rss_2.0Radiology and Oncology FeedSciendo RSS Feed for Radiology and Oncology and Oncology Feed of dynamic contrast enhancement on transition zone prostate cancer in Prostate Imaging Reporting and Data System Version 2.1<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2023-0007_s_005"> <title style='display:none'>Background</title> <p>The aim of the study was to analyse the effects of dynamic contrast enhanced (DCE)-MRI on transitional-zone prostate cancer (tzPCa) and clinically significant transitional-zone prostate cancer (cs-tzPCa) in Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1.</p> </sec> <sec id="j_raon-2023-0007_s_006"> <title style='display:none'>Patients and methods</title> <p>The diagnostic efficiencies of T2-weighted imaging (T2WI) + diffusion-weighted imaging (DWI), T2WI + dynamic contrast-enhancement (DCE), and T2WI + DWI + DCE in tzPCa and cs-tzPCa were compared using the score of ≥ 4 as the positive threshold and prostate biopsy as the reference standard.</p> </sec> <sec id="j_raon-2023-0007_s_007"> <title style='display:none'>Results</title> <p>A total of 425 prostate cases were included in the study: 203 cases in the tzPCa group, and 146 in the cs-tzPCa group. The three sequence combinations had the similar areas under the curves in diagnosing tzPCa and cs-tzPCa (all <italic>P</italic> &lt; 0.05). The sensitivity of T2WI + DCE and T2WI + DWI + DCE (84.7% and 85.7% for tzPCa; 88.4% and 89.7% for cs-tzPCa, respectively) in diagnosing tzPCa and cs-tzPCa was significantly greater than that of T2WI + DWI (79.3% for tzPCa; 82.9% for cs-tzPCa). The specificity of T2WI + DWI (86.5% for tzPCa; 74.9% for cs-tzPCa) were significantly greater than those of T2WI + DCE and T2WI + DWI + DCE (68.0% and 68.5% for tzPCa; 59.1% and 59.5% for cs-tzPCa, respectively) (all <italic>P</italic> &gt; 0.05). The diagnostic efficacies of T2WI + DCE and T2WI + DWI + DCE had no significant differences (all <italic>P</italic> &lt; 0.05).</p> </sec> <sec id="j_raon-2023-0007_s_008"> <title style='display:none'>Conclusions</title> <p>DCE can improve the sensitivity of diagnosis for tzPCa and cs-tzPCa, and it is useful for small PCa lesion diagnosis.</p> </sec> </abstract>ARTICLEtrue of peripheral nerve tumours: a case series<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2023-0005_s_005"> <title style='display:none'>Background</title> <p>Peripheral nerve tumours (PNTs) are rare, but important cause of peripheral nerve dysfunction. The aim of the study was to present a series of consecutive patients with PNTs evaluated in authors’ ultrasonography (US) practice.</p> </sec> <sec id="j_raon-2023-0005_s_006"> <title style='display:none'>Patients and methods</title> <p>The electronic medical records of patients with PNTs examined at our US laboratory from February 2013 to May 2020 were retrospectively reviewed. Data on gender, age, clinical features, PNT location, electrodiagnostic (EDx) features and US findings were collected.</p> </sec> <sec id="j_raon-2023-0005_s_007"> <title style='display:none'>Results</title> <p>In the analyzed period 2845 patients were examined in our US laboratory. From these 15 patients (0.5%) with PNTs were identified. Four of them (3 with confirmed neurofibromatosis) had multiple PNTs. Half of patients (53%) presented with features of peripheral nerve damage, and others with palpable mass or pain. The most often involved nerve was ulnar (36%). PNT cross sectional areas varied from 24 mm<sup>2</sup> to 1250 mm<sup>2</sup> (median, 61 mm<sup>2</sup>). Based in 5 patients on histological and in remaining patients on US features, schwannoma was diagnosed in 40%, neurofibroma in 27%, and perineurioma in 27% of patients.</p> </sec> <sec id="j_raon-2023-0005_s_008"> <title style='display:none'>Conclusions</title> <p>As in previous reports, PNTs in our series presented with neurological symptoms, palpable mass or pain. In contrast to other focal neuropathies, particularly nerves with schwannomas, in spite of their large thickening, often demonstrated well preserved function. Adding US to our clinical practice, enabled us to diagnose these rare peripheral nerve lesions that we missed before.</p> </sec> </abstract>ARTICLEtrue craniotomy for operative treatment of brain gliomas – experience from University Medical Centre Ljubljana<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0052_s_009"><title style='display:none'>Background</title> <p>Awake craniotomy is a neurosurgical technique that allows neurophysiological testing with patient cooperation during the resection of brain tumour in regional anaesthesia. This allows identification of vital functional (i.e. eloquent) brain areas during surgery and avoidance of their injury. The aim of the study was to present clinical experience with awake craniotomy for the treatment of gliomas at the University Medical Centre Ljubljana from 2015 to 2019.