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Wang L, Liu C, Song H, Yuan J, Zha Y, Deng Y. Update on kidney injury caused by multiple myeloma. Ann Hematol 2024:10.1007/s00277-024-05860-3. [PMID: 38942949 DOI: 10.1007/s00277-024-05860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
Multiple myeloma (MM) is a form of clonal plasma cell malignancy that associates with clinical manifestations such as anemia, hypercalcemia, bone pain, and renal impairment. Approximately 20-50% of MM patients at initial diagnosis experience renal injury, a vital complication that significantly influences prognosis and quality of life. This review seeks to clarify the multifaceted mechanisms of renal injury in MM, scrutinizing the pathogenic role of monoclonal proteins, the impact of hypercalcemia, and direct renal infiltration by plasma cells. Furthermore, it evaluates current diagnostic approaches, reviews management strategies, and highlights potential avenues for future research. By incorporating the latest scientific evidence and insights, this article aims to provide a comprehensive understanding of MM-associated renal impairment, offering a valuable resource for researchers and clinicians in handling this complex complication.
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Affiliation(s)
- Linhui Wang
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Chen Liu
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Haiyan Song
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Yuan
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, Guiyang, China.
| | - Yiyao Deng
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, Guiyang, China.
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Centre for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.
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2
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Park C, Azhideh A, Pooyan A, Alipour E, Haseli S, Satwah I, Chalian M. Diagnostic performance and inter-reader reliability of bone reporting and data system (Bone-RADS) on computed tomography. Skeletal Radiol 2024:10.1007/s00256-024-04721-4. [PMID: 38853160 DOI: 10.1007/s00256-024-04721-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE To evaluate the diagnostic performance and inter-reader reliability of the Bone Reporting and Data System (Bone-RADS) for solitary bone lesions on CT. MATERIALS AND METHODS This retrospective analysis included 179 patients (mean age, 56 ± 18 years; 94 men) who underwent bone biopsies between March 2005 and September 2021. Patients with solitary bone lesions on CT and sufficient histopathology results were included. Two radiologists categorized the bone lesions using the Bone-RADS (1, benign; 4, malignant). The diagnostic performance of the Bone-RADS was calculated using histopathology results as a standard reference. Inter-reader reliability was calculated. RESULTS Bone lesions were categorized into two groups: 103 lucent (pathology: 34 benign, 12 intermediate, 54 malignant, and 3 osteomyelitis) and 76 sclerotic/mixed (pathology: 46 benign, 2 intermediate, 26 malignant, and 2 osteomyelitis) lesions. The Bone-RADS for lucent lesions had sensitivities of 95% and 82%, specificities of 11% and 11%, and accuracies of 57% and 50% for readers 1 and 2, respectively. The Bone-RADS for sclerotic/mixed lesions had sensitivities of 75% and 68%, specificities of 27% and 27%, and accuracies of 45% and 42% for readers 1 and 2, respectively. Inter-reader reliability was moderate to very good (κ = 0.744, overall; 0.565, lucent lesions; and 0.851, sclerotic/mixed lesions). CONCLUSION Bone-RADS has a high sensitivity for evaluating malignancy in lucent bone lesions and good inter-reader reliability. However, it has poor specificity and accuracy for both lucent and sclerotic/mixed lesions. A possible explanation is that proposed algorithms heavily depend on clinical features such as pain and history of malignancy.
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Affiliation(s)
- Chankue Park
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
- OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Arash Azhideh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
- OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Atefe Pooyan
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
- OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ehsan Alipour
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
- OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sara Haseli
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
- OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ishan Satwah
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA.
- OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA.
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3
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Peacock JG, Adams A. When in Doubt, Add SPECT/CT: A Case of Mistaken Identity. J Nucl Med Technol 2024; 52:181-182. [PMID: 38839115 DOI: 10.2967/jnmt.123.266795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Indexed: 06/07/2024] Open
Abstract
A 63-y-old woman with a history of breast cancer presented with concerns of osseous metastasis. Initial whole-body planar bone scintigraphy revealed a focus of concern overlying the sternum. SPECT/CT images revealed the anomaly-localized activity in the needleless hub attached to the chemotherapy port. If not for the precision of SPECT/CT, such a rare artifact could have led to a false-positive diagnosis, particularly impactful in breast cancer patients. This case emphasizes the critical role of SPECT/CT in accurate diagnoses.
