Focal FDG uptake in mediastinal brown fat mimicking malignancy: a potential pitfall resolved on PET/CT

OBJECTIVE: A potential source of false-positive FDG PET interpretations in oncologic imaging is FDG uptake in brown fat. The purpose of this study was to determine the prevalence, location, and appearance of hypermetabolic brown fat in the mediastinum. MATERIALS AND METHODS: All PET/CT scans obtained at our cancer institution from August to October 2003 were retrospectively reviewed for increased FDG uptake in the mediastinum localized to fat on CT. The following features were recorded: location, appearance, maximal standard uptake value (SUV(max)) of hypermetabolic mediastinal brown fat, and presence of extramediastinal brown fat. RESULTS: PET/CT scans were obtained in 845 oncologic patients. Fifteen patients (1.8%) with focal hypermetabolic mediastinal brown fat were identified: nine women and two men (age range, 27-79; mean, 55.1 years) and four children (age range, 5-16 years; mean, 10 years). Hypermetabolic mediastinal brown fat (mean SUV(max), 5.7) was more common in children (4/8) than in adults (11/837) and more common in women (9/372) than in men (2/465). Foci of hypermetabolic brown fat were localized to the paratracheal, paraesophageal, prevascular, and pericardial regions; interatrial septum; and azygoesophageal recess. Five patients had focal hypermetabolic brown fat isolated to the mediastinum. Ten patients also had extramediastinal hypermetabolic brown fat in the neck, thorax, and abdomen. There was no difference in the body weight (p = 0.876) or body mass index (p = 0.538) of patients with hypermetabolic brown fat compared with age- and sex-matched control subjects. CONCLUSION: Hypermetabolic brown fat can be localized to the mediastinum and manifests as focal increased FDG uptake. Knowledge of this potential pitfall and precise localization with fusion PET/CT are important in preventing misinterpretation as malignancy.     

Short-term in vivo wear of cross-linked polyethylene

BACKGROUND: Cross-linked polyethylene was developed to reduce volumetric wear in prosthetic joints. Hip simulator studies have shown promising results with regard to wear reduction. This study evaluated the short-term in vivo wear of a moderately cross-linked polyethylene. METHODS: Linear head penetration, as an assessment of in vivo polyethylene wear, was measured in two groups of patients after total hip replacement. Twenty-four hips received a conventional polyethylene insert and thirty-four, a cross-linked polyethylene liner; both inserts were manufactured by the same company. Linear and volumetric wear rates were measured on radiographs with use of a validated computer-assisted technique and were adjusted for patient-related factors. Patient activity was assessed by a computerized two-dimensional accelerometer worn on the ankle. RESULTS: Patients with a conventional polyethylene insert showed a mean linear wear rate of 0.13 mm per year and a mean volumetric wear rate of 87.6 mm(3) per year. The group with a cross-linked polyethylene liner showed a mean linear wear rate of 0.02 mm per year and a mean volumetric wear rate of 17.0 mm(3) per year. Wear in the group with cross-linked polyethylene was 81% lower than that in the group with conventional polyethylene (p < 0.00001). Accounting for differences in patient activity, the adjusted wear rates per million cycles for a patient weight of 70 kg were 53 mm(3) per million cycles for conventional polyethylene and 15 mm(3) per million cycles for cross-linked polyethylene, a 72% reduction (p = 0.0002). No factor, other than the type of polyethylene, was found to influence the difference in wear rates between the two groups. CONCLUSIONS: The results of this study are promising. The in vivo wear reduction with this cross-linked polyethylene is consistent with the predictions of hip simulator studies.     

Phase II Study of Intravenous Doxil® in Malignant Pleural Mesothelioma

Twenty-four patients with pleural mesotheliomareceived 50 mg/m² of Doxil® every four weeks.At follow-up, the disease had stabilized in 43% percent ofpatients and had progressed in 57%. No objective responses wereobserved. Estimated median survival of all patients was 37 weeks.Major toxicities were erythrodysesthesia of hands and feet andmyelosuppression. No cardiac toxicity was observed. We concludedthat Doxil® at this dosage and schedule is inactiveagainst pleural mesothelioma.     

