Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma

PurposeTo investigate the relationships between pretreatment volume-based quantitative ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters and overall survival (OS) in patients with malignant pleural mesothelioma (MPM).Materials and methodsWe retrospectively reviewed data from 201 MPM patients, of whom 38 underwent surgical resection, and calculated the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), including primary tumors and nodal or distant metastatic lesions, on pretreatment ¹⁸F-FDG PET/CT. Relationships between clinicopathological factors (age, sex, performance status, European Organization for Research and Treatment of Cancer [EORTC] score, histological subtype, TNM stage, and treatment strategy), volume-based quantitative PET/CT parameters, and OS were evaluated using a Cox proportional hazards model and log-rank test.ResultsThe median follow-up was 15 months (range, 1–96 months; median, 17 months). In a univariate analysis of all patients, older age (p < 0.05), high EORTC score (p < 0.001), non-epithelioid histological subtype (p < 0.001), high T stage (p < 0.001), positive N/M status (p < 0.05, p < 0.001), advanced TNM stage (p < 0.001), non-surgical treatment (p < 0.001), and high SUVmax (p < 0.001), MTV (p < 0.001), or TLG (p < 0.001) were associated with significantly shorter OS. A multivariate analysis confirmed non-epithelioid subtype (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.14–2.48; p < 0.05), non-surgical treatment (HR: 0.58, 95% CI: 0.34–0.95; p < 0.05), and high TLG (HR: 1.97, 95% CI: 1.14–3.44; p < 0.05) as independent negative predictors.ConclusionsPretreatment volume-based quantitative ¹⁸F-FDG PET/CT parameters, especially TLG, could serve as potential surrogate markers for MPM prognosis.     

Coronary risk assessment at X-ray dose equivalent ungated chest CT: Results of a multi-reader study

ObjectivesTo determine the value of ultra-low dose chest CT with tin filtration for ordinal coronary artery calcium (CAC) risk scoring.Methods50 patients were prospectively included and underwent clinical standard dose chest CT (1.8 ± 0.7 mSv) and ultra-low dose CT (0.13 ± 0.01 mSv). Four radiologists estimated presence and extent of CAC.ResultsWeighted kappa values for CAC were 0.76–0.97 in standard dose and 0.75–0.95 in ultra-low dose CT (p < 0.001). Good to excellent agreement was observed for CAC ordinal risk assessment, with readers reporting identical risk in 81% of cases.ConclusionCAC risk can be qualitatively assessed from X-ray dose equivalent ungated chest CT.     

Early liver metastases in resectable periampullary cancer: Incidence and risk factors

PurposeThe aim of the present study was to estimate the incidence of very early hepatic metastases (HMs) (<6 months) and their imaging patterns after cephalic duodenopancreatectomy (CDP) for periampullary carcinoma (excluding duodenal carcinoma) and to identify their associated risk factors.MethodsFrom January 2003 to June 2016, all patients who underwent surgical treatment for periampullary carcinoma by CDP at our institution and with adequate pre- and postoperative CT scans were included. Univariate and multivariate logistic regressions were performed to determine factors associated with very early HM and recurrence.ResultsOf the 132 patients included retrospectively, 27 (20.5%) patients developed HMs. The mean time to diagnosis of HM was 103.9 ± 55.2 days. HMs were multiple in 81.4% of cases and bilobar in 59.3% of cases; their mean maximum size was 16.7 ± 12.7 mm.In univariate logistic analysis, lymphovascular emboli were significantly associated with HM (p = 0.02). No independent risk factors for HM were found in multivariate analysis. In multivariate logistic analysis, two independent risk factors were identified for the occurrence of early recurrence: tumor size >23 mm on preoperative CT scan (OR: 3.3; 95% CI: [1.2–9.3]; p = 0.02) and tumor differentiation (poor vs. good: OR 15.5; 95 CI [1.5–158.3]; moderate vs. good: OR: 17.1; 95% CI: [1.9–154.4]; p = 0.04).ConclusionsNearly one in five patients developed HM after CDP within 6 months with a highly consistent pattern. A thorough preoperative assessment, combining CT scan and MRI with a delay of less than three weeks before surgery, appears essential. A routine systematic postoperative CT scan at 8 weeks is also required prior to initiating adjuvant chemotherapy.The type of surgical intervention does not seem to be a risk factor, although the risk of HM occurrence appears to be related to the lymphovascular invasion of the tumor and maybe its degree of differentiation, elements not assessable by imaging.     

