1897 articles - 10.09.10
1: AJR Am J Roentgenol. 2010 Sep;195(3):W221-8.
Nishino M, Jackman DM, Hatabu H, Yeap BY, Cioffredi LA, Yap JT, Janne PA, Johnson BE, Van den Abbeele AD.
Department of Radiology, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02116, USA. Mizuki_Nishino@dfci.harvard.edu
OBJECTIVE: The purpose of this article is to compare the recently published revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (version 1.1) to the original guidelines (RECIST 1.0) for advanced non-small cell lung cancer (NSCLC) after erlotinib therapy and to evaluate the impact of the new CT tumor measurement guideline on response assessment. MATERIALS AND METHODS: Forty-three chemotherapy-naive patients with advanced NSCLC treated with erlotinib in a single-arm phase 2 multicenter open-label clinical trial were retrospectively studied. CT tumor measurement records using RECIST 1.0 that were generated as part of the prospective clinical trial were reviewed. A second set of CT tumor measurements was generated from the records to meet RECIST 1.1 guidelines. The number of target lesions, best response, and time to progression were compared between RECIST 1.1 and RECIST 1.0. RESULTS: The number of target lesions according to RECIST 1.1 decreased in 22 patients (51%) and did not change in 21 patients (49%) compared with the number according to RECIST 1.0 (p < 0.0001, paired Student's t test). Almost perfect agreement was observed between best responses using RECIST 1.1 and RECIST 1.0 (weighted kappa = 0.905). Two patients with stable disease according to RECIST 1.0 had progressive disease according to RECIST 1.1 criteria because of new lesions found on PET/CT. There was no significant difference in time to progression between RECIST 1.1 and RECIST 1.0 (p = 1.000, sign test). CONCLUSION: RECIST 1.1 provided almost perfect agreement in response assessment after erlotinib therapy compared with RECIST 1.0. Assessment with PET/CT was a major factor that influenced the difference in best response assessment between RECIST 1.1 and RECIST 1.0.
Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20729419&dopt=ExternalLink
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PMID: 20729419 [PubMed - in process]2: Radiology. 2010 Aug;256(2):585-97.
Tholen AT, de Monye C, Genders TS, Buskens E, Dippel DW, van der Lugt A, Hunink MG.
Department of Radiology, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
PURPOSE: To assess the effectiveness and cost-effectiveness of state-of-the-art noninvasive diagnostic imaging strategies in patients with a transient ischemic attack (TIA) or minor stroke who are suspected of having carotid artery stenosis (CAS). MATERIALS AND METHODS: All prospectively evaluated patients provided informed consent, and the local ethics committee approved this study. Diagnostic performance, treatment, long-term events, quality of life, and costs resulting from strategies employing duplex ultrasonography (US), computed tomographic (CT) angiography, contrast material-enhanced magnetic resonance (MR) angiography, and combinations of these modalities were modeled in a decision tree and Markov model. Data sources included a prospective diagnostic cohort study, a meta-analysis, and a review of the literature. Outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net health benefits (QALY-equivalents), with a willingness-to-pay threshold of euro 50,000 per QALY and a societal perspective. The strategy with the highest net health benefit was considered the most cost effective. Extensive one-way, two-way, and probabilistic sensitivity analyses to explore the effect of varying parameter values were performed. The reference case analysis assumed that patients underwent surgery 2-4 weeks after the first symptoms, and the effect of earlier intervention was explored. RESULTS: The reference case analysis showed that duplex US combined with CT angiography and surgery for 70%-99% stenoses was the most cost-effective strategy, with a net health benefit of 13.587 and 15.542 QALY-equivalents in men and women, respectively. In men, the CT angiography strategy with a 70%-99% cutoff yielded slightly more QALYs, at an incremental cost of euro 71,419 per QALY, compared with duplex US combined with CT angiography. In patients with a high-risk profile, in patients with a high prior probability of disease, and when patients could be treated within 2 weeks after the first symptoms, the CT angiography strategy with surgery for 50%-99% stenoses was the most cost-effective strategy. CONCLUSION: In diagnosing CAS, duplex US should be the initial test, and, if its results are positive, CT angiography should be performed; patients with 70%-99% stenoses should then undergo carotid endarterectomy. In patients with a high-risk profile, a high probability of CAS, or who can undergo surgery without delay, immediate CT angiography and surgery for 50%-99% stenoses is indicated.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20656842&dopt=ExternalLink
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PMID: 20656842 [PubMed - in process]3: Radiology. 2010 Aug;256(2):387-96.
Dave M, Elmunzer BJ, Dwamena BA, Higgins PD.
Department of Internal Medicine, Wayne State University, Detroit, Mich, USA.
