Radiological Course Research Articles

Overview of dental radiation technologists in Taiwan

Background/purposeIn Taiwan, there is no independent licensing system for dental radiation technologists. A licensed medical radiation technologist who engages in dental radiology is the so-called dental radiation technologist. This study explored mainly the profile of dental radiation technologists in Taiwan. Materials and methodsThis study used the methods of documentary analysis, dental radiation manpower survey, and the secondary data analysis to find the profile of dental radiation technologists in Taiwan. ResultsThere were currently 59 dental radiology departments and 101 dental radiation technologists (29 males and 72 females) in 57 hospitals and their branches. Of the 101 dental radiation technologists, 56 worked in the medical centers, 28 in the regional hospitals, and 17 in the district hospitals. More than half of the dental radiation technologists were concentrated in the medical centers (55.45%, 56/101) or the northern region of Taiwan (57.43%, 58/101), especially in the northern medical centers (30.69%, 31/101). ConclusionIn Taiwan, the manpower of dental radiation technologists is insufficient, and dental radiation technologists usually work in the dental departments of the hospitals. A large number of clinic dentists lack dental radiation technologists to assist in dental radiology works and the clinic dentists have to perform the dental radiology works by themselves. Therefore, a dental radiology education system should be established to design innovative dental radiology courses for radiological technology students. This in turn can provide a new practice direction for medical radiation technologists and expand their potential participation in the field of dental radiology.

Pneumopathie immuno-induite : un diagnostic différentiel de la pneumopathie à SARS-CoV-2

IntroductionLes inhibiteurs de points de contrôle immunitaire ont révolutionné la prise en charge de nombreux cancers et ont permis d’obtenir une efficacité et une réponse durable pour certains patients. L’immunothérapie est associée à des effets secondaires en lien avec l’infiltration de cellules immunitaires dans les tissus normaux pouvant entraîner des réactions dysimmunitaires disproportionnées. Ces effets secondaires peuvent toucher n’importe quel organe, dont le poumon, pouvant parfois engager le pronostic vital. Ils peuvent ressembler à des événements de nature infectieuse, dont la COVID-19.ObservationsNous rapportons le cas de 3 patients ayant présenté des toxicités pulmonaires sévères secondaires à l’immunothérapie entre mars et mai 2020 avec hypothèse initiale d’une pneumopathie à SARS-CoV-2. Après investigations approfondies, le diagnostic de toxicité pulmonaire à l’immunothérapie fut retenu, avec une évolution clinique et radiologique favorable suite à l’instauration d’une corticothérapie.ConclusionLa toxicité pulmonaire secondaire à l’immunothérapie reste un effet indésirable rare, mais pouvant engager le pronostic vital. La démarche diagnostique impose d’éliminer plusieurs diagnostics différentiels. Le tableau clinique est réversible et l’évolution habituellement favorable après instauration d’une corticothérapie.

Relationship Between Morphological Remodeling and Angiographic Types of Spontaneous Isolated Superior Mesenteric Artery Dissection After Conservative Management: Determinant Affecting Serial Radiologic Courses.