Impact of advanced modeled iterative reconstruction on interreader agreement in coronary artery measurements

ObjectivesTo evaluate the influence of advanced modeled iterative reconstruction (ADMIRE) on coronary artery computed tomography angiography (cCTA) measurements in comparison to filtered back projection (FBP).Material and methodsPhantom scans and coronary CTA studies of 27 patients were acquired with a third generation dual-source CT scanner. Images were reconstructed using FBP and ADMIRE. Phantom measurements were used as reference standard. In patient studies, representative axial slices of each coronary artery segment without (n = 308) and with coronary plaques (n = 40) were assessed in identical positions for comparison of FBP and ADMIRE reconstructions. Image analyses included quality assessment, phantom and coronary artery measurements, plaque analysis, and interreader agreement of two independent and blinded readers.ResultsMean image noise was lower on ADMIRE reconstructions with 31.3 ± 9.9 HU compared to 55.9 ± 15.7 HU on FBP reconstructions (p < 0.001). Measurement precision and interreader agreement of both observers were assessed satisfactorily on phantom images in comparison to the full width half maximum method. In patients, correlation of lumen diameters of both observers improved using ADMIRE with a Pearson’s r = 0.987 (95% confidence interval [CI], 0.983–0.989; p < 0.001) compared to FBP images with r = 0.939 (95% CI, 0.924–0.951; p < 0.001). Applying ADMIRE, agreement of both observers for lumen diameter measurements significantly increased (p < 0.001). This was also observed for the degree of stenosis (p < 0.001) with r = 0.560 using FBP (95% CI, 0.301–0.742) and with r = 0.818 using ADMIRE (95% CI, 0.680–0.900). Plaque density measurements correlated closely with a Pearson’s r of 0.951 in FBP (95% CI, 0.909–0.974) and 0.967 in ADMIRE (95% CI, 0.939–0.983).ConclusionsAdvanced modeled iterative reconstruction significantly improves coronary artery assessment in coronary CTA in comparison to FBP by improved image quality due to image noise removal. This renders improved interobserver agreement for coronary lumen diameter and degree of stenosis measurements without influencing mean plaque attenuation.     

Combining higher-load and lower-load resistance training exercises: A systematic review and meta-analysis of findings from complex training studies

ObjectivesThe aim of the present meta-analytical review was to determine the effectiveness of training programmes combining higher-load and lower-load exercises in one workout (i.e. complex training [CT]) on lower-body performance.DesignSystematic review and meta-analysis.MethodsA search of five electronic databases (PubMed, Web of Science, SportDiscus, CINAHL and Scopus) was conducted to identify all publications up to 7 March 2018. Meta-analyses were performed using a random-effects model with the dependent variables countermovement jump (CMJ) height, squat jump (SJ) height, one-repetition maximum (1-RM) squat performance and sprint time for 5 m, 10 m, 20 m, 30 m and 40 m, respectively.ResultsThe analysis comprised 33 studies and a total of 1064 healthy participants. The meta-analysis revealed that CT is effective in improving CMJ (95% confidence interval [CI] 5.6%–12.3%), SJ (95% CI 8.0%–17.4%), 1-RM squat (95% CI 16.4%–30.7%) and sprint performance (5 m = 95% CI −14.8% to −0.9%, 10 m = 95% CI −6.0% to −2.1%, 20 m = 95% CI −7.4% to −1.4%, 30 m = 95% CI −8.0% to −0.6%). However, when directly compared to traditional training methods, only 1-RM squat strength performance and 20 m sprint time were superior following CT interventions (95% CI 0.2%–13.7% and 95% CI −1.6% to −0.1%, respectively)ConclusionsCT is an acceptable method for improving jump, strength and sprint performance in athletes. Compared to traditional training methods, CT seems to produce superior training effects only for 1-RM squat and 20 m sprint performance; however, these findings were influenced by single studies and should be therefore interpreted with circumspection.     