PURPOSE: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for detection of primary sclerosing cholangitis (PSC) in patients with biochemical cholestasis. MATERIALS AND METHODS: Two reviewers searched MEDLINE, EMBASE, and other electronic databases to identify prospective studies in which MRCP was evaluated and compared with endoscopic retrograde cholangiopancreatography (ERCP), clinical examination, and/or histologic analysis for diagnosis of PSC in cholestasis and control cases. Main study inclusion criteria were (a) use of ERCP or percutaneous transhepatic cholangiography (PTC) as part of the reference standard for the diagnosis of PSC, (b) inclusion of patients with hepatobiliary disease other than PSC (ie, nonhealthy control subjects), (c) blinding of MRCP image readers to reference-standard results, (d) prospective study with ERCP or MRCP performed after subject recruitment into the study, and (e) inclusion of raw data (for true-positive, false-positive, true-negative, and false-negative results) that could be found or calculated from the original study data. Major exclusion criteria were duplicate article (on a primary study) that contained all or some of the original study data and inclusion of fewer than 10 patients with PSC. Methodologic quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies tool. Bivariate random-effects meta-analytic methods were used to estimate summary, sensitivity, specificity, and receiver operating characteristic (ROC) curves. RESULTS: Six manuscripts with 456 subjects (with 623 independent readings)--185 with PSC--met the study inclusion criteria. The summary area under the ROC curve was 0.91. High heterogeneity (inconsistency index, 78%) was found but became moderate (inconsistency index, 36%) with the exclusion of one study in which the diagnostic threshold was set for high sensitivity. There was no evidence of publication bias (P = .27, bias coefficient analysis). Sensitivity and specificity of MRCP for PSC detection across all studies were 0.86 and 0.94, respectively. Positive and negative likelihood ratios with MRCP were 15.3 and 0.15, respectively. In patients with high pretest probabilities, MRCP enabled confirmation of PSC; in patients with low pretest probabilities, MRCP enabled exclusion of PSC. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 94% and 13% for positive and negative MRCP results, respectively. CONCLUSION: MRCP has high sensitivity and very high specificity for diagnosis of PSC. In many cases of suspected PSC, MRCP is sufficient for diagnosis, and, thus, the risks associated with ERCP can be avoided.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20656832&dopt=ExternalLink
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PMID: 20656832 [PubMed - in process]4: AJR Am J Roentgenol. 2010 Aug;195(2):310-20.
Adams MC, Turkington TG, Wilson JM, Wong TZ.
Department of Biomedical Engineering, Duke University Medical Center, Durham, NC, USA.
OBJECTIVE: There is growing interest in using PET/CT for evaluating early response to therapy in cancer treatment. Although widely available and convenient to use, standardized uptake value (SUV) measurements can be influenced by a variety of biologic and technologic factors. Many of these factors can be addressed with close attention to detail and appropriate quality control. This article will review factors potentially affecting SUV measurements and provide recommendations on ways to minimize when using serial PET to assess early response to therapy. CONCLUSION: Scanner and reconstruction parameters can significantly affect SUV measurements. When using serial SUV measurements to assess early response to therapy, imaging should be performed on the same scanner using the same image acquisition and reconstruction protocols. In addition, attention to detail is required for accurate determination of the administered radiopharmaceutical dose.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20651185&dopt=ExternalLink
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PMID: 20651185 [PubMed - in process]5: AJR Am J Roentgenol. 2010 Aug;195(2):281-9.
Nishino M, Jagannathan JP, Ramaiya NH, Van den Abbeele AD.
Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02115, USA. Mizuki_Nishino@dfci.harvard.edu
OBJECTIVE: The objectives of this article are to review the new Response Evaluation Criteria in Solid Tumors (RECIST) guideline, version 1.1, highlighting the major changes in the new version compared with the original RECIST guideline (version 1.0), and to present case examples with representative imaging. CONCLUSION: Familiarity with the revised RECIST is essential in day-to-day oncologic imaging practice to provide up-to-date service to oncologists and their patients. Some of the changes in the revised RECIST affect how radiologists select, measure, and report target lesions.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20651182&dopt=ExternalLink
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PMID: 20651182 [PubMed - in process]6: Br J Radiol. 2010 Jul 20; [Epub ahead of print]
Diggelmann KV, Zytkovicz AE, Tuaine JM, Bennett NC, Kelly LE, Herst PM.
Radiation Oncology Department, Southern Blood and Cancer Centre, Dunedin Hospital, PO Box 1921, Dunedin, New Zealand.