ObjectiveTo monitor the radiological courses of symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD) after conservation, clarify the relationship between its morphological change and initial imaging classification, and identify these factors that affect dissection remodeling.MethodsEighty-nine conservative patients with SISMAD who underwent periodic follow-up of computed tomography angiography (CTA) were enrolled. Initial morphologic classification, imaging features and dissection remodeling were analyzed retrospectively. Logistic regression was used to identify predictors for remodeling. Receiver operating characteristics were performed for cutoff threshold.ResultsZerbib classification was adapted and initial CT appearance divided eighty-nine patients into: type I (15.7%), patent false lumen (FL) with both entry and re-entry; type II (37.1%), “cul-de-sac” shaped FL without re-entry; type III (27.0%), thrombosed FL with ulcer-like-projection (ULP); type IV (18%), intramural hematoma; type V (0%), dissecting aneurysm; and type VI (2.2%), total or partial occlusion of superior mesenteric artery (SMA). Follow-up CTA revealed complete remodeling (33.7%), partial remodeling (16.9%), no change (25.8%), type change (13.5%) and dissection progression (10.1%). There was no dissection-related mortality. Type I (92.9%) sustained patent FL and no angiographic change. Type II showed partial remodeling (42.4%), no change (27.3%) and dissection progression (27.3%), and the length of FL enhancement positively predicted dissection progression with the cutoff of 40.3 millimeters. Type III achieved complete remodeling (58.3%) or evolved into type II (41.7%), and the distance between SMA orifice and ULP negatively predicted type change with the cutoff of 23.5 millimeters. Type IV (87.5%) achieved complete remodeling due to hematoma absorption. One patient underwent stent placement for the evolution of ULP into an enlarged blind-ending FL 2 months after conservation.ConclusionAfter conservation, patent FL with a distal re-entry is no morphological change, FL thrombosis tends to be resolved, and the “cul-de-sac” shaped FL without re-entry is partially shortened, no change or progressively dilated. FL enhancement length ≥ 40.3 millimeters is a predictor for the blinding-end FL enlargement. Thrombosed FL with ULP evolves into a patent “cul-de-sac” shaped FL when the distance between SMA orifice to ULP is less than 23.5 millimeters. A careful follow-up is necessary for the lesions with demonstrated predictors.

Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors

BackgroundSarcoidosis is a multiorgan granulomatous disease with a variable course. OobjectivesThe purpose of this study is to identify the patients that are more likely to experience disease progression. MethodsA retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO). ResultsThe sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis. ConclusionsAt 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.

Benign Metastasizing Leiomyoma (BML) - A Rare Phenomenon with Even Rarer Radiology and Disease Course

Benign Metastasizing Leiomyoma (BML) - A Rare Phenomenon with Even Rarer Radiology and Disease Course

Neurological Manifestations of Mycoplasma pneumoniae Infection in Hospitalized Children: A Single-Center Experience

Objective: Mycoplasma pneumoniae is one of the major causes of upper and lower respiratory tract infection in childhood. Neurological diseases are among the most common extrapulmonary manifestations.This study aimed to share our center’s experience regarding the treatment characteristics and clinical and radiological course of patients with M. pneumoniae -related neurological symptoms in light of the available evidence. Material and Methods: The study included in hospitalized patients with positive primary M. pneumoniae serology M. pneumoniae serology was examined in serum from the acute period and, if possible, convalescent serum (1-4 weeks after disease onset) using M. pneumoniae -specific immunoglobulin M (IgM) and IgG enzyme-linked immunoassay. A 4-fold or greater increase in IgG titer between acute and convalescent serum samples was considered diagnostic for M. pneumoniae infection. The clinical, laboratory, and imaging results and demographic data of patients with CNS involvement were evaluated. Results: Review of the patients’ charts showed that 13 (25%) of the 52 patients with confirmed M. pneumoniae infection had neurological symptoms and findings. When evaluated together with clinical, laboratory, and imaging results, 6 patients were diagnosed with acute cerebellar ataxia, 4 patients with encephalitis, and 1 patient each with GBS, optic neuritis, and longitudinally extensive transverse myelitis. Conclusion: Although M. pneumoniae is known as mainly a respiratory pathogen, it also causes various neurological disorders. Although all of our patients had symptoms of respiratory tract infection, it has been shown that that M. pneumoniae can also cause neurological disease without respiratory symptoms. Further studies are needed to evaluate the most appropriate methods for early diagnosis and treatment of neurological involvement, considering the long-term burden of the disease.

Perception of Undergraduate Dental Students to Team Based Learning in one of the Oral Radiology Courses

Perception of Undergraduate Dental Students to Team Based Learning in one of the Oral Radiology Courses

Evaluation of an elective ultrasound course for medical students.

