Search

Ovarian cancer is the second most common gynecologic malignancy and is the fifth leading cause of cancer death in women. Imaging plays several critical roles in ovarian cancer: Detection, characterization, and staging. Imaging is also very important for the characterization of ovarian masses, since benign masses outnumber malignant masses. This article reviews the applications of different imaging modalities in the evaluation of ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: Biologically targeted therapies have been postulated as a viable strategy to improve outcomes for women with ovarian cancer. We assessed the safety, tolerance, pharmacokinetics, relevant circulating and image-derived biomarkers, and clinical activity of combination aflibercept and docetaxel in this population.Methods: For the phase 1 (pharmacokinetic) study, eligible patients had measurable, recurrent or persistent epithelial ovarian, primary peritoneal, or fallopian tube carcinoma with a maximum of two prior chemotherapy regimens. Aflibercept was administered intravenously over three dose levels (2, 4, or 6 mg/kg; one dose every 21 days) to identify the maximum tolerated dose for the phase 2 study. Pharmacokinetics were assessed and dynamic imaging was done during a lead-in phase with single-agent aflibercept (cycle 0) and during combination therapy with intravenous docetaxel (75 mg/m(2)). Eligibility for the phase 2 study was the same as for phase 1. Patients were enrolled in a two-stage design and given aflibercept 6 mg/kg intravenously and docetaxel 75 mg/m(2) intravenously, every 3 weeks. The primary endpoint was objective response rate (ORR) as assessed by Response Evaluation Criteria in Solid Tumors version 1.0. The trial has completed enrolment and all patients are now off study. The trial is registered at ClinicalTrials.gov, number NCT00436501.Findings: From the phase 1 study, the recommended phase 2 doses of aflibercept and docetaxel were found to be 6 mg/kg and 75 mg/m(2), respectively. Log-linear pharmacokinetics (for unbound aflibercept) were observed for the three dose levels. No dose-limiting toxicities were noted. 46 evaluable patients were enrolled in the phase 2 trial; 33 were platinum resistant (15 refractory) and 13 were platinum sensitive. The confirmed ORR was 54% (25 of 46; 11 patients had a complete response and 14 had a partial response). Grade 3-4 toxicities observed in more than two patients (5%) were: neutropenia in 37 patients (80%); leucopenia in 25 patients (54%); fatigue in 23 patients (50%); dyspnoea in ten patients (22%); and stomatitis in three patients (7%). Adverse events specifically associated with aflibercept were grade 1-2 hypertension in five patients (11%), and grade 2 proteinuria in one patient (2%).Interpretation: Combination aflibercept plus docetaxel can be safely administered at the dose and schedule reported here, and is associated with substantial antitumour activity. These findings suggest that further clinical development of this combination in ovarian cancer is warranted.Funding: US National Cancer Institute, US Department of Defense, Sanofi-Aventis, Gynecologic Cancer Foundation, Marcus Foundation, and the Commonwealth Foundation. [ABSTRACT FROM AUTHOR]

Background: Mental health issues are a major cause of poor life outcomes. Heartfulness (HFN) meditation is recommended for stress management and daily awareness. Although studies have shown that HFN can improve burnout and well-being, the biological mechanism underlying oxidative stress markers in a healthy human is unclear., Objective: The purpose of this study was to determine whether HFN meditation benefits mindfulness responses and also to examine the impact of HFN meditation on oxidative stress in healthy individuals., Methods: This prospective study involved 60 healthy individuals aged 18-24, divided into experimental and control groups, and implemented an HFN meditation intervention over 12 weeks. Both groups' serum malondialdehyde and serum nitrate levels were examined before and after the intervention. Additionally, psychometric evaluations concerning mindfulness and experiential avoidance were conducted utilizing scales such as the Mindful Attention Awareness Scale (MAAS), Five-Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), and Experiential Avoidance (EA)., Results: Following a three-month intervention period, serum malondialdehyde (MDA) levels in the experimental group did not show a significant increase, whereas in the control group, there was a significant increase (p < 0.000). Conversely, serum nitrate levels in the experimental group exhibited a significant increase (p < 0.05). Additionally, psychological stress decreased, as indicated by various questionnaire tools such as MAAS, FFMQ, SCS, and EA, with mindfulness showing an increase. However, a decrease in EA was seen., Conclusion: Heartfulness meditation has a positive impact on both mindfulness and oxidative stress. This suggests that consistent, long-term participation in HFN meditation could enhance mental health and foster overall well-being., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, MGM Dental College & Hospital (IEC-MGMDCH) issued approval (MGM/DCH/IEC/059/23). The study was initiated after ethical clearance on 15th February, 2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Patil et al.)

High levels of loneliness are prominent in teenagers ranging from ages 14-19. The 4-week Self-Care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills and self-observation. This study examined the impact of the Self-Care program on loneliness in high school students in the United States in a randomized, wait-list control trial with baseline and postintervention assessments. High school participants, aged 14-19, were randomized into a control-wait-listed group (n = 54) and a Heartfulness group (n = 54). Both the groups completed the intervention and the presurveys and postsurveys online, assessing their loneliness with the UCLA Loneliness Scale. The initial analysis noted the baseline equivalence of the data. A repeated measures ANOVA found a significant time * group interaction, with a significant decrease in loneliness reported in the Heartfulness Intervention group but no significant pre-post difference in the control group. In summary, the short online intervention program consisting of self-care tools decreased loneliness scores in the participants. This study opens up a new valley of possibilities, apart from existing research, and demonstrates that the online intervention used might be helpful to decrease loneliness levels in teens., (© 2022 The Authors. Applied Psychology: Health and Well-Being published by John Wiley & Sons Ltd on behalf of International Association of Applied Psychology.)

Background: Natalizumab (NTZ) is increasingly being used in Indian multiple sclerosis (MS) patients. There are no reports on its safety and efficacy, especially with respect to the occurrence of progressive multifocal leukoencephalopathy (PML)., Objectives: To describe the patient characteristics, treatment outcomes, and adverse events, especially the occurrence of PML in NTZ-treated patients., Methods: A multicentre ambispective study was conducted across 18 centres, from Jan 2012 to Dec 2021. Patients at and above the age of 18 years treated with NTZ were included. Descriptive and comparative statistics were applied to analyze data., Results: During the study period of 9 years, 116 patients were treated with NTZ. Mean age of the cohort was 35.6 ± 9.7 years; 83/116 (71.6%) were females. Relapse rate for the entire cohort in the year before NTZ was 3.1 ± 1.51 while one year after was 0.20±0.57 (p = 0.001; CI 2.45 -3.35). EDSS of the entire cohort in the year before NTZ was 4.5 ± 1.94 and one year after was 3.8 ± 2.7 (p = 0.013; CI 0.16-1.36). At last follow up (38.3 ± 22.78 months) there were no cases of PML identified., Conclusions: Natalizumab is highly effective and safe in Indian MS patients, with no cases of PML identified at last follow up., Competing Interests: Disclosure of Conflicts of Interest None of the authors has any conflict of interest to disclose., (Copyright © 2022. Published by Elsevier B.V.)

