Radioimmunotherapies with monoclonal antibodies to the B-lymphocyte antigen 20 (CD20) are effective treatments for B-cell lymphomas, but U.S. Food and Drug Administration-approved radioimmunotherapies exclusively use radiolabeled murine antibodies, potentially limiting redosing. The Food and Drug Administration recently approved 2 unlabeled anti-CD20 monoclonal antibodies, obinutuzumab and ofatumumab, termed next generation as they are humanized (obinutuzumab) or fully human (ofatumumab), thus potentially allowing a greater potential for redosing than with previous-generation anti-CD20 antibodies, including rituximab (chimeric) and tositumomab (murine), which contain more murine peptide sequences. We prepared Zr-ofatumumab andZr-obinituzumab and assessed their tumor targeting by PET/CT imaging and their biodistribution in a preclinical mouse model with CD20 xenografts to determine whether these antibodies have potential as theranostics or for radioimmunotherapy. Obinutuzumab, ofatumumab, rituximab, tositumomab, and human IgG (as control) were radiolabeled withZr. Raji Burkitt lymphoma xenografts were established in severe combined immunodeficient mice. Mice with palpable tumors ( = 4-9) were injected with Zr-obinutuzumab,Zr-ofatumumab, Zr-rituximab,Zr-tositumomab, or Zr-IgG, with small-animal PET/CT images acquired at 1, 3, and 7 d after injection, and then sacrificed for biodistribution analyses. At 1, 3, and 7 d after injection, all anti-CD20 antibodies showed clear tumor uptake on PET/CT, with minimal tumor uptake of IgG. Biodistribution data showed significantly ( < 0.005) higher tumor uptake for obinutuzumab (41.4 ± 7.6 percentage injected dose [%ID]/g), ofatumumab (32.6 ± 17.5 %ID/g), rituximab (28.6 ± 7.6 %ID/g), and tositumomab (28.0 ± 6.5 %ID/g) than IgG (7.2 ± 1.2 %ID/g). Tositumomab had much higher splenic uptake (186.4 ± 49.7 %ID/g, < 0.001) than the other antibodies. Zr-labeled obinutuzumab and ofatumumab localized to tumor as well as or better than labeled rituximab and tositumomab, 2 monoclonal antibodies that have been used previously in B-cell lymphoma radioimmunotherapy, and both obinutuzumab and ofatumumab have the potential for repeated dosing.

Objective: Transthoracic echocardiography (TTE) is routinely performed as part of standard acute ischemic stroke (AIS) workup. However, the overall yield of TTE is unclear and many patients may undergo unnecessary investigations. This study aims to investigate the utility of TTE as part of AIS workup.Methods: We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age >18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of <35%. Secondary endpoint was the proportion of patients who had a TTE-drive change in management.Results: Among 548 AIS patients (median age 71 [59-81] years, 50% female), 482 (87%) underwent TTE. Clinically relevant findings were observed in 183 (38%) patients, leading to additional workup in 41 (8.5%). Further workup was associated with younger median age (58 [50-65] vs. 72 [62-81], p < 0.0001, and was less likely in suspected large vessel etiology (p = 0.02). Abnormal TTE lead to treatment change in 24 (5%) patients; 22/24 were started on anticoagulation. TTE results were less likely to influence treatment changes in older patients (71 [60-80] vs. 58 [49-69] years, p = 0.02) with known atrial fibrillation (p = 0.01). Conclusion:Our findings suggest that despite widespread use, the overall yield of TTE in AIS is low. Stratifying patients according to their likelihood of benefitting from it will be important toward better resource utilization.

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Many radiologists are familiar with the preoperative imaging assessment of patients with labral tears, rotator cuff abnormalities, and end-stage arthritis, as well as the subsequent primary reconstructions and repairs commonly encountered in routine clinical management. However, the second-line surgical procedures and augmentation procedures performed for refractory or recurrent shoulder instability and the extra-articular surgical procedures of the shoulder girdle may challenge even the most experienced musculoskeletal radiologist. Knowledge of the indications, surgical techniques, expected postoperative imaging appearance, and complications of these uncommon shoulder girdle reconstructions and repairs will aid the radiologist in both the pre- and postoperative assessment of the injured shoulder. This article is divided into two parts. In the first part, procedures performed for shoulder instability are addressed, including capsular shift, Bristow-Latarjet coracoid transfer, remplissage, and humeral head allografts. In the second part, the imaging findings of extra-articular procedures of the shoulder girdle are reviewed, including biceps tenodesis, os acromiale fixation, and coracoclavicular ligament reconstruction. RSNA, 2017.

at our institution. Therapy paradigms (Tx) included Y90, cTACE, or mixed. Data collection included L-T from diagnosis to first presentation of LDT, survival duration from first LDT, age, gender, prior hepatectomy, prior octreotide or other chemotherapy, tumor burden, dominate lesion size, lobe involvement, and presence of extrahepatic metastasis. A Cox Regression with a backwards-likelihood ratio (threshold p < 0.10 for inclusion) analysis was performed for L-T and the duration of survivability after first LDT, controlling for the above factors.Results: For L-T, factors meeting threshold criteria included Tx (p ¼ 0.06), prior surgery (p ¼ 0.05), prior octreotide (p ¼ 0.007), dominant lesion size (p ¼ 0.03), multiplicity (p ¼ 0.02), and extrahepatic metastasis (p ¼ 0.09). For Tx, cTACE (24.3 months, p ¼ 0.04) and Mixed (32.6 months, p ¼ 0.06) had earlier presentations when compared to Y90 (52 months). For survivability, factors meeting threshold criteria were Tx (p ¼ 0.08), prior octreotide (p ¼ 0.04), any chemotherapy (p ¼ 0.02), and dominant lesion size (p ¼ 0.008). For Tx, cTACE (30.3 months, p ¼ 0.6) and Mixed (28.2 months, p ¼ 0.02) had longer survivability compared to Y90 (20.4 months). An ad hoc survival analysis accounting for L-T did not alter the above survivability outcomes. Conclusions: Our analysis agrees that cTACE-only may be a superior Tx than Y90-only, but also shines light that a mixed Tx may be even more efficacious in term of survivability than either alone. While Tx was an important factor predicting L-T, L-T does not influence the outcomes in our survivability analysis suggesting that a L-T bias is not present.