Review Of Radiological Images Research Articles

36P Indirect comparison of mobocertinib trial data vs real-world data in patients with EGFR exon 20 insertion (ex20ins)+ non-small cell lung cancer (NSCLC)

Mobocertinib received accelerated approval by the US FDA for the treatment of adult patients (pts) with locally advanced or metastatic NSCLC with EGFR ex20ins with disease progression on or after platinum-based chemotherapy (platinum), based on the results of a phase I/II single arm trial (NCT02716116). This study indirectly compared overall survival (OS), progression-free survival (PFS), and confirmed overall response rate (cORR) for the mobocertinib trial with real-world data (RWD). Clinical outcomes were compared in platinum-pretreated pts with EGFR ex20ins+ NSCLC treated with mobocertinib 160 mg QD in the second or later line in NCT02716116 (cut-off Nov 2020) vs. real-world treatment from a chart review study in Germany (RWD). RWD included platinum-pretreated pts with Eastern Cooperative Oncology Group (ECOG) 0-1 and no other malignancy in the prior 3 years. Inverse probability of treatment weighting method was used to adjust for group differences in key baseline variables, including age, sex, ECOG, smoking status, brain metastasis, time from advanced diagnosis, and histology. This study included 157 platinum-pretreated pts (n=114 mobocertinib/n=43 RWD; mean age: 60/60 years; male: 34%/21%; brain metastases: 35%/30%; median prior lines; 2/1). RWD platinum-pretreated pts received EGFR tyrosine kinase inhibitor (37%), chemotherapy (mono 26%, doublet 9%), and immunotherapy alone (19%) or combined with doublet chemotherapy (9%). Most baseline variables were balanced after weighting. For mobocertinib vs weighted RWD, cORR was 35% vs 0%, median PFS was 7.3 vs 2.5 months, and median OS was 24.0 vs 9.8 months (Table).Table: 36POutcomeMobocertinib (n = 114)RWDHazard Ratio (95% CI)Unweighted (n = 43)Weighted (n=109)UnweightedWeightedccORR, % (95% CI)35.1a (26.4, 44.6)0%b0%bMedian PFS, mo (95% CI) Log-rank p-value7.3a (5.6, 8.8)3.0 (2.0, 4.4)2.5 (1.5, 3.4)0.33 (0.22, 0.50) <0.0010.28 (0.17, 0.46) <0.001Median OS, mo (95% CI) Log-rank p-value24.0 (14.6, 28.8)11.3 (8.9, 14.5)9.8 (4.3, 13.3)0.49 (0.31, 0.77) 0.0030.48 (0.27, 0.86) 0.018a cORR and PFS: per investigator’s assessment using RECIST 1.1 b Tumor response was evaluated by review of radiologic images based on RECIST v1.1. c Inverse probability of treatment weighting with regression adjustment for time from advanced diagnosis. CI, confidence interval Open table in a new tab a cORR and PFS: per investigator’s assessment using RECIST 1.1 b Tumor response was evaluated by review of radiologic images based on RECIST v1.1. c Inverse probability of treatment weighting with regression adjustment for time from advanced diagnosis. CI, confidence interval Among platinum-pretreated pts with EGFR ex20ins+ NSCLC, mobocertinib showed significantly higher cORR, and prolonged PFS and OS compared to treatment in the real-world setting, with or without weighting to match baseline variables.

Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution.

PurposeSoftware solutions such as mRay allow review of radiological images on handheld devices. We investigated if the quality is adequate for evaluating CT scans of patients with suspected stroke.Methods50 patients (Median age 80 years, 28 females) were retrospectively selected. All patients had undergone multidetector CT angiography ± perfusion and presented with clinical signs of acute stroke. Out of the 50 patients, 19 had large-vessel occlusion (LVO), 5 had intracranial hemorrhage (ICH), 10 had severe intracranial stenosis of at least one major vessel, 2 had intracranial tumor and 15 had no or an unrelated pathology. One experienced neuroradiologist and one resident scored the anonymized pictures separately on two handheld devices (iPhone 7 Plus, MED-TAB) equipped with mRay Software and on a PACS workstation. Each case was reviewed on all three devices with a break in-between of at least 12 weeks. The scoring on the traditional workstation was compared with the two handheld devices, regarding detection of early ischemic signs, LVOs, CBV/CBF-mismatch, ICHs and severe stenosis. Both raters were asked to rate the diagnostic quality of both handheld devices regarding detection of LVOs, ICHs, early ischemic signs and overall.ResultsAll LVOs, intracranial tumors and ICHs were detected on both mobile devices. There was no significant difference in the rating of CCT and CBF ASPECTS between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices. Both raters assessed the diagnostic quality to be sufficient on both mobile devices to base treatment decisions on.ConclusionSoftware solutions such as mRay for handheld devices provide adequate diagnostic quality for the review of CT scans of suspected stroke patients.

