Bench to bedside molecular functional imaging in translational cancer medicine: to image or to imagine?

Ongoing research on malignant and normal cell biology has substantially enhanced the understanding of the biology of cancer and carcinogenesis. This has led to the development of methods to image the evolution of cancer, target specific biological molecules, and study the anti-tumour effects of novel therapeutic agents. At the same time, there has been a paradigm shift in the field of oncological imaging from purely structural or functional imaging to combined multimodal structure-function approaches that enable the assessment of malignancy from all aspects (including molecular and functional level) in a single examination. The evolving molecular functional imaging using specific molecular targets (especially with combined positron-emission tomography [PET] computed tomography [CT] using 2- [(18)F]-fluoro-2-deoxy-D-glucose [FDG] and other novel PET tracers) has great potential in translational research, giving specific quantitative information with regard to tumour activity, and has been of pivotal importance in diagnoses and therapy tailoring. Furthermore, molecular functional imaging has taken a key place in the present era of translational cancer research, producing an important tool to study and evolve newer receptor-targeted therapies, gene therapies, and in cancer stem cell research, which could form the basis to translate these agents into clinical practice, popularly termed "theranostics". Targeted molecular imaging needs to be developed in close association with biotechnology, information technology, and basic translational scientists for its best utility. This article reviews the current role of molecular functional imaging as one of the main pillars of translational research.

Crossbow injuries to the thumb

Archery injuries resulting in significant digital impairment are uncommon. The purpose of this study was to review seven patients treated at our institution for injuries of the left thumb sustained during recreational use of a crossbow. We reviewed all thumb injuries caused by crossbow use treated at Geisinger Health System between August 2011 and November 2012. The electronic medical records were reviewed to document mechanism of injury, injury pattern, patient characteristics, treatment, and outcomes. Seven patients were identified with injury to their left thumb, six males and one female. Two patients sustained contusions; two nerve injuries; one dorsal skin loss; one nail complex injury; two extensor tendon injury; three distal phalangeal fracture; one interphalangeal fracture-dislocation; two complete or partial amputations. These injuries were treated with standard techniques. Injuries sustained during recreational crossbow use result from trauma to the left thumb which is placed in a forward position on the crossbow stock. Increasing popularity of crossbow usage has made these injuries more prevalent. Standard techniques of treating hand trauma are sufficient to manage these injuries. With proper education and safety mechanisms, these injuries are preventable.

Abstract 198: Relationship Between 24 Hour Infarct Volume And Clinical Outcomes In IMS 3

Background: Prospective, core lab adjudication of 24 hour post randomization head CT in IMS3 enabled analysis of the association between 24 hour infarct volume (24HRIV) and clinical outcomes in patients randomized to IV tPA alone or IV/IA approach.

Methods: Manually calculated volumes of hypodense areas deemed acute and found within the affected territory on the IMS 3 follow-up CT scans expressed in cc were termed 24HRIV. These were correlated with several variables of interest in the IMS3 database including clinical outcomes expressed as modified Rankin score (mRS), baseline NIHSS (bNIHSS), follow-up NIHSS at 24 hours (fNIHSS), treatment allocation and occlusion location assessed on baseline CTA.

Results: Of the 656 randomized patients, 502 (76.5%) had available 24HRIV’s and were included in the analysis. Good outcomes (defined as mRS 0-2) were noted in 197 (39.2%) of patients. Mean (median) 24HRIV in patients with favorable outcomes was 24.2 (12.2) cc vs. 115 (75.11) cc in those with unfavorable outcomes (p< 0.00001). A strong correlation was noted between the 24HRIV and clinical outcomes across the entire spectrum of the mRS scale (Figure1). Mean (median) 24HRIV’s were not significantly different in the IV vs IV/IA group 76.8 (34.5) vs 84.8 (37.8) cc, p= 0.38. No differences in 24HRIV were noted between IV and IV/IA groups in patients with ICA occlusion on baseline CTA (mean 24HRIV 125.8 vs 123.8 cc's respectively, p=0.9) or MCA occlusion (mean 24HRIV 54.4 vs 54.6 cc's respectively, p=0.9). A strong correlation was found between 24HRIV and fNIHSS (spearman rho=0.7, p<0.0001).

Conclusions: In IMS 3, a significant correlation between 24 hour infarct volume on CT and clinical outcomes both at 24 hours and at 90 days was demonstrated. No significant differences in 24 hour infarct volumes were noted between the IV and the IV/IA group, suggesting that endovascular reperfusion strategies utilized during IMS3 overall lacked added effectiveness compared to IV t-PA alone.

Osteoradionecrosis of the mandible: through a radiologist's eyes

Head and neck malignancies constitute a major cause of morbidity and mortality all over the world. Radiotherapy plays a pivotal role in the management of these tumours; however, it has associated complications, with mandibular osteoradionecrosis (ORN) being one of the gravest orofacial complications. Early diagnosis, extent evaluation, and detection of complications of ORN are imperative for instituting an appropriate management protocol. ORN can closely mimic tumour recurrence, the differentiation of which has obvious clinical implications. The purpose of the present review is to acquaint the radiologist with the imaging features of mandibular ORN and the ways to differentiate ORN from tumour recurrence.