Erythema occurs in 80-90% of women treated for breast cancer with radiation therapy. There is currently no standard treatment for radiation-induced skin reactions. This study investigates the clinical efficacy of Mepilex Lite dressings in reducing radiation-induced erythema in women with breast cancer. A total of 30 patients were recruited; of these, 24 participants presented with 34 erythematous areas of skin for analysis. When erythema was visible, each affected skin area was randomly divided into two similar halves: one half was treated using Mepilex Lite dressings, the other half with standard aqueous cream. Skin reactions were assessed by the Radiation-Induced Skin Assessment Scale. We also evaluated any potential dose build-up by the dressings using a white water phantom, the dose distribution over the breast via thermoluminescent dosimeters (TLDs) and the surface skin temperature with an infrared thermographic scanner. Mepilex Lite dressings significantly reduced the severity of radiation-induced erythema compared with standard aqueous cream (p < 0.001), did not affect surface skin temperature and caused only a small (0.5 mm) dose build-up. TLD measurements showed that the inframammary fold was exposed to significantly higher doses of radiation than any other breast region (p < 0.0001). Mepilex dressings reduce radiation-induced erythema.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20647511&dopt=ExternalLink
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PMID: 20647511 [PubMed - as supplied by publisher]7: Radiology. 2010 Sep;256(3):887-97. Epub 2010 Jul 15.
Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J.
International Consortium of Neuroendovascular Centres, Interventional Neuroradiology Research Unit, Department of Radiology, University of Montreal, CHUM-Notre-Dame Hospital, Montreal, QC, Canada.
PURPOSE: To report an updated, systematic review of medical literature from January 2003 to July 2008, on endovascular treatment (EVT) of intracranial unruptured aneurysms (UAs) (a) to assess the morbidity and case fatality rate of EVT of UAs, (b) to understand how bias can affect results, and (c) to estimate the efficacy of EVT by using reported digital subtraction angiographic (DSA) results and clinical follow-up events. MATERIALS AND METHODS: This article was prepared in accordance with the Meta-Analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature was searched by using PubMed and the EMBASE and Cochrane Library databases. Eligibility criteria were (a) explicit procedural mortality and morbidity rates; (b) at least 10 patients; (c) saccular, intradural, nondissecting UAs; (d) original study published in English or French between January 2003 and July 2008; and (e) a methodological quality score higher than 6, according to Strengthening the Reporting of Observational Studies in Epidemiology criteria. End points included procedural mortality and morbidity, defined as a modified Rankin scale score of 3-6 at 1 month, and efficacy, estimated by using immediate and follow-up digital subtraction angiographic results, as well as delayed hemorrhagic events. RESULTS: Seventy-one studies were included. Procedural unfavorable outcome was found in 4.8% (random-effect weighted average; 189 of 5044) of patients (99% confidence interval [CI]: 3.9%, 6.0%). Immediate angiographic results showed satisfactory occlusion in 86.1% (2660 of 3089) of UAs. Recurrences were shown in 321 (24.4%) of 1316 patients followed up for 0.4-3.2 years. Retreatment was performed in 9.1% (random-effect weighted average; 166 of 1699) of patients (99% CI: 6.2%, 13.1%). The annual risk of bleeding after EVT was 0.2% (random-effect weighted average; nine of 1395) of patients (99% CI: 0.1%, 0.3%), but clinical follow-up was short, limited to the first 6 months for 76.7% (n = 1071) of reported patients. CONCLUSION: EVT of UAs can be performed with relative safety. The efficacy of treatment as compared with observation has not been rigorously documented. (c) RSNA, 2010.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20634431&dopt=ExternalLink
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PMID: 20634431 [PubMed - in process]8: Radiology. 2010 Jul;256(1):93-101.
Menke J.
Department of Diagnostic Radiology, University Hospital, Robert-Koch-Strasse 40, Goettingen, Germany. Menke-J@T-Online.de
PURPOSE: To use meta-analysis to determine the diagnostic accuracy of contrast agent-enhanced multidetector computed tomography (CT) in primary acute mesenteric ischemia (AMI). MATERIALS AND METHODS: The PubMed search engine and five other electronic databases were searched for "mesenteric ischemia," "computed tomography," and related terms in articles published between January 1996 and September 2009, without language restrictions. Reference lists of retrieved articles were also searched. Two reviewers independently selected six studies that reported 2 x 2 contingency data on the diagnostic accuracy of multidetector CT in primary AMI in at least 10 patients with disease and 10 patients without disease and that used surgery or clinical outcome as the reference standard. Study data were independently extracted by the two reviewers, and disagreement was resolved by consensus. The study quality was assessed by using items from the Quality Assessment of Diagnostic Accuracy Studies tool. The primary 2 x 2 count data were investigated with a bivariate random-effects meta-analysis of sensitivity and specificity. RESULTS: Three studies were prospective, and three were retrospective. All studies were of high quality. The CT scanners used in the included studies had between four and 40 rows. The between-study heterogeneity was low to moderate. Overall, AMI was found in 142 of 619 studied cases. The meta-analysis showed a pooled sensitivity of 93.3% (95% confidence interval: 82.8%, 97.6%) and a pooled specificity of 95.9% (95% confidence interval: 91.2%, 98.2%). CONCLUSION: On the basis of a thorough clinical examination, contrast-enhanced multidetector CT allows the diagnosis of primary AMI with high sensitivity and specificity. Thus, it may be used as the first-line imaging method.
