Case Report: Detection of Symptomatic Treatment-Related Changes in a Patient With Anaplastic Oligodendroglioma Using FET PET

Following local and systemic treatment of gliomas, the differentiation between glioma relapse and treatment-related changes such as pseudoprogression or radiation necrosis using conventional MRI is limited. To overcome this limitation, various amino acid PET tracers such as O-[2-(18F)-fluoroethyl]-L-tyrosine (FET) are increasingly used and provide valuable additional clinical information. We here report neuroimaging findings in a clincally symptomatic 53-year-old woman with a recurrent anaplastic oligodendroglioma with MRI findings highly suspicious for tumor progression. In contrast, FET PET imaging suggested treatment-related changes considerably earlier than the regression of contrast enhancement on MRI. In patients with oligodendroglioma, the phenomenon of symptomatic treatment-related changes is not well described, making these imaging findings unique and important for clinical decision-making.

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P14.32 Spatial discrepancies between FET PET and conventional MRI in patients with newly diagnosed glioblastoma

Neuro-Oncology ◽

10.1093/neuonc/noz126.267 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii74-iii74

Author(s):

P Lohmann ◽

P Stavrinou ◽

K Lipke ◽

E K Bauer ◽

G Ceccon ◽

...

Keyword(s):

Amino Acid ◽

Tumor Volume ◽

Newly Diagnosed ◽

Similarity Coefficients ◽

Fet Pet ◽

Spatial Similarity ◽

Conventional Mri ◽

Fluid Attenuated Inversion Recovery ◽

Amino Acid Pet ◽

Newly Diagnosed Glioblastoma

Abstract BACKGROUND In patients with glioblastoma, the tissue showing contrast enhancement (CE) in MRI is usually the target for resection or radiotherapy. However, the solid tumor mass typically extends beyond the area of CE. Amino acid PET can detect tumor parts that show no CE. We systematically investigated tumor volumes delineated by amino acid PET and MRI in newly diagnosed, untreated glioblastoma patients. MATERIAL AND METHODS Preoperatively, 50 patients with subsequently neuropathologically confirmed glioblastoma underwent O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET, fluid-attenuated inversion recovery (FLAIR), and CE MRI. Areas of CE were manually delineated. FET PET tumor volumes were segmented using a tumor-to-brain ratio ≥ 1.6. The percentage of overlapping volumes (OV), as well as Dice and Jaccard spatial similarity coefficients (DSC; JSC), were calculated. FLAIR images were evaluated visually. RESULTS In 86% of patients (n = 43), the FET PET tumor volume was significantly larger than the volume of CE (21.5 ± 14.3 mL vs. 9.4 ± 11.3 mL; P < 0.001). Forty patients (80%) showed both an increased uptake of FET and CE. In these 40 patients, the spatial similarity between FET and CE was low (mean DSC, 0.39 ± 0.21; mean JSC, 0.26 ± 0.16). Ten patients (20%) showed no CE, and one of these patients showed no FET uptake. In 10% of patients (n = 5), increased FET uptake was present outside of areas of FLAIR hyperintensity. CONCLUSION Our results show that the metabolically active tumor volume delineated by FET PET is significantly larger than tumor volume delineated by CE. The data strongly suggest that the information derived from FET PET should be integrated into the management of newly diagnosed glioblastoma patients. FUNDING This work was supported by the Wilhelm-Sander Stiftung, Germany

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THE UTILITY OF MRI IN CLINICAL DECISION-MAKING FOR PEDIATRIC ATHLETES WITH SYMPTOMATIC SUBFIBULAR OSSICLES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00230 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0023

Author(s):

James G. Gamble ◽

Charles M Chan ◽

Lawrence A Rinsky ◽

Steven L. Frick ◽

Kevin G. Shea

Keyword(s):

