MR spectroscopy features of brain in patients with mild and severe obstructive sleep apnea syndrome

PurposeWe investigated whether there are differences in metabolite ratios of different brain regions between mild and severe obstructive sleep apnea (OSA) patients.Materials and methodsA total of 17 mild OSA and 14 severe OSA patients were enrolled. N-acetyl aspartate (NAA)/creatine (Cr), choline (Cho)/Cr and NAA/Cho ratios were calculated by using multivoxel magnetic resonance spectroscopy (MRS) (TR: 1500, TE: 135 ms) from hippocampus, putamen, insular cortex, thalamus and temporal white matter. The relationship between the two groups was evaluated with Mann–Whitney U test.ResultsNAA/Cr ratios obtained from hippocampus was found to be significantly increased in severe OSA patients compared to mild OSA patients (P= .004). Cho/Cr ratios obtained from hippocampus and putamen in severe OSA patients were significantly increased when compared to mild OSA patients (P= .003 and P= .004, respectively). In addition, NAA/Cho ratios of putamen were significantly decreased in severe OSA patients when compared to mild OSA (P= .032).ConclusionMRS identified hypoxia-related metabolite and microstructural changes in hippocampus and putamen. The metabolite changes of increase in NAA/Cr and Cho/Cr ratios and decrease in NAA/Cho ratio were more pronounced with increasing severity of OSA syndrome.     

Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy

OBJECTIVE: The purpose of our study was to explore the feasibility and utility of 2D chemical shift imaging (CSI) MR spectroscopy in the evaluation of new areas of contrast enhancement at the site of a previously treated brain neoplasm. MATERIALS AND METHODS: Two-dimensional CSI (point-resolved spectroscopy sequence [PRESS]; TR/TE, 1,500/144) was performed in 29 consecutive patients (4-54 years old; mean age, 34 years) who had a new contrast-enhancing lesion in the vicinity of a previously diagnosed and treated brain neoplasm. Clinical and imaging follow-up, and histopathology in 16 patients, were used as indicators of the identity of a lesion. RESULTS: Diagnostic-quality spectra were obtained in 97% of the patients. The Cho/Cr (choline/creatine) and Cho/NAA (choline/N-acetyl aspartate) ratios were significantly higher, and the NAA/Cr ratios significantly lower, in tumor than in radiation injury (all three differences, p < 0.0001). The Cho/Cr and Cho/NAA ratios were significantly higher in radiation injury than in normal-appearing white matter (p < 0.0003 and p < 0.0001, respectively), whereas NAA/Cr ratios were not different (p = 0.075). Mean Cho/Cr ratios were 2.52 for tumor, 1.57 for radiation injury, and 1.14 for normal-appearing white matter. Mean Cho/NAA ratios were 3.48, 1.31, 0.79, and mean NAA/Cr ratios were 0.79, 1.22, and 1.38, respectively. When values greater than 1.8 for either Cho/Cr or Cho/NAA ratios were considered evidence of tumor, 27 of 28 patients could be correctly classified. CONCLUSION: Two-dimensional CSI MR spectroscopy can differentiate tumor from radiation injury in patients with recurrent contrast-enhancing intracranial lesions. In these lesions, the Cho/NAA and Cho/Cr ratios may be the best numeric discriminators.     

The relationship between pre-season fitness testing and injury in elite junior Australian football players

ObjectivesAustralian Football (AF) is a collision sport containing high injury rates in junior competition. Successful performance at the elite junior level not only requires superior specific football knowledge and skills, but also well developed fitness qualities. However, no studies have examined the link between physical fitness qualities and injury in AF.DesignProspective cohort.MethodsInjury data were collected through the use of a Player Movement Record (PMR) and a standardized Injury Report Form (IRF). Fitness test data was collected during the pre-season of the 2010 and 2011 seasons.Results382 players consented to participate in the study. The cohort experienced an injury incidence rate of 24.29/standardized club (40 players/club). A faster 5-m sprint was associated with ‘injury status’ (p = 0.016) and a ‘knee’ region (p ≤ 0.001) injury. A faster planned agility score was associated with an increased risk of a ‘hip/groin/thigh’ region (p = 0.010) injury, and specifically a ‘quadriceps strain’ (p = 0.005). A lower 20-m shuttle run was associated with an increased risk of a ‘shin/ankle/foot’ (p = 0.045) injury. Increased injury severity was associated with a higher left foot running vertical jump (VJ) (p = 0.040), and faster 5-m sprint (p = 0.043).ConclusionsLower aerobic endurance, faster 5-m acceleration and greater planned agility were associated with an increased risk of various injury types in elite junior AF players. Furthermore, a higher left foot running VJ and faster 5-m acceleration were associated with injury severity. These results may largely relate to a greater work capacity placing a higher load upon the musculoskeletal system in contact and non-contact situations.     