Purpose: We compared the magnitude of changes in bone mineral density (BMD), within and outside the radiation field, among women who received pelvic radiation therapy (RT) with or without chemotherapy for cervical cancer., Methods and Materials: In this secondary analysis of a prospective study, we analyzed serial computed tomography scans and dual-energy x-ray absorptiometry scans from 78 patients who received definitive RT or chemoradiation therapy (CRT) for cervical cancer at a single institution from 2008 to 2015. BMD values at L1, L2, L3, and L4 were measured. We compared changes in BMD within the radiation field (ie, at L4) with those outside the field (ie, at L1). Linear mixed models were also used to examine the effect of RT on changes in BMD over time and covariate adjustment., Results: The median age of the 78 patients was 45.5 years (range, 23-88 years); all received RT and 76 (97%) received concurrent CRT. Treatment was associated with significant declines in BMD in all 4 lumbar vertebral bodies over time (P < .05), with nadir at 3 months for L4 and at 1 year for L1. Pairwise comparisons at 3 months and 2 years after treatment indicated that BMD in L4 (within the RT field) had improved (P = .037), but BMD in L1 (outside the RT field) was no different at 3 months and 2 years., Conclusions: Significant BMD declines were observed in all lumbar vertebral bodies immediately after RT. However, in-field vertebral bodies reached nadir BMD earlier than those located outside the RT field. Our results suggest that treatment and patient-related factors other than RT may contribute to declines in BMD after treatment for cervical cancer. Routine bone density screening and post-RT therapy with hormones may be beneficial for selected patients who receive CRT for cervical cancer., (Copyright © 2022 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Background: Outcomes of COVID-19 in PwMS (persons with Multiple Sclerosis) on immunosuppressive therapies, particularly B-cell depletors, can be unpredictable. There has been a concern for postponing or avoiding use of Rituximab (RTX) during the COVID-19 pandemic. We report the course and outcomes of COVID-19 in PwMS receiving RTX., Methods: PwMS receiving RTX who contracted COVID-19 were closely monitored by tele-consultation and/or evaluated during hospital visits. Those requiring hospitalization for oxygen therapy or admission to ICU or expiring due to COVID-19 were considered to have severe disease. Those without desaturation and manageable at home were considered to have mild disease. Disease course and outcomes were noted., Results: Twelve out of 62 (19.4%) PwMS on RTX therapy developed COVID-19. Four (age 35-49 years; mean 43.5) had severe COVID; three of whom had Secondary Progressive MS (SPMS). One PwMS expired. Two had prolonged fever lasting >1 month. One demonstrated features of SARS-CoV-2 reactivation. Interval from last RTX infusion (average dose 750 mg) to COVID-19 onset ranged 1-4 (mean 3.7) months. Eight PwMS had mild COVID-19 (age 26-54 years; mean 37.7); six had RRMS and two SPMS. RTX dose was lower (average dose 625 mg) and infusion to COVID-19 onset duration was longer, ranging 4-20 (mean 9.5) months. Four patients, two each from mild and severe COVID-19 groups had neurological deterioration, but none had true relapses., Conclusion: RTX treated PwMS may have unpredictable disease outcomes if they contract COVID-19, but may be at risk of severe disease and persistent infection. In our series higher age, SPMS, shorter interval from RTX infusion to COVID-19 onset and higher dose of RTX were noted amongst those developing severe disease. RTX should be use cautiously during the COVID-19 pandemic and if unavoidable, less frequent and lower doses should be considered. Patients receiving RTX must be counselled to follow strict COVID-19 preventive measures., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Teenagers are highly susceptible to mental health issues and this problem has been exacerbated by the quarantine restrictions of COVID-19. This study evaluated the use of Heartfulness Meditation and Audio Brainwave Entrainment to help teenagers cope with mental health issues. It used 30-min Heartfulness meditation and 15-min brainwave entrainment sessions with binaural beats and isochronic tones three times a week for 4 weeks. Using a pretest-posttest methodology, participants were asked to complete a survey battery including the Pittsburgh Quality of Sleep Index, Perceived Stress Scale, Patient Health Question-9, Profile of Mood States, and Cambridge Brain Health assessment. Participants ( n = 40) were divided into four experimental groups: the control group ( n = 9), Audio Brainwave Entrainment group ( n = 9), Heartfulness Meditation group ( n = 10), and a combined group ( n = 12), for a 4-week intervention. Data were analyzed with paired t -tests. The singular Audio Brainwave Entrainment group did not see statistically significant improvements, nor did any of the intervention groups for brain health ( p > 0.05). This study, however, proved the efficacy of a 4-week Heartfulness Meditation program to regulate overall mood ( p = 0.00132), stress levels ( p = 0.0089), state depression (POMS; p = 0.0037), and anger ( p = 0.002). Results also suggest adding Audio Brainwave Entrainment to Heartfulness Meditation may improve sleep quality ( p = 0.0377) and stress levels ( p = 0.00016)., Competing Interests: FC-F is employed by BrainTap, the company that provided the ABE sessions. RI works for the Heartfulness Institute, but due to the absence of a commercial product from the organization, there is no financial interest. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Yadav, Cidral-Filho and Iyer.)

Clarithromycin is a commonly used antibiotic. Neuropsychiatric adverse effects are recognized, but the occurrence of seizures and status epilepticus (SE) has been rarely reported. We report the case of an elderly patient who developed generalized tonic-clonic seizures (GTCS) followed by nonconvulsive status epilepticus (NCSE), 2 days after starting clarithromycin. Other causes of seizures were excluded by magnetic resonance imaging (MRI) of the brain, CSF analysis, and routine laboratory studies, thus establishing the causal role of clarithromycin. Clarithromycin was stopped and parenteral antiepileptic drugs started, which controlled the status. In the elderly, symptoms like delirium, drowsiness, confusion, or seizures can occur due to an underlying systemic disease, brain pathology, or adverse effects of medications, all of which must be correctly differentiated. This case illustrates the occurrence of seizures and SE due to clarithromycin. Awareness about this possibility will help physicians recognize and treat such situations promptly. How to cite this article: Seetharam R, Iyer RB, Nooraine J, Ramachandran J. Clarithromycin-induced Seizures and Status Epilepticus. Indian J Crit Care Med 2021;25(8):945-947., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.)

