scholarly journals Lesion-level heterogeneity of radiologic progression in patients treated with pembrolizumab

2021 ◽  
Author(s):  
B.G. Topp ◽  
K. Thiagarajan ◽  
D.P. De Alwis ◽  
A. Snyder ◽  
M.D. Hellmann
Keyword(s):  
Lesion Level ◽  
Radiologic Progression

scholarly journals Usefulness of Imaging Response Assessment after Irreversible Electroporation of Localized Pancreatic Cancer—Results from a Prospective Cohort

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2862
Author(s):  
Rasmus V. Flak ◽  
Rune V. Fisker ◽  
Niels H. Bruun ◽  
Mogens T. Stender ◽  
Ole Thorlacius-Ussing ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Irreversible Electroporation ◽  
Response Assessment ◽  
Time Intervals ◽  
Patient Level ◽  
Positron Emission ◽  
Included Patient ◽  
Before And After ◽  
Lesion Level ◽  
Level Analysis

(1) Background: Irreversible electroporation (IRE) is a nonthermal ablation technique that is being studied in nonmetastatic pancreatic cancer (PC). Most published studies use imaging outcomes as an efficacy endpoint, but imaging interpretation can be difficult and has yet to be correlated with survival. The aim of this study was to examine the correlation of imaging endpoints with survival in a cohort of IRE-treated PC patients. (2) Methods: Several imaging endpoints were examined before and after IRE on 18F-fluorodeoxyglucose positron emission tomography (PET) with computed tomography. Separate analyses were performed at the patient and lesion levels. Mortality rate (MR) ratios for imaging endpoints after IRE were estimated. (3) Results: Forty-one patients were included. Patient-level analysis revealed that progressive disease (PD), as defined by RECIST 1.1, is correlated with a higher MR at all time intervals, but PD, as defined by EORTC PET response criteria, is only correlated with the MR in the longest interval. No correlation was found between PD, as defined by RECIST, and the MR in the lesion-level analysis. (4) Conclusions: Patient-level PD, as defined by RECIST, was correlated with poorer survival after IRE ablation, whereas no correlations were observed in the lesion-level analyses. Several promising lesion-level outcomes were identified.

scholarly journals Effects of methotrexate on radiologic progression in juvenile rheumatoid arthritis

1993 ◽  
Vol 36 (10) ◽  
pp. 1370-1374 ◽  
Author(s):  
Liora Harel ◽  
Linda Wagner-Weiner ◽  
Andrew K. Poznanski ◽  
Charles H. Spencer ◽  
Edem Ekwo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Juvenile Rheumatoid Arthritis ◽  
Radiologic Progression

scholarly journals Factors associated with failure of bony union after conservative treatment of acute cases of unilateral lumbar spondylolysis

2021 ◽  
Author(s):  
Masaki Tatsumura ◽  
Hisanori Gamada ◽  
Shun Okuwaki ◽  
Fumihiko Eto ◽  
Katsuya Nagashima ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Conservative Therapy ◽  
Bony Union ◽  
Pathological Stage ◽  
Factors Associated ◽  
Lumbar Spondylolysis ◽  
Lesion Level ◽  
Advanced Pathological Stage ◽  
Marrow Edema

Abstract Background: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudoarthrosis.Methods: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union.Results: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with advanced pathological stage (p = 0.004), contralateral pseudoarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0–193.9) for advanced pathological stage, 78.8 (95% CI 13–846) for contralateral pseudoarthrosis, and 175 (95% CI 8.5–8192) for L5 lesion level.Conclusions: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is advanced, the lesion level is L5, or there is contralateral pseudoarthrotic spondylolysis.

scholarly journals Detection and Segmentation of Pelvic Bones Metastases in MRI Images for Patients With Prostate Cancer Based on Deep Learning

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiang Liu ◽  
Chao Han ◽  
Yingpu Cui ◽  
Tingting Xie ◽  
Xiaodong Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Deep Learning ◽  
Bone Metastases ◽  
Model Development ◽  
Whole Body ◽  
Pelvic Bone ◽  
Skeletal Metastases ◽  
Dice Similarity Coefficient ◽  
Patient Level ◽  
Lesion Level

