Radiological Changes Research Articles

Spondylarthropathy?—Do I Have to Wait for Radiological Changes?

Spondylarthropathy?—Do I Have to Wait for Radiological Changes?

Foot deformities in rheumatoid arthritis patients and their effects on foot functions.

Foot problems are common clinical disorders in patients with Rheumatoid Arthritis (RA). The aim of this study was to investigate the frequency and impact of foot and ankle problems in patients with RA. A total of 164 feet of 82 RA patients with a diagnosis of one year or more were evaluated. Deformities including HV, CT, SF, PC, PP, MPS, MPV, and HT were examined in all RA patients. The Foot Function Index was used to measure the impact of these deformities on pain, disability, and movement limitations. Radiological changes were measured using the modified Larsen score. The frequency of deformity in RA patients was found to be 95.1%, with HV deformity being the most common at 84.1%. There was a statistically significant relationship between SF, HV, PP, and PC deformities and disease duration. In our sample of 82 patients, 70 (85.3%) reported past or present foot pain complaints. The most common site of pain was the ankle joint, with 44 (53.7%) patients experiencing ankle pain. A statistically significant increase in the frequency of ankle pain was found as DAS28 scores, body mass index (BMI), and disease duration increased. There was also a correlation between an increase in DAS28 scores and the frequency of forefoot pain. A significant correlation was found between MPV, HV, PP, and PC deformities and high FFI scores. Larsen radiological scores were not correlated with foot-ankle pain or duration of pain. These findings suggest that foot deformities are common in RA, and it is important to address them early in the disease course to minimize functional disability and improve quality of life.

Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression

This study evaluated the mid-term functional and radiological results of arthroscopic lunate core decompression for treating Kienböck disease. In a prospective cohort study, 40 patients with a confirmed diagnosis of Kienböck disease (Lichtman stages II to IIIb) underwent arthroscopic core decompression of the lunate bone. A cutting bur was used through the trans-4 portal with visualization from the 3-4 portal after synovectomy and debridement of radiocarpal joint using a shaver from the 6R portal. Disabilities of Arm, Shoulder, and Hand and visual analog scale scores, wrist range of motion, grip strength, radiological changes of Lichtman classification, carpal height ratio, and scapholunate angle were evaluated before and two years after the surgery. The mean of Disabilities of Arm, Shoulder, and Hand score improved from 52.5 ± 13 to 29.2 ± 16.3. The visual analog scale score also improved from 7.6 ± 1.8 to 2.7 ± 1.9. There was also an improvement in hand grip strength from 6.6 ± 2.7 kg to 12.3 ± 3.1 kg. Wrist range of motion in flexion, extension, ulnar deviation, and radial deviation improved significantly. Lichtman classification remained the same in 36 (90%) patients. Carpal height did not change. Intergroup evaluation showed no functional difference in response to surgery for different radiological Lichtman stages. More improvement was observed in patients with Lichtman stage II, but was not statistically significant. Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up. Therapeutic IV.

Management of initial and recurrent radiation-induced contrast enhancements following radiotherapy for brain metastases: Clinical and radiological impact of bevacizumab and corticosteroids.

The appearance of radiation-induced contrast enhancements (RICE) after radiotherapy for brain metastases can go along with severe neurological impairments. The aim of our analysis was to evaluate radiological changes, the course and recurrence of RICE and identify associated prognostic factors. We retrospectively identified patients diagnosed with brain metastases, who were treated with radiotherapy and subsequently developed RICE. Patient demographic and clinical data, radiation-, cancer-, and RICE-treatment, radiological results, and oncological outcomes were reviewed in detail. A total of 95 patients with a median follow-up of 28.8months were identified. RICE appeared after a median time of 8.0months after first radiotherapy and 6.4months after re-irradiation. Bevacizumab in combination with corticosteroids achieved an improvement of clinical symptoms and imaging features in 65.9% and 75.6% of cases, respectively, both significantly superior compared to treatment with corticosteroids only, and further significantly prolonged RICE-progression-free survival to a median of 5.6months. Recurrence of RICE after initially improved or stable imaging occurred in 63.1% of cases, significantly more often in patients after re-irradiation and was associated with high mortality of 36.6% after the diagnosis of flare-up. Response of recurrence significantly depended on the applied treatment and multiple courses of bevacizumab achieved good response. Our results suggest that bevacizumab in combination with corticosteroids is superior in achieving short-term imaging and symptom improvement of RICE and prolongs the progression-free time compared to corticosteroids alone. Long-term RICE flare-up rates after bevacizumab discontinuation are high, but repeated treatments achieved effective symptomatic control.

