Crestal bone loss around dental implants placed in head and neck cancer patients treated with different radiotherapy techniques: a prospective cohort study

The aim of this prospective cohort study was to evaluate how the radiation technique can affect crestal bone loss and the implant survival rate in head and neck cancer patients treated with radiotherapy. In this study, the type of radiotherapy treatment, i.e. three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT), was the predictor variable. The primary outcome variable was crestal bone loss, recorded at implant placement and after 3, 6, 12, and 24 months.

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Reproducibility of Voice Parameters: The Effect of Room Acoustics and Microphones

Computer analysis of voice recordings is an integral part of the evaluation and management of voice disorders. In many practices, voice samples are taken in rooms that are not sound attenuated and/or sound-proofed; further, the technology used is rarely consistent. This will likely affect the recordings, and therefore, their analyses.

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Filtered back projection revisited in low-kilovolt computed tomography angiography: sharp filter kernel enhances visualization of the artery of Adamkiewicz

Abstract

Purpose

The reliability of assessment of the artery of Adamkiewicz before the aortic repair is highly dependent on the display of the continuity of this artery with the aorta, mainly around the vertebral pedicle, by computed tomography angiography (CTA). We hypothesized that the sharp filter kernel can improve visualization of this continuity of the vessel structure because of its edge enhancement and high-spatial resolution. This study was performed to compare the subjective and objective image quality of spinal CTA reconstructed with sharp and smooth filter kernels.

Methods

We retrospectively reviewed 40 consecutive patients who had undergone 80-kV CTA to detect the artery of Adamkiewicz before aortic repair. We measured the CT number and the contrast-to-noise ratio of the anterior spinal artery to the spinal cord. Furthermore, the continuity of the artery of Adamkiewicz was evaluated using a 3-point scale (2 points, absolute; 0 points, undetectable).

Results

CTA with the sharp filter kernel showed a significantly higher CT number and contrast-to-noise ratio of the spinal artery than did CTA with the smooth filter kernel (P < .001 for both). Moreover, the sharp filter kernel showed a significantly higher continuity of the artery of Adamkiewicz with the aorta than did the smooth filter kernel (P < .001).

Conclusions

The sharp filter kernel significantly improved the image quality in low-tube-voltage CTA for the assessment of the artery of Adamkiewicz. Thus, CTA with the sharp filter kernel can generate a high-confidence level in the evaluation of the artery of Adamkiewicz.

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Editorial Board

Publication date: January 2019

Source: Archives of Oral Biology, Volume 97

Author(s):

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Proteomics of the acid-soluble fraction of whole and major gland saliva in burning mouth syndrome patients

Publication date: Available online 20 November 2018

Source: Archives of Oral Biology

Author(s): Tiziana Cabras, Barbara Manconi, Massimo Castagnola, Maria Teresa Sanna, Morena Arba, Shikha Acharya, Jörgen Ekström, Anette Carlén, Irene Messana

Abstract

OBJECTIVE

In the present study the salivary proteome of burning mouth syndrome patients and healthy subjects was characterized by a top-down proteomic approach and compared to highlight possible qualitative and quantitative differences that may give suggestions about the causes of this pathology which are still unknown.

MATERIALS AND METHODS

Resting and stimulated whole saliva, stimulated parotid and submandibular/sublingual saliva samples were collected from burning mouth syndrome patients (n = 16) and age- and gender-matched healthy subjects (n = 14). An equal volume of 0.2% trifluoroacetic acid was added to each sample immediately after collection and the supernatants were analysed by liquid chromatography coupled to electrospray-ionisation mass spectrometry. Proteins and peptides were quantified using a label-free approach measuring the extracted ion current peak areas of the main salivary proteins and peptides.

RESULTS

The quantitation of the main salivary proteins and peptides revealed a higher concentration of cystatin SN in resting saliva of burning mouth syndrome patients with respect to healthy controls and no other conspicuous changes.

CONCLUSIONS

The reported data showed that the salivary protein profile was not affected, in composition and relative abundance, by the burning mouth syndrome, except for the cystatin SN, a protein up-regulated in several pathological conditions, that might be considered potentially indicative of the disease.

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Peptides from rice endosperm protein restrain periodontal bone loss in mouse model of periodontitis

Publication date: Available online 20 November 2018

Source: Archives of Oral Biology

Author(s): Hikaru Tamura, Tomoki Maekawa, Hisanori Domon, Takumi Hiyoshi, Daisuke Yonezawa, Kosuke Nagai, Akihito Ochiai, Masayuki Taniguchi, Koichi Tabeta, Takeyasu Maeda, Yutaka Terao

Abstract

Objective

Food-derived peptides have been reported to exhibit antibacterial activity against periodontal pathogenic bacteria. However, no effect has been shown on inflammation and bone resorption in periodontal pathology. The overall objective of the current study was to investigate how rice peptides influence biological defense mechanisms against periodontitis-induced inflammatory bone loss, and identify their novel functions as a potential anti-inflammatory drug.

Design

The expression of inflammatory and osteoclast-related molecules was examined in mouse macrophage-derived RAW 264.7 cell cultures using qPCR. Subsequently, the effect of these peptides on inflammatory bone loss in mouse periodontitis was examined using a mouse model of tooth ligation. Briefly, periodontal bone loss was induced for 7 days in mice by ligating the maxillary second molar and leaving the contralateral tooth un-ligated (baseline control). The mice were microinjected daily with the peptide in the gingiva until the day before euthanization. One week after the ligation, TRAP-positive multinucleated cells (MNCs) were enumerated from five random coronal sections of the ligated sites in each mouse.

