Objective
To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase
18
F-FDG PET/CT in a series of newly diagnosed ...patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.
Patients and methods
This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase
18
F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed.
Results
The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (
p
< 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (
p
= 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio HR = 4.02,
p
< 0.001, and HR = 3.23,
p
< 0.001, respectively) and (HR = 2.83,
p
= 0.030 and HR = 2.38,
p
= 0.041, respectively).
Conclusion
Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients.
Clinical relevance statement
Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.
Key Points
•
Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients
.
•
High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS)
.
•
RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients
.
Objective
To evaluate diagnostic performance and inter-reviewer agreement (IRA) of the Gynecologic Imaging Reporting and Data System (GI-RADS) for diagnosis of adnexal masses (AMs) by pelvic ...ultrasound (US).
Patients and methods
A prospective multicenter study included 308 women (mean age, 41 ± 12.5 years; range, 15–73 years) with 325 AMs detected by US. All US examinations were analyzed, and AMs were categorized into five categories according to the GI-RADS classification. We used histopathology and US follow-up as the reference standards for calculating diagnostic performance of GI-RADS for detecting malignant AMs. The Fleiss kappa (
κ
) tests were applied to evaluate the IRA of GI-RADS scoring results for predicting malignant AMs.
Results
A total of 325 AMs were evaluated: 127 (39.1%) were malignant and 198 (60.9%) were benign. Of 95 AMs categorized as GI-RADS 2 (GR2), none was malignant; of 94 AMs categorized as GR3, three were malignant; of 13 AMs categorized as GR4, six were malignant; and of 123 AMs categorized as GR5, 118 were malignant. On a lesion-based analysis, the GI-RADS had a sensitivity, a specificity, and an accuracy of 92.9%, 97.5%, and 95.7%, respectively, when regarding only those AMs classified as GR5 for predicting malignancy. Considering combined GR4 and GR5 as a predictor for malignancy, the sensitivity, specificity, and accuracy of GI-RADS were 97.6%, 93.9%, and 95.4%, respectively. The IRA of the GI-RADS category was very good (
κ
= 0.896). The best cutoff value for predicting malignant AMs was >GR3.
Conclusions
The GI-RADS is very valuable for improving US structural reports.
Key Points
• There is still a lack of a standard in the assessment of AMs.
• GI-RADS is very valuable for improving US structural reports of AMs.
• GI-RADS criteria are easy and work at least as well as IOTA.
Background
There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions.
Purpose
To assess the accuracy of nonarthrographic MRI for ...detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions.
Study Type
Retrospective.
Population
84 patients (32 in BP‐lesion group and 52 in BP‐intact group‐as confirmed by arthroscopy).
Field Strength/Sequence
1.5‐T, T1‐weighted turbo spin echo (TSE), T2‐weighted TSE, and proton density‐weighted TSE spectral attenuated inversion recovery (SPAIR) sequences.
Assessment
Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter‐reader agreement (IRA) between radiologists was determined.
Statistical Tests
Student's t‐tests, Chi‐squared, and Fisher's exact tests, and 4‐fold table test were used. The IRA was calculated using Kappa statistics. A P‐value <0.05 was considered statistically significant.
Results
The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%–78.1%, 90.4%–92.3%, and 81%–86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%–86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%–100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76–0.98).
Data Conclusion
Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions.
Level of Evidence
3
Technical Efficacy
Stage 2
Objective
To assess the diagnostic accuracy and agreement of CT and MRI in terms of the Bosniak classification version 2019 (BCv2019).
Materials and methods
A prospective multi-institutional study ...enrolled 63 patients with 67 complicated cystic renal masses (CRMs) discovered during ultrasound examination. All patients underwent CT and MRI scans and histopathology. Three radiologists independently assessed CRMs using BCv2019 and assigned Bosniak class to each CRM using CT and MRI. The final analysis included 60 histopathologically confirmed CRMs (41 were malignant and 19 were benign).
Results
Discordance between CT and MRI findings was noticed in 50% (30/60) CRMs when data were analyzed in terms of the Bosniak classes. Of these, 16 (53.3%) were malignant. Based on consensus reviewing, there was no difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT (87.8%; 95% CI = 73.8–95.9% versus 75.6%; 95% CI = 59.7–87.6%;
p
= 0.09, 84.2%; 95% CI = 60.4–96.6% versus 78.9%; 95% CI = 54.4–93.9%;
p
= 0.5, and 86.7%; 95% CI = 64.0–86.6% versus 76.7%; 95% CI = 75.4–94.1%;
p
= 0.1, respectively). The number and thickness of septa and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. The inter-reader agreement (IRA) was substantial for determining the Bosniak class in CT and MRI (
k
= 0.66; 95% CI = 0.54–0.76,
k
= 0.62; 95% CI = 0.50–0.73, respectively). The inter-modality agreement of the BCv219 between CT and MRI was moderate (
κ
= 0.58).
Conclusion
In terms of BCv2019, CT and MRI are comparable in the classification of CRMs with no significant difference in diagnostic accuracy and reliability.
Key Points
•
There is no significant difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT.
•
The number of septa and their thickness and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI.
•
The inter-reader agreement was substantial for determining the Bosniak class in CT and MRI and the inter-modality agreement of the BCv219 between CT and MRI was moderate.
