Automatic calculation of myocardial external efficiency using a single <Superscript>11</Superscript>C-acetate PET scan

Background

Myocardial external efficiency (MEE) is defined as the ratio of kinetic energy associated with cardiac work [forward cardiac output (FCO)*mean systemic pressure] and the chemical energy from oxygen consumed (MVO₂) by the left ventricular mass (LVM). We developed a fully automated method for estimating MEE based on a single ¹¹C-acetate PET scan without ECG-gating.

Methods and Results

Ten healthy controls, 34 patients with aortic valve stenosis (AVS), and 20 patients with mitral valve regurgitation (MVR) were recruited in a dual-center study. MVO₂ was calculated using washout of ¹¹C -acetate activity. FCO and LVM were calculated automatically using dynamic PET and parametric image formation. FCO and LVM were also obtained using cardiac magnetic resonance (CMR) in all subjects. The correlation between MEE_PET-CMR and MEE_PET was high (r = 0.85, P < 0.001) without significant bias. MEE_PET was 23.6 ± 4.2% for controls and was lowered in AVS (17.2 ± 4.3%, P < 0.001) and in MVR (18.0 ± 5.2%, P = 0.004). MEE_PET was strongly associated with both NYHA class (P < 0.001) and the magnitude of valvular dysfunction (mean aortic gradient: P < 0.001, regurgitant fraction: P = 0.009).

Conclusion

A single ¹¹C-acetate PET yields accurate and automated MEE results on different scanners. MEE might provide an unbiased measurement of the phenotypic response to valvular disease.

     

Optimal load for the muscle power profile of prone bench pull in Brazilian Jiu-Jitsu athletes

Background

No studies were observed optimal intensity loads for the muscle power performance during prone bench pull exercise in Brazilian Jiu-Jitsu athletes (BJJ) and this exercise is more similar with grip technics.

Purpose

To identify the optimal intensity for the muscle power performance variables during PBP exercise in BJJ athletes.

Methods

Fifteen athletes (25.5 ± 4.9 years; 65.6 ± 12.2 kg; 177.5 ± 4.7 cm) performed PBP at 30, 40, 50 and 60% of one repetition maximum (1RM) in a random order. The mean power (MP), mean velocity (MV), mean propulsive power (MPP) and mean propulsive velocity (MPV) were determined by measuring the barbell displacement by a linear encoder.

Results

In all power performance variables, higher power output was observed at 40 and 50% 1RM when compared to 30 and 60% 1RM (MP: F = 29.07; p < 0.001; MV: F = 40.80; p < 0.001; MPP: F = 53.69; p = 0.003; MPV: F = 166.2; p > 0.001). Additionally, it was observed higher MPP at 50% 1RM when compared to 40% 1RM (F = 55.23; p < 0.001). The polynomial adjustment indicated that the optimal intensity load for producing highest power performance ranged from 45 to 50% 1RM (R ² = 0.938–0.989) across all variables.

Conclusion

The loads between 45 and 50% 1RM produced the optimal muscle power performance during PBP exercise in BJJ athletes.

     

Physiological factors associated with ski-mountaineering vertical race performance

Purpose

Despite their increasing popularity, there are no studies analyzing the performance of ski-mountaineering vertical races. For the first time, this study examined a vertical competition, exploring the association between laboratory measures and uphill performance by means of multiple regression analysis.

Methods

Nine high-level ski-mountaineers (age 20.6 ± 3.0 years, VO_2max 69.3 ± 7.4 mL/min/kg) performed an anthropometric assessment and a laboratory ski-mountaineering graded exercise test (GXT) to evaluate VO_2max, gross efficiency (GE), ventilatory thresholds (VTs), blood lactate thresholds (LTs), as well as the power output associated with these indices. Race characteristics in terms of vertical gain, length, and mean gradient were, respectively, as follows: 460 m, 3 km, 15.3% for junior men and senior women; 600 m, 3.5 km, 17.1% for senior men.

Results

Average race time was 23:35 ± 01:25 (mm:ss). Mean power output exerted during the race was 3.40 ± 0.34 W/kg, equal to 79.0 ± 3.5% of maximal and 95.3 ± 5.2% of VT2 calculated in the GXT. The most performance-correlated variable was the VO₂ at VT2 (mL/min/kg) (r = 0.91, p < 0.001), which accounted for the 80% of performance variation (adjusted R ² = 0.80, p = 0.001). When GE was included in the analysis, the regression model was significantly improved (adjusted R ² = 0.90, p = 0.031).