</p></sec> <sec id="j_raon-2022-0052_s_010"><title style='display:none'>Patients and methods</title> <p>Awake craniotomy was considered in patients with a gliomas near or within the language brain areas, in all cases of insular lesions and selected patients with lesions near or within primary motor brain cortex. Each patient was assessed before and after surgery.</p></sec> <sec id="j_raon-2022-0052_s_011"><title style='display:none'>Results</title> <p>During the 5-year period, 24 awake craniotomies were performed (18 male and 6 female patients; average age 41). The patient’s cooperation, discomfort and perceived pain assessed during the awake craniotomy were in majority of the cases excellent, slight, and moderate, respectively. After surgery, mild neurological worsening was observed in 13% (3/24) of patients. Gross total resection, in cases of malignant gliomas, was feasible in 60% (6/10) and in cases of low-grade gliomas in 29% (4/14). The surgery did not have important negative impact on functional status or quality of life as assessed by Karnofsky score and Short-Form 36 health survey, respectively (p &gt; 0.05).</p></sec> <sec id="j_raon-2022-0052_s_012"><title style='display:none'>Conclusions</title> <p>The results suggest that awake craniotomy for treatment of gliomas is feasible and safe neurosurgical technique. The proper selection of patients, preoperative preparation with planning, and cooperation of medical team members are necessary for best treatment outcome.</p></sec> </abstract>ARTICLEtrue islets implanted in an irreversible electroporation generated extracellular matrix in the liver<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2023-0006_s_009"><title style='display:none'>Background</title> <p>Pancreatic islet transplantation via infusion through the portal vein, has become an established clinical treatment for patients with type 1 diabetes. Because the engraftment efficiency is low, new approaches for pancreatic islets implantation are sought. The goal of this study is to explore the possibility that a non-thermal irreversible electroporation (NTIRE) decellularized matrix in the liver could be used as an engraftment site for pancreatic islets.</p></sec> <sec id="j_raon-2023-0006_s_010"><title style='display:none'>Materials and methods</title> <p>Pancreatic islets or saline controls were injected at sites pre-treated with NTIRE in the livers of 7 rats, 16 hours after NTIRE treatment. Seven days after the NTIRE treatment, islet graft function was assessed by detecting insulin and glucagon in the liver with immunohistochemistry.</p></sec> <sec id="j_raon-2023-0006_s_011"><title style='display:none'>Results</title> <p>Pancreatic islets implanted into a NTIRE-treated volume of liver became incorporated into the liver parenchyma and produced insulin and glucagon in 2 of the 7 rat livers. Potential reasons for the failure to observe pancreatic islets in the remaining 5/7 rats may include local inflammatory reaction, graft rejection, low numbers of starting islets, timing of implantation.</p></sec> <sec id="j_raon-2023-0006_s_012"><title style='display:none'>Conclusions</title> <p>This study shows that pancreatic islets can become incorporated and function in an NTIRE-generated extracellular matrix niche, albeit the success rate is low. Advances in the field could be achieved by developing a better understanding of the mechanisms of failure and ways to combat these mechanisms.</p></sec> </abstract>ARTICLEtrue of gold fiducial marker implantation on tumor control and toxicity in external beam radiotherapy of prostate cancer<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2023-0004_s_009"><title style='display:none'>Background</title> <p>Evidence regarding the effects of fiducials in image-guided radiotherapy (IGRT) for tumor control and acute and late toxicity is sparse.</p></sec> <sec id="j_raon-2023-0004_s_010"><title style='display:none'>Patients and methods</title> <p>Patients with primary low- and intermediate-risk prostate cancer, 40 with and 21 without gold fiducial markers (GFM), and treated between 2010 and 2015 were retrospectively included. The decision for or against GFM implantation took anaesthetic evaluation and patient choice into account. IGRT was performed using electronic portal imaging devices. The prescribed dose was 78 Gy, with 2 Gy per fraction. Biochemical no evidence of disease (bNED) failure was defined using the Phoenix criteria. Acute and late gastrointestinal (GI) and genitourinary toxicity (GU) were assessed using the Radiation Therapy Oncology Group criteria.