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Diagnostics, Volume 7, Issue 4 (December 2017)

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Cover Story (view full-size image) Biochemical recurrence following curative treatment for prostate cancer is a common problem. [...] Read more.
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Open AccessInteresting Images Functional Imaging with 18F-FDG PET/CT and Diffusion Weighted Imaging (DWI) in Early Response Evaluation of Combination Therapy of Elotuzumab, Lenalidomide, and Dexamethasone in a Relapsed Multiple Myeloma Patient
Diagnostics 2017, 7(4), 61; https://doi.org/10.3390/diagnostics7040061
Received: 6 December 2017 / Revised: 13 December 2017 / Accepted: 14 December 2017 / Published: 15 December 2017
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Abstract
Elotuzumab is the first monoclonal antibody approved for the treatment of relapsed-refractory multiple myeloma (MM) in combination with lenalidomide, an immunodulatory drug, and dexamethasone. We report on a multiply pre-treated MM patient with disease progression due to appearance of new focal lesions on
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Elotuzumab is the first monoclonal antibody approved for the treatment of relapsed-refractory multiple myeloma (MM) in combination with lenalidomide, an immunodulatory drug, and dexamethasone. We report on a multiply pre-treated MM patient with disease progression due to appearance of new focal lesions on imaging modalities, who was started on a combination treatment of elotuzumab, lenalidomide, and dexamethasone. After completion of three cycles of the new therapy the patient responded very well with a major decline of serological myeloma activity parameters serum monoclonal protein, kappa light chains, free light chains (FLC) ratio. The patient was also monitored with the functional imaging modalities 18F-FDG PET/CT and diffusion weighted imaging (DWI), which exhibited a mismatch of almost complete metabolic remission on positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-2-deoxy-d-glucose (18F-FDG) (consistent with the serological response), and signal elevation persistence on DWI. This case demonstrates the potentially superior performance of 18F-FDG PET/CT over DWI in early response evaluation of combined treatment with a monoclonal antibody, an immunomodulatory drug, and dexamethasone in MM. Full article
(This article belongs to the Section Medical Imaging)
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Open AccessCase Report Avid 18F-FDG Uptake in Idiopathic Tumoral Calcinosis Mimicking Lymph Node Metastasis
Diagnostics 2017, 7(4), 60; https://doi.org/10.3390/diagnostics7040060
Received: 7 September 2017 / Revised: 7 December 2017 / Accepted: 11 December 2017 / Published: 13 December 2017
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Abstract
Tumoral calcinosis is a benign condition characterized by periarticular calcified lesions that is frequently observed in patients with chronic renal failure. Tumoral calcinosis often presents with subcutaneous masses and joint swelling. We present a case of tumoral calcinosis with dramatically increased 18F-fluoro-2-deoxy-d-glucose
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Tumoral calcinosis is a benign condition characterized by periarticular calcified lesions that is frequently observed in patients with chronic renal failure. Tumoral calcinosis often presents with subcutaneous masses and joint swelling. We present a case of tumoral calcinosis with dramatically increased 18F-fluoro-2-deoxy-d-glucose (18F-FDG) uptake on positron emission tomography/computed tomography (PET/CT) that mimicked lymphoma or lymph node metastases. Full article
(This article belongs to the Special Issue Functional and Molecular Imaging of Kidney and Urogenital Disease)
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Open AccessInteresting Images Staphylococcus aureus Bacteremia from Diffuse Muscular Infection Following Acupuncture Visualized by 18F-FDG PET/CT and MRI
Diagnostics 2017, 7(4), 59; https://doi.org/10.3390/diagnostics7040059
Received: 20 November 2017 / Revised: 29 November 2017 / Accepted: 29 November 2017 / Published: 30 November 2017
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Abstract
We describe the clinical course of a 60-year old male admitted with Staphylococcus aureus bacteremia and back-pain. The patient was suspected of having spondylitis and treated as such with antibiotics; however, both fluorine-18 fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography and magnetic resonance imaging
