Whole-body Examination Research Articles

Predictive Role of Soluble B-Cell Maturation Antigen in Short-Term Monitoring of Differently Treated Multiple Myeloma Patients: A Prospective Study.

The management of multiple myeloma is challenging because the disease is incurable and unexpected relapses can threaten a patient's survival. Several assessment systems are currently available, but they often require invasive or costly procedures (e.g., instrumental bone marrow and whole-body examinations) or rely on non-specific markers in blood and urine that may not be sufficient to assess and monitor the disease. To address some of these limitations, the aim of this study was to evaluate the potential use of soluble B-Cell Maturation Antigen (BCMA), a promising new serum biomarker, as a toll for moniting multiple myeloma patients. An unselected cohort of 57 newly diagnosed or relapsed myeloma patients was followed up for 6 months after starting a new therapy. Soluble BCMA levels were measured in peripheral blood using a simple and inexpensive ELISA assay. Soluble BCMA was detectable in peripheral blood by a simple and inexpensive assay in all patients, even in non-secretory disease or during BCMA-targeted therapies, and significant changes in its levels were observed over time. The analysis showed that the decrease in sBCMA at 1 and 6 months reflects the quality of the clinical response to anti-myeloma regimens. The data provide interesting insights into the usefulness of sBCMA as a non-invasive toolfor early assessment of treatment efficacy. Its simple and cost-effective detection in peripheral blood could provide clinicians with an addiotional resource for monitoring disease progression and tailoring treatment strategies.

An autopsy of a patient with polyarteritis nodosa who developed fatal intestinal perforation accompanied by systemic multiple aneurysms and arterial thrombosis.

The patient was a 48-year-old man who had developed acute myocardial infarction 3 years earlier. He started experiencing recurrent attacks of abdominal pain 2 years earlier. One month before the presentation, he developed perforative peritonitis, which was treated with right hemicolectomy. Preoperative computed tomography revealed systemic thrombotic aneurysms and fibrinoid necrotizing vasculitis was detected in the vessels in the serosa of the resected intestinal specimen. These findings led to a diagnosis of polyarteritis nodosa. Despite the start of remission induction therapy with high-dose glucocorticoid and intermittent intravenous cyclophosphamide, the effect of immunosuppressive therapy was limited. Approximately 1 month after treatment initiation, he died from small intestinal perforation. Polyarteritis nodosa often exhibits nonspecific clinical symptoms, which make an early diagnosis difficult in some cases. Although the prognosis depends on the presence of ischemic lesions due to a ruptured aneurysm or intra-aneurysmal thrombi, it is not rare for the diagnosis to be made following acute myocardial infarction or acute abdominal pain. In young patients with ischemic organ dysfunction without any arteriosclerotic lesions at low risk of developing cardiovascular events, early diagnosis can be made by performing a whole-body examination with a differential diagnosis of polyarteritis nodosa.

European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics - Update 2024

This guideline was developed in close collaboration with multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF) and the European Organization for Research and Treatment of Cancer (EORTC). Recommendations for the diagnosis and treatment of melanoma were developed on the basis of systematic literature research and consensus conferences. Cutaneous melanoma (CM) is the most dangerous form of skin tumor and accounts for 90% of skin cancer mortality. The diagnosis of melanoma can be made clinically and must always be confirmed by dermoscopy. If melanoma is suspected, a histopathological examination is always required. Sequential digital dermoscopy and whole-body photography can be used in high-risk patients to improve the detection of early-stage melanoma. If available, confocal reflectance microscopy can also improve the clinical diagnosis in special cases. Melanoma is classified according to the 8th version of the American Joint Committee on Cancer classification. For thin melanomas up to a tumor thickness of 0.8 mm, no further diagnostic imaging is required. From stage IB, lymph node sonography is recommended, but no further imaging examinations. From stage IIB/C, whole-body examinations with computed tomography or positron emission tomography CT in combination with magnetic resonance imaging of the brain are recommended. From stage IIB/C and higher, a mutation test is recommended, especially for the BRAF V600 mutation. It is important to perform a structured follow-up to detect relapses and secondary primary melanomas as early as possible. A stage-based follow-up regimen is proposed, which in the experience of the guideline group covers the optimal requirements, although further studies may be considered. This guideline is valid until the end of 2026.

