Predictive value of OCT and MRI for postoperative visual recovery in patients with chiasmal compressive lesions.

PURPOSE: We aimed to investigate the predictive value of retinal thickness measured by optical coherence tomography (OCT) and mass biometrics measured using magnetic resonance image (MRI) for visual recovery after surgery for removal of a mass compressing the optic chiasm. METHODS: Consecutive patients who showed typical temporal visual field defect (VFD) with respect to the vertical meridian due to a chiasmal compressive mass and who underwent mass removal surgery were recruited. Ophthalmic examination was performed preoperatively and postoperatively. Retinal thickness was measured by the Cirrus OCT. The height and size of the mass and suprasellar extension (SSE) in both the sagittal and coronal planes were evaluated. Patients were divided into two groups based on the improvement in VFD (mean deviation [MD] change ≥ 5 dB: group R; others: group NR) and clinical characteristics were compared. RESULTS: Fifteen patients were included in the study. Eight (53.3%) patients were allocated into group R and others (7 patients, 46.7%) into group NR. Age, sex, initial visual acuity, initial MD was not different between the two groups. The retinal thicknesses were not different while tumor height, volume, and both sagittal and coronal SSE were significantly different between the two groups. (p = 0.029, 0.014, <0.001, and <0.001, respectively) All MRI parameters showed significant predictive value for the degree of MD recovery. CONCLUSION: MRI showed better predictive value than OCT in predicting postoperative VFD recovery in patients with temporal VFDs due to chiasmal compressive disorder.

Characterization of breast cancer subtypes based on quantitative assessment of intratumoral heterogeneity using dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging.

OBJECTIVE: To investigate whether intratumoral heterogeneity, assessed via dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI), reflects the molecular subtypes of invasive breast cancers. MATERIAL AND METHODS: We retrospectively evaluated data from 248 consecutive women (mean age ± standard deviation, 54.6 ± 12.2 years) with invasive breast cancer who underwent preoperative DCE-MRI and DWI between 2019 and 2020. To evaluate intratumoral heterogeneity, kinetic heterogeneity (a measure of heterogeneity in the proportions of tumor pixels with delayed washout, plateau, and persistent components within a tumor) was assessed with DCE-MRI using a commercially available computer-aided diagnosis system. Apparent diffusion coefficients (ADCs) were obtained using a region-of-interest technique, and ADC heterogeneity was calculated using the following formula: (ADCmax-ADCmin)/ADCmean. Possible associations between imaging-based heterogeneity values and breast cancer subtypes were analyzed. RESULTS: Of the 248 invasive breast cancers, 61 (24.6%) were classified as luminal A, 130 (52.4%) as luminal B, 25 (10.1%) as HER2-enriched, and 32 (12.9%) as triple-negative breast cancer (TNBC). There were significant differences in the kinetic and ADC heterogeneity values among tumor subtypes (p < 0.001 and p = 0.023, respectively). The TNBC showed higher kinetic and ADC heterogeneity values, whereas the HER2-enriched subtype showed higher kinetic heterogeneity values compared to the luminal subtypes. Multivariate linear analysis showed that the HER2-enriched (p < 0.001) and TNBC subtypes (p < 0.001) were significantly associated with higher kinetic heterogeneity values. The TNBC subtype (p = 0.042) was also significantly associated with higher ADC heterogeneity values. CONCLUSIONS: Quantitative assessments of heterogeneity in enhancement kinetics and ADC values may provide biological clues regarding the molecular subtypes of breast cancer. KEY POINTS: • Higher kinetic heterogeneity was associated with HER2-enriched and triple-negative breast cancer. • Higher ADC heterogeneity was associated with triple-negative breast cancer. • Aggressive breast cancer subtypes exhibited higher intratumoral heterogeneity based on MRI.

Diffusion Kurtosis MR Imaging of Invasive Breast Cancer: Correlations With Prognostic Factors and Molecular Subtypes.

