Medical Specialties Commons^™

Intrahepatic Cholangiocarcinoma Presenting As Li-Rads 5 "Hcc", Raja K. Dhanekula, Md, Donald Mitchell, Md, John Farber, Md, Ashwin R. Sama, Md, Jesse M. Civan, Md

Division of Gastroenterology and Hepatology Posters

Background

• Hepatocellular Carcinoma (HCC), if within Milan Criteria, is an indication for liver transplantation.

• In contrast, intrahepatic cholangiocarcinoma (IHCC) is a contra-indication to liver transplantation due to high rates of recurrence.

• LI-RADS 5 classification (synonymous with OPTN-5) carries a near 100% positive predictive value for HCC, allowing prioritization of patients for liver transplantation without histological confirmation.

• The “LI-RADS M” classification indicates the presence of malignancy not meeting diagnostic criteria for HCC. In theory, IHCC lesions should be identified as LI-RADS M and not LI-RADS 5.

Numerical Investigation Of Novel Microwave Applicators Based On Zero-Order Mode Resonance For Hyperthermia Treatment Of Cancer, David Vrba, Jan Vrba, Dario B. Rodrigues, Paul R. Stauffer

Department of Radiation Oncology Faculty Papers

This paper characterizes three novel microwave applicators based on zero-order mode resonators for use in hyperthermia treatment of cancer. The radiation patterns are studied with numerical simulations in muscle tissue-equivalent model at 434 MHz. The relative performance of the applicators is compared in terms of reflection coefficient, current distribution, power deposition (SAR) pattern, effective field size in 2D and 3D tissue volumes, and penetration depth. One particular configuration generated the most uniform SAR pattern, with 25% SAR covering 84 % of the treatment volume extending to 1 cm depth under the aperture, while remaining above 58% coverage as deep as …

Pulse Shaping For Improved Diagnosis Of Portal Hypertension Using Subharmonic Aided Pressure Estimation, Ipshita Gupta, John R. Eisenbrey, Maria Stanczak, Anush Sridharan, Jaydev K. Dave, Ji-Bin Liu, Christopher Hazard, Colette Shaw, Susan Shamini-Noori, Jonathan M. Fenkel, Michael Soluen, Chandra Sehgal, Kirk Wallace, Flemming Forsberg

Department of Radiology Posters

Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of contrast microbubbles (obtained by transmitting at the fundamental frequency fo and receiving at fo/2) and the ambient pressure (see fig.1).

A noninvasive ultrasound based pressure estimation procedure would be a major development in the diagnosis of portal hypertension and less invasive than the current catheter-based hepatic venous pressure gradient (HVPG) measurement.

The hypothesis of this study was that portal vein pressures can be monitored and quantified noninvasively in humans using SHAPE.

First selected waveforms were optimized in vitro and in canines, then SHAPE was …

Conversion Of Intermediate Lirads Categories To Hepatocellular Carcinoma In Patients With Chronic Hepatitis B: Korean Immigrant Experience, Kofi-Buaku Atsina, Md, Zhenteng Li, Md, Sandeep Deshmukh, Md

Department of Radiology Posters

Introduction and Objective

The Liver Imaging Reporting and Data System (LIRADS) was created to standardize the reporting and data collection of MR imaging for hepatocellular carcinoma (HCC) in high risk patients. The major categories for LIRADS have the following descriptors:

LI-RADS 1 = Definitely benign

LI-RADS 2 = Probably benign

LI-RADS 3 = Intermediate probability for HCC

LI-RADS 4 = Probably HCC

LI-RADS 5 = Definitely HCC

LI-RADS 5V = Definitely HCC with tumor in vein

LI-RADS M = Probable malignancy, not specific for HCC

LI-RADS T = Treated Observation

However, there is a paucity of quantitative evidence for the …

Four-Dimensional (4d) Subharmonic Aided Pressure Estimation For Monitoring Neoadjuvant Chemotherapy Response Of Breast Cancer, Kibo Nam, Maria Stanczak, Anush Sridharan, Adam C. Berger, Tiffany Avery, John R. Eisenbrey, Flemming Forsberg

Department of Radiology Posters

Introduction

Neoadjuvant chemotherapy is a well-established treatment option for patients with non-metastatic breast cancer. The patient response is correlated with survival. However, the optimal method for monitoring neoadjuvant therapy response has not been established. One factor that may affect the response of neoadjuvant therapy is the interstitial fluid pressure (IFP). Increased IFP prevents an effective delivery of therapeutic agents and reduces the efficacy of the therapy. Recently, subharmonic-aided pressure estimation (SHAPE) using contrast-enhanced ultrasound (CEUS) has been developed and its potential was demonstrated in animals as a non-invasive technique for IFP measurements. The SHAPE method estimates IFP based on the …