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We describe the clinical course of a 60-year old male admitted with Staphylococcus aureus bacteremia and back-pain. The patient was suspected of having spondylitis and treated as such with antibiotics; however, both fluorine-18 fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography and magnetic resonance imaging (MRI) with iv contrast showed significant inflammation of muscles and subcutaneous soft tissue in relation to the patients back and left shoulder, but no signs of the working diagnosis of spondylitis. The unusual location of the infection was not explained until a few days prior to being discharged when the patient reported visits to a local physiotherapist where he would have acupuncture performed for non-specific back pain. His last acupunctural procedure had been performed 6 days prior to admission. This case is, to our knowledge, the first to show muscular inflammation on both 18-F-FDG PET/CT and MRI following acupuncture due to S. aureus. This case highlights the need for clinicians to search for alternative explanations when imaging does not support the diagnosis. Full article
(This article belongs to the Section Medical Imaging)
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Open AccessReview Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management
Diagnostics 2017, 7(4), 58; https://doi.org/10.3390/diagnostics7040058
Received: 20 October 2017 / Revised: 11 November 2017 / Accepted: 14 November 2017 / Published: 29 November 2017
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Abstract
Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving
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Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings. Full article
(This article belongs to the Special Issue Novel Point-of-Care Technologies in Diagnostics)
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Open AccessArticle A Score-Based Approach to 18F-FDG PET Images as a Tool to Describe Metabolic Predictors of Myocardial Doxorubicin Susceptibility
Diagnostics 2017, 7(4), 57; https://doi.org/10.3390/diagnostics7040057
Received: 12 September 2017 / Revised: 13 October 2017 / Accepted: 23 October 2017 / Published: 26 October 2017
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Abstract
Purpose: To verify the capability of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to identify patients at higher risk of developing doxorubicin (DXR)-induced cardiotoxicity, using a score-based image approach. Methods: 36 patients underwent FDG-PET/CT. These patients had shown full remission after DXR-based chemotherapy
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Purpose: To verify the capability of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to identify patients at higher risk of developing doxorubicin (DXR)-induced cardiotoxicity, using a score-based image approach. Methods: 36 patients underwent FDG-PET/CT. These patients had shown full remission after DXR-based chemotherapy for Hodgkin’s disease (DXR dose: 40–50 mg/m2 per cycle), and were retrospectively enrolled. Inclusion criteria implied the presence of both pre- and post-chemotherapy clinical evaluation encompassing electrocardiogram (ECG) and echocardiography. Myocardial metabolism at pre-therapy PET was evaluated according to both standardized uptake value (SUV)- and score-based approaches. The capability of the score-based image assessment to predict the occurrence of cardiac toxicity with respect to SUV measurement was then evaluated. Results: In contrast to the SUV-based approach, the five-point scale method does not linearly stratify the risk of the subsequent development of cardiotoxicity. However, converting the five-points scale to a dichotomic evaluation (low vs. high myocardial metabolism), FDG-PET/CT showed high diagnostic accuracy in the prediction of cardiac toxicity (specificity = 100% and sensitivity = 83.3%). In patients showing high myocardial uptake at baseline, in which the score-based method is not able to definitively exclude the occurrence of cardiac toxicity, myocardial SUV mean quantification is able to further stratify the risk between low and intermediate risk classes. Conclusions: the score-based approach to FDG-PET/CT images is a feasible method for predicting DXR-induced cardiotoxicity. This method might improve the inter-reader and inter-scanner variability, thus allowing the evaluation of FDG-PET/CT images in a multicentral setting. Full article
(This article belongs to the Section Medical Imaging)
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Open AccessArticle Prospective Comparison of F-18 Choline PET/CT Scan Versus Axial MRI for Detecting Bone Metastasis in Biochemically Relapsed Prostate Cancer Patients
Diagnostics 2017, 7(4), 56; https://doi.org/10.3390/diagnostics7040056
Received: 22 September 2017 / Revised: 9 October 2017 / Accepted: 14 October 2017 / Published: 17 October 2017
Cited by 1 | PDF Full-text (433 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
We compared fluor-18 choline positron emission tomography/computed tomography (PET/CT) and axial skeleton magnetic resonance imaging (MRI) prospectively obtained for the detection of bone metastases in non-castrated patients with biochemically recurrent prostate cancer following primary treatment. PET/CT was performed 45 min post-injection of 3–4
