Uncovering associations between interest in One Health and pre-existing conditions and behaviours: Evidence from a UK survey.

This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.

Revival of positive nostalgic music during the first Covid-19 lockdown in the UK: evidence from Spotify streaming data.

This work shows that positive old music listening surged during the early phase of the Covid-19 pandemic, suggesting a rise in preference for nostalgia and positivity in music. Using the music streaming data of Spotify users in the UK and employing multivariate regression analysis, this work documents that users were more likely to listen to songs older than 5 years during the national lockdown that began in late March 2020 compared with the pre-lockdown period. Such a change in preference was not observed in the same period in 2019. Meanwhile, more frequent listening to old music is found in samples of positive songs and also negative songs. This suggests that the preference for nostalgic music is to a certain extent independent of the positivity bias during the pandemic found in the literature. Yet, this work also provides evidence that the nostalgia-seeking behaviour and the preference for positive songs reinforced each other during the lockdown as the surge in positive old music was more persistent than that in positive recent music.

Performance sensitivity analysis of brain metastasis stereotactic radiosurgery outcome prediction using MRI radiomics.

Recent studies have used T1w contrast-enhanced (T1w-CE) magnetic resonance imaging (MRI) radiomic features and machine learning to predict post-stereotactic radiosurgery (SRS) brain metastasis (BM) progression, but have not examined the effects of combining clinical and radiomic features, BM primary cancer, BM volume effects, and using multiple scanner models. To investigate these effects, a dataset of n = 123 BMs from 99 SRS patients with 12 clinical features, 107 pre-treatment T1w-CE radiomic features, and BM progression determined by follow-up MRI was used with a random decision forest model and 250 bootstrapped repetitions. Repeat experiments assessed the relative accuracy across primary cancer sites, BM volume groups, and scanner model pairings. Correction for accuracy imbalances across volume groups was investigated by removing volume-correlated features. We found that using clinical and radiomic features together produced the most accurate model with a bootstrap-corrected area under the receiver operating characteristic curve of 0.77. Accuracy also varied by primary cancer site, BM volume, and scanner model pairings. The effect of BM volume was eliminated by removing features at a volume-correlation coefficient threshold of 0.25. These results show that feature type, primary cancer, volume, and scanner model are all critical factors in the accuracy of radiomics-based prognostic models for BM SRS that must be characterised and controlled for before clinical translation.

Incidence and Predictors of Eosinophilic Myocardial Hypersensitivity in Patients Receiving Home Dobutamine.

ABSTRACT: We sought to examine incidence and predictors of eosinophilic myocardial hypersensitivity (EMH) in a cohort of patients in the home inotrope program of a quaternary cardiac transplant center. Patients on home inotropes with progression to heart transplantation or ventricular assist device (VAD) between January 2000 and May 2020 were included. EMH was diagnosed by the presence of an interstitial predominate eosinophilic infiltrate within the myocardium by experienced cardiac pathologists. From a cohort of 74 patients, 58% (43) were on dobutamine and 42% (31) were on milrinone. Dobutamine was associated with EMH incidence of 14% (6/43), with zero cases in the milrinone cohort. Mean age was 52 ± 12 years, 22% were female. More than half (62%) were nonischemic dilated cardiomyopathies, the remainder were ischemic cardiomyopathy. Dobutamine dose [250 (200-282) vs. 225 (200-291) µg/min] and duration of therapy [41 (23-79) vs. 53 (24-91) days] was similar between those with and without EMH. Median change in eosinophil count was 0.31 × 10 9 /L in the EMH group compared with only 0.03 × 10 9 /L in the non-EMH cohort, P = 0.02. Increase in peripheral eosinophil count of >0.20 × 10 9 /L demonstrated good discrimination between those with and without EMH, c-statistic 0.83 (95% CI 0.66-1.0). Heart failure hospitalization occurred in 83% of the EMH group versus 59% in the non-EMH group, P = 0.26. Requirement for VAD was significantly higher in the EMH group (83% vs. 41%, P = 0.05). In conclusion, EMH occurred in 14% of patients receiving home dobutamine. Rising eosinophil count should prompt physicians to consider EMH and switch to milrinone to avoid possible escalation to VAD.

Treatment planning system commissioning of the first clinical biology-guided radiotherapy machine.