BACKGROUND: The associations between diffusion kurtosis imaging (DKI)-derived parameters and clinical prognostic factors of breast cancer have not been fully evaluated; this knowledge may have implications for outcome prediction and treatment strategies. PURPOSE: To determine associations between quantitative diffusion parameters derived from DKI and diffusion-weighted imaging (DWI) and the prognostic factors and molecular subtypes of breast cancer. STUDY TYPE: Retrospective. POPULATION: A total of 383 women (mean age, 53.8 years; range, 31-82 years) with breast cancer who underwent preoperative breast MRI including DKI and DWI. FIELD STRENGTH/SEQUENCE: A 3.0 T; DKI using a spin-echo echo-planar imaging (EPI) sequence (b values: 200, 500, 1000, 1500, and 2000 sec/mm2 ), DWI using a readout-segmented EPI sequence (b values: 0 and 1000 sec/mm2 ) and dynamic contrast-enhanced breast MRI. ASSESSMENT: Two radiologists (J.Y.K. and H.S.K. with 9 years and 1 year of experience in MRI, respectively) independently measured kurtosis, diffusivity, and apparent diffusion coefficient (ADC) values of breast cancer by manually placing a regions of interest within the lesion. Diffusion measures were compared according to nodal status, grade, and molecular subtypes. STATISTICAL TESTS: Kruskal-Wallis test, Mann-Whitney U test with Bonferroni correction, receiver operating characteristic (ROC) analysis, and multivariate logistic regression analysis. (Statistical significance level of P < 0.05). RESULTS: All diffusion measures showed significant differences according to axillary nodal status and histological grade. Kurtosis showed significant differences among molecular subtypes. The luminal subtype (median 1.163) showed a higher kurtosis value compared to the HER2-positive (median 0.962) or triple-negative subtypes (median 1.072). ROC analysis for differentiating HER2-positive from luminal subtypes revealed that kurtosis yielded the highest area under the curve of 0.781. In multivariate analyses, kurtosis remained a significant factor associated with differentiation between HER2-positive and luminal (odds ratio [OR] = 0.993), triple-negative and luminal (OR = 0.995), and HER2-positive and triple-negative subtypes (OR = 0.994). DATA CONCLUSION: Quantitative diffusion parameters derived from DKI and DWI are associated with prognostic factors for breast cancer. Moreover, DKI-derived kurtosis can help distinguish between the molecular subtypes of breast cancer. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: 3.

Tumor stiffness measured by shear-wave elastography: association with disease-free survival in women with early-stage breast cancer.

OBJECTIVE: To determine whether shear-wave elastography (SWE)-measured tumor stiffness is associated with disease-free survival in females with early-stage invasive breast cancer. METHODS: This retrospective study included 202 consecutive females (mean age, 52.9 years; range, 25-84 years) with newly diagnosed T1-two breast cancer who underwent preoperative SWE between April 2015 and January 2016. Tumor stiffness was assessed and quantitative SWE features of each breast lesion were obtained by a breast radiologist. Cox proportional hazard models were used to identify associations between SWE features and disease-free survival after adjusting for clinicopathologic factors. RESULTS: Fifteen (7.4%) patients exhibited recurrence after a median follow-up of 56 months. Mean (Emean), minimum, and maximum elasticity values were higher in females with recurrence than in those without recurrence (184.4, 138.3, and 210.5 kPa vs 134.9, 101.7, and 159.8 kPa, respectively; p = 0.005, p = 0.005, and p = 0.012, respectively). Receiver operating characteristics curve analysis for prediction of recurrence showed that Emean yielded the largest area under the curve (0.717) among the quantitative SWE parameters, and the optimal cut-off value was 121.7 kPa. Multivariable Cox proportional hazards analysis revealed that higher Emean (>121.7 kPa) [adjusted hazard ratio (HR), 10.01; 95% CI: 1.31-76.33; p = 0.026] and lymphovascular invasion (adjusted HR, 7.72; 95% CI: 1.74-34.26; p = 0.007) were associated with worse disease-free survival outcomes. CONCLUSION: Higher SWE-measured Emean was associated with worse disease-free survival in females with early-stage invasive breast cancer. ADVANCES IN KNOWLEDGE: Tumor stiffness assessed with shear-wave elastography might serve as a quantitative imaging biomarker of disease-free survival in females with T1-two breast cancer.

