Standard Radiographic Assessment Research Articles

P44. Interobserver agreeability and clinical validity of the Miskin Classification System: a standardized radiographic assessment of lumbar degenerative disease

P44. Interobserver agreeability and clinical validity of the Miskin Classification System: a standardized radiographic assessment of lumbar degenerative disease

Current concepts of anti-EGFR targeting in metastatic colorectal cancer.

Anti-EGFR targeting is one of the key strategies in the treatment of metastatic colorectal cancer (mCRC). For almost two decades oncologists have struggled to implement EGFR antibodies in the mCRC continuum of care. Both sidedness and RAS mutational status rank high among the predictive factors for the clinical efficacy of EGFR inhibitors. A prospective phase III trial has recently confirmed that anti-EGFR targeting confers an overall survival benefit only in left sided RAS-wildtype tumors when given in first line. It is a matter of discussion if more clinical benefit can be reached by considering putative primary resistance mechanisms (e.g., HER2, BRAF, PIK3CA, etc.) at this early stage of treatment. The value of this procedure in daily routine clinical utility has not yet been clearly delineated. Re-exposure to EGFR antibodies becomes increasingly crucial in the disease journey of mCRC. Yet re- induction or re-challenge strategies have been problematic as they relied on mathematical models that described the timely decay of EGFR antibody resistant clones. The advent of liquid biopsy and the implementation of more accurate next-generation sequencing (NGS) based high throughput methods allows for tracing of EGFR resistant clones in real time. These displays the spatiotemporal heterogeneity of metastatic disease compared to the former standard radiographic assessment and re-biopsy. These techniques may move EGFR inhibition in mCRC into the area of precision medicine in order to apply EGFR antibodies with the increase or decrease of EGFR resistant clones. This review critically discusses established concepts of tackling the EGFR pathway in mCRC and provides insight into the growing field of liquid biopsy guided personalized approaches of EGFR inhibition in mCRC.

Tendoscopic treatment of acute posterior tibial tendon dysfunction: case report

We present a case of a rheumatoid patient presenting with acute signs of posterior tibial tendon dysfunction (PTTD). Magnetic resonance imaging (MRI) results were inconclusive regarding the grade of posterior tibial tendon (PTT) tear. We performed posterior tibial tendoscopy, releasing all tendon adherences, and accomplished complete synovectomy. By the end of the procedure, we observed PTT integrity, normal excursion, and mild tendinosis. At 24-month follow-up, the Visual Analog Scale for pain (VAS-Pain) decreased from 9 (preoperatively) to 1. The Foot and Ankle Outcome Score (FAOS) increased from 16% (preoperatively) to 94%. Clinically, the patient had a symmetric bilateral heel rise test and no pain over the course of the PTT. A standard radiographic assessment demonstrated a normal foot arch and hindfoot alignment. This report illustrates how posterior tibial tendoscopy can simultaneously provide accurate diagnosis and surgically address acute PTTD on a rheumatoid patient, relieving symptoms and improving midterm clinical scores. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Comparison Between Two Different Design Concepts of 4- Implant Assisted Mandibular Complete Overdenture:- periimplant bone height changes

Abstract:
 Purpose: This study was accomplished to evaluate the bone height changes radiographically and the reliability of use either two posterior short or inclined implants with two conventional anterior implants retaining mandibular overdenture.
 
 Materials and methods: Ten male mandibular completely edentulous patients were divided in two equal groups after delivered complete dentures. For the first group (short implant design- group A) two vertical implants were inserted in the canine areas and two short vertical implants were inserted in the 1st molar area. For the second group (inclined implant design- group B) two vertical implants were inserted in the canine areas and two 30o distally inclined implants were inserted in the second premolar area. Digital standardized periapical radiographic assessment for horizontal and vertical alveolar bone height changes was carried out at T0 (immediately), T6 (6 months), T12 (12 months) and after mandibular complete overdenture insertion.
 Result: 1. VBL decrease significantly with advance of time in both groups during the time intervals. The highest VBL around the implants was noted in the 1st six months followed by the 2nd six months, the highest amount of total VBL observed with the interval T0-T12, followed by the interval (T0-T6) and the inclined implant group showed significant higher total VBL than short implant group at the intervals T0-T6 and T0-12.
 2- HBL decreased significantly with advance of time in both groups. For short and inclined implant group, the highest amount of total HBL observed with the interval T0-T12, followed by the interval (T0-T6). Short implant group showed significant higher total HBL than inclined group at the interval T0-T6 and T0-T12.
 
