NCCN Guidelines® Insights: Hodgkin Lymphoma, Version 2.2022.

Hodgkin lymphoma (HL) is an uncommon malignancy of B-cell origin. Classical HL (cHL) and nodular lymphocyte-predominant HL are the 2 main types of HL. The cure rates for HL have increased so markedly with the advent of modern treatment options that overriding treatment considerations often relate to long-term toxicity. These NCCN Guidelines Insights discuss the recent updates to the NCCN Guidelines for HL focusing on (1) radiation therapy dose constraints in the management of patients with HL, and (2) the management of advanced-stage and relapsed or refractory cHL.

Evaluation of Adaptive Statistical Iterative Reconstruction-V Reconstruction Algorithm vs Filtered Back Projection in the Detection of Hypodense Liver Lesions: Reader Performance and Preferences.

OBJECTIVE: The aim of the study was to evaluate diagnostic accuracy and readers' experience in the detection of focal liver lesions on computed tomography with Adaptive Statistical Iterative Reconstruction-V (ASIR-V) reconstruction compared with filtered back projection (FBP) scans. METHODS: Fifty-five patients with liver lesions had FBP and ASIR-V scans. Two radiologists independently reviewed both sets of computed tomography scans, identifying and characterizing liver lesions. RESULTS: Adaptive Statistical Iterative Reconstruction-V scans had a reduction in dose length product (P < 0.0001) with no difference in image contrast (P = 0.1805); image noise was less for the ASIR-V scans (P < 0.0001) and contrast-to-noise ratio was better for ASIR-V (P = 0.0002). Both readers found more hypodense liver lesions on the FBP (P = 0.01) scans. Multiple subjective imaging scores were significantly less for the ASIR-V scans for both readers. CONCLUSIONS: Although ASIR-V scans were objectively better, our readers performed worse in lesion detection on them, suggesting a need for better education/experience with this technology during implementation.

Evaluation of low-dose CT angiography with model-based iterative reconstruction after endovascular aneurysm repair of a thoracic or abdominal aortic aneurysm.

OBJECTIVE: The objective of our study was to evaluate image quality and overall adequacy of low-dose CT angiography (CTA) with model-based iterative reconstruction (MBIR) in patients who had undergone endovascular aneurysm repair (EVAR) of a thoracic or abdominal aortic aneurysm. MATERIALS AND METHODS: Thirty patients, all of whom had undergone standard-dose CTA performed previously with adaptive statistical iterative reconstruction (ASIR), underwent low-dose CTA for surveillance after EVAR. Two radiologists randomly evaluated both studies, and quality parameters were assessed. The maximal aneurysm diameter was measured, and the images were evaluated to see whether an endoleak was present. The image noise and contrast-to-noise ratio (CNR) were measured. The volume CT dose index and dose-length product were recorded. RESULTS: The mean image score for low-dose CTA was acceptable to very good in all categories of assessment. There was no significant difference between low-dose CTA and standard-dose CTA in the evaluation of the stent lumen. Subjective assessments of stent configuration, aneurysm outline, aortic branch vessel outline, overall adequacy of vascular imaging, and overall adequacy of solid organ imaging were superior on standard-dose CTA. Interobserver agreement for endoleak detection was higher for low-dose CTA. There was no significant difference in the mean aneurysm diameter between the two readers on low-dose CTA and standard-dose CTA. The effective radiation dose for low-dose CTA was lower than standard-dose CTA during both the arterial (mean, 4.4 vs 16.2 mSv, respectively) and the delayed (2.4 vs 6.7 mSv) phase acquisitions. The measured image noise was lower (14.7 vs 19.3 HU) and CNR was higher (25.6 vs 17.1) on the low-dose CTA studies than on the standard-dose CTA studies. CONCLUSION: Low-dose CTA with MBIR enables up to 73% dose reduction as compared with CTA performed with ASIR while maintaining diagnostic adequacy for CTA surveillance of patients who have undergone EVAR of a thoracic or abdominal aortic aneurysm.

Predictive Value of Multiparametric Magnetic Resonance Imaging in Risk Group Stratification of Prostate Adenocarcinoma.

