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Dexamethasone is likely to play a role in the etiology of hiccups in patients receiving cisplatin-based regimens. Two hundred seventy-seven patients received three doses of ondansetron 8mg intravenously (IV) at 4hour intervals plus dexamethasone 20mg IV from the start of chemotherapy, followed by dexamethasone 5mg IV every 12hours, until chemotherapy was complete. Hiccups were observed in 114 (41.2%) patients, of whom 97.4% were men. Nausea and vomiting showed inverse correlations with hiccups (P < 0.0001 and P = 0.001, respectively). In 73 patients who experienced hiccups but lacked nausea/vomiting (H+N/V-), we discontinued dexamethasone in subsequent cycles. Sixty-six patients (90.4%) ceased hiccuping, but complete protection rates of nausea and vomiting decreased to 63% and 74%, respectively. For patients who experienced both hiccups and nausea/vomiting, the onset of nausea/vomiting usually was delayed to Day 3 or 4 and began after the cessation of hiccups. We conclude that cisplatin-related hiccups are predominant in males, dexamethasone-induced, and associated with protection against nausea/vomiting.

Purpose:To assess the cerebrovascular responses to short breath holding of cerebral gliomas using blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI). Materials and Methods:Six patients with a low-grade glioma and one patient with a high-grade glioma were studied using T2*-weighted echo planar imaging (EPI) during repeated periods of 15-second or 20-second breath-holding. Tumor vascularity was evaluated using dynamic susceptibility contrast perfusion MRI.Results: Increases in BOLD signal intensity during repeated breath-holding were consistently identified in patients' normal appearing gray matter, comparable with those in healthy adults. Absence of significant BOLD signal enhancement was noted both in low-grade and high-grade gliomas, which is either due to overwhelming hypoxia in a tumor, inadequacy or absence of hypercapnia-induced vasodilatation of tumor vessels, or both. Breath-hold regulated decreases in BOLD signals occurred only in the high-grade glioma, which is most likely due to the hypercapnia-induced steal effect that redistributes blood flow from tumor regions with unresponsive neovasculature to surrounding normal tissue. Conclusion:BOLD MRI during short breath holding can disclose differential cerebrovascular response between normal tissue and cerebral glioma.

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Purpose: To evaluate the response in patients undergoing SBRT using dynamic contrast-enhanced (DCE) integrated magnetic resonance positron emission tomography (MR-PET). Stereotactic body radiation therapy (SBRT) is efficacious as a front-line local treatment for non-small cell lung cancer (NSCLC). Materials and Methods: We prospectively enrolled 19 lung tumors in 17 nonmetastatic NSCLC patients who were receiving SBRT as a primary treatment. They underwent DCE-integrated 3T MR-PET before and 6 weeks after SBRT. The following image parameters were analyzed: tumor size, standardized uptake value (SUV), apparent diffusion coefficient, K trans , k ep , v e , v p , and iAUC 60 . Chest computed tomography (CT) was performed at 3 months after SBRT. Results: SBRT treatment led to tumor changes including significant decreases in the SUV max (-61%, P < 0.001), K trans mean (-72%, P 5 0.005), K trans standard deviation (SD; -85%, P 5 0.046), k ep mean (-53%, P 5 0.014), k ep SD (-63%, P 5 0.001), and v p SD (-58%, P 5 0.002). The PET SUV max was correlated with the MR k ep mean (P 5 0.002) and k ep SD (P < 0.001). The percentage reduction in K trans mean (P < 0.001) and k ep mean (P 5 0.034) at 6 weeks post-SBRT were significantly correlated with the percentage reduction in tumor size, as measured using CT at 3 months after SBRT. Univariate analyses revealed a trend toward disease progression when the initial SUV max > 10 (P 5 0.083). Conclusion: In patients with NSCLC who are receiving SBRT, DCE-integrated MR-PET can be used to evaluate the response after SBRT and to predict the local treatment outcome. Level of Evidence: 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2018;47:191-199. S tereotactic body radiotherapy (SBRT) is a standard treatment option for patients with stage I non-small cell lung cancer (NSCLC), who are not candidates for surgery.1 Nonrandomized, single-institution, and population-based studies have reported that the clinical outcomes of SBRT are comparable with those of primary surgery, with local control rates of over 90%.2 Furthermore, SBRT offers superior outcomes, lower costs, and greater patient convenience than conventional radiation therapy. 3To evaluate treatment response in cases of lung cancer, researchers commonly use the Response Evaluation Criteria View this article online at wileyonlinelibrary.com.

Myocardial perfusion imaging (MPI) with SPECT is a well-established tool for the diagnosis of coronary artery disease (CAD). However, soft-tissue attenuation is a common artifact that limits the diagnostic accuracy of MPI. The aim of this study was to determine whether attenuation correction (AC) improved the diagnostic performance of MPI, using coronary angiography as a reference standard. Methods: MEDLINE and EMBASE were searched until March 2015 for studies evaluating AC MPI for the diagnosis of CAD. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. For each study, the sensitivity, specificity, and diagnostic odds ratio, along with 95% confidence intervals (CIs), were calculated to determine the diagnostic accuracy of AC versus nonattenuation-corrected (NAC) MPI. A bivariate mixed-effects model was applied for pooling the data. Results: Of 201 articles, 17 studies (1,701 patients) were identified, including 5 studies that used CT AC, 12 studies that used radionuclide source AC (RAC), and 15 studies that reported NAC results. The pooled sensitivities across studies were 0. 95% CI, 24 (95% CI, 22 (95% CI,, and 9 (7-11). Significant differences in specificity and diagnostic odds ratios were noted when AC (including CT AC, RAC, and all AC) was compared with NAC. Conclusion: The results from this study suggested that AC should be applied to MPI to improve the diagnosis of CAD, especially the specificity.

Niemann-Pick type C disease (NPC) is a rare autosomal recessive lipid storage disorder caused by impaired cellular functions in processing and transporting low-density lipoprotein-cholesterol. In this report, we present magnetic resonance imaging (MRI), magnetic resonance spectrography (MRS) and 18-fluoro-2-deoxyglucose positron emission tomography (PET) imaging results for a 22-year-old male NPC patient. The patient's two MRI studies (at age 19 years and 22 years) demonstrated progressive changes of brain atrophy that were more prominent at the frontal lobes, and hyperintense signals in bilateral parietal-occipital periventricular white matter. MRS (at age 19 years) revealed no significant decrease in N-acetyl aspartate/choline ratio in the left frontal central white matter. PET (at age 22 years) showed significant bilateral hypometabolism in the prefrontal cortex and dorsomedial thalamus, and hypermetabolism in the parietal-occipital white matter, lenticular nucleus of the basal ganglia, cerebellum and pons. The imaging findings noted by MRI, MRS and 18-fluoro-2-deoxyglucose PET offered a possible supplementary explanation for the clinical neurological symptoms of this NPC patient.