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J E Husband

Publications and source records attributed to J E Husband.

At least 19 recordsLinked to original sources
PubMed2001

What is the prevalence of symptomatic or asymptomatic femoral head osteonecrosis in patients previously treated with chemoradiation? A magnetic resonance study of anal cancer patients.

It is generally assumed that femoral head osteonecrosis (FHO) is a serious but rare complication of pelvic radiotherapy. A review of the literature carried out by the authors indicates a prevalence of 4/763 (95% confidence interval 0.1%-1.3%). A recent publication has suggested that the prevalence of symptomatic FHO may be much greater than previously assumed as a result of sensitization of bone to radiation by concomitant treatment with chemotherapy. Magnetic resonance imaging (MRI) is currently the most sensitive modality for detecting and confirming symptomatic or asymptomatic FHO of any aetiology. The aim of this study therefore was to assess the prevalence of symptomatic and asymptomatic FHO in patients previously treated for anal cancer by chemoradiation (CRT). The hips of 34 currently disease-free individuals (11 men and 23 women; median age 67 years, range 32-86) were scanned using a coronal T1-weighted sequence. The images were assessed for evidence of FHO. The median time of scanning after the end of CRT was 35 months (range 6-107). No cases (0/34) of symptomatic or asymptomatic FHO were detected in these patients. Given the established sensitivity of MRI in the detection of FHO, it is concluded that changes indicative of osteonecrosis were uncommon after CRT in the current cohort of patients. Recent evidence from the literature suggests, however, that elderly females are at greatest risk of developing FHO after CRT.

Adult↗
PubMed2001

Dynamic contrast-enhanced MRI studies in oncology with an emphasis on quantification, validation and human studies.

Magnetic resonance imaging (MRI), after the administration of an extracellular, gadolinium-based contrast medium, can be used to detect and characterize human tumours. The success of dynamic contrast-enhanced MRI (DCE-MRI) is dependent on its ability to demonstrate intrinsic differences between a variety of tissues that affect contrast medium behaviour. Evidence is mounting that DCE-MRI measurements correlate with immunohistochemical surrogates of tumour angiogenesis. DCE-MRI can monitor the effectiveness of a variety of treatments including chemotherapy, hormonal manipulation, radiotherapy and novel therapeutic approaches including antiangiogenic drugs. Kinetic parameters in the treatment setting have been correlated with histopathological outcome and patient survival. This article reviews quantification analysis of these studies together with current and future clinical applications.

Contrast Media↗
PubMed2001

Computed tomography screening for lung cancer: back to basics.

After some years in the doldrums, interest in screening for lung cancer is resurging. Conflicting evidence from previous lung cancer screening trials, based on plain chest radiography, has been the subject of much debate: the failure to demonstrate a reduction in mortality has led to the widely held conclusion that screening for lung cancer is ineffective. The validity of this assumption has been questioned sporadically and a large study currently under way in the U.S.A. should help settle the issue. Recently, there has been interest in the use of computed tomography to screen for lung cancer; radiation doses have been reduced to 'acceptable' levels and the superiority of computed tomography (CT) over chest radiography for the identification of pulmonary nodules is unquestioned. However, whether improved nodule detection will result in a reduction in mortality has not yet been demonstrated. The present review provides a historical background to the current interest in low-dose CT screening, explains the arguments that previous studies have provoked, and discusses the recent and evolving status of lung cancer screening with CT. Ellis, S. M. et al. (2001).

Bias↗
PubMed2001

Effects of androgen deprivation on prostatic morphology and vascular permeability evaluated with mr imaging.

