BACKGROUND:Metastatic cancer patients receiving systemic chemotherapy face increased risks for venous thromboembolism (VTE). Benefit has been shown for prophylactic anticoagulants in risk-stratified populations. Ovarian cancer (OC) is commonly advanced at diagnosis and treated with chemotherapy. Despite high VTE rates among OC patients, predictors of risk in this population are not well studied, and information on the benefit of oral anticoagulants is lacking. OBJECTIVE:A quality improvement (QI) intervention to improve appropriate anticoagulation in risk-selected OC patients receiving first-line chemotherapy was implemented, prospectively assessing VTE risk reduction. METHODS:Patients receiving first-line chemotherapy for OC at Sheba Medical Center 2020-2025 were included. A QI program (launched 07/2023) included staff education, EMR-incorporated Khorana scoring, integrated apixaban prescriptions and targeted chemo-suite questionnaires. Data was extracted from the EMR using MDClone® software with Natural Language Processing to identify VTE events in imaging reports. Descriptive statistics were used to compare patients treated before and after program implementation. Predictors of VTE were evaluated with logistic regression. RESULTS:Patient characteristics were comparable before and after program implementation. VTE rates were high at 16.9% before, and 12.5% following roll-out. No increase in bleeding events or blood products consumption was appreciated. Program implementation was found to be a significant protective factor on multivariable analysis, adjusting for other risk factors (aOR = 0.39 (0.17-0.81), p = 0.015). CONCLUSION:The implementation of an oral anticoagulation QI program successfully decreased VTE events during first-line chemotherapy for OC with no appreciable increase in risk. Future work will focus on improved risk stratification and selection for thromboprophylaxis.

Background: The term “fatty kidney” refers to the accumulation of fat within the kidney. There is no clear definition of a fatty kidney. In our previous study, we defined a fatty kidney as one with fat accumulation of more than 4% in the kidney as detected by magnetic resonance imaging (MRI). This condition is associated with renal inflammation and contributes to the development of kidney dysfunction. Fat accumulation in the kidney can be detected using imaging modalities such as computed tomography (CT) or MRI. Given the clinical importance of renal fat deposition, the aim of this review was to investigate how imaging findings in this condition correlate to disease prevalence and metabolic disorders. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. The databases searched included PubMed, Scopus, Web of Science, and Cochrane Library up to August 2024. Studies employing MRI or CT for renal fat quantification were included. Data were extracted, and their quality was assessed using the QUADAS-2 tool. Results: Twenty-eight studies comprising 6994 participants met the inclusion criteria. Most studies used MRI (75%) for fat quantification, with CT limited to renal sinus evaluation. Renal fat fractions (FFs) ranged from 0.4% to 55.3%, with higher values consistently observed in individuals with obesity, diabetes, chronic kidney disease, and hypertension. A consistent positive association was observed between fatty kidney and fatty liver, suggesting shared pathogenic mechanisms. Conclusions: Fatty kidney appears to be a distinct and clinically relevant entity with strong links to metabolic dysfunction. Imaging-based quantification—particularly MRI—offers a promising tool for early detection, yet standardization is needed. The findings underscore the need for further research into fatty kidney as a modifiable risk factor for renal and cardiovascular disease.

BACKGROUND:Pancreatic ductal adenocarcinoma (PDAC) is a dismal disease, often diagnosed at advanced, unresectable stages. Early detection is critical to improve survival, but current imaging modalities are limited in detecting early stage malignancies. Diffusion tensor MRI (DT-MRI) has shown potential in identifying PDAC. This study confirms the feasibility of DT-MRI to measure pancreatic diffusion metrics and examines whether DT-MRI detects any differences in these metrics between high-risk genetic mutations carriers and controls. MATERIALS & METHODS:Retrospective data analysis included 18 high-risk individuals with PDAC-predisposing mutations and 17 controls undergoing routine pancreatic MRI. Participants underwent standard MRI and DT-MRI (3T scanner, b-values 0-500 and 100-500 s/mm2), with clinical, demographic, and pathological data collected. Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U-tests, and Benjamini-Hochberg corrections. RESULTS:Among 35 participants (14 males, 21 females), the median ages were 51 for high-risk and 65 for controls (p = 0.0436, Welch's t-test). DTI metrics (λ1, λ2 and λ3, apparent diffusion coefficient and fractional anisotropy) varied significantly between the two b-value pairs (p < 0.00001). However, these metrics and the λ1, λ2 and λ3 ratios (medians 1.1, 1.4, 2.4, IQRs 0.11, 0.22, 0.76, respectively) showed no significant differences between the high-risk and control groups after correction. Yet, λ1, λ2 and λ3 ratios showed IVIM-related directional variations, suggesting directional differences in capillary perfusion of the pancreas. CONCLUSION:DT-MRI effectively measures diffusion coefficients and IVIM contributions in the pancreas. No significant differences were found between high-risk individuals and controls, therefore, the method supports adjunct, bias-free use in future pancreatic cancer screening studies.

