Multi-view radiomics and dosiomics analysis with machine learning for predicting acute-phase weight loss in lung cancer patients treated with radiotherapy.

We propose a multi-view data analysis approach using radiomics and dosiomics (R&D) texture features for predicting acute-phase weight loss (WL) in lung cancer radiotherapy. Baseline weight of 388 patients who underwent intensity modulated radiation therapy (IMRT) was measured between one month prior to and one week after the start of IMRT. Weight change between one week and two months after the commencement of IMRT was analyzed, and dichotomized at 5% WL. Each patient had a planning CT and contours of gross tumor volume (GTV) and esophagus (ESO). A total of 355 features including clinical parameter (CP), GTV and ESO (GTV&ESO) dose-volume histogram (DVH), GTV radiomics, and GTV&ESO dosiomics features were extracted. R&D features were categorized as first- (L1), second- (L2), higher-order (L3) statistics, and three combined groups, L1 + L2, L2 + L3 and L1 + L2 + L3. Multi-view texture analysis was performed to identify optimal R&D input features. In the training set (194 earlier patients), feature selection was performed using Boruta algorithm followed by collinearity removal based on variance inflation factor. Machine-learning models were developed using Laplacian kernel support vector machine (lpSVM), deep neural network (DNN) and their averaged ensemble classifiers. Prediction performance was tested on an independent test set (194 more recent patients), and compared among seven different input conditions: CP-only, DVH-only, R&D-only, DVH + CP, R&D + CP, R&D + DVH and R&D + DVH + CP. Combined GTV L1 + L2 + L3 radiomics and GTV&ESO L3 dosiomics were identified as optimal input features, which achieved the best performance with an ensemble classifier (AUC = 0.710), having statistically significantly higher predictability compared with DVH and/or CP features (p < 0.05). When this performance was compared to that with full R&D-only features which reflect traditional single-view data, there was a statistically significant difference (p < 0.05). Using optimized multi-view R&D input features is beneficial for predicting early WL in lung cancer radiotherapy, leading to improved performance compared to using conventional DVH and/or CP features.

Anakinra injection site reaction on FDG PET/CT.

Adult-onset Still's disease (AOSD) is a rare inflammatory disorder of unknown etiology, mainly characterized by fever, arthritis, skin rash, and raised ferritin concentration. FDG PET/CT scan of a 29-year-old woman with AOSD showed extensive lymphadenopathy, hypermetabolic splenomegaly, and increased bone marrow uptake consistent with AOSD activity. In addition, large dense lesions with high FDG uptake in the subcutaneous fat in the thighs corresponding to injection sites were seen. She had been treated with prednisone and daily subcutaneous injection of 100 mg anakinra before the scan indicating the subcutaneous lesions as injection site reactions to anakinra.

[Spectral domain OCT in eyes with retinal artery occlusion]. / Aspects évolutifs de la rétine en coupe OCT spectral domain lors des oblitérations artérielles rétiniennes.

