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Background: Recent data suggest that subcutaneous adiposity represents an independent prognostic marker in cancer. We aimed to determine whether subcutaneous adiposity estimated by the subcutaneous adiposity tissue index (SATI) was associated with mortality in esophageal cancer. Methods: We conducted a retrospective analysis of a prospectively enrolled cohort from 2009 to 2015 with esophageal cancer at two major cancer centers. CT scans for initial staging were used to quantify adiposity and skeletal muscle areas. Subjects were categorized as above or below median SATI using sex-specific values. Sarcopenia was defined using previously established skeletal muscle area cutoffs. Cox proportional hazards modeling was performed to determine associations between SATI and all-cause mortality. Results: Of the original 167 patients, 78 met inclusion criteria and had CT images available. Mean age was 67 years, 81.8% had adenocarcinoma, and 58.9% had stage 3 or 4 disease. Median follow-up time was 29.5 months. Overall 5-year survival was 38.9% [95% confidence interval (CI), 26.8–50.7]. Lower body mass index, higher Charlson comorbidity score, and more advanced stage were independently associated with low SATI. Patients with low SATI had increased mortality (unadjusted HR 2.23; 95% CI, 1.20–4.12), even when adjusted for sarcopenia or for percent weight loss. In a multivariable model including age, histology, stage, and receipt of curative surgery, the association between low SATI and mortality was attenuated (adjusted HR 1.64; 95% CI, 0.81–3.34). Conclusions: Low subcutaneous adiposity as estimated by SATI may be associated with increased mortality in esophageal cancer. Impact: Interventions to reduce loss of subcutaneous fat may improve survival in esophageal cancer.

Quantitative imaging biomarkers are increasingly used in oncology clinical trials to assist the evaluation of tumor responses to novel therapies. To identify these biomarkers and ensure smooth clinical translation once they have been validated, it is critical to develop a reliable workflow-efficient imaging platform for integration in clinical settings. Here we will present a web-based volumetric response-assessment system that we developed based on an open-source image viewing platform (WEASIS) and a DICOM image archive (DCM4CHEE). Our web-based response-assessment system offers a DICOM imaging archiving function, standard imaging viewing and manipulation functions, efficient tumor segmentation and quantification algorithms, and a reliable database containing tumor segmentation and measurement results. The prototype system is currently used in our research lab to foster the development and validation of new quantitative imaging biomarkers, including the volumetric computed tomography technique, as a more accurate and early assessment method of solid tumor responses to targeted and immunotherapies.

OBJECTIVES This study aimed to quantify nonenhancing tumor (NT) component in clear cell renal cell carcinoma (ccRCC) and assess its association with histologically defined tumor necrosis, stage, and survival outcomes. METHODS Among 183 patients with ccRCC, multi-institutional changes in computed tomography attenuation of tumor voxels were used to quantify percent of NT. Associations of NT with histologic tumor necrosis and tumor stage/grade were tested using Wilcoxon signed rank test and with survival outcomes using Kaplan-Meier curves/Cox regression analysis. RESULTS Nonenhancing tumor was higher in ccRCC with tumor necrosis (11% vs 7%; P = 0.040) and higher pathological stage (P = 0.042 and P < 0.001, respectively). Patients with greater NT had higher incidence of cancer recurrence after resection (P < 0.001) and cancer-specific mortality (P < 0.001). CONCLUSION Nonenhancing tumor on preoperative computed tomographic scans in patients with ccRCC correlates with tumor necrosis and stage and may serve as an independent imaging prognostic biomarker for cancer recurrence and cancer-specific survival.