Background: COVID-19-related strokes are increasingly being diagnosed across the world. Knowledge about the clinical profile, imaging findings, and outcomes is still evolving. Here we describe the characteristics of a cohort of 62 COVID-19-related stroke patients from 13 hospitals, from Bangalore city, south India., Objective: To describe the clinical profile, neuroimaging findings, interventions, and outcomes in COVID-19-related stroke patients., Methods: This is a multicenter retrospective study of all COVID-19-related stroke patients from 13 hospitals from south India; 1st June 2020-31st August 2020. The demographic, clinical, laboratory, and neuroimaging data were collected along with treatment administered and outcomes. SARS-CoV-2 infection was confirmed in all cases by RT-PCR testing. The data obtained from the case records were entered in SPSS 25 for statistical analysis., Results: During the three-month period, we had 62 COVID-19-related stroke patients, across 13 centers; 60 (97%) had ischemic strokes, while 2 (3%) had hemorrhagic strokes. The mean age of patients was 55.66 ± 13.20 years, with 34 (77.4%) males. Twenty-six percent (16/62) of patients did not have any conventional risk factors for stroke. Diabetes mellitus was seen in 54.8%, hypertension was present in 61.3%, coronary artery disease in 8%, and atrial fibrillation in 4.8%. Baseline National Institutes of Health Stroke Scale score was 12.7 ± 6.44. Stroke severity was moderate (National Institutes of Health Stroke Scale 5-15) in 27 (61.3%) patients, moderate to severe (National Institutes of Health Stroke Scale 16-20) in 13 (20.9%) patients and severe (National Institutes of Health Stroke Scale 21-42) in 11 (17.7%) patients. According to TOAST classification, 48.3% was stroke of undetermined etiology, 36.6% had large artery atherosclerosis, 10% had small vessel occlusion, and 5% had cardioembolic strokes. Three (5%) received intravenous thrombolysis with tenecteplase 0.2 mg/kg and 3 (5%) underwent mechanical thrombectomy, two endovascular and one surgical. Duration of hospital stay was 16.16 ± 6.39 days; 21% (13/62) died in hospital, while 37 (59.7%) had a modified Rankin score of 3-5 at discharge. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality. A comparison to 111 historical controls during the non-COVID period showed a higher proportion of strokes of undetermined etiology, higher mortality, and higher morbidity in COVID-19-related stroke patients., Conclusion: COVID-19-related strokes are increasingly being recognized in developing countries, like India. Stroke of undetermined etiology appears to be the most common TOAST subtype of COVID-19-related strokes. COVID-19-related strokes were more severe in nature and resulted in higher mortality and morbidity. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality.

Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE) is a recently recognized, highly epileptogenic, distinct histopathological entity in drug-resistant epilepsy that primarily involves the frontal lobes. Surgical outcomes in MOGHE are variable. Although the diagnosis is based on histopathology, high-resolution MRI helps to differentiate MOGHE preoperatively from other forms of cortical malformations (i.e., mMCD II and FCD IIa). We discuss the clinical, electrographic, radiological and histopathological characteristics of MOGHE in two patients who underwent evaluation for drug-resistant epilepsy followed by electrocorticography-based resection. Both patients presented with childhood-onset refractory frontal lobe epilepsy with a high seizure burden. Interictal epileptiform discharges were widespread. PET abnormalities were disproportionate to the MRI findings. Cognitive impairment, persistent epileptiform discharges on post-resection electrocorticography and sub-optimal surgical outcomes suggest that MOGHE is a widespread pathology in focal epilepsy.

Sex cord-stromal tumors of the ovary (SCST) are uncommon ovarian tumors arising from sex cord and/or stromal cells of the ovaries. They may be nonfunctional and asymptomatic or functional presenting with hyperestrogenic, hyperandrogenic or cushingoid symptoms. They present in a wide age group of women, mostly in early stages and follow a nonaggressive clinical course after surgical resection. They differ from more prevalent epithelial ovarian tumors which tend to present in older women in advanced stages with poor prognosis. Some of SCSTs are associated with clinical syndromes. We will review imaging features on ultrasound, computed tomography and magnetic resonance imaging, epidemiology and clinical presentations of these tumors.

Background: HeartBot is an app designed to enable people 14 years and older to use relaxation tools offered by Heartfulness Institute to deal with daily stress and anxiety in a healthy, productive manner. These tools have proven effective in stress management and mental wellness when administered in a controlled environment by a certified proctor., Objective: This study aimed to explore the app's effectiveness and evaluate the implementation of the tools., Methods: In this study, 88 participants were recruited and randomly sorted into 2 groups, the HeartBot intervention group (n=46) and the waitlist control group (n=42). Pre- and postsurveys measured participants' stress levels using the Perceived Stress Scale (PSS) and their social-emotional well-being using the EPOCH (Engagement, Perseverance, Optimism, Connectedness, and Happiness) Measure of Adolescent Well-Being before and after they used the app for 21 days for 30 minutes every day., Results: The study received institutional review board approval on August 18, 2019. Participant recruitment lasted from the approval date until September 30, 2019. The 21-day challenge started on October 1, 2019. Of the 135 people who signed up, 88 completed the study. There was a statistically significant difference in the mean PSS scores before and after the intervention (from 18.3 to 7.89; P<.001). The paired Wilcoxon rank sum test on the EPOCH scores indicated a significant difference in the medians of the total scores (W=411.5, P<.001)., Conclusions: Evidence from this study shows that HeartBot is an effective app that can be used to manage stress and improve positive characteristics of emotional wellness. Future research and widespread usage of the app under this study are encouraged based on this preliminary evidence of its effectiveness., Trial Registration: ClinicalTrials.gov NCT04589520; https://clinicaltrials.gov/ct2/show/NCT04589520., (©Laya Iyer, Ranjani B Iyer, Vetriliaa Kumar. Originally published in JMIR Formative Research (http://formative.jmir.org), 29.01.2021.)

Background: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT., Methods: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment., Results: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P < .001), higher baseline bone-specific alkaline phosphatase (P < .001), and older age (P = .007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively., Conclusions: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women., (© 2020 American Cancer Society.)

Competing Interests: There are no conflicts of interest.

Background: Apomorphine is an option for continuous dopaminergic therapy in Parkinson's disease (PD). However, its effects in varied populations are limited due to its availability., Objective: To assess the efficacy and outcomes of apomorphine in Indian patients., Materials and Methods: Retrospective analysis of PD patients who underwent apomorphine response test (ART), along with the subset, who went on to apomorphine pumps., Results: Twenty-nine confirmed PD patients underwent ART and all PD patients showed good clinical response. 19 subjects developed adverse events which included: nausea ( n -15, 51.7%), vomiting ( n -10, 34.4%), sleepiness ( n -08; 27.5%), yawning ( n -07, 24.1%), postural hypotension ( n -03, 10.3%), dizziness ( n -03, 10.3%), and profuse sweating ( n -01, 3.4%). Apomorphine pumps were initiated in six subjects, with significant clinical improvement. Adverse events on pump included subcutaneous nodules, nausea, hypersexuality. Two among them subsequently discontinued the pump primarily due to financial constraints., Conclusions: Apomorphine adds up to the armamentarium for treatment of PD patients in India with good clinical responses., Competing Interests: There are no conflicts of interest., (Copyright: © 2006-2019 Annals of Indian Academy of Neurology.)