Survival after surgery for lung cancer among patients with autoimmune diseases.

While patients with autoimmune diseases (ADs) are at high risk for developing specific malignancies, including lung cancer, ADs may protect against the development of cancer through increased immune cell activity in tumors. This study aimed to investigate whether the presence of ADs affects surgical outcomes and survival after surgery for lung cancer. The medical records of 1236 patients who underwent surgery for non-small cell lung cancer between 2007 and 2018 were retrospectively reviewed. Perioperative and long-term outcomes were compared between patients with and without ADs using propensity score matching. Among the included patients, 115 with ADs and 1121 without ADs underwent surgery. Using 1-to-1 propensity score matching, 114 pairs were selected. Although there were no significant differences in the perioperative outcomes of the two groups, the overall and relapse-free survival rates were significantly lower in the group with ADs than in the group without ADs. Surgery for lung cancer can be performed without increasing the complications in patients with ADs. However, the long-term outcomes were significantly worse in patients with ADs than in those without ADs, suggesting that close follow-up for lung cancer and careful whole-body examination might be needed for patients with ADs.

Adult Acne in Middle-age: Effects on Mental Health in General Population of the Northern Finland Birth Cohort 1966.

The impact of adult acne on patients' mental health has not been widely studied, and most studies have been conducted within specific patient populations. The current study examines the association between adult acne and psychological symptoms in the Northern Finland Birth Cohort 1966 (NFBC1966) (n = 1,907). The cohort members attended a health study at the age of 46 years, which comprised a whole-body examination performed by dermatologists to identify acne, and answering the Beck Depression Inventory II (BDI-II), Athens Insomnia Scale (AIS), Generalized Anxiety Disorder (GAD-7), State-Trait Anxiety Inventory (STAI) and 15-dimensional measure of health-related quality of life (15D HRQoL) questionnaires. The prevalence of adult acne was 7.9% (n = 150) with no statistical differences between the sexes. Cases with acne presented more (18.9%) depressive symptoms (BDI-II > 14 points) compared with those without acne (9.7%) (p < 0.001). In adjusted logistic regression analyses, those with acne had a 2-fold risk (odds ratio (OR) 2.08, 95% confidence interval (95% CI) 1.23-3.38) of having depressive symptoms compared with controls. In conclusion, when treating adult acne patients, it is important to recognize the increased risk of mental health symptoms.

Association of Rosacea with Depressive and Anxiety Symptoms: A General Population Study

Background: The association between rosacea and psychiatric comorbidity has been reported previously. However, there is a lack of general population studies about this subject area. Objectives: The aim of this study was to the association between rosacea with depressive and anxiety symptoms at the population level. Methods: A clinical whole-body examination was performed by dermatologists for 1,932 subjects belonging to the Northern Finland Birth Cohort 1966 Study during the 46-year follow-up survey. The presence of depressive and anxiety symptoms was gathered by using validated Hopkins Symptom Checklist-25 (HSCL-25) included in the self-administered questionnaires. Binary logistic regression analysis was used to identify associations between rosacea and psychological symptoms. Results: Rosacea was found in dermatological evaluation in 15.1% of the study subjects (n = 292). In logistic regression analyses, after adjusting for confounding factors, those with rosacea had 1.6-fold (OR 1.55, 95% CI: 1.02–2.32) risk for psychiatric symptoms according to HSCL-25 when compared with controls. In separate analyses of the HSCL-25 depression subscale, the risk was increased, especially for depressive symptoms (OR 1.56, 95% CI: 1.10–2.18). Conclusions: Patients with rosacea seem to have increased risk for depressive and anxiety symptoms in general population. Physicians treating patients with rosacea should pay more attention to the psychosocial health of patients.