PURPOSE: Colectomy for cancer in obese patients is technically challenging and may be associated with worse outcomes. Whether visceral obesity, as measured on computed tomography, is a better predictor of complication than body mass index (BMI) or determines long-term oncologic outcomes has not been well characterized. This study examines the association between derived anthropometrics and postoperative complication and long-term oncologic outcomes. METHODS: Retrospective review of patients undergoing elective colectomy for cancer at a single tertiary-care center from 2010 to 2016. Adipose tissue distribution measurements, including visceral fat area (VFA), were determined from preoperative imaging. The primary outcome was 30-day postoperative complication; secondary outcomes included overall and disease-free survival. Multivariable logistic regression was performed to determine association between obesity metrics and outcome. RESULTS: Two hundred and sixty-four patients underwent 266 primary resections of colon cancer. Twenty-eight patients (10.5%) developed major morbidity (Clavien-Dindo grade ≥ III). VFA but not BMI was significantly associated with morbidity in multivariate analysis (p = 0.004, odds ratio 1.99, 95% confidence interval 1.25–3.19). No other imaging-derived anthropometric was associated with increased morbidity. In receiver operating characteristic analysis, VFA was predictive of major morbidity (area under curve 0.660). A cutoff value of VFA ≥ 191 cm(2) was associated with 50% sensitivity and 76% specificity for predicting major morbidity. Patients with VFA ≥ 191cm(2) had 19.4% risk of morbidity, whereas those with < 191 cm(2) had 7.2% risk (relative risk ratio 2.69, unadjusted p = 0.004). Neither VFA nor BMI was associated with overall or disease-free survival. CONCLUSION: VFA but not BMI predicts morbidity following elective surgery for colon cancer.

Background Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam. Methods We identified 69 patients who had MRIs within seven days of arrest and used a semi-automated algorithm to perform quantitative volumetric analysis of apparent diffusion coefficient (ADC) sequences at various thresholds. Area under receiver operating characteristic curves (ROC-AUC) were estimated to compare predictive values of quantitative MRI with pupillary exam at days 3, 5 and 7 post-arrest, for persistence of coma and functional outcomes at discharge. Cerebral Performance Category scores of 3–4 were considered poor outcome. Results Excluding patients where life support was withdrawn, ≥2.8% diffusion restriction of the entire brain at an ADC of ≤650 × 10−6 m2/s was 100% specific and 68% sensitive for failure to wake up from coma before discharge. The ROC-AUC of ADC changes at ≤450 × 10−6 mm2/s and ≤650 × 10−6 mm2/s were significantly superior in predicting failure to wake up from coma compared to bilateral absence of pupillary reflexes. Among survivors, >0.01% of diffusion restriction of the entire brain at an ADC ≤450 × 10−6 m2/s was 100% specific and 46% sensitive for poor functional outcome at discharge. The ROC curve predicting poor functional outcome at ADC ≤450 × 10−6 mm2/s had an AUC of 0.737 (0.574–0.899, p = 0.04). Conclusion Post-anoxic diffusion changes using quantitative brain MRI may aid in predicting persistent coma and poor functional outcomes at hospital discharge.

OBJECTIVEExtent of resection is an important prognostic factor in patients undergoing surgery for glioblastoma (GBM). Recent evidence suggests that intravenously administered fluorescein sodium associates with tumor tissue, facilitating safe maximal resection of GBM. In this study, the authors evaluate the safety and utility of intraoperative fluorescein guidance for the prediction of histopathological alteration both in the contrast-enhancing (CE) regions, where this relationship has been established, and into the non-CE (NCE), diffusely infiltrated margins.METHODSThirty-two patients received fluorescein sodium (3 mg/kg) intravenously prior to resection. Fluorescence was intraoperatively visualized using a Zeiss Pentero surgical microscope equipped with a YELLOW 560 filter. Stereotactically localized biopsy specimens were acquired from CE and NCE regions based on preoperative MRI in conjunction with neuronavigation. The fluorescence intensity of these specimens was subjectively classified in real time with subsequent quantitative image analysis, histopathological evaluation of localized biopsy specimens, and radiological volumetric assessment of the extent of resection.RESULTSBright fluorescence was observed in all GBMs and localized to the CE regions and portions of the NCE margins of the tumors, thus serving as a visual guide during resection. Gross-total resection (GTR) was achieved in 84% of the patients with an average resected volume of 95%, and this rate was higher among patients for whom GTR was the surgical goal (GTR achieved in 93.1% of patients, average resected volume of 99.7%). Intraoperative fluorescein staining correlated with histopathological alteration in both CE and NCE regions, with positive predictive values by subjective fluorescence evaluation greater than 96% in NCE regions.CONCLUSIONSIntraoperative administration of fluorescein provides an easily visualized marker for glioma pathology in both CE and NCE regions of GBM. These findings support the use of fluorescein as a microsurgical adjunct for guiding GBM resection to facilitate safe maximal removal.