Purpose: The aim of this study was to further assess the clinical utility of multiparametric magnetic resonance imaging (MP-MRI) in prostate cancer (PC) staging following 2023 clinical guideline changes, both as an independent predictor of high-stage (>T3a) or high-risk PC and when combined with patient characteristics. Methods and Materials: The present study was a retrospective review of 171 patients from 2008 to 2018 who underwent MP-MRI before radical prostatectomy at a single institution. The accuracy of clinical staging was compared between conventional staging and MP-MRI-based clinical staging. Sensitivity, specificity, positive predictive value, and negative predictive value were compared, and receiver operating characteristic curves were generated. Linear regression analyses were used to calculate concordance (C-statistic). Results: Of the 171 patients, final pathology revealed 95 (55.6%) with T2 disease, 62 (36.3%) with T3a disease, and 14 (8.2%) with T3b disease. Compared with conventional staging, MP-MRI-based staging demonstrated significantly increased accuracy in identifying T3a disease, intermediate risk, and high/very-high-risk PC. When combined with clinical characteristics, MP-MRI-based staging improved the area under the curve from 0.753 to 0.808 (P = .0175), compared with conventional staging. Conclusions: MP-MRI improved the identification of T3a PC, intermediate-risk PC, and high- or very-high-risk PC. Further, when combined with clinical characteristics, MP-MRI-based staging significantly improved risk stratification, compared with conventional staging. These findings represent further evidence to support the integration of MP-MRI into prostate adenocarcinoma clinical staging guidelines.

Ecological-niche modeling reveals current opportunities for Agave dryland farming in Sonora, Mexico and Arizona, USA.

For centuries, humans occupying arid regions of North America have maintained an intricate relationship with Agave (Agavoideae, Asparagaceae). Today Agave cultivation, primarily for beverage production, provides an economic engine for rural communities throughout Mexico. Among known dryland-farming methods, the use of rock piles and cattle-grazed areas stand out as promising approaches for Agave cultivation. Identifying new cultivation areas to apply these approaches in Arizona, USA and Sonora, Mexico warrants a geographic assessment of areas outside the known ranges of rock piles and grasslands. The objective of this study was to predict areas for dryland-farming of Agave and develop models to identify potential areas for Agave cultivation. We used maximum entropy (MaxEnt) ecological-niche-modeling algorithms to predict suitable areas for Agave dryland farming. The model was parameterized using occurrence records of Hohokam rock piles in Arizona and grassland fields cultivated with Agave in Sonora. Ten environmental-predictor variables were used in the model, downloaded from the WorldClim 2 climate database. The model identified potential locations for using rock piles as dryland-farming methods from south-central Arizona to northwestern Sonora. The Agave-grassland model indicated that regions from central to southern Sonora have the highest potential for cultivation of Agave, particularly for the species Agave angustifolia. Results suggest that there are many suitable areas where rock piles can be used to cultivate Agave in the Sonoran Desert, particularly in the border of southeastern Arizona and northwest Sonora. Likewise, cattle-grazing grasslands provide a viable environment for cultivating Agave in southern Sonora, where the expanding bacanora-beverage industry continues to grow and where different Agave products (e.g., syrups, fructans, saponins, and medicinal compounds) can potentially strengthen local economies.

Unusual combination of bilateral testicular microlithiasis and tubular ectasia of the rete testis with left intra- and extratesticular varicocele in a 17-year-old boy.

We describe the rare combination of testicular microlithiasis, unilateral intra/extratesticular varicocele, and tubular ectasia of the rete testis in a 17-year-old boy who presented with testicular pain following a trauma. He had a prior history of undescended testis and orchiopexy in childhood. His workup included a normal abdominal ultrasound and a sperm analysis demonstrating a low sperm count with sperm dysmotility. A follow-up ultrasound was unchanged, and he has been managed conservatively. This combined set of findings has not been previously reported.

Spatial distribution of enhanced atrazine degradation across northeastern Colorado cropping systems.