Long-term outcomes with high-dose-rate brachytherapy for the management of base of tongue cancer

PurposeTo report the long-term results of a prospective, nonrandomized clinical trial using high-dose-rate (HDR) brachytherapy (BT) for the management of base of the tongue (BOT) tumors.Methods and MaterialsBetween January 1992 and June 2011, 60 patients (mean age, 57 years; range, 36–78 years) with T1–T4 and N0-3 carcinoma of BOT were treated. Fifty-six patients (93%) had advanced (Stage III-IV) disease. HDR BT boost (mean dose, 17 Gy; range, 12–30 Gy) was delivered after 50–70 Gy (mean 62 Gy) locoregional external beam irradiation. Seventeen patients (28%) received radiochemotherapy (RCT) with cisplatin.ResultsThe 5-year actuarial rate of local tumor control, locoregional tumor control, overall survival (OS), and cancer-specific survival (CSS) was 57%, 50%, 47%, and 61%, respectively. OS was significantly better in patients (n = 17) receiving RCT (69% vs. 39%; p = 0.005). Delayed soft-tissue ulceration occurred in seven patients (12%). Only one patient (<2%) developed osteoradionecrosis. In univariate analysis, the tumor size (T1–T2–T3 vs. T4) was found to have a significant effect on CSS (p = 0.043), whereas the nodal status (N0 vs. N+) affected locoregional tumor control (p = 0.042), OS (p = 0.002), and CSS (p = 0.015). Low histologic grade (1–2) was associated with better CSS (p = 0.020), whereas RCT significantly improved OS (p = 0.012).ConclusionsExternal beam irradiation combined with interstitial HDR BT boost results in good local tumor control with an acceptable rate of late side effects in patients with BOT carcinoma. RCT improves OS. Our results are similar to those reported with traditional low-dose-rate BT implants.     

Correlation between enhancement characteristics of MR mammography and capillary density of breast lesions

ObjectiveTo correlate capillary density of breast lesions using the markers D2-40, CD31, and CD34 with early and late enhancement of magnetic resonance mammography (MRM).Materials and methodsThe local ethics committee approved this study, and informed consent was available from all patients. The study included 64 women with 66 histologically proven breast lesions (41 malignant, 25 benign). MR-enhancement 1 min after contrast medium administration was determined in the tumor (I_t1/I_t0 ratio) and in comparison to the surrounding tissue (I_t1/I_t1-fat ratio). Capillary density was quantified based on immunohistological staining with D2-40, CD31, and CD34 in breast tumors and surrounding breast tissue. Mean capillary densities were correlated with contrast enhancement in the tumor and surrounding breast tissue. The Kruskal–Wallis test was used to test whether lesions with different MR enhancement patterns differed in terms of capillary density.ResultsFor CD34, there was statistically significant correlation between capillary density and tumor enhancement (r = 0.329, p = 0.012), however not for the malignant or benign groups separately. Mean vessel number identified by staining with D2-40 and CD31 did not correlate significantly with tumor enhancement (D2-40: r = −0.188, p = 0.130; CD31: r = 0.095, p = 0.448). There were no statistically significant differences in capillary density between breast lesions with delayed enhancement or a plateau and lesions showing washout (Kruskal–Wallis test. D2-40: p = 0.173; CD31: p = 0.647; CD34: p = 0.515).ConclusionOf the three markers tested, CD34 showed best correlation between early contrast enhancement on MRM and capillary density. Further studies are necessary to clearly demonstrate an association between capillary density and contrast enhancement in breast tumors and surrounding tissue.     

