The evaluation of renal cell carcinoma (RCC) is routinely performed using the multimodality imaging approach, including ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Ultrasonography is the most frequently used imaging modality for the initial diagnosis of renal masses. The modality of choice for the characterization of the renal mass is multiphasic CT. Recent advances in CT technology have led to its widespread use as a powerful tool for preoperative planning, reducing the need for catheter angiography for the evaluation of vascular invasion. CT is also the standard imaging modality for staging and follow-up. MRI serves as a problem-solving tool in selected cases of undefined renal lesions. Newer MRI techniques, such as arterial spin labeling and diffusion-weighted imaging, have the potential to characterize renal lesions without contrast media, but these techniques warrant further investigation. PET may be a useful tool for evaluating patients with suspected metastatic disease, but it has modest sensitivity in the diagnosis and staging of RCC. The newer radiotracers may increase the accuracy of PET for RCC diagnosis and staging. In summary, the main imaging modality used for the characterization, staging, and surveillance of RCC is multiphasic CT. Other imaging modalities, such as MRI and PET, are used for selected indications.

The evaluation of renal cell carcinoma (RCC) is routinely performed using the multimodality imaging approach, including ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Ultrasonography is the most frequently used imaging modality for the initial diagnosis of renal masses. The modality of choice for the characterization of the renal mass is multiphasic CT. Recent advances in CT technology have led to its widespread use as a powerful tool for preoperative planning, reducing the need for catheter angiography for the evaluation of vascular invasion. CT is also the standard imaging modality for staging and follow-up. MRI serves as a problem-solving tool in selected cases of undefined renal lesions. Newer MRI techniques, such as arterial spin labeling and diffusion-weighted imaging, have the potential to characterize renal lesions without contrast media, but these techniques warrant further investigation. PET may be a useful tool for evaluating patients with suspected metastatic disease, but it has modest sensitivity in the diagnosis and staging of RCC. The newer radiotracers may increase the accuracy of PET for RCC diagnosis and staging. In summary, the main imaging modality used for the characterization, staging, and surveillance of RCC is multiphasic CT. Other imaging modalities, such as MRI and PET, are used for selected indications.

Background The utility of multiparametric MRI (mpMRI) in detecting suspected local recurrence post radical prostatectomy (RP) may be associated with PSA and Gleason grade. The purpose of the study was to evaluate the likelihood of detecting locally recurrent prostate cancer utilizing mpMRI in patients with suspected recurrence following radical prostatectomy (RP) parsed by PSA and Gleason grade. Methods One hundred ninety five patients with suspected local recurrence were imaged on a 1.5 T MRI with torso array and endorectal coil in this retrospective study. mpMRI interpretations were stratified by PSA and lower (Gleason < 7) vs. higher grade tumors (Gleason 8–10). Recursive partitioning was used to determine whether mpMRI interpretations could be classified as positive or negative. Results The majority of mpMRI interpretations in patients with lower Gleason grade tumors and PSA < 0.5 ng/mL were negative (68/78, 87.2%, p = 0.004). The majority of mpMRI interpretations in patients with higher Gleason grade tumors and PSA > 1.5 ng/mL were positive (8/9, 88.9%, p = 0.003). Findings were corroborated by recursive partitioning, which identified a PSA = 0.5 ng/ml in patients with lower grade tumors and a PSA = 1.5 ng/mL in patients with higher grade tumors as differentiating negative and positive mpMRIs. Conclusion In the setting of suspected recurrence after RP, mpMRI results are associated with PSA and Gleason grade, both of which can help guide when mpMRI may find utility. mpMRI is likely to be low diagnostic yield and negative for recurrence (87%) in the setting of lower Gleason grade tumors and PSA < 0.5 ng/mL. mpMRI is likely to be of low diagnostic value and positive for recurrence (89%) in the setting of PSA > 1.5 ng/mL and higher grade tumors; in this case, mpMRI findings may be more useful for directing biopsy and local therapy. Between these extremes, PSA > 0.5 ng/mL and lower grade tumors or PSA < 1.5 ng/mL and higher grade tumors, mpMRI results are less predictable, suggesting greater diagnostic value for detecting recurrence post prostatectomy.