</p></sec> <sec id="j_raon-2023-0004_s_011"><title style='display:none'>Results</title> <p>Most patients did not receive GFM due to contraindications for anaesthesia or personal choice (60% and 25%). Regarding tumor control, no significant differences were found regarding bNED and overall and disease-specific survival (<italic>p</italic> = 0.61, <italic>p</italic> = 0.56, and <italic>p</italic> &gt; 0.9999, respectively). No significant differences in acute and late GI (p = 0.16 and 0.64) and GU toxicity (<italic>p</italic> = 0.58 and 0.80) were observed.</p></sec> <sec id="j_raon-2023-0004_s_012"><title style='display:none'>Conclusions</title> <p>We were unable to detect significant benefits in bNED or in early or late GI and GU side effects after GFM implantation.</p></sec></abstract>ARTICLEtrue exposure to extremely low frequency magnetic fields near high-voltage power lines and assessment of possible increased cancer risk among Slovenian children and adolescents<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2023-0002_s_005"><title style='display:none'>Background</title> <p>Some previous research showed that average daily exposure to extremely low frequency (ELF) magnetic fields (MF) of more than 0.3 or 0.4 μT could potentially increase risk of childhood leukaemia.</p></sec> <sec id="j_raon-2023-0002_s_006"><title style='display:none'>Materials and methods</title> <p>To allow calculations of ELF MF around high voltage (HV) power lines (PL) for the whole Slovenia, a new three-dimensional method including precision terrain elevation data was developed to calculate the long-term average ELF MF. Data on population of Slovenian children and adolescents and on cancer patients with leukaemia’s aged 0–19 years, brain tumours at age 0–29, and cancer in general at age 0–14 for a 12-year period 2005–2016 was obtained from the Slovenian Cancer Registry.</p></sec> <sec id="j_raon-2023-0002_s_007"><title style='display:none'>Results</title> <p>According to the large-scale calculation for the whole country, only 0.5% of children and adolescents under the age of 19 in Slovenia lived in an area near HV PL with ELF MF density greater than 0.1 μT. The risk of cancer for children and adolescents living in areas with higher ELF MF was not significantly different from the risk of their peers.</p></sec> <sec id="j_raon-2023-0002_s_008"><title style='display:none'>Conclusions</title> <p>The new method enables relatively fast calculation of the value of low-frequency magnetic fields for arbitrary loads of the power distribution network, as the value of each source for arbitrary load is calculated by scaling the value for nominal load, which also enables significantly faster adjustment of calculated estimates in the power distribution network.</p></sec> </abstract>ARTICLEtrue in treatment of childhood cancer and subsequent primary neoplasm risk sICAM-1 correlates with tumor volume before primary radiochemotherapy of head and neck squamous cell carcinoma patients<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0043_s_005"><title style='display:none'>Background</title> <p>Biomarkers are of major interest to optimize diagnosis, prognosis and to guide treatment in head and neck cancer patients. Especially blood-based biomarkers appear promising as they can be easily collected and repeatedly analyzed during the course of radiochemotherapy.</p></sec> <sec id="j_raon-2022-0043_s_006"><title style='display:none'>Patients and methods</title> <p>At first, for a broad overview, multiple immune markers were evaluated in six plasma samples of three head and neck squamous cell carcinoma (HNSCC) patients at the beginning and the end of radio-chemotherapy. In this pre-selection, the soluble Intercellular Adhesion Molecule 1 (sICAM-1) appeared most promising. Thus, this marker was measured in multiple samples (n = 86) during treatment and follow-up in a cohort of eleven patients and correlated with tumor features and clinical data.</p></sec> <sec id="j_raon-2022-0043_s_007"><title style='display:none'>Results</title> <p>We found a strong correlation between the initial levels of sICAM-1 in the plasma and the gross tumor volumes of the primary tumor and the involved lymph nodes. However, during the course of treatment no systematic dynamics could be identified. Toxicity or infections did not seem to influence sICAM-1 concentrations.