Utilization of dynamic CT perfusion in the study of intracranial meningiomas and their surrounding tissue.

Objective: To use CT perfusion (CTP) to assess levels of ischemia in brain areas around intracranial meningiomas.

Materials And Methods: Fifteen patients with intracranial meningiomas were analysed preoperatively with CTP study. The cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) were measured in the edema, peritumoral edema and in the normal areas of brain.

Cost-effectiveness of 99mTc-sestamibi in predicting response to chemotherapy in patients with lung cancer: systematic review and meta-analysis.

Unlabelled: Multidrug resistance (MDR) is a major problem in lung cancer. (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) has been demonstrated to be a noninvasive marker for the diagnosis of MDR-related P glycoprotein and MDR-associated protein expression in various solid tumors. Studies have shown that (99m)Tc-MIBI could play a significant role in the management of lung cancer; for example, it could be used in the selection of patients for chemotherapy or radiotherapy or in combined protocols before the start of treatment.

Colorectal cancer: texture analysis of portal phase hepatic CT images as a potential marker of survival.

Purpose: To assess the utility of texture analysis of liver computed tomographic (CT) images by determining the effect of acquisition parameters on texture and by comparing the abilities of texture analysis and hepatic perfusion CT to help predict survival for patients with colorectal cancer.

Materials And Methods: The study comprised a phantom test and a clinical evaluation of 48 patients with colorectal cancer who had consented to retrospective analysis of hepatic perfusion CT data acquired during a research study approved by the institutional review board. Both components involved texture analysis to quantify the relative contribution of CT features between 2 and 12 pixels wide to overall image brightness and uniformity.

PET-CT in oncology: making the most of CT.

Combined positron emission tomography-computed tomography (PET-CT) has made a significant impact on cancer imaging. The use of CT to map tissue attenuation for correction of PET images and the ability to co-register the functional information provided by PET with the anatomical data afforded by CT, has resulted in demonstrable improvements in diagnostic accuracy. However, attenuation correction and anatomical localisation may not represent the full benefits of integrating CT with PET.

'Catapulted into sexual health nursing leadership'.

Kevin Miles, nurse consultant and lead clinician for genitourinary medical services at Camden Primary Care Trust, explains why he feels he is in a position to lead evidence-based changes.

Perfusion imaging with computed tomography: brain and beyond.

The availability of rapid imaging with multidetector CT systems and commercial analysis software has made perfusion imaging with CT an everyday technique, not only for the brain but also for other body organs. Perfusion imaging is usually performed as an adjunct to a conventional CT examination and is therefore particularly appropriate when a conventional CT is part of routine clinical protocols. The derived values are reproducible and have been validated against a range of reference techniques.

Androgen regulation of renal uridine diphosphoglucuronosyltransferase 1A1 in rats.

Many phase I and II enzymes are under hormonal regulation, resulting in sex-related expression patterns. This sex-related enzyme expression can result in differential metabolism of physiologically active endogenous substances, altered xenobiotic clearance, and differences in susceptibility to drug toxicities. Treatment of female Sprague-Dawley (SD) rats with 5 mg testosterone propionate/kg/day, 2 ml/kg s.

Three-dimensional selective-scale texture analysis of computed tomography pulmonary angiograms.

Objectives: This feasibility study aims to develop 3-dimensional (3D) selective-scale texture analysis of computed tomography pulmonary angiography to identify texture correlates for ventilated and vascular lung for visual and quantitative assessment of pulmonary disorders with altered vasculature.

Materials And Methods: Computed tomography pulmonary angiography examinations of 8 patients were considered in this study; 3 had normal lungs, 3 had pulmonary embolism (PE1, PE2, and PE3), 1 had only emphysema (PEmp), whereas the final patient had both emphysema and embolism (PEE). Before texture analysis, an initial automated segmentation procedure to include only the lung parenchyma and generation of isometric volume were carried out.

The cost-effective use of 18F-FDG PET in the presurgical evaluation of medically refractory focal epilepsy.

Unlabelled: This study applied decision tree analysis to evaluate the sensitivity, specificity, and cost-effectiveness of clinical algorithms that incorporate 18F-FDG PET.

Methods: A cohort of 176 patients was studied. The localization rate, accuracy, therapeutic impact on the presurgical decision-making process, and correlation with the postsurgical outcome were assessed for the tests commonly performed for seizure localization.

A comparison of two techniques for knee arthrodesis: the custom made intramedullary Mayday nail versus a monoaxial external fixator.

The most common indication for knee arthrodesis is pain and instability in an unreconstructable knee following an infected knee arthroplasty. In this study, we compare the use of the Mayday arthrodesis nail (Orthodynamics, Christchurch, UK) versus external fixation, Orthofix (Berkshire UK) and Stryker Hoffman II (County Cork, Ireland). All patients in this study underwent arthrodesis between 1995 and 2006 at Conquest Hospital, Hastings.

Does using self-completed sexual history questionnaires in HIV-positive men who have sex with men affect clinical outcomes?

This audit compared sexual histories taken by self-completed questionnaires (SQ) versus the 'gold-standard' of 'traditional' face-to-face interviews by health-care professionals (HP). It compared reporting of symptoms and sexual behaviour and looked at outcomes in terms of diagnoses of sexually transmitted infections. SQ were at least equal to HP and might therefore be a valuable tool in streamlining services.

Warburg revisited: imaging tumour blood flow and metabolism.

In the 1930s, Otto Warburg reported that anaerobic metabolism of glucose is a fundamental property of all tumours, even in the presence of an adequate oxygen supply. He also demonstrated a relationship between the degree of anaerobic metabolism and tumour growth rate. Today, this phenomenon forms the basis of tumour imaging with fluorodeoxyglucose positron emission tomography (FDG-PET).

