Comprehensive Imaging Analysis Research Articles

33P - Contrast enhanced chest CT in patients with breast cancer: Comprehensive imaging analysis and correlation with biological markers

BackgroundTo investigate the feasibility of virtual monoenergetic images (VMIs) derived from a dual-layer detector spectral CT (SDCT) in patients with breast cancer by assessing tumor conspicuity in comparison with conventional images (CI) and to correlate tumor conspicuity on VMIS with prognostic biomarkers. Methods64 patients with pathologically proven benign or breast cancers (14 benign lesions and 65 breast cancers) underwent arterial and 90s delayed phase scan on a SDCT for tumor staging between June 2016 and May 2018. CI were reconstructed at 120kVp, and VMI at 40 keV (VMI40). A retrospective spectral data analysis was performed to assess the regions of interest by using CI and VMI40 on arterial and delayed images (CIART, VMI40ART, CIDE, and VMI40DE). Two radiologists independently reviewed the 4 image sets for the conspicuity score of breast lesions. For quantitative analysis, measurement of Hounsfield units (HU) of breast lesions on VMI40ART and VMI40DE was performed. Receiver operating characteristic (ROC) analysis was performed. Estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), and Ki67 level were evaluated using histopathology. Statistically, conspicuity score and mean HU of malignant lesions were correlated with histological characteristics. ResultsThe mean conspicuity score of malignant lesions was significantly higher compared with that of benign lesions in all image sets (P < 0.05). The area under the ROC curve of conspicuity score for malignant lesions were greatest on VMI40DE. VMI40DE yielded significantly higher mean HU of malignant lesions compared to VMI40ART (P < 0.001). Malignant lesions on VMI40ART and VMI40DE revealed significantly higher mean HU compared to those of benign lesions (P < 0.001). The conspicuity score and the mean HU on VMI40ART were significantly higher in cancers with diameter greater than 2 cm, ER negativity, PR negativity, and Ki67 positivity (P < 0.05). ConclusionsVMI40DE is feasible to diagnose breast cancers with higher conspicuity score and better contrast enhancement compared with VMI40ART. Moreover, VMI40ART may serve as additional predictors of a poor breast cancer prognosis. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

A Systematic Review of Sellar and Parasellar Brown Tumors: An Analysis of Clinical, Diagnostic, and Management Profiles

To systematically review and analyze clinical, diagnostic, and management trends in sellar and parasellar brown tumors reported in existing literature. In this systematic review, PubMed, Ovid MEDLINE, Scopus, and Google Scholar databases were searched for reported cases of sellar/parasellar brown tumors. Relevant titles and abstracts were screened in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles meeting inclusion criteria were subjected to data extraction, summarization, and analysis. A rare case of parasellar brown tumor was also presented. Eight reports (including the current report) were eligible for inclusion. Mean patient age was 42.75 years. Reported symptoms included visual disturbances (n= 6), headache (n= 5), fatigue (n= 3), nausea/vomiting (n= 2), chest pain (n= 1), neck pain (n= 1), and dysphagia (n= 1). In cases where computed tomography findings were provided (n= 6), lesions were noted to be expansile and lytic. Lesions were hyperintense on T2-weighted magnetic resonance imaging (66.7%) and demonstrated contrast enhancement (83.3%). Histology unanimously showed multinucleated giant cells in a fibrovascular connective tissue stroma. Dramatic symptom resolution was noted in all patients who underwent resection of the sellar/parasellar brown tumor (n= 4; 50%). Sellar/parasellar brown tumors are a rare, tertiary manifestation of hyperparathyroidism and can be elusive to diagnose. Diagnosis requires a high index of clinical suspicion in addition to comprehensive biochemical testing, imaging, and histopathologic analysis. Surgical extirpation is favored in cases where the lesion is causing compressive symptoms, or if it is unresponsive to management of hyperparathyroidism.