Radiologic Changes in Patients with Temporomandibular Joint Hypermobility: A Cone Beam Computed Tomography Study

Radiologic Changes in Patients with Temporomandibular Joint Hypermobility: A Cone Beam Computed Tomography Study

Evaluation of the concentration of selected elements in serum patients with intervertebral disc degeneration

Quantitative analysis of the trace element content of human intervertebral discs (IVDs) is essential because it can identify specific enzymes or metabolites that may be related to human intervertebral disc degeneration (IVDD). The goal of this study was to assess the concentrations of copper (Cu), iron (Fe), manganese (Mn), lead (Pb), zinc (Zn), sodium (Na), magnesium (Mg), potassium (K), phosphorus (P), and calcium (Ca) in serum samples obtained from patients with IVDD in comparison to healthy volunteers (a control group). The study group consisted of 113 Caucasian patients qualified by a specialist neurosurgeon for microdiscectomy. The control group consisted of 113 healthy volunteers who met the eligibility criteria for blood donors. The examined clinical material was the serum samples obtained from both groups.Based on the quantitative analysis of selected elements, there were statistically significantly (p 0.05) higher concentrations of Cu (1180 μg/L±800 μg/L vs. 1230 μg/L±750 μg/L), Zn (790 μg/L±300 μg/L vs. 850 μg/L±200 μg/L), and Mg (21730 μg/L±4360 μg/L vs. 23820 μg/L±4990 μg/L) in the serum of healthy volunteers compared to those in the study group. In addition, statistically significant changes were not detected in the concentrations of any elements among either sex in either the study or control group or in their body mass index (BMI) values (p > 0.05). In the serum samples from the study group, the strongest relationships were noted between the concentrations of Zn and Pb (r = 0.61), Zn and P (r = 0.69), Zn and Ca (r = 0.84), Zn and Cu (r = 0.83), Mg and Ca (r = 0.74), and Ca and P (r = 0.98).It has been indicated that, above all, the concentrations of Cu, Zn, Ca, and Mg depend on the advancement of radiological changes, according to the Pfirrmann scale. However, no influence on pain intensity was found, depending on the concentration of the assessed elements.The analysis indicates that the determination of serum Cu, Zn, Ca, and Mg concentrations may have diagnostic significance in predicting the onset of lumbosacral IVDD. The predictive evaluation of changes in the concentrations of selected elements in patients with degenerative lumbar IVD lesions appears to be a promising, cost-effective strategy.

Педіатричні аспекти гострого гематогенного остеомієліту в дитини раннього віку: клінічний випадок

Acute hematogenous osteomyelitis is one of the common bacterial infections in children of early age, which is accompanied by mild symptoms at the initial stage of diagnosis. The onset of the disease is usually acute with fever, intoxication syndrome, focal signs of bone inflammation and limitation of limb function. Purpose - to show the features of diagnosis and treatment of acute hematogenous osteomyelitis in an infant based on clinical observation. Clinical case. The clinical case of a child of early age with acute hematogenous osteomyelitis, who was hospitalized with complaints of an increase in body temperature up to 40°C, restlessness, swelling and hyperemia of the lower part of the right thigh and right knee joint, and movement disorders in the right leg, was presented. The general condition of the child upon admission is severe due to intoxication, hyperthermic syndromes and local changes in the right lower limb, which was in a forced position, pronation. There were no active movements in the right leg, passives ones were painful. Rotational movements in the right leg are possible, but painful. The soft tissues in the area of the right hip and knee joints, as well as the thighs, were not changed in color, their swelling was noted. Conclusions. Symptoms of acute hematogenous osteomyelitis in young children are often nonspecific. Intoxication syndrome symptoms and local changes as movement disorders in the limb in children of this age group dominate. Pain can be detected during the examination, which is clearly localized with sensitivity over the infected bone; edema may be present. Changes of complete blood count are mild, while the determination of C-reactive protein during the initial evaluation can serve as a baseline value for sequential monitoring. The sensitivity of X-ray examination at the beginning of the disease is low, radiological changes appear only 7-21 days after infection. Empiric antimicrobial therapy aimed at Staphylococcus aureus should be prescribed immediately after the detection of acute hematogenous osteomyelitis clinical signs even before receiving results of additional research methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Mechanisms of Peripheral and Central Sensitization in Osteoarthritis Pain.

