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Schlicht F, Vosshenrich J, Donners R, Seifert AC, Fenchel M, Nickel D, Obmann M, Harder D, Breit HC. Advanced deep learning-based image reconstruction in lumbar spine MRI at 0.55 T - Effects on image quality and acquisition time in comparison to conventional deep learning-based reconstruction. Eur J Radiol Open 2024; 12:100567. [PMID: 38711678 PMCID: PMC11070664 DOI: 10.1016/j.ejro.2024.100567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
Objectives To evaluate an optimized deep leaning-based image post-processing technique in lumbar spine MRI at 0.55 T in terms of image quality and image acquisition time. Materials and methods Lumbar spine imaging was conducted on 18 patients using a 0.55 T MRI scanner, employing conventional (CDLR) and advanced (ADLR) deep learning-based post-processing techniques. Two musculoskeletal radiologists visually evaluated the images using a 5-point Likert scale to assess image quality and resolution. Quantitative assessment in terms of signal intensities (SI) and contrast ratios was performed by region of interest measurements in different body-tissues (vertebral bone, intervertebral disc, spinal cord, cerebrospinal fluid and autochthonous back muscles) to investigate differences between CDLR and ADLR sequences. Results The images processed with the advanced technique (ADLR) were rated superior to the conventional technique (CDLR) in terms of signal/contrast, resolution, and assessability of the spinal canal and neural foramen. The interrater agreement was moderate for signal/contrast (ICC = 0.68) and good for resolution (ICC = 0.77), but moderate for spinal canal and neuroforaminal assessability (ICC = 0.55). Quantitative assessment showed a higher contrast ratio for fluid-sensitive sequences in the ADLR images. The use of ADLR reduced image acquisition time by 44.4%, from 14:22 min to 07:59 min. Conclusions Advanced deep learning-based image reconstruction algorithms improve the visually perceived image quality in lumbar spine imaging at 0.55 T while simultaneously allowing to substantially decrease image acquisition times. Clinical relevance Advanced deep learning-based image post-processing techniques (ADLR) in lumbar spine MRI at 0.55 T significantly improves image quality while reducing image acquisition time.
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Affiliation(s)
- Felix Schlicht
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Alina Carolin Seifert
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Matthias Fenchel
- Siemens Healthcare GmbH, Magnetic Resonance, Allee am Röthelheimpark 2, Erlangen 91052, Germany
| | - Dominik Nickel
- Siemens Healthcare GmbH, Magnetic Resonance, Allee am Röthelheimpark 2, Erlangen 91052, Germany
| | - Markus Obmann
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Hanns-Christian Breit
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
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Andres L, Donners R, Harder D, Burssens A, Nüesch C, Krähenbühl N. Association Between Weightbearing CT and MRI Findings in Progressive Collapsing Foot Deformity. Foot Ankle Int 2024; 45:526-534. [PMID: 38419185 PMCID: PMC11083736 DOI: 10.1177/10711007241231221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Weightbearing computed tomography (WBCT) scans allow for a better understanding of foot alignment in patients suffering from progressive collapsing foot deformity (PCFD). However, soft tissue integrity (eg, spring ligament complex or tibialis posterior tendon) cannot be easily assessed via WBCT. As performing both WBCT and magnetic resonance imaging (MRI) might not be cost effective, we aimed to assess whether there is an association between osseous and soft tissue findings in WBCT and MRI. METHODS In this observational study, a consecutive cohort of 24 patients of various stages of PCFD (mean age 51 ± 18 years) underwent WBCT scans and MRI. Twenty-four healthy individuals of similar age, body mass index (BMI), and sex with WBCT scans were used as a control group. In addition to of osseous sinus tarsi impingement, 4 commonly used 3-dimensional (3D) measurements (talocalcaneal overlap [TCO], talonavicular coverage [TNC], Meary angle [MA], axial/lateral) were obtained using a dedicated postprocessing software (DISIOR 2.1, Finland) on the WBCT data sets. Sinus tarsi obliteration, spring ligament complex, tibiospring ligament integrity, as well as tibialis posterior tendon degeneration were evaluated with MRI. Statistical analysis was performed for significant (P < .05) correlation between findings. RESULTS None of the assessed 3D measurements correlated with either spring ligament complex or tibiospring ligament tears. BMI and TCO were found to be associated with tibialis posterior tendon tears. Seventy-five percent of patients with osseous sinus tarsi impingement on WBCT also showed signs of sinus tarsi obliteration on MRI. CONCLUSION Although WBCT reflects foot alignment and can reveal osseous sinus tarsi impingement in PCFD patients, the association between WBCT-based 3D measurements and ligament or tendon tears assessed via MRI is limited. WBCT appears complimentary to MRI regarding its diagnostic value. Both imaging options add important information and may impact decision making in the treatment of PCFD patients. LEVEL OF EVIDENCE Level IV, observational study.
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Affiliation(s)
- Lynn Andres
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Ricardo Donners
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Dorothee Harder
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Arne Burssens
- Department of Orthopaedics, University Hospital Ghent, Gent, Belgium
| | - Corina Nüesch
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
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Donners R, Candito A, Rata M, Sharp A, Messiou C, Koh DM, Tunariu N, Blackledge MD. Inter- and Intra-Patient Repeatability of Radiomic Features from Multiparametric Whole-Body MRI in Patients with Metastatic Prostate Cancer. Cancers (Basel) 2024; 16:1647. [PMID: 38730599 PMCID: PMC11083580 DOI: 10.3390/cancers16091647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: We assessed the test-re-test repeatability of radiomics in metastatic castration-resistant prostate cancer (mCPRC) bone disease on whole-body diffusion-weighted (DWI) and T1-weighted Dixon MRI. (2) Methods: In 10 mCRPC patients, 1.5 T MRI, including DWI and T1-weighted gradient-echo Dixon sequences, was performed twice on the same day. Apparent diffusion coefficient (ADC) and relative fat-fraction-percentage (rFF%) maps were calculated. Per study, up to 10 target bone metastases were manually delineated on DWI and Dixon images. All 106 radiomic features included in the Pyradiomics toolbox were derived for each target volume from the ADC and rFF% maps. To account for inter- and intra-patient measurement repeatability, the log-transformed individual target measurements were fitted to a hierarchical model, represented as a Bayesian network. Repeatability measurements, including the intraclass correlation coefficient (ICC), were derived. Feature ICCs were compared with mean ADC and rFF ICCs. (3) Results: A total of 65 DWI and 47 rFF% targets were analysed. There was no significant bias for any features. Pairwise correlation revealed fifteen ADC and fourteen rFF% feature sub-groups, without specific patterns between feature classes. The median intra-patient ICC was generally higher than the inter-patient ICC. Features that describe extremes in voxel values (minimum, maximum, range, skewness, and kurtosis) showed generally lower ICCs. Several mostly shape-based texture features were identified, which showed high inter- and intra-patient ICCs when compared with the mean ADC or mean rFF%, respectively. (4) Conclusions: Pyradiomics texture features of mCRPC bone metastases varied greatly in inter- and intra-patient repeatability. Several features demonstrated good repeatability, allowing for further exploration as diagnostic parameters in mCRPC bone disease.
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Affiliation(s)
- Ricardo Donners
- University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Antonio Candito
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
| | - Mihaela Rata
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
| | - Adam Sharp
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
| | - Christina Messiou
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
| | - Dow-Mu Koh
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
| | - Nina Tunariu
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
| | - Matthew D. Blackledge
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; (A.C.); (M.R.); (A.S.); (C.M.); (D.-M.K.); (N.T.)