PURPOSE: The RefleXion X1 is a novel radiotherapy machine designed for image-guided radiotherapy (IGRT) and biology-guided radiotherapy (BgRT). Its treatment planning system (TPS) generates IMRT and SBRT plans for a 6MV-FFF beam delivered axially via 50 firing positions with the couch advancing every 2.1 mm. The purpose of this work is to report the TPS commissioning results for the first clinical installation of RefleXion™ X1. METHODS: CT images of multiple phantoms were imported into the RefleXion TPS to evaluate the accuracy of data transfer, anatomical modeling, plan evaluation, and dose calculation. Comparisons were made between the X1, Eclipse™, and MIM™. Dosimetric parameters for open static fields were evaluated in water and heterogeneous slab phantoms. Representative clinical IMRT and SBRT cases were planned and verified with ion chamber, film, and ArcCHECK@ measurements. The agreement between TPS and measurements for various clinical plans was evaluated using Gamma analysis with a criterion of 3%/2 mm for ArcCHECK@ and film. End-to-end (E2E) testing was performed using anthropomorphic head and lung phantoms. RESULTS: The average difference between the TPS-reported and known HU values was -1.4 ± 6.0 HU. For static fields, the agreements between the TPS-calculated and measured PDD10 , crossline profiles, and inline profiles (FWHM) were within 1.5%, 1.3%, and 0.5 mm, respectively. Measured output factors agreed with the TPS within 1.3%. Measured and calculated dose for static fields in heterogeneous phantoms agreed within 2.5%. The ArcCHECK@ mean absolute Gamma passing rate was 96.4% ± 3.4% for TG 119 and TG 244 plans and 97.8% ± 3.6% for the 21 clinical plans. E2E film analysis showed 0.8 mm total targeting error for isocentric and 1.1 mm for off-axis treatments. CONCLUSIONS: The TPS commissioning results of the RefleXion X1 TPS were within the tolerances specified by AAPM TG 53, MPPG 5.a, TG 119, and TG 148. A subset of the commissioning tests has been identified as baseline data for an ongoing QA program.

Levosimendan and Continuous Outpatient Support With Inotropes in Patients With Advanced Heart Failure: A Single-Centre Descriptive Study.

ABSTRACT: To describe the use of levosimendan in a quaternary referral center with a dedicated heart failure service and compare its efficacy and safety to continuous outpatient support with inotropes (COSI) among patients with advanced heart failure (AHF) who require bridge-to-decision (BTD) or bridge-to-transplant (BTT) therapy. This study was a retrospective, single-center, descriptive study of patients with AHF who received either a single levosimendan infusion or COSI between 2018 and 2021. A total of 23 patients received a levosimendan infusion, and 14 were started on COSI. Three indications for levosimendan were identified: (1) to facilitate weaning of continuous inotropes, (2) to augment diuresis in cardiorenal syndrome, and (3) as first-line therapy for cardiogenic shock in selected patients. Eighty-three percent (19 of 23) of patients who received levosimendan survived to discharge, and there were few clinically significant adverse events. Overall survival at 12 months among patients who received levosimendan was 74%. No statistically significant difference in survival was observed at 12 months (P = 0.68) or beyond (P = 0.63) between patients who received levosimendan and were discharged with a plan for BTD or BTT and those who received COSI. Levosimendan is a safe and effective short-term therapy in AHF and offers comparable long-term survival to COSI in patients who require BTD or BTT therapy.

Pulmonary hypertension among children with in-hospital cardiac arrest: A multicenter study.

AIMS: To determine the prevalence of pulmonary hypertension (PH) among children with in-hospital cardiac arrest (IHCA) and its association with survival. METHODS: Children (<18 years) admitted to ICUs participating in the Virtual Pediatric Systems multicenter registry between January 2011 and December 2017 who had an IHCA during their hospitalization were included. Patients were classified by whether they had a documented diagnosis of PH at the time of IHCA. Clinical characteristics were compared between patients with and without PH. After propensity score matching, conditional logistic regression within the matched cohort determined the association between PH and survival to hospital discharge. RESULTS: Of 18,575 children with IHCA during the study period, 1,590 (8.6%) had a pre-arrest diagnosis of PH. Patients with PH were more likely to be 29 days to 2 years of age, female, Black/African American, and American Indian/Alaskan Native, and to be treated in a cardiac ICU or mixed PICU/cardiac ICU. At ICU admission, PH patients had a lower probability of death as determined by the Pediatric Index of Mortality 2 (PIM-2) score. Patients with PH were more likely to be receiving inhaled nitric oxide (13.0% vs. 2.1%; p < 0.001). Propensity score matching successfully matched 1,302 PH patients with 3,604 non-PH patients. Patients with PH were less likely to survive to hospital discharge (aOR 0.83; 95% CI: 0.72-0.95; p = 0.01) than non-PH patients. CONCLUSIONS: In this large multicenter study, 8.6% of children with IHCA had pre-existing documented PH. These children were less likely to survive to hospital discharge than those without PH.

