Bone Lesions Research Articles

Cryoablation for Malignant Bone and Soft Tissue Tumors and Histological Assessment of Ablated Tumors.

Cryoablation is a new, minimally invasive option for local tumor therapy that is attracting attention due to its potential interactions with the immune system. The purpose of this study was to evaluate the efficacy of cryoablation for local control of bone and soft tissue lesions, to elucidate risk factors for recurrence, and to clarify histological changes. Participants comprised 25 patients who underwent cryoablation for 53 discrete lesions of bone or soft tissue recurrence after resection or as metastases of cancer or sarcoma. Local progression-free survival was evaluated after completion of cryoablation. The histology of tumor tissues resected after cryoablation was assessed for seven cases. Local progression-free survival rates were 88.1% at 1 year and 79.7% at 2 and 3 years. Risk of local progression was significantly higher for recurrent lesions after resection, and for lesions ≥4.0 cm in diameter than for metastatic lesions, or lesions <4.0 cm, respectively (p<0.05 each). In a subgroup analysis of bone lesions, lesions with an extraskeletal component tended to be associated with worse local recurrence-free survival than those without an extraskeletal component. On histological examination, tissue in the ablated area was completely necrotic. In the border area between ablated and non-ablated areas, CD68-positive cells including CD16-M1-like and CD204-positive M2-like cells were more frequently observed than T cells. Cryoablation has shown good anti-tumor efficacy across various tumor types, including those affecting the bone. However, local control was inadequate for recurrent lesions and tumors larger than 4.0 cm in diameter. Further analysis of the relationship between macrophages and cryoablation is needed and may provide critical insights into achieving a more effective anti-tumor response.

Denosumab combined with radiotherapy as an alternative to surgery for advanced metastatic bone lesions and pathologic fractures: a retrospective case study of 38 patients

Background and purpose: Pathologic and impending fractures occur in patients with advanced metastatic disease and necessitate surgical interventions with high risk of complications. The aim of this study was to analyze the efficacy of combined treatment with denosumab and radiotherapy as an alternative to surgery in treating bone metastases of the pelvis and extremities. Methods: This retrospective cohort study included 38 patients with impending and pathologic fractures due to carcinoma metastases who received monthly injections of denosumab (120 mg/dose) and radiotherapy. Twenty-three patients received denosumab and single-dose radiotherapy of 8 Gy, and 15 patients received denosumab and fractionated radiotherapy. We assessed pain, radiographic signs of fracture healing, survival and complications. Results: Of the 38 patients 36 experienced pain reduction. Callus formation was observed in 11/17 patients with pathologic fractures, and increased mineralization was found in 12/21 patients with impending fractures. In 23/38 patients, we found both pain reduction and callus formation or increased mineralization. There were no statistically significant differences in treatment outcomes between the patients who received denosumab and single-dose radiotherapy and those who received denosumab and fractionated radiotherapy. The survival rates at 30 days and 1 year were 95% and 56%, respectively. Interpretation: Combined treatment with denosumab and radiotherapy may reduce pain and promote bone healing in patients with metastatic impending and pathologic fractures. In this combined treatment, the effect of single-dose radiotherapy appears to be comparable to that of fractionated regimens

Glenohumeral bone lesions occurring during the first episode of shoulder dislocation do not influence function at an average of 2 years

