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Gao T, Wei L, Jiang L, Ma S, Zhang W, Zhang Y, Wu F. Dose-Volume Parameters of Spared Magnetic Resonance Imaging-Defined Active Bone Marrow Predict Hematologic Toxicity in Pelvic Malignancies Patients Undergoing Radiotherapy: A Cohort Study. Technol Cancer Res Treat 2024; 23:15330338241255283. [PMID: 38752234 PMCID: PMC11102680 DOI: 10.1177/15330338241255283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024] Open
Abstract
Background: The objective of this investigation is to evaluate the superiority of dose-volume parameters relying on magnetic resonance imaging (MRI)-defined active bone marrow (ABM) over those based on total bone marrow (TBM) contoured via CT in the prediction of hematologic toxicity (HT) occurrence among patients with pelvic malignancies undergoing radiotherapy. Methods: The clinical data of 116 patients with pelvic malignancies treated with pelvic radiotherapy were analyzed retrospectively. The ABM areas on T1-weighted MRI were contoured. The statistical significance between TBM and ABM dose-volume measures was assessed through the utilization of either Student's t-test or Wilcoxon signed rank test. Logistic and linear regression models were employed to analyze the correlation between dose-volume parameters (V5-V50) and HT occurrence in pelvic ABM and TBM. Receiver operating characteristic (ROC) curves were used to compare predictors of HT2+. Results: There were significant differences in dosimetric parameters between ABM and TBM. Logistic regression analysis showed that ABM V5, ABM V10, ABM V15, ABM V20, and TBM V5 were significantly associated with the occurrence of HT2+ in pelvic malignancies. Linear regression analysis showed that ABM V5, ABM V10, and ABM V15 were significantly associated with white blood cell (WBC), absolute neutrophil count (ANC), hemoglobin (Hb), and lymphocyte (Lym) nadir. ABM V5, ABM V10, ABM V15, and ABM V30 were predictive of HT2+. Conclusions: More accurate prediction of HT in patients receiving pelvic radiotherapy may be achieved by relying on dose-volume parameters of MRI-based ABM. Further prospective studies are needed to confirm this.
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Affiliation(s)
- Ting Gao
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Liqun Wei
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Li Jiang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Shanshan Ma
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Wei Zhang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Yong Zhang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Fang Wu
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
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Wendling D, Meyer F, Chouk M, Verhoeven F, Prati C. Bone marrow replacement. Joint Bone Spine 2023; 90:105541. [PMID: 36758892 DOI: 10.1016/j.jbspin.2023.105541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHU de Besançon, université de Franche-Comté, boulevard Fleming, 25030 Besançon, France.
| | - Frédéric Meyer
- Service de rhumatologie, CHU de Besançon, université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Mickael Chouk
- Service de rhumatologie, CHU de Besançon, université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Frank Verhoeven
- Service de rhumatologie, CHU de Besançon, université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, CHU de Besançon, université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
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Qin X, Gong G, Wang L, Su Y, Yin Y. Dosimetric evaluation of bone marrow sparing in proton radiotherapy for cervical cancer guided by MR functional imaging. Radiat Oncol 2022; 17:207. [PMID: 36517839 PMCID: PMC9753489 DOI: 10.1186/s13014-022-02175-3] [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: 09/21/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To segment the pelvic active bone marrow (PABM) using magnetic resonance (MR) functional imaging and investigate the feasibility and dosimetric characteristics of cervical cancer proton radiotherapy for active bone marrow (ABM) sparing. METHODS We collected CT and MR simulation images of 33 patients with cervical cancer retrospectively. The PBM was contoured on the MRI FatFrac images; the PBM was divided into high-active bone marrow (ABM-high) and low-active bone marrow based on the fat content of the PBM. Four radiotherapy plans were created for each patient, which included intensity-modulated photon therapy (IMRT), bone marrow sparing IMRT (IMRT-BMS), intensity-modulated proton therapy (IMPT), and bone marrow sparing IMPT (IMPT-BMS). The dosimetric differences among the four plans were compared. RESULTS The ABM-high volume in the enrolled patients accounted for 45.2% of the total ABM volume. The target coverage was similar among the four radiotherapy plans. IMRT-BMS, IMPT, and IMPT-BMS reduced the Dmean of ABM-high by 16.6%, 14.2%, and 44.5%, respectively, compared to the Dmean of IMRT (p < 0.05). IMPT-BMS had the best protective effect on the bone marrow. Compared to IMRT, the volume of ABM-high receiving an irradiation dose of 5-40 Gy decreased by 10.2%, 36.8%, 58.8%, 67.4%, 64.9%, and 44.5%, respectively (p < 0.001). CONCLUSIONS The MR functional imaging technique helped in the grading and segmentation of PABM. MR functional image-guided proton radiotherapy for cervical cancer can achieve optimal BMS.