Resectable pancreatic adenocarcinoma: Role of CT quantitative imaging biomarkers for predicting pathology and patient outcomes

BackgroundsPatients with a pancreatic cancer amenable to surgery still have a poor prognosis and high risk of post-operative recurrence. We aimed to assess the value of quantitative imaging biomarkers using computed-tomography (CT) texture analysis to evaluate the pathologic tumor aggressiveness and predict disease-free survival (DFS) in patients with resectable pancreatic adenocarcinoma.MethodsWe retrospectively performed attenuation measurements and texture analysis on the portal-venous phase of the pre-operative CT scan of 99 patients that underwent resection of a pancreatic ductal adenocarcinoma in two university hospitals. Tumor attenuation parameters included: mean attenuation value of the whole tumor (WHOLE-AV), and of the most hypoattenuating area within the tumor (CENTRAL-AV). Tumor heterogeneity parameters included: standard deviation, entropy, skewness, and kurtosis.ResultsTumor attenuation parameters showed significant association with the tumor differentiation grade (CENTRAL-AV, Odds ratio (OR) 0.968, 95% confidence interval (CI) 0.94–0.998) and lymph node invasion (WHOLE-AV, OR 0.886, CI 0.823–0.955). Variables associated with early-recurrence were: lymph node ratio (R² = 0.15), kurtosis (R² = 0.08), and CENTRAL-AV (R² = 0.04). Lymph node ratio (Hazard ratio (HR) 1.02), and CENTRAL-AV (HR 0.98) were independently associated with shorter DFS. Patients with CENTRAL-AV < 62 Hounsfield units had a shorter 1-year DFS (35% versus 68%, p = 0.004).ConclusionTumors that are more hypoattenuating on the portal-venous phase on CT scan are potentially more aggressive with higher tumor grade, greater lymph node invasion, and shorter DFS.     

320-Row wide volume CT significantly reduces density heterogeneity observed in the descending aorta: Comparisons with 64-row helical CT

The aim of this study was to compare density heterogeneity on wide volume (WV) scans with that on helical CT scans. 22 subjects underwent chest CT using 320-WV and 64-helical modes. Density heterogeneity of the descending aorta was evaluated quantitatively and qualitatively. At qualitative assessment, the heterogeneity was judged to be smaller on WV scans than on helical scans (p < 0.0001). Mean changes in aortic density between two contiguous slices were 1.64 HU (3.40%) on WV scans and 2.29 HU (5.19%) on helical scans (p < 0.0001). CT density of thoracic organs is more homogeneous and reliable on WV scans than on helical scans.     

Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma

PurposeEfficient monitoring of tumor responsiveness to chemotherapy is essential to mitigate high mortality risks and cytotoxic effects of chemotherapeutics. However, there is no consensus on the most suitable diagnostic technique/parameters for assessing response to chemotherapy in malignant pleural mesothelioma (MPM). We compared the tumor responsiveness of MPM patients as assessed using modified RECIST (mRECIST) criteria and integrated 18F-FDG-PET/CT.MethodsHistologically confirmed MPM patients (N = 82) who were treated with three cycles of cisplatin and pemetrexed, or carboplatin and pemetrexed, were included. mRECIST and integrated 18F-FDG-PET/CT were used to evaluate MPM tumor response to chemotherapy. Metabolic non-responders were defined as those with a 25% or greater increase in SUVmax compared with the previous value. Time to progression (TTP) and overall survival (OS) were compared between metabolic-responders and non-responders.ResultsAfter three cycles of chemotherapy, 62(75.6%) of the patients were classified as having SD, 15 (18%) with partial remission (PR), and 5 (6%) with progressive disease (PD), based on mRECIST criteria. The cumulative median OS was 728.0 days (95% confidence interval [CI]: 545.9–910.1) and cumulative median TTP was 365.0 days (95% CI: 296.9–433.1). For the 82 patients, the disease control rate was 93.9%, whereas the metabolic response rate was only 71.9% (p < 0.001). All PD and PR patients were found to be metabolic responders on 18F-FDG-PET/CT; however, among the 62mRECIST SD patients, 18 (29%) were classified as metabolic non-responders. The median TTP for metabolic responders was 13.7 months, while it was 10.0 months for non-responders(p < 0.001). Metabolic responders had a trend toward longer OS, although the difference did not reach statistical significance (metabolic responders:33.9 months; non-responders: 21.6 months; p > 0.05).ConclusionSeveral mRECIST-confirmed SD MPM patients may be classified as metabolic non-responders on18F-FDGPET/CT. Metabolic response is significantly correlated with the median TTP, suggesting it should be included in the evaluation of the response to chemotherapy in MPM patients classified as mRECIST SD, to identify non-responders.     

Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency

PurposeTo evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH.Materials and methodsFrom January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV >5 mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients.Results172 patients (113 men, mean 60 ± 12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p = 0.005). At multivariate analysis, factors associated with a first EVH were spleen size > 135 mm (Odd Ratio [OR] = 1.32 [95% confident interval [CI] 1.16–1.51], p < 0.001), ascites (OR = 4.07 [95%CI-1.84–9.01], p = 0.001) and small/absent PUV (OR = 3.06 [95%CI-1.86–5.05], p < 0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0–1, 2–3, and 4–5, respectively).ConclusionsA simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.     

Exercise-based injury prevention for community-level adolescent cricket pace bowlers: A cluster-randomised controlled trial

ObjectivesTo investigate if an exercise-based injury prevention program (IPP) can modify risk factors for injury in community-level adolescent cricket pace bowlers.DesignCluster-randomised controlled trial.MethodsEight cricket organisations (training two times per week and no previous involvement in a structured IPP) participated in this cluster-randomised trial. Participants were aged 14–17 years, injury free, and not currently performing a rehabilitation/exercise program. Cricket organisations (clusters) were block-randomised by computerised number generation into an intervention group (performed an eight-week IPP at training) or control group (continued their usual cricket activity). Participants were not blinded to group allocation. Strength, endurance, and neuromuscular control were assessed at baseline and follow-up. Treatment effects were estimated using linear mixed models.ResultsSixty-five male adolescent pace bowlers (intervention n = 32 and control n = 33) were randomised. There were significant treatment effects favouring the intervention group for shoulder strength (90°/s) 0.05 (95% CI 0.02–0.09) N m/kg, hamstring strength (60°/s) 0.32 (95% CI 0.13–0.50) N m/kg, hip adductor strength dominant 0.40 (95% CI 0.26–0.55) N m/kg and non-dominant 0.33 (95% CI 0.20–0.47) N m/kg, SEBT reach distance dominant 3.80 (95% CI 1.63–6.04) percent of leg length (%LL) and non-dominant 3.60 (95% CI 1.43–5.78) %LL, and back endurance 20.4 (95% CI 4.80–36.0) seconds. No differences were observed for shoulder strength (180°/s) (p = 0.09), hamstring strength (180°/s) (p = 0.07), lumbopelvic stability (p = 0.90), and single leg squat knee valgus angle (dominant p = 0.06, non-dominant p = 0.15).ConclusionsExercise-based IPPs can modify risk factors for injury in community-level adolescent pace bowlers. Future research is needed to confirm if IPPs can also reduce injury risk in this population.     

