The utility of ADC value in diffusion-weighted whole-body MRI in the follow-up of patients with multiple myeloma. Correlation study with 18F-FDG PET-CT

OBJECTIVES

To analyze the feasibility of DWI-MRI and ADC to evaluate treatment response in patients with multiple myeloma (MM). To correlate the variations of ADC and SUVmax in ¹⁸F-FDG PET-CT.

METHODS

27 patients with MM that had a whole-body MRI and ¹⁸F-FDG PET-CT performed at baseline and after treatment were retrospectively recruited between February 2018 and May 2020. Three target bone lesions were selected for each patient and their ADC, SUVmax and Deauville score were measured in every study. Correlation between ADC and SUVmax of the lesions was evaluated, as well as changes in mean ADC, SUVmax, and Deauville score between studies. Patients were classified as responder or non-responder according to the IMWG, MRI (MY-RADS) and PET-CT (IMPeTUs) response criteria. Agreement between the MRI and PET-CT criteria with the IMWG criteria was evaluated.

RESULTS

The correlation between the ADC and SUVmax of all the target lesions was strong, negative and significant (r=-0.603; p < 0.001). After treatment, mean ADC in lesions from responders was significantly higher than in non-responders (1585.51 × 10^-6 mm²/s vs 698.17 × 10^-6 mm²/s; p < 0.001). SUVmax of the same lesions was significantly lower in responders than in non-responders (2.05 vs 5.33; p < 0.001). There was a very strong or strong agreement of the IMWG response criteria with both MRI (κ = 0.852; p < 0.001) and PET (κ = 0.767; p < 0.001) criteria.

CONCLUSION

DWI-MRI and ADC may be used to assess treatment response in MM patients, showing a good correlation with ¹⁸F-FDG PET-CT and the IMWG response criteria.

Phase II multicenter randomized controlled clinical trial on the efficacy of intra-articular injection of autologous bone marrow mesenchymal stem cells with platelet rich plasma for the treatment of knee osteoarthritis

Background

Mesenchymal stromal cells are a safe and promising option to treat knee osteoarthritis as previously demonstrated in different clinical trials. However, their efficacy, optimal dose and addition of adjuvants must be determined. Here, we evaluated the clinical effects of a dose of 100 × 10⁶ bone marrow mesenchymal stromal cells (BM-MSCs) in combination with Platelet Rich Plasma (PRGF®) as adjuvant in a randomized clinical trial.

Methods

A phase II, multicenter, randomized clinical trial with active control was conducted. Sixty patients diagnosed with knee OA were randomly assigned to 3 weekly doses of PRGF® or intraarticular administration of 100 × 10⁶ cultured autologous BM-MSCs plus PRGF®. Patients were followed up for 12 months, and pain and function were assessed using VAS and WOMAC and by measuring the knee range of motion range. X-ray and magnetic resonance imaging analyses were performed to analyze joint damage.

Results

No adverse effects were reported after BM-MSC administration or during follow-up. According to VAS, the mean value (SD) for PRGF® and BM-MSC with PRGF® went from 5 (1.8) to 4.5 (2.2) (p = 0.389) and from 5.3 (1.9) to 3.5 (2.5) (p = 0.01), respectively at 12 months. In WOMAC, the mean (SD) baseline and 12-month overall WOMAC scores in patients treated with PRGF® was 31.9 (16.2) and 22.3 (15.8) respectively (p = 0.002) while that for patients treated with BM-MSC plus PRGF® was 33.4 (18.7) and 23.0 (16.6) (p = 0.053). Although statistical significances between groups have been not detected, only patients being treated with BM-MSC plus PRGF® could be considered as a OA treatment responders following OARSI criteria. X-ray and MRI (WORMS protocol) revealed no changes in knee joint space width or joint damage.

Conclusions

Treatment with BM-MSC associated with PRGF® was shown to be a viable therapeutic option for osteoarthritis of the knee, with clinical improvement at the end of follow-up. Further phase III clinical trials would be necessary to confirm the efficacy.

Trial registration Clinical Trials.gov identifier NCT02365142. Nº EudraCT: 2011-006036-23

The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study

Some investigators have emphasized restoring the relationship between the sesamoid complex and the first metatarsal head to reduce the risk of hallux valgus recurring after surgical reconstruction. In a prospective study, we analyzed whether the first metatarsophalangeal joint could be realigned after scarf-Akin bunionectomy without lateral soft tissue release. A total of 25 feet, in 22 patients, were prospectively enrolled and analyzed using anteroposterior radiographs and coronal computed tomography scans obtained before and 3 months after surgery. The Yildirim sesamoid position decreased from a preoperative of 2 (range 1 to 3) to a postoperative position of 0 (range 0 to 1; p < .001), the mean first intermetatarsal angle decreased from 12.6° ± 2.4° to 5.8° ± 2.1° (p < .001), and the mean distance between the second metatarsal and the tibial sesamoid changed from 25.7 ± 4.6 to 25.9 ± 4.6 (p = .59). Our findings suggest that dislocation of the sesamoid complex is actually caused by displacement of the first metatarsal. In conclusion, the scarf-Akin bunionectomy adequately restores the alignment of the first metatarsophalangeal joint, including restoration of the sesamoid apparatus, without direct plantar-lateral soft tissue release.