 Conclusion: Within the limitations of this clinical radiographic study it can be concluded that (1) The 30o distally inclined implants inserted in the posterior areas for assisting mandibular complete overdenture induce vertical bone loss more than the axially inserted implants (short or conventional implants). (2) The short implants inserted in the posterior areas for assisting mandibular complete overdenture induce horizontal bone loss more than the axially inserted implants.
 Keywords: Short implants, O-ring ball attachment, VBL, HBL.

Long-Term Outcome of Small Head Metal-On-Metal Total Hip Arthroplasty: A 15-to-22 Year Follow-Up

BackgroundThe Metasul articular interface was a second-generation metal-on-metal (MoM) total hip arthroplasty (THA) that was introduced as a promising interface with improved manufacturing technology, better clearances, and enhanced metal hardness. In December 2001, the manufacturer recalled these implants due to the failure of cup osseointegration. MethodsBetween 1997 and 2004, 168 consecutive primary Metasul THAs were performed in 144 patients. Most patients received a cementless femoral and porous-coated acetabular component with 28 mm head. A competing risk analysis was performed for determination separately for bearing surface-related, recalled bearing failure, and end point revision for any reason. For clinical patient evaluation, we used Harris hip score and University of California at Los Angeles scores. Cobalt and chromium ion level measurement and standard radiographic assessment was performed. ResultsOf the 168 THAs, 19 hips were revised at a mean period of 15 years as follows: 12 of them were due to recalled acetabular component, five hips had noninterface-related complication, and two true interface surface failure. The survival distribution function of all hips with revision for any reason was 88.4%, for bearing interface relation 98.8%, and 92.6% for recalled cups. The mean Harris hip score and University of California at Los Angeles scores were 85 and 6, respectively, and the median Co and Cr blood levels were 1.0 and 0.91 μg/L. ConclusionExcluding the recalled components, Metasul articular interface has performed extremely well at a minimum follow-up of 15 years in this relatively young population. There were two interface-related revisions in the entire cohort.

Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study

IntroductionDistal radius fractures account for one-fifth of all fractures in the emergency department. Their classification based on standard radiographs is common practice although low inter-observer reliabilities and superiority of computer tomography (CT) scanning in evaluation of joint congruency have been reported.Materials and methodsWe retrospectively analyzed 96 displaced distal radius fractures scheduled for open reduction and internal fixation using standard radiographic assessment. The radiographs were classified with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA), Fernandez and Frykman classifications by three observers and inter-rater reliabilities were calculated. Additional CT scanning was performed in all cases and the following parameters were assessed: radiocarpal joint involvement, fracture extent into the radial sigmoid notch, i.e. the distal radio-ulnar joint, comminution of the metaphysis, and concomitant ulnar styloid fracture. The CT scans were used as a reference standard to determine sensitivity and accuracy of standard radiographic assessment in evaluation of distal radius fractures.ResultsThe inter-rater agreement for the AO classification was 35.4%, 68.8% for the Fernandez and 38.5% for the Frykman classification. Fracture extension into the radiocarpal joint was present in 81 cases (84.4%). Sigmoid notch involvement was found in 81 fractures (84.4%). Involvement of both joints was present in 72 cases (75%). The sensitivity of standard radiographs regarding radiocarpal joint involvement was 93.8%. Considering involvement of the distal radio-ulnar joint the false-negative rate using standard radiographs was 61.7% and the test’s accuracy for sigmoid notch involvement was 45.8%.ConclusionThis study demonstrates that involvement of the sigmoid notch is frequently missed in standard radiographs. The presented data support the frequent use of CT imaging to allow the holistic illustration of a fracture’s complexion and to ensure optimal pre-operative planning.

Inaccuracy of Forefoot Axial Radiographs in Determining the Coronal Plane Angle of Sesamoid Rotation in Adult Hallux Valgus Deformity: A Study Using Weightbearing Computed Tomography.

