3D volume growth rate evaluation in the EORTC-BTG-1320 clinical trial for recurrent WHO grade 2 and 3 meningiomas

BACKGROUND

We previously reported that tumor 3D volume growth rate (3DVGR) classification could help in the assessment of drug activity in patients with meningioma using three main classes and a total of five subclasses: class 1: decrease; 2: stabilization or severe slowdown; 3: progression. The EORTC-BTG-1320 clinical trial was a randomized phase II trial evaluating the efficacy of trabectedin for recurrent WHO 2 or 3 meningioma. Our objective was to evaluate the discriminative value of 3DVGR classification in the EORTC-BTG-1320.

METHODS

All patients with at least one available MRI before trial inclusion were included. 3D volume was evaluated on consecutive MRI until progression. 2D imaging response was centrally assessed by MRI modified Macdonald criteria. Clinical benefit was defined as neurological or functional status improvement or steroid decrease or discontinuation.

RESULTS

Sixteen patients with a median age of 58.5 years were included. Best 3DVGR classes were: 1, 2A, 3A and 3B in 2 (16.7%), 4 (33.3%), 2 (16.7%) and 4 (33.3%) patients, respectively. All patients with progression-free survival longer than 6 months had best 3DVGR class 1 or 2. 3DVGR classes 1 and 2 (combined) had a median overall survival of 34.7 months versus 7.2 months for class 3 (p=0.061). All class 1 patients (2/2), 75% of class 2 patients (3/4) and only 10% of class 3 patients (1/10) had clinical benefit.

CONCLUSIONS

Tumor 3DVGR classification may be helpful to identify early signals of treatment activity in meningioma clinical trials.

Three-dimensional evaluation of secondary alveolar bone grafting in patients with unilateral cleft lip and palate: A 2-3 year post-operative follow-up

OBJECTIVES

The present study aims to quantitatively assess secondary alveolar bone graft (SABG) resorption in unilateral cleft lip, alveolus and palate (UCLAP) patients in a 2-3 year longitudinal follow-up setting by using a validated 3D protocol. Furthermore, the potential relation of SABG resorption with maxillary canine position and a number of patient-related factors was investigated.

METHODS

UCLAP patients who underwent SABG and had good quality CBCT images at the following timepoints were included in the study: pre-operative (T0), immediate (T1), 6 months (T2) and either 1-2 years (T3) or 2-3 years (T4) post-operative. The final bone grafted region was defined on the T1 scans and refined in the registered T0 scans. The bone graft after resorption was determined by applying threshold-based segmentation on the registered T2, T3 or T4 scans within the segmented bone graft volume. The position of the canines was determined at every timepoint at the cleft and non-cleft side.

RESULTS

Forty-five UCLAP patients (mean age 9.0 ± 1.3 years) were included. In the first 6 months after SABG, 43.6% bone resorption was recorded. 2-3 years post-operative, 56% bone resorption was found if the maxillary canine was not yet erupted and 42.7% if it erupted through the graft. The vertical position of the canines was significantly higher on the cleft side at T3.

CONCLUSIONS

The present study reports significant SABG resorption over time. However, no correlation was found between SABG resorption and canine position, nor between other patient-related factors.

Effect of a 24-Week Concurrent Exercise Intervention on Neck Adiposity and Its Distribution in Young Adults: The ACTIBATE Randomized Controlled Trial