Conclusions

The study showed that the mean power output sustained during a vertical race is close to the power associated with VT2 and it is highly correlated with athletes’ physiological characteristics. Particularly, two variables, VO₂ at VT2 and GE, measurable with a specific GXT, accounted for the 90% of performance variation in a ski-mountaineering vertical race. Accordingly, training programs should focus on the maximal development of VT2 as well as on increasing GE by technical improvement.

     

Prognostic value of <Superscript>18</Superscript>F-fluorodeoxyglucose positron emission tomography in patients with gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma

Objective

Gastric neuroendocrine carcinomas (NEC) and mixed adenoneuroendocrine carcinoma (MANEC) are very rare, aggressive tumors of the stomach. We aimed to examine predictive role of pretreatment ¹⁸F-FDG PET/CT-assessed metabolic parameter of primary tumors and metastases in patients with gastric NEC and MANEC.

Methods

We conducted a review of the 27 patients with histopathologically confirmed NECs (n = 10) and MANEC (n = 17) of the stomach at our institution between January 2005 and December 2012. All patients underwent ¹⁸F-FDG-PET examination at diagnosis. Metabolic parameters [SUV_max, SUV_mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] of the primary tumor and metastases on baseline PET/CT were analyzed.

Results

The median follow-up duration was 39.4 months (95 % CI 20.0–58.1 months) and the median overall survival (OS) was 25.7 months (95 % CI 14.1–37.2 months). All gastric lesions were well visualized (average SUV_max = 12.0, range 3.0–41.8). When subjects were divided into two groups by ROC cut-off value of 210.9 and 612, patients with high TLG in primary lesion and metastases showed poorer prognosis compared to low TLG patients (P = 0.09, P = 0.002, respectively). In the sub-analysis of patients with metastasis (n = 12), patients with high TLG in whole body tumor showed significantly shorter OS compared to those with low TLG (31.7 ± 11.4 vs. 7.2 ± 2.1 months, P = 0.006).

Conclusion

¹⁸F-FDG PET/CT is useful in evaluating prognosis of advanced gastric cancer with neuroendocrine carcinoma components. Baseline MTV of primary gastric cancer with metastatic disease, and MTV, TLG of metastases may be prognostic markers in patients with gastric NEC and MANEC.

     

Efficacy of single-dose gonadotropin-releasing hormone agonist administration prior to magnetic resonance-guided focused ultrasound surgery for symptomatic uterine fibroids

Purpose

To investigate the effects of a single-dose GnRHa on the thermal ablation of MRgFUS in women with symptomatic fibroids.

Materials and method

In this pilot study, a single-dose GnRHa was administered in 17 patients with a total of 20 fibroids. Volume and scaled signal intensity (SSI) as an objective marker of fluid contents were prospectively followed up with serial MR scans. The control group of 17 patients with 19 fibroids were retrospectively enrolled and compared with GnRHa group in terms of non-perfused volume (NPV) and thermal dosimetry to assess the efficiency of thermal ablation.

Results

About 29 days after GnRHa administration, SSI and volume of fibroids were reduced by 55.1 and 10.6%, respectively (p < 0.05) but no adverse events were reported. NPV per unit energy (0.046 cm³/J ± 0.026 vs. 0.031 cm³/J ± 0.018, p = 0.041) was larger and SSI (8.4 ± 8.0 vs. 13.9 ± 12.0, p = 0.053) was lower in GnRHa group. Linear regression analysis showed that these two parameters were in a reverse correlation (p = 0.011).

Conclusion

GnRHa is supposed to reduce the fluid contents of fibroids including blood vessels and enhance the tissue responsiveness to thermal energy. A single dose prior to MRgFUS has the potential to improve treatment efficiency, while avoiding the side effects of multiple doses of GnRHa.

     

Return to sport: Does excellent 6-month strength and function following ACL reconstruction predict midterm outcomes?

Purpose

The purpose of this study was to determine whether patients with excellent 6-month functional testing after ACL reconstruction had (1) higher risk of subsequent ACL tears, (2) superior knee function, and (3) increased activity levels compared to those with delayed clearance for return to sports at midterm follow-up.