PURPOSE: To assess magnetic resonance (MR) measures of vascular permeability of prostate cancer treated with androgen deprivation and to correlate these with morphologic appearances and serum prostate-specific antigen (PSA) levels. MATERIALS AND METHODS: MR examinations in 56 consecutive patients with prostate cancer were performed before and after luteinizing hormone-releasing hormone analog treatment. T2-weighted and contrast medium-enhanced T1-weighted MR images were obtained. Pre- and posttreatment comparisons of morphologic features, glandular volume, and enhancement-related parameters (capillary permeability, leakage space, gadolinium accumulation) were made. RESULTS: Fifty-five tumors were seen before treatment; 42, after treatment. Signal intensity in the peripheral zone and seminal vesicles decreased on T2-weighted images in 42 (75%) and 25 (45%) patients, respectively. Median volume in tumor decreased by 65% (95% CI: 55%, 76%); in central gland, by 30% (95% CI: 25%, 35%). Reductions in tumor permeability (P <.001) and changes in washout patterns were observed (P <.001). Tumor permeability reductions coincided with a decrease in serum PSA levels in 91% of patients. A weak correlation between tumor permeability and volume change was seen (r = 0.55, P =.04). Reductions in peripheral zone (P <.001) and central gland (P =.009) permeability were noted. CONCLUSION: Androgen deprivation decreases tumor volume and vascular permeability and impairs detection of prostate cancers. Use of MR estimates of permeability may be an additional way of assessing prostatic tumor response to antiandrogen treatment.

Aged↗
PubMed2000

Dynamic contrast enhanced MRI of prostate cancer: correlation with morphology and tumour stage, histological grade and PSA.

AIM: To quantify MRI enhancement characteristics of normal and abnormal prostatic tissues and to correlate these with tumour stage, histological grade and tumour markers. MATERIALS AND METHODS: Quantitative gradient recalled echo MR images were obtained following bolus injection of gadopentetate dimeglumine in 48 patients with prostate cancer. Turbo spin-echo T2-weighted images at the same anatomical position were reviewed for the presence of tumours (45 regions), normal peripheral zone (33 regions), and normal appearing central gland (30 regions). Time-signal intensity parameters (onset time, mean gradient and maximal amplitude of enhancement and wash-out score) and modelling parameters (permeability surface area product, lesion leakage space and maximum gadolinium concentration) were correlated with tumour stage, histological grade (Gleason score) and serum prostatic specific antigen (PSA) levels. RESULTS: Significant differences were noted between peripheral zone and tumour with respect to signal intensity and modelling parameters (P = 0.0001), except onset time. No differences between central gland and tumour enhancement values were seen. There was weak correlation between MRI tumour stage and tumour vascular permeability (r(2) = 12%; P = 0.02) and maximum tumour gadolinium concentration (r(2) = 14%; P = 0.015). However, no significant correlations were seen with Gleason score or PSA levels. CONCLUSION: Quantification of MR contrast enhancement characteristics allows tissue discrimination in prostate cancer consistent with known variations in microvessel density estimates.

Aged↗
PubMed2000

Symptomatic brachial plexopathy following treatment for breast cancer: utility of MR imaging with surface-coil techniques.

PURPOSE: To investigate the clinical utility and diagnostic accuracy of magnetic resonance (MR) imaging in patients with symptomatic brachial plexopathy following treatment for breast cancer. MATERIALS AND METHODS: Fifty patients with symptoms of brachial plexopathy (principally pain, weakness, and paresthesia) who had received treatment for breast cancer, which included surgery, radiation therapy, and cytotoxic chemotherapy, underwent MR imaging at 1.5 T. MR imaging was performed by using a body coil, which was supplemented with surface-coil imaging of the cervical spine and shoulder-coil imaging of the brachial plexus. At review, two observers attempted to discriminate between tumor recurrence and nonmalignant causes of symptoms. The diagnosis was verified with histologic analysis or a follow-up of at least 12 months. RESULTS: Of 27 patients demonstrated to have tumor recurrence, 26 were correctly identified by using MR imaging; the recurrence was directly related to the brachial plexus in 17. During the follow-up, 21 patients remained free of recurrence, 20 of whom were determined to have a nonmalignant cause of symptoms. Two of the 50 patients were excluded from the analysis. The MR criteria used for detection of tumor yielded a sensitivity of 96%, specificity of 95%, positive predictive value of 96%, and negative predictive value of 95%. CONCLUSION: MR imaging is reliable and accurate in the diagnosis of symptomatic brachial plexopathy following breast cancer therapy.