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Donners R, Vosshenrich J, Gutzeit A, Bach M, Schlicht F, Obmann MM, Harder D, Breit HC. New-Generation 0.55 T MRI of the Knee-Initial Clinical Experience and Comparison With 3 T MRI. Invest Radiol 2024; 59:298-305. [PMID: 37747455 DOI: 10.1097/rli.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The aim of this study was to compare the detection rate of and reader confidence in 0.55 T knee magnetic resonance imaging (MRI) findings with 3 T knee MRI in patients with acute trauma and knee pain. MATERIALS AND METHODS In this prospective study, 0.55 T and 3 T knee MRI of 25 symptomatic patients (11 women; median age, 38 years) with suspected internal derangement of the knee was obtained in 1 setting. On the 0.55 T system, a commercially available deep learning image reconstruction algorithm was used (Deep Resolve Gain and Deep Resolve Sharp; Siemens Healthineers), which was not available on the 3 T system. Two board-certified radiologists reviewed all images independently and graded image quality parameters, noted MRI findings and their respective reporting confidence level for the presence or absence, as well as graded the bone, cartilage, meniscus, ligament, and tendon lesions. Image quality and reader confidence levels were compared ( P < 0.05 = significant), and clinical findings were correlated between 0.55 T and 3 T MRI by calculation of the intraclass correlation coefficient (ICC). RESULTS Image quality was rated higher at 3 T compared with 0.55 T studies (each P ≤ 0.017). Agreement between 0.55 T and 3 T MRI for the detection and grading of bone marrow edema and fractures, ligament and tendon lesions, high-grade meniscus and cartilage lesions, Baker cysts, and joint effusions was perfect for both readers. Overall identification and grading of cartilage and meniscal lesions showed good agreement between high- and low-field MRI (each ICC > 0.76), with lower agreement for low-grade cartilage (ICC = 0.77) and meniscus lesions (ICC = 0.49). There was no difference in readers' confidence levels for reporting lesions of bone, ligaments, tendons, Baker cysts, and joint effusions between 0.55 T and 3 T (each P > 0.157). Reader reporting confidence was higher for cartilage and meniscal lesions at 3 T (each P < 0.041). CONCLUSIONS New-generation 0.55 T knee MRI, with deep learning-aided image reconstruction, allows for reliable detection and grading of joint lesions in symptomatic patients, but it showed limited accuracy and reader confidence for low-grade cartilage and meniscal lesions in comparison with 3 T MRI.
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Affiliation(s)
- Ricardo Donners
- From the Department of Radiology, University Hospital Basel (R.D., J.V., M.B., F.S., M.O., D.H., H.-C.B.), Basel, Switzerland; and Institute of Radiology and Nuclear Medicine and Breast Center St. Anna (A.G.), Lucerne, Switzerland
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Li C, Krasniqi F, Donners R, Kettelhack C, Krieg AH. Synovial sarcoma: the misdiagnosed sarcoma. EFORT Open Rev 2024; 9:190-201. [PMID: 38457918 PMCID: PMC10958242 DOI: 10.1530/eor-23-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Synovial sarcoma is a rare and highly malignant soft tissue sarcoma. The inconspicuous and diversity of its early symptoms make it a highly misdiagnosed disease. The management of synovial sarcomas is challenging as they are rare and have a poor prognosis. Early and correct diagnosis and treatment are critical for clinical outcomes. Misdiagnosis or delayed diagnosis can have devastating consequences for the patient. The detection of SS18 gene rearrangement is considered a powerful tool in establishing the diagnosis of synovial sarcomas. Biopsies and testing for gene rearrangements are recommended for all patients in whom SS cannot be excluded. Surgery is the mainstay of treatment for synovial sarcomas. Neoadjuvant/adjuvant radiotherapy is recommended for patients with big tumors (>5 cm) or positive resection margins, and neoadjuvant/adjuvant chemotherapy is recommended for patients with high-risk tumors or advanced diseases. This article reviews synovial sarcomas from the perspectives of clinical and radiological presentation, histological and cytogenetic analysis, differential diagnosis, treatment, and prognosis.
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Affiliation(s)
- Chengxiang Li
- Department of Orthopedic, University Children´s Hospital (UKBB), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fatime Krasniqi
- Department of Oncology, University Hospital Basel, Basel, Switzerland
- The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland
| | - Ricardo Donners
- The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Christoph Kettelhack
- The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland
- Clarunis, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Switzerland
| | - Andreas H Krieg
- Department of Orthopedic, University Children´s Hospital (UKBB), Basel, Switzerland
- The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland
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Donners R, Tunariu N, Tovey H, Hall E, Chua S, Cook G, Du Y, Blackledge MD, Parker CC, Koh DM. The value of baseline 18F-sodium fluoride and 18F-choline PET activity for identifying responders to radium-223 treatment in castration-resistant prostate cancer bone metastases. Eur Radiol 2024; 34:1146-1154. [PMID: 37615760 PMCID: PMC10853307 DOI: 10.1007/s00330-023-10172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/27/2023] [Accepted: 07/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES To investigate whether baseline 18F-sodium fluoride (NaF) and 18F-choline PET activity is associated with metastatic castration-resistant prostate cancer (mCRPC) global and individual bone metastases' DWI MR imaging response to radium-223 treatment. METHODS Thirty-six bone-only mCRPC patients were prospectively recruited from three centers. Whole-body (WB)-MRI with DWI and 18F-NaF and 18F-choline PET/CT were performed at therapy baseline and 8-week intervals. In each patient, bone disease median global (g)ADC change between baseline and follow-up was calculated. Additionally, up to five bone target lesions per patient were delineated and individual median ADC change recorded. An ADC increase > 30% defined response per-patient and per-lesion. For the same targets, baseline 18F-NaF and 18F-choline PET SUVmax were recorded. Mean SUVmax across patient targets was correlated with gADC change and lesion SUVmax with per-lesion ADC change. RESULTS A total of 133 lesions in 36 patients (14 responders) were analyzed. 18F-NaF PET per-patient mean SUVmax was significantly higher in responders (median = 56.0 versus 38.7 in non-responders; p = 0.008), with positive correlation between SUVmax and gADC increase (rho = 0.42; p = 0.015). A 48.7 SUVmax threshold identified responders with 77% sensitivity and 75% specificity. Baseline 18F-NaF PET per-lesion SUVmax was higher in responding metastases (median = 51.6 versus 31.8 in non-responding metastases; p = 0.001), with positive correlation between baseline lesion SUVmax and ADC increase (rho = 0.39; p < 0.001). A 36.8 SUVmax threshold yielded 72% sensitivity and 63% specificity. No significant association was found between baseline 18F-choline PET SUVmax and ADC response on a per-patient (p = 0.164) or per-lesion basis (p = 0.921). CONCLUSION 18F-NaF PET baseline SUVmax of target mCRPC bone disease showed significant association with response to radium-223 defined by ADC change. CLINICAL RELEVANCE STATEMENT 18F-sodium fluoride PET/CT baseline maximum SUV of castration-resistant prostate cancer bone metastases could be used as a predictive biomarker for response to radium-223 therapy. KEY POINTS • 18F-sodium fluoride PET baseline SUVmax of castration-resistant prostate cancer bone metastases showed significant association with response to radium-223. • Baseline 18F-sodium fluoride PET can improve patient selection for radium-223 therapy. • Change in whole-body DWI parameters can be used for response correlation with baseline 18F-sodium fluoride PET SUVmax in castration-resistant prostate cancer bone metastases.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Nina Tunariu