ObjectiveTo establish and evaluate the 3D U-Net model for automated segmentation and detection of pelvic bone metastases in patients with prostate cancer (PCa) using diffusion-weighted imaging (DWI) and T1 weighted imaging (T1WI) images.MethodsThe model consisted of two 3D U-Net algorithms. A total of 859 patients with clinically suspected or confirmed PCa between January 2017 and December 2020 were enrolled for the first 3D U-Net development of pelvic bony structure segmentation. Then, 334 PCa patients were selected for the model development of bone metastases segmentation. Additionally, 63 patients from January to May 2021 were recruited for the external evaluation of the network. The network was developed using DWI and T1WI images as input. Dice similarity coefficient (DSC), volumetric similarity (VS), and Hausdorff distance (HD) were used to evaluate the segmentation performance. Sensitivity, specificity, and area under the curve (AUC) were used to evaluate the detection performance at the patient level; recall, precision, and F1-score were assessed at the lesion level.ResultsThe pelvic bony structures segmentation on DWI and T1WI images had mean DSC and VS values above 0.85, and the HD values were &lt;15 mm. In the testing set, the AUC of the metastases detection at the patient level were 0.85 and 0.80 on DWI and T1WI images. At the lesion level, the F1-score achieved 87.6% and 87.8% concerning metastases detection on DWI and T1WI images, respectively. In the external dataset, the AUC of the model for M-staging was 0.94 and 0.89 on DWI and T1WI images.ConclusionThe deep learning-based 3D U-Net network yields accurate detection and segmentation of pelvic bone metastases for PCa patients on DWI and T1WI images, which lays a foundation for the whole-body skeletal metastases assessment.

Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry

2021 ◽  
Vol 28 (1) ◽  
pp. 21-27
Author(s):  
Mark S. Dias ◽  
Ming Wang ◽  
Elias B. Rizk ◽  
Robin Bowman ◽  
Michael D. Partington ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spina Bifida ◽  
Cox Proportional Hazards ◽  
Patient Registry ◽  
Tethered Spinal Cord ◽  
Significant Treatment ◽  
Data Set ◽  
Traditional Concept ◽  
Lesion Level ◽  
Males And Females

OBJECTIVE The aims of this study were to review the National Spina Bifida Patient Registry (NSBPR) data set to study the rates of tethered spinal cord release (TCR) among patients with myelomeningocele and variability between centers, to compare TCR rates between males and females, and to study the relationships between TCR rates and other condition-specific characteristics. METHODS The NSBPR registry was queried to identify all patients with myelomeningocele. TCR rates were calculated over time using survival analyses; rates between centers and between males and females were compared. Cox proportional hazards models were constructed to identify relationships between TCR rates and sex, functional lesion level, ambulation status, treated hydrocephalus, and prior Chiari decompression. RESULTS Of 6339 patients with information about their operations, 1366 (21.5%) underwent TCR, with significant variability between centers. The majority (75.8%) underwent a single TCR. The annual TCR rate was linear between birth and 13 years (1.8%/year) but declined sharply from 14 to 21 years (0.7%/year). There was no period of time at which the TCR rate accelerated. There were no significant differences in TCR rates between males and females. TCR rate was not related to functional lesion level but was lower among nonambulators compared with community ambulators (p = 0.005) and among those with treated hydrocephalus (HR 0.30, p < 0.001), and higher among those having prior Chiari decompression (HR 1.71, p < 0.001). CONCLUSIONS These results extend the results of prior single-institution studies, demonstrate significant treatment variability between institutions, and challenge the traditional concept that tethering is related to spinal cord stretching due to spinal growth.

Clinical evaluation of AI software for rib fracture detection and its impact on junior radiologist performance

2021 ◽  
pp. 028418512110438
Author(s):  
Xiang Liu ◽  
Dijia Wu ◽  
Huihui Xie ◽  
Yufeng Xu ◽  
Lin Liu ◽  
...  
Keyword(s):  
Detection System ◽  
Ct Images ◽  
Diagnostic Efficiency ◽  
Fracture Detection ◽  
Patient Level ◽  
Primary Endpoints ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
Lesion Level ◽  
Missed Diagnosis

