Objective: The aim of our systematic review is to identify the effects of multidisciplinary team meetings (MDTM) for lung, breast, colorectal and prostate cancer. Methods: Our systematic review, ...performed following PRISMA guidelines, included studies examining the impact of MDTMs on treatment decisions, patient and process outcomes. Electronic databases PUBMED, EMBASE, Cochrane Library and Web of Science were searched for articles published between 2000 and 2020. Risk of bias and level of evidence were assessed using the ROBINS-I tool and GRADE scale. Results: 41 of 13,246 articles were selected, evaluating colorectal (21), lung (10), prostate (6) and breast (4) cancer. Results showed that management plans were changed in 1.6–58% of cases after MDTMs. Studies reported a significant impact of MDTMs on surgery type, and a reduction of overall performed surgery after MDTM. Results also suggest that CT and MRI imaging significantly increased after MDTM implementation. Survival rate increased significantly with MDTM discussions according to twelve studies, yet three studies did not show significant differences. Conclusions: Despite heterogeneous data, MDTMs showed a significant impact on management plans, process outcomes and patient outcomes. To further explore the impact of MDTMs on the quality of healthcare, high-quality research is needed.
tumor ablation techniques, like radiotherapy, cryo- and heat-based thermal ablation are successfully applied in oncology for local destruction of tumor masses. Although diverse in technology and ...mechanism of inducing cell death, ablative techniques share one key feature: they generate tumor debris which remains
. This tumor debris functions as an unbiased source of tumor antigens available to the immune system and has led to the concept of
cancer vaccination. Most studies, however, report generally modest tumor-directed immune responses following local tumor ablation as stand-alone treatment. Tumors have evolved mechanisms to create an immunosuppressive tumor microenvironment (TME), parts of which may admix with the antigen depot. Provision of immune stimuli, as well as approaches that counteract the immunosuppressive TME, have shown to be key to boost ablation-induced anti-tumor immunity. Recent advances in protein engineering have yielded novel multifunctional antibody formats. These multifunctional antibodies can provide a combination of distinct effector functions or allow for delivery of immunomodulators specifically to the relevant locations, thereby mitigating potential toxic side effects. This review provides an update on immune activation strategies that have been tested to act in concert with tumor debris to achieve
cancer vaccination. We further provide a rationale for multifunctional antibody formats to be applied together with
ablation to boost anti-tumor immunity for local and systemic tumor control.
We have linked the structural and dynamic properties in aqueous solution of amphiphilic charged diblock copolymers poly(butyl acrylate)-
b-poly(acrylic acid), PBA-
b-PAA, synthesized by controlled ...radical polymerization, with the physico-chemical characteristics of the samples. Despite product imperfections, the samples self-assemble in melt and aqueous solutions as predicted by monodisperse microphase separation theory. However, the PBA core are abnormally large; the swelling of PBA cores is not due to AA (the Flory parameter
χ
PBA
/
PAA
, determined at 0.25, means strong segregation), but to h-PBA homopolymers (content determined by liquid chromatography at the point of exclusion and adsorption transition, LC-PEAT). Beside the dominant population of micelles detected by scattering experiments, capillary electrophoresis CE analysis permitted detection of two other populations, one of h-PAA, and the other of free PBA-
b-PAA chains, that have very short PBA blocks and never self-assemble. Despite the presence of these free unimers, the self-assembly in solution was found out of equilibrium: the aggregation state is history dependant and no unimer exchange between micelles occurs over months (time-evolution SANS). The high PBA/water interfacial tension, measured at 20 mN/m, prohibits unimer exchange between micelles. PBA-
b-PAA solution systems are neither at thermal equilibrium nor completely frozen systems: internal fractionation of individual aggregates can occur.
The self-assembly of amphiphilic diblocks in water (large core size of micelles, low CMC but presence of free unimers, hysteretic fractionation) are explained via a precise physico/chemical analysis of samples.
Sexual assault survivors may sustain vaginal trauma that requires intervention in the emergency department, or operating room.