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Holly Tovey
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Emma Hall
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Sue Chua
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Gary Cook
- King's College London and Guy's and St. Thomas' PET Centre, St. Thomas' Hospital, King's College London, Westminster Bridge Rd, London, UK
| | - Yong Du
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | | | - Christopher C Parker
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Dow-Mu Koh
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
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Seifert AC, Breit HC, Schlicht F, Donners R, Harder D, Jan V. Comparing Metal Artifact Severity and Ability to Assess Near-Metal Anatomy Between 0.55 T and 1.5 T MRI in Patients with Metallic Spinal Implants-A Scanner Comparison Study. Acad Radiol 2024:S1076-6332(23)00718-3. [PMID: 38242732 DOI: 10.1016/j.acra.2023.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 01/21/2024]
Abstract
RATIONALE AND OBJECTIVES To compare image quality and metal artifact severity at 0.55 T and 1.5 T MRI in patients with spinal implants following posterior fusion surgery. MATERIALS AND METHODS 50 consecutive patients (mean age: 69 ± 12 years) who underwent 0.55 T and 1.5 T MRI following posterior fusion surgery of the lumbar or thoracolumbar spine were included. Examinations used metal artifact reduction protocols from clinical routine. Images were rated by two fellowship-trained musculoskeletal radiologists for image quality, ability to assess the spinal canal and the neural foramina, and artifact severity on 5-point Likert scales. Additionally, differences in artifact severity and visibility of near-metal anatomy among implant sizes (1-level vs. 2-level vs. >2-levels) were evaluated. RESULTS Signal/contrast (mean: 4.0 ± 0.3 [0.55 T] vs. 4.4 ± 0.6 [1.5 T]; p < .001) and resolution (3.8 ± 0.5 vs. 4.2 ± 0.7; p < .001) were rated lower at 0.55 T. The ability to assess the spinal canal (4.4 ± 0.5 vs. 4.2 ± 0.9; p = .69) and the neural foramina (3.8 ± 0.5 vs. 3.8 ± 0.9; p = .19) were however rated equally good with excellent interrater agreement (range: 0.84-0.94). Susceptibility artifacts were rated milder at 0.55 T (1.8 ± 0.5 vs. 3.0 ± 0.6; p < .001). For implant size-based subgroups, the visibility of near-metal anatomy decreased with implant length at 1.5 T, but remained unchanged at 0.55 T. In consequence, the spinal canal and neural foramina could be better assessed at 0.55 T in patients with multi-level implants (4.4 ± 0.5 vs. 3.6 ± 1.1; p < .001). CONCLUSION Metal artifacts of spinal implants are substantially less pronounced at 0.55 T MRI. When examining patients with multi-level posterior fusion, this translates into a superior ability to assess near-metal anatomy, where 1.5 T MRI reaches diagnostic limitations.
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Affiliation(s)
- Alina Carolin Seifert
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Hanns-Christian Breit
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Felix Schlicht
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Vosshenrich Jan
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
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Donners R, Figueiredo I, Westaby D, Koh DM, Tunariu N, Carreira S, de Bono JS, Fotiadis N. Multiparametric bone MRI targeting aides lesion selection for CT-guided sclerotic bone biopsies in metastatic castrate resistant prostate cancer. Cancer Imaging 2023; 23:121. [PMID: 38102655 PMCID: PMC10724964 DOI: 10.1186/s40644-023-00644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Bone biopsies in metastatic castrate-resistant prostate cancer (mCRPC) patients can be challenging. This study's objective was to prospectively validate a multiparametric bone MRI (mpBMRI) algorithm to facilitate target lesion selection in mCRPC patients with sclerotic bone disease for subsequent CT-guided bone biopsies. METHODS 20 CT-guided bone biopsies were prospectively performed between 02/2021 and 11/2021 in 17 mCRPC patients with only sclerotic bone disease. Biopsy targets were selected based on MRI, including diffusion-weighted (DWI) and T1-weighted VIBE Dixon MR images, allowing for calculation of the apparent diffusion coefficient (ADC) and the relative fat-fraction (rFF), respectively. Bone marrow with high DWI signal, ADC < 1100 µm2/s and rFF < 20% was the preferred biopsy target. Tumor content and NGS-feasibility was assessed by a pathologist. Prognostic routine laboratory blood parameters, target lesion size, biopsy tract length, visual CT density, means of HU, ADC and rFF were compared between successful and unsuccessful biopsies (p < 0.05 = significant). RESULTS Overall, 17/20 (85%) biopsies were tumor-positive and next-generation genomic sequencing (NGS) was feasible in 13/18 (72%) evaluated samples. Neither laboratory parameters, diameter, tract length nor visual CT density grading showed significant differences between a positive versus negative or NGS feasible versus non-feasible biopsy results (each p > 0.137). Lesion mean HU was 387 ± 187 HU in NGS feasible and 493 ± 218 HU in non-feasible biopsies (p = 0.521). For targets fulfilling all MRI selection algorithm criteria, 13/14 (93%) biopsies were tumor-positive and 10/12 (83%) provided NGS adequate tissue. CONCLUSIONS Multiparametric bone MRI can facilitate target lesion selection for subsequent CT-guided bone biopsy in mCPRC patients with sclerotic metastases. TRIAL REGISTRATION Committee for Clinical Research of the Royal Marsden Hospital registration number SE1220.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK.
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland.
| | - Ines Figueiredo
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Daniel Westaby
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Nina Tunariu
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Suzanne Carreira
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Johann S de Bono
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Nicos Fotiadis
- Department of Interventional Radiology, Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, UK
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Castagnoli F, Donners R, Tunariu N, Messiou C, Koh DM. Relative fat fraction of malignant bone lesions from breast cancer, prostate cancer and myeloma are significantly lower than normal bone marrow and shows excellent interobserver agreement. Br J Radiol 2023; 96:20230240. [PMID: 37750943 PMCID: PMC10646620 DOI: 10.1259/bjr.20230240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES To compare relative fat fraction (rFF) of active bone lesions from breast, prostate and myeloma malignancies and normal bone marrow; to assess its inter-reader agreement. METHODS Patients with breast (n = 26), myeloma (n = 32) and prostate cancer (n = 52) were retrospectively evaluated. 110 baseline rFF maps from whole-body MRI were reviewed by two radiologists. Regions of interest for up to four focal active lesions in each patient were drawn on rFF maps, one each at the cervicothoracic spine, lumbosacral spine, pelvis and extremity. The mean and standard deviation of rFF were recorded. The rFF of normal marrow was measured in the pelvis for patients without diffuse bone disease (n = 88). We compared the rFF of malignant bone lesions and normal marrow using Mann-Whitney test. Interobserver agreement was assessed by interclass correlation coefficient. RESULTS Malignant bone lesions showed significantly lower median rFF (13.87%) compared with normal marrow (89.76%) with little overlap (p < 0.0001). There was no significant difference in the median rFF of malignant lesions from breast (14.46%), myeloma (13.12%) and prostate cancer (13.67%) (p > 0.017, Bonferroni correction) and in the median rFF of bone disease according to their anatomical locations (p > 0.008, Bonferroni correction). There was excellent interobserver agreement (0.95). CONCLUSION The low rFF of active bone lesions in breast, prostate and myeloma malignancies provides high image contrast relative to normal marrow that may be used to detect bone metastases. ADVANCES IN KNOWLEDGE This study shows the importance of rFF towards detecting bone metastases.
