Michael Laniado

Desmoplastic fibroma of the bone: A report of two patients, review of the literature, and therapeutic implications

Desmoplastic fibroma (DF) is an extremely rare bone tumor. The recommendations for therapy are often based on limited personal experience, and the rate of local recurrence in the published cases is very high. Therefore, an analysis of treatment results of published cases was performed. Furthermore, DNA analysis of the tumors from two patients was also performed.

Dynamic MR imaging of liver metastases with Gd-EOB-DTPA:

PURPOSE To assess liver and lesion enhancements by dynamic MR imaging after bolus injection of the hepatobiliary contrast agent gadolinium ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) in patients with liver metastases and to compare the effect of different doses. MATERIAL AND METHODS A randomized double-blinded trial with doses of 12.5, 25 and 50 micromol/kg Gd-EOB-DTPA was performed in 35 patients with liver metastases. Liver enhancement, tumor enhancement and liver lesion contrast-to-noise (C/N) ratios were calculated from breath-hold gradient echo images (100/5/80 degrees) recorded precontrast and at different times up to 10 min postcontrast. RESULTS Normal liver showed a characteristic enhancement pattern, with a rapid enhancement in the first 45 s postcontrast and a slight but significant further increase up to 600 s. The initial enhancement in the lesions was also pronounced, but the enhancement was slightly decreased after 240 s postcontrast. At dose levels of 12.5 and 25 micromol/kg Gd-EOB-DTPA, C/N ratios significantly increased compared to baseline from 90 to 600 s. Postcontrast C/N-values obtained using 50 micromol/kg Gd-EOB-DTPA were not significantly increased, except for the examinations 480 s postcontrast. CONCLUSION In liver metastases, C/N ratios obtained with doses of 12.5 and 25 micromol/kg Gd-EOB-DTPA were slightly superior to 50 micromol/kg Gd-EOB-DTPA. This finding is probably due to a more pronounced extracellular effect of the contrast medium at higher doses.

MR-guided interventional breast procedures considering vacuum biopsy in particular

Histologic work-up of just MR-detected breast lesions has become essential with increasing use of contrast-enhanced MR imaging. In the present article an overview is given about the different MR-guided breast interventions, performed since 1990. Presently, for reasons of costs and image quality closed magnets are most widely used. The following approaches have been described: MR-guided freehand localization in supine position, stereotaxic localization in supine position and most frequently used localization in the prone position by means of a compression device that immobilises the breast to prevent tissue shift during intervention. Only limited experience exists with interventions on open magnets. MR-guided wire localization is a well-established procedure. Recently, percutaneous vacuum biopsy of enhancing breast lesions has become possible under MR guidance. The new system allows accurate and safe access to lesions in any location of the breast and direct check-up of representative excision by visualisation of the cavity. Thus reliable histologic evaluation of lesions smaller than 10 mm is possible with this approach.

MRI-Based Liver Iron Content Predicts for Nonrelapse Mortality in MDS and AML Patients Undergoing Allogeneic Stem Cell Transplantation

Purpose: Retrospective, surrogate marker–based studies have found inconsistent associations between systemic iron overload (SIO) and adverse outcome in patients undergoing allogeneic stem cell transplantation (allo-SCT). As a consequence, the impact of SIO in this context remains under debate. The aim of this study was to test whether the objective pretransplant quantification of liver-iron content (LIC) by magnetic resonance imaging (MRI) could circumvent these limitations and conclusively define the prognostic relevance of SIO. Experimental Design: The correlation between pretransplant LIC and surrogate parameters as well as the impact of SIO on posttransplant outcome was assessed within an observational study of patients (n = 88) with either myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) undergoing allo-SCT. Results: Ferritin levels of 1,000 ng/mL or more provided only poor specificity (31.8%) for predicting elevated LIC (≥125 μmol/g) and even higher thresholds (≥2,500 ng/mL) lacked an association with nonrelapse mortality (NRM). In contrast, LIC 125 μmol/g or more was a significant risk factor for NRM in uni- and multivariate analysis (HR = 2.98; P = 0.016). Multivariate Cox-regression further showed that LIC 125 μmol/g or more was associated with a decreased overall survival (HR = 2.24, P = 0.038), whereas ferritin or transfusion burden were not. Conclusions: SIO reflected by LIC is an independent negative prognostic factor for posttransplant outcome in patients with AML and MDS undergoing allo-SCT. Therefore, MRI-based LIC, and not interference-prone serum markers such as ferritin, should be preferred for pretransplant risk stratification and patient selection in future clinical trials. Clin Cancer Res; 18(23); 6460–8. ©2012 AACR.

Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound-fusion biopsy for the diagnosis of prostate cancer

To compare targeted, transperineal magnetic resonance imaging (MRI)/ultrasound (US)‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy and to evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/US‐fusion biopsies.

