Accuracy of gross tumour volume delineation with [68Ga]-PSMA-PET compared to histopathology for high-risk prostate cancer.

BACKGROUND: The delineation of intraprostatic lesions is vital for correct delivery of focal radiotherapy boost in patients with prostate cancer (PC). Errors in the delineation could translate into reduced tumour control and potentially increase the side effects. The purpose of this study is to compare PET-based delineation methods with histopathology. MATERIALS AND METHODS: The study population consisted of 15 patients with confirmed high-risk PC intended for prostatectomy. [68Ga]-PSMA-PET/MR was performed prior to surgery. Prostate lesions identified in histopathology were transferred to the in vivo [68Ga]-PSMA-PET/MR coordinate system. Four radiation oncologists manually delineated intraprostatic lesions based on PET data. Various semi-automatic segmentation methods were employed, including absolute and relative thresholds, adaptive threshold, and multi-level Otsu threshold. RESULTS: The gross tumour volumes (GTVs) delineated by the oncologists showed a moderate level of interobserver agreement with Dice similarity coefficient (DSC) of 0.68. In comparison with histopathology, manual delineations exhibited the highest median DSC and the lowest false discovery rate (FDR) among all approaches. Among semi-automatic approaches, GTVs generated using standardized uptake value (SUV) thresholds above 4 (SUV > 4) demonstrated the highest median DSC (0.41), with 0.51 median lesion coverage ratio, FDR of 0.66 and the 95th percentile of the Hausdorff distance (HD95%) of 8.22 mm. INTERPRETATION: Manual delineations showed a moderate level of interobserver agreement. Compared to histopathology, manual delineations and SUV > 4 exhibited the highest DSC and the lowest HD95% values. The methods that resulted in a high lesion coverage were associated with a large overestimation of the size of the lesions.

Pandemic impacts on public transport safety and stress perceptions in Nordic cities.

COVID-19 has brought severe disruption and demand suppression to mobility, especially to public transport (PT). A key challenge now is to restore trust that PT is safe again. This paper investigates pandemic impacts on PT safety and stress perceptions in three Nordic cities, drawing on 2018 and 2020 survey data analysed in structural equation models. While finding modest pandemic effects on safety and stress perceptions overall, strong heterogeneities exist across gender, age and geographic categories. Women perceive less PT safety and more stress, especially during the pandemic. Older adults reduced PT more during the pandemic and perceived no stress reduction like younger adults. Stockholm travellers feel less safe and more stressed than in Oslo and Bergen, whilst pandemic PT use and perceived safety reductions are least in Bergen. The paper discusses the long-term implications for theory and policy across multiple mobility scenarios accounting for modal change and travel demand uncertainties.

Pre-contrast T1 and cartilage thickness as confounding factors in dGEMRIC when evaluating human cartilage adaptation to physical activity.

BACKGROUND: The dGEMRIC (delayed Gadolinium-Enhanced MRI of Cartilage) technique has been used in numerous studies for quantitative in vivo evaluation of the relative glycosaminoglycan (GAG) content in cartilage. The purpose of this study was to determine the influence of pre-contrast T1 and cartilage thickness when assessing knee joint cartilage quality with dGEMRIC. METHODS: Cartilage thickness and T1 relaxation time were measured in the central part of the femoral condyles before and two hours after intravenous Gd-DTPA2- administration in 17 healthy volunteers from a previous study divided into two groups: 9 sedentary volunteers and 8 exercising elite runners. Results were analyzed in superficial and a deep weight-bearing, as well as in non-weight-bearing regions of interest. RESULTS: In the medial compartment, the cartilage was thicker in the exercising group, in weight-bearing and non-weight-bearing segments. In most of the segments, the T1 pre-contrast value was longer in the exercising group compared to the sedentary group. Both groups had a longer pre-contrast T1 in the superficial cartilage than in the deep cartilage. In the superficial cartilage, the gadolinium concentration was independent of cartilage thickness. In contrast, there was a linear correlation between the gadolinium concentration and cartilage thickness in the deep cartilage region. CONCLUSION: Cartilage pre-contrast T1 and thickness are sources of error in dGEMRIC that should be considered when analysing bulk values. Our results indicate that differences in cartilage structure due to exercise and weight-bearing may be less pronounced than previously demonstrated.