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10
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Donners R, Candito A, Blackledge M, Rata M, Messiou C, Koh DM, Tunariu N. Repeatability of quantitative individual lesion and total disease multiparametric whole-body MRI measurements in prostate cancer bone metastases. Br J Radiol 2023; 96:20230378. [PMID: 37660399 PMCID: PMC10607420 DOI: 10.1259/bjr.20230378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To assess the repeatability of quantitative multiparametric whole-body MRI (mpWB-MRI) parameters in advanced prostate cancer (APC) bone metastases. METHODS 1.5T MRI was performed twice on the same day in 10 APC patients. MpWB-MRI-included diffusion weighted imaging (DWI) and T1-weighted gradient-echo 2-point Dixon sequences. ADC and relative fat-fraction percentage (rFF%) maps were calculated, respectively. A radiologist delineated up to 10 target bone metastases per study. Means of ADC, b900 signal intensity(SI), normalised b900 SI, rFF% and maximum diameter (MD) for each target lesion and overall parameter averages across all targets per patient were recorded. The total disease volume (tDV in ml) was manually delineated on b900 images and mean global (g)ADC was derived. Bland-Altman analyses were performed with calculation of 95% repeatability coefficients (RC). RESULTS Seventy-three individual targets (median MD 26 mm) were included. Lesion mean ADC RC was 12.5%, mean b900 SI RC 137%, normalised mean b900 SI RC 110%, rFF% RC 3.2 and target MD RC 5.5 mm (16.3%). Patient target lesion average mean ADC RC was 6.4%, b900 SI RC 104% and normalised mean b900 SI RC 39.6%. Target average rFF% RC was 1.8, average MD RC 1.3 mm (4.8%). tDV segmentation RC was 6.4% and mean gADC RC 5.3%. CONCLUSIONS APC bone metastases' ADC, rFF% and maximum diameter, tDV and gADC show good repeatability. ADVANCES IN KNOWLEDGE APC bone metastases' mean ADC and rFF% measurements of single lesions and global disease volumes are repeatable, supporting their potential role as quantitative biomarkers in metastatic bone disease.
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Affiliation(s)
| | - Antonio Candito
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton, United Kingdom
| | - Matthew Blackledge
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton, United Kingdom
| | - Mihaela Rata
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton, United Kingdom
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Donners R, Gehweiler J, Kovacs B, Breit HC, Daikeler T, Harder D, Berger CT. Chronic stage magnetic resonance imaging findings in patients with shoulder injury related to vaccine administration (SIRVA). Skeletal Radiol 2023; 52:1695-1701. [PMID: 37012390 PMCID: PMC10069733 DOI: 10.1007/s00256-023-04334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Identify chronic shoulder MRI findings in patients with known shoulder injury related to vaccine administration (SIRVA). MATERIALS AND METHODS Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the MRI of nine patients with clinically established SIRVA. MRI was performed at least 4 weeks after vaccination and included intravenous contrast-enhanced sequences. MRI was reviewed for the presence of erosions, tendonitis, capsulitis, synovitis, bone marrow oedema, joint effusion, bursitis, cartilage defects, rotator cuff lesions, and lymphadenopathy. The number and location of focal lesions were recorded. RESULTS Erosions of the greater tuberosity were present in 8/9 (89%), tendonitis of the infraspinatus muscle tendon in 7/9 (78%), capsulitis, synovitis, and bone marrow oedema in 5/9 (56%) cases, respectively. Effusion was found in three, and subdeltoid bursitis, rotator cuff lesions as well as cartilage defects in one patient, respectively. None of our included subjects showed axillary lymphadenopathy. CONCLUSION In this case series, greater humeral tuberosity erosions, infraspinatus muscle tendonitis, capsulitis, synovitis, and bone marrow oedema were common MRI findings in chronic SIRVA.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | - Julian Gehweiler
- Department of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Balazs Kovacs
- Department of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Hanns-Christian Breit
- Department of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Thomas Daikeler
- Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
- University Centre for Immunology, University Hospital Basel, Basel, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Christoph T Berger
- Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
- University Centre for Immunology, University Hospital Basel, Basel, Switzerland
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Krieg AH, Dong C, Schmid MP, Speth BM, Harder D, Donners R. Long-term effects of retrograde approach on the knee after motorized femoral limb lengthening. Acta Orthop 2023; 94:128-134. [PMID: 36950849 PMCID: PMC10034712 DOI: 10.2340/17453674.2023.10323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND AND PURPOSE The retrograde femoral approach is an established technique for implantation of nails for leg lengthening and correction and in cases of distal femoral fractures. The purpose of this study was to determine the 10-year outcome of this technique by analyzing the clinical long-term effects and radiological status of the knee after leg lengthening via a retrograde femoral approach. PATIENTS AND METHODS This retrospective single-center study included 13 patients (median age at surgery 17 [range 15-20] years) who underwent unilateral, retrograde, femoral lengthening with a motorized nail. Outcome measurements were graded variables of the SF-36, ISKD score, and Lysholm score. MRI of both knees was performed in all patients. MRI was evaluated for the presence of degenerative changes and compared with the healthy contralateral knee. Cartilage condition was graded according to the International Cartilage Repair Society (ICRS) scoring system. RESULTS All patients were pain-free and had a full range of motion 10 (range 10.0-12.2) years after surgery. All postoperative knees showed fibrosis of Hoffa's fat pad and moderate to severe cartilage defects (ICRS Grade 2-4) of the trochlear groove (nail entry site). 6 out of 13 operated knees exhibited retropatellar cartilage defects. CONCLUSION Our study showed that patients were pain-free, but cartilage defects at the entry point and arthrofibrosis at Hoffa's fat pad were observed without causing clinical impairment.
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Affiliation(s)
- Andreas H Krieg
- Pediatric Orthopedic Department, University Children's Hospital Basel (UKBB), Basel.
| | - Chao Dong
- Pediatric Orthopedic Department, University Children's Hospital Basel (UKBB), Basel
| | | | - Bernhard M Speth
- Pediatric Orthopedic Department, University Children's Hospital Basel (UKBB), Basel
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel (USB), Basel, Switzerland
| | - Ricardo Donners
- Department of Radiology, University Hospital Basel (USB), Basel, Switzerland
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Rusche T, Vosshenrich J, Winkel DJ, Donners R, Segeroth M, Bach M, Merkle EM, Breit HC. More Space, Less Noise-New-generation Low-Field Magnetic Resonance Imaging Systems Can Improve Patient Comfort: A Prospective 0.55T-1.5T-Scanner Comparison. J Clin Med 2022; 11:jcm11226705. [PMID: 36431182 PMCID: PMC9692643 DOI: 10.3390/jcm11226705] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The objectives of this study were to assess patient comfort when imaged on a newly introduced 0.55T low-field magnetic resonance (MR) scanner system with a wider bore opening compared to a conventional 1.5T MR scanner system. MATERIALS AND METHODS In this prospective study, fifty patients (mean age: 66.2 ± 17.0 years, 22 females, 28 males) underwent subsequent magnetic resonance imaging (MRI) examinations with matched imaging protocols at 0.55T (MAGNETOM FreeMax, Siemens Healthineers; Erlangen, Germany) and 1.5T (MAGNETOM Avanto Fit, Siemens Healthineers; Erlangen, Germany) on the same day. MRI performed between 05/2021 and 07/2021 was included for analysis. The 0.55T MRI system had a bore opening of 80 cm, while the bore diameter of the 1.5T scanner system was 60 cm. Four patient groups were defined by imaged body regions: (1) cranial or cervical spine MRI using a head/neck coil (n = 27), (2) lumbar or thoracic spine MRI using only the in-table spine coils (n = 10), (3) hip MRI using a large flex coil (n = 8) and (4) upper- or lower-extremity MRI using small flex coils (n = 5). Following the MRI examinations, patients evaluated (1) sense of space, (2) noise level, (3) comfort, (4) coil comfort and (5) overall examination impression on a 5-point Likert-scale (range: 1= "much worse" to 5 = "much better") using a questionnaire. Maximum noise levels of all performed imaging studies were measured in decibels (dB) by a sound level meter placed in the bore center. RESULTS Sense of space was perceived to be "better" or "much better" by 84% of patients for imaging examinations performed on the 0.55T MRI scanner system (mean score: 4.34 ± 0.75). Additionally, 84% of patients rated noise levels as "better" or "much better" when imaged on the low-field scanner system (mean score: 3.90 ± 0.61). Overall sensation during the imaging examination at 0.55T was rated as "better" or "much better" by 78% of patients (mean score: 3.96 ± 0.70). Quantitative assessment showed significantly reduced maximum noise levels for all 0.55T MRI studies, regardless of body region compared to 1.5T, i.e., brain MRI (83.8 ± 3.6 dB vs. 89.3 ± 5.4 dB; p = 0.04), spine MRI (83.7 ± 3.7 dB vs. 89.4 ± 2.6 dB; p = 0.004) and hip MRI (86.3 ± 5.0 dB vs. 89.1 ± 1.4 dB; p = 0.04). CONCLUSIONS Patients perceived 0.55T new-generation low-field MRI to be more comfortable than conventional 1.5T MRI, given its larger bore opening and reduced noise levels during image acquisition. Therefore, new concepts regarding bore design and noise level reduction of MR scanner systems may help to reduce patient anxiety and improve well-being when undergoing MR imaging.
