Dynamic magnetic resonance imaging of regional contrast access as an additional prognostic factor in pediatric osteosarcoma

Abstract

After careful planning, a postgraduate Diploma in Surgical Anatomy was launched in 2009. This report describes the structure of the program, the challenges encountered in implementing and running the course, and results of evaluations. The qualification is targeted at junior doctors intending to become surgeons or radiologists and aims to equip them with a sound understanding of regional anatomy relevant to common diagnostic and therapeutic procedures, together with an understanding of common/important anatomical variations. The course is delivered by: (1) 24 weeks' distance learning, comprising selected readings, podcasts, multiple choice questions (MCQs), and research informed essays; and (2) two separate two‐week periods of intensive campus‐based learning and whole body dissection (four students per cadaver) assessed by oral examination, a class presentation of an anatomical variation, and formal MCQ examination. Campus‐based instruction is delivered by two surgical anatomists with additional input from a broad range of specialist surgeons and radiologists. Anonymous student evaluations over three successive courses show that all components of the course were highly rated. The success of the program may relate to several factors: an emphasis on clinically relevant anatomy, clear learning objectives, personalized student feedback, a low student to cadaver ratio, restricted class size, a wide range of supportive material, a dedicated team of surgical/radiological instructors, efficient course administration, and endorsement by the Royal Australasian College of Surgeons. Establishing a Diploma in Surgical Anatomy program requires a dedicated team of individuals, the setting and maintenance of appropriate educational standards, and collaboration with the professional body regulating the training of surgeons. Anat Sci Educ. © 2011 American Association of Anatomists.

Estimation of Potential Excess Cancer Incidence in Pediatric 201Tl Imaging

“…MRI has no associated radiation exposure. Preliminary use of dynamic contrast-enhanced MRI is promising in assessing tumor response to therapy, but not all parts of the world have access to this technique and it presents unique challenges related to standardization of image acquisition, processing, and analysis [26]. …”

Imaging Pediatric Bone Sarcomas

“…In some cases, MR may redirect clinical management by distinguishing between malignant (Figure 3) and non-malignant (Figure 4_) disease. Dynamic enhanced MR techniques obtained at the time of diagnosis provide baseline information for following tumor response to therapy 95-97 (Figure 5). Thus far, a prognostic role for such techniques based upon findings at the time of diagnosis has not been established 84 .…”

“…It serves as a surrogate variable for assessing drug delivery 67;95-97 but is not currently available for routine clinical use. This technique is an additional prognostic factor predictive of disease-free survival in patients receiving chemotherapy for osteosarcoma (p=0.035) 95;97 . A higher initial regional access of contrast was associated with greater disease-free survival 96 .…”

“…Dynamic enhanced MR sequences demonstrating and quantifying the degree of tumor necrosis as an indicator of biologic response is also now possible 28;95-97 (Figure 5). The slope of linear regression of the regional access of contrast is predictive of disease free survival.…”

Can Contrast-Enhanced MR Imaging Predict Survival in Breast Cancer?

“…In cancers other than breast cancer, it has been shown that dynamic contrast‐enhanced MR imaging (CE‐MRI) can contribute not only to establish the diagnosis, but also to identify patients with a poorer prognosis. Pharmacokinetic dynamic MR imaging was found to be a predictor of disease‐free survival in pediatric osteosarcoma (15). It has also been shown that MR imaging is able to assess tumor aggressiveness and offers information on the risk of local recurrence and on prediction of treatment success in cervical cancer (9, 12).…”