https://ctep.cancer.gov/protocolDevelopment/docs/recist_guideline.pdf

New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)

Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

/pdf/2015-american-thyroid-association-management-guidelines-for-32kri8vrhd.pdf

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Data Mining Practical Machine Learning Tools and Techniques

Hypoxia-inducible factor 1 (HIF-1) activates the transcription of genes that are involved in crucial aspects of cancer biology, including angiogenesis, cell survival, glucose metabolism and invasion. Intratumoral hypoxia and genetic alterations can lead to HIF-1alpha overexpression, which has been associated with increased patient mortality in several cancer types. In preclinical studies, inhibition of HIF-1 activity has marked effects on tumour growth. Efforts are underway to identify inhibitors of HIF-1 and to test their efficacy as anticancer therapeutics.

Targeting HIF-1 for cancer therapy

In the past decade, the field of medical image analysis has grown exponentially, with an increased number of pattern recognition tools and an increase in data set sizes. These advances have facilitated the development of processes for high-throughput extraction of quantitative features that result in the conversion of images into mineable data and the subsequent analysis of these data for decision support; this practice is termed radiomics. This is in contrast to the traditional practice of treating medical images as pictures intended solely for visual interpretation. Radiomic data contain first-, second-, and higher-order statistics. These data are combined with other patient data and are mined with sophisticated bioinformatics tools to develop models that may potentially improve diagnostic, prognostic, and predictive accuracy. Because radiomics analyses are intended to be conducted with standard of care images, it is conceivable that conversion of digital images to mineable data will eventually become routine practice. This report describes the process of radiomics, its challenges, and its potential power to facilitate better clinical decision making, particularly in the care of patients with cancer.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2015151169

Radiomics: Images Are More than Pictures, They Are Data.

The ability to assay tumor biologic features and the impact of drugs on tumor biology is fundamental to drug development. Advances in our ability to measure genomics, gene expression, protein expression, and cellular biology have led to a host of new targets for anticancer drug therapy. In translating new drugs into clinical trials and clinical practice, these same assays serve to identify patients most likely to benefit from specific anticancer treatments. As cancer therapy becomes more individualized and targeted, there is an increasing need to characterize tumors and identify therapeutic targets to select therapy most likely to be successful in treating the individual patient’s cancer. An example is the identification of HER2 overexpression to predict response to HER2-directed therapies such as trastuzumab and lapatinib [1]. There is a complementary need to assay cancer drug pharmacodynamics, namely the effect of a particular drug on the tumor, to determine whether or not the drug has “hit” the target and whether the drug is likely to be effective in slowing tumor growth and killing the cancer [2]. This is particular important in early drug trials as proof of mechanism and prediction of the likelihood of anticancer activity in patients.

Imaging Studies in Anticancer Drug Development

The poly-(adenosine diphosphate-ribose) polymerase (PARP) family of proteins participates in numerous functions, most notably the DNA damage response. Cancer vulnerability to DNA damage has led to development of several PARP inhibitors (PARPi). This class of drugs has demonstrated therapeutic efficacy in ovarian, breast, and prostate cancers, but with variable response. Consequently, clinics need to select patients likely to benefit from these targeted therapies. In vivo imaging of 18F-FluorThanatrace (18F-FTT) uptake has been shown to correspond to PARP-1 expression in tissue. This study characterizes the pharmacokinetics of 18F-FTT and tests kinetic and static models to guide metric selection in future studies assessing 18F-FTT as a biomarker of response to PARPi therapy. 
Methods: Fourteen prospectively enrolled ovarian cancer patients were injected with 18F-FTT and imaged dynamically for 60-minutes post-injection followed by up to two whole-body scans, with venous blood activity and metabolite measurements. Maximum and peak standardized uptake values (SUVmax and SUVpeak) were extracted from dynamic images and whole-body scans. Kinetic parameter estimates and SUVs were assessed for correlations with tissue PARP-1 immunofluorescence (n = 7). Simulations of population kinetic parameters enabled estimation of measurement bias and precision in parameter estimates. 
Results:18F-FTT blood clearance was variable, but labeled metabolite profiles were similar across patients, supporting use of a population parent fraction curve. Total distribution volume (VT) from a reversible two-tissue compartment model and Logan reference tissue distribution volume ratio (Logan DVR) from the first hour of PET acquisition correlated with tumor PARP-1 expression by immunofluorescence (r=0.76 and 0.83 respectively, p<0.05). DVR bias and precision estimates were 6.4% and 29.1%, respectively. SUVmax and SUVpeak acquired from images with midpoints of 57.5, 110±3, and 199±4 min highly correlated with PARP-1 expression (mean±standard deviation, r≥0.79, p<0.05). 
Conclusion: Tumor SUVmax and SUVpeak at 55-60 minutes post-injection and later and DVR from ≥ 60-minutes appear to be robust non-invasive measures of PARP-1 binding. 18F-FTT uptake in ovarian cancer was best described by models of reversible binding. However, pharmacokinetic patterns of tracer uptake were somewhat variable, especially at later time points.

