Comparative analyses of immune cells and alpha-smooth muscle actin-positive cells under the immunological microenvironment between with and without dense fibrosis in primary central nervous system lymphoma

Histopathologic examinations of primary central nervous system lymphoma (PCNSL) reveal concentric accumulation of lymphocytes in the perivascular area with fibrosis. However, the nature of this fibrosis in "stiff" PCNSL remains unclear. We have encountered some PCNSLs with hard masses as surgical findings. This study investigated the dense fibrous status and tumor microenvironment of PCNSLs with or without stiffness. We evaluated by silver-impregnation nine PCNSLs with stiffness and 26 PCNSLs without stiffness. Six of the nine stiff PCNSLs showed pathological features of prominent fibrosis characterized by aggregation of reticulin fibers, and collagen accumulations. Alpha-smooth muscle actin (αSMA)-positive spindle cells as a cancer-associated fibroblast, the populations of T lymphocytes, and macrophages were compared between fibrous and control PCNSLs. Fibrous PCNSLs included abundant αSMA-positive cells in both intra- and extra-tumor environments (5/6, 87% and 3/6, 50%, respectively). Conversely, only one out of the seven control PCNSL contained αSMA-positive cells in the intra-tumoral area. Furthermore, the presence of extra-tumoral αSMA-positive cells was associated with infiltration of T lymphocytes and macrophages. In conclusion, recognizing the presence of dense fibrosis in PCNSL can provide insights into the tumor microenvironment. These results may help stratify patients with PCNSL and improve immunotherapies for these patients.

Post-treatment magnetic resonance imaging predicts outcomes of maxillary sinus cancer treatment using super-selective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (RADPLAT)

OBJECTIVES

This study aimed to evaluate the prognostic value of magnetic resonance imaging (MRI) findings in predicting local recurrence in patients with maxillary sinus cancer treated with super-selective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (RADPLAT).

METHODS

This single-center retrospective study included consecutive patients with maxillary sinus squamous cell carcinoma, who underwent RADPLAT between October 2016 and September 2021. MRI was performed before (within 2 weeks) and 1 month after (post-treatment MRI) the start of treatment. Tumor reduction rates and pre-treatment cross-sectional areas were calculated from the maximum cross-sectional areas on pre- and post-treatment MRI T2-weighted axial images. Statistical analyses, including receiver operating characteristic analysis, were performed to assess the predictive value of the tumor reduction rates.

RESULTS

Twenty-four patients were included in this study. Recurrence occurred in seven patients with a median time of 213 days. The tumor reduction rates were significantly higher in the benign post-treatment changes group compared to the recurrence group (median, 0.814 vs. 0.174; p < 0.001). The cut-off value for the reduction rate between the groups was 0.3578. No significant difference was observed in the maximum pre-treatment cross-sectional area between the groups (p = 0.664). The inter-observer agreement for the tumor areas was excellent.

CONCLUSIONS

The tumor reduction rate calculated from MRI T2-weighted images may be a predictor of local recurrence in patients with maxillary sinus cancer treated with RADPLAT. Patients with lower reduction rates may benefit from early salvage surgeries.

Assessing the Histological Malignancy Grade of Olfactory Neuroblastoma Using the Apparent Diffusion Coefficient Histogram Analysis

Introduction Olfactory neuroblastoma (ONB) is a rare malignant tumor of the upper nasal cavity. The Hyams classification is an important histological grading system for diagnosing recurrence and predicting survival in ONB. This study aimed to evaluate the utility of apparent diffusion coefficient (ADC) histogram analysis in distinguishing between high-grade and low-grade ONB based on the Hyams classification system. Methods This retrospective study included 17 patients (11 males, six females; mean age 54 years, range 29-84) diagnosed with ONB who underwent pretreatment magnetic resonance imaging (MRI) including diffusion-weighted imaging between December 2017 and September 2022. Two board-certified radiologists outlined the regions of interest on ADC maps of the tumors. Mean, minimum, maximum ADC, standard deviation, skewness, kurtosis, and entropy were calculated from the ADC histograms. Patients were divided into low-grade (Hyams I-II) and high-grade (Hyams III-IV) groups based on histopathological evaluation by a board-certified pathologist. ADC histogram parameters were compared between the two groups using Mann-Whitney U tests. Two-sided p-values of < 0.05 were considered statistically significant. Results The study included 10 low-grade (two grade I, eight grade II) and seven high-grade (five grade III, one grade III/IV, one grade IV) ONB cases. Comparison between the low-grade and high-grade groups showed no statistically significant differences in any of the ADC histogram parameters analyzed: mean ADC (median 1.02 vs 0.95; p = 0.591), minimum ADC (0.84 vs 0.78; p = 0.494), maximum ADC (1.06 vs 1.19; p = 0.625), standard deviation (0.09 vs 0.14; p = 0.433), skewness (-0.48 vs -0.75; p = 0.133), kurtosis (2.79 vs 3.12; p = 0.161), and entropy (4.69 vs 5.06; p = 0.315). Conclusion This study demonstrated that ADC histogram analysis was unable to differentiate between high-grade and low-grade ONB based on the Hyams classification. The findings suggest that preoperative grading of ONB malignancy using ADC histogram parameters is challenging. Thus, grading based on preoperative imaging evaluation is difficult.