To evaluate the educational benefits of teaching ultrasound in an elective radiological course for medical students. We conducted a single-center retrospective analysis of a one-week elective ultrasound course in which 39 medical students (25 female; median age 25.8 ± 2.8 years, range 21-35, 4th and 5th years of undergraduate medical education) participated as part of their radiological training. The students completed a pre- and post-course questionnaire using a five-point Likert scale for self-assessment of technical knowledge, confidence in the procedure regarding different organs, motivation for performing ultrasound, and the importance of ultrasound in medical education. The students also assessed the value of ultrasound teaching in the context of their general medical degree. Pre-test and post-test scores showed significantly improved radiology knowledge (p ≤ 0.001) concerning all abdominal organs (liver, spleen, gallbladder, kidney, urinary bladder, aorta and retroperitoneum). A significant improvement was registered in performing ultrasound of peripheral arteries and venous structures (each p=0.001), and also of the thyroid gland (p=0.006). General surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments. Systematic training in ultrasound markedly improved the students' skills. This was especially pronounced for solid organ structures, while students requested more education regarding the retroperitoneum and vascular structures. Teaching ultrasound in an elective hands-on training course improves anatomical understanding and practical skills associated with increased motivation. The results affirm the necessity and clinical relevance of the course during the radiological training of medical students.

Self-Efficacy and Student Satisfaction in a Clinical-Year Diagnostic Imaging Course Using an Online Instruction Format.

Accurate interpretation of radiographic images is critical to diagnosing clinical patients. Remote instruction in radiology has become more common at veterinary colleges as academic institutions struggle to fill open veterinary radiologist positions and as a result of the COVID-19 pandemic. This study sought to gather the feedback of fourth-year veterinary students via pre- and post-study surveys (n = 45) and focus groups (n = 7) about a newly implemented 2-week long radiology rotation. Ninety-eight percent of students reported having taken an online course before, and on both pre- and post-study surveys, students commonly reported feeling interested, determined, and attentive. On average, students reported that they were neither more nor less engaged than they would have been in an in-person course and that they understood the material neither better nor worse than they would have in an in-person course. Students reported that the key to their success was primarily hard work; secondarily, instructor availability and student ability were important. Students did not rate luck as having much influence on their success. Although diagnostic imaging can be a challenging subject to master, students effectively learned this subject through online instruction. They provided feedback for the course's continued improvement; their comments centered around improved interactivity, including providing automated quiz questions' answers and increased instructor availability. Data collected in this study will help to guide further development of the radiology course.

Airway Amyloidosis: A Retrospective Analysis of 43 Patients.

Amyloidosis can involve any compartment in the thorax. We aimed to explore the clinical and radiologic presentation, treatment, and clinical course of airway amyloidosis. A computer-assisted search was performed to identify patients who had biopsy-proven airway amyloidosis and were evaluated at Mayo Clinic in Rochester, MN, from January 1, 1997 through December 31, 2019. Demographic, clinical, and radiologic features along with clinical outcomes were analyzed. We identified 43 patients who had airway amyloidosis. Median age was 60 years (range: 33 to 91 y), and 58% were female. Shortness of breath (63% of patients) and cough (44%) were the most common presenting symptoms. Most patients (82%) had localized amyloidosis with light chain being the most common amyloid type; 63% had tracheobronchial amyloidosis, and 23% had tracheal and upper airway involvement. On computed tomography of the chest, the most common findings were airway wall thickening with nodularity (60% of patients), airway calcification (53%), and airway occlusion without collapse (47%). On bronchoscopy (33 patients), the extent of amyloid involvement was most commonly submucosal (n=15) or nodular (n=8). External beam radiotherapy was the most common treatment modality. Among the 30 patients who had follow-up at our institution, the prognosis appeared to depend on the extent of the disease and whether patients had localized or systemic amyloidosis. Computed tomography of the chest, bronchoscopy, and biopsy are needed to establish the diagnosis of airway amyloidosis, and systemic amyloidosis should be ruled out. Treatment of amyloidosis requires a multidisciplinary approach.