We describe the case of a 16-year-old female who was referred to the ...emergency department for evaluation of continued bleeding from a vaginal laceration following sexual assault 38 h prior. The bleeding limited the medical forensic medical examination, but she was hemodynamically stable. After the application of tranexamic acid (TXA)-soaked gauze, the patient's bleeding was controlled and the wound was able to be evaluated and the examination completed.
To our knowledge, this is the first case in the literature that describes the use of topical TXA in a patient to achieve hemostasis in a vaginal laceration sustained from sexual violence.
Purpose
To assess the feasibility and accuracy of 3D ultrashort echo time (UTE) magnetic resonance (MR) thermometry of frozen tissue during cryoablation on a clinical 3T MR system.
Materials and ...Methods
Ex vivo porcine muscle specimens (n = 4) were imaged during two cycles of 10:3 minutes freeze‐thaw on a 3T clinical MR scanner. Continuous MR monitoring was performed using a 3D radial ramp‐sampled UTE sequence with a shortest TE of 70 μs. Fiber optic sensors were used for temperature reference. Data of three experiments were used as reference sets. Signal intensity values were normalized to baseline before cooling and related to temperature. Data for subzero temperatures were fit to a monoexponential function. In the separate validation set, the obtained fit was used to generate 3D MR temperature maps of frozen tissue at each imaging timepoint. Statistical analysis was performed to assess accuracy of the MR temperature maps.
Results
With 3D UTE imaging, MR signal was measured from frozen tissue down to temperatures as low as –40°C. Temperatures predicted from the MR temperature maps strongly correlated with sensor recorded values (r = 0.977, P < 0.001). Bland–Altman analysis demonstrated a mean difference between MR‐estimated temperatures and sensor readings of –1.2 ± 2.7°C with upper and lower limits of agreement of +4.1 and –6.5°C, respectively.
Conclusion
3D MR thermometry of frozen tissue using UTE signal intensity was feasible during cryoablation on a clinical 3T MR system. Down to temperatures as low as –40°C, accuracy of the MR temperature maps was within clinically acceptable limits. J. Magn. Reson. Imaging 2016;44:1572–1579.
The increasing incidence of prostate cancer cases worldwide has led to a tremendous demand for multiparametric MRI (mpMRI). In order to relieve the pressure on healthcare, reducing mpMRI scan time is ...necessary. This review focuses on recent techniques proposed for faster mpMRI acquisition, specifically shortening T2W and DWI sequences while adhering to the PI‐RADS (Prostate Imaging Reporting and Data System) guidelines. Speeding up techniques in the reviewed studies rely on more efficient sampling of data, ranging from the acquisition of fewer averages or
b
‐values to adjustment of the pulse sequence. Novel acquisition methods based on undersampling techniques are often followed by suitable reconstruction methods typically incorporating synthetic priori information. These reconstruction methods often use artificial intelligence for various tasks such as denoising, artifact correction, improvement of image quality, and in the case of DWI, for the generation of synthetic high
b
‐value images or apparent diffusion coefficient maps. Reduction of mpMRI scan time is possible, but it is crucial to maintain diagnostic quality, confirmed through radiological evaluation, to integrate the proposed methods into the standard mpMRI protocol. Additionally, before clinical integration, prospective studies are recommended to validate undersampling techniques to avoid potentially inaccurate results demonstrated by retrospective analysis. This review provides an overview of recently proposed techniques, discussing their implementation, advantages, disadvantages, and diagnostic performance according to PI‐RADS guidelines compared to conventional methods.
Level of Evidence
3
Technical Efficacy
Stage 3
To prospectively determine the accuracies of T2-weighted magnetic resonance (MR) imaging, dynamic contrast material-enhanced MR imaging, and quantitative three-dimensional (3D) proton MR ...spectroscopic imaging of the entire prostate for prostate cancer localization, with whole-mount histopathologic section findings as the reference standard.
This study was approved by the institutional review board, and informed consent was obtained from all patients. Thirty-four consecutive men with a mean age of 60 years and a mean prostate-specific antigen level of 8 ng/mL were examined. The median biopsy Gleason score was 6. T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and 3D MR spectroscopic imaging were performed, and on the basis of the image data, two readers with different levels of experience recorded the location of the suspicious peripheral zone and central gland tumor nodules on each of 14 standardized regions of interest (ROIs) in the prostate. The degree of diagnostic confidence for each ROI was recorded on a five-point scale. Localization accuracy and ROI-based receiver operating characteristic (ROC) curves were calculated.
