Cross-sectional study of therapy-related expectations/concerns of patients with metastatic renal cell carcinoma and physicians in Japan.

OBJECTIVE: To achieve patient-centricity in metastatic renal cell carcinoma (mRCC) treatment, it is essential to clarify the differences in perspectives between patients and physicians. This cross-sectional analysis of a web survey aimed to clarify the differences in expectations and concerns between mRCC patients and physicians regarding systemic mRCC therapy in Japan. METHODS: Surveys from 83 patients and 165 physicians were analyzed. RESULTS: The top three most significant differences in expectations of systemic therapy between patients and physicians (patient-based physician value) were "Chance of achieving treatment-free status" (-30.1%, p < 0.001), "Longer survival" (+25.8%, p < 0.001), and "Chance of eliminating all evidence of disease" (-25.6%, p < 0.001). The top three most significant differences in concerns for systemic therapy between patients and physicians (patient-based physician value) were "Lack of efficacy" (+36.1%, p < 0.001), "Lack of knowledge of treatment" (-28.2%, p < 0.001), and "Daily activities affected by side effects" (+22.3%, p < 0.001). Diarrhea, fatigue/malaise, and nausea/vomiting were patients' most distressing adverse events; 50.6% of patients had difficulty telling their physicians about adverse events such as fatigue, anxiety, and depression. CONCLUSIONS: This study demonstrated a gap between patients with mRCC and physicians in their expectations and concerns for systemic therapy. Japanese patients with mRCC suffer from a number of adverse events, some of which are not shared with physicians. This study highlights the importance of communicating well with patients in clinical practice to achieve patient-centricity in systemic treatment for mRCC.

Financial Toxicity in Japanese Patients with Metastatic Renal Cell Carcinoma: A Cross-Sectional Study.

Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0-36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL.

Efficacy of Low-Dose Estrogen-Progestins and Progestins in Japanese Women with Dysmenorrhea: A Systematic Review and Network Meta-analysis.

INTRODUCTION: Although several studies suggest beneficial effects of low-dose estrogen-progestins (LEPs) and progestins on dysmenorrhea in Japanese women, the difference in efficacy between drugs remains unknown. METHODS: We identified studies by searching the MEDLINE, Cochrane Library, and ICHUSHI databases and included randomized controlled trials (RCTs) that used total dysmenorrhea score and visual analogue scale (VAS) as outcome measures to evaluate LEPs and progestins for primary and secondary dysmenorrhea. We analyzed results by meta-analysis and network meta-analysis (NMA). RESULTS: We identified 10 articles on eight RCTs and included seven drugs (six LEPs and one progestin, i.e., dienogest) and placebo in the analysis. Meta-analysis showed improvements in total dysmenorrhea score and VAS for almost all drugs compared with placebo. In NMA, VAS in secondary dysmenorrhea improved more with dienogest than with norethisterone/ethinylestradiol (mean difference - 25.84 [95% CrI - 44.46 to - 7.15]). In the comparison of administration regimens, VAS improved more with progestin-continuous than LEP-cyclic and the surface under the cumulative ranking (SUCRA) of LEP-extended and progestin-continuous appeared to be higher than that of LEP-cyclic. CONCLUSIONS: We confirmed that LEPs and dienogest are effective for primary and secondary dysmenorrhea and suggest that continuous regimens may be more effective than cyclic regimens in improving outcomes.

Automatic whole brain vascular territory mapping.

Cerebral vascular territories are related to the clinical progression and outcome of ischemic stroke. The vascular territory map (VTM) helps to understand stroke pathophysiology and potentially the clinical prognosis. A VTM can be generated from the bolus arrival time map. However, previous methods require initial seed points to be chosen manually, and the region inferior to the circle of Willis is not included. In this paper, we propose a method to automatically generate a map of the whole cerebral vascular territory from CT perfusion imaging. We applied the proposed method to 19 cases of ischemic stroke to generate VTM for each case.Clinical Relevance- The proposed map may improve the interpretation of the physiological status of collateral flow for ischemic stroke, and aid in treatment decision making.

Complementary regional heterogeneity information from COPD patients obtained using oxygen-enhanced MRI and chest CT.