Integrated CT-PET imaging of esophageal cancer: unexpected and unusual distribution of distant organ metastases

CT-PET imaging is being increasingly used for the initial staging, assessment of treatment response, and follow-up of patients with esophageal carcinoma, primarily because of its superior detection of distant metastases compared to conventional methods. Our recent experience has shown that metastases from esophageal cancer can occur in unusual locations and have an unexpected presentation. Recognition of the distribution and appearance of esophageal metastases is important for optimal image interpretation in order to avoid confusion with more benign disease. This article reviews the location and appearance of metastases detected by CT-PET imaging in patients with esophageal cancer either at presentation or after preoperative or definitive chemoradiation therapy.     

From the Cover: Deep phenotyping to predict live birth outcomes in in vitro fertilization

Nearly 75% of in vitro fertilization (IVF) treatments do not result in live births and patients are largely guided by a generalized age-based prognostic stratification. We sought to provide personalized and validated prognosis by using available clinical and embryo data from prior, failed treatments to predict live birth probabilities in the subsequent treatment. We generated a boosted tree model, IVF_BT, by training it with IVF outcomes data from 1,676 first cycles (C1s) from 2003–2006, followed by external validation with 634 cycles from 2007–2008, respectively. We tested whether this model could predict the probability of having a live birth in the subsequent treatment (C2). By using nondeterministic methods to identify prognostic factors and their relative nonredundant contribution, we generated a prediction model, IVF_BT, that was superior to the age-based control by providing over 1,000-fold improvement to fit new data (p < 0.05), and increased discrimination by receiver–operative characteristic analysis (area-under-the-curve, 0.80 vs. 0.68 for C1, 0.68 vs. 0.58 for C2). IVF_BT provided predictions that were more accurate for ∼83% of C1 and ∼60% of C2 cycles that were out of the range predicted by age. Over half of those patients were reclassified to have higher live birth probabilities. We showed that data from a prior cycle could be used effectively to provide personalized and validated live birth probabilities in a subsequent cycle. Our approach may be replicated and further validated in other IVF clinics.     

Effect of titanium surface modified by plasma energy source on genotoxic response in vitro

Titanium (Ti) is currently the most widely used material for the manufacture of orthopedic and dental implants. Changes in the surface of commercial pure Ti (cp Ti) can determine the functional response of cells, and is therefore a critical factor for the success of the implant. However, the genotoxicity of titanium surfaces has been poorly studied. Thus, the purpose of this study was to evaluate the genotoxic potential of a new titanium surface developed by plasma treatment using argon-ion bombardment and compare it with an untreated titanium surface. Accordingly, comet assay, analysis of chromosomal aberrations (CAs), and Cytokinesis Block Micronucleus (CBMN) assay were carried out, using CHO-K1 (Chinese hamster ovary) cells grown on both titanium surfaces. Our results show that the untreated titanium surface caused a significant increase in % tail moment, in the number of cells with CAs, tetraploidy, micronucleus frequency, and other nuclear alterations when compared with the negative control and with the plasma-treated titanium surface. This difference may be attributed to increased surface roughness and changes in titanium oxide layer thickness.     

Differential growth inhibition and induction of apoptosis by gossypol between HCT116 and HCT116/Bax(-/-) colorectal cancer cells

1. Bax is a very important pro-apoptosis molecule. HCT116/Bax(-/-) cells do not express the pro-apoptosis Bcl-2 family member, Bax. In the present study, the anticancer effects of gossypol on HCT116 and HCT116/Bax(-/-) cells were compared in terms of inhibition of cell growth, inhibition of colony formation and induction of apoptosis. 2. Following treatment with concentrations more than 20 micromol/L gossypol, only slight differences (not significant) were seen between HCT116 and HCT116/Bax(-/-) cells in terms of the inhibition of cell growth and induction of apoptosis. No difference was seen in the inhibition of colony formation. Gossypol had no effect at concentrations < 2 micromol/L. The only effective concentration of gossypol to result in differences between HCT116 and HCT116/Bax(-/-) cells was 5 micromol/L. However, even at this concentration, Bax deficiency did not result in complete abolition of gossypol-induced growth inhibition or apoptosis. Exposure of cells to 5 micromol/L gossypol for 24 h did not cause any significant difference in the activation of caspase 2 between HCT116 and HCT116/Bax(-/-) cells; however, activation of caspase 3, 8 and 9 was significantly elevated in HCT116 cells, with the effect on caspase 3 activation being the greatest, compared with HCT116/Bax(-/-) cells. 3. These findings suggest that the contribution of Bax to gossypol-induced growth inhibition and apoptosis is dose dependent and that gossypol-induced apoptosis requires activation of caspase 3, 8, and 9.