Identification Of New Lesions Research Articles

Association between SPECT/CT total tumor volume (TTV) and new lesions (NLs) in early cycles of 177Lu-PSMA-617 (LuPSMA) and progression-free and overall survival (PFS and OS) in men with metastatic castration-resistant prostate cancer (mCRPC).

40 Background: LuPSMA is a newly established treatment in patients with mCRPC, but PSA and survival outcomes vary widely, and predictors of treatment responses are needed. LuPSMA delivers radiation to tumor tissues that can also be imaged with SPECT/CT which provides semiquantitative estimates of TTV and identification of NLs. This study investigates the use of SPECT/CT in early cycles to predict LuPSMA outcomes. Methods: Between June and December 2022, mCRPC patients who initiated the 2nd cycle of LuPSMA with SPECT/CT 24 hours post-treatment were retrospectively reviewed. We evaluated associations between TTV and the appearance of NLs at the start of the 2nd or 3rd cycle with PFS and OS using Cox regression analysis. NLs were classified as non-PSMA-avid with no or low uptake (< liver) with corresponding findings on CT and PSMA-avid (uptake > liver). All analyses were adjusted for change in PSA relative to baseline. Results: Sixty-six mCRPC patients (median age, 73.5) received a median of 4 (IQR: 3-5) cycles of LuPSMA. Median follow-up starting at 2nd cycle was 26 weeks (IQR: 21-36) with 47/66 (71%) alive at the time of the analysis. A reduction of ≥50% in PSA (PSA50) was noted in 33/66 (50%) patients. Changes in PSA and TTV at 2nd and 3rd cycle were apparently concordant in 50/66 (76%) and 42/51 (82%) and were significantly correlated (r= 0.55 and 0.56, both p<0.001). Patients with higher absolute TTV adjusted for PSA change at 2nd cycle had worse PFS and OS (HR=1.3 and 2.26) with consistent results at 3rd cycle (Table). NLs were detected in 13/66 (7/13 PSMA-avid, 6/13 non-PSMA-avid) and 7/51 patients (5/7 PSMA-avid, 2/7 non-PSMA-avid) at 2nd and 3rd cycle, respectively. Patients with NLs at 2nd cycle had higher risks of progression and death (HR=4.53 and 6.28). Conclusions: Higher SPECT/CT TTV at 2nd and 3rd cycle and detection of NLs at 2nd cycle were associated with higher risks of progression and death. Although changes in PSA and TTV were correlated, absolute SPECT/CT TTV in early cycles provided a complementary ability to predict outcomes of LuPSMA. [Table: see text]

Duodenal Metastasis from Colorectal Cancer: A Case Report

Background: The occurrence of metastatic colon lesions in various organs has been documented extensively in the literature. The liver, lungs, and bones are the most frequently affected sites. Metastasis in the duodenum due to colon cancer is an infrequent occurrence. Case Presentation: We present a detailed case report of a 65-year-old female patient diagnosed with metastatic colon cancer to the duodenum. The patient initially underwent extended right hemicolectomy for stage III low-grade adenocarcinoma of the colon. Adjuvant chemotherapy was administered, resulting in a period of apparent remission. However, in 2020, the patient experienced elevated tumor marker levels, prompting further investigations. Endoscopy revealed an irregular mass infiltrating the muscle layer in the duodenum, confirming malignant involvement. The patient underwent curative distal gastric duodenectomy, with pathology results indicating a colonic origin of the tumor. The patient received first-line palliative chemotherapy with FOLFOX rechallenge and the addition of AVASTIN. Several cycles of chemotherapy were completed, with satisfactory tumor response observed in follow-up PET scans. Maintenance therapy was initiated after achieving disease-free status on CT scans. However, in October 2022, the patient exhibited increasing tumor marker levels and new findings on PET scan, leading to the initiation of second-line palliative therapy with FOLFIRI and ramucirumab. The patient has received multiple cycles of second-line therapy, with the most recent PET scan in February 2023 showing a favorable treatment response, including a decrease in the size of existing nodes and no identification of new lesions. Conclusion: In conclusion, this case exemplifies the journey of a patient with stage 3 colon cancer who initially responded well to surgery and adjuvant chemotherapy, but experienced subsequent relapse in the duodenum. Despite surgical intervention and palliative chemotherapy, the patient developed metastasis in the liver, lung, and multiple lymph nodes.

