CT-derived body composition measurements as predictors for neoadjuvant treatment tolerance and survival in gastroesophageal adenocarcinoma.

PURPOSE: Treatment for gastroesophageal adenocarcinomas can result in significant morbidity and mortality. The purpose of this study is to supplement methods for choosing treatment strategy by assessing the relationship between CT-derived body composition, patient, and tumor features, and clinical outcomes in this population. METHODS: Patients with neoadjuvant treatment, biopsy-proven gastroesophageal adenocarcinoma, and initial staging CTs were retrospectively identified from institutional clinic encounters between 2000 and 2019. Details about patient, disease, treatment, and outcomes (including therapy tolerance and survival) were extracted from electronic medical records. A deep learning semantic segmentation algorithm was utilized to measure cross-sectional areas of skeletal muscle (SM), visceral fat (VF), and subcutaneous fat (SF) at the L3 vertebra level on staging CTs. Univariate and multivariate analyses were performed to assess the relationships between predictors and outcomes. RESULTS: 142 patients were evaluated. Median survival was 52 months. Univariate and multivariate analysis showed significant associations between treatment tolerance and SM and VF area, SM to fat and VF to SF ratios, and skeletal muscle index (SMI) (p = 0.004-0.04). Increased survival was associated with increased body mass index (BMI) (p = 0.01) and increased SMI (p = 0.004). A multivariate Cox model consisting of BMI, SMI, age, gender, and stage demonstrated that patients in the high-risk group had significantly lower survival (HR = 1.77, 95% CI = 1.13-2.78, p = 0.008). CONCLUSION: CT-based measures of body composition in patients with gastroesophageal adenocarcinoma may be independent predictors of treatment complications and survival and can supplement methods for assessing functional status during treatment planning.

Complications of Lung Transplantation: Update on Imaging Manifestations and Management.

As lung transplantation has become the most effective definitive treatment option for end-stage chronic respiratory diseases, yearly rates of this surgery have been steadily increasing. Despite improvement in surgical techniques and medical management of transplant recipients, complications from lung transplantation are a major cause of morbidity and mortality. Some of these complications can be classified on the basis of the time they typically occur after lung transplantation, while others may occur at any time. Imaging studies, in conjunction with clinical and laboratory evaluation, are key components in diagnosing and monitoring these conditions. Therefore, radiologists play a critical role in recognizing and communicating findings suggestive of lung transplantation complications. A description of imaging features of the most common lung transplantation complications, including surgical, medical, immunologic, and infectious complications, as well as an update on their management, will be reviewed here. Keywords: Pulmonary, Thorax, Surgery, Transplantation Supplemental material is available for this article. © RSNA, 2021.

Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders.

The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001⁻2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs.

Interrater Agreement and Diagnostic Accuracy of a Novel Computer-Aided Detection Process for the Detection and Prevention of Retained Surgical Instruments.

OBJECTIVE: The purpose of this study is to evaluate the diagnostic accuracy of a process incorporating computer-aided detection (CAD) for the detection and prevention of retained surgical instruments using a novel nondeformable radiopaque µTag. MATERIALS AND METHODS: A high-specificity CAD system was developed iteratively from a training set (n = 540 radiographs) and a validation set (n = 560 radiographs). A novel test set composed of 700 thoracoabdominal radiographs (410 with a randomly placed µTag and 290 without a µTag) was obtained from 10 cadavers embedded with confounding iatrogenic objects. Data were analyzed first by the blinded CAD system; radiographs coded as negative (n = 373) were then independently reviewed by five blinded radiologists. The reference standard was the presence of a µTag. Sensitivity and specificity were calculated. Interrater agreement was assessed with Cohen kappa values. Mean (± SD) image analysis times were calculated. RESULTS: The high-specificity CAD system had one false-positive (sensitivity, 79.5% [326/410]; specificity, 99.7% [289/290]). A combination of the CAD system and one failsafe radiologist had superior sensitivity (98.5% [404/410] to 100% [410/410]) and specificity (99.0% [287/290] to 99.7% [289/290]), with 327 (47%) radiographs not requiring immediate radiologist review. Interrater agreement was almost perfect for all radiologist pairwise comparisons (κ = 0.921-0.992). Cumulative mean image analysis time was less than one minute (CAD, 29 ± 2 seconds; radiologists, 26 ± 16 seconds). CONCLUSION: The combination of a high-specificity CAD system with a failsafe radiologist had excellent diagnostic accuracy in the rapid detection of a nondeformable radiopaque µTag.