Local control in advanced cancer of the nasopharynx: Is a boost dose by endocavitary brachytherapy of prognostic significance?

PurposeTo analyze whether local tumor control in advanced nasopharyngeal cancer (NPC) can be optimized by boosting the primary dose by endocavitary brachytherapy (EBT).Methods and MaterialsTo study the role of EBT, three data sets on NPC, that is, the “Vienna”, “Rotterdam,” and “Amsterdam” series, with a total number of 411 advanced NPC patients, were available. The Rotterdam series consisted of 72 patients (34 T1,2N+ and 38 T3,4N0,+) and were treated with neoadjuvant chemotherapy followed by external beam radiotherapy (dose 70/2 Gy). After 70/2 Gy, a boost was applied by EBT (in case of T1,2N+) or stereotactic radiation (in case of T3,4 tumors). The Amsterdam (Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute) series consisted of 76 patients (40 T1,2N+ and 36 T3,4N0,+) and were irradiated to a dose of 70/2 Gy with concomitant chemotherapy. No second boost by EBT was applied.ResultsIn the case of T1,2N+ tumors, the local relapse rate (LRR) was significantly smaller if a boost was applied, that is, 0% (0/34, EBT boost) vs. 14% (14/102, no EBT boost) (p = 0.023). For the T3,4 tumors, an LRR of 10% (4/38, EBT or stereotactic radiation boost) vs. 15% (17/111, no boost) was found (p = 0.463).ConclusionsIn the case of advanced NPC (T1,2N+ vs. T3,4N+,0), for early T-stages (T1,2N+), an EBT boost seems an excellent way to deliver highly conformal high doses of radiation to the nasopharynx, with high local control rates. For advanced T-stages (T3,4N+,0), the reduction in LRR (10% vs. 15%) was not significant (p = 0.463).     

The associations of early specialisation and sport volume with musculoskeletal injury in New Zealand children

ObjectiveTo investigate associations of early specialisation (highly specialised before age 13 years) and sport participation volume with injury history in New Zealand children.DesignCross-sectional survey study.MethodsChildren attending a national sports competition were invited to complete a questionnaire capturing specialisation level (high, moderate or low), participation volume and injury history. Multiple logistic regression was used to investigate associations between variables.ResultsNine hundred and fourteen children (538 female) completed the questionnaire. After adjusting for age, sex and hours of weekly sport participation, the odds of reporting an injury history were not significantly higher for early specialised children compared to children categorised as low specialisation (OR = 0.88; CI = 0.59–1.31; p = 0.53). Participating in more hours of sport per week than age in years (OR = 2.42; CI = 1.27–4.62; p = 0.02), playing one sport for more than 8 months of the year (OR = 1.60; CI = 1.07–2.36; p = 0.02), or exceeding a 2:1 weekly ratio of organised sport to recreational free-play hours (OR = 1.52; CI = 1.08–2.15; p = 0.02), increased the odds of reporting a ‘gradual onset injury’.ConclusionEarly specialisation in one sport did not increase the odds of reporting a history of injury. Exceeding currently recommended sport participation volumes was associated with increased odds of reporting a history of gradual onset injury.     

Differentiation of brain tumor-related edema based on 3D T1rho imaging

Background and purposeCerebral edema associated with brain tumors is an important source of morbidity. Its type depends largely on the capillary ultra-structures of the histopathologic subtype of underlying brain tumor. The purpose of our study was to differentiate vasogenic edema associated with brain metastases and infiltrative edema related to diffuse gliomas using quantitative 3D T1 rho (T1ρ) imaging.Materials and methodsPreoperative MR examination including whole brain 3D T1ρ imaging was performed in 23 patients with newly diagnosed brain tumors (9 with metastasis, 8 with lower grade glioma, LGG, 6 with glioblastoma, GBM). Mean T1ρ values were measured in regions of peritumoral non-enhancing T2 signal hyperintensity, excluding both enhancing and necrotic or cystic component, and normal-appearing white matter.ResultsMean T1ρ values were significantly elevated in the vasogenic edema surrounding intracranial metastases when compared to the infiltrative edema associated with either LGG or GBM (p = 0.02 and <0.01, respectively). No significant difference was noted between T1ρ values of infiltrative edema between LGG and GBM (p = 0.84 and 0.96, respectively).ConclusionOur study demonstrates the feasibility and potential diagnostic role of T1ρ in the quantitative differentiation between edema related to intracranial metastases and gliomas and as a potentially complementary tool to standard MR techniques in further characterizing pathophysiology of vasogenic and infiltrative edema.     

