Yu Mi Jeong

Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer

Introduction: The primary objective of this study was to determine the prognostic significance of computed tomography (CT)-determined sarcopenia in small-cell lung cancer (SCLC) patients. Methods: This retrospective study consisted of a total of 149 consecutive SCLC patients. The cross-sectional area of muscle at the level of the third lumbar vertebra (L3) was measured using baseline CT images. Sarcopenia was defined as a L3 muscle index of less than 55 cm2/m2 for men and of less than 39 cm2/m2 for women as proposed by international consensus of cancer cachexia. In addition, Korean-specific cutoffs for sarcopenia was also applied (49 cm2/m2 for men and 31 cm2/m2 for women). Overall survival (OS) and clinical characteristics of patients with or without sarcopenia were compared. Results: Mean patient age was 68.6 ± 9.5 years. Most were male (85.3%) and 67.8% had extensive disease at time of diagnosis. Sarcopenia was present in 118 patients (79.2%) and was significantly related to an advanced age (p = 0.028), male sex (p < 0.001), lower body mass index (p < 0.001), and poor performance status (p = 0.049). Sarcopenic patients had shorter OS than nonsarcopenic patients (median: 8.6 months versus 16.8 months; p = 0.031). Multivariable analysis revealed that sarcopenia was an independent prognostic factor of poor survival (hazards ratio: 1.68; 95% confidence interval: 1.04–2.72; p = 0.034), along with extensive stage (p < 0.001), supportive care only (p < 0.001), and an elevated lactate dehydrogenase level (p = 0.020). Using Korean sarcopenia cutoffs, sarcopenic patients were also found to have poorer OS than nonsarcopenic patients, however, the survival difference was not statistically significant (median: 8.4 months versus 12.7 months; p = 0.144 by the log-rank test). Conclusions: Sarcopenia as determined by CT could be used to predict prognosis in patients with SCLC. Optimum reference values to predict cancer-specific outcomes should be tailored by further studies.

MRI of Neurosyphilis Presenting as Mesiotemporal Abnormalities: a Case Report

The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.

Candida Septic Arthritis with Rice Body Formation: A Case Report and Review of Literature

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.

The Relationship between Sarcopenia and Systemic Inflammatory Response for Cancer Cachexia in Small Cell Lung Cancer.

Background The prognostic significance of sarcopenia, an important component of cancer cachexia, has been demonstrated in oncologic patients. Catabolic drivers have been suggested to be key features of cancer cachexia. Objective To determine the relationship between systemic inflammatory markers and CT-determined muscle mass in patients with SCLC. Methods Cross-sectional muscle areas were evaluated at the level of the third lumbar vertebra (L3) using baseline CT images in 186 SCLC patients. Sarcopenia was defined as a L3 muscle index (L3MI, muscle area at L3/height2) of < 55 cm2/m2 for men and of < 39 cm2/m2 for women. Systemic inflammatory markers investigated included serum white blood cell count (WBC), neutrophil: lymphocyte ratio (NLR), C-reactive protein (CRP), and albumin. Results Mean L3MI was 47.9 ± 9.7 cm2/m2 for men and 41.6 ± 7.0 cm2/m2 for women. Sarcopenia was present in 128 patients (68.8%), and sarcopenic patients had significant serum lymphocyte counts and albumin levels (p = 0.002 and 0.041, respectively), and higher NLRs and CRP levels (p = 0.011 and 0.026) than non-sarcopenic patients. Multivariable analysis revealed that CRP independently predicted L3MI (β = -0.208; 95% CI, -0.415 to -0.002; p = 0.048), along with gender and BMI (p values < 0.001) and performance status (p = 0.010). Conclusion The present study confirms a significant linear relationship exists between CT-determined muscle mass and CRP in SCLC patients. This association might provide a better understanding of the mechanism of cancer cachexia.

Evaluation of the growth pattern of carcinoma of colon and rectum by MDCT.

