A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin

Background and purposeThe diagnosis of patients with fever of unknown origin (FUO) remains a challenging medical problem for internal medicine. A reliable estimate of the diagnostic performance of FDG-PET and FDG-PET/CT in the assessment of FUO unidentified by conventional workup has never been systematically assessed, and present systematic review was aimed at this issue.MethodsA systematic search for relevant studies was performed of the PubMed, Embase, and Cochrane databases. Methodological quality of each study was assessed. Sensitivity, specificity and area under the curve (AUC) were meta-analyzed. Subgroup analyses were performed if results of individual studies were heterogeneous.ResultsThe inclusion criteria were met by nine studies. Overall, the studies had good methodological quality. Pooled sensitivity and specificity of FDG-PET for the detection of FUO were 0.826 (95% CI; 0.729–0.899) and 0.578 (95% CI; 0.488–0.665), respectively, and the AUC was 0.810. Heterogeneity among the results of FDG PET studies was present (QSE = 12.40, I² = 67.7%; QSp = 35.98, I² = 88.9%). Pooled sensitivity and specificity of FDG-PET/CT were 0.982 (95% CI; 0.936–0.998) and 0.859 (95% CI; 0.750–0.934), respectively, and the AUC was 0.947. We did not find any statistical differences in the AUC and Q* index between FDG-PET and FDG-PET/CT (Z = 0.566, p > 0.05).ConclusionsAlthough the FDG-PET studies that we examined were heterogeneous, FDG-PET appears to be a sensitive and promising diagnostic tool for the detection of the causes of FUO. FDG-PET/CT should be considered among the first diagnostic tools for patients with FUO in whom conventional diagnostics have been unsuccessful.     

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.     

Clinical usefulness of F-18 FDG PET in lymphoepithelioma-like gastric carcinoma

PurposeLymphoepithelioma-like carcinoma (LELC) is a rare type of gastric cancer. We evaluated the clinical usefulness of F-18 FDG positron emission tomography/computed tomography (PET/CT) in LELC of stomach.Materials and methodsA total of 28 patients (mean age = 59 years) who underwent preoperative F-18 FDG PET/CT were enrolled retrospectively. Nine patients underwent follow-up F-18 FDG PET/CT. Pathologic information was obtained through gastrectomy and the association with Epstein-Barr virus (EBV) was investigated in 26 patients.ResultsPET/CT detected 85.0% (17/20) of advanced gastric cancers (AGC) and 12.5% (1/8) of early gastric cancers (EGC). Most tumors (23/26, 88.5%) were EBV-associated. The maximum standardized uptake value of FDG-avid tumors was 7.5 ± 3.0. The sensitivity and specificity of PET/CT for the presence of lymph node metastasis was 47.8% (11/23) and 100.0% (13/13), respectively. PET/CT also detected a hepatic sarcomatoid carcinoma in one patient. The specificity of PET/CT for distant metastasis or second malignancy was 96.3%. Follow-up PET/CT detected malignant lesions in 3 of 9 patients; a liver metastasis, recurrent hepatic sarcomatoid carcinomas and a metachronous cholangiocarcinoma. PET/CT correctly excluded recurrence in the rest of the patients (6/6). The sensitivity and specificity of PET/CT for detecting recurrence or second malignancy was 100% and 100%, respectively.ConclusionF-18 FDG PET/CT would be a useful tool in evaluating distant metastasis or recurrence in patients with gastric LELC.     

Imaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity,specificity and diagnostic accuracy