BackgroundAfter a first shoulder dislocation, the rate of recurrence varies according to age and type of activity. The rule of bony lesions is logical but not demonstrated. We conducted a study to analyze bony lesions observed after a first episode of anterior shoulder dislocation in patients younger than 50 years of age. We assessed the functional outcomes and rate of recurrence among dislocations depending on bony lesions. MethodsWe conducted a prospective, multicenter study for an average of 2 years that included patients aged 18–50 years who had experienced a first episode of anterior shoulder dislocation and who agreed to undergo computed tomography imaging within 3 weeks of trauma. A minimum follow-up duration of 1 year was required for clinical analysis. ResultsNinety-two patients, with a mean follow-up duration of 2 years, participated in the study. Ultimately, 13 patients were excluded: 2 were lost to follow-up, 6 underwent stabilization surgery, and 5 had a follow-up duration of less than 1 year. The mean age at inclusion was 27 years and 94% were men. Glenoid lesions were observed in 39% of patients; humeral lesions were present in 95%. Recurrence occurred in 24% of cases. There was no significant difference in functional scores between patients with and without bony lesion. There was a lower rate of residual apprehension in non-recurrent patients compared with those who had experienced recurrence (p = 0.02) and a greater return to sport in the "no recurrence" subgroup (p = 0.02). The risk of recurrence was equivalent, regardless of the status of glenoid, humerus, or bipolar lesions. The sole predictor of recurrence after a first episode of dislocation was age younger than 20 years (p = 0.002). ConclusionOur study results provide insight into the functional outcomes and likelihood of dislocation recurrence with bony lesions after initial glenohumeral dislocation. If the first episode occurred before the age of 50 years, bony lesions were common. The overall recurrence rate was 24% with an average time of recurrence of 16 months (1-24). In our study, the presence of glenoid and/or humeral bony lesions doesn’t seem to be a risk factor for luxation recurrence.

68Ga-PSMA PET/CT and 18F-FDG PET/CT in the diagnosis of prostatic ductal cancer

PurposesTo explore the characteristics of PSMA PET/CT and FDG PET/CT images in prostatic ductal adenocarcinoma (DA) patients. MethodsWe retrospectively enrolled prostatic DA patients with PET/CT scans at Tongji Hospital from 2018 to 2022. Patients with prostatic acinar adenocarcinoma (AA) and benign pathology (BP) were enrolled by 1:1 matching. Differences in the uptake of primary and metastatic foci on PET among the groups were analyzed. ResultsA total of 42 patients were enrolled: 14 in each group. In primary foci, the mean PSMA uptake in the DA group was lower than that in the AA group (14.2 ± 9.6 vs. 27.1 ± 14.3, P = 0.009) and greater than that in the BP group (14.2 ± 9.6 vs. 4.7 ± 1.3, P = 0.003). The AUCs of the DA-AA ROC curve and DA-BP ROC curve were 0.781 and 0.872, respectively. The median PSMA uptake of metastatic lymph nodes in the DA group was lower than that in the AA group (5.6 vs. 14.2, P = 0.033), with no significant difference in metastatic bone lesions (9.5 vs 19.1, P = 0.485). No significant difference was found in the FDG uptake of primary and metastatic foci between the DA and AA groups (P > 0.05). ConclusionProstatic DA has greater PSMA uptake than BP diseases, but lower uptake in both primary foci and metastatic lymph nodes than AA on PSMA PET/CT, aiding in the differential diagnosis of DA, AA and BP diseases. Clinicians should combine traditional imaging with PSMA PET/CT to avoid underestimating the clinical stage of DA patients.

Update on cancer screening in children with syndromes of bone lesions, hereditary leiomyoma and renal cell carcinoma syndrome, and other rare syndromes.