Neck adipose tissue (NAT) accumulation and neck circumference are independent predictors of cardiometabolic risk (CMR) and low-grade chronic inflammation in young adults. The present study examines whether a 24-week concurrent exercise intervention can reduce NAT volume and neck circumference in young adults, and whether any changes in these variables are related to changes in body composition, CMR, and the inflammatory profile. Seventy-four participants (51 women, age 22 ± 2 years) were included in the main analyses, after being randomly assigned to either a (a) control (n = 34), (b) moderate-intensity exercise (n = 19), or (c) vigorous-intensity exercise (n = 21) group. Participants in the exercise groups trained 3-4 days/week (endurance + resistance exercise training). NAT volume and NAT distribution across different depots were estimated using computed tomography before and after the intervention. Anthropometric variables, body composition (determined by dual-energy X-ray absorptiometry), and CMR/inflammatory markers were also recorded. The exercise intervention did not reduce the total NAT volume, nor was NAT distribution affected (p > .05). However, it did reduce neck circumference in the vigorous-intensity exercise group compared with the moderate-intensity exercise and control groups (by 0.8 and 1 cm, respectively, p ≤ .05). Changes in total NAT and neck circumference were positively, albeit weakly, related (adj. R2: .05-.21, all p ≤ .05) to changes in body weight and adiposity, leptin (only total NAT), and CMR (only neck circumference). Altogether 24 weeks of concurrent exercise does not appear to reduce NAT accumulation in young adults, but may slightly reduce neck circumference in those who partake in vigorous exercise.

Comparison of Novel Volumetric Microperimetry Metrics in Intermediate Age-Related Macular Degeneration: PINNACLE Study Report 3

Purpose

To investigate and compare novel volumetric microperimetry (MP)-derived metrics in intermediate age-related macular degeneration (iAMD), as current MP metrics show high variability and low sensitivity.

Methods

This is a cross-sectional analysis of microperimetry baseline data from the multicenter, prospective PINNACLE study (ClinicalTrials.gov NCT04269304). The Visual Field Modeling and Analysis (VFMA) software and an open-source implementation (OSI) were applied to calculate MP-derived hill-of-vison (HOV) surface plots and the total volume (VTOT) beneath the plots. Bland-Altman plots were used for methodologic comparison, and the association of retinal sensitivity metrics with explanatory variables was tested with mixed-effects models.

Results

In total, 247 eyes of 189 participants (75 ± 7.3 years) were included in the analysis. The VTOT output of VFMA and OSI exhibited a significant difference (P < 0.0001). VFMA yielded slightly higher coefficients of determination than OSI and mean sensitivity (MS) in univariable and multivariable modeling, for example, in association with low-luminance visual acuity (LLVA) (marginal R2/conditional R2: VFMA 0.171/0.771, OSI 0.162/0.765, MS 0.133/0.755). In the multivariable analysis, LLVA was the only demonstrable predictor of VFMA VTOT (t-value, P-value: -7.5, <0.001) and MS (-6.5, <0.001).

Conclusions

The HOV-derived metric of VTOT exhibits favorable characteristics compared to MS in evaluating retinal sensitivity. The output of VFMA and OSI is not exactly interchangeable in this cross-sectional analysis. Longitudinal analysis is necessary to assess their performance in ability-to-detect change.

Translational Relevance

This study explores new volumetric MP endpoints for future application in therapeutic trials in iAMD and reports specific characteristics of the available HOV software applications.

Prediction of collapse in femoral head osteonecrosis: role of volumetric assessment

PURPOSE

The purpose of this study was to evaluate and compare the accuracy of three different techniques of measuring the extent of osteonecrosis involvement of the femoral head on MRI to determine the best predictor of collapse and to identify the size of the lesion volume which best predicts collapse.

METHODS

We prospectively enrolled 48 hips of osteonecrosis femoral head (ONFH) with stage 1 or 2 osteonecrosis and the enrolled patients were followed up for 1 year. Angular measurements (modified Kerboul Angle and modified index of necrotic extent) were compared with the 3D volumetric measurement of necrotic lesion based on MRI in predicting the collapse of the head. ROC analysis was done to evaluate the diagnostic performance of the 3 indices in predicting collapse. Survival analysis of all the hips in the collapsed and non-collapsed group were interpreted using Kaplan Meir survival analysis.

RESULTS

In lesion sizes larger than 25% of femoral head volume - 90.6% (29/32) of hips collapsed within 1 year as compared to 31.3% (5/16) hips collapsed in lesion volume <25% of femoral head (Log-rank test p = 0.001). There was good inter-observer (ICC, 0.94; 95% CI, 0.89-0.97) and intra-observer reliability (ICC, 0.93; 95% CI, 0.88-0.96).

