Magnetic resonance differentiation between T2 and T1 gallbladder carcinoma: significance of subserosal enhancement on the delayed phase dynamic study

Purpose

The aim of this study is to investigate whether subserosal enhancement on the delayed-phase dynamic magnetic resonance (MR) study (SED) can differentiate T2 from T1 gallbladder carcinoma (GBC).

Methods

The institutional research board approved this retrospective study. Between 1997 and 2006, there were surgically proven 11 T1 and 21 T2 GBC in 30 patients, all of whom had undergone preoperative contrast enhanced dynamic MR study, either with a 2D sequence (n=17) or 3D sequences (n=15). All images were reviewed by two radiologists for the presence of SED, and receiver operating characteristic (ROC) curve analysis was performed. Sensitivity, specificity, positive and negative predictive values were calculated by consensus.

Results

The areas under the ROC curves of the two readers were 0.91 and 0.86, and the kappa value was 0.78. Of the 21 T2 GBC, 18 and 3 showed positive and negative SED, respectively. Of the 11 T1 GBC, 1 and 10 showed positive and negative SED, respectively. The sensitivity, specificity, positive and negative predictive values of SED for diagnosing T2 lesions were 86%, 88%, 91% and 77%, respectively.

Conclusions

In conclusion, SED may be a useful sign to differentiate T2 from T1 GBC, which would affect the preoperative surgical planning of the patients.     

Diagnosis of suspicious breast lesions using an empirical mathematical model for dynamic contrast-enhanced MRI

The purpose of this study was to test whether an empirical mathematical model (EMM) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can distinguish between benign and malignant breast lesions. A modified clinical protocol was used to improve the sampling of contrast medium uptake and washout. T(1)-weighted DCE magnetic resonance images were acquired at 1.5 T for 22 patients before and after injection of Gd-DTPA. Contrast medium concentration as a function of time was calculated over a small region of interest containing the most rapidly enhancing pixels. Then the curves were fitted with the EMM, which accurately described contrast agent uptake and washout. Results demonstrate that benign lesions had uptake (P<2.0 x 10(-5)) and washout (P<.01) rates of contrast agent significantly slower than those of malignant lesions. In addition, secondary diagnostic parameters, such as time to peak of enhancement, enhancement slope at the peak and curvature at the peak of enhancement, were derived mathematically from the EMM and expressed in terms of primary parameters. These diagnostic parameters also effectively differentiated benign from malignant lesions (P<.03). Conventional analysis of contrast medium dynamics, using a subjective classification of contrast medium kinetics in lesions as "washout," "plateau" or "persistent" (sensitivity=83%, specificity=50% and diagnostic accuracy=72%), was less effective than the EMM (sensitivity=100%, specificity=83% and diagnostic accuracy=94%) for the separation of benign and malignant lesions. In summary, the present research suggests that the EMM is a promising alternative method for evaluating DCE-MRI data with improved diagnostic accuracy.     

硝酸镧对大鼠肝脏癌前病变发展的抑制作用及机制的初步探讨

研究硝酸镧对大鼠肝脏癌前病变的抑制作用及机制. 采用肝癌发生的短期动物模型, 连续用0.2, 10 mg·kg-1的La(NO3)3灌胃2个月后, 观察了不同剂量La(NO3)3对大鼠肝脏形态结构的影响, 免疫组化技术检测肝脏中细胞周期素D1和P16及PCNA的表达, 并做半定量分析. 同时取脾细胞进行淋巴细胞转化率试验. 结果表明, 0.2 mg·kg-1剂量硝酸镧组动物健康状况明显改善, 肝癌前病变程度明显减轻, cyclinD1, PCNA表达下降, P16表达上升, 淋巴细胞转化率升高. 提示低剂量硝酸镧具有一定阻抑肝癌前病变的作用.     

Three-dimensional contrast-enhanced ultrasound of the liver: Experience of 92 cases

Three-dimensional contrast-enhanced ultrasound (3D-CEUS) is a combination of three-dimensional ultrasound (3DUS) and contrast-enhanced ultrasound (CEUS). To evaluate the feasibility of 3D-CEUS in liver imaging, investigate possible influencing factors to its image quality, and evaluate the influence of 3D-CEUS to clinical outcome, low acoustic power (mechanical index, 0.08-0.13) 3D-CEUS was carried out in 102 focal liver lesions in 92 patients by using the LOGIQ 9 ultrasound scanner and a volume transducer (frequency range, 2-5 MHz; focusing ability, 2-25 cm in depth; azimuth aperture 5.9 cm). The lesions were classified into two groups: group 1 (n = 51) for characterization and group 2 (n = 51) for local treatment response evaluation. The factors that influenced the image quality of 3D-CEUS were analyzed. The image quality and usefulness of 3D-CEUS between the two groups were compared by using the χ²-test. The results showed that the lesion diameter, location, and scanning route had no significant influence on the image quality in both groups, whereas interfering factors damaged the image quality in group 1. In group 1, during arterial phase, high image quality was more frequently found in hyperenhanced and hypo- or non-enhanced lesions compared with isoenhanced lesions. In group 2, interfering factor and local treatment response had no obvious influence on the image quality. The visualization rate of high image quality was 94.1% (48/51) in group 2 vs. 72.6% (37/51) in group 1 (P = 0.012). The investigators found that 3D-CEUS improved confidence but made no change in diagnosis in 19 (37.3%) of 51 lesions in group 1, whereas 41 (80.4%) of 51 lesions in group 2 (P = 0.000). 3D-CEUS tends to obtain better image quality and lead to higher diagnostic confidence in the lesions for local treatment response evaluation, and perhaps is more useful in this aspect in future clinical settings.     