Computer-Aided Detection of Bone Metastasis using Bone Scintigraphy Scans

Abstract: When cancer cells spread from their original site to the bone then it is known as ‘Bone Metastasis’. Patients with solid tumors such as lung, breast, kidney, prostate etc. oftentimes develop bone metastasis. Cancer cells that spread to the bone mostly affect limbs, pelvis, spine, skull and ribs. Once tumors have metastasized to the bone, patients usually undergo skeletal complications collectively known as skeletal-related events (SRE) like skeletal remodelling, fractures, spinal cord compression, pain or anaemia and bowel incontinence. Therefore, early diagnosis of bone metastasis is crucial for increasing survivability as it has a major impact on treatment decision and at the same time it is a decisive factor in the evolution of the disease and the quality of life. ‘Bone Scintigraphy’ is accepted to be an efficient diagnostic tool for whole-body examination of bone metastasis. Computer-Aided Detection method is used to avoid mistakes which might be caused by human interference &amp; experimental sources. CAD system provides faster and more precise results that facilitates in the early detection of bone metastasis, hence increasing the patient’s chance of survival. To reduce the dependency of the system on source of the input image &amp; for making the system robust we have explored various done image enhancement techniques.

PRIMARY INTESTINAL-TYPE ADENOCARCINOMA OF THE TONGUE: REPORT OF A RARE CASE

Intestinal-type adenocarcinoma of the salivary glands is an exceedingly rare tumor. A 55-year-old male patient presented with an ulcerated mass in the tongue, measuring approximately 5 cm in diameter, with 2 years of evolution. The patient complained of pain. Histopathologically, the tumor presented proliferation of tall columnar cells, presenting basophilic nuclei and eosinophilic cytoplasm. Neoplastic cells were organized in anastomosing cords, showing patterns of papillary and solid growths, with duct-like structures. Cytologic and architectural features resembled those seen in well-differentiated colonic adenocarcinoma. Areas of comedonecrosis and perineural invasion were also identified. A preliminary diagnosis of adenocarcinoma was made, with 2 possibilities: intestinal-type adenocarcinoma of the salivary gland or metastatic adenocarcinoma of gastrointestinal origin. Both morphologic and immunohistochemical profiles are indistinguishable for these entities. Whole-body examination failed to identify any gastrointestinal primary tumor or that of other origins. Therefore, a gastrointestinal origin was clinically excluded. The patient was referred for cancer treatment. Intestinal-type adenocarcinoma of the salivary glands is an exceedingly rare tumor. A 55-year-old male patient presented with an ulcerated mass in the tongue, measuring approximately 5 cm in diameter, with 2 years of evolution. The patient complained of pain. Histopathologically, the tumor presented proliferation of tall columnar cells, presenting basophilic nuclei and eosinophilic cytoplasm. Neoplastic cells were organized in anastomosing cords, showing patterns of papillary and solid growths, with duct-like structures. Cytologic and architectural features resembled those seen in well-differentiated colonic adenocarcinoma. Areas of comedonecrosis and perineural invasion were also identified. A preliminary diagnosis of adenocarcinoma was made, with 2 possibilities: intestinal-type adenocarcinoma of the salivary gland or metastatic adenocarcinoma of gastrointestinal origin. Both morphologic and immunohistochemical profiles are indistinguishable for these entities. Whole-body examination failed to identify any gastrointestinal primary tumor or that of other origins. Therefore, a gastrointestinal origin was clinically excluded. The patient was referred for cancer treatment.