BackgroundPancreatic cancer, primarily pancreatic ductal adenocarcinoma (PDAC), accounts for 2.4% of cancer diagnoses and 5.8% of cancer death annually. Early diagnoses can improve 5-year survival in PDAC. The aim of this systematic review was to determine the sensitivity, specificity and diagnostic accuracy values for MRI, CT, PET&PET/CT, EUS and transabdominal ultrasound (TAUS) in the diagnosis of PDAC.MethodsA systematic review was undertaken to identify studies reporting sensitivity, specificity and/or diagnostic accuracy for the diagnosis of PDAC with MRI, CT, PET, EUS or TAUS. Proportional meta-analysis was performed for each modality.ResultsA total of 5399 patients, 3567 with PDAC, from 52 studies were included. The sensitivity, specificity and diagnostic accuracy were 93% (95% CI = 88–96), 89% (95% CI = 82–94) and 90% (95% CI = 86–94) for MRI; 90% (95% CI = 87–93), 87% (95% CI = 79–93) and 89% (95% CI = 85–93) for CT; 89% (95% CI = 85–93), 70% (95% CI = 54–84) and 84% (95% CI = 79–89) for PET; 91% (95% CI = 87–94), 86% (95% CI = 81–91) and 89% (95% CI = 87–92) for EUS; and 88% (95% CI = 86–90), 94% (95% CI = 87–98) and 91% (95% C = 87–93) for TAUS.ConclusionThis review concludes all modalities, except for PET, are equivalent within 95% confidence intervals for the diagnosis of PDAC.     

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.     

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.     

Impact on mortality of coronary and non-coronary cardiovascular findings in non-gated thoracic CT by malignancy status

PurposeThe prognostic value of coronary artery calcification (CAC) assessed on non-gated thoracic CT scans has only been explored in population-based studies. We explored the impact of the presence and extension of CAC, as well as of non-coronary atherosclerosis cardiovascular findings (NCACVF) in survival of patients with and without malignancies undergoing clinically indicated non-gated thoracic computed tomography (CT) scans.Materials and methodsBetween August and December 2012, a total of 1.901 patients aged between 35 and 74 years underwent clinically indicated non-gated, non-enhanced thoracic CT scans and followed for mortality through September 2016.ResultsThree hundred and thirty two (17.5%), 250 (13.2%), and 329 (17.3%) patients showed CAC in 1, 2, and 3 vessels, respectively, and the remaining had no CAC. Two hundred and fifty five (13.4%) patients had evidence of extensive calcification (CACSIS > 5). Only 62 (3.3%) had major NCACVF whereas 1635 (86%) had none or minimal NCACVF. After a median follow-up of 3.7 (3.5–3.9) years, 217 (11.4%) deaths occurred. Age [HR 1.03 (95% CI 1.01–1.05), p = 0.001], a history of malignancy [HR 8.04 (95% CI 5.95-10.9), p < 0.0001], and the NCACVF class [HR 1.79 (95% CI 1.45-2.19), p < 0.0001] were identified as independent predictors of death. CACSIS was found an independent predictor of death only among patients without malignancy (HR 1.10 (95% CI 1.02–1.20), p = 0.019).ConclusionsIn this study including clinically indicated non-gated standard thoracic CT scans, survival rates were associated to the CAC extension among patients without malignancy, and to the NCACVF class independent from the malignancy status.     

Apparent diffusion coefficient in the analysis of prostate cancer: determination of optimal b-value pair to differentiate normal from malignant tissue

PurposeDetermining optimal b-value pair for differentiation between normal and prostate cancer (PCa) tissues.MethodsForty-three patients with diagnosis or PCa symptoms were included. Apparent diffusion coefficient (ADC) was estimated using minimum and maximum b-values of 0, 50, 100, 150, 200, 500 s/mm2 and 500, 800, 1100, 1400, 1700 and 2000s/mm2, respectively. Diagnostic performances were evaluated when Area-under-the-curve (AUC) > 95%.Results15 of the 35 b-values pair surpassed this AUC threshold. The pair (50, 2000 s/mm2) provided the highest AUC (96%) with ADC cutoff 0.89 × 10–³ mm²/s, sensitivity 95.5%, specificity 93.2% and accuracy 94.4%.ConclusionsThe best b-value pair was b = 50, 2000 s/mm2.     

