Current and Future States of Natural Killer Cell-Based Immunotherapy in Hepatocellular Carcinoma.

Natural killer (NK) cells are innate lymphoid cells that exhibit high levels of cytotoxicity against NK-specific targets. NK cells also produce various cytokines, and interact with T cells, B cells, and dendritic cells to effectively serve as frontliners of the innate immune system. Produce various cytokines, and interact with T cells, B cells, and dendritic cells to effectively serve as frontliners of the innate immune system. Moreover, NK cells constitute the second most common immune cell in the liver. These properties have drawn significant attention towards leveraging NK cells in treating liver cancer, especially hepatocellular carcinoma (HCC), which accounts for 75% of all primary liver cancer and is the fourth leading cause of cancer-related death worldwide. Notable anti-cancer functions of NK cells against HCC include activating antibody-dependent cell cytotoxicity (ADCC), facilitating Gasdermin E-mediated pyroptosis of HCC cells, and initiating an antitumor response via the cGAS-STING signaling pathway. In this review, we describe how these mechanisms work in the context of HCC. We will then discuss the existing preclinical and clinical studies that leverage NK cell activity to create single and combined immunotherapies.

Understanding Spatial Correlation Between Multiparametric MRI Performance and Prostate Cancer.

BACKGROUND: Multiparametric MRI (mpMRI) has shown a substantial impact on prostate cancer (PCa) diagnosis. However, the understanding of the spatial correlation between mpMRI performance and PCa location is still limited. PURPOSE: To investigate the association between mpMRI performance and tumor spatial location within the prostate using a prostate sector map, described by Prostate Imaging Reporting and Data System (PI-RADS) v2.1. STUDY TYPE: Retrospective. SUBJECTS: One thousand one hundred forty-three men who underwent mpMRI before radical prostatectomy between 2010 and 2022. FIELD STRENGTH/SEQUENCE: 3.0 T. T2-weighted turbo spin-echo, a single-shot spin-echo EPI sequence for diffusion-weighted imaging, and a gradient echo sequence for dynamic contrast-enhanced MRI sequences. ASSESSMENT: Integrated relative cancer prevalence (rCP), detection rate (DR), and positive predictive value (PPV) maps corresponding to the prostate sector map for PCa lesions were created. The relationship between tumor location and its detection/missing by radiologists on mpMRI compared to WMHP as a reference standard was investigated. STATISTICAL TESTS: A weighted chi-square test was performed to examine the statistical differences for rCP, DR, and PPV of the aggregated sectors within the zone, anterior/posterior, left/right prostate, and different levels of the prostate with a statistically significant level of 0.05. RESULTS: A total of 1665 PCa lesions were identified in 1143 patients, and from those 1060 lesions were clinically significant (cs)PCa tumors (any Gleason score [GS] ≥7). Our sector-based analysis utilizing weighted chi-square tests suggested that the left posterior part of PZ had a high likelihood of missing csPCa lesions at a DR of 67.0%. Aggregated sector analysis indicated that the anterior or apex locations in PZ had the significantly lowest csPCa detection at 67.3% and 71.5%, respectively. DATA CONCLUSION: Spatial characteristics of the per-lesion-based mpMRI performance for diagnosis of PCa were studied. Our results demonstrated that there is a spatial correlation between mpMRI performance and locations of PCa on the prostate. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

Investigating MRI-Associated Biological Aspects of Racial Disparities in Prostate Cancer for African American and White Men.

