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European Radiology Jul 2013To evaluate a computer-aided detection (CADe) system for lytic and blastic spinal metastases on computed tomography (CT).
OBJECTIVE
To evaluate a computer-aided detection (CADe) system for lytic and blastic spinal metastases on computed tomography (CT).
METHODS
We retrospectively evaluated the CADe system on 20 consecutive patients with 42 lytic and on 30 consecutive patients with 172 blastic metastases. The CADe system was trained using CT images of 114 subjects with 102 lytic and 308 blastic spinal metastases. Lesions were annotated by experienced radiologists. Detected benign lesions were considered false-positive findings. Detector sensitivity and the number of false-positive findings were calculated as the criteria for detector performance, and free-response receiver operating characteristic (FROC) analysis was conducted. Detailed analysis of false-positive and false-negative findings was performed.
RESULTS
Algorithm runtime is 3 ± 0.5 min per patient. The system achieves a sensitivity of 83 % at 3.5 false positives per patient on average for blastic metastases and a sensitivity of 88 % at 3.7 false positives for lytic metastases. False positives appeared predominantly in the area of degenerative changes in the case of the blastic metastasis detector and in osteoporotic areas in the case of the lytic metastasis detector.
CONCLUSION
The CADe system reliably detects thoracolumbar spine metastases in real time. An additional study is planned to evaluate how the bone lesion CADe system improves radiologists' accuracy and efficiency in a clinical setting.
KEY POINTS
• Computer-aided detection (CADe) of bone metastases has been developed for spinal CT. • The CADe system exhibits high sensitivity with a tolerable false-positive rate. • Analysis of false-positive detection may further improve the system. • CADe may reduce the number of missed spinal metastases at CT interpretation.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Automation; False Positive Reactions; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Osteoporosis; ROC Curve; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies; Software; Spinal Neoplasms; Tomography, X-Ray Computed
PubMed: 23397381
DOI: 10.1007/s00330-013-2774-5 -
Journal of the Belgian Society of... Apr 2021Sclerotic lesions of the jaw are uncommon but may be clinically relevant. In this pictorial review, the most common sclerotic lesions are discussed. Three categories of...
Sclerotic lesions of the jaw are uncommon but may be clinically relevant. In this pictorial review, the most common sclerotic lesions are discussed. Three categories of lesions are distinguished; odontogenic sclerotic lesions, non-odontogenic sclerotic lesions, and mixed lytic-sclerotic lesions. In each group, non-neoplastic conditions are discussed first, followed by benign and malignant neoplasms. For each disease a brief overview is given, including histological features, epidemiology, symptoms, typical location, imaging features, and treatment. This review emphasizes which basic observations are essential to the evaluation of sclerotic jaw lesions and what elements have to be taken into account to create a proper differential diagnosis.
PubMed: 33870085
DOI: 10.5334/jbsr.2208 -
Molecular Imaging and Radionuclide... Oct 2018Primary malignant melanoma occurs most often in the skin and much less frequently in the choroid layer of the eyes, in the leptomeninges, oral cavity, nasal mucosa,...
Primary malignant melanoma occurs most often in the skin and much less frequently in the choroid layer of the eyes, in the leptomeninges, oral cavity, nasal mucosa, pharynx, esophagus, bronchus, under the nail and vaginal or anorectal mucosa. Primary melanoma of the gastrointestinal tract has been confirmed for lesions occurring in the esophagus, stomach, small bowel, and anorectum through several published reports, as these are the areas where melanocytes normally exist. The occurrence of primary malignant melanoma in the colon is relatively rare, because melanocytes are embryologically absent in the large bowel. Herein we report a patient whose colonic malignant melanoma was diagnosed and disseminated metastatic lesions were revealed with F-FDG PET/CT scan. There were multiple nodular lesions showing increased F-FDG uptake in both lungs. There was a soft tissue lesion with slightly increased F-FDG uptake, which extended to the intraluminal region of the thoracic esophagus. Increased metabolic activity was detected in the asymmetric stomach wall thickening site and in a soft tissue lesion located on the gall bladder wall that was filling the lumen. Multiple hypodense/hyper-metabolic lesions were identified in the liver. Multiple hyper-metabolic polypoid soft tissue lesions were visualized in almost the entire colonic segments. Multiple hyper-metabolic peritoneal implants were noted in all abdominal quadrants. Increased F-FDG uptake was detected at the right surrenal gland soft tissue lesion. There was a hyper-metabolic soft tissue lesion on the posterior wall of the rectum. Hyper-metabolic lytic lesions were seen at the thoracal and lumbar vertebrae, left scapula, left iliac bone, sacrum and left femur. There was no evidence of F-FDG avid skin lesions in both attenuation corrected and non-corrected images.