Histopathologic diversity of gastric cancers: Relationship between enhancement pattern on dynamic contrast-enhanced CT and histological type

PurposeTo evaluate the diagnostic value of contrast-enhanced computed tomography gastrography (CE-CTG) to predict the histological type of gastric cancer.Materials and methodsWe analyzed 47 consecutive patients with resectable advanced gastric cancer preoperatively evaluated by multiphasic dynamic contrast-enhanced CT. Two radiologists independently reviewed the CT images and they determined the peak enhancement phase, and then measured the CT attenuation value of the gastric lesion for each phase. The histological types of gastric cancers were assigned to three groups as differentiated-type, undifferentiated-type, and mixed-type. We compared the peak enhancement phase of the three types and compared the CT attenuation values in each phase.ResultsThe peak enhancement was significantly different between the three types of gastric cancers for both readers (reader 1, p = 0.001; reader 2, p = 0.009); most of the undifferentiated types had peak enhancement in the delayed phase. The CT attenuation values of undifferentiated type were significantly higher than those of differentiated or mixed type in the delayed phase according to both readers (reader 1, p = 0.002; reader 2, p = 0.004).ConclusionCE-CTG could provide helpful information in diagnosing the histological type of gastric cancers preoperatively.     

Training injury incidence in an amateur women’s rugby union team in New Zealand over two consecutive seasons

ObjectivesTo describe the training injury incidence in amateur women’s rugby union in New Zealand over two consecutive seasons.DesignA prospective cohort observational studyMethodsA total of 69 amateur women’s rugby 15s team playerswere observed. Training exposure and training injury incidence were calculated.ResultsThe 38 training injuries resulted in a total injury incidence of 11.4 (8.3–15.6) per 1,000 training-hours. There were 12 injuries that resulted in a time-loss injury incidence of 3.6 (95% CI: 2.0–6.3) per 1,000 training-hours. Forwards recorded more total (RR: 1.8 [95% CI: 0.9–3.5]; p = 0.0516) and time-loss (RR: 2.0 [95% CI: 0.6–6.6]; p = 0.2482) injuries than Backs. The tackle was the most common injury cause for total (3.0 [95% CI: 1.6–5.6] per 1,000 training-hours.) injuries, but collisions (1.5 [95% CI: 0.6–3.6] per 1,000 training-hours.) with the ground or another person were the most common cause for time-loss injuries.The training injuries occurred most often to the lower limb and during the latter part of training sessions. These injuries were mostly minor in nature resulting in minimal time-loss away from training.DiscussionThe time-loss injury incidence (3.6 per 1,000 training-hours.) for the amateur women’s rugby 15s team players was higher than that reported for National (1.2 per 1,000 training-hours.) and Rugby World Cup for women (0.2 to 3.0 per 1,000 training-hours.) competitions.ConclusionThe training injury incidence in amateur women’s rugby union in New Zealand was higher than that reported for national and international rugby union injury incidences.     

Early myocardial gadolinium enhancement in patients with myocarditis: Validation of “Lake Louise consensus” criteria using a single bolus of 0.1 mmol/Kg of a high relaxivity gadolinium-based contrast agent

ObjectivesGlobal early gadolinium enhancement (EGE) is an accepted cardiac magnetic resonance (CMR) criterion for diagnosis of myocarditis. However, recommended enhancement thresholds are based specifically on standard-relaxivity Gd-chelates. We evaluated the performance of a high relaxivity MR contrast agent for detection of myocardial hyperemia in patients referred for endomyocardial biopsy (EMB).MethodsWe retrospectively enrolled 54 patients (mean age: 44.1 years [range = 18–77 years]; 72% men) with suspected myocarditis who underwent CMR and EMB within four weeks of clinical onset. CMR imaging protocol included T2-weighted short tau inversion-recovery sequence, EGE and late gadolinium enhanced (LGE) imaging.For EGE imaging, free-breathing ECG-gated turbo spin echo T1-weighted (TSE T1w) sequences were acquired before and within the first three minutes after gadobenate dimeglumine (0.1 mmol/Kg) administration. The ratio (EGEr) between myocardial and musculoskeletal early enhancement was calculated. Myocardial edema, EGE and late gadolinium enhancement (LGE) were correlated with EMB results. Receiver operating characteristic (ROC) curve analysis of EGE values was applied on the overall population.ResultsEMB revealed myocarditis in 34/54 patients. Sensitivity, specificity and accuracy values of 0.61, 0.85 and 0.70, respectively, were obtained for a standard EGE threshold (EGEr > 4.0). ROC analysis revealed an area under the curve of 0.701 for EGEr (IC95%:0.556–0.846, p = 0.014) and 0.706 for absolute enhancement (IC95%:0.563–0.849, p = 0.012).Sensitivity, specificity and accuracy values were 0.67, 0.80 and 0.72, respectively, for myocardial edema and 0.76, 0.75 and 0.76, respectively, for LGE.ConclusionsHigh relaxivity contrast agents provide comparable results to standard-relaxivity chelates for EGE assessment in diagnosing myocarditis.     