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Affiliation(s)
- Justin G Peacock
- Department of Radiology and the Radiological Sciences, Uniformed Services University, Bethesda, Maryland;
- Department of Military Medical Operations, Armed Forces Radiobiology Research Institute, Bethesda, Maryland; and
| | - Amanda Adams
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
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4
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Expósito D, Martel J, Alvarez de Sierra B, Bueno A, Vilanova C, Vilanova JC. Neoplastic and Non-neoplastic Bone Lesions of the Knee. Semin Musculoskelet Radiol 2024; 28:225-247. [PMID: 38768589 DOI: 10.1055/s-0044-1781471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Numerous anatomical variants are described around the knee, many of which look like bony lesions, so it is important to know them to avoid unnecessary complementary tests and inadequate management. Likewise, several alterations in relation to normal development can also simulate bone lesions.However, numerous pathologic processes frequently affect the knee, including traumatic, inflammatory, infectious, and tumor pathology. Many of these entities show typical radiologic features that facilitate their diagnosis. In other cases, a correct differential diagnosis is necessary for proper clinical management.Despite the availability of increasingly advanced imaging techniques, plain radiography is still the technique of choice in the initial study of many of these pathologies. This article reviews the radiologic characteristics of tumor and nontumor lesions that may appear around the knee to make a correct diagnosis and avoid unnecessary complementary radiologic examinations and inadequate clinical management.
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Affiliation(s)
- Diana Expósito
- Department of Radiology, Hospital Sanitas La Moraleja, Madrid, Spain
| | - José Martel
- Department of Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Angel Bueno
- Department of Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Cristina Vilanova
- Department of Orthopaedic Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, Institute of Diagnostic Imaging (IDI) Girona, University of Girona, Girona, Spain
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5
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Chung M, Ton L, Lee AY. Forget Me Not: Incidental Findings on Breast MRI. JOURNAL OF BREAST IMAGING 2024:wbae023. [PMID: 38758984 DOI: 10.1093/jbi/wbae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Indexed: 05/19/2024]
Abstract
With the growing utilization and expanding role of breast MRI, breast imaging radiologists may encounter an increasing number of incidental findings beyond the breast and axilla. Breast MRI encompasses a large area of anatomic coverage extending from the lower neck to the upper abdomen. While most incidental findings on breast MRI are benign, identifying metastatic disease can have a substantial impact on staging, prognosis, and treatment. Breast imaging radiologists should be familiar with common sites, MRI features, and breast cancer subtypes associated with metastatic disease to assist in differentiating malignant from benign findings. Furthermore, detection of malignancies of nonbreast origin as well as nonmalignant, but clinically relevant, incidental findings can significantly impact clinical management and patient outcomes. Breast imaging radiologists should consistently follow a comprehensive search pattern and employ techniques to improve the detection of these important incidental findings.
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Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Ghasemi A, Ahlawat S. Bone Reporting and Data System (Bone-RADS) and Other Proposed Practice Guidelines for Reporting Bone Tumors. ROFO-FORTSCHR RONTG 2024. [PMID: 38490222 DOI: 10.1055/a-2262-8411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND The purpose of this article is to review the different bone tumor radiology reporting systems [Bone Reporting and Data System (Bone-RADS), Osseous Tumor Reporting and Data System (OT-RADS), Solitary Bone Tumor Imaging Reporting and Data System (BTI-RADS), and Radiological Evaluation Score for Bone Tumors (REST)] and summarize their advantages and disadvantages. METHODS A selective search of PubMed was performed for literature regarding the definition and discussion of bone tumor reporting systems. No time frame was selected, but the search was particularly focused on current literature on musculoskeletal radiology lexicon. RESULTS To date, four major reporting systems has been proposed to standardize and systematize the reporting of imaging studies of bone tumors: Bone-RADS, OT-RADS, BTI-RADS, and REST. Both Bone-RADS and OT-RADS aid in the characterization and management of bone lesions on CT and MRI. OT-RADS and REST can be applied to MRI and radiography, respectively. CONCLUSION Radiologists play a central role in the detection and characterization of asymptomatic (or incidentally detected) and symptomatic bone tumors. There are several existing bone tumor reporting systems with various advantages and disadvantages including emphasis on lesion characterization as well as management of incidentally detected bone lesions. KEY POINTS · Four bone tumor reporting systems have been proposed thus far.. · Bone-RADS guides management of incidental bone lesions on CT and MRI.. · OT-RADS guides management of bone lesions on MRI with high accuracy.. · BTI-RADS classifies bone tumors on CT and MRI..
