Toll-Like Receptor 4 Agonist Injection With Concurrent Radiotherapy in Patients With Metastatic Soft Tissue Sarcoma: A Phase 1 Nonrandomized Controlled Trial.

Importance: Metastatic soft tissue sarcomas (STSs) have limited systemic therapy options, and immunomodulation has not yet meaningfully improved outcomes. Intratumoral (IT) injection of the toll-like receptor 4 (TLR4) agonist glycopyranosyl lipid A in stable-emulsion formulation (GLA-SE) has been studied as immunotherapy in other contexts.

Objective: To evaluate the safety, efficacy, and immunomodulatory effects of IT GLA-SE with concurrent radiotherapy in patients with metastatic STS with injectable lesions.

MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study.

Objectives: A watch and wait strategy with the goal of organ preservation is an emerging treatment paradigm for rectal cancer following neoadjuvant treatment. However, the selection of appropriate patients remains a challenge. Most previous efforts to measure the accuracy of MRI in assessing rectal cancer response used a small number of radiologists and did not report variability among them.

CT perfusion as a potential biomarker for pancreatic ductal adenocarcinoma during routine staging and restaging.

Purpose: To evaluate the significance of CT perfusion parameters predicting response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma (PDAC).

Materials And Methods: Seventy patients with PDAC prospectively had CT perfusion acquisition incorporated into baseline multiphase staging CT. Twenty-eight who were naïve to therapy were retained for further investigation.

Virtual Unenhanced Dual-Energy CT Images Obtained with a Multimaterial Decomposition Algorithm: Diagnostic Value for Renal Mass and Urinary Stone Evaluation.

Background Virtual unenhanced (VUE) images obtained by using a dual-energy CT (DECT) multimaterial decomposition algorithm hold promise for diagnostic use in the abdomen in lieu of true unenhanced (TUE) images. Purpose To assess VUE images obtained from a DECT multimaterial decomposition algorithm in patients undergoing renal mass and urinary stone evaluation. Materials and Methods In this retrospective Health Insurance Portability and Accountability Act-compliant study, DECT was performed in patients undergoing evaluation for renal mass or urinary stone.

Durable tumor regression in highly refractory metastatic wild-type GIST following treatment with nivolumab.

Gastrointestinal stromal tumor (GIST) is a devastating disease, especially in the setting of metastasis. The natural progression of GIST has been significantly altered by the development of small molecule tyrosine kinase inhibitors (TKIs), including imatinib, sunitinib, and regorafenib, all of which are FDA approved. However, TKIs are not always well-tolerated, and the refractory disease continues to be a problem.

Patterns of distant metastases in 215 Merkel cell carcinoma patients: Implications for prognosis and surveillance.

Approximately one-third of Merkel cell carcinoma (MCC) patients eventually develop distant metastatic disease. Little is known about whether the location of the primary lesion is predictive of initial distant metastatic site, or if survival likelihood differs depending on the metastatic site. Such data could inform imaging/surveillance practices and improve prognostic accuracy.

Imaging of Abdominal Postoperative Complications.

We present a case-based review of abdominal postoperative complications, organized by organ system affected, including wound/superficial, hepatobiliary, pancreatic, gastrointestinal, genitourinary, and vascular complications. Both general complications and specific considerations for certain types of operations are described, as well as potential pitfalls that can be confused with complications. Representative cases are shown using all relevant imaging modalities, including CT, fluoroscopy, ultrasound, MRI, and nuclear medicine.

Bridging the Radiation Oncology and Diagnostic Radiology Communication Gap: A Survey to Determine Usefulness and Optimal Presentation of Radiotherapy Treatment Plans for Radiologists.

Rationale And Objectives: We hypothesized that providing visual-spatial information to radiologists on where radiation has been delivered in an easily accessible way may improve the accuracy of image interpretation and thereby improve quality of patient care. We present a national representation of radiologists' opinions regarding the usefulness and optimal approach for implementing a system to promote access to radiotherapy (RT) plans.