Pain, the primary symptom of osteoarthritis (OA), reduces both the quality and quantity of life for patients. The pathophysiology of OA pain is complex and often difficult to explain solely by radiological structural changes. One reason for this discrepancy is pain sensitization (peripheralsensitization [PS] and central sensitization [CS]) in OA. Thus, an understanding of pain sensitization is important when considering treatment strategies and development for OA pain. In recent years, pro-inflammatory cytokines, nerve growth factors (NGFs), and serotonin have been identified as causative agents that induce peripheral and central sensitization and are becoming therapeutic targets for OA pain. However, the characteristics of the clinical manifestations of pain sensitization elicited by these molecules remain unclear, and it is not well understood who among OA patients should receive the therapeutic intervention. Thus, this review summarizes evidence on the pathophysiology of peripheral and central sensitization in OA pain and the clinical features and treatment options for this condition. While the majority of the literature supports the existence of pain sensitization in chronic OA pain, clinical identification and treatment of pain sensitization in OA are still in their infancy, and future studies with good methodological quality are needed.

Biological equivalent dose is associated with radiological toxicity after lung stereotactic ablative radiation therapy

IntroductionStereotactic ablative radiation therapy (SABR) is the standard of care for inoperable early-stage non-small-cell lung cancer. Although the probability of grade ≥ II toxicities is low, many patients present radiological subclinical toxicities usually associated with long-term patient management challenges. We evaluated radiological changes and correlated them with the received Biological Equivalent Dose (BED). MethodsWe retrospectively analyzed chest CT scans of 102 patients treated with SABR. An experienced radiologist evaluated the radiation-related changes 6 months and 2 years after SABR. The presence of consolidation, ground-glass opacities, organizing pneumonia pattern, atelectasis and the extent of affected lung were recorded. Dose-volume histograms of the lung healthy tissue were transformed to BED. Clinical parameters such as age, smoking habits, and previous pathologies were registered and correlations between BED and radiological toxicities were drawn. ResultsWe observed a positive and statistically significant correlation between lung BED over 300 Gy and the presence of organizing pneumonia pattern, the degree of lung affectation and the 2-year prevalence and/or increase of these radiological changes. Radiological changes in patients receiving BED > 300 Gy to a healthy lung volume ≥ 30 cc increased or remained in the 2 years follow-up scan. We found no correlation between radiological changes and the analyzed clinical parameters. ConclusionsThere seems to be a clear correlation between BEDs higher than 300 Gy and radiological changes both short and long term. If confirmed in an independent patient cohort, these findings could lead to the first radiotherapy dose constraints for grade I pulmonary toxicity.

Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis.

Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF. Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24-113 months). Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years. Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.

КЛИНИКО-РЕНТГЕНОЛОГИЧЕСКИЙ АНАЛИЗ СТРУКТУР ПАРОДОНТА ПРИ АНАТОМО-ФУНКЦИОНАЛЬНЫХ НАРУШЕНИЯХ МУКОГИНГИВАЛЬНОГО КОМПЛЕКСА

Subject. Anatomical and functional disorders of the mucogingival complex.
 Objectives. To evaluate microcirculatory, clinical and radiological changes in periodontal tissues in various variants of mucogingival complex disorders.
 Methodology. The study was conducted at the Department of Therapeutic Dentistry of ASMU. In the course of the study, 80 patients (49 women, 31 men) aged 18 to 35 years were examined with a ratio of dentition close to orthognathic bite in the presence of maximum occlusion. Three groups were formed depending on the anatomical and functional state of the mucogingival complex. In the clinical part of the study, an objective assessment of the condition of periodontal tissues was carried out on the basis of a dental examination with a comprehensive analysis of the periodontal status. The X-ray examination included the analysis and description of cone-beam computed tomograms for patients of clinical groups. To assess microcirculation in periodontal tissues, the method of ultrasonic Dopplerography with functional probe breakdown was used.
 Results. In the studied groups, the level of oral hygiene was characterized as good, and the indicators of hygiene indices did not differ significantly, periodontal indices indicated the absence or minimal degree of inflammation in periodontal tissues. Carrying out a functional tension test made it possible to divide patients into subgroups according to the type of reaction: normal, compensated, subcompensated, decompensated. According to the results of the study of CBCT in the comparison group, pathological changes in the bone tissue of the alveolar process of the studied areas were not recorded, in patients of the first clinical group, in most cases (80.2%), pathological changes in the bone tissue of the alveolar process were not observed, in the rest (19.8%), a low level of alveolar bone was noted. In patients of the second clinical group, the phenomena of osteoporosis and an increase in the distance from the dental enamel-cement border to the edge of the outer cortical plate were recorded.
 Conclusions. X-ray changes in bone tissue most often corresponded to the already existing clinical symptoms of periodontal tissue damage against the background of mucogingival pathology. The predictors of prenosological diagnosis in anatomical and functional disorders of the mucogingival complex were changes in microcirculation indicators.