Guidance on the clinical understanding and use of long-acting injectable antipsychotics in Schizophrenia: Hong Kong Consensus Statements.

AIMS: There is increasing evidence showing the importance of long-acting injectable antipsychotics in the management of schizophrenia, especially in terms of improving patient medication compliance. A panel of experienced clinicians in Hong Kong mapped out a set of consensus statements with an aim to facilitate the understanding and use of long-acting injectable antipsychotics among local physicians. METHODS: Eight discussion areas regarding long-acting injectable antipsychotics were selected by the chairman of the consensus group. A series of meetings were held for the panelists to discuss the published literature and their clinical experience, followed by the drafting of consensus statements. At the final meeting, each consensus statement was voted on anonymously by all members based on its practicability of recommendation in Hong Kong. RESULTS: A total of 12 consensus statements on the rational use of long-acting injectable antipsychotics were established and accepted by the consensus group. CONCLUSION: The consensus statements aim to provide practical guidance for Hong Kong physicians on the use of long-acting injectable antipsychotics in schizophrenia patients. These statements may also serve as a reference for doctors in other parts of the Asia-Pacific region.

Lunacy in a tertiary emergency department: A 3-year cohort study of the association between moon cycles and occupational violence and aggression.

OBJECTIVE: Occupational violence and aggression (OVA) in the ED is an issue of global concern and increasing incidence. The empirical evidence for the relationship between the lunar cycle and 'lunatics' remains equivocal. The present study aims to examine the association between OVA in ED and the full moon (FM). METHODS: Data on all presentations were extracted from The Alfred Hospital ED records for consecutive patients over a 3-year period (January 2013-December 2015). The primary outcome of the present study is OVA among patients in the ED. Univariable and multivariable logistic regression were used to determine the association between aspects of the lunar cycle and OVA. RESULTS: There were 184 059 ED presentations during the 3 years, 6234 (3.4%) of which occurred on a FM. There were 1853 episodes of OVA, 57 (3.1%) of which occurred on a FM. OVA among patients presenting to ED was not associated with the FM (adjusted odds ratio [OR] 0.92 [95% confidence interval 0.70-1.20]; P = 0.53). However, the first quarter (FQ) (adjusted OR 1.38 [1.11-1.72]; P < 0.01) and third quarter (TQ) (adjusted OR 1.29 [95% confidence interval 1.03-1.62]; P = 0.03) moons of the lunar cycle were independently associated with OVA. CONCLUSIONS: Contrary to traditional beliefs, the FQ and TQ of the lunar cycle but not the FM were associated with OVA. This highlights a relatively unexplored relationship that has previously been overshadowed by the FM in the literature. Prediction models of violence in the ED could consider incorporating the FQ and TQ of the lunar cycle in their models.

Transcatheter Versus Surgical Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis With a Focus on Outcomes by Sex.

BACKGROUND AND AIMS: Women at increased surgical risk have been shown to have better outcomes with transcatheter aortic valve implantation (TAVI) as compared to surgical valve replacement (SAVR). With the scope of TAVI moving into low-surgical risk patients, we aimed to update the current literature to include the new low-risk randomised controlled trial (RCT) data in investigating outcomes by sex. METHODS: We systematically searched MEDLINE (Ovid), PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and reference lists for relevant RCTs comparing TAVI to SAVR published prior to 4 May 2020. Data extraction was performed by two independent authors and included trial design details, baseline characteristics and outcome data stratified by sex. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Quantitative synthesis of pooled data was performed using Mantel-Haenszel fixed or random effects model. Q-statistic and the I2 test were used for assessment of heterogeneity. RESULTS: Our search yielded eight RCTs included in the final quantitative synthesis. The overall pooled cohort was 8,040, of whom 41.4% were female. Women had significantly lower rates of one-year all-cause mortality (12.2% vs 17.7%, pooled OR 0.59, 95% CI 0.40-0.86) and one-year composite endpoint (9.7% vs 12.4%, pooled OR 0.73, 95% CI 0.58-0.92) with TAVI as compared to SAVR. The selective mortality benefit with TAVI over SAVR in women did not persist to 5 years (pooled HR 1.01, 95% CI 0.87-1.17). At 30 days, women demonstrated lower rates of major bleeding and acute kidney injury following TAVI compared to SAVR. For men, these outcomes were similar regardless of type of intervention. Both sexes were at increased risk of major vascular complications with TAVI as compared to SAVR, however women demonstrated nearly double the odds of major vascular complication with TAVI compared to men. CONCLUSION: Our updated meta-analysis demonstrates that at one-year women undergoing TAVI have significantly lower mortality and better safety outcomes compared to those undergoing SAVR. These benefits are not seen in men. In the new low-risk era, these results are ever more important for guiding appropriate patient selection.