Objective To evaluate the imaging features of hepatic epithelioid hemangioendothelioma (HEH) on multiphasic CT, MR, and FDG-PET-CT. Methods Bi-institutional review identified 67 adults (mean age, 47 years; 23 M/44 F) with pathologically proven HEH and pretreatment multiphasic CT ( n = 67) and/or MR ( n = 30) and/or FDG-PET-CT ( n = 13). Results HEHs were multifocal in 88% (59/67). Mean size of the dominant mass was 4.1 cm (range, 1.4–19 cm). The tumors were located in the peripheral, subcapsular regions of the liver in 96% (64/67). Capsular retraction was present in 81% (54/67 cases) and tumors were coalescent in 61% (41/67). HEH demonstrated peripheral ring enhancement on arterial phase imaging in 33% (21/64) and target appearance on the portal venous phase in 69% (46/67). Persistent peripheral enhancement on the delayed phase was seen in 49% (31/63). On MR, multilayered target appearance was seen on the T2-weighted sequences in 67% (20/30) and on the diffusion-weighted sequences in 61% (11/18). Target appearance on hepatobiliary phase of MRI was seen in 57% (4/7). On pre-therapy FDG-PET-CT, increased FDG uptake above the background liver parenchyma was seen in 62% (8/13). Conclusion HEHs typically manifest as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. Peripheral arterial ring enhancement and target appearance on portal venous phase are commonly seen on CT. Similarly, multilayered target appearance correlating with its histopathological composition is typically seen on multiple sequences of MR including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced multiphasic MR. Key Points • Hepatic epithelioid hemangioendotheliomas manifest on CT and MR as multifocal, coalescent hepatic nodules in peripheral subcapsular location, with associated capsular retraction. • Enhancement pattern on contrast-enhanced CT and MR can vary but peripheral ring enhancement on arterial phase and target appearance on portal venous phase are commonly seen. • Retrospective two-center study showed that cross-sectional imaging may help in the diagnosis.

Background: Cytoplasmic fatty acid-binding proteins facilitate the transport of lipids to specific compartments in cells. Fatty acid-binding protein 4 (FABP4), also known as aP2 or A-FABP, plays a key role in the development of atherosclerosis, insulin resistance, obesity, and metabolic syndrome (MS). The FABP4 polymorphisms are associated with protein expression changes in vitro and metabolic and vascular alterations in vivo. The aim of this study was to investigate the association between FABP4 messenger ribonucleic acid (mRNA) expression levels in epicardial (EAT), pericardial (PAT), and subcutaneous adipose tissues (SAT), and the extent of coronary atherosclerosis in coronary artery disease (CAD) patients with MS. Furthermore, the relationship between the extent of coronary atherosclerosis and epicardial adipose tissue volume (EATV) and FABP4 gene variations was evaluated. Patients and methods: A total of 37 patients undergoing coronary artery bypass grafting because of CAD (MS CAD group) and 23 non-MS patients undergoing heart valve surgery (control group) were included. Coronary angiography was performed for all patients and the extent of coronary atherosclerosis was assessed using the Sullivan's scoring system. The mRNA expression levels of FABP4 gene in EAT, PAT, and SAT, and FABP4 polymorphisms were analyzed using the quantitative real-time polymerase chain reaction (qRT-PCR). Results: An increased FABP4 expression was observed in EAT and PAT of MS CAD group compared to controls. In the MS CAD group, FABP4 mRNA expression levels in EAT was 2.8-fold higher compared to PAT. The expression of FABP4 in EAT was positively correlated with the extent of atherosclerosis and EATV in MS CAD group (r = 0.588, P = 0.001, r = 0.174, P = 0.001, respectively). There were no correlations between PAT and SAT versus the extent of atherosclerosis and EATV. The FABP4 EAT mRNA expression levels were found to significantly increase in mutant allele carriers of rs1054135, whereas they significantly decreased in mutant allele carriers of rs77878271 (T-87C) in MS CAD group (P < 0.05). The extent of atherosclerosis was also found to be significantly associated with rs1054135 (P < 0.05). A cut-off point of 57.5 cm(3) EATV was used indicating the presence of CAD with a significant area under the curve of 0.783%, 98% sensitivity, and 100% specificity (95% CI 0.620-0.880; P < 0.05). Conclusions: Our study results suggest that FABP4 expression in EAT is strongly associated with the extent of atherosclerosis and EATV in MS CAD patients. (C) 2019 Published by Elsevier Inc.

