BACKGROUND AND PURPOSE: Assessment of the collateral status has been emphasized for appropriate treatment decisions in patients with acute ischemic stroke. The purpose of this study was to introduce a multiphase MRA collateral imaging method (collateral map) derived from time-resolved dynamic contrast-enhanced MRA and to verify the value of the multiphase MRA collateral map in acute ischemic stroke by comparing it with the multiphase collateral imaging method (MRP collateral map) derived from dynamic susceptibility contrast-enhanced MR perfusion. MATERIALS AND METHODS:From a prospectively maintained registry of acute ischemic stroke, MR imaging data of patients with acute ischemic stroke caused by steno-occlusive lesions of the unilateral ICA and/or the M1 segment of the MCA were analyzed. We generated collateral maps using dynamic signals from dynamic contrast-enhanced MRA and DSC-MRP using a Matlab-based in-house program and graded the collateral scores of the multiphase MRA collateral map and the MRP collateral map independently. Interobserver reliabilities and intermethod agreement between both collateral maps for collateral grading were tested. RESULTS:Seventy-one paired multiphase MRA and MRP collateral maps from 67 patients were analyzed. The interobserver reliabilities for collateral grading using multiphase MRA or MRP collateral maps were excellent (weighted ϭ 0.964 and 0.956, respectively). The agreement between both collateral maps was also excellent (weighted ϭ 0.884; 95% confidence interval, 0.819 -0.949). CONCLUSIONS:We demonstrated that the dynamic signals of dynamic contrast-enhanced MRA could be used to generate multiphase collateral images and showed the possibility of the multiphase MRA collateral map as a useful collateral imaging method in acute ischemic stroke. ABBREVIATIONS:AIS ϭ acute ischemic stroke; DCE-MRA ϭ dynamic contrast-enhanced MRA; DSC-MRP ϭ dynamic susceptibility contrast-enhanced MR perfusion; mMRA ϭ multiphase MRA; MRP ϭ MR perfusion T he cerebral collaterals are alternative vascular channels for maintaining blood perfusion to the ischemic brain distal to an arterial occlusion. The collateral status varies among patients with Indicates open access to non-subscribers at www.ajnr.org http://dx.

To determine the prognostic significance of CT-determined cachexia scores (CSs) in 127 consecutive male small cell lung cancer (SCLC) patients, cross-sectional areas of muscle and fat tissues at the third lumbar vertebra (L3) were retrospectively measured on baseline CT images. CSs were determined based on the presence of sarcopenia and/or adipopenia. According to the presence of sarcopenia (L3 muscle index <55 cm /m , 86.8%) and adipopenia (L3 fat index <22 cm /m , 11.8%), CSs were defined as follows: CS2 (sarcopenia and adipopenia, 11.8%), CS1 (sarcopenia only, 74.8%) and CS0 (13.4%). CS2 was significantly related to lower body mass index (p < .001) and poor performance status (p = .002), and patients with CS2 had shorter OS than patients with CS1 or CS0 (median OS, 5.0 months vs. 8.9 months vs. 18.3 months; p = .007). Multivariable analysis revealed that CS was an independent prognostic factor of poor survival (HR, 1.99 for CS1 and 2.59 for CS2, p = .036 and .023, CS0 as a reference), along with extensive stage (p < .001), supportive care only (p < .001) and an elevated lactate dehydrogenase (p = .005). CT-determined CSs, based on the presence of sarcopenia and/or adipopenia, could be used to predict prognosis in male SCLC.