Dosimetric comparison of multichannel with one single-channel vaginal cylinder for vaginal cancer treatments with high-dose-rate brachytherapy

PurposeTo compare the three-dimensional (3D) image (CT/MR)-based planning with a multichannel vaginal cylinder (MVC) to a single-channel vaginal cylinder (SVC) for the treatment of vaginal cancer.Methods and MaterialsA total of 20 consecutive patients were treated with 3D CT/MR image-based high-dose-rate (HDR) brachytherapy using an MVC. All patients received external beam radiation therapy before HDR brachytherapy. A brachytherapy dose of 20–25 Gy of more than five fractions was delivered to clinical target volume (CTV). Retrospectively, treatment plans for all patients were generated using the central channel only to mimic an SVC applicator. The SVC plans were optimized to match CTV coverage with MVC plans. Dose homogeneity index as well as bladder, rectum, sigmoid, and urethral doses were compared.ResultsThe mean D₉₀ for CTV was 74.2 Gy (range: 48.8–84.1 Gy). The mean (±standard deviation) of dose homogeneity index for MVC vs. SVC was 0.49 (±0.19) and 0.52 (±0.23), respectively (p = 0.09). Mean bladder 0.1, 1, and 2 cc doses for MVC vs. SVC were 69 vs. 71.2 Gy (p = 0.35), 61.4 vs. 63.8 Gy (p = 0.1), and 59.5 vs. 60.9 Gy (p = 0.31), respectively. Similarly, mean rectum 0.1, 1, and 2 cc doses for MVC vs. SVC were 67.2 vs. 75.4 Gy (p = 0.005), 60.0 vs. 65.6 Gy (p = 0.008), and 57.3 vs. 62.0 Gy (p = 0.015), respectively, and mean sigmoid doses were 56.3 vs. 60.5 Gy (p = 0.10), 50.9 vs. 53.1 Gy (p = 0.09), and 49.1 vs. 50.7 Gy (p = 0.10), respectively.ConclusionThe 3D CT-/MR-based plan with MVC may provide better dose distribution in the management of certain clinical situations of vaginal cancer requiring intracavitary brachytherapy, especially in minimizing potential late rectal complications.     

Influence of maturational status in the exercise-induced release of cardiac troponin T in healthy young swimmers

ObjectivesTo determine the influence of maturational status on the release of cardiac troponin T (cTnT) induced by a bout of 30 min, high-intensity, continuous exercise.DesignQuasi-experimental, cross-sectional study.MethodsSeventy male, young, well trained swimmers (age range 7–18 years, training experience 1–11 years) were classified by maturational stages: Tanner stage I (n = 14), II (n = 15), III (n = 15), IV (n = 13), and V (n = 13). Participants underwent a distance-trial of 30 min continuous swimming, and cTnT was measured before, immediately after and 3 h after exercise. Changes in cTnT over time were compared among groups, and associated with exercise load.ResultsBasal cTnT was higher in Tanner-V (3.8–8.1 ng/L) compared with I (1.5–5.5 ng/L, p < 0.001), II (1.5–4.5 ng/L, p < 0.001) and III (1.5–6.8 ng/L, p = 0.003), and in IV (1.5–6.3 ng/L) compared with II (p = 0.036). Maximal elevations of cTnT from baseline were notable (p < 0.001) and comparable among maturational stages (p = 0.078). The upper reference limit for myocardial injury was exceeded in 35.7% of the participants, without differences among groups (p = 0.18). Baseline cTnT correlated with participant characteristics, and maximal cTnT elevations from baseline with exercise internal load (%HRpeak, r_s = 0.34, p =  0.003; %HRmean, r_s = 0.28, p = 0.02).ConclusionsMaturational status influences positively absolute pre- and post-exercise cTnT but not its elevation after a bout of 30 min, high-intensity, continuous exercise.     

