PRE-OPERATIVE MRI IMAGING ACCURATELY DETECTS THE ARTHROSCOPIC COMMA SIGN IN SUBSCAPULARIS TEARS

Glomus tumor is one of the most common temporal bone tumors. Most of them are benign and locally invasive, some are occasionally able to metastasize and have signs of malignancy. Diagnostic imaging is necessary before treatment. Computer tomography (CT) is traditionally used as a primary method of diagnosis, to recognize changes in the temporal bone. Role of magnetic resonance imaging (MRI) in temporal bone tumor diagnosis is not definitively determined.Purpose. To assess the possibilities of computer and magnetic resonance tomography, to develop an algorithm for the application of diagnostic imaging methods in the diagnosis of glomus tumors of the temporal bone.Material and methods. The article presents the experience of diagnosing 30 patients with glomus tumors.Results. The tympanic form of the glomus tumor was observed in 11 cases (37%), tympano-yugular in 19 cases (63%). CT and MRI data totally coincided in cases of small tumors (type A and B). In the presence of extended forms CT ability of assessing bone invasion, involvement of the internal carotid artery, internal jugular vein, and dural sinuses was lower than the MRI.

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ACUTE HIPPOCAMPAL INFARCTIONS PRESENTING AS SUDDEN ONSET TRANSIENT MEMORY LOSS, PICKED UP BY EARLY MRI IMAGING

10.26226/morressier.58e389b3d462b8029238481a ◽

2017 ◽

Author(s):

Lankanatha Alwis

Keyword(s):

Memory Loss ◽

Sudden Onset ◽

Mri Imaging

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SURGERY FOR RESIDUAL DISEASE AFTER RADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER

Problems in oncology ◽

10.37469/0507-3758-2019-65-5-721-725 ◽

2019 ◽

Vol 65 (5) ◽

pp. 721-725

Author(s):

Elmira Shakirova ◽

Andrey Panov ◽

Alevtina Akhmetzyanova ◽

Aliya Gafiullina ◽

L. Ibragimova ◽

...

Keyword(s):

Cervical Cancer ◽

Residual Disease ◽

Locally Advanced ◽

Residual Tumor ◽

Advanced Cervical Cancer ◽

Mri Imaging ◽

Recurrent Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Visible Effect ◽

Adjuvant Hysterectomy

Aims: Chemoradiation (CRT) is the standard treatment for locally advanced cervical cancer (LACC). However part of the patients develop recurrence during the first year after treatment despite good visible effect at the first follow-up. The role of completion surgery after radiotherapy (RT) is still debated. A number of papers have showed that up to 60% of patients have residual tumor after CRT and RT. But such a surgery is not widely recommended because of increased morbidity of the treatment. The aim of this study was to assess the results of surgery after radiotherapy of LACC. Method: We retrospectively evaluated data on 86 patients with cervical cancer IB - IIIB stages (mostly stage IIB) who underwent surgery in different modalities after CRT and RT with good clinical response in our department in 2015-2018. Results: When small asymptomatic residual disease was detected early after radiotherapy radical hysterectomy was feasible in most of the cases. Patients with clinical manifestation of recurrence had very poor prognosis. Surgery of recurrent cervical cancer sufficiently deteriorates quality of life, even if possible. Conclusion: Thorough examination with adding MRI imaging after initial treatment of cervical cancer needed to identify patients who may benefit from adjuvant hysterectomy.

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THREE-DIMENSIONAL PLANNING OF BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER BY CT/MRI IMAGES

Problems in oncology ◽

10.37469/0507-3758-2018-64-5-645-650 ◽

2018 ◽

Vol 64 (5) ◽

pp. 645-650

Author(s):

Olga Kravets ◽

Yelena Romanova ◽

Oleg Kozlov ◽

Mikhail Nechushkin ◽

A. Gavrilova ◽

...

Keyword(s):

Cervical Cancer ◽

Local Control ◽

Control Volume ◽

Locally Advanced ◽

Three Dimensional ◽

Advanced Cervical Cancer ◽

3D Ct ◽

Mri Imaging ◽

Tumor Target ◽

Locally Advanced Cervical Cancer

We present our results of 3D CT/MRI brachytherapy (BT) planning in 115 patients with locally advanced cervical cancer T2b-3bN0-1M0. The aim of this study was to assess the differences in the visualization of tumor target volumes and risk organs during the 3D CT/MRI BT. The results of the study revealed that the use of MRI imaging for dosimetric planning of dose distribution for a given volume of a cervical tumor target was the best method of visualization of the soft tissue component of the tumor process in comparison with CT images, it allowed to differentially visualize the cervix and uterine body, directly the tumor volume. Mean D90 HR-CTV for MRI was 32.9 cm3 versus 45.9 cm3 for CT at the time of first BT, p = 0.0002, which is important for local control of the tumor process. The contouring of the organs of risk (bladder and rectum) through MRI images allows for more clearly visualizing the contours, which statistically significantly reduces the dose load for individual dosimetric planning in the D2cc control volume, і.є. the minimum dose of 2 cm3 of the organ of risk: D2cc for the bladder was 24.3 Gy for MRI versus 34.8 Gy on CT (p = 0.045); D2cc for the rectum - 18.7 Gy for MRI versus 26.8 Gy for CT (p = 0.046). This is a prognostically important stage in promising local control, which allows preventing manifestation of radiation damage.