Methods: An anonymous survey was sent to the members of the Association of University Radiologists.

CT Detectability of Small Low-Contrast Hypoattenuating Focal Lesions: Iterative Reconstructions versus Filtered Back Projection.

Purpose To investigate performance in detectability of small (≤1 cm) low-contrast hypoattenuating focal lesions by using filtered back projection (FBP) and iterative reconstruction (IR) algorithms from two major CT vendors across a range of 11 radiation exposures. Materials and Methods A low-contrast detectability phantom consisting of 21 low-contrast hypoattenuating focal objects (seven sizes between 2.4 and 10.

Adnexal lesions detected on CT in postmenopausal females with non-ovarian malignancy: do simple cysts need follow-up?

Purpose: To assess whether CT morphology of adnexal lesions in postmenopausal women with history of non-ovarian cancer could be used to discriminate benign and malignant lesions, particularly focusing on applicability of the ACR criteria.

Materials And Methods: This was an IRB-approved HIPAA-compliant retrospective review of contrast-enhanced CTs of 199 women, 55 years and older. Lesions were classified as simple cystic, complex cystic, solid-cystic, or solid based on CT morphology, and were diagnosed as benign, indeterminate, or malignant on follow-up imaging or pathology.

A Checklist Manifesto: Effectiveness of Checklist Use in Hands-On Simulation Examining Competency in Contrast Reaction Management in a Randomized Controlled Study.

Objective: The purpose of this article is to assess the performance of a contrast reaction management checklist for optimal management of a contrast reaction scenario created using a high-fidelity hands-on simulation.

Materials And Methods: A safety checklist was designed that presented the five adverse events that most commonly occur after administration of IV contrast medium as well as their step-by-step management. Forty-three radiology residents were randomized into two groups, a checklist group (n = 22) and a control group (n = 21), as stratified by postgraduate year.

Imaging characterization of adnexal lesions: Do CT findings correlate with US?

Objective: To compare contrast-enhanced CT and US agreement in characterizing adnexal lesions in late post-menopausal women.

Materials And Methods: This was a HIPAA-compliant IRB-approved retrospective review of the contrast-enhanced CTs of 130 late post-menopausal women (> 55 years). The lesions were classified as simple cystic, minimally complex cystic, complex cystic, solid-cystic, or solid based on CT and US morphology.

First-in-Human Treatment With a Dendritic Cell-targeting Lentiviral Vector-expressing NY-ESO-1, LV305, Induces Deep, Durable Response in Refractory Metastatic Synovial Sarcoma Patient.

Effective induction of antitumor T cells is a pivotal goal of cancer immunotherapy. To this end, lentiviral vectors (LV) are uniquely poised to directly prime CD8 T-cell responses via transduction of dendritic cells in vivo and have shown promise as active cancer therapeutics in preclinical tumor models. However, until now, significant barriers related to production and regulation have prevented their widespread use in the clinic.

Prospective comparison of dual-energy CT aortography using 70% reduced iodine dose versus single-energy CT aortography using standard iodine dose in the same patient.

Purpose: To compare dual-energy computed tomography (DECT) aortography using a 70% reduced iodine dose to single-energy CT (SECT) aortography using a standard iodine dose in the same patient.

Methods: Twenty-one patients with a prior SECT aortography using standard iodine dose had DECT aortography using 70% reduced iodine dose. Section 120 kVp images were compared to DECT images reconstructed at both 50 and 77 keV.

Comparative Effectiveness of Hands-on Versus Computer Simulation-Based Training for Contrast Media Reactions and Teamwork Skills.

Purpose: To assess the performance of interprofessional teams of radiologists, technologists, and nurses trained with high-fidelity hands-on (HO) simulation and computer-based (CB) simulation training for contrast reaction management (CR) and teamwork skills (TS).

Methods: Nurses, technologists, and radiology residents were randomized into 11 teams of three (one of each). Six teams underwent HO training and five underwent CB training for CR and TS.

Why Thyroid Surgeons Are Frustrated with Radiologists: Lessons Learned from Pre- and Postoperative US.