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Affiliation(s)
- Ali Ghasemi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, United States
| | - Shivani Ahlawat
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, United States
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Elaasser B, Arakil N, Mohammad KS. Bridging the Gap in Understanding Bone Metastasis: A Multifaceted Perspective. Int J Mol Sci 2024; 25:2846. [PMID: 38474093 DOI: 10.3390/ijms25052846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The treatment of patients with advanced cancer poses clinical problems due to the complications that arise as the disease progresses. Bone metastases are a common problem that cancer patients may face, and currently, there are no effective drugs to treat these individuals. Prostate, breast, and lung cancers often spread to the bone, causing significant and disabling health conditions. The bone is a highly active and dynamic tissue and is considered a favorable environment for the growth of cancer. The role of osteoblasts and osteoclasts in the process of bone remodeling and the way in which their interactions change during the progression of metastasis is critical to understanding the pathophysiology of this disease. These interactions create a self-perpetuating loop that stimulates the growth of metastatic cells in the bone. The metabolic reprogramming of both cancer cells and cells in the bone microenvironment has serious implications for the development and progression of metastasis. Insight into the process of bone remodeling and the systemic elements that regulate this process, as well as the cellular changes that occur during the progression of bone metastases, is critical to the discovery of a cure for this disease. It is crucial to explore different therapeutic options that focus specifically on malignancy in the bone microenvironment in order to effectively treat this disease. This review will focus on the bone remodeling process and the effects of metabolic disorders as well as systemic factors like hormones and cytokines on the development of bone metastases. We will also examine the various therapeutic alternatives available today and the upcoming advances in novel treatments.
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Affiliation(s)
- Basant Elaasser
- Department of Anatomy, College of Medicine, Alfaisal University, Riyadh 1153, Saudi Arabia
| | - Nour Arakil
- Department of Anatomy, College of Medicine, Alfaisal University, Riyadh 1153, Saudi Arabia
| | - Khalid S Mohammad
- Department of Anatomy, College of Medicine, Alfaisal University, Riyadh 1153, Saudi Arabia
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Dekkers IA, Karst U, Stroomberg G, Clement O, Gianolio E, Nederveen AJ, Radbruch A, Quattrocchi CC. The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS). MAGMA (NEW YORK, N.Y.) 2024; 37:15-25. [PMID: 37702845 PMCID: PMC10876744 DOI: 10.1007/s10334-023-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023]
Abstract
Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 48, 48149, Münster, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Olivier Clement
- Service de Radiologie, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, 20 Rue LeBlanc, 75015, Paris, France
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Via Nizza 52, 10125, Turin, Italy
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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Uhl M, Herget GW. [Bone-RADS: Diagnostic algorithm for management of incidental solitary bone lesions]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:147-160. [PMID: 38260987 DOI: 10.1007/s00117-024-01263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
The bone reporting and data system (Bone-RADS) is a guideline of the Society of Skeletal Radiology for the standardized assessment of incidentally found solitary bone lesions. It consists of basic definitions and continuative algorithms for the radiological diagnosis of bone lesions in computed tomography (CT) and magnetic resonance imaging (MRI). This Continuing Medical Education (CME) article gives a compact summary of the Bone-RADS classification for users. After reading this article Bone-RADS can be used by anyone. The authors have compiled the critical comments and obstacles at the end of the article.