Ultrafast Dynamic Contrast-Enhanced MRI Using Compressed Sensing: Associations of Early Kinetic Parameters With Prognostic Factors of Breast Cancer.

OBJECTIVE. The purpose of this study was to investigate whether early kinetic parameters derived from ultrafast dynamic contrast-enhanced MRI (DCE-MRI) using compressed sensing are associated with prognostic factors for breast cancer. MATERIALS AND METHODS. We evaluated 201 consecutive women (mean age, 54.6 years) with breast cancer (168 invasive, 33 ductal carcinoma in situ) who underwent both ultrafast DCE-MRI using compressed sensing (temporal resolution, 4.7 seconds; spatial resolution, 0.8 × 1.1 × 0.9 mm) and surgery between 2018 and 2019. Early kinetic parameters (time to enhancement [TTE] and maximum slope [MS]) were measured in breast lesions by two radiologists using a software program and were correlated with histopathologic prognostic factors. The Mann-Whitney U test and linear regression analysis were used. RESULTS. The median TTE and MS values for breast cancer were 11.9 seconds and 7.7%/s, respectively. The median MS was significantly larger in invasive cancer lesions than in ductal carcinoma in situ lesions (8.4%/s vs 4.7%/s, p < .001). In women with invasive cancer, multivariate linear regression analyses showed that a larger tumor size (> 2 cm) (p = .048) and estrogen receptor-negative status (p < .001) were significantly associated with a shorter TTE. A higher histologic grade (grade 3) (p = .01) was significantly associated with a larger MS. We observed excellent interobserver agreement between two readers in the measurements of TTE and MS (intraclass correlation coefficients, 0.943 and 0.890, respectively). CONCLUSION. Ultrafast MRI-derived early enhancement parameters, such as TTE and MS, are associated with histopathologic prognostic factors in women with breast cancer.

[Platysma Infiltration on CT or MRI in Parotid Pathology]. / ì´í•˜ì„ ë³‘ë³€ì—ì„œ 활경근 침윤의 빈도와 ì¡°ê±´.

Purpose: To evaluate the incidence and condition of platysma infiltration in benign tumors, malignant tumors, and inflammatory disease in the parotid gland using CT or MRI. Materials and Methods: Patients with benign tumors (n = 314), malignant tumors (n = 52), and inflammatory disease (n = 22) in the parotid gland were included. The incidence of platysma infiltration and the relationship between platysma infiltration and the location, capsular involvement, and focality of the mass were retrospectively evaluated using CT or MRI. Results: The incidence of platysma infiltration was 0% in benign tumors,19.2% in malignant tumors (10/52), and 50.0% in inflammation (11/22). Platysma infiltration was positive in 10 of 13 patients with inflammatory lesion with capsular involvement. Platysmal infiltrations in inflammatory lesion showed diffuse lesion in 10 patients and focal lesion in one patient. Malignant tumor with platysmal infiltration showed all capsular involvement, and diffuse lesion in seven and focal lesion in three. Conclusion: Platysma infiltration was more common in patients with inflammatory disease than those with malignant tumors or benign tumors. In inflammatory disease, platysma infiltration was more common in patients with capsular involvement or diffuse lesion.

Ophthalmic Manifestations of Rathke's Cleft Cyst and Its Association to Radiological Characteristics.

