Changes in Body Composition During Adjuvant FOLFOX Chemotherapy and Overall Survival in Non-Metastatic Colon Cancer

The impact of longitudinal anthropometric changes during adjuvant chemotherapy on long-term survival in non-metastatic colon cancer is unclear. Herein, we analyzed the prognostic significance of computed tomography (CT)-measured body composition changes in colon cancer patients who underwent surgery followed by adjuvant FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) chemotherapy. Data of 167 patients with stage III or high-risk stage II colon cancer were analyzed. Skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral fat index (VFI), subcutaneous fat index (SFI), and total fat index (TFI) changes during chemotherapy were calculated using preoperative and postchemotherapy CT image data. The Cox proportional hazard model was used to determine the correlation between changes in anthropometric values and overall survival (OS). The median changes (%) in SMI, SMR, VFI, SFI, and TFI over 210 days during chemotherapy were 8.7% (p < 0.001), 3.4% (p = 0.001), -19% (p < 0.001), -3.4% (p = 0.936), and -11.9% (p < 0.001), respectively. Cut-off values of changes in SMI (skeletal muscle index change, SMIC) and SMR (skeletal muscle radiodensity change, SMRC) were defined at -2% and -2 Hounsfield units (HU) respectively, whereas those of changes in VFI (visceral fat index change, VFIC), SFI (subcutaneous fat index change, SFIC), and TFI (total fat index change, TFIC) were based on values that provided the largest χ2 on the Mantel-Cox test. Multivariable analysis revealed that low SMR measured on a postchemotherapy CT scan (hazard ratio, HR: 0.32, 95% confidence interval, CI: 0.15-0.70, p = 0.004) and visceral fat loss of at least 46.57% (HR: 0.31, 95% CI: 0.14-0.69, p = 0.004) were independent poor prognostic factors for OS. Severe visceral fat loss during FOLFOX chemotherapy and low skeletal muscle radiodensity measured on postchemotherapy CT scans are associated with poor OS in stage III and high-risk stage II colon cancer patients.ope

돼지 대장 모형을 이용한 용종 검출을 위한 magnetic resonance colonography 프로토콜 최적화 : 자기장 세기, 대장관 팽창 기법, MRI 촬영 기법이 미치는 영향

의과대학/박사Purpose: The aim of this study was to assess the diagnostic performance and image quality of magnetic resonance colonography (MRC) for colon polyp detection using pig colon phantoms and to evaluate the influence of magnetic field strength (1.5 T or 3.0 T), colonic distension technique (bright- or dark-lumen), and MRI sequence. Materials and Methods: Six pig colon segments (60-92 cm) with 56 artificial colon polyps (0.4？1.6 cm in diameter) were placed in plastic container containing soybean oil. The colon was distended using room air for dark-lumen MRC and with tap water or a gadolinium-chelate based enema fluid for bright-lumen MRC. Each colon phantom was scanned on both 1.5 T and 3.0 T scanners using the following three sequences: axial and coronal two-dimensional (2D) fast imaging with steady-state precession (True-FISP), axial and coronal T2-weighted fat-suppressed (FS) 2D single-shot fast spin echo (SSFSE), and/or axial and coronal T1-weighted FS three-dimensional gradient-echo (3D GRE) sequences. We tried to acquire the highest spatial resolution within a 20-s acquisition time. Two radiologists evaluated the presence of polyps based on a 4-point scale and analyzed image quality with respect to artifacts, colonic wall conspicuity, polyp conspicuity, and polyp contrast using a 5-point scale. Polyp detection sensitivity and image quality were compared between image protocols or sequences using McNemar test, Friedman test, logistic generalized estimating equations, and Wilcoxon signed-rank test. Result: For polyp detection sensitivity and image quality, MRC obtained at 1.5 T was better than that obtained at 3.0 T, and a bright-lumen technique was superior to a dark-lumen technique. Bright-lumen MRC at 1.5 T was most sensitive for polyp detection (p < 0.001) and gave the highest image quality (p < 0.05) regardless of polyp size and shape. SSFSE and 3D GRE sequences had highest sensitivity for polyp detection (83.9% and 83.0%, respectively) and image quality for bright-lumen MRC at 1.5 T. Conclusion: The most effective sequences of MRC for polyp detection were SSFSE- or 3D GRE-based bright-lumen MRC obtained with a 1.5 T scanner. These sequences had the highest polyp detection rate and the best image quality.ope

