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  • 1.
    Bäcklund, J.
    et al.
    Danderyd Hosp, Dept Radiol, Stockholm, Sweden..
    Dahl, E. Clewett
    St Gorans Univ Hosp, Dept Radiol, Stockholm, Sweden..
    Skorpil, Mikael
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Is CT indicated in diagnosing sacroiliac joint degeneration?2017In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229X, Vol. 72, no 8, p. 693.e9-693.e13Article in journal (Refereed)
    Abstract [en]

    AIM: To assess the value of computed tomography (CT) in the diagnosis of symptomatic sacroiliac (SI) joint degeneration.

    MATERIALS AND METHODS: CT images from 123 patients with clinically diagnosed SI joint pain were compared to age- and gender-matched controls without chronic back pain or previous back surgery. Degeneration was graded assessing joint space narrowing, osteophytes, subchondral sclerosis, cysts, and vacuum phenomena.

    RESULTS: The mean total score for the patients was 9.6 and for the controls 9.7 (p = 0.77). A subgroup analysis of the mean score for the SI joints that were subjected to surgery was 4.3, compared to 4.8 in the conservatively treated SI joints in the patient group (p = 0.23) and 4.8 for all SI joints in the control group (p = 0.25). For patients with unilateral left-sided pain (n = 40), the mean score for the left side was 5.2 and for the right side 4.9 (p = 0.49). For patients with right-sided pain (n = 41), the mean score for the right side was 4.8 and the left side 4.7 (p = 0.55).

    CONCLUSION: The prevalence of SI joint degeneration on CT is equal in symptomatic and non-symptomatic individuals. This study indicates that the value of CT is limited, but further studies are needed to establish if CT has a place in diagnosing SI joint degeneration.

  • 2.
    Linder, Gustav
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Korsavidou Hult, Nafsika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Bjerner, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Antaros Med AB, Molndal, Sweden.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    F-18-FDG-PET/MRI in preoperative staging of oesophageal and gastroesophageal junctional cancer2019In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229X, Vol. 74, no 9, p. 718-725Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate integrated 2-[F-18]-fluoro-2-deoxy-D-glucose (F-18-FDG) positron-emission tomography (PET)/magnetic resonance imaging (MRI), in comparison with the standard technique, integrated F-18-FDG-PET/computed tomography (CT), in preoperative staging of oesophageal or gastroesophageal junctional cancer.

    MATERIALS AND METHODS: In the preoperative staging of 16 patients with oesophageal or gastroesophageal junctional cancer, F-18-FDG-PET/MRI was performed immediately following the clinically indicated F-18-FDG-PET/CT. MRI-sequences included T1-weighted fat-water separation (Dixon's technique), T2-weighted, diffusion-weighted imaging (DWI), and gadolinium contrast-enhanced T1-weighted three-dimensional (3D) imaging. PET was performed with F-18-FDG. Two separate teams of radiologists conducted structured blinded readings of F-18-FDG-PET/MRI or F-18-FDG-PET/CT, which were then compared regarding tumour measurements and characteristics as well as assessment of inter-rater agreement (Cohen's kappa) for the clinical tumour, nodal and metastatic (TNM) stage.

    RESULTS: There were no medical complications. Comparison of tumour measurements revealed high correlations without significant differences between modalities. The maximum standardised uptake value (SUVmax) values of the primary tumour with F-18-FDG-PET/MRI had excellent correlation to those of F-18-FDG-PET/CT (0.912, Spearman's rho). Inter-rater agreement between the techniques regarding T-stage was only fair (Cohen's kappa, 0.333), arguably owing to relative over-classification of the T-stage using F-18-FDG-PET/CT. Agreements in the assessment of N- and M-stage were substantial (Cohen's kappa, 0.849 and 0.871 respectively).

    CONCLUSION: Preoperative staging with F-18-FDG-PET/MRI is safe and promising with the potential to enhance tissue resolution in the area of interest. F-18-FDG-PET/MRI and F-18-FDG-PET/CT correlated well for most of the measured values and discrepancies were seen mainly in the assessment of the T-stage. These results facilitate further studies investigating the role of F-18-FDG-PET/MRI in, e.g., predicting or determining the response to neoadjuvant therapy. 

  • 3.
    Mosavi, Firas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Wassberg, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Selling, Jonas
    Molin, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Whole-body diffusion-weighted MRI and (18)F-FDG PET/CT can discriminate between different lymphoma subtypes2015In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229X, Vol. 70, no 11, p. 1229-1236Article in journal (Refereed)
    Abstract [en]

    AIM: To determine whether combined 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) positron-emission tomography (PET)/computed tomography (CT) and diffusion-weighted imaging (DWI) can be used for characterisation of different lymphoma subtypes, i.e., indolent versus aggressive lymphoma, and also to assess the prognostic value of different quantitative parameters of whole-body (WB) DWI and (18)F-FDG PET/CT.