Body Composition in Patients with Follicular Lymphoma: Asso-Ciations between Changes in Radiomic Parameters in Patients Treated with R-CHOP-like and R-B Regimens: LyRa 01F

In patients with follicular lymphoma (FL), therapeutic advances have led to improved survival, and within this framework, it is important to identify treatment strategies offering a better quality of life. Using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), in patients treated with R-CHOP-like or R-Bendamustine regimens, we assessed changes in the bone mineral density (BMD), musculoskeletal index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at disease onset and at the end of therapy. We evaluated whether the high-steroid regimen could lead to more significant radiological changes than those induced by the steroid-free regimen and whether a low BMD at disease onset is an unfavorable prognostic index. Seventy-nine patients between 60 and 80 years old with a new diagnosis of FL were included in the study. Evaluation of Delta values (pre- and post-therapy mean values) in the two immunochemotherapy regimens showed differences in radiomic parameters within the two patient cohorts. The R-CHOP-like regimen was associated with a significant reduction in BMD, an increase in SAT and VAT, and a reduction in skeletal muscle density (SMD) and SMI. Moreover, patients with high FLIPI showed a BMD below the cut-off value. This study represents the first study demonstrating a prognostic correlation between FLIPI and low BMD.

Predictors of pulmonary sequelae after COVID-19 pneumonia: A 12-month follow-up study.

Since the beginning of the SARS-CoV-2 pandemic, over 550 million people have been infected worldwide. Despite these large numbers, the long-term pulmonary consequences of COVID-19 remain unclear. The aim of this single-center observational cohort study was to identify and characterize pulmonary sequelae of COVID-19 at 12 months from hospitalization and to reveal possible predictors for the persistence of long-term lung consequences. Based on the persistence or absence of radiological changes after 12 months from hospitalization, the whole population was categorized into NOT-RECOVERED (NOT-REC) and RECOVERED (REC) groups, respectively. Clinical and pulmonary function data tests and clinical data were also collected and compared in the two groups. In the NOT-REC group, high resolution computed tomography (HRCT) images were semiquantitatively scored analyzing ground-glass opacities (GGO), interstitial thickening (IT), consolidations (CO), linear and curvilinear band opacities, and bronchiectasis for each lung lobe. Logistic regression analyses served to detect the factors associated with 12-month radiological consequences. Out of the 421 patients followed after hospitalization for SARS-CoV-2 pneumonia, 347 met inclusion and exclusion criteria and were enrolled in the study. The NOT-REC patients (n = 24; 6.9%) were significantly older [67 (62-76) years vs. 63 (53-71) years; p = 0.02], more frequently current smokers [4 (17%) vs. 12 (4%); p = 0.02], and with more severe respiratory failure at the time of hospitalization [PaO2/FiO2 at admission: 201 (101-314) vs. 295 (223-343); p = 0.01] compared to REC group (n = 323; 93.1%). On multivariable analysis, being a current smoker resulted in an independent predictor for lung sequelae after 12 months from hospitalization [5.6 OR; 95% CI (1.41-22.12); p = 0.01]. After 12 months from hospital admission, a limited number of patients displayed persistent pulmonary sequelae with minimal extension. Being a current smoker at the time of SARS-CoV-2 infection is an independent predictive factor to lung consequences, regardless of the disease severity.

