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Moon DK, Gurnett CA, Aferol H, Siegel MJ, Commean PK, Dobbs MB. Soft-Tissue Abnormalities Associated with Treatment-Resistant and Treatment-Responsive Clubfoot: Findings of MRI Analysis. J Bone Joint Surg Am 2014; 96:1249-1256. [PMID: 25100771 PMCID: PMC4116564 DOI: 10.2106/jbjs.m.01257] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clubfoot treatment commonly fails and often results in impaired quality of life. An understanding of the soft-tissue abnormalities associated with both treatment-responsive and treatment-resistant clubfoot is important to improving the diagnosis of clubfoot, the prognosis for patients, and treatment. METHODS Twenty patients with clubfoot treated with the Ponseti method were recruited for magnetic resonance imaging (MRI) of their lower extremities. Among these were seven patients (six unilateral cases) with treatment-responsive clubfoot and thirteen patients (five unilateral cases) with treatment-resistant clubfoot. Demographic information and physical examination findings were recorded. A descriptive analysis of the soft-tissue abnormalities was performed for both patient cohorts. For the patients with unilateral clubfoot, we calculated the percentage difference in cross-sectional area between the affected limb and the unaffected limb in terms of muscle, subcutaneous fat, intracompartment fat, and total area. With use of the Wilcoxon signed-rank test, we compared inter-leg differences in cross-sectional areas and the intracompartment adiposity index (IAI) between treatment-responsive and treatment-resistant groups. The IAI characterizes the cross-sectional area of fat within a muscle compartment. RESULTS Extensive soft-tissue abnormalities were more present in patients with treatment-resistant clubfoot than in patients with treatment-responsive clubfoot. Treatment-resistant clubfoot abnormalities included excess epimysial fat and intramuscular fat replacement as well as unique patterns of hypoplasia in specific muscle groups that were present within a subset of patients. Among the unilateral cases, treatment-resistant clubfoot was associated with a significantly greater difference in muscle area between the affected and unaffected limb (-47.8%) compared with treatment-responsive clubfoot (-26.6%) (p = 0.02), a significantly greater difference in intracompartment fat area between the affected and unaffected limb (402.6%) compared with treatment-responsive clubfoot (9%) (p = 0.01), and a corresponding higher inter-leg IAI ratio (8.7) compared with treatment-responsive clubfoot (1.5) (p = 0.01). CONCLUSIONS MRI demonstrated a range of soft-tissue abnormalities in patients, including unique patterns of specific muscle-compartment aplasia/hypoplasia that were present in patients with treatment-resistant clubfoot and not present in patients with treatment-responsive clubfoot. Correlations between MRI, physical examination, and treatment responsiveness may aid in the development of a prognostic classification system for clubfoot. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Adkins D, Ley J, Dehdashti F, Siegel MJ, Wildes TM, Michel L, Trinkaus K, Siegel BA. A prospective trial comparing FDG-PET/CT and CT to assess tumor response to cetuximab in patients with incurable squamous cell carcinoma of the head and neck. Cancer Med 2014; 3:1493-501. [PMID: 25081631 PMCID: PMC4298375 DOI: 10.1002/cam4.294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 01/13/2023] Open
Abstract
Computed tomography (CT), the standard method to assess tumor response to cetuximab in incurable squamous cell carcinoma of the head and neck (SCCHN), performs poorly as judged by the disparity between high disease control rate (46%) and short time to progression (TTP) (70 days). F-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/CT is an alternative method to assess tumor response. The primary objective of this prospective trial was to evaluate the metabolic response of target lesions, assessed as the change in maximum standardized uptake value (SUVmax) on FDG-PET/CT before and after 8 weeks (cycle 1) of cetuximab. Secondary objectives were to compare tumor response by CT (RECIST 1.0) and FDG-PET/CT (EORTC criteria) following cycle 1, and determine TTP with continued cetuximab administration in patients with disease control by CT after cycle 1 but stratified for disease control or progression by FDG-PET/CT. Among 27 patients, the mean percent change of SUVmax of target lesions after cycle 1 was −21% (range: +72% to −81%); by FDG-PET/CT, partial response (PR)/stable disease (SD) occurred in 15 patients (56%) and progression in 12 (44%), whereas by CT, PR/SD occurred in 20 (74%) and progression in 7 (26%). FDG-PET/CT and CT assessments were discordant in 14 patients (P = 0.0029) and had low agreement (κ = 0.30; 95% confidence interval [CI]: 0.12, 0.48). With disease control by CT after cycle 1, median TTP was 166 days (CI: 86, 217) if the FDG-PET/CT showed disease control and 105 days (CI: 66, 159) if the FDG-PET/CT showed progression (P < 0.0001). Median TTP of the seven patients whose post cycle 1 CT showed progression compared to the 12 whose FDG-PET/CT showed progression were similar (53 [CI: 49, 56] vs. 61 [CI: 50, 105] days, respectively). FDG-PET/CT may be better than CT in assessing benefit of cetuximab in incurable SCCHN.