Adult↗
PubMed1999

Evaluating the effect of rectal distension and rectal movement on prostate gland position using cine MRI.

PURPOSE: To evaluate the dynamic interrelationship between rectal distension and rectal movements, and to determine the effect of rectal movement on the position of the prostatic gland using cine magnetic resonance imaging (MRI). METHODS AND MATERIALS: Fifty-five patients with biopsy-proven or suspected prostate cancer were examined in the axial plane using repeated spoiled gradient-echo sequences every 10 seconds for 7 minutes. Twenty-four patients received bowel relaxants before imaging. Images were analyzed for the degree of rectal distension, for the incidence, magnitude, and number of rectal and prostate movements. RESULTS: Rectal movements were seen in 28 (51%) patients overall, in 10 (42%) of those receiving bowel relaxants and in 18 (58%) not receiving bowel relaxants. The incidence of rectal movements correlated with the degree of rectal distension (p = 0.0005), but the magnitude of rectal movements did not correlate with the degree of rectal distension. Eighty-six rectal movements resulting in 33 anterior-posterior (AP) prostate movements were seen. The magnitude of rectal movements correlated well with degree of prostate movements (p < 0.001). Prostate movements in the AP direction were seen in 16 (29%) patients, and in 9 (16%) patients the movement was greater than 5 mm. The median prostate AP displacement was anterior by 4.2 (-5 to +14 mm). CONCLUSIONS: Cine MRI is able to demonstrate near real time rectal and associated prostate movements. Rectal movements are related to rectal distension and result in significant displacements of the prostate gland over a time period similar to that used for daily fractionated radiotherapy treatments. Delivery of radiotherapy needs to take into account these organ movements.

Aged↗
PubMed1999

Features of unusual metastases from prostate cancer.

A retrospective study of CT examinations on 508 patients with prostate carcinoma was performed in order to document the presence or absence of uncommon nodal and extranodal metastases according to pre-defined criteria. 45 atypical metastases were demonstrated in 36 patients. There were 23 atypical nodal metastases including unusual distribution (19/23), large volume (7/23) and atypical morphology or contrast enhancement pattern (8/23). 22 atypical extranodal metastases included orbit/skull base (11), pulmonary (4), liver (3), intracranial (2), ocular (1) and adrenal (1). Atypical prostate carcinoma metastases are usually encountered in the presence of known advanced disease but can be the presenting feature of malignancy or the only sign of distant spread. Knowledge of atypical manifestations of metastatic disease will reduce diagnostic delay, allow accurate staging and lead to the effective and timely delivery of appropriate treatment.

Adult↗
PubMed1999

Comparative efficacy of and sequence choice for two oral contrast agents used during MR imaging.

OBJECTIVE: Our objective was to compare the efficacy of a positive and a negative oral contrast agent and to determine the optimal sequence choice for use in pelvic MR imaging. SUBJECTS AND METHODS: We undertook a prospective randomized trial of 57 patients with pelvic cancer who were examined with MR imaging after oral administration of a positive contrast agent (27 patients) or a negative contrast agent (30 patients). T1- and T2-weighted breath-hold and non-breath-hold gradient-recalled echo and turbo spin-echo sequences were obtained. Using the hard-copy images, we graded filling and distention of the small bowel, bowel wall conspicuity, delineation of normal and pathologic structures, and artifacts. RESULTS: Good or excellent small-bowel filling and distention was obtained in 17 patients (63%) receiving the positive agent and in 26 patients (87%) receiving the negative agent, and bowel wall conspicuity was graded good or excellent in 19 patients (70%) and 20 patients (67%), respectively. Normal and pathologic structures were better delineated with the negative agent (20 patients [74%] and 27 patients [90%], respectively; p = .02). Breath-hold gradient-recalled echo T1-weighted images were preferred for the positive agent (78%), and breath-hold T2-weighted images were preferred for the negative agent (93%). Contrast artifacts were more frequently seen with the negative agent (11% and 93%, respectively; p = .0001), and such artifacts were eliminated using T2-weighted sequences. CONCLUSION: Both contrast agents were effective in pelvic MR imaging, but delineation of normal and pathologic structures was better with the negative agent. Gradient-recalled echo T1-weighted sequences are recommended for positive contrast agents, and breath-hold T2-weighted sequences are recommended for negative contrast agents.