Radiological Changes in Postural Deformities after Deep Brain Stimulationin Patients with Parkinson’s Disease

BACKGROUNDː Axial postural deformities are frequent and disabling complications of Parkinson’s disease(PD). Although several studies have addressed the effects of deep brain stimulation (DBS) on the improvement ofpostural deformities in PD, there is little detailed information about it. In this paper, we report a prospective observational study evaluating the radiological changes in postural deformities after subthalamic nucleus (STN)-DBSin PD patients.METHODSː Of the 53 patients participating in the present study, 48 were completely followed up prospectivelyfor 12 months after surgery. We assessed the coronal Cobb angulation representing scoliosis, the thoracic andlumbar sagittal Cobb angulation representing thoracic kyphosis and lumbar lordosis, and forward tilt angulation.Anteroposterior and lateral X-rays of the whole spine in the standing position were taken preoperatively and at 6and 12 months postoperatively.RESULTSː The number of PD patients with scoliosis defined as over 10 degrees in terms of the coronal Cobbangles was decreased after STN-DBS, 25/48 (52.1%) at 6 months and 23/48 (47.9%) at 12 months, while preoperatively, 30/48 (62.5%) patients had Cobb angles of over 10. The mean coronal Cobb angle was significantly improved after DBS (14.2 ± 12.1 preoperatively, 12.6 ± 12.6 at 6 months after DBS, and 11.4 ± 11.1 at 12 monthsafter DBS). On the other hand, there was no statistically significant improvement in thoracic kyphosis angulation,lumbar lordosis angulation, and forward tilt angulation after STN-DBS.CONCLUSIONSː The coronal Cobb angles indicated that scoliosis was significantly improved after STN-DBS.

How Artificial Intelligence Is Driving Changes in Radiology

How Artificial Intelligence Is Driving Changes in Radiology

Radiation-Induced Changes Associated with Obliteration of Brain AVMs after Repeat Radiosurgery.

Radiation-induced changes can occur after stereotactic radiosurgery for brain AVMs, potentially causing symptomatic complications. We evaluated the incidence of such changes and the efficacy of repeat gamma knife radiosurgery for incompletely obliterated AVMs. We retrospectively evaluated 150 patients who underwent gamma knife radiosurgery for AVMs between 2002 and 2020; twenty-five underwent further radiosurgical procedures for incompletely obliterated AVMs. We recorded the median margin doses at the first (median, 20 Gy; range, 12-23 Gy; AVM volume, 0.026-31.3 mL) and subsequent procedures (median, 18 Gy; range, 12-23 Gy; AVM volume, 0.048-9.2 mL). After the first treatment, radiologic radiation-induced changes developed in 48 (32%) patients, eight of whom had symptomatic changes. After repeat gamma knife radiosurgery, 16 of 25 patients achieved complete AVM obliteration (64%). The development of radiation-induced changes after the first treatment was significantly associated with successful obliteration by subsequent radiosurgery (OR = 24.0, 95% CI 1.20-483, P = .007). Radiation-induced changes occurred in only 5 (20%) patients who underwent a second gamma knife radiosurgery, one of whom experienced transient neurologic deficits. Between the first and repeat gamma knife radiosurgery procedures, there was no significant difference in radiologic and symptomatic radiation-induced changes (P = .35 and P = 1.0, respectively). Radiation-induced changes after the first gamma knife radiosurgery were associated with AVM obliteration after a repeat procedure. The risk of symptomatic radiation-induced changes did not increase with retreatment. When the first procedure fails to achieve complete AVM obliteration, a favorable outcome can be achieved by a repeat gamma knife radiosurgery, even if radiation-induced changes occur after the first treatment.

Radiomic features of contralateral and ipsilateral hemispheres for prediction of glioma genetic markers

Purpose: Radiomic features of gliomas are often used to predict genetic markers from radiological studies. Radiomic features were extracted from the contralateral brain to test if tumor texture is driving the predictive power of machine learning models. Ideally, these contralateral models would be a negative control for tumor radiomics models, since many studies use contralateral normal appearing white matter for normalization. This study used those features to attempt to predict IDH mutation status, MGMT promoter methylation, TERT promoter mutation, and ATRX mutation status with random forests.Methods: Radiomic features were extracted from the tumor region, a mirrored contralateral region, a spherical region within the tumor, a spherical region on the contralateral, and a spherical sample of the ipsilateral side. These features were used independently to predict IDH, MGMT, TERT, and ATRX using random forests.Main Findings: Contralateral features alone were as predictive of IDH mutation status as tumor features and had predictive power for several genetic markers.Conclusion: Normalization with contralateral brain should be done carefully, and further investigation of potential radiological changes to the contralateral is warranted.