Technical Note: Performance of CyberKnife® tracking using low-dose CT and kV imaging.

PURPOSE: To investigate the effects of CT protocol and in-room x-ray technique on CyberKnife® (Accuray Inc.) tracking accuracy by evaluating end-to-end tests. METHODS: End-to-end (E2E) tests were performed for the different tracking methods (6D skull, fiducial, spine, and lung) using an anthropomorphic head phantom (Accuray Inc.) and thorax phantom (CIRS Inc.). Bolus was added to the thorax phantom to simulate a large patient and to evaluate the performance of lung tracking in a more realistic condition. The phantoms were scanned with a Siemens Sensation Open 24 slice CT at low dose (120 kV, 70 mAs, 1.5 mm slice thickness) and high dose (120 kV, 700 mAs, 1.5 mm slice thickness) to generate low-dose and high-dose digitally reconstructed radiographs (DRRs). The difference in initial phantom alignment, Δ(Align), and in total targeting accuracy, E2E, were obtained for all tracking methods with low- and high-dose DRRs. Additionally, Δ(Align) was determined for different in-room x-ray imaging techniques (0.5 to 50 mAs and 100 to 140 kV) using a low-dose lung tracking plan. RESULTS: Low-dose CT scans produced images with high noise; however, for these phantoms the targets could be easily delineated on all scans. End-to-end results were less than 0.95 mm for all tracking methods and all plans. The greatest difference in initial alignment Δ(Align) and E2E results between low- and high-dose CT protocols was 0.32 and 0.24 mm, respectively. Similar results were observed with a large thorax phantom. Tracking using different in-room x-ray imaging techniques (mAs) corresponding to low exposures (resulting in high image noise) or high exposure (resulting in image saturation) had alignment accuracy Δ(Align) greater than 1 mm. CONCLUSIONS: End-to-end targeting accuracy within tolerance (<0.95 mm) was obtained for all tracking methods using low-dose CT protocols, suggesting that CT protocol should be set by target contouring needs. Additionally, high tracking accuracy was achieved for in-room x-ray imaging techniques that produce high-quality images.

Consensus statements on the clinical usage and characteristics of aripiprazole for Hong Kong.

Aripiprazole, a dopamine partial agonist, is a second-generation anti-psychotic that is widely used for the treatment of schizophrenia and other psychotic disorders. A group of psychiatric experts in Hong Kong developed a set of consensus statements, aiming to facilitate the understanding of clinical properties and usages of aripiprazole among local physicians. Of note, because aripiprazole long-acting injectable has been available locally not long before the establishment of the consensus panel, which limited the discussion on its use in the local context, the consensus statements were focused primarily on oral aripiprazole. To draft the consensus statements, the panellists discussed the published evidence and their clinical experience regarding aripiprazole in a series of meetings based on several areas. At the final meeting, each drafted statement was voted on anonymously by all panellists based on its practicability of recommendation in Hong Kong. A set of consensus statements on the characteristics and clinical use of aripiprazole was established and accepted by the panel. These statements serve to provide a practical reference for physicians in Hong Kong, and possibly other parts of the Asia-Pacific region, on the use of aripiprazole in people with schizophrenia spectrum disorders and other psychotic problems.

The relationship between computed tomography derived skeletal muscle index, psoas muscle index and clinical outcomes in patients with operable colorectal cancer.