The management of children with syndromes associated with an increased risk of benign and malignant neoplasms is a complex challenge for healthcare professionals. The 2023 AACR Childhood Cancer Predisposition Workshop provided updated consensus guidelines on cancer surveillance in these syndromes, aiming to improve early detection, intervention, and reduce morbidity associated with such neoplasms. In this paper, we review several of the rare conditions discussed in this workshop. Ollier disease and Maffucci syndrome are enchondromatoses (disorders featuring benign bone lesions) with up to 50% risk of malignancy, including chondrosarcoma. These patients require surveillance with baseline whole-body MRI and routine monitoring of potential malignant transformation of bony lesions. Hereditary Multiple Osteochondromas carry a lower risk of chondrosarcoma (<6%) but still require lifelong surveillance and baseline imaging. Related syndromes of benign bone lesions are also described. Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC), associated with fumarate hydratase pathogenic variants, is discussed in detail. Surveillance for RCC in pediatric age is recommended, as well as prompt intervention when a lesion is detected. Schinzel-Giedion Syndrome and Rubinstein-Taybi Syndrome are described for their associated malignancies and other complications, as well as expert consensus on the need for childhood cancer surveillance. Clinical recommendations, including imaging modalities and frequency of screenings, were proposed and are tailored to each syndrome's age-specific tumor risk profile. In all syndromes, patients and their families should be educated about the potential malignancy risk and advised to seek medical care for rapid growth of a mass, persistent pain, or other unexplained symptoms.

Clinical impact of [18F]FDG-PET/CT in ARI0002h treatment, a CAR-T against BCMA for relapsed/refractory multiple myeloma

Multiple myeloma (MM) remains incurable, with poor outcomes in heavily pre-treated patients with plasmacytomas. Chimeric antigen receptor (CAR) T-cell therapy has emerged as a promising treatment option; however, outcomes after such therapy in patients with soft-tissue plasmacytomas and other bone lesions remain poorly understood. Data regarding these parameters is scarce within the specific context of CAR T-cell treatment. This study included 63 patients with relapsed/refractory MM (RRMM), treated either in the CARTBCMA-HCB-01 clinical trial (ARI0002h; academic BCMA-targeted CAR T-cell therapy) or due to compassionate use. The aim was to evaluate the impact of soft-tissue involvement (extramedullary [EMD] and paraskeletal [PS] plasmacytomas) in response, survival and safety. Baseline [18F]FDG-PET/CT from five participating centers were reviewed centrally. Of the 63 patients, 52.4% presented plasmacytomas at the time of inclusion (21 PS, exclusively, and 12 EMD). Per responses, there were no significant differences between patients with and without plasmacytomas. A correlation was present between IMWG responses and those obtained by [18F]FDG-PET/CT at day 100 (Bologna Criteria). No differences were observed in progression-free survival (PFS) or overall survival (OS) between patients with or without plasmacytomas. However, both PFS and OS were significantly shorter in patients with EMD. Interestingly, [18F]FDG-PET/CT response assessed on day 100, in accordance with the Bologna Criteria, was predictive of survival outcomes. A metabolic tumor volume (MTV) of 25 or more at baseline [18F]FDG-PET/CT was associated with earlier disease progression and a shorter OS. These results highlight the importance of EMD evaluation by [18F]FDG-PET/CT before and after CAR T-cell infusion. NCT04309981, and EudraCT, 2019-001472-11.

[18F]FDG PET/CT performs better than CT in determining the bone biopsy site : randomized controlled clinical trial

BackgroundBone biopsy is the gold standard for diagnosing bone metastases. However, there is no clinical consensus regarding the optimal imaging test for determining the puncture site.MethodsWe compared the performance of [18F]FDG PET/CT with CT in detecting bone metastases to achieve the highest biopsy efficiency. This registered prospective study enrolled 273 patients with bone lesions who were treated between January 2020 and March 2021. Patients were randomly assigned to undergo [18F]FDG PET/CT or CT to determine the puncture site before bone biopsy. The accuracy, sensitivity, specificity, second biopsy rate, diagnostic time and cost-effectiveness of the two imaging tests were compared.ResultsThe accuracy and sensitivity of [18F]FDG PET/CT group in detecting bone metastases were significantly higher than CT group(97.08% vs. 90.44%, 98.76% vs. 92.22%, P < 0.05). The second biopsy rate was significantly lower in the [18F]FDG PET/CT group (2.19% vs. 5.15%; P < 0.05). The diagnostic time of [18F]FDG PET/CT was 18.33 ± 2.08 days, which was significantly shorter than 21.28 ± 1.25 days in CT group ( P < 0.05). The cost of [18F] FDG PETCT is 11428.35 yuan, and the cost of CT is 13287.52 yuan; the incremental cost is 1859.17 yuan. SUVmax > 6.3 combined with ALP > 103 U/L showed a tendency for tumor metastases with an AUC of 0.901 (95%CI 0.839 to 0.946, P < 0.001).Conclusion[18F]FDG PET/CT has better performance and cost-effectiveness than CT in determining the bone biopsy site for suspect bone metastases.Trial registrationThe prospective study was registered on 2018-04-10, and the registration number is ChiCTR1800015540.