Reports of enhanced atrazine degradation and reduced residual weed control have increased in recent years, sparking interest in identifying factors contributing to enhanced atrazine degradation. The objectives of this study were to (i) assess the spatial distribution of enhanced atrazine degradation in 45 commercial farm fields in northeastern Colorado (Kit Carson, Larimer, Logan, Morgan, Phillips, and Yuma counties) where selected cultural management practices and soil bio-chemo-physical properties were quantified; (ii) utilize Classification and Regression Tree (CART) Analysis to identify cultural management practices and (or) soil bio-chemophysical attributes that are associated with enhanced atrazine degradation; and (iii) translate our CART Analysis into a model that predicts relative atrazine degradation rate (rapid, moderate, or slow) as a function of known management practices and (or) soil properties. Enhanced atrazine degradation was widespread within a 300-km radius across northeastern Colorado, with approximately 44% of the fields demonstrating rapid atrazine degradation activity (laboratory-based dissipation time halflife [DT50] < 3 d). The most rapid degradation rates occurred in fields that received the most frequent atrazine applications. Classification and Regression Tree Analysis resulted in a prediction model that correctly classified soils with rapid atrazine DT50 80% of the time and soils with slow degradation (DT50 > 8 d) 62.5% of the time. Significant factors were recent atrazine use history, soil pH, and organic matter content. The presence/absence of atzC polymerase chain reaction (PCR) product was not a significant predictor variable for atrazine DT50. In conclusion, enhanced atrazine degradation is widespread in northeastern Colorado. If producers know their atrazine use history, soil pH, and OM content, they should be able to identify fields exhibiting enhanced atrazine degradation using our CART Model.

Megafire affects stream sediment flux and dissolved organic matter reactivity, but land use dominates nutrient dynamics in semiarid watersheds.

Climate change is causing larger wildfires and more extreme precipitation events in many regions. As these ecological disturbances increasingly coincide, they alter lateral fluxes of sediment, organic matter, and nutrients. Here, we report the stream chemistry response of watersheds in a semiarid region of Utah (USA) that were affected by a megafire followed by an extreme precipitation event in October 2018. We analyzed daily to hourly water samples at 10 stream locations from before the storm event until three weeks after its conclusion for suspended sediment, solute and nutrient concentrations, water isotopes, and dissolved organic matter concentration, optical properties, and reactivity. The megafire caused a ~2,000-fold increase in sediment flux and a ~6,000-fold increase in particulate carbon and nitrogen flux over the course of the storm. Unexpectedly, dissolved organic carbon (DOC) concentration was 2.1-fold higher in burned watersheds, despite the decreased organic matter from the fire. DOC from burned watersheds was 1.3-fold more biodegradable and 2.0-fold more photodegradable than in unburned watersheds based on 28-day dark and light incubations. Regardless of burn status, nutrient concentrations were higher in watersheds with greater urban and agricultural land use. Likewise, human land use had a greater effect than megafire on apparent hydrological residence time, with rapid stormwater signals in urban and agricultural areas but a gradual stormwater pulse in areas without direct human influence. These findings highlight how megafires and intense rainfall increase short-term particulate flux and alter organic matter concentration and characteristics. However, in contrast with previous research, which has largely focused on burned-unburned comparisons in pristine watersheds, we found that direct human influence exerted a primary control on nutrient status. Reducing anthropogenic nutrient sources could therefore increase socioecological resilience of surface water networks to changing wildfire regimes.

Citizen science reveals unexpected solute patterns in semiarid river networks.

Human modification of water and nutrient flows has resulted in widespread degradation of aquatic ecosystems. The resulting global water crisis causes millions of deaths and trillions of USD in economic damages annually. Semiarid regions have been disproportionately affected because of high relative water demand and pollution. Many proven water management strategies are not fully implemented, partially because of a lack of public engagement with freshwater ecosystems. In this context, we organized a large citizen science initiative to quantify nutrient status and cultivate connection in the semiarid watershed of Utah Lake (USA). Working with community members, we collected samples from ~200 locations throughout the 7,640 km2 watershed on a single day in the spring, summer, and fall of 2018. We calculated ecohydrological metrics for nutrients, major ions, and carbon. For most solutes, concentration and leverage (influence on flux) were highest in lowland reaches draining directly to the lake, coincident with urban and agricultural sources. Solute sources were relatively persistent through time for most parameters despite substantial hydrological variation. Carbon, nitrogen, and phosphorus species showed critical source area behavior, with 10-17% of the sites accounting for most of the flux. Unlike temperate watersheds, where spatial variability often decreases with watershed size, longitudinal variability showed an hourglass shape: high variability among headwaters, low variability in mid-order reaches, and high variability in tailwaters. This unexpected pattern was attributable to the distribution of human activity and hydrological complexity associated with return flows, losing river reaches, and diversions in the tailwaters. We conclude that participatory science has great potential to reveal ecohydrological patterns and rehabilitate individual and community relationships with local ecosystems. In this way, such projects represent an opportunity to both understand and improve water quality in diverse socioecological contexts.

FDG-PET Imaging of Dementia and Neurodegenerative Disease.