For both readers, areas under the ROC curve for T2-weighted MR, dynamic contrast-enhanced MR, and 3D MR spectroscopic imaging were 0.68, 0.91, and 0.80, respectively. Reader accuracy in tumor localization with dynamic contrast-enhanced imaging was significantly better than that with quantitative spectroscopic imaging (P < .01). Reader accuracy in tumor localization with both dynamic contrast-enhanced imaging and spectroscopic imaging was significantly better than that with T2-weighted imaging (P < .01).
Compared with use of T2-weighted MR imaging, use of dynamic contrast-enhanced MR imaging and 3D MR spectroscopic imaging facilitated significantly improved accuracy in prostate cancer localization.
Purpose
Along with a number of other malignancies, the term “oligometastatic” prostate cancer has recently emerged. It represents an attempt to define a subtype of cancer with a limited metastatic ...load that might perform more favorably than a distinctly disseminated disease, or even one that may be managed in a potentially curative way. Since there is currently a knowledge gap of what imaging modalities should be utilized to classify patients as having this type of tumor, we aimed to shed light on the role of conventional and marker-based imaging in the setting of synchronous oligometastatic prostate cancer as well as summarize the available evidence for its clinical application.
Methods
A literature search on December 15th 2017 was conducted using the Pubmed database.
Results
Functional imaging techniques like
68
Ga PSMA.
68
Ga PSMA PET-CT has currently been shown the best detection rates for the assessment of nodal, bone and visceral metastases, especially for smaller lesions at low PSA levels.
Conclusions
Functional imaging helps detect low-burden disease metastatic patients. However, these imaging modalities are not available in every center and thus clinicians may be prone to prescribe systemic treatment rather than referring patients for cytoreductive treatments. We hope that the ongoing prospective trials will help guide clinicians in making a more personalized management of synchronous metastatic patients.
To retrospectively compare transition zone (TZ) cancer detection and localization accuracy of 3-T T2-weighted magnetic resonance (MR) imaging with that of multiparametric (MP) MR imaging, with ...radical prostatectomy specimens as the reference standard.
The informed consent requirement was waived by the institutional review board. Inclusion criteria were radical prostatectomy specimen TZ cancer larger than 0.5 cm(3) and 3-T endorectal presurgery MP MR imaging (T2-weighted imaging, diffusion-weighted DW imaging apparent diffusion coefficient ADC maps b < 1000 sec/mm(2), and dynamic contrast material-enhanced DCE MR imaging). From 197 patients with radical prostatectomy specimens, 28 patients with TZ cancer were included. Thirty-five patients without TZ cancer were randomly selected as a control group. Four radiologists randomly scored T2-weighted and DW ADC images, T2-weighted and DCE MR images, and T2-weighted, DW ADC, and DCE MR images. TZ cancer suspicion was rated on a five-point scale in six TZ regions of interest (ROIs). A score of 4-5 was considered a positive finding. A score of 4 or higher for any ROI containing TZ cancer was considered a positive detection result at the patient level. Generalized estimating equations were used to analyze detection and localization accuracy by using ROI-receiver operating characteristics (ROC) curve analyses for the latter. Gleason grade (GG) 4-5 and GG 2-3 cancers were analyzed separately.
Detection accuracy did not differ between T2-weighted and MP MR imaging for all TZ cancers (68% vs 66%, P = .85), GG 4-5 TZ cancers (79% vs 72%-75%, P = .13), and GG 2-3 TZ cancers (66% vs 62%-65%, P = .47). MP MR imaging (area under the ROC curve, 0.70-0.77) did not improve T2-weighted imaging localization accuracy (AUC = 0.72) (P > .05).
Use of 3-T MP MR imaging, consisting of T2-weighted imaging, DW imaging ADC maps (b values, 50, 500, and 800 sec/mm(2)), and DCE MR imaging may not improve TZ cancer detection and localization accuracy compared with T2-weighted imaging.
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120281/-/DC1.
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