Results

Rice peptides REP9 and REP11 significantly inhibited transcription activity of inflammatory and osteoclast-related molecules. Local treatment with the rice peptides, in mice subjected to ligature-induced periodontitis, inhibited inflammatory bone loss, explaining the decreased numbers of osteoclasts in bone tissue sections.

Conclusion

Therefore, these data suggested that the rice peptides possess a protective effect against periodontitis.

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Leptin Stimulates DMP-1 and DSPP Expression in Human Dental Pulp via MAPK 1/3 and PI3K Signaling Pathways

Publication date: Available online 20 November 2018

Source: Archives of Oral Biology

Author(s): Jenifer Martín-González, Antonio Pérez-Pérez, Daniel Cabanillas-Balsera, Teresa Vilariño-García, Victor Sánchez-Margalet, Juan José Segura-Egea

Abstract

Introduction

: To investigate the physiological function of leptin in human dental pulp, and to determine the specific pathways implicated in its effect.

Methods

Twenty-seven dental pulp samples were obtained from human third molars. Pulp samples were treated with or without human recombinant leptin. Leptin functional effect was analyzed in terms of regulation of the synthesis levels of DSPP and DMP-1, determined by immunoblot.

Results

Leptin stimulated DMP-1 and DSPP synthesis in all human dental pulp specimens. The stimulatory effect of leptin on DMP-1 and DSPP synthesis was partially prevented by blocking mitogen-activated protein kinase (MAPK 1/3) and phosphatidylinositol 3 kinase (PI3K) pathways, respectively.

Conclusions

The present study demonstrates the functional effect of leptin in human dental pulp stimulating the expression of DMP-1 and DSPP, both proteins implicated in dentinogenesis. Leptin stimulates DSPP expression via PI3K pathway and DMP-1 synthesis via MAPK 1/3 pathway. These results support the role of leptin in pulpal reparative response, opening a new research line that could have translational application to the clinic in vital pulp therapy procedures.

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Betamethasone suppresses the inflammatory response in LPS-stimulated dental pulp cells through inhibition of NF-κB

Publication date: Available online 20 November 2018

Source: Archives of Oral Biology

Author(s): Dan Wang, Ning-Xin Zhu, Man Qin, Yuan-Yuan Wang

Abstract

Objective

This study aimed to investigate the anti-inflammatory effect of betamethasone on LPS-stimulated human dental pulp stem cells (DPSCs) and its associated mechanism. The osteo-/odontogenic differentiation and osteoclast effect of betamethasone on DPSCs and stem cells from human exfoliated deciduous teeth (SHED) were evaluated.

Design

The proliferative effect of betamethasone on DPSCs was analyzed using a cholecystokinin octapeptide assay. The anti-inflammatory effect of betamethasone was investigated using quantitative polymerase chain reaction (qPCR) and ELISA. The anti-inflammatory mechanism was explored using qPCR, Western blot, and immunofluorescence staining. Glucocorticoid receptor antagonist mifepristone was applied to verify the anti-inflammatory mechanism of betamethasone. The osteo-/odontogenic differentiation and osteoclast effect of betamethasone on DPSCs and SHED were detected by qPCR.

Results

1 μg L^-1 betamethasone was found to have the strongest effect on DPSCs proliferation. The expression of pro-inflammatory cytokines and mediators, as well as prostaglandin E₂ (PGE₂) were significantly decreased following treatment with betamethasone in LPS- stimulated DPSCs. They were also decreased in response to an NF-κB inhibitor, Bay 11-7082. Betamethasone and Bay 11-7082 significantly inhibited the expression of p-p65 and promoted the nuclear exclusion of p65. The anti-inflammatory effect of betamethasone was clearly reversed by adding mifepristone. Gene expression associated with osteo-/odontogenic differentiation was significantly up-regulated in betamethasone and osteogenic media (OM) treated groups. The ratio of the receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) at the mRNA level was suppressed in DPSCs and elevated in SHED.

Conclusions

Betamethasone has an anti-inflammatory effect on LPS- stimulated DPSCs through a blockade of NF-κB activation and exhibits an osteo-/odonto-inductive effect on DPSCs and SHED. Although betamethasone displays an osteoclast effect on SHED.

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Real-Time Standard View Classifcation in Transthoracic Echocardiography Using Convolutional Neural Networks

Publication date: Available online 20 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Andreas Østvik, Erik Smistad, Svein Arne Aase, Bjørn Olav Haugen, Lasse Lovstakken

Abstract

Transthoracic echocardiography examinations are usually performed according to a protocol comprising different probe postures providing standard views of the heart. These are used as a basis when assessing cardiac function, and it is essential that the morphophysiological representations are correct. Clinical analysis is often initialized with the current view, and automatic classification can thus be useful in improving today's workflow. In this article, convolutional neural networks (CNNs) are used to create classification models predicting up to seven different cardiac views. Data sets of 2-D ultrasound acquired from studies totaling more than 500 patients and 7000 videos were included. State-of-the-art accuracies of 98.3% ± 0.6% and 98.9% ± 0.6% on single frames and sequences, respectively, and real-time performance with 4.4 ± 0.3 ms per frame were achieved. Further, it was found that CNNs have the potential for use in automatic multiplanar reformatting and orientation guidance. Using 3-D data to train models applicable for 2-D classification, we achieved a median deviation of 4° ± 3° from the optimal orientations.

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Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort.