Methods

A total of 223 patients underwent primary ACL reconstruction by a single surgeon and had functional and isokinetic testing performed 6 months post-operatively between 1998 and 2005. Of the 223 patients, 52 (23 %) made the excellent group and were allowed return to sport at 6 months, and the remaining 171 (77 %) constituted the delayed group. Rate of ACL graft tear and native contralateral ACL tear was compared between groups. In addition, IKDC and Tegner scores were compared at a mean 4-year follow-up.

Results

The graft rupture rate was similar in the excellent group (3.8 %, n = 2) compared to the delayed group (4.7 %, n = 8; p = 0.30). However, there was a higher rate of contralateral ACL tear in the excellent group (15.4 %, n = 8 vs. 5.3 %, n = 9; p = 0.003). The excellent 6-month group had superior IKDC scores (94.3 ± 6.4 vs. 90.9 ± 9.7; p = 0.04) and Tegner scores (6.6 ± 1.8 vs. 5.7 ± 1.6; p = 0.01).

Conclusion

Patients with an excellent performance on their isokinetic strength and functional testing at 6 months after ACL reconstruction have superior knee function and higher activity levels at midterm follow-up. However, these patients appear to be at greater risk of contralateral ACL injury, which may be related to their increased activity level. When isokinetic and functional testing is used for return-to-sport decisions, physicians should caution patients about the risk of contralateral ACL injury for high performing patients.

Level of evidence

Retrospective Review with Control, Level III.

     

Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to <Emphasis Type="Italic">N</Emphasis>-Butyl Cyanoacrylate

Purpose

To identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).

Materials and Methods

Institutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.

Results

Technical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.

Conclusion

Uterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.

Level of Evidence

Level 4, Case Control Study

     

Multiparametric MR imaging detects therapy efficacy of radioactive seeds brachytherapy in pancreatic ductal adenocarcinoma xenografts

Objective

To investigate the therapeutic efficacy of Iodine-125 (¹²⁵I) seeds brachytherapy to pancreatic ductal adenocarcinoma (PDAC) xenografts via multiparametric magnetic resonance imaging (MRI) analysis.

Materials and methods

Twenty mice were implanted subcutaneously with SW-1990 PDAC xenografts. The tumor-bearing mice were randomly divided into ¹²⁵I seeds group (n = 10) and blank control group (n = 10). Treatment response was monitored by diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) obtained 1 day before, 14 and 60 days after treatment. Imaging results were correlated with histopathology.

Results

¹²⁵I seeds brachytherapy resulted in a significant increase in mean tumor apparent diffusion coefficient (ADC) values compared to the control at 14 and 60 days after treatment (p < 0.05). DCE-MRI showed a significant decrease in the perfusion parameters including K^trans and K_ep (p < 0.05). The mean ADCs within the peripheral region of the tumors were linearly proportional to the mean apoptotic cell density (p = 0.015; Spearman’s coefficient = 0.945). The K^trans and K_ep were linearly proportional to microvessel density (MVD) (p = 0.043, 0.047; Spearman’s coefficient = 0.891, 0.884).

Conclusion

¹²⁵I seeds brachytherapy leads to effective inhibition of PDAC cell proliferation, higher degree of necrosis and necroptosis, and lower MVD. Both DW-MRI and DCE-MRI are feasible to monitor a response to ¹²⁵I seeds brachytherapy in the PDAC xenografts. This paper shows an original project concerning about a possible palliative treatment not only in a murine model (preclinical setting) but also in humans.

     

FDG-PET/CT predicts survival and lung metastasis of hypopharyngeal cancer in a multi-institutional retrospective study

Objectives

We investigated a possible correlation between the maximum standardized uptake value (SUV_max), which is assessed by pretreatment ¹⁸F-fluorodeoxyglucose positron emission tomography with computed tomography, and the overall survival (OS) in patients with hypopharyngeal squamous cell carcinoma from two institutions on long-term follow-up, and examined whether SUV_max is correlated with several survival outcomes, including lung metastasis-free survival.

Methods

A total of 81 patients were enrolled. The survival rate was calculated by the Kaplan–Meier method. Both univariate and multivariate survival analyses were assessed by a Cox proportional hazards model.