Background: Leishmania donovani is a protozoan parasite that causes visceral leishmaniasis, a potentially fatal disease in humans and dogs. The epidemiology and transmission dynamics of L. donovani ...in Sudan are poorly understood. We aim to determine the prevalence and characterization of L. donovani in human hospital cases and domestic dogs using different diagnostic methods in two localities in Gadarif State, Sudan. Methods: A cross-sectional study was conducted from October 2019 to April 2020. Whole blood samples and lymph node aspirates were collected from 69 human and 32 dog participants for parasitological, immunological, and molecular tests. Results: No parasites were detected in blood samples from either humans or dogs. Lymph node microscopy revealed 71.01% positivity in humans and 9.4% in dogs. The IT Leish test showed 82.6% positivity in humans and 43.75% in dogs. PCR confirmed L. donovani infection in all six selected samples (three from humans and three from dogs). Conclusion: The study confirmed the presence of L. donovani in both human and dog populations in the study area, suggesting that dogs may act as reservoirs or hosts for the parasite. The IT Leish kit test was the most sensitive and specific method, while microscopy of blood and lymph node smears was the least sensitive method. Further studies are needed to elucidate the role of dogs in the transmission cycle of L. donovani and the risk factors associated with human infection.
•ACR TI-RADS predicts malignant thyroid nodules with high diagnostic validity.•Combined TR4/TR5 increases sensitivity of ACR TI-RADS for malignant thyroid nodules.•The referring clinicians accept ACR ...TI-RADS as a valuable reporting system.
To assess diagnostic validity and reproducibility of Thyroid Imaging Reporting and Data System (TI-RADS) for interpretation of thyroid nodules by thyroid ultrasonography (US).
A prospective multicentre study initially included 557 patients with clinically suspected thyroid nodules. After exclusion, a final cohort of 380 patients with 948 thyroid nodules detected by US were enrolled. Based on American College of Radiology (ACR) TI-RADS, three radiologists analysed all US examinations independently and assigned a TI-RADS category to each thyroid nodule. The final diagnosis was based on cytology which was used as reference standard for calculating diagnostic performance of TI-RADS for predicting malignant thyroid nodules. The Fleiss and weighted kappa (κ) statistics were applied to assess inter-observer agreement of morphological features and TI-RADS scoring results for thyroid nodules. Additionally, we made a simple screening among referring clinicians to assess the clinical response to application of TI-RADS.
A total of 948 thyroid nodules were evaluated; 136 (14.3%) were malignant, and 812 (85.7%) were benign. The papillary carcinoma was the most common malignant thyroid nodules (81.6%). The best cut-off value for predicting malignant thyroid nodules was > TR3. On a lesion-based analysis, the TI-RADS had a sensitivity, specificity, and an accuracy of 98.3%, 90.9%, and 92.1%, respectively when regarding those thyroid nodules classified as > TR3 for predicting malignancy. The inter-observer agreement of the TI-RADS category was good (κ = 0.636). Ninety percent of referring clinicians accept TI-RADS.
TI-RADS improves diagnostic performance of US for predicting malignant thyroid nodules with high validity and high reproducibility.
Calcium phosphate ceramic materials are extensively used for bone replacement and regeneration in orthopedic, dental, and maxillofacial surgical applications. In order for these biomaterials to work ...effectively it is imperative that they undergo the process of degradation and resorption
. This allows for the space to be created for the new bone tissue to form and infiltrate within the implanted graft material. Several factors affect the biodegradation and resorption of calcium phosphate materials after implantation. Various cell types are involved in the degradation process by phagocytic mechanisms (monocytes/macrophages, fibroblasts, osteoblasts) or via an acidic mechanism to reduce the micro-environmental pH which results in demineralization of the cement matrix and resorption via osteoclasts. These cells exert their degradation effects directly or indirectly through the cytokine growth factor secretion and their sensitivity and response to these biomolecules. This article discusses the mechanisms of calcium phosphate material degradation
.
Background: The fact that bacteria have no geographical boundaries has made bacterial resistance to antibiotics a worldwide issue that requires collaboration and unity to address. Aim: evaluate the ...effect of nursing-based intervention to optimize the self-prescribed and the misuse of antibiotics among mothers of children less than 5 years. Methods: A quasi-experimental design was used to conduct this study. The study was conducted in Maternal Child Health Centers in Mansoura City & Beni-Suef City, Egypt, 100 participants were included in the study. A structured interview questionnaire was used to collect the data, which consisted of five parts; socio-demographic data, knowledge questions about antibiotics and their resistance, attitude scale towards self-prescribed antibiotics, questionnaire on safe use of antibiotics, and patterns of self-prescribed antibiotic use. Results: 41 % of the study group used self-prescribed antibiotics more than 6 times in the previous 6 months and 100 % of them used them to treat fever and sore throat, followed by 76 % for vomiting and diarrhea. There were significant improvements in participants' knowledge, attitudes towards self-prescribed antibiotics, and safe use of antibiotics after implementing the nursing intervention. Conclusion: The nursing-based intervention was successful in attaining its objectives in improving the total knowledge, attitudes and practices of the studied group. Recommendation: Health education about appropriate antibiotic use should be approved as a part of the preventive services obtained for the mothers.
Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, ...classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification.
A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard.
The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79).
MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.
The endless problem of energy supplies are always floating on the surface. As a result, there are a daily improvement to optimize power generators, networks and system configuration. Renewable ...distributed generators (RDG) are in the heart of these developments. The size of RDG is increasing daily so, it must be optimized to maximize benefits and eliminate drawbacks. Optimization algorithms are one of the fast growing techniques. In this study the Manta Ray Foraging optimization algorithm (MRFO) is applied to minimize power losses through sizing and allocation of DG type I integrated into radial distribution network (RDN). The proposed technique was tested on three different networks, IEEE 33, 69 and 85 test systems. Also, three cases were assumed to evaluate the effectiveness of MRFO algorithm. The results were compared to recent applied techniques.
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