CONCLUSIONS

The Volumetric method assessed the severity of lesion size with the future collapse better and more predictably than angular measurements. Necrotic lesion volume of 25% is a potential cut off beyond which future collapse of early ONFH can be predicted and aid in the further management. This study can help in solving the mystery behind prediction of collapse in ONFH.

The effectiveness of mineralized plasmatic matrix in the closure of alveolar clefts with volumetric assessment

Objectives: The purpose of this study is to assess the effectiveness of mineralized plasmatic matrix in the soft tissue closure of naso-alveolar fistula, to estimate the postoperative bone fill and volume of the graft placed in the alveolar cleft defect using cone-beam computed tomography (CBCT) at 3rd- month and 6th- month. Material and methods: 10 patients, in the age group of 15‑30 years were included in this study. They were diagnosed with unilateral cleft lip and alveolus defects with or without a cleft palate requiring late secondary alveolar bone grafting. Alveolar cleft defects were closed with mineralized plasmatic matrix (MPM), a combination of autogenous iliac bone graft and platelet rich plasma (PRP) and platelet rich fibrin (PRF). Results: The mean defect volume pre-operatively is 0.75 cm³ and at the end of 3rd-month postoperatively is 0.51 cm³ and at 6th-month postoperatively is 0.27 cm³. The average percentage of bone fill between preoperative (A) & 3th- month postoperatively (B) is 33.4% and between 3rd-month (B) and 6th-month post operatively (C) is 49.5%. Conclusions: Utilization of this new matrix (MPM), has shown to be effective in the closure of the cleft defect, oro-nasal fistula and also reduction in the volume of the residual cleft defect seen with sequential cone-beam computed tomography (CBCT) radiographs.

On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI

Primary glioblastoma (GBM), IDH-wildtype, especially with multifocal appearance/growth (mGBM), is associated with very poor prognosis. Several clinical parameters have been identified to provide prognostic value in both unifocal GBM (uGBM) and mGBM, but information about the influence of radiological parameters on survival for mGBM cohorts is scarce. This study evaluated the prognostic value of several volumetric parameters derived from magnetic resonance imaging (MRI). Data from the Department of Neurosurgery, Leipzig University Hospital, were retrospectively analyzed. Patients treated between 2014 and 2019, aged older than 18 years and with adequate peri-operative MRI were included. Volumetric assessment was performed manually. One hundred and eighty-three patients were included. Survival of patients with mGBM was significantly shorter (p < 0.0001). Univariate analysis revealed extent of resection, adjuvant therapy regimen, residual tumor volume, tumor necrosis volume and ratio of tumor necrosis to initial volume as statistically significant for overall survival. In multivariate Cox regression, however, only EOR (for uGBM and the entire cohort) and adjuvant therapy were independently significant for survival. Decreased ratio of tumor necrosis to initial tumor volume and extent of resection were associated with prolonged survival in mGBM but failed to achieve statistical significance in multivariate analysis.

Higher Physical Activity Is Related to Lower Neck Adiposity in Young Men, but to Higher Neck Adiposity in Young Women: An Exploratory Study

The role of lifestyle behaviors on neck adipose tissue (NAT), a fat depot that appears to be involved in the pathogenesis of different cardiometabolic diseases and in inflammatory status, is unknown. In this cross-sectional and exploratory study, the authors examined the relationship between sedentary time and physical activity (PA) with neck adiposity in young adults. A total of 134 subjects (69% women, 23 ± 2 years) were enrolled. The time spent in sedentary behavior and PA of different intensity were objectively measured for 7 consecutive days (24 hr/day), using a wrist (nondominant)-worn accelerometer. The NAT volume was assessed using computed tomography, and the compartmental (subcutaneous, intermuscular, and perivertebral) and total NAT volumes were determined at the level of vertebra C5. Anthropometric indicators and body composition (by dual-energy X-ray absorptiometry) were determined. The time spent in light physical activity and moderate physical activity (MPA) and the overall PA were inversely associated with the intermuscular NAT volume in men, as were the MPA and overall PA with total NAT volume (all ps ≤ .04). Sedentary time was directly related to the total NAT volume (p = .04). An opposite trend was observed in women, finding a direct relationship of MPA with the subcutaneous NAT; of light physical activity, MPA, and overall PA with the perivertebral NAT; and of light physical activity with total NAT volumes (all ps ≤ .05). The observed associations were weak, and after adjusting for multiplicity, the results became nonsignificant (p > .05). These findings suggest that the specific characteristics of PA (time and intensity) might have sex-dependent implications in the accumulation of NAT.