MRI features of hepatocellular carcinoma related to biologic behavior

Imaging studies including magnetic resonance imaging (MRI) play a crucial role in the diagnosis and staging of hepatocellular carcinoma (HCC). Several recent studies reveal a large number of MRI features related to the prognosis of HCC. In this review, we discuss various MRI features of HCC and their implications for the diagnosis and prognosis as imaging biomarkers. As a whole, the favorable MRI findings of HCC are small size, encapsulation, intralesional fat, high apparent diffusion coefficient (ADC) value, and smooth margins or hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI. Unfavorable findings include large size, multifocality, low ADC value, non-smooth margins or hypointensity on hepatobiliary phase images. MRI findings are potential imaging biomarkers in patients with HCC.ope

Intralymphatic immunotherapy with tyrosine-adsorbed allergens: a double-blind, placebo-controlled trial

Background: Most previous studies used aluminum hydroxide-absorbed allergen extracts in evaluating the potential therapeutic roles of intralymphatic allergen-specific immunotherapy (ILAIT). In this study, we evaluated the therapeutic efficacy and safety of ILAIT with L-tyrosine-adsorbed allergen extracts of Dermatophagoides farinae, D. pteronyssinus, cat, dog, or mixtures thereof, in patients with allergic rhinitis induced by these allergens. Methods: In this randomized, double-blind, placebo-controlled trial, study subjects received three intralymphatic injections of L-tyrosine-adsorbed allergen extracts (active group) or saline (placebo group) at 4-week intervals. Results: Although ILAIT reduced daily medication use and skin reactivity to HDM and cat allergens at 4 months after treatment, overall symptom score on a visual analog scale (VAS), sinonasal outcome test-20 (SNOT-20), rhinoconjunctivitis quality of life questionnaire (RQLQ), daily symptom score (dSS), daily medication score (dMS), daily symptom medication score (dSMS), nasal reactivity to HDM allergen, and basophil activity to HDM, cat, and dog allergens at 4 months and 1 year after treatment were similar between the treatment and control groups. Intralymphatic injection was more painful than a venous puncture, and pain at the injection site was the most frequent local adverse event (12.8%); dyspnea and wheezing were the most common systemic adverse events (5.3%). Conclusions: ILAIT with L-tyrosine-adsorbed allergen extracts does not exhibit profound therapeutic efficacy in allergic rhinitis and can provoke moderate-to-severe systemic reactions and cause pain at the injection site. Trial registration: clinicaltrials.gov: NCT02665754; date of registration: 28 January 2016.ope

A Case of Adenocarcinomatous Transformation of a Sacrococcygeal Teratoma in an Adult

Sacrococcygeal teratoma (SCT) is an unusual tumor in adults. The incidence of malignant transformation of this tumor increases when its excision is delayed beyond 1 month of age. We report an uncommon case of adenocarcinoma arising within the colonic mucosa of a mature teratoma of the sacrococcyx in a 44-year-old male. The patient received surgical resection for a sacrococcygeal mass in a local hospital and was diagnosed with adenocarcinoma arising from SCT. He was referred to our hospital for further treatment and received chemotherapy as adjuvant treatment. After 4.5 years, the coccygeal mass recurred on follow-up imaging workup, and surgical resection was performed. On pathologic work-up, residual disease at the resection margin was identified microscopically. Pathologic diagnosis was a primary adenocarcinoma arising from the colonic mucosa within a mature teratoma. The patient received adjuvant-chemotherapy and radiotherapy and has been followed up.ope

Apparent diffusion coefficient of hepatocellular carcinoma on diffusion-weighted imaging: Histopathologic tumor grade versus arterial vascularity during dynamic magnetic resonance imaging

