Corresponding ctDNA and tumor burden dynamics in metastatic melanoma patients on systemic treatment.

Radiographic imaging is the current standard for monitoring progression of tumor-burden and therapeutic resistance in patients with metastatic melanoma. Plasma circulating tumor DNA (ctDNA) has shown promise as a survelience tool, but longitudinal data on the dynamics between plasma ctDNA concentrations and radiographic imaging is lacking. We evaluated the relationship between longitudinal radiographic measures of tumor burden and ctDNA concentrations in plasma on 30 patients with metastatic melanoma on systemic treatment. In 9 patients with no radiographic evidence of disease over a total of 15 time points, ctDNA concentrations were undetectable. In 21 patients with radiographic tumor burden, ctDNA was detected in 81 % of 58 time points. Plasma ctDNA concentrations demonstrated a modest positive correlation with total tumor burden (TTB) measurements (R2= 0.49, p < 0.001), with the greatest degree of correlation observed under conditions of progressive disease (PD) (R2 = 0.91, p = 0.032). Plasma ctDNA concentrations were significantly greater at times of RECIST v1.1 progression (PD; 22.1 % ± 5.7 %) when compared to samples collected during stable disease (SD; 4.99 % ± 3.0 %) (p = 0.012); this difference was independent of total tumor burden (p = 0.997). Changes in plasma ctDNA showed a strong correlation with changes in TTB (R2= 0.88, p<0.001). These data suggest that measurements of plasma ctDNA during therapy are a better surrogate for responding versus non-responding disease compared to absolute tumor burden.

The lifesaving effects of cardiac adhesions.

Patients that incur myocardial disruption from penetrating cardiac injuries have an average 6%-10% expectancy rate of reaching the hospital alive. If prompt recognition on arrival is not immediate, the morbidity and mortality are significantly higher due to the secondary physiologic sequalae of either cardiogenic or hemorrhagic shock. Even after a triumphant arrival at a medical facility, out of that 6%-10%, half of those patients are not expected to survive. The unique significance of the presenting case breaks this tradition, expanding past the paradigms and issuing an exceptional understanding of the protective effects that cardiac surgery can futuristically cause through preformed adhesions. In our case, the cardiac adhesions achieved this by containing a penetrating cardiac injury that had caused complete ventricular disruption.

Impact of COVID-19 on Radiology Residency Selection Process: A Survey of Radiology Residency Programs in the US.

RATIONALE AND OBJECTIVES: Virtual residency interviews have become crucial in maintaining CDC-recommended precautionary measures throughout the ongoing COVID-era. However, scant literature exists regarding the direct impact the pandemic has had on the radiology program selection process, including preferred modalities of residency interviews and social media utilization. This survey aimed to understand how radiology programs adapted to changes in the 2020-2021 virtual application cycle. MATERIALS AND METHODS: A 32-question survey was distributed to 194 residency programs between July and August of 2021. Data were analyzed primarily by using descriptive statistics and Paired Student's T-testing. RESULTS: A total of 31 programs completed the survey, yielding a response rate of 16%. When queried about the perceived success of virtual interviews during the 2020-2021 application cycle, 21 programs (68%) said the new interview format was very successful. Twenty-seven of the programs (87%) believed they were able to adequately gauge applicants through virtual interviews. However, when surveyed about personal preferences for interviews, the responses were more evenly distributed between virtual (11/31, 35%) and in-person (14/31, 45%). Pre-COVID, the top three criteria programs used to rank candidates were USMLE Step 1 score (20/31, 65%), letters of recommendation (17/31, 55%), and MSPE (12/31, 39%). Within the virtual, COVID-19 era, these criteria remained statistically unchanged (p = 0.22): USMLE Step 1 score (21/31, 68%), letters of recommendation (17/31, 55%), and MSPE (14/31, 45%). About half of programs who had not previously utilized social media (12 of 23, 52%) created accounts, mostly via Twitter or Instagram. CONCLUSION: The primary findings indicate that programs perceived success with virtually interviewing and ranking applicants, the criteria to rank applicants remain unchanged despite the virtual environment, and programs' social media utilization increased.

Longitudinal Relationship between Idylla Plasma ctBRAF V600 Mutation Detection and Tumor Burden in Patients with Metastatic Melanoma.