Results

SUV_max ≥15.2 in institution A (p = 0.0306) or SUV_max ≥8 in institution B (p = 0.0132) was significantly predictor of a lower OS. We disaggregated the data by high SUV_max (SUV_max ≥15.2 from institution A and SUV_max ≥8 from institution B) and low SUV_max (SUV_max <15.2 from institution A and SUV_max <8 from institution B). Patients with a high SUV_max exhibited a significantly lower OS in both univariate (p = 0.001) and multivariate (p = 0.0046) analyses for adjusted for the clinical stage and treatment group. The patients with a high SUV_max exhibited significantly shorter disease-specific (p = 0.0068), distant metastasis-free (p = 0.0428), and lung metastasis-free (p = 0.0328) survivals.

Conclusions

High SUV_max was significantly correlated with a lower OS, disease-specific survival, distant metastasis-free survival, and lung metastasis-free survival in a multi-institutional retrospective study.

     

Heterogeneity index evaluated by slope of linear regression on <Superscript>18</Superscript>F-FDG PET/CT as a prognostic marker for predicting tumor recurrence in pancreatic ductal adenocarcinoma

Purpose

¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been investigated as a method to predict pancreatic cancer recurrence after pancreatic surgery. We evaluated the recently introduced heterogeneity indices of ¹⁸F-FDG PET/CT used for predicting pancreatic cancer recurrence after surgery and compared them with current clinicopathologic and ¹⁸F-FDG PET/CT parameters.

Methods

A total of 93 pancreatic ductal adenocarcinoma patients (M:F = 60:33, mean age = 64.2 ± 9.1 years) who underwent preoperative ¹⁸F-FDG PET/CT following pancreatic surgery were retrospectively enrolled. The standardized uptake values (SUVs) and tumor-to-background ratios (TBR) were measured on each ¹⁸F-FDG PET/CT, as metabolic parameters. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were examined as volumetric parameters. The coefficient of variance (heterogeneity index-1; SUVmean divided by the standard deviation) and linear regression slopes (heterogeneity index-2) of the MTV, according to SUV thresholds of 2.0, 2.5 and 3.0, were evaluated as heterogeneity indices. Predictive values of clinicopathologic and ¹⁸F-FDG PET/CT parameters and heterogeneity indices were compared in terms of pancreatic cancer recurrence.

Results

Seventy patients (75.3%) showed recurrence after pancreatic cancer surgery (mean recurrence = 9.4 ± 8.4 months). Comparing the recurrence and no recurrence patients, all of the ¹⁸F-FDG PET/CT parameters and heterogeneity indices demonstrated significant differences. In univariate Cox-regression analyses, MTV (P = 0.013), TLG (P = 0.007), and heterogeneity index-2 (P = 0.027) were significant. Among the clinicopathologic parameters, CA19–9 (P = 0.025) and venous invasion (P = 0.002) were selected as significant parameters. In multivariate Cox-regression analyses, MTV (P = 0.005), TLG (P = 0.004), and heterogeneity index-2 (P = 0.016) with venous invasion (P < 0.001, 0.001, and 0.001, respectively) demonstrated significant results.

Conclusions

The heterogeneity index obtained using the linear regression slope, could be an effective predictor of pancreatic cancer recurrence after pancreatic cancer surgery, in addition to ¹⁸F-FDG PET/CT volumetric parameters and clinicopathologic parameters.

     

Diffusion weighted imaging in differentiating malignant and benign neuroblastic tumors

Purpose

Our aim was to assess diffusion weighted imaging (DWI) of neuroblastic tumors and whether apparent diffusion coefficient (ADC) value may have a role in discrimination among neuroblastoma, ganglioneuroblastoma and ganglioneuroma.

Material and methods

The DWIs (b = 0–800 s/mm²) of 24 children (13 girls, 11 boys) who were diagnosed neuroblastic tumors on histopathological examination (neuroblastoma = 15, ganglioneuroblastoma = 5, ganglioneuroma = 4) were evaluated retrospectively. The ADC maps were performed by drawing freehand ROI on PACS (Sectra Workstation IDS7, Linköping, Sweden).

Results

We observed a significant decrease in ADC value of neuroblastomas 0.869 ± 0.179 × 10^?3 mm²/s compared to ganglioneuroblastomas 0.97 ± 0.203 × 10^?3 mm²/s and ganglioneuromas 1.147 ± 0.299 × 10^?3 mm²/s (p = 0.026). There was no significant difference in between ganglioneuroblastoma and ganglioneuroma (p = 0.16). In detecting neuroblastomas; the sensitivity, specificity, negative and positive predictive values of ADC were 74, 67, 78.6, 66 % respectively with a cut-off value of 0.93 × 10^?3 mm²/s.