</p></sec> <sec id="j_raon-2022-0043_s_008"><title style='display:none'>Conclusions</title> <p>sICAM-1 appears to reflect the pre-treatment total tumor burden (primary tumor and involved lymph nodes) in head and neck tumor patients. However, it does not seem to be a dynamic marker reflecting response during radiochemotherapy. Thus, if our findings are confirmed in future, sICAM-1 could be used as a staging marker: if high sICAM-1 levels but low tumor burden are found it might be reasonable to intensify staging investigations to rule out further, yet undetected, tumor sites.</p></sec></abstract>ARTICLEtrue the changes in the tumour vascular micro-environment in spinal metastases treated with stereotactic body radiotherapy - a single arm prospective study<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0046_s_005"><title style='display:none'>Background</title> <p>The primary objective was to quantify changes in vascular micro-environment in spinal metastases (SM) patients treated with stereotactic body radiotherapy (SBRT) with multi-parametric dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI). The secondary objective was to study plasma biomarkers related to endothelial apoptosis.</p></sec> <sec id="j_raon-2022-0046_s_006"><title style='display:none'>Patients and methods</title> <p>Patients were imaged with DCE-MRI at baseline/1-week/12-weeks post-SBRT. Metrics including normalised time-dependent leakage (Ktrans), permeability surface product (PS), fractional plasma volume (Vp), extracellular volume (Ve) and perfusion (F) were estimated using distributed parameter model. Serum acid sphingomyelinase (ASM) and sphingosine-1-phosphate (S1P) were quantified using ELISA. Clinical outcomes including physician-scored and patient-reported toxicity were collected.</p></sec> <sec id="j_raon-2022-0046_s_007"><title style='display:none'>Results</title> <p>Twelve patients (with varying primary histology) were recruited, of whom 10 underwent SBRT. Nine patients (with 10 lesions) completed all 3 imaging assessment timepoints. One patient died due to pneumonia (unrelated) before follow-up scans were performed. Median SBRT dose was 27 Gy (range: 24–27) over 3 fractions (range: 2–3). Median follow-up for alive patients was 42-months (range: 22.3–54.3), with local control rate of 90% and one grade 2 or higher toxicity (vertebral compression fracture). In general, we found an overall trend of reduction at 12-weeks in all parameters (Ktrans/PS/Vp/Ve/F). Ktrans and PS showed a reduction as early as 1-week. Ve/Vp/F exhibited a slight rise 1-week post-SBRT before reducing below the baseline value. There were no significant changes, post-SBRT, in plasma biomarkers (ASM/S1P).</p></sec> <sec id="j_raon-2022-0046_s_008"><title style='display:none'>Conclusions</title> <p>Tumour vascular micro-environment (measured by various metrics) showed a general trend towards downregulation post-SBRT. It is likely that vascular-mediated cell killing contributes to excellent local control rates seen with SBRT. Future studies should evaluate the effect of SBRT on primary-specific spinal metastases (e.g., renal cell carcinoma).</p></sec></abstract>ARTICLEtrue perfusion changes in oncological clinical applications by hyperspectral imaging: a literature review<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0051_s_005"><title style='display:none'>Background</title> <p>Hyperspectral imaging (HSI) is a promising imaging modality that uses visible light to obtain information about blood flow. It has the distinct advantage of being noncontact, nonionizing, and noninvasive without the need for a contrast agent. Among the many applications of HSI in the medical field are the detection of various types of tumors and the evaluation of their blood flow, as well as the healing processes of grafts and wounds. Since tumor perfusion is one of the critical factors in oncology, we assessed the value of HSI in quantifying perfusion changes during interventions in clinical oncology through a systematic review of the literature.</p></sec> <sec id="j_raon-2022-0051_s_006"><title style='display:none'>Materials and methods</title> <p>The PubMed and Web of Science electronic databases were searched using the terms “hyperspectral imaging perfusion cancer” and “hyperspectral imaging resection cancer”. The inclusion criterion was the use of HSI in clinical oncology, meaning that all animal, phantom, <italic>ex vivo</italic>, experimental, research and development, and purely methodological studies were excluded.</p></sec> <sec id="j_raon-2022-0051_s_007"><title style='display:none'>Results</title> <p>Twenty articles met the inclusion criteria. The anatomic locations of the neoplasms in the selected articles were as follows: kidneys (1 article), breasts (2 articles), eye (1 article), brain (4 articles), entire gastrointestinal (GI) tract (1 article), upper GI tract (5 articles), and lower GI tract (6 articles).