Volumetric Carotid Flow Characteristics in Doppler Ultrasonography in Healthy Population Over 65 Years Old

Background: Carotid flow velocity criteria are well established, with age being a factor influencing measurements. However, there are no volumetric standards for the flow in extracranial arteries. The aim of the study was related to volumetric flow assessment of extracranial arteries in a healthy population >65 years old. Methods: Doppler volumetric measurements of internal carotid (ICA), external carotid (ECA) and vertebral arteries (VA) were performed in 123 healthy volunteers >65 years old and compared with 56 healthy volunteers <65 years old. Results: The continuous decline in cerebral blood flow (CBF) volume was observed (p < 0.00001). Volumetric reference values were established in study groups: 1., 65–69 years: 898.5 ± 119.1; 2., 70–74 years: 838.5 ± 148.9; 3., 75–79 years: 805.1 ± 99.3; 4., >80 years: 685.7 ± 112.3 (mL/min). Significant differences were observed between groups: 1 and 3.4, as well as 3 and 4 (p = 0.0295, < 0.000001, 0.00446 respectively). CBF volume decreases gradually with age: 28–64 years—6.2 mL/year (p = 0.0019), 65–75 years—11.4 mL/year (p = 0.0121) and >75 years—14.3 mL/year (p = 0.0074). This is a consequence of flow volume decline in ICA (p = 0.00001) and to lesser extent ECA (p = 0.0011). The decrease of peak systolic (p = 0.002) and end diastolic (p = < 0.00001) velocities in ICA and peak systolic velocity in ECA (p = 0.0017) were observed. Conclusions: CBF decreases with ageing. Volumetric assessment of CBF may play an important additional role in diagnostics of patients with carotid stenosis. Doppler assessment of cerebral flow volume may create an interesting tool for identifying patients with diminished cerebrovascular reserve and higher risk of ischemic symptoms occurrence.

Association of volume and voxel intensity of the articular disc and lateral pterygoid muscle in migraine patients: a study with magnetic resonance imaging

Objectives: To compare the volume and voxel intensity of articular disc and lateral pterygoid muscle (LPM) between a group of migraine patients and a control group (those without history of headache) by using magnetic resonance imaging (MRI).Patients and methods: MRI scans of 17 migraine patients and 15 healthy controls subjects were analysed and processed, using ITK-SNAP software, by a single investigator, for calculation of volumes and voxel intensity of articular disc and superior and inferior head of LPM.Results: There were statistically significant differences between migraine patients and controls regarding the volume and voxel intensity of articular disc and inferior head of LPM, increasing in migraine patients. Intra-rater was highly consistent and reproducible (intra-class correlation coefficient [ICC] = 1).Conclusions: Higher voxel intensity in disc and inferior head of LPM of MRI scans was linked to the increased volume of articular disc, inferior head of LPM and migraine.

Sonographic Bedside Quantification of Pleural Effusion Compared to Computed Tomography Volumetry in ICU Patients

Objectives

To date, the reliability of ultrasound for the quantitative assessment of pleural effusion has been limited. In the following study, an easy and cost-effective bedside ultrasound method was developed and investigated for specific use in the intensive care unit (ICU).

Methods

22 patients (median age: 58.5 years, range: 37–88 years, 14 men and 8 women) with a total of 31 pleural effusions were examined in the ICU. The inclusion criterion was complete visualization of the effusion on chest computed tomography (CT). The ultrasound (US) examination was performed less than 6 h after the diagnostic CT scan. The pleural effusion volume was calculated volumetrically from the CT scan data. Within 4.58 +/- 2.87 h after the CT scan, all patients were re-examined with US in the ICU. The fluid crescent's thickness was measured between each intercostal space (ICS) with the patient in a supine position and a 30° inclination of the torso. The US measurements were compared to the calculated CT volumes using regression analysis, resulting in the following formula: V=13.330 x ICS6 (V=volume of the effusion [ml]; ICS6=sonographic measurement of the thickness of the liquid crescent [mm] in the sixth ICS).