Conclusion

Our study stands out as the most comprehensive study with larger sample size on this topic. Moreover, we are able to suggest a cut-off value which can discriminate neuroblastoma from ganglioneuroblastoma and ganglioneuroma. We believe that ADC will evolve to an objective, quantitative measurement in discrimination among malignant and benign neuroblastic tumors.

     

Tibial ACL insertion site length: correlation between preoperative MRI and intra-operative measurements

Purpose

This study was undertaken primarily to identify the tibial insertion site length of ruptured ACL fibres in patients undergoing primary ACL reconstruction. A secondary aim was to evaluate the correlation of pre- and intra-operative measurements.

Methods

In 146 patients undergoing primary ACL reconstruction, a preoperative measurement on MRI of the tibial ACL insertion site length was taken by two raters and then compared with single surgeon’s intra-operative measurements using a specialized ruler. Inclusion criteria were primary ACL reconstruction and MRI performed within 3 months prior to surgery on one specific MRI machine at the study centre. Inter-rater and intra-rater reliability based on intra class correlation (ICC) was calculated. Additionally, correlation between preoperative and postoperative measurements and the anthropometric data was assessed using Pearson correlation.

Results

The tibial ACL insertion site had a mean length of 16.6 ± 1.6 mm (11.9–21.0) as measured by MRI, and 16.4 ± 1.6 mm (11.0–20.0) as measured intra-operatively. The ICCs for intra- and inter-rater reliability of the MRI measurements were 0.99 (95 % CI 0.97; 0.99; p < 0.001) and 0.81 (95 % CI 0.75; 0.86; p < 0.001), respectively. Regression analysis demonstrated, after controlling for subject height and weight, that the MRI measurements significantly predicted intra-operative measurement of tibial insertion site length (β = 0.796; R ²-change 0.77; p < 0.001).

Conclusion

Preoperative measurement of the tibial ACL length is possible using MRI and can be a valuable aid in more efficient preoperative planning given the knowledge of expected dimensions of special knee structures.

Level of evidence

III.

     

Visual and quantitative comparison of <Superscript>18</Superscript>F-fluorodeoxyglucose PET/CT findings in the detection of pelvic tumor recurrence in colorectal cancer

Objective

This study aimed to visually and quantitatively compare ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging in determining postoperative pelvic recurrence in colorectal cancer (CRC).

Materials and methods

This retrospective analysis focused on 96 patients (age: mean 62.6 ± 10.5) with surgically resected CRC (time interval after surgery: 19.2 ± 20.4 months). The standard of reference was histopathologic confirmation (n = 27) or imaging follow-up (n = 69). For visual analysis, three independent nuclear physicians interpreted the PET/CT findings. For the quantitative analysis, the normalized standardized uptake values (nSUVs: nSUV_max, nSUV_peak, nSUV_mean) were calculated by applying the mean SUV of a normal liver. We evaluated the areas under the receiver operating characteristic curves (AUCs) for all the quantitative parameters.

Results

Of the 96 patients, 49 showed pelvic recurrence and 47 revealed no tumor recurrence. Sensitivity and specificity were 85.7 and 80.9 %, respectively, for visual analysis, and 65.3 and 83.0 %, respectively, for quantitative analysis. The AUC (0.766, CI: 0.668–0.846) of nSUV_max was largest comparing nSUV_peak and nSUV_mean values, without significant difference (p value >0.316). Sensitivity of lesion detection was superior in visual analysis (p value = 0.02), but specificity was not significantly different (p = 0.80). After inclusive and exclusive combinations, sensitivity and specificity were slightly increased to 89.8 % (p = 0.54) and 91.5 % (p = 0.14), respectively.

Conclusions

Visual interpretation was superior to quantitative analysis in pelvic tumor recurrence in CRC. Though it was possible to improve diagnostic performance through combinatory analysis, the effect was not statistically significant.

     

Additive value of 320-section low-dose dynamic volume CT in relation to 3-T MRI for the preoperative evaluation of brain tumors

Purpose

To assess whether 320-section low-dose dynamic volume computed tomography (320-LDVCT) with adaptive iterative dose reduction (AIDR) adds value to 3-T MRI for the preoperative evaluation of brain tumors.