Inter-observer and intra-observer agreement of bone reporting and data system (Bone-RADS) in the interpretation of bone tumors on computed tomography

ObjectiveTo assess inter-observer & intra-observer agreement of the American College of Radiology (ACR) bone reporting and data system (Bone-RADS) in the interpretation of bone tumors on computed tomography (CT). MethodsThis retrospective study included 273 bone tumors 184 (67.4 %) benign and 89 (32.6 %) malignant. Two blinded radiologists independently reviewed the CT images to assess the defined CT features of bone lesions and assign a bone-RADS category. A third observer reviewed the CT images twice with one month interval and reported the specified CT features and final bone-RADS category for bone lesions. Inter-observer and intra-observer agreement of bone-RADS were analyzed. ResultsThere was almost perfect inter-observer agreement between the two reviewers for all defined variables as well as bone-RADS categories (Kappa = 92.2 %). Overall intra-observer agreement was also perfect for all defined CT features and bone RADS categories with higher percentage than inter-observer one (κ = 98.3 %). ConclusionBone-RADS is an effective clinical tool for practicing radiologists in the risk assessment and management of bone tumors with perfect agreement among observers. To our knowledge, no studies have been conducted for assessing reliability or validity of the recent ACR Bone-RADS using CT. Hence, this study could serve as a cornerstone for further upcoming studies to assess the reproducibility and validity of the ACR Bone-RADS.

Palliative care of proximal femur metastatic disease and osteolytic lesions: results following surgical and radiation treatment

BackgroundFemoral bone metastases (FBM) or lesions (FBL) can lead to loss of mobility and independence due to skeletal-related events (SRE), e.g. pain, deformity and pathological fractures. Aim of this study was to analyze effects of radiotherapy and surgery, different surgical techniques and complications on disease-specific survival (DSS).MethodsPatients who underwent palliative therapy for FBM or FBL between 2014 and 2020 were retrospectively analyzed. Chi-square test was used to detect intergroup differences. Survival was calculated using Kaplan-Meier method, Cox regression and compared using log-rank test. Complications were evaluated using Chi-Square test.Results145 patients were treated for proximal femoral BM/BL or pathologic fractures (10 bilaterally). Three groups were classified: surgery only (S, n = 53), surgery with adjuvant radiation (S + RT, n = 58), and primary radiation only (RT, n = 44). Most common primary tumors were breast (n = 31), prostate (n = 27), and non-small cell lung cancer (n = 27). 47 patients underwent surgery for an impending, 61 for a manifest pathological fracture. There were no significant differences in DSS between the 3 groups (S = 29.8, S + RT = 32.2, RT = 27.1 months), with the S + RT group having the longest one-year survival. Local complications occurred in 25 of 145 patients after a mean interval of 9.9 months.ConclusionDue to the steadily increasing incidence and survival of patients with FBM/FBL, indication for prevention and treatment of painful and immobilizing SREs should be critically assessed. Surgical treatment should always be performed with maximum stability and, whenever possible, adjuvant RT.

Restoring mobility: roles of percutaneous consolidation for pelvic ring bone lesions-a multicenter study.