BACKGROUND: Understanding the characteristics of multiparametric MRI (mpMRI) in patients from different racial/ethnic backgrounds is important for reducing the observed gaps in clinical outcomes. PURPOSE: To investigate the diagnostic performance of mpMRI and quantitative MRI parameters of prostate cancer (PCa) in African American (AA) and matched White (W) men. STUDY TYPE: Retrospective. SUBJECTS: One hundred twenty-nine patients (43 AA, 86 W) with histologically proven PCa who underwent mpMRI before radical prostatectomy. FIELD STRENGTH/SEQUENCE: 3.0 T, T2-weighted turbo spin echo imaging, a single-shot spin-echo EPI sequence diffusion-weighted imaging, and a gradient echo sequence dynamic contrast-enhanced MRI with an ultrafast 3D spoiled gradient-echo sequence. ASSESSMENT: The diagnostic performance of mpMRI in AA and W men was assessed using detection rates (DRs) and positive predictive values (PPVs) in zones defined by the PI-RADS v2.1 prostate sector map. Quantitative MRI parameters, including Ktrans and ve of clinically significant (cs) PCa (Gleason score ≥ 7) tumors were compared between AA and W sub-cohorts after matching age, prostate-specific antigen (PSA), and prostate volume. STATISTICAL TESTS: Weighted Pearson's chi-square and Mann-Whitney U tests with a statistically significant level of 0.05 were used to examine differences in DR and PPV and to compare parameters between AA and matched W men, respectively. RESULTS: A total number of 264 PCa lesions were identified in the study cohort. The PPVs in the peripheral zone (PZ) and posterior prostate of mpMRI for csPCa lesions were significantly higher in AA men than in matched W men (87.8% vs. 68.1% in PZ, and 89.3% vs. 69.6% in posterior prostate). The Ktrans of index csPCa lesions in AA men was significantly higher than in W men (0.25 ± 0.12 vs. 0.20 ± 0.08 min-1; P < 0.01). DATA CONCLUSION: This study demonstrated race-related differences in the diagnostic performances and quantitative MRI measures of csPCa that were not reflected in age, PSA, and prostate volume. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

Characterization of Microwave Generator Energy and Ablation Volumes following Transarterial Embolization in an In Vivo Porcine Liver Model.

PURPOSE: To characterize the relationship between ablation zone volume (AZV) and microwave ablation (MWA) energy in an in vivo porcine liver model following arterial embolization. MATERIALS AND METHODS: With Institutional Animal Care and Use Committee (IACUC) approval, 11 female swine underwent either right (n = 5) or left (n = 6) hepatic artery embolization under fluoroscopic guidance. Subsequently, ultrasound (US)-guided MWA was performed in each liver segment (left lateral, left medial, right medial, and right lateral) at either 30 W (n = 4 lobes), 60 W (n = 4), 65 W (n = 20), 90 W (n = 8), 120 W (n = 4), or 140 W (n = 4) continuously for 5 minutes. Postprocedural volumetric segmentation was performed on standardized multiphase T1 magnetic resonance (MR) imaging sequences. RESULTS: Mean AZVs in embolized lobes (15.8 mL ± SD 10.6) were significantly larger than those in nonembolized lobes (11.2 mL ± SD 6.5, P < .01). MWA energy demonstrated significant positive linear correlation with both embolized (R2 = 0.66, P < .01) and nonembolized (R2 = 0.64, P < .01) lobes. The slope of the linear models corresponded to a 0.95 mL/kJ (SD ± 0.16) and 0.54 mL/kJ (SD ± 0.09) increase in ablation volume per applied kilojoule of energy (E) in embolized and nonembolized lobes, respectively. In the multivariate model, embolization status significantly modified the relationship between E and AZV as described by the following interaction term: 0.42∗E∗(embolization status) (P = .031). CONCLUSIONS: Linear models demonstrated a near 1.8-fold increase in ratio of AZV per unit E, R(AZV:E), when applied to embolized lobes relative to nonembolized lobes. Absolute AZV differences between embolized and nonembolized lobes were greater at higher-power MWA.

Technical Feasibility and Safety of Image-Guided Biphasic Monopolar Pulsed Electric Field Ablation of Metastatic and Primary Malignancies.