</p></sec> <sec id="j_raon-2022-0051_s_008"><title style='display:none'>Conclusions</title> <p>HSI is a potentially attractive imaging modality for clinical application in oncology, with assessment of mastectomy skin flap perfusion after reconstructive breast surgery and anastomotic perfusion during reconstruction of gastrointenstinal conduit as the most promising at present.</p></sec> </abstract>ARTICLEtrue multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0047_s_006"><title style='display:none'>Background</title> <p>Reliable predictors are urgently needed to identify stage II nasopharyngeal carcinoma (NPC) patients who could benefit from concurrent chemoradiotherapy (CCRT). We aimed to develop a nomogram integrating MRI-identified multidimensional features of lymph nodes to predict survival and assist the decision-making of CCRT for stage II NPC.</p></sec> <sec id="j_raon-2022-0047_s_007"><title style='display:none'>Patients and methods</title> <p>This retrospective study enrolled 242 stage II NPC patients treated from January 2007 to December 2017. Overall survival (OS) was the primary endpoint. Performance of nomogram was evaluated using calibration curves, Harrell Concordance Index (C-index), area under the curve (AUC) and decision curves analysis (DCA) and was compared with TNM staging. According to the individualized nomogram score, patients were classified into two risk cohorts and therapeutic efficacy of CCRT were evaluated in each cohort.</p></sec> <sec id="j_raon-2022-0047_s_008"><title style='display:none'>Results</title> <p>Three independent prognostic factors for OS: age, number and location of positive lymph nodes were included into the final nomogram. T stage was also incorporated due to its importance in clinical decision-making. Calibration plots demonstrated a good match between the predicted and our observed OS rates. C-index for nomogram was 0.726 compared with 0.537 for TNM staging (<italic>p</italic> &lt; 0.001). DCAs confirmed the superior clinical utility of nomograms compared with TNM staging. CCRT compared to intensity-modulated radiotherapy (IMRT) delivered OS benefit to patients in the high-risk group (5-year: 89.9% <italic>vs</italic>. 72.1%; 10-year: 72.5% <italic>vs</italic>. 34.2%, <italic>p</italic> = 0.011), but not in the low-risk group.</p></sec> <sec id="j_raon-2022-0047_s_009"><title style='display:none'>Conclusions</title> <p>This lymph node features-based nomogram demonstrated excellent discrimination and predictive accuracy for stage II patients and could identify patients who can benefit from CCRT.</p></sec></abstract>ARTICLEtrue of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0050_s_006"><title style='display:none'>Background</title> <p>In Slovenia, cancer care services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer control can be impacted also by access to other health services and changes in health-seeking behaviour. In this follow up study, we explored changes in cancer burden and cancer care beyond the first months after the onset of the COVID-19 epidemic.</p></sec> <sec id="j_raon-2022-0050_s_007"><title style='display:none'>Materials and methods</title> <p>We analysed routinely collected data for the period January 2019 through July 2022 from three sources: (1) pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor (source: Slovenian Cancer Registry); (2) referrals issued for oncological services (source: e-referral system); and (3) outpatient appointments and diagnostic imaging performed (source: administrative data of the Institute of Oncology Ljubljana – IOL). Additionally, changes in certain clinical and demographic characteristics in patients diagnosed and treated during the epidemic were analysed using the Hospital-Based Cancer Registry of the IOL (period 2015–2021).</p></sec> <sec id="j_raon-2022-0050_s_008"><title style='display:none'>Results</title> <p>After a drop in referrals to follow-up cancer appointments in April 2020, in June-August 2020, there was an increase in referrals, but it did not make-up for the drop in the first wave; the numbers in 2021 and 2022 were even lower than 2020. Referrals to first cancer care appointments and genetic testing and counselling increased in 2021 compared to 2019 and in 2022 increased further by more than a quarter. First and follow-up outpatient appointments and cancer diagnostic imaging at the IOL dropped after the onset of the epidemic in March 2020 but were as high as expected according to 2019 baseline already in 2021. Some deficits remain for follow-up outpatients’ appointments in surgical and radiotherapy departments. There were more CT, MRI and PET scans performed during the COVID-19 period than before. New cancer diagnoses dropped in all observed years 2020, 2021 and until July 2022 by 6%, 3% and 8%, respectively, varying substantially by cancer type. The largest drop was seen in the 50−64 age group (almost 14% in 2020 and 16% in 2021), while for patients older than 80 years, the numbers were above expected according to the 2015–2019 average (4% in 2020, 8% in 2021).