Optimal treatment of thyroid cancer is highly dependent on accurate staging of the extent of disease at presentation. Preoperative ultrasonography (US) is the most sensitive method for detecting metastatic lymph nodes and is recommended as part of the standard preoperative workup. Missed findings on preoperative scans may lead to understaging and inadequate surgical management, which subsequently predispose these patients to residual disease postoperatively and a higher risk for recurrence, possibly requiring repeat surgery.

The Reliability of a Standardized Reporting System for the Diagnosis of Appendicitis.

Purpose: Computed tomography (CT) is a fast and ubiquitous tool to evaluate intra-abdominal organs and diagnose appendicitis. However, traditional CT reporting does not necessarily capture the degree of uncertainty and indeterminate findings are still common. The purpose of this study was to evaluate the reproducibility of a standardized CT reporting system for appendicitis across a large population and the system's impact on radiologists' certainty in diagnosing appendicitis.

Soft-Tissue Sarcomas: An Update for Radiologists Based on the Revised 2013 World Health Organization Classification.

Objective: Soft-tissue sarcomas are a diverse group of malignancies, and our rapidly improving understanding of their molecular pathogenesis and treatment is leading to better clinical outcomes. The revised 2013 World Health Organization (WHO) classification of soft-tissue sarcomas introduced several important changes. We provide a comprehensive overview of the relevant changes for radiologists.

Imaging of Pancreas Transplantation and Its Complications.

Whole pancreas transplantation is an effective treatment for obtaining euglycemic status in patients with insulin-dependent diabetes mellitus, and is usually performed concurrent with renal transplantation in the affected patient. This article discusses complex surgical anatomical details of pancreas transplantation including surgical options for endocrine and exocrine drainage pathways. It then describes several possible complications related to surgical factors in the immediate post operative period followed by other complications related to systemic issues, vasculature, and the pancreatic parenchyma.

Computed Tomography Angiography for Preoperative Thoracoabdominal Flap Planning.

Mastectomy rates have increased, coinciding with more advanced reconstruction options. Deep inferior epigastric perforator (DIEP) flaps decrease abdominal donor site morbidity, but require considerable technical expertise. Preoperative computed tomography angiography (CTA) can accurately demonstrate DIEA anatomy and perforator courses, facilitating preoperative planning and flap design, allowing for more targeted intraoperative microdissection.

Perceived Barriers to the Use of High-Fidelity Hands-On Simulation Training for Contrast Reaction Management: Why Programs are Not Using It.

Although subjective and objective benefits of high-fidelity simulation have been reported in medicine, there has been slow adoption in radiology. The purpose of our study was to identify the perceived barriers in the use of high-fidelity hands-on simulation for contrast reaction management training. An IRB exempt 32 questions online web survey was sent to 179 non-military radiology residency program directors listed in the Fellowship and Residency Electronic Interactive Database Access system (FREIDA).

Rectal imaging: part 2, Perianal fistula evaluation on pelvic MRI--what the radiologist needs to know.

Objective: The purpose of this article is to provide an overview of pelvic MRI for the evaluation of perianal fistulas, with a description of the technique, illustration of relevant normal anatomy, and examples of various fistula types.

Conclusion: MRI evaluation of perianal fistulas can be challenging, and knowledge of relevant pelvic anatomy and fistula classification remains crucial in the diagnosis. MRI is highly accurate for fistula depiction and, by providing an accurate assessment of disease status and extension, can help surgical planning to minimize recurrence and detect clinically unapparent disease.

A survey on the use of premedication prior to iodinated and gadolinium-based contrast material administration.

Purpose: The aim of this study was to assess Society of Uroradiology member use of premedication before the intravenous administration of low-osmolality iodinated contrast materials (LOCM) and gadolinium-based contrast materials (GBCM).

Methods: Society of Uroradiology members were invited to complete a Web-based survey concerning the use of premedication. The survey included scenarios concerning intravenous LOCM or GBCM injection in which respondents were asked whether they would recommend premedication or withhold contrast material injection.