Decision Making ◽

Chronic Pain ◽

Clinical Decision Making ◽

Clinical Decision ◽

Operative Management ◽

Lateral Malleolus ◽

Ankle Fractures ◽

Mri Findings ◽

Avulsion Fractures ◽

Non Operative Management

Background: Pediatric athletes commonly sustain inversion-type ankle fractures.1,2 Approximately 1% will form post-traumatic subfibular ossicles (SO), especially after tip avulsion fractures.3,4 Athletes with SOs can have pain and recurrent sprains.5,6,7 Here we show the utility of magnetic resonance imaging (MRI) in clinical decision-making for athletes with ankle symptoms and the presence of a SO. Our hypothesis is that MRI can predict which athletes have a stable SO and will respond to non-operative management, and which athletes have an unstable SO and will need surgery. Methods: We performed an IRB approved retrospective cohort study. Children were eligible from our practices if (1) they had radiographic evidence of a SO, (2) they had symptoms of pain and recurrent sprains, and (3) they had undergone MRI during their clinical evaluation. We identified 19 eligible children (20 ankles;) eight girls and eleven boys, ages 5–19 years. Nine involved the left ankle; 11 the right ankle. Most frequent sport was soccer (12/16) followed by basketball (3/14.) From the radiograph we determined ossicle size and location. MRI images were considered positive if fluid-sensitive sequences showed a high-intensity signal between the SO and the fibular epiphysis. Main outcome was treatment (non-surgical or surgical) relative to the MRI findings. Results: Size shape and location: Size and shape were variable. Width ranged from 2 – 10.4 mm and length from 4 – 13.5 mm. Concerning location all were in the distal 1/3 pf the epiphysis. Six were anterior and 14 were anterior-inferior to the fibular tip. MRI findings: Sixteen of the 20 ankles (80%) had positive MRI findings (figure 1), and 4 had negative findings (figure 2). The ATFL attached directly to the fragment in 11 of the 16 MRI positive ankles. Clinical decision making: All athletes with negative MRI findings responded to non-operatively management. Ten of the 16 ankles with positive MRIs have had surgery. Eight had excision of the ossicle and two had internal fixation based on the size of the ossicle. Surgical findings confirmed attachment of the ATFL to the fragment (figure 3.) Six athletes with positive MRIs continue to be under observation. Conclusions The results support our hypothesis that MRI has predictive value in clinical decision-making for symptomatic athletes with a SO. When fluid-sensitive MRI sequences show high signal intensity between the ossicle and the fibular epiphysis, and when the ATFL attaches to the ossicle, the athlete has a poor prognosis for non-operative management. [Figure: see text][Figure: see text] References: Su AW, Larson AN. Pediatric ankle fractures: Concepts and treatment principles. Foot Ankle Clin. 2015;20(4):705-719. Pommering TL, Kluchurosky L, Hall SL. Ankle and foot injuries in pediatric and adult athletes. Prim Care 2005;32(1):133-161. Han SH, Choi WJ, Kim S, Kim S-J, Lee JW. Ossicles associate with chronic pain around the malleoli of the ankle. 2008;90-B:1049-1054. Gamble JG, Sugi M, Tileston KR, Chan CM, Livingston KS. The natural history of type VII all-epiphyseal fractures of the lateral malleolus. Orthop J Sports Med. 2019; 7(3) (suppl 1) DOI 10.1177/2325967119S00116. Pill SG, Hatch M, Linton JM, Davidson RS. JBJS 2013;95: e115(1-6). Han SH, Choi WJ, Kim S, Kim SJ, Lee JW. Ossicles associated with chronic pain around the malleoli of the ankle. J Bone Joint Surg Br. 2008;90(8):1049-1054. Danielsson LG. Avulsion fracture of the lateral malleolus in children. Injury 12:165-167

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Clinical Diagnosis and the Order of Information

Medical Decision Making ◽

10.1177/0272989x9801800409 ◽

1998 ◽

Vol 18 (4) ◽

pp. 412-417 ◽

Cited By ~ 32

Author(s):

George R. Bergus ◽

Gretchen B. Chapman ◽

Barcey T. Levy ◽

John W. Ely ◽

Robert A. Oppliger

Keyword(s):

Urinary Tract ◽

Physical Examination ◽

Clinical Decision Making ◽

Laboratory Data ◽

Clinical Information ◽

Clinical History ◽

Clinical Decision ◽

Background Information ◽

Likelihood Ratios ◽

Patient’S History

Background. Information order can influence judgment. However, it remains unclear whether the order of clinical data affects physicians' interpretations of these data when they are engaged in familiar diagnostic tasks. Methods. Of 400 randomly selected family physicians who were given a questionnaire involving a brief written scenario about a young woman with acute dysuria, 315 (79%) returned usable responses. The physicians had been randomized into two groups, and both groups had received the same clinical information but in different orders. After learning the patient's chief com plaint, physicians received either the patient's history and physical examination results followed by the laboratory data (the H&P-first group) or the laboratory data followed by the history and physical examination results (the H&P-last group). The results of the history and physical examination were supportive of the diagnosis of UTI, while the laboratory data were not. All physicians judged the probability of a urinary tract infection (UTI) after each piece of information. Results. The two groups had similar mean estimates of the probability of a UTI after learning the chief complaint (67.4% vs 67.8%, p = 0.85). At the end of the scenario, the H&P-first group judged UTI to be less likely than did the H&P-last group (50.9% vs 59.1 %, p = 0.03) despite having identical information. Comparison of the mean likelihood ratios attributed to the clinical information showed that the H&P-first group gave less weight to the history and phys ical than did the H&P-last group (p = 0.04). Conclusions. The order in which clinical information was presented influenced physicians' estimates of the probability of dis ease. The clinical history and physical examination were given more weight by phy sicians who received this information last. Key words: diagnosis; urinary tract infec tions ; judgment; primary care; clinical decision making. (Med Decis Making 1998;18: 412-417)