Publication Types: Meta-Analysis Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20574087&dopt=ExternalLink
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PMID: 20574087 [PubMed - indexed for MEDLINE]9: AJR Am J Roentgenol. 2010 Jul;195(1):260-8.
Yuan Y, Chen XS, Liu SY, Shen KW.
Department of Diagnostic Radiology, Changzheng Hospital, Shanghai, China.
OBJECTIVE: Prediction of pathologic complete remission in breast cancer after preoperative therapy presents difficulties. We performed a meta-analysis to determine the ability of MRI to predict pathologic complete remission in patients with breast cancer after preoperative therapy. MATERIALS AND METHODS: Medical subject heading terms ("MRI" and "Breast Neoplasm") and key words ("neoadjuvant" or "primary systemic" or "preoperative" or "presurgery") were used for a literature search in the MEDLINE database. A meta-analysis of pooled data from eligible studies was performed to estimate the accuracy of MRI in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. RESULTS: Twenty-five studies were included in this meta-analysis. Pooled weighted estimates of sensitivity and specificity were 0.63 (range, 0.56-0.70) and 0.91 (range, 90.89-0.92), respectively. Heterogeneity between studies was highly influenced by the pathologic complete remission rate, with a regression coefficient of -6.160 (p = 0.020). Subgroup analysis showed that the specificity of MRI in studies with a pathologic complete remission rate of > or = 20% was lower than that in studies with a pathologic complete remission rate of < 20% (p = 0.0003). CONCLUSION: This meta-analysis indicates that MRI has high specificity and relatively lower sensitivity in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. The pathologic complete remission rate may influence the performance of MRI accuracy in this setting, which deserves further investigation.
Publication Types: Meta-Analysis Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20566826&dopt=ExternalLink
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PMID: 20566826 [PubMed - indexed for MEDLINE]10: AJR Am J Roentgenol. 2010 Jul;195(1):101-6.
Jaffe TA, Wickersham NW, Sullivan DC.
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA. jaffe002@mc.duke.edu
OBJECTIVE: The objective of our study was to examine radiologists' opinions and practice patterns concerning tumor measurements in cancer patients. MATERIALS AND METHODS: An electronic mail survey was sent to 565 abdominal imaging radiologists at 55 U.S. National Cancer Institute (NCI)-funded cancer centers. The survey contained questions about departmental demographics, procedures for interpretation of imaging in oncologic patients, and opinions concerning the role of radiologists in using the Response Evaluation Criteria in Solid Tumors (RECIST) system for tumor measurements. RESULTS: Two hundred ninety-six responses (52%) were received. The distribution of the size of the respondents' abdominal imaging groups was as follows: 1-5 (16/295, 5%), 6-10 (112/295, 38%), 11-15 (77/295, 26%), and > 20 (73/295, 25%). Most respondents dictate some but not all tumor measurements in the first clinical scan (236/270, 87%). For follow-up imaging, 95% (255/268) of respondents dictate tumor measurements for selected index lesions. Most respondents believe inclusion of tumor measurements in the first scan is the responsibility of the radiologist (248/262, 95%). Ninety percent of respondents (235/261) believe inclusion of several index lesion measurements is satisfactory to document disease activity. Eighty-two percent (214/260) of respondents were familiar with RECIST. Forty-two percent (110/262) of respondents' departments have a centralized process for approval of industry-sponsored oncologic trials in which imaging is an important component of the protocol end point. CONCLUSION: Most oncologic imaging at NCI-sponsored cancer centers includes tumor measurements on initial and follow-up imaging. Very few radiology departments have a centralized process for approval of clinical trial protocols that require imaging.
Publication Types: Multicenter Study
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20566802&dopt=ExternalLink
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PMID: 20566802 [PubMed - indexed for MEDLINE]11: Radiology. 2010 Jun;255(3):988-1000.
Gerretsen SC, le Maire TF, Miller S, Thurnher SA, Herborn CU, Michaely HJ, Kramer H, Vanzulli A, Vymazal J, Wasser MN, Ballarati CE, Kirchin MA, Pirovano G, Leiner T.
