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Medical Imaging Article
Review Article
Imaging in multiple sclerosis: A new spin on lesions
Corresponding author: Dr Fadi El-Merhi, Diagnostic Radiology Department, American University of Beirut Medical Center, Beirut, Lebanon
This article evaluates the most relevant state-of-the-art magnetic resonance (MR) techniques that are clinically available to investigate multiple sclerosis (MS). The
presence of hypo- and hyperintense lesions on T1- and T2-weighted magnetic resonance imaging (MRI) sequences in white matter (WM) is a common finding that is
occasionally a diagnostic challenge for the radiologist. The technical requirements and how they may help to understand, classify or follow-up these pathologies are
briefly summarized. The gold standard for MS diagnosis is pathological correlation. Yet due to limited availability of biopsy and autopsy material, there is a high demand
for imaging as a diagnostic as well as prognostic indicator. With the progress in MRI during the last decade, MRI now plays a leading role in the diagnosis and follow-up of
MS. A number of correlative pathological and MR studies have helped to define pathological substrates of MS in focal lesions and normal appearing white matter (NAWM).
Vascular spaces mimicking MS lesions have been minimized by the enhanced differentiation of WM and grey (GM) matter parenchyma. The aim of this article is to enhance
the current understanding of histopathology and radiological characteristics of MS lesions in space and time.
Medical Imaging Article
Pictorial Essay
Radiological diagnosis of spinal arachnoid cysts: A pictorial essay
Corresponding author: Dra Carolina Ospina Moreno, Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
Spinal arachnoid cysts (AC) are intraspinal extramedullary loculated cerebral spinal fluid collections. They are relatively uncommon lesions. Spinal AC often cause
symptoms such as pain, weakness and radiculopathy. In this pictorial essay we demonstrate the main radiological features of spinal AC, as well as symptoms and
complications associated with them. We also describe the main differential diagnoses.
Radiation Oncology Article
Original Article
Economic evaluation of single-fraction versus multiple-fraction palliative radiotherapy
for painful bone metastases in breast, lung and prostate cancer
Corresponding author: Dr Nisha Nair, Burden of Disease, Epidemiology, Equity and Cost Effectiveness
Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
Introduction: Single- and multiple-fraction external beam radiotherapy (SFX-EBRT and MFX-EBRT) are palliative treatment options for localized metastatic bone pain.
MFX is the preferred choice in many developed countries. Evidence shows little difference in how effectively SFX and MFX reduce pain. However, SFX is associated with
higher retreatment and (in one meta-analysis) pathological fracture rates. MFX is, however, more time-consuming and expensive. We estimated the cost-effectiveness of
SFX versus MFX for metastatic bone pain in breast, prostate and lung cancer in New Zealand.
Methods: We constructed a Markov microsimulation model to estimate health gain (in quality-adjusted life-years or QALYs), health system costs (in real 2011 NZ dollars)
and cost-effectiveness. The model was populated using effect estimates from randomized controlled trials and other studies, and New Zealand cancer and cost data.
Disability weights from the 2010 Global Burden of Disease study were used in estimating QALYs.
Results: Across all three cancers, QALY gains were similar for SFX compared to MFX, and per patient costs were less for SFX than MFX, with a difference of NZ$1469 (95%
uncertainty interval $1112 to $1886) for lung cancer, $1316 ($810 to $1854) for prostate cancer and $1344 ($855 to $1846) for breast cancer. Accordingly, from a cost-
effectiveness perspective, SFX was the preferable treatment option. Various sensitivity analyses did not overturn the clear preference for SFX.
Conclusion: For all three cancers, SFX was clearly more cost-effective than MFX. This adds to the case for desisting from offering MFX to patients with metastatic bone
pain, from a cost-effectiveness angle.
Radiation Oncology Article
Guidelines
Australia and New Zealand Faculty of Radiation Oncology Lung Interest Cooperative: 2015 consensus guidelines for the
use of advanced technologies in the radiation therapy treatment of locally advanced non-small cell lung cancer
Corresponding author: Dr Patrick M Dwyer, Northern New South Wales Cancer Institute, Lismore, NSW
Definitive radiation therapy (RT), generally combined with chemotherapy, is the standard of care for patients with unresectable locally advanced (stage II-III) non-small
cell lung cancer (LA-NSCLC). With the advent of newer technologies, RT for LA-NSCLC has changed significantly in recent years. Some of these advances include PET/CT
in treatment planning, 4DCT simulation, 3D/4D cone beam CT image guidance and IMRT/VMAT. Many of these techniques were used in the most recent RTOG randomised
controlled trial of chemo-RT for Stage III NSCLC, which reported a median overall survival of 28.7 months in patients randomised to the standard therapy arm, much higher
than previously documented.[1] Currently, many radiation oncology departments in Australia and New Zealand are in the process of implementing these techniques.
In 2015, the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) conducted a
patterns-of-practice survey amongst radiation oncologists to investigate the range of radiation therapy management of lung cancer in Australia and New Zealand and
to define the gaps in optimal patient care. Results of this survey are published in this issue of the journal. There was appreciable variation in methods of simulation,
planning and image verification techniques noted from the survey. With this in mind, the FROLIC executive committee identified the need to develop guidelines for the
use of advanced RT technologies in the treatment of LA-NSCLC. In August 2015, the inaugural FROLIC workshop was conducted with the aims of sharing knowledge and
experience regarding the optimal use of the advanced techniques in LA-NSCLC with a view to developing consensus guidelines. We felt there is a need to develop local
guidelines relevant to the Australian and New Zealand context for the implementation of new technologies. These guidelines may assist in departments accelerating their
implementation and reduce variations in practice. They will help to ensure high quality utilisation of these technologies and best practice radiation therapy for patients
with LA-NSCLC.
What’s in Issue 5?
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