Salt-and-Pepper Noise Sign on Fat-Fraction Maps by Chemical-Shift-Encoded MRI: A Useful Sign to Differentiate Bone Islands From Osteoblastic Metastases-A Preliminary Study.
- 作者列表："Jeon SW","Kwack KS","Yun JS","Gho SM","Park S
:OBJECTIVE. The objective of our study was to assess the diagnostic utility of the "salt-and-pepper noise" sign on fat-fraction maps by chemical-shift-encoded MRI (CSE-MRI) compared with the halo sign on fat-suppressed T2-weighted imaging and mean attenuation on CT for differentiating bone islands from osteoblastic metastases. MATERIALS AND METHODS. Twenty-nine patients with 43 sclerotic vertebral bone marrow lesions (26 osteoblastic metastases, 17 bone islands) were included retrospectively. All patients underwent CT and MRI, including a CSE-MRI sequence on a 1.5-T MRI system, from November 2016 to January 2019. The salt-and-pepper noise sign was defined as the speckled appearance of white and black pixels that is similar to the appearance of background air on a fat-fraction map. ROC curves were analyzed to compare the diagnostic performance of the salt-and-pepper noise sign, halo sign, and mean CT attenuation between the two groups. RESULTS. The salt-and-pepper noise sign was significantly associated with bone islands (p < 0.001). The sensitivity, specificity, and accuracy for discriminating bone islands from osteoblastic metastases were 92.31-96.15%, 100%, and 95.35-97.67% for the salt-and-pepper noise sign; 88.46-92.31%, 88.24-94.12%, and 90.70% for the halo sign; and 96.15%, 94.12-100%, and 95.35-97.67% for mean CT attenuation, respectively. There was no statistically significant difference of diagnostic performances among the imaging characteristics for differentiating between bone islands and osteoblastic metastases (p > 0.05). Interobserver agreement for the salt-and-pepper noise sign, halo sign, and mean CT attenuation was almost perfect (κ ≥ 0.953, κ = 0.905, and ICC = 0.966, respectively). CONCLUSION. The salt-and-pepper noise sign is present in bone islands on fat-fraction maps by CSE-MRI and can aid in differentiating bone islands from osteoblastic metastases.
: 目的。我们研究的目的是通过化学位移编码MRI (CSE-MRI) 评估脂肪分数图上 “椒盐噪声” 标志的诊断效用与脂肪抑制T2-weighted成像上的晕征和CT上的平均衰减比较，用于鉴别骨岛和成骨转移瘤。材料和方法。回顾性纳入 29 例 43 个椎体硬化骨髓病变 (26 个成骨转移瘤，17 个骨岛)。所有pa t ien t s underwen t C T和MRI，包括 1.5-T MRI sys t em上的CSE-MRI序列，自 2016 年 11 月t o 2019 年 1 月。盐和胡椒噪声标志被定义为白色和黑色像素的斑点外观，类似于脂肪分数图上背景air的外观。分析ROC曲线，比较两组椒盐噪声征、晕征和平均CT衰减的诊断性能。结果。椒盐噪声征与骨岛显著相关 (p <0.001)。区分骨岛与成骨转移瘤的敏感性、特异性和准确性为椒盐噪声征的 92.31-96.15% 、 100% 和 95.35-97.67%; 88.46-92.31%，晕征分别为 88.24-94.12% 和 90.70%; 平均CT衰减分别为 96.15% 、 94.12-100% 和 95.35-97.67%。骨岛与骨转移瘤的影像学特征鉴别诊断差异无统计学意义 (p> 0.05)。盐和胡椒噪声征、晕征和平均CT衰减的观察者间一致性几乎完全 (κ ≥ 0.953，κ = 0.905，ICC = 0.966)。结论。通过CSE-MRI在脂肪分数图上的骨岛中存在椒盐噪声征，可帮助鉴别骨岛和成骨细胞转移。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.