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We compared fluor-18 choline positron emission tomography/computed tomography (PET/CT) and axial skeleton magnetic resonance imaging (MRI) prospectively obtained for the detection of bone metastases in non-castrated patients with biochemically recurrent prostate cancer following primary treatment. PET/CT was performed 45 min post-injection of 3–4 MBq/kg F-18 methyl choline. MRI included T1- and fluid sensitive T2-weighted images of the spine and pelvis. Readers were initially blinded from other results and all scans underwent independent double reading. The best valuable comparator (BVC) defined the metastatic status. On the basis of the BVC, 15 out of 64 patients presented with 24 bone metastases. On a patient level, the sensitivity and specificity of MRI and PET were not significantly different. On a lesion level, the sensitivity of MRI was significantly better compared to PET, and the specificity did not differ significantly. In conclusion, axial MRI is an interesting screening tool for the detection of bone metastases because of its low probability of false negative results. However, F-18 choline PET is a valuable addition as it can overrule false positive MRI results and detect non-axial metastases. Full article
(This article belongs to the Special Issue Imaging of Bone Metastases in Oncology)
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Open AccessConcept Paper Implementing a Multidisciplinary Tumor Board in the Community Practice Setting
Diagnostics 2017, 7(4), 55; https://doi.org/10.3390/diagnostics7040055
Received: 1 September 2017 / Revised: 13 October 2017 / Accepted: 13 October 2017 / Published: 17 October 2017
Cited by 1 | PDF Full-text (158 KB) | HTML Full-text | XML Full-text
Abstract
Multidisciplinary tumor boards are an opportunity for radiologists to demonstrate value to referring clinicians, the hospital, and patients. Multidisciplinary tumor boards are commonly utilized in academic institutions, but may not be readily available in community practice. We discuss strategies academic radiologists may employ
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Multidisciplinary tumor boards are an opportunity for radiologists to demonstrate value to referring clinicians, the hospital, and patients. Multidisciplinary tumor boards are commonly utilized in academic institutions, but may not be readily available in community practice. We discuss strategies academic radiologists may employ to assist in the implementation of a multidisciplinary tumor board in the community practice setting. Summary: Strategies to assist in the implementation of a multidisciplinary tumor board in the community practice setting are described. Full article
(This article belongs to the Section Medical Imaging)
Open AccessReview Single Domain Antibodies as New Biomarker Detectors
Diagnostics 2017, 7(4), 52; https://doi.org/10.3390/diagnostics7040052
Received: 23 August 2017 / Revised: 7 September 2017 / Accepted: 8 September 2017 / Published: 17 October 2017
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Abstract
Biomarkers are defined as indicators of biological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention. Biomarkers have been widely used for early detection, prediction of response after treatment, and for monitoring the progression of diseases. Antibodies represent promising tools for recognition
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Biomarkers are defined as indicators of biological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention. Biomarkers have been widely used for early detection, prediction of response after treatment, and for monitoring the progression of diseases. Antibodies represent promising tools for recognition of biomarkers, and are widely deployed as analytical tools in clinical settings. For immunodiagnostics, antibodies are now exploited as binders for antigens of interest across a range of platforms. More recently, the discovery of antibody surface display and combinatorial chemistry techniques has allowed the exploration of new binders from a range of animals, for instance variable domains of new antigen receptors (VNAR) from shark and variable heavy chain domains (VHH) or nanobodies from camelids. These single domain antibodies (sdAbs) have some advantages over conventional murine immunoglobulin owing to the lack of a light chain, making them the smallest natural biomarker binders thus far identified. In this review, we will discuss several biomarkers used as a means to validate diseases progress. The potential functionality of modern singe domain antigen binders derived from phylogenetically early animals as new biomarker detectors for current diagnostic and research platforms development will be described. Full article
(This article belongs to the collection Biomarkers in Medicine)
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