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  • ISSN: 2333-7095
    Early Online
    Volume 8, Issue 1
    Research Article
    Robson Ferrigno*, Maria Thereza Mansur Starling, Erlon Gil, Paulo Lazaro de Moraes, Pedro Henrique da Rocha Zanuncio, and Livia Alvarenga Fagundes Ferrigno
    Purpose: This retrospective series aims to report the Brazilian single institutional experience and predictive factors for outcomes in patients with early stage and medically inoperable NSCLC treated with SBRT.
    Materials/methods: Retrospective analysis of 82 consecutive patients with NSCLC stages IA – IIA (T1aN0M0 – T2bN0M0), by AJCC 8th edition criteria treated from May 2013 to March 2019 with SBRT. All patients were staged with PET/CT and considered medically inoperable. The median age was 77 years old and median tumor size was 2.2cm. Histological subtype was adenocarcinoma in 54 (65.8%), patients, squamous cell carcinoma (SCC), in 25 (30.5%), and 3 (3.7%), had no biopsy. Fifty and six (68.3%), patients were treated with 48Gy in 4 fractions (BED=105.6Gy10), and 26 (31.7%), with 40Gy in 4 fractions (BED=80Gy10) delivered twice a week. Local recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS), were estimated by Kaplan-Meier method. BED, histological subtype, age and tumor size were factors analyzed for outcomes. Statistical differences in survival curves were calculated by Long Rank test and the hazard ratios were determined by Cox regression model.
    Results: With a median follow up of 25 months, the 3-year LRFS, DFS and OS were 82.8%, 68.4%, and 57.9%, respectively. Patients treated with BED=10.6Gy10 had superior 3-year LRFS (89.9% vs 70.0%; p=0.049) and SCC histological subtype was a negative predictive factor for 3-year LRFS compared with adenocarcinoma (90.8% Vs 55.7%; p=0.023). Tumor size and age were not predictive factors for LRFS, DFS and OS. Patients with adenocarcinoma had better 3-year DFS than those with SCC (75.7% % Vs 40.9%; p=0.014). Any grade of pneumonitis occurred with a median of 11 months after the last fraction of SBRT. RTOG grades 1 and 2 pneumonitis occurred in 36 (43.9%), and 4 (4.9%), patients, respectively. Four (4.9%) patients developed thoracic pain with no rib fracture and one patient developed rib fracture.
    Conclusions: Results of this series are similar to the literature and confirm that BED larger than 100Gy10 is more effective for local control than lower level in the treatment of NSCLC with SBRT. Patients with SCC had lower LRFS and DFS compared with those with adenocarcinoma. The radiation dose of 48Gy in 4 fractions was effective and safe for patients with peripheral early stages tumors.
    Sadaf Batool Faisal*, Amina Hameed, Tuba Tariq, Muhammad Imran Khan and Claude Pierre-Jerome
    Objective: To determine the association of lumbar paraspinal muscle atrophy with lumbar disc herniation and spinal stenosis.
    Material and methods: Prospective study of 160 consecutive patients was done who presented with lower back pain and had disc herniation on MRI lumbar spine. Disc herniation with its pattern and spinal stenosis with its grade were analyzed. Paraspinal muscle atrophy of Multifidus, Longissimus and Iliocostalis was noted at each level of disc herniation and spinal stenosis and their correlation with muscle atrophy grade and laterality was studied.
    Results: 79% patients with disc herniation showed Multifidus muscle atrophy however no significant association was seen between paraspinal muscle atrophy and disc herniation (P=.15). Significant correlation was seen between muscle atrophy laterality and disc herniation pattern (P< .001). 90% patients with spinal stenosis showed paraspinal muscle atrophy. Significant association was also seen between paraspinal muscle atrophy and spinal stenosis of any grade (P< .001).
    Conclusion: There is correlation between paraspinal muscle atrophy and spinal stenosis. Pattern of disc herniation and symmetry of paraspinal muscle atrophy also has significant correlation but more studies need to be done with large sample size.