Background: Obesity is associated with metabolic syndrome and fat accumulation in various organs such as the liver and the kidneys. Our goal was to assess, using magnetic resonance imaging (MRI) Dual-Echo phase sequencing, the association between liver and kidney fat deposition and their relation to obesity. Methods: We analyzed MRI scans of individuals who were referred to the Chaim Sheba Medical Center between December 2017 and May 2020 to perform a study for any indication. For each individual, we retrieved from the computerized charts data on sex, and age, weight, height, body mass index (BMI), systolic and diastolic blood pressure (BP), and comorbidities (diabetes mellitus, hypertension, dyslipidemia). Results: We screened MRI studies of 399 subjects with a median age of 51 years, 52.4% of whom were women, and a median BMI 24.6 kg/m2. We diagnosed 18% of the participants with fatty liver and 18.6% with fat accumulation in the kidneys (fatty kidneys). Out of the 67 patients with fatty livers, 23 (34.3%) also had fatty kidneys, whereas among the 315 patients without fatty livers, only 48 patients (15.2%) had fatty kidneys (p < 0.01). In comparison to the patients who did not have a fatty liver or fatty kidneys (n = 267), those who had both (n = 23) were more obese, had higher systolic BP, and were more likely to have diabetes mellitus. In comparison to the patients without a fatty liver, those with fatty livers had an adjusted odds ratio of 2.91 (97.5% CI; 1.61–5.25) to have fatty kidneys. In total, 19.6% of the individuals were obese (BMI ≥ 30), and 26.1% had overweight (25 < BMI < 30). The obese and overweight individuals were older and more likely to have diabetes mellitus and hypertension and had higher rates of fatty livers and fatty kidneys. Fat deposition in both the liver and the kidneys was observed in 15.9% of the obese patients, in 8.3% of the overweight patients, and in none of those with normal weight. Obesity was the only risk factor for fatty kidneys and fatty livers, with an adjusted OR of 6.3 (97.5% CI 2.1–18.6). Conclusions: Obesity is a major risk factor for developing a fatty liver and fatty kidneys. Individuals with a fatty liver are more likely to have fatty kidneys. MRI is an accurate modality for diagnosing fatty kidneys. Reviewing MRI scans of any indication should include assessment of fat fractions in the kidneys in addition to that of the liver.

PDF file - 43K, the objective responses of individual patients to various types of immunotherapies.

MR-guided radiotherapy allows the delivery of effective doses of radiation to tumors situated close to critical structures. An ESTRO-ASTRO consensus paper defining oligometastatic disease from a radiation oncology perspective states that “the feasibility of safely delivering curative intent metastasis directed radiotherapy (MDRT) determines the maximum number of sites that can be treated with radiotherapy in oligometastatic disease (OMD). The risk of toxicity impacts treatment indications for OMD” [1]. The main limitation on delivery of safe SBRT is the exposure of surrounding critical organs to radiation. Real-time imaging is crucial when there is a moving target (such as influenced by breathing or peristalsis) situated close to bowel or other major organs. We will discuss some rare tumors treated with MR-guided SBRT that we have treated in our institution or that have been reported in the literature.

PDF file - 74K, the baseline and treatment characteristics of evaluated TIL patients treated with or without ipilimumab before TIL ACT.

