What Factors Are Associated with Local Metastatic Lesion Progression After Intramedullary Nail Stabilization?

Purpose: to investigate the diagnostic opportunities of contrast magnetic resonance imaging with the effect of magnetization transfer effect in the diagnosis of focal metastatic lesions in the brain.Materials and methods.Images of contrast MRI of the brain of 16 patients (mean age 49 ± 18.5 years) were analysed. Diagnosis of the direction is focal brain lesion. All MRI studies were carried out using the Toshiba Titan Octave with magnetic field of 1.5 T. The contrast agent is “Magnevist” at concentration of 0.2 ml/kg was used. After contrasting process two T1-weighted studies were performed: without T1-SE magnetization transfer with parameters of pulse: TR = 540 ms, TE = 12 ms, DFOV = 24 sm, MX = 320 × 224 and with magnetization transfer – T1-SE-MTC with parameters of pulse: ΔF = −210 Hz, FA(МТС) = 600°, TR = 700 ms, TE = 10 ms, DFOV = 23.9 sm, MX = 320 x 224. For each detected metastatic lesion, a contrast-to-brain ratio (CBR) was calculated. Comparative analysis of CBR values was carried out using a non-parametric Wilcoxon test at a significance level p < 0.05. To evaluate the sensitivity and specificity of the techniques in the detection of metastatic foci (T1-SE and T1-SE-MTC), ROC analysis was used. The sample is divided into groups: 1 group is foci ≤5 mm in size, 2 group is foci from 6 to 10 mm, and 3 group is foci >10 mm. Results.Comparative analysis of CBR using non-parametric Wilcoxon test showed that the values of the CBR on T1-weighted images with magnetization transfer are significantly higher (p <0.001) that on T1-weighted images without magnetization transfer. According to the results of the ROC analysis, sensitivity in detecting metastases (n = 90) in the brain on T1-SE-MTC and T1-SE was 91.7% and 81.6%, specificity was 100% and 97.6%, respectively. The accuracy of the T1-SE-MTC is 10% higher in comparison with the technique without magnetization transfer. Significant differences (p < 0.01) between the size of the foci detected in post-contrast T1- weighted images with magnetization transfer and in post-contrast T1-weighted images without magnetization transfer, in particular for foci ≤5 mm in size, were found. Conclusions1. Comparative analysis of CBR showed significant (p < 0.001) increase of contrast between metastatic lesion and white matter on T1-SE-MTC in comparison with T1-SE.2. The sensitivity, specificity and accuracy of the magnetization transfer program (T1-SE-MTC) in detecting foci of metastatic lesions in the brain is significantly higher (p < 0.01), relative to T1-SE.3. The T1-SE-MTC program allows detecting more foci in comparison with T1-SE, in particular foci of ≤5 mm (96% and 86%, respectively, with p < 0.05).

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Use of hybrid shots in planning Perfexion Gamma Knife treatments for lesions close to critical structures

Journal of Neurosurgery ◽

10.3171/jns/2008/109/12/s7 ◽

2008 ◽

Vol 109 (Supplement) ◽

pp. 34-40 ◽

Cited By ~ 13

Author(s):

Paula L. Petti ◽

David A. Larson ◽

Sandeep Kunwar

Keyword(s):

Optic Nerve ◽

Gamma Knife ◽

Pituitary Tumor ◽

Metastatic Lesion ◽

Conformity Index ◽

Target Coverage ◽

Critical Areas ◽

Planning Technique ◽

Small Targets ◽

Critical Structure

Object The authors investigated the use of different collimator values in different sectors (hybrid shots) when treating patients with lesions close to critical structures with the Perfexion model Gamma Knife. Methods Twelve patients with various tumors (6 with a pituitary tumor, 3 with vestibular schwannoma, 2 with meningioma, and 1 with metastatic lesion) that were within 4 mm of the brainstem, optic nerve, pituitary stalk, or cochlea were considered. All patients were treated at the authors' institution between June 2007 and March 2008. The patients' treatments were replanned in 2 different ways. In the first plan, hybrid shots were used such that the steepest dose gradient was aligned with the junction between the target and the critical structure(s). This was accomplished by placing low-value collimators in appropriate sectors. In the second plan, no hybrid shots were used. Sector blocking (either manual or dynamic) was required for all plans to reduce the critical structure doses to acceptable levels. Prescribed doses ranged from 12 to 30 Gy at the periphery of the target. The plans in each pair were designed to be equally conformal in terms of both target coverage (as measured by the Paddick conformity index) and critical structure sparing. Results The average number of shots required was roughly the same using either planning technique (16.7 vs 16.6 shots with and without hybrids). However, for all patients, the number of blocked sectors required to protect critical areas was larger when hybrid shots were not used. On average, nearly twice as many blocked sectors (14.8 vs 7.0) were required for the plans that did not use hybrid shots. The number of high-value collimators used in each plan was also evaluated. For small targets (≤ 1 cm3), for which 8 mm was considered a high value for the collimator, plans employing hybrids used an average of 2.3 times as many 8-mm sectors as did their nonhybrid counterparts (7.4 vs 3.2 sectors). For large targets (> 1 cm3), for which 16 mm was considered a high value for the collimator, hybrid plans used an average of 1.4 times as many 16-mm sectors as did the plans without hybrids (10.7 vs 7.7 sectors). Decreasing the number of blocked sectors and increasing the number of high-value collimator sectors led to use of shorter beam-on times. Beam-on times were 1–39% higher (average 17%) when hybrid shots were not allowed. The average beam-on time for plans with and without hybrid shots was 67.4 versus 78.4 minutes. Conclusions The judicious use of hybrid shots in patients for whom the target is close to a critical structure is an efficient way to achieve conformal treatments while minimizing the beam-on time. The reduction in beam-on time with hybrid shots is attributed to a reduced use of blocked sectors and an increased number of high-value collimator sectors.

