Assessment of dose to functional sub-structures in the lower urinary tract in locally advanced cervical cancer radiotherapy.

PURPOSE: To provide an analysis of dose distribution in sub-structures that could be responsible for urinary toxicity after Image-Guided Adaptive BrachyTherapy (IGABT) in Locally Advanced Cervical Cancer (LACC). METHODS: 105 LACC patients treated with radiochemotherapy and IGABT were selected. Sub-structures (bladder wall, trigone, bladder neck, urethra) were contoured on IGABT-planning MRIs. D2cm3 and D0.1cm3, ICRU Bladder-Point (ICRU BP) and Posterior-Inferior Border of Symphysis points (PIBS, PIBS + 2 cm, PIBS - 2 cm) doses were extracted. Internal-Urethral-Ostium (IUO) and PIBS-Urethra (PIBS-U) points were defined as urethral dose surrogates. Finally, the Vaginal Reference Length (VRL) was extracted. Values were converted into total EBRT + BT equivalent dose in 2 Gy fractions using α/ß = 3 and T1/2 = 1.5 h. RESULTS: Median D2cm3 for bladder and trigone were 71.7[interquartile-range:66.5;74.1]Gy and 57.8[53.3;63.6]Gy, respectively, while median D0.1cm3 were 82.2[77.6;89.1]Gy and 70.7[62.0;76.7]Gy, respectively. Median ICRU BP dose was 63.7[56.5;70.5]Gy and correlated with trigone D2cm3 and D0.1cm3, while bladder and trigone D2cm3 had poor correlation (R2 = 0.492), as well as D0.1cm3 (R2 = 0.356). Bladder neck D0.1cm3 was always lower than trigone D0.1cm3 and higher than IUO. Correlation between PIBS + 2 cm and IUO was poor (R2 = 0.273), while PIBS and PIBS-U were almost equal (R2 = 0.990). VRL correlated with dose to bladder base. CONCLUSIONS: The study confirmed that ICRU BP and trigone doses correlate. Bladder D2cm3 is not representative of trigone dose because hotspots are often placed in the bladder dome. VRL is a good indicator for bladder base sparing. In addition to D2cm3 and D0.1cm3 for whole bladder, ICRU BP, trigone D2cm3 and D0.1cm3, IUO and PIBS are useful for lower urinary tract reporting.

Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5-7 years after laparoscopic ventral hernia repair.

BACKGROUND: Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5-7 years after LVHR, using two validated non-invasive radiologic methods. METHODS: Real-time transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (MRI) was applied to 30 patients with prior LVHR and implantation of IPM (Intramesh W3, Cousin Biotech, France). The visceral slide was measured in nine predefined abdominal segments. Values

[Isolated purulent arthritis of lumbar facet joint]. / Isoleret purulent artrit i lumbalt intervertebralled.

We present the case of a 51-year-old woman suffering from septic arthritis of a lumbar facet joint, which was probably caused by an infected central venous catheter. Increased uptake on the bone scintigraphy was an early finding. Magnetic resonance imaging (MRI) of the spine contributed to the diagnosis by showing lesions of the facet joint and involvement of the surrounding soft tissues. Percutaneous needle aspiration guided by computed tomography established a bacteriological diagnosis. The positive response to antibiotic therapy was confirmed by MRI.