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Affiliation(s)
- Markus Uhl
- Klinik für Diagnostische und Interventionelle Radiologie, Kinderradiologie und Neuroradiologie, Artemed Klinikum Freiburg, Sautierstr. 1, 79104, Freiburg, Deutschland.
| | - Georg W Herget
- Klinik für Orthopädie und Unfallchirurgie des Universitätsklinikums Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
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10
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Nikiforaki K, Marias K. MRI Methods to Visualize and Quantify Adipose Tissue in Health and Disease. Biomedicines 2023; 11:3179. [PMID: 38137400 PMCID: PMC10740979 DOI: 10.3390/biomedicines11123179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
MRI is the modality of choice for a vast range of pathologies but also a sensitive probe into human physiology and tissue function. For this reason, several methodologies have been developed and continuously evolve in order to non-invasively monitor underlying phenomena in human adipose tissue that were difficult to assess in the past through visual inspection of standard imaging modalities. To this end, this work describes the imaging methodologies used in medical practice and lists the most important quantitative markers related to adipose tissue physiology and pathology that are currently supporting diagnosis, longitudinal evaluation and patient management decisions. The underlying physical principles and the resulting markers are presented and associated with frequently encountered pathologies in radiology in order to set the frame of the ability of MRI to reveal the complex role of adipose tissue, not as an inert tissue but as an active endocrine organ.
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Affiliation(s)
- Katerina Nikiforaki
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology—Hellas, 70013 Heraklion, Greece;
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology—Hellas, 70013 Heraklion, Greece;
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece
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11
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Parillo M, van der Molen AJ, Asbach P, Elsholtz FHJ, Laghi A, Ronot M, Wu JS, Mallio CA, Quattrocchi CC. The role of iodinated contrast media in computed tomography structured Reporting and Data Systems (RADS): a narrative review. Quant Imaging Med Surg 2023; 13:7621-7631. [PMID: 37969632 PMCID: PMC10644138 DOI: 10.21037/qims-23-603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective In recent years, there has been a large-scale dissemination of guidelines in radiology in the form of Reporting & Data Systems (RADS). The use of iodinated contrast media (ICM) has a fundamental role in enhancing the diagnostic capabilities of computed tomography (CT) but poses certain risks. The scope of the present review is to summarize the current role of ICM only in clinical reporting guidelines for CT that have adopted the "RADS" approach, focusing on three specific questions per each RADS: (I) what is the scope of the scoring system; (II) how is ICM used in the scoring system; (III) what is the impact of ICM enhancement on the scoring. Methods We analyzed the original articles for each of the latest versions of RADS that can be used in CT [PubMed articles between January, 2005 and March, 2023 in English and American College of Radiology (ACR) official website]. Key Content and Findings We found 14 RADS suitable for use in CT out of 28 RADS described in the literature. Four RADS were validated by the ACR: Colonography-RADS (C-RADS), Liver Imaging-RADS (LI-RADS), Lung CT Screening-RADS (Lung-RADS), and Neck Imaging-RADS (NI-RADS). One RADS was validated by the ACR in collaboration with other cardiovascular scientific societies: Coronary Artery Disease-RADS 2.0 (CAD-RADS). Nine RADS were proposed by other scientific groups: Bone Tumor Imaging-RADS (BTI-RADS), Bone‑RADS, Coronary Artery Calcium Data & Reporting System (CAC-DRS), Coronavirus Disease 2019 Imaging-RADS (COVID-RADS), COVID-19-RADS (CO-RADS), Interstitial Lung Fibrosis Imaging-RADS (ILF-RADS), Lung-RADS (LU-RADS), Node-RADS, and Viral Pneumonia Imaging-RADS (VP-RADS). Conclusions This overview suggests that ICM is not strictly necessary for the study of bones and calcifications (CAC-DRS, BTI-RADS, Bone-RADS), lung parenchyma (Lung-RADS, LU-RADS, COVID-RADS, CO-RADS, VP-RADS and ILF-RADS), and in CT colonography (C-RADS). On the other hand, ICM plays a key role in CT angiography (CAD-RADS), in the study of liver parenchyma (LI-RADS), and in the evaluation of soft tissues and lymph nodes (NI-RADS, Node-RADS). Future studies are needed in order to evaluate the impact of the new iodinated and non-iodinate contrast media, artificial intelligence tools and dual energy CT in the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Aart J. van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Asbach