Kaposi’s sarcoma management from a plastic surgery perspective

Aim of the study Kaposi's sarcoma (KS) is a low-grade angioproliferative tumor arising from endothelial cells and associated with Human Herpes Virus 8 infection. Although there are considerable number of patients referred for surgical excision, the plastic surgery literature on KS is exceptionally scarce. In this study, it was aimed to emphasize the differences in the management of Kaposi's Sarcoma and help to understand the importance of a multidisciplinary approach, accordingly the sake of choosing the ideal treatment method for each lesion. Materials and methods Thirty patients who were operated with the diagnosis of KS between March 2015 and January 2020 were included. Preoperative HIV tests and detailed whole-body examinations of the patients were performed. As a surgical method, for lesions with sizes ranging from 0.5 * 1 cm to 2 * 3 cm, excisions were made over the deep skin fascia by placing a margin between 0.5-1 cm, considering the anatomical location and elasticity of the skin. Results Primary repair was performed in 23 patients (40 lesions) and 12 lesions of 8 patients were repaired with a skin graft. In four patients the repair was performed with local skin flaps. In a patient with a lesion on the finger, the defect that occurred after the excision of the lesion was repaired with a pedicled regional flap. Conclusions One-stage surgical excision of the lesions provides remarkable advantages, compared to the therapies such as radiotherapy, laser, or chemotherapy which require several administrations.

Yield of FDG PET/CT for Defining the Extent of Disease in Patients with Kaposi Sarcoma.

Simple SummaryThe potential role of positron emission tomography/computed tomography with fluorodeoxyglucose (FDG PET/CT) for assessing the extent of Kaposi sarcoma is not well studied. We analyzed FDG PET/CTs performed on 75 patients referred to our department for Kaposi sarcoma staging or restaging. FDG PET/CTs detected most lymph nodes, bone, and muscle lesions, whereas digestive and mucous lesions could be missed. Most cutaneous lesions can be identified when whole-body FDG PET/CT (including lower limbs) is performed. Thus, a true whole-body FDG PET/CT can be recommended for staging purposes in patients with active Kaposi sarcoma and, if positive, be useful for therapeutic evaluation and follow-up.Background: Positron emission tomography/computed tomography with fluorodeoxyglucose (F-18) (FDG PET/CT) is increasingly used in Kaposi sarcoma (KS), but its value has not been assessed. Objectives: In this study, we aimed to evaluate the diagnostic accuracy of FDG PET/CT to define the extent of disease in KS. Methods: Consecutive patients with KS referred to our department for FDG PET/CT were included. The diagnostic accuracy of FDG PET/CT for cutaneous and extra-cutaneous KS staging was assessed on a per lesion basis compared to staging obtained from clinical examination, standard imaging, endoscopy, histological analyses, and follow-up. Results: From 2007 to 2017, 75 patients with FDG PET/CT were analyzed. The sensitivity and specificity of FDG PET/CT for the overall detection of KS lesions were 71 and 98%, respectively. Sensitivity and specificity were 100 and 85% for lymph nodes, 87 and 98% for bone, 87 and 100% for lungs, and 100 and 100% for muscle involvement, whereas sensitivity was only 17% to detect KS digestive involvement. The sensitivity of the diagnostic for KS cutaneous involvement increased from 73 to 88% when using a whole-body examination. Conclusion: FDG PET/CT showed good sensitivity and specificity for KS staging (digestive involvement excepted) and could be used for staging patients with active KS.