OBJECTIVES: Apparent diffusion coefficient (ADC) has been suggested to reflect the tumor grades of hepatocellular carcinomas (HCCs); i.e., it can be used as a biomarker to predict the patients' prognosis. To verify its feasibility as a biomarker, the present study sought to determine how the ADC values of HCC are affected by a tumor's histopathologic grade and arterial vascularity. MATERIALS AND METHODS: From 131 consecutive patients, 141 surgically resected HCCs (16 well-differentiated [wd-HCCs], 83 moderately-differentiated [md-HCCs], and 42 poorly-differentiated HCCs [pd-HCCs]) were subjected to a comparison of the tumors' arterial vascularity (non-, slightly-, or markedly-hypervascular) determined on dynamic magnetic resonance imaging (MRI) and the ADC was measured retrospectively. RESULTS: The pd-HCCs (1.05+/-0.16 x 10-3 mm2/s) had a significantly lower ADC than md-HCCs (1.16+/-0.21 x 10-3 mm2/s; p = 0.010), but there was no significant difference compared to wd-HCCs (1.11+/-0.18 x 10-3 mm2/s; p = 0.968). The mean ADC was significantly higher in markedly hypervascular lesions (1.20+/-0.20 x 10-3 mm2/s) than in nonhypervascular lesions (0.95+/-0.14 x 10-3mm2/s; p<0.001) or slightly hypervascular lesions (1.04+/-0.15 x 10-3mm2/s; p<0.001). The ADC values and arterial vascularity were significantly correlated in wd-HCCs (p = 0.005) and md-HCCs (p<0.001). The mean ADC of pd-HCCs was significantly lower than those of other lesions, even in the markedly hypervascular lesion subgroup (p = 0.020). CONCLUSION: Although pd-HCC constantly shows low ADCs regardless of arterial vascularities, ADCs cannot stably stratify histopathologic tumor grades due to the variable features of wd-HCCs; and the ADC should be used with caution as a tumor biomarker of HCC.ope

Clinical Staging of Mass-Forming Intrahepatic Cholangiocarcinoma: Computed Tomography Versus Magnetic Resonance Imaging

We compared the performance of computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative clinical staging of mass-forming intrahepatic cholangiocarcinoma (iCCA), using the eighth American Joint Committee on Cancer (AJCC) system. This retrospective, multicenter, cohort study consecutively identified patients who underwent partial hepatectomy for mass-forming iCCA and had preoperative CT and MRI performed from January 2009 to December 2015. CT and MRI characteristics were used to determine clinical stage based on the eighth AJCC system. Performances of CT and MRI for clinical T and N staging were compared using generalized estimating equations. In 334 patients (median age, 63 years; 221 men), MRI sensitivities were significantly higher than CT sensitivities for detecting T1b or higher stages (91.0% vs. 80.5%, respectively, P 5 cm (i.e., T1b for single tumor) and extrahepatic organ invasion (i.e., T4). Sensitivities of CT and MRI were not different for N stage (65.0% vs. 64.0%, respectively, P = 0.808), but the specificity of CT was significantly higher than that of MRI (80.7% vs. 72.9%, respectively, P = 0.001) when using a composite reference standard. Conclusion: MRI showed superior sensitivity to CT for diagnosing T2 and T3 stages, particularly multiple tumors. CT and MRI had comparable sensitivity for N staging, but CT provided higher specificity than MRI.ope

Pseudoglandular Formation in Hepatocellular Carcinoma Determines Apparent Diffusion Coefficient in Diffusion-Weighted MRI