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Radiology, Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Henry Jürgen Elsholtz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Radiology, Campus Benjamin Franklin, Berlin, Germany
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology-Sapienza University of Rome, Roma, Italy
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon, AP-HP Nord, Clichy, France
- Université Paris Cité, CRI UMR1148, Paris, France
| | - Jim S. Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Aboulafia AJ. CORR Insights®: What Is the Prevalence of Clinically Important Findings Among Incidentally Found Osseous Lesions? Clin Orthop Relat Res 2023; 481:2003-2004. [PMID: 37229545 PMCID: PMC10499093 DOI: 10.1097/corr.0000000000002710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Albert J Aboulafia
- Associate Professor, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Blackburn CW, Richardson SM, DeVita RR, Dong O, Faraji N, Wurtz LD, Collier CD, Getty PJ. What Is the Prevalence of Clinically Important Findings Among Incidentally Found Osseous Lesions? Clin Orthop Relat Res 2023; 481:1993-2002. [PMID: 36975798 PMCID: PMC10499109 DOI: 10.1097/corr.0000000000002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Patients with incidentally found musculoskeletal lesions are regularly referred to orthopaedic oncology. Most orthopaedic oncologists understand that many incidental findings are nonaggressive and can be managed nonoperatively. However, the prevalence of clinically important lesions (defined as those indicated for biopsy or treatment, and those found to be malignant) remains unknown. Missing clinically important lesions can result in harm to patients, but needless surveillance may exacerbate patient anxiety about their diagnosis and accrue low-value costs to the payor. QUESTIONS/PURPOSES (1) What percentage of patients with incidentally discovered osseous lesions referred to orthopaedic oncology had lesions that were clinically important, defined as those receiving biopsy or treatment or those found to be malignant? (2) Using standardized Medicare reimbursements as a surrogate for payor expense, what is the value of reimbursements accruing to the hospital system for the imaging of incidentally found osseous lesions performed during the initial workup period and during the surveillance period, if indicated? METHODS This was a retrospective study of patients referred to orthopaedic oncology for incidentally found osseous lesions at two large academic hospital systems. Medical records were queried for the word "incidental," and matches were confirmed by manual review. Patients evaluated at Indiana University Health between January 1, 2014, and December 31, 2020, and those evaluated at University Hospitals between January 1, 2017, and December 31, 2020, were included. All patients were evaluated and treated by the two senior authors of this study and no others were included. Our search identified 625 patients. Sixteen percent (97 of 625) of patients were excluded because their lesions were not incidentally found, and 12% (78 of 625) were excluded because the incidental findings were not bone lesions. Another 4% (24 of 625) were excluded because they had received workup or treatment by an outside orthopaedic oncologist, and 2% (10 of 625) were excluded for missing information. A total of 416 patients were available for preliminary analysis. Among these patients, 33% (136 of 416) were indicated for surveillance. The primary indication for surveillance included lesions with a benign appearance on imaging and low clinical suspicion of malignancy or fracture. A total of 33% (45 of 136) of these patients had less than 12 months of follow-up and were excluded from further analysis. No minimum follow-up criteria were applied to patients not indicated for surveillance because this would artificially inflate our estimated rate of clinically important findings. A total of 371 patients were included in the final study group. Notes from all clinical encounters with orthopaedic and nonorthopaedic providers were screened for our endpoints (biopsy, treatment, or malignancy). Indications for biopsy included lesions with aggressive features, lesions with nonspecific imaging characteristics and a clinical picture concerning for malignancy, and lesion changes seen on imaging during the surveillance period. Indications for treatment included lesions with increased risk of fracture or deformity, certain malignancies, and pathologic fracture. Diagnoses were determined using biopsy results if available or the documented opinion of the consulting orthopaedic oncologist. Imaging reimbursements were obtained from the Medicare Physician Fee Schedule for 2022. Because imaging charges vary across institutions and reimbursements vary across payors, this method was chosen to enhance the comparability of our findings across multiple health systems and studies. RESULTS Seven percent (26 of 371) of incidental findings were determined to be clinically important, as previously defined. Five percent (20 of 371) of lesions underwent tissue biopsy, and 