Purpose To investigate whether the degree of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) is associated with the amount of breast metabolic activity measured by breast parenchymal uptake (BPU) of 18F-FDG on positron emission tomography / computed tomography (PET/CT). Materials and Methods An Institutional Review Board (IRB)-approved retrospective study was performed. Of 327 patients who underwent preoperative breast MRI from 1/1/12 to 12/31/15, 73 patients had 18F-FDG PET/CT evaluation performed within 1 week of breast MRI and no suspicious findings in the contralateral breast. MRI was performed on a 1.5T or 3.0T system. The imaging sequence included a triplane localizing sequence followed by sagittal fat-suppressed T2-weighted sequence, and a bilateral sagittal T1-weighted fat-suppressed fast spoiled gradient-echo sequence, which was performed before and three times after a rapid bolus injection (gadobenate dimeglumine, Multihance; Bracco Imaging; 0.1 mmol/kg) delivered through an IV catheter. The unaffected contralateral breast in these 73 patients underwent BPE and BPU assessments. For PET/CT BPU calculation, a 3D region of interest (ROI) was drawn around the glandular breast tissue and the maximum standardized uptake value (SUVmax) was determined. Qualitative MRI BPE assessments were performed on a 4-point scale, in accordance with BI-RADS categories. Additional 3D quantitative MRI BPE analysis was performed using a previously published in-house technique. Spearman's correlation test and linear regression analysis was performed (SPSS, v. 24). Result The median time interval between breast MRI and 18F-FDG PET/CT evaluation was 3 days (range, 0–6 days). BPU SUVmax mean value was 1.6 (SD, 0.53). Minimum and maximum BPU SUVmax values were 0.71 and 4.0. The BPU SUVmax values significantly correlated with both the qualitative and quantitative measurements of BPE, respectively (r(71) = 0.59, P < 0.001 and r(71) = 0.54, P < 0.001). Qualitatively assessed high BPE group (BI-RADS 3/4) had significantly higher BPU SUVmax of 1.9 (SD = 0.44) compared to low BPE group (BI-RADS 1/2) with an average BPU SUVmax of 1.17 (SD = 0.32) (P < 0.001). On linear regression analysis, BPU SUVmax significantly predicted qualitative and quantitative measurements of BPE (β = 1.29, t(71) = 3.88, P < 0.001 and β = 19.52, t(71) = 3.88, P < 0.001). Conclusion There is a significant association between breast BPU and BPE, measured both qualitatively and quantitatively. Increased breast cancer risk in patients with high MRI BPE could be due to elevated basal metabolic activity of the normal breast tissue, which may provide a susceptible environment for tumor growth. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017.