The Importance of a Comprehensive Review of Radiological Images: A Case of Pseudomonas Empyema.

The Importance of a Comprehensive Review of Radiological Images: A Case of Pseudomonas Empyema.

Internet-based measurement of visual assessment skill of trainee radiologists: developing a sensitive tool.

Expert radiologists exhibit high levels of visual diagnostic accuracy from review of radiological images, doing so after accumulating years of training and experience. To train new radiologists, learning interventions must focus on the development of these skills. By developing a web-based measure of image assessment, a key part of visual diagnosis, we aimed to capture differences in the performance of expert, trainee and non-radiologists. 12 consultant paediatric radiologists, 12 radiology registrars, and 39 medical students were recruited to the study. All participants completed a two-part, online task requiring them to visually assess 30 images (25 containing an abnormality) drawn from a library of 150 paediatric skeletal radiographs assessed prior to the study. Participants first identified whether an image contained an abnormality, and then clicked within the image to mark its location. Performance measures of identification accuracy, localisation precision, and task time were collected. Despite the difficulties of web-based testing, large differences in performance, both in terms of the accuracy of abnormality identification and in the precision of abnormality localisation were found between groups, with consultant radiologists the most accurate both at identifying images containing abnormalities (p < 0.001) and at localising abnormalities on the images (p < 0.001). Our data demonstrate that an online measurement of radiological skill is sufficiently sensitive to detect group level changes in performance consistent with the development of expertise. The developed tool will allow future studies assessing the impact of different training strategies on cognitive performance and diagnostic accuracy.

Atypical Presentation of Glioblastoma Multiforme.

BackgroundGlioblastoma multiforme (GBM) is a highly malignant glial tumour classified by the World Health Organization (WHO) as a stage IV astrocytoma. It varies in shape and size and can be cystic, vascular and necrotic. It often appears as a ring-enhancing lesion on magnetic resonance imaging (MRI). The most common symptoms of GBM, such as headache, vomiting and seizures, are due to increased intracranial pressure. The objective of this case report is to describe an atypical presentation of GBM.Case ReportA 53-year-old woman of Italian origin presented with a 2-week history of lack of coordination in her hands and some difficulty in speech. Electromyography for assessment of her arms and cranial bulbar function was normal. However, 2 days later, the patient presented to the emergency department with progressive weakness in her left arm and leg as well as difficulty in speech. Mild left facial asymmetry was noted. A brain MRI revealed a right frontal mass. Stereotactic surgical resection was performed 2 days later, and biopsy confirmed the diagnosis of GBM. Although headache and other features of raised intracranial pressure are the most common initial symptoms of GBM, any atypical neurological or psychiatric presentation in an adult patient should raise suspicion for this tumour.ConclusionCareful analysis of an adult with atypical signs and symptoms along with thorough review of radiological tests will facilitate early diagnosis of dangerous tumours such as GBM.LEARNING POINTAn adult patient with symptoms that do not conform to a neurological condition should be investigated for a brain tumour.Careful history taking and examination are essential for reaching the correct diagnosis as soon as possible.Meticulous review of radiological images in order to detect subtle changes in brain anatomy is essential.

Imaging-detected acute muscle injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games

BackgroundAcute muscle injuries in elite athletes are responsible for a large portion of time loss injuries.AimTo describe the frequency, the anatomic distribution, and severity of imaging-detected acute muscle injuries among...

Epidemiology of imaging-detected tendon abnormalities in athletes participating in the Rio de Janeiro 2016 Summer Olympics

BackgroundTendon abnormalities are prevalent among both elite and non-elite athletes. Cross-sectional imaging modalities are used to confirm and evaluate the severity of such lesions.AimTo describe the demographics, prevalence, anatomical location...