Valoración de los factores pronósticos radiopatológicos del cáncer de mama triple negativo y análisis del carcinoma in situ como factor pronóstico

ObjectivesTo analyze what factors in magnetic resonance imaging (MRI) and histological study of triple-negative breast cancers are related to tumor recurrence and to shorter disease-free survival. To analyze survival and recurrence in function of the presence of an in situ component.Material and methodsThis was a retrospective study of MRI staging examinations in 122 women with triple-negative breast cancer done from 2007 through 2014. In the MRI, we evaluated morphological variables (size, margins, morphology, internal signal in T2-weighted sequences) and dynamic variables (perfusion and diffusion). In the histological study, we evaluated Ki67, p53, CK5/6, nuclear grade, and Scarff-Bloom grade, as well as the presence of an in situ component and tumor grade (high grade or not high grade). We compared the variables between patients with tumor recurrence and those without, and we conducted a survival analysis.ResultsNon-nodular enhancement was more common in patients with tumor recurrence (p  = 0.038) and was associated with shorter disease-free survival (p = 0.023). Neither diffusion restriction (p = 0.079) nor ki67 (p = 0.052) was associated with a worse prognosis. An in situ component was detected in 44% of triple-negative tumors, and a greater proportion of patients in the group with tumor recurrence had an in situ component; however, the presence of an in situ component was not associated with shorter survival (p = 0.185).ConclusionNon-nodular enhancement was associated with a worse prognosis. Diffusion restriction, ki67, and the presence of an in situ component were not associated with shorter disease-free survival.     

Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study

ObjectivesTo examine gait parameters in people with gout during different walking speeds while adjusting for body mass index (BMI) and foot-pain, and to determine the relationship between gait parameters and foot-pain and disability.MethodGait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age- and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure.ResultsAt the self-selected speed, gout participants demonstrated increased step time (p = 0.017), and stance time (p = 0.012), and reduced velocity (p = 0.031) and cadence (p = 0.013). At the fast speed, gout participants demonstrated increased step time (p = 0.007), swing time (p = 0.005) and stance time (p = 0.019) and reduced velocity (p = 0.036) and cadence (p = 0.009). For participants with gout, step length was correlated with total MFPDI (r = −0.62, p = 0.008), function (r = −0.65, p = 0.005) and physical appearance (r = −0.50, p = 0.041); stride length was correlated with total MFPDI (r = −0.62, p = 0.008), function (r = −0.65, p = 0.005) and physical appearance (r = −0.50, p = 0.041); and velocity was correlated with total MFPDI (r = −0.60, p = 0.011), function (r = −0.63, p = 0.007) and work/leisure (r = −0.53, p = 0.030).ConclusionGait patterns exhibited by people with gout are different from controls during both self-selected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.     

Injury risk is different in team and individual youth sport

ObjectivesThis study compared sports injury incidence in young high-level athletes from various team and individual sports and investigated if sport participation patterns are linked to injuries.DesignProspective cohort follow-up.MethodsPupils from a public sports school (12–19 years) were recruited over two separate school years (2008–2009: 42 weeks, n = 199 athletes; 2009–2010: 40 weeks, n = 89 athletes). Training and competition volume and intensity were recorded via a personal sports diary. Sports injuries (time-loss definition) were registered by medical staff members using a standardized questionnaire.ResultsInjury incidence was significantly higher in team compared with individual sports (6.16 versus 2.88 injuries/1000 h, respectively), as a result of a higher incidence of both traumatic (RR = 2.17; CI95% = 1.75–2.70; p < 0.001), and overuse injuries (RR = 2.06; CI95% = 1.46–2.91; p < 0.001). A Cox proportional hazards regression revealed that team sports participation had a hazard ratio of 2.00 (CI95% = 1.49–2.68; p < 0.001) compared to individual sports, with additionally previous injury being a risk and age a protective factor. The number of competitions per 100 days was significantly higher in team sports, whereas the number of intense training sessions per 100 days was significantly lower. In team sports, the number of competitions per 100 days was positively associated with injuries (HR = 1.072; CI95% [1.033; 1.113]; p < 0.001), while in individual sports the number of competitions per 100 days had a protective effect (HR = 0.940; CI95% [0.893; 0.989]; p = 0.017).ConclusionsTeam sports participation entailed a higher injury risk, whatever the injury category. Further research should elucidate the role of characteristics related to sport participation in injury causation.     