Dept of Cardiovascular MR Research, Maastricht Univ Hosp, Peter Debijelaan 25, 6229HX Maastricht, the Netherlands.
PURPOSE: To prospectively compare the image quality and diagnostic performance achieved with doses of gadobenate dimeglumine and gadopentetate dimeglumine of 0.1 mmol per kilogram of body weight in patients undergoing contrast material-enhanced magnetic resonance (MR) angiography of the pelvis, thigh, and lower-leg (excluding foot) for suspected or known peripheral arterial occlusive disease. MATERIALS AND METHODS: Institutional review board approval was granted from each center and informed written consent was obtained from all patients. Between November 2006 and January 2008, 96 patients (62 men, 34 women; mean age, 63.7 years +/- 10.4 [standard deviation]; range, 39-86 years) underwent two identical examinations at 1.5 T by using three-dimensional spoiled gradient-echo sequences and randomized 0.1-mmol/kg doses of each agent. Images were evaluated on-site for technical adequacy and quality of vessel visualization and offsite by three independent blinded readers for anatomic delineation and detection/exclusion of pathologic features. Comparative diagnostic performance was determined in 31 patients who underwent digital subtraction angiography. Data were analyzed by using the Wilcoxon signed-rank, McNemar, and Wald tests. Interreader agreement was determined by using generalized kappa statistics. Differences in quantitative contrast enhancement were assessed and a safety evaluation was performed. RESULTS: Ninety-two patients received both agents. Significantly better performance (P < .0001; all evaluations) with gadobenate dimeglumine was noted on-site for technical adequacy and vessel visualization quality and offsite for anatomic delineation and detection/exclusion of pathologic features. Contrast enhancement (P < or = .0001) and detection of clinically relevant disease (P < or = .0028) were significantly improved with gadobenate dimeglumine. Interreader agreement for stenosis detection and grading was good to excellent (kappa = 0.749 and 0.805, respectively). Mild adverse events were reported for four (six events) and five (eight events) patients after gadobenate dimeglumine and gadopentetate dimeglumine, respectively. CONCLUSION: Higher-quality vessel visualization, greater contrast enhancement, fewer technical failures, and improved diagnostic performance are obtained with gadobenate dimeglumine, relative to gadopentetate dimeglumine, when compared intraindividually at 0.1-mmol/kg doses in patients undergoing contrast-enhanced MR angiography for suspected peripheral arterial occlusive disease. Copyright RSNA, 2010
Publication Types: Clinical Trial, Phase III Comparative Study Multicenter Study Randomized Controlled Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20501735&dopt=ExternalLink
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PMID: 20501735 [PubMed - indexed for MEDLINE]12: Radiology. 2010 May;255(2):622-8.
Sawlani RN, Raizer J, Horowitz SW, Shin W, Grimm SA, Chandler JP, Levy R, Getch C, Carroll TJ.
Department of Radiology, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL 60611, USA.
PURPOSE: To derive a magnetic resonance (MR)-based imaging metric that reflects local perfusion changes resulting from the administration of angiogenic-inhibiting chemotherapy in patients with recurrent glioblastoma multiforme (GBM). MATERIALS AND METHODS: In this retrospective Institutional Review Board-approved HIPAA-compliant study, 16 patients (12 men, four women; mean age, 51.8 years + or - 15.1 [standard deviation]) with recurrent GBM received bevacizumab every 3 weeks (15 mg per kilogram of body weight) as part of a clinical trial. Baseline MR images were acquired, and follow-up images were acquired every 6 weeks thereafter until tumor progression or death. Imaging included perfusion and T1-weighted contrast material-enhanced MR imaging. Perfusion images were analyzed both with and without correction for contrast material leakage. The volumes of interest were selected as enhancing voxels on T1-weighted contrast-enhanced MR images. Relative cerebral blood volume (rCBV) maps were created from analysis of MR perfusion images. The volumes of interest were used to calculate the following parameters: size, mean rCBV, mean leakage coefficient K(2), and hyperperfusion volume (HPV), which is the fraction of the tumor with an rCBV higher than a predetermined threshold. Percent change in each parameter from baseline to first follow-up was compared with time to progression (TTP) by using a Cox proportional hazards model with calculation of hazard ratios. RESULTS: The most significant hazard ratio was seen with a DeltaHPV cutoff of rCBV greater than 1.00 (hazard ratio, 1.077; 95% confidence interval: 1.026, 1.130; P = .002). The only significant ratios greater than one were those that resulted from perfusion calculated as mean rCBV and DeltaHPV. The ratios were also higher after correction for leakage. CONCLUSION: This pilot study derived an imaging metric (HPV) that reflects local perfusion changes in GBMs. This metric was found to show a significantly improved correlation to TTP as compared with more commonly used metrics.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20413772&dopt=ExternalLink
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PMID: 20413772 [PubMed - indexed for MEDLINE]13: Radiology. 2010 May;255(2):386-95.