Background Colorectal cancer is a leading cause of cancer morbidity and mortality worldwide. Knowledge of colorectal cancer tumor growth is of importance for basic understanding of tumor biology and for the clinical handling of the disease. Purpose To conduct a retrospective evaluation of the growth pattern of colorectal cancer by multidetector computed tomography (MDCT). Material and Methods Pathologically proven adenocarcinomas of the colon and rectum in 44 patients were examined by MDCT on at least two separate occasions with an interval of >1 month in patients not receiving therapy. Maximal longitudinal diameters, wall thicknesses, and volume changes, as determined by serial CT scans, were used in calculation of growth rates. Results Mean longitudinal diameters of tumors at initial and follow-up investigations were 3.8 cm (1.0–9.1 cm) and 5.4 cm (2.5–12.2 cm), respectively. The mean growth rate of longitudinal tumor diameter was 3.4 cm/year (0–13.8 cm/year). Mean axial wall thicknesses at initial and follow-up investigations were 1.4 cm (0.6–6.6 cm) and 1.9 cm (0.8–6.8 cm), respectively. Mean growth rate of tumor axial wall thickness was 1.0 cm/year (0–3.1 cm/year). Mean tumor volumes at initial and follow-up investigations were 1975 cm3 (172–9756 cm3; median, 1490) and 3545 cm3 (442–15211 cm3; median, 2846), respectively. Mean growth rate of tumor volume was 2912 cm3/year (216–12548 cm3/year; median, 1698), and volume doubling times varied from 0.05 to 7.1 years (mean, 1.2; median, 0.7). Significant correlations were observed between initial wall thickness and volume growth rate (p = 0.004). No significant difference was observed between other initial tumor size and growth rate. Conclusion The tumor growth doubling time of colorectal cancer has a very broad aspect. The initial wall thickness of the tumor on MDCT appears to be the most powerful parameter showing correlation with the volume growth rate.

Prognostic Significance of Modified Advanced Lung Cancer Inflammation Index (ALI) in Patients with Small Cell Lung Cancer_ Comparison with Original ALI.

Background Advanced lung cancer inflammation index (ALI, body mass index [BMI] x serum albumin/neutrophil-lymphocyte ratio [NLR]) has been shown to predict overall survival (OS) in small cell lung cancer (SCLC). CT enables skeletal muscle to be quantified, whereas BMI cannot accurately reflect body composition. The purpose was to evaluate prognostic value of modified ALI (mALI) using CT-determined L3 muscle index (L3MI, muscle area at L3/height2) beyond original ALI. Methods L3MIs were calculated using the CT images of 186 consecutive patients with SCLC taken at diagnosis, and mALI was defined as L3MI x serum albumin/NLR. Using chi-squared test determined maximum cut-offs for low ALI and low mALI, the prognostic values of low ALI and low mALI were tested using Kaplan-Meier method and Cox proportional hazards analysis. Finally, deviance statistics was used to test whether the goodness of fit of the prognostic model is improved by adding mALI as an extra variable. Results Patients with low ALI (cut-off, 31.1, n = 94) had shorter OS than patients with high ALI (median, 6.8 months vs. 15.8 months; p < 0.001), and patients with low mALI (cut-off 67.7, n = 94) had shorter OS than patients with high mALI (median, 6.8 months vs. 16.5 months; p < 0.001). There was no significant difference in estimates of median survival time between low ALI and low mALI (z = 0.000, p = 1.000) and between high ALI and high mALI (z = 0.330, p = 0.740). Multivariable analysis showed that low ALI was an independent prognostic factor for shorter OS (HR, 1.67, p = 0.004), along with advanced age (HR, 1.49, p = 0.045), extensive disease (HR, 2.27, p < 0.001), supportive care only (HR, 7.86, p < 0.001), and elevated LDH (HR, 1.45, p = 0.037). Furthermore, goodness of fit of this prognostic model was not significantly increased by adding mALI as an extra variable (LR difference = 2.220, p = 0.136). Conclusion The present study confirms mALI using CT-determined L3MI has no additional prognostic value beyond original ALI using BMI. ALI is a simple and useful prognostic indicator in SCLC.

Prevalence of and Factors Associated with Sarcopenia in Korean Cancer Survivors: Based on Data Obtained by the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2011

ABSTRACT Using a representative dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we analyzed anthropometric and dual-energy X-ray absorptiometry (DXA)-determined body composition findings for 493 cancer survivors (mean age a61.1 ± 12.6 years; 35.7% male). A much higher proportion of men (30.1%) than women (0.6%) met the criteria of sarcopenia. Subjects with a history of lung cancer, genitourinary cancer, or gastric cancer were prone to develop sarcopenia (31.6%, 26.3%, and 21.4%, respectively). Furthermore, sarcopenia was more prevalent among elderly (≥65 years; P < 0.001), those with a lower BMI level (<23 kg/m2; P < 0.001), heavy drinker (P = 0.012), or smoker (P < 0.001), and those with inadequate intakes of protein (P = 0.017) and vitamin A (P = 0.024). Multivariable logistic analyses revealed sarcopenia was significantly associated with male gender (odds ratio [OR], 68.14; 95% CI, 15.52–299.13), a BMI of <23 kg/m2 (OR 35.93, 95% CI, 8.24–156.67), and inadequate protein intake (OR 3.07, 95% CI, 1.30–7.22); these factors are significant predictors of sarcopenia in Korean cancer survivors.

Using three-dimensional isotropic SPACE MRI to detect posterolateral corner injury of the knee.

