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Lee JO, Kim DH, Chae HD, Lee E, Kang JH, Lee JH, Kim HJ, Seo J, Chai JW. Assessing visibility and bone changes of spinal metastases in CT scans: a comprehensive analysis across diverse cancer types. Skeletal Radiol 2024; 53:1553-1561. [PMID: 38407627 DOI: 10.1007/s00256-024-04623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To analyze the characteristics of spinal metastasis in CT scans across diverse cancers for effective diagnosis and treatment, using MRI as the gold standard. METHODS A retrospective study of 309 patients from four centers, who underwent concurrent CT and spinal MRI, revealing spinal metastasis, was conducted. Data on metastasis including total number, volume, visibility on CT (visible, indeterminate, or invisible), and type of bone change were collected. Through chi-square and Mann-Whitney U tests, we characterized the metastasis across diverse cancers and investigated the variation in the intra-individual ratio representing the percentage of lesions within each category for each patient. RESULTS Out of 3333 spinal metastases from 309 patients, 55% were visible, 21% indeterminate, and 24% invisible. Sclerotic and lytic lesions made up 47% and 43% of the visible and indeterminate categories, respectively. Renal cell carcinoma (RCC), prostate cancer, and hepatocellular carcinoma (HCC) had the highest visibility at 86%, 73%, and 67% (p < 0.0001, p < 0.0001, and p = 0.003), while pancreatic cancer was lowest at 29% (p < 0.0001). RCC and HCC had significantly high lytic metastasis ratios (interquartile range (IQR) 0.96-1.0 and 0.31-1.0, p < 0.001 and p = 0.005). Prostate cancer exhibited a high sclerotic lesion ratio (IQR 0.52-0.97, p < 0.001). About 39% of individuals had invisible or indeterminate lesions, even with a single visible lesion on CT. The intra-individual ratio for indeterminate and invisible metastases surpassed 18%, regardless of the maximal size of the visible metastasis. CONCLUSIONS This study highlights the variability in characteristics of spinal metastasis based on the primary cancer type through unique lesion-centric analysis.
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Affiliation(s)
- Jung Oh Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
| | - Hee-Dong Chae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea
| | - Ji Hee Kang
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jiwoon Seo
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jee Won Chai
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
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Gille R, Allignet B, Izarn F, Peyrat P, Boyle H, Fléchon A. Bone Metastases in Non-Seminomatous Germ Cell Tumors: A 20-Year Retrospective Analysis. J Clin Med 2024; 13:3280. [PMID: 38892991 PMCID: PMC11172778 DOI: 10.3390/jcm13113280] [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: 03/30/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Non-seminomatous germ cell tumors (NSGCTs) represent a rare yet the most prevalent malignancy among young men. Bone metastases (BMs) are exceedingly uncommon in this neoplasm, and available data regarding the initial disease presentation, survival outcomes, and prognostic significance of BMs are limited. Methods: We conducted a retrospective analysis of 40 NSGCT patients with BMs treated between 2001 and 2021 in our tertiary care center. The cohort was stratified into synchronous (n = 29) and metachronous (n = 11) groups based on the presence of BM at diagnosis or only at relapse, respectively. We assessed overall survival (OS), progression-free survival (PFS), disease presentation, and treatments. Results: After a median follow-up of 93 months, the 5-year PFS and OS rates were 37.6% and 53.9% in the synchronous group and 18.2% and 36.4% in the metachronous group, respectively. At the initial diagnosis, most patients were classified into the IGCCCG poor prognostic group (n = 34, 85%). BMs were mostly asymptomatic (n = 23, 57.5%), involved the spine (n = 37, 92.5%), and could become visible only after disease response (n = 4, 10%). A pathological examination of resected bone lesions after first-line treatment revealed necrosis (n = 5, 71.4%), teratoma, or seminoma (both n = 1, 14.3%). At first relapse, eight patients in the synchronous group did not experience bone recurrence, while eight patients experienced recurrence at the initial affected bone site. Conclusions: In NSGCT patients, BMs often present asymptomatically and may initially be unnoticed. However, these patients may have a poorer prognosis compared to those in the IGCCCG poor prognostic group. Further studies including control groups are needed to assess the independent prognostic significance of BMs.