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NEWS2 score in the practice of infectious diseases hospital in COVID-19 patients. Implementation and results

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-1-7-16 ◽

2021 ◽

Vol 18 (1) ◽

pp. 7-16

Author(s):

К. N. Popova ◽

A. A. Zhukov ◽

I. L. Zykina ◽

D. V. Troschanskiy ◽

I. N. Tyurin ◽

...

Keyword(s):

Mobile Application ◽

Clinical Decision Making ◽

Medical Information ◽

Prognostic Significance ◽

Clinical Information ◽

Clinical Decision ◽

Clinical State ◽

Medical Assistance ◽

Therapy Effectiveness ◽

Analytical System

Amidst the new COVID-19 pandemic, there is a need for a reliable medical tool to monitor patients’ vital conditions with clinical information continuity. This tool is essential for timely detection of the risk of the patient’s clinical state deterioration throughout all the stages of medical assistance. The objective is to assess results of the NEWS2 score implementation at the in-patient stage of medical care.Methods. 183,732 scores of the NEWS2 score in 10,290 hospitalized patients were analyzed. All the assessed results of the NEWS2 score were retrospectively analyzed. The NEWS2 score results were added to the United Medical Information and Analytical System of Moscow (EMIAS) database through the NEWS2 mobile application. The researchers analyzed the descriptive statistics of the score; the prognostic significance of NEWS2 in the prediction of the disease outcome was assessed as well as the accuracy of the used methods. Results. As the result of the research, deviations from standard methods in the application of the NEWS2 score were outlined, which allowed the researchers to develop the corrective measures. The received data confirmed that interval assessment by the NEWS2 score and the trend analysis were important when making clinical and organizational decisions. Specific parameters of the score use during the COVID-19 pandemic were outlined, which helped to adjust the in-hospital procedures for clinical decision-making process, routing, and the continuity of all stages of medical assistance was established. Conclusion. The use of the NEWS2 score in medical practice makes it possible to predict the risks of clinical deterioration in the patient's condition, conduct bedside monitoring of therapy effectiveness, and optimize in-hospital routing. However, to ensure the validity of the score, it is necessary to plan activities for the personnel training and motivation, as well as to monitor careful adherence to the protocol.

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Radiogenomics and Radiomics in Liver Cancers

Diagnostics ◽

10.3390/diagnostics9010004 ◽

2018 ◽

Vol 9 (1) ◽

pp. 4 ◽

Cited By ~ 10

Author(s):

Aman Saini ◽

Ilana Breen ◽

Yash Pershad ◽

Sailendra Naidu ◽

M. Knuttinen ◽

...

Keyword(s):

Clinical Decision Making ◽

Clinical Information ◽

Clinical Decision ◽

Molecular Profile ◽

Imaging Features ◽

Imaging Data ◽

Prognostic Information ◽

Cross Sectional ◽

Related Field ◽

Liver Cancers

Radiogenomics is a computational discipline that identifies correlations between cross-sectional imaging features and tissue-based molecular data. These imaging phenotypic correlations can then potentially be used to longitudinally and non-invasively predict a tumor’s molecular profile. A different, but related field termed radiomics examines the extraction of quantitative data from imaging data and the subsequent combination of these data with clinical information in an attempt to provide prognostic information and guide clinical decision making. Together, these fields represent the evolution of biomedical imaging from a descriptive, qualitative specialty to a predictive, quantitative discipline. It is anticipated that radiomics and radiogenomics will not only identify pathologic processes, but also unveil their underlying pathophysiological mechanisms through clinical imaging alone. Here, we review recent studies on radiogenomics and radiomics in liver cancers, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastases to the liver.