Related Articles

Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort.

Angle Orthod. 2018 Nov 20;:

Authors: Isfeld D, Flores-Mir C, Leon-Salazar V, LagravÈre M

Abstract
OBJECTIVES:: To test the reliability and usefulness of the midpalatal suture maturation classification and methodology proposed in 2013 by Angelieri et al. for successful prediction of rapid maxillary expansion (RME) treatment results.
MATERIALS AND METHODS:: Reliability testing focused on 16 patients aged 9.5-17 years with early mixed to full permanent dentition, representing all proposed palatal maturation stages, from available preexpansion cone-beam computed tomography (CBCT). A retrospective observational longitudinal (cohort) study evaluated 63 preadolescent and adolescent patients aged 11-17 years with full permanent dentition treated with tooth-borne RME appliances who had CBCT records taken at pre- (T1) and postexpansion (T2). CBCT three-dimensional landmarking produced skeletal and dental widths and dental angulations used to evaluate the extent of skeletal and/or dental expansion. A regression model was used to assess the prediction capability of the T1 palatal suture classification of each subject for dental and skeletal changes.
RESULTS:: There was almost perfect intraexaminer agreement and slight to poor interexaminer agreement, differing from previously reported reliability, affected by necessary operator calibration and the degree of postacquisition image sharpness and clarity. Further exploration of its scientific basis suggested that the proposed classification was ill-founded. Results from the cohort study were also wholly unsupportive of efficacy of the proposed palatal suture maturation classification in predicting the magnitude of portrayed changes.
CONCLUSIONS:: Clinicians should be cautious in applying this classification. Although it has merits, the palatal classification still needs much more research and validation.

PMID: 30457354 [PubMed - as supplied by publisher]

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Stability of orthodontic treatment outcomes after 1-year treatment with the eruption guidance appliance in the early mixed dentition: A follow-up study.

Related Articles

Stability of orthodontic treatment outcomes after 1-year treatment with the eruption guidance appliance in the early mixed dentition: A follow-up study.

Angle Orthod. 2018 Nov 20;:

Authors: Myrlund R, Keski-Nisula K, Kerosuo H

Abstract
OBJECTIVES:: To investigate occlusal stability from the early mixed to the permanent dentition in children after early treatment with the eruption guidance appliance (EGA).
MATERIALS AND METHODS:: Of 46 participants who received 1-year early EGA treatment, 35 attended a follow-up examination at age 12. Group 1 (n = 21) started their EGA treatment at mean age 7.7 years, and group 2 at 9.1 years. Following 1-year treatment, the EGA was used as a retainer. Changes in overjet, overbite, sagittal molar relationship, and anterior crowding were measured on casts obtained before EGA treatment, after EGA treatment, and at follow-up to evaluate occlusal stability.
RESULTS:: Mean overjet, overbite, sagittal molar relation, and mandibular crowding improved significantly during the study period. Participants with good compliance during the retention period had significantly smaller overjet and overbite values than those with poor compliance.
CONCLUSIONS:: Early correction of increased overjet, overbite, and class II molar relation with the EGA is maintainable and can also be effective in the permanent dentition, provided the EGA is worn regularly as a retainer.

PMID: 30457353 [PubMed - as supplied by publisher]

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Cone-beam evaluation of pharyngeal airway space in adult skeletal Class II patients with different condylar positions.

Related Articles

Cone-beam evaluation of pharyngeal airway space in adult skeletal Class II patients with different condylar positions.

Angle Orthod. 2018 Nov 20;:

Authors: Xu J, Sun R, Wang L, Hu X

Abstract
OBJECTIVES:: To test the null hypothesis that there is no significant difference in pharyngeal airway space among adult skeletal Class II patients with different condylar positions using cone-beam computed tomography (CBCT).
MATERIALS AND METHODS:: The CBCT records of 60 patients with skeletal Class II malocclusion (ANB angle ≥ 4°, Wits ≥ 0) were selected from the CBCT database. According to the condyle position, the patients were divided in three groups: anterior group (CD ≤ -12%), centric group (-12% ≤ CD ≤ +12%), and posterior group (CD ≥ +12%). Three-dimensional (3D) pharyngeal airway models were reconstructed using InvivoDental software 5.1.3. The volume and area of the pharyngeal airway space were measured in the 3D airway model.
RESULTS:: The volume and area of the pharyngeal airway space in the centric group were significantly smaller than those in the posterior group ( P < .01). The volume and area of the pharyngeal airway space were smallest in the anterior group and significantly increased in the centric and posterior groups ( P < .001).
CONCLUSIONS:: The null hypothesis was rejected. Significant differences were noted in pharyngeal airway space among adult skeletal Class II patients with different condylar positions.