PURPOSE: To assess the technical feasibility and safety of image-guided percutaneous biphasic monopolar pulsed electric field (PEF) ablation of primary and metastatic tumors. METHODS AND METHODS: With IRB approval and HIPAA compliance, this retrospective, single-institution study cohort of 17 patients (mean age: 53.5 years, range: 20 - 94 years) with overall progressive disease underwent 26 PEF ablation procedures for 30 metastatic (90%) and primary (10%) target lesions in the thorax (n=20), abdomen (n=7), and head and neck (n=3). Concurrent systemic therapy was used in 14/17 patients (82%). Follow-up imaging was scheduled for 1, 3, and 6 months after PEF ablation, and target and off-target lesion sizes were recorded. The overall response was assessed by the RECIST 1.1 criteria with imaging immediately before PEF serving as baseline. Adverse events (AEs) were determined by the Society of Interventional Radiology classification. RESULTS: PEF ablation procedures were well tolerated and technically feasible for all 17 of 17 patients. The mean initial size of the target and off-target tumors were 2.6±1.5 cm (range: 0.4 - 6.9cm) and 2.2±1.1 cm (range: 1.0 - 5.2cm), respectively. Overall, 15/30 (50%) target lesions and 12/24 (50%) off-target lesions were unchanged or decreased in size at the patient's last follow-up. Eight patients had overall stable disease (47%) at the last follow-up. There were nine mild (9/26, 35%) and one moderate (1/26, 4%) AE. CONCLUSION: All PEF procedures were technically feasible with one moderate AE and stable disease for 47% of patients with a median follow-up period of three months.

Impact of PSMA PET on Prostate Cancer Management.

OPINION STATEMENT: PSMA-PET has been a practice-changing imaging biomarker for the management of men with PCa. Research suggests improved accuracy over conventional imaging and other PET radiotracers in many contexts. With multiple approved PSMA-targeting radiotracers, PSMA PET will become even more available in clinical practice. Its increased use requires an understanding of the prospective data available and caution when extrapolating from prior trial data that utilized other imaging modalities. Future trials leveraging PSMA PET for treatment optimization and management decision-making will ultimately drive its clinical utility.

High-resolution prostate diffusion MRI using eddy current-nulled convex optimized diffusion encoding and random matrix theory-based denoising.

OBJECTIVE: To develop and evaluate a technique combining eddy current-nulled convex optimized diffusion encoding (ENCODE) with random matrix theory (RMT)-based denoising to accelerate and improve the apparent signal-to-noise ratio (aSNR) and apparent diffusion coefficient (ADC) mapping in high-resolution prostate diffusion-weighted MRI (DWI). MATERIALS AND METHODS: Eleven subjects with clinical suspicion of prostate cancer were scanned at 3T with high-resolution (HR) (in-plane: 1.0 × 1.0 mm2) ENCODE and standard-resolution (1.6 × 2.2 mm2) bipolar DWI sequences (both had 7 repetitions for averaging, acquisition time [TA] of 5 min 50 s). HR-ENCODE was retrospectively analyzed using three repetitions (accelerated effective TA of 2 min 30 s). The RMT-based denoising pipeline utilized complex DWI signals and Marchenko-Pastur distribution-based principal component analysis to remove additive Gaussian noise in images from multiple coils, b-values, diffusion encoding directions, and repetitions. HR-ENCODE with RMT-based denoising (HR-ENCODE-RMT) was compared with HR-ENCODE in terms of aSNR in prostate peripheral zone (PZ) and transition zone (TZ). Precision and accuracy of ADC were evaluated by the coefficient of variation (CoV) between repeated measurements and mean difference (MD) compared to the bipolar ADC reference, respectively. Differences were compared using two-sided Wilcoxon signed-rank tests (P < 0.05 considered significant). RESULTS: HR-ENCODE-RMT yielded 62% and 56% higher median aSNR than HR-ENCODE (b = 800 s/mm2) in PZ and TZ, respectively (P < 0.001). HR-ENCODE-RMT achieved 63% and 70% lower ADC-CoV than HR-ENCODE in PZ and TZ, respectively (P < 0.001). HR-ENCODE-RMT ADC and bipolar ADC had low MD of 22.7 × 10-6 mm2/s in PZ and low MD of 90.5 × 10-6 mm2/s in TZ. CONCLUSIONS: HR-ENCODE-RMT can shorten the acquisition time and improve the aSNR of high-resolution prostate DWI and achieve accurate and precise ADC measurements in the prostate.