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A histoanatomical study of the fiber bundle forming the ‘Comma Sign,’ a critical marker of the torn edge of the subscapularis tendon

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03775-6 ◽

2021 ◽

Author(s):

Ryuzo Arai ◽

Yoshihiro Hagiwara ◽

Yoshifumi Saijo ◽

Shuichi Matsuda

Keyword(s):

Fiber Bundle ◽

Subscapularis Tendon ◽

Comma Sign

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Serial Lipocalin 2 and Oncostatin M levels reflect inflammation status and treatment response in axial spondyloarthritis

Arthritis Research & Therapy ◽

10.1186/s13075-021-02521-y ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Florence W. L. Tsui ◽

Aifeng Lin ◽

Ismail Sari ◽

Zhenbo Zhang ◽

Hing Wo Tsui ◽

...

Keyword(s):

Back Pain ◽

Treatment Response ◽

Axial Spondyloarthritis ◽

Objective Assessment ◽

Joint Inflammation ◽

Oncostatin M ◽

Lipocalin 2 ◽

Mri Imaging ◽

Treatment Responses ◽

Transient Elevation

Abstract Background Informative serum biomarkers for monitoring inflammatory activity and treatment responses in axial spondyloarthritis (axSpA) are lacking. We assessed whether Lipocalin 2 (LCN2) and Oncostatin M (OSM), both having roles in inflammation and bone remodeling, may accurately reflect chronic joint inflammation and treatment response in axSpA. Previous reports in animal models showed involvement of LCN2 and OSM in joint/gut inflammation. We asked whether they also play a role in human axSpA. Methods We analyzed a longitudinal observational axSpA cohort (286 patients) with yearly clinical assessments and concurrent measurements of serum LCN2 and OSM (1204 serum samples) for a mean of 4 years. Biomarker levels were correlated with MRI scoring and treatment response. Results Persistent and transient elevation of LCN2 and OSM were observed in axSpA patients. Persistent elevation of LCN2 or OSM, but not CRP, correlated with sacroiliac joint (SIJ) MRI SPARCC scores (Pearson’s correlation p = 0.0005 and 0.005 for LCN2 and OSM respectively), suggesting that LCN2/OSM outperforms CRP as reflective of SIJ inflammation. We observed both concordant and discordant patterns of LCN2 and OSM in relationship to back pain, the cardinal clinical symptom in axSpA. Twenty-six percent (73/286) of the patients remained both clinically and serologically active (CASA). Sixty percent (173/286) of the patients became clinically quiescent, with back pain resolved, but 53% (92/173) of them were serologically active (CQSA), indicating that pain control may not indicate control of joint inflammation, as reflected by positive MRI imaging of SIJ. With respect to treatment responses, transient elevation of LCN2 or OSM over time was predictive of better response to all treatments. Conclusion In axSpA, persistent LCN2 and/or OSM elevation reflects chronic SIJ inflammation and suboptimal treatment response. In our cohort, half of the currently deemed clinically quiescent patients with back pain resolved continued to demonstrate chronic joint inflammation. LCN2 and OSM profiling outperforms CRP as a predictive measure and provides an objective assessment of chronic local inflammation in axSpA patients.

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The Role of Serum 5-HIAA as a Predictor of Progression and an Alternative to 24-h Urine 5-HIAA in Well-Differentiated Neuroendocrine Neoplasms

Biology ◽

10.3390/biology10020076 ◽

2021 ◽

Vol 10 (2) ◽

pp. 76

Author(s):

Maria Wedin ◽

Sagar Mehta ◽

Jenny Angerås-Kraftling ◽

Göran Wallin ◽

Kosmas Daskalakis

Keyword(s):

Liver Tumor ◽

Disease Surveillance ◽

Tumor Burden ◽

Neuroendocrine Neoplasms ◽

Mri Imaging ◽

Exact Test ◽

Recist 1.1 ◽

Tumor Involvement ◽

Well Differentiated ◽

Disease Stages

Our aim was to investigate the clinical utility of serum 5HIAA for disease surveillance and diagnostic purposes in a cohort of patients with well-differentiated neuroendocrine neoplasms (WD-NENs). Forty-eight patients with WD-NENs and concurrent serum and urinary 5HIAA testing, as well as CT/MRI imaging, were included. Analysis of matching-pairs did not reveal any association between RECIST 1.1 responses and changes in serum 5HIAA levels (p = 0.673). In addition, no correlation was evident between RECIST 1.1 responses and >10%, >25% or >50% changes in serum 5HIAA levels (Fisher’s exact test p = 0.380, p > 0.999, and p > 0.999, respectively). The presence of liver metastases and extensive liver tumor involvement were associated with higher serum 5HIAA levels (p = 0.045 and p = 0.041, respectively). We also confirmed a strong linear correlation between the measurements of serum and urine 5HIAA (n = 24, r = 0.791, p < 0.0001). The concordance rate of serum and urinary 5HIAA positivity at standardized laboratory cut-offs was 75%. In patients with normal renal function tests, the concordance between the two methods was as high as 89%, and a sensitivity and specificity of 80% and 88.9%, respectively, was evident (Cohen’s kappa coefficient = 0.685). In conclusion, serum 5HIAA performs well compared to urinary testing for diagnostic purposes, mainly in advanced disease stages, and corresponds well to liver tumor burden. However, it is not adequate to predict tumor progression.