[Intestinal pneumatosis and portomesenteric gas: a case review]

Intestinal pneumatosis (presence of gas in the intestinal wall and in the portomeseteric veins) is an infrequent clinical situation that has been associated with extended bowel necrosis and fatal outcome. However, there are other reasons that can justify these findings without such an outcome. Recent advances in diagnostic imaging techniques, especially multislice computerized tomography (MSCT), have allowed precise and quick diagnosis of these entities. In this article, we review the MSCT radiological manifestations of intestinal pneumatosis, as well as the different diagnoses related with the findings observed in a patient diagnosed with esophageal carcinoma under chemotherapy treatment.

Cervicobrachialgia and pancoast tumor: value of standard anteroposterior cervical radiographs in early diagnosis

Ten patients diagnosed with Pancoast tumor were studied retrospectively. The definitive diagnosis was made between 2 and 24 months after the onset of pain. Pain localization was hard to pinpoint; some patients reported pain in four different sites (neck, shoulder, arm, and scapula). Five patients had previously been diagnosed with degenerative, inflammatory, or infectious diseases of the cervical spine or shoulder. In the remaining five patients, the diagnosis was made during the first clinical visit. In three patients, an orthopedic surgeon made the diagnosis by viewing a standard anteroposterior (AP) cervical radiograph. The radiographic evidence arousing suspicion of a Pancoast tumor was the lack of pulmonary air at the top of the affected lung. Furthermore, a parallel study was conducted on 100 consecutive patients seeking treatment for neck pain. By examining the AP radiographs of their cervical spines, the third rib and the top of both lungs were observed in all cases. This study stresses the value of standard AP cervical radiographs in the diagnosis of Pancoast tumor.

[Chest X-ray plate in bed-ridden patients in the Intensive Care Unit]

Chest radiographs using portable equipment is one most frequently used radiological investigations for bed-ridden patients. As the investigation is carried out using ionising radiation, the protection measures to be applied should be known. These investigations are normally hindered by the patient's condition and it is important to take into account that this circumstance can cause differences in the radiological study. As in all radiological studies, the reading and the diagnosis should be systematic and it is necessary to recognise the different elements that these patients may bare, in addition to the symptomatology of the possible pathologies that may exist in the chest.

Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings

We compared several image methods in the evaluation of the possible physeal effect in 47 osteosarcomas and 18 Ewing's sarcomas in children. The minimal follow-up was 3 years (range, 3-17). In the histological study, the physis was affected in 53% of the cases. We correlated the histological findings and the findings from the different image methods. There were more false-positive than false-negative results, and in the computed tomography and magnetic resonance imaging (MRI) studies, there were no false negatives. The accuracy of MRI (predictive positive value plus predictive negative value) was the best (90.3%), and it is the technique that we prefer. According to these findings, we can safely preserve the epiphysis in cases of metaphyseal tumors showing no contact between the tumor and the growth plate in the MRI images. If the tumor shows contact with part of the physis, it is also possible to preserve the epiphysis.

Complications of bone lengthening

Bone lengthening is a surgical method which requires meticulous technique, continuous attention, and satisfactory cooperation on the part of the patient. The absence of common criteria makes it difficult both to classify the complications which arise, and to compare them with those of other authors. We report the complications in a group of 61 patients who were studied prospectively. Disorders of the lengthening callus accounted for 45% of all complications, and a further 33% arose in the joints. The remainder occurred in the bone, the apparatus and the soft tissues, of which the most common were stiffness of the joints, axial deviations and loosening of the pins, while articular subluxation, fractures with angulation and delayed consolidation occurred less frequently. In our study, the overall number of complications per lengthening process was 2.1. In bilateral lengthening, the rate was 1 per segment, while in unilateral cases the mean was 2.7. Problems which we defined as severe, requiring that the lengthening had to be halted, occurred in 1.8% of the total complications. The aetiology of the length discrepancy has an important role in the complications which occur in each segment. Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical.

Splenic embolization prior to myelosuppressive treatment in hepatocarcinoma and active chronic hepatitis

In the treatment of active chronic hepatitis and hepatocellular carcinoma some effective drugs can produce myelosuppression. Hypersplenism may considerably limit the dosage of such drugs. Splenectomy is an effective treatment for hypersplenism, although it is not without complications. Partial splenic embolization is a good and safe procedure; 15 patients were treated in order to achieve higher platelet and leukocyte counts. Embolization has been performed with gelfoam with local and systemic antibiotics (Spigos' protocol) and 50-75% of the splenic parenchyma was infarcted. All patients could be treated for the underlying hepatopathy with adequate dosages of interferon or chemotherapeutic drugs.

The open-ended guidewire as superselective catheter for intraarterial chemotherapy: experience in 190 procedures

With intraarterial infusion, high levels of chemotherapeutic agents can be achieved in the tumoral area. We present our experience with open-ended guidewire (OEGW) associated with steerable guidewires (SGW) as superselective catheters for intraarterial chemotherapeutic infusion and embolization. This technique was used successfully in 62 patients (190 procedures) over 15 months.

Platinum wire embolization of an intrahepatic arterioportal fistula

We report a case of arterioportal fistula in the right hepatic lobe. The lesion was selectively catheterized with an open-ended guidewire and successfully embolized with small pieces of platinum wire.