Computerized Tomography derived psoas muscle indices in a healthy young population in the United States.

Objective: Psoas muscle metrics from diagnostic computerized tomography (CT) scans are emerging as clinically relevant biomarkers. Most muscle metrics from the US population are from older cohorts with co-morbidities. Published reports from a young or healthy population in the United States on psoas muscle metrics optimized for age, body mass index (BMI), and sex are lacking. This study determines the psoas muscle index (PMI) and psoas muscle density (PMD) for a normal young Midwestern US population. Methods: Retrospective cross-sectional analysis of pre-existent abdominal non-contrast CT scans from a young (19-40 years old), Midwestern, predominately Caucasian population was conducted within Aquarius iNtuition software automatically after manual identification of the psoas muscle. Electronic medical records provided access to subject data and archived CT scans were reviewed. Results: From 193 (45 male, 148 female) CT scans, for males, PMI was 5.9 cm2/m2 (SD=1.7) and PMD 48.4 HU (SD=5.5); for females PMI was 5.4 cm2/m2 (SD=1.4) and PMD 48.18 HU (SD=5.5). BMI was significantly correlated with PMI and PMD for both men (p<0.001, p<0.001 respectively) and women (p<0.001, p<0.001 respectively). Conclusion: Psoas muscle metrics are newly generated for PMI and PMD in a healthy population, allowing for future comparison studies determining muscle status.

Evaluation of Adaptive Statistical Iterative Reconstruction-V Reconstruction Algorithm vs Filtered Back Projection in the Detection of Hypodense Liver Lesions: Reader Performance and Preferences.

OBJECTIVE: The aim of the study was to evaluate diagnostic accuracy and readers' experience in the detection of focal liver lesions on computed tomography with Adaptive Statistical Iterative Reconstruction-V (ASIR-V) reconstruction compared with filtered back projection (FBP) scans. METHODS: Fifty-five patients with liver lesions had FBP and ASIR-V scans. Two radiologists independently reviewed both sets of computed tomography scans, identifying and characterizing liver lesions. RESULTS: Adaptive Statistical Iterative Reconstruction-V scans had a reduction in dose length product (P < 0.0001) with no difference in image contrast (P = 0.1805); image noise was less for the ASIR-V scans (P < 0.0001) and contrast-to-noise ratio was better for ASIR-V (P = 0.0002). Both readers found more hypodense liver lesions on the FBP (P = 0.01) scans. Multiple subjective imaging scores were significantly less for the ASIR-V scans for both readers. CONCLUSIONS: Although ASIR-V scans were objectively better, our readers performed worse in lesion detection on them, suggesting a need for better education/experience with this technology during implementation.

MUC1 and HIF-1alpha Signaling Crosstalk Induces Anabolic Glucose Metabolism to Impart Gemcitabine Resistance to Pancreatic Cancer.

Poor response to cancer therapy due to resistance remains a clinical challenge. The present study establishes a widely prevalent mechanism of resistance to gemcitabine in pancreatic cancer, whereby increased glycolytic flux leads to glucose addiction in cancer cells and a corresponding increase in pyrimidine biosynthesis to enhance the intrinsic levels of deoxycytidine triphosphate (dCTP). Increased levels of dCTP diminish the effective levels of gemcitabine through molecular competition. We also demonstrate that MUC1-regulated stabilization of hypoxia inducible factor-1α (HIF-1α) mediates such metabolic reprogramming. Targeting HIF-1α or de novo pyrimidine biosynthesis, in combination with gemcitabine, strongly diminishes tumor burden. Finally, reduced expression of TKT and CTPS, which regulate flux into pyrimidine biosynthesis, correlates with better prognosis in pancreatic cancer patients on fluoropyrimidine analogs.

Duodenal gangliocytic paraganglioma with lymph node metastases: A case report and comparative review of 31 cases.