TYK2 Activating Alterations in Acute Lymphoblastic Leukemia: Novel Driver Oncogenes with Potential Avenues for Precision Medicine?

Utilization of Next Generation Sequencing (NGS) and advances in genomic profiling have led to identification of new lesions in acute lymphoblastic leukemia (ALL) cases. TYK2 alterations are among those that warrant an in-depth characterization of the underlying mechanisms that result in leukemogenesis, targetability potential and drug response. The current literature around the functional significance and clinical importance of these alterations in driving hematological cancer (in particular, leukemia) is limited. This review focuses on recent findings demonstrating the leukemogenic potential of TYK2 alterations. Specifically, the molecular consequences of aberrant TYK2 levels are detailed and the effects of TYK2 deficiency or dysregulated activation are explored in carcinogenesis and leukemogenesis. In addition, the functional role of TYK2 in JAK/STAT signaling, possible cross talk to other cancer-related pathways and overarching avenues for pharmacological intervention in TYK2-altered ALL are also described.

Evaluating the Clinical Utility and Cost of Imaging Strategies in Adults with Newly Diagnosed Primary Intradural Spinal Tumors

In patients with new primary intradural spinal tumors, the best screening strategy for additional central nervous system (CNS) lesions is unclear. The goal of this study was to document the rate of additional CNS tumors in these patients. Adults with primary intradural spinal tumors were retrospectively reviewed. Imaging strategy at diagnosis was classified as focused spine (cervical, thoracic, or lumbar), total spine, or complete neuraxis (brain and total spine). Tumor pathology, genetic syndromes, and presence of additional CNS lesions at diagnosis or follow-up were collected. The study comprised 319 patients with mean age of 51 years and mean follow-up of 41 months. In 151 patients with focused spine imaging, 3 (2.0%) were found to have new lesions with 2 (1.4%) requiring treatment. In 35 patients with total spine imaging, there were no additional lesions. In 133 patients with complete neuraxis imaging, 4 (3.0%) were found to have new lesions with 2 (1.5%) requiring treatment. There was no difference in the identification of new lesions (P= 0.542) or new lesions requiring treatment (P= 0.772) across imaging strategies. Among patients without genetic syndromes, rates of new lesions requiring treatment were 1.4% for focused spine, 0% for total spine, and 2.2% for complete neuraxis (P= 0.683). There were no cases of delayed identification causing risk to life or neurological function. Complete neuraxis imaging carried an increased charge of $4420 per patient. Among patients without an underlying genetic syndrome, the likelihood of identifying additional CNS lesions requiring treatment is low. In appropriate cases, focused spine imaging may be a more cost-effective strategy.

Gadolinium-Enhancing Lesions Lead to Decreases in White Matter Tract Fractional Anisotropy in Multiple Sclerosis.

Although MRI identification of new lesions forms the basis for monitoring disease progression in multiple sclerosis patients, how lesion activity relates to longitudinal white matter changes in the brain is unknown. We hypothesized that patients with gadolinium-enhancing lesions would show greater longitudinal decline in fractional anisotropy in major tracts compared to those with stable disease. Thirty patients with relapsing-remitting multiple sclerosis were included in this study-13 had enhancing lesions at baseline and 17 did not. Each patient underwent at least two 3 Tesla contrast-enhanced MRI scans with a DTI sequence with a median interval of 2.1 years between scans. The forceps major and minor of the corpus callosum and the bilateral corticospinal tracts were selected as the major white matter tracts of interest. These tracts were reconstructed using region-of-interest placement on standard anatomical landmarks and a fiber assignment by continuous tracking algorithm using TrackVis (version 0.5.2.2) software. Mixed-effects regression models were used to determine the association between enhancing lesions and subsequent longitudinal change in fractional anisotropy. In patients with enhancing lesions, there was greater decline in fractional anisotropy compared to those with stable disease in the forceps major (P = .026), right corticospinal tract (P = .032), and marginally in the left corticospinal tract (P = .050), but not the forceps minor (P = .11). Fractional anisotropy of major white matter tracts declined more rapidly in patients with enhancing lesions, suggesting greater diffuse white matter injury with active inflammatory disease. DTI may provide a means of monitoring white matter injury following relapses.