Emerged donor limb growth morbidity and malalignment after combined ipsilateral tibial and fibular cortical harvest graft in children. Early follow-up report.

The quantity of bone grafts required in certain pediatric conditions is sometimes substantial. This retrospective study details the radiological changes occurring in the donor leg and ankle following the simultaneous harvest of large diaphyseal cortical grafts from the tibia and fibula in 14 children (16 legs). The following preoperative and follow-up radiological parameters were measured and compared for donor legs: the longitudinal continuous regeneration of fibula, distal fibular station, medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle (PPTA), anterior distal tibial angle and interphyseal angle (tibia diaphyseal angulation) in both coronal and sagittal planes. Additionally, the impact of fibular regeneration in combined harvests was separately analyzed. Children were operated at the mean age of 52 months. Mean follow-up of 25.2 months was available. At follow-up, the donor tibia healed completely in all legs whereas fibular regeneration was complete only in 10 legs (62.5%). At follow-up, ankle valgus was present in 6 out of 16 legs (37%) and tibia valga increased in all legs except one (94%). Procurvatum was present in 7 legs. The fibular nonregeneration group was prone to ankle valgus deformity ( P = 0.014), valgus angulation of tibial diaphysis ( P = 0.0076) and lower mean PPTA ( P = 0.026) when compared to the regenerate group. There was a complication of stress fracture in one donor tibia. Combined tibial and fibular harvest is a major surgical undertaking in children. The donor limbs have their share of complications postharvest, more so when the fibula remains nonregenerated. Serial monitoring of donor sites is emphasized.

Clinical Implications of FDG-PET in Pancreatic Ductal Adenocarcinoma Patients Treated with Neoadjuvant Therapy

PurposeTo evaluate the clinical significance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with pancreatic ductal adenocarcinoma who underwent neoadjuvant therapy. MethodsAmong 285 consecutive patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma between 2015 and 2021, 86 who underwent preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography after completion of neoadjuvant treatment were reviewed. Among preoperative factors, including post-treatment maximum standardized uptake value, predictors of early recurrence and poor prognosis were identified using multivariate analysis for decision making in surgery. ResultsNineteen (22%) patients with pancreatic ductal adenocarcinoma demonstrated high maximum standardized uptake (≥ 4.5). High post-treatment maximum standardized uptake (≥ 4.5) predicted early recurrence within 6 months after surgery and correlated with shorter recurrence-free survival. Elevated post-treatment CA19-9 level (> 37 U/ml) and maximum standardized uptake ≥ 4.5 were independent prognostic factors. Post-treatment, a high maximum standardized uptake value indicated a poorer prognosis than a low maximum standardized uptake value in both patients with elevated CA19-9 and normal CA19-9 levels. The median overall survival in patients with elevated post-treatment CA19-9 and high maximum standardized uptake was only 17 months; 67% experienced early recurrence. Dynamic changes in maximum standardized uptake during neoadjuvant therapy were correlated with pathological response to neoadjuvant therapy, but not with radiological response or change in CA19-9 level. ConclusionsPost-treatment assessment using maximum standardized uptake value is useful for stratifying patients with pancreatic ductal adenocarcinoma who will benefit from surgery. Instead of subsequent curative resection, additional neoadjuvant therapy should be considered in patients with a persistently high maximum standardized uptake value.

Osteoarthropathy of the front thorax

This article reviews the data on a unique, rare rheumatologic syndrome osteoarthropathy of the anterior thorax (OAAT), characterized by inflammation of the bone, joint, and ligament structures that form the skeleton of the anterior thorax. OAAT is part of chronic non-bacterial osteomyelitis, which occurs in adults and children and may be due to genetic mutations. The basis of this disorder is osteitis (focal lesion of the sternum, clavicles, and ribs with a tendency to the destruction of mainly articular parts and development of bone proliferation hyperostosis), arthritis with possible ankylosis development, as well as enthesitis and ligamentitis with ectopic ossification of affected soft tissues. Many patients also show similar dermatological changes: commonly palmar and plantar pustulosis and sometimes acne inversa (purulent hidradenitis and globular acne). The article describes typical radiological, scintigraphic, and MRI changes in the musculoskeletal system. The classification of chronic non-bacterial osteomyelitis is reviewed. Diseases that may mimic OAAT are listed. Treatments for chronic non-bacterial osteomyelitis, including bisphosphonates and biologics, are reported.