BACKGROUND: Computed tomography-based measures of body composition are emerging as important prognostic factors for patients with colorectal cancer (CRC). The aim of this study was to examine the relationship between total skeletal muscle index (SMI), psoas muscle index (PMI) and clinical outcomes in patients with operable CRC. METHODS: A retrospective cohort study of prospectively maintained database at Glasgow Royal Infirmary. CT image at L3 was carried out to assess total skeletal and psoas muscle areas and these were normalized for height squared to calculate SMI and PMI respectively. Patients were classified into high and low groups using calculated optimal thresholds and their relationship to clinical outcomes was studied using logistic regression analysis. RESULTS: Of the 1002 patients included, 55% were male, 50% had low SMI and 42% had low PMI. A moderate correlation was found between total skeletal muscle and psoas areas (rs = 0.70, p < 0.001). On univariate analysis, low SMI was associated with length of hospital stay (OR, 1.47; 95% CI, 1.15-1.89, p = 0.002) and overall survival (HR, 2.29; 95% CI, 1.47-3.58, p < 0.001). On multivariate analysis, low SMI was independently associated with length of hospital stay (HR 1.32; 95% CI, 1.02-1.70, p < 0.05). On univariate analysis, low PMI was associated with length of hospital stay (OR, 1.34; 95% CI, 1.04-1.73, p < 0.05) and overall survival (OR, 1.43; 95% CI, 1.10-1.86 p < 0.01). On multivariate analysis, low PMI was not independently significant. CONCLUSION: The present study shows that though both total skeletal muscle index and psoas muscle index were directly associated and had prognostic value, total skeletal muscle index had independent prognostic value in patients with operable CRC.

Review article: Outcomes of patients who are not transported following ambulance attendance: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to evaluate the outcomes of patients who are not transported to hospital following ambulance attendance. A database search was conducted using PubMed, Medline, Embase, CINAHL and Cochrane Library. Studies were included if they analysed the outcomes of patients who were not transported following ambulance attendance. The primary outcome of this review was subsequent presentation to an ED following a non-transport decision. Secondary outcome measures included hospital admission, subsequent presentation to alternative service provider (e.g. private physician), and death at follow up. The search yielded 1953 non-duplicate articles, of which 10 met the inclusion criteria. Three studies specified that the non-transport decision was emergency medical services (EMS)-initiated, seven studies did not specify. Meta-analysis found substantial heterogeneity between estimates (I2 >50%) that was likely because of differences in study design, length of follow up, patient demographic and sample size. Between 5% and 46% (pooled estimate 21%; 95% CI 11-31%) of non-transport patients subsequently presented to ED. Few (pooled estimate 8%; 95% CI 5-12%) EMS-initiated non-transport patients were admitted to hospital compared to the unspecified group (pooled estimate 40%; 95% CI 7-72%). Mortality rates were low across included studies. Studies found varying estimates for the proportion of patients discharged at the scene that subsequently presented to ED. Few patients were admitted to hospital when the non-transport decision was initiated by EMS, indicating EMS triage is a relatively safe practice. More research is needed to elucidate the context of non-transport decisions and improve access to alternative pathways.

Sleep Outcomes With Cognitive Behavioral Therapy for Insomnia Are Similar Between Older Adults With Low vs. High Self-Reported Physical Activity.

We examined whether baseline self-reported physical activity is associated with the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older veterans. Community-dwelling veterans aged 60 years and older with insomnia received CBT-I in a randomized controlled trial. Participants who received active treatment were divided into low and high physical activity based on self-report. Sleep outcomes were measured by sleep diary, questionnaire and wrist actigraphy; collected at baseline, post-treatment, 6-month and 12-month follow-up. Mixed-effects models compared differences between physical activity groups in change in sleep outcome from baseline to each follow-up, and equivalence tests examined if physical activity groups were clinically equal. There were no significant differences in sleep outcomes between physical activity groups. Equivalence tests suggested possible equality in physical activity groups for five of seven sleep outcomes. Efficacy of CBT-I in older veterans was not associated with self-reported physical activity at baseline. Older adults with insomnia who report low levels of physical activity can benefit from CBT-I.

Extending viability of Lactobacillus plantarum and Lactobacillus johnsonii by microencapsulation in alginate microgels.