Administration, Oral↗
PubMed1998

T1-weighted magnetic resonance imaging in breast cancer vertebral metastases: changes on treatment and correlation with response to therapy.

PURPOSE: To document the MR appearances of vertebral metastases in breast cancer on treatment and to determine whether a single T1-weighted (T1-W) sequence of the spine could provide a quick and effective method of response assessment. PATIENTS AND METHODS: One-hundred and nine spinal magnetic resonance (MR) examinations in 41 metastatic breast cancer patients on treatment were reviewed. The changes in number, size and signal intensity of vertebral metastases during 68 intervals (mean length 6.9 months) were documented. T1-W signal intensity (SI) before and after treatment was assigned to three patterns: (A) low homogeneous SI; (B) low heterogeneous SI; and (C) high homogeneous SI. For each interval between MR examinations, an objective assessment of the overall response (disease regression, no change, disease progression) to treatment of metastases was made based on standard assessment criteria. RESULTS: The number and size of treated vertebral metastases increased in 47% and 43% of cases and showed no change in 53% and 54% of cases, respectively. A reduction in size of lesions was seen in 3% of cases only and no reduction in the number of lesions was seen. T1-W [corrected] signal intensity changes occurred in approximately one-third of cases documented. The most commonly observed SI change in 25% of all intervals (17 of 68) was from type A to type B. There was no correlation between SI change and response to therapy. T1-W [corrected] MR response assessment, based on changes in size and number of vertebral metastases, accurately predicted progression of disease in 79% of cases and stable disease in 75% of cases. It did not predict regression of disease. CONCLUSION: A T1-W MR spinal assessment is a simple and effective method of evaluation of therapeutic response of lytic and sclerotic vertebral metastases in breast cancer being able to distinguish patients with progressive disease from those with a favourable response (no change or disease regression) to therapy. These findings have important clinical implications.

Breast Neoplasms↗
PubMed1998

Correlation of CT with histopathological findings in patients with gastric and gastro-oesophageal carcinomas following neoadjuvant chemotherapy.

UNLABELLED: Gastric carcinoma is the fourth commonest cause of death from malignant disease in United Kingdom. In the Western hemisphere, it usually presents with advanced disease, which contributes to its very poor prognosis. Pre-operative (neoadjuvant) chemotherapy offers the possibility of down-staging such tumours and the potential to render tumours operable. Computed tomography (CT) plays a central role in the assessment of patients presenting with the disease, and in those who undergo chemotherapy, in evaluating their response. OBJECTIVE: This study was undertaken to evaluate the role of CT in predicting loco-regional spread of tumour following neoadjuvant chemotherapy in non-metastatic gastric and gastro-oesophageal cancers. METHODS AND MATERIALS: We correlated CT evidence of loco-regional spread with pathological findings following surgery in 21 patients who received pre-operative chemotherapy. RESULTS: Residual masses were seen on CT in 19 patients, and 15 contained active tumour, although in four patients no viable tumour was demonstrated at histopathology. The overall accuracy of CT in assessing loco-regional disease was disappointing with sensitivities, specificities, positive and negative predictive values of 57%, 43%, 75% and 33%, respectively. CONCLUSIONS: We conclude that CT is not accurate in identifying residual loco-regional spread and therefore should not preclude surgery in those patients who have received neoadjuvant chemotherapy.