Variable flip angle 3D ultrashort echo time (UTE) T1 mapping of mouse lung: A repeatability assessment.

BACKGROUND: Lung T1 is a potential translational biomarker of lung disease. The precision and repeatability of variable flip angle (VFA) T1 mapping using modern 3D ultrashort echo time (UTE) imaging of the whole lung needs to be established before it can be used to assess response to disease and therapy. PURPOSE: To evaluate the feasibility of regional lung T1 quantification with VFA 3D-UTE and to investigate long- and short-term T1 repeatability in the lungs of naive mice. STUDY TYPE: Prospective preclinical animal study. POPULATION: Eight naive mice and phantoms. FIELD STRENGTH/SEQUENCE: 3D free-breathing radial UTE (8 µs) at 4.7T. ASSESSMENT: VFA 3D-UTE T1 calculations were validated against T1 values measured with inversion recovery (IR) in phantoms. Lung T1 and proton density (S0 ) measurements of whole lung and muscle were repeated five times over 1 month in free-breathing naive mice. Two consecutive T1 measurements were performed during one of the imaging sessions. STATISTICAL TESTS: Agreement in T1 between VFA 3D-UTE and IR in phantoms was assessed using Bland-Altman and Pearson 's correlation analysis. The T1 repeatability in mice was evaluated using coefficient of variation (CV), repeated-measures analysis of variance (ANOVA), and paired t-test. RESULTS: Good T1 agreement between the VFA 3D-UTE and IR methods was found in phantoms. T1 in lung and muscle showed a 5% and 3% CV (1255 ± 63 msec and 1432 ± 42 msec, respectively, mean ± SD) with no changes in T1 or S0 over a month. Consecutive measurements resulted in an increase of 2% in both lung T1 and S0 . DATA CONCLUSION: VFA 3D-UTE shows promise as a reliable T1 mapping method that enables full lung coverage, high signal-to-noise ratio (∼25), and spatial resolution (300 µm) in freely breathing animals. The precision of the VFA 3D-UTE method will enable better design and powering of studies. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Knee dGEMRIC at 7 T: comparison against 1.5 T and evaluation of T1-mapping methods.

BACKGROUND: dGEMRIC (delayed Gadolinium Enhanced Magnetic Resonance Image of Cartilage) is a well-established technique for cartilage quality assessment in osteoarthritis at clinical field strengths. The method is robust, but requires injection of contrast agent and a cumbersome examination procedure. New non-contrast-agent-based techniques for cartilage quality assessment are currently being developed at 7 T. However, dGEMRIC remains an important reference technique during this development. The aim of this work was to compare T1 mapping for dGEMRIC at 7 T and 1.5 T, and to evaluate three T1-mapping methods at 7 T. METHODS: The knee of 10 healthy volunteers and 9 patients with early signs of cartilage degradation were examined at 1.5 T and 7 T after a single (one) contrast agent injection (Gd-(DTPA)2-). Inversion recovery (IR) sequences were acquired at both field strengths, and at 7 T variable flip angle (VFA) and Look-Locker (LL) sequences were additionally acquired. T1 maps were calculated and average T1 values were estimated within superficial and deep regions-of-interest (ROIs) in the lateral and medial condyles, respectively. RESULTS: T1 values were 1.8 (1.4-2.3) times longer at 7 T. A strong correlation was detected between 1.5 T and 7 T T1 values (r = 0.80). For IR, an additional inversion time was required to avoid underestimation (bias±limits of agreement - 127 ± 234 ms) due to the longer T1 values at 7 T. Out of the two 3D sequences tested, LL resulted in more accurate and precise T1 estimation compared to VFA (average bias±limits of agreement LL: 12 ± 202 ms compared to VFA: 25 ± 622 ms). For both, B1 correction improved agreement to IR. CONCLUSION: With an adapted sampling scheme, dGEMRIC T1 mapping is feasible at 7 T and correlates well to 1.5 T. If 3D is to be used for T1 mapping of the knee at 7 T, LL is preferred and VFA is not recommended. For VFA and LL, B1 correction is necessary for accurate T1 estimation.

