Radiomic analysis of patient and inter-organ heterogeneity in response to immunotherapies and BRAF targeted therapy in metastatic melanoma.

Background: Variability in treatment response may be attributable to organ-level heterogeneity in tumor lesions. Radiomic analysis of medical images can elucidate non-invasive biomarkers of clinical outcome. Organ-specific radiomic comparison across immunotherapies and targeted therapies has not been previously reported. Methods: We queried UPMC Hillman Cancer Center registry for patients with metastatic melanoma (MEL) treated with immune checkpoint inhibitors (ICI) (anti-PD1/CTLA4 [ipilimumab+nivolumab; I+N] or anti-PD1 monotherapy) or BRAF targeted therapy. Best overall response was measured using RECIST v1.1. Lesions were segmented into discrete volume-of-interest with 400 radiomics features extracted. Overall and organ-specific machine-learning models were constructed to predict disease control (DC) versus progressive disease (PD) using XGBoost. Results: 291 MEL patients were identified, including 242 ICI (91 I+N, 151 PD1) and 49 BRAF. 667 metastases were analyzed, including 541 ICI (236 I+N, 305 PD1) and 126 BRAF. Across cohorts, baseline demographics included 39-47% female, 24-29% M1C, 24-46% M1D, and 61-80% with elevated LDH. Among patients experiencing DC, the organs with the greatest reduction were liver (-88%±12%, I+N; mean±S.E.M.) and lung (-72%±8%, I+N). For patients with multiple same-organ target lesions, the highest inter-lesion heterogeneity was observed in brain among patients who received ICI while no intra-organ heterogeneity was observed in BRAF. 267 patients were kept for radiomic modeling, including 221 ICI (86 I+N, 135 PD1) and 46 BRAF. Models consisting of optimized radiomic signatures classified DC/PD across I+N (AUC=0.85) and PD1 (0.71) and within individual organ sites (AUC=0.72∼0.94). Integration of clinical variables improved the models' performance. Comparison of models between treatments and across organ sites suggested mostly non-overlapping DC or PD features. Skewness, kurtosis, and informational measure of correlation (IMC) were among the radiomic features shared between overall response models. Kurtosis and IMC were also utilized by multiple organ-site models. Conclusions: Differential organ-specific response was observed across BRAF and ICI with within organ heterogeneity observed for ICI but not for BRAF. Radiomic features of organ-specific response demonstrated little overlap. Integrating clinical factors with radiomics improves the prediction of disease course outcome and prediction of tumor heterogeneity.

Ultrasound and magnetic resonance imaging features of fetal urogenital anomalies: A pictorial essay.

This pictorial essay focuses on ultrasound (US) and magnetic resonance imaging (MRI) features of fetal urogenital anomalies. Fetal urogenital malformations account for 30%-50% of all anomalies discovered during pregnancy or at birth. They are usually detected by fetal ultrasound exams. However, when ultrasound data on their characteristics is insufficient, MRI is the best option for detecting other associated anomalies. The prognosis highly depends on their type and whether they are associated with other fetal abnormalities.

Jugular foramen versus hypoglossal canal in axial CT scan.

Background: Differentiating jugular foramen from hypoglossal canal in computed tomography (CT) scan is vital for correct diagnosis of posterior fossa pathologies; however, it has been shown that the ability for differentiating these skull base elements is limited. The purpose of this study was to produce a simple algorithm for differentiating the jugular foramen from the hypoglossal canal in axial CT scan on two levels (top level where bony carotid canal is evident and lower level where bony carotid canal is not evident). Methods: Data derived from axial CT scan of 250 patients (500 sides) were used for producing algorithm. At top level petro-occipital fissure utilized for recognizing occipital condyle in which hypoglossal canal is located; and, at lower level the distance between the posterior border of the anatomic element (jugular foramen or hypoglossal canal) and the tangent to the anterior bony part is used for producing algorithm. Results: The mean age of patients was 38.1 ± 19 years. The petro-occipital fissure can be used in all patients for differentiating hypoglossal canal. At lower level the distance between the anterior tangent and the posterior border of the element was significantly lower for hypoglossal canal (P value < 0.001). The distance more than 3.5 mm with sensitivity 83.8% and specificity 97.1% differentiate jugular foramen from hypoglossal canal. Conclusion: Simple algorithms based on quantitative morphologic features of the jugular foramen and hypoglossal canal can be used with high sensitivity and specificity to distinguish these elements.

Evaluation of Follow-Up CT Scans in Patients with Severe Initial Pulmonary Involvement by COVID-19.

Objective: To investigate the predictive factors of residual pulmonary opacity on midterm follow-up CT scans in patients hospitalized with COVID-19 pneumonia. Materials and Methods: This prospective study was conducted in a tertiary referral university hospital in Iran, from March 2020 to December 2020. Patients hospitalized due to novel coronavirus pneumonia with bilateral pulmonary involvement in the first CT scan were included and underwent an 8-week follow-up CT scan. Pulmonary involvement (PI) severity was assessed using a 25-scale semiquantitative scoring system. Density of opacities was recorded using the Hounsfield unit (HU). Results: The chest CT scans of 50 participants (mean age = 54.4 ± 14.2 years, 72% male) were reviewed, among whom 8 (16%) had residual findings on follow-up CT scans. The most common residual findings were faint ground-glass opacities (GGOs) (14%); fibrotic-like changes were observed in 2 (4%) patients. Demographic findings, underlying disease, and laboratory findings did not show significant association with remaining pulmonary opacities. The total PI score was significantly higher in participants with remaining parenchymal involvement (14.5 ± 6.5 versus 10.2 ± 3.7; P=0.02). On admission, the HU of patients with remaining opacities was significantly higher (-239.8 ± 107.6 versus -344.0 ± 157.4; P=0.01). Remaining pulmonary findings were more frequently detected in patients who had received antivirals, steroid pulse, or IVIG treatments (P=0.02, 0.02, and 0.001, respectively). Only the PI score remained statistically significant in multivariate logistic regression with 88.1% accuracy (OR = 1.2 [1.01-1.53]; P=0.03). Conclusion: Pulmonary opacities are more likely to persist in midterm follow-up CT scans in patients with severe initial pulmonary involvement.

Percutaneous Sclerotherapy for Giant Symptomatic Liver Hemangiomas: A Pilot Study.

This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%-71.1% lesion volume reduction and a 12.9%-41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.