Comparison of LIRADS 5 Image Guided Core Biopsy Derived From Formalin Fixed and Frozen Tissue Cores for Radiogenomics and Radioproteomics Analysis in Well, Moderate and Poorly Differentiated Hepatocellular Carcinoma.

The aim of this pilot study is to evaluate and compare the quality of the genomics and proteomics data obtained from paired Formalin Fixed Paraffin Embedded (FFPE) and frozen (FF) tissue percutaneous core biopsies of Liver Imaging Reporting and Data System 5 (LIRADS 5) hepatocellular carcinoma (HCC) of varying histological grades. The preliminary data identified differentially expressed proteins and genes in poor, moderate and well differentiated HCC biopsies, with a greater efficacy in fresh frozen samples. The data offered valuable insights into the characteristics and suitability of samples for future studies.

AtPCa-Net: anatomical-aware prostate cancer detection network on multi-parametric MRI.

Multi-parametric MRI (mpMRI) is widely used for prostate cancer (PCa) diagnosis. Deep learning models show good performance in detecting PCa on mpMRI, but domain-specific PCa-related anatomical information is sometimes overlooked and not fully explored even by state-of-the-art deep learning models, causing potential suboptimal performances in PCa detection. Symmetric-related anatomical information is commonly used when distinguishing PCa lesions from other visually similar but benign prostate tissue. In addition, different combinations of mpMRI findings are used for evaluating the aggressiveness of PCa for abnormal findings allocated in different prostate zones. In this study, we investigate these domain-specific anatomical properties in PCa diagnosis and how we can adopt them into the deep learning framework to improve the model's detection performance. We propose an anatomical-aware PCa detection Network (AtPCa-Net) for PCa detection on mpMRI. Experiments show that the AtPCa-Net can better utilize the anatomical-related information, and the proposed anatomical-aware designs help improve the overall model performance on both PCa detection and patient-level classification.

Endoportal Radiofrequency Ablation and Stent Placement in Patients with Portal Vein Tumor Thrombosis from Hepatocellular Carcinoma: A Study on Feasibility and Safety.

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer, with 10-40% of cases involving portal vein tumor thrombosis (PVTT), leading to poor outcomes and a short survival. The effectiveness of PVTT treatment in patients with HCC is still controversial. Methods: This prospective dual-center study cohort comprised 60 patients with HCC and PVTT who underwent PVR-EPRFA-ST using a novel intravascular radiofrequency system followed by vascular stent placement across the PVTT stenosed segment under fluoroscopy guidance. Results: PVR-EPRFA-ST was technically and clinically successful in 54/60 (90%) and 37/54 (68.5%) patients, respectively. The mean tumor size, PVTT length, post-ablation luminal diameter, and median duration of the recanalized PV patency were 8.6 ± 3.4 cm, 4.1 ± 2.1 cm, 10.3 ± 1.8 mm, and 13.4 months. Higher technical and clinical success rates were associated with a longer survival (177 ± 17.3 days, HR: 0.3, 95%CI 0.12-0.71, p = 0.04; and 233 ± 18.3 days, HR: 0.14, 0.07-0.27, p < 0.001). A shorter survival was associated with Child-Pugh C (HR: 2.7, p = 0.04), multiple tumors (HR: 1.81, p = 0.03), and PVTT length (HR: 1.16, p = 0.04). Conclusions: PVR-EPRFA-ST was feasible and effective for the treatment of selected patients with PVTT, especially in patients with Child-Pugh A/B, single tumors, or a shorter PVTT length.

ChatGPT in radiology: A systematic review of performance, pitfalls, and future perspectives.