INTRODUCTION: Retinal artery occlusions are a straightforward, essentially clinical diagnosis. The role of spectral domain ocular coherence tomography (SD-OCT) in this condition is not well described. PURPOSE: Anoxic retinal edema develops in the acute phase of retinal artery occlusion (RAO) followed by a regressive phase giving way to retinal atrophy. The purpose of the study was to determine dynamics of theses retinal changes in central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) using spectral domain optical coherence tomography (SD-OCT). PATIENTS AND METHODS: A prospective study of patients hospitalized at Hôpital Edouard-Herriot de Lyon between June and September 2009 was performed after patient education and informed consent. Retinal thickness of patients with central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or cilio-retinal artery occlusion was measured centered on the macula or on the site of occlusion with spectral domain optical coherence tomography (SD-OCT) using Cirrus(®) (Carl Zeiss Meditec, Germany) upon admission, throughout hospitalization, at 1 month and at 3 months. Thickness and reflectivity of the various retinal layers were compared with the fellow eye. RESULTS: Fourteen patients were included (seven CRAO, six BRAO and one cilio-retinal artery occlusion). SD-OCT in the acute phase showed retinal thickening and increased reflectivity confined to the inner retinal layers supplied by the retinal circulation with decreased reflectivity from the photoreceptor and retinal pigment epithelial layers secondary to a shadowing effect in the affected area. These changes subsequently resolved at 1 month and gave way to a marked thinning of the inner retinal layers by 3 months. In one case of CRAO associated with an ophthalmic artery occlusion and consequent occlusion of the ciliary circulation as well, initial OCT revealed complete retinal thickening involving both the inner and outer layers. DISCUSSION: This study demonstrates that the anoxic intracellular edema resulting from retinal artery occlusions (RAO) observed histologically appears on OCT as a thickening of the inner retinal layers in the acute stage of the condition, giving way to atrophic areas starting at approximately 1 month ("pseudonormalization") and becoming clearly atrophic at 3 months. CONCLUSION: SD-OCT is useful in the diagnosis of RAO, especially if the patient is seen later in the disease process, when the ischemic retinal whitening is no longer present on fundus exam.

Transcranial Doppler ultrasound in the acute phase of aneurysmal subarachnoid hemorrhage.

BACKGROUND: Angiographic studies suggest that acute vasospasm within 48 h of aneurysmal subarachnoid hemorrhage (SAH) predicts symptomatic vasospasm. However, the value of transcranial Doppler within 48 h of SAH is unknown. METHODS: We analyzed 199 patients who had at least 1 middle cerebral artery (MCA) transcranial Doppler examination within 48 h of SAH onset. Abnormal MCA mean blood flow velocity (mBFV) was defined as >90 cm/s. Delayed cerebral ischemia (DCI) was defined as clinical deterioration or radiological evidence of infarction due to vasospasm. RESULTS: Seventy-six patients (38%) had an elevation of MCA mBFV >90 cm/s within 48 h of SAH onset. The predictors of elevated mBFV included younger age (OR = 0.97 per year of age, p = 0.002), admission angiographic vasospasm (OR = 5.4, p = 0.009) and elevated white blood cell count (OR = 1.1 per 1,000 white blood cells, p = 0.003). Patients with elevated mBFV were more likely to experience a 10 cm/s fall in velocity at the first follow-up than those with normal baseline velocities (24 vs. 10%, p < 0.01), suggestive of resolving spasm. DCI developed in 19% of the patients. An elevated admission mBFV >90 cm/s during the first 48 h (adjusted OR = 2.7, p = 0.007) and a poor clinical grade (Hunt-Hess score 4 or 5, OR = 3.2, p = 0.002) were associated with a significant increase in the risk of DCI. CONCLUSION: Early elevations of mBFV correlate with acute angiographic vasospasm and are associated with a significantly increased risk of DCI. Transcranial Doppler ultrasound may be an early useful tool to identify patients at higher risk to develop DCI after SAH.

Centrifugal distribution of regional cerebral blood flow and its time course in traumatic intracerebral hematomas.

Cerebral blood flow (CBF) alterations following post-traumatic contusions have been demonstrated in recent papers. We evaluated regional CBF (rCBF) by means of Xenon-enhanced computerized tomography (Xe-CT) in 29 traumatic intracerebral hematomas, from 22 patients with severe head injury (GCS < or = 8). Fifty traumatic hematoma/Xe-CT CBF measurements were obtained from 39 Xe-CT studies performed during the acute phase (corresponding to the first 20 days post-injury). The rCBF was measured in three different regions of interest: the hemorrhagic core, the perihematoma edematous low-density area, and a 1-cm rim of perihematoma normal-appearing brain tissue, surrounding the edematous low-density area. We found a centrifugal improvement of rCBF as well as a decrease in the rates of CBF levels below 18 mL/100 g/min from the core to the periphery (p < 0.0001), which persisted over time. Ischemic rCBF values were detected in the perihematoma low-density area only in 24% of the traumatic hematomas. The time course of rCBF levels showed a reduced flow in the first 24 h, with a recovery of flow from day 2 to day 4, followed by another reduced flow (p < or = 0.0001) both in the perihematoma edematous low-density area and in the non-lesioned tissue. Our findings suggest that the only area with persistent ischemic values was the hemorrhagic core. Low rCBF levels seen in the perihematoma low-density area may only be ascribed partially to ischemia and can possibly recover over time. These results could encourage a surgical approach based on an early evacuation of the hemorrhagic core associated to a preservation of the surrounding edematous tissue.