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.     

Identification of comorbidities that place men at highest risk of death from androgen deprivation therapy before brachytherapy for prostate cancer

PurposeTo determine which specific comorbidities predispose men to excess mortality by androgen deprivation therapy (ADT) given before and during brachytherapy for prostate cancer.Methods and MaterialsWe analyzed 5972 men with T1c–T3b prostate cancer treated with brachytherapy-based radiation with or without neoadjuvant ADT. Cox multivariable analysis with propensity scoring was used to determine if ADT was associated with increased all-cause mortality (ACM) in men divided into groups stratified by cardiac comorbidities. Tests for interaction between risk group and outcome were performed.ResultsADT was associated with increased ACM in men with a history of myocardial infarction or congestive heart failure, regardless of whether they underwent revascularization (adjusted hazard ratio [AHR], 2.1 [95% confidence interval {CI}, 1.02–4.17; p = 0.04]) or not (AHR, 1.8 [95% CI, 1.05–3.20; p = 0.03]), but this effect was not seen in men with less severe comorbidity. However, among men with diabetes, there was a significant interaction with risk group (p = 0.01) such that ADT was associated with excess mortality in men with low-risk disease (AHR = 2.21 [1.04–4.68]; p = 0.04) but not in men with intermediate or high-risk disease (AHR, 0.64 [0.33–1.22]; p = 0.17).ConclusionsADT was associated with excess ACM in all patients with a history of congestive heart failure or myocardial infarction, regardless of whether they were revascularized, and in diabetics with low-risk disease. ADT for gland downsizing before brachytherapy should be avoided in these men.     

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.     

Diagnostic value of cone beam computed tomography (CBCT) in occult scaphoid and wrist fractures

ObjectiveEvaluate the diagnostic value of cone beam computed tomography (CBCT) for scaphoid and wrist fractures that are missed on standard radiographs.Materials and methodsBetween September 2014 and October 2015, we prospectively enrolled 49 patients with a clinically suspected scaphoid fracture following an acute injury but had normal radiographs. Each patients underwent radiographs, CBCT and (magnetic resonance imaging) MRI within 7 days of the initial injury event. Both exam were evaluated independently by two radiologists.ResultsFor scaphoid cortical fractures CBCT sensitivity is 100% (95% CI: 75%–100%), specificity 97% (95% CI: 83%–100%). CBCT diagnosed all 24 corticals wrist fractures, corresponding to a sensitivity of 100% (95% CI: 83%–100%), specificity of 95% (95% CI: 75%–100%). Kappa agreement rate between the two radiologists was K = 0.95 (95% CI: 0.85–1) for scaphoid fractures and K = 0.87 (95% CI: 0.73–1) for wrist fractures.ConclusionsCBCT is superior to radiographs for diagnosing occult cortical fractures. Because of its low radiation dose, we believe that CBCT can be used in current practice as a replacement or supplement to radiographs to detect these fractures and optimize the cost-effectiveness ratio by limiting the number of needless immobilizations.     