PURPOSE: The purpose of this study was to systematically review the reported performances of ChatGPT, identify potential limitations, and explore future directions for its integration, optimization, and ethical considerations in radiology applications. MATERIALS AND METHODS: After a comprehensive review of PubMed, Web of Science, Embase, and Google Scholar databases, a cohort of published studies was identified up to January 1, 2024, utilizing ChatGPT for clinical radiology applications. RESULTS: Out of 861 studies derived, 44 studies evaluated the performance of ChatGPT; among these, 37 (37/44; 84.1%) demonstrated high performance, and seven (7/44; 15.9%) indicated it had a lower performance in providing information on diagnosis and clinical decision support (6/44; 13.6%) and patient communication and educational content (1/44; 2.3%). Twenty-four (24/44; 54.5%) studies reported the proportion of ChatGPT's performance. Among these, 19 (19/24; 79.2%) studies recorded a median accuracy of 70.5%, and in five (5/24; 20.8%) studies, there was a median agreement of 83.6% between ChatGPT outcomes and reference standards [radiologists' decision or guidelines], generally confirming ChatGPT's high accuracy in these studies. Eleven studies compared two recent ChatGPT versions, and in ten (10/11; 90.9%), ChatGPTv4 outperformed v3.5, showing notable enhancements in addressing higher-order thinking questions, better comprehension of radiology terms, and improved accuracy in describing images. Risks and concerns about using ChatGPT included biased responses, limited originality, and the potential for inaccurate information leading to misinformation, hallucinations, improper citations and fake references, cybersecurity vulnerabilities, and patient privacy risks. CONCLUSION: Although ChatGPT's effectiveness has been shown in 84.1% of radiology studies, there are still multiple pitfalls and limitations to address. It is too soon to confirm its complete proficiency and accuracy, and more extensive multicenter studies utilizing diverse datasets and pre-training techniques are required to verify ChatGPT's role in radiology.

Percutaneous interstitial brachytherapy ablation for targeting oligometastatic gynecologic cancers.

INTRODUCTION: Treatment of recurrent oligometastatic gynecologic malignancy may involve targeted surgery, thermal ablation, or CT-guided high-dose-rate interstitial brachytherapy ablation (CT-HDR-IBTA). The purpose of this study was to describe the safety and efficacy of CT-HDR-IBTA for oligometastatic gynecologic malignancies. METHODS: With institutional review board approval (IRB) approval and compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance, we searched our database to assemble a single-arm study cohort of all patients with oligometastatic gynecologic cancers who underwent CT-HDR-IBTA from 2012-2022 with follow-up. The electronic record was reviewed to determine relevant clinicopathological variables including patient demographics, prior treatments, clinical course, local control, and local and distant recurrence with follow-up imaging. RESULTS: The study cohort comprised 37 lesions in 34 patients treated with CT-HDR-IBTA for recurrent oligometastatic uterine (n = 17), cervix (n = 1), or ovarian cancer (n = 16) with an average lesion size of 2.5 cm with an average patient age of 61.4 years. Each lesion was treated with an average radiation dose of 23.8 Gy in 1.8 fractions and a median follow-up time of 24.0 months. The primary efficacy of CT HDR ITBA was 73% with a median progression-free survival of 8.0 months (95% CI 3.6-12.8 months) and with 58% of patients still alive at 43 months with median overall survival not reached. The rate of Grade 1 adverse events was 22% without any Grade 2, 3 or 4 events. CONCLUSIONS: CT HDR IBTA was safe and effective for treating oligometastatic gynecologic cancers in a heavily pretreated cohort.

Rare occurrence of uterine arteriovenous malformation clinically mimicking a malignant growth: A critical reminder for pathologists

Arteriovenous malformation (AVM) is a rare lesion in the uterus, which can lead to abnormal uterine bleeding. While AVM has been described in other organs in the literature, there is a paucity of pathology reports of the AVM in uterus. On gross examination, the uterus was markedly enlarged and partly distorted with a pedunculated solid mass, which on the cut surface showed multiple well-circumscribed hemorrhagic cysts ranging from 0.1 to 4.0 cm in size. Microscopically, they were malformed dilated vascular structures containing organized thrombi. We present this case of uterine AVM with gross and microscopic findings, which can serve as a crucial reminder for pathologists to keep in the differential diagnoses as a potential cause of abnormal uterine bleeding.