Gradual-onset surfing-related injuries in New Zealand: A cross-sectional study

ObjectivesGradual-onset injuries associated with surfing have not previously been closely examined. This study investigated the duration, mechanisms, body locations and types of gradual-onset injuries in a sample of New Zealand surfers.DesignRetrospective, cross-sectional online survey.MethodsSelf-identified surfers reported gradual-onset surfing-related injuries experienced in the preceding 12 months.ResultsRespondents (n = 1473, age range 8–74 years) reported a total of 550 gradual-onset major injuries: 44% acute duration (<3 months) and 56% chronic (≥3 months). The injury incidence proportion was 27%. Shoulder (146 injuries, 64% chronic), low back (115 injuries, 58% chronic) and neck (105 injuries, 46% chronic) were the most commonly reported injury locations. Prolonged paddling was the most commonly reported mechanism of injury (40% of all injuries). Incidence proportion for gradual-onset major injuries was 6% higher for greater surfing abilities compared to lower abilities (p=0.01), and 13% higher for long boarders compared to short boarders (p = 0.001). Respondents reporting any gradual-onset surfing injury, compared to those with no injury, averaged 3 more years surfing experience (p < 0.001), were 3 years older (p < 0.001), and reported 43 h more surfing exposure in the preceding 12 months (p<0.001).ConclusionsThe most common gradual-onset surfing injuries involved the shoulder, low back, and neck, most frequently attributable to paddling. Risk factors for these injuries included board type, higher ability, older age, more hours/year, and years of surfing. These findings affirm the existence of sufficient injury burden to justify investigation of surfing injury prevention initiatives.     

Injury epidemiology in Australian male professional soccer

ObjectivesTo describe the injury epidemiology of the Australian male professional soccer league (A-League) over 6 consecutive seasons.DesignProspective observational cohort study.MethodsMatch-loss injury data was collected from each A-League club (n = 10) for each competition match (n = 27/season) over 6 seasons (2012/13–2017/18). Injuries were collected weekly through a standardised protocol and were classified by setting, mechanism, severity, the type and location on the body. Generalised Linear Models were used to estimate the injury incidences (injury/round/season), whilst rate ratios were reported for total injuries and within abovementioned injury classifications.ResultsOverall injury incidence was not significantly different ranging from 4.8 (95%CI:4.1–5.8) to 6.7 (95%CI:5.8–7.8) between seasons 2012/13 to 2017/18 (p > 0.05). Match injuries remained stable whilst training injuries decreased across the 6 seasons (exp(β) 0.59[95%CI:0.36–1.0]; p = 0.04). Respectively, contact and non-contact injuries were not significantly different across the 6 seasons, although non-contact injuries were more common than contact injuries (p > 0.05). Mild severity injuries decreased (exp(β) 0.64 [95%CI:0.4–0.9];p = 0.02), whilst moderate severity injuries increased (exp(β) 1.7 [95%CI:1.0–2.8];p = 0.04) in season 2017/18 compared to 2012/13. The most common injuries were at thigh (23–36%), of which the majority were hamstring injuries (54%–65%) of muscle/tendon type (50–60% of total injuries/season). Injuries remained stable across the seasons by type and location (p > 0.05 and p > 0.05, respectively).ConclusionsInjury rates, mechanisms, locations and types have remained relatively stable over recent seasons of the A-League. Current Australian professional soccer league medical practices may have contributed to the stability of injury rates.     