BACKGROUND:Computed tomography (CT) is the main diagnostic modality for detecting pancreatic adenocarcinoma.OBJECTIVES:To assess the frequency of missed pancreatic adenocarcinoma on CT scans according to different CT protocols.METHODS:The medical records of consecutive pancreatic adenocarcinoma patients were retrospectively collected (12/2011-12/2015). Patients with abdominal CT scans performed up to a year prior to cancer diagnosis were included. Two radiologists registered the presence of radiological signs of missed cancers. The frequency of missed cancers was compared between portal and pancreatic/triphasic CT protocols.RESULTS:Overall, 180 CT scans of pancreatic adenocarcinoma patients performed prior to cancer diagnosis were retrieved; 126/180 (70.0%) were conducted using pancreatic/triphasic protocols and 54/180 (30.0%) used portal protocols. The overall frequency of missed cancers was 6/180 (3.3%) in our study population. The frequency of missed cancers was higher with the portal CT protocols compared to the pancreatic/triphasic protocols: 5/54 (9.3%) vs. 1/126 (0.8%), P = 0.01. CT signs of missed cancers included small hypodense lesions, peri-pancreatic fat stranding, and dilated pancreatic duct with a cut-off sign.CONCLUSIONS:The frequency of missed pancreatic adenocarcinoma is higher on portal CT protocols. Physicians should consider the cancer miss rate on different CT protocols.

Supplementary table 2 (AEs of PA patients)

BACKGROUNDPerivascular cuffing as the sole imaging manifestation of pancreatic ductal adenocarcinoma (PDAC) is an under-recognized entity.OBJECTIVESTo present this rare finding and differentiate it from retroperitoneal fibrosis and vasculitis.METHODSPatients with abdominal vasculature cuffing were retrospectively collected (January 2011 to September 2017). We evaluated vessels involved, wall thickness, length of involvement and extra-vascular manifestations.RESULTSFourteen patients with perivascular cuffing were retrieved: three with celiac and superior mesenteric artery (SMA) perivascular cuffing as the only manifestation of surgically proven PDAC, seven with abdominal vasculitis, and four with retroperitoneal fibrosis. PDAC patients exhibited perivascular cuffing of either or both celiac and SMA (3/3). Vasculitis patients showed aortitis with or without iliac or SMA cuffing (3/7) or cuffing of either or both celiac and SMA (4/7). Retroperitoneal fibrosis involved the aorta (4/4), common iliac (4/4), and renal arteries (2/4). Hydronephrosis was present in 3/4 of retroperitoneal fibrosis patients. PDAC and vasculitis demonstrated reduced wall thickness in comparison to retroperitoneal fibrosis (PDAC: 1.0 ± 0.2 cm, vasculitis: 1.2 ± 0.5 cm, retroperitoneal fibrosis: 2.4 ± 0.4 cm; P = 0.002). There was no significant difference in length of vascular involvement (PDAC: 6.3 ± 2.1 cm, vasculitis: 7.1 ± 2.6 cm, retroperitoneal fibrosis: 8.7 ± 0.5 cm).CONCLUSIONSCeliac and SMA perivascular cuffing can be the sole finding in PDAC and may be indistinguishable from vasculitis. This entity may differ from retroperitoneal fibrosis as it spares the aorta, iliac, and renal arteries and demonstrates thinner walls and no hydronephrosis.

Rationale and objectives: Intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is a true precancerous lesion, which shares common features with pancreatic IPMN (IPMN-P). While IPMN-P is a well described entity for which guidelines were formulated and revised, IPMN-B is a poorly described entity. We carried out a systematic review to evaluate the existing literature, emphasizing the role of MRI in IPMN-B depiction. Materials and methods: PubMed database was used to identify original studies and case series that reported MR Imaging features of IPMN-B. The search keywords were "IPMN OR intraductal papillary mucinous neoplasm OR IPNB OR intraductal papillary neoplasm of the bile duct AND Biliary OR biliary cancer OR hepatic cystic lesions". Risk of bias and applicability were evaluated using the QUADAS-2 tool. Results: 884 Records were Identified through database searching. 12 studies satisfied the inclusion criteria, resulting in MR features of 288 patients. All the studies were retrospective. Classic features of IPMN-B are underdescribed. Few studies note worrisome features, concerning for an underlying malignancy. 50 % of the studies had a high risk of bias and concerns regarding applicability. Conclusions: The MRI features of IPMN-B are not well elaborated and need to be further studied. Worrisome features and guidelines regarding reporting the imaging findings should be established and published. Radiologists should be aware of IPMN-B, since malignancy diagnosis in an early stage will yield improved prognosis

Characteristics of pancreatic atrophy patients and their matched control patients