Background: CD40 is a 48 kDa type I transmembrane protein that is constitutively expressed on hematopoietic cells such as dendritic cells, macrophages, and B cells. Engagement of CD40 by CD40L expressed on T cells results in the production of proinflammatory cytokines, induces T helper cell function, and promotes macrophage activation. The involvement of CD40 in chronic immune activation has resulted in CD40 being proposed as a therapeutic target for a range of chronic inflammatory diseases. CD40 antagonists are currently being explored for the treatment of autoimmune diseases and several anti-CD40 agonist mAbs have entered clinical development for oncological indications., Results: To better understand the mode of action of anti-CD40 mAbs, we have determined the x-ray crystal structures of the ABBV-323 (anti-CD40 antagonist, ravagalimab) Fab alone, ABBV-323 Fab complexed to human CD40 and FAB516 (anti-CD40 agonist) complexed to human CD40. These three crystals structures 1) identify the conformational CD40 epitope for ABBV-323 recognition 2) illustrate conformational changes which occur in the CDRs of ABBV-323 Fab upon CD40 binding and 3) develop a structural hypothesis for an agonist/antagonist switch in the LCDR1 of this proprietary class of CD40 antibodies., Conclusions: The structure of ABBV-323 Fab demonstrates a unique method for antagonism by stabilizing the proposed functional antiparallel dimer for CD40 receptor via novel contacts to LCDR1, namely residue position R32 which is further supported by a closely related agonist antibody FAB516 which shows only monomeric recognition and no contacts with LCDR1 due to a mutation to L32 on LCDR1. These data provide a structural basis for the full antagonist activity of ABBV-323.

Objectives: There is an increasing trend in the levels of stress, anxiety, and depression among adolescents aged 12 to 17. The Heartfulness Program for Schools (HPS) is a program designed to manage stress and build social-emotional skills to cope with real-life challenges. This quantitative study explores the impact of HPS customized for middle school students. Methods: Participants recruited from the 7 th and 8 th grade classrooms, including the HPS group (N = 74) and control group (N = 38), completed 2 surveys that measured levels of stress and well-being at baseline and after the completion of the 13-week elective. Results: Data collected from the pre-test resulted in similar baseline scores for both groups. Post-test findings revealed a statistically significant decrease in the stress levels in the HPS group showing improvement in coping skills, stress management, and increase in overall well-being. Conclusions: This study suggests that HPS helps reduce stress levels and improve well-being in children by cultivating positivity and fostering social and self-awareness. Integrating HPS in a school curriculum will benefit the students in building their emotional intelligence, and will nurture their relationship and mental well-being within and beyond the school.

Objectives: Knowledge of the detailed pattern of failure can be useful background knowledge in clinical decision making and potentially drive the development of new treatment strategies by increasing radiotherapy dose prescription to high-risk sub-regions of the target. Here, we analyze patterns of recurrence in patients with vulvar cancer treated with radiotherapy according to original planning target volumes and radiation dose delivered., Methods: We analyzed dose-planning and post-treatment recurrence scans from patients with vulvar cancer treated at two institutions from January 2009 through October 2014. We delineated the recurrences and merged the dose-planning and recurrence scans for each patient by using deformable co-registration. We estimated the center of each recurrence on the merged scans with the goal of relating them to the original dose plan., Results: We evaluated 157 patients who received radiotherapy for vulvar cancer. Median age was 68 years (range 29-91). Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IVB were included. Twenty-nine patients had recurrent disease; 156 patients had squamous cell carcinoma and one patient had adenosquamous carcinoma of the vulva. Among the 157 patients, 37 patients with recurrent disease had recurrence scans available for review, for a total of 80 recurrence sites; 53% of the recurrences were located in the region to which the highest dose (60-70 Gy) had been prescribed. Patients who received definitive radiotherapy developed failure primarily in the high-dose region (80.5%), whereas patients who received adjuvant radiotherapy had a more scattered failure pattern (p<0.0001). Among the latter group, 29.5% failed in the high-dose region., Conclusions: Patients who received definitive versus adjuvant radiotherapy had different failure patterns, indicating that separate approaches are needed to improve both adjuvant and definitive radiotherapy for vulvar cancer., Competing Interests: Competing interests: CSV, IRV received a grant from Kræftens Bekæmpelse (The Danish Cancer Society)., (© IGCS and ESGO 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To identify potential magnetic resonance imaging (MRI) biomarkers to predict the aggressiveness of endometrial cancer., Materials and Methods: Seventy-one patients with endometrial cancer who underwent MRI staging were analysed retrospectively. The signal intensity (SI) of the tumours was assessed on sagittal T2-weighted imaging (WI) and sagittal T1WI sequences). The depth of myometrial invasion, tumour grade and subtype, lymphovascular invasion, and microsatellite stability status were assessed histopathologically, and these findings were compared with MRI findings using logistic regression. The log-rank test was used to assess differences in survival among groups defined by different MRI measurements., Results: Tumours with qualitative higher signal than that of normal myometrium on the late T1WI DCE image sequences were more likely to have lymphovascular space invasion (p<0.001). Tumours that had a higher SI tumour ratio (T1 post-contrast arterial/T1 precontrast) had a higher chance of being microsatellite stable (odds ratio 2.36). The SI ratio of the tumour to the myometrium showed that lower T2 tumour/T2 myometrial ratio correlated with ≥50% depth of myometrial invasion as determined by imaging (p=0.006). Endometrial tumours showing a SI of >209 on delayed T1WI sequences had longer recurrence-free survival than those with tumours showing a SI ≤209 (p=0.014). Tumour subtype and grade were not associated with MRI findings., Conclusion: The SI of endometrial cancer on MRI may be used to predict the aggressiveness of the tumour and microsatellite stability status. Further studies are needed to confirm these findings., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

