Treatment options for patients who develop brain metastases secondary to non-small-cell lung cancer have rapidly expanded in recent years. As a key adjunct to surgical and radiation therapy options, ...systemic therapies are now a critical component of the oncologic management of metastatic CNS disease in many patients with non-small-cell lung cancer. The aim of this review article was to provide a guide for radiologists, outlining the role of systemic therapies in metastatic non-small-cell lung cancer, with a focus on tyrosine kinase inhibitors. The critical role of the blood-brain barrier in the development of systemic therapies will be described. The final sections of this review will provide an overview of current imaging-based guidelines for therapy response. The utility of the Response Assessment in Neuro-Oncology criteria will be discussed, with a focus on how to use the response criteria in the assessment of patients treated with systemic and traditional therapies.
•3D-printing technology can be used to design customized phantoms.•Virtual monoenergetic images boost iodine-associated attenuation.•This contrast boost improves visualization of hypodense liver ...lesions as well.•VMI should be considered when screening after focal liver lesions.
The well-known boost of iodine associated-attenuation in low-keV virtual monoenergetic images (VMI_low) is frequently used to improve visualization of lesions and structures taking up contrast media. This study aimed to evaluate this concept in reverse. Hence to investigate if increased attenuation within the liver allows for improved visualization of little or not-enhancing lesions.
A 3D-printed phantom mimicking the shape of a human liver exhibiting a lesion in its center was designed and printed. Both, parenchyma- and lesion-mimic were filled with different solutions exhibiting 80/100/120HU and 0/15/40/60HU, respectively. Further, a total of 74 contrast-enhanced studies performed on a spectral detector CT scanner (SDCT) were included in this retrospective study. Patients had MRI or follow-up proven cysts and/or hypodense metastases. VMI of 40–200 keV as well as conventional images (CI) were reconstructed. ROI were placed in lesion and parenchyma(-mimics) on CI and transferred to VMI. Signal- and contrast-to-noise ratio were calculated (S-/CNR). Further, two radiologists independently evaluated image quality. Data was statistically assessed using ANOVA or Wilcoxon-test.
In phantoms, S/CNR was significantly higher in VMI_low. The cyst-mimic in highly attenuating parenchyma-mimic on CI yielded a CNR of 6.4 ± 0.8; using VMI_40 keV, mildly hypodense lesion-mimic in poorly attenuating parenchyma-mimic exhibited a similar CNR (5.8 ± 0.9; p ≤ 0.05). The same tendency was observed in patients (cyst in CI/metastasis in VMI_40 keV: 4.4 ± 1.2/3.9 ± 1.8; p ≤ 0.05). Qualitative analysis indicated a benefit of VMI_40 keV (p ≤ 0.05).
VMI_low from SDCT allow for an improved visualization of hypodense focal liver lesions exploiting the concept of contrast blooming in reverse.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
We have derived a formula for calculating the polarization state of the Lyman-α line in plasma caused by anisotropy in the electron velocity distribution function. Calculation results under the ...condition of the magnetically confined fusion plasma show that the longitudinal alignment of 0.01 is caused by approximately 10%-20% difference in the electron temperature in the directions parallel and perpendicular to the magnetic field. It is also found that the polarization decreases with the increasing electron density, ne, due to the collisional population averaging effect over the magnetic sublevels in the range of ne > 1018 m−3 and is virtually extinguished at ne = 1021 m−3.