Ocular Symptoms and Rosacea: A Population-Based Study

Background: The symptoms of ocular rosacea are often non-specific and there is no dependable diagnostic test for the disease, which may cause difficulties in diagnostics. The aim of this study was to examine the association between clinical findings of rosacea and self-reported ocular symptoms in a general population of middle-aged subjects. Methods: A clinical whole-body examination by a dermatologist was performed for 1,932 subjects belonging to the Northern Finland Birth Cohort 1966 Study. The presence of ocular symptoms was self-reported. The difference between rosacea and ocular symptoms was tested. Logistic regression analysis was used to identify associations between rosacea and ocular symptoms. Results: The prevalence of rosacea was 15.1% (n = 292); in the subjects with rosacea, erythematoteleangiectatic rosacea was found in 83.2% (n = 242), papulopustular in 15.4% (n = 45), ocular in 0.03% (n = 1), and phymatic in 0.1% (n = 3). Ocular symptoms in rosacea subjects were common, with dryness (32.3%), tearing (29.4%), foreign-body sensation (21.8%), and photophobia (20.5%) being the most common ones. Foreign-body sensation was reported significantly more often in those with rosacea compared to those without (p < 0.04). In logistic regression analyses, after adjusting, the subjects with rosacea had a 1.5-fold increased risk for decreased visual acuity in the dark (OR 1.48, 95% CI 1.01–2.14) compared to those without rosacea. Conclusion: Eye symptoms are common in subjects with rosacea. All patients with rosacea should be asked about ocular symptoms and both skin and eyelids should be examined even if the cutaneous findings are mild.

Comparison of Volumetric Quantitative PET Parameters Before and After a CT-Based Elastic Deformation on Dual-Time 18FDG-PET/CT Images: A Feasibility Study in a Perspective of Radiotherapy Planning in Head and Neck Cancer.

BackgroundThe use of 18FDG-PET/CT for delineating a gross tumor volume (GTV, also called MTV metabolic tumor volume) in radiotherapy (RT) planning of head neck squamous cell carcinomas (HNSCC) is not included in current recommendations, although its interest for the radiotherapist is of evidence. Because pre-RT PET scans are rarely done simultaneously with dosimetry CT, the validation of a robust image registration tool and of a reproducible MTV delineation method is still required.ObjectiveOur objective was to study a CT-based elastic registration method on dual-time pre-RT 18FDG-PET/CT images to assess the feasibility of PET-based RT planning in patients with HNSCC.MethodsDual-time 18FDG-PET/CT [whole-body examination (wbPET) + 1 dedicated step (headPET)] were selected to simulate a 2-times scenario of pre-RT PET images deformation on dosimetry CT. ER-headPET and RR-headPET images were, respectively, reconstructed after CT-to-CT rigid (RR) and elastic (ER) registrations of the headPET on the wbPET. The MTVs delineation was performed using two methods (40%SUVmax, PET-Edge). The percentage variations of several PET parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG) were calculated between wbPET, ER-headPET, and RR-headPET. Correlation between MTV values was calculated (Deming linear regression). MTVs intersections were assessed by two indices (OF, DICE) and compared together (Wilcoxon test). Additional per-volume analysis was evaluated (Mann-Whitney test). Inter- and intra-observer reproducibilities were evaluated (ICC = intra-class coefficient).Results36 patients (30M/6F; median age = 65 y) were retrospectively included. The changes in SUVmax, SUVmean and SUVpeak values between ER-headPET and RR-headPET images were <5%. The variations in MTV values between ER-headPET and wbPET images were −6 and −3% with 40%SUVmax and PET Edge, respectively. Their correlations were excellent whatever the delineation method (R2 > 0.99). The ER-headPET MTVs had significant higher mean OF and DICE with the wbPET MTVs, for both delineation methods (p ≤ 0.002); and also when lesions had a volume > 5cc (excellent OF = 0.80 with 40%SUVmax). The inter- and intra-observer reproducibilities for MTV delineation were excellent (ICC ≥ 0.8, close to 1 with PET-Edge).ConclusionOur study demonstrated no significant changes in MTV after an elastic deformation of pre-RT 18FDG-PET/CT images acquired in dual-time mode. This opens possibilities for HNSCC radiotherapy planning improvement by transferring GTV-PET on dosimetry CT.

Prevalence and Cutaneous Comorbidity of Acne Vulgaris in the Working Population.