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Sartoretti E, Sartoretti T, Koh DM, Sartoretti-Schefer S, Kos S, Goette R, Donners R, Benz R, Froehlich JM, Matoori S, Dubsky P, Plümecke T, Forstner R, Ruch W, Meissnitzer M, Hergan K, Largiader S, Gutzeit A. Humor in radiological breast cancer screening: a way of improving patient service? Cancer Imaging 2022; 22:57. [PMID: 36209196 PMCID: PMC9548186 DOI: 10.1186/s40644-022-00493-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer screening is essential in detecting breast tumors, however, the examination is stressful. In this study we analyzed whether humor enhances patient satisfaction. Methods In this prospective randomized study 226 patients undergoing routine breast cancer screening at a single center during October 2020 to July 2021 were included. One hundred thirty-two were eligible for the study. Group 1 (66 patients) received an examination with humorous intervention, group 2 (66 patients) had a standard breast examination. In the humor group, the regular business card was replaced by a self-painted, humorous business card, which was handed to the patient at the beginning of the examination. Afterwards, patients were interviewed with a standardized questionnaire. Scores between the two study groups were compared with the Mann-Whitney U test or Fisher’s exact test. P-values were adjusted with the Holm’s method. Two-sided p-values < 0.05 were considered significant. Results One hundred thirty-two patients, 131 female and 1 male, (mean age 59 ± 10.6 years) remained in the final study cohort. Patients in the humor group remembered the radiologist’s name better (85%/30%, P < .001), appreciated the final discussion with the radiologist more (4.67 ± 0.73–5;[5, 5] vs. 4.24 ± 1.1–5;[4, 5], P = .017), felt the radiologist was more empathetic (4.94 ± 0.24–5;[5, 5] vs.4.59 ± 0.64–5;[4, 5], P < .001), and rated him as a humorous doctor (4.91 ± 0.29–5;[5, 5] vs. 2.26 ± 1.43–1;[1, 4], P < .001). Additionally, patients in the humor group tended to experience less anxiety (p = 0.166) and felt the doctor was more competent (p = 0.094). Conclusion Humor during routine breast examinations may improve patient-radiologist relationship because the radiologist is considered more empathetic and competent, patients recall the radiologist’s name more easily, and value the final discussion more. Trial registration We have a general approval from our ethics committee because it is a retrospective survey, the patient lists for the doctors were anonymized and it is a qualitative study, since the clinical processes are part of the daily routine examinations and are used independently of the study. The patients have given their consent to this study and survey. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00493-z.
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Affiliation(s)
- Elisabeth Sartoretti
- Faculty of Medicine, University of Zürich, Pestalozzistrasse 3, 8032, Zürich, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Postfach 4466, 6002, Luzern, Switzerland
| | - Thomas Sartoretti
- Faculty of Medicine, University of Zürich, Pestalozzistrasse 3, 8032, Zürich, Switzerland
| | - Dow Mu Koh
- Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Sabine Sartoretti-Schefer
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Sebastian Kos
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna- Strasse 32, 6006, Lucerne, Switzerland
| | - Romana Goette
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna- Strasse 32, 6006, Lucerne, Switzerland
| | - Ricardo Donners
- Department of Radiology, University Hospital Basel, University of Basel, Süotaöstrasse 21/ Petersgraben 4, 4031, Basel, Switzerland
| | - Robyn Benz
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Johannes M Froehlich
- Clinical Research Group, Klus Apotheke Zürich, Hegibachstrasse 102, 8032, Zürich, Switzerland
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, Pavillon Jean- Coutu 2940, chemin de Polythechnique, Montréal, Québec, H3T 1J4, Canada
| | - Peter Dubsky
- Breast Center, Hirslanden Clinic St Anna, St. Anna- Strasse 32, 6006, Lucerne, Switzerland
| | - Tino Plümecke
- Institute of Sociology, University of Freiburg, Freiburg, Germany
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University, Müllner- Hauptstrasse 48, 5020, Salzburg, Austria
| | - Willibald Ruch
- Department of Psychology, University of Zurich, Binzmühlestrasse 14, Box 1, 8050, Zurich, Switzerland
| | - Matthias Meissnitzer
- Department of Radiology, Paracelsus Medical University, Müllner- Hauptstrasse 48, 5020, Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University, Müllner- Hauptstrasse 48, 5020, Salzburg, Austria
| | - Selina Largiader
- Faculty of Medicine, University of Zürich, Pestalozzistrasse 3, 8032, Zürich, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Postfach 4466, 6002, Luzern, Switzerland
| | - Andreas Gutzeit
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Postfach 4466, 6002, Luzern, Switzerland. .,Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zürich, Vladimir-Prelog-Weg 1-5/10, 8093, Zürich, Switzerland.
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Donners R, Fotiadis N, Figueiredo I, Blackledge M, Westaby D, Guo C, Fenor de la Maza MDLD, Koh DM, Tunariu N. Optimising CT-guided biopsies of sclerotic bone lesions in cancer patients. Eur Radiol 2022; 32:6820-6829. [PMID: 35881184 PMCID: PMC9474436 DOI: 10.1007/s00330-022-09011-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 11/06/2022]
Abstract
Objectives Investigate the laboratory, imaging and procedural factors that are associated with a tumour-positive and/or NGS-feasible CT-guided sclerotic bone lesion biopsy result in cancer patients. Methods In total, 113 CT-guided bone biopsies performed in cancer patients by an interventional radiologist in one institution were retrospectively reviewed. Sixty-five sclerotic bone biopsies were eventually included and routine blood parameters and tumour marker levels were recorded. Non-contrast (NC) biopsy CTs (65), contrast-enhanced CTs (24), and PET/CTs (22) performed within four weeks of biopsy were reviewed; lesion location, diameter, lesion-to-cortex distance, and NC-CT appearance (dense-sclerosis versus mild-sclerosis) were noted. Mean NC-CT, CE-CT HU, and PET SUVmax were derived from biopsy tract and lesion segmentations. Needle diameter, tract length, and number of samples were noted. Comparisons between tumour-positive/negative and next-generation sequencing (NGS)-feasible/non-feasible biopsies determined significant (p < 0.05) laboratory, imaging, and procedural parameter differences. Results Seventy-four percent of biopsies were tumour-positive. NGS was feasible in 22/30 prostate cancer patients (73%). Neither laboratory blood parameters, PET/CT availability, size, nor lesion-to-cortex distance affected diagnostic yield or NGS feasibility (p > 0.298). Eighty-seven percent of mildly sclerotic bone (mean 244 HU) biopsies were positive compared with 56% in dense sclerosis (622 HU, p = 0.005) and NC-CT lesion HU was significantly lower in positive biopsies (p = 0.003). A 610 HU threshold yielded 89% PPV for tumour-positive biopsies and a 370 HU threshold 94% PPV for NGS-feasible biopsies. FDG-PET and procedural parameters were non-significant factors (each p > 0.055). Conclusion In cancer patients with sclerotic bone disease, targeting areas of predominantly mild sclerosis in lower CT-attenuation lesions can improve tumour tissue yield and NGS feasibility. Key Points • Areas of predominantly mild sclerosis should be preferred to areas of predominantly dense sclerosis for CT-guided bone biopsies in cancer patients. • Among sclerotic bone lesions in prostate cancer patients, lesions with a mean HU below 370 should be preferred as biopsy targets to improve NGS feasibility. • Laboratory parameters and procedure related factors may have little implications for CT-guided sclerotic bone biopsy success.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, London, UK. .,Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Nicos Fotiadis
- Department of Interventional Radiology, Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, UK.