702 Background: Both the randomized METEOR and CABOSUN studies in ccRCC found substantial benefit for patients receiving (C). We have previously reported (C) to have significant activity in vhRCC. To date no comparative data exists in evaluating the utility of (C) in ccRCC and vhRCC. Methods: This is a retrospective study of patients with ccRCC and vhRCC who received (C) at a single center from 1/2014-9/2017. Data tabulated included baseline characteristics, toxicity, dose reductions, time on (C) and survival data. A blinded radiologist assessed the radiographic response using RECIST v1.1. Cox regression analysis of time to treatment failure (TTF) in ccRCC and vhRCC was performed, adjusting for age, gender, IMDC score, neutrophil to lymphocyte ratio (NLR), prior TKI treatment, and number of metastatic sites. Statistical analysis were performed using SPSS 23.0. Results:Time to treatment failure was significantly longer in vhRCC compared with ccRCC (16.1 vs 7.64 months, HR 0.42, 95%CI 0.22-0.79, p = 0.007). This difference persisted in the adjusted Cox regression model (HR 0.36, 95% CI 0.15-0.85, p = 0.02). Conclusions: In this retrospective comparative analysis of C treated vhRCC and ccRCC patients, C was found to have substantial activity in both cohorts of patients. The IMDC score was important to predict outcome. Both heavily pretreated patients with ccRCC and those with vhRCC appeared to have substantial benefit.[Table: see text]

Optimal integration of multiparametric MRI (mp MRI) into prostate brachytherapy practice necessitates an understanding of imaging findings pertinent to prostate cancer detection and staging. This review will summarize prostate cancer imaging findings and tumor staging on mp MRI, including an overview of the Prostate Imaging Reporting and Data System (PIRADS)–structured reporting schema, mp MRI findings observed in the post-therapy setting including cases of post-treatment recurrence, and MRI concepts integral to successful salvage brachytherapy.

To assess the effects of bevacizumab and everolimus, individually and combined, on CT perfusion (CTp) parameters in liver metastases from neuroendocrine tumors (mNET) and normal liver.

Mesenchymal chondrosarcoma of bone is a rare high-grade variant of chondrosarcoma, which typically has central intramedullary location. The tumor is characterized by admixture of highly anaplastic small round malignant cells and islands of mineralized low-grade hyaline cartilage. It is most unusual for this tumor to arise on the surface of a long bone. We describe a patient with periosteal mesenchymal chondrosarcoma that arose at the surface of the right tibia with multifocal bone metastases. Radiographic, CT, MRI, and PET-CT features of this unusual tumor are presented.

PURPOSE: To present an overview of mp MRI techniques necessary for high-resolution imaging of prostate.METHODS: We summarize examples from our clinical experience and concepts from the current literature that illustrate normal prostate anatomy on multiparametric MRI (mp MRI).RESULTS: Our experience regarding optimal mp MRI image acquisition is provided, as well as a summary of prostate and periprostatic anatomy and anatomical variants that pose challenges for BT.CONCLUSIONS: mp MRI provides unparalleled assessment of the prostate and periprostatic anatomy, making it the most appropriate imaging modality to facilitate prostate BT treatment planning, implantation, and followup. This work provides an introduction to prostate mp MR imaging, anatomy, and anatomical variants essential for successful integration mp MRI into prostate brachytherapy practice. (C) 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

To explore the efficacy and safety of pazopanib in a ‘real‐world’ setting in unselected patients, as data regarding unselected patients with metastatic clear‐cell renal cell carcinoma (ccRCC) treated with first‐line pazopanib are limited.