Comprehensive imaging analysis of a patient with neurofibromatosis type 1 combined with hypophosphatemic osteomalacia

Comprehensive imaging analysis of a patient with neurofibromatosis type 1 combined with hypophosphatemic osteomalacia

Periacetabular Osteotomy Improves Pain and Function in Patients With Lateral Center-edge Angle Between 18° and 25°, but Are These Hips Really Borderline Dysplastic?

AbstractBackgroundThe treatment of mild or borderline acetabular dysplasia is controversial with surgical options including both arthroscopic labral repair with capsular closure or plication and periacetabular osteotomy (PAO). The degree to which improvements in pain and function might be achieved u

Tectal glioma as a distinct diagnostic entity: a comprehensive clinical, imaging, histologic and molecular analysis

Tectal glioma (TG) is a rare low-grade tumor occurring predominantly in the pediatric population. There has been no detailed analysis of molecular alterations in TG. Risk factors associated with inferior outcome and long-term sequelae of TG have not been well-documented. We retrospectively studied TGs treated or referred for review at St. Jude Children’s Research Hospital (SJCRH) between 1986 and 2013. Longitudinal clinical data were summarized, imaging and pathology specimen centrally reviewed, and tumor material analyzed with targeted molecular testing and genome-wide DNA methylation profiling. Forty-five patients with TG were included. Twenty-six (57.8%) were male. Median age at diagnosis was 9.9 years (range, 0.01–20.5). Median follow-up was 7.6 years (range, 0.5–17.0). The most common presenting symptoms were related to increased intracranial pressure. Of the 22 patients treated at SJCRH, 19 (86%) required cerebrospinal fluid diversion and seven (32%) underwent tumor-directed surgery. Five patients (23%) received radiation therapy and four (18%) systemic therapy. Ten-year overall and progression-free survival were 83.9 ± 10.4% and 48.7 ± 14.2%, respectively. Long-term morbidities included chronic headaches, visual symptoms and neurocognitive impairment. Lesion ≥3cm2, contrast enhancement and cystic changes at presentation were risk factors for progression. Among those with tumor tissue available, 83% showed growth patterns similar to pilocytic astrocytoma and 17% aligned best with diffuse astrocytoma. BRAF duplication (a marker of KIAA1549-BRAF fusion) and BRAF V600E mutation were detected in 25% and 7.7%, respectively. No case had histone H3 K27M mutation. DNA methylation profile of TG was distinct from other brain tumors. In summary, TG is an indolent, chronic disease with unique clinical and molecular profiles and associated with long term morbidities. Large size, contrast enhancement and cystic changes are risk factors for progression.

Symptom Onset in Aortic Stenosis: Relation to Sex Differences in Left Ventricular Remodeling

ObjectivesThe aim of this study was to establish sex differences in remodeling and outcome in aortic stenosis (AS) and their associations with biomarkers of myocardial fibrosis. BackgroundThe remodeling response and timing of symptoms is highly variable in AS, and sex plays an important role. MethodsA total of 174 patients (133 men, mean age 66.2 ± 13.3 years) with asymptomatic moderate to severe AS underwent comprehensive stress cardiac magnetic resonance imaging, transthoracic echocardiography, and biomarker analysis (matrix metalloproteinase [MMP]-2, -3, -7, -8, and -9; tissue inhibitor matrix metalloproteinases-1 and -4; syndecan-1 and -4; and N-terminal pro–B-type natriuretic peptide), and were followed up at 6-month intervals. A primary endpoint was a composite of typical AS symptoms necessitating referral for aortic valve replacement, cardiovascular death, or major adverse cardiovascular events. ResultsFor a similar severity of AS, male patients demonstrated higher indexed left ventricular (LV) volumes and mass, more concentric remodeling (higher LV mass/volume), a trend to more late gadolinium enhancement (present in 51.1% men vs. 34.1% women; p = 0.057), and higher extracellular volume index than female patients (13.27 [interquartile range (IQR): 11.5 to 17.0] vs. 11.53 [IQR: 10.5 to 13.5] ml/m2, p = 0.017), with worse systolic and diastolic function and higher MMP-3 and syndecan-4 levels, whereas female patients had higher septal E/e′. Male sex was independently associated with indexed LV mass (β = 13.32 [IQR: 9.59 to 17.05]; p < 0.001). During median follow-up of 374 (IQR: 351 to 498) days, a primary outcome, driven by spontaneous symptom onset, occurred in 21.8% of male and 43.9% of female patients (relative risk: 0.50 [95% confidence interval: 0.31 to 0.80]; p = 0.004). Measures of AS severity were associated with the primary outcome in both sexes, whereas N-terminal pro–B-type natriuretic peptide, MMP-3, and mass/volume were only associated in men. ConclusionsIn AS, women tolerate pressure overload with less concentric remodeling and myocardial fibrosis but are more likely to develop symptoms. This may be related to higher wall stress and filling pressures in women.