Results

A significant correlation between the sonographically measured and the CT-calculated volumes was best observed for the sixth ICS (R2=0.589; ICC=0.7469 with p<0.0001 and a 95% CI of 0.5364–0.8705).

Conclusion

The sonographic assessment of pleural effusions in a supine position and a 30° inclination of the torso is feasible for the volumetric estimation of pleural effusion. This is especially true for ICU patients with severe primary diseases and orthopnea who are unable to sit upright or lie flat.

Three-dimensional volumetric analysis of mandibular condyle changes in growing subjects: A retrospective cross-sectional study

OBJECTIVE

The purpose of this study is to analyze the mandibular condylar volumein a sample of subjects 11-26 years old.

METHODS

CBCT condylescans from 94 patients (mean age 18.2 ± 4.5 y) acquired with areconstructed layer thickness of 0.5 mm and a 512×512 matrix were examined. Data on condylar volume were compared among three groups with different age ranges: 11-16 years, 17-21years, and 22-26 years. Condylar volumetric measurements were performed with Mimics™ software.

RESULTS

A significant increase in condylar volume from puberty to young adulthood was detected (p < 0.01). Females showed a higher condylar volume in the 17-21 y group compared with the 11-16 y group. Males showed differences among all three groups.

CONCLUSION

The mandibular condyle growth seems to continue at least until 17-21 years in males but seems to stop before 17 years in females.

Tooth wear during orthodontic treatment with fixed appliances: a systematic review

OBJECTIVES

Tooth wear, additional to the physiologic alterations of the dentition, may occur during orthodontic treatment. The objective of the present review was to investigate systematically the literature relevant to its progression in patients having undergone comprehensive orthodontic treatment.

DATA SOURCES

Search without restrictions in eight databases since inception and hand searching until October 2017 was performed.

DATA SELECTION

Studies evaluating tooth wear immediately before and after the completion of orthodontic treatment with fixed appliance were evaluated independently and in duplicate.

DATA EXTRACTION

Following study retrieval and selection, data on volumetric and surface tooth wear was extracted. Individual study risk of bias assessment was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

DATA SYNTHESIS

All three finally included studies reported wear of teeth during the period of treatment but were at serious risk of bias. Two of them investigated tooth wear by 3D volumetric measurements and one used grading scales. The mean volume reduction was 1.02 mm³ per tooth for the incisor group [95% Confidence Interval (CI): 0.84-1.20], 1.62 mm³ for the canines [95% CI: 0.8-2.38; I²= 96%; random effects method] and 0.95 mm³ for premolars and molars [95% CI: 0.84-1.07]. The overall quality of evidence limited the confidence in the observed estimates.

CONCLUSIONS

Varying degrees of tooth wear were reported after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much is associated with orthodontic treatment and/or physiologic alterations of the dentition.

The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial

BACKGROUND

Edema is a possibility with all heating modalities due to the increase in local blood flow caused by vasodilation. Despite the frequent application of superficial heat modalities, their relative effect on hand volume has not been determined for the upper extremity. The objective of this study was to compare the immediate effects of hot packs and whirlpool on hand volume for patients with distal radius fracture (DRF) and to determine whether any changes in volume between these modalities were still present 30 minutes after heat application. Finally, to determine whether there were any differences in volume change between groups after 3 repeated therapy visits.

METHODS

Sixty patients with clinically healed DRFs were divided into 2 groups. Half received therapeutic whirlpool at each therapy visit, and the other half received a moist hot pack treatment for 3 consecutive visits. Hand volume was measured before heat, after heat, and at the end of each 30-minute therapy session.

RESULTS

There was a significant difference between groups immediately after heat application, as patients in the whirlpool group experienced an initial volume increase greater than those who received a hot pack. When remeasured after a hand therapy session approximately 30 minutes later, this group difference in volume change was no longer significant. The overall change in volume from enrollment in the study to completion of the study 3 weeks later was not statistically different between groups.