Diagnostic performance of contrast-enhanced CT-scan in sinusoidal obstruction syndrome induced by chemotherapy of colorectal liver metastases: Radio-pathological correlation

PurposeSinusoidal obstruction syndrome (SOS) is a likely side effect of colorectal liver metastases (CRLM) chemotherapy. This study aimed to assess computed tomography scan (CT-scan) performance for SOS diagnosis for patients receiving neoadjuvant chemotherapy (NC) prior to CRLM surgery, comparing obtained results with pathological gold standard.MethodsPreoperative CT-scans of 67 patients who had received a NC prior to liver resection for CRLM from 2011 to 2016 were retrospectively analysed. Positive diagnosis and severity of SOS were established after consensual review of the slides by three pathologists. Preoperative CT-scans were separately interpreted by two radiologists and evocative signs of SOS were sought, defined according to a literature review and operators experience. In order to identify SOS predictors, univariate analysis and multivariate logistic regression were used to study CT-scan signs and pathological results correlation.ResultsTwenty-nine patient (43%) had an SOS, 22 (33%) were low-grade and 7 (10%) were high-grade. All patient had received a median of 6 cures (3–27) containing Oxaliplatin for 53 (79%) of them. In univariate analysis, hepatic heterogeneity (p < 0.001), puddle-like or micronodular appearance (p < 0.001), peripheral distribution of heterogeneity (p = 0.085), clover-like sign (p = 0.02), splenomegaly (p = 0.0026), spleen volume increase ≥30% (p = 0.04) or splenic length increase ≥15% (p = 0.04), as well as the subjective impression of the observer (P < 0.001) were significantly associated with SOS diagnosis. In multivariate analysis, clover-like sign (OR 1.87, 95% CI 1.18–2.95, p = 0.0081), increase in spleen volume ≥30% (OR 1.29, 95% CI 1.01–1.64, p = 0.04), and the peripheral distribution of heterogeneity (OR 1.53, 95% CI 1.21–1.94, p < 0.001) were independent SOS predictors. The area under the ROC curve was 0.804. The inter-observer agreement for SOS diagnosis was moderate (Kappa = 0.546).ConclusionCT-scan can detect suggestive signs of SOS in patients receiving chemotherapy for CRLM. By integrating clinical and biological information into CT-scan data, it may be fruitful to create a positive diagnostic and severity score for chemotherapy-induced SOS.     

Correlation of the torsion values measured by rotational profile,kinematics, and CT study in CP patients

BackgroundThe purpose of study was to analyze correlations between bony torsions measured by Staheli’s rotation profile, computed tomography (CT) torsional study, and gait analysis in patients with cerebral palsy (CP).Materials & methodThe study group comprised of 26 children with CP (spastic diplegia, Gross Motor Function Classification System (GMFCS) 1–2, mean age 12.6 years) with torsional deformities. All subjects were assessed by examining: 1) rotational profile [internal rotation (IR) and external rotation (ER)], 2) CT torsional profile [femoral anteversion (FAV) and tibial torsion (TT)], and 3) gait analysis [mean hip rotation (HR) and mean knee rotation (KR)]. Statistical analysis was performed using the Pearson correlation test.ResultsIn the femur, there was good correlation between FAV and Staheli’s rotational profile of IR and ER (Pearson correlation coefficient (PC = 0.69, 0.52, p < 0.05)). ER correlated very strongly with mean HR during gait (PC = 0.8, p < 0.05). There was, however, poor correlation between HR and IR (p > 0.05), and between HR and FAV (p > 0.05).In the tibia, mean KR correlated well with thigh-foot angle (TFA) (PC = 0.72) and CT tibia torsion (TT) (PC = 0.62). TT also correlated with TFA (PC = 0.62).ConclusionGait analysis and Staheli’s rotational profile reflect both static and dynamic factors of gait abnormalities. However, CT study reflect static factor primarily. Dynamic factors tend to influence the measurements of the femoral torsion only due to large rotational arc of hip joint. In surgical planning, it must be considered that HR sometimes does not correlate with CT anteversion angle. Similarly, it must also be considered that KR correlates well with TFA and CT TT angle.     