PURPOSE: To evaluate the ophthalmic features of Rathke's cleft cyst (RCC) and its association with radiological characteristics. METHODS: In this retrospective single-center study, patients who showed typical findings suggestive of RCC on magnetic resonance imaging (MRI) and underwent relevant ophthalmic examination were recruited retrospectively. Patients were stratified into two groups according to the presence or absence of ophthalmic symptoms related to RCC. We reviewed patients' demographic information, initial symptoms, endocrinological status, ophthalmic features, and characteristics of MRI. Height, size and location of RCC, as well as the optic chiasm displacement assessed from MRI. RESULTS: Thirty-three patients (20 women and 13 men) were included in this study from among 335 patients with RCC on MRI. Fifteen patients had ophthalmic manifestation related to the cyst (Ophthalmic group), whereas 18 patients were not (Non-ophthalmic group). Headache was the most common initial symptom (15 patients, 45.5%), followed by visual disturbance (7, 21.2%), diplopia (1, 3.0%), retro-orbital pain (1, 3.0%), galactorrhea (1, 3.0%), and peripheral extremity discomfort (1, 3.0%). In seven asymptomatic patients (21.2%), the lesion was an incidental finding during a regular medical examination. Ophthalmic manifestation included visual field defect (14 patients, 93.3%) and diplopia (1 patient, 6.7%). The height, volume, and the coronal and sagittal displacements were larger in the ophthalmic group (P < .001, all). Eleven patients who manifested ophthalmic symptoms underwent excision surgeries and nine of them (81.8%) experienced visual function improvement. CONCLUSION: Appropriate ophthalmic examinations are warranted in patients with RCC, and treatment should be actively considered in patients with ophthalmic manifestations.

Identification of prognostic mRNAs in metastatic cutaneous melanoma.

Cutaneous melanoma is the most common cause of skin cancer-related deaths worldwide. There is an urgent need to identify prognostic biomarkers to facilitate decision-making for treatment of metastatic cutaneous melanoma. Gene expression microarrays and RNA-seq technology have recently improved or changed current prognostic and therapeutic strategies for several cancers. However, according to the current melanoma staging system, prognosis is almost entirely dependent on clinicopathological features. To identify novel prognostic biomarkers, we investigated gene expression and clinical data for patients with cutaneous melanoma from three cohorts of The Cancer Genome Atlas and Gene Expression Omnibus. Kaplan-Meier survival analysis using median values of each gene as cutoff value revealed that nine genes (ABCC3, CAPS2, CCR6, CDCA8, CLU, DPF1, PTK2B, SATB1, and SYNE1) were statistically significant prognostic biomarkers of metastatic cutaneous melanoma in all three independent cohorts. Low expression of two genes (CDCA8 and DPF1) and high expression of seven genes (ABCC3, CAPS2, CCR6, CLU, PTK2B, SATB1, and SYNE) were significantly associated with positive metastatic cutaneous melanoma prognoses. In conclusion, we suggest nine novel prognostic biomarkers for cutaneous metastatic melanoma.

Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent.

BACKGROUND: Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high risk of morbidity associated with surgery. The purpose of this study was to evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for the treatment of VAOS. METHODS: The records of 72 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2006 to November 2018 were retrospectively evaluated. RESULTS: Of the 72 patients, 43 presented with transient ischemic attacks. Forty-seven patients (65.3%) manifested other brachiocephalic stenoses; of these, 40 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications (n = 8, 11.1%) included sudden asystole (n = 1), acute in-stent thrombosis (n = 3), minor stroke (n = 3), and stent shortening (n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 13.0 months) was achieved in 49 patients and revealed in-stent restenosis in 1 patient (2.0%) and stent malposition by shortening in 2 patients (4.1%). Follow-up records were available in 57 patients (mean 15.6 months). Three of the 57 patients (n = 3, 5.3%) had recurrent symptoms of vertebrobasilar ischemia and none was retreated. CONCLUSIONS: Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow.

Kinetic Heterogeneity of Breast Cancer Determined Using Computer-aided Diagnosis of Preoperative MRI Scans: Relationship to Distant Metastasis-Free Survival.