AIM: To investigate whether microencapsulation of Lactobacillus in alginate microbeads will lead to increased longevity during refrigerated storage or simulated digestion. MATERIALS AND METHODS: Microscopy was used to confirm that Lactobacillus plantarum ATCC BAA-793 and Lactobacillus johnsonii ATCC 33200 were immobilised within the microbeads and laser scattering analysis was used to determine the mean diameter of the microbeads. The number of viable cells were enumerated throughout refrigerated storage and simulated digestion experiments. RESULTS: Microencapsulation was shown to have differing effects on viability depending on the species, but led to extended viability during refrigerated storage and simulated digestion in L. johnsonii and L. plantarum respectively. CONCLUSION: Fermented functional foods contain microbes beneficial to human health. However, extended shelf storage and the harsh environment of the GI tract significantly reduces the number of viable microbes reaching the consumer. Microencapsulation allows beneficial microbes to reach the gut of the consumer in higher numbers, and thus confer greater health benefits.

A generalized parametric response mapping method for analysis of multi-parametric imaging: A feasibility study with application to glioblastoma.

PURPOSE: Parametric response map (PRM) analysis of functional imaging has been shown to be an effective tool for early prediction of cancer treatment outcomes and may also be well-suited toward guiding personalized adaptive radiotherapy (RT) strategies such as sub-volume boosting. However, the PRM method was primarily designed for analysis of longitudinally acquired pairs of single-parameter image data. The purpose of this study was to demonstrate the feasibility of a generalized parametric response map analysis framework, which enables analysis of multi-parametric data while maintaining the key advantages of the original PRM method. METHODS: MRI-derived apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) maps acquired at 1 and 3-months post-RT for 19 patients with high-grade glioma were used to demonstrate the algorithm. Images were first co-registered and then standardized using normal tissue image intensity values. Tumor voxels were then plotted in a four-dimensional Cartesian space with coordinate values equal to a voxel's image intensity in each of the image volumes and an origin defined as the multi-parametric mean of normal tissue image intensity values. Voxel positions were orthogonally projected onto a line defined by the origin and a pre-determined response vector. The voxels are subsequently classified as positive, negative or nil, according to whether projected positions along the response vector exceeded a threshold distance from the origin. The response vector was selected by identifying the direction in which the standard deviation of tumor image intensity values was maximally different between responding and non-responding patients within a training dataset. Voxel classifications were visualized via familiar three-class response maps and then the fraction of tumor voxels associated with each of the classes was investigated for predictive utility analogous to the original PRM method. Independent PRM and MPRM analyses of the contrast-enhancing lesion (CEL) and a 1 cm shell of surrounding peri-tumoral tissue were performed. Prediction using tumor volume metrics was also investigated. Leave-one-out cross validation (LOOCV) was used in combination with permutation testing to assess preliminary predictive efficacy and estimate statistically robust P-values. The predictive endpoint was overall survival (OS) greater than or equal to the median OS of 18.2 months. RESULTS: Single-parameter PRM and multi-parametric response maps (MPRMs) were generated for each patient and used to predict OS via the LOOCV. Tumor volume metrics (P ≥ 0.071 ± 0.01) and single-parameter PRM analyses (P ≥ 0.170 ± 0.01) were not found to be predictive of OS within this study. MPRM analysis of the peri-tumoral region but not the CEL was found to be predictive of OS with a classification sensitivity, specificity and accuracy of 80%, 100%, and 89%, respectively (P = 0.001 ± 0.01). CONCLUSIONS: The feasibility of a generalized MPRM analysis framework was demonstrated with improved prediction of overall survival compared to the original single-parameter method when applied to a glioblastoma dataset. The proposed algorithm takes the spatial heterogeneity in multi-parametric response into consideration and enables visualization. MPRM analysis of peri-tumoral regions was shown to have predictive potential supporting further investigation of a larger glioblastoma dataset.

Quantitative Perfusion and Permeability Biomarkers in Brain Cancer from Tomographic CT and MR Images.

Dynamic contrast-enhanced perfusion and permeability imaging, using computed tomography and magnetic resonance systems, are important techniques for assessing the vascular supply and hemodynamics of healthy brain parenchyma and tumors. These techniques can measure blood flow, blood volume, and blood-brain barrier permeability surface area product and, thus, may provide information complementary to clinical and pathological assessments. These have been used as biomarkers to enhance the treatment planning process, to optimize treatment decision-making, and to enable monitoring of the treatment noninvasively. In this review, the principles of magnetic resonance and computed tomography dynamic contrast-enhanced perfusion and permeability imaging are described (with an emphasis on their commonalities), and the potential values of these techniques for differentiating high-grade gliomas from other brain lesions, distinguishing true progression from posttreatment effects, and predicting survival after radiotherapy, chemotherapy, and antiangiogenic treatments are presented.