Cachexia, a wasting syndrome associated with advanced cancer and metastasis, is rarely documented in breast cancer patients. However, the incidence of cachexia in breast cancer is now thought to be largely underestimated. In our case report of a breast cancer patient with bone metastasis monitored during the course of her treatment, we document the development of cachexia by image analysis in relation to her metastatic burden. Elucidation of the link between metastatic burden and cachexia could unveil a highly specific screening process for metastasis, by assessing true muscle mass loss. Our patient was a 49-year-old premenopausal woman, with metastatic invasive ductal breast carcinoma in the vertebral and iliac bones on presentation, which progressed with new metastases to her hips, thigh bones, and vertebrae. In the two-year period, that is between her diagnosis and death, she lost >10% of her baseline weight. During these two years, we retrospectively identified a decrease in paraspinal muscle (PM) at the third lumbar vertebra followed by a sharp decline in weight. The increased tumor burden over time in metastatic sites was accompanied by a decrease in abdominal muscle and visceral and subcutaneous fat and was followed by the patient's demise. The increasing tumor burden in the patient was correlated with the mass of other tissues to determine the tissue that could best serve as a surrogate marker to cachexia and tumor burden. We noted a strong negative correlation between PM area and metastatic tumor area at the third lumbar vertebral level, with PM loss correlating to increasing tumor burden. The monitoring of PM wasting may serve as a marker, and therefore a prognostic factor, for both cachexia and extent of metastatic disease, especially in breast cancer, where metastasis to bone is frequent. Based on our data and review of the literature in this case study, longitudinal monitoring of cachexia in the selected muscle groups can give clinicians early indications of the extent of cachexia in metastatic breast cancer patients.

e14596 Background: Radiomics features, which are quantitative features generated by computational analysis of routine clinical imaging like CT scans, have been shown to be associated with clinical outcomes and tumor’s behavior in some solid tumors. We compared the radiomic features of malignant and benign pheochromocytomas/paragangliomas (P/P). Methods: Through an IRB approved study at our institution, we identified 20 consecutive patients with P/P and with available contrast-enhanced abdominopelvic CT. A radiologist with experience in oncologic imaging identified and segmented tumors on every slice using a MatLab-based imaging platform. The entire tumor image then underwent computational analysis generating 1160 radiomics features reflecting tumor size, shape, density, textural heterogeneity, and margins. These radiomics features were compared between malignant and benign P/P using Wilcoxon-Rank sum test. Results: Of the twenty patients included in this analysis, there were 6 patients with malignant P/P and 14 patients with benign tumors. Patients had been followed for at least 5 and many for at least 10 years after resection of the tumor. At diagnosis, the mean age of patients with benign and malignant tumors were 51 and 45, respectively. A 60% majority of patients with benign tumors were females while a 77% majority of patients with malignant tumors were male. Benign P/P were significantly different from malignant ones in: tumor intensity textures (spatial correlation [p-value = 0.0010], Laws [p-value = 0.0064], LoG [p-value = 0.0087], and Gabor [p-value = 0.0325]), and tumor local surface shape (Shape Index SI7 [p-value = 0.0325]). Conclusions: This initial analysis sought to discern differences in these rare tumors that might be exploited clinically. The results show that compared to benign tumors, malignant P/P tend to have more heterogenous texture, irregular edges, and less rounded shape on contrast enhanced abdominal CT scan. However, because these radiomics phenotype properties are subtle, they cannot be made reliably in an objective fashion using human visual assessment and thus these radiomics features may have a role as a quantitative imaging biomarker in P/P to predict tumor behavior. The cohort is being expanded and data will be updated at the time of the presentation. With larger numbers, the contribution to the radiomics profile of a SDHx mutation will be explored in greater depth to understand the differential impact of SDHx loss and of evolution into a cancer to the radiomics profiles.