Retropharyngeal abscess due to Fusobacterium necrophorum complicated by progressive internal carotid artery stenosis and multiple cranial nerve palsies

BACKGROUND

A case of retropharyngeal abscess complicated by both artery and nerve injury has rarely been reported.

METHODS

A 36-year-old woman suddenly presented with right eye visual loss, dilated pupil, reduced direct light reflex, ptosis and ocular motility disorder on the side of inflammation progression, and was diagnosed with retropharyngeal abscess due to Fusobacterium necrophorum. The patient was treated only with antibiotics and, no further surgery was necessary but tracheotomy. Four months later, MRA showed right ICA occlusion and left ICA stenosis. MRI revealed continuous spread of inflammation due to the abscess from the retropharyngeal to the intracranial space.

RESULTS

These severe complications would be attributed to an endothelial damage to the arterial wall and an ischemic neuropathy caused by inflammation and thrombogenesis due to Fusobacterium necrophorum.

CONCLUSIONS

This case should provide a better understanding of the mechanism of vascular and cranial nerve injury due to retropharyngeal infections, and highlights the need for early antibiotic therapy and repeated vascular evaluation.

Radiological features of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma: case series and systematic review

PURPOSE

To comprehensively summarize the clinical data and CT/MRI characteristics of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA).

METHODS

Twenty-seven lesions from 25 study articles identified through a systematic review and three lesions from our institution associated with TL-LGNPPA were evaluated.

RESULTS

The mean age of the patients at diagnosis was 35.7 years, and the male-to-female ratio was nearly half. The chief complaint was nasal obstruction, followed by epistaxis. All patients underwent excision. None of the patients had neck nodes or distant metastases. All patients survived with no locoregional/distant recurrence during 3-93 months of follow-up. All lesions were located at the posterior edge of the nasal septum, attached to the nasopharyngeal parietal wall, and showed no laterality. The mean lesion diameter was 1.7 cm. The margins of lesions were well-defined and lobulated, followed by well-defined smooth margins. None of lesions were associated with parapharyngeal space or skull base destruction. All lesions were iso- and low-density on non-contrast CT. Adjacent skull base sclerosis was detected in 63.6% of lesions. High signal intensity on T2-weighted imaging and mostly iso-signal intensity on T1-weighted imaging compared to muscle tissue. Most lesions were heterogeneous and exhibited moderate contrast enhancement. Relatively large lesions (≥1.4 cm) tended to be more lobulated than smooth margins compared to relatively small lesions (<1.4 cm) (p = 0.016).

CONCLUSION

We summarized the clinical and radiological features of TL-LGNPPA to facilitate accurate diagnosis and appropriate management.

Abstract WP172: Delayed Leukoencephalopathy Following Acute Ischemic Stroke

Background and Purpose: Delayed leukoencephalopathy (DL) following ischemic stroke with large vessel occlusion (LVO) is rarely reported and the pathophysiology is unclear. We aimed to investigate the incidence, clinical characteristics of DL following acute ischemic stroke.

Methods: Consecutive ischemic stroke patients were screened. Inclusion criteria were: 1) onset to door time within 7 days; and 2) availability of initial and a second or more MRI after 14 days from onset with DWI, FLAIR, and MRA. We defined DL as newly detected diffuse hyperintensities restricted to the white matter on FLAIR mostly accompanied with partial DWI hyperintensities after 14 days from onset. First, we estimated the incidence of DL and whether a LVO would be a factor associated with DL following all the acute ischemic stroke. Second, limiting the patients with LVO, we evaluated the incidence and the factors associated with DL.

Results: We screened 1,857 consecutive ischemic stroke patients. Of all, 792 with all the acute ischemic stroke (573 (72%) male, median age 67 years), and 183 with LVO (128 (70%) male, median age 67 years) were included in each analysis. DL were detected in 18 patients in all the acute ischemic stroke (2%), and 17 in patients with LVO (9%) (Figure). First, LVO was strongly associated with DL following all the acute ischemic stroke (OR 62.3, 95% CI 8.23 to 471, p <0.001). Second, limiting the patients with LVO, factors associated with DL were age/10 years (OR 1.64, 95% CI 1.08 to 2.47, p = 0.019), NIHSS score at admission (OR 1.06, 95% CI 1.01 to 1.11, p = 0.014), complete recanalization (OR unable to calculate due to 100% prevalence in DL group, p <0.001), and mechanical thrombectomy (OR 14.2, 95% CI 3.90 to 52.0 p <0.001).