Using C-Arm X-ray images from marker insertion to confirm the gold fiducial marker identification in an MRI-only prostate radiotherapy workflow.

Prostate cancer radiotherapy workflows, solely based on magnetic resonance imaging (MRI), are now in clinical use. In these workflows, intraprostatic gold fiducial markers (GFM) show similar signal behavior as calcifications and bleeding in T2-weighted MRI-images. Accurate GFM identification in MRI-only radiotherapy workflows is therefore a major challenge. C-arm X-ray images (CkV-images), acquired at GFM implantation, could provide GFM position information and be used to confirm correct identification in T2-weighted MRI-images. This would require negligible GFM migration between implantation and MRI-imaging. Marker migration was therefore investigated. The aim of this study was to show the feasibility of using CkV-images to confirm GFM identification in an MRI-only prostate radiotherapy workflow. An anterior-posterior digitally reconstructed radiograph (DRR)-image and a mirrored posterior-anterior CkV-image were acquired two weeks apart for 16 patients in an MRI-only radiotherapy workflow. The DRR-image originated from synthetic CT-images (created from MRI-images). A common image geometry was defined between the DRR- and CkV-image for each patient. A rigid registration between the GFM center of mass (CoM) coordinates was performed and the distance between each of the GFM in the DRR- and registered CkV-image was calculated. The same methodology was used to assess GFM migration for 31 patients in a CT-based radiotherapy workflow. The distance calculated was considered a measure of GFM migration. A statistical test was performed to assess any difference between the cohorts. The mean absolute distance difference for the GFM CoM between the DRR- and CkV-image in the MRI-only cohort was 1.7 ± 1.4 mm. The mean GFM migration was 1.2 ± 0.7 mm. No significant difference between the measured total distances of the two cohorts could be detected (P = 0.37). This demonstrated that, a C-Arm X-ray image acquired from the GFM implantation procedure could be used to confirm GFM identification from MRI-images. GFM migration was present but did not constitute a problem.

Cone beam CT for QA of synthetic CT in MRI only for prostate patients.

PURPOSE: Magnetic resonance imaging (MRI)-only radiotherapy is performed without computed tomography (CT). A synthetic CT (sCT) is used for treatment planning. The aim of this study was to develop a clinically feasible quality assurance (QA) procedure for sCT using the kV-cone beam CT (CBCT), in an MRI-only workflow for prostate cancer patients. MATERIAL AND METHOD: Three criteria were addressed; stability in Hounsfield Units (HUs), deviations in HUs between the CT and CBCT, and validation of the QA procedure. For the two first criteria, weekly phantom measurements were performed. For the third criteria, sCT, CT, and CBCT for ten patients were used. Treatment plans were created based on the sCT (MriPlannerTM ). CT and CBCT images were registered to the sCT. The treatment plan was copied to the CT and CBCT and recalculated. Dose-volume histogram (DVH) metrics were used to evaluate dosimetric differences between the sCT plan and the recalculated CT and CBCT plans. HU distributions in sCT, CT, and CBCT were compared. Well-defined errors were introduced in the sCT for one patient to evaluate efficacy of the QA procedure. RESULTS: The kV-CBCT system was stable in HU over time (standard deviation <40 HU). Variation in HUs between CT and CBCT was <60 HU. The differences between sCT-CT and sCT-CBCT dose distributions were below or equal to 1.0%. The highest mean dose difference for the CT and CBCT dose distribution was 0.6%. No statistically significant difference was found between total mean dose deviations from recalculated CT and CBCT plans, except for femoral head. Comparing HU distributions, the CBCT appeared to be similar to the CT. All introduced errors were identified by the proposed QA procedure, except all tissue compartments assigned as water. CONCLUSION: The results in this study shows that CBCT can be used as a clinically feasible QA procedure for MRI-only radiotherapy of prostate cancer patients.