2% (eight of 371) received surgical intervention. Fewer than 2% (six of 371) of lesions were malignant. Serial imaging changed the treatment of 1% (two of 136) of the patients, corresponding to a rate of one in 47 person-years. Median reimbursements to work up the incidental findings analyzed was USD 219 (interquartile range USD 0 to 404), with a range of USD 0 to 890. Among patients indicated for surveillance, the median annual reimbursement was USD 78 (IQR USD 0 to 389), with a range of USD 0 to 2706. CONCLUSION The prevalence of clinically important findings among patients referred to orthopaedic oncology for incidentally found osseous lesions is modest. The likelihood of surveillance resulting in a change of management was low, but the median reimbursements associated with following these lesions was also low. We conclude that after appropriate risk stratification by orthopaedic oncology, incidental lesions are rarely clinically important, and judicious follow-up with serial imaging can be performed without incurring high costs. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Collin W. Blackburn
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Spencer M. Richardson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert R. DeVita
- Department of Radiology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Oliver Dong
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Navid Faraji
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - L. Daniel Wurtz
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher D. Collier
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick J. Getty
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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LaPrade CM, Andryk LM, Christensen JL, Neilson JC, Wooldridge AN, Hackbarth DA, Bedi M, King DM. Natural history of intraosseous low-grade chondroid lesions of the proximal humerus. Front Oncol 2023; 13:1200286. [PMID: 37637054 PMCID: PMC10457155 DOI: 10.3389/fonc.2023.1200286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Enchondromas and grade 1 chondrosarcomas are commonly encountered low-grade chondroid tumors in the proximal humerus. While there is a concern for malignant transformation, few studies have evaluated the natural history of these lesions. The purpose of this study is to evaluate the natural history of proximal humerus low-grade chondroid lesions managed both conservatively and surgically, and to define management criteria using clinical and radiographic findings for these low-grade chondroid lesions. Methods The patient population included 90 patients intended for conservative treatment and 22 patients proceeding directly to surgery. Data collection was based on a combination of chart review and patient imaging and descriptive statistics were calculated for each group. Results No malignant transformations were noted amongst any group. In the conservative treatment group, 7 of 64 (11%) progressed to surgery after an average of 20.3 months of conservative treatment due to persistent pain unexplained by other shoulder pathology. Importantly, 71% experienced continued pain at a mean of 53.1 months post-operatively. The group that went directly to surgery also demonstrated pain in 41% at an average follow-up of 57.3 months. Discussion Low-grade cartilaginous lesions of the proximal humerus without concerning imaging findings can be managed with conservative treatment and the risk of malignant transformation is very low. Patients with a clear source of their shoulder pain unrelated to their tumor and without concerning characteristics on imaging can be managed with serial annual radiographic imaging. Patients undergoing surgery for these indolent tumors are likely to experience persistent pain even after surgery.
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Affiliation(s)
| | - Logan M. Andryk
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joshua L. Christensen
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - John C. Neilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam N. Wooldridge
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Donald A. Hackbarth
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David M. King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
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15
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Ribeiro GJ, Gillet R, Blum A, Teixeira PAG. Imaging report and data system (RADS) for bone tumors: where do we stand and future directions. Skeletal Radiol 2023; 52:151-156. [PMID: 36074158 DOI: 10.1007/s00256-022-04179-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Affiliation(s)
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France
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Hoffman RJ, Stanborough RO, Garner HW. Diagnostic Imaging Approach to Solitary Bone Lesions. Semin Roentgenol 2022; 57:241-251. [DOI: 10.1053/j.ro.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/11/2022]
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