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Evison M, Robinson SD, Sharman A, Datta S, Rammohan K, Duerden R, Montero-Fernandez MA, Gilligan D. Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group. Clin Radiol 2024; 79:404-412. [PMID: 38565483 DOI: 10.1016/j.crad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies.
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Affiliation(s)
- M Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
| | - S D Robinson
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, UK.
| | - A Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Datta
- Department of Radiology, Royal Alexandra Hospital, NHS Glasgow and Clyde, Glasgow, UK
| | - K Rammohan
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Duerden
- Department of Radiology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - M A Montero-Fernandez
- Department of Histopathology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gilligan
- Department of Oncology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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2
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Stankiewicz LN, Rossi FMV, Zandstra PW. Rebuilding and rebooting immunity with stem cells. Cell Stem Cell 2024; 31:597-616. [PMID: 38593798 DOI: 10.1016/j.stem.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024]
Abstract
Advances in modern medicine have enabled a rapid increase in lifespan and, consequently, have highlighted the immune system as a key driver of age-related disease. Immune regeneration therapies present exciting strategies to address age-related diseases by rebooting the host's primary lymphoid tissues or rebuilding the immune system directly via biomaterials or artificial tissue. Here, we identify important, unanswered questions regarding the safety and feasibility of these therapies. Further, we identify key design parameters that should be primary considerations guiding technology design, including timing of application, interaction with the host immune system, and functional characterization of the target patient population.
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Affiliation(s)
- Laura N Stankiewicz
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Fabio M V Rossi
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Peter W Zandstra
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
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3
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Klug M, Strange CD, Truong MT, Kirshenboim Z, Ofek E, Konen E, Marom EM. Thymic Imaging Pitfalls and Strategies for Optimized Diagnosis. Radiographics 2024; 44:e230091. [PMID: 38602866 DOI: 10.1148/rg.230091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Thymic imaging is challenging because the imaging appearance of a variety of benign and malignant thymic conditions are similar. CT is the most commonly used modality for mediastinal imaging, while MRI and fluorine 18 fluorodeoxyglucose (FDG) PET/CT are helpful when they are tailored to the correct indication. Each of these imaging modalities has limitations and technical pitfalls that may lead to an incorrect diagnosis and mismanagement. CT may not be sufficient for the characterization of cystic thymic processes and differentiation between thymic hyperplasia and thymic tumors. MRI can be used to overcome these limitations but is subject to other potential pitfalls such as an equivocal decrease in signal intensity at chemical shift imaging, size limitations, unusual signal intensity for cysts, subtraction artifacts, pseudonodularity on T2-weighted MR images, early imaging misinterpretation, flow and spatial resolution issues hampering assessment of local invasion, and the overlap of apparent diffusion coefficients between malignant and benign thymic entities. FDG PET/CT is not routinely indicated due to some overlap in FDG uptake between thymomas and benign thymic processes. However, it is useful for staging and follow-up of aggressive tumors (eg, thymic carcinoma), particularly for detection of occult metastatic disease. Pitfalls in imaging after treatment of thymic malignancies relate to technical challenges such as postthymectomy sternotomy streak metal artifacts, differentiation of postsurgical thymic bed changes from tumor recurrence, or human error with typical "blind spots" for identification of metastatic disease. Understanding these pitfalls enables appropriate selection of imaging modalities, improves diagnostic accuracy, and guides patient treatment. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Maximiliano Klug
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Chad D Strange
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Mylene T Truong
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Zehavit Kirshenboim
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Efrat Ofek
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Eli Konen
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
| | - Edith Michelle Marom
- From the Division of Diagnostic Imaging (M.K., Z.K., E.K., E.M.M.) and Institute of Pathology (E.O.), The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan, 5265601, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (M.K., Z.K., E.O., E.K., E.M.M.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.D.S., M.T.T.)
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4
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Fenioux C, Abbar B, Boussouar S, Bretagne M, Power JR, Moslehi JJ, Gougis P, Amelin D, Dechartres A, Lehmann LH, Courand PY, Cautela J, Alexandre J, Procureur A, Rozes A, Leonard-Louis S, Qin J, Cheynier R, Charmeteau-De Muylder B, Redheuil A, Tubach F, Cadranel J, Milon A, Ederhy S, Similowski T, Johnson DB, Pizzo I, Catalan T, Benveniste O, Hayek SS, Allenbach Y, Rosenzwajg M, Dolladille C, Salem JE. Thymus alterations and susceptibility to immune checkpoint inhibitor myocarditis. Nat Med 2023; 29:3100-3110. [PMID: 37884625 DOI: 10.1038/s41591-023-02591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
Immune checkpoint inhibitors (ICI) have transformed the therapeutic landscape in oncology. However, ICI can induce uncommon life-threatening autoimmune T-cell-mediated myotoxicities, including myocarditis and myositis. The thymus plays a critical role in T cell maturation. Here we demonstrate that thymic alterations are associated with increased incidence and severity of ICI myotoxicities. First, using the international pharmacovigilance database VigiBase, the Assistance Publique Hôpitaux de Paris-Sorbonne University data warehouse (Paris, France) and a meta-analysis of clinical trials, we show that ICI treatment of thymic epithelial tumors (TET, and particularly thymoma) was more frequently associated with ICI myotoxicities than other ICI-treated cancers. Second, in an international ICI myocarditis registry, we established that myocarditis occurred earlier after ICI initiation in patients with TET (including active or prior history of TET) compared to other cancers and was more severe in terms of life-threatening arrythmias and concurrent myositis, leading to respiratory muscle failure and death. Lastly, we show that presence of anti-acetylcholine-receptor antibodies (a biological proxy of thymic-associated autoimmunity) was more prevalent in patients with ICI myocarditis than in ICI-treated control patients. Altogether, our results highlight that thymic alterations are associated with incidence and seriousness of ICI myotoxicities. Clinico-radio-biological workup evaluating the thymus may help in predicting ICI myotoxicities.
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Affiliation(s)
- Charlotte Fenioux
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Henri Mondor Hospital, Department of Oncology, Créteil, France
| | - Baptiste Abbar
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Oncology, Paris, France
| | - Samia Boussouar
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Marie Bretagne
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - John R Power
- Department of Medecine, University of California, San Diego, San Diego, CA, USA
| | - Javid J Moslehi
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul Gougis
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Damien Amelin
- Sorbonne Université, INSERM, Association Institut de Myologie, Center of Research in Myology, UMRS 974, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Lorenz H Lehmann
- Department of Cardiology, University Hospital Heidelberg; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre-Yves Courand
- Fédération de Cardiologie, IMMUCARE, Hôpital de La Croix-Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon; Université de Lyon, CREATIS UMR INSERM U1044, INSA, Lyon, France
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Center for Cardiovascular and Nutrition Research, INSERM 1263, INRAE 1260, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Paris, France
| | - Joachim Alexandre
- CHU de Caen Normandie, Department of Pharmacology, Pharmacoepidemiology Unit; Normandie Université, UNICAEN, INSERM U1086 ANTICIPE Centre François Baclesse, Caen, France
| | - Adrien Procureur
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Antoine Rozes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sarah Leonard-Louis
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Laboratoire de Neuropathologie, Paris, France
| | - Juan Qin
- Department of Medecine, University of California, San Francisco, San Francisco, CA, USA
| | - Rémi Cheynier
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | | | - Alban Redheuil
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Radiology, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Jacques Cadranel
- Hôpitaux de Paris, Tenon Hospital, Department of Pulmonology and Thoracic Oncology and GRC Theranoscan Sorbonne University, Paris, France
| | - Audrey Milon
- Hôpitaux de Paris, Tenon Hospital, Department of Radiology, Paris, France
| | - Stéphane Ederhy
- Hôpitaux de Paris, Saint-Antoine Hospital, Department of Cardiology, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique'; Assistance Publique -Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 'Département R3S', Paris, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian Pizzo
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Toniemarie Catalan
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Benveniste
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Yves Allenbach
- Department of Internal Medicine, Sorbonne University, AP-HP, INSERM UMRS 974, Pitié-Salpêtrière Hospital, Paris, France
| | - Michelle Rosenzwajg
- Hôpitaux de Paris, Pitié Salpêtrière Hospital, Department of Immunology, Paris, France
| | - Charles Dolladille
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France.
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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5
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Vester SC, Bergmann W, van den Broek DHN, Veraa S, Schaafsma IA. Presumed residual thymic tissue is a common finding in thoracic computed tomography in adult dogs. Vet Radiol Ultrasound 2023; 64:1015-1024. [PMID: 37850432 DOI: 10.1111/vru.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Residual thymic tissue is a common incidental finding in thoracic CT of human adults. To determine whether presumed residual thymic tissue is also a common incidental finding in adult dogs, a two part-study was performed. The first part was a prospective, descriptive design where CT examination was performed in six canine cadavers within 24 h after death and presumed residual thymic tissue was examined pathologically. The second part of the study was a retrospective, analytical design where medical records of our institution were searched for thoracic CT scans of adult dogs performed in the year 2020. Age, sex, breed, presence of presumed thymic tissue, location, shape, attenuation, homogeneity, and width of the tissue were recorded and comparisons were performed using these data. In 4 of 6 of the prospective cases, thymic tissue was present on histology and in 2 of 6 dogs the presence of thymic tissue could not be confirmed. For the retrospective study, in 161/169 (95.3%) cases with presumed residual thymic tissue were detected. Shape and size were highly variable with either homogeneous (46.6%), heterogeneous (42.9%), or mixed (10.6%) attenuation. Dogs with presumed residual thymic tissue were significantly younger (median: 9.1 years; range: 1.2-14.3 vs. median: 10.5 years; range: 9.4-12.3) as were dogs with homogeneous attenuation of the tissue (median: 8.1 years; range: 1.2-14.3 vs. median: 9.5 years; range: 4.0-14.3). In conclusion, results indicated that presumed residual thymic tissue is a common CT finding in adult dogs and can be considered incidental.
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Affiliation(s)
- Siemone C Vester
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Wilhelmina Bergmann
- Faculty of Veterinary Medicine, Department of Biomolecular Health Sciences, Utrecht University, Utrecht, the Netherlands
| | - Dirk H N van den Broek
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Stefanie Veraa
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Irene A Schaafsma
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Utrecht University, Utrecht, the Netherlands
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Omidvari N, Jones T, Price PM, Ferre AL, Lu J, Abdelhafez YG, Sen F, Cohen SH, Schmiedehausen K, Badawi RD, Shacklett BL, Wilson I, Cherry SR. First-in-human immunoPET imaging of COVID-19 convalescent patients using dynamic total-body PET and a CD8-targeted minibody. SCIENCE ADVANCES 2023; 9:eadh7968. [PMID: 37824612 PMCID: PMC10569706 DOI: 10.1126/sciadv.adh7968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
With most of the T cells residing in the tissue, not the blood, developing noninvasive methods for in vivo quantification of their biodistribution and kinetics is important for studying their role in immune response and memory. This study presents the first use of dynamic positron emission tomography (PET) and kinetic modeling for in vivo measurement of CD8+ T cell biodistribution in humans. A 89Zr-labeled CD8-targeted minibody (89Zr-Df-Crefmirlimab) was used with total-body PET in healthy individuals (N = 3) and coronavirus disease 2019 (COVID-19) convalescent patients (N = 5). Kinetic modeling results aligned with T cell-trafficking effects expected in lymphoid organs. Tissue-to-blood ratios from the first 7 hours of imaging were higher in bone marrow of COVID-19 convalescent patients compared to controls, with an increasing trend between 2 and 6 months after infection, consistent with modeled net influx rates and peripheral blood flow cytometry analysis. These results provide a promising platform for using dynamic PET to study the total-body immune response and memory.
