MRI of the kidney—state of the art

Ultrasound and computed tomography (CT) are modalities of first choice in renal imaging. Until now, magnetic resonance imaging (MRI) has mainly been used as a problem-solving technique. MRI has the advantage of superior soft-tissue contrast, which provides a powerful tool in the detection and characterization of renal lesions. The MRI features of common and less common renal lesions are discussed as well as the evaluation of the spread of malignant lesions and preoperative assessment. MR urography technique and applications are discussed as well as the role of MRI in the evaluation of potential kidney donors. Furthermore the advances in functional MRI of the kidney are highlighted.     

ALA—Photodynamic treatment in Lichen sclerosus—clinical and immunological outcome focusing on the assesment of antinuclear antibodies

BackgroundLichen sclerosus (LS) is a difficult to treat, often relapsing disease with unknown background. Autoimmune diseases also coexist with LS. Over recent years photodynamic therapy (PDT) has been shown to be a noninvasive and successful therapeutic approach for the effective treatment of many conditions. However, the change of immune status of the patients based on ANA antibodies has not been yet reported. Our aim was to observe the clinical response followed by possible changes in autoimmune antibodies levels before and after PDT for LS.Material and MethodsWe enrolled 100 women with Lichen sclerosus with or without a concomitant autoimmune disease. All patients received 10 cycles of PDT (65 treated with DIOMED Light, 35 with PhotoDYN Light). We assessed autoimmune antibodies before and after PDT in addition to the clinical response evaluation.Two-year prospective controlled before-and-after study.ResultsFollowing PDT, patients showed a significant attenuation in symptoms’ intensity (itching, pruritus, vulvar discomfort). After therapy 41% of patients had partial response, 51% of patients had no symptoms and 8% had persistent or worsened symptoms. The most frequent autoimmune disease were thyroid disorders, followed by vitiligo and arthritis. 57% patients with an additional autoimmune disease before PDT had ANA antibodies. The mean level of ANA in this group diminished significantly after PDT treatment (261.74 IU/ml before vs. 123.20 IU/ml after treatment).ConclusionBased on our results, we assume that PDT may influence the immune status of patients with Lichen sclerosus.     

Photodynamic therapy in oral potentially malignant disorders—Critical literature review of existing protocols

IntroductionOral cancer is a serious public health issue. Apart from its high rate of prevalence, incidence and mortality, it can often result in more complex and expensive treatment when diagnosed late. Potentially malignant disorders (PMDs) can precede oral cancer, and are usually treated by surgical excision. However, in many cases patients are elderly and multiple interventions may be required. Photodynamic therapy (PDT) is a simple alternative, which has been successfully used in the treatment of oral PMDs.ObjectiveDue to the lack of standardization regarding photosensitizers (PTSs), types of irradiation, and methods of application, the objective of this study was to analyze existing PDT protocols in an attempt to identify the one that demonstrates greater efficiency, reliability and feasibility in the treatment of oral PMDs for both researchers and clinicians.MethodsOriginal clinical studies published only in English between 1993 and 2016 were searched in Pubmed/Medline database using the following keywords: photodynamic therapy; oral potentially malignant disorder; oral premalignant lesions. Review articles; experimental studies; case-reports; commentaries; and letters to the Editor were excluded from the selection.Results and conclusionBased on the 16 studies selected, the topical 5-ALA-20% PTS, associated to a LED light applied for 15 min with a 7-day interval between sessions emerged as the most frequently used PDT protocol, with satisfactory results. Due to its low rate of side effects, this PDT protocol presents good potential for the treatment of oral PMDs. Further clinical studies are required to ascertain its long-term validity in preventing oral cancer.     

Haralick’s texture features for the prediction of response to therapy in colorectal cancer: a preliminary study

Purpose

Haralick features Texture analysis is a recent oncologic imaging biomarker used to assess quantitatively the heterogeneity within a tumor. The aim of this study is to evaluate which Haralick’s features are the most feasible in predicting tumor response to neoadjuvant chemoradiotherapy (CRT) in colorectal cancer.