PubMed: 30317855
DOI: 10.4274/mirt.65807 -
Journal of Surgical Case Reports Aug 2020Up-to-date management for metastatic epidural spinal cord compression is based on appropriate scoring systems. In this case, separation surgery and stereotactic...
Up-to-date management for metastatic epidural spinal cord compression is based on appropriate scoring systems. In this case, separation surgery and stereotactic radiosurgery achieved an optimized outcome. A 75-year-old man had thoracic band-like pain, left lower limb weakness and difficulty ambulating for 6 weeks. Spinal images showed a T4 metastatic epidural spinal cord compression with a pathological fracture of T4 and T10 and L3 lytic lesions. There was no other neoplastic lesion. The metastasized T4 was decompressed by a posterolateral right costotransversectomy, vertebrectomy and insertion of an expandable titanium cage. The spinal sagittal alignment was restored with T1-T7 pedicle screw fixation. Post-operatively the pain and motor power improved significantly so that the patient was discharged home. Separation surgery and adjuvant stereotactic radiosurgery of the spine successfully improved tumor burden, pain control and overall prognosis.
PubMed: 32855794
DOI: 10.1093/jscr/rjaa217 -
American Journal of Hematology Jul 2016Multiple myeloma accounts for approximately 10% of hematologic malignancies.The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma... (Review)
Review
Multiple myeloma accounts for approximately 10% of hematologic malignancies.The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging. Patients with del(17p), t(14;16), and t(14;20) have high-risk multiple myeloma. Patients with t(4;14) translocation and gain(1q) have intermediate-risk. All others are considered standard-risk. Initial treatment consists of bortezomib, lenalidomide, dexamethasone (VRD). In high-risk patients, carfilzomib, lenalidomide, dexamethasone (KRD) is an alternative to VRD. In eligible patients, initial therapy is given for approximately 3-4 months followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT at first relapse. Patients not candidates for transplant are treated with Rd until progression, or alternatively, a triplet regimen such as VRD for approximately 12-18 months. After ASCT, lenalidomide maintenance is considered for standard risk patients especially in those who are not in very good partial response or better, while maintenance with a bortezomib-based regimen is needed for patients with intermediate or high-risk disease. Patients with indolent relapse can be treated with 2-drug or 3-drug combinations. Patients with more aggressive relapse require a triplet regimen or a combination of multiple active agents. Am. J. Hematol. 91:720-734, 2016. © 2016 Wiley Periodicals, Inc.
Topics: Antineoplastic Combined Chemotherapy Protocols; Hematopoietic Stem Cell Transplantation; Humans; Multiple Myeloma; Risk Assessment
PubMed: 27291302
DOI: 10.1002/ajh.24402 -
Clinical Nephrology. Case Studies 2020Longstanding, severe hyperparathyroidism (HPT) can lead to the formation of "brown tumors". A brown tumor is a radiolucent bone lesion that is locally destructive; it is...
Longstanding, severe hyperparathyroidism (HPT) can lead to the formation of "brown tumors". A brown tumor is a radiolucent bone lesion that is locally destructive; it is not a neoplasm, but rather a stromal mass consisting of fibrous tissue, poorly mineralized woven bone, and supporting vasculature. These tumors are a rare complication of advanced primary or secondary HPT. We present a young female with chronic kidney disease (CKD) on hemodialysis with uncontrolled secondary HPT (SHPT). The patient presented with progressive lower extremity weakness and back pain. CT imaging showed multiple lytic bone lesions involving several ribs and the spine. Subsequent MRI imaging of the thoracic and lumbar spine confirmed expansile bone lesions consistent with brown tumors. One mass protruded into the spinal canal causing severe stenosis at T3 with underlying cord edema. The other lesion at T12 caused only moderate spinal canal stenosis. Our patient underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy (PTX).
PubMed: 33062583
DOI: 10.5414/CNCS110195 -
Journal of Surgical Case Reports Jan 2021Multiple myeloma is a hematologic malignancy frequently presenting with spinal lytic lesions. The authors report the case of a patient with an extensively destructive...
Multiple myeloma is a hematologic malignancy frequently presenting with spinal lytic lesions. The authors report the case of a patient with an extensively destructive osteolytic MM lesion in the cervical spine treated exclusively with radiotherapy. Computed tomography and magnetic resonance imaging scans showed an arrest of further progression of instability and resolution of the lytic lesion, showing signs of new bone formation. Whereas surgery should be considered for cases of spinal instability and potential neurological injury, this case demonstrates that isolated radiotherapy can be used in select cases to treat MM lesions and restore the structural integrity of the spinal elements.
PubMed: 33505656
DOI: 10.1093/jscr/rjaa563 -
Journal of Clinical Laboratory Analysis Jul 2022Acinetobacter Baumannii is an opportunistic nosocomial pathogen belonging to the Moraxellaceae family. The emergence of multidrug resistant strains of this pathogen...