Methods

The study population was comprised of 16 consecutive patients with brain tumors who, in addition to preoperative 3-T MRI, underwent 320-LDVCT with AIDR. Two radiologists independently evaluated the CT and MRI studies; one measured the relative cerebral blood volume (rCBV) in the tumor and contralateral brain on CT and MR perfusion maps. Interobserver agreement was assessed by κ statistics.

Results

In 3 of 16 patients (19 %), 320-LDVCT added diagnostic value to 3-T MRI studies with respect to the visualization of feeders (κ = 0.77), and in 12 (75 %) it helped the delineation of venous structures (κ = 0.71) and the relationship between the tumor and adjacent vessels (κ = 0.85). The average standardized rCBV value was 12.2 ± 2.40 (range 0.7–36.6) on MR and 8.80 ± 2.77 (range 0.8–38.0) on CT perfusion studies; the correlation between these values was very strong (r = 0.92, p < 0.0001). According to the neurosurgeons, 320-LDVCT added helpful information for surgery in 4 patients (25 %).

Conclusion

The 320-LDVCT can add value to 3-T MRI for the tumor feeders and relationship between the tumor and adjacent vessels.

     

Low-tube-voltage selection for triple-rule-out CTA: relation to patient size

Objectives

To investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA).

Methods

We retrospectively included 73 patients (age 64?±?14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients’ chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA.

Results

There was no significant difference in BMI (26.0?±?4.6 vs. 28.0?±?6.7 kg/m²), PC (103?±?7 vs. 104?±?10 cm²) and TSA?(92?±?15 vs. 91?±?19 cm²) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p?<?0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7?±?4.1 vs. 20.7?±?10.7 mSv; p?<?0.001).

Conclusions

100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction.

Key Points

? 100 kV protocols result in a significantly lower radiation dose. ? Mean vascular attenuation is significantly higher using 100 kV. ? SNR and CNR are not significantly different between 100 kV and 120 kV. ? 100 kV CTA is feasible regardless of patient size while maintaining image quality.

     

Predictive value of <Superscript>18</Superscript>F-FDG PET/CT in adults with T-cell lymphoblastic lymphoma: post hoc analysis of results from the GRAALL-LYSA LLO3 trial

Purpose

We examined whether FDG PET can be used to predict outcome in patients with lymphoblastic lymphoma (LL).

Methods

This was a retrospective post hoc analysis of data from the GRAAL-LYSA LL03 trial, in which the treatment of LL using an adapted paediatric-like acute lymphoblastic leukaemia protocol was evaluated. PET data acquired at baseline and after induction were analysed. Maximum standardized uptake values (SUV_max), total metabolic tumour volume and total lesion glycolysis were measured at baseline. The relative changes in SUV_max from baseline (ΔSUV_max) and the Deauville score were determined after induction.

Results

The population analysed comprised 36 patients with T-type LL. SUV_max using a cut-off value of ≤8.76 vs. >8.76 was predictive of 3-year event-free survival (31.6% vs. 80.4%; p = 0.013) and overall survival (35.0% vs. 83.7%; p = 0.028). ΔSUV_max using a cut-off value of ≤80% vs. >80% tended also to be predictive of 3-year event-free survival (40.0% vs. 76.0%; p = 0.054) and overall survival (49.2% vs. 85.6%; p = 0.085). Total metabolic tumour volume, baseline total lesion glycolysis and response according to the Deauville score were not predictive of outcome.

Conclusions

A low initial SUV_max was predictive of worse outcomes in our series of patients with T-type LL. Although relatively few patients were included, the study also suggested that ΔSUV_max may be useful for predicting therapeutic efficacy.

     

Relationships between left ventricular asynchrony and myocardial blood flow

Objective

⁸²Rb PET protocols enable determination of left ventricular asynchrony (LVAS) at rest and stress, along with myocardial blood flow (MBF). We hypothesized that in patients with resting LVAS, MBF differs between those with stress-induced LVAS improvement and those with stress-induced LVAS deterioration.