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Affiliation(s)
- Romane Gille
- Campus Lyon Sud Charles Mérieux, University Claude-Bernard Lyon 1, 69921 Oullins-Pierre-Bénite, France;
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
| | - Benoît Allignet
- Department of Radiation Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France;
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1 , CNRS, Inserm, CREATIS UMR 5220, U1294, 69621 Lyon, France
| | - Floriane Izarn
- Campus Lyon Sud Charles Mérieux, University Claude-Bernard Lyon 1, 69921 Oullins-Pierre-Bénite, France;
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
| | - Patrice Peyrat
- Department of Surgery, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France;
| | - Helen Boyle
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
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Liu MC, Ho CC, Lin YT, Chai JW, Hung SW, Wu CH, Li JR, Liu YJ. Opportunistic screening with multiphase contrast-enhanced dual-layer spectral CT for osteoblastic lesions in prostate cancer compared with bone scintigraphy. Sci Rep 2024; 14:5310. [PMID: 38438474 PMCID: PMC10912417 DOI: 10.1038/s41598-024-55427-5] [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] [Received: 11/23/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
Our study aimed to compare bone scintigraphy and dual-layer detector spectral CT (DLCT) with multiphase contrast enhancement for the diagnosis of osteoblastic bone lesions in patients with prostate cancer. The patients with prostate cancer and osteoblastic bone lesions detected on DLCT were divided into positive bone scintigraphy group (pBS) and negative bone scintigraphy group (nBS) based on bone scintigraphy. A total of 106 patients (57 nBS and 49 pBS) was included. The parameters of each lesion were measured from DLCT including Hounsfield unit (HU), 40-140 keV monochromatic HU, effective nuclear numbers (Zeff), and Iodine no water (InW) value in non-contrast phase (N), the arterial phase (A), and venous phase (V). The slope of the spectral curve at 40 and 100 keV, the different values of the parameters between A and N phase (A-N), V and N phase (V-N), and hybrid prediction model with multiparameters were used to differentiate pBS from nBS. Receiver operating characteristic analysis was performed to compare the area under the curve (AUC) for differentiating the pBS group from the nBS group. The value of conventional HU values, slope, and InW in A-N and V-N, and hybrid model were significantly higher in the pBS group than in the nBS group. The hybrid model of all significant parameters had the highest AUC of 0.988, with 95.5% sensitivity and 94.6% specificity. DLCT with arterial contrast enhancement phase has the potential to serve as an opportunistic screening tool for detecting positive osteoblastic bone lesions, corresponding to those identified in bone scintigraphy.
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Affiliation(s)
- Ming-Cheng Liu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Ph.D. Program of Electrical and Communications Engineering, Feng Chia University, Taichung, Taiwan, ROC
| | - Chi-Chang Ho
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yen-Ting Lin
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Siu-Wan Hung
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chen-Hao Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan, ROC
| | - Yi-Jui Liu
- Ph.D. Program of Electrical and Communications Engineering, Feng Chia University, Taichung, Taiwan, ROC.
- Department of Automatic Control Engineering, Feng Chia University, No. 100 Wenhwa Rd., Xitun Dist., Taichung, 407102, Taiwan, ROC.
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Perrella A, Bagnacci G, Di Meglio N, Di Martino V, Mazzei MA. Thoracic Diseases: Technique and Applications of Dual-Energy CT. Diagnostics (Basel) 2023; 13:2440. [PMID: 37510184 PMCID: PMC10378112 DOI: 10.3390/diagnostics13142440] [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: 05/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Dual-energy computed tomography (DECT) is one of the most promising technological innovations made in the field of imaging in recent years. Thanks to its ability to provide quantitative and reproducible data, and to improve radiologists' confidence, especially in the less experienced, its applications are increasing in number and variety. In thoracic diseases, DECT is able to provide well-known benefits, although many recent articles have sought to investigate new perspectives. This narrative review aims to provide the reader with an overview of the applications and advantages of DECT in thoracic diseases, focusing on the most recent innovations. The research process was conducted on the databases of Pubmed and Cochrane. The article is organized according to the anatomical district: the review will focus on pleural, lung parenchymal, breast, mediastinal, lymph nodes, vascular and skeletal applications of DECT. In conclusion, considering the new potential applications and the evidence reported in the latest papers, DECT is progressively entering the daily practice of radiologists, and by reading this simple narrative review, every radiologist will know the state of the art of DECT in thoracic diseases.
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Affiliation(s)
- Armando Perrella
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Giulio Bagnacci
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Nunzia Di Meglio
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Vito Di Martino
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
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Confavreux CB, Follet H, Mitton D, Pialat JB, Clézardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. Cancers (Basel) 2021; 13:cancers13225711. [PMID: 34830865 PMCID: PMC8616502 DOI: 10.3390/cancers13225711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.
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Affiliation(s)
- Cyrille B. Confavreux
- Centre Expert des Métastases Osseuses (CEMOS), Département de Rhumatologie, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
- Correspondence:
| | - Helene Follet
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
| | - David Mitton
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC, UMR_T 9406, 69622 Lyon, France;
| | - Jean Baptiste Pialat
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- CREATIS, CNRS UMR 5220, INSERM U1294, INSA Lyon, Université Jean Monnet Saint-Etienne, 42000 Saint-Etienne, France
- Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
| | - Philippe Clézardin
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
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