</p></sec> <sec id="j_raon-2022-0050_s_009"><title style='display:none'>Conclusions</title> <p>Our results show a varying effect of COVID-19 epidemic in Slovenia for different types of cancers and at different stages on the patient care pathway – it is probably a mixture of changes in health-seeking behaviour and systemic changes due to modifications in healthcare organisation on account of COVID-19. A general drop in new cancer cases reflects disruptions in the pre-diagnostic phase and could have profound long-term consequences on cancer burden indicators.</p></sec> </abstract>ARTICLEtrue immunotherapy with CAR T cells: well-trodden paths and journey along lesser-known routes<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0049_s_005"><title style='display:none'>Background</title> <p>Chimeric antigen receptor (CAR) T cell therapy is a clinically approved cancer immunotherapy approach using genetically engineered T cells. The success of CAR T cells has been met with challenges regarding efficacy and safety. Although a broad spectrum of CAR T cell variants and applications is emerging, this review focuses on CAR T cells for the treatment of cancer. In the first part, the general principles of adoptive cell transfer, the architecture of the CAR molecule, and the effects of design on function are presented. The second part describes five conceptual challenges that hinder the success of CAR T cells; immunosuppressive tumour microenvironment, T cell intrinsic properties, tumour targeting, manufacturing cellular product, and immune-related adverse events. Throughout the review, selected current approaches to address these issues are presented.</p></sec> <sec id="j_raon-2022-0049_s_006"><title style='display:none'>Conclusions</title> <p>Cancer immunotherapy with CAR T cells represents a paradigm shift in the treatment of certain blood cancers that do not respond to other available treatment options. Well-trodden paths taken by pioneers led to the first clinical approval, and now the journey continues down lesser-known paths to treat a variety of cancers and other serious diseases with CAR T cells.</p></sec> </abstract>ARTICLEtrue study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy and localization of hyperfunctioning parathyroid glands on [F]fluorocholine PET/ CT using deep learning – model performance and comparison to human experts<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0037_s_006"><title style='display:none'>Background</title> <p>In the setting of primary hyperparathyroidism (PHPT), [<sup>18</sup>F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT.</p></sec> <sec id="j_raon-2022-0037_s_007"><title style='display:none'>Patients and methods</title> <p>We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model’s decision process.</p></sec> <sec id="j_raon-2022-0037_s_008"><title style='display:none'>Results</title> <p>The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p &lt; 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model’s decision process, had correctly identified the foreground PET signal.</p></sec> <sec id="j_raon-2022-0037_s_009"><title style='display:none'>Conclusions</title> <p>Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research.</p></sec> </abstract>ARTICLEtrue radiotherapy with simultaneous integrated boost for bone metastases in selected patients with assumed favourable prognosis<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0053_s_006"><title style='display:none'>Background</title> <p>Stereotactic body radiotherapy (SBRT) concepts for dose escalation are increasingly used for bone metastases in patients with oligometastatic or oligoprogressive disease. For metastases that are not suitable for SBRT-regimens, a treatment with 30/40 Gy with simultaneous integrated boost (SIB) in 10 fractions represents a possible regimen. The aim of this study was to investigate the feasibility of this concept and the acute and subacute toxicities.