Improving Accuracy for Image Fusion in Abdominal Ultrasonography

Image fusion involving real-time ultrasound (US) is a technique where previously recorded computed tomography (CT) or magnetic resonance images (MRI) are reformatted in a projection to fit the real-time US images after an initial co-registration. The co-registration aligns the images by means of common planes or points. We evaluated the accuracy of the alignment when varying parameters as patient position, respiratory phase and distance from the co-registration points/planes. We performed a total of 80 co-registrations and obtained the highest accuracy when the respiratory phase for the co-registration procedure was the same as when the CT or MRI was obtained. Furthermore, choosing co-registration points/planes close to the area of interest also improved the accuracy. With all settings optimized a mean error of 3.2 mm was obtained. We conclude that image fusion involving real-time US is an accurate method for abdominal examinations and that the accuracy is influenced by various adjustable factors that should be kept in mind

Data from: Electromagnetic source imaging in presurgical workup of patients with epilepsy: a prospective study

Objective: To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy. Methods: We prospectively recorded magnetoencephalography (MEG) simultaneously with electroencephalography (EEG) and performed EMSI, comprising electric (ESI), magnetic source imaging (MSI) and analysis of combined MEG-EEG datasets (cEMSI), using two different software packages. As reference standard for irritative zone (IZ) and seizure onset zone (SOZ) we used intracranial recordings and for localization accuracy, outcome one year after operation. Results: We included 141 consecutive patients. EMSI showed localized epileptiform discharges (ED) in 94 patients (67%). Most of the ED-clusters (72%) were identified by both modalities, 15% only by EEG and 14% only by MEG. Agreement was substantial between inverse solutions and moderate between software packages. EMSI provided new information that changed the management plan in 34% of the patients, and these changes were useful in 80%. Depending on the method, EMSI had a concordance of 53-89% with IZ and 35%-73% with SOZ. Localization accuracy of EMSI was between 44% and 57%, which was not significantly different from MRI (49-76%) and PET (54-85%). cEMSI achieved significantly higher odds ratio compared to ESI and MSI. Conclusions: EMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients. Classification of Evidence: This study provides Class IV evidence that EMSI had a concordance of 53-89% and 35%-73% (depending on analysis) for the localization of epilepsy as compared with intracranial recordings - IZ zone and SOZ respectively

Appendix 1-9

Supporting documents for the paper

De-identified data

Magnetoencephalography by Electa and EEG easy cap. Recorded on maintenance antiepileptic drugs for 1.5 hours. Electromagnetic soureimaging using both BESA and CURRY software. Both compared to MR and PE

Methods for Solving Problems of Discrete Probability

Katedra pravděpodobnosti a matematické statistikyDepartment of Probability and Mathematical StatisticsMatematicko-fyzikální fakultaFaculty of Mathematics and Physic

Image1_Importance of Comprehensive Molecular Profiling for Clinical Outcome in Children With Recurrent Cancer.TIF

<p>Purpose: Pediatric cancers are often difficult to classify and can be complex to treat. To ensure precise diagnostics and identify relevant treatment targets, we implemented comprehensive molecular profiling of consecutive pediatric patients with cancer relapse. We evaluated the clinical impact of extensive molecular profiling by assessing the frequency of identified biological onco-drivers, altered diagnosis, and/or identification of new relevant targeted therapies.</p><p>Patients and Methods: Forty-six tumor samples (44 fresh-frozen; two formalin-fixed paraffin embedded), two bone marrow aspirates, three cerebrospinal fluid samples, and one archived DNA were obtained from 48 children (0–17 years; median 9.5) with relapsed or refractory cancer, where the disease was rapidly progressing in spite of their current treatment or they had exhausted all treatment options. The samples were analyzed by whole-exome sequencing (WES), RNA sequencing (RNAseq), transcriptome arrays, and SNP arrays. Final reports were available within 3–4 weeks after patient inclusion and included mutation status, a description of copy number alterations, differentially expressed genes, and gene fusions, as well as suggestions for targeted treatment.</p><p>Results: Of the 48 patients, 33 had actionable findings. The most efficient method for the identification of actionable findings was WES (39%), followed by SNP array (37%). Of note, gene fusions were identified by RNAseq in 21% of the samples. Eleven findings led to clinical intervention, i.e., oncogenetic counseling, targeted treatment, and treatment based on changed diagnosis. Four patients received compassionate use targeted therapy. Six patients experienced direct benefits in the form of stable disease or response.</p><p>Conclusion: The application of comprehensive genetic diagnostics in children with recurrent cancers allowed for discovery and implementation of effective targeted therapies and hereby improvement of outcome in some patients.</p

Table1_Importance of Comprehensive Molecular Profiling for Clinical Outcome in Children With Recurrent Cancer.PDF

<p>Purpose: Pediatric cancers are often difficult to classify and can be complex to treat. To ensure precise diagnostics and identify relevant treatment targets, we implemented comprehensive molecular profiling of consecutive pediatric patients with cancer relapse. We evaluated the clinical impact of extensive molecular profiling by assessing the frequency of identified biological onco-drivers, altered diagnosis, and/or identification of new relevant targeted therapies.</p><p>Patients and Methods: Forty-six tumor samples (44 fresh-frozen; two formalin-fixed paraffin embedded), two bone marrow aspirates, three cerebrospinal fluid samples, and one archived DNA were obtained from 48 children (0–17 years; median 9.5) with relapsed or refractory cancer, where the disease was rapidly progressing in spite of their current treatment or they had exhausted all treatment options. The samples were analyzed by whole-exome sequencing (WES), RNA sequencing (RNAseq), transcriptome arrays, and SNP arrays. Final reports were available within 3–4 weeks after patient inclusion and included mutation status, a description of copy number alterations, differentially expressed genes, and gene fusions, as well as suggestions for targeted treatment.</p><p>Results: Of the 48 patients, 33 had actionable findings. The most efficient method for the identification of actionable findings was WES (39%), followed by SNP array (37%). Of note, gene fusions were identified by RNAseq in 21% of the samples. Eleven findings led to clinical intervention, i.e., oncogenetic counseling, targeted treatment, and treatment based on changed diagnosis. Four patients received compassionate use targeted therapy. Six patients experienced direct benefits in the form of stable disease or response.</p><p>Conclusion: The application of comprehensive genetic diagnostics in children with recurrent cancers allowed for discovery and implementation of effective targeted therapies and hereby improvement of outcome in some patients.</p