    Eduardo de Paiva*
    The asymmetric CIA and CIB/CIB-2 model applicators containing the beta emitters 106Ru/106Rh are used in radiotherapy to treat ciliary body melanomas or melanomas close to the iris. A serious drawback in the use of these sources is the difficult determination of absorbed dose distributions around them, mainly because of the short range of the beta particles and the steep dose gradients. Furthermore, this symmetry makes the measurements and calculations even harder and may explain the very low quantity of data on them. In this work a simple numerical method was implemented to estimate the dose rates along the central and lateral axis of curved and asymmetric 106Ru/106Rh plaques and results have shown to differ in less than 19% compared to the only Monte Carlo simulation available.
    Case Report
    Hsiaoju Lee, Naresh Damuka, John A Katzenellenbogen, Bhuddhika Shrimani L Pathirannahel, Jinbin Xu, Robert H Mach, Kiran Kumar Solingapuram Sai*
    Peroxisome proliferator-activated receptor gamma (PPAR-γ) is a ligand-activated nuclear receptor transcription factor that plays a vital role in lipid regulation, antitumor, and anti-inflammatory responses. PET imaging of PPAR-γ could provide critical information on tumor pathogenesis and treatment strategies. In this study, we report the radiochemistry and initial biological evaluations of [18F]KS-7-51, a p-fluoroethoxy phenyl derivative in a murine model of prostate cancer (PC3). In vitro cell uptake studies of [18F]KS-7-51 in PC3 cells showed high selectivity and specificity. Biodistribution in PC3-bearing mice demonstrated modest tumor uptake and blockade with KS-7-51 showed specificity. These results demonstrate the utility of [18F]KS-7-51 as a PPAR-γ PET imaging agent.
    Raiyan T. Zaman*, Don Vernekhol, and Lei Xing
    Purpose: X-ray CT plays a pivotal role in diagnostic imaging, radiotherapy, and its indispensable contribution to preclinical small animal imaging research. This study characterizes a distinctive energy spectrum of a novel 3-mercaptobenzoic-acid (3MBA)-protected-144-atoms gold-nanoparticles (3MBA-Au-144-NPs) after X-ray excitation and detects vulnerable atherosclerotic plaques non-invasively using this novel contrast agent in mice carotid arteries for the first time to the best of our knowledge.
    Methods: We designed a four-chamber heart apex model using a 3D-printer and filled with four different concentrations of 3MBA-Au-144-NPs. The X-ray system was equipped with a pencil beam collimator, which was calibrated using a 1x1 in² large radiochromic film. The tube was operated at 320 kVp with 12.5 mA current and multiple filtration options were available for the X-ray excitation source. The resulting pencil beam had a 3.2 mm diameter. The four-chamber apex was translated and rotated relative to the stationary pencil beam. Each sample chamber was irradiated for 2-minutes and emitted fluorescent X-rays from the excited 3MBA-Au-144-NPs were collected with CdTe and Silicon Drift (SD) detectors for 15 seconds. The spectra were used for L-shell XRF peak isolation and sonogram generation of this novel 3MBA-Au-144-NPs. The distribution and concentration of 3MBA-Au-144-NPs were reconstructed with an alternative maximum likelihood expectation maximization algorithm. For in vivo detection of unstable plaques, we developed atherosclerotic mice model after feeding them 1% high cholesterol diet (HCD) for four weeks before diabetic was induced by intraperitoneal injection of streptozotocin (STZ) to accelerate the plaque progression. Two weeks after the diabetic induction, surgically left carotid artery was ligated. Two weeks after the surgical ligation, a 250 µL of 3MBA-Au-144-NPs was IV injected after 6 hours of fasting. One hour after injection, the mice were imaged non-invasively with a cone-beam micro-CT system.