CONCLUSION

Whirlpool is a potential consideration when selecting a heat modality for patients with DRF.

Assessment of radiologic response to targeted therapies in patients with hepatocellular carcinoma

The development of new treatment options for hepatocellular carcinoma has changed not only the way in which cancer is treated, but also how it is diagnosed, especially the assessment of tumor response. The traditional radiologic methods, which are mainly based on the evaluation of changes in tumor size, are considered to be insufficiently sensitive and unreliable for determining tumor progression when targeted therapies such as sorafenib are involved. Several lines of research are currently focusing on the development of new assessment tools that try to combine morphological and vascular functional data in order to obtain an accurate measurement of tumor characteristics, such as volume, density or vascularization. This article presents some of the new instruments that have reported positive results.

A novel method to estimate the volume of bone defects using cone-beam computed tomography: an in vitro study

INTRODUCTION

The routine use of high-resolution images derived from 3-dimensional cone-beam computed tomography (CBCT) datasets enables the linear measurement of lesions in the maxillary and mandibular bones on 3 planes of space. Measurements on different planes would make it possible to obtain real volumetric assessments. In this study, we tested, in vitro, the accuracy and reliability of new dedicated software developed for volumetric lesion assessment in clinical endodontics.

METHODS

Twenty-seven bone defects were created around the apices of 8 teeth in 1 young bovine mandible to simulate periapical lesions of different sizes and shapes. The volume of each defect was determined by taking an impression of the defect using a silicone material. The samples were scanned using an Accuitomo 170 CBCT (J. Morita Mfg Co, Kyoto, Japan), and the data were uploaded into a newly developed dedicated software tool. Two endodontists acted as independent and calibrated observers. They analyzed each bone defect for volume. The difference between the direct volumetric measurements and the measurements obtained with the CBCT images was statistically assessed using a lack-of-fit test. A correlation study was undertaken using the Pearson product-moment correlation coefficient. Intra- and interobserver agreement was also evaluated.

RESULTS

The results showed a good fit and strong correlation between both volume measurements (ρ > 0.9) with excellent inter- and intraobserver agreement.

CONCLUSIONS

Using this software, CBCT proved to be a reliable method in vitro for the estimation of endodontic lesion volumes in bovine jaws. Therefore, it may constitute a new, validated technique for the accurate evaluation and follow-up of apical periodontitis.

Mandibular symphysis graft versus iliac cortical graft in reconstructing floor in orbital blow out fracture: A comparative study

Aim:

The purpose of this study was to clinically and radiologically assess and compare the outcome of internal orbital reconstruction with an iliac bone graft and mandibular symphysis graft in orbital blow out fractures.

Materials and Methods:

Eight consecutive patients with unilateral orbital blow out fractures were enrolled in this prospective study. CT scan imaging and volumetric assessment of the orbit was done for all patients using GE Discovery VCT Workstation 4.4. Patients with defect of area less than 2 cm² and orbital volume expansion of less than 4.7 cm³ were treated with mandibular symphysis graft, in contrast the others were treated with a medial cortical graft from the anterior ilium. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and volumetric assessment were used to observe graft posture, bone defects and contour.

Results:

Group I cases showed that orbital volume changes of less than 2cm³ can be effectively reduced. Group II cases showed that orbital volume changes of more than 4.5 cm³ could not be effectively restored in spite of using large iliac graft. All eight patients had satisfactory correction of hypoglobus. Diplopia and ocular motility restriction resolved in all affected patients post operatively between 4^th day and 2^nd week. At 3-month follow-up, computed tomography demonstrated that the middle section of the orbital floor was well elevated in all 8 orbits. All grafts were still in situ, with density measured in Hounsfield units revealed that the Mandible Symphyseal graft was denser.

Conclusion:

The mandibular symphysis graft is a good, simple reconstructive option in small orbital floor defects with orbital volume change less than 4.71 ml. In larger defects with huge orbital volume changes that require more volume of graft, iliac graft is useful albeit, perfect, volumetric restoration is not always possible