Adult↗
PubMed1998

Magnetic resonance imaging of prostate cancer: comparison of image quality using endorectal and pelvic phased array coils.

OBJECTIVE: To compare endorectal coil (ERC) and pelvic phased array (PPA) coil magnetic resonance imaging for delineation of the prostate gland and seminal vesicles. To compare ERC images at different inflation volumes of the ERC air balloon. MATERIALS AND METHODS: Twenty-one patients underwent T2-weighted examinations using PPA and ERC. The ERC evaluations were performed at three balloon inflation volumes (60, 100 and 140 ml). All patients had proven prostate cancer. Images were analysed for visibility of anatomic structures, gland distortion, tumour visualization, artefacts (coil flare, coil-related artefact and rectal movement) and overall image quality. A grading system was used for each parameter. RESULTS: ERC assessments at increasing balloon inflations showed equivalent anatomical detail and overall image quality. However, increasing gland distortion and decreasing coil related flare was found with higher air inflations (P = 0.13 and P = 0.006, respectively). When compared with ERC images, visibility of the anterior gland and neurovascular bundles was better with the PPA coil (P = 0.0001 and 0.002, respectively). The overall image quality was superior with the PPA coil (P = 0.0001). However, no significant difference in visualization of tumour or delineation of tumour extent was observed between the two techniques. CONCLUSIONS: PPA imaging of the prostate gland provides images of superior quality compared with the ERC. This is mainly due to fewer artefacts with the PPA coil and improved anterior gland visibility. When ERC is used, air inflation to at least 100 ml reduces coil flare artefact.

Aged↗
PubMed1998

CT of calcified liver metastases in colorectal carcinoma.

PURPOSE: To assess the incidence, characteristics and prognostic significance of calcification within colorectal hepatic metastases. MATERIALS AND METHODS: A retrospective analysis of CT in 265 patients with locally advanced or metastatic cancer was performed. Four groups were defined: (a) calcification within liver metastases prior to therapy, (b) noncalcified liver metastases with development of calcification on therapy, (c) noncalcified liver metastases, and (d) advanced local tumour without liver metastases. The number of calcified deposits in each patient was documented. A marker lesion was analysed for character, distribution and percentage of calcification. Survival between the four groups was compared. RESULTS: Twenty-nine (11%) patients had calcified liver metastases at presentation and 10 (4%) developed calcification during chemotherapy. Analysis of a marker lesion showed that the most frequent characteristic was fine calcification with a variable distribution. The most frequent change on treatment was alteration in the extent of calcification. Calcification developing on treatment was usually central. There was no difference in survival between groups 1, 2 and 3, but groups 1, 2 and 3 had a shorter survival than group 4. CONCLUSION: Calcification of liver metastases shows a variable pattern and may develop or change during therapy. Liver metastatic calcification may not carry any prognostic significance in colorectal cancer.

Antimetabolites, Antineoplastic↗
PubMed1998

Radiation induced liver injury detected by particulate reticuloendothelial contrast agent.

Radiation induced liver injury detected by a particulate reticuloendothelial MR contrast agent is described in a patient with metastatic colon cancer. The irradiated hepatic parenchyma failed to darken after ferumoxide administration. This finding suggests that detection of metastatic disease after ferumoxide contrast agents may be impaired in patients who have previously received upper abdominal radiation treatment.

Aged↗
PubMed1998

Pneumomediastinum complicating bleomycin related lung damage.

We describe two patients who developed spontaneous pneumomediastinum without pneumothorax against a background of bleomycin-induced pulmonary interstitial disease whilst on treatment for metastatic germ cell tumours of the testis. Pneumomediastinum is a rare but recognized complication of bleomycin-induced lung toxicity, which has previously only been described in association with pneumothorax.

Antimetabolites, Antineoplastic↗