Increased frequency of acute local reaction to intra-articular hylan GF-20 (synvisc) in patients receiving more than one course of treatment.

BACKGROUND: Intra-articular knee injections with hylan GF-20 (Synvisc) have been shown to provide temporary relief of osteoarthritic symptoms. Several studies have suggested that repeated courses of treatment with this product may be administered without an increase in the likelihood of an adverse reaction. The present study was performed to test the hypothesis that the likelihood of a painful reaction to hylan GF-20 does not increase in patients who receive more than one course of treatment. METHODS: The records of all patients who had received more than one course of treatment with hylan GF-20 were compared with a group of patients who had received only one course of treatment during the same fifteen-month period at a single center. The single-course group was prospectively enrolled and followed, as part of an ongoing randomized trial. The two groups were compared with respect to several demographic and clinical parameters as well as with respect to the frequency of painful acute local reactions following injections of hylan GF-20. RESULTS: Local reactions to hylan GF-20 occurred significantly more often in patients who had received more than one course of treatment than they did in patients who had received only a single course of treatment; the reactions occurred in four (21%) of nineteen patients in the former group and in one (2%) of the forty-two patients in the latter (p = 0.029). All of the reactions were severe enough to cause the patient to seek unscheduled care. Following corticosteroid injection, the reactions abated without apparent sequelae. With the numbers available, no significant differences were detected between the multiple-course and single-course groups in terms of age, gender, body-mass index, or severity or bilaterality of the disease. CONCLUSIONS: The present study suggests that it may be reasonable to counsel patients who have been treated with a course of hylan GF-20 and who desire an additional course that the likelihood of a painful acute local reaction to the medication appears to be increased. Additional study of the frequency of acute local reactions following repeated courses of hylan GF-20 and investigation of the mechanisms of those reactions are warranted.

Systemic inflammatory response with plasma C-reactive protein elevation in disk-related lumbosciatic syndrome.

OBJECTIVE: To look for a systemic inflammatory response in patients with disk-related lumbosciatic syndrome by using an ultrasensitive (US) plasma C-reactive protein (CRP) assay, and to determine whether plasma CRP-US levels correlated with clinical and/or laboratory features. PATIENTS AND METHODS: Plasma CRP was assayed using an enzyme-linked immunosorbent assay (ELISA) (detection limit, 5 microg/L) in patients with sciatica shown by computed tomography to be due to a disk herniation. Levels in 35 patients aged 23 to 64 years were compared to those in age- and sex-matched controls. RESULTS: Mean CRP-US levels measured by ELISA were significantly higher in the patients than in the controls (1.68 vs 0.74 mg/L; P = 0.002). There was a trend toward higher CRP-US levels in the patients with more severe nerve root symptoms. CONCLUSION: The significantly higher plasma CRP-US levels by ELISA in our patients with disk-related lumbosciatic syndrome is consistent with a systemic inflammatory response to the local nerve root impingement.

[The value of various ultrasound criteria in objective assessment of acute reactive cholecystitis. A prospective follow-up study of ventilated intensive care patients]. / Stellenwert verschiedener Ultraschallkriterien zur Objektivierung einer reaktiven akuten Cholezystitis. Eine prospektive Verlaufsstudie bei intensivtherapiepflichtigen Beatmungspatienten.