Hallux abducto valgus is a triplane deformity with recent attention given to the significance of correcting the coronal plane component. This study explored the accuracy of the forefoot axial (FFA) study as a standard radiographic assessment method compared with weightbearing computed tomography (CT). Twelve feet with hallux abducto valgus from 12 individuals were included in this study. Three images of the affected foot were taken: FFA radiograph and weightbearing CT with the foot in maximum pronation (pronated CT) and maximum supination (supinated CT). Five investigators determined the sesamoid rotation angles (SRAs) from each of the images. The measurements from a single investigator were used to compare the SRA means from each of the image types, and those from all five investigators were used to determine reliability. The mean ± SD SRA was 22.1° ± 7.6° for pronated CT, 10.5° ± 5.0° for supinated CT, and 12.2° ± 9.4° for FFA images. The mean SRA from the pronated CT was significantly greater than the supinated CT (P < .001) and FFA (P < .005) SRAs. There were no significant differences in mean SRA between the FFA and supinated CT images (P > .99). Results indicated high reliability in measurements among investigators. Using weightbearing CT, these findings indicate that the sesamoids significantly alter their position in the coronal plane, as determined by the SRA, with changes in weightbearing subtalar joint position. Moreover, the affected foot positioning required for determining the SRA from the FFA radiograph seems to significantly underestimate the true SRA. Thus, use of this image in surgical hallux abducto valgus planning is called into question.

A real 3D measurement technique for the tibial slope: differentiation between different articular surfaces and comparison to radiographic slope measurement

BackgroundThe tibial slope plays an important role in knee surgery. However, standard radiographic measurement techniques have a low reproducibility and do not allow differentiation between medial and lateral articular surfaces. Despite availability of three-dimensional imaging, so far, no real 3D measurement technique was introduced and compared to radiographic measurement, which were the purposes of this study.MethodsComputed tomography scans of 54 knees in 51 patients (41 males and 10 females) with a mean age of 46 years (range 22–67 years) were included. A novel 3D measurement technique was applied by two readers to measure the tibial slope of medial and lateral tibial plateau and rim. A statistical analysis was conducted to determine the intraclass correlation coefficient (ICC) for the new technique and compare it to a standard radiographic measurement.ResultsThe mean 3D tibial slope for the medial plateau and rim was 7.4° and 7.6°, for the lateral plateau and rim 7.5° and 8.1°, respectively. The mean radiographic slope was 6.0°. Statistical analysis showed an ICC between both readers of 0.909, 0.987, 0.918, 0.893, for the 3D measurement of medial plateau, medial rim, lateral plateau and lateral rim, respectively, whereas the radiographic technique showed an ICC of 0.733.ConclusionsThe proposed novel measurement technique shows a high intraclass agreement and offers an applicable opportunity to assess the tibial slope three-dimensionally. Furthermore, the medial and lateral articular surfaces can be measured separately and one can differentiate the slope from the plateau and from the rim. As three-dimensional planning becomes successively more important, our measurement technique might deliver a useful supplement to the standard radiographic assessment in slope related knee surgery.Level of evidenceLevel III, diagnostic study.

Standard Radiographic Assessment of Femoral Cam Morphology is Influenced by Neck-Shaft Angle and Femoral Version