BACKGROUND: The heterogeneous distribution of emphysema is a key feature of chronic obstructive pulmonary disease (COPD) patients that typically is evaluated using high-resolution chest computed tomography (HRCT). Oxygen-enhanced pulmonary magnetic resonance imaging (OEMRI) is a new method to obtain information regarding regional ventilation, diffusion, and perfusion in the lung without radiation exposure. We aimed to compare OEMRI with HRCT for the assessment of heterogeneity in COPD patients. METHODS: Forty patients with stable COPD underwent quantitative HRCT, OEMRI, and pulmonary function tests, including arterial blood gas analysis. OEMRI was also performed on nine healthy control subjects. We measured the severity of emphysema (percent low attenuation volume; LAV%) in whole lungs and the standard deviations (SDs) of the LAV% values of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal heterogeneity. Similarly, relative enhancement ratios of oxygen (RERs) in whole lungs from OEMRI and SD-RER were analyzed. RESULTS: COPD patients showed a lower mean RER than control subjects (12.6% vs 22.0%, p<0.01). The regional heterogeneity of the RERs was not always consistent with the LAV distribution. Both the HRCT (LAV% and SD-LAV) and the OEMRI (RER and SD-RER) indices were significantly associated with the diffusion capacity (DLCO) and partial pressure of oxygen in arterial blood (PaO2). The PaO2 was associated only with the heterogeneity index of HRCT (SD-LAV) (R2 = 0.39); however, the PaO2 was associated with both the mean RER and heterogeneity (SD-RER) in the multivariate analysis (R2 = 0.38). CONCLUSIONS: OEMRI-derived parameters were directly associated with oxygen uptake in COPD patients. Although the OEMRI-derived parameters were not identical to the HRCT-derived parameters, the cranial-caudal heterogeneity in HRCT or OEMRI was complementary to that in evaluations of oxygen uptake in the lungs. Functional imaging seems to provide new insights into COPD pathophysiology without radiation exposure.

Left Gastric Vein Visualization with Hepatopetal Flow Information in Healthy Subjects Using Non-Contrast-Enhanced Magnetic Resonance Angiography with Balanced Steady-State Free-Precession Sequence and Time-Spatial Labeling Inversion Pulse.

Objective: To selectively visualize the left gastric vein (LGV) with hepatopetal flow information by non-contrast-enhanced magnetic resonance angiography under a hypothesis that change in the LGV flow direction can predict the development of esophageal varices; and to optimize the acquisition protocol in healthy subjects. Materials and Methods: Respiratory-gated three-dimensional balanced steady-state free-precession scans were conducted on 31 healthy subjects using two methods (A and B) for visualizing the LGV with hepatopetal flow. In method A, two time-spatial labeling inversion pulses (Time-SLIP) were placed on the whole abdomen and the area from the gastric fornix to the upper body, excluding the LGV area. In method B, nonselective inversion recovery pulse was used and one Time-SLIP was placed on the esophagogastric junction. The detectability and consistency of LGV were evaluated using the two methods and ultrasonography (US). Results: Left gastric veins by method A, B, and US were detected in 30 (97%), 24 (77%), and 23 (74%) subjects, respectively. LGV flow by US was hepatopetal in 22 subjects and stagnant in one subject. All hepatopetal LGVs by US coincided with the visualized vessels in both methods. One subject with non-visualized LGV in method A showed stagnant LGV by US. Conclusion: Hepatopetal LGV could be selectively visualized by method A in healthy subjects.

B1 Power Optimization for Chemical Exchange Saturation Transfer Imaging: A Phantom Study Using Egg White for Amide Proton Transfer Imaging Applications in the Human Brain.

The chemical exchange saturation transfer (CEST) effect on an egg white (EW) suspension was investigated for optimization of magnetization transfer (MT) power (B1,rms) and pH dependency with the addition of lactic acid. Applying a higher MT pulse, B1,rms, Z-spectrum shows higher asymmetry and the magnetisation transfer ratio (MTR)asym signal increases to around 1-3.5 ppm, indicating a higher CEST effect. Amide proton transfer (APT) at 3.5 ppm shows a signal elevation in MTRasym with the application of higher B1,rms power and high pH. In addition, the hydroxyl proton signal in MTRasym increases as pH is reduced by lactic acid. In Z-spectrum of B1,rms at 1.0 µT and 2.0 µT, the dependence on CEST effect of amide proton and hydroxyl proton could be observed by using an EW suspension phantom. The CEST MT power was optimized on the EW suspension phantom with pH dependency and further confirmed on volunteers. In addition, APT imaging at 3.5 ppm using B1,rms at 1.0 µT performed on two human brains with different pathophysiological conditions indicated appropriate ATP effect.

Diagnostic performance between contrast enhancement, proton MR spectroscopy, and amide proton transfer imaging in patients with brain tumors.

