scholarly journals MRI-guided Radiotherapy Identifies Early Pseudoprogression of Glioblastoma

2020 ◽  
Author(s):  
Kolton K Jones ◽  
Sarah Dooley ◽  
Danilo Maziero ◽  
John C Ford ◽  
Radka Stoyanova ◽  
...  
Keyword(s):  
Volume Expansion ◽  
Significant Proportion ◽  
Volume Growth ◽  
Target Volume ◽  
Adjuvant Temozolomide ◽  
Contrast Enhanced ◽  
Treatment Paradigm ◽  
Mri Guided ◽  
True Progression ◽  
Tumor Enlargement

Abstract Background The standard glioblastoma treatment paradigm consists of surgery, pre-radiotherapy MRI, six weeks of chemoradiotherapy, followed by post-radiotherapy MRI and continued adjuvant temozolomide. In a significant proportion of patients, post-radiotherapy MRI demonstrates tumor enlargement due to either treatment failure (true progression) or treatment response (pseudoprogression). Recently introduced MRI-guided radiotherapy systems obtain daily MRI of glioblastoma patients, and we hypothesized that progression can be identified early during radiotherapy.Methods Fourteen glioblastoma patients underwent tri-Cobalt-60 MRI-guided radiotherapy in 30 fractions over 6 weeks delivered with concurrent temozolomide. The tumor target volume was delineated on MRI before each of the 30 fractions. The images obtained by the 0.35 T MRI-guided system is shown to be similar to T2-weighted images obtained by a clinical diagnostic MRI-scanner. Hyperintense volumes were measured over time through radiotherapy.Results Four of fourteen patients demonstrated increases of at least 25% and 1.5 cc in T2 hyperintense volume through radiation therapy. This volume expansion correlated with both T2/FLAIR and contrast-enhanced volume expansion on post-radiotherapy diagnostic MRIs. In three of four cases, significant volume growth only started at week three of treatment, with the most prominent changes occurring during weeks four and five. While patient numbers are limited, patients with growth during therapy exhibited excellent survival, consistent with the known improved survival of patients with pseudoprogression.Conclusions Daily MRI acquisition during radiotherapy identifies early pseudoprogression typically starting during week 3 or 4 of treatment. This and other daily MRI techniques during radiotherapy could enable early adaptation of therapy in glioblastoma patients.

A CT-free protocol to treat osteoid osteoma of the hip region in childhood and adolescence by percutaneous drilling and by hip arthroscopy

2021 ◽  
pp. 112070002199626
Author(s):  
Oliver Eberhardt ◽  
Thekla von Kalle ◽  
Rebecca Matthis ◽  
Richard Doepner ◽  
Thomas Wirth ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Standard Form ◽  
Childhood And Adolescence ◽  
Ct Guided ◽  
Contrast Enhanced ◽  
Mri Guided ◽  
Mri Diagnostics

Introduction: It is often difficult to clinically and radiologically diagnose intra-articular osteoid osteomas and osteoid osteomas of the hip joint. Treatment can also be difficult due to complex locational relationships. CT-guided radiofrequency ablation is currently the standard form of treatment. In this paper we report on a minimally-invasive concept for treating osteoid osteomas near the hip joint in children and adolescents which does not involve using computed tomography. Material and method: 10 patients with an average age of 12.1 years underwent treatment for osteoid osteomas in the hip joint region. The diagnosis was made using a contrast-enhanced MRI. The osteoid osteomas were marked percutaneously using x-ray and MRI guidance. MRI-guided drilling/curettage was performed in 4 cases and arthroscopic resection in 6 cases. Results: All lesions were successfully treated using the MRI-guided method. All patients were free of pain after the treatment. There was no instance of recurrence during the follow-up period, which averaged 10 months. The effective dose for marking the lesion was between 0.0186 mSv and 0.342 mSV (mean 0.084 mSV). Conclusions: Our MRI diagnostics protocol, the MRI-guided drilling and the minimally invasive hip arthroscopy represent an alternative to CT-guided radiofrequency ablation in the treatment of osteoid osteomas. Radiation exposure can thereby be significantly reduced. Hip arthroscopy can also be used to treat secondary pathologies such as femoroacetabular impingement.

scholarly journals Clinical and Contrast-Enhanced Ultrasound Echography Outcomes in Psoriatic Arthritis Patients after One Year of Continuous Therapy with Anti-TNF Drugs

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Claudio Bonifati ◽  
Fulvia Elia ◽  
Dario Graceffa ◽  
Fabrizio Ceralli ◽  
Elisa Maiani ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Significant Proportion ◽  
Joint Inflammation ◽  
Joint Involvement ◽  
Contrast Enhanced Ultrasound ◽  
Continuous Therapy ◽  
Clinical Variables ◽  
Contrast Enhanced ◽  
Before And After ◽  
One Year