Diagnostic performance of MRI for prediction of muscle-invasiveness of bladder cancer: A systematic review and meta-analysis

PurposeTo review the diagnostic performance of ≥1.5-T MRI for local staging of bladder cancer.MethodsMEDLINE and EMBASE were searched up to February 21, 2017. We included diagnostic accuracy studies published since 2000 that used ≥1.5-T MRI for local staging (≥T2 [muscle-invasive]) in patients with bladder cancer, using pathology as the reference standard. The methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity and specificity were pooled and plotted in a hierarchical summary receiver operating characteristics plot. Sensitivity analyses using several clinically relevant covariates were performed.Results24 studies (1774 patients) were included. Pooled sensitivity was 0.92 (95% CI 0.88–0.95) with specificity of 0.87 (95% CI 0.78–0.93). Sensitivity analyses showed that sensitivity estimates were comparable and consistently high across all subgroups, but specificity estimates were variable. Studies using 3-T scanners had higher specificity (0.93 [95% CI 0.86–0.98]) than those using 1.5-T scanners (0.83 [95% CI 0.74–0.98]). Studies using multiparametric MRI (conventional + ≥2 functional sequences) showed the highest accuracy with sensitivity and specificity of 0.94 (95% CI 0.89–1.00) and 0.95 (95% CI 0.89–0.98), respectively.ConclusionsMRI shows good diagnostic performance for predicting muscle-invasiveness of bladder cancer. Multiparametric 3-T MRI seems to improve both sensitivity and specificity.     

Improved detection of melanoma metastases by iodine maps from dual energy CT

ObjectiveMetastatic disease in melanoma has an unpredictable nature with deposits in rare locations such as musculature. Dual energy CT (DECT) provides high contrast-visualization of enhancement by using spectral properties of iodine. Purpose of this study was to evaluate whether iodine maps from DECT improve lesion detection in staging examinations of melanoma patients.MethodsThis retrospective study was approved by IRB and written informed consent was obtained from all patients. 75 contrast-enhanced DECT scans (thorax and abdomen) from 75 melanoma patients (n = 69 stage IV; n = 6 stage III) were analysed. For each patient, conventional CT and iodine maps were reviewed independently by two radiologists. The number of lesions detected by reviewing the iodine maps following conventional CT was recorded. Unweighted Cohens Kappa coefficient (κ) was used for concordance analysis, Wilcoxon test for comparing lesion detection rates.ResultsIn 26 patients, at least one reader found additional lesions on iodine maps (inter-reader agreement 89%, κ = 0.74 (0.742–0.747)). Compared to grey-scale images, mean detection rate for metastases improved from 86% (range 82–90) to 94% (90–99%) (p ≤ 0.01), for muscle metastases from 8% (8-8%) to 99% (98–100%) (p ≤ 0.06). Findings included 2 pulmonary emboli.ConclusionIodine maps from DECT improve detection of metastases, especially muscle metastases, and relevant findings in staging examinations of melanoma patients.     

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.     

Transplant renal artery stenosis: Evaluation with contrast-enhanced ultrasound

ObjectiveTo assess the efficacy of contrast-enhanced ultrasound (CEUS) in depicting transplant renal artery stenosis (TRAS).Materials and methodsSeventy-eight patients (56 men and 22 women; aged 36 ± 12.2 years) who were suspected of TRAS due to either Doppler ultrasound (DUS) abnormalities or difficult control of blood pressure and/or persistent deterioration of renal function were enrolled to perform CEUS. The reference standard for the TRAS diagnoses was computed tomography angiography (CTA). The diagnostic performance of DUS and CEUS parameters was assessed by the area under the receiver operating characteristic curve (AUC).ResultsTRAS was diagnosed in 32 out of 78 cases by CTA. The AUC, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CEUS in predicting TRAS were 0.92, 92.3%, 87.5%, 95.7%, 93.3%, and 91.7%, respectively. CEUS rectified 13 (28.3%) false-positive cases on DUS, which were confirmed by CTA. Compared to DUS parameters, CEUS showed the highest AUC, statistically significant differences of AUC were found (P = 0.006–0.039), except for that of the PSV ratio in the main transplant renal artery to that in interlobar artery (PSV-ratio) (AUC: 0.92 versus 0.86, P = 0.422). However, CEUS showed a significantly higher specificity (95.7% versus 76.1%, P = 0.008) and the same sensitivity compared to PSV-ratio.ConclusionsCEUS is superior to DUS in depicting TRAS. Moreover, our results suggest that CEUS might potentially be used as a noninvasive tool to spare many patients from unnecessary CTA.     

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.