Large Urethral Calculus Formation on an Transobturator Synthetic Sling in the Urethra

Study Objective: Describe radiologic findings of calcium hydroxylapatite used for urethral bulking. Design: A retrospective chart review of two patients where calcium hydroxyapatite injections were incidentally visualized by radiologic means and raised clinical suspicions of cancer. Setting: Urogynecology and reconstructive pelvic surgery practice in community based, university affiliated teaching hospital. Patients: Patients undergoing radiologic imaging with prior urethral bulking treatments for intrinsic sphincteric deficiency. Intervention: Consultation with radiologic colleagues and counseling of patients regarding incidental visualization during subsequent pelvic imaging studies. Review of radiologic images. Measurements and Main Results: Ultrasound and CT descriptions of images are given. Conclusion: Numerous injection materials have been utilized for urethral bulking and ureterovesical reflux. Due to inherent differences between the materials, radiologic appearances will vary. The patients should be advised prior to the procedure that the bulking material might be seen during any future imaging. Radiologist should be educated about these procedures and the imaging findings that may result. 552

Magnetic Resonance Imaging for Detection of Brain Abnormalities in Fetuses with Cleft Lip and/or Cleft Palate

To determine the prevalence of brain abnormalities identified by prenatal imaging of fetuses with cleft lip with or without cleft palate (CL/P) or cleft palate only (CP) and to compare with postnatal imaging and neurologic evaluation. This was a retrospective review of radiologic images (magnetic resonance imaging [MRI] and sonography) of fetuses diagnosed with CL/P or CP at the Advanced Fetal Care Center at Children's Hospital Boston between 2002 and 2008. Images were reviewed for possible brain abnormalities by a pediatric radiologist who specializes in this field. Postnatal imaging was also assessed whenever available and correlated with clinical findings. A large, tertiary-care, academic pediatric hospital. One hundred twenty-six fetuses and 105 corresponding infants. Brain abnormalities were found in 8 of 126 fetuses (6.3%) by prenatal MRI. The malformations were corpus callosal dysgenesis (n = 3), encephalocele (n = 1), hypoplasia of the cerebellar hemispheres or vermis (n = 3), and white matter neuronal migration anomaly (n = 1). An additional 2 patients were diagnosed with brain abnormalities postnatally that had not been detected on prenatal imaging. The possibility of brain anomalies should be assessed in a fetus found to have CL/P or CP by sonography and/or MRI. Central nervous system imaging and careful neurodevelopmental follow-up is indicated in these infants.

The impact of subtrochanteric fracture criteria on hip fracture classification

Hospital diagnosis codes are useful for assessing hip fracture rates in large populations. However, these codes do not reliably differentiate hip fractures that occur in the subtrochanteric region. Identification of subtrochanteric fractures requires review of radiographic images to distinguish these fractures from the more commonly occurring trochanteric fractures. This study examines the accuracy of coded hospital diagnoses for hip fracture compared to fracture site verification based on operative and radiologic data. The variability in subtrochanteric fracture assignment was also examined using different anatomic criteria. This retrospective study includes female members of Kaiser Permanente Northern California age 60 years and older with nontraumatic hip fracture during 2007-2008. Anatomic site was verified by operative and radiologic records, including radiographic image review for fractures occurring in the subtrochanteric region. Two different criteria were compared for subtrochanteric fracture. We identified 2,824 women with incident hip fracture during the 2-year period. The average age was 82.9 ± 8.2 years and 15% were non-White. International Classification of Diseases, Ninth Revision (ICD-9) coding was accurate for femoral neck and trochanteric fractures (>90% confirmed by operative/radiologic reports), compared to only 26% for subtrochanteric fractures using the Orthopedic Trauma Association (OTA) criteria for subtrochanteric fracture. Using OTA classification, 1.3% of hip fractures were assigned as subtrochanteric compared to 4.2% when the criteria were broadened to include the lesser trochanter. Both femoral neck and pertrochanteric fracture rates increased exponentially with age, while age-related rates in subtrochanteric fracture differed by diagnostic classification method; the broader criteria including the lesser trochanter produced age-related trends that mirrored femoral neck and pertrochanteric fractures. Unlike femoral neck and pertrochanteric fractures, epidemiologic studies of subtrochanteric fractures cannot rely on ICD-9 codes alone. Review of radiologic images using OTA criteria is required for identification of subtrochanteric fractures occurring below the lesser trochanter.