Oba Y, Zaza T.
Division of Pulmonary and Critical Care Medicine, University of Missouri-Columbia, One Hospital Drive, CE 412, Columbia, MO 65212, USA. obay@health.missouri.edu
PURPOSE: To systematically examine whether abandoning daily routine chest radiography would adversely affect outcomes, such as mortality and length of stay (LOS), and identify a subgroup in which daily routine chest radiography might be beneficial. MATERIALS AND METHODS: This was a meta-analysis of clinical trials that examined the effect of abandoning daily routine chest radiography in adults in intensive care units (ICUs). Studies were identified through searches of MEDLINE, Cochrane Database, Database of Abstracts of Reviews of Effects, Biological Abstracts, and CINAHL. The results were expressed as odds ratios (ORs) or weighted mean difference (WMD) along with their 95% confidence intervals (CIs). RESULTS: Eight studies with a total of 7078 patients were identified. A pooled analysis revealed that the elimination of daily routine chest radiography did not affect either hospital or ICU mortality (OR, 1.02;[95% CI: 0.89, 1.17; P = .78 and OR, 0.92; 95% CI: 0.76, 1.11; P = .4, respectively). There was no significant difference in ICU LOS (WMD = 0.19 days; 95% CI: -0.13, 0.51; P = .25), hospital LOS (WMD = -0.29 days; 95% CI: -0.71, 0.13; P = .18), and ventilator days (WMD = 0.33 days; 95% CI: -0.12, 0.78; P = .15) between the on-demand and daily routine groups. Regression analyses failed to identify any subgroup in which performing daily routine chest radiography was beneficial. CONCLUSION: Systematic but unselective daily routine chest radiography can likely be eliminated without increasing adverse outcomes in adult patients in ICUs. Further studies are necessary to identify the specific patient population that would benefit from daily routine chest radiographs.
Publication Types: Meta-Analysis
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20413752&dopt=ExternalLink
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PMID: 20413752 [PubMed - indexed for MEDLINE]14: Radiology. 2010 May;255(2):342-51.
Durieux V, Gevenois PA.
Research Unit in Information and Communication, Department of Information and Communication Sciences, Universite Libre de Bruxelles, Brussels, Belgium.
Bibliometrics is a set of mathematical and statistical methods used to analyze and measure the quantity and quality of books, articles, and other forms of publications. There are three types of bibliometric indicators: quantity indicators, which measure the productivity of a particular researcher; quality indicators, which measure the quality (or "performance") of a researcher's output; and structural indicators, which measure connections between publications, authors, and areas of research. Bibliometric indicators are especially important for researchers and organizations, as these measurements are often used in funding decisions, appointments, and promotions of researchers. As more and more scientific discoveries occur and published research results are read and then quoted by other researchers, bibliometric indicators are becoming increasingly important. This article provides an overview of the currently used bibliometric indicators and summarizes the critical elements and characteristics one should be aware of when evaluating the quantity and quality of scientific output.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20413749&dopt=ExternalLink
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PMID: 20413749 [PubMed - indexed for MEDLINE]15: AJR Am J Roentgenol. 2010 May;194(5):1365-72.
Bommart S, Cliche A, Therasse E, Giroux MF, Vidal V, Oliva VL, Soulez G.
Department of Radiology, CHU-Montpellier Arnaud de Villeneuve, Montpellier, France.
OBJECTIVE: The purpose of this study was to evaluate the usefulness of renal length, volume, and resistive index measurements at Doppler ultrasound and MR angiography in predicting improvement after renal angioplasty. MATERIALS AND METHODS: Fifty-one patients underwent Doppler ultrasound examinations and MR angiography before percutaneous transluminal renal angioplasty. Renal length, total and cortical volumes, and resistive index were calculated. Combinations of length, volume, and resistive index measurements were correlated with improvement in blood pressure and renal function after percutaneous transluminal renal angioplasty. Thresholds for improving patient selection were chosen after analysis of receiver operating characteristics curves. RESULTS: Lower total and cortical volumes on MR angiograms and shorter kidney length on Doppler ultrasound images were found among patients with successful blood pressure control (p = 0.042, p = 0.035, and p = 0.016, respectively). Renal length measured with Doppler ultrasound and cortical volume measured with MR angiography weighted by resistive index were the best predictive factors (p = 0.004, p = 0.006). Using a threshold of renal length-resistive index product less than 7 cm, therapeutic response was predicted with a sensitivity of 87% and specificity of 50%, whereas with a threshold value of 52 mL/m(2) for cortical renal volume-resistive index product divided by body surface area, sensitivity of 86% and specificity of 50% were obtained. CONCLUSION: Renal length and volume combined with resistive index measurements appear to be predictive of therapeutic response after percutaneous transluminal renal angioplasty.