Methods

We retrospectively analyzed ⁸²Rb rest/regadenoson stress PET studies of 195 patients evaluated for known or suspected coronary artery disease. MBF was computed from first-pass data; function and relative perfusion were computed from myocardial equilibrium data. LVAS was defined as phase contraction bandwidth (BW) above ⁸²Rb gender-specific normal limits, with changes defined as BW moving into or out of normal ranges.

Results

Among the 195 patients, 64 had LVAS at rest, of whom 13 reverted to normal and 51 continued to have LVAS with stress. Patients who did not improve had lower stress MBF (1.04 ± 0.69 vs 1.58 ± 0.67, p = .02) and coronary flow reserve (1.94 ± 1.16 vs 3.04 ± 1.22, p = .01) than those who did improve. ROC analysis indicated that the parameter most strongly associated with improvement in asynchrony for patients with resting LVAS was reduction in MBF heterogeneity (ROC area (accuracy) = 84%, sensitivity = 92%, and specificity = 67%).

Conclusion

LVAS is highly correlated with MBF and CVR, with stress-induced improvement in synchronicity most strongly associated with improved MBF homogeneity.

     

Prognostic value of pre-treatment <Superscript>18</Superscript>F-FDG-PET uptake in small-cell lung cancer

Purpose

Small-cell lung cancer (SCLC) is an aggressive disease, despite an initially favorable response to treatment, and its prognosis is still poor. Multiple parameters have been studied as possible prognostic factors, but none of them are reliable enough to change the treatment approach. ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is a novel imaging technique for staging of SCLC. The aim of this study was to evaluate the prognostic value of pre-treatment FDG-PET parameters on clinical outcome in limited stage (LS) SCLC patients treated with curative thoracic radiotherapy (RT) and chemotherapy.

Methods

Clinical records of 46 LS-SCLC patients with pre-treatment FDG-PET imaging were retrospectively reviewed. Patients were treated with definitive RT for a total dose of 50–60 Gy and chemotherapy. The clinical endpoints were progression-free survival (PFS) and overall survival (OS).

Results

The median age was 59 (range 30–82) years, and median follow-up time was 23.2 months (range 5–82.8 months). Median OS was 30.9 months for pre-treatment tumor maximum standardized uptake value (SUV_max) <9.3 and 20.6 months for SUV_max ≥9.3 (p = 0.027) and PFS was 55.6 months for SUV_max <9.3 and 38.6 months for SUV_max ≥9.3 (p = 0.16). Median OS was 73 months for pre-treatment lymph node SUV_max <5.8 and 21 months for ≥5.8 (p = 0.01) and PFS was 38.6 months (range 6.8–70.3 months) for SUV_max-LN ≥5.8; all patients with SUV_max-LN <5.8 were alive (p = 0.07). Median survival time was 28.2 months (range 21.7–34.7 months) for patients younger than 65 and 8.7 months (range 5.7–11.8 months) for those ≥65 years (p = 0.00).

Conclusions

Pre-treatment FDG-PET uptake may be a valuable tool to evaluate prognosis in SCLC patients. Patients with a higher pre-treatment FDG uptake may be considered at increased risk of failure and may benefit from more aggressive treatment approaches.

     

Relationship between stature level and success in elite judo: an analysis on four consecutive Olympic Games

Purpose

The rationale of our study derived from the important changes in judo rules, with particular consideration of the leg grabs. Therefore, the present study aimed at demonstrating the relationships between stature and successful matches in elite judo, in relation to both genders and seven weight categories.

Methods

Stature levels and final ranking position of each participant were recorded on the base of the year of Olympic Game (Athens 2004, Beijing 2008, London 2012, Rio 2016), gender, and weight class. A one-way ANCOVA was applied to determinate possible differences (p ≤ 0.05) among judoka’s statures related to each Olympic Game.

Results

Results showed that no difference has been reported for stature level of each judo Olympic Game in all and only male judoka. On the contrary, for female, difference (p = 0.007) on judoka’s stature levels among ranking positions generally emerged, reporting increases in stature levels between the first and the fifth (from 163.62 ± 7.95 to 167.90 ± 8.88 cm; p = 0.004), and the seventh (from 163.62 ± 7.95 to 168.26 ± 8.53 cm; p = 0.016) ranking position.

Conclusion

Considering that no relationship between stature and successful matches in elite judo emerged in the analyzed four Olympics Games, it can speculate that no advantage can be attributed to the taller judoka’s for the rule changes regarding the leg grabs.