Lesion Location in Poststroke Depression and Emotional Incontinence

Behavioral neurology classically associates poststroke depression (PSD) with left frontal infarcts and pseudobulbar symptoms of emotional incontinence (PSEI) with bifrontal lesions, but evidence for these associations is inconsistent. In this prospective study, undertaken to better understand the neuroanatomic localization of PSD and PSEI, 148 consecutive patients (mean age, 62) were evaluated 2 to 4 months poststroke. One author, a neurologist, performed the neurologic examination and review of radiologic images; the other, a nurse, independently assessed patients for PSD …

A multidisciplinary study investigating radiotherapy in Ewing’s sarcoma: end results of POG #8346

Purpose: To determine if involved field radiation (IF) is equivalent to standard whole bone radiation (SF) in local tumor control; to establish patterns of failure following treatment; and to determine response, event-free survival (EFS), and overall survival rates from multidisciplinary therapy in Ewing’s sarcoma. Methods and Materials: Between 1983 and 1988, 184 children with Ewing’s sarcoma were enrolled onto Pediatric Oncology Group 8346 (POG 8346). A total of 178 (97%) met eligibility criteria; 6 had pathology other than Ewing’s sarcoma. Induction chemotherapy of cyclophosphamide/doxorubicin (adriamycin )(C/A) x 12 weeks was followed by local treatment either surgery or radiation therapy and C/A, dactinomycin, and vincristine for 50 weeks. Resection was advised for patients with small primary tumors if accomplished without functional loss. Forty patients were randomized to receive SF, whole bone radiation to 39.6 Gy plus a 16.2 Gy boost (total 55.8 Gy) or IF to 55.8 Gy, and the remainder were assigned to IF radiation. Results: Of 178 eligible patients, 141 (79%) had localized disease and 37 (21%) had metastases at presentation. Their 5-year EFS was 51% (SE 5%) and 23% (SE 7%) respectively. The response rate to induction chemotherapy was 88% (28% complete, 60% partial), but after radiotherapy the response rate increased to 98%. Thirty-seven of the localized patients underwent resection, of whom 16 (43%) required postoperative radiotherapy; the 5-year EFS of these surgical patients was 80% (SE 7%). The remaining 104 localized patients were eligible for randomization or assignment to receive radiotherapy; the 5-year EFS of these patients was 41% (SE 5%), with no significant difference in EFS between those randomized to SF vs. IF. Site of primary tumor correlated with 5-year EFS: distal extremity 65% (SE 8%), central 63% (SE 10%), proximal extremity 46% (SE 8%), and pelvic–sacral 24% (SE 10%) ( p = 0.004). Initial tumor size did not correlate significantly with EFS. Patterns of failure among the 141 localized patients revealed 23% of patients experienced a local failure, while 40% had a systemic failure. The 5-year local control rate for the surgical patients +/- postoperative radiotherapy was 88% (SE 6%), while for the patients undergoing radiotherapy alone it was 65% (SE 7%). There was no difference in local control between those randomized to SF vs. IF. The 5-year local control rate for the patients with pelvic–sacral tumors was 44% (SE 15%), significantly worse than the local control rates for those with central tumors 82% (SE 8%), distal extremity 80% (SE 8%), or proximal extremity 69% (SE 9%) ( p = 0.023). However, quality of radiotherapy correlated with outcome. Patients who had appropriate radiotherapy had a 5-year local control of 80% (SE 7%), while those with minor deviations had 5-year local control of 48% (SE 14%), and those with major deviations had a local control of only 16% (SE 15%) ( p = 0.005). The local failure was within an irradiated volume in 62% of patients, outside the irradiated volume in 24% of cases, while the precise location could not be determined in the remaining 14%. Conclusions: As most failures in Ewing’s sarcoma are systemic, improved EFS requires more effective systemic chemotherapy. Adequate IF radiotherapy requires treatment to appropriate volumes as defined by MRI imaging and full radiation doses. Pretreatment review of radiologic images with a musculoskeletal radiologist to determine appropriate tumor volumes, as well as use of conformal radiotherapy techniques are important for improved outcome.