198 Background: When compared to healthy populations subjects are defined as sarcopenic if they have severe loss of lean muscle mass (LMM). Sarcopenia is associated with poor outcomes in some studies of pancreatic cancer (PDA) but the prevelance remains uncertain in resected patients and there is little data about changes in LMM during neoadjuvant chemotherapy. Muscle mass can be reliably quantified in cancer patients using routine imaging. We analyzed a large cohort of patients undergoing surgery at a high-volume center to quantify LMM at baseline and with treatment, and to determine the association of sarcopenia with tumor histology and outcomes. Methods: We analyzed subjects undergoing surgery for PDA at the Pancreas Center at Columbia University from 2011-2014. We utilized CT scans to measure cross sectional area of muscle at the L3 vertebral body (LMM in cm2) and used height to define a smooth muscle index (SMI-cm/m). Sarcopenia was determined based on SMI < 38.9 for females and < 55.4 for males. In subjects undergoing neoadjuvant chemotherapy, SMI was also calculated on post therapy scans. We collected information on clinical and pathological variables and performed statistical analyses utilizing SAS 9.4 software. Results: Among subjects with available imaging (n = 106) sarcopenia rates at initial staging were high whether they were immediately resectable (52%) or locally advanced (63%). Rates of sarcopenia were higher in males than females (77 vs 38%, p < 0.001). Sarcopenic status was not correlated with survival, tumor stage or grade but was associated with age, gender, and BMI. Among locally advanced subjects who proceeded to surgery after neoadjuvant chemotherapy (n = 40) there was no change in SMI or incidence of sarcopenia following treatment (median 171 days). Conclusions: Sarcopenia is highly prevalent at diagnosis in subjects undergoing surgery for PDA but was not associated with survival, tumor grade or stage in this cohort. Subjects who successfully completed neoadjuvant treatment did not experience significant loss in LMM despite extensive treatment suggesting that lack of change in LMM may assist in predicting favorable response to neoadjuvant therapy in PDA.

BACKGROUND AND PURPOSE: A limitation in postoperative monitoring of patients with glioblastoma is the lack of objective measures to quantify residual and recurrent disease. Automated computer-assisted volumetric analysis of contrast-enhancing tissue represents a potential tool to aid the radiologist in following these patients. In this study, we hypothesize that computer-assisted volumetry will show increased precision and speed over conventional 1D and 2D techniques in assessing residual and/or recurrent tumor. MATERIALS AND METHODS: This retrospective study included patients with native glioblastomas with MR imaging performed at 24–48 hours following resection and 2–4 months postoperatively. 1D and 2D measurements were performed by 2 neuroradiologists with Certificates of Added Qualification. Volumetry was performed by using manual segmentation and computer-assisted volumetry, which combines region-based active contours and a level set approach. Tumor response was assessed by using established 1D, 2D, and volumetric standards. Manual and computer-assisted volumetry segmentation times were compared. Interobserver correlation was determined among 1D, 2D, and volumetric techniques. RESULTS: Twenty-nine patients were analyzed. Discrepancy in disease status between 1D and 2D compared with computer-assisted volumetry was 10.3% (3/29) and 17.2% (5/29), respectively. The mean time for segmentation between manual and computer-assisted volumetry techniques was 9.7 minutes and

ContextThe conventional view that obesity is beneficial for bone strength has recently been challenged by studies that link obesity, particularly visceral obesity, to low bone mass and fractures. It is controversial whether effects of obesity on bone are mediated by increased bone resorption or decreased bone formation.ObjectiveThe objective of the study was to evaluate bone microarchitecture and remodeling in healthy premenopausal women of varying weights.DesignWe measured bone density and trunk fat by dual-energy x-ray absorptiometry in 40 women and by computed tomography in a subset. Bone microarchitecture, stiffness, remodeling, and marrow fat were assessed in labeled transiliac bone biopsies.ResultsBody mass index (BMI) ranged from 20.1 to 39.2 kg/m(2). Dual-energy x-ray absorptiometry-trunk fat was directly associated with BMI (r = 0.78, P < .001) and visceral fat by computed tomography (r = 0.79, P < .001). Compared with women in the lowest tertile of trunk fat, those in the highest tertile had inferior bone quality: lower trabecular bone volume (20.4 ± 5.8 vs 29.1 ± 6.1%; P = .001) and stiffness (433 ± 264 vs 782 ± 349 MPa; P = .01) and higher cortical porosity (8.8 ± 3.5 vs 6.3 ± 2.4%; P = .049). Bone formation rate (0.004 ± 0.002 vs 0.011 ± 0.008 mm(2)/mm · year; P = .006) was 64% lower in the highest tertile. Trunk fat was inversely associated with trabecular bone volume (r = -0.50; P < .01) and bone formation rate (r = -0.50; P < .001). The relationship between trunk fat and bone volume remained significant after controlling for age and BMI.ConclusionsAt the tissue level, premenopausal women with more central adiposity had inferior bone quality and stiffness and markedly lower bone formation. Given the rising levels of obesity, these observations require further investigation.