Prognostic value of 3′-Deoxy-3′-18F-Fluorothymidine ([18F] FLT PET) in patients with recurrent malignant gliomas

Introduction3′-deoxy-3′-18F-fluorothymidine ([¹⁸F] FLT) PET has been proven to be of value in diagnosis and assessment of glioma grading, in differentiating tumor recurrence from necrosis, in response assessment and in predicting overall survival (OS) in the primary high grade glioma. In this study, we evaluated the value of [¹⁸F] FLT PET-CT in predicting the OS of patients with recurrent malignant glioma.MethodsFifty-six patients with recurrent malignant glioma were enrolled in this prospective study. The PET-CT and contrast-enhanced MRI scans were performed in all patients. Tumor volume was determined from both PET image (proliferative volume, PV) and MRI image (Vol-MRI). Patients were followed up clinically until death. The likelihood of using PET-derived parameters of SUV_max, tumor-to-normal (T/N) ratio, and PV to predict the OS of patients were assessed in comparison with Vol-MRI and other clinical parameters.ResultThe follow up periods for all patients ranged from 1.5 to 35.6 months with median of 9.8 months. Univariate analysis showed that the following parameters were significantly correlated with OS: grade of primary tumor (p = 0.042), Karnofsky performance score (KPS) (p = 0.041), T/N ratio (p < 0.01), Vol-MRI (p = 0.041), and PV (p < 0.001). However, multivariate Cox regression showed that only the PV (p < 0.001) and T/N ratio (p = 0.001) were independent predictors. The thresholds to predict OS were 16.88 cm³ for PV and 10.94 for T/N ratio. Kaplan–Meier analyses using these thresholds showed a significant discrimination between short and long OS groups (p < 0.001).ConclusionThe PV and T/N ratio of tumor on [¹⁸F] FLT PET-CT are independent predictors of survival in patients with recurrent malignant glioma. The PV on [¹⁸F] FLT PET seems to be more predictive than tumor volume on T1-weighted MRI for OS.     

Utilidad de la resonancia magnética dinámica con contraste para caracterizar tumores ováricos ecográficamente indeterminados

ObjectivesTo determine whether there is a significant relationship between the shape of the time-intensity curve on dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of ovarian tumors classified as indeterminate at ultrasonography and the type of lesion (benign, borderline, or malignant) to enable an accurate presurgical diagnosis.Material and methodsWe used dynamic contrast-enhanced MRI to study 68 ovarian tumors that were classified as indeterminate at ultrasonography. We included only cases for which a definitive diagnosis (histologic diagnosis or ≥1 year stability on imaging tests) was available. Each case was classified as benign, borderline, or malignant.To analyze the MRI studies, we marked regions of interest in the lesion and in the myometrium (as a reference). We obtained a curve defined by the relation between the intensity of enhancement and time and classified each tumor according to four predefined curve types. We also analyzed semiquantitative parameters. Finally, we compared the results for each of the three groups of tumors.ResultsWe found significant associations (p < 0.001) between the curves without early enhancement and benign and borderline lesions as well as between the curves with early enhancement and malignant lesions. Malignant lesions were significantly associated with the semiquantitative enhancement parameters: maximum (p = 0.002), maximum relative (p = 0.006), and relative (p = 0.018).ConclusionsIn ovarian tumors classified as indeterminate at ultrasonography, dynamic contrast-enhanced MRI can be useful for classification as benign, borderline, or malignant because the malignant lesions are significantly associated with early enhancement curves.     

Comparison between acoustic radiation force impulse quantification data and perfusion-CT parameters in hepatocellular carcinoma