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Affiliation(s)
- Xiaohang Qin
- grid.410587.fDepartment of Graduate, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China ,grid.410587.fDepartment of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- grid.410587.fDepartment of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lizhen Wang
- grid.410587.fDepartment of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ya Su
- grid.410587.fDepartment of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- grid.410587.fDepartment of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Aparisi Gómez MP, Ayuso Benavent C, Simoni P, Musa Aguiar P, Bazzocchi A, Aparisi F. Imaging of Bone Marrow: From Science to Practice. Semin Musculoskelet Radiol 2022; 26:396-411. [PMID: 36103883 DOI: 10.1055/s-0042-1745803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The study of the bone marrow may pose important challenges, due to its changing features over the life span, metabolic stress, and in cases of disease or treatment. Bone marrow adipocytes serve as storage tissue, but they also have endocrine and paracrine functions, contributing to local and systemic metabolism.Among different techniques, magnetic resonance (MR) has the benefit of imaging bone marrow directly. The use of advanced MR techniques for bone marrow study has rapidly found clinical applications. Beyond the clinical uses, it has opened up pathways to assess and quantify bone marrow components, establishing the groundwork for further study of its implications in physiologic and pathologic conditions.We summarize the features of the bone marrow as an organ, address the different modalities available for its study, with a special focus on MR advanced techniques and their addition to analysis in recent years, and review some of the challenges in interpreting the appearance of bone marrow.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | | | - Paolo Simoni
- Department of Radiology, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem, Porto Alegre - RS, Brazil
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
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Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers (Basel) 2022; 14:cancers14143480. [PMID: 35884541 PMCID: PMC9317366 DOI: 10.3390/cancers14143480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023] Open
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.
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Imaging of the Aging Spine. Radiol Clin North Am 2022; 60:629-640. [DOI: 10.1016/j.rcl.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Musa Aguiar P, Zarantonello P, Aparisi Gómez MP. Differentiation Between Osteoporotic And Neoplastic Vertebral Fractures: State Of The Art And Future Perspectives. Curr Med Imaging 2021; 18:187-207. [PMID: 33845727 DOI: 10.2174/1573405617666210412142758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
Vertebral fractures are a common condition, occurring in the context of osteoporosis and malignancy. These entities affect a group of patients in the same age range; clinical features may be indistinct and symptoms non-existing, and thus present challenges to diagnosis. In this article, we review the use and accuracy of different imaging modalities available to characterize vertebral fracture etiology, from well-established classical techniques, to the role of new and advanced imaging techniques, and the prospective use of artificial intelligence. We also address the role of imaging on treatment. In the context of osteoporosis, the importance of opportunistic diagnosis is highlighted. In the near future, the use of automated computer-aided diagnostic algorithms applied to different imaging techniques may be really useful to aid on diagnosis.
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Affiliation(s)
- Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
| | - Paola Zarantonello
- Department of paediatric orthopedics and traumatology, IRCCS Istituto Ortopedico Rizzoli; Via G. C. Pupilli 1, 40136 Bologna. Italy
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Differentiation of Vertebral Metastases From Focal Hematopoietic Marrow Depositions on MRI: Added Value of Proton Density Fat Fraction. AJR Am J Roentgenol 2021; 216:734-741. [PMID: 33405947 DOI: 10.2214/ajr.19.22698] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the added value of proton density fat fraction (PDFF) in differentiating vertebral metastases from focal hematopoietic marrow depositions. MATERIALS AND METHODS. The study included 44 patients with 30 vertebral metastases and 14 focal hematopoietic marrow depositions who underwent spinal MRI. The final diagnoses were based on histologic confirmation, follow-up MRI, or PET/CT. Two musculoskeletal radiologists with 1 and 15 years of experience independently interpreted both image sets (i.e., images from conventional MRI alone versus images from conventional MRI and PDFF combined). Using a 5-point scale, the readers scored their confidence in the malignancy of the vertebral lesions. The diagnostic performance (AUC) of the two image sets was assessed via ROC curve analyses. Sensitivities, specificities, and accuracies (for both image sets) were compared using the McNemar test. Kappa coefficients were calculated to assess interobserver agreement. RESULTS. Both readers showed improved diagnostic performance after PDFF was added (AUC, 0.840-0.912 and 0.805-0.895 for readers 1 and 2, respectively). However, adding PDFF did not significantly improve the sensitivity and specificity of either reader (p > .05). Interobserver agreement significantly improved from moderate (κ = 0.563) to excellent (κ = 0.947) after PDFF was added. CONCLUSION. The addition of PDFF to a conventional MRI protocol improved the diagnostic performance for differentiating vertebral metastases from focal hematopoietic marrow depositions but without resulting in significant improvement in sensitivity and specificity.