PurposeAlthough acne vulgaris (AV) is a common disease and can persist into adulthood, there are few large-scale epidemiological studies on the prevalence of acne vulgaris in adults. The aim of our study was to characterise the epidemiology and comorbidity of acne vulgaris in working adults in Germany.Patients and MethodsWithin the framework of a cross-sectional study, a total of 161,269 employees underwent dermatological whole-body examinations in more than 500 German companies between 2001 and 2016. Point prevalence rates for acne vulgaris and further skin diseases and their 95% confidence intervals were calculated and differences between participants with and without acne vulgaris were tested with chi-squared tests.ResultsMean age was 43.2 years ± 10.9, 55.5% were male. In total, n = 5311 people (3.3%) with acne vulgaris were identified. Prevalence decreased by age. Controlling for age and gender, acne was significantly associated with folliculitis (OR = 1.91; CI: 1.76–2.07), contact dermatitis (OR = 1.74; CI: 1.08–2.81), rosacea (OR = 1.74; CI: 1.40–2.15), pyoderma (OR = 1.58; 1.22–2.06), seborrheic dermatitis (OR = 1.47; CI: 1.27–1.71), hand eczema (OR = 1.34; CI: 1.00–1.76), verruca vulgaris plantaris (OR = 1.29; CI: 1.09–1.51), tinea pedis (OR = 1.27; CI: 1.10–1.47), spider veins (OR = 1.26; CI: 1.16–1.38) and telangiectasia (OR = 1.15; CI: 1.02–1.30).ConclusionThese data underline the importance of acne vulgaris in the adult population. Further studies to better understand the pathophysiology of AV and its comorbidity in different phases of adulthood would be desirable to develop appropriate guidelines and therapy concepts.

1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 2.

The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.

Comparison of superficial wound documentation using 2D forensic photography, 3D photogrammetry, Botscan\xa9 and VR with real-life examination

Evidence acquisition, interpretation and preservation are essential parts of forensic case work that make a standardized documentation process fundamental. The most commonly used method for the documentation and interpretation of superficial wounds is a combination of two modalities: two-dimensional (2D) photography for evidence preservation and real-life examination for wound analysis. As technologies continue to develop, 2D photography is being enhanced with three-dimensional (3D) documentation technology. In our study, we compared the real-life examination of superficial wounds using four different technical documentation and visualization methods.To test the different methods, a mannequin was equipped with several injury stickers, and then the different methods were applied. A total of 42 artificial injury stickers were documented in regard to orientation, form, color, size, wound borders, wound corners and suspected mechanism of injury for the injury mechanism. As the gold standard, superficial wounds were visually examined by two board-certified forensic pathologists directly on the mannequin. These results were compared to an examination using standard 2D forensic photography; 2D photography using the multicamera system Botscan©, which included predefined viewing positions all around the body; and 3D photogrammetric reconstruction based on images visualized both on screen and in a virtual reality (VR) using a head-mounted display (HMD).The results of the gold standard examination showed that the two forensic pathologists had an inter-reader agreement ranging from 69% for the orientation and 11% for the size of the wounds. A substantial portion of the direct visual documentation showed only a partial overlap, especially for the items of size and color, thereby prohibiting the statistical comparison of these two items. A forest plot analysis of the remaining six items showed no significant difference between the methods. We found that among the forensic pathologists, there was high variability regarding the vocabulary used for the description of wound morphology, which complicated the exact comparison of the two documentations of the same wound.There were no significant differences for any of the four methods compared to the gold standard, thereby challenging the role of real-life examination and 2D photography as the most reliable documentation approaches. Further studies with real injuries are necessary to support our evaluation that technical examination methods involving multicamera systems and 3D visualization for whole-body examination might be a valid alternative in future forensic documentation.

Reduction of emission time for [68Ga]Ga-PSMA PET/CT using the digital biograph vision: a phantom study.

