<title>Improved quantitative MR thermometry using a 1.5-T scanner to monitor cooled applicator systems during laser-induced interstitial thermotherapy (LITT)</title>

ZusammenfassungDieser Beitrag gibt einen Überblick über Magnetresonanztomographie-basierte (MRT-basierte) Methoden zur Quantifizierung der Muskeldegeneration. Neben Muskelvolumen kann mit Dixon-Bildgebung insbesondere der prozentuale Fettgehalt bestimmt werden. Daneben gibt es Ansätze, frühe Anzeichen einer Degeneration über die Verteilung des Entzündungsgrades oder der Natriumkonzentration in der Muskulatur zu visualisieren und quantifizieren. Bis auf die Natrium-Bildgebung werden diese Methoden bei Muskelerkrankungen routinemäßig zur Diagnose und Verlaufskontrolle eingesetzt.Im Bereich der Osteologie und Gerontologie wird zwar die Bedeutung der Muskel-Knochen-Einheit unter anderem für Frakturprädiktion und Gebrechlichkeit im Alter immer wieder betont, Degeneration der Muskulatur wird aber im Wesentlichen über extrinsische Parameter wie Muskelkraft und -funktion erfasst. Häufig benutzte intrinsische Parameter wie DXA Lean Mass oder Muskelvolumen, bestimmt mit CT oder MRT, korrelieren nur mäßig mit extrinsischen Parametern. Eine genauere Charakterisierung von Muskelqualität sollte dieses Manko aber beseitigen. Mit CT und MRT stehen entsprechende Methoden zur Verfügung, die jetzt aber in Studien zur altersassoziierten Muskeldegeneration, in Interventionsstudien und in Studien zur Frakturrisikoprognostik auch eingesetzt werden müssen.

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Differentiating PSP from MSA using MR planimetric measurements: a systematic review and meta-analysis

Journal of Neural Transmission ◽

10.1007/s00702-021-02362-8 ◽

2021 ◽

Author(s):

Beatrice Heim ◽

Florian Krismer ◽

Klaus Seppi

Keyword(s):

Sensitivity And Specificity ◽

Meta Analysis ◽

Risk Of Bias ◽

Index Test ◽

Study Quality ◽

Parkinsonian Syndromes ◽

Quantitative Mr ◽

Meta Analyses ◽

Planimetric Measurements

AbstractDifferential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology. Quantitative MR planimetric measurements were reported to discriminate between progressive supranuclear palsy (PSP) and non-PSP-parkinsonism. Several studies have used midbrain to pons ratio (M/P) and the Magnetic Resonance Parkinsonism Index (MRPI) in distinguishing PSP patients from those with Parkinson's disease. The current meta-analysis aimed to compare the performance of these measures in discriminating PSP from multiple system atrophy (MSA). A systematic MEDLINE review identified 59 out of 2984 studies allowing a calculation of sensitivity and specificity using the MRPI or M/P. Meta-analyses of results were carried out using random effects modelling. To assess study quality and risk of bias, the QUADAS-2 tool was used. Eight studies were suitable for analysis. The meta‐analysis showed a pooled sensitivity and specificity for the MRPI of PSP versus MSA of 79.2% (95% CI 72.7–84.4%) and 91.2% (95% CI 79.5–96.5%), and 84.1% (95% CI 77.2–89.2%) and 89.2% (95% CI 81.8–93.8%), respectively, for the M/P. The QUADAS-2 toolbox revealed a high risk of bias regarding the methodological quality of patient selection and index test, as all patients were seen in a specialized outpatient department without avoiding case control design and no predefined threshold was given regarding MRPI or M/P cut-offs. Planimetric brainstem measurements, in special the MRPI and M/P, yield high diagnostic accuracy for the discrimination of PSP from MSA. However, there is an urgent need for well-designed, prospective validation studies to ameliorate the concerns regarding the risk of bias.

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Laser interstitial thermotherapy (LITT) for the treatment of tumors of the brain and spine: a brief review

Journal of Neuro-Oncology ◽

10.1007/s11060-020-03652-z ◽

2021 ◽

Vol 151 (3) ◽

pp. 429-442

Author(s):

Clark Chen ◽

Ian Lee ◽

Claudio Tatsui ◽

Theresa Elder ◽

Andrew E. Sloan

Keyword(s):

Brain Tumors ◽

Minimally Invasive ◽

Radiation Necrosis ◽

Spinal Metastasis ◽

Clinical Approach ◽

Invasive Treatment ◽

Primary Indication ◽

Interstitial Thermotherapy ◽

The Brain

Abstract Introduction Laser Interstitial Thermotherapy (LITT; also known as Stereotactic Laser Ablation or SLA), is a minimally invasive treatment modality that has recently gained prominence in the treatment of malignant primary and metastatic brain tumors and radiation necrosis and studies for treatment of spinal metastasis has recently been reported. Methods Here we provide a brief literature review of the various contemporary uses for LITT and their reported outcomes. Results Historically, the primary indication for LITT has been for the treatment of recurrent glioblastoma (GBM). However, indications have continued to expand and now include gliomas of different grades, brain metastasis (BM), radiation necrosis (RN), other types of brain tumors as well as spine metastasis. LITT is emerging as a safe, reliable, minimally invasive clinical approach, particularly for deep seated, focal malignant brain tumors and radiation necrosis. The role of LITT for treatment of other types of tumors of the brain and for spine tumors appears to be evolving at a small number of centers. While the technology appears to be safe and increasingly utilized, there have been few prospective clinical trials and most published studies combine different pathologies in the same report. Conclusion Well-designed prospective trials will be required to firmly establish the role of LITT in the treatment of lesions of the brain and spine.

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Laser interstitial thermotherapy (LITT) monitoring using high-resolution digital mammography: theory and experimental studies

Physics in Medicine and Biology ◽

10.1088/0031-9155/47/16/313 ◽

2002 ◽

Vol 47 (16) ◽

pp. 2987-2999 ◽

Cited By ~ 14

Author(s):

Ahmed M Minhaj ◽

Fabrice Manns ◽

Peter J Milne ◽

David B Denham ◽

Nelson Salas Jr ◽

...

Keyword(s):

High Resolution ◽

Digital Mammography ◽

Experimental Studies ◽

Interstitial Thermotherapy

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Laser interstitial thermotherapy in stereotactical neurosurgery

Lasers in Medical Science ◽

10.1007/bf02594061 ◽

1992 ◽

Vol 7 (1-4) ◽

pp. 121-126 ◽

Cited By ~ 34

Author(s):

F. X. Roux ◽

L. Merienne ◽

B. Leriche ◽

S. Lucerna ◽

B. Turak ◽

...

Keyword(s):

Interstitial Thermotherapy

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Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine141185 ◽

2015 ◽

Vol 23 (4) ◽

pp. 400-411 ◽

Cited By ~ 48

Author(s):

Claudio E. Tatsui ◽

R. Jason Stafford ◽

Jing Li ◽

Jonathan N. Sellin ◽

Behrang Amini ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Real Time ◽

Spinal Cord Compression ◽

Spinal Metastasis ◽

Cord Compression ◽

The Mean ◽

Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

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