Can Comprehensive Imaging Analysis with Analytic Morphomics and Geriatric Assessment Predict Serious Complications in Patients Undergoing Pancreatic Surgery?

We aimed to determine whether comprehensive imaging analysis with analytic morphomics (AM) enhances or replaces geriatric assessment (GA) in risk-stratifying pancreatic surgery patients. One hundred thirty-four pancreatic surgery patients were identified from a prospective cohort. Sixty-three patients in the cohort had preoperative CT scans in addition to comprehensive geriatric assessments. CT scans were processed using AM. Associations with National Surgical Quality Improvement Program (NSQIP) serious complications were evaluated using univariate analysis and robust elastic net modeling to obtain AUROC curves by adding AM and GA measures to our previously defined clinical base risk model (age, body mass index, American Society of Anesthesiologists classification, and Charlson comorbidity index). NSQIP serious complications were associated with low psoas Hounsfield units (HUs) (p = 0.002), low-density (0 to 30 HU) psoas area (p = 0.01), visceral fat HU (p ≤ 0.001), visceral fat area (p = 0.009), subcutaneous fat HU (p = 0.023), and total body area (p = 0.012) on univariate analysis. Elastic net models incorporating the base model with geriatric assessment and psoas HU (AUC = 0.751), and AM alone (AUC = 0.739) have greater predictive value than the base model alone (AUC = 0.601). The model utilizing AM and GA in combination had the highest predictive value (AUC = 0.841). When combined, AM and GA improve prediction of NSQIP serious complications compared to either technique alone. The additive nature of these two modalities suggests they likely capture unique aspects of a patient’s fitness for surgery.

Comprehensive ionic imaging and bio-energetic analysis of club drug-induced cognitive deficiency

Comprehensive ionic imaging and bio-energetic analysis of club drug-induced cognitive deficiency

Chemoembolization and Radioembolization for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) continues to represent a major worldwide problem. Although treatments such as resection, transplantation, and ablation may provide a chance for a cure, these options are often precluded because of advanced disease presentation. Palliative treatments include transarterial embolization and systemic therapies. This review will summarize the state of the science for embolic therapies in HCC (conventional and drug-eluting chemoembolization, radioembolization) as well as discuss related topics including HCC staging, assessment of response, and ongoing clinical trials.

Comprehensive confocal imaging and 3D computer analysis of blood and lymphatic vascular channels across entire lymph nodes