| | - Ines Figueiredo
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | - Matthew Blackledge
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | - Daniel Westaby
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | - Christina Guo
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, London, UK.,Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | - Nina Tunariu
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, London, UK.,Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
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Donners R, Zaugg C, Gehweiler JE, Boldanova T, Heim MH, Terracciano LM, Boll DT. Computed tomography (CT) and magnetic resonance imaging (MRI) of diffuse liver disease: a multiparametric predictive modelling algorithm can aid categorization of liver parenchyma. Quant Imaging Med Surg 2022; 12:1186-1197. [PMID: 35111615 DOI: 10.21037/qims-21-384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/06/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Liver steatosis is common and tracking disease evolution to steatohepatitis and cirrhosis is essential for risk stratification and resultant patient management. Consequently, diagnostic tools allowing categorization of liver parenchyma based on routine imaging are desirable. The study objective was to compare established mono-factorial, dynamic single parameter and iterative multiparametric routine computed tomography (CT) and magnetic resonance imaging (MRI) analyses to distinguish between liver steatosis, steatohepatitis, cirrhosis and normal liver parenchyma. METHODS A total of 285 multi-phase contrast enhanced CT and 122 MRI studies with histopathological correlation of underlying parenchymal condition were retrospectively included. Parenchymal conditions were characterized based on CT Hounsfield units (HU) or MRI signal intensity (SI) measurements and calculated HU or SI ratios between non-contrast and contrast enhanced imaging time points. First, the diagnostic accuracy of mono-factorial analyses using established, static non-contrast HU and in- to opposed phase SI change cut-offs to distinguish between parenchymal conditions was established. Second, single dynamic discriminator analyses, with optimized non-contrast and enhancement HU and SI ratio cut-off values derived from the data, employing receiver operating characteristic (ROC) curve areas under the curve (AUCs) and the Youden index for maximum accuracy, were used for disease diagnosis. Third, multifactorial analyses, employing multiple non-contrast and contrast enhanced HU and SI ratio cut-offs in a nested, predictive-modelling algorithm were performed to distinguish between normal parenchyma, liver steatosis, steatohepatitis and cirrhosis. CT and MRI analyses were performed separately. RESULTS No single CT or MRI parameter showed significant difference between all four parenchymal conditions (each P>0.05). Mono-factorial static-CT-discriminator analyses identified liver steatosis with 75% accuracy. Mono-factorial MRI analyses identified steatosis with 89% accuracy. Single-dynamic CT parameter analyses identified normal parenchyma with 72% accuracy and cirrhosis with 75% accuracy. Single-dynamic MRI parameter analyses identified fatty parenchyma with 90% accuracy. Multifactorial CT analyzes identified normal parenchyma with 84%, liver steatosis with 95%, steatohepatitis with 95% and cirrhosis with 80% accuracy. Multifactorial predictive modelling of MRI parameters identified normal parenchyma with 79%, liver steatosis with 89%, steatohepatitis with 92% and cirrhosis with 89% accuracy. CONCLUSIONS Multiparametric analyses of quantitative measurements derived from routine CT and MRI, utilizing a predictive modelling algorithm, can help to distinguish between normal liver parenchyma, liver steatosis, steatohepatitis and cirrhosis.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Carmen Zaugg
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Julian E Gehweiler
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tuyana Boldanova
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Markus H Heim
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Donners R, Figueiredo I, Tunariu N, Blackledge M, Koh DM, de la Maza MDLDF, Chandran K, de Bono JS, Fotiadis N. Multiparametric bone MRI can improve CT-guided bone biopsy target selection in cancer patients and increase diagnostic yield and feasibility of next-generation tumour sequencing. Eur Radiol 2022; 32:4647-4656. [PMID: 35092476 PMCID: PMC9213271 DOI: 10.1007/s00330-022-08536-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/02/2022]
Abstract
Objectives To evaluate whether multiparametric bone MRI (mpBMRI) utilising a combination of DWI signal, ADC and relative fat-fraction (rFF) can identify bone metastases, which provide high diagnostic biopsy yield and next-generation genomic sequencing (NGS) feasibility. Methods A total of 150 CT-guided bone biopsies performed by interventional radiologists (3/2013 to 2/2021) at our centre were reviewed. In 43 patients, contemporaneous DWI and rFF images, calculated from 2-point T1w Dixon MRI, were available. For each biopsied lesion, a region of interest (ROI) was delineated on ADC and rFF images and the following MRI parameters were recorded: visual classification of DWI signal intensity (SI), mean, median, 10th and 90th centile ADC and rFF values. Non-parametric tests were used to compare values between tumour positive/negative biopsies and feasible/non-feasible NGS, with p-values < 0.05 deemed significant. Results The mpBMRI combination high DWI signal, mean ADC < 1100 µm2/s and mean rFF < 20% identified tumour-positive biopsies with 82% sensitivity, 80% specificity, a positive predictive value (PPV) of 93% (p = 0.001) and NGS feasibility with 91% sensitivity, 78% specificity and 91% PPV (p < 0.001). The single MRI parameters DWI signal, ADC and rFF failed to distinguish between tumour-positive and tumour-negative biopsies (each p > 0.082). In NGS feasible biopsies, mean and 90th centile rFF were significantly smaller (each p < 0.041). Single ADC parameters did not show significant difference regarding NGS feasibility (each p > 0.292). Conclusions MpBMRI utilising the combination of DWI signal, ADC and rFF can identify active bone metastases, which provide biopsy tissue with high diagnostic yield and NGS feasibility. Key Points • Multiparametric bone MRI with diffusion-weighted and relative fat-fraction images helps to identify active bone metastases suitable for CT-guided biopsy. • Target lesions for CT-guided bone biopsies in cancer patients can be chosen with greater confidence. • CT-guided bone biopsy success rates, especially yielding sufficient viable tissue for advanced molecular tissue analyses, can be improved.