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Affiliation(s)
- Negar Omidvari
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Pat M. Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - April L. Ferre
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA, USA
| | - Jacqueline Lu
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA, USA
| | - Yasser G. Abdelhafez
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
- Radiotherapy and Nuclear Medicine Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Fatma Sen
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Stuart H. Cohen
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Ramsey D. Badawi
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Barbara L. Shacklett
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Simon R. Cherry
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
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7
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Sandstedt M, Chung RWS, Skoglund C, Lundberg AK, Östgren CJ, Ernerudh J, Jonasson L. Complete fatty degeneration of thymus associates with male sex, obesity and loss of circulating naïve CD8 + T cells in a Swedish middle-aged population. Immun Ageing 2023; 20:45. [PMID: 37653480 PMCID: PMC10470174 DOI: 10.1186/s12979-023-00371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Fatty degeneration of thymus (or thymus involution) has long been considered a normal ageing process. However, there is emerging evidence that thymic involution is linked to T cell aging, chronic inflammation and increased morbidity. Other factors, aside from chronological age, have been proposed to affect the involution rate. In the present study, we investigated the imaging characteristics of thymus on computed tomography (CT) in a Swedish middle-aged population. The major aims were to establish the prevalence of fatty degeneration of thymus and to determine its associations with demographic, lifestyle and clinical factors, as well as inflammation, T cell differentiation and thymic output. RESULTS In total, 1 048 randomly invited individuals (aged 50-64 years, 49% females) were included and thoroughly characterized. CT evaluation of thymus included measurements of attenuation, size and a 4-point scoring system, with scale 0-3 based on the ratio of fat and soft tissue. A majority, 615 (59%) showed complete fatty degeneration, 259 (25%) predominantly fatty attenuation, 105 (10%) half fatty and half soft-tissue attenuation, while 69 (6.6%) presented with a solid thymic gland with predominantly soft-tissue attenuation. Age, male sex, high BMI, abdominal obesity and low dietary intake of fiber were independently associated with complete fatty degeneration of thymus. Also, fatty degeneration of thymus as well as low CT attenuation values were independently related to lower proportion of naïve CD8+ T cells, which in turn was related to lower thymic output, assessed by T-cell receptor excision circle (TREC) levels. CONCLUSION Among Swedish middle-aged subjects, nearly two-thirds showed complete fatty degeneration of thymus on CT. This was linked to depletion of naïve CD8+ T cells indicating that CT scans of thymus might be used to estimate immunological aging. Furthermore, our findings support the intriguing concept that obesity as well as low fiber intake contribute to immunological aging, thereby raising the possibility of preventive strategies.
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Affiliation(s)
- Mårten Sandstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Rosanna W S Chung
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Camilla Skoglund
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna K Lundberg
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Ernerudh
- Department of Clinical Immunology and Transfusion Medicine and Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Lena Jonasson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
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8
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Molazem M, Soroori S, Bahonar A, Karimi S. Computed Tomographic Features of Thymus in Dogs: Correlation with Age, Gender, Breed and Body Fat Content. Vet Sci 2023; 10:418. [PMID: 37505824 PMCID: PMC10384453 DOI: 10.3390/vetsci10070418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The thymus is the first lymphoid organ formed to regulate a newborn's immunity. It reaches its maximum size during puberty, after which it undergoes an atrophic procedure called involution, but its ability to grow again in response to some stresses, such as infections, neoplasia, surgeries, chemotherapy, and radiotherapy is maintained. There is no comprehensive study on computed tomographic features of thymus in dogs. So, the goal of the present study is to gain better insight into the thymus using computed tomography as a non-invasive method. METHODS One hundred and fifty dogs classified in five age groups and five breed groups were recruited to this study and the thymus was evaluated using a 2-slice computed tomography machine. The inclusion criteria for the present study were having a normal complete blood count, plain and post-contrast CT scan examination of the thoracic region and no history of neoplasia, chemotherapy or radiotherapy. The visibility, density, enhancement, grade, size, volume, shape, borders and lateralization of the thymus were evaluated and statistical analysis was performed. The effect of obesity on thymic grade and volume was also investigated. RESULTS The visibility, density, dorsal length, volume and grade decreased with increasing age. The thymic shape and lateralization were mostly wedge shaped and left sided, respectively. The borders became concave with aging and increasing body fat content caused an increase in the fatty degeneration of the thymus. CONCLUSIONS Declining thymic density, grade, size and volume with aging are related to thymic involution and fatty degeneration was accelerated by increasing body fat content. Females and males were different only in thymic shape and small and large breeds were different only in thymic volume. The thymus was visible in some geriatric dogs with no underlying disease. We expect that the present work can be used by radiologists in reading thoracic computed tomography but investigation of thymic characteristics in dogs with neoplasia and history of chemotherapy, radiotherapy and thoracic surgeries can complete this study.
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Affiliation(s)
- Mohammad Molazem
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Diagnostic Imaging, University of Tehran, Azadi Street, Tehran 1419963111, Iran
| | - Sarang Soroori
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Diagnostic Imaging, University of Tehran, Azadi Street, Tehran 1419963111, Iran
| | - Alireza Bahonar
- Faculty of Veterinary Medicine, Department of Food Hygiene and Quality, University of Tehran, Azadi Street, Tehran 1419963111, Iran
| | - Saghar Karimi
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Diagnostic Imaging, University of Tehran, Azadi Street, Tehran 1419963111, Iran
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Omidvari N, Jones T, Price PM, Ferre AL, Lu J, Abdelhafez YG, Sen F, Cohen SH, Schmiedehausen K, Badawi RD, Shacklett BL, Wilson I, Cherry SR. First-in-human immunoPET imaging of COVID-19 convalescent patients using dynamic total-body PET and a CD8-targeted minibody. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.14.23287121. [PMID: 36993568 PMCID: PMC10055575 DOI: 10.1101/2023.03.14.23287121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
With the majority of CD8+ T cells residing and functioning in tissue, not blood, developing noninvasive methods for in vivo quantification of their biodistribution and kinetics in humans offers the means for studying their key role in adaptive immune response and memory. This study is the first report on using positron emission tomography (PET) dynamic imaging and compartmental kinetic modeling for in vivo measurement of whole-body biodistribution of CD8+ T cells in human subjects. For this, a 89Zr-labeled minibody with high affinity for human CD8 (89Zr-Df-Crefmirlimab) was used with total-body PET in healthy subjects (N=3) and in COVID-19 convalescent patients (N=5). The high detection sensitivity, total-body coverage, and the use of dynamic scans enabled the study of kinetics simultaneously in spleen, bone marrow, liver, lungs, thymus, lymph nodes, and tonsils, at reduced radiation doses compared to prior studies. Analysis and modeling of the kinetics was consistent with T cell trafficking effects expected from immunobiology of lymphoid organs, suggesting early uptake in spleen and bone marrow followed by redistribution and delayed increasing uptake in lymph nodes, tonsils, and thymus. Tissue-to-blood ratios from the first 7 h of CD8-targeted imaging showed significantly higher values in the bone marrow of COVID-19 patients compared to controls, with an increasing trend between 2 and 6 months post-infection, consistent with net influx rates obtained by kinetic modeling and flow cytometry analysis of peripheral blood samples. These results provide the platform for using dynamic PET scans and kinetic modelling to study total-body immunological response and memory.
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Affiliation(s)
- Negar Omidvari
- Department of Biomedical Engineering, University of California Davis; Davis, CA, USA
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center; Sacramento, CA, USA
| | - Pat M Price
- Department of Surgery and Cancer, Imperial College London; London, United Kingdom
| | - April L Ferre
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis; Davis, CA, USA
| | - Jacqueline Lu
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis; Davis, CA, USA
| | - Yasser G Abdelhafez
- Department of Radiology, University of California Davis Medical Center; Sacramento, CA, USA
- Radiotherapy and Nuclear Medicine Department, South Egypt Cancer Institute, Assiut University, Egypt
| | - Fatma Sen
- Department of Radiology, University of California Davis Medical Center; Sacramento, CA, USA
| | - Stuart H Cohen
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center; Sacramento, CA, USA
| | | | - Ramsey D Badawi
- Department of Biomedical Engineering, University of California Davis; Davis, CA, USA
- Department of Radiology, University of California Davis Medical Center; Sacramento, CA, USA
| | - Barbara L Shacklett
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis; Davis, CA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center; Sacramento, CA, USA
| | | | - Simon R Cherry
- Department of Biomedical Engineering, University of California Davis; Davis, CA, USA
- Department of Radiology, University of California Davis Medical Center; Sacramento, CA, USA
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Cordella A, Saunders JH, Stock E. CT Characteristics of the Thymus in Adult Dogs with Non-Thymic Neoplasia Compared to Young Dogs. Vet Sci 2023; 10:vetsci10030192. [PMID: 36977231 PMCID: PMC10051521 DOI: 10.3390/vetsci10030192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The thymus is a lymphatic mediastinal organ that is largely subject to changes with age. In human patients, the CT characteristics of the thymus in children and adults is well described. Furthermore, it is known in human medicine that stress can lead to a reduction in the size of the thymus, followed by a phase of hyperplasia (called the ‘rebound effect’). The visualization of thymic tissue in the cranial mediastinum of adult dogs with neoplasia is possible and could be related to a similar effect. In this study, we aimed to describe the CT characteristics of the thymus in adult dogs with neoplasia and to compare the aspect of the thymus in these dogs to juvenile dogs with a presumed normal thymus. A total of 11 adult dogs with neoplasia and 20 juvenile dogs were included. Several CT features of the thymus were evaluated, including the size, shape, and pre- and post-contrast attenuation values. The overall appearance was lobulated in all of the adult dogs and homogeneous in all of the juvenile dogs; it was left-sided in all of the adult dogs, while it was located in the midline in a few of the juvenile dogs (right-sided only in one). The thymus was less attenuating in adult dogs, in some cases with negative minimum pre-contrast attenuation values. In some dogs with neoplasia, the thymus can be detected at CT examination despite their age.
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11
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Murata O, Suzuki K, Takeuchi T. Thymus variants on imaging of patients with primary Sjögren's syndrome and polymyositis/dermatomyositis: clinical and immunological significance. Immunol Med 2023; 46:25-31. [PMID: 36200743 DOI: 10.1080/25785826.2022.2129371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated the presence of radiographic thymus variants using a scoring system and examined their association with clinical and immunological features in primary Sjögren's syndrome (pSS) and polymyositis/dermatomyositis (PM/DM) patients. Cases of 72 patients with pSS and 47 with PM/DM were randomly selected from all visitors to our department who received chest CT scanning, excluding those with thymoma or thymic cyst, or age <30 years. We quantitatively interpreted and assessed thymus size and attenuation score in axial CT images. Thymic enlargement was identified in 16 (22.2%) pSS and 14 (29.8%) PM/DM patients. A thymus attenuation score ≥ 2 was seen in 11 (15.3%) pSS and 9 (19.1%) PM/DM patients. Thymic enlargement showed a significant association with the titre of rheumatoid factor in PM/DM patients. Thymic enlargement and score showed a significant association with body weight in pSS patients. Radiographic thymus variants are often observed in pSS and PM/DM patients, particularly in cases of PM/DM, and may suggest the role of an abnormal immune response in their pathogenesis.