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Background: Lung cancer patients often experience stressful wait times and delays throughout the diagnostic phase of care. In an effort to streamline this process, a multidisciplinary team at The Ottawa Hospital (TOH) created a "Navigation Day" whereby patients and their family partake in a day-long visit and receive concurrent coordinated testing. At the Navigation Day, patients have teaching, introduction to social work, access to specialist care for symptom control, and same day appointments via dedicated test slots for positron emission tomographyecomputed tomography (PET-CT) scans, pulmonary function tests (PFTs) and/or magnetic resonance imaging (MRI) of the head. We evaluated the impact of this program on wait times and patient satisfaction. Method: Patients with a suspicion of lung cancer on chest CT who were referred during three time periods relative to the implementation of Navigation Day were included: one year pre-launch, one year post-launch, and two years post-launch. Mean wait times for PET, PFT, and/or MRI tests were calculated for each time period. To specifically assess the impact of dedicated slots on wait times, patients within each time period were stratified according to whether they underwent their test on the same day or different day from their Navigation Day. Student's t-test and ANOVA were used to assess for significance. Patient satisfaction was measured by examining provincially-collected data from a standardized survey used by all diagnostic assessment programs in Ontario, and data from program-specific feedback surveys distributed at TOH. Result: At one year post-launch, mean wait times improved from 15.5 to 9.2 days for PET (p<0.0001, ttest), from 15.7 to 9.6 days for PFT (p<0.0001), and from 16.0 to 10.2 days for MRI (p<0.0001). These improvements were sustained at two years post-launch, and MRI wait time improved even further from 10.2 to 6.6 days (p<0.0001, t-test). Those patients who underwent tests within a dedicated slot experienced the shortest wait times for all tests, at 5.8 days for PET, 5.8 days for PFT, and 6.3 days for MRI (p<0.0001, ANOVA). Wait time dispersion also improved by 11.2% for PET, 10.1% for PFT, and 19.1% for MRI. Patient satisfaction in the categories of quality of care, rapidity of care, coordination of care, and being informed remained high following the implementation of Navigation Day. Conclusion: Implementation of a Navigation Day significantly improved timeliness of diagnostic services (PET, PFT, and MRI) for potential lung cancer patients. This program represents an innovative service delivery model for other lung cancer care centers.

Background: Advanced lung cancer patients are predisposed to thrombosis due to many factors related to the disease and treatment, apart from the genetic and phenotypic factors. We aimed to determine the incidence of thromboembolic events (TEs) in advanced Non-Small Cell Lung Cancer (NSCLC) patients treated with platinum chemotherapy and study the baseline and treatment attributes predicting the onset of such events. Method: We evaluated advanced NSCLC patients on platinum chemotherapy for predetermined risk factors for thrombosis at baseline and routine visits. Patients with prior thromboembolism were excluded. The baseline patient characteristics were noted and patients were assigned to Khorana risk group as per the Khorana scores. The duration of follow up was until 4 weeks from the last chemotherapy. TEs occurring between the first dose of chemotherapy and 4 weeks after the last dose were considered as related. Predetermined factors associated with thromboembolism were studied in univariate analysis by chi square test. Result: A total of 188 patients were screened, out of which 21 patients were excluded and two patients were lost to follow up. The mean age of was 57.5 years (range 30e79). Majority of the patients were male (83.2%) and either current or former smokers (62.3 %). 69.5% of patients had a normal Body mass Index (BMI) while 13.2 % were overweight (BMI 25-29.9 kg/m 2) and 1.2 % were class I obese (BMI 30-34.9kg/m 2 ). Majority of the patients (78.1%) belonged to the intermediate Khorana group (Risk score 1-2) while 23.0% belonged to high risk (Khorana score of 3) .Of the 165 patients who completed follow up, 67.8% received carboplatin-gemcitabine, 30.3% carboplatin-pemetrexed, 1.2% cisplatin-pemetrexed and 0.6 % carboplatin-paclitaxel. Median duration on platinum was 94 days (range 1-478). TE's occurred in 4.8% of patients. Three patients developed venous pulmonary thromboembolism and 5 patients developed cerebral infarction, out of which 4 had arterial cerebral infarction and one patient had superior sagittal sinus thrombosis. The majority of events (7 out of 8) occurred within 100 days of starting chemotherapy. None of the presumed risk factors were found to be related to TEs on univariate analysis. Conclusion: Despite the lower incidence of TEs in our study, exclusion of patients with prior thrombosis suggests de novo thrombosis on platinum chemotherapy .None of the predetermined risk factors for thrombosis were found to be statistically related to the occurrence of TEs, possibly due to the small number of events and sample size.Background: Depletion of skeletal muscle mass (sarcopenia) have been associated with poor prognosis in patients with malignancy. Although CTdetermined skeletal muscle index (muscle area/height 2 , cm/m 2 ) is regarded as a reference standard to evaluate the presence of sarcopenia, it is unclear the agreement of DECT derived images on the quantification of skeletal muscle area (SMA). The purpose of this study to evaluate the agreement of SMA quantification between dual-ener...