Effective second-line treatment with cetuximab and bevacizumab in a patient with hepatic metastases of colorectal cancer and hyperbilirubinemia

Background: Irinotecan-based second-line chemotherapy of metastatic colorectal cancer (CRC) is effective, it might, however, be contraindicated in cases of severe liver dysfunction due to advanced liver metastases. Case Report: A 57-year-old woman with diffuse CRC liver metastases showed progressive disease on first-line treatment with capecitabine and oxaliplatin (XELOX). Chronic cholestasis and hyperbilirubinemia caused by advanced liver involvement prohibited second-line treatment with irinotecan-based chemotherapy. We initiated combined antibody treatment with cetuximab and bevacizumab. Results: Clinical performance status as well as laboratory parameters improved rapidly. Staging investigations after 8 weeks revealed a partial remission. Since bilirubin levels had returned to the upper limit of normal, therapy could be changed to standard irinotecan, 5-fluorouracil, folinic acid, and bevacizumab. Conclusion: Combined treatment with cetuximab and bevacizumab may be considered as an effective treatment option in patients who cannot be treated with standard chemotherapy regimens due to impaired liver metabolism of cytotoxic substances

Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion

Renal magnetic resonance (MR) imaging has undergone major improvements in the past several years. This review focuses on the technical basics and clinical applications of MR angiography (MRA) with the goal of enabling readers to acquire high-resolution, high quality renal artery MRA. The current role of contrast agents and their safe use in patients with renal impairment is discussed. In addition, an overview of promising techniques on the horizon for renal MR is provided. The clinical value and specific applications of renal MR are critically discussed

Gadobutrol in Renally Impaired Patients: Results of the GRIP Study.

OBJECTIVE: The aim of this study was to assess the potential risk of gadobutrol-enhanced magnetic resonance imaging (MRI) in patients with moderate to severe renal impairment for the development of nephrogenic systemic fibrosis (NSF). MATERIALS AND METHODS: We performed a prospective, international, multicenter, open-label study in 55 centers. Patients with moderate to severe renal impairment scheduled for any gadobutrol-enhanced MRI were included. All patients received a single intravenous bolus injection of gadobutrol at a dose of 0.1 mmol/kg body weight. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period. RESULTS: A total of 908 patients were enrolled, including 586 with moderate and 284 with severe renal impairment who are at highest risk for developing NSF. The mean time since renal disease diagnosis was 1.83 and 5.49 years in the moderate and severe renal impairment cohort, respectively. Overall, 184 patients (20.3%) underwent further contrast-enhanced MRI with other gadolinium-based contrast agents within the 2-year follow-up. No patient developed symptoms conclusive of NSF. CONCLUSIONS: No safety concerns with gadobutrol in patients with moderate to severe renal impairment were identified. There were no NSF cases

Epicardial adipose tissue in patients with heart failure

<p>Abstract</p> <p>Purpose</p> <p>The aim of this study was to evaluate the extent of epicardial adipose tissue (EAT) and its relationship with left ventricular (LV) parameters assessed by cardiovascular magnetic resonance (CMR) in patients with congestive heart failure (CHF) and healthy controls.</p> <p>Background</p> <p>EAT is the true visceral fat deposited around the heart which generates various bioactive molecules. Previous studies found that EAT is related to left ventricular mass (LVM) in healthy subjects. Further studies showed a constant EAT to myocardial mass ratio in normal, ischemic and hypertrophied hearts.</p> <p>Methods</p> <p>CMR was performed in 66 patients with CHF due to ischemic cardiomyopathy (ICM), or dilated cardiomyopathy (DCM) and 32 healthy controls. Ventricular volumes, dimensions and LV function were assessed. The amount of EAT was determined volumetrically and expressed as mass indexed to body surface area. Additionally, the EAT/LVM and the EAT/left ventricular remodelling index (LVRI) ratios were calculated.</p> <p>Results</p> <p>Patients with CHF had less indexed EAT mass than controls (22 ± 5 g/m²versus 34 ± 4 g/m², p < 0.0001). In the subgroup analysis there were no significant differences in indexed EAT mass between patients with ICM and DCM (21 ± 4 g/m²versus 23 ± 6 g/m², p = 0.14). Linear regression analysis showed that with increasing LV end-diastolic diameter (LV-EDD) (r = 0.42, p = 0.0004) and LV end-diastolic mass (LV-EDM) (r = 0.59, p < 0.0001), there was a significantly increased amount of EAT in patients with CHF. However, the ratio of EAT mass/LV-EDM was significantly reduced in patients with CHF compared to healthy controls (0.54 ± 0.1 versus 0.21 ± 0.1, p < 0.0001). In CHF patients higher indexed EAT/LVRI-ratios in CHF patients correlated best with a reduced LV-EF (r = 0.49, p < 0.0001).</p> <p>Conclusion</p> <p>Patients with CHF revealed significantly reduced amounts of EAT. An increase in LVM is significantly related to an increase in EAT in both patients with CHF and controls. However, different from previous reports the EAT/LVEDM-ratio in patients with CHF was significantly reduced compared to healthy controls. Furthermore, the LV function correlated best with the indexed EAT/LVRI ratio in CHF patients. Metabolic abnormalities and/or anatomic alterations due to disturbed cardiac function and geometry seem to play a key role and are a possible explanation for these findings.</p