    Results: Two distinctive L-shell energy peaks were observed at 10 KeV and 11.13 KeV for 3MBA-Au-144-NPs in the energy spectrum of the SD detector. K-shell fluorescence events vanished in the Compton scatter and characteristic background of the tungsten source due to the lead shielding for the SD and CdTe detectors. There is a space missing at 12.5 KeV. The signal intensity varied with different 3MBA-Au-144-NPs concentration of 5%, 10%, 20%, and 100%. The X-ray fluorescence (XRF) intensity showed a highly linear response (R2=0.999) with respect to different concentrations of 3MBA-Au-144-NPs. High XRF signal was detected in the left carotid artery at 2 mm below the ligation and in aortic arch. Non-ligated right carotid artery (negative control) showed no such signal.
    Conclusion: These distinct energy spectra in the L-shell fluorescent energies render 3MBA-Au-144-NPs as a viable contrast agent for future in vivo XFCT imaging.
    Felix Githui Wairimu, Callen Kwamboka Onyambu*, RoseAchieng Nyabanda, and Gladys Nthambi Mwango
    Background: The radiology report is a crucial tool to communicate the radiological examination findings to the referring clinicians. There is no universally agreed structure or style of radiological report, and each radiologist and the referring clinician potentially has their own preferred structure and content of the same. At Kenyatta National Hospital (KNH) all reports are written and typed by the radiologist and verbal communication of radiological findings are made to the referring clinicians on critical results. There is no Radiology Information System/ Picture Archiving and Communication (RIS/PACS). The radiologists have to grapple with improving the turnaround time (TAT) and clinician’s satisfaction with the reports. KNH is a tertiary referral and teaching hospital with referring clinicians ranging from consultants in different specialties, residents, medical officers and interns.
    Objective: The main objective of this study was to evaluate the clinicians’ satisfaction, preference and opinion concerning the radiology reports within Kenyatta National Hospital.
    Materials and methods: A total of 400 eligible referring clinicians (consultants and registrars) were contacted via text message between the months of June and July, 2018 and requested to fill a 6-part semi-structured online questionnaire concerning radiology reports. Part A of the questionnaire asked about demographics of the respondents, while parts B, C and D assessed the confidence of the referring clinicians in the reports, content, style, language and delivery of the radiology reports they received, respectively using 5-point Likert scale. The clinicians ranked 4 reports of varying content and style concerning a hypothetical patient in part E of the questionnaire. The clinicians were also requested to give reason(s) for the ranking and give any additional comment they had concerning radiology reports.
    Results: A response rate of 28.25 % (113) was reported. 59.29% (67) of the respondents were male and 40.70% (46) female. The response rate for registrars was 82.3% (93) and for consultants 17.7% (20). Median length of general practitioners’ work experience was 3.5 years, because most doctors work first as general practitioners before doing a specialty, while that of a specialist was 8.9 years.
    While detailed itemized report written under subheadings for each organ/system is preferred by 79.4% (n=90) of the clinicians. A detailed itemized radiology report is more popular with the clinicians (55.1%, n=62) than a summarized itemized report (24.3%, n=28). 84% of the clinicians (n=95) ranked a format that did not give details of the findings but only summarized the findings as their least preferred.
    Conclusion: Clinicians at our hospital value the radiology report in the management of patients.
    However, challenges of not having electronic reporting system, means reports are delivered manually hence delay. There are challenges of relaying critical results to referrers who may have not left their telephone contact. Also, with manual requisitions there are challenges of delivering the report within the shortest possible time.
    Referring clinicians preferred structured reporting as opposed to conventional prose reporting.
    Manoucheher Aghajanzadeh*, Rasool Hassanzadeh, Sima Falah Arzpeyma, Siamak Geranmayeh, and Mohammad Taghi Ashoobi
    Background: In this study, we aimed to comparison the results of Magnetic Resonance Imaging [MRI] and Computed Tomography [CT] scan in the diagnosis of Elastofibroma Dorsi (ED)with postoperative histopathology as the gold standard diagnostic tool. Clinical characteristics of ED and radiologic features of MRI and CT scan are also discussed.