Kinetic and static analysis of poly-(adenosine diphosphate-ribose) polymerase-1 (PARP-1) targeted 18F-FluorThanatrace (18F-FTT) PET images of ovarian cancer.

Pilot Feasibility Study to Assess the Utility of PET Scanning in the Pre-Operative Evaluation of Internal Mammary Nodes in Breast Cancer Patients Presenting with Medial Hemisphere Tumors.

The vessel wall MR imaging (VWI) literature was systematically reviewed to assess the criteria and measurement methods of VWI-related imaging endpoints for symptomatic intracranial plaque in patients with ischemic events. PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data from 47 studies. A modified Guideline for Reporting Reliability and Agreement Studies was used to assess completeness of reporting. The specific VWI-pulse sequence used to identify plaque was reported in 51% of studies. A VWI-based criterion to define plaque was reported in 38% of studies. A definition for culprit plaque was reported in 40% of studies. Frequently scored qualitative imaging endpoints were plaque quadrant (21%) and enhancement (21%). Frequently measured quantitative imaging endpoints were stenosis (19%), lumen area (15%), and remodeling index (14%). Reproducibility for all endpoints ranged from good to excellent (range: ICCT1 hyperintensity = 0.451 to ICCstenosis = 0.983). However, rater specialty and years of experience varied among studies. Investigators are using different criteria to identify and measure VWI-imaging endpoints for culprit intracranial plaque. Early awareness of these differences to address methods of acquisition and measurement will help focus research resources and efforts in technique optimization and measurement reproducibility. Consensual definitions to detect plaque will be important to develop automatic lesion detection tools particularly in the era of radiomics.

Imaging endpoints of intracranial atherosclerosis using vessel wall MR imaging: a systematic review

T otal-body (TB) PET scanners with an axial ﬁ eld of view (AFOV) of at least 60 cm can image dynamic radiopharmaceutical distributions in the whole body. Although the bene ﬁ ts of the ﬁ ne temporal sampling and dramatic increase in system sensitivity afforded by TB PET imaging have been postulated for some time, it was not until the last few years that such systems have become available in both clinical and research settings. This article sum-marizes what we have learned in this short time and explores the long-term impact of TB PET.

David A. Mankoff

Papers

Imaging Studies in Anticancer Drug Development

Kinetic and static analysis of poly-(adenosine diphosphate-ribose) polymerase-1 (PARP-1) targeted 18F-FluorThanatrace (18F-FTT) PET images of ovarian cancer.

Pilot Feasibility Study to Assess the Utility of PET Scanning in the Pre-Operative Evaluation of Internal Mammary Nodes in Breast Cancer Patients Presenting with Medial Hemisphere Tumors.

Imaging endpoints of intracranial atherosclerosis using vessel wall MR imaging: a systematic review

Total-Body PET: Will It Change Science and Practice?