Value of multislice CT coronary arteries calcification scoring in the prediction of coronary arteries pathology in chronic kidney disease patients

PurposeTo determine the value of multislice CT coronary artery calcification (CAC) scoring in the prediction of future cardiac events in known chronic kidney disease (CKD) patients using conventional coronary angiography as the standard reference.Patients and methodsFifty-eight patients with CKD on hemodialysis underwent CT CAC scoring using multislice scanner and conventional coronary angiography. Results of CAC scoring were compared to the findings of conventional coronary angiography.ResultsMean CAC scoring in patients with significant coronary arteries stenotic lesions was higher than in patients with no significant coronary arteries stenotic lesions with significant difference (P < 0.001).Mean patient CAC scoring was strongly correlated with the number of coronary arteries with significant stenotic lesions (r = 0.910).ConclusionCT CAC scoring is a non-invasive technique which can be used in the evaluation and follow up of CKD patients’ coronary arteries without the use of contrast medium reducing the number of invasive coronary angiography needed.     

The predictive value of computed tomography in the detection of reflux esophagitis in patients undergoing upper endoscopy

BackgroundReflux esophagitis (RE) may mimic symptoms requiring cross-sectional imaging.MethodsFrom 565 patients who had CT and esophagogastroduodenoscopy within four days apart, CT scans of 72 patients with RE confirmed by esophagogastroduodenoscopy and 108 matched patients without RE were evaluated for distal esophageal wall characteristics.ResultsIn RE patients the distal esophageal wall thickness was greater (5.2 ± 2.0 mm) compared to patients without RE (3.5 ± 1.2 mm, p < 0.0001) with AUC of 0.78 and 56% sensitivity, 88% specificity for a 5.0 mm cut-off.ConclusionsThere is a moderate association between distal esophageal wall thickness on CT and RE diagnosed by esophagogastroduodenoscopy as the reference standard.     

Repeated CT scans in trauma transfers: An analysis of indications,radiation dose exposure,and costs

ObjectivesTo identify the number of CT scans repeated in acute trauma patients receiving imaging before being referred to a trauma center, to define indications, and to assess radiation doses and costs of repeated CT.MethodsThis retrospective study included all adult trauma patients transferred from other hospitals to a Level-I trauma center during 2014. Indications for repeated CT scans were categorized into: inadequate CT image data transfer, poor image quality, repetition of head CT after head injury together with completion to whole-body CT (WBCT), and follow-up of injury known from previous CT. Radiation doses from repeated CT were determined; costs were calculated using a nation-wide fee schedule.ResultsWithin one year, 85/298 (28.5%) trauma patients were transferred from another hospital because of severe head injury (n = 45,53%) and major body trauma (n = 23;27%) not manageable in the referring hospital, repatriation from a foreign country (n = 14;16.5%), and no ICU-capacity (n = 3;3.5%). Of these 85 patients, 74 (87%) had repeated CT in our center because of inadequate CT data transfer (n = 29;39%), repetition of head CT with completion to WBCT (n = 24;32.5%), and follow-up of known injury (n = 21;28.5%). None occurred because of poor image quality. Cumulative dose length product (DLP) and annual costs of potential preventable, repeated CT (inadequate data transfer) was 631mSv (81′304mGy*cm) and 35′233€, respectively.ConclusionA considerable number of transferred trauma patients undergo potentially preventable, repeated CT, adding radiation dose to patients and costs to the health care system.     

Is gender still a predisposing factor in contrast-media associated adverse drug reactions? A systematic review and meta-analysis of randomized trials and observational studies

ObjectiveTo evaluate the role of gender as a risk factor for developing contrast media-associated adverse drug reactions (CM-ADRs) by comparing the incidence of CM-ADR between male and female patients according to study design, ADR type, and computed tomography (CT) examination.Material and methodsWe systematically searched three electronic databases for eligible studies. In the studies included (n = 18), we assessed effect estimates of the relative incidence of CM-ADR, analysed by experimental design, ADR type and CT examination. This was calculated by using a random effects model if clinical conditions showed heterogeneity; otherwise, a fixed effects model was used.ResultsWe identified 10,776 patients administered CM. According to the designs, studies were classified into randomised controlled trials (RCTs) and observational studies. Results were as follows: risk ratio (RR) = 1.07 (95% confidence interval (CI): 0.79–1.46, P = 0.66) for RCTs, and RR = 0.77 (95% CI: 0.58–1.04, P = 0.09) for observational studies. The results of analysis according to ADR type and for undergoing CT demonstrated that the incidence of CM-ADR did not differ between males and females.ConclusionsWe found no significant difference in the incidence of CM-ADRs between male and female patients according to study design, ADR type, or CT examination. Future studies to determine why gender has shown different roles as a risk factor between CM-ADRs and non-CM ADRs are needed.     