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Donners R, Yiin RSZ, Blackledge M, Koh DM. Whole-body diffusion-weighted MRI of normal lymph nodes: prospective apparent diffusion coefficient histogram and nodal distribution analysis in a healthy cohort. Cancer Imaging 2021; 21:64. [PMID: 34838136 PMCID: PMC8627090 DOI: 10.1186/s40644-021-00432-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Whole body DWI (WB-DWI) enables the identification of lymph nodes for disease evaluation. However, quantitative data of benign lymph nodes across the body are lacking to allow meaningful comparison of diseased states. We evaluated apparent diffusion coefficient (ADC) histogram parameters of all visible lymph nodes in healthy volunteers on WB-DWI and compared differences in nodal ADC values between anatomical regions. METHODS WB-DWI was performed on a 1.5 T MR system in 20 healthy volunteers (7 female, 13 male, mean age 35 years). The b900 images were evaluated by two radiologists and all visible nodes from the neck to groin areas were segmented and individual nodal median ADC recorded. All segmented nodes in a patient were summated to generate the total nodal volume. Descriptors of the global ADC histogram, derived from individual node median ADCs, including mean, median, skewness and kurtosis were obtained for the global volume and each nodal region per patient. ADC values between nodal regions were compared using one-way ANOVA with Bonferroni post hoc tests and a p-value ≤0.05 was deemed statistically significant. RESULTS One thousand sixty-seven lymph nodes were analyzed. The global mean and median ADC of all lymph nodes were 1.12 ± 0.27 (10- 3 mm2/s) and 1.09 (10- 3 mm2/s). The average median ADC skewness was 0.25 ± 0.02 and average median ADC kurtosis was 0.34 ± 0.04. The ADC values of intrathoracic, portal and retroperitoneal nodes were significantly higher (1.53 × 10- 3, 1.75 × 10- 3 and 1.58 × 10- 3 mm2/s respectively) than in other regions. Intrathoracic, portal and mesenteric nodes were relatively uncommon, accounting for only 3% of the total nodes segmented. CONCLUSIONS The global mean and median ADC of all lymph nodes were 1.12 ± 0.27 (10- 3 mm2/s) and 1.09 (10- 3 mm2/s). Intrathoracic, portal and retroperitoneal nodes display significantly higher ADCs. Normal intrathoracic, portal and mesenteric nodes are infrequently visualized on WB-DWI of healthy individuals. TRIAL REGISTRATION Royal Marsden Hospital committee for clinical research registration number 09/H0801/86, 19.10.2009.
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Affiliation(s)
- Ricardo Donners
- Department of Diagnostic Radiolog, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, Surrey, SM2 5PT, UK.
| | - Raphael Shih Zhu Yiin
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei St 3, Singapore, 529889, Singapore
| | - Matthew Blackledge
- Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | - Dow-Mu Koh
- Department of Diagnostic Radiology, Institute of Cancer Research and The Royal Marsden NHS, Foundation Trust, Downs Road, Sutton, London, Surrey, SM2 5PT, UK
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Donners R, Yiin RSZ, Koh DM, De Paepe K, Chau I, Chua S, Blackledge MD. Whole-body diffusion-weighted MRI in lymphoma-comparison of global apparent diffusion coefficient histogram parameters for differentiation of diseased nodes of lymphoma patients from normal lymph nodes of healthy individuals. Quant Imaging Med Surg 2021; 11:3549-3561. [PMID: 34341730 DOI: 10.21037/qims-21-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023]
Abstract
Background Morphologic features yield low diagnostic accuracy to distinguish between diseased and normal lymph nodes. The purpose of this study was to compare diseased lymphomatous and normal lymph nodes using global apparent diffusion coefficient (gADC) histogram parameters derived from whole-body diffusion-weighted MRI (WB-DWI). Methods 1.5 Tesla WB-DWI of 23 lymphoma patients and 20 healthy volunteers performed between 09/2010 and 07/2015 were retrospectively reviewed. All diseased nodal groups in the lymphoma cohort and all nodes visible on b900 images in healthy volunteers were segmented from neck to groin to generate a total diffusion volume (tDV). A connected component-labelling algorithm separated spatially distinct nodes. Mean, median, skewness, kurtosis, minimum, maximum, interquartile range (IQR), standard deviation (SD), 10th and 90th centile of the gADC distribution were derived from the tDV of each patient/volunteer and from spatially distinct nodes. gADC and regional nodal ADC parameters were compared between malignant and normal nodes using t-tests and ROC curve analyses. A P value ≤0.05 was deemed statistically significant. Results Mean, median, IQR, 10th and 90th centiles of gADC and regional nodal ADC values were significantly lower in diseased compared with normal lymph nodes. Skewness, kurtosis and tDV were significantly higher in lymphoma. The SD, min and max gADC showed no significant difference between the two groups (P>0.128). The diagnostic accuracies of gADC parameters by AUC from highest to lowest were: 10th centile, mean, median, 90th centile, skewness, kurtosis and IQR. A 10th centile gADC threshold of 0.68×10-3 mm2/s identified diseased lymphomatous nodes with 91% sensitivity and 95% specificity. Conclusions WB-DWI derived gADC histogram parameters can distinguish between malignant lymph nodes of lymphoma patients and normal lymph nodes of healthy individuals.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.,Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, UK.,Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - Katja De Paepe
- Department of Radiology, University Hospitals Leuven, Herestaat 49, Belgium
| | - Ian Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, Surrey SM2 5PT, UK
| | - Sue Chua
- Department of Nuclear Medicine and PET, Royal Marsden Hospital, Sutton SM2 5PT, UK
| | - Matthew D Blackledge
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton SM2 5NG, UK
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Donners R, Gutzeit A, Gehweiler JE, Manneck S, Kovacs BK, Harder D. Orthopaedic surgeons do not consult radiology reports. Fact or fiction? Eur J Radiol 2021; 142:109870. [PMID: 34304032 DOI: 10.1016/j.ejrad.2021.109870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To find out how orthopaedic surgeons handle radiological reports and to identify ways to improve musculoskeletal radiology service and interdisciplinary communication. METHOD An anonymised 14-question online survey was distributed among 27 orthopaedic departments in German-speaking parts of Europe. It was available to trainees and consultants between 22/10/2020 and 05/06/2021. The questionnaire collected information regarding the participants' habits of consulting radiology reports depending on the imaging modality, reasons for not reading reports and asked for improvement recommendations for the radiology service. RESULTS 81 orthopaedists participated. 20% would never consult a plain radiograph report. In contrast, only 4% would never consult a CT report and no one claimed to never consult an MRI report. 43%, 67% and 86% would routinely consult radiology reports of radiographs, CT and MRI studies, respectively. Long time to report availability (24%), a general lack of time (19%) and too long texts (17%) were the most popular reasons for not consulting the reports. 62% of participants voted to sometimes disagree with the reports and in cases of opinion discrepancy 51% would always or often contact the radiologist. 64% preferred to be informed directly via phone about relevant unexpected findings. Most popular report improvement recommendations were more rapid report availability (24%), inclusion of significant images (19%) and inclusion of more angle and distance measurements (16%). In the free text column, a desire for direct interdisciplinary discussion of equivocal cases was often stated (30%). CONCLUSIONS Concluding, this survey showed that orthopaedic surgeons routinely consult radiology reports. The participants expressed a desire for increased, direct interdisciplinary communication to solve equivocal cases and improve patient care.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland; Department of Radiology, Royal Marsden Hospital Downs Road, SM2 5PT Sutton, UK.
