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Purpose: To report the efficacy and late side effects(LSEs) of CT-based image-guided brachytherapy for the treatment of cervical cancer. Materials: Between 2008 and 2014, 100 patients with FIGO stage IIB-IVA cervical carcinoma were analyzed. The patients received pelvic irradiation (45-50 Gy in 25 fractions) with concurrent chemotherapy, whereas the mean prescribed EBRT dose, including initial and boost doses to positive lymph nodes, ranged from 54 to 64 Gy. Afterwards, intracavitary(IC) or combined intracavitary/interstitial(IC/IS) brachytherapy was performed using a CT-based procedure with prescribed doses of 6 or 8 Gy in 3-7 fractions. Results: The median follow-up time was 46 months. The 5-year local control, distant metastasis-free survival, and overall survival rates were 88.9%, 81.8%, 77.9%, respectively. IC/IS brachytherapy improved the HR-CTV D90 compared with IC (p<0.01). Seven patients (7.0%) had grade 2 bladder LSEs and none had grade 3/4 bladder LSEs. There was no significant relationship between bladder LSEs and the dose-volume histogram (p>0.05 for all). Thirty-seven patients (37%) had grade 2 rectal LSEs, 3(3%) had grade 3 rectal LSE. The rectum D1cc, D2cc, and D5cc values were significantly higher in patients with grades 2/3 rectal toxicity than in those with grades 0/1 (p<0.05 for all). There was no grade 2 and above small bowel LSEs. Conclusions: CT-based brachytherapy planning can achieve excellent local control with acceptable morbidity. HR-CTV D90 can increase in the IC/IS group compared with the IC group. The D1cc, D2cc, and D5cc all showed excellent predictive values for rectal LSEs.
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Alterations of the topological organization of abnormal regions or network-level structural aberrations are still poorly understood for post-traumatic stress disorder (PTSD). Herein, we investigated brain structural networks in recent-onset PTSD patients, all affected by the coalmine-flood disaster. Cortical networks were studied in recent onset PTSD patients (n = 15) and matched healthy controls (n = 25). Cortical networks were constructed by thresholding correlation matrices of 150 regions and quantified using graph theoretical approaches. Contributions of high-degree nodes, and regional and global network measures, including degree and betweenness, were studied. Compared with healthy controls, PTSD patients showed altered quantitative values in global network properties, characterized by shorter path length and higher clustering. Moreover, PTSD patients exhibited decreased connectivity in the right lingual gyrus, parahippocampal gyrus, left supramarginal gyrus, parahippocampal gyrus, bilateral superior and inferior frontal gyrus, superior frontal gyrus, and posterior cingulate gyrus. Nodal centrality decreased predominantly in the occipital regions (lingual gyrus) and default-mode regions, while increased correlations and centralities were observed in the medial temporal lobe and posterior cingulate cortex. PTSD-related networks exhibited a less efficient organization and regional connectivity. According to these findings, we conclude that regional connections involving fear-processing and re-experiential-processing cortex may play a role in maintaining or adapting to PTSD pathology.
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Encéfalo/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Imagen por Resonancia Magnética , Trastornos por Estrés Postraumático/diagnóstico por imagen , Accidentes de Trabajo , Enfermedad Aguda , Adulto , Encéfalo/patología , Femenino , Inundaciones , Sustancia Gris/patología , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Minería , Tamaño de los Órganos , Esposos , Trastornos por Estrés Postraumático/patología , SobrevivientesRESUMEN
RATIONALE AND OBJECTIVES: This study evaluated the altered regional cerebral blood flow (rCBF) in resting state in patients with acute posttraumatic stress disorder (PTSD) 3 months after trauma. MATERIALS AND METHODS: The rCBF was measured in 30 patients with acute PTSD and 36 healthy controls. RESULTS: Survivors with acute PTSD showed decreased rCBF, the Clinician-Administered PTSD Scale score correlated negatively with the rCBF, and rCBF at resting state decreased in acute PTSD. CONCLUSIONS: PTSD symptom severity was associated with diminished cerebral blood flow in the right insular cortex and right orbital medial frontal gyrus. The rCBF may predict PTSD symptom severity.
