Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Combined clinical significance of MRI and serum mannose-binding lectin in the prediction of spinal tuberculosis

BACKGROUND

Spinal tuberculosis (STB) is a local manifestation of systemic infection caused by Mycobacterium tuberculosis, accounting for a significant proportion of joint tuberculosis cases. This study aimed to explore the diagnostic value of MRI combined with mannose-binding lectin (MBL) for STB.

METHODS

124 patients suspected of having STB were collected and divided into STB and non-STB groups according to their pathological diagnosis. Serum MBL levels were measured using ELISA and a Pearson analysis was constructed to determine the correlation between MBL and STB. ROC was plotted to analyze their diagnostic value for STB. All the subjects included in the study underwent an MRI.

RESULTS

The sensitivity of MRI for the diagnosis of STB was 84.38% and specificity was 86.67%. The serum MBL levels of the patients in the STB group were significantly lower than the levels in the non-STB group. ROC analysis results indicated that serum MBL's area under the curve (AUC) for diagnosis of STB was 0.836, with a sensitivity of 82.3% and a specificity was 77.4%. The sensitivity of MRI combined with MBL diagnosis was 96.61%, and the specificity was 92.31%, indicating that combining the two diagnostic methods was more effective than using either one alone.

CONCLUSIONS

Both MRI and MBL had certain diagnostic values for STB, but their combined use resulted in a diagnostic accuracy than either one alone.

T1-Weighted, Dynamic Contrast-Enhanced MR Perfusion Imaging Can Differentiate between Treatment Success and Failure in Spine Metastases Undergoing Radiation Therapy

BACKGROUND AND PURPOSE

Current imaging techniques have difficulty differentiating treatment success and failure in spinal metastases undergoing radiation therapy. This study investigated the correlation between changes in dynamic contrast-enhanced MR imaging perfusion parameters and clinical outcomes following radiation therapy for spinal metastases. We hypothesized that perfusion parameters will outperform traditional size measurements in discriminating treatment success and failure.

MATERIALS AND METHODS

This retrospective study included 49 patients (mean age, 63 [SD, 13] years; 29 men) with metastatic lesions treated with radiation therapy who underwent dynamic contrast-enhanced MR imaging. The median time between radiation therapy and follow-up dynamic contrast-enhanced MR imaging was 62 days. We divided patients into 2 groups: clinical success (n = 38) and failure (n = 11). Failure was defined as PET recurrence (n = 5), biopsy-proved (n = 1) recurrence, or an increase in tumor size (n = 7), while their absence defined clinical success. A Mann-Whitney U test was performed to assess differences between groups.

RESULTS

The reduction in plasma volume was greater in the success group than in the failure group (-57.3% versus +88.2%, respectively; P < .001). When we assessed the success of treatment, the sensitivity of plasma volume was 91% (10 of 11; 95% CI, 82%-97%) and the specificity was 87% (33 of 38; 95% CI, 73%-94%). The sensitivity of size measurements was 82% (9 of 11; 95% CI, 67%-90%) and the specificity was 47% (18 of 38; 95% CI, 37%-67%).

CONCLUSIONS

The specificity of plasma volume was higher than that of conventional size measurements, suggesting that dynamic contrast-enhanced MR imaging is a powerful tool to discriminate between treatment success and failure.

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.

Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective

Conventional magnetic resonance imaging (MRI) remains the modality of choice to image bone marrow. However, the last few decades have witnessed the emergence and development of novel MRI techniques, such as chemical shift imaging, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and whole-body MRI, as well as spectral computed tomography and nuclear medicine techniques. We summarize the technical bases behind these methods, in relation to the common physiologic and pathologic processes involving the bone marrow. We present the strengths and limitations of these imaging methods and consider their added value compared with conventional imaging in assessing non-neoplastic disorders like septic, rheumatologic, traumatic, and metabolic conditions. The potential usefulness of these methods to differentiate between benign and malignant bone marrow lesions is discussed. Finally, we consider the limitations hampering a more widespread use of these techniques in clinical practice.

Early diagnosis of spinal tuberculosis by magnetic resonance: perfusion weighted imaging in a rabbit model

BACKGROUND

This study aimed to analyze the application value of magnetic resonance (MR)-perfusion weighted imaging (PWI) in the early imaging diagnosis of rabbit spinal tuberculosis.

