Abstract Background Sunitinib and everolimus are standard first-line and second-line therapies, respectively, in clear cell renal cell carcinoma (ccRCC). Objective To conduct a randomized phase 2 ...trial comparing sunitinib and everolimus in non–clear cell RCC (non-ccRCC). Design, setting, and participants Patients with metastatic, non-ccRCC, or ccRCC with >20% sarcomatoid features (ccSRCC) were randomized to receive sunitinib or everolimus with crossover at disease progression. Outcome measurement and statistical analysis Primary end point was progression-free survival (PFS) in first-line therapy; 108 patients were needed to show improvement in median PFS (mPFS) from 12 wk with sunitinib to 20 wk with everolimus. Results and limitations Interim analysis of 68 patients (papillary 27 , chromophobe 12 , unclassified 10 , translocation 7 , ccSRCC 12 ) prompted early trial closure. The mPFS in first-line therapy was 6.1 mo with sunitinib and 4.1 mo with everolimus ( p = 0.6); median overall survival (mOS) was not reached with sunitinib and was 10.5 mo with everolimus, respectively ( p = 0.014). At final analysis, mOS was 16.2 and 14.9 mo with sunitinib and everolimus, respectively ( p = 0.18). There were four partial responses (PRs) in first-line therapy (sunitinib: 3 of 33 9%; everolimus, 1 of 35 2.8%) and four PRs in second-line therapy (sunitinib: 2 of 21 9.5%; everolimus, 2 of 23 8.6%), with mPFS of 1.8 mo and 2.8 mo, respectively. In patients without sarcomatoid features in their tumors ( n = 49), mOS was 31.6 mo with sunitinib and 10.5 mo with everolimus ( p = 0.075). Genomic profiling of a chromophobe RCC from a patient with a PR to first-line everolimus revealed a somatic TSC2 mutation. Conclusions In this trial, everolimus was not superior to sunitinib. Both agents demonstrated modest efficacy, underscoring the need for better therapies in non-ccRCC. Patient summary This randomized phase 2 trial provides the first head-to-head comparison of everolimus and sunitinib in patients with metastatic non–clear cell renal cell carcinoma (non-ccRCC). The observed very modest efficacy underscores the need to develop more effective therapies for non-ccRCC.
The coronavirus disease 2019 (COVID-19) pandemic is a global health care emergency. Although reverse-transcription polymerase chain reaction testing is the reference standard method to identify ...patients with COVID-19 infection, chest radiography and CT play a vital role in the detection and management of these patients. Prediction models for COVID-19 imaging are rapidly being developed to support medical decision making. However, inadequate availability of a diverse annotated data set has limited the performance and generalizability of existing models. To address this unmet need, the RSNA and Society of Thoracic Radiology collaborated to develop the RSNA International COVID-19 Open Radiology Database (RICORD). This database is the first multi-institutional, multinational, expert-annotated COVID-19 imaging data set. It is made freely available to the machine learning community as a research and educational resource for COVID-19 chest imaging. Pixel-level volumetric segmentation with clinical annotations was performed by thoracic radiology subspecialists for all COVID-19-positive thoracic CT scans. The labeling schema was coordinated with other international consensus panels and COVID-19 data annotation efforts, the European Society of Medical Imaging Informatics, the American College of Radiology, and the American Association of Physicists in Medicine. Study-level COVID-19 classification labels for chest radiographs were annotated by three radiologists, with majority vote adjudication by board-certified radiologists. RICORD consists of 240 thoracic CT scans and 1000 chest radiographs contributed from four international sites. It is anticipated that RICORD will ideally lead to prediction models that can demonstrate sustained performance across populations and health care systems.
PURPOSE We aimed to investigate the value of magnetic resonance imaging (MRI)-based parameters in differentiating between progressive massive fibrosis (PMF) and lung cancer. METHODS This ...retrospective study included 60 male patients (mean age, 67.0+ or -9.0 years) with a history of more than 10 years working in underground coal mines who underwent 1.5 T MRI of thorax due to a lung nodule/mass suspicious for lung cancer on computed tomography. Thirty patients had PMF, and the remaining ones had lung cancer diagnosed histopathologically. The sequences were as follows: coronal single-shot turbo spin echo (SSH-TSE), axial T1- and T2-weighted spin-echo (SE), balanced turbo field echo, T1-weighted high-resolution isotropic volume excitation, free-breathing and respiratory triggered diffusion-weighted imaging (DWI). The patients' demographics, lesion sizes, and MRI-derived parameters were compared between the patients with PMF and lung cancer. RESULTS Apparent diffusion coefficient (ADC) values of DWI and respiratory triggered DWI, signal intensities on Tl-weighted SE, T2-weighted SE, and SSH-TSE imaging were found to be significantly different between the groups (p < 0.001, for all comparisons). Median ADC values of free-breathing DWI in patients with PMF and cancer were 1.25 (0.93-2.60) and 0.76 (0.53-1.00) (* 10.sup.3 mm.sup.2/s), respectively. Most PMF lesions were predominantly iso- or hypointense on Tl-weighted SE, T2-weighted SE, and SSH-TSE, while most malignant ones predominantly showed high signal intensity on these sequences. CONCLUSION MRI study including SE imaging, specially Tl-weighted SE imaging and ADC values of DWI can help to distinguish PMF from lung cancer.