Background Intraperitoneal chemotherapy is used to treat peritoneal surface-spreading malignancies. We sought to determine whether volume and surface area of the intraperitoneal chemotherapy compartments are associated with overall survival and posttreatment glomerular filtration rate (GFR) in malignant peritoneal mesothelioma (MPM) patients. Methods Thirty-eight MPM patients underwent X-ray computed tomography peritoneograms during outpatient intraperitoneal chemotherapy. We calculated volume and surface area of contrast-filled compartments by semiautomated computer algorithm. We tested whether these were associated with overall survival and posttreatment GFR. Results Decreased likelihood of mortality was associated with larger surface areas (p = 0.0201) and smaller contrast-filled compartment volumes (p = 0.0341), controlling for age, sex, histologic subtype, and presence of residual disease >0.5 cm postoperatively. Larger volumes were associated with higher posttreatment GFR, controlling for pretreatment GFR, body surface area, surface area, and the interaction between body surface area and volume (p = 0.0167). Discussion Computed tomography peritoneography is an appropriate modality to assess for maldistribution of intraperitoneal chemotherapy. In addition to identifying catheter failure and frank loculation, quantitative analysis of the contrast-filled compartment’s surface area and volume may predict overall survival and cisplatin-induced nephrotoxicity. Prospective studies should be undertaken to confirm and extend these findings to other diseases, including advanced ovarian carcinoma.

BACKGROUND The amount of fibroglandular tissue (FGT) has been linked to breast cancer risk based on mammographic density studies. Currently, the qualitative assessment of FGT on mammogram (MG) and magnetic resonance imaging (MRI) is prone to intra and inter-observer variability. The purpose of this study is to develop an objective quantitative FGT measurement tool for breast MRI that could provide significant clinical value. METHODS An IRB approved study was performed. Sixty breast MRI cases with qualitative assessment of mammographic breast density and MRI FGT were randomly selected for quantitative analysis from routine breast MRIs performed at our institution from 1/2013 to 12/2014. Blinded to the qualitative data, whole breast and FGT contours were delineated on T1-weighted pre contrast sagittal images using an in-house, proprietary segmentation algorithm which combines the region-based active contours and a level set approach. FGT (%) was calculated by: [segmented volume of FGT (mm(3))/(segmented volume of whole breast (mm(3))] ×100. Statistical correlation analysis was performed between quantified FGT (%) on MRI and qualitative assessments of mammographic breast density and MRI FGT. RESULTS There was a significant positive correlation between quantitative MRI FGT assessment and qualitative MRI FGT (r=0.809, n=60, P

Background Bevacizumab is a humanized antibody against vascular endothelial growth factor approved for treatment of recurrent glioblastoma. There is a need to discover imaging biomarkers that can aid in the selection of patients who will likely derive the most survival benefit from bevacizumab. Methods The aim of the study was to examine if pre- and posttherapy multimodal MRI features could predict progression-free survival and overall survival (OS) for patients with recurrent glioblastoma treated with bevacizumab. The patient population included 84 patients in a training cohort and 42 patients in a testing cohort, separated based on pretherapy imaging date. Tumor volumes of interest were segmented from contrast-enhanced T1-weighted and fluid attenuated inversion recovery images and were used to derive volumetric, shape, texture, parametric, and histogram features. A total of 2293 pretherapy and 9811 posttherapy features were used to generate the model. Results Using standard radiographic assessment criteria, the hazard ratio for predicting OS was 3.38 (P < .001). The hazard ratios for pre- and posttherapy features predicting OS were 5.10 (P < .001) and 3.64 (P < .005) for the training and testing cohorts, respectively. Conclusion With the use of machine learning techniques to analyze imaging features derived from pre- and posttherapy multimodal MRI, we were able to develop a predictive model for patient OS that could potentially assist clinical decision making.