Pelvic artery aneurysm screening provides value in patients with thoracic aortic aneurysms.

Approximately » of patients with thoracic aortic aneurysms (TAAs) have concomitant abdominal aortic aneurysms (AAAs), thereby justifying the addition of an abdominal CT scan to a chest CT scan in patients with a newly diagnosed or suspected TAA. However, the prevalence of pelvic artery aneurysms (PAAs) in these patients is unknown. The purpose of this study was to determine the prevalence of PAAs in patients with TAAs and to assess what patient specific factors were associated with PAAs, thereby providing insight into the usefulness of pelvic imaging in TAA patients. Consecutive non-operated patients seen in Cardiac Surgery clinic between 2008 and 2013 with a TAA and a CT scan of the chest/abdomen/pelvis were included. Scans of 371 patients were evaluated for PAAs using threshold diameters of 20 and 15 mm for common iliac artery aneurysms (CIAs) and internal iliac artery aneurysms (IIAs), respectively, on 3D analysis. The prevalence of PAAs was determined and multiple logistic regression was used to identify associated risk factors. 41 of 371 (11.1%) patients with a TAA had at least one PAA. Factors showing positive associations with PAAs included increased age (p = 0.0004), male gender (p = 0.0007), descending TAA location (p = 0.0024) and presence of an AAA (p < 0.0001). The results of our study suggest that the addition of pelvic imaging for PAA screening in patients undergoing an initial CT scan of the chest and abdomen for a TAA is valuable, particularly in patients with the following demographics: age ≥65, male gender, descending TAA location, and/or known AAA.

Evaluation for abdominal aortic aneurysms is justified in patients with thoracic aortic aneurysms.

Aortic aneurysms are a significant cause of mortality, and the presence of multiple aneurysms may affect treatment plans. The purpose of this study was to determine the frequency of abdominal aortic aneurysms (AAAs) in patients with thoracic aortic aneurysms (TAAs) and to establish whether patient specific factors, such as gender and comorbidities, influenced the frequency of AAAs, thereby indicating if and when abdominal aortic evaluation is justified. Electronic medical records were reviewed from 1000 patients with a computed tomography (CT) angiogram of the chest and abdomen and a clinical diagnosis of TAA from Cardiac Surgery clinic between 2008 and 2013. 538 patients with history of aortic intervention, dissection, rupture or trauma were excluded. The frequency of AAAs among the 462 remaining patients was established, and statistical analysis was used to elucidate differences in frequency based on age, gender, comorbidities, and TAA location. Overall, 104 of 462 (22.5 %) patients with a TAA also had an AAA. There were significant differences in the frequency of AAA based on TAA location, age, and comorbidities. The following comorbidities showed positive associations with AAA using logistic regression analysis: age ≥65 (P < 0.0001; OR 30.1; CI 7.14-126.61), smoking history (P < 0.0001; OR 4.1; 2.35-7.30), and hypertension (P = 0.024; OR 2.1; CI 1.11-4.16). Aneurysms in the proximal/mid descending (P < 0.0001; OR 4.96; CI 2.32-10.61) and diaphragm level (P < 0.0001; OR 38.4; CI 14.71-100.15) of the aorta also showed a positive association with AAAs when adjusted for age and gender. AAA screening in patients with TAA is a reasonable, evidence-based option regardless of the TAA location, with the strongest support in patients >age 55, with systemic hypertension, a smoking history and/or a TAA in the descending thoracic aorta.