Background Higher peak enhancement and washout component values measured on preoperative breast MRI scans with computer-aided diagnosis (CAD) are presumed to be associated with worse recurrence-free survival. Purpose To investigate whether CAD-extracted kinetic features of breast cancer and the heterogeneity of these features at preoperative MRI are associated with distant metastasis-free survival in women with invasive breast cancer. Materials and Methods Consecutive women with newly diagnosed invasive breast cancer who underwent preoperative MRI were retrospectively evaluated between 2011 and 2012. A commercially available CAD system was used to extract the peak enhancement and delayed enhancement profiles of each breast cancer case from preoperative MRI data. The kinetic heterogeneity of these features (a measure of heterogeneity in the proportions of tumor pixels with delayed washout, plateau, and persistent components within a tumor) was calculated to evaluate intratumoral heterogeneity. Cox proportional hazards models were used to investigate the associations between CAD-extracted kinetic features and distant metastasis-free survival after adjusting for clinical-pathologic factors. Results A total of 276 consecutive women (mean age, 53 years) were evaluated. In 28 of 276 (10.1%) women, distant metastasis developed at a median follow-up of 79 months. A higher degree of kinetic heterogeneity was observed in women with distant metastases than in those without distant metastases (mean, 0.70 ± 0.2 vs 0.43 ± 0.3; P < .001). Multivariable Cox proportional hazards analysis revealed that a higher degree of kinetic heterogeneity (hazard ratio [HR], 19.2; 95% confidence interval [CI]: 4.2, 87.1; P < .001), higher peak enhancement (HR, 1.001; 95% CI: 1.000, 1.002; P = .045), the presence of lymphovascular invasion (HR, 3.3; 95% CI: 1.5, 7.5; P = .004), and a higher histologic grade (ie, grade 3) (HR, 2.2; 95% CI: 1.0, 4.9; P = .044) were associated with worse distant metastasis-free survival. Conclusion Higher values of kinetic heterogeneity and peak enhancement as determined with computer-aided diagnosis of preoperative MRI were associated with worse distant metastasis-free survival in women with invasive breast cancer. © RSNA, 2020 See also the editorial by El Khouli and Jacobs in this issue.

Hashimoto's Encephalopathy with Unusual MRI Findings Mimicking Meningoencephalitis: A Case Report and Literature Review.

Hashimoto's encephalopathy (HE) is a rare autoimmune disease characterized by a high serum concentration of antithyroid antibodies without evidence of cerebral disease. Magnetic resonance imaging (MRI) findings in HE patients are nonspecific, although diffuse or focal white matter changes have been reported in several cases. We present a rare case involving a 79-year-old woman with elevated antithyroid antibody levels and abnormal imaging findings similar to meningoencephalitis. Serial MRI initially showed multiple T2 hyperintense lesions with diffuse leptomeningeal enhancement that disappeared after steroid therapy.

CT diagnosis of non-traumatic gastrointestinal perforation: an emphasis on the causes.

Gastrointestinal tract (GI) perforations can occur due to various causes such as trauma, iatrogenic factor, infectious condition, peptic ulcer, inflammatory disease, or a neoplasm. Because GI perforations represent an emergency and life-threatening condition, prompt diagnosis and surgical treatment are required in most cases. However, according to the underlying causes of GI perforations, additional treatment strategies may be needed. Adjuvant chemotherapy or immunotherapy may be required in various GI neoplasms such as adenocarcinoma, lymphoma or gastrointestinal stromal tumor. Inflammatory bowel disease is a chronic disease repeating cycle of intermittent, thus appropriate medical treatment and periodic follow-up are also required. Moreover, vascular intervention may have a role in some cases of mesenteric ischemia associated with mesenteric artery occlusion. Recently, computed tomography (CT) has been the first choice for patients with suspected GI perforations, because CT plays an important role in the accurate assessment of the perforation site, the pathology causing the perforation and the ensuing complications. This review will illustrate characteristic CT findings that differentiate underlying pathologies causing GI perforations to help clinicians decision-making regarding an optimal treatment plan.

Primary central nervous system lymphoma and atypical glioblastoma: Differentiation using radiomics approach.