BACKGROUND: Circulating tumor DNA (ctDNA) may complement radiography for interim assessment of patients with cancer. OBJECTIVE: Our objective was to explore the relationship between changes in plasma ctDNA versus radiographic imaging among patients with metastatic melanoma. METHODS: Using the Idylla system, we measured B-Raf proto-oncogene (BRAF) V600 ctDNA in plasma from 15 patients with BRAF V600E/K-positive primary tumors undergoing standard-of-care monitoring, including cross-sectional computed tomography (CT) imaging. BRAF V600 mutant allele frequency (%MAF) was calculated from the Idylla Cq values and directly measured using droplet digital polymerase chain reaction (ddPCR). RESULTS: The Idylla ctDNA assay demonstrated 91% sensitivity, 96% specificity, 91% positive predictive value, and 96% negative predictive value for the presence of > 93 mm metastatic disease. Qualitative ctDNA results corresponded to changes in RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 status determined by CT imaging in 11 of 15 subjects (73%). Calculated %MAF results correlated with ddPCR (R2 = 0.94) and provided evidence of progressive disease 55 and 97 days in advance of CT imaging for two subjects with persistently positive qualitative results. CONCLUSIONS: Overall, interim ctDNA results provided evidence of partial response or progressive disease an average of 82 days before radiography. This pilot study supports the feasibility of using the Idylla plasma BRAF V600 ctDNA assay as a complement to CT scanning for routine monitoring of therapeutic response. Somatic mutation quantification based on Cq values shows promise for identifying disease progression and warrants further validation.

Iliocaval fistula with high output cardiac failure.

Fistulous communications between the common iliac arteries and inferior vena cava are very uncommon and usually occur as a result of trauma, aneurysmal rupture, or endovascular repair. They can present with signs of high output cardiac failure including hypotension, venous congestion, and pulmonary hypertension. This case outlines the utility of CTA in diagnosing iliocaval fistulas and the importance of considering this diagnosis in a patient with signs of right heart strain and high output cardiac failure.

Early nontumorous CT findings after irreversible electroporation of locally advanced pancreatic cancer.

PURPOSE: The use of irreversible electroporation (IRE) has been a relatively recent development in the palliative treatment of locally advanced pancreatic cancer. With CT as a key modality in patient follow-up, recognition of nontumorous imaging findings is paramount after IRE. METHODS: A retrospective review of patients having undergone IRE for locally advanced pancreatic adenocarcinoma was performed. A total of 36 patients met inclusion criteria and their imaging studies were reviewed by two radiologists. Nontumorous abnormalities identified in the peri-electroporation bed on Computed Tomography (CT) during the early postoperative period (within 30 days) were characterized and classified into categories. RESULTS: Our results indicate that the most common nontumorous findings in the peri-electroporation bed were vascular, followed by changes involving the gastrointestinal tract, peritoneal cavity, and, infrequently, the biliary tree. CONCLUSIONS: Interpretation of CT imaging of the postoperative peri-electroporation bed is challenging. This review of CT findings allows the radiologist to recognize and anticipate significant nontumorous findings in the peri-electroporation bed during early follow-up after IRE.

CT Findings of Patients Treated with Irreversible Electroporation for Locally Advanced Pancreatic Cancer.

Introduction. In patients with locally advanced pancreatic cancer (LAPC), IRE has been shown to be safe for local disease control and palliation. As IRE continues to gain acceptance it is important to characterize the expected imaging findings. Materials and Methods. A review of our prospective soft tissue ablation registry from July 2010 to June 2013 was performed on patients who had undergone IRE for LAPC. Five masses treated with intraoperative IRE ablation for pancreatic tumors that underwent CT imaging before and after ablation were reviewed. Results and Discussion. Following IRE, the postablation bed is larger than the original ablated tumor. This ablation zone may get smaller in size (due to decreased edema and hyperemia) in the following months and more importantly remains stable provided there is no recurrence. In cases of recurrent disease there is increased size of the ablation bed, mass effect, and new or worsening vascular encasement or occlusion. Conclusion. CT imaging remains the best current imaging modality to assess post-IRE ablation changes. Serial imaging over at least 2-6 months must be employed to detect recurrence by comparing with prior studies in conjunction with clinical and serum studies. Larger imaging studies are underway to evaluate a more ideal imaging modality for this unique patient population.