Ultrasound of the abdomen was performed in 30 artificially respirated patients under intensive care conditions for 7 days per patient over a time period of 6 months to elucidate the therapeutic value of different ultrasonographic findings with respect to the diagnosis "reactive acute cholecystitis". Our results show, that neither the detection of concrements or sludge within the gallbladder, nor the transient dilatation of the bile duct, nor a transient wall-thickening or the occurrence of a three-layered wall of the gallbladder can be interpreted as reliable sonographic criteria for the occurrence of an acute reactive cholecystitis. From this we conclude, that reactive acute cholecystitis leading to the indication for cholecystectomy can only be diagnosed from the combination of clinical and sonographic findings. However, reactive acute cholecystitis can almost certainly be excluded, even in obscure upper abdominal symptoms, when the sonogram of the gallbladder is normal.

Assessment of blood echogenicity as an alternative measure to erythrocyte sedimentation rate.

OBJECTIVE: To determine the relation between erythrocyte sedimentation rate and blood echogenicity and whether measurement of erythrocyte sedimentation rate could be replaced by measurement of blood echogenicity in monitoring acute phase reactions. DESIGN: Simultaneous measurement of echogenicity of flowing blood and erythrocyte sedimentation rate in blood samples and comparison of results. SETTING: A radiological department in a university hospital. SUBJECTS: 83 patients with a suspected venous thrombosis and 36 healthy volunteers. MAIN OUTCOME MEASURES: Correlations between the erythrocyte sedimentation rate, packed cell volume, and echogenicity of flowing blood. RESULTS: Blood echogenicity correlated poorly with the packed cell volume, but strongly correlated with the erythrocyte sedimentation rate (when the packed cell volume was within reference limits) (correlation coefficient = 0.73). Blood samples with a greatly raised erythrocyte sedimentation rate were highly echogenic. Only one of the 30 samples with an erythrocyte sedimentation rate below 10 mm in first hour had a higher echogenicity than the least echogenic sample of the 19 with a sedimentation rate above 30 mm in first hour. CONCLUSIONS: Echogenicity of flowing blood correlates with the erythrocyte sedimentation rate and its measurement may compete with conventional methods for evaluating the long term changes in acute phase reactions. Also, it has the added advantage that non-invasive in vivo measurements of blood echogenicity may become possible.

MRI and cranial traumas in the acute phase.

The authors have reviewed 12 cases of severe cranial trauma examined by MRI and determine the position of this method in exploration in the acute phase. Since the 1970's, computerized tomography (CT) has completely modified the emergency diagnosis. Intra- and extracerebral blood effusions are readily recognized, but the patient is often in a dangerous situation and little help is obtained from CT which does not detect shearing lesions located in the white matter, the corpus callosum or the brain stem. Early MRI examination performed with gradient-echo sequences provides a better anatomico-clinical correlation, a better prognostic approach and even a new therapeutic approach.

The acute inflammatory response to myocardial infarction: imaging with indium-111 labelled autologous neutrophils.

The uptake of indium-111 labelled neutrophils was examined in 30 patients with acute myocardial infarction by planar imaging and single photon emission computed tomography. The time from venepuncture to reinjection of the autologous labelled neutrophils was less than 2.5 hours and imaging was carried out 24 hours later. Twenty three patients had a positive uptake of neutrophils in the myocardium and imaging was improved by single photon emission computed tomography. There was a significant difference between the intervals from the onset of chest pain to injection of labelled neutrophils between patients with positive and negative images; early reinjection was more likely to produce a positive image. Indeed, all nine patients reinjected within 18 hours of the onset of symptoms had positive images. The results suggest that the stimulus for activation and migration of neutrophils is transient; this is an important factor if neutrophil release products play a role in cell damage after coronary occlusion.