Molecular imaging programs in the United States: results of a national survey

RATIONALE AND OBJECTIVES: We sought to identify and describe the characteristics of molecular imaging (MI) programs in the United States and to determine the factors considered critical for their future. MATERIALS AND METHODS: In a cross-sectional study, a validated survey was sent to members of the Society of Chairmen in Academic Radiology Departments (SCARD) in the United States, and 26 variables were studied. RESULTS: The response rate was 40.3%; 67.9% of the departments surveyed have an MI program. The main focus of 47.4% of departments is oncology. The number of radiologists working for the department was the only variable found to be significantly positively correlated with (1) number of researchers in the MI program, (2) number of MI modalities available, (3) total number of grants, and (4) having ongoing MI clinical trials. These four variables plus the number of federal grants and the space used by MI programs were independent of the geographical region, hospital size (number of beds), and department size (number of radiological examinations per year). All the MI programs received grants during 2005. Only 16.1% have no alliances with industry. Among all the departments, 82% identified staff training and recruitment as the keys for success; 78.57% considered oncology the most important future application of MI and cancer management the hospital service most affected by MI. CONCLUSION: MI programs are starting to be more widespread throughout the United States, and the trend is for more academic radiology departments to become engaged in MI activities; their development is independent of department characteristics. Radiology departments strongly agreed about the key components for success of MI initiatives and the areas that will be most affected by MI applications.     

Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips

Purpose  To determine the diagnostic accuracy of 3D-CTA using volume rendering (VR) in the detection of residual or recurrent cerebral aneurysms after clipping. Material and methods  Between January 2006 and November 2007, 45 patients (20 female, 25 male) with 50 intracranial aneurysms treated using titanium clips were enrolled in this study. IADSA and 3D-CTA were performed within 1 month after surgery in 27 (60%) patients, after 1 year in 12 (26%) patients and after 5 years in six (13%) patients. In blinded fashion, CTA and DSA images were independently interpreted by two senior neuroradiologists with 7 years of experience in vascular diagnostic neuroradiology. The diagnostic performance of MDCTA compared with DSA for the detection of aneurysm remnants was measured by receiver operating characteristic (ROC) analysis. The area under the ROC curve, 95% confidence interval (CI), sensitivity, and specificity were calculated. Results  For the detection of residue–recurrent aneurysm; the sensitivity and specificity of MDCTA were 87.5% (95% CI = 52.9–97.8%) and 97.4% (95% CI = 86.5–99.5%) for the first reader and 87.5% (95% CI = 52.9–97.8%) and 100% (95% CI = 90.8–100%) for the second reader respectively. Receiver operating characteristic (ROC) analysis revealed good diagnostic performance for 3D-CTA (mean area under ROC curve (Az) = 0.98 and 0.99 for the first and the second observer, respectively) The kappa values extracted from the interobserver concordance analysis for agreement observers regarding the use of MDCTA for assessment of a remnant neck was 0.62. Conclusion  Using MDCTA, it is possible to demonstrate the status of intracranial aneurysms after surgical clipping in the immediate postoperative period as well as long-term follow-up with an high sensitivity and specificity when comparing with the findings of DSA.     

The molecular aspects of chordoma

Chordomas are one of the rarest bone tumors, and they originate from remnants of embryonic notochord along the spine, more frequently at the skull base and sacrum. Although they are relatively slow growing and low grade, chordomas are highly recurrent, aggressive, locally invasive, and prone to metastasize to the lungs, bone, and the liver. Chordomas highly and generally show a dual epithelial-mesenchymal differentiation. These tumors resist chemotherapy and radiotherapy; therefore, radical surgery and high-dose radiation are the most used treatments, although there is no standard way to treat the disease. The molecular biology process behind the initiation and progression of a chordoma needs to be revealed for a better understanding of the disease and to develop more effective therapies. Efforts to discover the mysteries of these molecular aspects have delineated several molecular and genetic alterations in this tumor. Here, we review and describe the emerging insights into the molecular landscape of chordomas.     

Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria

INTRODUCTION: For patients with hepatocellular carcinoma (HCC) in particular, living donor liver transplant (LDLT) improves access to transplant. We report our results in 36 patients with HCC who underwent LDLT with a median follow-up >1 year. METHODS Underlying diagnoses included: hepatitis C (24), hepatitis B (9), cryptogenic cirrhosis (1), hemochromatosis (1), and primary biliary cirrhosis (1). Patients with tumors >or= 5 cm received IV doxorubicin intraoperatively and 6 cycles of doxorubicin at 3-week intervals. Patients were followed with CT scan and alpha-fetoprotein levels every 3 months for 2 years posttransplant. Mean waiting time, pretransplant treatment, tumor variables, and survival were analyzed. Univariate and multivariate analysis were done to analyze tumor variables; Kaplan-Meier and log rank were used to compare survivals. P < 0.05 was considered significant. RESULTS Mean wait for LDLT was 62 days, compared with 459 days in 50 patients with HCC transplanted with cadaveric organs during the same time period (P = 0.0001). At median follow-up of 450 days, there have been 10 deaths due to non-tumor-related causes and 3 deaths from recurrence; recurrence has also been observed in 3 other patients. On univariate and multivariate analysis, bilobar distribution was the only significant tumor variable (P = 0.03, log rank = 0.02). Fifty-three percent of patients exceeded UNOS priority criteria. One- and two-year patient survivals were 75% and 60%, respectively. Freedom from recurrence at 365 and 730 days was 82% and 74%, respectively. Overall and in patients with HCC > 5 cm (n = 12), there were no statistically significant differences in survival or in freedom from recurrence between recipients of living donor and cadaveric grafts. CONCLUSION Although one third of patients had tumors > 5 cm, the incidence of recurrence as well as patient survival and freedom from recurrence are comparable to results after cadaveric transplant. LDLT allows timely transplantation in patients with early or with large HCC.     

Treatment of missed posterior dislocation of the shoulder by delayed open reduction and glenoid reconstruction with corticocancellous iliac bone autograft

This is a report of a 2-year follow-up of a missed posterior shoulder disclocation treated with open reduction and glenoid reconstruction with corticocancellous iliac bone autograft. In such cases, this treatment option may be an alternative to hemiarthroplasty of the shoulder.     

Extraforaminal lumbar arterial anatomy

BACKGROUND: There are few studies carried out to reveal lumbar arterial anatomy. The studies of vascular anatomy of the lumbar zone are usually based on the angiographic imaging methods and barium injected radiographic sections of human specimens. METHODS: Upon the recent breakthroughs in the microscopic anatomic dissections, the vascular structure of this zone is examined in 16 cadavers. Arterial anatomies of the extraforaminal zones of 80 lumbar vertebral objects were studied. RESULTS: In each segment, lumbar artery, extraforaminal branches of the lumbar artery and the spinal (foraminal) branch were described. The spinal branch is originated from lumbar artery and extends as the dorsal branch. The dorsal branch is divided into 4 branches: ganglionic, transverse, ascending, and descending. Diameters of the lumbar artery, spinal, dorsal, and ganglionic branches were measured at each stage. The mean diameter of the lumbar artery was 2.7 mm, the dorsal branch was 2.0 mm, the foraminal branch was 1.9 mm, and the ganglionic branch was 1.0 mm, respectively. CONCLUSION: Knowledge of lumbar arterial anatomy is needed for carrying out a successful surgical operation and reducing complications.