Conclusions: DL is not an uncommon phenomenon especially after LVO. Age, neurological severity, mechanical thrombectomy, and complete recanalization might be related to DL.

Radiological features of human papillomavirus-related multiphenotypic sinonasal carcinoma: systematic review and case series

PURPOSE

To comprehensively summarize the radiological characteristics of human papillomavirus (HPV)-related multiphenotypic sinonasal carcinomas (HMSCs).

METHODS

We reviewed the findings for patients with HMSCs who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) and included nine cases from nine publications that were identified through a systematic review and three cases from our institution. Two board-certified radiologists reviewed and evaluated the radiological images.

RESULTS

The locations in almost all cases included the nasal cavity (11/12, 91.7%). The involved paranasal sinuses included the ethmoid sinus (6/12, 50.0%) and maxillary sinus (3/12, 25.0%). The mean long diameter of the tumors was 46.3 mm. The margins in 91.7% (11/12) of the cases were well-defined and smooth. Heterogeneous enhancement on contrast-enhanced CT, heterogeneous high signal intensities on T2-weighted images and heterogeneous enhancement on gadolinium-enhanced T1-weighted images were noted in 2/2, 5/5, and 8/8 cases, respectively. Mean apparent diffusion coefficient values in two cases of our institution were 1.17 and 1.09 × 10^-3 mm²/s. Compressive changes in the surrounding structures were common (75%, 9/12). Few cases showed intraorbital or intracranial extension. None of the cases showed a perineural spread, neck lymph node metastasis, or remote lesions.

CONCLUSIONS

We summarized the CT and MRI findings of HMSCs. Knowledge of such characteristics is expected to facilitate prompt diagnosis and appropriate management.

A review of the microtremor horizontal-to-vertical spectral ratio (MHVSR) method

The single-station microtremor horizontal-to-vertical spectral ratio (MHVSR) method was initially proposed to retrieve the site amplification function and its resonance frequencies produced by unconsolidated sediments overlying high-velocity bedrock. Presently, MHVSR measurements are predominantly conducted to obtain an estimate of the fundamental site frequency at sites where a strong subsurface impedance contrast exists. Of the earthquake site characterization methods presented in this special issue, the MHVSR method is the furthest behind in terms of consensus towards standardized guidelines and commercial use. The greatest challenges to an international standardization of MHVSR acquisition and analysis are (1) the what - the underlying composition of the microtremor wavefield is site-dependent, and thus, the appropriate theoretical (forward) model for inversion is still debated; and (2) the how - many factors and options are involved in the data acquisition, processing, and interpretation stages. This paper reviews briefly a historical development of the MHVSR technique and the physical basis of an MHVSR (the what). We then summarize recommendations for MHVSR acquisition and analysis (the how). Specific sections address MHVSR interpretation and uncertainty assessment.

Comprehensive radiological features of laryngeal sarcoidosis: cases series and systematic review

PURPOSE

To comprehensively summarize the characteristic radiological findings of laryngeal sarcoidosis.

METHODS

We reviewed patients with laryngeal sarcoidosis who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) and included 8 cases from 8 publications that were found through a systematic review and 6 cases from our institutions. Two board-certified radiologists reviewed and evaluated the radiological images.

RESULTS

Almost all cases exhibited supraglottic lesions 13/14 (92.9%) and most of them involved aryepiglottic folds (12/13, 92.3%), epiglottis (11/14, 78.6%), and arytenoid region (10/14, 71.4%). Most lesions were bilateral (12/14, 85.7%). All cases showed well-defined margins and a diffuse swelling appearance (14/14, 100%). Non-contrast CT revealed a low density (4/5, 80%). The contrast-enhanced CT showed a slight patchy enhancement predominantly at the margin of the lesion in most cases (12/13, 92.3%). In one case, T2-weighted images showed high signal intensity peripherally and low signal intensity centrally (1/1, 100%). Gadolinium-enhanced MRI showed moderate heterogeneous enhancement predominantly at the margin of the lesion (2/2, 100%). In one case, diffusion-weighted imaging showed intermediate signal intensity; the apparent diffusion coefficient value was 2.4 × 10^-3 mm²/s. The larynx was the only region affected by sarcoidosis in 57.1% (8/14) of the cases. Involvement of the neck lymph nodes and distant organs was observed in 4/14 (28.6%) patients, respectively.

CONCLUSION

We summarized the CT and MRI findings of patients with laryngeal sarcoidosis. Knowledge of these characteristics is expected to facilitate prompt diagnosis and appropriate management.

GFAP variant p. Tyr366Cys demonstrated widespread brain cavitation in neonatal Alexander disease

Alexander disease is a rare form of leukodystrophy caused by heterozygous mutations in the gene encoding glial fibrillary acidic protein (GFAP). Brain cavitation in the white matter, predominantly distributed in the frontal periventricular area, has been described in some cases. Here, we present a case of a 1-year-old boy with neonatal Alexander disease caused by the p. Tyr366Cys GFAP variant, with rapid and widespread white matter cavitation. This case broadens the radiological spectrum of Alexander disease and suggests a possible genotype-phenotype correlation between the p. Tyr366Cys variant and cavitation.