Improving prostate brachytherapy quality assurance with MRI–CT fusion–based sector analysis in a phase II prospective trial of men with intermediate-risk prostate cancer

PurposeWe combined sector analysis with MRI–CT fusion to comprehensively assess postimplant dosimetry after prostate brachytherapy.Methods and MaterialsSubjects were 50 men with intermediate-risk prostate cancer treated with ¹²⁵I brachytherapy in a prospective phase II clinical trial. On Day 30 after the implantation, dosimetry was evaluated in the prostate base, midgland, and apex regions on fused MRI–CT scans and CT scans. Volumes of each sector receiving 100% of the prescribed dose (V₁₀₀) and doses to 90% of each sector (D₉₀) were also calculated on the ultrasonogram used for treatment planning and compared with values derived from CT and fused MRI–CT scans.ResultsFused MRI–CT scans revealed lower-than-expected doses for the whole prostate (V₁₀₀ = 91.3%, D₉₀ = 152.9 Gy) compared with CT scans (98.5% and 183.6 Gy, p < 0.0001) and lower doses to the prostate base (V₁₀₀ = 79%, D₉₀ = 130 Gy) vs. CT (96% and 170 Gy, p < 0.0001). However, lower doses to the prostate base did not adversely affect biochemical outcomes in men with biopsy-proven disease at the base. At a median followup time of 42 months, the mean prostate-specific antigen level for all patients was 0.3 ng/mL, and no patient had experienced biochemical or clinical progression or recurrence.ConclusionsMRI–CT fusion–based sector analysis was feasible and revealed significantly lower doses to the prostate base than doses estimated from CT alone, although this did not affect biochemical outcomes. MRI–CT fusion–based sector analysis may be useful for developing MRI-based dosimetric markers to predict disease outcomes and treatment-related morbidity.     

General health complaints and sleep associated with new injury within an endurance sporting population: A prospective study

ObjectivesTo examine the association between subjective health complaints, sleep quantity and new injury within an endurance sport population.DesignProspective cohort study.MethodsNinety-five endurance sporting participants were recruited from running, triathlon, swimming, cycling and rowing disciplines. Over 52-week period participants submitted weekly data regarding subjective health complaints (SHCs) (cardiorespiratory, gastrointestinal and psychological/lifestyle), sleep quantity, training load and new injury episodes. Applying a 7- and 14-day lag period, a shared frailty model was used to explore new injury risk associations with total SHCs and sleep quantity.Results92.6% of 95 participants completed all 52 weeks of data submission and the remainder of the participants completed ≥30 weeks. Seven-day lag psychological/lifestyle SHCs were significantly associated with new injury risk (Hazard ratio (HR) = 1.32; CI 95% = 1.01–1.72, p < 0.04). In contrast, cardiorespiratory (HR = 1.15; CI 95% = 0.99–1.36, p = 0.07) and gastrointestinal (HR = 0.77; CI 95% = 0.56–1.05, p = 0.09) SHCs were not significantly associated with new injury risk. New injury risk had a significant increased association with 14-day lag <7 h/day sleep quantity (HR = 1.51; CI 95% = 2.02–1.13, p < 0.01) and a significant decreased association with >7 h/day sleep quantity (HR = 0.63, CI 95% = 0.45–0.87, p < 0.01. A secondary regression analysis demonstrated no significant association with total SHCs and training load factors (Relative Risk (RR) = 0.08, CI 95% = 0.04–0.21, p = 0.20).ConclusionsTo minimise an increased risk of new injuries within an endurance sporting population, this study demonstrates that psychological/lifestyle subjective health complaints and sleep quantity should be considered. The study also highlights a lag period between low sleep quantity and its subsequent impact on new injury risk. No association was demonstrated between subjective health complaints, sleep quantity and training load factors.     