    Materials & Methods: In a retrospective study, we identified all patients with ED who treated in our center between 2000 and 2019. The data including signs, symptoms and imaging’s feature and surgical approaches were reviewed. The results of MRI and CT scan were compared with histopathologic findings.
    Results: The records of 12 patients who were diagnosed for ED were reviewed. Four of these patients were asymptomatic and were excluded from the study. These patients presented with mass and pain. The mean age of the patients was 64 years. Five of the patients underwent MRI, two patients CT scan and one patient both imaging technique. Core needle biopsy was performed in 3 patients and incisional biopsy was performed in 2 patients. In 3 patients the mass were primarily completely resected without pre or intra operative histopathologic verification. All of the patients underwent wide resection. The postoperative histopathologic results in all of them were compatible with MRI and CT scan findings.
    Conclusion: As the results of MRI and CT scan are compatible with postoperative histopathologic assessment, these tools are useful for assessments of ED especially in asymptomatic patients that can potentially avoid from unnecessary biopsy and surgery.
    Special Issue on Head and Neck Imaging
    Review Article
    Toru Chikui1*, Masahiro Ohga2, Erina Kitamoto1, Tomoko Shiraishi3, Shintaro Kawano4, Takashi Yoshiura5 and Kazunori Yoshiura1
    Abstract: Diffusion Weighted Image (DWI) has various roles such as tissue characterization, the prediction and monitoring of the response to treatment and differentiation of recurrent tumors from post-therapeutic changes. The malignant tumors have a lower ADC compared to benign lesions. Follow-up of early response to cancer treatment is reflected in an ADC increase in the primary tumor and nodal metastases; whereas nonresponding lesions tend to reveal only a slight increase or even a decrease in ADC during follow-up. However, there are many limitations regarding the performance of DWI in the head and neck region, therefore, many attempts has been performed to overcome the flaws of the diffusion-weighted single-shot-echo planar imaging.
    The pharmacokinetic analyses of dynamic contrast enhanced MRI (DCE-MRI) can provide physiological condition of the tissue, and Tofts and Kermode Model has been applied to the head and neck region. Some researchers have used it for the prediction and monitoring of the tumor response to cancer therapy. The general consensus is that the early changes of these parameters during the early phase after the treatment are useful for the interpretation of the response to the treatment. However, the parameters reported in the literature vary considerably; therefore, it is difficult to compare the values of the parameters among research groups.
    Both DWI and the pharmacokinetic analysis of the DCE-MRI have shown a wide range of potential benefits in this region, but more comparative studies with established scan techniques and the quantification of the data are required.
    Tanaka R* and Hayashi T
    Abstract: Dual Energy or dual source Computed Tomography (DECT) is advantageous for clinical CT interpretation. Compared to conventional imaging, this technique enables tissue differentiation of tissues, such as kidney stones, with higher precision and has additional features such as automatic bone-, bone marrow-, and plaque removal and virtual non-contrast image generation. Moreover, DECT can potentially remove beam hardening artifacts and generate images as good as those acquired using monoenergetic high energy. This review includes studies on DECT dentomaxillofacial imaging and discusses potential applications of DECT in dentomaxillofacial imaging, focusing on monoenergetic imaging.
    Ariji Y*, Nakayama M, Nishiyama W and Ariji E
    Abstract: Sonographic elastography is a new technique for measurement of the tissue stiffness, and is currently under investigation for tissue characterization in several anatomic sites. This article introduces methodologies of sonographic elastography, and mentions the possibility of its application to oral and maxillofacial regions.
    Sonographic elastography seems to be suboptimal for salivary gland malignancies, because there are many pathological types, and overlap between pleomorphic adenoma and malignant tumors. As to cervical lymph nodes, most studies have documented promising results of high accuracy for malignancy, although further larger studies are required to validate these findings. Therefore, sonographic elastography may become a useful ancillary technique in the routine diagnostic work-up for lymph nodes in the near future. For the masseter muscle, sonographic elastography has a possibility for exploring the causes of muscle pain, understanding the state of the muscle, selecting therapeutic methods, and evaluating therapeutic effect.s
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