Improved assessment of middle ear recurrent/residual cholesteatomas using temporal subtraction CT

PURPOSE

The purpose of this study was to investigate the usefulness of temporal subtraction CT (TSCT) of temporal bone CT for the detection of postoperative recurrent/residual cholesteatoma of the middle ear.

METHODS

Thirty-two consecutive patients with surgically proven postoperative recurrent/residual cholesteatoma and 14 consecutive patients without recurrent/residual lesion matched the selection criteria and were retrospectively evaluated. TSCT imaging was generated with the use of serial postoperative CT. Two experienced radiologists and two residents evaluated the presence of bone erosive change by comparison serial CT studies, and CT and TSCT. The detection rate of bone erosive change, sensitivity and specificity of the recurrence/residual lesions, and reading time for each reader were evaluated.

RESULTS

TSCT + CT significantly improved the detection of bone erosive changes compared to CT-only evaluation (17.4-41.3% vs. 37.0-58.7%, p = 0.008-0.046). The mean sensitivity and specificity of TSCT + CT for experienced radiologists were 0.77 and 1.00, and 0.52 and 0.97 without TSCT. The mean sensitivity and specificity of TSCT + CT for residents were 0.64 and 1.00, and 0.41 and 1.00 without TSCT. Sensitivity showed an increase in all readers. The use of TSCT significantly reduced the reading time per case in all readers (p < 0.001).

CONCLUSION

TSCT improves the depiction of newly occurring progressive bone erosive changes, and detection sensitivity and reading time in postoperative recurrence/residual cholesteatoma of middle ear.

CT and MR imaging of laryngeal metastasis from renal cell carcinoma: A case report

Laryngeal metastasis is an extremely rare condition. To the best of our knowledge, there has been no previous report on a laryngeal metastasis from renal cell carcinoma, which describes on details of the CT and MR imaging findings. A male patient in his 80s. Laryngoscopy revealed reddish-colored masses in the right false vocal cord and in the subglottic larynx. CT and MR imaging of this case showed multiple hypervascularized lesions with a wash-out effect in the supra and subglottis of the larynx and in the right intervertebral foramen of the cervical spine. Angiography revealed a hypervascular tumor consistent with the subglottic lesion. The histopathology and immunohistochemistry findings were compatible with laryngeal metastasis from renal clear cell carcinoma. A history of postoperative renal clear cell carcinoma about 7 years ago was later confirmed, which was not stated at the time of the initial imaging evaluation. It is a possible differential diagnosis in cases of multiple hypervascular masses in the head and neck region with a history of renal carcinoma. In particular, if the contrast-enhancement pattern of the lesion on the dynamic CT is similar to that of renal cell carcinoma. It is also important to reconfirm the patient's medical history, including postoperative status.

The use of angiotensin receptor blockers is associated with greater recovery of cardiac function than angiotensin-converting-enzyme inhibitors among patients with dilated cardiomyopathy

Background

We previously showed that angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) were associated with heart failure with recovered ejection fraction (HFrecEF) in patients with dilated cardiomyopathy (DCM). However, the different effects of these drugs on cardiac reverse remodeling have not been fully elucidated. The aim of this study was to assess comparative effectiveness of ACEi versus ARB on recovery of left ventricular ejection fraction (LVEF) among patients with DCM.

Methods

We analyzed the clinical personal records of DCM, a national database of Japanese Ministry of Health, Labour and Welfare, from 2003 to 2014. Patients with LVEF &lt;40% and on either ACEi or ARB were included. Eligible patients were divided into two groups according to the use of ACEi or ARB. A one-to-one propensity case-matched analysis was used. A propensity score was estimated by fitting a logistic-regression model which adjusted for age, sex, duration of HF, NYHA functional class (I-II vs. III-IV), systolic blood pressure, diastolic blood pressure, heart rate, atrial fibrillation, pacing, left bundle branch block, LVEF, hypertension, diabetes mellitus, hyperuricemia, chronic kidney disease, B-type natriuretic peptide (BNP), beta-blockers, mineralocorticoid receptor antagonists, loop diuretics, thiazides, digitalis, amiodarone, and oral inotropes. The primary outcome was defined as LVEF ≥40% at 3 years of follow-up.