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Affiliation(s)
- Okinori Murata
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Division of Allergy and Rheumatology, Iwate Medical University School of Medicine, Morioka, Japan
| | - Katsuya Suzuki
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
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Berkan O, Kiziloğlu I, Keles E, Duman L, Bozkurt M, Adibelli Z, Oncel G, Berkan N, Ekemen Keles Y, Jones JH, Inan AH, Solak C, Emiroğlu M, Yildirim M, Dursun A, Ilhan E, Camyar A, Inceer O, Nart A, Yilmaz MB. Does the Thymus Index Predict COVID-19 Severity? J Comput Assist Tomogr 2023; 47:236-243. [PMID: 36728781 PMCID: PMC10044592 DOI: 10.1097/rct.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The COVID-19 (coronavirus disease 2019) pandemic is a global health emergency that is straining health care resources. Identifying patients likely to experience severe illness would allow more targeted use of resources. This study aimed to investigate the association between the thymus index (TI) on thorax computed tomography (CT) and prognosis in patients with COVID-19. METHODS A multicenter, cross-sectional, retrospective study was conducted between March 17 and June 30, 2020, in patients with confirmed COVID-19. The patients' clinical history and laboratory data were collected after receiving a signed consent form. Four experienced radiologists who were blinded to each other and patient data performed image evaluation. The appearance of the thymus was assessed in each patient using 2 published systems, including the TI and thymic morphology. Exclusion criteria were lack of initial diagnostic thoracic CT, previous sternotomy, pregnancy, and inappropriate images for thymic evaluation. A total of 2588 patients with confirmed COVID-19 and 1231 of these with appropriate thoracic CT imaging were included. Multivariable analysis was performed to predict the risk of severe disease and mortality. RESULTS The median age was 45 (interquartile range, 33-58) years; 52.2% were male. Two hundred forty-nine (20.2%) patients had severe disease, and 60 (4.9%) patients died. Thymus index was significantly associated with mortality and severe disease (odds ratios, 0.289 [95% confidence interval, 0.141-0.588; P = 0.001]; and 0.266 [95% confidence interval, 0.075-0.932; P = 0.038]), respectively. Perithymic lymphadenopathy on CT imaging had a significantly strong association with grades of TI in patients with severe disease and death ( V = 0.413 P = 0.017; and V = 0.261 P = 0.002, respectively). A morphologically assessable thymus increased the probability of survival by 17-fold and the absence of severe disease by 12-fold. CONCLUSION Assessment of the thymus in patients with COVID-19 may provide useful prognostic data for both disease severity and mortality.
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Affiliation(s)
- Ocal Berkan
- From the Departments of Cardiovascular Surgery
| | | | - Ercan Keles
- From the Departments of Cardiovascular Surgery
| | - Lale Duman
- Department of Radiology, Bornova Türkan Özilhan Hospital
| | - Mehmet Bozkurt
- Department of Radiology, Tepecik Education and Research Hospital
| | - Zehra Adibelli
- Department of Radiology, Bozyaka Education and Research Hospital
| | - Guray Oncel
- Department of Radiology, İzmir Çiğli Training and Research Hospital, İzmir, Turkey
| | - Nevsin Berkan
- Molecular Biology & Genetics, University of Lorraine, Nancy, France
| | - Yildiz Ekemen Keles
- Department of Pediatric İnfection Diseases, Tepecik Education and Research Hospital, İzmir
| | - Jeremy H Jones
- Department of Academic Writing, Kocaeli University, Umuttepe, İzmit
| | | | - Cihan Solak
- Department of Radiology, Adana Guney Hospital, Adana
| | - Mustafa Emiroğlu
- Department of General Surgery, Tepecik Education and Research Hospital
| | - Mehmet Yildirim
- Department of General Surgery, Bozyaka Education and Research Hospital
| | - Ayberk Dursun
- Department of General Surgery, Tepecik Education and Research Hospital
| | - Enver Ilhan
- Department of General Surgery, Bozyaka Education and Research Hospital
| | - Asuman Camyar
- Department of Allergy and Immunology, İzmir Çiğli Training and Research Hospital
| | - Ozge Inceer
- Department of Infectious Disease and Clinical Microbiology, İzmir Çiğli Training and Research Hospital
| | - Ahmet Nart
- General Surgery, İzmir Çiğli Training and Research Hospital
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
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Safai Zadeh E, Görg C, Prosch H, Horn R, Jenssen C, Dietrich CF. The Role of Thoracic Ultrasound for Diagnosis of Diseases of the Chest Wall, the Mediastinum, and the Diaphragm-Narrative Review and Pictorial Essay. Diagnostics (Basel) 2023; 13:767. [PMID: 36832255 PMCID: PMC9956010 DOI: 10.3390/diagnostics13040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay.
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Affiliation(s)
- Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Rudolf Horn
- Center da Sandà Val Müstair, 7536 Sta. Maria, Switzerland
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland
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An P, Li X, Qin P, Ye Y, Zhang J, Guo H, Duan P, He Z, Song P, Li M, Wang J, Hu Y, Feng G, Lin Y. Predicting model of mild and severe types of COVID-19 patients using Thymus CT radiomics model: A preliminary study. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:6612-6629. [PMID: 37161120 DOI: 10.3934/mbe.2023284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To predict COVID-19 severity by building a prediction model based on the clinical manifestations and radiomic features of the thymus in COVID-19 patients. METHOD We retrospectively analyzed the clinical and radiological data from 217 confirmed cases of COVID-19 admitted to Xiangyang NO.1 People's Hospital and Jiangsu Hospital of Chinese Medicine from December 2019 to April 2022 (including 118 mild cases and 99 severe cases). The data were split into the training and test sets at a 7:3 ratio. The cases in the training set were compared in terms of clinical data and radiomic parameters of the lasso regression model. Several models for severity prediction were established based on the clinical and radiomic features of the COVID-19 patients. The DeLong test and decision curve analysis (DCA) were used to compare the performances of several models. Finally, the prediction results were verified on the test set. RESULT For the training set, the univariate analysis showed that BMI, diarrhea, thymic steatosis, anorexia, headache, findings on the chest CT scan, platelets, LDH, AST and radiomic features of the thymus were significantly different between the two groups of patients (P < 0.05). The combination model based on the clinical and radiomic features of COVID-19 patients had the highest predictive value for COVID-19 severity [AUC: 0.967 (OR 0.0115, 95%CI: 0.925-0.989)] vs. the clinical feature-based model [AUC: 0.772 (OR 0.0387, 95%CI: 0.697-0.836), P < 0.05], laboratory-based model [AUC: 0.687 (OR 0.0423, 95%CI: 0.608-0.760), P < 0.05] and model based on CT radiomics [AUC: 0.895 (OR 0.0261, 95%CI: 0.835-0.938), P < 0.05]. DCA also confirmed the high clinical net benefits of the combination model. The nomogram drawn based on the combination model could help differentiate between the mild and severe cases of COVID-19 at an early stage. The predictions from different models were verified on the test set. CONCLUSION Severe cases of COVID-19 had a higher level of thymic involution. The thymic differentiation in radiomic features was related to disease progression. The combination model based on the radiomic features of the thymus could better promote early clinical intervention of COVID-19 and increase the cure rate.
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Affiliation(s)
- Peng An
- Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Xiumei Li
- Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Internal Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Ping Qin
- Department of Infectious Disease, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Pharmacy and Laboratory, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - YingJian Ye
- Department of Infectious Disease, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Junyan Zhang
- Department of Pharmacy and Laboratory, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Peng Duan
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Zhibing He
- Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Ping Song
- Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Mingqun Li
- Department of Pharmacy and Laboratory, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Jinsong Wang
- Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Infectious Disease, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Yan Hu
- Department of Infectious Disease, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Pharmacy and Laboratory, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Guoyan Feng
- Department of Radiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
- Department of Internal Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
| | - Yong Lin
- Department of Infectious Disease, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China
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Samir A, Bastawi RA, Baess AI, Sweed RA, Eldin OE. Thymus CT-grading and rebound hyperplasia during COVID-19 infection: a CT volumetric study with multivariate linear regression analysis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9108347 DOI: 10.1186/s43055-022-00784-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The importance of thymic CT-grading and presence of thymic rebound hyperplasia during COVID-19 infection were only investigated in a few studies. This multivariate study aims to evaluate the relation between thymus CT-grading and rebound during COVID-19 infection and the following: (1) the patients' age, (2) the patients' blood lymphocytic count, (3) the CT-volumetry of the diseased lung parenchyma, (4) the patient's clinical course and prognosis, and finally (5) the final radiological diagnosis. Results Multicenter retrospective analyses were conducted between March and June 2021 on 325 adult COVID-19 patients with positive PCR results and negative history of malignant or autoimmune diseases. They included 186 males and 139 females (57.2%:42.8%). Their mean age was 40.42 years ± 14.531 SD. Three consulting radiologists performed CT-grading of the thymus gland (grade 0–3) and CT-severity scoring (CT-SS) of the pathological lung changes in consensus. Two consulting pulmonologists correlated the clinical severity and blood lymphocytic count. Pearson correlation coefficient (r) and linear regression analyses were statistically utilized. Sub-involuted thymus (with CT-grade 0:2) was detected in 42/325 patients (12.9%); all of them had a mild clinical course and low CT-SS (0–1). Thymic rebound hyperplasia was the only positive CT-finding in 15/325 patients (4.6%) without pathological lung changes. A weak positive significant correlation was proved between thymic grade and patient's age, clinical course, and CT-SS (r = 0.217, 0.163, and 0.352 with p ≤ 0.0001, < 0.0001, and 0.002, respectively). A weak negative significant correlation was found between thymic grade and lymphocytic count (r = − 0.343 and p ≤ 0.0001). A strong positive significant correlation was encountered between clinical severity against patients' age and CT-SS (r = 0.616 and 0.803 with p ≤ 0.0001). Conclusions The presence of sub-involuted thymus or thymic rebound should not be radiologically overlooked in COVID-19 patients. During COVID-19 infection, the presence of sub-involuted thymus with low CT-grading (0–2) was correlated with young age groups, low CT-severity scoring, mild clinical course, and better prognosis (good prognostic factor). It was seldom seen in old hospitalized patients. Atypically, it was also correlated with normal lymphocytic count or even lymphocytosis. The thymic rebound could be the only positive CT-finding even during the absence of lung involvement.