PMID: 30457352 [PubMed - as supplied by publisher]

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Mast cells as protectors of health

Publication date: Available online 20 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Anne Dudeck, Martin Köberle, Oliver Goldmann, Nicole Meyer, Jan Dudeck, Stefanie Lemmens, Manfred Rohde, Nestor González Roldán, Kirsten Dietze-Schwonberg, Zane Orinska, Eva Medina, Sven Hendrix, Martin Metz, Ana Claudia Zenclussen, Esther von Stebut, Tilo Biedermann

Abstract

Mast cells (MC), well known for their effector functions in Th2 skewed allergic and also autoimmune inflammation, become increasingly acknowledged for their role in protection of health. It is now clear that they are also key modulators of immune responses at interface organs like skin or gut. MC can prime tissues for adequate inflammatory responses and cooperate with dendritic cells in T cell activation. They also regulate harmful immune responses in trauma and help to successfully orchestrate pregnancy. This review focusses on the beneficial effects of mast cells on tissue homeostasis and elimination of toxins or venoms. MC can enhance pathogen clearance in many bacterial, viral, and parasite infections, e.g. by TLR2 triggered degranulation, secretion of antimicrobial cathelicidins, recruiting neutrophils or by providing extracellular DNA traps. The role of MC in tumors is more ambiguous, however, encouraging new findings show they can change the tumor microenvironment towards anti-tumor immunity when adequately triggered. Uterine tissue remodeling by α-chymase (MCP-5) is crucial for successful embryo implantation. MCP-4 and the tryptase MCP-6 emerge to be protective in CNS trauma by reducing inflammatory damage and excessive scar formation, thereby protecting axon growth. Last but not least, we see proteases like carboxypeptidase A released by FcεRI activated MC detoxify an increasing number of venoms and endogenous toxins. A better understanding of the plasticity of MC will help to improve these advantageous effects, and hint on ways to cut down detrimental MC actions.

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Inter-laboratory variability in multiplexed pneumococcal antibody testing

Publication date: Available online 20 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): David C. LaFon, Moon H. Nahm

Summary

This pragmatic, updated assessment of variability among pneumococcal antibody assays suggests that variability may now be greater than previously reported, and potentially influential in clinical decision making.

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Clinical, imaging, and intervention factors associated with the upgrade of isolated flat epithelial atypia

Publication date: Available online 20 November 2018

Source: Clinical Imaging

Author(s): Erin Alencherry, Rakhee Goel, Sarah Gore, Cheryl Thompson, Christina Dubchuk, Philip Bomeisl, Hannah Gilmore, Kathryn Dyhdalo, Donna M. Plecha

Abstract

Purpose

This study aims to determine clinical, imaging, and intervention factors associated with the upgrade of flat epithelial atypia (FEA) diagnosed on vacuum-assisted biopsy (VAB) in order to formulate criteria for excision and better assist in management.

Methods

Between 2012 and 2015, 254 patients had a form of atypia diagnosed on ultrasound, MRI or stereotactic VAB and met eligibility for this study. Demographic, imaging, biopsy and pathology characteristics were analyzed for association with upgrade. We compared isolated FEA to all of the atypias grouped together.

Results

Of the 254 atypia lesions, 72 (28%) were isolated FEA, and the upgrade rate was 2.8% (2/72). Statistically significant factors present with upgrade of isolated FEA include personal history of breast cancer and cancer diagnosis on a concurrent separate core biopsy. Other factors associated with upgrade include first degree family history of breast cancer, segmental calcification distribution, extent of calcifications >2 cm, and <25% of calcifications removed on biopsy.

Conclusion

In patients with biopsy results of isolated FEA, in the absence of personal or first degree family history of breast cancer, cancer on a concurrent biopsy, segmental calcification distribution, extent of calcifications >2 cm, and only 0–24% calcifications removed on biopsy, patients may be safely followed with imaging, avoiding unnecessary excision.

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Classic metaphyseal lesion acquired during physical therapy

Publication date: Available online 20 November 2018

Source: Clinical Imaging

Author(s): Lynn M. Della Grotta, Megan B. Marine, Tara L. Harris, Boaz Karmazyn

Abstract

A classic metaphyseal lesion (CML) is highly specific for nonaccidental trauma. Missing CMLs can be devastating to the child as the child can continue to be exposed to inflicted trauma. Yet, there are rare case reports on CMLs that occur due to birth trauma, IV line placement, and treatment for clubfoot. We present a case of a CML in the tibia that occurred in the hospital secondary to physical therapy, that also caused a femoral shaft fracture, in a term child with hypertonic lower extremities secondary to myelomeningocele. Radiologists, as well as child abuse pediatricians, should be aware of the rare exception when CML is secondary to non-abusive injury.

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Prevalence, Characterization, and Impact of Voice Disorders in Fado Singers

Publication date: Available online 20 November 2018

Source: Journal of Voice

Author(s): Pedro Melo Pestana, Susana Vaz-Freitas, Maria Conceição Manso

Abstract

Introduction

Fado is a genre of urban folk music from Portugal characterized by some particularities. Some indictions in the study point this population of singers to be at higher risk of developing voice disorders.

Aim

This study aims to provide estimates of the prevalence of voice disorders in Fado singers, and to characterize the professional practice and the impact of voice disorders on their careers.

Methods

This is a cross sectional study based on a self-administered questionnaire split into six parts and 55 questions.

Results

A gender-balanced sample of 111 singers was achieved. Most of them recorded at least once. Winter and spring were found to be the most difficult seasons in which to sing. The overall prevalence of self-reported voice disorders was 39.6%, significantly higher in females. Almost all sought clinical guidance. Vocal fold nodules, functional dysphonia, and vocal fold polyp were the most common diagnoses. Vocal fatigue and hoarseness were the main symptoms reported. Nearly half of the singers had to cancel shows due to voice disorders.

Conclusion

Fado singers reveal both a relative high prevalence of voice disorders and related concerns, even though some discrepancies were found regarding other apparently similar singer populations. These results lead support the need for further investigation regarding the risk or protective factors influencing voice disorders.