Gangliocytic paraganglioma (GP) is a rare tumor of uncertain origin most often located in the second portion of the duodenum. It is composed of three cellular components: Epithelioid endocrine cells, spindle-like/sustentacular cells, and ganglion-like cells. While this tumor most often behaves in a benign manner, cases with metastasis are reported. We describe the case of a 62-year-old male with a periampullary GP with metastases to two regional lymph nodes who was successfully treated with pancreaticoduodenectomy. Using PubMed, EMBASE, EBSCOhost MEDLINE and CINAHL, and Google Scholar, we searched the literature for cases of GP with regional lymph node metastasis and evaluated the varying presentations, diagnostic workup, and disease management of identified cases. Thirty-one cases of GP with metastasis were compiled (30 with at least lymph node metastases and one with only distant metastasis to bone), with age at diagnosis ranging from 16 to 74 years. Ratio of males to females was 19:12. The most common presenting symptoms were abdominal pain (55%) and gastrointestinal bleeding or sequelae (42%). Twenty-five patients underwent pancreaticoduodenectomy. Five patients were treated with local resection alone. One patient died secondary to metastatic disease, and one died secondary to perioperative decompensation. The remainder did well, with no evidence of disease at follow-up from the most recent procedure (except two in which residual disease was deliberately left behind). Of the 26 cases with sufficient histological description, 16 described a primary tumor that infiltrated deep to the submucosa, and 3 described lymphovascular invasion. Of the specific immunohistochemistry staining patterns studied, synaptophysin (SYN) stained all epithelioid endocrine cells (18/18). Neuron specific enolase (NSE) and SYN stained most ganglion-like cells (7/8 and 13/18 respectively), and S-100 stained all spindle-like/sustentacular cells (21/21). Our literature review of published cases of GP with lymph node metastasis underscores the excellent prognosis of GP regardless of specific treatment modality. We question the necessity of aggressive surgical intervention in select patients, and argue that local resection of the mass and metastasis may be adequate. We also emphasize the importance of pre-surgical assessment with imaging studies, as well as post-surgical follow-up surveillance for disease recurrence.

Does endorectal coil MRI increase the accuracy of preoperative prostate cancer staging?

INTRODUCTION: We sought to investigate the association of preprostatectomy magnetic resonance imaging (MRI) and surgical pathologic findings in patients with prostate cancer. MATERIALS AND METHODS: All patients with prostate cancer and preprostatectomy MRI available between 2002 and 2015 were included. Age, prostate-specific antigen at diagnosis, Gleason score at biopsy, MRI technique, radiology report suggestive of prostate cancer, extraprostatic invasion and seminal vesicle involvement, lymphadenopathy and final pathology report were retrospectively reviewed. Data was analyzed for sensitivity, specificity, positive and negative predictive values of MRI findings for predicting T3 disease. Consistency of MRI findings with pathology report was compared between MRIs with or without endorectal coil (ERC). RESULTS: A cohort of 83 patients was identified. Eighty-seven percent of the patients had MRI findings suggestive of prostate cancer. MRI was performed with and without ERC in 21 (25.3%) and 62 (74.3%) patients respectively. Eighty-five percent of patients with ERC and 88.7% of those without ERC had MRI findings suggestive of prostate cancer (p = 0.659). MRI correlated with final surgical pathology stage T3 in 53 patients (64%). MRI findings were consistent with final pathology report in 70% of ERC group and 61.3% of non ERC group (p = 0.482). In terms of extra prostatic invasion or seminal vesicle involvement, MRI had specificity, sensitivity, positive and negative predictive values of 84.44%, 37.84%, 66.67% and 62.3% respectively. CONCLUSIONS: MRI was specific but not sensitive in determining extraprostatic or seminal vesicle invasion. MRI was not accurate for lymph node involvement. In addition, using an ERC did not increase the accuracy of prostate MRI in this small cohort.

Cystic Cervicitis: A Case Report and Literature Review of Cystic Cervical Lesions.

We present a case of a 30-year-old woman who, while undergoing infertility evaluation, was found to have a large cystic cervical mass, shown to be cystic cervicitis on cervical cone biopsy. Differential diagnosis for benign cystic cervical lesions includes Nabothian cysts, tunnel cluster, endocervical hyperplasia, and cervicitis, whereas cystic cervical malignancies include adenocarcinoma and adenoma malignum. While it is crucial to differentiate benign from malignant lesions, imaging characteristics often overlap and may not provide a specific diagnosis. In difficult cases, definitive diagnosis should be based on clinical presentation and cervical biopsy.

MR imaging of the female pelvis at 3T.

The recent development of the transmit-receive body coil and the dedicated torso phased-array radio frequency receive coil for 3.0T MR imaging systems has promoted a move toward higher-field, whole-body MR imaging, including pelvic MR imaging. The female pelvis is an anatomic area that may benefit particularly from the advantages of high-field systems. In this article, the authors present their initial experience with the optimization of sequences for MR imaging of the female pelvis at 3.0T, and include a short description of parallel imaging. They compare some of the physical properties of 1.5T and 3.0T, discuss some of the challenges during sequence optimization for the female pelvis at 3.0T, and give examples of female pelvic abnormalities.