This study aimed to assess the early functional rehabilitation outcomes following percutaneous consolidation for pelvic ring tumor lesions. In this multicenter retrospective study, patients with pelvic bone tumor lesions, whether primitive or metastatic, underwent percutaneous consolidation (cementoplasty, screw fixation, or both). The primary outcome was postoperative weight-bearing ambulation. Secondary outcomes included hospitalization duration, procedural complications, and long-term consolidation. Inclusion criteria were patients treated for prophylactic consolidation or pathological fractures. Kaplan-Meier analysis was used for the primary outcome and hospital stay, with p-values < 0.05 indicating significance. A total of 143 consecutive procedures were performed in 138 patients (mean age, 65 years ± 13; 68 men) who underwent percutaneous screw fixation, cementoplasty, or both. Postoperative weight-bearing ambulation was achieved in 142/143 cases (99%). In total, 117/143 (82%) of these were in the first 24 h. 81/143 (57%) were discharged within 24 h (median, one day; Q3, one day; Q4, 112 days). 133/138 (96.5%) patients achieved long-term consolidation. The most common pattern was isolated acetabular involvement (N = 40; 28%). Of the 19 adverse events, 10 were asymptomatic. Three patients had delayed infections and one required screw removal. Percutaneous consolidation effectively achieved postoperative weight-bearing ambulation and represents a safe and durable treatment option for patients with pelvic bone lesions. ClinicalTrials.gov: NCT06155890. Question How can radiology continue to help improve care for patients with metastatic pelvic ring lesions? Findings 99% of patients achieved postoperative weight-bearing, with 82% doing so within 24 h. Clinical relevance Percutaneous consolidation enabled rapid functional rehabilitation of oncology patients, allowing short hospital stays with low complication rates, and demonstrating the expanding role of radiologists in diagnosis, risk assessment, and treatment planning, thereby enhancing patient care.

Differential bone morphology and hypoxia activity in skeletal metastases of ER+ and ER− breast cancer

Bone metastases occur in the majority of advanced breast cancer patients, and the most common complications are osteolytic bone metastases. However, due to the limitations of models and methodologies for bone metastasis studies, the intricacies of bone metastasis have not been fully acknowledged and revealed in prior work. Our earlier study indicated that certain breast cancer cells undergo a pre-osteolytic stage before the establishment of overt metastatic lesions. Here, we further identify a differential bone morphology between ER (estrogen receptor)+ and ER− breast cancer. Specifically, we observe a more pronounced osteolytic phenotype in the bone metastatic lesions of ER− cells investigated, linked to elevated hypoxia signaling that stimulates the secretion of osteolytic inducers from cancer cells. In the in vivo mouse model, the application of the hypoxia-inducible factor (HIF) inhibitor 2-methoxyestradiol demonstrates a promising efficacy in suppressing tumor growth and osteoclast differentiation in the bone lesions established by bone-tropic subpopulation of ER− MDA-MB-231 cell. Overall, our findings explore the complexity of phenotype and morphology in bone metastatic lesions of ER+ and ER− breast cancer, which offers a compelling rationale for leveraging HIF inhibitors to the treatment targeting skeletal complications of breast cancer bone metastases, especially for ER− tumors.

Lithium-containing 45S5 Bioglass-derived glass-ceramics have antioxidant activity and induce new bone formation in a rat preclinical model of type 1 diabetes mellitus