Results

Out of 4,618 eligible patients, 2,238 patients received ACEi and 2,380 patients received ARB. Propensity score matching yielded 1,341 pairs. Mean age was 56.0 years and 2,041 (76.1%) was male. Mean LVEF was 27.6%, and median duration of HF was 1 year. The primary outcome was observed more frequently in ARB group than in ACEi group (59.8% vs. 54.1%; odds ratio [OR] 1.26; 95% confidence interval [CI] 1.08–1.47; P=0.003). The change in LVEF from baseline to 3 years of follow-up was greater in ARB group than in ACEi group (15.8±0.4 vs. 14.0±0.4%, P=0.002). In the ACEi group, 946 patients (70.6%) continued to receive ACEi at 3 years of follow-up, while 1,088 patients (81.3%) continued to receive ARB in the ARB group. Per-protocol analysis consistently showed that ARB increased the prevalence of HFrecEF (62.0% vs. 54.0%; OR 1.39; 95% CI 1.17–1.66; P&lt;0.001). Subgroup analysis showed that ARB increased frequency of HFrecEF regardless systolic blood pressure, heart rate, LVEF, chronic kidney disease, and concomitant use of beta-blockers and mineralocorticoid receptor antagonists.

Conclusions

The use of ARB was associated with HFrecEF more frequently than ACEi among patients with DCM and reduced LVEF.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Sciences Research Grants from the Japanese Ministry of Health, Labour and Welfare (Comprehensive Research on Cardiovascular Diseases)Japan Agency for Medical Research and Development (AMED) grant

Physiological pseudo-thickened cauda equina associated with dural sac dilatation on magnetic resonance imaging

OBJECTIVES

In daily clinical practice, the assessment of the thickness of the cauda equina on lumbar spine magnetic resonance imaging is an important parameter. However, its relevance to the size of the dural sac in non-pathological conditions is unknown. To examine the relationship between the size of the dural sac and the apparent thickness of the cauda equina nerve root using lumbar spine magnetic resonance imaging in non-pathological conditions.

METHODS

We retrospectively measured the dural sac diameter and vertebral body diameter, counted the apparent number, and calculated total cross-sectional area of the cauda equina, dural sac ratio and the area of one apparent nerve root of cauda equina in 100 cases. Spearman's rank correlation coefficient (ρ) was used.

RESULTS

Dural sac ratio and diameter were positively correlated with the area of one apparent nerve root (ρ=0.77, P<0.001; ρ=0.74, P<0.001; respectively) and negatively correlated with the apparent number of cauda equina in a single cross-section (ρ=-0.63, P<0.001; ρ=-0.52, P<0.001; respectively).

CONCLUSIONS

A larger dural sac ratio and diameter was associated with an apparently thicker cauda equina and lower visible number. In a larger dural sac, the physiologically clumped and apparently thicker cauda equina should not be misdiagnosed as pathological.

Phase I expansion study of P-cadherin-targeted 90Y-FF-21101 antibody in advanced chemorefractory colorectal and pancreatic-biliary cancers

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Background: Overexpression of the cell-cell adhesion protein P-cadherin has been associated with a more aggressive cancer cell phenotype, cancer stem cell properties, tumor invasion and metastasis. We determined the safety and recommended Phase II dose of the yttrium-labeled P-cadherin-targeted 90Y-FF-21101 monoclonal antibody (mAb) in patients (pts) with advanced tumors, and focused our expansion study in advanced colorectal (CRC) and pancreatic-biliary cancers (non-CRC tumors). We report the safety, efficacy, and correlative pharmacokinetics (PK)/pharmacodynamics (PD) in this cohort. Methods: Pts enrolled must have progressed on all standard therapies. 25 mCi/m2 (8 mCi/mg mAb) 90Y-FF-21101 was administered intravenously every 12 weeks (wks) until disease progression or unacceptable toxicity. Disease response was assessed based on RECIST v1.1 every 8 wks (1 cycle = 28 days). Serum mAb PK, existence of anti-drug antibodies (ADA) and tumor P-cadherin expression were also evaluated. Results: 31 pts [mean age 63 (range, 39-89); 14F/17M; median number of prior therapies, 3 (range, 1-11)] with CRC (18) and non-CRC tumors [pancreatic (8), cholangiocarcinoma (3), duodenal (2)] received a median of 1 (range, 1-2) dose of 90Y-FF-21101. Median duration on study was 8.1 (3.9 – 27) wks (CRC) and 8 (1.1-17.1) wks (pancreatic-biliary). Myelosuppression was the most common treatment-related adverse event [thrombocytopenia (87%; Grade (Gr) 3/4 in 45%), lymphopenia (74%; Gr 3/4 in 61%), anemia (52%; Gr 3/4 in 13%), leukopenia (32%; Gr 3/4 in 16%)], in addition to fatigue (68%, 1 Gr 3) and nausea (39%, 1 Gr 3). Three pts required dose reduction to 20 mCi/m2 with subsequent infusion after Gr 3/4 thrombocytopenia [(pancreatic (2), CRC (1)]. The clinical benefit rate in pts with CRC based on stable disease (SD) for ≥8 wks is 43.8% (7/16 pts), with a median PFS of 8.1 wks and OS of 27 wks [median PFS, 7.9 wks; OS, 17.1 wks in non-CRC]. Longer-term SD was maintained in 2 pts with CRC for 17-24 wks; one continues on treatment. Enrollment is ongoing in the non-CRC cohort. FF-21101 has a mean t1/2 of approximately 65 hours, and post-treatment ADA titers have been observed in < 5% of pts. Tumor P-cadherin expression analysis by IHC demonstrated H-scores > 150 in 88% (14/16) of CRC pts, 75% (9/12) for non-CRC; 2 CRC pts with SD ≥17 wks had H-scores ≥190. Conclusions: 90Y-FF-21101 administered every 12 wks demonstrated expected toxicities and has been generally well-tolerated, with preliminary evidence of benefit demonstrated in heavily pre-treated pts with advanced CRC. The optimal dose and schedule for this radioimmunotherapeutic will continue to be explored, along with pre-treatment P-cadherin expression as a predictive biomarker for disease response. Clinical trial information: NCT02454010.