Influence of age and sex on the longitudinal relaxation time, T1, of the lung in healthy never-smokers.

BACKGROUND: As several studies have provided evidence that lung disease affects the T1 of the human lung, our purpose was to investigate the effect of age on the T1-relaxation time in the lungs of healthy never-smokers, including group difference between sexes. MATERIALS AND METHODS: The Snapshot FLASH pulse sequence (inversion recovery with multiple gradient echo read-outs) was used to quantify lung T1 in 30 healthy never-smoking volunteers at 1.5 Tesla. Measurements were performed under breathhold of a tidal inspiration. Additionally, subjects underwent clinical MRI and pulmonary function tests. A linear regression model of T1 as a function of age and sex was tested. RESULTS: The slope of lung T1 at tidal end-inspiration as a function of age was statistically different between males and females (P < 0.001). In a linear regression model of T1 as a function of age and sex, females have slope of -4.1 ms/year (95% confidence interval [CI], [-5.2, -3.0]) at P < 0.001, and males -0.064 ms/year (95% CI, [-1.2, 1.1]) at P = 0.9, with a whole model R(2) = 0.83. CONCLUSION: The observed dependencies of lung T1 on age and sex are here attributed to a previously reported difference in blood T1 between sexes, and a previously reported decrease of pulmonary blood volume with increasing age. This may have implications for the interpretation of lung T1 measurements in both healthy individuals and patients.

COPD Patients Have Short Lung Magnetic Resonance T1 Relaxation Time.

Magnetic resonance imaging (MRI) may provide attractive biomarkers for assessment of pulmonary disease in clinical trials as it is free from ionizing radiation, minimally invasive and allows regional information. The aim of this study was to characterize lung MRI T1 relaxation time as a biomarker of chronic obstructive pulmonary disease (COPD); and specifically its relationship to smoking history, computed tomography (CT), and pulmonary function test (PFT) measurements in comparison to healthy age-matched controls. Lung T1 and inter-quartile range (IQR) of T1 maps from 24 COPD subjects and 12 healthy age-matched non-smokers were retrospectively analyzed from an institutional review board approved study. The subjects underwent PFTs and two separate MR imaging sessions at 1.5 tesla to test T1 repeatability. CT scans were performed on the COPD subjects. T1 repeatability (intraclass correlation coefficient) was 0.72 for repeated scans acquired on two visits. The lung T1 was significantly shorter (p < 0.0001) and T1 IQR was significantly larger (p = 0.0002) for the COPD subjects compared to healthy controls. Lung T1 significantly (p = 0.001) correlated with lung density assessed with CT. Strong significant correlations (p < 0.0001) between lung T1 and all PFT measurements were observed. Cigarette exposure did not correlate with lung T1 in COPD subjects. In conclusion, lung MRI T1 mapping shows potential as a repeatable, radiation free, non-invasive imaging technique in the evaluation of COPD.

Evaluation of a deep learning magnetic resonance imaging reconstruction method for synthetic computed tomography generation in prostate radiotherapy.

Background and Purpose: In magnetic resonance imaging (MRI) only radiotherapy computed tomography (CT) is excluded. The method relies entirely on synthetic CT images generated from MRI. This study evaluates the compatibility of a commercial synthetic CT (sCT) with an accelerated commercial deep learning reconstruction (DLR) in MRI-only prostate radiotherapy. Materials and Methods: For a group of 24 patients (cohort 1) the effects of DLR were studied in isolation. MRI data were reconstructed conventionally and with DLR from identical k-space data, and sCTs were generated for both reconstructions. The sCT quality, Hounsfield Unit (HU) and dosimetric impact were investigated. In another group of 15 patients (cohort 2) effects on sCT generation using accelerated MRI acquisition (40 % time reduction) reconstructed with DLR were investigated. Results: sCT images from both cohorts, generated from DLR MRI data, were of clinically expected image quality. The mean dose differences for targets and organs at risks in cohort 1 were <0.06 Gy, corresponding to a 0.1 % prescribed dose difference. Similar dose differences were observed in cohort 2. Gamma pass rates for cohort 1 were 100 % for criteria 3 %/3mm, 2 %/2mm and 1 %/1mm for all dose levels. Mean error and mean absolute error inside the body, between sCTs, averaged over all cohort 1 subjects, were -1.1 ± 0.6 [-2.4 0.2] and 2.9 ± 0.4 [2.3 3.9] HU, respectively. Conclusions: DLR was suitable for sCT generation with clinically negligible differences in HU and calculated dose compared to the conventional MRI reconstruction method. For sCT generation DLR enables scan time reduction, without compromised sCT quality.

