Highlights • A noninvasive and reliable surrogate method of determining MGMT status could serve to complement brain tumor biopsy or as an alternative in those patients who have a contraindication to ...undergo an invasive procedure. • The significance of magnetic resonance 3D volumetrics and qualitative imaging features for predicting MGMT methylation status in glioblastoma was evaluated (73.6% accuracy achieved). • Our analysis showed that the edema/necrosis volume ratio, tumor/necrosis volume ratio, edema volume, and tumor location and enhancement characteristics were associated with the status of MGMT promoter methylation in glioblastoma. • The results of our study provide further evidence of an association between standard preoperative MRI features and MGMT methylation status in glioblastoma.
Radiomics is the extraction of multidimensional imaging features, which when correlated with genomics, is termed radiogenomics. However, radiogenomic biological validation is not sufficiently ...described in the literature. We seek to establish causality between differential gene expression status and MRI-extracted radiomic-features in glioblastoma.
Radiogenomic predictions and validation were done using the Cancer Genome Atlas and Repository of Molecular Brain Neoplasia Data glioblastoma patients (
= 93) and orthotopic xenografts (OX;
= 40). Tumor phenotypes were segmented, and radiomic-features extracted using the developed radiome-sequencing pipeline. Patients and animals were dichotomized on the basis of Periostin (
expression levels. RNA and protein levels confirmed RNAi-mediated
knockdown in OX. Total RNA of tumor cells isolated from mouse brains (knockdown and control) was used for microarray-based expression profiling. Radiomic-features were utilized to predict
expression status in patient, mouse, and interspecies.
Our robust pipeline consists of segmentation, radiomic-feature extraction, feature normalization/selection, and predictive modeling. The combination of skull stripping, brain-tissue focused normalization, and patient-specific normalization are unique to this study, providing comparable cross-platform, cross-institution radiomic features.
expression status was not associated with qualitative or volumetric MRI parameters. Radiomic features significantly predicted
expression status in patients (AUC: 76.56%; sensitivity/specificity: 73.91/78.26%) and OX (AUC: 92.26%; sensitivity/specificity: 92.86%/91.67%). Furthermore, radiomic features in OX were significantly associated with patients with similar
expression levels (AUC: 93.36%; sensitivity/specificity: 82.61%/95.74%;
= 02.021E-15).
We determined causality between radiomic texture features and
expression levels in a preclinical model with clinical validation. Our biologically validated radiomic pipeline also showed the potential application for human-mouse matched coclinical trials.
Spontaneous urinary collecting system rupture is caused by increased ureteral intraluminal pressure secondary to an obstruction. Rarely, a small stone exerts high intraureteral pressure especially if ...it is located distally. Many management modalities with good outcomes have been implicated.
Herein, we present a case of nontraumatic rupture of the renal calyx due to a 4 mm obstructing stone at the vesicoureteral junction.
CT scan of abdomen and pelvis without contrast, CT scan of the abdomen and pelvis with intravenous contrast, Cystoscopy, Double–J ureter stent, Urinary Foley catheter.
The diagnosis was confirmed by CT imaging. Non-contrast enhanced CT scan of abdomen and pelvis showed obstructive calculi measuring 4 mm in the right vesicoureteral junction. Contrast-enhanced CT scan revealed leakage of contrast in the perinephric space at the right major calyx with intact bilateral ureters, suggestive of calyceal rupture. The treatment involved antibiotics and double-J stenting.
This case demonstrates that spontaneous calyceal rupture should be suspected in urolothiasis patients presenting for a severe pain even if the calculus is small (less than 5 mm) and the laboratory markers are normal. An immediate management is required to relief symptoms and prevent further complications.
•Renal calyceal rupture occurs secondary to a relatively large obstructing ureteral calculus.•High index of suspicion for calyceal rupture should be present even in the scenario of a small urolithiasis.•Contrast enhanced CT scan is vital for the diagnosis.•Management by a double–J ureter stent insertion can yield good clinical outcome.
Glioblastomas are highly infiltrated by diverse immune cells, including microglia, macrophages, and myeloid-derived suppressor cells (MDSCs). Understanding the mechanisms by which ...glioblastoma-associated myeloid cells (GAMs) undergo metamorphosis into tumor-supportive cells, characterizing the heterogeneity of immune cell phenotypes within glioblastoma subtypes, and discovering new targets can help the design of new efficient immunotherapies. In this study, we performed a comprehensive battery of immune phenotyping, whole-genome microarray analysis, and microRNA expression profiling of GAMs with matched blood monocytes, healthy donor monocytes, normal brain microglia, nonpolarized M0 macrophages, and polarized M1, M2a, M2c macrophages. Glioblastoma patients had an elevated number of monocytes relative to healthy donors. Among CD11b
cells, microglia and MDSCs constituted a higher percentage of GAMs than did macrophages. GAM profiling using flow cytometry studies revealed a continuum between the M1- and M2-like phenotype. Contrary to current dogma, GAMs exhibited distinct immunological functions, with the former aligned close to nonpolarized M0 macrophages.