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Farmakis SG, Herman TE, Siegel MJ. Neonatal presentation of posterior urethral valves and tethered spinal cord. J Perinatol 2014; 34:647-8. [PMID: 25073498 DOI: 10.1038/jp.2014.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
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Abstract
The diagnosis of acute right lower quadrant pain in a pediatric population is challenging. Acute appendicitis is the most common cause of an acute surgical abdomen. The common mimics of acute appendicitis are acute gastrointestinal and gynecologic diseases. This article reviews the sonographic findings of the spectrum of common acute abdominal emergencies in children with a focus on imaging clues to a specific diagnosis. This awareness can impact on diagnostic accuracy and impact patient management.
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Farmakis SG, Herman TE, Siegel MJ. Thymoma with osseous metaplasia in an adolescent. Pediatr Radiol 2014; 44:888-92. [PMID: 24442387 DOI: 10.1007/s00247-013-2865-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/11/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
A 13-year-old girl was incidentally found to have a partially calcified anterior mediastinal mass during the work-up for a left humeral lesion. The resected specimen demonstrated a lymphocyte predominant World Health Organization type B1 thymoma with nodules of metaplastic bone consistent with osseous metaplasia. In addition, she had multiple osteochondromas, a periosteal chondroma of the humerus, a metaplastic osseous pseudotumor of the thigh, and other benign-appearing sclerotic foci, all manifestations of what is likely an autosomal dominant disorder.
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Siegel MJ, Jokerst CE, Rajderkar D, Hildebolt CF, Goyal S, Dehdashti F, Johnston NW, Siegel BA. Diffusion-weighted MRI for staging and evaluation of response in diffuse large B-cell lymphoma: a pilot study. NMR IN BIOMEDICINE 2014; 27:681-91. [PMID: 24700565 PMCID: PMC4026031 DOI: 10.1002/nbm.3105] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/02/2014] [Accepted: 03/07/2014] [Indexed: 05/22/2023]
Abstract
The aim of this study was to compare diffusion-weighted MRI (DW-MRI) with positron emission tomography/computed tomography (PET/CT) for the staging and evaluation of the treatment response in patients with diffuse large B-cell lymphoma (DLBCL). Institutional review board approval was obtained for this study; all subjects gave informed consent. Twelve patients were imaged before treatment and eight of these were also imaged after two cycles of chemotherapy using both DW-MRI and PET/CT. Up to six target lesions were selected at baseline for response assessment based on International Working Group criteria (nodes > 1.5 cm in diameter; extranodal lesions > 1 cm in diameter). For pretreatment staging, visual analysis of the numbers of nodal and extranodal lesions based on PET/CT was performed. For interim response assessment after cycle 2 of chemotherapy, residual tumor sites were assessed visually and the percentage changes in target lesion size, maximum standardized uptake value (SUVmax ) and apparent diffusion coefficient (ADC) from pretreatment values were calculated. In 12 patients studied pretreatment, there were 46 nodal and 16 extranodal sites of lymphomatous involvement. Agreement between DW-MRI and PET/CT for overall lesion detection was 97% (60/62 tumor sites; 44/46 nodal and 16/16 extranodal lesions) and, for Ann Arbor stage, it was 100%. In the eight patients who had interim assessment, five of their 49 tumor sites remained abnormal on visual analysis of both DW-MRI and PET/CT, and there was one false positive on DW-MRI. Of their 24 target lesions, the mean pretreatment ADC value, tumor size and SUVmax were 772 µm(2) /s, 21.3 cm(2) and 16.9 g/mL, respectively. At interim assessment of the same 24 target lesions, ADC values increased by 85%, tumor size decreased by 74% and SUVmax decreased by 83% (all p < 0.01 versus baseline). DW-MRI provides results comparable with those of PET/CT for staging and early response assessment in patients with DLBCL.