In vivo MRI and PET imaging in a translational ILD mouse model expressing non-resolving fibrosis and bronchiectasis-like pathology after repeated systemic exposure to bleomycin.

Drug-induced interstitial lung disease (ILD) is crucial to detect early to achieve the best treatment outcome. Optimally, non-invasive imaging biomarkers can be used for early detection of disease progression and treatment follow-up. Therefore, reliable in vivo models are warranted in new imaging biomarker development to accelerate better-targeted treatment options. Single-dose bleomycin models have, for a long time, served as a reference model in fibrosis and lung injury research. Here, we aimed to use a clinically more relevant animal model by systemic exposure to bleomycin and assessing disease progression over time by combined magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging. Methods: C57BL/6 mice received bleomycin (i.p. 35iU/kg) or saline as control twice per week for 4 weeks. Mice were monitored until 2 weeks after cessation of bleomycin administration (w4 + 1 and w4 + 2), referred to as the resting period. MRI scans were performed in weeks 3 and 4 and during the resting weeks. [18F]FDG-PET was performed at the last week of dosing (w4) and 2 weeks after the last dosing (w4 + 2). Lung tissue sections were stained with Masson's trichrome and evaluated by modified Ashcroft scoring. Lung volume and lesion volumes were assessed using MRI, as well as 3D mapping of the central airways. Results and discussion: Bleomycin-challenged mice showed increased lung weights (p < 0.05), while total lung volume was unchanged (w4 and onward). Histology analysis demonstrated fibrotic lesions emanating from the distal parts of the lung. Fibrosis progression was visualized by MRI with significantly increased high signal in bleomycin-exposed lungs compared to controls (p < 0.05). In addition, a significant increase in central airway diameter (p < 0.01) was displayed in bleomycin-exposed animals compared to controls and further continued to dilate as the disease progressed, comparing the bleomycin groups over time (p < 0.05-0.001). Lung [18F]FDG uptake was significantly elevated in bleomycin-exposed mice compared to controls (p < 0.05). Conclusion: Non-invasive imaging displayed progressing lesions in the lungs of bleomycin-exposed mice, using two distinct MRI sequences and [18F]FDG-PET. With observed fibrosis progression emanating from distal lung areas, dilation of the central airways was evident. Taken together, this chronic bleomycin-exposure model is translationally more relevant for studying lung injury in ILD and particularly in the context of DIILD.

Nowhere to go - Effects on elderly's travel during Covid-19.

The COVID-19 pandemic has presented numerous, significant challenges for elderly in their daily life. In order to reach a deeper understanding of the feelings and thoughts of the elderly related to their possibilities to travel and engage in activities during the pandemic, this study takes a qualitative approach to exploring the views of the elderly themselves. The study focuses on experiences during the COVID-19 pandemic. A number of in-depth semi-structured interviews with elderly aged 70 and above, were conducted in June 2020. Applied Thematic Analysis (ATA) was applied, as a first stage, to investigate meaningful segments of data. In a second stage these identified segments were combined into a number of themes. This study reports the outcome of the ATA analysis. More specifically we report experiences, motivations and barriers for travel and activity participation, and discuss how these relate to the health and well-being of elderly, and vice versa. These findings highlight the strong need to develop a transport system that to a higher extent addresses the physical as well as the mental health of old people, with a particular focus on facilitating social interactions.

Geometric impact and dose estimation of on-patient placement of a lightweight receiver coil in a clinical magnetic resonance imaging-only radiotherapy workflow for prostate cancer.

