Purpose
To test the ability of shutter‐speed dynamic contrast‐enhanced (DCE) MRI to estimate water exchange (WX) using simulations and assess its performance in clinical case studies of malignant and ...benign breast tumors.
Methods
Data were simulated using a 1‐compartment tracer kinetic (TK) model combined with a 2‐pool WX model (2PX) and with a 2‐compartment TK model. Typical DCE‐MRI acquisition parameters were used with both WX‐sensitive (8°) and ‐insensitive (25°) flip angles. Clinical data were obtained from patients with malignant and benign breast tumors. Data were fitted using a 2‐compartment TK model and a 1‐compartment TK model combined with 4 WX models: fast exchange limit (FXL), no exchange, 2PX, and shutter‐speed.
Results
Fits to the 1‐compartment simulated data were excellent, but estimates of WX obtained using the 2PX and shutter‐speed models were poor. One‐compartment TK model fits to the clinical malignant tumor data were bad, except for the shutter‐speed model. However, that overestimated TK parameters compared to the best‐fit 2‐compartment TK model, which predicted a significant blood volume and leaky capillaries (1 tracer compartment is insufficient, 2 are necessary). All models produced excellent fits to the clinical benign tumor data with little variation between parameter estimates (1 tracer compartment is sufficient).
Conclusion
The 2PX and shutter‐speed models were unable to estimate WX from the DCE‐MRI data. A good fit to malignant tumor data using the shutter‐speed model was not explained by WX, but the choice of an inappropriate TK model leading to distorted parameter estimates.
Randomized controlled trials (RCT) have shown no overall benefit of renal revascularization in atherosclerotic renovascular disease (ARVD). However, 25% of patients demonstrate improvement in renal ...function. We used the ratio of magnetic resonance parenchymal volume (PV) to isotopic single kidney glomerular filtration rate (isoSKGFR) ratio as our method to prospectively identify "improvers" before revascularization.
Patients with renal artery stenosis who were due revascularization were recruited alongside non-ARVD hypertensive CKD controls. Using the controls, 95% CI were calculated for expected PV:isoSK-GFR at given renal volumes. For ARVD patients, "improvers" were defined as having both >15% and >1ml/min increase in isoSK-GFR at 4 months after revascularization. Sensitivity and specificity of PV:isoSK-GFR for predicting improvers was calculated.
30 patients (mean age 68 ±8 years), underwent revascularization, of whom 10 patients had intervention for bilateral RAS. Stented kidneys which manifested >15% improvement in function had larger PV:isoSK-GFR compared to controls (19±16 vs. 6±4ml/ml/min, p = 0.002). The sensitivity and specificity of this equation in predicting a positive renal functional outcome were 64% and 88% respectively. Use of PV:isoSK-GFR increased prediction of functional improvement (area under curve 0.93). Of note, non-RAS contralateral kidneys which improved (n = 5) also demonstrated larger PV:isoSK-GFR (15.2±16.2 ml/ml/min, p = 0.006).
This study offers early indicators that the ratio of PV:isoSK-GFR may help identify patients with kidneys suitable for renal revascularization which could improve patient selection for a procedure associated with risks. Calculation of the PV:isoSK-GFR ratio is easy, does not require MRI contrast agent.
The use of magnetic resonance (MR) imaging scans alone for radiation therapy treatment planning (MR-only planning) has been highlighted as one method of improving patient outcomes. Recent technologic ...advances have meant that introducing MR-only planning to the clinic is becoming a reality, with several specialist radiation therapy clinics using this technique for treatment. As such, substantial efforts are being made to introduce this technique into wide-spread clinical implementation. A systematic review of publications investigating the clinical implementation of pelvic MR-only radiation therapy treatment planning was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase, Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases were searched (timespan: all years to January 2, 2019). Twenty-six articles met the inclusion criteria. The studies were grouped into the following categories: (1) MR acquisition and synthetic computed tomography generation verification, (2) MR distortion quantification and phantom development, (3) clinical validation of patient treatment positioning in an MR-only workflow, and (4) MR-only commissioning processes. Key conclusions from this review are (1) MR-only planning has been implemented clinically for prostate cancer treatments; (2) a substantial amount of work remains to translate MR-only planning into widespread clinical implementation for all pelvic sites; (3) MR scanner distortions are no longer a barrier to MR-only planning, but they must be managed appropriately; (4) MR-only–based patient positioning verification shows promise, but limited evidence is reported in the literature and further investigation is required; and (5) a number of MR-only commissioning processes have been reported, which can aid centers as they undertake local commissioning; however, this needs to be formalized in guidance from national bodies.