Background and purposeInfarct volume may predict clinical outcome in acute stroke, but manual segmentation techniques limit its routine use. We hypothesized that computer-assisted volumetric analysis to quantify acute infarct volume will show no difference compared with manual segmentation but will show increased speed of performance and will correlate with outcome.Materials and methodsPatients with acute stroke younger than 18 years were included. Infarct volume on diffusion-weighted imaging was quantified by using computer-assisted volumetric and manual techniques. The Pediatric Stroke Outcome Measure scored clinical outcome. Computer-assisted volumetric and manual techniques were compared with correlation coefficients. Linear regression analysis compared Pediatric Stroke Outcome Measure with core infarct volume and percentage volume of brain infarction.ResultsTwenty-three patients were analyzed (mean age, 4.6 years). Mean infarct volume from computer-assisted volumetric and manual approaches was 65.6 and 63.7 mL, respectively (P = .56). Concordance correlation between methods was 0.980, and between users, 0.968. The mean times for segmentation between computer-assisted volumetric and manual techniques were

In subarachnoid hemorrhage (SAH), brain injury visible within 48 h of onset may impact on admission neurological disability and 3-month functional outcome. With volumetric MRI, we measured the volume of brain injury visible after SAH, and assessed the association with admission clinical grade and 3-month functional outcome. Retrospective cohort study conducted in the Neurocritical Care Division, Columbia University Medical Center, New York, USA. On brain MRI acquired within 48 h of SAH-onset and before aneurysm-securing (n = 27), two blinded readers measured DWI and FLAIR-lesion volumes using semi-automated, computer segmentation software. Compared to post-resuscitation Hunt–Hess grade 1–3 (70 %), high-grade patients (30 %) had higher lesion volumes on DWI (34 ml [IQR: 0–64] vs. 2 ml [IQR: 0.5–7], P = 0.02) and on FLAIR (81 ml [IQR: 24–127] vs. 3 ml [IQR: 0–27], P = 0.02). On DWI, each 10 ml increase in lesion volume was associated with a 101 %-increase in the odds of presenting with 1 grade more in the Hunt–Hess scale (aOR 2.01, 95 % CI 1.10–3.68, P = 0.02), but was not significantly associated with 3-month outcome. On FLAIR, each 10 ml increase in lesion volume was associated with 34 % higher odds of a 1-point increase on the Hunt–Hess scale (aOR 1.34, 95 % CI 1.06–1.68, P = 0.01) and 139 % higher odds of a 1-point increase on the 3-month mRS (aOR 2.39, 95 % CI 1.13–5.07, P = 0.02). The volume of brain injury visible on DWI and FLAIR within 48 h after SAH is proportional to neurological impairment on admission. Moreover, FLAIR-imaging implicates chronic brain injury—predating SAH—as potentially relevant cause of poor functional outcome.