Individual analysis of functional Magnetic Resonance Imaging (fMRI) scans requires user-adjustment of the statistical threshold in order to maximize true functional activity and eliminate false ...positives. In this study, we propose a novel technique that uses radiomic texture analysis (TA) features associated with heterogeneity to predict areas of true functional activity. Scans of 15 right-handed healthy volunteers were analyzed using SPM8. The resulting functional maps were thresholded to optimize visualization of language areas, resulting in 116 regions of interests (ROIs). A board-certified neuroradiologist classified different ROIs into Expected (E) and Non-Expected (NE) based on their anatomical locations. TA was performed using the mean Echo-Planner Imaging (EPI) volume, and 20 rotation-invariant texture features were obtained for each ROI. Using forward stepwise logistic regression, we built a predictive model that discriminated between E and NE areas of functional activity, with a cross-validation AUC and success rate of 79.84% and 80.19% respectively (specificity/sensitivity of 78.34%/82.61%). This study found that radiomic TA of fMRI scans may allow for determination of areas of true functional activity, and thus eliminate clinician bias.
Introduction
The aim of the present study is to assess whether postoperative residual non-enhancing volume (PRNV) is correlated and predictive of overall survival (OS) in glioblastoma (GBM) patients.
...Methods
We retrospectively analyzed a total 134 GBM patients obtained from The University of Texas MD Anderson Cancer Center (training cohort, n = 97) and The Cancer Genome Atlas (validation cohort, n = 37). All patients had undergone postoperative magnetic resonance imaging immediately after surgery. We evaluated the survival outcomes with regard to PRNV. The role of possible prognostic factors that may affect survival after resection, including age, sex, preoperative Karnofsky performance status, postoperative nodular enhancement, surgically induced enhancement, and postoperative necrosis, was investigated using univariate and multivariate Cox proportional hazards regression analyses. Additionally, a recursive partitioning analysis (RPA) was used to identify prognostic groups.
Results
Our analyses revealed that a high PRNV (HR 1.051; p-corrected = 0.046) and old age (HR 1.031; p-corrected = 0.006) were independent predictors of overall survival. This trend was also observed in the validation cohort (higher PRNV: HR 1.127, p-corrected = 0.002; older age: HR 1.034, p-corrected = 0.022). RPA analysis identified two prognostic risk groups: low-risk group (PRNV < 70.2 cm
3
; n = 55) and high-risk group (PRNV ≥ 70.2 cm
3
; n = 42). GBM patients with low PRNV had a significant survival benefit (5.6 months; p = 0.0037).
Conclusion
Our results demonstrate that high PRNV is associated with poor OS. Such results could be of great importance in a clinical setting, particularly in the postoperative management and monitoring of therapy.
Abstract
INTRODUCTION
Radiomics is extraction of multidimensional imaging features which when correlated with genomics is termed radiogenomics. The radiogenomic relationship has never been ...biologically validated. Towards creating a co-clinical glioblastoma treatment paradigm, we sought to establish causality between differential gene expression status and MRI-extracted radiomic-texture features in glioblastoma.
METHODS
Radiogenomic predictions and validation were done using orthotopic xenograft models (n = 40) and the Cancer Genome Atlas glioblastoma patient cohort with matched imaging (n = 94). Tumor phenotypes were segmented and radiomic features extracted using machine learning algorithms. Patients and animals were dichotomized based on Periostin (POSTN) expression levels. RNA and protein levels confirmed RNAi-mediated POSTN knockdown. Total RNAs of tumor cells isolated from mouse brains (knockdown and control) was used for microarray-based expression profiling. Radiomic features were then utilized to predict POSTN expression status in patient and mouse, and interspecies.
RESULTS
Our robust machine learning based analytical pipeline consists of segmentation, radiomic texture extraction, feature normalization and selection, and predictive-model generation. POSTN expression status was not associated with qualitative or volumetric MRI parameters. However, radiomic features significantly predicted POSTN expression status in both patients (AUC 100%, sensitivity/specificity: 100%/100%) and animal model (AUC 95.24%, sensitivity/specificity: 100%/88.88%). Furthermore, texture features in xenografts were significantly associated with humans with similar POSTN expression levels (AUC 74.36%, sensitivity/specificity: 74.42%/87.17%; P-value .0279).
CONCLUSION
We established a high degree of causality between radiomic texture features and POSTN expression levels in a preclinical model with clinical validation. Our biologically validated machine learning-based radiomic pipeline also showed potential application in human-mouse matched co-clinical trials and opens an avenue for the personalized co-clinical glioblastoma treatment paradigm.
Congenital anomalies of the kidney and the urinary tract such as renal agenesis and ectopic ureter have complex development. These anomalies have variable presentations and associations. In this ...report, we highlight the case of a young man with congenital renal agenesis presenting for a urinary tract infection. Abdominal and pelvic computed tomography imaging revealed the rare association of renal agenesis with contralateral ectopic ureter and subsequent hydroureteronephrosis. A urinary tract infection can be the presenting complication of such association, and a long follow-up is needed to anticipate the management.
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