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Circulación Cerebrovascular/fisiología , Trastornos por Estrés Postraumático/fisiopatología , Sobrevivientes/estadística & datos numéricos , Enfermedad Aguda , Adulto , Encéfalo/irrigación sanguínea , China , Desastres , Femenino , Inundaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Descanso , Índice de Severidad de la Enfermedad , Marcadores de Spin , Trastornos por Estrés Postraumático/psicología , Sobrevivientes/psicología , TiempoRESUMEN
The study aimed for evaluating the diagnostic value of a 2D Turbo Spin Echo (TSE) magnetic resonance (MR) imaging sequence implanted slice-encoding metal artifact correction (SEMAC) and view-angle tilting (VAT) in patients with spinal instrumentation.Sixty-seven consecutive patients with an average age of 59.7â±â17.8 years old (range: 32-75 years) were enrolled in this study. Both sagittal, axial T1-weighted and T2-weighted MRI images were acquired with a standard TSE sequence and a high-bandwidth TSE sequence implemented the SEMAC and VAT techniques. Three continuous sections around the instrumentation in axial and sagittal images were selected for quantitative evaluation. The measurement included cumulative areas of signal void on axial images and the length of spinal canal obscuration on sagittal images. Three radiologists independently evaluated all images blindly. The inter-observer reliability was evaluated with inter-class coefficient. We defined patients with discomfortable symptoms caused by spinal instrumentation as spinal instrumentation adverse reaction.Visualizations of all periprosthetic anatomic structures were significantly better for SEMAC-VAT compared with standard imaging. For axial images, the area of signal void at the level of the instrumentation were statistically reduced with SEMAC-VAT TSE sequences than with standard TSE sequences for T2-weighted images (9.9â±â2.6âcm vs 29.8â±â14.7âcm, Pâ<â0.001). For sagittal imaging, the length of spinal canal obscuration at the level of the instrumentation was reduced from 5.2â±â2.0âcm to 1.2â±â0.6âcm on T2-weighted images (Pâ<â0.001), and from 4.8â±â2.1âcm to 1.1â±â0.5âcm on T1-weighted images with SEMAC-VAT sequences (Pâ<â0.001). Interobserver agreement for visualization of anatomic structures and image quality was good for both SEMAC-VAT (kâ=â0.77 and 0.68, respectively) and standard (kâ=â0.74 and 0.80, respectively) imaging. The number of abnormal findings noted on SEMAC images (59 findings) was significantly higher than detected on standard images (40 findings). The incidence rate of spinal instrumentation adverse reaction was 38.81%.MR images with SEMAC-VAT can significantly reduce metal artifacts for spinal instrumentation and improve delineation of the instrumentation and periprosthetic region. Furthermore, SEMAC-VAT technique can improve diagnostic accuracy in patients with post-instrumentation spinal diseases.
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Artefactos , Tornillos Óseos , Aumento de la Imagen , Imagen por Resonancia Magnética/métodos , Complicaciones Posoperatorias/diagnóstico , Médula Espinal/cirugía , Titanio , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Estudios ProspectivosRESUMEN
Previous studies have indicated regional abnormalities of both gray and white matter in amblyopia. However, alterations of cortical thickness associated with changes in white matter integrity have rarely been reported. In this study, structural magnetic resonance imaging and diffusion tensor imaging (DTI) data were obtained from 15 children with anisometropic amblyopia and 15 age- and gender-matched children with normal sight. Combining DTI and surface-based morphometry, we examined a potential linkage between disrupted white matter integrity and altered cortical thickness. The fractional anisotropy (FA) values in the optic radiations (ORs) of children with anisometropic amblyopia were lower than in controls (P < 0.05). The cortical thickness in amblyopic children was lower than controls in the following subregions: lingual cortex, lateral occipitotemporal gyrus, cuneus, occipital lobe, inferior parietal lobe, and temporal lobe (P < 0.05, corrected), but was higher in the calcarine gyrus (P < 0.05, corrected). Node-by-node correlation analysis of changes in cortical thickness revealed a significant association between a lower FA value in the OR and diminished cortical thickness in the following subregions: medial lingual cortex, lateral occipitotemporal gyrus, lateral, superior, and medial occipital cortex, and lunate cortex. We also found a relationship between changes of cortical thickness and white matter OR integrity in amblyopia. These findings indicate that developmental changes occur simultaneously in the OR and visual cortex in amblyopia, and provide key information on complex damage of brain networks in anisometropic amblyopia. Our results also support the hypothesis that the pathogenesis of anisometropic amblyopia is neurodevelopmental.