</p></sec> <sec id="j_raon-2022-0053_s_007"><title style='display:none'>Patients and methods</title> <p>Clinical records for dose-escalated radiotherapy of all consecutive patients treated with this regimen were evaluated retrospectively (24 patients with 28 target volumes for oncologic outcomes and 25 patients with 29 target volumes for treatment feasibility and dose parameters analysis). Analysis of radiotherapy plans included size of target volumes and dosimetric parameter for target volumes and organs at risk (OAR). Acute and subacute toxicities were evaluated according to Common Terminology Criteria for Adverse Events (CTCAE) V4.0.</p></sec> <sec id="j_raon-2022-0053_s_008"><title style='display:none'>Results</title> <p>The most common localization was the spine (71.4%). The most common histology was prostate cancer (45.8%). Oligometastatic or oligoprogressive disease was the indication for dose-escalated radiotherapy in 19/24 patients (79.2%). Treatment was feasible with all patients completing radiotherapy. Acute toxicity grade 1 was documented in 36.0% of the patients. During follow up, one patient underwent surgery due to bone instability. The 1-year local control and patient-related progression-free survival (PFS) were 90.0 ± 6.7% and 33.3 ± 11.6%, respectively.</p></sec> <sec id="j_raon-2022-0053_s_009"><title style='display:none'>Conclusions</title> <p>Dose-escalated hypofractionated radiotherapy with simultaneous integrated boost for bone metastases resulted in good local control with limited acute toxicities. Only one patient required surgical intervention. The regimen represents an alternative to SBRT in selected patients.</p></sec></abstract>ARTICLEtrue PET-CT as an important diagnostic tool and prognostic marker in suspected recurrent cervical carcinoma after radiotherapy: comparison with MRI<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0042_s_006"> <title style='display:none'>Background</title> <p>Recurrent disease in post-irradiation patients with cervical cancer is often difficult to delineate on magnetic resonance imaging (MRI), because posttreatment changes can have a similar appearance, and further evaluation is often required. The aims of the study were to evaluate positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG PET-CT) diagnostic role in suspected recurrent cervical cancer after radiotherapy, compare it to MRI, and assess their prognostic impact in these patients.</p> </sec> <sec id="j_raon-2022-0042_s_007"> <title style='display:none'>Patients and methods</title> <p>This cohort retrospective study included patients previously treated with radiotherapy for carcinoma of uterine cervix with suspected recurrence, who had undergone MRI of abdomen and pelvis, and were subsequently evaluated on FDG PET-CT, with minimum follow-up period of 12 months.</p> </sec> <sec id="j_raon-2022-0042_s_008"> <title style='display:none'>Results</title> <p>In the total of 84 patients included in analysis, MRI <italic>vs</italic>. FDG PET-CT showed sensitivity, specificity and accuracy of 80.1%, 52.4% and 66.7%, <italic>vs</italic>. 97.6%, 61.9% and 79.8%, respectively. Patients with positive findings on MRI (Log Rank, p = 0.003) and PET-CT (Log Rank, p &lt; 0.001) had shorter progression-free survival (PFS) than those with negative results. In univariate Cox regression models, MRI and FDG PET-CT results were found to be related to PFS (p = 0.005 and p &lt; 0.001, respectively). However, multivariate analysis proved only FDG PET-CT to be independent prognostic factor, where patients with positive FDG PET-CT results had almost nine times higher risk of progression (p &lt; 0.001).</p> </sec> <sec id="j_raon-2022-0042_s_009"> <title style='display:none'>Conclusion</title> <p>FDG PET-CT represents useful diagnostic tool in suspected recurrent cervical cancer after radiotherapy, showing high sensitivity in its detection. In addition, it is an independent factor in predicting progression-free survival in these patients.</p> </sec> </abstract>ARTICLEtrue in diagnostics and management of gestational trophoblastic disease<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0038_s_009"><title style='display:none'>Background</title> <p>Gestational trophoblastic disease (GTD) is a heterogeneous group of rare tumours characterised by abnormal proliferation of trophoblastic tissue. It consists of benign or premalignant conditions, such as complete and partial molar pregnancy and variants of malignant diseases. The malignant tumours specifically are commonly referred to as gestational trophoblastic neoplasia (GTN). They consist of invasive mole, choriocarcinoma, placental-site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT).</p></sec> <sec id="j_raon-2022-0038_s_010"><title style='display:none'>Conclusions</title> <p>Patients with GTD are often asymptomatic, although vaginal bleeding is a common presenting symptom. With the advances in ultrasound imaging in early pregnancy, the diagnosis of molar pregnancy is most commonly made in the first trimester of pregnancy. Sometimes, additional imaging such as chest X-ray, CT or MRI can help detect metastatic disease. Most women can be cured, and their reproductive function can be preserved. In this review, we focus on the advances in management strategies for gestational trophoblastic disease as well as possible future research directions.</p></sec> </abstract>ARTICLEtrue myxoma: single tertiary centre experience<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0041_s_006"><title style='display:none'>Background</title> <p>Although cardiac myxoma (CM) are rare and benign, they can cause life-threatening complications, such as hemodynamic disturbances or embolization. Surgical excision of the tumour is the treatment of choice. The aim of the study was to evaluate the epidemiological characteristics, clinical presentation, imaging findings, and outcomes of surgical treatment of patients with CM treated in the largest tertiary care centre in Slovenia.</p></sec> <sec id="j_raon-2022-0041_s_007"><title style='display:none'>Patients and methods</title> <p>We retrospectively analysed the medical records of all patients referred to our institution between January 2005 and December 2020 and identified 39 consecutive adult patients with pathologically confirmed CM.</p></sec> <sec id="j_raon-2022-0041_s_008"><title style='display:none'>Results</title> <p>The average annual incidence of CM in the study was 3 per 2 million population per year. Patients were more often female (n = 25, 64%). The mean age at diagnosis was 63.1 ± 13.6 years. Dyspnoea was the most common presenting symptom (31%). CM was an incidental finding in 11 patients (28%). Seven patients presented with thromboembolic event (18%). Transthoracic echocardiography (TTE) was performed in all patients, however additional imaging was required in 22 patients (56%). All patients in our series were successfully treated surgically without in-hospital mortality. During the follow-up period (6 months to 16 years) three patients (8%) died, and all deaths were unrelated to CM. There was no recurrence of CM during the follow-up.</p></sec> <sec id="j_raon-2022-0041_s_009"><title style='display:none'>Conclusions</title> <p>Our single-centre study confirms that CM is rare cardiac tumour with diverse clinical presentation. Our data shows data that CM might be more prevalent than considered before. Surgical resection of the tumour is safe with excellent short- and long-term outcomes.</p></sec> </abstract>ARTICLEtrue of haemophilia early arthropathy detection with ultrasound (HEAD-US) in children: a comparative magnetic resonance imaging (MRI) study<abstract> <title style='display:none'>Abstract</title> <sec id="j_raon-2022-0040_s_006"><title style='display:none'>Background</title> <p>Ultrasound (US) has been proven to be reliable in the assessment of early haemophilic arthropathy in the adult haemophilic population, however few studies so far focused on the reliability of US specifically in the paediatric haemophilic population. We were interested if the changing appearance of the growing bone hinders the ultrasonographic evaluation of the pathologic processes caused by haemophilic arthropathy. The aim of the study was to assess the reliability of US for evaluation of haemophilic arthropathy in children in comparison to magnetic resonance imaging (MRI).</p></sec> <sec id="j_raon-2022-0040_s_007"><title style='display:none'>Patients and methods</title> <p>The study included all children aged 6 years or more with severe haemophilia in the country (n = 10). We assessed their elbows, knees, and ankles bilaterally by US and compared the results to the MRI as the reference standard. Pearson correlation coefficient (r) was used to analyse correlation.</p></sec> <sec id="j_raon-2022-0040_s_008"><title style='display:none'>Results</title> <p>The correlation with MRI for the US for the total score was excellent for all joints (r = 0.849 for the elbows, r = 1 for knees, r = 0.842 for ankles). The correlation of scores for specific joint components showed fair, moderate, or excellent correlation for all joint components in all joints. The correlation was the lowest for the evaluation of cartilage and bone in the ankles (r = 0.546 and r = 0.478) and bone in the elbows (r = 0.499).</p></sec> <sec id="j_raon-2022-0040_s_009"><title style='display:none'>Conclusions</title> <p>Our study proved that US using the HEAD-US method performed by paediatric radiologists is a reliable tool for detection and quantification of haemophilic arthropathy in children in comparison to MRI.</p></sec> </abstract>ARTICLEtrue