Purpose Invasive lobular breast cancer (ILC) may be hard to detect using conventional imaging modalities and usually shows less avidity to 18F-FDG PET/CT. 68Ga–fibroblast activation protein inhibitor (FAPI) PET/CT has shown promising results in detecting non–18F-FDG–avid cancers. We aimed to assess the feasibility of detecting metastatic disease in patients with non–18F-FDG–avid ILC. Methods This prospective study included patients with metastatic ILC, infiltrative to soft tissues, which was not 18F-FDG avid. The patients underwent 68Ga-FAPI PET/CT for evaluation, which was correlated with the fully diagnostic CT performed at the same time. Results Seven women (aged 57 ± 10 years) were included. Among the 30 organs and structures found to be involved by tumor, the number of findings observed by FAPI PET/CT was significantly higher than that observed by CT alone (P = 0.022), especially in infiltrative soft tissue and serosal locations. Conclusions This small pilot trial suggests a role for 68Ga-FAPI PET/CT in ILC, which needs to be confirmed by subsequent trials.

PDF file - 60K, the baseline characteristics and response to ipilimumab in 19 patients previously treated with TIL ACT.

BackgroundWe present our experience with MR-guided stereotactic body radiotherapy (SBRT) for 200 consecutive patients with prostate cancer with minimum 3-month follow-up.MethodsTreatment planning included fusion of the 0.35-Tesla planning MRI with multiparametric MRI and PET-PSMA for Group Grade (GG) 2 or higher and contour review with an expert MRI radiologist. No fiducials or rectal spacers were used. Prescription dose was 36.25 Gy in 5 fractions over 2 weeks to the entire prostate with 3-mm margins. Daily plan was adapted if tumor and organs at risk (OAR) doses differed significantly from the original plan. The prostate was monitored during treatment that was automatically interrupted if the target moved out of the PTV range.ResultsMean age was 72 years. Clinical stage was T1c, 85.5%; T2, 13%; and T3, 1.5%. In addition, 20% were GG1, 50% were GG2, 14.5% were GG3, 13% were GG4, and one patient was GG5. PSA ranged from 1 to 77 (median, 6.2). Median prostate volume was 57cc, and 888/1000 (88%) fractions required plan adaptation. The most common acute GU toxicity was Grade I, 31%; dysuria and acute gastrointestinal toxicity were rare. Three patients required temporary catheterization. Prostate size of over 100cc was associated with acute fatigue, urinary hesitance, and catheter insertion. Prostate Specific Antigen (PSA) decreased in 99% of patients, and one patient had regional recurrence.ConclusionMR-guided prostate SBRT shows low acute toxicity and excellent short-term outcomes. Real-time MRI ensures accurate positioning and SBRT delivery.

CCR Translation for This Article from Adoptive Transfer of Tumor-Infiltrating Lymphocytes in Patients with Metastatic Melanoma: Intent-to-Treat Analysis and Efficacy after Failure to Prior Immunotherapies

PDF file - 112K, the correlation of different variables to one another and their p values.

The evaluation of response to chemotherapy and targeted therapies in colorectal liver metastases has tradi-tionally been based on size changes, as per the RECIST criteria. However, therapy may alter tissue composition and not only tumor size, therefore, functional imaging techniques such as diffusion-weighted magnetic resonance imaging (DWI) may offer a more comprehensive assessment of treatment response.The aim of this systematic review and meta-analysis was to evaluate the use of DWI in the prediction and assessment of response to treatment in colorectal liver metastases and to determine if there is a baseline apparent diffusion coefficient (ADC) cut-off value that can predict a favorable response. A literature search was conducted using the MEDLINE/PubMed database, and risk of bias was evaluated using the QUADAS-2 tool. The mean differences between responders and non-responders were pooled.A total of 16 studies met the inclusion criteria, and various diffusion-derived techniques and coefficients were found to have potential for predicting and assessing treatment response. However, discrepancies were noted between studies. The most consistent predictor of response was a lower baseline ADC value calculated using traditional mono-exponential methods. Non-mono-exponential techniques for calculating DWI-derived param-eters were also reported. A meta-analysis of a subset of studies failed to establish a cut-off value of ADC due to heterogeneity, but revealed a pooled mean difference of-0.12 x 10-3 mm2/s between responders and non -responders.The results of this systematic review suggest that diffusion-derived techniques and coefficients may contribute to the evaluation and prediction of treatment response in colorectal liver metastases. Further controlled pro-spective studies are needed to confirm these findings and to guide clinical and radiological decision-making in the management of patients with CRC liver metastases.