Dosimetric Validation For An Automatic Brain Metastases Planning Software Using Single-Isocenter Dynamic Conformal Arcsdosimetric Validation For An Automatic Brain Metastases Planning Software Using Single-Isocenter Dynamic Conformal Arcs., Haisong Lui, Jun Li, Evangelos Pappas, David W. Andrews, James J. Evans, Maria Werner-Wasik, Yan Yu, Adam Dicker, Wenyin Shi

Department of Radiation Oncology Faculty Papers

An automatic brain-metastases planning (ABMP) software has been installed in our institution. It is dedicated for treating multiple brain metastases with radiosurgery on linear accelerators (linacs) using a single-setup isocenter with noncoplanar dynamic conformal arcs. This study is to validate the calculated absolute dose and dose distribution of ABMP. Three types of measurements were performed to validate the planning software: 1, dual micro ion chambers were used with an acrylic phantom to measure the absolute dose; 2, a 3D cylindrical phantom with dual diode array was used to evaluate 2D dose distribution and point dose for smaller targets; and 3, …

Bone Mineral Density In Mucopolysaccharidosis Ivb, Francyne Kubaski, Heidi H. Kecskemethy, Howard T. Harcke, Shunji Tomatsu

Department of Radiology Faculty Papers

To date, the only published reports of bone mineral density (BMD) in MPS IV involve patients with MPS IVA; no reports exist describing BMD for MPS IVB. In this prospective study of BMD in three patients with MPS IVB, BMD was acquired by dual-energy X-ray absorptiometry (DXA) at whole body (WB), lumbar spine (LS), and lateral distal femur (LDF). Functional abilities, ambulatory status, medical history, and height z-score were evaluated. Three patients with MPS IVB (two females), aged 17.7, 31.4 and 31.7 years, were evaluated. Every patient was ambulatory and one sustained two fractures caused by trauma. Whole body and …

Safety Of Lobar Hepatic Arterial Embolization In Metastatic Uveal Melanoma Patients With Underlying Gilbert's Disease, David C. Feldstein, Md, Robert D. Adamo, Md, Carin F. Gonsalves, Md, Fsir, David J. Eschelman, Ms, Fsir, Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pa, Takami Sato, Md, Phd

Department of Medical Oncology Posters

Introduction

❖ Uveal melanoma is the most common primary intraocular malignant tumor in adults.

❖ Up to half of all patients develop systemic metastases, with liver involvement in >90% of patients.¹

❖ Various liver-directed, locoregional therapies (i.e. chemoembolization, immunoembolization, radioembolization, and ablation) have played a significant role in prolonging the lives of patients with metastatic uveal melanoma.²

❖ Elevated bilirubin levels are typically considered a relative contraindication for lobar hepatic arterial embolization treatment, given mainly the increased risk of precipitating hepatic failure.

❖ Gilbert's syndrome, also known as benign unconjugated hyperbilirubinemia, is a hereditary disorder of bilirubin conjugation. …

Hepatocellular Carcinoma After Locoregional Therapy: Magnetic Resonance Imaging Findings In Falsely Negative Exams., David Becker-Weidman, Jesse M. Civan, Sandeep P. Deshmukh, Christopher G. Roth, Steven K. Herrine, Laurence Parker, Donald G. Mitchell

Division of Gastroenterology and Hepatology Faculty Papers

AIM: To elucidate causes for false negative magnetic resonance imaging (MRI) exams by identifying imaging characteristics that predict viable hepatocellular carcinoma (HCC) in lesions previously treated with locoregional therapy when obvious findings of recurrence are absent.

METHODS: This retrospective institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study included patients who underwent liver transplantation at our center between 1/1/2000 and 12/31/2012 after being treated for HCC with locoregional therapy. All selected patients had a contrast-enhanced MRI after locoregional therapy within 90 d of transplant that was prospectively interpreted as without evidence of residual or recurrent tumor. Retrospectively, 2 …

Thermal Dosimetry For Bladder Hyperthermia Treatment. An Overview., Gerben Schooneveldt, Akke Bakker, Edmond Balidemaj, Rajiv Chopra, Johannes Crezee, Elisabeth D. Geijsen, Josefin Hartmann, Maarten C.C.M. Hulshof, H. Petra Kok, Margarethus M. Paulides, Alejandro Sousa-Escandon, Paul R. Stauffer, Paolo F. Maccarini