OBJECTIVES
Acinetobacter Baumannii is an opportunistic nosocomial pathogen belonging to the Moraxellaceae family. The emergence of multidrug resistant strains of this pathogen caused many problems for hospitals and patients. The aim of the current study was to isolate, identify, and morphologically, physiologically, and in vivo analyze a new lytic bacteriophage targeting extensively drug-resistant (XDR) A. baumannii.
MATERIALS AND METHODS
Different wastewater samples were tested for isolation of lytic bacteriophage against 19 A. baumannii isolates obtained from patients hospitalized in a hospital in Arak, Iran, from January 2019 to March 2019. The phenotypic and genotypic characteristics of A. baumannii strains (resistance genes including: adeA, adeB, adeC, adeR, adeS, ISAba1, blaOXA-23, blaOXA-24) were analyzed. The isolated phage characteristics including adsorption time, pH and thermal stability, host range, one-step growth rate, electron microscopy examination, and therapeutic efficacy of the phage were also investigated. Therapeutic efficacy of the phage was evaluated in a rat model with burn infection of XDR A. baumannii. The lesion image was taken on different days after burning and infection induction and was compared with phage untreated lesions.
RESULTS
The results showed unique characteristics of the isolated phage (vB-AbauM-Arak1) including high specificity for Acinetobacter baumannii, stability at a relatively wide range of temperatures and pH values, short adsorption time, short latent period, and large burst size. In relation to the therapeutic efficacy of the phage, the lesion area decreased in phage-treated groups over 14 days than in those untreated, significantly (p < 0.05).
CONCLUSION
Our findings demonstrated that isolated lytic phage was able to eliminate burn infections caused by XDR A. baumannii in a rat model. So, it may be recommended as alternative options toward to developing a treatment for extensively drug resistant Acinetobacter infections.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Animals; Anti-Bacterial Agents; Bacteriophages; Burns; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Iran; Phage Therapy; Rats
PubMed: 35708005
DOI: 10.1002/jcla.24497 -
IDCases 2022We report a case of calvarial lytic lesions in neurosyphilis with ocular involvement. A 42-year-old woman with a past medical history of polysubstance abuse presented...
We report a case of calvarial lytic lesions in neurosyphilis with ocular involvement. A 42-year-old woman with a past medical history of polysubstance abuse presented with recent bilateral vision loss. CT revealed numerous calvarial lytic lesions and multiple myeloma was initially suspected. Syphilis screening with RPR and confirmative CSF studies were positive for active infection. The patient was treated with Penicillin G and demonstrated clinical improvement. The objective of this study was to provide insight into a rare manifestation of syphilis with osseous involvement and encourage further discourse into establishment of standards of care for syphilitic osteomyelitis. There exist no evidence-based guidelines regarding optimal treatment route and duration, role of bone biopsy, determination of therapeutic impact, and threshold for surgical intervention in the management of syphilitic osteomyelitis.
PubMed: 35145857
DOI: 10.1016/j.idcr.2022.e01408 -
Ghana Medical Journal Sep 2018Metastatic tumours of the oral cavity are not common. The most common site for bone metastases in the head and neck region is the mandible. Metastatic lesion of the...
Metastatic tumours of the oral cavity are not common. The most common site for bone metastases in the head and neck region is the mandible. Metastatic lesion of the mandible most commonly originate from the lungs in men and breast in women, and these lesions (or tumours) usually are carcinomas rather than sarcomas. We report two cases of metastatic lesions in the mandible: (1) A 19year old male with right mandibular swelling and a nodular swelling in the distal two-third of the right tibia. Radiograghs revealed sclerotic lesion with a sunburst appearance in both the jaw and tibia. Histology of the jaw lesion confirmed a metastatic osteosarcoma of the mandible. (2) A 51year old female with a right mandibular swelling with associated swelling in the anterior neck, right shoulder and right parietal region of the skull. Computerised tomography scan (CT) of the jaws showed an osteolytic lesion of the right mandible. CT scan of the brain also showed a large lytic lesion seen in the posterior aspect of the right parietal bone. Histology of the jaw mass confirmed a metastatic follicular carcinoma from the thyroid. Mandibular metastasis may be the first presenting feature of underlying occult malignancy of another primary site. Therefore, clinicians should maintain a high level of suspicion while evaluating patients with a history of cancer presenting with oral lesions.
Topics: Adenocarcinoma, Follicular; Carcinoma; Diagnosis, Differential; Fatal Outcome; Female; Humans; Male; Mandibular Neoplasms; Middle Aged; Osteosarcoma; Palliative Care; Tomography, X-Ray Computed; Young Adult
PubMed: 30602804
DOI: 10.4314/gmj.v52i3.11