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Faculty Opinions recommendation of Intercalary allograft reconstructions using a compressible intramedullary nail: a preliminary report.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5165956.5102055 ◽

2010 ◽

Author(s):

R Lor Randall

Keyword(s):

Intramedullary Nail ◽

Preliminary Report

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METASTATIC LESION OF THE SPINE: DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT

Problems in oncology ◽

10.37469/0507-3758-2019-65-6-868-876 ◽

2019 ◽

Vol 65 (6) ◽

pp. 868-876

Author(s):

Anton Yarikov ◽

Anton Yermolaev ◽

Igor Smirnov ◽

Anton Denisov ◽

Olga Perlmutter ◽

...

Keyword(s):

Malignant Tumors ◽

Epidemiological Studies ◽

Metastatic Lesion ◽

Spinal Cord Damage ◽

Metastatic Lesions ◽

Spinal Lesions ◽

Cancer Pathology ◽

Surgical Methods ◽

The Stability ◽

Methods Of Treatment

Epidemiological studies show an increase in the number of people with cancer. Bone metastases are a frequent manifestation of generalized cancer, because it is in malignant tumors of the spine more often than other bones of the skeleton becomes a target for metastasis. The article describes in detail the methods of diagnosis of spinal lesions in cancer pathology. Particular attention is paid to the scales reflecting the severity of the patient’s condition, the degree of spinal cord damage, the severity of pain in metastasis to the spine, the prognosis of survival in oncovertebrology and evaluation of the stability of the spine in metastatic lesions. Further, the paper presents non-radical (decompression, vertebroplasty) and radical (spondylectomy, corporectomy) surgical methods of treatment

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T1.12 Humerus diaphyseal fractures treatment with intramedullary nail in adults

Injury ◽

10.1016/s0020-1383(13)70038-x ◽

2013 ◽

Vol 44 ◽

pp. S4

Author(s):

T. Kurtulmus ◽

G. Saka ◽

N. Saglam ◽

F. Kücükdurmaz ◽

U. Öztürk

Keyword(s):

Intramedullary Nail ◽

Diaphyseal Fractures

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Heterotopic ossification in lymph node metastasis after rectal cancer resection: a case report and literature review

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02098-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hideki Nagano ◽

Tamotsu Togawa ◽

Takeshi Watanabe ◽

Kenji Ohnishi ◽

Toshihisa Kimura ◽

...

Keyword(s):

Rectal Cancer ◽

Case Report ◽

Lymph Node ◽

Heterotopic Ossification ◽

Tumor Cells ◽

Digestive Tract ◽

Histological Examination ◽

Metastatic Lesion ◽

Axillary Lymph ◽

The Brain

Abstract Background Heterotopic ossification (HO) is the formation of osseous tissue outside the skeleton. HO in malignant tumors of the digestive tract is extremely rare, as is ossification in metastatic lesions from HO-negative digestive tract tumors. Regarding the pathogenesis of HO, two theories have been proposed. The first is that the osteoblastic metaplasia of tumor cells (driven by the epithelial-mesenchymal transition, EMT) results in HO, and the second is that factors secreted by cancer cells lead to the metaplasia of stromal pluripotent cells into osteoblasts. However, the osteogenic mechanisms remain unclear. Case presentation An 83-year-old Japanese woman underwent low anterior rectal resection for rectal cancer before presentation at our institution, in June 2018. The final diagnosis was stage IIB rectal adenocarcinoma (T4aN0M0). Histological examination did not reveal HO in the primary tumor. Thirteen months after the operation, a solitary metastatic lesion in the brain 20 mm in size and a solitary metastatic lesion in a right axillary lymph node 20 mm in size were diagnosed. The patient was treated with gamma-knife therapy for the brain metastasis. One month later, she was referred to our institution. She underwent lymph node resection. Histological examination revealed that most portions of the affected lymph node were occupied by metastatic tumor cells and that central necrosis and four small ossified lesions without an osteoblast-like cell rim were present in the peripheral region. Immunohistochemical analysis showed tumor cells positive for BMP-2, osteonectin, osteocalcin, AE1/AE3, TGF-β1, Gli2, Smad2/3, and CDX2 and negative for nestin, CD56, and CK7. Conclusion This is the first English case report of HO in a metachronous metastatic lymph node after the curative resection of HO-negative rectal cancer. Unlike HO lesions in past reports, the HO lesion did not show peripheral osteoblast-like cells, and the immunohistochemical findings indicated that the present case resulted from the EMT.

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