Teaching Radiology Courses: How to Address Learning Needs of Medical Students Through Interacting in Radiology

Radiologists in radiology courses (RC) at teaching and university hospitals train medical students in competent image interpreting and reporting (IIR). Information extracted from imaging is crucial for clinical decisions and therapies. This article attempted to explore a teaching approach adapted from adult education for clinical teachers in radiology to address learning needs (LN) in radiology by interacting and tailoring teaching content to LN. The following conclusions were drawn: Addressing LN could encourage students to learn about IIR; Integrating students to negotiate teaching content should take place if feasible, despite high workload and little teaching time in clinical routine; Negotiating with students and co-teachers of other imaging disciplines would help to tailor course specifics to LN and avoid redundancies; Interacting with medical students could be efficient and effective for clinical teaching and learning in RC.

Does Juvenile Idiopathic Arthritis Affect the Course of Legg-Calvé-Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years.

Background: This study aimed to determine the clinical and radiological course in children who had Legg–Calvé–Perthes disease (LCPD) associated with juvenile idiopathic arthritis (JIA). Methods: In a retrospective chart review between 2007 and 2019, eight consecutive JIA patients diagnosed with concomitant LCPD were identified and compared with a case-control group of 10 children with LCPD only. Results: LCPD was diagnosed at a mean age of 8.1 years (3.0–14.7) in children with JIA as compared to 6.1 years (2.9–10.0) in controls. According to the modified Harris Hip Score (mHHS), four children with JIA and all controls had an excellent result. Regarding the fragmentation severity and the duration of each stage, we found no differences using the lateral pillar and modified Elizabethtown classification. Five hips were classified as Stulberg I/II, two hips as Stulberg III, and one hip as Stulberg V with no evidence of hip dysplasia or severe overcoverage in either group. Conclusions: The radiological outcome of LCPD did not differ between both groups, while the clinical outcome was slightly better in controls. Physicians should be aware that children with LCPD may have JIA too. In suspicious cases, further investigations are recommended, and patients should be referred to pediatric rheumatologists.

Експериментальне моделювання туберкульозного спондиліту

Актуальність. Туберкульозний спондиліт (ТС) в структурі кістково­суглобового туберкульозу у дорослих займає провідне місце і досягає 40–61,5 %. Метою даної публікації є висвітлення процесу моделювання туберкульозного спондиліту і його особливостей у морських свинок для подальшого використання результатів експерименту у лікувальній та науковій практиці. Матеріали та методи. Експеримент ставився на 40 статевозрілих морських свинках. Моделювання туберкульозного спондиліту проводилось на основі розробленого нами способу (патент № 112423 (UА) Україна). Усі тварини були розподілені на чотири рівні групи: 1­ша — 3­тя групи (основні) — виконувалась ін’єкція 0,5 мл суспензії М.tuberculosis (0,1 мг сухої маси в 1 мл) в тіло хребця згідно з методикою; 4­та група — контрольна. Тваринам робилась ін’єкція стерильного фізіологічного розчину (0,9% — 0,5 мл) в тіло хребця. Група 1 (10 свинок) — лікування специфічними антибактеріальними препаратами (АБП) першого ряду (ізоніазид, стрептоміцин, рифампіцин). Група 2 (10 свинок) — лікування специфічними антибактеріальними препаратами другого ряду (амікацин, рифабутин, офлоксацин). Група 3 (10 свинок) — не проводилося лікування. За всіма тваринами проводилося динамічне спостереження з клінічними, рентгенологічними, патоморфологічними і лабораторними дослідженнями. Виведення ­експериментальних тварин з досліду проходило за раніше розробленим графіком — при виявленні ознак досліджуваних стадій туберкульозного процесу. Всім виведеним з експерименту тваринам проводилося патоморфологічне дослідження. При цьому основна увага приділялася вивченню патоморфології уражених специфічним процесом хребців. Результати. У результаті морфологічного дослідження встановлено наявність активного туберкульозного процесу в тілах хребців і паравертебральних тканинах у тварин із модельованим туберкульозом і лікуванням специфічним АБП першого ряду, а також у тварин, які не приймали специфічного лікування. Важливо зазначити, що ступінь вираженості деструктивних змін у вражених хребцях у тварин нелікованих і тих, які приймали АБП першого ряду, практично однаковий. У тварин, яким моделювали туберкульоз і лікували специфічним АБП другого ряду, виявлено пригнічення патологічного процесу з утворенням молодої кісткової та сполучної тканини різного ступеня зрілості та наявністю зони, що відмежовує вогнище запалення від здорової тканини в ранні терміни захворювання (один місяць). В результаті виконаної роботи вдалося простежити стадійність розвитку туберкульозного спондиліту у морської свинки та сучасні особливості клінічного, рентгенологічного та патоморфологічного перебігу. Виявлена ідентичність моделі основних клінічних форм туберкульозного спондиліту у морської свинки та людини. Висновки. Дане дослідження показало, що проведення сучасної інтенсивної специфічної антибактеріальної терапії в умовах експерименту дозволяє досягти відмежування деструктивного процесу в порівняно ранні терміни розвитку захворювання (4–5 тижнів). Отримані нові знання про патоморфологічні особливості перебігу туберкульозного спондиліту дозволяють проводити радикальні оперативні втручання на хребті без ризику генералізації туберкульозного процесу в більш ранні терміни.