Non-echoplanar diffusion weighed imaging and T1-weighted imaging for cholesteatoma mastoid extension

OBJECTIVES

A broad mastoid extension limits cholesteatoma resection via a transmeatal approach including endoscopic ear surgery. Therefore, a preoperative diagnosis of mastoid extension is a the most critical factor to determine whether to perform mastoidectomy. The purpose of this study was to assess the efficacy of non-echoplanar diffusion-weighted imaging (non-EPI DWI) and T1-weighted imaging in the evaluation of mastoid extension in cholesteatomas of the middle ear.

METHODS

Patients who underwent magnetic resonance imaging (MRI) for pretreatment evaluation before primary surgery for pars flaccida or tensa cholesteatoma, which revealed a high-signal intensity in the mastoid on T2-weighed imaging were retrospectively evaluated. Two board-certified radiologists retrospectively evaluated the extent of cholesteatomas on MRI with non-EPI DWI, non-EPI DWI- and T1-weighted axial imaging. The presence of a high signal intensity on non-EPI DWI or low or high signal intensity on T1-weighted imaging in the mastoid was evaluated. All cases were subclassified as M+ (surgically mastoid extension-positive) or M- (surgically mastoid extension-negative).

RESULTS

A total of 59 patients with middle ear cholesteatoma were evaluated. There were 37 M+ cases and 22 M- cases. High-signal intensity on non-EPI DWI exhibited a sensitivity of 0.89 and specificity of 0.82, whereas partial low-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.84 and specificity of 0.91 for detecting mastoid involvement. Complete high-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.73 and specificity of 0.89 for detecting non-involvement of the mastoid. The sensitivity (0.92) and specificity (0.96) of combined non-EPI DWI and T1-weighted imaging evaluation were higher than those of with non-EPI DWI or T1-weighted imaging alone. The interobserver agreement for the presence of high-signal intensity in the mastoid cavity on non-EPI DWI was very good at 0.82, that of a partial low-signal intensity area in the mastoid cavity lesions on T1-weighted imaging was good, at 0.76 and that of complete high-signal intensity in the mastoid cavity lesions on T1-weighted imaging was good, at 0.67.

CONCLUSIONS

The signal intensity on non-EPI DWI and T1-weighted imaging of the mastoid could be used to accurately assess the extent of middle ear cholesteatoma, which could facilitate surgical treatment planning.

Correlation between the magnetic resonance imaging features of squamous cell carcinoma of the buccal mucosa and pathologic depth of invasion

OBJECTIVE

The objective of this study was to determine correlations between magnetic resonance imaging (MRI) features including radiologic depth of invasion (r-DOI) and pathologic DOI (p-DOI) of squamous cell carcinoma of the buccal mucosa.

STUDY DESIGN

In total, 31 lesions were retrospectively evaluated. MRI findings included detectability, buccinator muscle invasion (positive: BMI+, negative: BMI-), buccal fat pad invasion (positive: BFPI+, negative: BFPI-), and r-DOI measured on T2-weighted images (T2-DOI) and contrast-enhanced T1-weighted images (CET1-DOI). These findings were compared to the p-DOI of the tumors.

RESULTS

The p-DOI values of undetectable lesions were smaller than those of detectable lesions (P < .001), and the cutoff value was 1 mm. BMI+ and BFPI+ lesions had significantly larger p-DOI values than the corresponding BMI- and BFPI- lesions (P < .001), with cutoff values of 5 and 6 mm, respectively. The correlation coefficient between CET1-DOI and p-DOI was 0.68 (P < .001). CET1-DOI values were larger than p-DOI (P < .001) and the average difference between them was 3.4 mm. T2-DOI was inconclusive in 50% of cases. Interobserver agreements of MRI evaluation were good to very good.

CONCLUSION

MRI-derived parameters were useful in estimating p-DOI and may be helpful in predicting the depth of invasion of tumors and the risk of lymph node metastasis.

Pre-treatment MRI predictor of high-grade malignant parotid gland cancer

OBJECTIVES

We aimed to evaluate pre-treatment MRI predictors of high-grade malignant parotid gland cancer by comparing MRI findings and texture parameters between high-grade and intermediate/low-grade parotid gland cancers.

