Metastatic Neoplasm Volume Kinetics Following 2-Stage Stereotactic Radiosurgery.

BACKGROUND: Multisession staged stereotactic radiosurgery (SRS) represents an alternative approach for management of large brain metastases (LBMs), with potential advantages over fractionated SRS. This study investigated clinical efficacy and safety of 2-stage stereotactic radiosurgery (2-SSRS) in patients with LBMs. METHODS: Patients with LBMs treated with 2-SSRS between 2014 and 2020 were evaluated. Demographic, clinical, and radiologic data were obtained. Volumetric measurements at first SRS session, second SRS session, and follow-up imaging studies were obtained. Characteristics that might predict response to 2-SSRS were evaluated through Fisher exact or Mann-Whitney U test. RESULTS: The study included 24 patients with 26 LBMs. Median (range) marginal doses for first and second SRS sessions were 15 Gy (14-18 Gy) and 15 Gy (12-16 Gy), respectively. Median (range) tumor volumes at first SRS session, second SRS session, and 3-month follow-up were 8.1 cm3 (1.5-28.5 cm3), 3.3 cm3 (0.8-26.1 cm3), and 2.2 cm3 (0.2-10.1 cm3), respectively. Of 26 lesions, 24 (92%) demonstrated early local control following the first SRS session, with 17 lesions (71%) demonstrating a decrease of ≥30% in T1 postcontrast MRI volume before the second SRS session and 3 lesions (12%) remaining stable. Eventually, 4 lesions showed disease progression after 2-SSRS. The median time to local progression was not reached; the median time to intracranial progression was 9.1 months. CONCLUSIONS: Our study supports the effectiveness and safety of 2-SSRS as a treatment modality for patients with LBMs, especially in poor surgical candidates. The local failure rate and low occurrence of adverse effects are comparable to other staged radiosurgery studies.

Magnetic resonance elastography of the brain: A study of feasibility and reproducibility using an ergonomic pillow-like passive driver.

Magnetic resonance elastography (MRE) can be used to noninvasively resolve the displacement pattern of induced mechanical waves propagating in tissue. The goal of this study is to establish an ergonomically flexible passive-driver design for brain MRE, to evaluate the reproducibility of MRE tissue-stiffness measurements, and to investigate the relationship between tissue-stiffness measurements and driver frequencies. An ergonomically flexible passive pillow-like driver was designed to induce mechanical waves in the brain. Two-dimensional finite-element simulation was used to evaluate mechanical wave propagation patterns in brain tissues. MRE scans were performed on 10 healthy volunteers at mechanical frequencies of 60, 50, and 40 Hz. An axial mid-brain slice was acquired using an echo-planar imaging sequence to map the displacement pattern with the motion-encoding gradient along the through-plane (z) direction. All subjects were scanned and rescanned within 1 h. The Wilcoxon signed-rank test was used to test for differences between white matter and gray matter shear-stiffness values. One-way analysis of variance (ANOVA) was used to test for differences between shear-stiffness measurements made at different frequencies. Scan-rescan reproducibility was evaluated by calculating the within-subject coefficient of variation (CV) for each subject. The finite-element simulation showed that a pillow-like passive driver is capable of efficient shear-wave propagation through brain tissue. No subjects complained about discomfort during MRE acquisitions using the ergonomically designed driver. The white-matter elastic modulus (mean ±â€¯standard deviation) across all subjects was 3.85 ±â€¯0.12 kPa, 3.78 ±â€¯0.15 kPa, and 3.36 ±â€¯0.11 kPa at frequencies of 60, 50, and 40 Hz, respectively. The gray-matter elastic modulus across all subjects was 3.33 ±â€¯0.14 kPa, 2.82 ±â€¯0.16 kPa, and 2.24 ±â€¯0.14 kPa at frequencies of 60, 50, and 40 Hz, respectively. The Wilcoxon signed-rank test confirmed that the shear stiffness was significantly higher in white matter than gray matter at all three frequencies. The ranges of within-subject coefficients of variation for white matter, gray matter, and whole-brain shear-stiffness measurements for the three frequencies were 1.8-3.5% (60 Hz), 4.7-6.0% (50 Hz), and 3.7-4.1% (40 Hz). An ergonomic pneumatic pillow-like driver is feasible for highly reproducible in vivo evaluation of brain-tissue shear stiffness. Brain-tissue shear-stiffness values were frequency-dependent, thus emphasizing the importance of standardizing MRE acquisition protocols in multi-center studies.

Effect of parallel radiofrequency transmission on arterial input function selection in dynamic contrast-enhanced 3 Tesla pelvic MRI.

BACKGROUND: To evaluate whether parallel radiofrequency transmission (mTX) can improve the symmetry of the left and right femoral arteries in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of prostate and bladder cancer. METHODS: Eighteen prostate and 24 bladder cancer patients underwent 3.0 Tesla DCE-MRI scan with a single transmission channel coil. Subsequently, 21 prostate and 21 bladder cancer patients were scanned using the dual channel mTX upgrade. The precontrast signal ( S0) and the maximum enhancement ratio (MER) were measured in both the left and the right femoral arteries. Within the patient cohort, the ratio of S0 and MER in the left artery to that in the right artery ( S0_LR, MER_LR) was calculated with and without the use of mTX. Left to right asymmetry indices for S0 ( S0_LRasym) and MER ( MER_LRasym) were defined as the absolute values of the difference between S0_LR and 1, and the difference between MER_LR and 1, respectively. RESULTS: S0_LRasym, and MER_LRasym were 0.21 and 0.19 for prostate cancer patients with mTX, and 0.43 and 0.45 for the ones imaged without it (P < 0.001). Also, for the bladder cancer patients, S0_LRasym, and MER_LRasym were 0.11 and 0.9 with mTX, while imaging without it yielded 0.52 and 0.39 (P < 0.001). CONCLUSION: mTX can significantly improve left-to-right symmetry of femoral artery precontrast signal and contrast enhancement.

Quantitative Comparison of 2 Dual-Energy X-ray Absorptiometry Systems in Assessing Body Composition and Bone Mineral Measurements.

Dual-energy X-ray absorptiometry (DXA) is widely used in body composition measurement and evaluation. Because of its numerous applications, the probability of instrument discrepancies has increased dramatically. This study quantitatively compares 2 different DXA systems. In this study, 96 subjects (60 female and 36 male, aged 19-82 years) were recruited and scanned using a General Electric Lunar iDXA and a Hologic Discovery scanner. Four measurements (percent fat, total mass, bone mineral density [BMD], and bone mineral content [BMC]) were quantitatively compared in the whole body and in specific anatomic regions (arms, legs, trunk, android, gynoid, head, ribs, and pelvis). A simple linear regression of each measurement was performed to examine the correlation between the 2 systems. Percent fat, total mass, BMC, and BMD were highly correlated between the 2 DXA systems, with correlation r values greater than 0.854 for both the whole body and the individual anatomic regions except for BMC and BMD in ribs. The high correlation between the 2 DXA systems with systematic differences enabled development of calibration equations for extending the multisystem measurements to advanced quantitative analyses.