PubMed · 13945469
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H FLEISCHHACKER. 1963. [Preleukemic states].. https://pubmed.ncbi.nlm.nih.gov/13945469/
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PURPOSE: To evaluate intensity-modulated whole pelvis radiotherapy (IM-WPRT) (with bone marrow [BM] as a planning constraint) as a means to reduce the volume of pelvic BM irradiated. METHODS AND MATERIALS: Ten women with cervical or endometrial cancer previously treated using IM-WPRT were selected for this analysis. Using the treatment planning CT scan, the clinical target volume was defined to encompass the gross tumor, parametrial tissues, uterus (if present), and regional lymph nodes. The clinical target volume was expanded by a 1-cm margin to form the planning target volume (PTV). The bladder, rectum, small bowel, and pelvic BM were delineated in each patient. Three plans were created for each patient: a standard four-field WPRT plan, an IM-WPRT treatment plan designed to conform the dose to the PTV while minimizing dose to the normal tissues (excluding BM), and a BM-sparing (BMS) IM-WPRT plan that included the BM as an additional treatment planning constraint. Dose-volume histograms for the PTV, small bowel, and BM were compared for each patient. RESULTS: For each of the 10 patients, BMS IM-WPRT treatment plans demonstrated a significant reduction of the volume of BM receiving >40% (18 Gy) of the prescription dose (45 Gy) compared with both IM-WPRT and four-field treatment. On average, BMS IM-WPRT resulted in only 60% of the BM volume irradiated to >50% of the dose compared with 87.4% (p <0.001) of the BM volume in a four-field plan and 75.7% (p < 0.003) of the volume in an IM-WPRT plan. Furthermore, the BMS IM-WPRT plans resulted in significant sparing of all other normal tissues that was comparable to the original IM-WPRT. In all 10 cases, the BMS IM-WPRT treatment plan did not result in any significant differences in the PTV and small bowel dose-volume histograms compared with the IM-WPRT treatment plans. CONCLUSION: BMS IM-WPRT significantly reduces the volume of pelvic BM irradiated compared with conventional WPRT. In addition, BMS IM-WPRT did not compromise the improvements previously seen in IM-WPRT treatment plans that did not consider BM. Clinical studies are necessary to assess the significance of BMS IM-WPRT in reducing hematologic toxicity.
OBJECTIVE: To describe the MR findings of bone marrow edema syndrome (BMES) of the foot and its evolution at 1 year follow-up. DESIGN AND PATIENTS: Twenty-five of 32 patients with disabling foot and ankle pain unrelated to trauma diagnosed as BMES when MR imaging demonstrated a bone marrow edema pattern in one or more bones without any radiological or underlying clinical cause, were re-evaluated by MR imaging 1 year later. RESULTS: On the initial MR examinations an average of 4.7 individual bones were involved by bone marrow edema. Soft tissue edema was present in every patient and joint effusion in 10 patients. MR imaging at 1 year showed resolution of bone edema in 18 patients (72%), partial improvement in five (20%) and no improvement in two (8%). Six patients (24%) developed similar symptoms in the other foot during follow-up. Ten of 17 available plain radiographs showed some loss of radiodensity. Further bone marrow edema developed in bones of the same foot that were initially normal, or in uninvolved distant bone marrow areas in the same affected bone, in six of seven patients on follow-up MR imaging. CONCLUSIONS: The evolution of the MR findings of BMES of the foot is to complete resolution or partial improvement at 1 year in the majority of cases. Migration to the other foot occurs in up to a quarter of patients.
The purpose of this investigation is to evaluate the diagnostic ability of three-dimensional spoiled gradient-echo (3D SPGR) magnetic resonance (MR) imaging in cases of osteonecrosis of the femoral head (ONFH), and to determine the accuracy of 3D SPGR imaging in area and volume measurement of ONFH. T1-weighted spin-echo (SE) and 3D SPGR imaging were performed on 20 femoral heads obtained from patients with ONFH. After MR imaging, the femoral heads were cut parallel to the imaging plane and were evaluated histologically. Areas and volumes of necrotic lesions were measured with a computer program and the deviation between MR images and anatomical measurements was evaluated. A low signal intensity band on 3D SPGR MR images was observed in all femoral heads and corresponded histologically to repaired marrow with viable fibrous mesenchymal tissue. The area proximate to the low band area coincided with the necrotic region. Both area and volume measurements by T1-weighted SE and 3D SPGR images showed a strong correlation to histological measurements. The discrepancies between histological and imaging results were minimal in 3D SPGR imaging, especially at the anterior and posterior portions of the femoral head. Three-dimensional SPGR imaging provides more accurate measurements of the area and volume of a necrotic lesion than T1-weighted SE imaging.