Is Remote Learning as Effective as In-Person Learning for Contouring Education? A Prospective Comparison of Face-to-Face versus Online Delivery of the Anatomy and Radiology Contouring Bootcamp

The Anatomy and Radiology Contouring (ARC) Bootcamp was a face-to-face (F2F) intervention providing integrated education for radiation oncology (RO) residents and medical physicists. To increase access, we launched an online offering in 2019. We evaluated the effect of the online course on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it with the F2F course.Using modules, the online course offers content similar to that of the F2F comparator. Participants from the 2019 F2F and the 2019-2020 online course completed pre- and postevaluations assessing anatomy and radiology knowledge, contouring skills, self-confidence, and course satisfaction.There were 180 individuals enrolled (F2F: n = 40; online: n = 140); 57 participants (F2F: n = 30; online: n = 27) completed both evaluations. The online course had a wider geographic participation (19 countries) than F2F (4 countries). F2F had primarily RO resident participation (80%), compared with online (41%). Both cohorts demonstrated similar improvements in self-confidence pertaining to anatomy and radiology knowledge, contouring skills, and interpreting radiology images (all P < .001). Both the online (mean ± SD improvement: 6.6 ± 6.7 on a 40-point scale; P < .001) and F2F (3.7 ± 5.7; P = .002) groups showed anatomy and radiology knowledge improvement. Only the F2F group demonstrated improvement with the contouring assessment (F2F: 0.10 ± 0.17 on a 1-point Dice scale; P = .004; online: 0.07 ± 0.16; P = .076). Both cohorts perceived the course as a positive experience (F2F: 4.8 ± 0.4 on a 5-point scale; online: 4.5 ± 0.6), stated it would improve their professional practice (F2F: 4.6 ± 0.5; online: 4.2 ± 0.8), and said they would recommend it to others (F2F: 4.8 ± 0.4; online: 4.4 ± 0.6).The online ARC Bootcamp demonstrated improved self-confidence, knowledge scores, and high satisfaction levels among participants. The offering had lower completion rates but was more accessible to geographic regions, provided a flexible learning experience, and allowed for ongoing education during the COVID-19 pandemic.