Diabetes mellitus (DM) has been associated with complications that affect the skeletal system, such as alterations in bone repair, osteoporosis, and an increased risk of fractures. In this context, the use of biomaterials able to promote osteogenic differentiation and, at the same time, limit the oxidative stress induced by DM offers a novel perspective to ensure the repair of diabetic bone tissue. Since lithium (Li) has been recently identified as a biologically active ion with osteogenic and antioxidant properties, the localized and controlled release of Li ions from bioactive glass-ceramic materials represents a promising therapeutic alternative for the treatment of bone lesions in DM. Thus, the aim of this study was to evaluate the potential osteogenic and antioxidant effects of glass-ceramic microparticles derived from a 45S5-type bioactive glass (Bioglass) containing (% by weight) 45% SiO2, 24.5% Na2O, 24.5% CaO, and 6% P2O5, in which Na2O was partially substituted by 5% of Li2O (45S5.5Li), in an experimental model of type 1 DM (DM1). The results obtained demonstrate, for the first time, that both 45S5 and 45S5.5Li glass-ceramic microparticles possess antioxidant activity and stimulate bone formationin vivoboth under physiological conditions and under experimental DM1 in rats. In this sense, they would have potential application as inorganic osteogenic agents in different strategies of bone tissue regenerative medicine.

Odontogenic Keratocyst in Pediatric Patients: Case Report and Literature Review

Odontogenic Keratocysts (OKC) are bone lesions that represent 10% of cystic lesions of the jaws. They are commonly reported as radiographic findings since they are usually asymptomatic given the anteroposterior development through the bone marrow, although they can generate large increases in volume with displacement of surrounding structures and perforation of the bone cortices. These lesions are closely associated with Nevus Basal Cell Syndrome (NBCS) also known as Gorlin Syndrome (GS) or Gorlin-Goitz (GZ), where the 75 to 89% of these patients exhibit OKC lesions. This report presents the treatment of a case present in the mandible of a pediatric patient associated to NBCS and bibliographic review The purpose of this paper is to present recommendations on the current management of this pathology based on the available literature.

FDG PET/CT Scan Still Can Help in Evaluation of Prostate Cancer.

Although 18F-FDG PET/CT scan is not the preferred modality to evaluate prostate cancer patients due to generally low uptake of FDG in prostate cancer cells, it can still be helpful in some selected cases with diagnostic dilemma. Here we are presenting an unusual prostate cancer case, status post radical prostatectomy, with heterogenous uptake in osseous lesions on 68Ga-PSMA PET/CT scan and low PSA values. He was referred for further evaluation with 18F-FDG PET/CT scan, revealing widely metastatic lesions in bone and liver, in addition to mildly avid recurrence in prostatectomy surgical bed and also metastasis in the spleen.

Abstract A004: E2F5 conditional knockout in mammary epithelium drives organotropic metastasis in breast cancer

Abstract Breast cancer ranks as the most commonly diagnosed cancer in women with 90% of associated deaths caused by distant metastasis. The metastatic lesions in brain, lung, liver, bone and lymph nodes in human breast cancer are not arbitrary, but rather are a complex mechanism of extrinsic and intrinsic regulatory factors controlling organ-specific colonization. Specialized mechanisms driving bone, brain and lung cancer have been described. However, the studies of liver and lymph node metastatic drivers are limited despite the prevalence of metastases in these organs. A significant limitation is the lack of genetically engineered mouse models that develop mammary tumors that spontaneously metastasize to liver and lymph nodes. Our previous research identified the role for E2F5 in both mammary gland development and breast cancer. Loss of E2F5 resulted in tumorigenesis after a latency of one year and 70% of mice showed metastatic lesions in lung, lymph node and liver. Transplantation of these spontaneous tumors into FVB MMTV Cre mice recapitulated the metastatic pattern observed in the primary tumors. We propose that E2F5 regulates drivers of metastasis and potentiates organ tropism to lymph nodes and the liver. To address this hypothesis, we conducted serial transplantations of tumors originating from the lymph nodes and liver back into the mammary gland. This enrichment study led to a significant increase in organ-specific metastasis, with 60% and 77% of penetrance observed in two distinct mouse lineages with liver (LVM) and lymph node tropism (LNM). Immunohistochemical studies confirmed a complete epithelial-mesenchymal transition (EMT) phenotype in LVM that is conserved in the cell lines generated. LNM showed a partial EMT with a more epithelial phenotype in cell lines. We observed the presence of an immune enriched environment in primary and metastatic tumors in both lineages. Bulk-RNA sequencing studies uncovered the presence of unique organotropic pathways associated with liver and lymph node metastasis. We observed enriched pathways from the primary tumor as major component of our organotropic drivers with a clear distinction between liver and lymph node enriched lineages. Additionally, a gradual acquisition of distant organ-specific markers and signaling pathways suggests that phenotypic mimicry and tumor plasticity are key for successful events of colonization to liver and lymph nodes in our model. With these results, we unravel potential mechanisms responsible for the organotropic metastases in breast cancer under the absence of the transcription factor E2F5. Citation Format: Jesus A. Garcia Lerena, Briana To, Jing-Ru Jhan, Eran Andrechek. E2F5 conditional knockout in mammary epithelium drives organotropic metastasis in breast cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A004.