This article provides an overview of PET in cervical cancer, primarily with regard to the use of 18 F-2-fluoro-2-deoxy-d-glucose-PET/computed tomography. A brief discussion of upcoming technologies, such as PET/MR imaging, is presented., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To assess the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease (RD) at primary cytoreduction in advanced ovarian cancer., Methods: A prospective, non-randomized, multicenter trial of patients who underwent primary debulking for stage III-IV epithelial ovarian cancer previously identified 9 criteria associated with suboptimal (>1cm residual) cytoreduction. This is a secondary post-hoc analysis looking at the ability to predict any RD. Four clinical and 18 radiologic criteria were assessed, and a multivariate model predictive of RD was developed., Results: From 7/2001-12/2012, 350 patients met eligibility criteria. The complete gross resection rate was 33%. On multivariate analysis, 3 clinical and 8 radiologic criteria were significantly associated with the presence of any RD: age≥60years (OR=1.5); CA-125≥600U/mL (OR=1.3); ASA 3-4 (OR=1.6); lesions in the root of the superior mesenteric artery (OR=4.1), splenic hilum/ligaments (OR=1.4), lesser sac >1cm (OR=2.2), gastrohepatic ligament/porta hepatis (OR=1.4), gallbladder fossa/intersegmental fissure (OR=2); suprarenal retroperitoneal lymph nodes (OR=1.3); small bowel adhesions/thickening (OR=1.1); and moderate-severe ascites (OR=2.2). All ORs were significant with p<0.01. A 'predictive score' was assigned to each criterion based on its multivariate OR, and the rate of having any RD for patients who had a total score of 0-2, 3-5, 6-8, and ≥9 was 45%, 68%, 87%, and 96%, respectively., Conclusions: We identified 11 criteria associated with RD, and developed a predictive model in which the rate of having any RD was directly proportional to a predictive score. This model may be helpful in treatment planning., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The purpose of this article is to review the use of dual-energy CT (DECT) in the assessment of gynecologic cancer., Conclusion: DECT has the potential to improve diagnostic performance, may improve the ability to differentiate between simple cystic lesions and primary ovarian cancer, and may also improve the detection of musculoskeletal and liver metastases. Additional studies will be needed to determine the direction of future developments and the degree to which DECT will affect the imaging and management of gynecologic cancer.

Aim: To determine the ability of magnetic resonance imaging (MRI) in detecting tumour-free margins from the internal os (IO)., Materials and Methods: A database search yielded 79 women with early-stage cervical cancer who underwent radical hysterectomy and preoperative MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI in assessment of ≤5 and >5 mm IO involvement were calculated with histopathological surgical specimen findings considered to be the reference standard. A main and subset analysis was performed. The subset analysis included only those patients who would have been considered for radical trachelectomy., Results: For predicting a distance between the tumour and the IO of ≤5 mm, MRI had a sensitivity of 73%, a specificity of 98.3%, a PPV of 95%, a NPV of 88.1%, and an accuracy of 89.8% for the main analysis, and sensitivity of 81.8%, a specificity of 93.2% a PPV of 69.2% a NPV of 96.5% and an accuracy of 91.4% for the subset analysis., Conclusion: MRI has high specificity, NPV, and accuracy in detecting tumour from the IO, making MRI suitable for treatment planning in patients desiring trachelectomy to preserve fertility., (Published by Elsevier Ltd.)

Objective: It is now recognized that ovarian cancer includes a heterogeneous group of malignant epithelial tumors originating from the ovaries, fallopian tubes, or peritoneum. This development has prompted the International Federation of Gynecology and Obstetrics (FIGO) to issue a revised staging system that can provide prognostic information and guidance on personalized management of ovarian cancer., Conclusion: We review the epidemiology of ovarian cancer, the new FIGO staging system, and the role of imaging in the assessment, staging, and follow-up of ovarian cancer.

Objective: To evaluate treatment outcomes for patients with vulvar cancer with grossly positive pelvic lymph nodes (PLNs)., Methods: From a database of 516 patients with vulvar cancer, we identified patients with grossly positive PLNs without distant metastasis at initial diagnosis. We identified 20 patients with grossly positive PLNs; inclusion criteria included PLN 1.5cm or larger in short axis dimension on CT/MRI (n=11), FDG-avid PLN on PET/CT (n=3), or biopsy-proven PLN disease (n=6). Ten patients were treated with chemoradiation therapy (CRT), 4 with RT alone, and 6 with various combinations of surgery, RT or CRT. Median follow-up time for patients who had not died of cancer was 47months (range, 4-228months)., Results: Mean primary vulvar tumor size was 6.4cm; 12 patients presented with 2009 AJCC T2 and 8 with T3 disease. All patients had grossly positive inguinal nodes, and the mean inguinal nodal diameter was 2.8cm. The 5-year overall survival and disease specific survival rates were 43% and 48%, respectively. Eleven patients had recurrences, some at multiple sites. There were 9 recurrences in the vulva, but no isolated nodal recurrences. Four patients developed distant metastasis within 6months of starting radiation therapy., Conclusions: Aggressive locoregional treatment can lead to favorable outcomes for many patients with grossly involved PLNs that is comparable to that of grossly involved inguinal nodes only. We recommend modification of the FIGO stage IVB classification to more accurately reflect the relatively favorable prognosis of patients with PLN involvement., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio<50% and height elevation≤3 mm., Materials and Methods: In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by two-sided Z test for independent binomial proportions., Results: The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas≥5 mm (n=21) was 0.76; ≥6 mm (n=16), 0.75; and ≥10 mm (n=5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p>0.37)., Conclusion: In this large screening population, nonpolypoid adenomas had a very low prevalence (<1%), and advanced pathologic features were uncommon in polyps<10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.

Objective: To analyze the surgical outcome and safety of posterior quadrant disconnection in medically refractory epilepsy arising from the posterior head region from a level IV tertiary care center over a period of three years., Materials and Methods: Seven consecutive patients who underwent posterior quadrant disconnection for refractory epilepsy were analyzed., Results: We analyzed the data of seven (n = 7) consecutive posterior quadrant epilepsy patients who underwent posterior quadrant disconnection with a mean age of 8.5 years over the last three years of which 4 were male and 3 females. All patients underwent extensive pre-surgical evaluation including detailed history, examination, prolonged video EEG recordings, neuropsychological testing, MRI brain, DTI, PET scan (n = 6), fMRI (n = 4), WADA test (n = 1) and invasive recording (n = 1), Of seven patients four had left sided pathology and three had right sided pathology. All patients except one underwent pure disconnection and one underwent partial resection., Conclusion: Posterior quadrant disconnection is effective surgical procedure for medically refractory epilepsy arising from the posterior quadrant in carefully selected patients without morbidity or functional disability across various age groups especially in children. In our series, all seven patient had good seizure outcome and none had functional disabilities.

Objective: To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer., Methods: This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed., Results: From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p=0.01); CA-125 ≥ 500 U/mL (p<0.001); ASA 3-4 (p<0.001); suprarenal retroperitoneal lymph nodes >1cm (p<0.001); diffuse small bowel adhesions/thickening (p<0.001); and lesions >1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A 'predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758., Conclusions: We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Ictal Pet in presurgical workup of refractory epilepsy is seldom performed and limited due to technical difficulties. In carefully selected patient subset with frequent extratemporal seizures, ictal PET depicts 'seizure onset zone' with high spatial resolution even within a widespread pathology. We here depict a four year old with posterior quadrant dysplasia evaluated with ictal PET.