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Kuncman Ł, Stawiski K, Masłowski M, Kucharz J, Fijuth J. Dose-volume parameters of MRI-based active bone marrow predict hematologic toxicity of chemoradiotherapy for rectal cancer. Strahlenther Onkol 2020; 196:998-1005. [PMID: 32621010 PMCID: PMC7653786 DOI: 10.1007/s00066-020-01659-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/13/2020] [Indexed: 01/22/2023]
Abstract
Purpose Magnetic resonance imaging (MRI) is routinely used for locoregional staging of rectal cancer and offers promise for the prediction of hematologic toxicity. The present study compares the clinical utility of MRI-based active bone marrow (BMact) delineation with that of CT-based bone marrow total (BMtot) delineation for predicting hematologic toxicity. Methods A prospective cohort study was performed. Eligible patients had stage II/III rectal cancer and qualified for preoperative chemoradiotherapy. The BMact areas on T1-weighted MRI were contoured. The impact of the dose–volume parameters of BMact/BMtot and clinical data on hematologic toxicity were assessed. Basic endpoints were the occurrence of grade 3/4 hematologic toxicity and peripheral blood parameters reaching a nadir. Linear regression models were generated for the nadirs and receiver operating characteristic (ROC) curves for the occurrence of grade 3/4 hematologic toxicity. Results Thirty-five patients were enrolled. Women presented higher dose–volume parameters of BMact, BMtot, and lymphocyte nadir (ALCnadir%) than men. Models for the prediction of ALCnadir% (V5-V20BMtot, V5-V30BMact) and platelet nadir (PLTnadir%; V5-V10BMtot, V5-V20BMact) were statistically significant. In the ROC curves, a baseline lymphocyte level of 1.81 × 103/ml was adopted as the cutoff for predicting grade 3/4 lymphopenia, with specificity of 77.8% and sensitivity of 73.1%. The multivariate linear regression model for ALCnadir% had R2 = 0.53, p = 0.038. In the tenth step of selection, V5BMact (p = 0.002) and gender (p = 0.019) remained. The multivariate linear regression model for PLTnadir% had R2 = 0.20, p = 0.34. In the sixth step of selection, V15BMact remained (p = 0.026). Conclusion The dose–volume parameters of BMact serve as better predictors of ALCnadir% and PLTnadir% than BMtot.
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Affiliation(s)
- Łukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, Zakład Radioterapii, W.W.C.O.iT. im. M. Kopernika w Łodzi, Pabianicka 62 street, 93-513, Łódź, Poland. .,Department of External Beam Radiotherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Zakład Teleradioterapii, Wojewódzkie W.W.C.O.iT. im. M. Kopernika w Łodzi, Pabianicka 62 street, 93-513, Łódź, Poland.
| | - Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Zakład Biostatystyki i Medycyny Translacyjnej, Cenrum Mazowiecka 15 street, 92-215, Łódź, Poland
| | - Michał Masłowski
- Department of External Beam Radiotherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Zakład Teleradioterapii, Wojewódzkie W.W.C.O.iT. im. M. Kopernika w Łodzi, Pabianicka 62 street, 93-513, Łódź, Poland
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Klinika Nowotworów Układu Moczowego, Centrum Onkologii-Instytut im. Marii Skłodowskiej-Curie ul. Roentgena 5, 02-781, Warszawa, Poland
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, Zakład Radioterapii, W.W.C.O.iT. im. M. Kopernika w Łodzi, Pabianicka 62 street, 93-513, Łódź, Poland.,Department of External Beam Radiotherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Zakład Teleradioterapii, Wojewódzkie W.W.C.O.iT. im. M. Kopernika w Łodzi, Pabianicka 62 street, 93-513, Łódź, Poland
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Role of diffusion-weighted magnetic resonance imaging in the evaluation of vertebral bone marrow lesions. Pol J Radiol 2020; 85:e215-e223. [PMID: 32612719 PMCID: PMC7315053 DOI: 10.5114/pjr.2020.95441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/10/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating vertebral marrow pathologies. To determine the sensitivity, specificity, and threshold apparent diffusion coefficient (ADC) values that can aid in the differentiation of malignant from benign bone marrow lesions. Material and methods This observational study included 100 patients, who underwent MRI examination with a 1.5 Tesla scanner. The ADC values of normal and pathological vertebrae were estimated, and the threshold ADC values were computed by receiver operating characteristic (ROC) analysis. The results were correlated with histopathological diagnosis, clinical follow-up, and other investigations. Statistical analysis was done by employing unpaired two-tailed Student’s t-test and the p-value of < 0.05 was deemed as statistically significant. Results Vertebral bone marrow lesions had a male predominance and there was a predilection towards thoracic and lumbar vertebrae, with L4 being the commonest. Metastasis was the commonest lesion, followed by spondylodiscitis. The mean ADC value of benign pathologies was significantly greater than malignant pathologies (p < 0.05). The threshold value for the demarcation between benign and malignant pathologies was computed to be 1.21 × 10-3 mm2/s. DW imaging had sensitivity of 100%, specificity of 92.31%, positive predictive value of 87.5%, and negative predictive value of 100%. Conclusions Vertebral marrow lesions can be differentiated as benign or malignant with good sensitivity and specificity with the help of DW-ADC maps.
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Diagnostic accuracy of diffusion tensor imaging in differentiating malignant from benign compressed vertebrae. Neuroradiology 2019; 61:1291-1296. [DOI: 10.1007/s00234-019-02286-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/26/2019] [Indexed: 12/23/2022]
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