Background and Purpose: For pelvic magnetic resonance imaging (MRI)-only radiotherapy the use of receiver coil bridges (CB) is recommended to avoid deformation of the patient. Development in coil technology has enabled lightweight, flexible coils. In this work we evaluate the effects of a lightweight coil in a pelvic MRI-only radiotherapy workflow. Materials and Methods: Twenty-one patients, referred to prostate MRI-only radiotherapy, were included. Images were acquired with and without CB. Anatomical deformation from the on-patient coil placement was measured in the anterior-posterior (AP) and left-right (LR) direction. The change in signal-to-noise ratio (SNR) was measured in phantom and in vivo.The clinical treatment plan, created on the image with CB, was transferred and recalculated on the image without the CB. Dose metrics for the targets (planning- and clinical target volume) and organs at risks (OAR) were analyzed. Results: There was a statistically significant increase in SNR in-vivo (median 21 %, p = 0.002) when removing the CB. Anatomical differences after removing the CB in patients were -1.5 mm in AP (median change) and + 2.5 mm in LR direction. Dosimetric differences for the target structures were clinically negligible, but statistically significant. The difference in target mean doses were 0.2 % (both p = 0.004) of the prescribed dose. No dosimetric differences were observed for the OAR, except for the penile bulb. Conclusions: We concluded that anatomical change and dosimetric differences, originating from scanning without CB were minor. The CB can thereby be removed from the workflow, enabling easier patient positioning and increased SNR when using lightweight coils.

MRI-only radiotherapy from an economic perspective: Can new techniques in prostate cancer treatment be cost saving?

Background and Purpose: The aim of this study was to analyze a magnetic resonance imaging (MRI)-only radiotherapy workflow from an economic perspective in terms of reduced time, costs and systematic uncertainties. Material/Methods: A documented Swedish clinical implementation of MRI-only radiotherapy was used as template for cost assessments compared to a combined computed tomography (CT)/MRI workflow. The costs were taken from official regional price lists from 2021. MRI-only specific quality assurance (QA) was assumed necessary in an initial phase. Treatment plans for target volumes with margins of 5-10 mm were created for ten prostate cancer patients prescribed 78 Gy in 39 fractions. The risk of Grade ≥ 2 rectal toxicity or rectal bleeding was calculated using the QUANTEC recommended NTCP model and costs estimated based on subsequent diagnostic examinations. Results: The exclusion of the CT-examination and faster target delineation were the main contributors to cost reductions. Additional QA procedures limited the initial cost reduction to 14 EUR/patient. Long-term MRI-only reduced the costs by 209 EUR/patient. Reducing margins resulted in Grade ≥ 2 rectal toxicity or rectal bleeding probability of 9.7 % for 7 mm margin and 6.0 % for 5 mm margin. This margin reduction resulted in an additional cost reduction of 46 EUR/patient. Conclusion: An MRI-only workflow implementation is associated with reduced costs when the workflow tasks are more time efficient and side effects are reduced as a result of margin reduction. The short-term economic benefits are limited due to extra costs of QA procedures. The economic benefits of MRI-only will make impact first when the workflow is well established, and margin reduction has been included.

A texture analysis approach to quantify ventilation changes in hyperpolarised ³He MRI of the rat lung in an asthma model.