Aim To determine the patterns of metastasis and recurrence in thymic epithelial tumours based on longitudinal imaging studies, and to correlate the patterns with World Health Organization (WHO) ...histological classifications. Materials and methods Seventy-seven patients with histopathologically confirmed thymomas ( n =62) and thymic carcinomas ( n =15) who were followed with cross-sectional follow-up imaging after surgery were retrospectively studied. All cross-sectional imaging studies during the disease course were reviewed to identify metastasis or recurrence. The sites of involvement and the time of involvement measured from surgery were recorded. Results Metastasis or recurrence was noted in 24 (31%) of the 77 patients. Patients with metastasis or recurrence were significantly younger than those without (median age: 46 versus 60, respectively; p =0.0005), and more commonly had thymic carcinomas than thymomas ( p =0.002). The most common site of involvement was the pleura (17/24), followed by the lung (9/24), and thoracic nodes (9/24). Abdominopelvic involvement was noted in 12 patients, most frequently in the liver ( n =8). Lung metastasis was more common in thymic carcinomas than thymomas ( p =0.0005). Time from surgery to the development of metastasis or recurrence was shortest in thymic carcinoma, followed by high-risk thymomas, and was longest in low-risk thymoma (median time in months: 25.1, 68.8, and not reached, respectively; p =0.0015). Conclusions The patterns of metastasis and recurrence of thymic epithelial tumours differ significantly across histological subgroups, with thymic carcinomas more commonly having metastasis with shorter length of time after surgery. The knowledge of different patterns of tumour spread may contribute to further understanding of the biological and clinical behaviours of these tumours.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract
We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible ...and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar
1+
line emissions at 472.69 nm (3p
4
4s
2
P
3/2
–3p
4
4p
2
D
3/2
), 473.59 nm (3p
4
4s
4
P
5/2
–3p
4
4p
4
P
3/2
), 476.49 nm (3p
4
4s
2
P
1/2
–3p
4
4p
2
P
3/2
), 480.60 nm (3p
4
4s
4
P
5/2
–3p
4
4p
4
P
5/2
) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar
13+
line emission at 18.79 nm (2s
2
2p
2
P
3/2
–2s2p
2
2
P
3/2
) and Ar
14+
line emission at 22.11 nm (2s
2
1
S
0
–2s2p
1
P
1
). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar
1+
emission and the line intensity ratio of Ar
13+
and Ar
14+
ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m
2
/s and ~ 0.3 m
2
/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The purpose of this review is to familiarise radiologists with the spectrum of hepatic toxicity seen in the oncology setting, in view of the different systemic therapies used in cancer patients. ...Drug-induced liver injury can manifest in various forms, and anti-neoplastic agents are associated with different types of hepatotoxicity. Although chemotherapy-induced liver injury can present as hepatitis, steatosis, sinusoidal obstruction syndrome, and chronic parenchymal damages, molecular targeted therapy-associated liver toxicity ranges from mild liver function test elevation to fulminant life-threatening acute liver failure. The recent arrival of immune checkpoint inhibitors in oncology has introduced a new range of immune-related adverse events, with differing mechanisms of liver toxicity and varied imaging presentation of liver injury. High-dose chemotherapy regimens for haematopoietic stem cell transplantation are associated with sinusoidal obstruction syndrome. Management of hepatic toxicity depends on the clinical scenario, the drug in use, and the severity of the findings. In this article, we will (1) present the most common types of oncological drugs associated with hepatic toxicity and associated liver injuries; (2) illustrate imaging findings of hepatic toxicities and the possible differential diagnosis; and (3) provide a guide for management of these conditions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Imaging plays an active role in the surveillance of gastrointestinal stromal tumours (GISTs). Risk stratification schemes, based on size, mitotic count, and anatomical site of origin of the GIST, ...help in planning preoperative and postoperative imaging strategies especially in determining the frequency and duration of surveillance; however, there is no clear consensus on the optimal imaging strategies in patients with GISTs who are completely cured by surgery and patients who are at risk of recurrence. In addition, current surveillance protocols depend on the resectability of the primary tumour and presence of metastatic disease. The objective of this article is to provide a comprehensive review of the role of the different imaging methods for surveillance of GISTs, focusing on the guidelines recommended by National Comprehensive Cancer Network and European Society of Medical Oncology – European Network for Rare adult solid Cancers, and to propose practical guidelines for surveillance of GISTs for various risk categories.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Objective To describe the pattern of dedifferentiated liposarcoma (DDLPS) metastases and to analyze their predictors and outcome. Materials and methods In this retrospective study, we ...reviewed the imaging and clinical records of all consenting patients with histopathology-confirmed DDLPS seen from 2000 through 2012. The predictive value of clinical and histopathologic parameters for metastasis later in the disease course was analyzed using univariate and multivariate analyses. Survival of patients with and without metastasis was compared using Log-rank test. Results Records of 148 patients (57 women, 91 men; mean age 59 years, range 30–87 years) were reviewed. Distant metastases were observed in 44/148 patients (29.7%), 9/44 (20.5%) at presentation and 35/44 (79.5%) developing them later at a median interval of 8 months (IQR = 0.80–26 months). Median duration of follow-up was 38 months (IQR = 18–74 months) with 77/148 patients (31 with metastases) deceased at the time of analysis. Median survival was 28 months (IQR = 10–56 months) for patients with metastases and 38 months (IQR, 17–65 months) for patients without metastases (p = 0.0123, Log-Rank test; Hazard ratio 1.79 95% confidence interval 1.11–2.84). Lung was the most common site of metastases (33 patients, 22.3%). On univariate analysis, grade and local recurrence were associated with subsequent risk of metastasis where as age, tumor size, site, de novo dedifferentiation, number of previous surgical resections, margin positivity and chemoradiation were not. On multivariate analysis, high tumor grade (p-value = 0.0005, OR 5.05; 95% CI 2.01–13.48) and local recurrence (p-value = 0.0025, OR 4.46; 95% CI 1.67–13.40) predicted metastasis. Conclusion Lung was most frequent site of DDLPS metastases. Risk of developing metastatic disease was statistically associated with tumor grade and local recurrence. Metastatic disease was associated with decreased survival.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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