FDG PET/MR for lymph node staging in head and neck cancer

OBJECTIVE To assess the diagnostic value of PET/MR (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for lymph node staging in head and neck cancer. MATERIALS AND METHODS This prospective study was approved by the local ethics committee; all patients signed informed consent. Thirty-eight patients with squamous cell carcinoma of the head and neck region underwent a PET scan on a conventional scanner and a subsequent PET/MR on a whole-body hybrid system after a single intravenous injection of FDG. The accuracy of PET, MR and PET/MR for lymph node metastases were compared using receiver operating characteristic (ROC) analysis. Histology served as the reference standard. RESULTS Metastatic disease was confirmed in 16 (42.1%) of 38 patients and 38 (9.7%) of 391 dissected lymph node levels. There were no significant differences between PET/MR, MR and PET and MR (p>0.05) regarding accuracy for cervical metastatic disease. Based on lymph node levels, sensitivity and specificity for metastatic involvement were 65.8% and 97.2% for MR, 86.8% and 97.0% for PET and 89.5% and 95.2% for PET/MR. CONCLUSIONS In head and neck cancer, FDG PET/MR does not significantly improve accuracy for cervical lymph node metastases in comparison to MR or PET.

The double-line sign of osteonecrosis: evaluation on chemical shift MR images

The MR appearance of osteonecrosis was assessed on selective fat and water images to further evaluate the features of the double-line sign of osteonecrosis. Conventional T1- and T2-weighted spin-echo and frequency selective chemical shift images of eight patients with avascular necrosis of the femoral head and three patients with bone infarcts were retrospectively reviewed. Eight of 11 patients showed a double-line sign on T2-weighted spin-echo images. In these cases correlation with selective water images revealed that a chemical shift artifact contributed to the appearance and location of the hyperintense line. The double-line sign was not seen in three patients with radiologically and clinically proven osteonecrosis. It is concluded that chemical shift imaging improves our understanding of the nature of the double-line sign.

A Multicenter Phase 1 Study of EMD 525797 (DI17E6), a Novel Humanized Monoclonal Antibody Targeting αv Integrins, in Progressive Castration-resistant Prostate Cancer with Bone Metastases After Chemotherapy

BACKGROUND EMD 525797 (DI17E6) is a deimmunized, humanized monoclonal immunoglobulin G2 antibody against the αv subunit of human integrins. Blocking αv integrins may be an effective strategy for inhibiting prostate cancer (PCa) metastasis. OBJECTIVE Evaluate EMD 525797 safety/tolerability and pharmacokinetics (PK) in castration-resistant PCa patients. Secondary objectives included antitumor activity assessments. DESIGN, SETTING, AND PARTICIPANTS A phase 1 open-label study in 26 patients (four European centers). Eligible patients (≥ 18 yr) had histologically proven PCa with bone metastases after prior chemotherapy and evidence of progressive disease (PD) based on prostate-specific antigen (PSA) values. INTERVENTION Patients received three intravenous EMD 525797 infusions (250, 500, 1000, or 1500 mg every 2 wk). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Treatment-emergent adverse events (TEAEs) and dose-limiting toxicities (DLTs) were assessed. PK parameters were calculated according to noncompartmental standard methods. Antitumor activity measures were response after 6 wk, changes in PSA levels, and pain interference total score. Descriptive statistics were used. RESULTS AND LIMITATIONS Patients were treated for a mean of 16.8 ± 16.7 wk. No DLTs were reported in any of the cohorts. All patients experienced TEAEs, which were considered drug-related in 11 patients. Four deaths occurred during the trial and were considered not related to EMD 525797. EMD 525797 showed dose-dependent, nonlinear PK. Eighteen of 26 patients did not show PD for ≥ 18 wk. Two patients (500-mg cohort), treated for 42.4 and 76.3 wk, had clinically significant PSA reductions and pain relief, including one patient with confirmed partial response. This trial was not specifically designed to assess clinical activity, and further investigations are needed in randomized controlled trials. CONCLUSIONS No DLTs were reported in any of the evaluated cohorts. There was evidence of clinical activity. For the currently ongoing phase 2 trial, EMD 525797 doses of 750 and 1500 mg every 3 wk were chosen. TRIAL REGISTRATION NCT00958477 (EMR 62242-002).

Direct comparison of multiparametric magnetic resonance imaging (MRI) results with final histopathology in patients with proven prostate cancer in MRI/ultrasonography‐fusion biopsy

To compare multiparametric magnetic resonance imaging (mpMRI) of the prostate and histological findings of both targeted MRI/ultrasonography‐fusion prostate biopsy (PBx) and systematic PBx with final histology of the radical prostatectomy (RP) specimen.

FDG PET/MR for the assessment of lymph node involvement in lymphoma: initial results and role of diffusion-weighted MR.

RATIONALE AND OBJECTIVES The purpose of this study was to evaluate the sensitivity and specificity of positron emission tomography/magnetic resonance imaging (PET/MR) with 18F-fluorodeoxyglucose (FDG) for nodal involvement in malignant lymphoma. MATERIALS AND METHODS Twenty-seven patients with malignant lymphoma (16 men and 11 women; mean age, 45 years) were included in this retrospective study. The patients underwent FDG PET/MR after intravenous injection of FDG (176-357 MBq FDG, 282 MBq on average). Follow-up imaging and histology served as the standard of reference. RESULTS One-hundred and twenty-seven (18.1%) of 702 lymph node stations were rated as having lymphoma involvement based on the standard of reference. One-hundred and twenty-four (17.7%) of 702 lymph node stations were rated as positive by FDG PET/MR. The sensitivity and specificity of FDG PET/MR for lymph node station involvement were 93.8% and 99.4%. CONCLUSIONS FDG PET/MR is feasible for lymphoma staging and has a high sensitivity and specificity for nodal involvement in lymphoma. Comparison with PET/CT is necessary to determine whether FDG PET/MR can replace PET/CT for lymphoma staging.