Dementia syndromes present a diagnostic challenge given their overlapping clinical features and insidious presentations. Cerebral 2-deoxy-2-[F-18]fluoroglucose (FDG) positron emission tomography (PET) is a functional imaging modality commonly used in the evaluation of dementia. While its role in the clinical assessment of dementia is evolving, FDG PET allows for qualitative and quantitative characterization of major dementia syndromes and variants by means of detecting distinct patterns of cortical hypometabolism. Familiarity with these "metabolic signatures" in dementia syndromes can be helpful when interpreting cerebral FDG PET.

Imaging appearance of cystic and solid mesothelioma of the tunica vaginalis.

We present the case of a 32-year-old male who presented with a growing scrotal mass initially diagnosed as benign adenomatoid tumor on ultrasound 6 years prior. Repeat ultrasound showed an abnormal extra-testicular mass with nodular and cystic components and internal vascularity. A computed tomography scan of the abdomen and pelvis confirmed a right extra-testicular scrotal mass with cystic and solid enhancing components. The patient underwent radical orchiectomy and postoperative pathology diagnosed mesothelioma of the tunica vaginalis of the testis. Mesothelioma of the tunica vaginalis of the testis is an exceptionally rare disease. We discuss the risk factors, imaging features, and treatment strategies of the disease.

Primary Neuroendocrine Tumor of the Ileostomy Stoma on 68Ga-DOTATATE PET/CT.

A 75-year-old man presented with bleeding ileostomy stoma 20 years after total colectomy and end ileostomy for chronic ulcerative colitis. On physical examination, the stoma was mass-like and firm with friable mucosa. Wedge biopsy of the ileostomy stoma revealed well-differentiated neuroendocrine tumor (intermediate grade). Ga-DOTATATE PET/CT showed mass-like focal radiotracer uptake at the ileostomy site without radiotracer-avid lymphadenopathy or distant metastatic disease. No additional sites of neoplasm in the gastrointestinal tract were further identified by endoscopy. The diagnosis of isolated primary neuroendocrine tumor of the ileostomy stoma was confirmed, an extremely rare entity.

Behavior of atrazine in limited irrigation cropping systems in colorado: prior use is important.

Glyphosate-resistant (GR) corn may be a major component of new cropping systems to optimize the use of limited irrigation water supply while sustaining production. Because atrazine is an important tool for residual weed control in GR corn, we examined atrazine binding to soil, dissipation, movement, and early season weed control in limited and full irrigation cropping systems. These systems included continuous corn under conventional tillage and full irrigation (CCC-FI) and under no-tillage and deficit irrigation (CCC-DI), a sunflower-wheat-corn rotation under no-tillage and deficit irrigation (SWC-DI), and a wheat-fallow-wheat-corn rotation under no tillage and natural precipitation (WFWC-NP). Crop rotation and herbicide use history influenced atrazine behavior more than amount or type of irrigation. Atrazine dissipated more rapidly in the top 30 cm of soil in the CCC-FI and CCC-DI plots (half-life [T(1/2)] = 3-12 d), which had received previous applications of the herbicide, compared with the SWC-DI and WFWC-NP plots, which had no history of atrazine use (T(1/2) = 15-22 d). Laboratory assays indicated that the different rates of degradation were at least partly due to differences in microbial degradation in the soil. Atrazine moved the most in the top 30 cm in the SWC-DI and WFWC-NP plots. This greater movement is probably due to the slower rate of atrazine degradation. Studies of the behavior of pre-emergence herbicides in new limited irrigation cropping systems must consider all characteristics of the systems, not just amount and timing of irrigation.

Phosphorus Management in High-Yield Systems.

The discovery and development of phosphorus (P) and P fertilizers provide context for current management conventions. Average crop yields were stagnant before the Green Revolution but have steadily increased since. This, along with conventional P management, has resulted in widely depleting soil P levels. Improved technology and management are needed to meet the increasing P demand. Modern hybrids and cultivars have different P demand and uptake patterns that require changes in conventional P fertilizer placement and timing. Phosphorus fertilizer recommendations based on soil analysis remains valid, but evidence suggests a need for recalibrating soil test P (STP) critical levels (the STP concentration at which a response to P fertilizer would not be expected) and P fertilizer rates to accommodate high-yield scenarios. Considering higher P fertilizer rates as a single solution poses environmental challenges, highlighting the need for improved P use efficiency (PUE). Phosphorus fertilization approaches that have the potential to improve PUE and enable high yields include crop-specific precision placement of P, informed timing of P fertilizers, and new enhanced efficiency sources of P fertilizer. This paper examines these management approaches from historical, production, and environmental perspectives in modern cropping systems.

