Magnetic Resonance (MR) Patterns of Brain Metastasis in Lung Cancer Patients: Correlation of Imaging Findings with Symptom

IntroductionAsymptomatic brain metastasis in lung cancer patients, if detected early have been reported to show survival benefit with treatment. These asymptomatic metastasis have been found to be smaller and less in number than those with symptoms. We however observed that many lung cancer patients bear a significant metastatic load in the brain irrespective of the stage or neurologic symptoms at the time of initial presentation.Material and MethodsA retrospective study was conducted on 175 patients of proven non-small cell lung cancer to assess the patterns of brain metastasis in the two groups of patients, with and without neurologic symptoms. All patients had undergone screening magnetic resonance imaging for brain metastasis as an initial staging protocol. The patients with brain metastasis were divided into two groups: asymptomatic (group I) and symptomatic (group II). The lesions were studied with regards to the number, size, site, nature (solid with and without necrosis), and presence of perilesional edema and intralesional hemorrhage in both the groups in various stages of disease.ResultsBrain metastasis was seen in 62 (31.3%) patients of whom 46.7% were neurologically asymptomatic. Patients (90.3%) with brain metastasis were in stage IV at the time of presentation. No statistically significant correlation was found between the two groups regarding the number of lesions (p = 0.554), size of lesion (p = 0.282), site of lesion (p = 0.344), nature of lesion (p = 0.280), presence of perilesional edema (p = 0.404), and presence or absence of intralesional hemorrhage (p = 0.09). In our study, brain metastases were present only in stages III and IV disease with no statistically significant difference in the lesion patterns.ConclusionThe study reveals almost equal number of patients with brain metastasis in the symptomatic and asymptomatic groups with no significant difference in lesion patterns. We therefore conclude that although imaging surveillance of the brain for metastasis will detect asymptomatic metastasis early for early institution of appropriate therapy the prognosis in these patients would not solely depend on the presence or absence of symptoms and the pattern of lesion may have an influence on the patients’ response to therapy and survival benefit specially for those asymptomatic patients with equally large metastatic load

MRI Appearance of Florid Cystic Endosalpingiosis of the Uterus: a Case Report

Endosalpingiosis is a non-neoplastic proliferation of ectopic tubal epithelium. It may be found incidentally or the patients may present with chronic pelvic pain. It may resemble a gynecologic malignancy on imaging findings and clinicians and radiologists should be aware of this benign entity to render a correct diagnosis and to avoid over-treatment. We report here the MR imaging appearance of a case of florid cystic endosalpingiosis

Simultaneous PET/MRI: Impact on cancer management-A comprehensive review of cases

The metabolic mapping of malignancy in whole body in a single examination by PET/CT has gained widespread acceptance where the CT provides an anatomical correlate for the PET. MRI offers advantage over CT in providing better anatomical information owing to its high soft tissue resolution especially in brain, liver, neck, pelvis and bone marrow. Simultaneous PET/MRI is a new multimodal imaging modality that is expected to improve the diagnostic performance of imaging wherein better anatomical and metabolic information can be acquired at the same time and space during a single examination time. Also, MR attributes like diffusion, perfusion and spectroscopy may further add to its diagnostic potential. In this article, we present our initial experience in illustrated cases done with simultaneous PET/MRI and outline its potential for several clinical applications in oncology

Role of quantitative pharmacokinetic parameter (transfer constant: Ktrans ) in the characterization of breast lesions on MRI

Background: The semi-quantitative analysis of the time-intensity curves in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has a limited specificity due to overlapping enhancement patterns after gadolinium administration. With the advances in technology and faster sequences, imaging of the entire breast can be done in a few seconds, which allows measuring the transit of contrast (transfer constant: K trans ) through the vascular bed at capillary level that reflects quantitative measure of porosity/permeability of tumor vessels. Aim: Our study aims to evaluate the pharmacokinetic parameter K trans for enhancing breast lesions and correlate it with histopathology, and assess accuracy, sensitivity, and specificity of this parameter in discriminating benign and malignant breast lesions. Materials and Methods: One hundred and fifty-one women with 216 histologically proved enhancing breast lesions underwent high temporal resolution DCE-MRI for the early dynamic analysis for calculation of pharmacokinetic parameters (K trans ) using standard two compartment model. The calculated values of K trans were correlated with histopathology to calculate the sensitivity, specificity, and accuracy. Results: Receiver operating characteristic (ROC) curve analysis revealed a mean K trans value of 0.56, which reliably distinguished benign and malignant breast lesions with a sensitivity of 91.1% and specificity of 90.3% with an overall accuracy of 89.3%. The area under curve (AUC) was 0.907. Conclusion: K trans is a reliable quantitative parameter for characterizing benign and malignant lesions in routine DCE-MRI of breasts

Technical Note: MRI-guided breast biopsy - our preliminary experience

The diagnostic potential of breast MRI can be fully utilized only when it is possible to biopsy lesions detected on MRI, especially when they are not visible on mammography or USG. We would like to describe our experience with MRI-guided wire localization and biopsy

Put–Call Ratio Volume vs. Open Interest in Predicting Market Return: A Frequency Domain Rolling Causality Analysis

This study examined the efficacy of the Put–Call Ratio (PCR), a widely used information ratio measured in terms of volume and open interest, in predicting market return at different time scale. Volume PCR was found to be an efficient predictor of the market return in a short period of 2.5 days and open interest PCR in a long period of 12 days. Thus, traders and portfolio managers should use the appropriate PCR depending upon the time horizon of their trade and investment. The results are robust even after controlling for the information generated from the futures market

Influence of foreign institutional holding on corporate risk-return profile: a panel quantile regression analysis

AbstractThe study investigates the influence of foreign institutional investment on the risk-return profile of firms. Corporate risk is analyzed as business risk and financial risk in this study. The impact of foreign institutional investor’s (FII) holding on business and financial risk taking behavior is studied on 174 listed non-financial firms in India using panel quantile regression methodology for a span of 20 years which include the pre and post 2008 financial crisis periods as well. Panel fixed effect model was found to be appropriate in this study The impact of FII holding is also studied through the distribution of the risk through panel quantile regression. The impact of FII holding on risk taking behaviour of the firms is studied primarily across high, average and low proportion of corporate risk. Overall FII holding has an inverse relationship with corporate risk taking behavior of firms. The positive impact of FII holding across all types of firms in terms of the risk-return profile indicates that their presence is long term and reduces risk taking behaviour of the corresponding firm. The implications of this study will be significant in regulating FII inflows and outflows to ensure discipline on the part of firm management in improving its risk-return profile

MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer

Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well

Integrated 18F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging (18F-FDG PET/MRI), a multimodality approach for comprehensive evaluation of dementia patients: A pictorial essay

Dementia, caused by irreversible neurodegenerative disorders such as Alzheimer's disease or reversible non-degenerative conditions, is rapidly becoming one of the most alarming health problems in our aging society. This cognitive disorder associated with a multitude of clinical differentials with overlapping clinical, pathological, and imaging features is difficult to diagnose and treat, as it often presents late after significant neuronal damage has already occurred. Novel disease-modifying treatments being developed will have to be corroborated with innovative imaging biomarkers so that earlier reliable diagnosis can be made and treatment initiated upon. Along with new specific PET radiotracers, integrated PET/MRI with combined methodological advantage and simultaneously acquired structural-cum-functional information may help achieve this goal. The present pictorial essay details our experiences with PET/MRI in dementing disorders, along with reviewing recent advances and future scope