The aim of this phantom study was to optimize the [68Ga]Ga-PSMA PET/CT examination in terms of scan time duration and image reconstruction parameters, in combination with PSF and TOF modelling, in a digital Biograph Vision PET/CT scanner. Three types of phantoms were used: 1) soft-tissue tumor phantom consisting of six spheres mounted in a torso phantom; 2) bone-lung tumor phantom; 3) resolution phantom. Phantom inserts were filled with activity concentrations (ACs) that were derived from clinical data. Phantom data were acquired in list-mode at one bed position. Images with emission data ranging from 30 to 210 s in 30-s increments were reconstructed from a reference image acquired with 3.5-min emission. Iterative image reconstruction (OSEM), point-spread-function (PSF) and time-of-flight (TOF) options were applied using different iterations, Gaussian filters, and voxel sizes. The criteria for image quality was lesion detectability and lesion quantification, evaluated as contrast-to-noise ratio (CNR) and maximum AC (peak AC), respectively. A threshold value of CNR above 6 and percentage maximum AC (peak AC) deviation range of ±20% of the reference image were considered acceptable. The proposed single-bed scan time reduction was projected to a whole-body examination (patient validation scan) using the continuous-bed-motion mode. Sphere and background ACs of 20 kBq/mL and 1 kBq/mL were selected, respectively. The optimized single-bed scan time was approximately 60 s using OSEM-TOF or OSEM-TOF+PSF (four iterations, 4.0-mm Gaussian filter and almost isotropic voxel size of 3.0-mm side length), resulting in a PET spatial resolution of 6.3 mm for OSEM-TOF and 5.5 mm for OSEM-TOF+PSF. In the patient validation, the maximum percentage difference in lesion quantification between standard and optimized protocol (whole-body scan time of 15 vs. 5 min) was below 19%. A reduction of single-bed and whole-body scan time for [68Ga]Ga-PSMA PET/CT compared to current recommended clinical acquisition protocols is postulated. Clinical studies are warranted to validate the applicability of this protocol.

Osteoarthritis in Pseudoxanthoma Elasticum Patients: An Explorative Imaging Study.

Pseudoxanthoma elasticum (PXE) is a systemic disease affecting the skin, eyes, and cardiovascular system of patients. Cardiovascular disease is associated with osteoarthritis (OA), which is the most common cause of joint pain. There is a lack of systematic investigations on joint manifestations in PXE in the literature. In this explorative study, we aimed to investigate whether patients with PXE are more at risk for developing osseous signs of OA. Patients with PXE and hospital controls with whole-body low-dose CT examinations available were included. OA was assessed using the OsteoArthritis Computed Tomography (OACT)-score, which is a 4-point Likert scale, in the acromioclavicular (AC), glenohumeral (GH), facet, hip, knee, and ankle joints. Additionally, intervertebral disc degeneration was scored. Data were analyzed using ordinal logistic regression adjusted for age, body mass index (BMI), and smoking status. In total, 106 PXE patients (age 56 (48–64), 42% males, BMI 25.3 (22.7–28.2)) and 87 hospital controls (age 55 (43–67), 46% males, BMI 26.0 (22.5–29.2)) were included. PXE patients were more likely to have a higher OA score for the AC joints (OR 2.00 (1.12–3.61)), tibiofemoral joint (OR 2.63 (1.40–5.07)), and patellofemoral joint (2.22 (1.18–4.24)). For the other joints, the prevalence and severity of OA did not differ significantly. This study suggests that patients with PXE are more likely to have structural OA of the knee and AC joints, which needs clinical confirmation in larger groups and further investigation into the mechanism.