Feasibility of PET-enabled dual-energy CT imaging: First physical phantom and initial patient study results.

Dual-energy (DE) CT enables material decomposition by using two different x-ray energies and may be combined with PET for improved multimodality imaging. However, this increases radiation dose and may require a hardware upgrade due to the added second x-ray CT scan. The recently proposed PET-enabled DECT method allows dual-energy imaging using a conventional PET/CT scanner without the need to change scanner hardware or increase radiation exposure. Here we demonstrate the first-time physical phantom and patient data evaluation of this method. The PET-enabled DECT method reconstructs a gamma-ray CT (gCT) image at 511keV from the time-of-flight PET data with the maximum-likelihood attenuation and activity (MLAA) approach and then combines this image with the low-energy x-ray CT images to form a dual-energy image pair for material decomposition. To improve the image quality of gCT, a kernel MLAA method was developed using the x-ray CT as a priori information. Here we developed a general open-source implementation for gCT reconstruction and used this implementation for the first real data validation using both physical phantom study and human-subject study. Results from PET-enabled DECT were compared using x-ray DECT as the reference. Further, we applied the PET-enabled DECT method in another patient study to evaluate bone lesions. Compared to the standard MLAA, results from the kernel MLAA showed significantly improved image quality. PET-enabled DECT with the kernel MLAA was able to generate fractional images that were comparable to the x-ray DECT, with high correlation coefficients for both the phantom study and human subject study (R > 0.99). The application study also indicates that PET-enabled DECT has potential to characterize bone lesions. Results from this study have demonstrated the feasibility of this PET-enabled method for CT imaging and material decomposition. PET-enabled DECT shows promise to provide comparable results to x-ray DECT.

Approach to Determining Etiology of Hypophosphatemia in a Patient with Coexisting Phosphaturic Mesenchymal Tumor and Fibrous Dysplasia

Abstract Dysregulated fibroblast growth factor-23 (FGF23) production is a demonstrated cause of hypophosphatemia and osteomalacia. Diseases associated with these conditions include phosphaturic mesenchymal tumor (PMT) causing tumor induced osteomalacia (TIO), various forms of rickets, and fibrous dysplasia (FD). Coexistence of two conditions that can increase FGF23 concentrations is rare. We report a case of a 79-year-old man who presented with rib and right flank pain. Imaging revealed bone lesions in the right iliac wing, left supra-acetabular area, and L4 vertebral body. Biopsies showed a right iliac PMT and left supra-acetabular FD. Cryoablation of both lesions resolved the phosphaturia with normalization of phosphorus level. Coexistence of PMT and FD in this patient with hypophosphatemia raised questions about the source of the FGF23, meaning of co-existence of PMT and FD in the same patient and, about the nature of the third lesion in the L4 vertebral body. Using FGF23 mRNA chromogenic in situ hybridization, we identified the PMT, rather than the FD, as the source of FGF23. Lack of GNAS mutation in the PMT suggested it being independent of FD. Assessment by the intact FGF23: total FGF23 ratio as well as gallium-DOTATATE scan suggested that the vertebral body lesion could represent FD. Other than understanding difference in underlying molecular processing of FGF23 in PMT and FD, testing for mutations, imaging studies as well as in situ hybridization helped solve the questions arising from this unique case of coexistence of PMT and FD.