Background. We wanted to verify retrospectively the proportion of patients with psoriatic arthritis who were in remission after 1 year of continuous therapy with either etanercept or adalimumab. Remission was defined as the absence of both clinical and contrast-enhanced ultrasound (CEUS) findings suggestive of joint inflammation. Patients and Methods. The data of twenty-five patients with psoriatic arthritis were available for the clinical and CEUS evaluations before and after 1 year of continuous therapy with etanercept or adalimumab. The count of swollen (ACR66), tender (ACR68), and active inflamed joints (AJC) was used to measure the severity of joint involvement. PASI was used to score the severity of psoriasis. HAQ, DLQI, VAS pain, and VAS itching were administered to each patient before starting therapy and every 3 months, up to 1 year. Results. Eight (32%) out of twenty-five patients were in remission after 1 year of therapy with etanercept or adalimumab. A significant reduction of all clinical variables analysed was seen during the course of therapy. Conclusion. Although a significant proportion of patients achieved remission of arthritis after 1 year of effective anti-TNF therapy, the majority of them continued to have either clinical or CEUS findings suggestive of persistence of joint inflammation.

scholarly journals PD-0315: High precision of MRI-guided target volume delineation before breast-conserving surgery

2013 ◽  
Vol 106 ◽  
pp. S121
Author(s):  
M.D. den Hartogh ◽  
M.E.P. Philippens ◽  
I.E. Dam ◽  
C.E. Kleynen ◽  
J.H.A. Tersteeg ◽  
...  
Keyword(s):  
High Precision ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Target Volume Delineation ◽  
Volume Delineation ◽  
Mri Guided

scholarly journals EP-1923: Integration of microscopic spread and geometric uncertainties into a single target volume expansion

2018 ◽  
Vol 127 ◽  
pp. S1045-S1046
Author(s):  
E. Sterpin ◽  
K. Haustermans ◽  
M. Lambrecht ◽  
X. Geets ◽  
T. Mackie ◽  
...  
Keyword(s):  
Volume Expansion ◽  
Target Volume ◽  
Geometric Uncertainties ◽  
Single Target

scholarly journals Advanced ultrasound Methods in assessment of carotid plaque instability: A prospective multimodal study

2019 ◽  
Author(s):  
Mahtab Zamani ◽  
Karolina Skagen ◽  
Helge Scott ◽  
David Russell ◽  
Mona Skjelland
Keyword(s):  
Carotid Artery ◽  
Stroke Risk ◽  
Significant Proportion ◽  
Contrast Enhanced Ultrasound ◽  
Carotid Artery Plaque ◽  
Plaque Instability ◽  
Carotid Mri ◽  
Contrast Enhanced ◽  
Risk Of Rupture ◽  
18F Fdg

Abstract Background: A significant proportion of ischemic strokes are caused by emboli from atherosclerotic, unstable carotid artery plaques. The selection of patients for endarterectomy in current clinical practice is primarily based on the degree of carotid artery stenosis and clinical symptoms. However, the content of the plaque is known to be more important for stroke risk. Intraplaque neovascularization (IPN) has recently emerged as a possible surrogate marker for plaque instability. Neo-microvessels from the adventitial vasa vasorum grow into the full thickness of the vessel wall in an adaptive response to hypoxia, causing subsequent intraplaque haemorrhage and plaque rupture. Conventional ultrasound cannot detect IPN. Contrast-enhanced ultrasound and Superb Microvascular Imaging (SMI), have, however, shown promise in IPN assessment. Recent research using Shear Wave Elastography (SWE) has also reported reduced tissue stiffness in the artery wall (reduced mean Young’s modulus) in unstable compared to stable plaques. The purpose of this study is to identify unstable carotid artery plaques at risk of rupture and future ischemic stroke risk using multimodal assessments. Methods: Thirty symptomatic and 30 asymptomatic patients >18 years, with >50% carotid stenosis referred to Oslo University Hospital ultrasound lab will be included in this on-going project. Patients will undergo contrast enhanced ultrasound, SMI, carotid-MRI and PET-(18F-FDG). Contrast enhanced ultrasound will be analyzed semi-quantitatively (5-levels of visual classification) and quantitatively by plotting time-intensity curve analyses to obtain plaque peak contrast enhancement intensity. Plaques removed at carotid endarterectomy will be assessed histologically and the number of microvessels, areas of inflammation, granulation, calcification, lipid and fibrosis will be measured. Discussion: This multimodality study will primarily provide information on the clinical value of advanced ultrasound methods (SMI, SWE) for the detection of unstable carotid artery plaque in comparison with other methods including contrast-enhanced ultrasound, carotid-MRI and PET-(18F-FDG) using histology as the gold standard. Secondly, findings from the methods mentioned above will be related to cerebrovascular symptoms, blood tests (leukocytes, CRP, ESR, lipoproteins and inflammatory markers) and cardiovascular risk factors at inclusion and at 1-year follow-up. The overall aim is to optimize detection of plaque instability which can lead to better preventive decisions and reduced stroke rate.

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