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Multidetector Computed Tomographic Evaluation of the Normal Characteristics of the Thymus in the Pediatric Population. J Belg Soc Radiol 2022; 106:110. [DOI: 10.5334/jbsr.2971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
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The unilateral involution in the thymus of a 96-year-old male leads to the preservation of structural integrity in one thymic lobe, as assessed by the expression of medullar and cortical antigens and the presence of CD3+ cells. Heliyon 2022; 8:e11734. [PMID: 36411931 PMCID: PMC9674545 DOI: 10.1016/j.heliyon.2022.e11734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
The process of thymic involution begins soon after birth and continues through adult life. Although evolutionary conserved in all vertebrates, the thymic involution has no defined kinetics. Little is known about the pace of its regression in humans, except that there is a marked increase of thymic involution after puberty. This report describes the unusual structural findings in the thymus of a 96-year-old male. The morphological parameters of the organ were evaluated using H&E and immunohistochemistry (IHC) techniques. The macroscopic examination showed a typical organ's weight and size, except that the right thymic lobe presented a well-preserved organ and the left lobe was significantly adiposed. The H&E staining of the thymic sections from the left and right lobes confirmed advanced thymic adiposity in the left lobe and preserved thymic epithelial space containing hematoxylin-stained cells in the right lobe. The multiplex immunostaining of the right lobe sections with antibodies specific to cytokeratins -14 and -8, CD3, and CD4 revealed the presence of medullar and cortical epithelium and mix population of CD3+/CD4+ and CD3+/CD4- T cells. The T cells were associated with the medulla but not with the cortex of the thymus. The immunostaining with an antibody to FoxN1 showed that the protein was expressed in the thymic epithelium. Taken together, we provide evidence that the thymus of a 96-year-old man involuted different kinetics in each of the two thymic lobes. Furthermore, the presence of CD3+/CD4+ and CD3+/CD4-cells gives a hand to the hypothesis that a pool of T-cells may associate with this primary lymphatic organ for as long as there is the available thymic epithelium and be a source of lymphocytes aiding adaptive immune responses to old age.
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Suzuki K, Kitami A, Okada M, Takamiya S, Ohashi S, Tanaka Y, Uematsu S, Kadokura M, Suzuki T, Hashizume N, Fujisawa H. Evaluation of age-related thymic changes using computed tomography images: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29950. [PMID: 35960086 PMCID: PMC9371532 DOI: 10.1097/md.0000000000029950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We aimed to investigate if Computed tomography (CT) attenuation values can help improve the identification of age-related changes in the thymus. We assessed CT images of 405 patients aged 0 to 80 years. We measured the area of the anterior mediastinum at the level of the carina and its average CT attenuation value. We evaluated the thymic area, the ratio of the thymus area to the total thoracic area, and the CT attenuation value. Additionally, we evaluated changes in the thymus area in the 0 to 13-year age group. The area of the thymus decreased from birth to the middle 20s. After the middle 20s, the area tended to increase and plateau till after 50 years of age. The ratio of the thymic area to the thoracic area decreased from age 0 to 20 years, but remained stable after 20 years of age. The CT attenuation values were stable from birth to puberty, decreased after puberty, and were stable again in the late 50s and beyond. The thymus of children showed mass formation, but the shape changed with age. No significant differences in the CT attenuation value were found across underlying conditions for the 0 to 13-year age group. The decrease in the CT attenuation values, observed with advancing age, reflects adipose degeneration of the thymus, indicating that by the late 50s, thymic tissue is replaced completely by adipose tissue. Our data suggest that adipose degeneration of the thymus begins after puberty and advances with age.
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Affiliation(s)
- Kosuke Suzuki
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- *Correspondence: Kosuke Suzuki, 35-1, Chigasakichuo, Tsuzuki-ku, Yokohama city, Kanagawa, Japan (e-mail: )
| | - Akihiko Kitami
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Momoka Okada
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shinnosuke Takamiya
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shinichi Ohashi
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yoko Tanaka
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Syugo Uematsu
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Mitsutaka Kadokura
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Takashi Suzuki
- Department of Thoracic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Norihiro Hashizume
- Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hidefumi Fujisawa
- Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
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19
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Genetic, parental and lifestyle factors influence telomere length. Commun Biol 2022; 5:565. [PMID: 35681050 PMCID: PMC9184499 DOI: 10.1038/s42003-022-03521-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/22/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe average length of telomere repeats (TL) declines with age and is considered to be a marker of biological ageing. Here, we measured TL in six blood cell types from 1046 individuals using the clinically validated Flow-FISH method. We identified remarkable cell-type-specific variations in TL. Host genetics, environmental, parental and intrinsic factors such as sex, parental age, and smoking are associated to variations in TL. By analysing the genome-wide methylation patterns, we identified that the association of maternal, but not paternal, age to TL is mediated by epigenetics. Single-cell RNA-sequencing data for 62 participants revealed differential gene expression in T-cells. Genes negatively associated with TL were enriched for pathways related to translation and nonsense-mediated decay. Altogether, this study addresses cell-type-specific differences in telomere biology and its relation to cell-type-specific gene expression and highlights how perinatal factors play a role in determining TL, on top of genetics and lifestyle.
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20
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Ye F, Liu J, Chen L, Zhu B, Yu L, Liang B, Xu L, Li S, Lu S, Fan L, Yang D, Zheng X. Time-course analysis reveals that corticosteroids resuscitate diminished CD8+ T cells in COVID-19: a retrospective cohort study. Ann Med 2021; 53:181-188. [PMID: 33183091 PMCID: PMC7877944 DOI: 10.1080/07853890.2020.1851394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To illustrate the effect of corticosteroids and heparin, respectively, on coronavirus disease 2019 (COVID-19) patients' CD8+ T cells and D-dimer. METHODS In this retrospective cohort study involving 866 participants diagnosed with COVID-19, patients were grouped by severity. Generalized additive models were established to explore the time-course association of representative parameters of coagulation, inflammation and immunity. Segmented regression was performed to examine the influence of corticosteroids and heparin upon CD8+ T cell and D-dimer, respectively. RESULTS There were 541 moderate, 169 severe and 156 critically ill patients involved in the study. Synchronous changes of levels of NLR, D-dimer and CD8+ T cell in critically ill patients were observed. Administration of methylprednisolone before 14 DFS compared with those after 14 DFS (β = 0.154%, 95% CI=(0, 0.302), p=.048) or a dose lower than 40 mg per day compared with those equals to 40 mg per day (β = 0.163%, 95% CI=(0.027, 0.295), p=.020) significantly increased the rising rate of CD8+ T cell in 14-56 DFS. CONCLUSIONS The parameters of coagulation, inflammation and immunity were longitudinally correlated, and an early low-dose corticosteroid treatment accelerated the regaining of CD8+ T cell to help battle against SARS-Cov-2 in critical cases of COVID-19.
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Affiliation(s)
- Fangzhou Ye
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Liangkai Chen
- School of Public Health, Ministry of Education Key Lab of Environment and Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Zhu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yu
- Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Boyun Liang
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Xu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Sumeng Li
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Sihong Lu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Fan
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Dongliang Yang
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zheng
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
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Araki T, Hammer M, Sodickson A. Fat content quantification using dual-energy CT for differentiation of anterior mediastinal lesions from normal or hyperplastic thymus. Curr Probl Diagn Radiol 2021; 51:334-339. [PMID: 34364734 DOI: 10.1067/j.cpradiol.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/23/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Detection of fat content in thymic lesions is crucial to differentiate thymic hyperplasia from thymic tumors or other anterior mediastinal pathologies. PURPOSE To assess the feasibility of dual-energy CT (DECT) fat content quantification for the differentiation of anterior mediastinal lesions from benign thymic lesions and the normal spectrum of the thymus. MATERIALS AND METHODS Chest DECT images of 465 patients (median 61 years, 63% female) were visually evaluated by two radiologists and semiquantitatively scored based on the degree of fatty degeneration ranging from completely fatty (score 0) to predominantly soft-tissue (score 3), and anterior mediastinal mass (score 4). A subset of scans (n =134 including all cases with scores 2-4 and 20 randomly-selected cases from scores 0 and 1) underwent quantitative DECT analysis (fat fraction, iodine density, and conventional CT value). DECT values were compared across the semiquantitative scores. RESULTS Results of visual evaluation included 35 with predominantly solid thymus (score 3) and 15 with anterior mediastinal mass (score 4). The most common clinical diagnoses of the 15 masses (including 8 with pathologic confirmation) were metastases (n = 10) and lymphoma (n = 4). CT values in the abnormal thymus were significantly higher than those in score 3 (median: 69.7 HU versus 19.9 HU, P <0.001). There was no significant difference in iodine density values (median: 1.7 mg/ml versus 1 mg/ml, P = 0.09). However, the fat fraction value was significantly lower in the abnormal thymus (score 4) than in the predominantly soft-tissue attenuation thymuses (score 3) (median: 12.8% versus 38.7%, P <0.001). ROC curve analysis showed that fat fraction had an AUC of 0.96 (P <0.001), with a cutoff of <39.2% fat fraction yielding 100% sensitivity and 85% specificity. CONCLUSION DECT fat fraction measurements of the thymus may provide additional value in distinguishing anterior mediastinal lesions from benign thymus. Use of DECT may reduce the need for subsequent imaging evaluation.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, The Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
| | - Mark Hammer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aaron Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Murata O, Suzuki K, Sugiura H, Kondo Y, Takeshita M, Koga K, Takiguchi M, Kurisu R, Kassai Y, Yasuoka H, Yamaoka K, Morita R, Yoshimura A, Takeuchi T. Thymus variants on imaging in patients with rheumatoid arthritis-Clinical and immunological significance. Rheumatology (Oxford) 2021; 60:5595-5600. [PMID: 33590850 DOI: 10.1093/rheumatology/keab164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We sought to clarify the presence of radiographic thymus variants using a scoring system, and their association with clinical and immunological features in RA patients. METHODS 387 RA patients randomly selected from all patients visiting our department who underwent chest CT scanning, with exclusion of patients with thymoma or thymic cyst, or age < 30 y. Thymus size and attenuation score in axial CT images were quantitatively interpreted and assessed. Associations between immunophenotype data and clinical and serological features were analysed in a subset of patients. RESULTS Thymic enlargement was found in 76 (19.6%) patients, and a thymus attenuation score ≥ 2 was found in 50 (12.9%) patients. The score was significantly associated with antibodies to citrullinated peptide antigens (ACPA) positivity. Thymic enlargement was significantly associated with the proportions of CD4+ effector memory T cells. CONCLUSION Radiographic thymus variants were frequently observed in RA patients, and may reflect an abnormal immune response involved in the pathogenesis of RA.
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Affiliation(s)
- Okinori Murata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Koga
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Maiko Takiguchi
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Rina Kurisu
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Yoshiaki Kassai
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Hidekata Yasuoka
- Fujita Health University School of Medicine, Division of Rheumatology, Department of Internal Medicine, Aichi, Japan
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Rimpei Morita
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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23
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Xia C, Chen S, Baikpour M, Pierce TT, Duan Y, Li Q, Chen L, Cheah E, Samir AE. Cervical Extension of the Normal Thymus in Children and Adolescents: Sonographic Features and Prevalence. JOURNAL OF ULTRASOUND IN MEDICINE 2021; 40:2361-2367. [PMID: 33491815 DOI: 10.1002/jum.15619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aims to confirm the prevalence of incidental cervical extension of normal thymus in children and adolescents undergoing neck ultrasound and describe the ultrasound appearance to minimize future misdiagnosis. MATERIALS AND METHODS This retrospective study was conducted in a single institution. Thyroid and lower neck ultrasound images of the consecutive pediatric subjects between January 1, 2011 and September 30, 2017 were independently reviewed by 2 radiologists for the presence of cervical thymus. When identified on sonographic images, cervical thymus was described on the basis of echogenicity, location, and shape. RESULTS In 278 consecutive cases, the 2 reviewers identified 105 (37.8%) and 103 (37.1%) cases respectively as having sonographically visible tissue in the expected location of cervical extension of the thymus. The internal echotexture was variable with 38.1% of cases being hypoechoic, 37.1% mixed, and 24.8% hyperechoic. Cervical extension of the thymus was most commonly (65.0%) to the left of the trachea or (30.9%) bilateral/anterior to the trachea; isolated right paratracheal thymus was uncommon. Thymic shape was variable: quadrilateral (30.9%), oval (29.9%), triangular (25.8%), and other (13.4%). The logistic regression model including age, gender, and BMI z-scores showed that, when controlled for sex and BMI z-scores, younger age was a predictor for the presence of cervical thymic extension (p < .001). CONCLUSION Cervical thymic extension is sonographically visible as a soft tissue mass of variable appearance in about a third of children and adolescents undergoing neck ultrasonography with decreasing prevalence with age. Sonographically visible cervical thymic tissue is more common in younger patients.
