Somatostatin-based radiopeptide therapy with [177Lu-DOTA]-TOC versus [90Y-DOTA]-TOC in neuroendocrine tumours

Purpose: Somatostatin-based radiopeptide treatment is generally performed using the β-emitting radionuclides 90Y or 177Lu. The present study aimed at comparing benefits and harms of both therapeutic approaches. Methods: In a comparative cohort study, patients with advanced neuroendocrine tumours underwent repeated cycles of [90Y-DOTA]-TOC or [177Lu-DOTA]-TOC until progression of disease or permanent adverse events. Multivariable Cox regression and competing risks regression were employed to examine predictors of survival and adverse events for both treatment groups. Results: Overall, 910 patients underwent 1,804cycles of [90Y-DOTA]-TOC and 141 patients underwent 259cycles of [177Lu-DOTA]-TOC. The median survival after [177Lu-DOTA]-TOC and after [90Y-DOTA]-TOC was comparable (45.5months versus 35.9months, hazard ratio 0.91, 95% confidence interval 0.63-1.30, p = 0.49). Subgroup analyses revealed a significantly longer survival for [177Lu-DOTA]-TOC over [90Y-DOTA]-TOC in patients with low tumour uptake, solitary lesions and extra-hepatic lesions. The rate of severe transient haematotoxicities was lower after [177Lu-DOTA]-TOC treatment (1.4 vs 10.1%, p = 0.001), while the rate of severe permanent renal toxicities was similar in both treatment groups (9.2 vs 7.8%, p = 0.32). Conclusion: The present results revealed no difference in median overall survival after [177Lu-DOTA]-TOC and [90Y-DOTA]-TOC. Furthermore, [177Lu-DOTA]-TOC was less haematotoxic than [90Y-DOTA]-TOC

Ultrafast MR imaging of the pelvic floor

OBJECTIVE: The aim of this study was to compare pelvic floor anatomy and laxity at rest and on straining (Valsalva's maneuver) using dynamic ultrafast MR imaging in women who were continent versus those with stress incontinence differing in obstetric history. MATERIALS AND METHODS: Thirty continent women were divided into three equal groups (nulliparous, previous cesarean delivery, previous vaginal delivery) and compared with 10 women with stress-incontinence with a history of at least one vaginal delivery. MR imaging of the pelvic floor at rest and on maximal strain was performed, using axial T2-weighted fast spin-echo images followed by sagittal ultrafast T2-weighted single-shot fast spin-echo sequences. Mean population age (age range, 22-45 years; mean +/- SD, 36 +/- 5.4 years), was similar in the four groups, as was parity in the three parous groups. RESULTS: Mean distances between the bladder floor and pubococcygeal line at rest did not differ between the four groups. On straining, bladder floor descent was 1.1 +/- 0.9, 1.0 +/- 1.1, and 1.9 +/- 0.9 cm in continent nulliparous, cesarean delivery, and vaginal delivery women, respectively, versus 3.2 +/- 1.0 cm in incontinent women (p = 0.0005). Cervical descent was greater in incontinent versus nulliparous women (p = 0.0019). Bladder floor descent was greater in the continent vaginal delivery group than in continent cesarean delivery control patients (p = 0.04). In patients with stress incontinence, symptoms did not correlate with amplitude of descent. The right levator muscle was thinner overall than the left, regardless of frequency direction (p = 0.001). CONCLUSION: Ultrafast MR imaging using the T2-weighted single-shot fast spin-echo sequence allows dynamic evaluation of the pelvic compartments at maximal strain with no need for contrast medium. Pelvic floor laxity and supporting fascia abnormalities were most common in patients with stress incontinence followed by continent women with a history of vaginal delivery. The results are therefore compatible with the hypothesis of vaginal delivery as a contributory factor to stress incontinence in older parous women

Somatostatin-based radiopeptide therapy with [ 177 Lu-DOTA]-TOC versus [ 90 Y-DOTA]-TOC in neuroendocrine tumours

Abstract Purpose Somatostatin-based radiopeptide treatment is generally performed using the β-emitting radionuclides 90 Y or 177 Lu. The present study aimed at comparing benefits and harms of both therapeutic approaches

Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT.

PURPOSE: To assess the diagnostic performance of dual-energy dual-source computed tomography (CT) in the detection of endoleaks after endovascular abdominal aortic aneurysm (AAA) repair. MATERIALS AND METHODS: This study was local ethics board approved, and written informed consent was obtained from all patients. One hundred eighteen patients (21 women, 97 men; mean age, 74 years +/- 8 [standard deviation]) underwent follow-up dual-energy dual-source CT during the nonenhanced, arterial, and delayed phases after AAA repair. Delayed phase CT images were acquired in the dual-energy mode for reconstruction of virtual nonenhanced images. Two blinded and independent readers evaluated the data for the presence or absence of endoleaks during three reading sessions: Standard nonenhanced, arterial phase, and delayed phase images were read during session A; virtual nonenhanced, arterial phase, and delayed phase images, during session B; and virtual nonenhanced and delayed phase images, during session C. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated, with the session A image data set as the reference standard. Radiation dose parameters were estimated. RESULTS: Reading session A revealed that 52 (44%) of 118 patients had endoleaks. Overall sensitivity, specificity, NPV, and PPV for CT endoleak detection during sessions B and C were identical: 100%, 97%, 100%, and 96%, respectively. The accuracy of the session B and session C readings was not significantly different from that of the session A reading (P = .50). The effective radiation dose in the image acquisition protocol involving one dual-energy scan was significantly (P < .001) lower than the effective doses in the protocols involving standard triple-phase scanning (mean difference, 61%) and standard nonenhanced and delayed phase scanning (mean difference, 41%). CONCLUSION: Compared with standard protocols, one dual-energy dual-source CT scan performed during the delayed phase with reconstruction of virtual nonenhanced images enables detection of endoleaks after endovascular AAA repair with high accuracy and a considerably lower radiation dose

Low-dose CT coronary angiography for the prediction of myocardial ischaemia

The purpose of this study was to prospectively determine the accuracy of low-dose computed tomography coronary angiography (CTCA) for the diagnosis of functionally relevant coronary artery disease (CAD) using cardiac magnetic resonance (CMR) as a standard of reference. Forty-one consecutive patients (age 64 +/- 10 years) underwent k-space and time broad-use linear acquisition speed-up technique accelerated CMR (1.5 T) and dual-source CTCA using prospective electrocardiography gating within 1 day. CTCA lesions were analysed and diameter stenoses of more than 50% and more than 75% were compared with CMR findings taken as the reference standard for assessing the functional relevance of CAD. CMR revealed perfusion defects in 21/41 patients (51%). A total of 569 coronary segments were analysed with low-dose CTCA. The image quality of low-dose CTCA was diagnostic in 566/569 segments (99.5%) in 39/41 patients (95%). Low-dose CTCA revealed stenoses of more than 50% in 58/123 coronary arteries (47.2%) in 24/41 patients (59%) and more than 75% stenoses in 46/123 coronary arteries (37.4%) in 23/41 patients (56%). Using a greater than 50% diameter stenosis, low-dose CTCA yielded the following per artery sensitivity, specificity, positive and negative predictive values, and accuracy for the detection of perfusion defects: 89%, 79%, 72%, 92% and 83%, respectively. Low-dose CTCA is reliable for ruling out functionally relevant CAD, but is a poor predictor of myocardial ischaemia