On 2019 August 14, the Advanced LIGO and Virgo interferometers detected the high-significance gravitational wave (GW) signal S190814bv. The GW data indicated that the event resulted from a neutron ...star-black hole (NSBH) merger, or potentially a low-mass binary BH merger. Due to the low false-alarm rate and the precise localization (23 deg2 at 90%), S190814bv presented the community with the best opportunity yet to directly observe an optical/near-infrared counterpart to an NSBH merger. To search for potential counterparts, the GROWTH Collaboration performed real-time image subtraction on six nights of public Dark Energy Camera images acquired in the 3 weeks following the merger, covering >98% of the localization probability. Using a worldwide network of follow-up facilities, we systematically undertook spectroscopy and imaging of optical counterpart candidates. Combining these data with a photometric redshift catalog, we ruled out each candidate as the counterpart to S190814bv and placed deep, uniform limits on the optical emission associated with S190814bv. For the nearest consistent GW distance, radiative transfer simulations of NSBH mergers constrain the ejecta mass of S190814bv to be Mej < 0.04 M at polar viewing angles, or Mej < 0.03 M if the opacity is κ < 2 cm2g−1. Assuming a tidal deformability for the NS at the high end of the range compatible with GW170817 results, our limits would constrain the BH spin component aligned with the orbital momentum to be χ < 0.7 for mass ratios Q < 6, with weaker constraints for more compact NSs.
•Accurate Synthetic-CT (sCT) generation for anorectal cancers.•Deep learning sCT generation with varied input data.•T2-SPACE MRI sequence use for generalisable pelvic synthetic-CT.
Comprehensive ...dosimetric analysis is required prior to the clinical implementation of pelvic MR-only sites, other than prostate, due to the limited number of site specific synthetic-CT (sCT) dosimetric assessments in the literature. This study aims to provide a comprehensive assessment of a deep learning-based, conditional generative adversarial network (cGAN) model for a large ano-rectal cancer cohort. The following challenges were investigated; T2-SPACE MR sequences, patient data from multiple centres and the impact of sex and cancer site on sCT quality.
RT treatment position CT and T2-SPACE MR scans, from two centres, were collected for 90 ano-rectal patients. A cGAN model trained using a focal loss function, was trained and tested on 46 and 44 CT-MR ano-rectal datasets, paired using deformable registration, respectively. VMAT plans were created on CT and recalculated on sCT. Dose differences and gamma indices assessed sCT dosimetric accuracy. A linear mixed effect (LME) model assessed the impact of centre, sex and cancer site.
A mean PTV D95% dose difference of 0.1% (range: −0.5% to 0.7%) was found between CT and sCT. All gamma index (1%/1 mm threshold) measurements were >99.0%. The LME model found the impact of modality, cancer site, sex and centre was clinically insignificant (effect ranges: −0.4% and 0.3%). The mean dose difference for all OAR constraints was 0.1%.
Focal loss cGAN models using T2-SPACE MR sequences from multiple centres can produce generalisable, dosimetrically accurate sCTs for ano-rectal cancers.
The third observing run by LVC has brought the discovery of many compact binary coalescences. Following the detection of the first binary neutron star merger in this run (LIGO/Virgo S190425z), we ...performed a dedicated follow-up campaign with the Zwicky Transient Facility (ZTF) and Palomar Gattini-IR telescopes. The initial skymap of this single-detector gravitational wave (GW) trigger spanned most of the sky observable from Palomar Observatory. Covering 8000 deg2 of the initial skymap over the next two nights, corresponding to 46% integrated probability, ZTF system achieved a depth of 21 mAB in g- and r-bands. Palomar Gattini-IR covered 2200 square degrees in J-band to a depth of 15.5 mag, including 32% integrated probability based on the initial skymap. The revised skymap issued the following day reduced these numbers to 21% for the ZTF and 19% for Palomar Gattini-IR. We narrowed 338,646 ZTF transient "alerts" over the first two nights of observations to 15 candidate counterparts. Two candidates, ZTF19aarykkb and ZTF19aarzaod, were particularly compelling given that their location, distance, and age were consistent with the GW event, and their early optical light curves were photometrically consistent with that of kilonovae. These two candidates were spectroscopically classified as young core-collapse supernovae. The remaining candidates were ruled out as supernovae. Palomar Gattini-IR did not identify any viable candidates with multiple detections only after merger time. We demonstrate that even with single-detector GW events localized to thousands of square degrees, systematic kilonova discovery is feasible.
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