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Affiliation(s)
- Chunxia Xia
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuang Chen
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Masoud Baikpour
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theodore T Pierce
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yu Duan
- Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Li
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Eugene Cheah
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Thymic Epithelial Neoplasms: Radiologic-Pathologic Correlation. Radiol Clin North Am 2021; 59:169-182. [PMID: 33551079 DOI: 10.1016/j.rcl.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thymic epithelial neoplasms, as classified by the World Health Organization, include thymoma, thymic carcinoma, and thymic carcinoid. They are a rare group of tumors and are often diagnosed incidentally in the work-up of parathymic syndrome, such as myasthenia gravis, or when mass effect or local invasion causes other symptoms. In each of these scenarios, understanding the radiologic-pathologic relationship of these tumors allows clinical imagers to contribute meaningfully to management decisions and overall patient care. Integrating important imaging features, such as local invasion, and pathologic features, such as necrosis and immunohistochemistry, ensures a meaningful contribution by clinical imagers to the care team.
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25
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Chang H, Cong H, Wang H, Du L, Tian DC, Ma Y, Xu Y, Wang Y, Yin L, Zhang X. Thymic Involution and Altered Naive CD4 T Cell Homeostasis in Neuromyelitis Optica Spectrum Disorder. Front Immunol 2021; 12:645277. [PMID: 34335563 PMCID: PMC8322781 DOI: 10.3389/fimmu.2021.645277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Circulating T helper cells with a type 17-polarized phenotype (TH17) and expansion of aquaporin-4 (AQP4)-specific T cells are frequently observed in patients with neuromyelitis optica spectrum disorder (NMOSD). However, naive T cell populations, which give rise to T helper cells, and the primary site of T cell maturation, namely the thymus, have not been studied in these patients. Here, we report the alterations of naive CD4 T cell homeostasis and the changes in thymic characteristics in NMOSD patients. Flow cytometry was performed to investigate the naive CD4+ T cell subpopulations in 44 NMOSD patients and 21 healthy controls (HC). On immunological evaluation, NMOSD patients exhibited increased counts of CD31+thymic naive CD4+ T cells and CD31-cental naive CD4+ T cells along with significantly higher fraction and absolute counts of peripheral blood CD45RA+ CD62L+ naive CD4+ T cells. Chest computed tomography (CT) images of 60 NMOSD patients and 65 HCs were retrospectively reviewed to characterize the thymus in NMOSD. Thymus gland of NMOSD patients exhibited unique morphological characteristics with respect to size, shape, and density. NMOSD patients showed exacerbated age-dependent thymus involution than HC, which showed a significant association with disease duration. These findings broaden our understanding of the immunological mechanisms that drive severe disease in NMOSD.
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Affiliation(s)
- Haoxiao Chang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hengri Cong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huabing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - De-Cai Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuetao Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yupeng Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linlin Yin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Beijing, China
- *Correspondence: Linlin Yin, ; Xinghu Zhang,
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Linlin Yin, ; Xinghu Zhang,
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26
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The contribution of thymic tolerance to central nervous system autoimmunity. Semin Immunopathol 2020; 43:135-157. [PMID: 33108502 PMCID: PMC7925481 DOI: 10.1007/s00281-020-00822-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases of the central nervous system (CNS) are associated with high levels of morbidity and economic cost. Research efforts have previously focused on the contribution of the peripheral adaptive and innate immune systems to CNS autoimmunity. However, a failure of thymic negative selection is a necessary step in CNS-reactive T cells escaping into the periphery. Even with defective thymic or peripheral tolerance, the development of CNS inflammation is rare. The reasons underlying this are currently poorly understood. In this review, we examine evidence implicating thymic selection in the pathogenesis of CNS autoimmunity. Animal models suggest that thymic negative selection is an important factor in determining susceptibility to and severity of CNS inflammation. There are indirect clinical data that suggest thymic function is also important in human CNS autoimmune diseases. Specifically, the association between thymoma and paraneoplastic encephalitis and changes in T cell receptor excision circles in multiple sclerosis implicate thymic tolerance in these diseases. We identify potential associations between CNS autoimmunity susceptibility factors and thymic tolerance. The therapeutic manipulation of thymopoiesis has the potential to open up new treatment modalities, but a better understanding of thymic tolerance in CNS autoimmunity is required before this can be realised.
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27
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Deniz S, Susam S, Aksel N, Gayaf M, Güldaval F, Erbaycu AE, Yılmaz U. Effect of Rebound Thymic Hyperplasia on Survival in Chemotherapy-Treated Lung Cancer. Turk Thorac J 2020; 21:303-307. [PMID: 33031720 DOI: 10.5152/turkthoracj.2020.18163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/03/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Thymus is a lymphoepithelial system in which cells responsible for the immune system are produced and directed. The aim of this study is to determine the overall survival effect of rebound thymic hyperplasia (RTH) in patients with non-small cell lung cancer (NSCLC) treated with systemic chemotherapy (CT). MATERIALS AND METHODS The study was designed as retrospective case series. One hundred and thirty patients who met the inclusion criteria were evaluated. Demographic data, type of tumor, and treatments administered were recorded. The frequency of RTH development and the relationship between RTH development and survival was investigated. RESULTS The median age of the patients was 59, and nine of 13 patients (69.4%) with RTH were iden-tified as stable disease, two patients had a partial response (15.3%), and two were evaluated as progres-sive disease (15.3%). Of the remaining 117 patients, 78 (66.6%) had stable disease, 11 (9.4%) had com-plete response, 21 (17.9%) had partial response, and seven patients were evaluated as having progressive disease (5.9%). The patients were categorized into two groups: Group 1 - without RTH and group 2 - with RTH. Thirteen (10%) of 130 patients developed RTH (group 2), while the remaining 117 (90%) patients did not have RTH (group 1). There was no difference between the two groups (59.1 years) in terms of age (p = 0.933). The RTH developed after a median time of 4.5 months (2-7 months) after CT had been administered. Overall survival was longer in patients with RTH than in patients without RTH (20.04 months) (95% CI, 4.79-35.29) vs. 10.05 months (95% CI, 8.74-11.36; p=0.049). CONCLUSION The developing of RTH during systemic CT may be a prognostic marker in stage 4 non-small cell lung cancer.
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Affiliation(s)
- Sami Deniz
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Seher Susam
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Nimet Aksel
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Mine Gayaf
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Filiz Güldaval
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Ahmet Emin Erbaycu
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Ufuk Yılmaz
- Department of Chest Diseases, Health Science University, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
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Araki T, Washko GR, Schiebler ML, O'Connor GT, Hatabu H. The Framingham Heart Study: Populational CT-based phenotyping in the lungs and mediastinum. Eur J Radiol Open 2020; 7:100260. [PMID: 32984450 PMCID: PMC7495061 DOI: 10.1016/j.ejro.2020.100260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023] Open
Abstract
The Framingham Heart Study (FHS) is one of the largest and established longitudinal populational cohorts. CT cohorts of the FHS since 2002 provided a unique opportunity to assess non-cardiac thoracic imaging findings. This review deals with image-based phenotyping studies from recent major publications regarding interstitial lung abnormalities (ILAs), pulmonary cysts, emphysema, pulmonary nodules, pleural plaques, normal spectrum of the thymus, and anterior mediastinal masses, concluding with the discussion of future directions of FHS CT cohorts studies in the era of radiomics and artificial intelligence.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Department of Pulmonology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Hussein SA, Sabri YY, Fouad MA, Al-Zawam HH, Mohamed NM. Role of different imaging modalities in the evaluation of normal and diseased thymus. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The appearance of the thymus on imaging studies showed great variability. Thymus imaging is a great challenge. This cross-sectional prospective study investigated the diagnostic value of different imaging modalities in the evaluation of normal and diseased thymus. Chest X-ray was done as a primary survey. Chest computed tomography (CT) was done for 82 patients, chest magnetic resonant imaging (MRI) was done for 40 patients, and 18 flurodeoxy glucose positron emission tomography (18 FDG-PET) was done for 2 patients. Ultrasonography (US) of the anterior mediastinum was done for 2 pediatric patients. Histopathological assessment was done for all cases with diseased thymus.
Results
The study included 158 patients divided into 2 groups: group A, 79 patients with normal thymus for age and group B, 79 patients with thymic lesions detected by one or more of the used modalities. The large-sized thymus was in 79 patients, who were subcategorized to patients with myasthenia gravis (12 patients) and patients with mediastinal masses (67 patients). Imaging findings in normal and diseased thymus gland were compared and lesion analysis by various modalities displayed with histopathological correlation.
Conclusion
There are different imaging modalities for thymus gland evaluation. CT is beneficial for primary assessment giving the morphology and density, and MRI is the imaging modality of choice in diseased thymus owing to functional assessment of the gland; however, X-ray may be helpful as a primary survey tool before CT and MRI. Chest ultrasound could be a suitable primary assessment tool in pediatrics before MRI because it is an easy bedside test.
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Thomas R, Wang W, Su DM. Contributions of Age-Related Thymic Involution to Immunosenescence and Inflammaging. IMMUNITY & AGEING 2020; 17:2. [PMID: 31988649 PMCID: PMC6971920 DOI: 10.1186/s12979-020-0173-8] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/02/2020] [Indexed: 01/10/2023]
Abstract
Immune system aging is characterized by the paradox of immunosenescence (insufficiency) and inflammaging (over-reaction), which incorporate two sides of the same coin, resulting in immune disorder. Immunosenescence refers to disruption in the structural architecture of immune organs and dysfunction in immune responses, resulting from both aged innate and adaptive immunity. Inflammaging, described as a chronic, sterile, systemic inflammatory condition associated with advanced age, is mainly attributed to somatic cellular senescence-associated secretory phenotype (SASP) and age-related autoimmune predisposition. However, the inability to reduce senescent somatic cells (SSCs), because of immunosenescence, exacerbates inflammaging. Age-related adaptive immune system deviations, particularly altered T cell function, are derived from age-related thymic atrophy or involution, a hallmark of thymic aging. Recently, there have been major developments in understanding how age-related thymic involution contributes to inflammaging and immunosenescence at the cellular and molecular levels, including genetic and epigenetic regulation, as well as developments of many potential rejuvenation strategies. Herein, we discuss the research progress uncovering how age-related thymic involution contributes to immunosenescence and inflammaging, as well as their intersection. We also describe how T cell adaptive immunity mediates inflammaging and plays a crucial role in the progression of age-related neurological and cardiovascular diseases, as well as cancer. We then briefly outline the underlying cellular and molecular mechanisms of age-related thymic involution, and finally summarize potential rejuvenation strategies to restore aged thymic function.