Computer-assisted contouring combined with bone ostectomy for dental implant placement of craniofacial fibrous dysplasia involving the right maxilla.

Craniofacial fibrous dysplasia (CFD) affecting the jaws can result in facial asymmetry, posing a unique challenge for dental implant placement in edentulous areas. This case report introduces an innovative approach for rehabilitating the posterior maxilla affected by CFD using a computer-guided technique for maxillary recontouring and substitution bone grafting at implant sites. A 58-year-old edentulous female with a craniofacial fibrous dysplasia bone lesion affecting the right maxilla was referred for correction of asymmetry and dental implant placement. A computer guide was devised for shaving and contouring the right maxilla. Following virtual maxillary reduction, a second guide was created over the osteomized 3D model to plan the location of future dental implants and guide bone ostectomies for allograft substitution. Particulate bone substitute was applied to ostectomy sites in the affected maxillary alveolar ridge. Four implants were placed successfully four months post-operation, with integration confirmed by clinical examination after one year of follow-up. This treatment approach emerges as a reliable and effective modality for simultaneous dental implant rehabilitation in edentulous alveolar bone and jaw contouring in CFD cases.

An open annotated dataset and baseline machine learning model for segmentation of vertebrae with metastatic bone lesions from CT.

Automatic analysis of pathologic vertebrae from computed tomography (CT) scans could significantly improve the diagnostic management of patients with metastatic spine disease. We provide the first publicly available annotated imaging dataset of cancerous CT spines to help develop artificial intelligence frameworks for automatic vertebrae segmentation and classification. This collection contains a dataset of 55 CT scans collected on patients with various types of primary cancers at two different institutions. In addition to raw images, data include manual segmentations and contours, vertebral level labeling, vertebral lesion-type classifications, and patient demographic details. Our automated segmentation model uses nnU-Net, a freely available open-source framework for deep learning in healthcare imaging, and is made publicly available. This data will facilitate the development and validation of models for predicting the mechanical response to loading and the resulting risk of fractures and spinal deformity.

TRATAMENTO CIRURGICO DE CERATOCISTOS ODONTOGÊNICOS: RELATO DE CASO CLÍNICO

Introduction: The keratocyst or keratocyst is an odontogenic tumor characterized as a lesion that affects the maxillary and mandibular regions. It is considered a benign lesion, reaching a prevalence of 3% to 11% among all odontogenic cysts, resulting in major bone loss. It can be asymptomatic and is usually diagnosed through routine radiographs or histopathological findings. Objective: To present a clinical case concerning the diagnosis and surgical treatment of an odontogenic keratocyst in the anterior mandibular region. Clinical case: Male, normosystemic, melanodermic patient. An increase in extraoral volume was observed on the right side of the face in the anterior region of the mandible. Panoramic radiography revealed well-defined, unilocular radiolucent images in the areas of the right lower first premolar, left lower third molar and bilateral upper third molars. On intraoral physical examination, bone bulging was observed in the region of the tooth in question. A computerized tomography scan was then requested, in which extensive expansive bone lesions were detected. Marsupialization and local decompression of the two upper lesions and the lower right lesion were performed, detecting the presence of liquid content. Firstly, an incisional biopsy was carried out and a decompression drain was installed in the three lesions. The histopathological report was of an odontogenic keratocyst. The decompression device remained in place for 30 days in the lower right lesion and approximately 15 days in the upper lesions, showing a significant reduction in the lesions. The lower right lesion was then enucleated. The 6-month post-operative image showed bone formation with no signs of recurrence. Conclusion: The proposed treatment proved to be effective in treating odontogenic keratocysts, but follow-up imaging is extremely important in view of the possibility of recurrence.