Imaging features of small (≤ 3 cm) pancreatic solid tumors on gadoxetic-acid-enhanced MR imaging and diffusion-weighted imaging: an initial experience

Objective

The objective was to determine imaging features that distinguish small (≤3cm) solid pancreatic adenocarcinoma, neuroendocrine tumor (NET) and solid pseudopapillary tumor (SPT) on gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighed imaging (DWI).

Materials and methods

Twenty-four adenocarcinomas, 10 NETs and 8 SPTs were retrospectively included. Two radiologists analyzed morphologic features, signal intensity of the tumors on MR images including DWI (b=800) and dynamic enhancement pattern with consensus. Tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.

Results

All adenocarcinomas had an ill-defined margin and irregular shape, and more frequently had pancreatic duct dilatation compared with other tumors (P<.05). All SPTs and all but one of the adenocarcinomas (95.8%) had no arterial enhancement with progressively increased enhancement, whereas seven NETs (70%) had arterial enhancement with progressively decreased enhancement (P<.01). The mean value of tumor-to-parenchyma ratio on arterial and portal phases was significantly higher for NETs, and the mean value of tumor ADCs was significantly lower for SPTs than for other tumors (P<.05).

Conclusions

Gadoxetic-acid-enhanced MRI may aid in differentiation between small adenocarcinomas, NETs and SPTs based on morphologic features with dynamic enhancement pattern in adenocarcinomas, dynamic enhancement pattern with tumor-to-parenchyma ration on arterial and portal phases in NETs, and dynamic enhancement pattern with lower ADC value in SPTs.     

Multifocal Tracheal Chondromata

Chondromata of the trachea occur rarely. There are only 10 prior case reports in the literature, all of which have been of unifocal chondromata. We present the first case report, to our knowledge, of multifocal tracheal chondromata in a patient with laryngopharyngeal reflux. Evaluation, diagnosis, and management are discussed.     

Effects of water exchange on MRI-based determination of relative blood volume using an inversion-prepared gradient echo sequence and a blood pool contrast medium

A prostate tumor model in rats was used to compare histometric parameters of prostate cancer physiology with those obtained by magnetic resonance imaging (MRI). The study was focused on vascular physiology as reflected by relative blood volume v(b). Histometry and MRI showed a significant increase in mean v(b) in tumor compared to normal prostate tissue (histometry: normal tissue v(b)=0.69+/-0.19%, tumor tissue v(b)=1.10+/-0.31%, P<.001; MRI: normal tissue v(b)=0.67+/-0.23%, tumor tissue v(b)=1.77+/-0.67%, P<.001). The experimental work showed that MRI yielded a 60.9+/-0.76% higher v(b) than histometry in tumors, while no significant difference in v(b) was found between both methods in normal prostate tissue. Water exchange is known to affect signal intensity on contrast-enhanced MRI. This article investigated the influence of water exchange between intravascular and extravascular space to account for the discrepancy in the values of v(b) obtained with a dynamic inversion-prepared gradient echo MRI sequence and histometry in tumor and normal prostate tissue. The expected influence of water exchange on v(b) was modeled by a computer simulation of the MRI signal and compared with experimental results measured with MRI and histometry. The simulation was based on a two-compartment model indicating that v(b) may be overestimated by MRI. The magnitude of overestimation leads from 10% for the slow water exchange regime to 70% for fast water exchange. Since slow water exchange is probably predominant and even if the observed histological differences in tumor tissue are considered, an overestimation of only 15% due to water exchange is predicted by the simulation. Therefore the overestimation of tumor blood volume by MRI of 60.9% compared to histometry seems to be attributable to additional causes besides water exchange.     

抗肿瘤中药微量元素硒的研究

与抗肿瘤作用关系密切的中药微量元素主要有Se、Ge、Zn、Cu、Fe、Mn、Mo、I、B、Si、Li等，本文介绍了近年来Se的研究。Se是人体健康必需的超微量元素．与某些地方病、癌的发生关系密切。是同时具备防癌和促免疫两种活性的理想防癌剂。大部分补气、补血、补肾、补阳等中药富含Se等微量元素，具有抗癌等药理作用．特别是人参等12种中药的抗癌作用尤明显。     

Investigation of adverse health effects of residual oil fly ash emitted from a heavy-oil-fuelled Hungarian power plant

The adverse health effects of the Residual Oil Fly Ash (ROFA) emitted by a Hungarian power plant on inhabitants living in the villages surrounding the city where the power plant is situated and in the city itself were investigated. For the investigations, data obtained from the National Public Health and Medical Officer Services, the National Cancer Registry of Hungary, the Public Administration Office of Pest and Fejér Counties were used. The frequency of lower respiratory system diseases and malignant neoplasms amongst the inhabitants of the settlements 0–13 km far from the power station compared with that of the control settlement for different age-groups were calculated. The prevalence and incidence rates, calculated for the inhabitants of the city where the power plant is situated were always comparable to those of the control settlement, because the heavy metal containing ROFA particles emitted from the 202-m-high stack are deposited outside the town. The prevalence rates of adult patients treated for malignant neoplasms and chronic lower respiratory system diseases were about two times and up to eight times higher than in the control settlement, respectively, for three villages situated 8–12 km far from the source in the predominant direction of wind blow as of 1st of January 2000 and 1st of January 2002. In these villages, the incidence rates for newly recognised malignant neoplasms of lip, oral cavity and pharynx were four times higher than those in the control settlement between 1st of January 2000 and 1st of January 2002. It may be supposed that the emitted fly ash is responsible for the more frequent occurrence of the examined diseases in the investigated settlements. Data presented are suggestive of an increased risk, which will further be investigated by the usual methods of the epidemiology.     