Temporally Consistent Probabilistic Detection of New Multiple Sclerosis Lesions in Brain MRI

Detection of new Multiple Sclerosis (MS) lesions on magnetic resonance imaging (MRI) is important as a marker of disease activity and as a potential surrogate for relapses. We propose an approach where sequential scans are jointly segmented, to provide a temporally consistent tissue segmentation while remaining sensitive to newly appearing lesions. The method uses a two-stage classification process: 1) a Bayesian classifier provides a probabilistic brain tissue classification at each voxel of reference and follow-up scans, and 2) a random-forest based lesion-level classification provides a final identification of new lesions. Generative models are learned based on 364 scans from 95 subjects from a multi-center clinical trial. The method is evaluated on sequential brain MRI of 160 subjects from a separate multi-center clinical trial, and is compared to 1) semi-automatically generated ground truth segmentations and 2) fully manual identification of new lesions generated independently by nine expert raters on a subset of 60 subjects. For new lesions greater than 0.15 cc in size, the classifier has near perfect performance (99% sensitivity, 2% false detection rate), as compared to ground truth. The proposed method was also shown to exceed the performance of any one of the nine expert manual identifications.

Utility of fluorodeoxyglucose-positron emission tomography in the identification of new lesions in lung cancer patients for the assessment of therapy response

Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) has added positron emission tomography (PET) as an optional complement for the detection of new lesions. In this study, we evaluate the utility of fluorodeoxyglucose (FDG)-PET in the identification of new lesions and progressive disease not recognized on computed tomography (CT) in patients with nonsmall cell lung cancer (NSCLC) undergoing therapy. Seventy patients (30 female, 40 male; mean age 67±14 years, range, 39-94 years) with NSCLC underwent FDG-PET before and after chemotherapy and/or radiotherapy, whereas 69 patients underwent CT imaging. Overall (OS) and progression-free survivals (PFS) were calculated for RECIST 1.1 with CT alone, RECIST 1.1 with PET for the identification of new lesions, visual PET, and semiquantitative PET using a change in standardized uptake value ranging from -15 to -50%. PET identified new lesions in 26 patients, resulting in 10 patients (14.5%) being upgraded to progressive disease. The combination of CT and PET for the detection of new lesions improved the prediction of survival (OS: P=0.0491 for all stages and P=0.0033 for stage IV; PFS: P=0.0045 for stage IV) compared with CT imaging alone (OS: P=0.1362 for all stages and P=0.1625 for stage IV; PFS: P=0.0632 for stage IV). Furthermore, a change in standardized uptake value of -35% was the most discriminative for the prediction of survival for the semiquantitative PET approach (OS: P=0.0393 for all stages, P=0.0051 for stage IV; PFS: P=0.0092 for stage IV) and more discriminative than the visual PET approach (OS: P=0.2699 for all stages, P=0.0105 for stage IV; PFS: P=0.014 for stage IV). FDG-PET is helpful in identifying new lesions in NSCLC patients, resulting in the improved assessment of therapy response with CT imaging combined with FDG-PET compared with CT imaging alone. Although RECIST 1.1 includes FDG-PET only as an optional adjunct, we recommend the implementation of PET imaging in the assessment of therapy response.