METHODS

Patients underwent a pre-treatment MRI and had a parotid gland cancer resection with pathological evaluation. Evaluation objectives included attributive factors such as age and gender, several MRI findings of T1- and T2-weighted images, post-contrast fat suppression T1-weighted images, ADC value and 40 texture parameters calculated from T2-weighted axial images. Such objects were compared between high-grade and intermediate/low-grade lesions.

RESULTS

Of the parotid gland cancers surveyed, 39 were included for analysis. Of these, 18 were high-grade lesions, 2 were intermediate-grade lesions, and 19 were low-grade lesions. The high-grade group was significantly older than the low- and intermediate-grade groups (p = 0.01). There were more males in the high-grade group than in the low- and intermediate-grade groups (p = 0.01). There were also significantly more MRI findings of neck lymph node metastases in the high-grade group than in the low- and intermediate-grade groups (p < 0.001). Other MRI findings and texture parameters did not show significant differences between the two groups (p = 0.07-1.00).

CONCLUSIONS

Morphological assessment on MRI and texture parameters alone is not sufficient to estimate the grade of parotid cancer. MRI findings of neck lymph node metastases, as well as patient characteristics such as age (older patients) and gender (male) can be suggestive of high-grade parotid gland cancer in pre-treatment evaluation.

Cyclin dependent kinase 1 (CDK1) positively regulates cardiac hypertrophy and fibrosis via TGF-beta pathway

Background

Transforming growth factor beta (TGF-β) critically mediates cardiac fibrosis by transforming fibroblasts to myofibroblasts in pathological conditions. Cyclin dependent kinases (CDKs), cell cycle-regulating proteins, are known to be intimately involved in cardiac fibrosis. Among CDK isoforms, CDK1 is essential for cell cycle progression and cell division. It is reported some interphase CDKs such as CDK4 or CDK6 were involved in cardiac fibrosis, however, detailed mechanisms of cardiac fibrosis through CDK1 and its interactions with TGF-β in cardiac fibrotic process haven't been elucidated. We hypothesize that CDK1 is involved in cardiac fibrotic process via TGF-β pathway and its suppression decreases TGF-β expression and transformation to myofibroblasts from fibroblasts presenting antifibrotic effect.

Methods and results

Isolated neonatal rat cardiac fibroblasts were treated with angiotensin II (ANG II, 1 μM, 24 h) or phosphate-buffered saline (PBS). ANG II increased CDK1 and TGF-β in cardiac fibroblasts, by 97% and 292%, respectively (p&lt;0.05). Administration of Ro-3306, a specific CDK1 inhibitor (1 μM, 24 h), suppressed TGF-β protein levels in ANG II-treated cardiac fibroblasts by 58% (p&lt;0.05). Similarly, knockdown of CDK1 by RNA silencing also inhibited ANG II-induced increases in TGF-β in cardiac fibroblasts by 39% (p&lt;0.05). ANG II increased alpha-smooth muscle actin (α-SMA), which is a marker of myofibroblasts, and knockdown of CDK1 significantly suppressed it by 49% (p&lt;0.05). In vivo study, 11-week-old male C57BL/6J mice were administered ANG II continuously with infusion pump, at a dose of 1000 ng/kg/min, for a week. Also, Ro-3306 was intraperitoneally injected at a dose of 2 mg/kg/day, every other day, for a week. First, Ro-3306 attenuated ANG II-mediated cardiac hypertrophy indicated by heart weight and echocardiographic parameter as to left ventricular wall thickness. Second, CDK1 and TGF-β expression were significantly augmented in ANG II-infused mice by 404% and 113%, respectively (p&lt;0.05). Injection of Ro-3306 suppressed TGF-β protein levels by 48%, although the difference wasn't statistically significant (p=0.09). Finally, histopathological examination (Masson's trichrome stain) demonstrated remarkable repression of ANG II-induced cardiac fibrosis by Ro-3306.

Conclusions

CDK1 positively controls cardiac fibrotic process by regulating transformation to cardiac myofibroblasts from fibroblasts via TGF-β pathway. It also presents an antihypertrophic effect on ANG II stimulation. CDK1 is a potential therapeutic target of cardiac fibrosis and hypertrophy.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): KAKENHI

Phase I Study of P-cadherin-targeted Radioimmunotherapy with 90Y-FF-21101 Monoclonal Antibody in Solid Tumors

PURPOSE

⁹⁰Y-FF-21101 is an Yttrium-90-conjugated, chimeric mAb that is highly specific for binding to human placental (P)-cadherin, a cell-to-cell adhesion molecule overexpressed and associated with cancer invasion and metastatic dissemination in many cancer types. We report the clinical activity of ⁹⁰Y-FF-21101 in a first-in-human phase I study in patients with advanced solid tumors.