In preclinical research, allergic asthma is investigated in rats sensitised with the antigen ovalbumin (OVA), followed by a challenge with aerosolised OVA to induce an inflammatory reaction of the lower airways. This causes diffuse, nonfocal ventilation defects that lead to heterogeneously distributed signal intensities in hyperpolarised (HP) (3)He MR images, which are difficult to assess directly by diagnostic grading or volumetry. Texture analysis can characterise these changes and does not require segmentation of the lung structures prior to the analysis. The aim of this work was to evaluate a texture analysis approach to quantify changes in lung ventilation in HP (3)He MRI of OVA-challenged rats. OVA-challenged animals were treated with two different compound doses to evaluate the sensitivity of the texture analysis. Four groups were investigated using HP (3)He MRI at 4.7 T: controls, vehicle-treated, and low- and high-dose budesonide-treated rats. In addition, broncho-alveolar lavage was performed and the eosinophil cell count was used as a biological reference marker. First-order texture, geometrical features and features based on second-order statistics using run-length and grey-level co-occurrence matrices were calculated. In addition, wavelet transforms were applied to compute first-order statistics on multiple scales. The texture analysis was able to show significant differences between the control and untreated vehicle groups as well as between the vehicle and treatment groups. This is in agreement with the findings of the eosinophil cell counts, which were used as a marker for the severity of inflammation. However, not all features used in the different texture analysis methods could differentiate between the treatment groups. In conclusion, texture analysis can be used to quantify changes in lung ventilation as measured with HP (3)He MRI after therapeutic intervention with budesonide.

Favorable fatty acid composition in adipose tissue in healthy Iraqi- compared to Swedish-born men - a pilot study using MRI assessment.

Middle Eastern immigrants are at high-risk for insulin resistance. Fatty acid composition (FAC) plays an important role in the development of insulin resistance but has not been investigated in people of Middle Eastern ancestry. Here, the aim was to assess the FAC in visceral and subcutaneous adipose tissue (VAT and SAT) in healthy Iraqi- and Swedish-born men using a magnetic resonance imaging (MRI) method.This case-control study included 23 Iraqi- and 15 Swedish-born middle-aged men, without cardiometabolic disease. Using multi-echo MRI of the abdomen, the fractions of saturated, monounsaturated, and polyunsaturated fatty acids (fSFA, fMUFA, and fPUFA) were estimated in VAT and SAT. SAT was further analyzed in deep and superficial compartments (dSAT and sSAT).In all depots, fPUFA was significantly higher and fSFA significantly lower in Iraqi men, independently of age and BMI. In both Iraqi- and Swedish-born men, higher fPUFA and lower fMUFA were found in sSAT vs. dSAT. Among Iraqi men only, higher fPUFA and lower fMUFA were found in SAT vs. VAT.Iraqi-born men presented a more favorable abdominal FAC compared to Swedish-born men. This MRI method also revealed different FACs in different abdominal depots. Our results may reflect a beneficial FAC in Middle Eastern immigrants.

Tensor-valued diffusion magnetic resonance imaging in a radiotherapy setting.

Background and purpose: Diagnostic information about cell density variations and microscopic tissue anisotropy can be gained from tensor-valued diffusion magnetic resonance imaging (MRI). These properties of tissue microstructure have the potential to become novel imaging biomarkers for radiotherapy response. However, tensor-valued diffusion encoding is more demanding than conventional encoding, and its compatibility with MR scanners that are dedicated to radiotherapy has not been established. Thus, our aim was to investigate the feasibility of tensor-valued diffusion MRI with radiotherapy dedicated MR equipment. Material and methods: A tensor-valued diffusion protocol was implemented, and five healthy volunteers were scanned with different resolutions using conventional head coil and radiotherapy coil setup with fixation masks. Signal-to-noise-ratio (SNR) was evaluated to assess the risk of signal bias due to rectified noise floor. We also evaluated the repeatability and reproducibility of the microstructure parameters. One patient with brain metastasis was scanned to investigate the image quality and the transferability of the setup to diseased tissue. Results: A resolution of 3 × 3 × 3 mm3 provided images with SNR > 3 for 93 % of the voxels using radiotherapy coil setup. The parameter maps and repeatability characteristics were comparable to those observed with a conventional head coil. The patient evaluation demonstrated successful parameter analysis also in tumor tissue, with SNR > 3 for 93 % of the voxels. Conclusion: We demonstrate that tensor-valued diffusion MRI is compatible with radiotherapy fixation masks and coil setup for investigations of microstructure parameters. The reported reproducibility may be used to plan future investigations of imaging biomarkers in brain cancer radiotherapy.

Pelvic U-Net: multi-label semantic segmentation of pelvic organs at risk for radiation therapy anal cancer patients using a deeply supervised shuffle attention convolutional neural network.

BACKGROUND: Delineation of organs at risk (OAR) for anal cancer radiation therapy treatment planning is a manual and time-consuming process. Deep learning-based methods can accelerate and partially automate this task. The aim of this study was to develop and evaluate a deep learning model for automated and improved segmentations of OAR in the pelvic region. METHODS: A 3D, deeply supervised U-Net architecture with shuffle attention, referred to as Pelvic U-Net, was trained on 143 computed tomography (CT) volumes, to segment OAR in the pelvic region, such as total bone marrow, rectum, bladder, and bowel structures. Model predictions were evaluated on an independent test dataset (n = 15) using the Dice similarity coefficient (DSC), the 95th percentile of the Hausdorff distance (HD95), and the mean surface distance (MSD). In addition, three experienced radiation oncologists rated model predictions on a scale between 1-4 (excellent, good, acceptable, not acceptable). Model performance was also evaluated with respect to segmentation time, by comparing complete manual delineation time against model prediction time without and with manual correction of the predictions. Furthermore, dosimetric implications to treatment plans were evaluated using different dose-volume histogram (DVH) indices. RESULTS: Without any manual corrections, mean DSC values of 97%, 87% and 94% were found for total bone marrow, rectum, and bladder. Mean DSC values for bowel cavity, all bowel, small bowel, and large bowel were 95%, 91%, 87% and 81%, respectively. Total bone marrow, bladder, and bowel cavity segmentations derived from our model were rated excellent (89%, 93%, 42%), good (9%, 5%, 42%), or acceptable (2%, 2%, 16%) on average. For almost all the evaluated DVH indices, no significant difference between model predictions and manual delineations was found. Delineation time per patient could be reduced from 40 to 12 min, including manual corrections of model predictions, and to 4 min without corrections. CONCLUSIONS: Our Pelvic U-Net led to credible and clinically applicable OAR segmentations and showed improved performance compared to previous studies. Even though manual adjustments were needed for some predicted structures, segmentation time could be reduced by 70% on average. This allows for an accelerated radiation therapy treatment planning workflow for anal cancer patients.

Correction: Lättman, K., et al. Perceived Accessibility, Satisfaction with Daily Travel, and Life Satisfaction among the Elderly. Int. J. Environ. Res. Public Health 2019, 16, 4498.

There were errors in the original article [...].

Prospective Clinical Feasibility Study for MRI-Only Brain Radiotherapy.

OBJECTIVES: MRI-only radiotherapy (RT) provides a workflow to decrease the geometric uncertainty introduced by the image registration process between MRI and CT data and to streamline the RT planning. Despite the recent availability of validated synthetic CT (sCT) methods for the head region, there are no clinical implementations reported for brain tumors. Based on a preceding validation study of sCT, this study aims to investigate MRI-only brain RT through a prospective clinical feasibility study with endpoints for dosimetry and patient setup. MATERIAL AND METHODS: Twenty-one glioma patients were included. MRI Dixon images were used to generate sCT images using a CE-marked deep learning-based software. RT treatment plans were generated based on MRI delineated anatomical structures and sCT for absorbed dose calculations. CT scans were acquired but strictly used for sCT quality assurance (QA). Prospective QA was performed prior to MRI-only treatment approval, comparing sCT and CT image characteristics and calculated dose distributions. Additional retrospective analysis of patient positioning and dose distribution gamma evaluation was performed. RESULTS: Twenty out of 21 patients were treated using the MRI-only workflow. A single patient was excluded due to an MRI artifact caused by a hemostatic substance injected near the target during surgery preceding radiotherapy. All other patients fulfilled the acceptance criteria. Dose deviations in target were within ±1% for all patients in the prospective analysis. Retrospective analysis yielded gamma pass rates (2%, 2 mm) above 99%. Patient positioning using CBCT images was within ± 1 mm for registrations with sCT compared to CT. CONCLUSION: We report a successful clinical study of MRI-only brain radiotherapy, conducted using both prospective and retrospective analysis. Synthetic CT images generated using the CE-marked deep learning-based software were clinically robust based on endpoints for dosimetry and patient positioning.