Objective: This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability ...of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. Materials and Methods: A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age interquartile range, 55.5 years 50-61.8) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via web-based review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss' kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). Results: Interobserver reliability (Fleiss' kappa) in each segment ranged 0.242-0.662 before the consensus and increased to 0.301-0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728-0.805 and 0.849-0.884; vascular territory, 0.756-0.902 and 0.852-0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. Conclusion: The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.
To investigate the accuracy of model-based iterative reconstruction (MIR) for volume measurement of part-solid nodules (PSNs) and solid nodules (SNs) in comparison with filtered back projection (FBP) ...or hybrid iterative reconstruction (HIR) at various radiation dose settings.
CT scanning was performed for eight different diameters of PSNs and SNs placed in the phantom at five radiation dose levels (120 kVp/100 mAs, 120 kVp/50 mAs, 120 kVp/20 mAs, 120 kVp/10 mAs, and 80 kVp/10 mAs). Each CT scan was reconstructed using FBP, HIR, or MIR with three different image definitions (body routine level 1 IMR-R1, body soft tissue level 1 IMR-ST1, and sharp plus level 1 IMR-SP1; Philips Healthcare). The SN and PSN volumes including each solid/ground-glass opacity portion were measured semi-automatically, after which absolute percentage measurement errors (APEs) of the measured volumes were calculated. Image noise was calculated to assess the image quality.
Across all nodules and dose settings, the APEs were significantly lower in MIR than in FBP and HIR (all
< 0.01). The APEs of the smallest inner solid portion of the PSNs (3 mm) and SNs (3 mm) were the lowest when MIR (IMR-R1 and IMR-ST1) was used for reconstruction for all radiation dose settings. (IMR-R1 and IMR-ST1 at 120 kVp/100 mAs, 1.06 ± 1.36 and 8.75 ± 3.96,
< 0.001; at 120 kVp/50 mAs, 1.95 ± 1.56 and 5.61 ± 0.85,
= 0.002; at 120 kVp/20 mAs, 2.88 ± 3.68 and 5.75 ± 1.95,
= 0.001; at 120 kVp/10 mAs, 5.57 ± 6.26 and 6.32 ± 2.91,
= 0.091; at 80 kVp/10 mAs, 5.84 ± 1.96 and 6.90 ± 3.31,
= 0.632). Image noise was significantly lower in MIR than in FBP and HIR for all radiation dose settings (120 kVp/100 mAs, 3.22 ± 0.66; 120 kVp/50 mAs, 4.19 ± 1.37; 120 kVp/20 mAs, 5.49 ± 1.16; 120 kVp/10 mAs, 6.88 ± 1.91; 80 kVp/10 mAs, 12.49 ± 6.14; all
< 0.001).
MIR was the most accurate algorithm for volume measurements of both PSNs and SNs in comparison with FBP and HIR at low-dose as well as standard-dose settings. Specifically, MIR was effective in the volume measurement of the smallest PSNs and SNs.
This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac ...MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy.
A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age interquartile range, 55.5 years 50-61.8) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via web-based review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss' kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA).
Interobserver reliability (Fleiss' kappa) in each segment ranged 0.242-0.662 before the consensus and increased to 0.301-0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728-0.805 and 0.849-0.884; vascular territory, 0.756-0.902 and 0.852-0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points.
The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.
To evaluate the accuracy of emphysema volume (EV) and airway measurements (AMs) produced by various iterative reconstruction (IR) algorithms and virtual monoenergetic images (VME) at both low- and ...standard-dose settings.
Computed tomography (CT) images were obtained on phantom at both low- (30 mAs at 120 kVp) and standard-doses (100 mAs at 120 kVp). Each CT scan was reconstructed using filtered back projection, hybrid IR (iDose
; Philips Healthcare), model-based IR (IMR-R1, IMR-ST1, IMR-SP1; Philips Healthcare), and VME at 70 keV (VME70). The EV of each air column and wall area percentage (WA%) of each airway tube were measured in all algorithms. Absolute percentage measurement errors of EV (APE
) and AM (APE
) were then calculated.
Emphysema volume was most accurately measured in IMR-R1 (APE
in low-dose, 0.053 ± 0.002; APE
in standard-dose, 0.047 ± 0.003; all
< 0.001) and AM was the most accurate in IMR-SP1 on both low- and standard-doses CT (APE
in low-dose, 0.067 ± 0.002; APE
in standard-dose, 0.06 ± 0.003; all
< 0.001). There were no significant differences in the APE
of IMR-R1 between low- and standard-doses (all
> 0.05). VME70 showed a significantly higher APE
than iDose
, IMR-R1, and IMR-ST1 (all
< 0.004). VME70 also showed a significantly higher APE
compared with the other algorithms (all
< 0.001).
IMR was the most accurate technique for measurement of both EV and airway wall thickness. However, VME70 did not show a significantly better accuracy compared with other algorithms.