METHODS

Spinal tuberculosis model was established using ATCC25177 Mycobacterium tuberculosis strain in the lumbar spine of rabbits. Forty rabbits were divided into 2 groups: rabbits in the experiment group were injected with 0.2 ml of 5.0 mg/ml tuberculosis suspension (n = 30) and those in the control group were injected with 0.2 ml of normal saline (n = 10) after vertebrae drilling surgery. Routine MRI and MR-PWI were performed at 4, 6, and 8 weeks after surgery. The statistical difference in terms of perfusion parameter values in the early MR-PWI scan of spinal tuberculosis between two groups was analyzed. The receiver operating characteristic (ROC) curve analysis was conducted for the accuracy of MR-PWI parameters in the early diagnosis of spinal tuberculosis.

RESULTS

Except time to peak, the other perfusion parameters in the experiment group were all increased with time. In addition, the difference between the two groups, as well as the differences at each time point was statistically significant (all P < 0.05). First-pass enhancement rate (Efirst), early enhancement rate (Ee), peak height (PH), maximum slope of increase (MSI), maximum signal enhancement rate (Emax) and signal enhancement rate (SER) showed high values in early diagnosing spinal tuberculosis.

CONCLUSION

The parameters including Efirst, Ee, PH, MSI, Emax and SER may provide valuable imaging evidence for the early diagnosis of spinal tuberculosis in clinical application.

Dynamic contrast-enhanced magnetic resonance perfusion volumetrics can differentiate tuberculosis of the spine and vertebral malignancy

BACKGROUND

There is considerable overlap in radiologic features of tubercular and malignant spinal lesions on conventional magnetic resonance imaging (MRI).

PURPOSE

To evaluate the role of dynamic contrast-enhanced (DCE) MRI perfusion parameters in differentiating vertebral malignancy from spinal tuberculosis.

MATERIAL AND METHODS

This was a prospective study and we enrolled consecutive patients presenting with a clinical/radiologic evidence of vertebral lesions. DCE-MRI of the spine was performed using 3D volume interpolated breath-hold examination (VIBE) sequence after intravenously injecting 0.1 mmol/kg body weight of gadopentetate dimeglumine. We used Tofts model to calculate DCE parameters that included K^trans (transfer constant), k_ep (rate constant), v_e (fractional volume of extracellular extravascular space), and iAUC (initial area under the curve). We compared the mean value of each perfusion parameter by type of lesion (tubercular/malignant) at 0.05 significance level and performed receiver operating characteristic curve analysis.

RESULTS

We could confirm histologic/cytologic diagnosis in 35 of the 45 patients recruited. Of these, 19 were tubercular and 16 were malignant lesions. The mean (± standard deviation) of k_ep (min^-1) was significantly higher (2.89 ± 3.3) in malignant compared to tubercular lesions (0.81 ± 0.19), whereas v_e was significantly lower in malignant (0.27 ± 0.13 mL/g) compared to benign lesions (0.47 ± 0.12 mL/g) at 0.05 significance level. k_ep cutoff of ≥1.17 min^-1 had a sensitivity of 93.8% and specificity of 100% with a diagnostic accuracy of 94.4% in detecting malignant disease.

CONCLUSION

High k_ep is the single best predictor of malignant vertebral lesions. We recommend k_ep cutoff value of ≥1.17 min^-1 that has high diagnostic accuracy in identifying malignant lesions.

Magnetic Resonance Image under Variable Model Algorithm in Diagnosis of Patients with Spinal Metastatic Tumors

The aim of this study was to explore the adoption of the variable model algorithm in magnetic resonance imaging (MRI) image analysis and evaluate the effect of the algorithm-based MRI in the diagnosis of spinal metastatic tumor diseases. 100 patients with spinal metastatic tumors who were treated in hospital were recruited as the research objects. All patients were randomly divided into the experimental group (MRI image analysis based on variable model) and the control group (conventional MRI image diagnosis), and the MRI of the experimental group was segmented using the conventional algorithm with variable model and the improved algorithm with GVF force field. The accuracy index (Dice coefficient D) values were used to evaluate the vertebral segmentation effect of the improved variable model algorithm with the introduction of GVF force field, and the recognition rate, sensitivity, and specificity indexes were used to evaluate the effects of the two algorithms on the recognition of MRI image features of spinal metastatic tumors. The results showed that the mean D value of the variable model improvement algorithm for the segmentation of five vertebrae of spinal metastatic tumors was significantly improved relative to the conventional variable model algorithm, and the difference was statistically significant (P < 0.05). At the number of 80 iterations, the recognition rate, sensitivity, and specificity of MRI image segmentation of the traditional variable model algorithm processing group were 89.32%, 74.88%, and 86.27%, respectively, while the recognition rate, sensitivity, and specificity of MRI image segmentation of the variable model improvement algorithm processing group were 97.89%, 96.75%, and 96.45%, respectively. The results of the latter were significantly better than those of the former, and the differences were statistically significant (P < 0.05); and the comparison of MRI images showed that the variable model improvement algorithm was more rapid and accurate in identifying the focal sites of patients with spinal metastases. The accuracy of MRI images based on the variable model algorithm increased from 69.5% to 92%, and the difference was statistically significant (P < 0.05). In short, MRI image analysis based on the variable model algorithm had great adoption potential in the clinical diagnosis of spinal metastatic tumors and was worthy of clinical promotion.