Department of Radiation Oncology Faculty Papers

The urinary bladder is a fluid-filled organ. This makes, on the one hand, the internal surface of the bladder wall relatively easy to heat and ensures in most cases a relatively homogeneous temperature distribution; on the other hand the variable volume, organ motion, and moving fluid cause artefacts for most non-invasive thermometry methods, and require additional efforts in planning accurate thermal treatment of bladder cancer. We give an overview of the thermometry methods currently used and investigated for hyperthermia treatments of bladder cancer, and discuss their advantages and disadvantages within the context of the specific disease (muscle-invasive or non-muscle-invasive bladder …

Bh3 Mimetic Abt-737 Sensitizes Colorectal Cancer Cells To Ixazomib Through Mcl-1 Downregulation And Autophagy Inhibition., Lifeng Yang, Juefeng Wan, Sheng Xiao, Darryll Barkhouse, Ji Zhu, Guichao Li, Bo Lu, Zhen Zhang

Department of Radiation Oncology Faculty Papers

The proteasome inhibitor MLN9708 is an orally administered drug that is hydrolyzed into its active form, MLN2238 (ixazomib). Compared with Bortezomib, MLN2238 has a shorter proteasome dissociation half-life and a lower incidence and severity of peripheral neuropathy, which makes it an attractive candidate for colorectal cancer treatment. In the present study, we observed that MLN2238 induced autophagy, as evidenced by conversion of the autophagosomal marker LC3 from LC3I to LC3II, in colorectal cancer cell lines. Mcl-1, an anti-apoptotic Bcl-2 family protein, was markedly elevated after treating a colorectal cancer cell line with MLN2238. We proved that inhibiting Mcl-1 expression enhances …

Establishing The Feasibility Of The Dosimetric Compliance Criteria Of Rtog 1308: Phase Iii Randomized Trial Comparing Overall Survival After Photon Versus Proton Radiochemotherapy For Inoperable Stage Ii-Iiib Nsclc., Tawfik Giaddui, Wenzhou Chen, Jialu Yu, Liyong Lin, Charles B. Simone, Lulin Yuan, Yutao U.T. Gong, Q. Jackie Wu, Radhe Mohan, Xiaodong Zhang, Jaques B. Bluett, Michael Gillin, Kevin Moore, Elizabeth O'Meara, Jennifer Presley, Jeffrey D Bradley, Zhongxing Liao, James Galvin, Ying Xiao

Department of Radiation Oncology Faculty Papers

BACKGROUND: To establish the feasibility of the dosimetric compliance criteria of the RTOG 1308 trial through testing against Intensity Modulation Radiation Therapy (IMRT) and Passive Scattering Proton Therapy (PSPT) plans.

METHODS: Twenty-six lung IMRT and 26 proton PSPT plans were included in the study. Dose Volume Histograms (DVHs) for targets and normal structures were analyzed. The quality of IMRT plans was assessed using a knowledge-based engineering tool.

RESULTS: Most of the RTOG 1308 dosimetric criteria were achieved. The deviation unacceptable rates were less than 10 % for most criteria; however, a deviation unacceptable rate of more than 20 % was …

Development Of A Temperature Sensitive Face Mask For Identification And Triage Of Febrile Patients, Annemarie Daecher, Flemming Forsberg, John R. Eisenbrey

Department of Radiology Posters

Abstract:

Many infectious diseases are most transmittable when the carrier is presenting with fever. We propose a disposable face mask that changes color as an indicator of fever to provide hospitals with a quick and inexpensive method for triaging infected patients while limiting exposure to others. Two blue thermochromatic dyes which transition to white at 89°F and 92°F were mixed with white paint and applied to 5 types of disposable face masks. During trials, a wearer either sat at rest or ran on a treadmill for 20 minutes and images were obtained every 5 minutes with a thermal camera to …

Dielectric Properties Measurements Of Brown And White Adipose Tissue In Rats From 0.5 To 10 Ghz, Dario B. Rodrigues, Paul R. Stauffer, E. Colebeck, A. Z. Hood, S. Salahi, P. F. Maccarini, E. Topsakal

Department of Radiation Oncology Faculty Papers

Brown adipose tissue (BAT) plays an important role in whole body metabolism and with appropriate stimulus could potentially mediate weight gain and insulin sensitivity. Although imaging techniques are available to detect subsurface BAT, there are currently no viable methods for continuous acquisition of BAT energy expenditure. Microwave (MW) radiometry is an emerging technology that allows the quantification of tissue temperature variations at depths of several centimeters. Such temperature differentials may be correlated with variations in metabolic rate, thus providing a quantitative approach to monitor BAT metabolism. In order to optimize MW radiometry, numerical and experimental phantoms with accurate dielectric properties …