Objectives:Cam-type femoroacetabular impingement (FAI) is a three-dimensional (3D) deformity that is still difficult to assess using traditional two-dimensional (2D) radiographic views. While measurements of alpha angle and head-neck offset are used to estimate the likelihood of actual impingement, these 2D measurements do not account for z-axis variations in femoral version (FV) and neck-shaft angle (NSA). The purpose of this qualitative proof-of-concept study was to evaluate the potential variation in alpha angle and neck-shaft offset measurements with incremental changes in NSA and FV by simulating traditional radiographic views with software-generated Digitally-Reconstructed Radiographs (DRRs). We hypothesize that incremental changes in hip morphology will produce qualitative changes in alpha angle and neck-shaft offset.Methods:3D-CT reconstruction images were obtained from one subject with symptomatic cam-type FAI. The 3D reconstruction was cleaned to include only the femoral head, neck and subtrochanteric region along with the ipsilateral hemipelvis. Using 3D medical image processing software (Mimics; Materialise, Inc.; Belgium), the pre-processed 3D model was manipulated in a standardized manner to simulate 5-degree incremental variations in FV and NSA (-15 degrees to +15 degrees for FV; -15 degrees to +10 degrees for NSA). Negative FV reflected external rotation of the femoral head-neck unit, whereas negative NSA reflected abduction of the femoral head-neck unit. Each modified 3D model was then used to generate DRRs corresponding to traditional 2D radiographic views used for assessment of cam-FAI (Anteroposterior [AP], False Profile [FP]), Cross Table Lateral [CTL], Frog Leg Lateral [FLL], 45- and 90-degree Dunn [45D and 90D, respectively]. Alpha angle and head-neck offset were measured on each radiographic view corresponding to each incremental change in FV and NSA. All measurements utilized the perfect circle technique and were made by two independent observers for assessment of inter-observer reliability. Two-way random effects ANOVA was used for statistical assessment of inter-observer reliability and reported as intra-class correlation coefficients (κ). Comparisons between groups were performed using two-tailed paired t-tests assuming unequal variance. P-values less than 0.05 were considered statistically significant.Results:Inter-observer reliability (κ) for head-neck offset and alpha angles were 0.46 (fair) and 0.88 (excellent), respectively. Variations in head-neck offset and alpha angle with incremental variations in FV and NSA are summarized in Figure 1. There were statistically significant changes in mean alpha angles when the NSA was adjusted from Neutral to -5 degrees (p=0.01) and from -5 degrees to -10 degrees (p<0.001). There were no statistically significant differences in alpha angles or head-neck offsets between each incremental change in FV (p<0.05). Alpha angle measurements were significantly more variable than head-neck offset measurements for all variations in FV (p<0.001) and NSA (p=0.02) (Figure 2).Conclusion:Two-dimensional evaluation of three-dimensional Cam morphology (alpha angle and head-neck offset) was found to be significantly affected by alterations in femoral version and head-neck offset. Head-neck offset measurements were significantly less variable than alpha angle measurements across all FVs and NSAs within each radiographic view. Future work should be done to develop standardized procedures for routine 3D radiographic assessment of cam-type FAI.Figure 1.Figure 2.

Can preoperative imaging predict the outcomes after arthroscopic release for elbow arthritis?

IntroductionThe primary symptoms of elbow osteoarthritis are the progressive development of stiffness along with pain at the end range of motion due to osteophyte impingement. Surgical treatment involves resecting these “bone stops”. In the literature, these osteophytic lesions are more common than cartilage lesions, which suggests they may occur beforehand. The aim of our study was to confirm osteophytes are more common than cartilage lesions, and also to establish a link between these lesions and the functional outcomes. MethodsThis was a prospective multicenter (8 hospitals) study conducted in the context of a symposium of the Francophone Arthroscopy Society (SFA). Eighty-seven patients with elbow osteoarthritis treated by arthroscopic release were included. The clinical outcomes (range of motion in flexion, extension and pronation-supination; strength; pain at rest and during activity; satisfaction; Andrews and Carson score; QuickDASH, Patient-Rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Self-Evaluation Elbow (SEE) were determined before the procedure and at the 6-month follow-up visit. A standard radiographic assessment was done before the surgery and at the last follow-up visit. A CT arthrogram was done before the procedure. The presence of joint narrowing, osteophytes, filling of fossa along with secondary osteochondroma was evaluated in terms of their location, severity, size and/or number. The presence of radial head subluxation was recorded. The Bröberg & Morrey and Rettig & Hastings classification systems were applied. All the postoperative clinical data along with their change (difference between preoperative and postoperative values) were compared to the imaging findings. ResultsOsteophytes were found in 95% of our patients. They were located at the olecranon in 85% of cases and at the coronoid process in 81%. Filled fossae found in 94% of cases. The olecranon, coronoid and radial fossa were filled in 83%, 80% and 60% of elbows, respectively. On the initial X-rays, joint narrowing was found in 68% of elbows. CT arthrogram identified narrowing in 70% of cases. Narrowing was present in the humeroradial joint in 60% of cases and in the humeroulnar joint in 23% of cases. The presence of joint narrowing on CT arthrogram was a negative prognostic factor for pain during activity (p<0.05) along with the Quick DASH (p<0.01) and PREE (p<0.05). Involvement of the humeroradial joint impacted pain at rest (p<0.01). Narrowing of the humeroulnar joint was associated with worse outcomes in terms of pain at rest (p<0.05) and during activity (p<0.05), QuickDASH (p<0.005), MEPS (p<0.05), PREE (p<0.05) and the SEE (p<0.05). The presence of loose bodies before the procedure was associated with better outcomes in terms of pain at rest (p<0.05), QuickDASH (p<0.001), MEPS (p<0.001), Andrews & Carson score (p<0.05) and PREE (p<0.005). The osteoarthritis stage in the Bröberg & Morrey or the Rettig & Hastings classification systems did not impact the various clinical parameters or functional outcome scores. Discussion/ConclusionIn the imaging work-up, signs of impingement (osteophytes and filling of fossa) are more common than signs of joint narrowing. The presence of humeroulnar and/or humeroradial impingement when there are no cartilage lesions visible may correspond to a pre-arthritic stage. The outcomes of arthroscopic release are better in elbows with isolated impingement than in those with cartilage lesions, especially at the humeroulnar joint. Excision of secondary osteochondromas is also an excellent surgical indication. Current classification systems cannot be used to determine the prognosis before arthroscopic release of elbow osteoarthritis cases. Level of evidenceIII, Prospective multicenter observational cohort study