Purpose: Conformal treatment of para-aortic lymph nodes (PAN) in cervical cancer allows dose escalation and reduces normal tissue toxicity. Currently, data documenting the precise location of involved PAN are lacking. We define the spatial distribution of this high-risk nodal volume by analyzing fluorodeoxyglucose (FDG)-avid lymph nodes (LNs) on positron emission tomography/computed tomography (PET/CT) scans in patients with cervical cancer., Methods and Materials: We identified 72 PANs on pretreatment PET/CT of 30 patients with newly diagnosed stage IB-IVA cervical cancer treated with definitive chemoradiation. LNs were classified as left-lateral para-aortic (LPA), aortocaval (AC), or right paracaval (RPC). Distances from the LN center to the closest vessel and adjacent vertebral body were calculated. Using deformable image registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution., Results: We identified 72 PET-positive para-aortic lymph nodes (37 LPA, 32 AC, 3 RPC). All RPC lymph nodes were in the inferior third of the para-aortic region. The mean distance from aorta for all lymph nodes was 8.3 mm (range, 3-17 mm), and from the inferior vena cava was 5.6 mm (range, 2-10 mm). Of the 72 lymph nodes, 60% were in the inferior third, 36% were in the middle third, and 4% were in the upper third of the para-aortic region. In all, 29 of 30 patients also had FDG-avid pelvic lymph nodes., Conclusions: A total of 96% of PET positive nodes were adjacent to the aorta; PET positive nodes to the right of the IVC were rare and were all located distally, within 3 cm of the aortic bifurcation. Our findings suggest that circumferential margins around the vessels do not accurately define the nodal region at risk. Instead, the anatomical extent of the nodal basin should be contoured on each axial image to provide optimal coverage of the para-aortic nodal compartment., (Copyright © 2013. Published by Elsevier Inc.)

Purpose: Current information about the anatomic distribution of lymph node (LN) metastases from cervical cancer is not precise enough for optimal treatment planning for highly conformal radiation therapy. To accurately define the anatomic distribution of these LN metastases, we mapped [(18)F] fluorodeoxyglucose positron emission tomography (FDG PET)-positive LNs from 50 women with cervical cancer., Methods and Materials: Records of patients with cervical cancer treated from 2006 to 2010 who had pretreatment PET/computed tomography (CT) scans available were retrospectively reviewed. Forty-one consecutive patients (group 1) with FDG-avid LNs were identified; because there were few positive paraortic LNs in group 1, 9 additional patients (group 2) with positive paraortic LNs were added. Involved LNs were contoured on individual PET/CT images, mapped to a template CT scan by deformable image registration, and edited as necessary by a diagnostic radiologist and radiation oncologists to most accurately represent the location on the original PET/CT scan., Results: We identified 190 FDG-avid LNs, 122 in group 1 and 68 in group 2. The highest concentrations of FDG-avid nodes were in the external iliac, common iliac, and paraortic regions. The anatomic distribution of the 122 positive LNs in group 1 was as follows: external iliac, 78 (63.9%); common iliac, 21 (17.2%); paraortic, 9 (7.4%); internal iliac, 8 (6.6%); presacral, 2 (1.6%); perirectal, 2 (1.6%); and medial inguinal, 2 (1.6%). Twelve pelvic LNs were not fully covered when the clinical target volume was defined according to Radiation Therapy Oncology Group guidelines for intensity modulated radiation therapy for cervical cancer., Conclusions: Our findings clarify nodal volumes at risk and can be used to improve target definition in conformal radiation therapy for cervical cancer. Our findings suggest several areas that may not be adequately covered by contours described in available atlases., (Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether hormonal therapies have efficacy in patients with recurrent low-grade serous carcinoma of the ovary or peritoneum., Methods: We searched departmental databases for patients with histologically-confirmed, evaluable, recurrent low-grade serous ovarian or peritoneal carcinoma who received hormonal therapy at our institution between 1989 and 2009. We retrospectively reviewed patients' medical records for demographic, disease, hormonal therapy, and estrogen receptor and progesterone receptor expression data. We used the Response Evaluation Criteria in Solid Tumors version 1.1 to determine patients' responses to hormonal therapy. Because patients could have received more than one evaluable hormonal therapy regimen, we chose to define the outcome metric as "patient-regimens." Median time to disease progression (TTP) and overall survival (OS) were also calculated. Regression analysis was also performed., Results: We identified 64 patients with recurrent low-grade serous carcinoma of the ovary or peritoneum. Patients' median TTP and median OS were 7.4 and 78.2 months, respectively. Patients received 89 separate hormonal patient-regimens, which produced an overall response rate of 9% (6 complete responses and 2 partial responses). Sixty-one percent of the patient-regimens resulted in a progression-free survival duration of at least 6 months. Patient-regimens involving ER+/PR+ disease produced a longer median TTP (8.9 months) than patient-regimens involving ER+/PR- disease did (6.2 months; p=0.053). This difference approached but did not reach statistical significance., Conclusions: Hormonal therapies have moderate anti-tumor activity in patients with recurrent low-grade serous carcinoma of the ovary or peritoneum. Further study to determine whether ER/PR expression status is a predictive biomarker for this rare cancer subtype is warranted., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: The purpose of this article is to determine whether early postoperative CT provides prognostic information in patients with advanced ovarian, tubal, or primary peritoneal carcinoma with optimal debulking reported at primary cytoreduction., Materials and Methods: Our study included 63 patients who underwent primary cytoreductive surgery for presumed advanced ovarian cancer, who had optimal debulking (residual disease ≤ 1 cm) reported at surgery, and who underwent CT before and 7-49 days after surgery. Two radiologists independently retrospectively interpreted all postoperative CT scans and scored lesions on a 5-point scale, where 1 indicates normal and 5 indicates definitely malignant. Lesions larger than 1 cm with a CT score of 4 or 5 were considered suboptimally debulked residual disease., Results: Suboptimally debulked residual disease on CT (range, 1.1-5.8 cm) was reported by reader 1 for 29 of 63 patients (46%) and by reader 2 for 31 of 63 patients (49%), with substantial interobserver agreement (κ = 0.75). Patients with suboptimally debulked residual disease on CT had significantly worse median progression-free survival (p = 0.001, both readers) and overall survival (p ≤ 0.010, both readers). By univariate and multivariate analyses, suboptimally debulked residual disease on CT remained a significant independent predictor of progression-free survival (p = 0.001, both readers) and overall survival (p ≤ 0.006, both readers)., Conclusion: Our study showed that residual disease larger than 1 cm was present on early postoperative CT in almost half of the patients deemed to have optimally debulked disease at primary cytoreduction. Residual disease larger than 1 cm detected on early postoperative CT was associated with significant decreases in both progression-free and overall survival.