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Stimulus-induced gamma power predicts the amplitude of the subsequent visual evoked response

Publication date: Available online 20 November 2018

Source: NeuroImage

Author(s): Mats W.J. van Es, Jan-Mathijs Schoffelen

Abstract

The efficiency of neuronal information transfer in activated brain networks may affect behavioral performance. Gamma-band synchronization has been proposed to be a mechanism that facilitates neuronal processing of behaviorally relevant stimuli. In line with this, it has been shown that strong gamma-band activity in visual cortical areas leads to faster responses to a visual go cue. We investigated whether there are directly observable consequences of trial-by-trial fluctuations in non-invasively observed gamma-band activity on the neuronal response. Specifically, we hypothesized that the amplitude of the visual evoked response to a go cue can be predicted by gamma power in the visual system, in the window preceding the evoked response. Thirty-three human subjects (22 female) performed a visual speeded response task while their magnetoencephalogram (MEG) was recorded. The participants had to respond to a pattern reversal of a concentric moving grating. We estimated single trial stimulus-induced visual cortical gamma power, and correlated this with the estimated single trial amplitude of the most prominent event-related field (ERF) peak within the first 100 ms after the pattern reversal. In parieto-occipital cortical areas, the amplitude of the ERF correlated positively with gamma power, and correlated negatively with reaction times. No effects were observed for the alpha and beta frequency bands, despite clear stimulus onset induced modulation at those frequencies. These results support a mechanistic model, in which gamma-band synchronization enhances the neuronal gain to relevant visual input, thus leading to more efficient downstream processing and to faster responses.

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Highlights from 2017: impactful topics published in the Annals of Nuclear Medicine

Abstract

The aim of the review is to highlight articles published in 2017 in the Annals of Nuclear Medicine, an official peer-reviewed journal of the Japanese Society of Nuclear Medicine. Among all published manuscripts during the past year, we conducted a subjective selection of the most relevant topics. Fourteen fascinating articles are included in this review, ranging in topic from preclinical to clinical arenas.

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C.R. Goldfarb, M. Chamarthy, F. Ongseng, S.R. Parmett, D.L. Bushnell, R. Mirtcheva-Trocheva, U. Sen, L.S. Zuckier. Nuclear Medicine Board Review: Questions and answers for self-assessment, 4th Edition

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18 F-FDGPET/CT in fever of unknown origin and inflammation of unknown origin: a Chinese multi-center study

Abstract

Purpose

To evaluate the clinical value of ¹⁸F-FDG-PET/CT for the diagnosis of fever of unknown origin (FUO) and inflammation of unknown origin (IUO) in Chinese population, as well as the characteristics of PET/CT in different category of etiological disease.

Methods

A total of 376 consecutive patients with FUO/IUO who underwent FDG-PET/CT at 12 hospitals were retrospectively studied. FDG uptake was quantitatively and visually evaluated, by using SUV_max and a 4-grade scale respectively. A questionnaire survey to the clinicians was used to evaluate the significance of PET/CT in diagnosing of FUO/IUO. Data analysis included the etiological distribution in the study population, image characteristics in different category of diseases, and clinical significance of PET/CT.

Results

In 376 studied patients, the infectious diseases accounted for 33.0% of patients, rheumatologic diseases for 32.4%, malignancies for 19.1%, miscellaneous causes for 6.6%, and cause unknown for 8.8%. However, the etiological distribution among hospitals was varied. In addition, the etiological disease composition ratio has changed over time in China. On PET/CT examinations, 358 (95.2%) of the patients had a positive finding. Within them, local high uptake lesion was found in 219 cases, and nonspecific abnormal uptake (NAU) was found in 187 cases. FDG uptake in malignant diseases was significantly higher than in other category diseases both on SUV_max and visual scores (t-value range from 4.098 to 5.612, all P value < 0.001). Based on a clinical questionnaire survey, PET/CT provided additional diagnostic information for 77.4% of patients, and 89.6% of patients benefited from PET/CT examination.

Conclusions

FDG PET/CT is a valuable tool for clinical diagnosis of FUO/IUO, and it is of great significance in further investigating the usefulness of PET/CT in non-neoplastic diseases.

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FDG PET/CT imaging in detecting and guiding management of invasive fungal infections: a retrospective comparison to conventional CT imaging

Abstract

Purpose

Invasive fungal infections (IFIs) are common in immunocompromised patients. While early diagnosis can reduce otherwise high morbidity and mortality, conventional CT has suboptimal sensitivity and specificity. Small studies have suggested that the use of FDG PET/CT may improve the ability to detect IFI. The objective of this study was to describe the proven and probable IFIs detected on FDG PET/CT at our centre and compare the performance with that of CT for localization of infection, dissemination and response to therapy.

Methods

FDG PET/CT reports for adults investigated at Peter MacCallum Cancer Centre were searched using keywords suggestive of fungal infection. Chart review was performed to describe the risk factors, type and location of IFIs, indication for FDG PET/CT, and comparison with CT for the detection of infection, and its dissemination and response to treatment.

Results

Between 2007 and 2017, 45 patients had 48 proven/probable IFIs diagnosed prior to or following FDG PET/CT. Overall 96% had a known malignancy with 78% being haematological. FDG PET/CT located clinically occult infection or dissemination to another organ in 40% and 38% of IFI patients, respectively. Of 40 patients who had both FDG PET/CT and CT, sites of IFI dissemination were detected in 35% and 5%, respectively (p < 0.001). Of 18 patents who had both FDG PET/CT and CT follow-up imaging, there were discordant findings between the two imaging modalities in 11 (61%), in whom normalization of FDG avidity of a lesion suggested resolution of active infection despite a residual lesion on CT.

