Imaging rectal cancer in 2018: how good are we?

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Colorectal Cancer is one of the leading causes of cancer deaths worldwide. Learning objectives: Critical role of radiologist in multidisciplinary pre-treatment assessment of rectal cancer will be outlined. Surgically relevant anatomy and surgical procedures for treatment of high, mid and low rectal tumors will be discussed in the context of interpretation of rectal magnetic resonance imaging (MRI) findings and staging computed tomography (CT) scans. Most up-to-date MR imaging protocols for rectal tumor staging and post treatment assessment will be outlined. Rectal and anal cancer staging will be discussed using multiple cases demonstrating entities corresponding to different types of rectal tumors. Pitfalls of MR imaging with case-based examples will also be discussed. Outcomes: Attendees will increase their familiarity with the most up-to-date imaging techniques for staging and surveillance of rectal cancer. Attendees will enhance their ability to conduct pre-treatment assessment of rectal tumors, including identifying risk factors for recurrence and predicting clear circumferential resection margin. Attendees will also become familiar with pitfalls commonly encountered on rectal MRI scans

Imaging esophageal cancer in 2018: achievements and challenges

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Esophageal cancer is the 8th most common cancer worldwide and the 6th leading cause of cancer death worldwide with 5-year survival rates rarely exceeding 40%. Learning objectives: Epidemiology and causes of esophageal cancer will be discussed. Surgical and minimally invasive approaches to treatment of esophageal cancer will be discussed with imaging correlation. Role of CT and PET/CT in staging and surveillance of esophageal cancer will be outlined. Potential role of diffusion weighted imaging, PET/MRI and novel molecular imaging markers for preoperative and post-treatments assessment of esophageal cancer will be discussed. Outcomes: Attendees will increase their familiarity with the most up-to-date imaging techniques for staging and surveillance of esophageal cancer as well as of the most current experimental approaches. Attendees will broaden their understanding of the role of a radiologist in the multidisciplinary management of esophageal cancer patients

The iodide-transport-defect-causing mutation R124H: a δ-amino group at position 124 is critical for maturation and trafficking of the Na+/I− symporter

Na+ /I2 symporter (NIS)-mediated active accumulation of I2 in thyrocytes is a key step in the biosynthesis of the iodine-containing thyroid hormones T3 and T4. Several NIS mutants have been identified as a cause of congenital I2 transport defect (ITD), and their investigation has yielded valuable mechanistic information on NIS. Here we report novel findings derived from the thorough characterization of the ITD-causing mutation R124H, located in the second intracellular loop (IL-2). R124H NIS is incompletely glycosylated and colocalizes with endoplasmic reticulum (ER)-resident protein markers. As a result, R124H NIS is not targeted to the plasma membrane and therefore does not mediate any I2 transport in transfected COS-7 cells. Strikingly, however, the mutant is intrinsically active, as revealed by its ability to mediate I2 transport in membrane vesicles. Of all the amino acid substitutions we carried out at position 124 (K, D, E, A, W, N and Q), only Gln restored targeting of NIS to the plasma membrane and NIS activity, suggesting a key structural role for the d-amino group of R124 in the transporter’s maturation and cell surface targeting. Using our NIS homology model based on the structure of the Vibrio parahaemolyticus Na+ /galactose symporter, we propose an interaction between the d-amino group of either R or Q124 and the thiol group of C440, located in IL-6. We conclude that the interaction between IL-2 and IL-6 is critical for the local folding required for NIS maturation and plasma membrane trafficking.Fil: Paroder, Viktoriya. Albert Einstein College of Medicine; Estados UnidosFil: Nicola, Juan Pablo. University of Yale; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ginter, Christopher S.. Albert Einstein College of Medicine; Estados UnidosFil: Carrasco, Nancy. Albert Einstein College of Medicine; Estados Unidos. University of Yale; Estados Unido

Can ¹⁸F-FDG PET/CT Radiomics Features Predict Clinical Outcomes in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma?