Background Reliable magnetic resonance imaging (MRI) diagnosis is important in cases of posterolateral corner (PLC) injury due to the limitations of physical examination in patients with multi-ligament injury. Purpose To document the appearance of PLC of the knee on three-dimensional (3D) isotropic MR images, and to determine the significance of MRI findings in patients with confirmed posterolateral rotatory instability. Material and Methods Twenty-five patients that underwent surgery for posterolateral instability, and 25 individuals with normal MRI constituted the study cohort. The PLC appearances (popliteofibular, fabellofibular, arcuate ligaments, popliteomeniscal fascicle) were analyzed using 3D isotropic proton density sequence and routine two-dimensional (2D) MRI. In addition, the “fibular cap” sign was evaluated. Statistical analysis was performed using the Chi-square and McNemar’s tests. Results Thickening of popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle was significantly more frequent in the PLC injury group than in the control group (P < 0.05). The sensitivity and specificity of 3D MRI for popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle injury were 63/92%, 54/100%, 46/100%, and 58/92%, respectively. On comparing 3D and 2D images with respect to injury detectability (grade 3 or 4), both modalities visualized injuries, but 3D detected grade 3 or grade 1 rather than grade 4 or 0, respectively. The fibular cap sign was observed significantly more frequently in PLC group, with 58% sensitivity and 100% specificity, and was better observed by 3D than 2D (P < 0.05). Conclusion 3D MRI is a valid modality for detecting PLC abnormalities as it visualizes pathologies in each component and exhibits the positive fibular cap sign.

Prognostic significance of CT-emphysema score in patients with advanced squamous cell lung cancer.

BACKGROUND Although emphysema is a known independent risk factor of lung cancer, no study has addressed the prognostic impact of computed tomography (CT)-emphysema score in advanced stage lung cancer. METHODS For 84 consecutive patients with stage IIIB and IV squamous cell lung cancer that underwent palliative chemotherapy, severity of emphysema was semi-quantitatively scored using baseline chest CT images according to the Goddard scoring system (possible scores range, 0-24). The cutoff of high CT-emphysema score was determined using the maximum chi-squared test and the prognostic significance of the high CT-emphysema score was evaluated using Kaplan-Meier analysis and Cox proportional hazards analysis. RESULTS The median CT-emphysema score was 5 (range, 0-22). Patients with a high CT-emphysema score (≥4) tended to have poorer overall survival (OS) (median: 6.3 vs. 13.7 months) than those with a score of <4 (P=0.071). Multivariable analysis revealed that a higher CT-emphysema score was a significant independent prognostic factor for poor OS [hazard ratio (HR) =2.06; 95% confidence interval (CI), 1.24-3.41; P=0.005), along with no response to first-line therapy (P=0.009) and no second-line therapy (P<0.001). CONCLUSIONS CT-emphysema score is significantly associated with poor prognosis in patients with advanced squamous cell lung cancer.

Morphologic Evaluation of Ductus Diverticulum Using Multi - Detector Computed Tomography: Comparison with Traumatic Pseudoaneurysm of the Aortic Isthmus

Objectives To evaluate morphologic variations at the aortic isthmus with particular attention to ductus diverticulum, a mimicker of traumatic pseudoaneurysm, and to describe differences using Computed Tomography (CT) images. Patients and Methods From December 2013 to December 2014, patients who underwent a chest CT examination after blunt trauma at our emergency department were included. Aortic isthmus morphologies were evaluated using multiplanar reconstruction (MPR) and maximum intensity projection (MIP) images as follows. Type I -concave contour, type II -convexity without a discrete bulge, or type III -a discrete focal bulge (defined as ductus diverticulum). Results After excluding 11 cases of traumatic pseudoaneurysm of the aortic isthmus, a total of 432 trauma patients (mean age = 47.1 ± 19.1 years, number of males = 318) were evaluated for aortic isthmus morphology, and classified as follows; type I (n = 240, 55.6%), type II (n = 157, 36.3%), and type III (n = 35, 8.1%). As compared with traumatic pseudoaneurysm (n = 11), ductus diverticulum had a smaller vertical diameter (5.5 ± 1.3 mm vs. 11.2 ± 2.7 mm, P < 0.001), a broader base (14.9 ± 4.1 mm vs. 8.8 ± 4.5 mm, P < 0.001), a smoother margin (97.1% vs. 27.3%, P < 0.001), and formed obtuse angle with the aortic wall. Furthermore, ductus diverticulum was not associated with the presence of a dissection flap or hemomediastinum. Conclusion Ductus diverticulum, a mimicker of traumatic pseudoaneurysm of the aortic isthmus, is a frequently observed anatomic variant during CT examinations. Familiarity with its CT imaging findings could avoid it being confused with traumatic pseudoaneurysm in blunt trauma patients.