Conclusion

FDG PET/CT was able to localize clinically occult infection and dissemination and was particularly helpful in demonstrating response to antifungal therapy.

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FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial

Abstract

Purpose

We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin's lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial.

Methods

We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors.

Results

Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p < 0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p < 0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p < 0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p < 0.01).

Conclusion

After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.

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Challenges are opportunities

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Correction to: Highlights from 2017: impactful topics published in the Annals of Nuclear Medicine

The author names in the original version of this article were inversed. Correct author names were reflected here.

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Value proposition of PSMA-targeted α–particle radioligand therapy in metastatic prostate cancer

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Outcome of patients with early-stage follicular lymphoma staged with 18 F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) and treated with radiotherapy alone

Abstract

Purpose/objective(s)

To evaluate the impact of positron emission tomography (PET) staging on overall survival (OS) and progression-free survival (PFS) in patients with early-stage (stages I and II) follicular lymphoma (ESFL) treated with radiation therapy alone.

Materials/methods

Eighty-five patients with ESFL treated with curative-intent radiation therapy (RT) between December 2000 and May 2011 were identified. Of those, 13 who had no PET staging and 25 who received additional systemic therapy were excluded from the analysis. Thus, we analyzed 47 patients with PET-staged ESFL treated with definitive radiation therapy alone (dose > 23Gy). Tumour features, pre-treatment computed tomography (CT) and PET stage, dose fractionation, and radiation therapy field extent were recorded. The Kaplan–Meier method was used to estimate the OS and PFS. Patterns of failure were assessed as cumulative incidences assuming competing risks.

Results

Median age was 57 years (range 24–83); 43% were females. Most were PET stage 1 (76.6%). Median maximum nodal diameter was 3 cm. Median pre-treatment lactate dehydrogenase (LDH) was 327.5 (range 123–607, upper normal limit = 220). Twenty-six patients (55.3%) had infra-diaphragmatic disease. All received 30–36Gy in 15–24 fractions, with 59.6% treated with involved-field radiation therapy (IFRT) techniques. There was no significant difference in PFS between CT stage I and stage II (HR 1.30 95% CI [0.25–6.72], p = 0.75) with a 5-year PFS of 77% and 78% respectively. However, stage I on PET staging had a significantly better PFS than stage II (HR 4.66 95% CI [1.15–18.8], p = 0.038), with 5-year PFS of 84% and 60% respectively. Ten patients had recurrent disease, with distant disease being the first site of failure in seven patients. Seven-year OS was 91% (95% CI 79–100) for the whole cohort.

Conclusion

FDG-PET should be considered an essential element in the evaluation of patients with ESFL being considered for RT.

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FDG-PET imaging to detect and characterize underlying causes of fever of unknown origin: an unavoidable path for the foreseeable future

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Salvage extended field or involved field nodal irradiation in 18 F-fluorocholine PET/CT oligorecurrent nodal failures from prostate cancer

Abstract

Purpose

The concept of metastasis-directed therapy for nodal oligorecurrences with stereotactic body radiotherapy is increasingly accepted. Hence, the comparison between salvage extended field radiotherapy (s-EFRT) and salvage involved field radiotherapy (s-IFRT) in patients with ¹⁸F-fluorocholine (FCH) PET/CT+ nodal oligorecurrences from prostate cancer is worthy of investigation.

Methods

Patients with oligorecurrent nodes on FCH PET/CT treated with salvage radiotherapy between 2009 and 2017 in a single tertiary cancer centre were selected for this study. Patients treated with s-IFRT were compared with those treated with s-EFRT. Toxicities and times to failure (TTF) were compared between the two groups.

Results

The study included 62 patients with positive lymph nodes only who underwent FCH PET/CT for a rising PSA level after radical prostatectomy or radiotherapy. Of these patients, 35 had s-IFRT and 27 had s-EFRT. After a median follow-up of 41.8 months (range 5.9–108.1 months), no differences were observed in acute or late gastrointestinal and genitourinary toxicities of grade 2 or more between the two groups. The 3-year failure rates were 55.3% (95% CI 37.0–70.3%) in the s-IFRT group and 88.3% (95% CI 66.9–96.1%) in the s-EFRT group (p = 0.0094). In multivariate analysis of TTF, an interval of >5 years was significantly correlated with better outcomes (HR = 0.33, 95% CI 0.13–0.86, p = 0.023). There was a strong trend toward better outcomes with s-EFRT even after adjusting for concomitant androgen-deprivation therapy (HR = 0.38, 95% CI 0.12–1.27, p = 0.116).

Conclusion

FCH PET-positive node-targeted s-EFRT is feasible with low rates of toxicity and longer TTF, suggesting that oligorecurrent nodal disease diagnosed on FCH PET is unlikely.

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68 Ga-PSMA-11 PET/CT in recurrent prostate cancer: efficacy in different clinical stages of PSA failure after radical therapy

Abstract

Objectives

The primary objective was the evaluation of Gallium 68 (⁶⁸Ga)-prostate-specific membrane antigen (PSMA)-11 positron emission tomography/computed tomography (PET/CT) detection rate, for identifying the site of prostate cancer (PCa) relapse (local vs systemic), stratifying the population according to different clinical stages of biochemical recurrence (BCR). Secondary aims were: 1) to evaluate the association of clinical/pathologic features and ⁶⁸Ga-PSMA-11 PET/CT detection rate, 2) to compare ⁶⁸Ga-PSMA-11 PET/CT with other imaging procedures, and 3) to evaluate the positive predictive value (PPV) in a per-patient analysis.