Purpose: To conduct post-hoc analysis of National CT Colonography Trial data and compare the sensitivity and specificity of computed tomographic (CT) colonography in participants younger than 65 years with those in participants aged 65 years and older., Materials and Methods: Of 2600 asymptomatic participants recruited at 15 centers for the trial, 497 were 65 years of age or older. Approval of this HIPAA-compliant study was obtained from the institutional review board of each site, and informed consent was obtained from each subject. Radiologists certified in CT colonography reported lesions 5 mm in diameter or larger. Screening detection of large (≥10-mm) histologically confirmed colorectal neoplasia was the primary end point; screening detection of smaller (6-9-mm) colorectal neoplasia was a secondary end point. The differences in sensitivity and specificity of CT colonography in the two age cohorts (age < 65 years and age ≥ 65 years) were estimated with bootstrap confidence intervals (CIs)., Results: Complete data were available for 477 participants 65 years of age or older (among 2531 evaluable participants). Prevalence of adenomas 1 cm or larger for the older participants versus the younger participants was 6.9% (33 of 477) versus 3.7% (76 of 2054) (P < .004). For large neoplasms, mean estimates for CT colonography sensitivity and specificity among the older cohort were 0.82 (95% CI: 0.644, 0.944) and 0.83 (95% CI: 0.779, 0.883), respectively. For large neoplasms in the younger group, CT colonography sensitivity and specificity were 0.92 (95% CI: 0.837, 0.967) and 0.86 (95% CI: 0.816, 0.899), respectively. Per-polyp sensitivity for large neoplasms for the older and younger populations was 0.75 (95% CI: 0.578, 0.869) and 0.84 (95% CI: 0.717, 0.924), respectively. For the older and younger groups, per-participant sensitivity was 0.72 (95% CI: 0.565, 0.854) and 0.81 (95% CI: 0.745, 0.882) for detecting adenomas 6 mm in diameter or larger., Conclusion: For most measures of diagnostic performance and in most subsets, the difference between senior-aged participants and those younger than 65 years was not statistically significant.

Objective: To study the behavior of hypoattenuating liver lesions, deemed too small to characterize at baseline scanning with multidetector computed tomography (CT), in patients with rectal cancer., Methods: Retrospective review of locally advanced rectal cancer patients from a radiation oncology therapy database was conducted. Patients who presented before neoadjuvant chemoradiation without metastases at baseline CT and with follow-up scans for at least 1 year after therapy were evaluated. CT studies were reviewed for the presence and change in size of hypoattenuating liver lesions (<15 mm) at baseline and follow-up., Results: A total of 616 consecutive patients from the radiotherapy database were reviewed. Of these, 70 patients with a total of 163 hepatic lesions met the selection criteria. The mean patient age was 62.4 years (range, 26-85 years). All patients subsequently underwent surgery and adjuvant chemotherapy. The mean time of radiographic imaging from baseline CT to most recent surveillance CT was 3.3 years (range, 1.1-7.4 years). Two radiologists independently reviewed the CTs. The lesions were stable in 56 of 70 (80.0%, 95% confidence interval: 69%, 89%) patients. Of 163 lesions, 148 (90.8%) were stable, 8 (4.9%) regressed, and 7 (4.3%) progressed in size. No significant difference in results was found for patients stratified according to T-stage (P = 0.41) and N-stage (P > 0.99)., Conclusion: In patients with rectal cancer, majority of small hypoattenuating liver lesions remain stable and are treated as benign lesions, at multidetector CT follow-up of more than a year. Nevertheless, hepatic lesion stability during systemic therapy should still be interpreted with caution and closely followed for at least 1 year after completion of therapy.

Objective: The purpose of our study was to compare the effect of three different full-laxative bowel preparations on patient compliance, residual stool and fluid, reader confidence, and polyp detection at CT colonography (CTC)., Subjects and Methods: A total of 2531 patients underwent CTC followed by colonoscopy for the American College of Radiology Imaging Network (ACRIN) National CTC Trial. Of this total, 2525 patients used one of three bowel preparations with bisacodyl tablets and stool and fluid tagging: 4 L of polyethylene glycol (PEG); 90 mL of phosphosoda; or 300 mL of magnesium citrate. Patients reported percent compliance with the bowel preparation and radiologists graded each CTC examination for the amount of residual fluid and stool on a scale from 1 (none) to 4 (nondiagnostic). Reader confidence for true-positive findings was reported on a 5-point scale: 1 (low) to 5 (high). Sensitivity and specificity for detecting polyps ≥ 6 mm and ≥ 1 cm compared with colonoscopy were calculated for each preparation., Results: The most commonly prescribed preparation was phosphosoda (n = 1403) followed by PEG (n = 1020) and magnesium citrate (n = 102). Phosphosoda had the highest patient compliance (p = 0.01), least residual stool (p < 0.001), and highest reader confidence versus PEG for examinations with polyps (p = 0.06). Magnesium citrate had significantly more residual fluid compared with PEG and phosphosoda (p = 0.006). The sensitivity and specificity for detecting colon polyps ≥ 6 mm and ≥ 1 cm did not differ significantly between preparations., Conclusion: Polyp detection was comparable for all three preparations, although phosphosoda had significantly higher patient compliance and the least residual stool.

Purpose: To determine whether the reader's preference for a primary two-dimensional (2D) or three-dimensional (3D) computed tomographic (CT) colonographic interpretation method affects performance when using each technique., Materials and Methods: In this institutional review board-approved, HIPAA-compliant study, images from 2531 CT colonographic examinations were interpreted by 15 trained radiologists by using colonoscopy as a reference standard. Through a survey at study start, study end, and 6-month intervals, readers were asked whether their interpretive preference in clinical practice was to perform a primary 2D, primary 3D, or both 2D and 3D interpretation. Readers were randomly assigned a primary interpretation method (2D or 3D) for each CT colonographic examination. Sensitivity and specificity of each method (primary 2D or 3D), for detecting polyps of 10 mm or larger and 6 mm or larger, based on interpretive preference were estimated by using resampling methods., Results: Little change was observed in readers' preferences when comparing them at study start and study end, respectively, as follows: primary 2D (eight and seven readers), primary 3D (one and two readers), and both 2D and 3D (six and six readers). Sensitivity and specificity, respectively, for identifying examinations with polyps of 10 mm or larger for readers with a primary 2D preference (n = 1128 examinations) were 0.84 and 0.86, which was not significantly different from 0.84 and 0.83 for readers who preferred 2D and 3D (n = 1025 examinations) or from 0.76 and 0.82 for readers with a primary 3D preference (n = 378 examinations). When performance by using the assigned 2D or 3D method was evaluated on the basis of 2D or 3D preference, there was no difference among those readers by using their preferred versus not preferred method of interpretation. Similarly, no significant difference among readers or preferences was seen when performance was evaluated for detection of polyps of 6 mm or larger., Conclusion: The reader's preference for interpretive method had no effect on CT colonographic performance., (RSNA, 2011)