Cancer imaging: is it cost-effective?

With expenditure on imaging patients with cancer set to increase in line with rising cancer prevalence, there is a need to demonstrate the cost-effectiveness of advanced cancer imaging techniques. Cost-effectiveness studies aim to quantify the cost of providing a service relative to the amount of desirable outcome gained, such as improvements in patient survival. Yet, the impact of imaging on the survival of patients with cancer is small compared to the impact of treatment and is therefore hard to measure directly.

Texture analysis in non-contrast enhanced CT: impact of malignancy on texture in apparently disease-free areas of the liver.

Objectives: To determine whether texture analysis of non-contrast enhanced computed tomography (CT) images in apparently disease-free areas of the liver is altered by the presence of extra- and intra-hepatic malignancy in colorectal cancer patients.

Materials And Methods: Hepatic attenuation and texture were assessed from non-contrast enhanced CT in three groups of colorectal cancer patients: (A) 15 controls with no malignancy; (B) nine patients with extra-hepatic malignancy but no liver involvement; (C) eight patients with hepatic metastases. Regions of interest were manually constructed only over apparently normal areas of liver tissue excluding major blood vessels and areas of intra-hepatic fat, which may otherwise alter CT texture irrespective of the presence of malignancy.

Cancer imaging - making the most of your gamma camera.

As MRI threatens the use of bone scintigraphy for skeletal metastases and 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) emerges as the main focus in nuclear oncology, the future role of the gamma camera in cancer imaging appears unclear. However, there is a range of pre-existing conventional gamma camera techniques that have incremental benefit over CT and other structural imaging techniques, but are yet to be fully exploited in the care of cancer patients. This article reviews some of the more advanced conventional nuclear medicine techniques for cancer imaging.

Hepatic enhancement in colorectal cancer: texture analysis correlates with hepatic hemodynamics and patient survival.

Rationale And Objectives: Perfusion imaging of the liver has attracted interest as a potential means for earlier detection of hepatic metastases, but the techniques are complex and do not form part of routine imaging protocols. This study assesses whether the hemodynamic status of the liver of patients with colorectal cancer but apparently normal hepatic morphology is reflected by texture features within a single portal-phase contrast enhanced computed tomography (CT) image and correlates texture with overall survival.

Materials And Methods: Portal-phase CT images from 27 patients with colorectal cancer but no apparent hepatic metastases were processed using a band-pass filter that highlighted image features at different spatial frequencies.

Colorectal cancer: imaging surveillance following resection of primary tumour.

Most patients with colorectal cancer undergo treatment with curative intent and subsequently enter a surveillance programme. The primary aim of surveillance is to identify patients with disease relapse at a resectable stage. However, the identification of local recurrence and metachronous carcinoma are also important aspects of follow up.

Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana.

Problem: As programmes to deliver antiretroviral therapy (ART) are implemented in resource-constrained settings, the problem becomes not how these programmes are going to be financed but who will be responsible for delivering and sustaining them.

Approach: Physician-led models of HIV treatment and care that have evolved in industrialized countries are not replicable in settings with a high prevalence of HIV infection and limited access to medical staff. Therefore, models of care need to make better use of available human resources.

Apoptotic cells protect mice from autoimmune inflammation by the induction of regulatory B cells.

The maintenance of immune tolerance to apoptotic cells (AC) within an inflammatory milieu is vital to prevent autoimmunity. To investigate this, we administered syngeneic AC i.v.

In search of biologic correlates for liver texture on portal-phase CT.

Rationale And Objectives: The acceptance of computer-assisted diagnosis (CAD) in clinical practice has been constrained by the scarcity of identifiable biologic correlates for CAD-based image parameters. This study aims to identify biologic correlates for computed tomography (CT) liver texture in a series of patients with colorectal cancer.

Materials And Methods: In 28 patients with colorectal cancer, total hepatic perfusion (THP), hepatic arterial perfusion, and hepatic portal perfusion (HPP) were measured using perfusion CT.

Hepatic entropy and uniformity: additional parameters that can potentially increase the effectiveness of contrast enhancement during abdominal CT.

Aim: To determine how hepatic entropy and uniformity of computed tomography (CT) images of the liver change after the administration of contrast material and to assess whether these additional parameters are more sensitive to tumour-related changes in the liver than measurements of hepatic attenuation or perfusion.

Materials And Methods: Hepatic attenuation, entropy, uniformity, and perfusion were measured using multi-phase CT following resection of colorectal cancer. Based on conventional CT and fluorodeoxyglucose positron emission tomography, 12 patients were classified as having no evidence of malignancy, eight with extra-hepatic tumours only, and eight with metastatic liver disease.

Quantifying emerging drugs for very rare conditions.

Background: EU legislation is encouraging pharmaceutical companies to develop drugs for rare conditions, but their often high cost, and potential for long-term administration has led to debate about their affordability and cost-effectiveness.

Aim: To investigate how many drugs are in development for very rare conditions.

Methods: We defined very rare conditions as having a prevalence of <1:50,000, and identified pharmaceuticals in phase II, phase III trials or pre-registration for these conditions using commercial databases.

A nurse- and pharmacist-led treatment advice clinic for patients attending an HIV outpatient clinic.

Aim: This paper is a report of a study to map care pathways, examine the approach of different treatment advisors and explore the acceptability of a nurse- and pharmacist-led treatment advice clinic in order to aid decision-making for the future development and evaluation of the clinic.

Background: High levels of adherence to antiretroviral drugs are a prerequisite for a successful and durable virological and immunological response to HIV. Treatment guidelines acknowledge that adherence is a process, not a single event, and that adherence support must be integrated into clinical follow-up for all patients receiving these drugs.