This study aimed to assess the usefulness of radiomics features of 18F-FDG PET/CT in patients with locally advanced esophageal cancers (ESCC) in predicting outcomes such as clinical tumor (cT) and nodal (cN) categories, PET response to induction chemotherapy (PET response), progression-free survival (PFS), and overall survival (OS). Pretreatment PET/CT images from patients who underwent concurrent chemoradiotherapy from July 2002 to February 2017 were segmented, and data were split into training and test sets. Model development was performed on the training datasets and a maximum of five features were selected. Final diagnostic accuracies were determined using the test dataset. A total of 86 PET/CTs (58 men and 28 women, mean age 65 years) were segmented. Due to small lesion size, 12 patients were excluded. The diagnostic accuracies as derived from the CT, PET, and combined PET/CT test datasets were as follows: cT category—70.4%, 70.4%, and 81.5%, respectively; cN category—69.0%, 86.2%, and 86.2%, respectively; PET response—60.0%, 66.7%, and 70.0%, respectively; PFS—60.7%, 75.0%, and 75.0%, respectively; and OS—51.7%, 55.2%, and 62.1%, respectively. A radiomics assessment of locally advanced ESCC has the potential to predict various clinical outcomes. External validation of these models would be further helpful

Meaningful words in rectal MRI synoptic reports: How “polypoid” may be prognostic

PurposeThis study explored the clinicopathologic outcomes of rectal tumor morphological descriptors used in a synoptic rectal MRI reporting template and determined that prognostic differences were observed.MethodsThis retrospective study was conducted at a comprehensive cancer center. Fifty patients with rectal tumors for whom the synoptic descriptor "polypoid" was chosen by three experienced radiologists were compared with ninety comparator patients with "partially circumferential" and "circumferential" rectal tumors. Two radiologists re-evaluated all cases. The outcome measures were agreement among two re-interpreting radiologists, clinical T staging with MRI (mrT) and descriptive nodal features, and degrees of wall attachment of tumors (on MRI) compared with pathological (p) T and N stage when available.ResultsRe-evaluation by two radiologists showed moderate to excellent agreement in tumor morphology, presence of a pedicle, and degree of wall attachment (k = 0.41-0.76) and excellent agreement on lymph node presence and size (ICC = 0.83-0.91). Statistically significant lower mrT stage was noted for polypoid morphology, wherein 98% were mrT1/2, while only 7% and 2% of partially circumferential and circumferential tumors respectively were mrT1/2. Pathologic T and N stages among the three morphologies also differed significantly, with only 14% of polypoid cases higher than stage pT2 compared to 48% of partially circumferential cases and 60% of circumferential cases.ConclusionUsing a "polypoid" morphology in rectal cancer MRI synoptic reports revealed a seemingly distinct phenotype with lower clinical and pathologic T and N stages when compared with alternative available descriptors.Precis"Polypoid" morphology in rectal cancer confers a lower clinical and pathologic T and N stage and may be useful in determining whether to proceed with surgery versus neoadjuvant treatment

Radiomics-based prediction of microsatellite instability in colorectal cancer at initial computed tomography evaluation

PURPOSE:To predict microsatellite instability (MSI) status of colon cancer on preoperative CT imaging using radiomic analysis. METHODS:This retrospective study involved radiomic analysis of preoperative CT imaging of patients who underwent resection of stage II-III colon cancer from 2004 to 2012. A radiologist blinded to MSI status manually segmented the tumor region on CT images. 254 Intensity-based radiomic features were extracted from the tumor region. Three prediction models were developed with (1) only clinical features, (2) only radiomic features, and (3) "combined" clinical and radiomic features. Patients were randomly separated into training (n = 139) and test (n = 59) sets. The model was constructed from training data only; the test set was reserved for validation only. Model performance was evaluated using AUC, sensitivity, specificity, PPV, and NPV. RESULTS:Of the total 198 patients, 134 (68%) patients had microsatellite stable tumors and 64 (32%) patients had MSI tumors. The combined model performed slightly better than the other models, predicting MSI with an AUC of 0.80 for the training set and 0.79 for the test set (specificity = 96.8% and 92.5%, respectively), whereas the model with only clinical features achieved an AUC of 0.74 and the model with only radiomic features achieved an AUC of 0.76. The model with clinical features alone had the lowest specificity (70%) compared with the model with radiomic features alone (95%) and the combined model (92.5%). CONCLUSIONS:Preoperative prediction of MSI status via radiomic analysis of preoperative CT adds specificity to clinical assessment and could contribute to personalized treatment selection