Material and methods

This population was enrolled through a prospective, open label, single-center trial performed at the Nuclear Medicine of the University Hospital of Bologna (Eudract: 2015-004589-27 OsSC). The inclusion criteria were: (1) proven PCa, (2) surgery or radiotherapy as definitive therapy, (3) proven BCR, (4) prostate-specific antigen (PSA) 0.2–2 ng/ml, (5) age ≥ 35 years, and 6() willing to sign an informed consent. Three-hundred and thirty-two (332) patients were enrolled between March 2016 and June 2017; mean/median PSA was 0.84/0.61 ng/ml, 97.9% (325/332) of patients received radical prostatectomy and 2.1% (7/332) radiotherapy. Different patterns of BCR were identified by referent physicians as follows: (a) persisting detectable PSA after radical prostatectomy in 13.5% (45/332) of patients (subgroup 1), (b) first-time PSA failure after radical therapy in 44.9% (149/332) (subgroup 2), and (c) PSA increase after salvage or hormonal therapy in 41.6% (138/332) (subgroup 3).

Results

Primary objective: ⁶⁸Ga-PSMA-11 PET/CT detection rate was 53.6% (CI 95% 48.1%–59.1%). In a patient-based analysis, disease confined to pelvis (prostate bed and/or lymph-nodes) was detected in 24.7% of cases (82/332). The presence of at least one distant lesion was observed in 28.9% of cases (96/332). The detection rate in different subgroups was: subgroup 1 = 64.5%, subgroup 2 = 45.6%, and subgroup-3  = 58.7%. Secondary objectives: 1) PSA (p = 0.041) and PSAdt (p = 0.001) showed association with ⁶⁸Ga-PSMA-11 PET/CT detection rate, and 2) correlative imaging was available in 73.2% of patients (243/332). When ⁶⁸Ga-PSMA-11 PET/CT was positive, correlative imaging resulted negative in 83% of cases (108/130). 3) The calculated PPV was 96.2%.

Conclusion

Our data confirmed the efficacy of ⁶⁸Ga-PSMA-11 PET/CT for detecting local vs systemic disease in PCa patients presenting PSA failure after radical therapy. Furthermore, ⁶⁸Ga-PSMA-11 PET/CT detection rate is different depending on the clinical stage of BCR, and this information should be taken into consideration by referring physicians.

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18 F-FDG PET/CT is useful for determining survival outcomes of patients with multiple myeloma classified as stage II and III with the Revised International Staging System

Abstract

Purpose

This study evaluated the prognostic role of ¹⁸F-FDG PET/CT at baseline in patients with newly diagnosed multiple myeloa (MM) and evaluated the prognostic relevance of ¹⁸F-FDG PET/CT for each stage according to the Revised International Staging System (R-ISS).

Method

We retrospectively analyzed the records of 167 patients with newly diagnosed MM. ¹⁸F-FDG PET/CT was performed prior to induction therapy in patients with newly diagnosed MM.

Results

In the total cohort, the presence of more than three hypermetabolic focal lesions (FLs) or extramedullary disease (EMD) on baseline PET/CT was associated with significantly inferior progression-free survival (PFS) and overall survival (OS) than other patients. Because most patients (91%) with EMD had more than three FLs, PET/CT positivity was defined as the presence of more than three FLs or the presence of EMD. In multivariate analyses, PET/CT positivity was an independent predictor of PFS and OS in all patients. Fifty-five patients (46.1%) with R-ISS II were PET/CT-positive at baseline and had significantly shorter PFS and OS. PET/CT positivity was also correlated with poor PFS and OS in patients with R-ISS III.

Conclusion

¹⁸F-FDG PET/CT was an independent predictor of survival outcomes in patients with newly diagnosed MM. In addition, performing ¹⁸F- FDG PET/CT at diagnosis may be useful for determining the survival outcomes of MM patients with R-ISS II and III.

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Initial clinical experience performing sialendoscopy for salivary gland protection in patients undergoing 225 Ac-PSMA-617 RLT

Abstract

Purpose

The main side effect of prostate-specific membrane antigen targeting alpha therapy (PSMA TAT) is dry mouth syndrome. Inflammation of the salivary glands and consequent reduced salivary function have been reported in patients after radioiodine therapy. The beneficial effects of sialendoscopy on radiation-induced inflammation in tissue are well known. Thus sialendoscopy with dilatation, saline irrigation and steroid injections (prednisolone) was performed before and after ²²⁵Ac-PSMA-617 TAT to reduce inflammatory effects in the salivary glands and to improve or prevent xerostomia.

Methods

Eleven men with metastatic castration-resistant prostate cancer (mean age 68.5 years, range 58–80 years) underwent sialendoscopy, dilatation, saline irrigation and steroid injection of both submandibular and both parotid glands before or after every cycle of ²²⁵Ac-PSMA-617 TAT. Sialendoscopy and steroid injection were performed by a senior ENT physician. Quality of life was evaluated using two health-related quality of life (HRQOL) questionnaires, the Xerostomia Questionnaire (XQ) and the Xerostomia Inventory (XI) before and 3 months after the intervention.

Results

In all 11 patients both parotid and both submandibular glands were affected by radiation sialadenitis and sialendoscopy was performed. The patients experienced no complications after sialendoscopy, and showed a significant improvement in HRQOL as measured using the XQ and XI. After sialendoscopy the XQ score decreased significantly from 77.7 ± 13.6 to 42.7 ± 14.8 (p = 0.003) and the XI score decreased from 44.5 ± 6.9 to 25.8 ± 12.8 (p = 0.003). Due to the limited number of patients we only report tendencies.

