The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation.

INTRODUCTION:: The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination. METHODS:: In a prospective cohort study, 92 cases were divided into 2 groups: "clinically cholesteatoma" ( n = 79) and "clinically no cholesteatoma" ( n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability. RESULTS:: The sensitivity and specificity were 89.3% and 75%, respectively, in the "clinically cholesteatoma" group and 0% and 100% in the "clinically no cholesteatoma" group. Non-EPI DW MRI had a positive predictive value of 98.5% when cholesteatoma was suspected clinically and a negative predictive value of 84.6% when cholesteatoma was not suspected clinically. CONCLUSION:: If cholesteatoma is suspected clinically, non-EPI DW MRI is not necessary. If there is no clinical suspicion of cholesteatoma in second-look situations, sensitivity is low and serial follow-up MRI with long intervals is advised.

Patupilone (epothilone B) for recurrent glioblastoma: clinical outcome and translational analysis of a single-institution phase I/II trial.

BACKGROUND: Patients with glioblastoma (GBM) inevitably develop recurrent or progressive disease after initial multimodal treatment and have a median survival of 6-9 months from time of progression. To date, there is no accepted standard treatment for GBM relapse or progression. Patupilone (EPO906) is a novel natural microtubule-stabilizing cytotoxic agent that crosses the blood-brain barrier and has been found to have preclinical activity in glioma models. METHODS: This is a single-institution, early-phase I/II trial of GBM patients with tumor progression who qualified for second surgery with the goal of evaluating efficacy and safety of the single-agent patupilone (10 mg/m(2), every 3 weeks). Patients received patupilone 1 week prior to second surgery and every 3 weeks thereafter until tumor progression or toxicity. Primary end points were progression-free survival (PFS) and overall survival (OS) at 6 months as well as patupilone concentration in tumor tissue. Secondary end points were toxicity, patupilone concentration in plasma and translational analyses for predictive biomarkers. RESULTS: Nine patients with a mean age of 54.6 ± 8.6 years were recruited between June 2008 and April 2010. Median survival and 1-year OS after second surgery were 11 months (95% CI, 5-17 months) and 45% (95% CI, 14-76), respectively. Median PFS was 1.5 months (95% CI, 1.3-1.7 months) and PFS6 was 22% (95% CI, 0-46), with 2 patients remaining recurrence-free at 9.75 and 22 months. At the time of surgery, the concentration of patupilone in tumor tissue was 30 times higher than in the plasma. Tumor response was not predictable by the tested biomarkers. Treatment was generally well tolerated with no hematological, but cumulative, though reversible sensory neuropathy grade ≤3 was seen in 2 patients (22%) at 8 months and grade 4 diarrhea in the 2nd patient (11%). Non-patupilone-related peri-operative complications occurred in 2 patients resulting in discontinuation of patupilone therapy. There were no neurocognitive changes 3 months after surgery compared to baseline. CONCLUSIONS: In recurrent GBM, patupilone can be given safely pre- and postoperatively. The drug accumulates in the tumor tissue. The treatment results in long-term PFS in some patients. Patupilone represents a valuable novel compound which deserves further evaluation in combination with radiation therapy in patients with GBM.

[Percutaneous vertebroplasty: methods, indications, results]. / Perkután vertebroplasztika: módszer, indikációk, eredmények.

Percutaneous vertebroplasty (PVP) is a radiologically guided therapeutic procedure, which consists of percutaneous injection of a liquid polymer (bone cement) into a destroyed vertebral body. PVP was invented in 1984, in France, first for treating vertebral body haemangioma. Since its introduction the indications have been expanded progressively and today PVP is indicated mainly for treatment of vertebral haemangioma, malignant vertebral tumor and osteoporotic vertebral compression fracture. The unique advantage of this technique is that besides the stabilization of the vertebral body--and partly in connection with this--it affords prompt and lasting pain relief. Based on published data the success rate of the procedure is 80-100% with a complication rate of 1-10%. Thus, PVP is a valuable minimally invasive tool, providing immediate pain relief and early mobility in carefully selected patients. However, further work is needed to define the benefits of PVP compared to the standard treatment. The purpose of this paper is to demonstrate the technique by analyzing scientific reports published to date and summarizing the first author's own experience gained at the University Hospital of Geneva, Department of Neuroradiology, Switzerland.