Texture analysis of bone marrow in knee MRI for classification of subjects with bone marrow lesion — Data from the Osteoarthritis Initiative

Visualization of bone marrow lesion (BML) can improve the diagnosis of many bone disorders that are associated with it. A quantitative approach in detecting BML could increase the accuracy and efficiency of diagnosing those bone disorders. In this paper, we investigated the feasibility of using magnetic resonance imaging (MRI)-based texture to (a) identify slices and (b) classify subjects with and without BML. A total of 58 subjects were studied; 29 of them were affected by BML. The ages of subjects ranged from 45 to 74 years with a mean age of 59. Texture parameters were calculated for the weight-bearing region of distal femur. The parameters were then analyzed using Mann–Whitney U test and individual feature selection methods to identify potentially discriminantive parameters. Forward feature selection was applied to select features subset for classification. Classification results from eight classifiers were studied. Results show that 98 of the 147 parameters studied are statistically significantly different between the normal and affected marrows: parameters based on co-occurrence matrix are ranked highest in their separability. The classification of subjects achieved an area under the receiver operating characteristic curve (AUC) of 0.914, and the classification of slices achieved an AUC of 0.780. The results show that MRI-texture-based classification can effectively classify subjects/slices with and without BML.     

A systematic approach to magnetic resonance imaging evaluation of epiphyseal lesions

Magnetic Resonance Imaging (MRI) is the preferred modality of choice to image epiphyseal lesions. It provides excellent soft tissue resolution and extent of disease. A wide spectrum of tumor and tumor like lesions can involve the epiphysis. Early and accurate diagnosis as well as appropriate management of epiphyseal lesions is critical as these conditions may lead to disabling complications such as, limb length discrepancy, angular or joint surface deformities and secondary osteoarthritis. In this article, we discuss the role of conventional sequences, such as T1W, fluid sensitive T2W and intravenous (IV) Gadolinium enhanced sequences as well as the additional value of problem solving MRI sequences such as, chemical shift and diffusion weighted imaging. Based on the imaging findings on various MRI sequences and lesion characteristics, a systematic approach directed to the diagnoses of epiphyseal lesions is presented and discussed. MRI features of clinically and biopsy proven examples of the epiphyseal lesions, such as osteomyelitis, intra-osseous abscess, infiltrative malignancy, metastases, transient osteoporosis, subchondral insufficiency fracture, avascular necrosis, osteochondral fracture, osteochondritis dissecans, eosinophilic granuloma and geode are demonstrated. Using this systematic approach, the reader will be able to better characterize epiphyseal lesions with a potential to positively affect patient management.     

Numerical analysis of ossicular chain lesion of human ear

Abstract Lesion of ossicular chain is a common ear disease impairing the sense of hearing. A comprehensive numerical model of human ear can provide better understanding of sound transmission. In this study, we propose a three-dimensional finite element model of human ear that incorporates the canal, tympanic membrane, ossicular bones, middle ear suspensory ligaments/muscles, middle ear cavity and inner ear fluid. Numerical analysis is conducted and employed to predict the effects of middle ear cavity, malleus handle defect, hypoplasia of the long process of incus, and stapedial crus defect on sound transmission. The present finite element model is shown to be reasonable in predicting the ossicular mechanics of human ear.     

5-Hydroxymethyl-, 5-Formyl- and 5-Carboxydeoxycytidines as Oxidative Lesions and Epigenetic Marks

The four non-canonical nucleotides in the human genome 5-methyl-, 5-hydroxymethyl-, 5-formyl- and 5-carboxydeoxycytidine (mdC, hmdC, fdC and cadC) form a second layer of epigenetic information that contributes to the regulation of gene expression. Formation of the oxidized nucleotides hmdC, fdC and cadC requires oxidation of mdC by ten-eleven translocation (Tet) enzymes that require oxygen, Fe(II) and α-ketoglutarate as cosubstrates. Although these oxidized forms of mdC are widespread in mammalian genomes, experimental evidence for their presence in fungi and plants is ambiguous. This vagueness is caused by the fact that these oxidized mdC derivatives are also formed as oxidative lesions, resulting in unclear basal levels that are likely to have no epigenetic function. Here, we report the xdC levels in the fungus Amanita muscaria in comparison to murine embryonic stem cells (mESCs), HEK cells and induced pluripotent stem cells (iPSCs), to obtain information about the basal levels of hmdC, fdC and cadC as DNA lesions in the genome.     

CTA成像在下肢血管闭塞病变中的应用及与血管腔内疗效的关系

本文探讨计算机体层扫描血管造影(CTA)检查在下肢血管闭塞病变中的应用价值及与血管腔内疗效的关系。选取经数字减影血管造影(DSA)确诊的93例下肢血管闭塞病变患者,采用CTA检查,分析CTA诊断病变部位结果、血管狭窄程度及与DSA诊断结果的一致性,并探讨CTA征象与患者血管腔内疗效的关系。结果显示,CTA诊断下肢血管闭塞病变部位、狭窄程度与DSA诊断结果均具有较高一致性(P<0.05);病变血管长度>1.41 cm、血管狭窄程度4级、病变血管远端CT值>62.65 Hu、钙化性斑块是下肢血管闭塞病变血管腔内治疗失败的危险因素(P<0.05)。CTA检查是诊断下肢血管闭塞病变的可靠方法,通过检查患者病变血管长度、血管狭窄程度、远端CT值及管腔内粥样斑块性质,有助于降低治疗盲目性,提高血管腔内治疗成功率。