A Call For The Structured Physicist Report, John M. Boone, Phd, Mahadevappa Mahesh, Ms, Phd, Eric L. Gingold, Phd, J. Anthony Seibert, Phd

Department of Radiology Faculty Papers

Introduction:

The field of diagnostic radiology continues to struggle with the clinical adoption of the structured interpretive report, with many radiologists preferring a semistructured, free-text dictation style to a more rigid, highly structured approach that some professional leaders have promoted [1]. Although structured reporting compliance in the radiologist community has been difficult to achieve, diagnostic radiologists have been thinking about and discussing this important issue for many years; it is also a part of the ACR’s Imaging 3.0_ campaign [2]. In the breast imaging community, the well-established BI-RADS_ recommendations produce a very structured report, with a discussion of interpretive findings …

Evaluation Of A Pacap Peptide Analogue Labeled With (68)Ga Using Two Different Chelating Agents., Pardeep Kumar, Sushil Kumar Tripathi, Chang-Po Chen, Neil Mehta, Bishnuhari Paudyal, Eric Wickstrom, Mathew L. Thakur

Department of Radiology Faculty Papers

OBJECTIVE: The authors have conjugated chelating agents (DOTA and NODAGA) with a peptide (pituitary adenylate cyclase-activating peptide [PACAP] analogue) that has a high affinity for VPAC1 receptors expressed on cancer cells. To determine a suitable chelating agent for labeling with (68)Ga, they have compared the labeling kinetics and stability of these peptide conjugates.

METHODS: For labeling, (68)GaCl3 was eluted in 0.1 M HCl from a [(68)Ge-(68)Ga] generator. The influences of peptide concentration, pH, and temperature on the radiolabeling efficiency were studied. The stability was evaluated in saline, human serum, DTPA, transferrin, and metallic ions (FeCl3, CaCl2, and ZnCl2). Cell binding …

Biodistribution And Pharmacokinetics Study Of Sirna-Loaded Anti-Ntsr1-Mab-Functionalized Novel Hybrid Nanoparticles In A Metastatic Orthotopic Murine Lung Cancer Model., Maryna Perepelyuk, Chellappagounder Thangavel, Yi Liu, Robert B. Den, Bo Lu, Adam E. Snook, Sunday A. Shoyele

Department of Radiation Oncology Faculty Papers

Small interfering RNA (siRNA) is effective in silencing critical molecular pathways in cancer. The use of this tool as a treatment modality is limited by lack of an intelligent carrier system to enhance the preferential delivery of this molecule to specific targets in vivo. In the present study, the in vivo behavior of novel anti-NTSR1-mAb-functionalized antimutant K-ras siRNA-loaded hybrid nanoparticles, delivered by i.p. injection to non-small-cell lung cancer in mice models, was investigated and compared to that of a naked siRNA formulation. The siRNA in anti-NTSR1-mAb-functionalized hybrid nanoparticles was preferentially accumulated in tumor-bearing lungs and metastasized tumor for at least …

Cogstate Computerized Memory Tests In Patients With Brain Metastases: Secondary Endpoint Results Of Nrg Oncology Rtog 0933., Chip Caine, Snehal Deshmukh, Vinai Gondi, Minesh Mehta, Wolfgang Tomé, Benjamin W. Corn, Andrew Kanner, Howard Rowley, Vijayananda Kundapur, Albert Denittis, Jeffrey Noah Greenspoon, Andre A. Konski, Glenn S. Bauman, Adam Raben, Wenyin Shi, Merideth Wendland, Lisa Kachnic

Department of Radiation Oncology Faculty Papers

Whole brain radiotherapy (WBRT) is associated with memory dysfunction. As part of NRG Oncology RTOG 0933, a phase II study of WBRT for brain metastases that conformally avoided the hippocampal stem cell compartment (HA-WBRT), memory was assessed pre- and post-HA-WBRT using both traditional and computerized memory tests. We examined whether the computerized tests yielded similar findings and might serve as possible alternatives for assessment of memory in multi-institution clinical trials. Adult patients with brain metastases received HA-WBRT to 30 Gy in ten fractions and completed Hopkins Verbal Learning Test-Revised (HVLT-R), CogState International Shopping List Test (ISLT) and One Card Learning …