Immediate Loading of Two Unsplinted Implants in Edentulous Patients with Mandibular Overdentures: A 10-year Retrospective Review of Patients from a Previously Conducted 1-year Cohort Study

This 10-year retrospective study aimed to report implant bone changes in completely edentulous patients after a mandibular immediate loading protocol using two ball attachments. This study was initially designed as a prospective 1-year cohort study, then extended with a 10-year retrospective evaluation of implant bone change. In the first part of the study, 43 edentulous patients wearing satisfactory maxillary and mandibular dentures for at least 3 months were included. Two interforaminal implants (Brånemark system, Nobel Biocare) were placed symmetrically in the anterior mandible using a surgical template and a torque greater than 40 Ncm. Immediately following surgery, 2.25-mm-diameter ball abutments were screwed to the implants, and their matrices (Dalbo Plus, Cendres et Métaux) were incorporated in the denture base. In an initial 1-year study, clinical recalls were scheduled 3, 6, and 12 months after implant placement with a team of two investigators. The follow-up consisted of a clinical examination and a standardized radiographic assessment of the vertical bone change. Implant stability was then monitored. The patient satisfaction was evaluated with a questionnaire before and 3 months after loading. The second part of the study occurred 10 years after the inclusion, as patients were recalled for an implant bone change monitoring. The included patients were 28 to 80 years of age (mean: 61 ± 11.4 years). Three out of 86 implants failed during the healing phase (survival rate of 96.5% [90.1%, 99.2%]). Implant stability was maintained all along the 1-year follow-up (Δ = 73.33, 95% CI [72.39 to 74.26], P = .032). The mean radiographic bone loss was 0.27 ± 0.35 mm at 3 months after surgery, 0.47 ± 0.42 mm after 1 year, and 0.95 ± 0.98 mm after 10 years. General visual analog scale satisfaction was increased by 25 units with the treatment. No patients were lost to follow-up at 1 year, but five were lost at 10 years. This protocol of immediate loading of two unsplinted mandibular implants in overdenture patients using ball attachments is a clinically viable treatment with a high implant success rate and improved satisfaction.

Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates.

Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento's modification of Lindstorm criteria respectively. There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento's modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius.

Multimodal imaging patterns predict survival in recurrent glioblastoma patients treated with bevacizumab.

Bevacizumab is a humanized antibody against vascular endothelial growth factor approved for treatment of recurrent glioblastoma. There is a need to discover imaging biomarkers that can aid in the selection of patients who will likely derive the most survival benefit from bevacizumab. The aim of the study was to examine if pre- and posttherapy multimodal MRI features could predict progression-free survival and overall survival (OS) for patients with recurrent glioblastoma treated with bevacizumab. The patient population included 84 patients in a training cohort and 42 patients in a testing cohort, separated based on pretherapy imaging date. Tumor volumes of interest were segmented from contrast-enhanced T1-weighted and fluid attenuated inversion recovery images and were used to derive volumetric, shape, texture, parametric, and histogram features. A total of 2293 pretherapy and 9811 posttherapy features were used to generate the model. Using standard radiographic assessment criteria, the hazard ratio for predicting OS was 3.38 (P < .001). The hazard ratios for pre- and posttherapy features predicting OS were 5.10 (P < .001) and 3.64 (P < .005) for the training and testing cohorts, respectively. With the use of machine learning techniques to analyze imaging features derived from pre- and posttherapy multimodal MRI, we were able to develop a predictive model for patient OS that could potentially assist clinical decision making.