Multifractal analysis of the UV/VIS spectra of malignant ascites: Confirmation of the diagnostic validity of a clinically evaluated spectral analysis

Multifractal (MF) approach was applied for the analysis of ultraviolet/visible (UV/VIS) spectra as an independent confirmation of the diagnostic efficacy of UV/VIS spectral analysis of intraperitoneal fluids, ascites, taken from patients with a known clinical diagnosis. Recently, it was reported that from UV/VIS spectra differentiation of malignant from benign ascites is possible. Here, it was shown that by using MF analysis of UV/VIS spectra, the objective classification of UV/VIS spectra is possible. The applicability of UV/VIS analysis and MF classification of spectra were evaluated on N=68 cases, of which M=64 and B=4 were clinically confirmed as malignant and benign, respectively. The overall diagnostic efficacy was 89.71% when using on-line analysis of UV/VIS spectra (61 out of 68 samples were positively recognized: 58 malignant and 3 benign), and even 95.59% by using off-line MF classsification (65 out of 68 samples were classified correctly: 63 malignant and 2 benign). It can be inferred that UV/VIS spectral analysis of ascites, combined with MF analysis, could be suggested as a successful and safe screening method in the evaluation of intraperitoneal fluids.     

Laryngeal Granular Cell Tumor

Granular cell tumor (GCT) of the larynx is an uncommon, benign laryngeal neoplasm. Abrikossoff first described the tumor in 1926 as myoblastoma. The origin of this tumor has been debated in the literature. Most of the authors believe that the tumor is of neural origin due to the characteristic immunohistochemical-staining pattern. The authors describe two cases of laryngeal GCTs located in different sites with a review of the histological and clinical features, the differential diagnosis, and the treatment and the prognosis of the tumor.     

MR characteristics of neoplasms and vascular malformations associated with epilepsy

We assessed the magnetic resonance (MR) imaging characteristics of two categories of epileptogenic substrates, neoplasms, and vascular malformations, to determine MR sensitivity and typical imaging features. A blinded retrospective analysis was performed on MR scans from 41 patients who had a neoplasm or vascular malformation surgically resected as treatment for medically refractory epilepsy. Abnormalities were assessed for sensitivity of MR detection, prediction of pathologic category, location, calvarial remodelling, signal intensity, and effect on adjacent tissue. Pathologic findings consisted of 33 tumors and 8 vascular malformations. We correctly localized 100% of the 41 lesions and predicted the correct pathologic category for 95% of these lesions. Neoplastic and vascular lesions (NVLs) associated with epilepsy had certain characteristic features. The temporal lobe was the most common site for NVL, involved in 68%. NVL were located in the brain periphery in 85% and remodelled the calvarium in 32%. NVL were associated with mass effect in 61%, volume loss in 1%, and no effect on adjacent tissue in 37%. NVL associated with epilepsy can be detected with high sensitivity using MR imaging. The temporal lobe location, cortical involvement, and calvarial remodelling are findings typical of NVL. MR characteristics can successfully predict the pathologic substrate of these lesions.     

Limitations of the permeability-limited compartment model in estimating vascular permeability and interstitial volume fraction in DCE-MRI

Dynamic contrast-enhanced magnetic resonance imaging commonly uses compartment models to estimate tissue parameters in general and perfusion parameters in particular. Compartment models assume a homogeneous distribution of the injected tracer throughout the compartment volume. Since tracer distribution within a compartment cannot be assessed, the parameters obtained by means of a compartment model might differ from the actual physical values.This work systematically examines the widely used permeability-surface-limited one-compartment model to determine the reliability of the parameters obtained by comparing them with their actual values. A computer simulation was used to model spatial tracer distribution within the interstitial volume using diffusion of contrast agent in tissue. Vascular parameters were varied as well as tissue parameters. The vascular parameters used were capillary radius (4 and 12 μm), capillary permeability (from 0.03 to 3.3 μm/s) and intercapillary distances from 30 to 300 μm. The tissue parameters used were tortuosity (λ), porosity (α) and interstitial volume fraction (v_e).Our results suggest that the permeability-surface-limited compartment model generally underestimates capillary permeability for capillaries with a radius of 4 μm by factors from ≈0.03 for α=0.04, to ≈ 0.1 for α=0.2, to ≈ 0.5 for α=1.0. An overestimation of actual capillary permeability for capillaries with a radius of 12 μm by a factor of ≥1.3 was found for α=1.0, while α=0.2 yielded an underestimation by a factor of ≈0.3 and α=0.04 by a factor of ≈ 0.03. The interstitial volume fraction, v_e, obtained by the compartment model differed with increasing intercapillary distances and for low vessel permeability, whereas v_e was found to be estimated approximately accurately for P=0.3 μm/s and P=3.3 μm/s for vessel distances <100 μm.