Background: Mammographic density (MD) represents one of the strongest predictors of breast cancer risk. Tamoxifen, a selective estrogen receptor modulator (SERM) and proven chemopreventive agent, causes reductions in MD which correlate with subsequent breast cancer risk. Current methods for measuring MD, such as the Cumulus technique, are labor intensive and not fully automated, which limits utility in the clinical setting. Breast MRI is being used with increasing frequency in high-risk women for breast cancer screening and yields 3-dimensional views of breast volume. Breast MRI fibroglandular tissue volume (MRIV) has been correlated with MD in cross-sectional studies, but less is known about changes in breast density over time on MRI and its relation to breast cancer risk. One study reported a significant reduction in breast MRIV but not MD with the SERM, raloxifene, in high-risk women. We implemented a novel MRI segmentation method to measure MRIV compared to MD in 20 high-risk postmenopausal women that received high-dose vitamin D supplementation for 1 year. Methods: Twenty high-risk postmenopausal women [defined as a 5-year breast cancer risk per the Gail model of ≥1.67%, lobular or ductal carcinoma in situ (LCIS/DCIS)] were assigned to a 1-year intervention of vitamin D3 20,000 IU or 30,000 IU weekly. Other eligibility criteria included baseline MD ≥25% (as assessed qualitatively by BIRADS category) and no current SERM use. Women underwent a digital mammogram and breast MRI at baseline and 12 months. MD was evaluated by the Cumulus technique and MRIV was measured using a novel segmentation method on noncontrast T1-weighted images from breast MRIs. The method incorporated two well-established image analysis techniques, the region-based active contour model and watershed algorithm, into a unified framework. Specific anatomical landmarks were introduced into the algorithm to consistently identify breast boundaries on longitudinal MRI slices. For fibroglandular tissue segmentation, an algorithm combining region-based active contours and level-set approach was used to allow for easy initialization and fast speed. Correlation coefficients and paired t-tests were used to compare MD and MRIV and changes from baseline to 12 months. Results: From Nov 2007 to Jan 2011, 20 postmenopausal women were enrolled and 16 were evaluable at 12 months. Mean baseline breast density measurements were lower for MD compared to MRIV, 12.89% (SD 11.99) vs. 26.64% (SD 6.95), respectively. After 1 year of high-dose vitamin D, there was no significant change in MD or MRIV, mean absolute changes of -0.14% vs. -1.12%, respectively. We did not observe a significant correlation between MD and MRIV density measurements (correlation coefficient= -0.31, p=0.08). Discussion: We observed greater changes over time in breast density on serial breast MRI compared to mammography, however, no significant changes in MD or MRIV was noted after a 1-year intervention of vitamin D. Longer follow-up may be required in order to detect changes in breast density with non-hormonal interventions. Citation Format: Parijatham S Thomas, Mary Beth Terry, Xiaotao Guo, Binsheng Zhao, Richard Ha, Swathi Namburi, Tong Xiao, Dawn Hershman, Susan Refice, Katherine D Crew. Changes in breast density with mammography and breast MRI among high-risk postmenopausal women [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-01-08.

e13064 Background: Catheter-administered intraperitoneal (IP) chemotherapy is used for peritoneal surface-spreading malignancies to maximize local drug concentrations. Computed tomography (CT) peritoneography can be used to assess for catheter failure and infusate maldistribution, which may contribute to treatment failure and systemic toxicities like cisplatin-induced nephrotoxicity. There is no standard system to assess infusate distribution, and no reported outcomes data from patients assessed with CT peritoneography. We hypothesized that volume and surface area of the compartment available to IP chemotherapy is associated with overall survival and post-treatment estimated glomerular filtration rate (eGFR) in malignant peritoneal mesothelioma (MPM) patients. Methods: Chart review identified 38 MPM patients who underwent CT peritoneograms while receiving IP cisplatin between 2000 and 2011. Volume and surface area of the contrast-filled compartments were calculated by semiautomated computer algorithm supervised by a physician. We retrospectively tested whether surface area and volume were associated with overall survival and post-treatment eGFR, controlling for demographic and disease factors. Results: Larger surface areas were associated with decreased likelihood of mortality, controlling for volume, age, sex and histologic subtype (Hazard Ratio=.999 cm-2, p=.035). Larger volumes correlated with higher post-treatment eGFR, controlling for pre-treatment eGFR, body surface area (BSA), surface area and the interaction between BSA and volume (β=.154 cc/min/cm3, p=.017). Conclusions: The association of larger surface areas with improved overall survival is consistent with more direct drug contact with potential areas of tumor spread. The association of larger volumes with higher post-treatment eGFR is consistent with less cisplatin diffusion into the circulation due to lower intra-abdominal pressures, which vary inversely with volume. CT peritoneography is an appropriate modality to assess distribution of catheter-administered intraperitoneal chemotherapy. Quantitative analysis of contrast-filled compartment surface area and volume may be predictive of treatment efficacy and side effects.