AIMS Echocardiographic assessment of patients with mitral valve stenosis (MS) requires a detailed evaluation of mitral valve anatomy, mitral valve area (MVA), and pressure gradient and presence concomitant valve diseases. Our aim was to evaluate planimetric MVA and transmitral flow velocities using cardiac magnetic resonance (CMR) in patients with isolated MS and to compare with transthoracic echocardiography (TTE) to determine the reliability. METHODS AND RESULTS Thirty-one patients (mean age 50.4 ± 10.2, 90.3% women) with isolated MS who were in a normal sinus rhythm were included in the study. Patients with ejection fraction <50%, atrial fibrillation, moderate-to-severe mitral valve insufficiency, moderate-to-severe stenosis and insufficiency of other valves, and previous commissurotomy and valvulotomy were excluded. Planimetric MVA and diastolic velocities were measured with TTE and CMR. There were strong correlations between measurements of planimetric MVA and transmitral diastolic velocities (P < 0.0001). Assessment of Bland-Altman analysis revealed strong agreement on measuring planimetric MVA with values -0.018 cm(2) (SD = 0.98 cm(2)) and the limits of agreement were -0.131 to 0.094. CONCLUSION CMR is a reliable method in patients with MS for diagnosis and follow-up.

OBJECTIVE. This article will review the multimodality imaging spectrum of medullary thyroid carcinoma (MTC) with an emphasis on anatomic and functional imaging. Recent advances in the molecular cytogenetics of this tumor and the impact on diagnosis, prognosis, and development of novel targeted therapy will be discussed.CONCLUSION. MTC is a neuroendocrine tumor with unique clinicopathologic and radiologic features compared with other thyroid malignancies. Imaging plays an important role in the optimal management of this malignancy.

Objective: Cardiac visceral fat is accepted to be a new marker for cardiometabolic risk due to its association with increased cardiovascular risk factors. This study aimed to compare the expression of 11 beta hydroxysteroid dehydrogenases (11 beta-HSD)-1, glucocorticoid receptor (GCR), and CD68 in mediastinal and subcutaneous adipose tissues (MAT, and SAT, respectively) and to assess their possible relationships with the development of coronary artery disease (CAD).Methods and results: Expression of 11 beta-HSD-1, GCR, and CD68 mRNA levels were measured by quantitative real-time polymerase chain reaction in MAT and SAT tissues of 37 patients undergoing coronary artery bypass grafting due to CAD (CAD group) and 19 non-CAD patients (controls) undergoing heart valve surgery. 11 beta-HSD-1 in MAT and SAT and GCR expression in MAT and SAT were found to be significantly increased in CAD group when compared with controls (P<.05, respectively). In CAD group, 11 beta-HSD-1 mRNA levels were found to be significantly higher in MAT compared to SAT (P<.05). CD68 mRNA levels were significantly higher in MAT of CAD group compared to controls (P<.05). Immunohistochemical analyses demonstrated the presence of CD68+ cells and increased 11 beta-HSD-1 expression in MAT of CAD group compared to SAT.Conclusion: The present study demonstrate that the mediastinal fat exhibits a pathogenic mRNA profile of 11 beta-HSD-1, GCR, and CD68. The identification of 11 beta-HSD-1 expression within the mediastinal fat, along with increased GCR expressions and the presence of CD68+ cells highlight that MAT potentially contributes to the pathogenesis of CAD. (C) 2013 Elsevier Inc. All rights reserved.

Foreign body perforation of the gastrointestinal (GI) tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made. We report the case of a 69-year-old woman who experienced severe pain in the right iliac fossa. The presumptive diagnosis was acute purulent appendicitis or diverticulitis. Multidetector computed tomography (MDCT) imaging showed the fish bone perforation of the terminal ileum. A high index of suspicion should always be maintained in order for the correct diagnosis to be made.