT joint scores were significantly higher in the OA patients than in controls (38.7?±?6.6 vs. 32.2?±?0.4, p?=?0.02; 37.5?±?5.4 vs. 32.2?±?0.4, p?=?0.03, respectively). Quantitative arthro-PET and PET/CT maximum SUV-lean joint scores were higher in the OA patients, although they did not reach statistical significance (20.8?±?4.2 vs. 18?±?1.8, p?=?0.13; 22.8?±?5.38 vs. 20.1?±?1.54, p=?0.21). By definition, OA patients had higher radiographic joint scores than controls (30.9?±?31.3 vs. 0, p?=?0.03).

Conclusion

Hand imaging using a small field of view PEM system (arthro-PET) with FDG is feasible, performing comparably to PET/CT in assessing metabolic joint activity. Arthro-PET and PET/CT showed higher joint FDG uptake in OA. Further exploration of arthro-PET in arthritis management is warranted.     

Initial experience of correlating parameters of intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging at 3.0 T in nasopharyngeal carcinoma

Purpose

To determine the correlation between intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters.

Methods

Thirty-eight newly diagnosed NPC patients were prospectively enrolled. Diffusion-weighted images (DWI) at 13 b-values were acquired using a 3.0-T MRI system. IVIM parameters including the pure molecular diffusion (D), perfusion-related diffusion (D*), perfusion fraction (f), DCE-MRI parameters including maximum slope of increase (MSI), enhancement amplitude (EA) and enhancement ratio (ER) were calculated by two investigators independently. Intra- and interobserver agreement were evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Relationships between IVIM and DCE-MRI parameters were evaluated by calculation of Spearman’s correlation coefficient.

Results

Intra- and interobserver reproducibility were excellent to relatively good (ICC?=?0.887-0.997; narrow width of 95 % limits of agreement). The highest correlation was observed between f and EA (r?=?0.633, P?f and MSI (r?=?0.598, P?=?0.001). No correlation was observed between f and ER (r?=?-0.162; P?=?0.421) or D* and DCE parameters (r?=?0.125–0.307; P?>?0.119).

Conclusion

This study suggests IVIM perfusion imaging using 3.0-T MRI is feasible in NPC, and f correlates significantly with EA and MSI.

Key Points

? Assessment of tumour perfusion is important in nasopharyngeal carcinoma. ? DCE-MRI provided perfusion information with the use of intravenous contrast media. ? Perfusion information could be provided by non-invasive IVIM MRI. ? IVIM parameter f correlated with DCE-MRI parameters.