The diagnostic accuracy of neck ultrasound, 4D-Computed tomographyand sestamibi imaging in parathyroid carcinoma

IntroductionOur aim was to investigate the accuracy of available imaging modalities for parathyroid carcinoma (PC) in our institution and to identify which imaging modality, or combination thereof, is optimal in preoperative determination of precise tumor location.MethodsAll operated PC patients in our institution between 2000 and 2015 that had at least one of the following in-house preoperative scans: neck ultrasonography (US), neck 4D-Computed Tomography (4DCT) and 99mTc Sestamibi SPECT/CT (MIBI). Sensitivity, specificity and accuracy of PC tumor localization were assessed individually and in combination.Results20 patients fulfilled the inclusion criteria and were analysed. There were 18 US, 18 CT and 9 MIBI scans. The sensitivity and accuracy for tumor localisation of US was 80% (CI 56–94%) and 73% respectively, of 4DCT was 79% (CI 58–93%) and 82%, and of MIBI was 81% (CI 54–96%) and 78%. The sensitivity and accuracy of the combination of CT and MIBI was 94% (CI 73–100%) and 95% and for the combination of US, CT and MIBI was 100% (CI 72–100%) and 100% respectively. The wash-out of the PC lesions, expressed as a percentage change in Hounsfield Units from the arterial phase to early delayed phase was −9.29% and to the late delayed phase was −16.88% (n = 11).ConclusionsThe sensitivity of solitary preoperative imaging of PC patients, whether by US, CT or MIBI, is approximately 80%. Combinations of CT with MIBI and US increase the sensitivity to 95% or better. Combined preoperative imaging of patients with clinical possibility of PC is therefore recommended.     

Differentiation of small intrahepatic mass-forming cholangiocarcinoma from small liver abscess by dual source dual-energy CT quantitative parameters

PurposeTo investigate the use of dual source dual-energy CT (DECT) quantitative parameters compared with the use of conventional CT for differentiating small (≤3 cm) intrahepatic mass-forming cholangiocarcinoma (IMCC) from small liver abscess (LA) during the portal venous phase (PVP).Material and methodsIn this institutional review board-approved, retrospective study, 64 patients with IMCCs and 52 patients with LAs who were imaged in PVP using dual-energy mode were included retrospectively. A radiologist drew circular regions of interest in the lesion on the virtual monochromatic images (VMI), color-coded iodine overlay images, and linear blending images with a linear blending ratio of 0.3 to obtain CT value, its standard deviation, slope (k) of spectral curve and normalized iodine concentration (NIC). Two radiologists assessed lesion type on the basis of qualitative CT imaging features.ResultsCT values on VMI at 50–130 keV (20 keV-interval), k, and NIC values were significantly higher in IMCCs than in LAs (p < 0.0001). The best single parameter for differentiating IMCC from LA was CT value at 90 keV, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89.1%, 86.5%, 87.9%, 89.1%, and 86.5%, respectively. The best combination of parameters was CT value at 90 keV, k, and NIC, with values of 87.5%, 84.6%, 83.6%, 87.5%, and 84.6%, respectively. Compared with CT value at linear blending images, CT value at 90 keV showed greater sensitivity (89.1% vs 60.9%, p < 0.0001) and similar specificity (86.5% vs 84.6%, p = 1.0000), and combined CT value at 90 keV, k, and NIC showed greater sensitivity (87.5% vs 60.9%, p < 0.0001) and similar specificity (84.6% vs 84.6%, p = 1.0000). Compared with qualitative analysis, CT value at 90 keV showed greater sensitivity (89.1% vs 65.6%, p = 0.0059) and specificity (86.5% vs 69.2%, p = 0.0352), and combined CT value at 90 keV, k, and NIC showed greater sensitivity (87.5% vs 65.6%, p = 0.0094) and similar specificity (84.6% vs 69.2%, p > 0.05).ConclusionQuantitative analysis of dual source dual-energy CT quantitative parameters showed greater accuracy than quantitative and qualitative analyses of conventional CT for differentiating small IMCCs from small LAs on single PVP scan.