Event Abstract Back to Event Comprehensive confocal imaging and 3D computer analysis of blood and lymphatic vascular channels across entire lymph nodes Inken Kelch1, 2*, Gib Bogle1, 3, Anthony Phillips1, 2, 4, Ian J. LeGrice3, 5, Gregory B. Sands3, Dane A. Gerneke3, Claudia J. Mansell1, 2 and P. Rod Dunbar1, 2 1 Maurice Wilkins Centre for Molecular Biodiscovery, New Zealand 2 The University of Auckland, School of Biological Sciences, New Zealand 3 The University of Auckland, Auckland Bioengineering Institute, New Zealand 4 The University of Auckland, Department of Surgery, New Zealand 5 The University of Auckland, Department of Physiology, New Zealand Lymph nodes (LNs) are highly organized organs of the adaptive immune system (1,2). An intricate network of blood and lymphatic vascular channels serves as entry and exit routes for lymphocytes but its overall structure and dynamism during LN activation remains poorly understood (3,4,5). By using a new automated imaging system which enables extended tissue imaging of whole lymph nodes at confocal resolution (6), we aim to gain new spatial information on the LN topology and make structural changes measurable through computer analysis. Fluorescently labeled vascular systems of murine LNs were imaged at 2 µm pixel resolution in their entirety of up to 8 mm3 and analyzed using in-house designed software tools. High-resolution volume images of the blood and lymphatic networks alone provided new insights into their labyrinthine arrangement in LN subcompartments, while additional computer reconstruction allowed sophisticated measurements in 3D. As a first step, we calculated the blood vessel network volume, individual segment diameters, and the distribution of distance to the nearest blood vessel. Current experimentation is employing measurements of the vessel diameters to revisualize the blood vessel network, allowing functional elements such as the feed arteriole and putative high endothelial venules to be extracted and analyzed in detail. Subsequently, we plan to investigate LNs at different stages of the immune response to gather more information on the remodeling processes of vascular networks in response to increased lymphocyte traffic. Ultimately, we wish to elucidate the topological relationship and dynamism of structural elements in LNs and draw a comprehensive map of LN anatomy. Acknowledgements The authors wish to thank the Maurice Wilkins Centre for Molecular Biodiscovery and the University of Auckland for funding this project.

Neuroendocrine Liver Metastasis Treated by Using Intraarterial Therapy: Volumetric Functional Imaging Biomarkers of Early Tumor Response and Survival

To determine if volumetric changes of diffusion-weighted and contrast material-enhanced magnetic resonance (MR) imaging can help assess early tumor response to intraarterial therapy (IAT) in neuroendocrine liver metastasis (NELM). This retrospective single-center comprehensive imaging analysis was performed in compliance with HIPAA and was institutional review board approved. Informed patient consent was waived. Seventy-one patients (39 men; mean age, 62.3 years) with NELM treated with IAT were analyzed retrospectively. MR studies were performed before and 3-4 weeks after therapy. The index lesion was segmented to provide volumetric functional analysis of apparent diffusion coefficient (ADC) and contrast-enhanced MR imaging in the hepatic arterial phase (HAP) and portal venous phase (PVP). Tumor response was defined as increase in volumetric ADC of 15% or greater and decrease in volumetric enhancement of 25% or greater during the HAP or of 50% or greater during the PVP. Patient overall survival was the primary end point after therapy initiation. Univariate analysis included Kaplan-Meier survival curves. The Cox proportional hazards regression model was used to detect interactions between volumetric ADC and contrast-enhanced MR imaging and to calculate the hazard ratio. There was significant increase in mean volumetric ADC (27%, P < .0001) and significant decrease in mean volumetric enhancement during the HAP (-25.3%, P < .0001) and the PVP (-22.4%, P < .0001) in all patients. Patients who had 15% or greater volumetric ADC increase (n = 49) after therapy had better prognosis than those who had less than 15% increase in volumetric ADC (n = 22) (log-rank test, P < .002). Patients who had 25% or greater decrease in volumetric arterial enhancement (n = 40) or 50% or greater decrease in venous enhancement (n = 18) had better prognosis than those who had less than 25% decrease in volumetric arterial enhancement (n = 31) or less than 50% decrease in venous enhancement (n = 53) (log-rank test, P < .02). Volumetric functional MR imaging criteria may act as biomarkers of early response, indicating that these criteria may be important to incorporate in future NELM clinical trials.