    MATERIALS AND METHODS: Pre-therapeutic WB magnetic resonance imaging (MRI) including DWI and (18)F-FDG PET/CT were performed in lymphoma patients. Different quantitative DWI and (18)F-FDG PET/CT parameters were evaluated for characterisation of different lymphoma subtypes. These parameters were also correlated, both separately and in combination, against overall survival (OS) and progression-free survival (PFS). A lesion-by-lesion analysis was performed for correlation analysis between maximum standardised uptake value (SUVmax), mean standardised uptake value (SUVmean) and mean apparent diffusion coefficient (ADC).

    RESULTS: Fifty patients were included in the study and divided into three groups: Hodgkin's lymphoma (HL), n=12; aggressive non-Hodgkin's lymphoma (NHL), n=29 (including 20 patients with diffuse large B-cell lymphoma, DLBCL); and indolent NHL, n=9. Indolent NHL showed significantly lower mean ADC values than the other two lymphoma groups (p=0.013). Aggressive NHL had a higher SUVmax than HL. The OS analysis of all patients showed a relationship (p=0.006) between increased mean ADC and longer OS. A model with both SUVmean and mean ADC, strengthened the possibility to predict PFS; however, a separate analysis of the DLBCL patients showed that none of the quantitative parameters could predict OS or PFS.

    CONCLUSION: ADC can discriminate between indolent and aggressive NHL. This finding can be useful in assessing possible transformation from indolent to aggressive NHL. ADC, ADC/SUV, and SUV cannot predict OS/PFS independent of lymphoma subtype.

  • 4.
    Rossitti, Sandro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Absence of the common carotid artery in a patient with a persistent trigeminal artery variant2001In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229X, Vol. 56, no 1, p. 79-81Article in journal (Refereed)
    Abstract [en]

    We found the present case when retrospectively reviewing the files of patients with intracranial aneurysm in our institution. It concerns the coexistence of a rare developmental anomaly of the aortic arch vessels and a persistent carotid-vertebrobasilar communication variant. Since no common embryologic basis is known, this association was probably fortuitous. Each of these particular anomalies can pose unique diagnostic and therapeutic difficulties.

  • 5.
    von Below, Catrin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Daouacher, G.
    Cent Hosp Karlstad, Dept Urol, Karlstad, Sweden..
    Wassberg, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Grzegorek, R.
    Cent Hosp Karlstad, Dept Urol, Karlstad, Sweden..
    Gestblom, C.
    Cent Hosp Karlstad, Dept Pathol, Karlstad, Sweden..
    Sörensen, Jens
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Walden, M.
    Cent Hosp Karlstad, Dept Urol, Karlstad, Sweden..
    Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer2016In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229X, Vol. 71, no 4, p. 328-334Article in journal (Refereed)
    Abstract [en]

    AIM: To prospectively validate 3 T magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) for preoperative lymph node (LN) staging in a clinical setting, in intermediate- and high-risk prostate cancer (PCa) patients using laparoscopic extended LN dissection (ePLND) as the reference standard. MATERIALS AND METHODS: Between August 2011 and May 2013, 40 newly diagnosed intermediate and high-risk PCa patients underwent preoperative LN staging with 3 T MRI DWI using histopathology of ePLND as the reference standard. The sensitivity, specificity, and accuracy of MRI DWI were calculated. A subgroup analysis of proven LN-positive patients was made to investigate differences in PSA, Gleason score, number, and size of LN metastases, estimated risk of LN involvement, and if curative treatment was indicated, between the true-positive and the false-negative groups. RESULTS: A total of 728 LN were harvested from six anatomical regions per patient (external, obturator, internal) with a mean number of 18 LNs per patient (range 11-40). Twenty patients had histologically proven LN-positive disease. MRI DWI was true positive in 11 patients, false negative in nine patients, false positive in two patients, and true negative in 18 patients, resulting in 90% specificity, 55% sensitivity, and 72.5% accuracy. The true-positive patients had significantly more involved LNs (mean 6.9 versus 2.7, p = 0.017), with larger diameter (mean 12.3 versus 5.2 mm, p = 0.048) and fewer were treated with curative intent (six versus nine, p = 0.03), compared with the false-negative group. CONCLUSION: MRI DWI LN staging has a low sensitivity but high specificity. The true-positive patients have a considerably higher burden of LN metastases compared to false-negative patients.

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