Dr. Edith H. Quimby: A pioneering medical physicist and educator with outstanding contributions in radiation dosimetry

Dr. Edith H. Quimby: A pioneering medical physicist and educator with outstanding contributions in radiation dosimetry

ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2

BackgroundHigh-Flow Nasal Cannula (HFNC) therapy is useful treatment in patients with acute respiratory failure (ARF). The ROX index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) has been evaluated to predict success of HFNC in patients with pneumonia. ObjectiveThe aim of this study was to determine whether the ROX Index could predict HFNC therapy success in patients with ARF due to SARS-CoV-2 pneumonia. MethodsAn observational, prospective study was performed including patients admitted with ARF secondary to SARS-CoV-2 pneumonia who met criteria for HFNC therapy initiation. Demographic, radiological, laboratory and clinical course data were collected. The ROX index was calculated at 1 h, 6 h, 12 h and 24 h after starting HFNC. ResultsIn total 85 patients were included (age, 64.51 + 11.78 years; male, 69.4%). HFNC failed in 47 (55.3%) patients, of whom 45 (97.8%) were initially managed with noninvasive ventilation (NIV). ROX index at 24 h was the best predictor of HFNC success (AUC 0.826, 95%CI 0.593–1.00, p = 0.015) with a cut-off point of 5.35 (S 0.91, Sp 0.79, PPV 0.92, NPP 0.79). In multivariate logistic regression analysis ROX index at 24 h proved the best predictor of HFNC success. ConclusionsROX index at 24 h with a cut-off point of 5.35 predicts HFNC success in patients with SARS-Cov-2-induced ARF.

Assessment of hospitalized patients with coronavirus disease 2019

Introduction Coronaviruses are a large family of viruses that lead to diseases in animals or humans. Objective To assess clinical, radiological, and laboratory criteria, as well as treatment of patients hospitalized with coronavirus disease 2019, and the relation to radiological progression and hospital stay. Patients and methods This study was a prospective observational study conducted in an isolation sector in a private hospital in Saudi Arabia. Data were obtained from electronic records. Results A total of 30 patients were enrolled (24 males and six females), and their mean age was 51.2±15.05 years. The presenting symptoms were fever (83.3%), cough (33.3%), shortness of breathing (26.7%), body aches (16.7%), and sore throat (10%). Chest radiograph was abnormal in 76.6%. C-reactive protein (CRP) was high at 112.59±140±0.50 mg/l, and serum ferritin was 763.21±652.18 μg/l. Lactate dehydrogenase (LDH) was higher than normal at 312.86±161 U/l. Mean D-dimer was 0.97±1.11 μg/ml. international normalized ratio was 1.09±0.194. Fibrinogen was high at 575.32±220.08 mg/dl, and activated partial thromboplastin time was 37.94±17.46 s. There was a strong positive correlation between serum ferritin and temperature, LDH, and aspartate transaminase. CRP had a strong positive correlation with alanine transaminase, total leukocytic count, lymphocytes, and neutrophil/lymphocyte ratio. Hospital stay was positively correlated with ferritin. LDH was negatively correlated with lymphocytic count. The correlation between radiological course and laboratory follow-up was poor. Conclusion Coronavirus disease 2019 affects males more than females and is more in elderly. Fever is a common presenting symptom. Infection affects many blood indices, such as LDH, ferritin, CRP, and fibrinogen. Radiological course of the lesions is not affected by those blood indices, whereas hospital stay is affected. The outcome is favorable in most of the patients.

CSF neurofilament light chain predicts 10-year clinical and radiologic worsening in multiple sclerosis.