Endostar Rebuilding Vascular Homeostasis and Enhancing Chemotherapy Efficacy in Cervical Cancer Treatment

Background

The incidence rate of cervical cancer is the highest in the reproductive tract and is not sensitive to chemotherapy. An appropriate amount of anti-angiogenic agents can reconstruct tumor blood vessels in a short period of time and form vascular homeostasis, increase the function of blood vessel perfusion and reverse the multidrug resistance of chemotherapy, which is also called “vascular normalization.” Endostar (a recombinant human endostatin) was developed by China and as a multi-target anti-angiogenesis agent. Many reports about endostar involved the treatment of non-small cell lung cancer, fewer reports are on cervical cancer.

Purpose

To determine whether endostar can rebuild tumor vascular homeostasis and enhance chemotherapy effects for patients with cervical cancer.

Methods

In this study, the patients with cervical cancer within stage IIB2 were selected, endostar combined with cisplatin+paclitaxel neoadjuvant chemotherapy (NACT) before radical surgical operation was adopted, patients outcome and adverse reaction were followed up. The changes of tumor vascular structure and perfusion function before and after endostar given were evaluated by histopathology and dynamic contrast-enhanced magnetic resonance imaging (DEC-MRI). VEGF-Notch signal pathway was detected for the regulating mechanism of vascular proliferation in different groups. GraphPad Prism 6 software was used for statistical analysis of the study results.

Results

Endostar enhanced the short-term (2 year) overall survival (OS), progression-free survival (PFS) rates for cervical cancer patients. All the same, endostar increased long-term (5 year) OS for cervical cancer patients. Endostar therapy exhibited with mild adverse reaction. MRI showed endostar+NACT further reduce tumor volume than NACT alone. The parameters of Ktrans, Ve for DEC-MRI in endostar group exhibited obviously increase than NACT group. Tumor vascular maturation index α-SMA/CD31 in endostar group increased obviously than NACT group, correspondingly Ki67 staining for tumor proliferative rates, lymphovascular space invasion in endostar group further declined than NACT group. The genes and proteins expression of VEGFR2, Notch1, Notch4, Dll4, Jag1 were obviously downregulated in endostar group comparing to NACT group.

Conclusion

Endostar restored vascular homeostasis in cervical cancer temporarily, enhanced chemotherapeutic agents effects in cervical cancer, increased patient OS ratio. Endostar+NACT treatment may provide a new target therapy for cervical cancer.

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Clinical value of high-resolution dynamic contrast-enhanced (DCE) MRI in diagnosis of cutaneous squamous cell carcinoma

BACKGROUND

While uncomplicated cases of skin squamous cell carcinoma (cSCC) can be treated with surgery topical therapy alone, more objective and non-invasive examination methods are needed to guide clinicians to make more detailed biopsy and surgical plans for lesions with atypical or subcutaneous growth. High-resolution magnetic resonance imaging (HR-MRI) is a novel skin imaging method.

MATERIALS AND METHODS

Prospective collection of 19 patients with clinically suspected cSCC. All patients underwent high-resolution DCE-MRI using a 70-mm microscopy coil before operation. The imaging features and results of surgical pathology were recorded. K^trans , K_ep , V_e values, and the time-signal curve (TIC) types were determined using DCE images.

RESULTS

16 cases of cSCC, 3 cases of acanthoma. The subcutaneous invasion of all lesions was clearly displayed, of which 8 lesions invaded the subcutaneous fat layer, 5 invaded the muscle layer, 1 invaded the periosteum, 2 invaded the cap fascia, and the layer of all lesions invasion judged by HR-MR imaging was consistent with the postoperative pathology. The main manifestations of cSCC were ill-defined margin, obvious inhomogeneous enhancement, higher perfusion parameters value and type-III TIC, while acanthoma showed well-defined and type-I TIC. Some imaging findings (such as boundary, enhancement) and DCE perfusion parameters of the two groups overlap.

CONCLUSION

High-resolution DCE-MRI can fully and directly display the subcutaneous invasion of cSCC, and more work needs to be done to prove its value. Next, we will expand the sample size, and further explore its value in the differential diagnosis and prognosis evaluation of cSCC from acanthoma or other skin tumors.