Generally, carbohydrate antigen 19–9 (CA 19–9) is not useful for screening pancreatic cancer in the asymptomatic general population. This study aimed to evaluate the utility of CA 19–9 level as a ...screening indicator of pancreatic cancer in asymptomatic patients with new-onset diabetes.
We retrospectively reviewed the medical records of patients who visited our health promotion center for health check-ups without cancer related symptoms from January 2005 to January 2014, and were newly diagnosed with diabetes mellitus (DM) within 2 years before their visit.
Of the 5111 asymptomatic patients with new-onset DM (<2 years) selected for analyses, 87 (1.7%) eventually developed pancreatic cancer after the health check-up. In the subgroup of 322 patients with high total bilirubin levels (>1.7 mg/dL) at the screening time, 42 (73.7%) of 57 patients with high CA 19–9 levels (>37 IU/mL) had been diagnosed as pancreatic cancer during follow-up period and 12 (4.5%) of 265 patients with normal CA 19–9 levels had finally developed pancreatic cancer (OR = 16.3). In the subgroup of 4789 patients with normal bilirubin levels, pancreatic cancer had been detected in 20 (3.8%) of 522 patients with high CA 19–9 level, while only 13 (0.3%) in 4267 patients with normal CA 19–9 levels (OR = 12.6), respectively.
CA 19–9 levels after a diagnosis of new-onset DM could be a useful biomarker of pancreatic cancer, especially in patients with high serum bilirubin.
Background:
Although inflammatory breast cancer (IBC) has poor overall survival (OS), there is little information about using imaging features for predicting the prognosis. Computed tomography ...(CT)-based texture analysis, a non-invasive technique to quantify tumor heterogeneity, could be a potentially useful imaging biomarker. The aim of the article was to investigate the usefulness of chest CT-based texture analysis to predict OS in IBC patients.
Methods:
Of the 3,130 patients with primary breast cancers between 2006 and 2016, 104 patients (3.3%) with IBC were identified. Among them, 98 patients who underwent pre-treatment contrast-enhanced chest CT scans, got treatment in our institution, and had a follow-up period of more than 2 years were finally included for CT-based texture analysis. Texture analysis was performed on CT images of 98 patients, using commercially available software by two breast radiologists. Histogram-based textural features, such as quantification of variation in CT attenuation (mean, standard deviation, mean of positive pixels MPP, entropy, skewness, and kurtosis), were recorded. To dichotomize textural features for survival analysis, receiver operating characteristic curve analysis was used to determine cutoff points. Clinicopathologic variables, such as age, node stage, metastasis stage at the time of diagnosis, hormonal receptor positivity, human epidermal growth factor receptor 2 positivity, and molecular subtype, were assessed. A Cox proportional hazards model was used to determine the association of textural features and clinicopathologic variables with OS.
Results:
During a mean follow-up period of 47.9 months, 41 of 98 patients (41.8%) died, with a median OS of 20.0 months. The textural features of lower mean attenuation, standard deviation, MPP, and entropy on CT images were significantly associated with worse OS, as was the M1 stage among clinicopathologic variables (all
P-
values < 0.05). In multivariate analysis, lower mean attenuation (hazard ratio HR, 3.26;
P
= 0.003), lower MPP (HR, 3.03;
P
= 0.002), and lower entropy (HR, 2.70;
P
= 0.009) on chest CT images were significant factors independent from the M1 stage for predicting worse OS.
Conclusions:
Lower mean attenuation, MPP, and entropy on chest CT images predicted worse OS in patients with IBC, suggesting that CT-based texture analysis provides additional predictors for OS.
Tumor heterogeneity and vascularity can be noninvasively quantified using histogram and perfusion analyses on computed tomography (CT) and magnetic resonance imaging (MRI). We compared the ...association of histogram and perfusion features with histological prognostic factors and progression-free survival (PFS) in breast cancer patients on low-dose CT and MRI.
This prospective study enrolled 147 women diagnosed with invasive breast cancer who simultaneously underwent contrast-enhanced MRI and CT before treatment. We extracted histogram and perfusion parameters from each tumor on MRI and CT, assessed associations between imaging features and histological biomarkers, and estimated PFS using the Kaplan-Meier analysis.
Out of 54 histogram and perfusion parameters, entropy on T2- and postcontrast T1-weighted MRI and postcontrast CT, and perfusion (blood flow) on CT were significantly associated with the status of subtypes, hormone receptors, and human epidermal growth factor receptor 2 (
< 0.05). Patients with high entropy on postcontrast CT showed worse PFS than patients with low entropy (
= 0.053) and high entropy on postcontrast CT negatively affected PFS in the Ki67-positive group (
= 0.046).
Low-dose CT histogram and perfusion analysis were comparable to MRI, and the entropy of postcontrast CT could be a feasible parameter to predict PFS in breast cancer patients.
Quality of life (QoL) has become a major concern as the survival time of breast cancer increases. We investigated the changes in QoL through comprehensive categorical analysis, for the first three ...years after breast cancer treatment including radiotherapy.