Radiology education in Turkey is mainly taught during clinical years of medical school and often lacks main principles. Exposure to the fundamentals of radiology at an early stage of medical ...education may drastically help students generate a better understanding of radiology and expand their interest in the specialty. With the Principles of Radiology Course that we provided, pre- and post-session tests, and assessment survey at the end of the course, we aimed to evaluate the effectiveness of such an online course among Turkish medical students.
A total of nine online sessions on imaging modalities principles was developed by radiology professors. Each session was given through Zoom by radiologists from different U.S.-institutions to Turkish medical students from state (n = 33) and private (n = 8) universities. Pretests and post-tests were given to participants via Qualtrics before and after each session, respectively. Paired two-sample t-tests were conducted to detect the variance and p=-.05 was used as the significance level. An evaluation survey was distributed at the end of the course to collect their feedback through SurveyMonkey.
A total of 1,438 predominantly Turkish (99.32%) medical students engaged with this course. An average of 506 students completed both pre-test and post-test. There was a statistically significant (p < .001) increase in the scores in post-test (meanrange:7.585.21-8.53) relative to pre-test (meanrange:5.103.52-8.53). Four hundred and thirty-nine participants (F/M:63.33%/35.54%) completed the end-of-course survey. A total of 71% and 69.70% of the participants strongly agreed that the course would be useful in their clinical practice and had increased their understanding of radiology. They also reported that their level of confidence in the subjects had increased 68% and reached a weighted average of 3.09/4. The survey revealed that 396 (90.21%) of the participants strongly or somewhat agree that introductory principles and concepts should be presented in earlier years of medical education. Compared to in-person education, 358 (81.55%) found the course extremely or very convenient.
Online lecture series consisting of the principles of the radiological imaging modalities can be offered to Turkish medical students to enhance their grasp of the various imaging modalities and their correct clinical application.
The Coronavirus disease 2019 (COVID-19) presents open questions in how we clinically diagnose and assess disease course. Recently, chest computed tomography (CT) has shown utility for COVID-19 ...diagnosis. In this study, we developed Deep COVID DeteCT (DCD), a deep learning convolutional neural network (CNN) that uses the entire chest CT volume to automatically predict COVID-19 (COVID+) from non-COVID-19 (COVID-) pneumonia and normal controls. We discuss training strategies and differences in performance across 13 international institutions and 8 countries. The inclusion of non-China sites in training significantly improved classification performance with area under the curve (AUCs) and accuracies above 0.8 on most test sites. Furthermore, using available follow-up scans, we investigate methods to track patient disease course and predict prognosis.
Amaç: Adrenal kortikal karsinomun (AKK) Bilgisayarlı Tomografi (BT) görüntüleme özelliklerini araştırmak.
Gereç ve yöntem: Patolojik olarak AKK tanısı almış 15 hastanın (K/E: 8/7, ortanca aralık: 53 ...yıl 31-74 yıl) kalitatif ve kantitatif BT bulguları retrospektif olarak değerlendirildi. Lezyonların fonksiyonel durumlarına klinik notlardan ulaşıldı.
Bulgular: Hastaların patolojik tanısı cerrahi (n=12) veya cerrahi eşliğinde biyopsi (n=3) ile konulmuştu. 9 lezyon (%60) fonksiyonel, 6 lezyon (%40) non-fonksiyoneldi. Fonksiyonel lezyonların 5’i androjen, 4’ü kortizon üretmekteydi. Kalitatif değerlendirmede 13 lezyon (%93) nekroz, 3 lezyon (%20) kalsifikasyon ve 1 lezyon (%7) makroskobik yağ içeriyordu. Lezyonların tamamı iyi sınırlı olup heterojen kontrastlanmaktaydı. Lezyonların ortanca (aralık) boyutu 9,7 cm (6.3-18 cm) idi. Prekontrast, arteriyel faz, portal faz ve geç faz ortanca (aralık) dansite değerleri sırasıyla şöyleydi: 34 HU (22-41 HU), 46 HU (27-65 HU), 60 HU (29-90 HU), 48 HU (28-64 HU). 9 hastada 15. dakika geç faz elde olunmuştu. Ortanca (aralık) mutlak (MKYY) ve bağıl (BKYY) kontrast yıkanma yüzdeleri sırasıyla şöyleydi: %48,8 (%-3.8-62.5) ve %21 (%-1.5-30.8). Sadece bir lezyonun MKYY değeri %60’in üzerindeydi.