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Assessment and Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer: A Comparison of Imaging Modalities and Future Perspectives

Cancers ◽

10.3390/cancers13143521 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3521

Author(s):

Valeria Romeo ◽

Giuseppe Accardo ◽

Teresa Perillo ◽

Luca Basso ◽

Nunzia Garbino ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Tumor Response ◽

Imaging Techniques ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Complete Response ◽

Mri Imaging ◽

Future Perspectives ◽

Advanced Imaging

Neoadjuvant chemotherapy (NAC) is becoming the standard of care for locally advanced breast cancer, aiming to reduce tumor size before surgery. Unfortunately, less than 30% of patients generally achieve a pathological complete response and approximately 5% of patients show disease progression while receiving NAC. Accurate assessment of the response to NAC is crucial for subsequent surgical planning. Furthermore, early prediction of tumor response could avoid patients being overtreated with useless chemotherapy sections, which are not free from side effects and psychological implications. In this review, we first analyze and compare the accuracy of conventional and advanced imaging techniques as well as discuss the application of artificial intelligence tools in the assessment of tumor response after NAC. Thereafter, the role of advanced imaging techniques, such as MRI, nuclear medicine, and new hybrid PET/MRI imaging in the prediction of the response to NAC is described in the second part of the review. Finally, future perspectives in NAC response prediction, represented by AI applications, are discussed.

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The Use of the Comma Sign and Tissue for Recognition, Reduction, and Stability During Arthroscopic Repair of Combined Anterosuperior Cuff Tears

Video Journal of Sports Medicine ◽

10.1177/26350254211011183 ◽

2021 ◽

Vol 1 (4) ◽

pp. 263502542110111

Author(s):

Jocelyn Corbaz ◽

William G. Blakeney ◽

George Athwal ◽

Stefan Bauer

Keyword(s):

Major Complication ◽

Muscle Quality ◽

Rotator Interval ◽

Double Row ◽

Arterial Blood ◽

Goutallier Classification ◽

Ligamentous Structure ◽

Loop Technique ◽

Cerebral Saturation ◽

Comma Sign

Background: The comma sign is a useful marker for combined retracted supraspinatus and subscapularis tears. It was first described by the group of Burkhart as a “composite ligamentous structure” of the rotator interval attached to the retracted subscapularis. However, Neyton and coworkers suggested that the ruptured superior part of subscapularis is pulled upward by supraspinatus retraction. This video illustrates the value of “comma” recognition for reduction and repair stability. We feel that the comma tissue can be a composition of rotator interval ligaments with or without superior subscapularis contribution depending on an associated cleavage tear. Indications: Patients with retracted anterosuperior tears, unless muscle quality is poor (Goutallier classification ≥3). Understanding of the comma tissue is difficult but of crucial importance to assess complex anterosuperior cuff tears for reduction and repair with stability by maintaining and integrating this comma link into the repair construct. Technique Description: Arthroscopic setup includes beach chair position, armholder, cerebral saturation monitoring (target mean arterial blood pressure of about 70 mm Hg). Previously described circumferential portals were used for a repair with a double row construct (4 medial anchors: 2.5 for subscapularis; 1.5 for supraspinatus) and 2 lateral anchors. The superior boarder of subscapularis as well as the retracted capsular layer of supraspinatus was reduced and fixed using a lasso loop technique. Key stages are (1) tendon manipulation with 2 traction sutures; (2) tendon release; (3) comma reduction; (4) footprint preparation (burr, microfracture); (5) retrograde suture passing; (6) knot tying, knotless lateral row; and (7) a close surgeon to physiotherapist rehabilitation link (6 weeks passive to 90°, no resistance training for 3-6 months). Results: Senior author’s (S.B.) series: 32 anterosuperior tears over 4 years (mean age: 62 years, 48-73 years), minimum follow-up 1 year showed good results (mean SSV: 85% [preop. 35%], range: 40%-95%; mean Constant: 82 [preop. 30], range: 40-90). One major complication (cutibacterium infection; brick layer; workers compensation; invalidity demand; Constant/Subjective Shoulder Value both 40) and minor temporary stiffness at 3 months (8 patients; 22%). Conclusion: Adequate reduction and comma integration into a solid repair construct, as well as responsible rehabilitation surveillance, deliver successful results after technically intricate anterosuperior repairs.

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