PURPOSE: To explore the relationship among parameters of magnetic resonance spectroscopy (MRS) and amide proton transfer (APT) imaging, and to assess the diagnostic performance of MRS and APT imaging for grading brain tumors in comparison with contrast enhancement of conventional MRI for preoperative grading in patients with brain tumor. MATERIALS AND METHODS: Institutional Review Board approval and written informed consent were obtained. Forty-one patients with suspected brain tumors were enrolled in the study. Single-voxel MRS and 2D APT imaging of the same slice level were conducted using a 3T MRI scanner. Positive or negative contrast enhancement on T1 -weighted images was assessed by two neuroradiologists. Correlations among metabolite concentrations, metabolite ratios, and calculated histogram parameters, including mean APT (APTmean ) and the 90th percentile of APT (APT90 ) were assessed using Spearman's correlation coefficient. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis for contrast enhancement and MRS and APT imaging. Values of P < 0.05 were considered statistically significant. RESULTS: Positive correlations with statistical significance were found between total concentration of choline (Cho) and APT90 (r = 0.49), and between Cho/creatine (Cr) and APTmean (r = 0.65) as well as APT90 (r = 0.49). A negative correlation with statistical significance was observed between NAA/Cr and APTmean (r = -0.52). According to ROC curves, Cho/Cr, APTmean , APT90 , demonstrated higher area under the curve (AUC) values than that of contrast enhancement in grading gliomas. CONCLUSION: Significant correlations were observed between metabolite concentrations and ratios on MRS and APT values. MRS and APT imaging showed comparable diagnostic capability for grading brain tumors, suggesting that both MRS and APT imaging offer potential for quantitatively assessing similar biological characteristics in brain tumors on noncontrast MRI. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:732-739.

Evaluation of Appropriate Readout Sequence for Renal MRI Perfusion Using ASTAR (ASL) Technique.

The aim of this study was to compare true-steady state free precession (True-SSFP) with fast field echo (FFE) as readout imaging sequences for renal arterial spin labeling (ASL), and to optimize the imaging condition. Renal ASL perfusion images were acquired using signal targeting with alternated radio frequency using asymmetric inversion slab (ASTAR) technique with respiratory triggering at 3T MRI system, using either 3D True-SSFP or FFE as the readout sequence. Inversion time (TI) varied from 800 to 2400 ms. Appropriate flip angles were estimated for each sequence by simulating signal intensity (SI). The SI of the renal cortex, vertebral body, and intestinal tract were measured, and the contrast ratio of the cortex (CRcortex) or intestine (CRintestine) related to vertebra was calculated. The image quality of the kidneys, background signal suppression, and misregistration were evaluated by four-point scales. As a result, in quantitative evaluation, the average of CRcortex of each TI (800, 1200, 1600, 2000, and 2400 msec) were 0.49, 0.57, 0.63, 0.63, and 0.56 in FFE, and 0.59, 0.71, 0.73, 0.73, and 0.68 in True-SSFP, respectively. IN qualitative evaluation, ASL images with True-SSFP readout were significantly better than those with FFE readout. In conclusion, True-SSFP sequences will be recommended as read out imaging sequence for obtaining ASL image compared with FFE image.

Dynamic oxygen-enhanced MRI of cerebrospinal fluid.

Oxygen causes an increase in the longitudinal relaxation rate of tissues through its T1-shortening effect owing to its paramagnetic properties. Due to such effects, MRI has been used to study oxygen-related signal intensity changes in various body parts including cerebrospinal fluid (CSF) space. Oxygen enhancement of CSF has been mainly studied using MRI sequences with relatively longer time resolution such as FLAIR, and T1 value calculation. In this study, fifteen healthy volunteers were scanned using fast advanced spin echo MRI sequence with and without inversion recovery pulse in order to dynamically track oxygen enhancement of CSF. We also focused on the differences of oxygen enhancement at sulcal and ventricular CSF. Our results revealed that CSF signal after administration of oxygen shows rapid signal increase in both sulcal CSF and ventricular CSF on both sequences, with statistically significant predominant increase in sulcal CSF compared with ventricular CSF. CSF is traditionally thought to mainly form from the choroid plexus in the ventricles and is absorbed at the arachnoid villi, however, it is also believed that cerebral arterioles contribute to the production and absorption of CSF, and controversy remains in terms of the precise mechanism. Our results demonstrated rapid oxygen enhancement in sulcal CSF, which may suggest inhaled oxygen may diffuse into sulcal CSF space rapidly probably due to the abundance of pial arterioles on the brain sulci.