PATIENTS AND METHODS

The safety and efficacy of ⁹⁰Y-FF-21101 were evaluated in a phase I 3+3 dose-escalation study in patients with advanced solid tumors (n = 15) over a dose range of 5-25 mCi/m². Dosimetry using ¹¹¹In-FF-21101 was performed 1 week prior to assess radiation doses to critical organs. Patients who demonstrated clinical benefit received repeated ⁹⁰Y-FF-21101 administration every 4 months.

RESULTS

¹¹¹In-FF-21101 uptake was observed primarily in the spleen, kidneys, testes, lungs, and liver, with tumor uptake observed in the majority of patients. Organ dose estimates for all patients were below applicable limits. P-cadherin expression H-scores ranged from 0 to 242 with 40% of samples exhibiting scores ≥100. FF-21101 protein pharmacokinetics were linear with increasing antibody dose, and the mean half-life was 69.7 (±12.1) hours. Radioactivity clearance paralleled antibody clearance. A complete clinical response was observed in a patient with clear cell ovarian carcinoma, correlating with a high tumor P-cadherin expression. Stable disease was observed in a variety of other tumor types, without dose-limiting toxicity.

CONCLUSIONS

The favorable safety profile and initial antitumor activity observed for ⁹⁰Y-FF-21101 warrant further evaluation of this radioimmunotherapeutic (RIT) approach and provide initial clinical data supporting P-cadherin as a potential target for cancer treatment.

Phase I Study of P-cadherin-targeted Radioimmunotherapy with 90Y-FF-21101 Monoclonal Antibody in Solid Tumors

PURPOSE

⁹⁰Y-FF-21101 is an Yttrium-90-conjugated, chimeric mAb that is highly specific for binding to human placental (P)-cadherin, a cell-to-cell adhesion molecule overexpressed and associated with cancer invasion and metastatic dissemination in many cancer types. We report the clinical activity of ⁹⁰Y-FF-21101 in a first-in-human phase I study in patients with advanced solid tumors.

PATIENTS AND METHODS

The safety and efficacy of ⁹⁰Y-FF-21101 were evaluated in a phase I 3+3 dose-escalation study in patients with advanced solid tumors (n = 15) over a dose range of 5-25 mCi/m². Dosimetry using ¹¹¹In-FF-21101 was performed 1 week prior to assess radiation doses to critical organs. Patients who demonstrated clinical benefit received repeated ⁹⁰Y-FF-21101 administration every 4 months.

RESULTS

¹¹¹In-FF-21101 uptake was observed primarily in the spleen, kidneys, testes, lungs, and liver, with tumor uptake observed in the majority of patients. Organ dose estimates for all patients were below applicable limits. P-cadherin expression H-scores ranged from 0 to 242 with 40% of samples exhibiting scores ≥100. FF-21101 protein pharmacokinetics were linear with increasing antibody dose, and the mean half-life was 69.7 (±12.1) hours. Radioactivity clearance paralleled antibody clearance. A complete clinical response was observed in a patient with clear cell ovarian carcinoma, correlating with a high tumor P-cadherin expression. Stable disease was observed in a variety of other tumor types, without dose-limiting toxicity.

CONCLUSIONS

The favorable safety profile and initial antitumor activity observed for ⁹⁰Y-FF-21101 warrant further evaluation of this radioimmunotherapeutic (RIT) approach and provide initial clinical data supporting P-cadherin as a potential target for cancer treatment.

The nationwide registry of hospitalized heart failure patients in Japan: Japanese Registry Of Acute Decompensated Heart Failure (JROADHF)

Background and aim

Heart failure (HF) is a growing healthcare problem worldwide. This study aimed to describe clinical characteristics and long-term outcomes of HF patients in Japan.

Methods and results

JROADHF (the Japanese Registry Of Acute Decompensated Heart Failure) is a retrospective, multicentre, nationwide observational database of 13,238 patients hospitalized due to HF in 128 hospitals randomly selected from Japanese Circulation Society (JCS)-certified teaching hospitals during 2013. At inclusion, demographic and clinical data were collected from medical records with linkage to a nationwide claim-based database, the Japanese Diagnosis Procedure Combination (DPC). Patients were followed up to 5 years after discharge at each participating site. Patients were old as the median age of 81 years and women were older (74.8±12.8 vs 81.6±11.1 y.o). Mean left ventricular ejection fraction (LVEF) was 47%, and 45% were HF with preserved ejection fraction of &gt;50% (HFpEF). Causes of HF included ischemic in 27%, valvular in 19%, arrhythmia in 17%, and hypertensive in 16%. Median length of hospital stay was 18 days and in-hospital mortality was 7.7%. All-cause mortality during 1 and 4 years were 22.3% and 48.4%, respectively. Hospitalization rates due to HF within 1 and 4 years were as high as 30.5 and 48.4%, respectively.

Conclusions

Contemporary nationwide registry revealed that hospitalized HF patients were elder and had more HFpEF, and their prognosis was still poor compared to the data shown in prior registries.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development (AMED) Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus