Magnetic Resonance Imaging after Nasopharyngeal Endoscopic Resection and Skull Base Reconstruction

Background: Postoperative imaging after nasopharyngeal endoscopic resection (NER) and skull base reconstruction is quite challenging due to the complexity of the post-surgical and regional anatomy. Methods: In this retrospective observational study, we included patients treated with NER from 2009 to 2019 and submitted to Magnetic Resonance Imaging (MRI) 6 and 12 months after surgery. A radiologist with 15 years of experience analyzed all MRI scans. Results: A total of 50 patients were considered in this study, 18 of whom were excluded due to imaging unavailability, and 16 of whom were not considered due to major complications and/or persistent disease. Sixteen patients were evaluated to identify the expected findings. Inflammatory changes were observed in 16/64 subsites, and regression of these changes was observed in 8/64 at 1 year. Fibrosis was observed in 5/64 subsites and was unmodified at 1 year. The nasoseptal flap showed homogeneous enhancement at 6 months (100%) and at 1 year. The temporo-parietal fascia flap (TPFF) showed a decrease in the T2- signal intensity of the mucosal layer in 57% of the patients at 1 year and a decrease in enhancement in 43%. Conclusions: Identifying the expected findings after NER and skull base reconstruction has a pivotal role in the identification of complications and recurrence.

Relationship between circulating FSH levels and body composition and bone health in patients with prostate cancer who undergo androgen deprivation therapy: The BLADE study

Background

Among its extragonadal effects, follicle-stimulating hormone (FSH) has an impact on body composition and bone metabolism. Since androgen deprivation therapy (ADT) has a profound impact on circulating FSH concentrations, this hormone could potentially be implicated in the changes of fat body mass (FBM), lean body mass (LBM), and bone fragility induced by ADT. The objective of this study is to correlate FSH serum levels with body composition parameters, bone mineral density (BMD), and bone turnover markers at baseline conditions and after 12 months of ADT.

Methods

Twenty-nine consecutive non-metastatic prostate cancer (PC) patients were enrolled from 2017 to 2019 in a phase IV study. All patients underwent administration of the luteinizing hormone-releasing hormone antagonist degarelix. FBM, LBM, and BMD were evaluated by dual-energy x-ray absorptiometry at baseline and after 12 months of ADT. FSH, alkaline phosphatase, and C-terminal telopeptide of type I collagen were assessed at baseline and after 6 and 12 months. For outcome measurements and statistical analysis, t-test or sign test and Pearson or Spearman tests for continuous variables were used when indicated.

Results

At baseline conditions, a weak, non-significant, direct relationship was found between FSH serum levels and FBM at arms (r = 0.36) and legs (r = 0.33). Conversely, a stronger correlation was observed between FSH and total FBM (r = 0.52, p = 0.006), fat mass at arms (r = 0.54, p = 0.004), and fat mass at trunk (r = 0.45, p = 0.018) assessed after 12 months. On the other hand, an inverse relationship between serum FSH and appendicular lean mass index/FBM ratio was observed (r = -0.64, p = 0.001). This is an ancillary study of a prospective trial and this is the main limitation.

Conclusions

FSH serum levels after ADT could have an impact on body composition, in particular on FBM. Therefore, FSH could be a promising marker to monitor the risk of sarcopenic obesity and to guide the clinicians in the tailored evaluation of body composition in PC patients undergoing ADT.

Funding

This research was partially funded by Ferring Pharmaceuticals. The funder had no role in design and conduct of the study, collection, management, analysis, and interpretation of the data and in preparation, review, or approval of the manuscript.

Clinical trial number

clinicalTrials.gov NCT03202381, EudraCT Number 2016-004210-10.

The added value of radiomics in determining patient responsiveness to laryngeal preservation strategies

PURPOSE OF REVIEW

Laryngeal cancer (LC) is a highly aggressive malignancy of the head and neck and represents about 1-2% of cancer worldwide.Treatment strategies for LC aim both to complete cancer removal and to preserve laryngeal function or maximize larynx retention.Predicting with high precision response to induction chemotherapy (IC) is one of the main fields of research when considering LC, since this could guide treatment strategies in locally advanced LC.

RECENT FINDINGS

Radiomics is a noninvasive method to extract quantitative data from the whole tumor using medical imaging. This signature could represent the underlying tumor heterogeneity and phenotype.During the last five years, some studies have highlighted the potential of radiomics in the pretreatment assessment of LC, in the prediction of response to IC, and in the early assessment of response to radiation therapy. Although these represent promising results, larger multicentric studies are demanded to validate the value of radiomics in this field.

SUMMARY

The role of radiomics in laryngeal preservation strategies is still to be defined. There are some early promising studies, but the lack of validation and larger multicentric studies limit the value of the papers published in the literature and its application in clinical practice.

Fat Body Mass and Vertebral Fracture Progression in Women With Breast Cancer

Importance

Women with early breast cancer (EBC) exposed to aromatase inhibitors (AIs) may experience fragility fractures despite treatment with bone-active drugs. Risk factors for fractures in patients receiving AIs and denosumab have not been explored to date.

Objectives

To evaluate whether an association exists between dual x-ray absorptiometry (DXA)-measured fat body mass (FBM) and vertebral fracture (VF) progression in postmenopausal women with EBC undergoing adjuvant therapy with AIs in combination with denosumab and to examine whether VF was associated with common risk factors for bone fracture and parameters of body composition other than FBM.

Design, Setting, and Participants

For this prospective, single-center, cohort study, 237 patients with EBC who were undergoing adjuvant treatment with AIs and denosumab (60 mg every 6 months) were enrolled at the Breast Unit of the ASST Spedali Civili of Brescia from September 2014 to June 2018. Data analysis was conducted in June 2022.

Exposure

Body composition parameters, bone mineral density, and morphometric VFs were assessed by DXA at study entry and after 18 months of therapy.

Main Outcomes and Measures

VF progression, defined as either new or worsening of preexisting VFs, between the 2 time points.

Results

Of the 237 patients enrolled (median [range] age, 61 [28-84] years), 17 (4.4%) reported VF progression. Univariable analysis found an association between VF progression and a history of clinical fractures (odds ratio [OR], 3.22; 95% CI, 1.19-8.74; P = .02), Fracture Risk Assessment Tool (FRAX) score for major fractures (OR, 4.42; 95% CI, 1.23-13.79; P = .04), percentage of FBM (OR, 6.04; 95% CI, 1.69-21.63; P = .006), and android fat (OR, 9.58; 95% CI, 1.17-78.21; P = .04) and an inverse association with appendicular lean mass index-FBM ratio (OR, 0.25, 95% CI, 0.08-0.82; P = .02). Multivariable analysis revealed percentage of FBM (OR, 5.41; 95% CI, 1.49-19.59; P = .01) and FRAX score (OR, 3.95; 95% CI, 1.09-14.39; P = .04) as independent variables associated with VF progression.

Conclusions and Relevance

The findings of this study suggest that baseline FBM is an independent factor for VF progression in patients with EBC treated with adjuvant AIs and denosumab. This observation is new and indicates that diet and exercise may synergize with denosumab in the management of bone health in this patient setting.

Role of Body Composition in the Prediction of Skeletal Fragility Induced by Hormone Deprivation Therapies in Cancer Patients

PURPOSE OF REVIEW

This review paper is intended to show that changes in body composition are key in the pathogenesis of bone fragility amongst patients with breast and prostate cancer receiving hormone deprivation therapies (HDTs) and that the mechanism is based on the development of alterations in bone quality rather than in bone quantity.

RECENT FINDINGS

Preclinical and clinical data suggest a tight connection amongst bone, adipose and muscular tissues by means of several soluble mediators, potentially leading to (1) bone resorption and bone quality deterioration in sarcopenic obese subjects, (2) bone mineral deposition in healthy trained subjects. Cancer patients treated with HDTs frequently fall into the first condition, named osteosarcopenic obesity. Current clinical guidelines for the prevention of treatment-induced osteoporosis focus on bone mineral density (BMD) as a main predictive factor for fracture risk; however, the pathophysiology underlying HDT-induced bone fragility differs from that of primary and postmenopausal osteoporosis, suggesting a prevalent role for bone quality alterations. Focusing on available data from clinical trials, in our review we suggest osteosarcopenic obesity as a common target for the prevention and treatment of HDTs-related metabolic and skeletal complications, beyond a BMD-centred approach.

Whole-body diffusion-weighted magnetic resonance imaging to assess bone response in patients with hormone-sensitive metastatic prostate cancer randomly assigned to receive androgen deprivation + enzalutamide ± zoledronic acid

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Background: Bone is frequently involved in metastatic hormone sensitive prostate cancer (mHSPC). Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) is a promising imaging technique for the assessment of bone response in prostate cancer. It is not known whether the addition of antiresorptive agents can improve disease response in bone in mHSPC patients undergoing next generation hormonal agents. Methods: In this multicenter phase II study patients with de novo or relapsed mHSPC and bone metastases at bone scan were randomly allocated with a 1:1 ratio to receive either androgen deprivation therapy (ADT) plus Enzalutamide (E arm) or the same combination with the addition of Zoledronic Acid (EZ arm). The study was designed to observe a significant increase in bone response rate in the experimental arm after 12 months of treatment, as assessed through WB-DW-MRI. WB-DW-MRI was performed centrally at baseline and after 6 and 12 months and images were evaluated by the same radiologist. Results: From February 2018 to June 2021, 126 mHSPC patients were randomized, 64 in EZ arm and 62 in E arm. A total of 111 patients, 54 from E arm and 57 from EZ arm, were eligible for WB-DW-MRI assessment (15 patients were excluded because of the absence of bone target lesions at MRI or specific contraindications to MRI). Bone response at 6 months was observed in 41 patients (76%) in E arm and 41 patients (72%) in EZ arm; the corresponding bone response at 12 months were 44 (82%) and 44 (77%), respectively (OR 0.77; 95%IC 0.30-1.93; p = 0.6). Complete response was the best overall bone response after 12 months in 9 patients (17%) from E arm and in 11 patients (19%) from EZ arm. In the same period, treatment was interrupted due to disease progression in 7 (13%) and 7 (12%) patients in E and EZ arm, respectively. Conclusions: The addition of Zoledronic Acid to Enzalutamide and ADT did not improve bone disease response in patients with mHSPC. WB-DW-MRI was able to detect bone responses in a great proportion of patients. Clinical trial information: NCT03336983 .