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Farmakis SG, Herman TE, Siegel MJ. Congenital infantile fibrosarcoma. J Perinatol 2014; 34:329-30. [PMID: 24675019 DOI: 10.1038/jp.2013.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/04/2013] [Indexed: 01/22/2023]
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Siegel MJ, Ramirez-Giraldo JC, Graser A. Abdominal dual-source dual-energy CT: Uses in clinical practice. APPLIED RADIOLOGY 2013. [DOI: 10.37549/ar2035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Herman TE, Siegel MJ, Mathur A, Vachharajani A. Neonatal marfan syndrome with hiatus hernia and intrathoracic stomach. J Perinatol 2013; 33:652-3. [PMID: 23897310 DOI: 10.1038/jp.2013.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 11/09/2022]
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Weiser DA, Kaste SC, Siegel MJ, Adamson PC. Imaging in childhood cancer: a Society for Pediatric Radiology and Children's Oncology Group Joint Task Force report. Pediatr Blood Cancer 2013; 60:1253-60. [PMID: 23572212 PMCID: PMC4636336 DOI: 10.1002/pbc.24533] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 02/21/2013] [Indexed: 12/25/2022]
Abstract
Contemporary medical imaging is a cornerstone of care for children with cancer. As 5-year survival rates for children with cancer exceed 80%, imaging technologies have evolved in parallel to include a wide array of modalities. Here, we overview the risks and benefits associated with commonly used imaging modalities and survey the current landscape of medical imaging for children with cancer. We find evidence-based imaging guidelines to assist in protocol development and to guide decision-making for optimal patient care are often lacking. The substantial variation in protocol-based recommendations for imaging both during and following therapy may hinder optimal clinical research and clinical care for children with cancer.
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Siegel MJ, Hildebolt C, Bradley D. Effects of Automated Kilovoltage Selection Technology on Contrast-enhanced Pediatric CT and CT Angiography. Radiology 2013; 268:538-47. [PMID: 23564712 DOI: 10.1148/radiol.13122438] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Siegel MJ, Acharyya S, Hoffer FA, Wyly JB, Friedmann AM, Snyder BS, Babyn PS, Khanna G, Siegel BA. Whole-body MR imaging for staging of malignant tumors in pediatric patients: results of the American College of Radiology Imaging Network 6660 Trial. Radiology 2012; 266:599-609. [PMID: 23264347 DOI: 10.1148/radiol.12112531] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare whole-body magnetic resonance (MR) imaging with conventional imaging for detection of distant metastases in pediatric patients with common malignant tumors. MATERIALS AND METHODS This institutional review board-approved, HIPAA-compliant, multicenter prospective cohort study included 188 patients (109 male, 79 female; mean age, 10.2 years; range, < 1 to 21 years) with newly diagnosed lymphoma, neuroblastoma, or soft-tissue sarcoma. Informed consent was obtained and all patients underwent noncontrast material-enhanced whole-body MR imaging and standard-practice conventional imaging. All images were reviewed centrally by 10 pairs of readers. An independent panel verified the presence or absence of distant metastases. Detection of metastasis with whole-body MR and conventional imaging was quantified by using the area under the receiver operating characteristic curve (AUC). The effects of tumor subtype, patient age, and distant skeletal and pulmonary disease on diagnostic accuracy were also analyzed. RESULTS Of the 134 eligible patients, 66 (33 positive and 33 negative for metastasis) were selected for image review and analysis. Whole-body MR imaging did not meet the noninferiority criterion for accuracy when compared with conventional imaging for detection of metastasis (difference between average AUCs was -0.03 [95% confidence interval: -0.10, 0.04]); however, the average AUC for solid tumors was significantly higher than that for lymphomas (P = .006). More skeletal metastases were detected by using whole-body MR imaging than by using conventional imaging (P = .03), but fewer lung metastases were detected (P < .001). Patient age did not affect accuracy. CONCLUSION The noninferior accuracy for diagnosis of distant metastasis in patients with common pediatric tumors was not established for the use of whole-body MR imaging compared with conventional methods. However, improved accuracy was seen with whole-body MR imaging in patients with nonlymphomatous tumors.
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Herman TE, Siegel MJ. Thanatophoric dysplasia, type I. J Perinatol 2012; 32:476-8. [PMID: 22643294 DOI: 10.1038/jp.2011.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Herman TE, Siegel MJ. Type 2 sacrococcygeal teratoma endodermal sinus tumor. J Perinatol 2011; 31:804-6. [PMID: 22124518 DOI: 10.1038/jp.2011.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hughes D, Siegel MJ. MRI of complex cyanotic congenital heart disease: pre- and post surgical considerations. Int J Cardiovasc Imaging 2010; 26:333-43. [DOI: 10.1007/s10554-010-9732-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 08/15/2010] [Indexed: 11/24/2022]
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Khan O, Filippi M, Freedman MS, Barkhof F, Dore-Duffy P, Lassman H, Trapp B, Bar-Or A, Zak I, J Siegel M, Lisak R. Reply. Ann Neurol 2010. [DOI: 10.1002/ana.22145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Craft JSS, Koby M, Siegel MJ, Resar L, Lee RR, Chu JY, Launius G, Dadash-Zadehm M, Le DeBaun MR. Neuropsychologic Deficits in Children with Sickle Cell Disease and Cerebral Infarction: Role of Lesion Site and Volume. Child Neuropsychol 2010. [DOI: 10.1076/chin.5.2.92.3170] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hughes D, Siegel MJ. Computed Tomography of Adult Congenital Heart Disease. Radiol Clin North Am 2010; 48:817-35. [DOI: 10.1016/j.rcl.2010.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khan O, Filippi M, Freedman MS, Barkhof F, Dore-Duffy P, Lassmann H, Trapp B, Bar-Or A, Zak I, Siegel MJ, Lisak R. Chronic cerebrospinal venous insufficiency and multiple sclerosis. Ann Neurol 2010; 67:286-90. [PMID: 20373339 DOI: 10.1002/ana.22001] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Herman TE, Siegel MJ. Obesity with necrotizing gallstone pancreatitis. Clin Pediatr (Phila) 2010; 49:195-8. [PMID: 19745100 DOI: 10.1177/0009922809344816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Herman TE, Siegel MJ. Fanconi's anemia, type A presenting as VACTERL association with atresia right external auditory canal. J Perinatol 2010; 30:73-6. [PMID: 20038942 DOI: 10.1038/jp.2009.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Herman TE, Siegel MJ. Mullerian dygenesis, renal agenesis, endometriosis, and ascites. Clin Pediatr (Phila) 2010; 49:89-92. [PMID: 19628758 DOI: 10.1177/0009922809338283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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