Intramedullary Pilomyxoid Astrocytoma with Intracerebral Metastasis Exhibiting Oligoden-Droglioma-Like Features

Intramedullary glioma are rare and their biological behaviour can differ from their cerebral counterparts. Pilomyxoid astrocytoma (PMA, WHO grade II), predominantly occur in the hypothalamic/chiasmatic region of infants and children. The few reported cases of pediatric intramedullary PMA displayed a particularly aggressive behavior. Here, we report a diagnostically challenging case of a five year old female patient presenting with intramedullary glioma and local tumor recurrence three years later. Twelve years after the initial manifestation, a second tumor was found intracerebrally. We performed a comprehensive histological, molecular pathological and imaging analysis of the tumors from both localizations. The results revealed a metastasizing PMA with unique histological and genetic features. Our study indicates that PMA comprise a heterogeneous group including aggressive subtypes which may not be compatible with the current classification according to WHO grade II. Furthermore, the case emphasizes the increasing relevance of molecular pathological markers complementing classic histo-logical diagnosis.

Speckle tracking: distinction of physiologic from pathologic LVH?

Speckle tracking: distinction of physiologic from pathologic LVH?

Imaging Response in the Primary Index Lesion and Clinical Outcomes Following Transarterial Locoregional Therapy for Hepatocellular Carcinoma

Response Evaluation Criteria in Solid Tumors (RECIST) (unidimensional), World Health Organization (WHO) (bidimensional), and European Association for Study of the Liver (EASL) (necrosis) guidelines are commonly used to assess response following therapy for hepatocellular carcinoma (HCC). No universally accepted standard exists. To evaluate intermethod agreement between these 3 imaging guidelines and to introduce the concept of the "primary index lesion" as a biomarker for response. Single-center comprehensive imaging analysis including 245 consecutive patients with HCC who were treated with chemoembolization or radioembolization between January 2000 and December 2008. Computed tomography and magnetic resonance imaging scans (N = 1065) were reviewed to assess response in the "primary index lesion," defined as the largest tumor targeted during first treatment. Intermethod agreement (kappa statistics) between RECIST, WHO, and EASL guidelines response; correlation of WHO and EASL response in the primary index lesion with time to progression and survival. Kappa coefficients were 0.86 (95% confidence interval [CI], 0.80-0.92) between the WHO and RECIST guidelines, 0.24 (95% CI, 0.16-0.33) between RECIST and EASL, and 0.28 (95% CI, 0.19-0.36) between WHO and EASL. Disease progressed in 96 patients; 113 died. The hazard ratio for time to progression in responders compared with nonresponders was 0.36 (95% CI, 0.23-0.57) for WHO, 0.38 (95% CI, 0.24-0.58) for RECIST, and 0.38 (95% CI, 0.22-0.64) for EASL. Hazard ratios for survival in responders compared with nonresponders in univariate and multivariate analyses were 0.46 (95% CI, 0.32-0.67) and 0.55 (95% CI, 0.35-0.84) for WHO and 0.36 (95% CI, 0.22-0.57) and 0.54 (95% CI, 0.34-0.85) for EASL. Hazard ratios for survival in responders vs nonresponders in patients with solitary and multifocal HCC were 0.39 (95% CI, 0.19-0.77) and 0.51 (95% CI, 0.32-0.82) for WHO and 0.26 (95% CI, 0.10-0.67) and 0.47 (95% CI, 0.28-0.79) for EASL. Among a group of patients with HCC, agreement for classification of therapeutic response was high between the RECIST and WHO guidelines but low between each of these and EASL. Application of these methods to measure response in a primary index lesion resulted in statistically significant correlations with disease progression and survival.

Abstract No. 139: Chemoembolization for hepatocellular carcinoma: Comprehensive imaging and survival analysis in a 172 patient cohort

Abstract No. 139: Chemoembolization for hepatocellular carcinoma: Comprehensive imaging and survival analysis in a 172 patient cohort