BackgroundNeurofilament light chain (NfL) is an attractive biomarker of disease activity and progression in MS, but there is a lack in long-term prognostic data.ObjectiveTo test the long-term clinical and radiological prognostic value of cerebrospinal fluid (CSF)-NfL among newly diagnosed patients with MS.MethodsNewly diagnosed MS patients where followed prospectively with baseline CSF-NfL and repeated MRI and clinical assessments for up to 10 years. Associations between baseline CSF-NfL and longitudinal MRI and clinical assessments were found by Generalized Estimating Equations analysis.ResultsForty-two participants were included. CSF-NfL at baseline was significantly associated with the rate of atrophy in globus pallidus (p = 0.009) and hippocampus (p = 0.001) as evaluated by MRI. Baseline volumes of thalamus (β −0.33; 95% CI −0.57 to −0.10, p = 0.006), T1 (β 0.28; 95% CI 0.11 to 0.44, p = 0.001) and T2 (β 0.16; 95% CI 0.04 to 0.27, p = 0.008) lesions and baseline levels of CSF-NfL (β 0.9; 95% CI 0.3 to 1.5, p = 0.002) significantly predicted EDSS worsening over 10 years. Baseline CSF-NfL gave a comparable prediction to the best MRI volumetric predictors.ConclusionCSF-NfL predicted the clinical and radiological course of newly diagnosed patients with MS over a 10-year period, underlining its prognostic role.

P24.03 Dynamic Circulating Tumor DNA Interim Results From The ALKternate Clinical Trial

The ALKternate clinical trial is a proof-of-concept study enrolling patients with advanced ALK-rearranged NSCLC, harboring secondary resistance to 2ndgeneration ALK-inhibitor therapy (Trial in Progress#1012). Patients receive induction lorlatinib and at confirmed disease control enter an active phase alternating lorlatinib with crizotinib testing the hypothesis that via altering selection pressure and suppressing emerging resistance clones, sustained sensitivity to lorlatinib and improved disease control may be achieved. Patients prospectively enrolled in ALKternate receive sequential plasma sampling, analyzed real-time via the Resolution Bioscience ctDxTM NGS liquid biopsy platform. Results are correlated with prior therapy, clinical and radiological course on trial. Interim censor date was April 07, 2021. 14 patients have been screened for trial, 3 screen failed, 2 due to ctDNA confirming non-ALK drivers, 1 without prior resistance. N=2/11 were ineligible for the alternating arm due to primary lorlatinib resistance. N=6/9 proceeding to alternating ALKi had baseline CNS disease. The ALK fusion variant was identified in N=7/9, 1+ ALK KDMs in N=7/9, 1+ ALK bypass variants (co-occurring) in N=6/9. The variant allelic frequency (VAF) of ctDNA decreased in N=7/9, N=2/9 harboring MET amplification. Complete temporal ctDNA VAF data will be presented via stream-plots accompanying the results of Table 1, as in Figure 2. At immature median(m) follow-up 12.1mo, m-time on alternating therapy is 7.8mo. In those with persisting positive ctDNA at 6mo, time to treatment failure (TTTF) was 6.1mo and not reached in those with no detectable ctDNA. All with PD on alternating (N=5/9) crossed-over to continuous lorlatinib, PFS 5.6mo.Figure 2ALK5 VAF stream-plotView Large Image Figure ViewerDownload Hi-res image Download (PPT) Preliminary analysis of the ALKternate clinical trial dynamic plasma ctDNA profiles on alternating therapy indicate the inherent genetic heterogeneity in ALK NSCLC at drug resistance and with clearing of plasma ctDNA when alternating ALK-inhibitor therapy, an efficacy advantage is suggested.

Aseptic necrosis of the femoral head in the course of haemophilia; a different clinical and radiological course compared to typical Legg-Calve-Perthes disease (twenty years of follow-up) – case report

The authors analyse the course of aseptic necrosis of the femoral head in a 7-year-old boy with haemophilia A (factor VIII level - 0%) caused by massive haemarthrosis into the hip joint (joint tamponade). The patient’s clinical and radiological symptoms differed from those in classic LCP disease, and now, after 20 years, the consequences of necrosis do not confirm typical Perthes disease (LCP). Significant shortening (about 5 cm) of the limb and the X-ray image of the proximal end of the femur resemble the consequences of severe necrosis of the femoral head in the treatment of an infant with developmental dysplasia of the hip (DDH). The study presents necrosis of the femoral head in the course of haemophilia due to its extremely rare occurrence as opposed to haemophilic arthropathy typical for this disease. This description may also contribute to considerations on the etiopathology of LCP disease.