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006 Lucerne, Switzerland; Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 1-5 / 10, 8093 Zurich, Switzerland; Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
| | - Julian E Gehweiler
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Sebastian Manneck
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Balazs K Kovacs
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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Donners R, Obmann MM, Boll D, Gutzeit A, Harder D. Dixon or DWI - Comparing the utility of fat fraction and apparent diffusion coefficient to distinguish between malignant and acute osteoporotic vertebral fractures. Eur J Radiol 2020; 132:109342. [PMID: 33068837 DOI: 10.1016/j.ejrad.2020.109342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare fat fraction (FF) and apparent diffusion coefficient (ADC) as discriminators distinguishing malignant from acute/subacute osteoporotic vertebral fractures. METHOD 1.5 T MRIs of 42 malignant and 27 acute/subacute osteoporotic vertebral fractures (38 patients) were retrospectively reviewed. Two readers independently classified fractures as malignant or osteoporotic based on conventional imaging morphology. Diagnostic reader confidence was rated as confident or not confident. FF was derived from axial T1 gradient-echo 2-point Dixon MRI. ADC maps were calculated from axial b50 and b900 images. Both readers independently performed ROI measurements of mean FF and ADC of the same fractured vertebrae. FF and ADC values, corresponding ROC curves and optimized cut-off value performance were compared. Inter-reader agreement was analysed by calculation of intraclass correlation coefficients (ICCs). A p-value < 0.05 was deemed significant. RESULTS Mean FF and ADC were significantly lower in malignant (9.5 % and 1.05 × 10-3 mm²/s) compared to osteoporotic fractures (32 % and 1.34 × 10-3 mm²/s, all p < 0.001). The optimal cut-off FF was 11.5 %, detecting malignant fractures with 86 %/89 % sensitivity/specificity. The optimal ADC cut-off of 1.04 × 10-3 mm/s² yielded 62 %/96 % sensitivity/specificity. FF AUC (0.93) was significantly larger than ADC AUC (0.82, p = 0.03). In the subgroup of nine cases reported with low expert reader confidence, the optimized cut-off specificities of FF (83 %) and ADC (83 %) exceeded reader specificity (50 %). There was excellent inter-reader agreement for mean FF (ICC = 0.99) and good agreement for mean ADC (ICC = 0.86) measurements. CONCLUSION FF and ADC can improve reader specificity to distinguish between malignant and acute or subacute osteoporotic vertebral fractures. As single discriminator, FF was superior to ADC.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Markus M Obmann
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Daniel Boll
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland; Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 1-5 / 10, 8093, Zurich, Switzerland; Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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Harder D, Hirschmann A, Donners R. Quantitative Chemical Shift Imaging of the Spine: Comparing T1 and T2 Dixon MRI for Identification of Vertebral Malignancy. Semin Musculoskelet Radiol 2020. [DOI: 10.1055/s-0040-1722514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Donners R, Krieg AH, Baumhoer D, Boll DT, Harder D. Quantitative signal intensity ratios to distinguish between subfascial lipoma and atypical lipomatous tumor/well-differentiated liposarcoma using short-tau inversion recovery (STIR) MRI. Diagn Interv Imaging 2020; 101:383-390. [PMID: 32107197 DOI: 10.1016/j.diii.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To establish simple quantitative variables at short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) to identify lipomas with high specificity in patients with indeterminate subfascial lipomatous tumors. MATERIALS AND METHODS The MRI examinations of 26 patients (14 men, 12 women; mean age 63±12.5 [SD] years; range: 40-84years) with histopathologically proven subfascial atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLs) and those of 68 patients (32 men, 36 women; mean age, 56±13.5 [SD] years; range: 21-83years) with lipomas were retrospectively reviewed. Ratios derived from region of interest based signal intensity (SI) measurements of tumors and adjacent fat on STIR images were calculated and maximum tumor diameters were noted. Diagnostic parameter capabilities were assessed using ROC curve analysis. Interreader agreement was evaluated by calculation of intraclass correlation coefficients (ICC). RESULTS Using a cut-off value of 1.18, STIR-SI ratios allowed discriminating between lipoma and ALT/WDL (AUC=0.88; P<0.001) yielding 93% specificity (95% CI: 77-99%) and 74% sensitivity (95% CI: 61-84%) for the diagnosis of lipoma. Interreader agreement was excellent (ICC=0.93). A significant difference in maximum tumor diameter was found between ALT/WDLs (mean: 18.1±6.0 [SD] cm; range: 5.6-33.1cm) and lipomas (mean: 9.7±5.0 [SD] cm; range: 2.9-29.1cm) (P<0.001). Using a cut-off of 11cm, maximum tumor diameter allowed discriminating between lipoma and ALT/WDLs with 92% specificity (95% CI: 75-99%) and 69% sensitivity (95% CI: 57-80%). The combination of a STIR-SI ratio<1.4 and maximum tumor diameter<11cm yielded 100% specificity (95% CI: 87-100%) and 65% sensitivity (95% CI: 54-77%) for the diagnosis of lipoma. CONCLUSION The combination of STIR-SI ratio and maximum diameter allows discriminating between lipoma and ALT/WDL in initially indeterminate lipomatous tumors.
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Affiliation(s)
- R Donners
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - A H Krieg
- Bone and Soft tissue Sarcoma Center, University Basel (KWUB), University Childrens Hospital (UKBB), 4031 Basel, Switzerland
| | - D Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital and University of Basel, 4031 Basel, Switzerland
| | - D T Boll
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - D Harder
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
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Abstract
Whole-body diffusion-weighted MRI has emerged as a powerful diagnostic tool for disease detection and staging mainly used in systemic bone disease. The large field-of-view functional imaging technique highlights cellular tumor and suppresses normal tissue signal, allowing quantification of an estimate of total disease burden, summarized as the total diffusion volume (tDV), as well as global apparent diffusion coefficient (gADC) measurements. Both tDV and gADC have been shown to be repeatable quantitative parameters that indicate tumor heterogeneity and treatment effects, thus potential, noninvasive, imaging biomarkers informing on disease prognosis and therapy response.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Matthew Blackledge
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
| | - Elmar M Merkle
- Department of Radiology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK; Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK.
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Freyhardt P, Donners R, Riemert A, Schnorr J, Stolzenburg N, Rinnenthal JL, Bernhardt U, Hamm B, Günther RW, Streitparth F. Renal denervation by CT-guided periarterial injection of hyperosmolar saline, vincristine, paclitaxel and guanethidine in a pig model. EUROINTERVENTION 2017; 12:e2262-e2270. [PMID: 27890860 DOI: 10.4244/eij-d-15-00354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate the feasibility, safety and efficacy of renal sympathetic denervation with CT-guided periarterial injection of potentially neurolytic agents in pigs. METHODS AND RESULTS Unilateral injection of formulations containing either 5M hyperosmolar saline, vincristine, paclitaxel or guanethidine around the renal artery was performed in 24 normotensive pigs with six animals per group. Needle placement and injections were performed under CT fluoroscopy guidance. Blood pressure measurements and CT scans were performed immediately before and after the intervention and four weeks after treatment. After euthanasia, norepinephrine (NE) concentrations of both kidneys were determined. The renal arteries and surrounding tissue were examined histologically to evaluate nerve fibre degeneration. Procedures were technically successful with good periarterial distribution of the injectant in all but one pig in the guanethidine group. No major adverse events or post-interventional complications occurred. In the vincristine group, NE concentrations of the renal parenchyma were lower on the treated side in all pigs with a mean decrease of 53% (38%-62%, p<0.01) compared to the contralateral control. Correspondingly, histological examination revealed neural degeneration in all animals treated with vincristine. In the other groups, no significant drop of NE values, or histological signs of nerve fibre degeneration were found. CONCLUSIONS CT-guided periarterial injection of the different substances was feasible and safe. Renal sympathetic denervation was achieved with vincristine. In contrast, hyperosmolar saline, paclitaxel and guanethidine do not seem to be appropriate for renal denervation in a pig model at the dosage used.
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Affiliation(s)
- Patrick Freyhardt
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Freyhardt P, Schütze J, Donners R, Schnorr J, Stolzenburg N, Rinnenthal J, Hamm B, Günther R, Streitparth F. Experimentelle renale Denervation mittels transaortaler periarterieller Ethanolinjektion in Feinnadeltechnik. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Freyhardt P, Donners R, Riemert A, Schnorr J, Stolzenburg N, Rinnenthal J, Hamm B, Günther R, Streitparth F. Renale Sympathikolyse mittels CT-gestützter periarterieller Injektion von Vincristin, hypertoner Kochsalzlösung, Paclitaxel und Guanethidin im Schweinemodell. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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