P16.06 * EARLY PERFUSION CHANGES IN PATIENTS WITH RECURRENT HIGH-GRADE GLIOMAS TREATED WITH BEVACIZUMAB: PRELIMINARY EVALUATION BY THE PARAMETRIC RESPONSE MAP DERIVED FROM DYNAMIC CONTRAST-ENHANCED MRI

OBJECTIVE: To determine whether early monitoring of the effects of bevacizumab in patients with recurrent high-grade gliomas, by the Parametric Response Map derived from Dynamic Contrast-Enhanced MRI (DCE-MRI), may be a predictor of the response to treatment assessed through conventional MRI follow-up. METHODS: 20 patients have been enrolled in the present study. For each patient two DCE-MRI examinations, before and after the first dose of bevacizumab, were acquired. The region of interest was defined on the IAUGC (Initial Area Under Gadolinium Concentration) maps, using co-registered T1-weighted contrast-enhanced images as a guide to the tumour location. For both perfusion parameters, the parametric response map (PRM) (1) was calculated. The PRM is a voxel-wise analytic method allowing to identify and quantify the regions wherein the parameter value increased, decreased or remained stable, during or after therapy. The modifications of hyper and hypo-perfused sub-volumes, including tumour necrosis, was assessed within the lesion using a volumetric histogram analysis. The significance of changes in the different perfusion metrics, observed at baseline and during treatment, was established. The relationships between changes in perfusion and morphological MRI modifications at first follow-up were investigated. On the same patients, serial evaluations of plasma and serum VEGF levels and Von Willebrand factor (vWF) antigen were performed at the same time points. RESULTS: Early significant reductions in both IAUGC and Ktrans values, after a single dose of bevacizumab, were observed. Both the PRMs and the histogram modifications indicated the normalizing effect of bevacizumab on tumour pathological vasculature. An improvement in hypoxia after a single dose of bevacizumab seems to be predictive of a greater reduction in T1-weighted contrast-enhanced volumes at first follow-up and a better response to treatment. Circulating plasma levels of VEGF and vWF antigen significantly increased in all patients after a single dose of bevacizumab. Preliminary results showed a tendency to a significant relationship between changes in median IAUGC and in levels of vWF antigen, while no correlation was found between changes in tumour size and circulating parameters. CONCLUSIONS: Early monitoring of the modifications induced on perfusion maps, derived from DCE-MRI, as well as the variations of vWF antigen, may provide useful information to document and predict the effect of anti-angiogenic agents. REFERENCE: 1. Galbán, C.J. et al. Prospective analysis of parametric response map-derived MRI biomarkers: identification of early and distinct glioma response patterns not predicted by standard radiographic assessment. CLIN CANCER RES. 2011 Jul 15;17(14):4751-4760.

Identification of early and distinct glioblastoma response patterns treated by boron neutron capture therapy not predicted by standard radiographic assessment using functional diffusion map

BackgroundRadiologic response of brain tumors is traditionally assessed according to the Macdonald criteria 10 weeks from the start of therapy. Because glioblastoma (GB) responds in days rather than weeks after boron neutron capture therapy (BNCT) that is a form of tumor-selective particle radiation, it is inconvenient to use the Macdonald criteria to assess the therapeutic efficacy of BNCT by gadolinium-magnetic resonance imaging (Gd-MRI). Our study assessed the utility of functional diffusion map (fDM) for evaluating response patterns in GB treated by BNCT.MethodsThe fDM is an image assessment using time-dependent changes of apparent diffusion coefficient (ADC) in tumors on a voxel-by-voxel approach. Other than time-dependent changes of ADC, fDM can automatically assess minimum/maximum ADC, Response Evaluation Criteria In Solid Tumors (RECIST), and the volume of enhanced lesions on Gd-MRI over time. We assessed 17 GB patients treated by BNCT using fDM. Additionally, in order to verify our results, we performed a histopathological examination using F98 rat glioma models.ResultsOnly the volume of tumor with decreased ADC by fDM at 2 days after BNCT was a good predictor for GB patients treated by BNCT (P value = 0.022 by log-rank test and 0.033 by wilcoxon test). In a histopathological examination, brain sections of F98 rat glioma models treated by BNCT showed cell swelling of both the nuclei and the cytoplasm compared with untreated rat glioma models.ConclusionsThe fDM could identify response patterns in BNCT-treated GB earlier than a standard radiographic assessment. Early detection of treatment failure can allow a change or supplementation before tumor progression and might lead to an improvement of GB patients’ prognosis.