Purpose: To determine the impact of pseudoglandular formation on apparent diffusion coefficient (ADC) values of hepatocellular carcinoma (HCC) in diffusionweighted imaging (DWI), and to validate the results using histopathological grades. Materials and Methods: We assessed 182 HCCs surgically resected from 169 consecutive patients. Each type of tumor pseudoglandular formation was categorized into “non-,” “mixed-,” or “pure-,” based on official histopathology reports. The ADC for each tumor was independently measured, using the largest region of interest on the ADC map. Data were assessed using the analysis of variance test, with Bonferroni correction for post hoc analysis to stratify the relationship of ADCs with pseudoglandular formation, followed by subgroup analysis according to the histopathological tumor grades. Results: The mean ADC was significantly higher in pure pseudoglandular lesions (n = 5, 1.29 ± 0.08 × 10-3 mm2/s) than in non- seudoglandular lesions (n = 132, 1.08 ± 0.17 × 10-3 mm2/s; P = 0.003) or mixed-pseudoglandular lesions (n = 45, 1.16 ± 0.24 × 10-3 mm2/s; P = 0.034). The ADC values and pseudoglandular formation were significantly correlated in moderately differentiated HCCs (n = 103; r = 0.307, P = 0.007), while well- (n = 19) and poorly-differentiated HCCs (n = 60) did not show significant correlation (r = 0.105 and 0.068, respectively; P = 0.600 and 0.685, respectively). Conclusion: The degree of pseudoglandular formation could be one of the determinants of ADC in DWI of HCCs-especially moderately differentiated HCCs-while its influence does not appear to be significant in well- or poorly differentiated HCCs.ope

Validation of 10-Minute Delayed Hepatocyte Phase Imaging with 30° Flip Angle in Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastasis

OBJECTIVES: To compare 10-minute delayed hepatocyte phase imaging using a 30° flip angle (10min-FA30) and 20-minute hepatocyte phase imaging using a 10° FA (20min-FA10) in gadoxetic acid-enhanced MRI of patients with possible liver metastases, regarding lesion-to-liver contrast-to-noise ratio (CNR) and focal hepatic lesion (FHL) detection to evaluate whether 10min-FA30 would be superior to 20min-FA10. MATERIALS AND METHODS: Eighty-three patients with 248 liver metastases and 78 benign FHLs who underwent gadoxetic acid-enhanced MRI with 10min-FA30 and 20min-FA10 were enrolled. Lesion-to-liver CNRs were compared between the two image groups. Two radiologists independently assessed the presence of FHLs using a four-point scale and detection sensitivity was calculated. RESULTS: The mean CNR for liver metastases on the 10min-FA30 (248.5 ± 101.6) were significantly higher than that of the 20min-FA10 (187.4 ± 77.4) (p < 0.001). The mean CNR difference between the two image groups was 61.2 ± 56.8. There was no significant difference in detection sensitivity of FHLs for two readers between 10min-FA30 (mean 97.7%) and 20min-FA10 (mean 97.9%), irrespective of the lesion size or malignancy. CONCLUSION: 10min-FA30 yielded higher CNR with similar sensitivity compared to 20min-FA10. This finding indicates that 10min-FA30 can potentially replace 20min-FA10 with higher diagnostic performance and save 10 minutes of time.ope

Prognostic value of gallbladder wall thickening in patients with acute hepatitis A.

PURPOSE: To investigate the clinical significance of gallbladder (GB) wall thickening frequently observed in patients with acute hepatitis A. METHODS: A total of 328 consecutive patients who were diagnosed with acute hepatitis A and underwent abdominal ultrasonography were enrolled retrospectively. Patients were divided into two groups: GB wall thickening (≥3 mm, group A) and no thickening (group B). Group A was subdivided into two subgroups (GB wall thickening of ≥10 mm, group A-1 and ≥3 mm to <10 mm, group A-2). The laboratory results related to liver function, hospitalization duration, and time to normalization of liver function were compared between the groups. RESULTS: A total of 230 patients showed GB wall thickening (group A). Besides gamma-glutamyl transpeptidase and alkaline phosphatase, all laboratory results of group A were significantly higher than those of group B (P<0.05). Compared with group B, the hospitalization duration and the time to normalization of liver function were significantly longer in group A (P<0.05). Group A-1 included 146 patients and group A-2 included 84 patients. No significant differences in laboratory results, hospitalization duration, and time to normalization of liver function were found between the two subgroups. In the multivariate logistic regression analysis, serum alanine transaminase, total bilirubin and albumin levels, and hospitalization duration were significantly associated with GB wall thickening in patients with hepatitis A. CONCLUSION: The presence of GB wall thickening in patients with acute hepatitis A suggests a poorer prognosis irrespective of the degree of GB wall thickening or the degree of liver enzyme elevation.ope