OBJECTIVES: To evaluate the diagnostic performance of magnetic resonance (MR) radiomics-based machine-learning algorithms in differentiating primary central nervous system lymphoma (PCNSL) from non-necrotic atypical glioblastoma (GBM). METHODS: Seventy-seven patients (54 individuals with PCNSL and 23 with non-necrotic atypical GBM), diagnosed from January 2009 to April 2017, were enrolled in this retrospective study. A total of 6,366 radiomics features, including shape, volume, first-order, texture, and wavelet-transformed features, were extracted from multi-parametric (post-contrast T1- and T2-weighted, and fluid attenuation inversion recovery images) and multiregional (enhanced and non-enhanced) tumour volumes. These features were subjected to recursive feature elimination and random forest (RF) analysis with nested cross-validation. The diagnostic abilities of a radiomics machine-learning classifier, apparent diffusion coefficient (ADC), and three readers, who independently classified the tumours based on conventional MR sequences, were evaluated using receiver operating characteristic (ROC) analysis. Areas under the ROC curves (AUC) of the radiomics classifier, ADC value, and the radiologists were compared. RESULTS: The mean AUC of the radiomics classifier was 0.921 (95 % CI 0.825-0.990). The AUCs of the three readers and ADC were 0.707 (95 % CI 0.622-0.793), 0.759 (95 %CI 0.656-0.861), 0.695 (95 % CI 0.590-0.800) and 0.684 (95 % CI0.560-0.809), respectively. The AUC of the radiomics-based classifier was significantly higher than those of the three readers and ADC (p< 0.001 for all). CONCLUSIONS: Large-scale radiomics with a machine-learning algorithm can be useful for differentiating PCNSL from atypical GBM, and yields a better diagnostic performance than human radiologists and ADC values. KEY POINTS: • Machine-learning algorithm radiomics can help to differentiate primary central PCNSL from GBM. • This approach yields a higher diagnostic accuracy than visual analysis by radiologists. • Radiomics can strengthen radiologists' diagnostic decisions whenever conventional MRI sequences are available.

Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings.

MR findings of early infectious spondylodiscitis are non-specific and may be confused with those of other conditions. Therefore, it is important to recognize early MR signs of conditions, such as inappreciable cortical changes in endplates, confusing marrow signal intensities of vertebral bodies, and inflammatory changes in paraspinal soft tissues, and subligamentous and epidural spaces. In addition, appreciation of direct inoculation, such as in iatrogenic spondylodiscitis may be important, because the proportion of patients who have undergone recent spine surgery or a spinal procedure is increasing. In this review, the authors focus on the MR findings of early spondylodiscitis, atypical findings of iatrogenic infection, and the differentiation between spondylodiscitis and other disease entities mimicking infection.

Apparent diffusion coefficient of breast cancer and normal fibroglandular tissue in diffusion-weighted imaging: the effects of menstrual cycle and menopausal status.

The purpose of this study was to investigate prospectively whether the apparent diffusion coefficients (ADCs) of both breast cancer and normal fibroglandular tissue vary with the menstrual cycle and menopausal status. Institutional review board approval was obtained, and informed consent was obtained from each participant. Fifty-seven women (29 premenopausal, 28 postmenopausal) with newly diagnosed breast cancer underwent diffusion-weighted imaging twice (interval 12-20 days) before surgery. Two radiologists independently measured ADC of breast cancer and normal contralateral breast tissue, and we quantified the differences according to the phases of menstrual cycle and menopausal status. With normal fibroglandular tissue, ADC was significantly lower in postmenopausal than in premenopausal women (P = 0.035). In premenopausal women, ADC did not differ significantly between proliferative and secretory phases in either breast cancer or normal fibroglandular tissue (P = 0.969 and P = 0.519, respectively). In postmenopausal women, no significant differences were found between ADCs measured at different time intervals in either breast cancer or normal fibroglandular tissue (P = 0.948 and P = 0.961, respectively). The within-subject variability of the ADC measurements was quantified using the coefficient of variation (CV) and was small: the mean CVs of tumor ADC were 2.90 % (premenopausal) and 3.43 % (postmenopausal), and those of fibroglandular tissue ADC were 4.37 % (premenopausal) and 2.55 % (postmenopausal). Both intra- and interobserver agreements were excellent for ADC measurements, with intraclass correlation coefficients in the range of 0.834-0.974. In conclusion, the measured ADCs of breast cancer and normal fibroglandular tissue were not affected significantly by menstrual cycle, and the measurements were highly reproducible both within and between observers.