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Affiliation(s)
- Rachel Thomas
- Cell Biology, Immunology, and Microbiology Graduate Program, Graduate School of Biomedical Sciences, Fort Worth, Texas 76107 USA
| | - Weikan Wang
- Cell Biology, Immunology, and Microbiology Graduate Program, Graduate School of Biomedical Sciences, Fort Worth, Texas 76107 USA
| | - Dong-Ming Su
- 2Department of Microbiology, Immunology, and Genetics, University of North Texas Health Science Center, Fort Worth, Texas 76107 USA
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Inoue M, Orita S, Inage K, Fujimoto K, Shiga Y, Kanamoto H, Abe K, Kinoshita H, Norimoto M, Umimura T, Sato T, Sato M, Suzuki M, Enomoto K, Eguchi Y, Aoki Y, Akazawa T, Ohtori S. Radiological Assessment of Damage to the Iliopsoas Muscle by the Oblique Lateral Interbody Fusion Approach. Spine Surg Relat Res 2019; 4:152-158. [PMID: 32405562 PMCID: PMC7217679 DOI: 10.22603/ssrr.2019-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION There are several reports about invasive muscle injury during posterior spinal surgery. However, few reports have evaluated the association between the clinical symptoms and changes in the physical properties of the psoas major after oblique lateral interbody fusion (OLIF). Therefore, the current study aimed to investigate the relationship between the clinical symptoms and changes in the psoas major muscle before and after OLIF. METHODS Twenty-seven patients who underwent single-level OLIF following the diagnosis of degenerative lumbar disease were included in the study. The cross-sectional areas (CSAs) of the psoas major on the approaching and contralateral sides were measured in the axial computed tomography view of the surgical intervertebral space preoperatively and postoperatively at 1 week and 3, 6, and 12 months. The preoperative and postoperative changes in the CSAs were compared. Muscle degeneration was evaluated using axial magnetic resonance images at the same level as that in the CSA evaluation preoperatively and at 12 months postoperatively. Additionally, the relationship between these parameters and postoperative lower limb symptoms was investigated. RESULTS Significant swelling of the psoas major on the approach side was observed 1 week postoperatively (p < 0.05). No postoperative muscle degeneration was observed. Three cases of paresthesia in the front of the thigh were observed, but no association was found with changes in CSA in any of the cases. CONCLUSIONS The OLIF approach caused swelling of the psoas major 1 week postoperatively with no more muscle degeneration in the mid-term. Although numbness of the lower limbs was found in some cases, no association was found with changes in CSA. Our study findings suggest that the OLIF approach causes temporary injury or swelling of the psoas major, but the long-term damage to the muscle is not significant.
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Affiliation(s)
- Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic surgery, Saiseikai Narashino Hospital, Narashino, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirohito Kanamoto
- Department of Orthopaedic surgery, Kanamoto Orthopaedics Clinic, Numazu, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Guaraldi G, Franconi I, Milic J, Besutti G, Pintassilgo I, Scaglioni R, Ligabue G, Riva N, Raimondi A, Menozzi M, Carli F, Zona S, Santoro A, Malagoli A, Borghi V, Torricelli P, Cossarizza A, Mussini C. Thymus Imaging Detection and Size Is Inversely Associated With Metabolic Syndrome and Frailty in People With HIV. Open Forum Infect Dis 2019; 6:ofz435. [PMID: 31660382 PMCID: PMC6809752 DOI: 10.1093/ofid/ofz435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may experience accentuating aging in relation to immuno-activation. Little is known regarding thymus (THY) involution in this process. We sought to investigate the relationship between THY imaging detection/size and clinically relevant aging outcomes such as metabolic syndrome (MetS), multimorbidity (MM), and frailty in PWH. METHODS This was a cross-sectional observational study including 665 HIV patients (81% males; median age, 53 years) attending Modena HIV Metabolic Clinic from 2014 to 2017. They underwent thoracic computed tomography scan as part of the medical assessment for cardiovascular disease, in which THY detection and size were reported using a semiquantitative score. Outcome measures were MetS, MM, and frailty. RESULTS THY was detected in 27.0% of subjects; 71.1% showed THY size of grade 1-2, and 28.9% exhibited grade ≥3. Covariates that inversely correlated with THY detection were age, male gender, body mass index (BMI), and HIV duration. Covariates that inversely correlated with MetS were age, HIV duration, BMI, and THY grade 1-2. Covariates that inversely correlated with MM were age, HIV duration, and CD4 nadir. Covariates that inversely correlated with frailty were age, HIV duration, CD4 nadir, BMI, and THY detection. CONCLUSIONS THY is inversely associated with MetS and frailty in PWH.
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Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Iacopo Franconi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Radiology Unit, University of Modena and Reggio Emilia, Italy
| | - Ines Pintassilgo
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Guido Ligabue
- Radiology Unit, University of Modena and Reggio Emilia, Italy
| | - Nicoletta Riva
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Alessandro Raimondi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Marianna Menozzi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Federica Carli
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Stefano Zona
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Antonella Santoro
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | - Vanni Borghi
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
| | | | - Andrea Cossarizza
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Infectious Diseases Unit, University of Modena and Reggio Emilia, Italy
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Sen A, Valsalamony J, Raj J. CT density of cervical thymus, in comparison with mediastinal thymus. Insights Imaging 2019; 10:97. [PMID: 31565757 PMCID: PMC6766458 DOI: 10.1186/s13244-019-0781-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/15/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives Cervical component of thymus is noted more in children and young adults than in older age group. CT texture (lobules of soft tissue interspersed with fat), similarity with CT density of mediastinal thymus and continuity with mediastinal thymus on sagittal/coronal images, are given as the criteria for diagnosis of the cervical thymus. But CT densities of cervical and mediastinal components of the thymus may vary. The purpose of our study was to compare CT densities of cervical and mediastinal parts of the thymus, in cases where ultrasonography correlation was available. Methods We retrospectively identified 22 patients who had undergone CT between May 2015 and May 2017 and in whom ultrasonography (USG) correlation was available. CT densities of cervical and mediastinal components of thymus were measured. Results CT density of cervical thymus is lower than the CT density of mediastinal thymus by ~ 25 HU. There is a moderate positive correlation between CT densities of cervical and mediastinal parts of the thymus. CT densities of both cervical and mediastinal thymus were found to reduce with age, but the reduction was statistically significant only in the cervical thymus in this study.
Conclusions CT densities of cervical and mediastinal components of the thymus may vary, with CT density of cervical thymus being lower. There is a positive correlation between CT densities of cervical and mediastinal parts of the thymus. CT density of cervical thymus reduces with age.
Understanding these may help avoid confusion on CT and avoid the need for correlative USG, saving time and effort. Electronic supplementary material The online version of this article (10.1186/s13244-019-0781-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anitha Sen
- Department of Radiodiagnosis, Regional Cancer Centre, Thiruvananthapuram, Kerala, 695011, India.
| | - Jiji Valsalamony
- Department of Radiodiagnosis, Regional Cancer Centre, Thiruvananthapuram, Kerala, 695011, India
| | - Jubie Raj
- Department of Radiodiagnosis, Regional Cancer Centre, Thiruvananthapuram, Kerala, 695011, India
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Abstract
The contributions of the peripheral adaptive and innate immune systems to CNS autoimmunity have been extensively studied. However, the role of thymic selection in these conditions is much less well understood. The thymus is the primary lymphoid organ for the generation of T cells; thymic mechanisms ensure that cells with an overt autoreactive specificity are eliminated before they emigrate to the periphery and control the generation of thymic regulatory T cells. Evidence from animal studies demonstrates that thymic T cell selection is important for establishing tolerance to autoantigens. However, there is a considerable knowledge gap regarding the role of thymic selection in autoimmune conditions of the human CNS. In this Review, we critically examine the current body of experimental evidence for the contribution of thymic tolerance to CNS autoimmune diseases. An understanding of why dysfunction of either thymic or peripheral tolerance mechanisms rarely leads to CNS inflammation is currently lacking. We examine the potential of de novo T cell formation and thymic selection as novel therapeutic avenues and highlight areas for future study that are likely to make these targets the focus of future treatments.
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Das P, Santos S, Park GK, Hoseok I, Choi HS. Real-Time Fluorescence Imaging in Thoracic Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:205-220. [PMID: 31403028 PMCID: PMC6687041 DOI: 10.5090/kjtcs.2019.52.4.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022]
Abstract
Near-infrared (NIR) fluorescence imaging provides a safe and cost-efficient method for immediate data acquisition and visualization of tissues, with technical advantages including minimal autofluorescence, reduced photon absorption, and low scattering in tissue. In this review, we introduce recent advances in NIR fluorescence imaging systems for thoracic surgery that improve the identification of vital tissues and facilitate the resection of tumorous tissues. When coupled with appropriate NIR fluorophores, NIR fluorescence imaging may transform current intraoperative thoracic surgery methods by enhancing the precision of surgical procedures and augmenting postoperative outcomes through improvements in diagnostic accuracy and reductions in the remission rate.
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Affiliation(s)
- Priyanka Das
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sheena Santos
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Kate Park
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - I Hoseok
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Putman RK, Gudmundsson G, Axelsson GT, Hida T, Honda O, Araki T, Yanagawa M, Nishino M, Miller ER, Eiriksdottir G, Gudmundsson EF, Tomiyama N, Honda H, Rosas IO, Washko GR, Cho MH, Schwartz DA, Gudnason V, Hatabu H, Hunninghake GM. Imaging Patterns Are Associated with Interstitial Lung Abnormality Progression and Mortality. Am J Respir Crit Care Med 2019; 200:175-183. [PMID: 30673508 PMCID: PMC6635786 DOI: 10.1164/rccm.201809-1652oc] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/23/2019] [Indexed: 11/16/2022] Open
Abstract
Rationale: Interstitial lung abnormalities (ILA) are radiologic abnormalities on chest computed tomography scans that have been associated with an early or mild form of pulmonary fibrosis. Although ILA have been associated with radiologic progression, it is not known if specific imaging patterns are associated with progression or risk of mortality. Objectives: To determine the role of imaging patterns on the risk of death and ILA progression. Methods: ILA (and imaging pattern) were assessed in 5,320 participants from the AGES-Reykjavik Study, and ILA progression was assessed in 3,167 participants. Multivariable logistic regression was used to assess factors associated with ILA progression, and Cox proportional hazards models were used to assess time to mortality. Measurements and Main Results: Over 5 years, 327 (10%) had ILA on at least one computed tomography, and 1,435 (45%) did not have ILA on either computed tomography. Of those with ILA, 238 (73%) had imaging progression, whereas 89 (27%) had stable to improved imaging; increasing age and copies of MUC5B genotype were associated with imaging progression. The definite fibrosis pattern was associated with the highest risk of progression (odds ratio, 8.4; 95% confidence interval, 2.7-25; P = 0.0003). Specific imaging patterns were also associated with an increased risk of death. After adjustment, both a probable usual interstitial pneumonia and usual interstitial pneumonia pattern were associated with an increased risk of death when compared with those indeterminate for usual interstitial pneumonia (hazard ratio, 1.7; 95% confidence interval, 1.2-2.4; P = 0.001; hazard ratio, 3.9; 95% confidence interval, 2.3-6.8;P < 0.0001), respectively. Conclusions: In those with ILA, imaging patterns can be used to help predict who is at the greatest risk of progression and early death.