Background The detection of rib fractures (RFs) on computed tomography (CT) images is time-consuming and susceptible to missed diagnosis. An automated artificial intelligence (AI) detection system may be helpful to improve the diagnostic efficiency for junior radiologists. Purpose To compare the diagnostic performance of junior radiologists with and without AI software for RF detection on chest CT images. Materials and methods Six junior radiologists from three institutions interpreted 393 CT images of patients with acute chest trauma, with and without AI software. The CT images were randomly split into two sets at each institution, with each set assigned to a different radiologist First, the detection of all fractures (AFs), including displaced fractures (DFs), non-displaced fractures and buckle fractures, was analyzed. Next, the DFs were selected for analysis. The sensitivity and specificity of the radiologist-only and radiologist-AI groups at the patient level were set as primary endpoints, and secondary endpoints were at the rib and lesion level. Results Regarding AFs, the sensitivity difference between the radiologist-AI group and the radiologist-only group were significant at different levels (patient-level: 26.20%; rib-level: 22.18%; lesion-level: 23.74%; P < 0.001). Regarding DFs, the sensitivity difference was 16.67%, 14.19%, and 16.16% at the patient, rib, and lesion levels, respectively ( P < 0.001). No significant difference was found in the specificity between the two groups for AFs and DFs at the patient and rib levels ( P > 0.05). Conclusion AI software improved the sensitivity of RF detection on CT images for junior radiologists and reduced the reading time by approximately 1 min per patient without decreasing the specificity.

Combination therapy in rheumatoid arthritis

2020 ◽  
pp. 457-462
Author(s):  
Ben G.T. Coumbe ◽  
Elena Nikiphorou ◽  
Tuulikki Sokka-Isler
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Treat To Target ◽  
Combination Therapies ◽  
Treatment Benefit ◽  
Combination Strategies ◽  
Therapeutic Landscape ◽  
The Cost ◽  
Lower Disease Activity ◽  
Radiologic Progression

The therapeutic armamentarium available for treatment of rheumatoid arthritis (RA) has changed significantly over the past 30 years, transforming the therapeutic landscape and prognosis for a substantial proportion of patients with RA. Combination therapies represent an important therapeutic paradigm for management of rheumatoid arthritis. The rationale for combination therapies is clear and demonstrated to bring treatment benefit to patients achieving lower disease activity scores and reduced radiologic progression according to ‘treat-to-target’ principles. A rigorous evidence-based debate is required involving not only parameters related to disease activity scores and radiologic progression, but related to the cost-effectiveness analysis of using many of these newer agents compared to older csDMARDs. This chapter addresses the evidence related to the utilization of combination strategies for the management of RA as compared to monotherapy.

scholarly journals Comparison of Likert and PI-RADS version 2 MRI scoring systems for the detection of clinically significant prostate cancer

2020 ◽  
Vol 93 (1112) ◽  
pp. 20200298 ◽  
Author(s):  
Jeries P Zawaideh ◽  
Evis Sala ◽  
Maria Pantelidou ◽  
Nadeem Shaida ◽  
Brendan Koo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Detection Rates ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Threshold Score ◽  
Lesion Level ◽  
Clinically Significant ◽  
Histological Results

Objective: To compare the performance of Likert and Prostate Imaging–Reporting and Data System (PI-RADS) multiparametric (mp) MRI scoring systems for detecting clinically significant prostate cancer (csPCa). Methods: 199 biopsy-naïve males undergoing prostate mpMRI were prospectively scored with Likert and PI-RADS systems by four experienced radiologists. A binary cut-off (threshold score ≥3) was used to analyze histological results by three groups: negative, insignificant disease (Gleason 3 + 3; iPCa), and csPCa (Gleason ≥3 +4). Lesion-level results and prostate zonal location were also compared. Results: 129/199 (64.8%) males underwent biopsy, 96 with Likert or PI-RADS score ≥3, and 21 with negative MRI. A further 12 patients were biopsied during follow-up (mean 507 days). Prostate cancer was diagnosed in 87/199 (43.7%) patients, 65 with (33.6%) csPCa. 30/92 (32.6%) patients with negative MRI were biopsied, with an NPV of 83.3% for cancer and 86.7% for csPCa. Likert and PI-RADS score differences were observed in 92 patients (46.2%), but only for 16 patients (8%) at threshold score ≥3. Likert scoring had higher specificity than PI-RADS (0.77 vs 0.66), higher area under the curve (0.92 vs 0.87, p = 0.002) and higher PPV (0.66 vs 0.58); NPV and sensitivity were the same. Likert had more five score results (58%) compared to PI-RADS (36%), but with similar csCPa detection (81.0 and 80.6% respectively). Likert demonstrated lower proportion of false positive in the predominately AFMS-involving lesions. Conclusion: Likert and PI-RADS systems both demonstrate high cancer detection rates. Likert scoring had a higher AUC with moderately higher specificity and lower positive call rate and could potentially help to reduce the number of unnecessary biopsies performed. Advances in knowledge: This paper illustrates that the Likert scoring system has potential to help urologists reduce the number of prostate biopsies performed.

Sign in / Sign up

Export Citation Format

Share Document