ObjectiveTo find out, if ultrasound elastography of hepatocellular carcinoma (HCC) can predict patterns of tumor perfusion in volume perfusion computed tomography (VPCT).Material and methods25 consecutive patients (mean age, 68.9; range, 51–85 years) with liver cirrhosis suspected of HCC underwent VPCT and acoustic radiation force impulse (ARFI) elastography the same day. Quantitative elasticity values were registered, while blood flow (BF), blood volume (BV) and hepatic perfusion index (HPI) of the HCC lesions were calculated. Additionally, we identified histologic WHO grading, lesion size and localization. The Siemens Acuson S 3000 HELX-System with Virtual Touch™-Software and Siemens Somatom Definition Flash with Syngo^® software were used.ResultsA total of 43 HCC lesions were assessed. Mean shear wave velocity was 2.6 m/s (range, 1.1–4.3 m/s). There was no significant linear correlation between the elasticity values and BF (p = 0.751), BV (p = 0.426) and HPI (p = 0.437). However, elasticity values were higher, the larger the tumor was (p = 0.008). Shear wave velocity declined with increasing distance of the HCC to the skin surface (p = 0.028) and depending on liver segment. In addition, elasticity values were higher in less differentiated HCCs. This trend was not statistically significant (p = 0.842).ConclusionTissue elasticity in HCC does not correlate with the degree of tumor vascularization, but calculated values are influenced both by the tumor size and localization inside the liver.     

Declining use of brachytherapy for the treatment of prostate cancer

PurposeTo analyze the recent trends in the utilization of external beam radiation therapy (EBRT) and brachytherapy (BT) for the treatment of prostate cancer.Methods and MaterialsUsing the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized prostate adenocarcinoma between 2004 and 2009 who were treated with radiation as local therapy. We evaluated the utilization of BT, EBRT, and combination BT + EBRT by the year of diagnosis and performed a multivariable analysis to determine the predictors of BT as treatment choice.ResultsBetween 2004 and 2009, EBRT monotherapy use increased from 55.8% to 62.0%, whereas all BT use correspondingly decreased from 44.2% to 38.0% (BT-only use decreased from 30.4% to 25.6%, whereas BT + EBRT use decreased from 13.8% to 12.3%). The decline of BT utilization differed by patient race, SEER registry, median county income, and National Comprehensive Cancer Network risk categorization (all p < 0.001), but not by patient age (p = 0.763) or marital status (p = 0.193). Multivariable analysis found that age, race, marital status, SEER registry, median county income, and National Comprehensive Cancer Network risk category were independent predictors of BT as treatment choice (all p < 0.001). Moreover, after controlling for all available patient and tumor characteristics, there was decreasing utilization of BT with increasing year of diagnosis (odds ratio for BT = 0.920, 95% confidence interval: 0.911–0.929, p < 0.001).ConclusionsOur analysis reveals decreasing utilization of BT for prostate cancer. This finding has significant implications in terms of national health care expenditure.     

Brachytherapy provides comparable outcomes and improved cost-effectiveness in the treatment of low/intermediate prostate cancer

PurposeTo evaluate the cost-effectiveness and outcomes of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy compared with intensity-modulated radiation therapy (IMRT) in patients with low/intermediate risk of prostate cancer.Methods and MaterialsOne thousand three hundred twenty-eight patients with low or intermediate risk of prostate cancer were treated with LDR (n = 207), HDR with four fractions (n = 252), or IMRT (n = 869) between January 1992 and December 2008. LDR patients were treated with palladium seeds to a median dose of 120 Gy, whereas HDR patients were treated to a median dose 38.0 Gy (four fractions). IMRT patients received 42–44 fractions with a median dose of 75.6 Gy. Clinical outcomes were compared, including biochemical failure, cause-specific survival, and overall survival.ResultsOverall, no differences in 5-year biochemical control (BC) or cause-specific survival were noted among treatment modalities. The calculated reimbursement for LDR brachytherapy, HDR brachytherapy with four fractions, and IMRT was $9,938; $17,514; and $29,356, respectively. HDR and LDR brachytherapy were statistically less costly to Medicare and the institution than IMRT (p < 0.001), and LDR brachytherapy was less costly than HDR brachytherapy (p = 0.01 and p < 0.001). Incremental cost-effectiveness ratios for cost to Medicare for BC with IMRT were $4045 and $2754 per percent of BC for LDR and HDR brachytherapy, respectively. Incremental cost-effectiveness ratio using institutional cost comparing IMRT with LDR and HDR brachytherapy was $4962 and $4824 per 1% improvement in BC.ConclusionsIn this study of patients with low and intermediate risk of prostate cancer, comparable outcomes at 5 years were noted between modalities with increased costs associated with IMRT.