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Information needs for the OR and PACU electronic medical record

Applied Clinical Informatics ◽

10.4338/aci-2014-02-ra-0015 ◽

2014 ◽

Vol 05 (03) ◽

pp. 630-641 ◽

Cited By ~ 7

Author(s):

V. Herasevich ◽

J.R. Hebl ◽

M.J. Brown ◽

B.W. Pickering ◽

M.A. Ellsworth

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Medical Error ◽

Information Needs ◽

Clinical Decision Making ◽

Information Overload ◽

Clinical Information ◽

Clinical Decision ◽

Anesthesia Providers ◽

Survey Responses

Summary Objective: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers. Materials and Methods: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings. Results: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU. Conclusion: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error. Citation: Herasevich V, Ellsworth MA, Hebl JR, Brown MJ, Pickering BW. Information needs for the OR and PACU electronic medical record. Appl Clin Inf 2014; 5: 630–641http://dx.doi.org/10.4338/ACI-2014-02-RA-0015

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Health record systems that meet clinical needs

Italian Journal of Medicine ◽

10.4081/itjm.2012.248 ◽

2012 ◽

Author(s):

Gabriella Negrini

Keyword(s):

Health Care ◽

Decision Making ◽

Patient Safety ◽

Health Care Professionals ◽

Clinical Decision Making ◽

Clinical Information ◽

Clinical Decision ◽

Health Record ◽

Record System ◽

Health Records

Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

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The study of left ventricular diastolic function by Doppler echocardiography: the essential for the clinician

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2009.339 ◽

2016 ◽

Vol 72 (1) ◽

Author(s):

Enrico Vizzardi ◽

Pompilio Faggiano ◽

Ermanna Chiari ◽

Diego Maffeo ◽

Silvia Frattini ◽

...

Keyword(s):

Diastolic Function ◽

Doppler Echocardiography ◽

Clinical Decision Making ◽

Systolic Function ◽

Correct Diagnosis ◽

Clinical Information ◽

Left Ventricular Diastolic Function ◽

Clinical Decision ◽

Left Ventricular ◽

Ventricular Diastolic Function

The study of diastolic function by Doppler-echocardiography is complex and demanding. The cardiologist/echocardiographist must have a systematic approach to the study of left ventricular diastolic function, not only based on the Doppler index, but integrating Doppler patterns with other echo-parameters (chamber dimensions, wall thicknesses, systolic function, valve function and morphology) and clinical information. A rational interpretation of clinical and instrumental data can allow a correct diagnosis, which is essential for clinical decision-making.

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Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2017-000217 ◽

2017 ◽

Vol 4 (2) ◽

pp. 92-94 ◽

Cited By ~ 1

Author(s):

Vishnu Mohan ◽

Gretchen Scholl ◽

Jeffrey A Gold

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Large Fraction ◽

Clinical Information ◽

Clinical Decision ◽

Information Gathering ◽

High Fidelity ◽

Struggling Learners ◽

Effective Decision Making ◽

Main Component

Learners who struggle with clinical decision making are often the most challenging to identify and remediate. While for some learners, struggles can be directly traced to a poor knowledge base, for many others, it is more difficult to understand the reason for their struggles. One of the main component of effective decision making is access to accurate and complete clinical information. The electronic health record (EHR) is the main source of clinical information and, with its widespread adoption, has come increased realisation that a large fraction of users have difficulty in effectively gathering and subsequently processing information out of the EHR. We previously documented that high-fidelity EHR-based simulation improves EHR usability and, when combined with eye and screen tracking, generates important measures of usability. We hypothesised that the same simulation exercise could help distinguish whether learners had difficulty in knowledge, information gathering or information processing. We report the results of the first three struggling learners who participated in this exercise. In each case, the simulation was able to ‘diagnose’ the aetiology for the learners’ struggle and assist in formulating an appropriate solution. We suggest that high-fidelity EHR-based simulation can be a powerful tool in the standard approach to understanding struggling learners.

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Neuroimaging findings in pediatric sports-related concussion

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.1.peds14510 ◽

2015 ◽

Vol 16 (3) ◽

pp. 241-247 ◽

Cited By ~ 33

Author(s):

Michael J. Ellis ◽

Jeff Leiter ◽

Thomas Hall ◽

Patrick J. McDonald ◽

Scott Sawyer ◽

...

Keyword(s):

Decision Making ◽

Arachnoid Cyst ◽

Clinical Decision Making ◽

Demyelinating Disease ◽

Skull Fracture ◽

Clinical Decision ◽

Return To Play ◽

Mri Findings ◽

Imaging Results ◽

The Impact

OBJECT The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.

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