Publication Types: Controlled Clinical Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20410427&dopt=ExternalLink
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PMID: 20410427 [PubMed - indexed for MEDLINE]16: AJR Am J Roentgenol. 2010 May;194(5):1250-6.
Sharma A, Digumarthy SR, Kalra MK, Lanuti M, Shepard JA.
Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114, USA. asharma2@partners.org
OBJECTIVE: The objective of our study was to assess the characteristics of locoregional lymph node enlargement after successful radiofrequency ablation (RFA) in the treatment of malignant lung tumors. MATERIALS AND METHODS: Follow-up CT examinations of 14 patients (seven men, seven women; age range, 30-90 years) who underwent 16 RFA sessions for the treatment of primary (n = 9) or metastatic (n = 5) lung tumors with a mean follow-up of 35 +/- 15 (SD) months (range, 7-60 months) were retrospectively reviewed by two thoracic radiologists. The site and size of hilar and mediastinal lymph nodes were recorded at baseline and at follow-up 1, 3, and 6 months after RFA sessions. In addition, the size, type, and location of the ablated lesion or lesions were recorded. All complications from RFA were recorded. Data were analyzed using the Fisher's exact test. RESULTS: An increase in lymph node size was detected after 10 of 16 (62.5%) RFA sessions at 1-month follow-up. In four of 10 patients, only one node had enlarged, and in the remaining six patients, more than one nodal region had enlarged. The average increase in nodal size was 3 mm in the short-axis diameter and 4 mm in the long-axis diameter. Twenty-eight percent of RFA sessions were associated with enlargement of at least one lymph node to greater than 10 mm in short-axis diameter at 1-month follow-up. CT showed that nodes had decreased in size at 3- and 6-month follow-ups. Lesion size, location, and complications were not shown to be significantly associated with mediastinal lymph node enlargement (p > 0.05). CONCLUSION: Recognition of reversible locoregional lymph node enlargement after RFA is important to prevent misdiagnosis of nodal metastatic disease.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20410411&dopt=ExternalLink
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PMID: 20410411 [PubMed - indexed for MEDLINE]17: AJR Am J Roentgenol. 2010 May;194(5):1204-9.
Schaaf WE Jr, Wootten CT, Donnelly LF, Ying J, Shott SR.
Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA.
OBJECTIVE: Genioglossus advancement, an operation to pull the tongue anteriorly, is a treatment of obstructive sleep apnea (OSA) secondary to glossoptosis. MRI predictors to identify which children will benefit from genioglossus advancement would be helpful for planning. We reviewed imaging findings on MR sleep studies as biomarkers to predict success or failure of genioglossus advancement in the treatment of OSA in children and young adults. MATERIALS AND METHODS: Twenty-eight patients who had undergone genioglossus advancement and preoperative MRI were identified. For each subject, genioglossus advancement, which was performed to treat OSA, was categorized as a success or failure on the basis of polysomnography and clinical criteria. Static and dynamic cine MR sequences were retrospectively evaluated for multiple parameters including measurements of the size of the tongue and of the bony confines of the supraglottic airway, the ratio of tongue size to bony confines size, static size and dynamic changes of the retroglossal airway, tonsil size, and soft palate thickness. Radiologists were blinded to the outcome of genioglossus advancement (i.e., success or failure category). Numeric biomarkers were compared in an analysis-of-covariance model adjusting for patient age. RESULTS: Genioglossus advancement was successful for the treatment of OSA in 17 patients and failed in 11 patients. The relative size of the tongue (tongue-bony confines ratio) was larger in patients with a successful surgical outcome than in those for whom the procedure failed (mean ratio, 0.51 vs 0.46; p = 0.023). Smaller adenoids were associated with a successful outcome (mean size of adenoids, 9.1 vs 12.4 mm; p = 0.049). No other biomarker-including absolute tongue size and airway size or dynamic airway motion-was significant. CONCLUSION: The relative (not absolute) tongue size and small size of the adenoid tonsils on MRI were predictors of success of genioglossus advancement for the treatment of glossoptosis causing OSA. These findings may be helpful in guiding surgical decision making in children with OSA.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20410404&dopt=ExternalLink
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PMID: 20410404 [PubMed - indexed for MEDLINE]18: AJR Am J Roentgenol. 2010 May;194(5):W439-44.
Li L, Zeng XQ, Li YH.
Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, Guangdong 510515, China.
OBJECTIVE: The purpose of this article is to describe a modified technique of using digital subtraction angiography guidance combined with the double-needle technique and the filling-defects technique for foam sclerotherapy of peripheral venous malformations. The short-term efficacy and safety of the technique were evaluated. MATERIALS AND METHODS: Fourteen patients with peripheral venous malformations were treated with foam sclerotherapy. Sclerosing foam was prepared using the Tessari method to mix room air with 5% sodium morrhuate in a 4:1 ratio. Percutaneous foam sclerotherapy of venous malformations under digital subtraction angiography guidance was performed using a combined technique modified with the double-needle technique and the filling-defects technique. Follow-up clinical and radiologic assessment and evaluation of patient satisfaction were performed to evaluate the end result. RESULTS: At a mean of 9.3 months (range, 6-12 months) after the last session, the overall outcome was rated as excellent improvement (i.e., clinical obliteration and asymptomatic) in four (28.6%) of 14 patients, good improvement (i.e., substantial improvement in size and symptoms of > 50%) in nine patients (64.3%), or moderate improvement (i.e., significant decrease in size and symptoms of </= 50%) in one patient (7.1%). No major complications occurred. CONCLUSION: Digital subtraction angiography-guided percutaneous foam sclerotherapy modified with the double-needle technique and the filling-defects technique is an alternative method with favorable short-term results for treating peripheral venous malformations.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20410391&dopt=ExternalLink
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PMID: 20410391 [PubMed - indexed for MEDLINE]19: Br J Radiol. 2010 Apr;83(988):276-89.
Lumbreras B, Donat L, Hernandez-Aguado I.
Departament of Public Health, University Miguel Hernandez, Alicante, Spain. blumbreras@umh.es
The objective of this review is to summarise the available evidence on the frequency and management of incidental findings in imaging diagnostic tests. Original articles were identified by a systematic search of the MEDLINE, EMBASE and Cochrane Library Plus databases using appropriate medical headings. Extracted variables were study design; sample size; type of imaging test; initial diagnosis; frequency and location of incidental findings; whether clinical follow-up was performed; and whether a definitive diagnosis was made. Study characteristics were assessed by one reviewer and checked by a second reviewer. Any disagreement was solved by consensus. The relationship between the frequency of incidental findings and the study characteristics was assessed using a one-way ANOVA test, as was the frequency of follow-up of incidental findings and the frequency of confirmation. 251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8-31.3%). The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1-41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0-81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1-49.7). The mean frequency of clinical follow-up was 64.5% (95% CI 52.9-76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1-59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance.
Publication Types: Research Support, Non-U.S. Gov't Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20335439&dopt=ExternalLink
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PMID: 20335439 [PubMed - indexed for MEDLINE]20: Radiology. 2010 Apr;255(1):218-24.
Eisenberg RL, Bankier AA, Boiselle PM.
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. rleisenb@bidmc.harvard.edu
PURPOSE: To determine the familiarity of radiologists with the Fleischner Society guidelines for management of small lung nodules and to assess whether their decisions for nodule management are consistent with these recommendations. MATERIALS AND METHODS: Institutional review board exemption was granted for this electronic survey, which was sent to a sample of 7000 radiologists randomly selected from the Radiological Society of North America (RSNA) directory. Three clinical scenarios for nodule management were presented. Information about policies and guidelines for nodule management, awareness of published guidelines, and respondent demographics was obtained. Associations between these parameters and management recommendations were assessed by using a chi(2) test. Respondents were also asked about tube current settings for routine chest computed tomographic examinations and those performed solely for nodule follow-up. RESULTS: Of 834 respondents (response rate, 11.9%), 649 (77.8%) were aware of the Fleischner Society guidelines and 490 (58.8%) worked in practices that employed them or similar guidelines. Management selections were consistent with the Fleischner guidelines in 34.7%-60.8% of responses for the three scenarios. A significantly higher rate of concordance was associated with awareness of the Fleischner guidelines, presence of written policies based on them, a teaching practice setting, practice in a group with at least one member having chest radiology fellowship training, and fewer than 5 years of experience practicing radiology (P < .05 for all associations). The spectrum of tube current settings used was similar between the subgroups of respondents who were aware and those who were unaware of the Fleischner guidelines. CONCLUSION: Among survey respondents, there was high awareness and adoption of the Fleischner guidelines, but radiologists showed varying degrees of conformance with these recommendations. Future efforts are necessary to bridge the gap between awareness and implementation of these evidence-based guidelines. RSNA, 2010
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20308458&dopt=ExternalLink
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PMID: 20308458 [PubMed - indexed for MEDLINE]