Radiation dose of nuclear medicine technicians performing PET/MR

Since october 2015, PET/MR has been used extensively for clinical routine in the nuclear medicine department of the Pitié-Salpêtrière Hospital (Paris, France) with a throughput of 11 to 15 patients each day. While many studies have been conducted to investigate dose reduction strategies to patients with hybrid PET/MR devices, no study has focused on staff radiation safety. Knowing that patient positioning within the scanner takes longer in PET/MR than in PET/CT because of the placement of several local MR receive coils, a retrospective study was carried out to measure the radiation doses to nuclear medicine technologists from the patient. The analysis was conducted during one year on 1332 clinical PET/MR studies performed with the Signa PET/MR system (General Electric Healthcare) in our department. The whole-body exposure of the technologist staff was on average for all PET/MR exams10.3 ± 4 nSv per injected MBq of 18 F. When performing brain PET/MR exams only, the whole-body exposure was on average 8.7 ± 2 nSv per injected MBq of 18 F. Brain PET/MR provides lower radiation dose than whole-body examinations for cancer screening due to a lower injected activity (2 vs. 3 MBq kg−1) and shorter patient positioning (5 vs. 15 min). When starting PET/MR in a nuclear medicine department, an important step is to optimise patient positionning within the scanner to minimise radiation dose received by the technical staff from patients.

Clinical evaluation of a new adaptive iterative metal artifact reduction method in whole-body low-dose CT skeletal survey examinations.

To evaluate a new adaptive iterative metal artifact reduction algorithm (AiMAR) in whole-body low-dose CT (WBLDCT) skeletal survey examinations. Projection data were retrospectively obtained from 25 clinical WBLDCT skeletal survey patients, each with two types of metal implants. Images were reconstructed with bone and soft tissue kernels using four settings-original and AiMAR with strengths of 2, 4, and 5. All images were anonymized and randomized for a reader study, where three musculoskeletal radiologists independently determined the overall ranking of all series based on diagnostic quality, and local scoring of metal artifact and anatomy visualization for each implant. Quantitative image noise analysis was performed in areas close to the implants. Intraclass correlation coefficients (ICC) and Krippendorff's alpha were computed for inter-rater reliability. AiMAR 4 was ranked the highest for 64.3% of the series across eight types of implants. For local scoring task, AiMAR 4 showed better metal artifact and anatomy visualization than the original and AiMAR 2. AiMAR 4 was comparable in anatomy visualization but inferior to AiMAR 5 in metal artifact scores. AiMAR 4 led to 56.3% noise reduction around the implant areas compared with the original images, and AiMAR 5 68.1% but also resulted in anatomy blurring in 40% of the implants. ICC and Krippendorff's alpha revealed at least substantial reliability in the local scores among the readers. AiMAR was evaluated in WBLDCT skeletal surveys. AiMAR 4 demonstrated the highest overall quality ranking and improved local scores with noise reduction around implant areas.

Automated diagnosis of bone metastasis based on multi-view bone scans using attention-augmented deep neural networks.

Bone scintigraphy is accepted as an effective diagnostic tool for whole-body examination of bone metastasis. However, the manual analysis of bone scintigraphy images requires extensive experience and is exhausting and time-consuming. An automated diagnosis system for such images is therefore much desired. Although automatic or semi-automatic methods for the diagnosis of bone scintigraphy images have been widely studied, they employ various steps to classify the images, including segmentation of the entire skeleton, detection of hot spots, and feature extraction, which are complex and inadequately validated on small datasets, thereby resulting in low accuracy and reliability. In this paper, we describe the development of a deep convolutional neural network to determine the absence or presence of bone metastasis. This model consisting of three sub-networks that aim to extract, aggregate, and classify high-level features in a data-driven manner. There are two main innovations behind this method; First, the diagnosis is performed by jointly analyzing both anterior and posterior views, which leads to high accuracy. Second, a spatial attention feature aggregation operator is proposed to enhance the spatial location information. A large annotated bone scintigraphy image dataset containing 15,474 examinations from 13,811 patients was constructed to train and evaluate the model. The proposed method is compared with three human experts. The high classification accuracy achieved demonstrates the effectiveness of the proposed architecture for the diagnosis of bone scintigraphy images, and that it can be applied as a clinical decision support tool.