861 A Standardized Radiographic Assessment of the Tumor-Vein Interface Predicts the Need for Venous Resection and the Presence of Histologic Venous Invasion in Borderline Resectable Pancreatic Cancer

861 A Standardized Radiographic Assessment of the Tumor-Vein Interface Predicts the Need for Venous Resection and the Presence of Histologic Venous Invasion in Borderline Resectable Pancreatic Cancer

Introduction

Introduction

Femoroacetabular Impingement Research Symposium

Femoroacetabular Impingement Research Symposium

Automatic multi-modal MR tissue classification for the assessment of response to bevacizumab in patients with glioblastoma

BackgroundCurrent methods for evaluation of treatment response in glioblastoma are inaccurate, limited and time-consuming. This study aimed to develop a multi-modal MRI automatic classification method to improve accuracy and efficiency of treatment response assessment in patients with recurrent glioblastoma (GB). Materials and methodsA modification of the k-Nearest-Neighbors (kNN) classification method was developed and applied to 59 longitudinal MR data sets of 13 patients with recurrent GB undergoing bevacizumab (anti-angiogenic) therapy. Changes in the enhancing tumor volume were assessed using the proposed method and compared with Macdonald's criteria and with manual volumetric measurements. The edema-like area was further subclassified into peri- and non-peri-tumoral edema, using both the kNN method and an unsupervised method, to monitor longitudinal changes. ResultsAutomatic classification using the modified kNN method was applicable in all scans, even when the tumors were infiltrative with unclear borders. The enhancing tumor volume obtained using the automatic method was highly correlated with manual measurements (N=33, r=0.96, p<0.0001), while standard radiographic assessment based on Macdonald's criteria matched manual delineation and automatic results in only 68% of cases. A graded pattern of tumor infiltration within the edema-like area was revealed by both automatic methods, showing high agreement. All classification results were confirmed by a senior neuro-radiologist and validated using MR spectroscopy. ConclusionThis study emphasizes the important role of automatic tools based on a multi-modal view of the tissue in monitoring therapy response in patients with high grade gliomas specifically under anti-angiogenic therapy.

Methodology and Interpretation of Radiographic Outcomes in Surgically Treated Pelvic Fractures

To identify and evaluate previously described methods for the measurement, and interpretation, of radiographic outcomes of operatively treated pelvic fractures. A systematic review of the available literature was performed using all major databases (MEDLINE, EMBASE, MEDLINE IN-PROGRESS, and Cochrane Central) in August 2009. Inclusion criteria were case series, cohort studies, or clinical trials regarding orthopaedic treatment of acute traumatic pelvic ring fractures treated surgically in adults, with at least 12 weeks of radiographic follow-up. Exclusion criteria were case reports or case series of <10 patients, review articles, foreign language articles, and series where time frame of outcome measurement was not stated were excluded. Modality, and timeline, of the radiographic assessment was recorded. Next, the description of the method of radiographic measurement technique used was scrutinized for standardization. The interpretation of the radiographic measurement was evaluated, and any grading scale used was recorded. The interpretation of the quality of the radiographic result as described by each author was recorded. Finally, a qualitative methodological analysis was performed. Number of standardized radiographic assessment techniques used (3 of 31) and interpretation scales used (13 of 31) were calculated. Nonweighted mean follow-up time (30.6 months) and overall positive radiographic outcomes were calculated (78.6% good or excellent). Reporting of radiographic outcomes in pelvic fractures has been done using largely unstandardized and universally untested measurement techniques. The interpretations of these measurements are also inconsistent and untested. Substantive future research is needed in this area.