Massive labial lipomatous hypertrophy in familial partial lipodystrophy seen on computed tomographic angiography.

We present a 28-year-old female with a rare familial partial lipodystrophy. Originally presenting at the age of 14, she began experiencing hypertrophy of the fat in the mons pubis and labia majora regions. By the age of 24 she had disfiguring hypertrophy of these areas with severe fatty overgrowth, similar in nature to that experienced by her father and paternal grandmother. During her workup and planning for suction lipectomy, she underwent computed tomography angiography with the imaging manifestation of severe massive subcutaneous fat hypertrophy; the imaging appearance was only able to be explained after a thorough review of the patient's history and medical literature.

Radiation-Induced Sarcoma on 18F-FDG PET/CT After Treatment of Gorham-Stout Disease of the Maxilla.

Gorham-Stout disease is a rare disorder characterized by proliferation of lymphatic and vascular channels within bone resulting in osteolysis. A 53-year-old man with Gorham-Stout disease involving the left maxilla underwent previous treatment including radiation therapy and intralesional chemotherapeutic injections. He later presented with anemia, facial pain, weight loss, and nasal cavity hemorrhage. CT imaging demonstrated a mass centered within the right maxillary sinus with locoregional involvement. PET/CT showed prominent FDG activity involving the mass centered in the right maxillary sinus with low-grade avidity involving the contralateral maxilla in regions of treated Gorham-Stout disease. Biopsy of the mass confirmed radiation-induced sarcoma.

Sediment potentially controls in-lake phosphorus cycling and harmful cyanobacteria in shallow, eutrophic Utah Lake.

Lakes worldwide are impacted by eutrophication and harmful algal or cyanobacteria blooms (HABs) due to excessive nutrients, including legacy P released from sediments in shallow lakes. Utah Lake (northern Utah, USA) is a shallow lake with urban development primarily on the east side of the watershed, providing an opportunity to evaluate HABs in relation to a gradient of legacy sediment P. In this study, we investigated sediment composition and P concentrations in sediment, pore water, and the water column in relation to blooms of harmful cyanobacteria species. Sediments on the east side of the lake had P concentrations up to 1710 mg/kg, corresponding to elevated P concentrations in pore water (up to 10.8 mg/L) and overlying water column (up to 1.7 mg/L). Sediment P concentrations were positively correlated with Fe2O3, CaO, and organic matter abundance, and inversely correlated with SiO2, demonstrating the importance of sediment composition for P sorption and mineral precipitation. Although the sediment contained <3% Fe2O3 by weight, approximately half of the sediment P was associated with redox-sensitive Fe oxide/hydroxide minerals that could be released to the water column under reducing conditions. Cyanobacteria cell counts indicate that blooms of Aphanizomenon flos-aquae and Dolichospermum flosaquae species tend to occur on the east side of Utah Lake, corresponding to areas with elevated P concentrations in the sediment, pore water, and water column. Our findings suggest that shallow lake eutrophication may be a function of P in legacy sediments that contribute to observed HABs in specific locations of shallow lakes.

Computed Tomographic Angiography of the Abdominal Aorta.

Computed tomographic (CT) angiography (CTA) has become the preferred imaging test of choice for various aortic conditions because of its excellent spatial resolution, rapid image acquisition, and its wide availability. CTA provides a robust tool for planning aortic interventions and diagnosing acute and chronic vascular diseases in the abdomen. CTA is the standard for imaging aneurysms before intervention and evaluating the aorta in the acute setting to assess traumatic injury, dissection, and aneurysm rupture. Knowledge of the imaging features of these disease processes, inflammatory vasculitides, and occlusive atherosclerotic disease is essential for guiding surgical and medical management of patients.

Nuclear Imaging in Metastatic Paraganglioma.

Paragangliomas associated with mutations of the SDHD gene can occasionally result in distant metastasis. Diagnosis can be difficult, and nuclear imaging is used to evaluate the case further. Not all tumors are alike; nuclear avidity may differ. We present a case in which metastatic paraganglioma caused by mutations of the SDHD gene was negative on 123I-metaiodobenzylguanidine scintigraphy and positive on 111In-labeled octreotide scintigraphy. This situation presents an opportunity for a novel therapeutic approach toward metastatic paraganglioma using targeted peptide receptor radionuclide therapy.