A total of 1156 patients were enrolled from 17 institutions. All survivors were grouped according to a surveillance period of 9-15 months (first year), 21-27 months (second year), and 33-39 months (third year) from the end of radiotherapy. The 5-dimensional questionnaire by the EuroQol group (EQ-5D) and the EORTC Quality of Life Questionnaire; breast cancer specific module (QLQ-BR23) were checked by self-administrated method.
First, second and third year groups comprised 51.0, 28.9, and 21.0%. In EQ-5D-3 L (3-Likert scale) analysis, pain/discomfort and anxiety/depression categories showed lower QoL. In multivariate analyses of EQ-5D-VAS (visual-analogue scale), categories of pain/discomfort and self-care were improved with time; axillary dissection was a significant clinical factor deteriorates pain/discomfort, self-care and usual activities. In QLQ-BR23 analysis, the lowest scored category was sexual activity, followed by sexual enjoyment, future perspective, and hair loss, and the best scored category was breast symptoms. In multivariate analyses, arm symptoms, breast symptoms and body image were improved with time.
Categories of pain/discomfort and self-care in EQ-5D-VAS, arm/breast symptoms and body image in QLQ-BR23 were improved, while categories of anxiety/depression and future perspective BR23 were not, suggesting necessity of psychosocial support. This research provides comprehensive information on the categorical aspects of QoL and changes during early follow-up after breast cancer treatment.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Bone marrow NGAL, VEGF, and sRAGE levels in patients with hematologic cancer.•VEGF was an independent variable that significantly affected NGAL.•VEGF showed intergroup patterns similar to those of ...NGAL.•VEGF showed the highest level in the myeloproliferative neoplasm group.•sRAGE showed no significant differences among the comparison groups.
Inflammation is a known risk factor of cancer development, including inflammation-driven leukemogenesis. Evaluation of inflammation-related cytokines in early diagnosis stages is crucial to understand the development of hematologic malignancy. Our aim was to measure three cytokines- neutrophil gelatinase-associated lipocalin (NGAL), vascular endothelial growth factor (VEGF), and soluble receptor for advanced glycation end-products (sRAGE) in bone marrow (BM) samples from patients diagnosed with hematologic malignancy and compare these measurements with the control. Additionally, we evaluated whether NGAL was significantly associated with sRAGE, VEGF, and several hematological parameters.
BM samples were collected from 73 patients, who were classified into myeloproliferative neoplasm (MPN), acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), plasma cell neoplasm (PCN) and control groups according to the BM smear and pathology review. An immunoassay, a Luminex assay, and an enzyme-linked immunosorbent assay were used to quantitate NGAL, VEGF, and sRAGE, respectively, while all measurements of NGAL, VEGF and sRAGE were performed on BM supernatants. Data on hematological parameters were collected from medical records. Intergroup comparisons were performed using the Kruskal-Wallis H-test and Pearson Chi-Square test. Single and multiple regression analyses were performed to analyze the relationships among the parameters.
The independent factors associated with NGAL were neutrophil counts and VEGF. As for both NGAL and VEGF, the MPN (n = 23) group showed the highest level, while the MDS (n = 12) group showed low levels. NGAL levels in the AML (n = 13) and MDS groups were lower than in the control group (n = 14). The MPN group demonstrated higher VEGF levels than the AML and MDS groups. The MDS group showed lower VEGF levels than the PCN (n = 11) group. No statistical difference between the hematologic malignancy and control groups or among the hematologic malignancy groups was observed for sRAGE levels.
NGAL was related to neutrophil count and VEGF. NGAL and VEGF showed similar intergroup patterns, reflecting that NGAL was associated with VEGF.
Even though chronic abdominal pain is 1 of the most common reasons for hospital visits, diagnostic testing is often time-consuming and treatment is inadequate. Abdominal myofascial pain syndrome ...(AMPS) is usually not included as a differential diagnosis, but it should be considered in cases of chronic abdominal pain. The purpose of this study was to investigate the clinical characteristics of AMPS and to assess the effect of sonography-guided trigger point injections (TPI).A total of 100 patients with AMPS from 2012 to 2018 were retrospectively evaluated for clinical characteristics and TPI effects. AMPS was diagnosed using Srinivasan and Greenbaum's criteria, and the TPIs were performed at intervals of 2 to 4 weeks. The Visual Analog Scale (VAS) ratio was calculated by subtracting the final VAS from the initial VAS score and dividing it by the initial VAS score after injections, and the patients were divided into 4 groups: non-responders, mild, moderate, and good responders.The median duration of pain was 12 months, and the median number of hospital visits before TPI was 2. Of the 100 patients, 66 (66%) were categorized as good responders, 11 (11%) as moderate responders, 7 (6.9%) as mild responders, and 16 (15.7%) as non-responders. When the initial and final VAS scores were compared, the sonography-guided injections were found to be effective in alleviating pain (P < .001). Moreover, patients who received the injections 2 or more times tended to have more significant pain reduction than those who received a single injection (P < .001).Patients with AMPS suffer from long-term pain and undergo many hospital visits and diagnostic tests. TPI with lidocaine can be an effective and safe treatment for patients with chronic AMPS.
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