Sonuç: AKK’lar BT’de genellikle büyük (>6cm), iyi sınırlı, heterojen kontrastlanan, nekrotik kitleler şeklinde görülür. Makroskobik yağ ve kalsifikasyon içerebilir ve geç faz imajlarda sınırlı kontrast yıkanması gösterirler.
Objective: To evaluate computed tomography (CT) imaging manifestations of adrenocortical carcinomas (ACC).
Materials and Methods: Qualitative, and quantitative CT findings of 15 patients (Eight women, seven men; median age range, 53 years 31-74 years) with 15 pathologically proven ACCs were retrospectively analyzed. Lesions' functional status were captured through clinical notes.
Results: Pathologic diagnosis was based on either surgery (n=12) or surgical biopsy (n=3). Nine lesions were functioning (60%, androgen n=5 or cortisol n=4) and 6 lesions were non-functioning (40%). In qualitative CT analysis, 13 (93%), 3 (20%), and 1 (7%) lesion had necrosis, calcification and macroscopic fat, respectively. All lesions showed well-defined borders and heterogeneous enhancement. Median range density on precontrast, arterial phase, portal phase, and 15-minute delay phase were 34 HU (22-41 HU), 46 HU (27-65 HU), 60 HU (29-90 HU), and 48 HU (28-64 HU), respectively. Nine patients had 15-minute delay phase available. Median (range) absolute and relative percentage of enhancement wash-out (APEW and RPEW) values were 48.8% (-3.8-62.5%) and 21% (-1.5-30.8%). Only one lesion had an APEW above %60.
Conclusion: ACCs usually manifest as, large (>6cm), well-defined, heterogeneously enhancing, necrotic masses on CT. These lesions may include calcification or macroscopic fat and tend to show limited wash-out on delay phase CT.
INTRODUCTION
Radiology education is essential for nonradiologist specialists and practitioners as well as for radiologists. We conducted a survey to gather the opinions of Turkish medical students ...from first to sixth grade regarding their radiology curricula, radiology education content, and perceptions of various imaging modalities and to assess the amount, adequacy, and homogeneity of radiology education in various schools.
METHODS
Turkish medical students were reached by student ambassadors from 10 different schools of medicine via social media and email. They were provided with a 20-question survey—via the SurveyMonkey platform—related to their radiology curriculum and their perceptions of the radiology education at their schools and of different imaging modalities. Subjective parameters were scaled by a 4-point Likert scale and the results are reported by percentages of students.
RESULTS
A total of 988 medical students (F/M: 61%/39%) from 41 different medical schools participated in this survey. Of those, 57% were preclinical students (≤ third year of medical school), while 43% were clinical students (> third year). More than half of the students (51%) stated that the amount of radiology education included in their curriculum was too little, while 44% of them stated it was just right and only 5% stated it was too much. Only 31% of the participants stated that they were able to review radiology images on their own. When asked about their level of confidence in identifying the position of lines and tubes, pneumonia, pneumothorax, and pleural effusion on chest radiographs, 41%, 39%, 41%, and 41% of the participants, respectively, stated that they were not confident. Thirty-five percent of the participants had not received any training in comparing normal to abnormal imaging of bone fractures, pneumonia, pleural effusion, subdural hemorrhage, or pneumothorax. The majority of the Turkish medical students in this survey had never heard (57%) nor used (64%) the American College of Radiology Appropriateness Criteria.
CONCLUSIONS
The radiology curriculum in Turkey differs among various schools and most students stated that preclinical radiology course content was inadequate. Further studies and improvements must be conducted to provide high-quality, equitable radiology education that begins during preclinical training with respect to the students’ opinions.
Multiparametric MRI in rectal cancer Gurses, Bengi; Boge, Medine; Altinmakas, Emre ...
Diagnostic and interventional radiology,
05/2019, Letnik:
25, Številka:
3
Journal Article
Recenzirano
Odprti dostop
MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with posttreatment evaluation. This ...occurs due to similar signal intensities of tumoral and posttreatment fibrotic, necrotic, and inflamed tissue. This limitation occurs with conventional MRI of the rectum with morphologic sequences. There is a need towards increasing the accuracy of MRI, especially for posttreatment evaluation. The term multiparametric MRI implies addition of functional sequences, namely, diffusion and perfusion to the routine protocol. This review summarizes the technique, potential implications and previously published studies about multiparametric MRI of rectal cancer.
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