247 HEPATIC T1-TIME, CARDIAC STRUCTURE, FUNCTION AND CARDIOVASCULAR OTUCOMES IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION UNDERGOING CARDIAC MAGNETIC RESONANCE IMAGING

Aim

Liver damage is frequently encountered in patients with cardiovascular (CV) disease, due to congestion or metabolic dysfunction-associated fatty liver disease (MAFLD). It has been shown that liver disease is associated with worse outcomes in patients with CV disease. Nevertheless, the association of liver disease with cardiac structure and function and CV events in patients with heart failure and reduced ejection fraction (HFrEF) is poorly known.

Methods

We retrospectively enrolled consecutive patients with HFrEF undergoing Cardiac Magnetic Resonance (CMR) Imaging. In addition to standard cardiac T1-mapping, 3 regions of interest were also defined at the liver parenchyma. Patients were stratified according to hepatic T1 mapping. Linear regression analysis adjusted for demographics and clinical characteristics was performed to cross-sectionally examine the association between hepatic T1-time on CMR and measures of cardiac structure and function. The Kaplan-Meier survival and Cox regression analyses were performed to prospectively investigate the association between hepatic T1-time and the composite adverse outcome of hospitalization for HF or all-cause death.

Results

Overall, 106 HFrEF patients were included in the study (mean age 56 ± 14 years, 75% male). Mean hepatic T1-time was 558 ± 70 ms. In logistic regression analysis, left-ventricle (LV) end-diastolic volume (EDV) (p = 0.027), left atrial volume (LAV) (p = 0.015), right-ventricle (RV) EDV (p < 0.001) and RVEF (p = 0.035) were positively associated with hepatic T1-time. Over a mean follow-up of 5 ± 2 years, 32 patients (30%) experienced the composite outcome at a rate of 6.7 per 100 person-year. In Cox regression analysis, higher hepatic T1-time was independently associated with an increased risk of developing the composite outcome (adjusted-hazard ratio 1.07, 95% confidence interval: 1.01–1.12, p = 0.011). In particular, patients with a hepatic T1-time ≥558 ms had a higher risk of adverse outcomes compared to those with a hepatic T1-time <558 ms (log-rank p = 0.02).

Conclusion

Among HFrEF patients undergoing CMR, higher hepatic T1-time was significantly associated with poorer measures of cardiac size and function. Hepatic T1-time was also significantly associated with higher rates of hospitalization for HF or all-cause-mortality. This parameter may be useful to stratify HFrEF patients at risk of adverse cardiovascular outcomes.

RAPID score in Covid-19 patients: a clinical-radiological index for the safe discharge from the Emergency Department. A preliminary report

To evaluate the performance of a clinical-radiological index (RAPID-Covid score) in achieving Safe Discharge (SD) of patients accessing the Emergency Department (ED) with symptoms suggesting Covid-19. Clinical and radiological data were retrospectively collected from 853 consecutive patients admitted to the ED during the pandemics with symptoms suggesting Covid-19. Illness severity was graded with RAPID-Covid score, composed of chest X-ray findings, clinical symptoms and PaO2/FiO2. Patients with RAPIDCovid score ≥5 were admitted. Primary outcome was SD of patients to home care. SD was defined as survival of the patient, without evidence of second access to ED requiring hospitalization. 212/853 patients were discharged. 27/212 had a score ≥5 but refused admission. 185/212 were discharged with score <5: 147/185 (79,5%) survived and did not re-access ED; 1/185 (0,5%) died at home after first ED-dismissal; 37/185 (20,0%) had a second access. Of these 15/37 (8,1%) were newly dismissed and one of them (1/15) died at home; 22/37 (11,9%) were hospitalized, 1/22 died during hospitalization. SD was obtained in 161/185 patients (87%). Readmissions occurred 5,1±2,6days from first discharge. Follow-up was 16,7±6,0days. RAPID-Covid score proves useful for SD of Covid-19 to home care. 6-10days may further increase confidence.