Materials and Methods

After MRI and histological assessment, eight patients were enrolled and divided into two groups based on response to neoadjuvant CRT in complete responders (CR) and non-responders (NR). Oblique Axial T2-weighted MRI sequences before CRT were analyzed by two radiologists in consensus drawing a ROI around the tumor. 14 over 192 Haralick’s features were extrapolated from normalized gray-level co-occurrence matrix in four different directions. A dedicated statistical analysis was performed to evaluate distribution of the extracted Haralick’s features computing mean and standard deviation.

Results

Pretreatment MRI examination showed significant value (p < 0.05) of 5 over 14 computed Haralick texture. In particular, the significant features are the following: concerning energy, contrast, correlation, entropy and inverse difference moment.

Conclusions

Five Haralick’s features showed significant relevance in the prediction of response to therapy in colorectal cancer and might be used as additional imaging biomarker in the oncologic management of colorectal patients.

     

The new NHS colorectal cancer screening programme and the potential role of radiology?

The NHS Bowel Cancer Screening Programme is the first nationally coordinated screening programme to be introduced in the UK for 18 years. Currently, the screening algorithm is based upon faecal occult blood testing and colonoscopy for those screenees testing positive. This commentary provides radiologists with an update on the rationale for colorectal cancer screening, explains the organizational structure of the new UK NHS programme, and explores the possible role for radiology in the current and future screening algorithms.     

The use of β-TCP in the surgical treatment of tibial plateau fractures

The objective of this study was to evaluate the outcome of using β-TCP in the treatment of depression tibial plateau fractures. A total of 124 patients with depression tibial fractures were included in this study and followed for a minimum of 12 months. All the cases were treated with open reduction and internal fixation, and grafted with β-TCP ceramic. The clinical and radiological outcomes were assessed using Hospital for Special Surgery (HSS) score of knee and Rasmussen score during the follow-up. No obvious redisplacement was found at the follow-up assessment. Most of the patients had excellent HSS score and Rasmussen clinical score. Bone healing was noted in all fractures and Schatzker II-type fractures had the best functional outcome. The results suggested that using β-TCP combined with open reduction and rigid internal fixation was an effective treatment for depression fractures of the tibial plateau.     

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

Objective

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

Methods

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

Results

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

Conclusion

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

     

Evolution of adjuvant treatment in endometrial cancer—no evidence and new questions?

Purpose

For endometrial cancer (EC), clinical and pathological risk factors are taken to triage patients and estimate their prognosis. Lymph node involvement (pN+), lymphovascular space involvement (LSVI), grading, age of the patients, and T classification are internationally accepted parameters for treatment decisions.

Materials and methods

Studies on adjuvant radiation, chemotherapy, and chemoradiation are discussed against the background of risk stratification and clinical decision-making in early-to-advanced stage endometrial cancer. Recent publications on adjuvant treatment in high-risk disease and its implications for the patients with regard to expected oncologic benefit and treatment-related toxicity are discussed.

Results

Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI?≥?50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment.

Summary and perspectives

In the future, integrated genomic characterization of tumors might be helpful for treatment individualization in the adjuvant setting.

     

Can contrast-enhanced ultrasonography replace multidetector-computed tomography in the detection of liver metastases from colorectal cancer?

Purpose

To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and 4-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC).

Materials and methods

Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly and the combination of US, CEUS, biphasic MDCT, IOUS, follow up and biopsy was the gold standard.

Results

Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS and MDCT and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (p = 0.02). In a patient-by-patient analysis MDCT had a non-significantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, p = 0.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (p = 0.02).

Conclusion

Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a non-significant better sensitivity (p = 0.06) in detecting liver metastases in patients with CRC.     

Protective effects of systemic dermatan sulfate treatment in a preclinical model of radiation-induced oral mucositis

Purpose

Oral mucositis is a frequent, dose-limiting side effect of radio(chemo)therapy of head-and-neck malignancies. The epithelial radiation response is based on multiple tissue changes, which could offer targets for a biologically tailored treatment. The potential of dermatan sulfate (DS) to modulate radiation-induced oral mucositis was tested in an established preclinical mucositis model.

Methods

Irradiation was either applied alone or in combination with daily DS treatment (4?mg/kg, subcutaneously) over varying time intervals. Irradiation comprised single dose irradiation with graded doses to the lower tongue surface or daily fractionated irradiation of the whole tongue. Fractionation protocols (5?×?3?Gy/week) over one (days 0–4) or two weeks (days 0–4, 7–11) were terminated by an additional local single dose irradiation to a defined treatment field on the lower tongue surface to induce the mucosal radiation response. The additional single dose irradiation (top-up) on day 7 (after one week of fractionation) or day 14 (after 2 weeks of fractionation) comprised graded doses in order to generate full dose–effect curves. Ulceration of the epithelium of the lower tongue, corresponding to confluent mucositis, was analysed as clinically relevant endpoint. Additionally, the time course parameters, latent time and ulcer duration were analysed.

Results

DS treatment significantly reduced the incidence of ulcerations. DS application over longer time intervals resulted in a more pronounced reduction of ulcer frequency, increased latent times and reduced ulcer duration.

Conclusion

DS has a significant mucositis-ameliorating activity with pronounced effects on mucositis frequency as well as on time course parameters.

     

On the possible benefits of a hybrid VMAT technique in the treatment of non–small cell lung cancer

To assess, using clinical cases, the potential of a hybrid technique for the treatment of non–small cell lung cancer (NSCLC)-blending volumetric-modulated arc therapy (VMAT) and conformal radiation therapy (CRT) fields, and to consider potential issues with implementation of such a technique. Eight clinical cases already treated with CRT were used for a planning study comparing target coverage and organs at risk (OAR) sparing between CRT and hybrid VMAT (VMATh). Quality assurance (QA) implications of the resultant hybrid plans are discussed. The hybrid technique resulted in superior target conformity or improved sparing of OAR or both. The hybrid technique shows promise, but the QA implications of motion at treatment need careful consideration.     

Is the Use of Fullerene in Photodynamic Therapy Effective for Atherosclerosis?

The purpose of this study was to evaluate Fullerene as a therapeutic photosensitizer in the treatment of atherosclerosis. An atherosclerotic experimental rabbit model was prepared by causing intimal injury to bilateral external iliac arteries using balloon expansion. In four atherosclerotic rabbits and one normal rabbit, polyethylene glycol-modified Fullerene (Fullerene-PEG) was infused into the left external iliac artery and illuminated by light emitting diode (LED), while the right external iliac artery was only illuminated by LED. Two weeks later, the histological findings for each iliac artery were evaluated quantitatively and comparisons were made among atherosclerotic Fullerene+LED artery (n = 4), atherosclerotic light artery (n = 4), normal Fullerene+LED artery (n = 1), and normal light artery (n = 1). An additional two atherosclerotic rabbits were studied by fluorescence microscopy, after Fullerene-PEG-Cy5 complex infusion into the left external iliac artery, for evaluation of Fullerene-PEG incorporated within the atherosclerotic lesions. The degree of atherosclerosis in the atherosclerotic Fullerene+LED artery was significantly (p < 0.05) more severe than that in the atherosclerotic LED artery. No pathological change was observed in normal Fullerene+LED and LED arteries. In addition, strong accumulation of Fullerene-PEG-Cy5 complex within the plaque of the left iliac artery of the two rabbits was demonstrated, in contrast to no accumulation in the right iliac artery. We conclude that infusion of a high concentration of Fullerene-PEG followed by photo-illumination resulted not in a suppression of atherosclerosis but in a progression of atherosclerosis in experimental rabbit models. However, this intervention showed no adverse effects on the normal iliac artery.