Quantitative ultrasound imaging of therapy response in bladder cancer in vivo.

Background and aimsQuantitative ultrasound (QUS) was investigated to monitor bladder cancer treatment response in vivo and to evaluate tumor cell death from combined treatments using ultrasound-stimulated microbubbles and radiation therapy.MethodsTumor-bearing mice (n=45), with bladder cancer xenografts (HT- 1376) were exposed to 9 treatment conditions consisting of variable concentrations of ultrasound-stimulated Definity microbubbles [nil, low (1%), high (3%)], combined with single fractionated doses of radiation (0 Gy, 2 Gy, 8 Gy). High frequency (25 MHz) ultrasound was used to collect the raw radiofrequency (RF) data of the backscatter signal from tumors prior to, and 24 hours after treatment in order to obtain QUS parameters. The calculated QUS spectral parameters included the mid-band fit (MBF), and 0-MHz intercept (SI) using a linear regression analysis of the normalized power spectrum.Results and conclusionsThere were maximal increases in QUS parameters following treatments with high concentration microbubbles combined with 8 Gy radiation: (ΔMBF = +6.41 ± 1.40 (±SD) dBr and SI= + 7.01 ± 1.20 (±SD) dBr. Histological data revealed increased cell death, and a reduction in nuclear size with treatments, which was mirrored by changes in quantitative ultrasound parameters. QUS demonstrated markers to detect treatment effects in bladder tumors in vivo

An Investigation of Vascular Strategies to Augment Radiation Therapy

Radiation therapy is administered to more than 50% of patients diagnosed with cancer. Mechanisms of interaction between radiation and tumour cells are relatively well understood on a molecular level, but much remains uncertain regarding how radiation interacts with the tumour as a whole. Recent studies have suggested that tumour response to radiation may in fact be regulated by endothelial cell response, consequently stressing the role of tumour blood vessels in radiation treatment response. As a result, various treatment regimens have been proposed to strategically combine radiation with vascular targeting agents. A great deal of effort has been aimed towards developing efficient vascular targeting agents. Nonetheless, no optimal method has yet been devised to strategically deliver such agents. Recent evidence suggesting that these drugs may “normalize” tumour blood vessels and enhance radiosensitivity, is supporting experiments where anti-angiogenic drugs are combined with cytotoxic therapies such as radiotherapy. In contrast, ultrasound-stimulated microbubbles have recently been demonstrated to enhance radiation therapy by biophysically interacting with endothelial cells. When combined with single radiation doses, these microbubbles are believed to cause localized vascular destruction followed by tumour cell death. Finally, a new form of ‘pro-angiogenics’ has also been demonstrated to induce a therapeutic tumour response. The overall aim of this thesis is to study the role of tumour blood vessels in treatment responses to single-dose radiation therapy and to investigate radiation-based vascular targeting strategies. Using pharmacological and biophysical agents, blood vessels were altered to determine how they influence tumour cell death, clonogenicity, and tumour growth, and to study how these may be optimally combined with radiation. Three-dimensional high-frequency power Doppler ultrasound was used throughout these studies to investigate vascular response to therapy.Ph

The role of color Duplex in diagnosing chronic cerebrospinal venous insufficiency in patients with multiple sclerosis

Introduction: CCSVI, has been recently hypothesized to play a role in the etiology of MS. It can be reliably assessed using Doppler sonography by evaluating the extra cerebral venous hemodynamics with changes in posture. Aim of study: To evaluate the prevalence of CCSVI in patients with MS. Patients and methods: A total of 60 patients were studied; (52) with relapsing–remitting MS, (4) with primary progressive MS and (4) with secondary progressive MS. Sixty healthy age and gender-matched controls were enrolled in this study. Patients were subjected to full clinical history, neurological examination and Doppler ultrasound assessment. Results: CCSVI defined as the presence of at least two positive venous hemodynamic criteria and was present in 8 of the 60 MS patients (13%) and was not found at any of the 60 controls (0%). Four patients showed the full 4 criteria for diagnosis while the other 4 patients only showed 2 criteria. CCSVI was noticed more to be frequent among SP and PP patients (25% and 25% respectively) in respect of RR MS (50%) and showing high significant value. Conclusion: We conclude that CCSVI is an unlikely cause of MS and it is likely to be a late secondary phenomenon

Congenital biscuspid aortic valve in pediatric and early adults: Does valvular phenotype affect other parameters?

Aim of the study: Our study is a prospective study aiming to assess congenital bicuspid aortic valve using cardiac MRI and to detect a relationship between the leaflet fusion pattern and other functional parameters including valvular regurge, stenosis and pressure gradient. Patients and methods: This prospective study included 114 cases 104 of them had bicuspid aortic valve, diagnosed by echocardiography while the rest (10 cases) were normal control cases. All functional and morphological cardiovascular abnormalities were recorded as well as any associated congenital diseases. Two different radiologists read the MRI blindly to each other. Results: Patients age ranged from 40 days up to 20 years with 62 patients being in the pediatric age group (<12 years). They were 78males and 26 females. We found 54 cases (53.8%) of 1-RL morphology, 34 cases (32.7%) of 1-RN morphology, 8 cases (7.7%) of 0-AP and 6 cases (5.8%) of 0-Lateral. Aortic stenosis and regurgitation were found in 80.75% of cases. Aortic stenosis was the most common valvular lesion being more evident in the 1-RN valve type. Aortic regurge was more predominant in the pediatric age group with no predilection for a specific valve phenotype. Left ventricular function was normal in most of our cases with only 10 cases showing impairment due to long standing valvular lesion. Thirty-eight cases (36.5%) had associated aortic dilatation. Twenty-six patients (25%) showed associated aortic coarctation. Intra cardiac shunts (24 patients 23%) were the second most common associated anomaly after coarctation. Most of the associated congenital anomalies were found with the 1-RL valve morphology type. Other associated congenital anomalies were detected in 44 patients (42.3%). Conclusion: Cardiac Magnetic resonance should be performed for patients with bicuspid aortic valve to determine the valve phenotype, function and aortopathy for risk stratification and surgical management. Patients with RL type should be properly imaged to detect associated congenital anomalies

US LI-RADS: Ultrasound liver imaging reporting and data system application for screening and surveillance of hepatocellular carcinoma during national mass screening campaign for patients with positive HCV serological test

Purpose: We aimed to apply Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) to the patients with positive serological HCV test surveyed during the national mass screening campaign. Methods: We conducted a cross-sectional study that recruited patients with positive serological test for HCV, who underwent the national mass screening campaign during the period from April 2019 to June 2020. Each operator was required to classify the patients into one of the following three categories according to the US visualization into: A, no or minimal limitations; (2) B, moderate limitations; and (3) C, severe limitations. Results: A total of 763 HCV patients were recruited in the present study. Conclusion: US is the modality of choice during mass screening for HCC, yet the presence of the human factor (being operator dependent) and the lack of unified reporting scheme were drawbacks; thus US- LI-RADS, overcome the latter drawback with ready to go plan according to the given score of each individual patient