Implementation of Dual-Source RF Excitation in 3 T MR-Scanners Allows for Nearly Identical ADC Values Compared to 1.5 T MR Scanners in the Abdomen

Background: To retrospectively and prospectively compare abdominal apparent diffusion coefficient (ADC) values obtained within in a 1.5 T system and 3 T systems with and without dual-source parallel RF excitation techniques. Methodology/Principal Findings: After IRB approval, diffusion-weighted (DW) images of the abdomen were obtained on three different MR systems (1.5 T, a first generation 3 T, and a second generation 3 T which incorporates dual-source parallel RF excitation) on 150 patients retrospectively and 19 volunteers (57 examinations total) prospectively. Seven regions of interest (ROI) were throughout the abdomen were selected to measure the ADC. Statistical analysis included independent two-sided t-tests, Mann-Whitney U tests and correlation analysis. In the DW images of the abdomen, mean ADC values were nearly identical with nonsignificant differences when comparing the 1.5 T and second generation 3 T systems in all seven anatomical regions in the patient population and six of the seven in the volunteer population (p.0.05 in all distributions). The strength of correlation measured in the volunteer population between the two scanners in the kidneys ranged from r = 0.64–0.88 and in the remaining regions (besides the spleen), r.0.85. In the patient population the first generation 3 T scanner had different mean ADC values with significant differences (p,0.05) compared to the other two scanners in each of the seven distributions. In the volunteer population, the kidneys shared similar ADC mean values in comparison to the other two scanners with nonsignificant differences

Fast Inner-Volume Imaging of the Lumbar Spine with a Spatially Focused Excitation Using a 3D-TSE Sequence

Rationale and Objectives: The purpose of this study was to evaluate the feasibility and technical quality of a zoomed three-dimensional (3D) turbo spin-echo (TSE) sampling perfection with application optimized contrasts using different flip-angle evolutions (SPACE) sequence of the lumbar spine. Materials and Methods: In this prospective feasibility study, nine volunteers underwent a 3-T magnetic resonance examination of the lumbar spine including 1) a conventional 3D T2-weighted (T2w) SPACE sequence with generalized autocalibrating partially parallel acquisition technique acceleration factor 2 and 2) a zoomed 3D T2w SPACE sequence with a reduced field of view (reduction factor 2). Images were evaluated with regard to image sharpness, signal homogeneity, and the presence of artifacts by two experienced radiologists. For quantitative analysis, signal-to-noise ratio (SNR) values were calculated. Results: Image sharpness of anatomic structures was statistically significantly greater with zoomed SPACE (P < .0001), whereas the signal homogeneity was statistically significantly greater with conventional SPACE (cSPACE; P = .0003). There were no statistically significant differences in extent of artifacts. Acquisition times were 8:20 minutes for cSPACE and 6:30 minutes for zoomed SPACE. Readers 1 and 2 selected zSPACE as the preferred sequence in five of nine cases. In two of nine cases, both sequences were rated as equally preferred by both the readers. SNR values were statistically significantly greater with cSPACE. Conclusions: In comparison to a cSPACE sequences, zoomed SPACE imaging of the lumbar spine provides sharper images in conjunction with a 25% reduction in acquisition time