Does Ethnicity Influence Response To Docetaxel Based-Chemotherapy For Patients With Castration Resistant Prostate Cancer? The New Mexico Perspective.

INTRODUCTION: Metastatic prostate cancer is lethal in 15 % of the patients. Ethnic variations in response to docetaxel in patients with metastatic prostate cancer have not been studied. The aim of this study was to identify ethnic differences in the response to docetaxel, among patients with castration resistant metastatic prostate cancer.PATIENTS AND METHODS: We queried the New Mexico Cancer Registry then the electronic charts of all castration resistant metastatic prostate cancer patients who were treated with docetaxel between 1999 and 2010 at the University of New Mexico Cancer Center. Patient characteristics that might influence the response to docetaxel such as age, prior treatment including hormones, chemotherapy, radiotherapy, and surgery, concurrent chemotherapy, site of disease, baseline PSA, and number of docetaxel courses were recorded. Progression of disease after start of treatment was defined as identification of new lesions or a biochemical recurrence. The primary end point was overall survival. Secondary end points were progression-free survival and PSA response to docetaxel. RESULTS: Despite a lower incidence of prostate cancer in NM, the death rate is higher than the national average. Although not statistically significant, the overall survival for patients treated with docetaxel is highest among Non Hispanic Whites, followed by Native Americans and worst among the Hispanic population. The progression free survival was greatest in the Native American population followed by Non Hispanic Whites, followed by Hispanics. Compared to published data, the survival of New Mexicans with prostate cancer treated with docetaxel is worse.CONCLUSION: Hispanic males with castration resistant metastatic prostate cancer on docetaxel, tended to have the lowest overall survival and progression free survival, but overall the differences between New Mexican ethnicities were not statistically significant.

Incidence of Noncarious Cervical Lesions and Their Relation to the Presence of Wear Facets

Noncarious cervical lesions are characterized by loss of tooth structure in the cervical area, compromising its integrity and resulting in esthetic problems for the patient. The purpose of this study was to assess noncarious cervical lesions in young patients in an attempt to establish a possible relationship to the presence of wear facets. First-year dental students of Bauru Dental School were studied to verify the prevalence of noncarious cervical lesions and their relationship to the presence of wear facets. After 3 years, the students were examined again to verify the incidence of new lesions, trying to establish a correlation to the previous existence of wear facets. Of the 1,131 teeth analyzed, 129 had noncarious cervical lesions. Twenty-nine of the 40 students had at least one tooth with one lesion. After 3 years, the incidence of new lesions was 57. Mandibular first molars (22.3%), mandibular first premolars (13.2%), mandibular second premolars (13.2%), and maxillary first molars (12.4%) showed the highest prevalence of lesions. On final analysis, 86.8% of all teeth presenting lesions showed wear facets. The identification of new lesions associated with the presence of wear facets identified during the first exam 3 years earlier was statistically significant (p < 0.01). The patterns of wear facets found in the study population examined were associated with an increased occurrence of noncarious cervical lesions. Occlusal factors, especially the presence of wear facets, should be considered in the management of noncarious cervical lesions.

Bone disease in multiple myeloma.

Bone disease in multiple myeloma.

Pulmonary tuberculosis: contributions of radiology in diagnosis and treatment.

This review records the important place that radiologic examinations have had in the diagnosis and treatment of pulmonary tuberculosis in the past nine decades. Very soon after the discovery of x-rays it became apparent that chest roentgenograms would be a help in identifying pulmonary lesions. As the quality of the examinations improved, the benefits became significantly better. Earlier lesions were diagnosed. Follow-up studies after medical or surgical treatment were increasingly helpful. Newly developed techniques allowed demonstration of extrapulmonary complications. Radiologic monitoring of collapse therapy played a critical role in the successes achieved. Even after the medical conquest of active tuberculous lesions by drug therapy, identification of new lesions and follow-up of treated patients remains a significant role for radiology. Control of this once fatal and widely feared disease depends on continued early recognition and appropriate treatment.