Conclusion

Sialendoscopy with dilatation, saline irrigation and steroid injection had beneficial effects on salivary gland function and HRQOL in patients undergoing ²²⁵Ac-PSMA-617 RLT. However, even with sialadenoscopic support after multiple cycles of TAT, salivary gland function was reduced and xerostomia was present. Therefore, not only inflammation but also the direct effect of radiation is a putative cause of dry mouth. Further research is necessary to determine the main side effects of PSMA TAT.

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68 Ga-PSMA-11 PET/CT in prostate cancer patients with biochemical recurrence after radical prostatectomy and PSA <0.5 ng/ml. Efficacy and impact on treatment strategy

Abstract

Purpose

The primary aim of this retrospective, single-centre analysis was to assess the performance of ⁶⁸Ga-PSMA-11 PET/CT in prostate cancer (PCa) patients in early PSA failure after radical prostatectomy (RP). The secondary aim was to assess the potential impact of ⁶⁸Ga-PSMA-11 PET/CT on treatment strategy.

Methods

⁶⁸Ga-PSMA-11 PET/CT is performed in our institution within an investigational new drug (IND) trial in PCa patients with biochemical recurrence (BCR). The records of all patients enrolled between March 2016 and July 2017 were evaluated. These records were retrospectively analysed according to the following inclusion criteria: (a) RP as primary therapy, (b) proven BCR, ©) PSA levels in the range 0.2–0.5 ng/ml at the time of the ⁶⁸Ga-PSMA-11 PET/CT investigation, and (d) no salvage radiotherapy (S-RT) performed after recurrence. The performance of ⁶⁸Ga-PSMA-11 PET/CT was evaluated in terms of detection rate on a per-patient and a per-region basis (local vs. distant lesions). We further performed an intention-to-treat (ITT) analysis. The patient cohort was grouped into three subpopulations, blinded to the ⁶⁸Ga-PSMA-11 PET/CT results, according to the patients' characteristics and different patterns of treatment: (1) S-RT (with or without systemic treatment), (2) stereotactic body radiotherapy (SBRT) (with or without systemic treatment), and (3) systemic treatment. The treatment strategy was re-evaluated for each patient taking into consideration the ⁶⁸Ga-PSMA-11 PET/CT images.

Results

We enrolled 119 PCa patients (mean age 66 years, range 44–78 years) with a mean PSA level at the time of ⁶⁸Ga-PSMA-11 PET/CT of 0.34 ng/ml (median 0.32 ng/ml, SD ±0.09, range 0.20–0.50 ng/ml). ⁶⁸Ga-PSMA-1 1 PET/CT was positive in 41 of the 119 patients, resulting in an overall detection rate of 34.4%. ⁶⁸Ga-PSMA-11 uptake was observed in the prostate bed (3 patients, 2.5%), in the pelvic lymph nodes (21, 17.6%), in the retroperitoneal lymph nodes (4, 3.4%) and in the skeleton (21, 17.6%). Regarding ITT, 81 patients (68.1%) were considered possible candidates for S-RT only in the prostate bed and none of the patients (0%) for SBRT. According to the ⁶⁸Ga-PSMA-11 PET/CT results, the intended treatment was changed in 36 patients (30.2%). According to the PET/CT results, S-RT was recommended in 70 patients (58.8%), only to the prostate bed in 58 (48.7%) and SBRT in 29 (24.4%). The intended RT planning was modified in 36 (87.8%) of 41 patients with a positive ⁶⁸Ga-PSMA-11 PET/CT result.

Conclusion

In our patient series with PSA levels <0.5 ng/ml, ⁶⁸Ga-PSMA-11 PET/CT had a detection rate of 34.4%. In the ITT analysis, 30.2% of patients had a change in the intended treatment. These data support the hypothesis that ⁶⁸Ga-PSMA-11 PET/CT is a useful procedure in the management of PCa patients showing early recurrence after RP, and should be implemented in routine clinical practice.

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High-Resolution Chest Computed Tomography Imaging of the Lungs: Impact of 1024 Matrix Reconstruction and Photon-Counting Detector Computed Tomography

Objectives The aim of this study was to evaluate if a high-resolution photon-counting detector computed tomography (PCD-CT) system with a 1024×1024 matrix reconstruction can improve the visualization of fine structures in the lungs compared with conventional high-resolution CT (HRCT). Materials and Methods Twenty-two adult patients referred for clinical chest HRCT (mean CTDI vol, 13.58 mGy) underwent additional dose-matched PCD-CT (mean volume CT dose index, 13.37 mGy) after written informed consent. Computed tomography images were reconstructed at a slice thickness of 1.5 mm and an image increment of 1 mm with our routine HRCT reconstruction kernels (B46 and Bv49) at 512 and 1024 matrix sizes for conventional energy-integrating detector (EID) CT scans. For PCD-CT, routine B46 kernel and an additional sharp kernel (Q65, unavailable for EID) images were reconstructed at 1024 matrix size. Two thoracic radiologists compared images from EID and PCD-CT noting the highest level bronchus clearly identified in each lobe of the right lung, and rating bronchial wall conspicuity of third- and fourth-order bronchi. Lung nodules were also compared with the B46/EID/512 images using a 5-point Likert scale. Statistical analysis was performed using a Wilcoxon signed rank test with a P

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