Objective: To evaluate the utility of preoperative magnetic resonance imaging (MRI) in determining whether primary disease site is cervical or endometrial in patients with inconclusive preoperative endometrial biopsy., Methods: We retrospectively identified all patients who underwent pelvic MRI and who had a preoperative diagnosis of cervical or endometrial cancer at MD Anderson Cancer Center between 1990 and 2006. The subset in which endometrial biopsy did not clarify the primary disease site was analyzed. Magnetic resonance imaging results were compared with postoperative histopathologic findings., Results: A total of 168 patients who underwent MRI who had a preoperative diagnosis of cervical or endometrial cancer were identified. Of these patients, 51 had an inconclusive endometrial biopsy. Magnetic resonance imaging suggested an endometrial primary tumor without cervical invasion in 28 patients, of whom 21 (75%) actually had such a tumor and 7 had an endometrial primary tumor with cervical invasion. Magnetic resonance imaging suggested an endometrial primary tumor with cervical invasion in 3 patients, all of whom had such a tumor. Magnetic resonance imaging suggested a cervical primary tumor in 6 patients, of whom 5 had such a tumor and 1 had an endometrial primary tumor without cervical invasion. Magnetic resonance imaging was inconclusive (did not clarify primary disease site or no lesion visualized) in 14 (27%) of 51 patients, 6 of whom had an endocervical primary tumor or an endometrial tumor with cervical involvement. Overall, preoperative MRI was either inaccurate or unhelpful in 22 (43%) of 51 patients., Conclusion: Preoperative MRI in patients with inconclusive endometrial biopsy is inaccurate or unhelpful in nearly half of patients.

Objectives: This study was conducted to estimate the accuracy of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as compared with contrast-enhanced CT (CECT) in detecting cancer in patients who have normal cancer antigen (CA)-125 (<35 U/dL) but are suspected of having a recurrent disease based on clinical symptoms., Methods: We retrospectively reviewed the records of patients who had undergone primary cytoreductive surgery and subsequently underwent CECT and FDG-PET/CT for suspected recurrence. [18F]-fluorodeoxyglucose positron emission tomography/computed tomography and CECT interpretation to evaluate a recurrent disease was carried out independently by 2 experienced radiologists who were blinded to the final diagnosis for the suspected recurrence. Long-term follow-up imaging (12 months) and biopsy reports were used to assess the true status of the suspected recurrence seen on FDG-PET/CT or CECT. Sensitivity and specificity of all modalities were estimated. McNemar test was used to compare pairs of modalities. All tests were 2-sided, and P < or = 0.05 was considered statistically significant., Results: Sixty-six patients met the eligibility criteria for inclusion in our analysis. Fifty-eight percent (18/31) and 54% (17/31) of the patients with normal CA-125 levels had evidence of a recurrent disease on FDG-PET/CT and CECT, respectively. Thirty-one percent (6/19) of the patients with no indication of cancer on CECT had evidence of disease on FDG-PET/CT images, which was supported by pathological proof., Conclusion: [18F]-Fluorodeoxyglucose positron emission tomography/computed tomography is capable of detecting ovarian cancer recurrence in symptomatic patients with normal CA-125 levels and, in this setting, has slightly better sensitivity than CECT and can be considered as the frontline modality for all such patients.

Introduction: We previously reported a 52% correlation between the primary surgeon's assessment and the postoperative computed tomographic (CT) scan findings of residual disease in patients reported to have undergone cytoreduction to residual disease of 1 cm or smaller. This is a follow-up analysis of survival and prognostic factors for patients who had concordant and discordant postoperative CT scan findings., Methods: Patients scheduled for primary cytoreductive surgery for presumed advanced ovarian carcinoma were offered enrollment in a prospective study evaluating the ability of preoperative CT scan to predict cytoreductive outcome. If cytoreduction to residual disease of 1 cm or smaller was reported, a CT scan was done 7 to 35 days postoperatively. The CT scan findings were graded by protocol radiologists using a qualitative analysis scale from 1 (normal) to 5 (definitely malignant)., Results: From January 2001 to September 2006, 285 patients were enrolled; 67 patients were eligible. Postoperative CT scans confirmed the primary surgeon's assessment of no residual disease larger than 1 cm in 38 cases (57%). In 29 cases (43%), the radiologist found residual disease larger than 1 cm and reported it as probably or definitely malignant. Comparing concordant versus discordant findings, there was no significant difference in median progression-free survival (21 vs 17 months; P = 0.365) or overall survival (60 vs 43 months; P = 0.146). Age (P = 0.040), stage (P = 0.038), and residual disease of 0.5 mm or smaller versus 0.6 to 1.0 cm (P = 0.018) were significant for overall survival on multivariate analysis., Conclusions: On this follow-up analysis, only age, stage, and residual disease were significant prognostic factors for overall survival. Discordant findings between the primary surgeon's assessment and the postoperative CT scan findings of residual disease was not an independent prognostic factor.

Background: The ability of integrated positron emission tomography and computed axial tomography (PET-CT) to detect colonic pathology is not fully defined. The purpose of this study was to assess the ability of PET-CT to detect colonic pathology and to determine the significance of ((18)F)2-fluoro-2-deoxyglucose ((18)F-FDG) activity noted incidentally in the colon on PET-CT., Methods: Records for all patients who underwent PET-CT and colonoscopy at our institution were reviewed. Patients with history of colonic malignancy or colon surgery were excluded., Results: Fifty-eight patients had incidental colonic (18)F-FDG activity on PET (Group A) and 272 had none (Group B). In Group A, 65% of patients had pathologic findings detected on colonoscopy that corresponded to the site of PET activity. Standardized uptake value (SUV) readings were not helpful in distinguishing true-positives from false-positives. In Group B, 11.8% of patients were found to have significant colonic findings. Lesions not detected by PET-CT included 4 colon cancers, 7 advanced adenomas, and 10 patients with colonic lymphoma. Overall, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT for detecting significant pathology were 53%, 93%, 65%, 89%, and 85%, respectively. For detecting colon cancer and adenomas 10 mm or more, the sensitivity, specificity, PPV, NPV, and accuracy of PET-CT were 72%, 90%, 45%, 96%, and 88%, respectively., Conclusions: Incidental colonic activity detected by PET-CT warrants further evaluation with colonoscopy. However, negative PET-CT does not rule out significant colonic pathology including colon cancer, advanced adenomas, or lymphoma.

Objective: The purpose of this article is to illustrate the overlapping radiologic patterns in proven tuberculosis cases in patients initially referred to our cancer center for presumed malignancy., Conclusion: Tuberculosis can simulate malignancy both clinically and radiologically, especially in its extrapulmonary form.