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Affiliation(s)
| | - Gunnar Gudmundsson
- Department of Respiratory Medicine and Sleep, Faculty of Medicine, Landspital University Hospital and
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gisli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Tomoyuki Hida
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | - Osamu Honda
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuro Araki
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mizuki Nishino
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | | | | | | | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan; and
| | | | - George R. Washko
- Pulmonary and Critical Care Division
- Center for Pulmonary Functional Imaging, and
| | - Michael H. Cho
- Pulmonary and Critical Care Division
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Hiroto Hatabu
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | - Gary M. Hunninghake
- Pulmonary and Critical Care Division
- Center for Pulmonary Functional Imaging, and
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Nacka-Aleksić M, Pilipović I, Kotur-Stevuljević J, Petrović R, Sopta J, Leposavić G. Sexual dimorphism in rat thymic involution: a correlation with thymic oxidative status and inflammation. Biogerontology 2019; 20:545-569. [DOI: 10.1007/s10522-019-09816-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/12/2019] [Indexed: 01/05/2023]
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Tripathy PR, Chaudhary B, Gaikwad MR, Britto NJ. A large thymic mass with persistent active tissue in an elderly cadaver. Anat Cell Biol 2019; 52:93-96. [PMID: 30984460 PMCID: PMC6449587 DOI: 10.5115/acb.2019.52.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/24/2018] [Accepted: 11/15/2018] [Indexed: 11/27/2022] Open
Abstract
Thymus is an encapsulated organ having its bilateral origin from the third pharyngeal pouch. It appears to be a single organ but actually it is bilobed. It attains its maximum development at puberty and then it begins to involute. The parenchyma is replaced by adipocytes and lymphocyte production declines. Here we present a large thymus with a small area of persistent active tissue in it which was obtained during routine undergraduate dissection class. Tissues taken from different quadrants of the large thymic mass were processed, embedded in paraffin and sections were taken for hematoxylin and eosin staining which showed presence of thymic tissue in only one quadrant. Further sections from that quadrant was treated with cytokeratin to confirm its epithelial origin. Therefore knowledge of a large persistent thymus will be helpful to the radiologists and surgeons for making differential diagnosis and in avoiding unnecessary surgical intervention.
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Abstract
PURPOSE The aim of this study was to better assess the prevalence and appearance of thymic tissue in adults stratified by age using multidetector computed tomography (MDCT) in order to prevent misinterpretation of normal thymic tissue as pathology. MATERIALS AND METHODS This study examined the CT appearance of the thymus in 597 trauma patients aged 30 to 69 years (M=48.0 y, SD=11.3). Three body fellowship-trained attending radiologists independently reviewed the CT scans. Reviewers assigned one of 5 grades on the basis of the relative proportions of fat and soft tissue in the thymic bed: complete fatty replacement (grade 0), predominantly fat (grade 1), even mix of soft tissue and fat (grade 2), predominantly soft tissue (grade 3), and discrete confluent thymic tissue (grade 4). Objectively, fixed-area region of interest values of the thymic bed were obtained. Interrater reliability was calculated. RESULTS Increased fatty replacement of the thymus occurred with increasing age. We found residual thymic tissue (≥grade 1) in the following age categories: 30 to 39 years (83.0%), 40 to 49 years (71.9%), 50 to 59 years (52.6%), and 60 to 69 years (34.8%). Kappa comparisons for the entire sample were excellent (κ=0.86). Higher grades had higher region of interest values. CONCLUSIONS Residual thymic tissue in adults on MDCT is both more prevalent and more prominent than that reported in earlier studies and can be visible into the seventh decade. We recommend that radiologists and clinicians familiarize themselves with the normal range appearances of the thymus on MDCT, in order to prevent misinterpretation of normal thymic tissue as pathology, which may result in unnecessary procedures.
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Kamath C, Witczak J, Adlan MA, Premawardhana LD. Managing thymic enlargement in Graves' disease. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM180119. [PMID: 30703065 PMCID: PMC6365683 DOI: 10.1530/edm-18-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Thymic enlargement (TE) in Graves' disease (GD) is often diagnosed incidentally when chest imaging is done for unrelated reasons. This is becoming more common as the frequency of chest imaging increases. There are currently no clear guidelines for managing TE in GD. Subject 1 is a 36-year-old female who presented with weight loss, increased thirst and passage of urine and postural symptoms. Investigations confirmed GD, non-PTH-dependent hypercalcaemia and Addison's disease (AD). CT scans to exclude underlying malignancy showed TE but normal viscera. A diagnosis of hypercalcaemia due to GD and AD was made. Subject 2, a 52-year-old female, was investigated for recurrent chest infections, haemoptysis and weight loss. CT thorax to exclude chest malignancy, showed TE. Planned thoracotomy was postponed when investigations confirmed GD. Subject 3 is a 47-year-old female who presented with breathlessness, chest pain and shakiness. Investigations confirmed T3 toxicosis due to GD. A CT pulmonary angiogram to exclude pulmonary embolism showed TE. The CT appearances in all three subjects were consistent with benign TE. These subjects were given appropriate endocrine treatment only (without biopsy or thymectomy) as CT appearances showed the following appearances of benign TE - arrowhead shape, straight regular margins, absence of calcification and cyst formation and radiodensity equal to surrounding muscle. Furthermore, interval scans confirmed thymic regression of over 60% in 6 months after endocrine control. In subjects with CT appearances consistent with benign TE, a conservative policy with interval CT scans at 6 months after endocrine control will prevent inappropriate surgical intervention. Learning points: Chest imaging is common in modern clinical practice and incidental anterior mediastinal abnormalities are therefore diagnosed frequently. Thymic enlargement (TE) associated with Graves' disease (GD) is occasionally seen in view of the above. There is no validated strategy to manage TE in GD at present. However, CT (or MRI) scan features of the thymus may help characterise benign TE, and such subjects do not require thymic biopsy or surgery at presentation. In them, an expectant 'wait and see' policy is recommended with GD treatment only, as the thymus will show significant regression 6 months after endocrine control.
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Affiliation(s)
- C Kamath
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK
| | - J Witczak
- Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr, Caerphilly, UK
| | - M A Adlan
- Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr, Caerphilly, UK
| | - L D Premawardhana
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK
- Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr, Caerphilly, UK
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Luo H, Xie S, Ma C, Zhang W, Tschöpe C, Fa X, Cheng J, Cao J. Correlation Between Thymus Radiology and Myasthenia Gravis in Clinical Practice. Front Neurol 2019; 9:1173. [PMID: 30697185 PMCID: PMC6340958 DOI: 10.3389/fneur.2018.01173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/18/2018] [Indexed: 01/09/2023] Open
Abstract
Background: The ability to distinguish between a normal thymus, thymic hyperplasia, and thymoma should aid in clinical management and decision making for patients with myasthenia gravis (MG). We sought to determine the accuracy of routine radiological examinations in predicting thymic pathology. Methods: We retrospectively analyzed the records of patients with MG who had undergone thymectomy from the Second Affiliated Hospital of Zhengzhou University. Each patient received at least one initial radiological diagnosis and one histological diagnosis, and the patients were classified into the all-patient, CT, contrast CT, and MRI groups. The sensitivity, accuracy and specificity of each group were calculated for different histological types. Results: This study included 114 patients. All sensitivity, specificity and accuracy values except for sensitivity to hyperplasia in each group for different histological types were satisfactory. MRI had higher sensitivity (68.4, 95% CI: 43.5–87.4%) to histological hyperplasia than did CT (14.3, 95% CI: 0.4–57.9%) and contrast CT (26.7, 95% CI: 7.8–55.1%). Contrast CT had higher specificity (97.9, 95% CI: 88.9–99.95%) for histological hyperplasia than did MRI (88.5, 95% CI: 69.9–97.6%). Discussion: For patients with MG, CT, contrast CT, and MRI examinations can effectively identify thymoma. Additionally, compared with CT or contrast CT, MRI may have a stronger ability to distinguish thymoma and detect hyperplasia.
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Affiliation(s)
- Huan Luo
- MR Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Ophthalmology, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Shanshan Xie
- MR Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Ma
- MR Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Cardiology, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Wenqiang Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Xianen Fa
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- MR Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Cao
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
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Priola AM, Gned D, Veltri A, Priola SM. Case 261: Thymoma Embedded in Thymus with Pleural Implant in Myasthenia Gravis Lambert-Eaton Overlap Syndrome. Radiology 2018; 290:264-269. [PMID: 30571477 DOI: 10.1148/radiol.2018161761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 29-year-old woman presented with a 6-month history of progressive general fatigue, fluctuating limb weakness, and difficulty climbing stairs. She initially experienced occasional episodes of transient diplopia that developed while reading in the evening. She subsequently started to experience dry eyes and mouth, difficulty chewing, and mild dysphagia that worsened throughout the day. Her medical history included hypothyroidism from Hashimoto thyroiditis and pneumonia with left pleural effusion. She had no smoking history, and her body mass index was normal (23.8 kg/m2). No medication use was reported at admission. Physical examination revealed mild bilateral ptosis, reduced muscle tone and strength that worsened in proximal leg muscles, and decreased deep tendon reflexes. An edrophonium test revealed improvement in muscle strength and eyelid ptosis. Repetitive nerve stimulation revealed low amplitude of compound muscle action potential at rest (0.21 mV), with a marked increase (700%; normal increase, <60%) at high-rate stimulation (50 Hz). Laboratory work-up was unremarkable except for detection of acetylcholine receptor antibodies in the serum (21.30 nmol/L) and P/Q-type voltage-gated calcium channel antibodies (220 pmol/L). Recent MRI of the brain and spine at an outside hospital showed no abnormal findings. At admission, the patient underwent CT of the chest, abdomen, and pelvis followed by thoracic MRI to further evaluate CT findings.
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Affiliation(s)
- Adriano M Priola
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
| | - Dario Gned
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
| | - Andrea Veltri
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
| | - Sandro M Priola
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
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Mediastinal Remnant Thymic Tissue Misdiagnosed as Ectopic Parathyroid Hyperplasia in Secondary Hyperparathyroidism. Clin Nucl Med 2018; 43:943-945. [PMID: 30325824 DOI: 10.1097/rlu.0000000000002316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 56-year-old woman with secondary hyperparathyroidism was referred for preoperative localization of hyperfunctioning parathyroid lesions. Tc-MIBI dual-phase and SPECT/CT parathyroid scan showed multiple focal activities behind the thyroid and in the anterior mediastinum, diagnosed as parathyroid hyperplasia. However, the histopathological findings proved them to be hyperplastic parathyroid glands and remnant thymic tissue after parathyroidectomy and unnecessary thoracotomy, respectively.
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Harrington KA, Kennedy DS, Tang B, Hickie C, Phelan E, Torreggiani W, Halpenny D. Computed tomographic evaluation of the thymus-does obesity affect thymic fatty involution in a healthy young adult population? Br J Radiol 2018; 91:20170609. [PMID: 29356558 DOI: 10.1259/bjr.20170609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine a relationship between increased body mass index (BMI) and fatty involution of the thymus in subjects aged between 20 and 30 years. METHODS CT images of 94 patients aged between 20 and 30 years were reviewed. Quantitative thymic mean attenuation was recorded and qualitative thymic attenuation was assigned to 1 of 4 possible grades. BMI and subcutaneous fat thickness were documented. Correlations between thymic attenuation, and BMI and subcutaneous fat thickness were assessed using linear regression models. Differences in thymic attenuation in overweight vs normal weight patients were assessed using t-test and Pearson Χ2 analysis. RESULTS Low mean thymic attenuation values were associated with higher patient BMI (p = 0.024). Normal weight patients had a mean quantitative thymic attenuation of 15.5 Hounsfield unit and overweight patients had a mean quantitative thymic attenuation of -16.4 Hounsfield unit (p = 0.0218). There was a significant association between increasing subcutaneous fat thickness and reduced mean quantitative thymic attenuation (p < 0.0001). There was also a significant difference in subcutaneous fat thickness when comparing qualitatively assessed thymic Grade 0 with grades 2 and 3 (p = 0.027 and 0.001 respectively); and Grade 1 with Grade 3 (p = 0.001). CONCLUSION In patients between 20 and 30 years old, the degree of thymic fatty infiltration is related to BMI. Advances in knowledge: Multidetector CT can assess fatty involution of the thymus gland. This retrospective study demonstrates a relationship between BMI and thymus gland fatty involution. Subjects with increased subcutaneous fat have decreased mean thymus gland attenuation.
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Affiliation(s)
- Kate A Harrington
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - David S Kennedy
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Bobby Tang
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Conor Hickie
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Emma Phelan
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - William Torreggiani
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Darragh Halpenny
- 2 Radiology Department, Memorial Sloan Kettering Cancer Center , New York, NY , USA
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Klimiec E, Quirke M, Leite MI, Hilton-Jones D. Thymus imaging in myasthenia gravis: The relevance in clinical practice. Muscle Nerve 2018; 58:153-156. [PMID: 29424940 DOI: 10.1002/mus.26096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The ability to distinguish between normal thymus, thymic hyperplasia, and thymoma should aid clinical management and decision making in patients with myasthenia gravis (MG). We sought to determine the accuracy of routine imaging in predicting thymic pathology. METHODS We retrospectively analyzed records of patients with MG from the Oxford Myasthenia Centre registry who had undergone thymectomy. Each patient received 1 radiological diagnosis and 1 histological diagnosis. RESULTS We included 106 patients. Radiological and histological diagnoses agreed in 73 (68.9%) patients. Sensitivity and specificity, respectively, were calculated for each radiological diagnosis as follows: thymoma 90% and 95.5%, hyperplasia 17.6% and 98.6%, and normal 96.9% and 60.8%. DISCUSSION Routine chest computed tomography and MRI can effectively identify thymoma. However, they are not reliable tools to differentiate between thymic hyperplasia and normal thymus in patients with MG. Muscle Nerve, 2018.
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Affiliation(s)
- Elzbieta Klimiec
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals, Headley Way Headington, Oxford, OX3 9DU, United Kingdom
| | - Mary Quirke
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals, Headley Way Headington, Oxford, OX3 9DU, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals, Headley Way Headington, Oxford, OX3 9DU, United Kingdom
| | - David Hilton-Jones
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals, Headley Way Headington, Oxford, OX3 9DU, United Kingdom
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Priola AM, Priola SM, Gned D, Giraudo MT, Veltri A. Nonsuppressing normal thymus on chemical-shift MR imaging and anterior mediastinal lymphoma: differentiation with diffusion-weighted MR imaging by using the apparent diffusion coefficient. Eur Radiol 2017; 28:1427-1437. [PMID: 29143106 DOI: 10.1007/s00330-017-5142-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/14/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To prospectively evaluate usefulness of the apparent diffusion coefficient (ADC) in differentiating anterior mediastinal lymphoma from nonsuppressing normal thymus on chemical-shift MR, and to look at the relationship between patient age and ADC. METHODS Seventy-three young subjects (25 men, 48 women; age range, 9-29 years), who underwent chemical-shift MR and diffusion-weighted MR were divided into a normal thymus group (group A, 40 subjects), and a lymphoma group (group B, 33 patients). For group A, all subjects had normal thymus with no suppression on opposed-phase chemical-shift MR. Two readers measured the signal intensity index (SII) and ADC. Differences in SII and ADC between groups were tested using t-test. ADC was correlated with age using Pearson correlation coefficient. RESULTS Mean SII±standard deviation was 2.7±1.8% for group A and 2.2±2.4% for group B, with no significant difference between groups (P=.270). Mean ADC was 2.48±0.38x10-3mm2/s for group A and 1.24±0.23x10-3mm2/s for group B. A significant difference between groups was found (P<.001), with no overlap in range. Lastly, significant correlation was found between age and ADC (r=0.935, P<.001) in group A. CONCLUSIONS ADC of diffusion-weighted MR is a noninvasive and accurate parameter for differentiating lymphoma from nonsuppressing thymus on chemical-shift MR in young subjects. KEY POINTS • SII cannot differentiate mediastinal lymphoma from nonsuppressing normal thymus at visual assessment • ADC is useful for distinguishing nonsuppressing normal thymus from mediastinal lymphoma • ADC is more accurate than transverse-diameter and surface-area in this discrimination • ADC of normal thymus is age dependent and increases with increasing age.
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Affiliation(s)
- Adriano Massimiliano Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
| | - Sandro Massimo Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Maria Teresa Giraudo
- Department of Mathematics, "Giuseppe Peano", University of Torino, Via Carlo Alberto 10, 10123, Torino, Italy
| | - Andrea Veltri
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
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Araki T, Yanagawa M, Sun F, Dupuis J, Nishino M, Yamada Y, Washko GR, Christiani DC, Tomiyama N, O’Connor GT, Hunninghake GM, Hatabu H. Pleural abnormalities in the Framingham Heart Study: prevalence and CT image features. Occup Environ Med 2017; 74:756-761. [PMID: 28468931 PMCID: PMC5701783 DOI: 10.1136/oemed-2016-104178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence of pleural abnormalities in the general population is an epidemiologically important index of asbestos exposure, which has not been investigated since a radiography-based study in 1980. METHODS We examined 2633 chest CT scans (mean 59.2 years, 50% female) from the Framingham Heart Study (FHS) for the presence and image characteristics of pleural plaques and diffuse pleural thickening. Demographics and pulmonary function were stratified by the presence of pleural abnormalities in association with interstitial lung abnormalities. RESULTS Pleural abnormalities were present in 1.5% (95% CI 1.1% to 2.1%). Pleural lesions were most commonly bilateral (90.0%), multiple (77.5%), calcified (97.5%) and commonly involved posterior (lower: 92.5%, middle: 87.5%), anterior (upper: 77.5%, middle: 77.5%) and diaphragmatic areas (72.5%). Participants with pleural abnormalities were significantly older (75.7 years, p <0.0001), male (92.5%, p <0.0001), former or current smokers (80.0%, p <0.001) with higher pack-years (33.3, p <0.0001). No significant reduction was noted in pulmonary function measures (p=0.07-0.94) when adjusted for the associated covariates, likely due to small number of cases with pleural abnormalities. Information about prior history of asbestos exposure and occupation was not available. CONCLUSIONS Pleural plaques and diffuse pleural thickening are present on CT in 1.5% of the FHS cohort. The current prevalence of the pleural abnormalities is smaller than that reported in the previous population-based study using chest radiography, likely representing lower asbestos exposure in recent decades. The posterior portion of the pleura is most frequently involved but the anterior portion is also commonly involved.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fangui Sun
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- The National Heart Lung and Blood Institute’s Framingham Heart Study, Framingham, MA
| | - Mizuki Nishino
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Yoshitake Yamada
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - George R. Washko
- The Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - David C. Christiani
- Department of Environmental Health, Harvard School of Public Health, Boston, MA
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - George T. O’Connor
- The National Heart Lung and Blood Institute’s Framingham Heart Study, Framingham, MA
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Gary M. Hunninghake
- The Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Haider U, Richards P, Gianoukakis AG. Thymic Hyperplasia Associated with Graves' Disease: Pathophysiology and Proposed Management Algorithm. Thyroid 2017; 27:994-1000. [PMID: 28578595 DOI: 10.1089/thy.2017.0086] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The association between Graves' disease (GD) and thymic hyperplasia (TH) was first described in 1912 and has been reported numerous times thereafter. TH associated with GD presents as an incidental mediastinal mass on chest X-ray or computed tomography (CT). The pathogenesis of TH in the setting of GD is unclear but seems to involve a complex interplay of hormonal and immunological mechanisms. SUMMARY Here, the effect that thyroid hormones and autoimmunity have on thymic growth and size is reviewed. The authors' experience, along with a review of published case reports, reveals that general physicians may be unfamiliar with this association. This lack of familiarity may result in an aggressive management course, including surgical intervention, along with its associated risks and costs. The differential diagnosis and diagnostic workup of thymic enlargement associated with GD is discussed in light of the available clinical evidence. CONCLUSION Recent literature confirms the generally benign nature of TH associated with GD, and supports a conservative approach for the diagnostic workup and initial management. Practical management recommendations for thymic enlargement associated with GD have been formulated and are presented here.
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Affiliation(s)
- Uzma Haider
- 1 Division of Endocrinology and Metabolism, Harbor-UCLA Medical Center , Torrance, California
- 2 David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Patrick Richards
- 1 Division of Endocrinology and Metabolism, Harbor-UCLA Medical Center , Torrance, California
- 2 David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Andrew G Gianoukakis
- 1 Division of Endocrinology and Metabolism, Harbor-UCLA Medical Center , Torrance, California
- 2 David Geffen School of Medicine at UCLA , Los Angeles, California
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Snyder PW, Everds NE, Craven WA, Werner J, Tannehill-Gregg SH, Guzman RE. Maturity-related Variability of the Thymus in Cynomolgus Monkeys (Macaca fascicularis). Toxicol Pathol 2016; 44:874-91. [PMID: 27226125 DOI: 10.1177/0192623316649258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Terminal body weights (TBWs), thymus weight parameters, and thymus morphology were retrospectively evaluated in 453 cynomolgus monkeys assigned to control groups on nonclinical toxicity studies. Morphology of bone, ovary, and testis/epididymis were used to determine maturity status of individual animals. There was no correlation between TBW and thymus weight (absolute and/or relative to TBW or brain weight). Thymus weight parameters and grades of decreased lymphocytes in the thymus were highly variable in immature animals compared to mature animals. There was also high (up to 11-fold) variability of thymus weight parameters within a given control group on the same study (generally 3 or 4 animals per sex). Several parameters evaluated had more pronounced age-related changes in males when compared to females. Our results demonstrate the inherent variability of thymus weight parameters and morphologic observations for cynomolgus monkeys on toxicology studies. Changes in thymus parameters in cynomolgus monkeys are unreliable indicators of immunomodulation or immunotoxicity in the absence of other relevant findings. Therefore, the thymus parameters commonly evaluated in preclinical safety assessments should not be the primary data set used to determine the presence of a direct test article-related effect on the immune system.
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Affiliation(s)
- Paul W Snyder
- Experimental Pathology Laboratories, West Lafayette, Indiana, USA
| | | | - W A Craven
- Amgen Inc., South San Francisco, California, USA
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