Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis

PURPOSE

To assess the diagnostic value of multiparametric magnetic resonance imaging (MRI) including dynamic Gd-EOB-DTPA-enhanced (DCE) and diffusion-weighted (DW) imaging for diagnosis and staging of hepatic fibrosis in primary sclerosing cholangitis (PSC) using transient elastography as a standard reference.

MATERIAL AND METHODS

Multiparametric MRI was prospectively performed on a 3.0-Tesla scanner in 47 patients (age 43.9±14.3 years). Transient elastography derived liver stiffness measurements (LSM), DCE-MRI derived parameters (hepatocellular uptake rate (Ki), arterial (Fa), portal venous (Fv) and total (Ft) blood flow, mean transit time (MTT), and extracellular volume (Ve)) and the apparent diffusion coefficient (ADC) were calculated. Correlation and univariate analysis of variance with post hoc pairwise comparison were applied to test for differences between LSM derived fibrosis stages (F0/F1, F2/3, F4). ROC curve analysis was used as a performance measure.

RESULTS

Both ADC and Ki correlated significantly with LSM (r= -0.614; p<0.001 and r= -0.368; p=0.01). The ADC significantly discriminated fibrosis stages F0/1 from F2/3 and F4 (p<0.001). Discrimination of F0/1 from F2/3 and F4 reached a sensitivity/specificity of 0.917/0.821 and 0.8/0.929, respectively. Despite significant inter-subject effect for classification of fibrosis stages, post hoc pairwise comparison was not significant for Ki (p>0.096 for F0/1 from F2/3 and F4). LSM, ADC and Ki were significantly associated with serum-based liver functional tests, disease duration and spleen volume.

CONCLUSION

DW-MRI provides a higher diagnostic performance for detection of hepatic fibrosis and cirrhosis in PSC patients in comparison to Gd-EOB-DTPA-enhanced DCE-MRI.

KEY POINTS

• Both ADC and hepatocellular uptake rate (Ki) correlate significantly with liver stiffness (r= -0.614; p<0.001 and r= -0.368; p=0.01). • The DCE-imaging derived quantitative parameter hepatocellular uptake rate (Ki) fails to discriminate pairwise intergroup differences of hepatic fibrosis (p>0.09). • DWI is preferable to DCE-imaging for discrimination of fibrosis stages F0/1 to F2/3 (p<0.001) and F4 (p<0.001).

Comparison of contrast-enhanced modified T1-weighted 3D TSE black-blood and 3D MP-RAGE sequences for the detection of cerebral metastases and brain tumours

OBJECTIVES

To compare a modified T1-weighted 3D TSE black-blood sequence with sub-millimetre resolution (T1-mVISTA) with a magnetization-prepared rapid gradient echo (MP-RAGE) sequence for the diagnosis of cerebral malignomas.

METHODS

Forty-six patients with known or suspected intracranial tumours and 15 control patients were included in this retrospective study. All patients underwent T1-mVISTA (0.75-mm isotropic resolution, 4:43 min) and MP-RAGE (0.8-mm isotropic resolution, 4:46 minutes) at 3-Tesla in random order after application of contrast agent. Two experienced radiologists determined the number of lesions. Maximum diameter, diagnostic confidence (DC), visual assessment of contrast enhancement (VCE) and CNRlesion/parenchyma were assessed for each lesion.

RESULTS

Significantly more lesions were detected with T1-mVISTA compared to the MP-RAGE (61 vs. 36; p < 0.05). Further, DC and VCE was rated significantly higher in the T1-mVISTA (p < 0.05 and p < 0.001). Mean CNRlesion/parenchyma was twofold higher for T1-mVISTA (24.2 ± 17.5 vs. 12.7 ± 11.5, p < 0.001). The 25 lesions detected only in T1-mVISTA were significantly smaller than those detected in both sequences (4.3 ± 3.7 mm vs. 11.3 ± 10.7 mm; p < 0.01).

CONCLUSIONS

T1-mVISTA increases the contrast of lesions significantly compared to MP-RAGE and might therefore improve detection rates of small lesions in early stages of disease.

KEY POINTS

• T1-mVISTA leads to significantly higher contrast-to-noise ratios of cerebral malignomas. • T1-mVISTA detects significantly more metastatic lesions compared to 3D-MPRAGE. • Lesions detected only by T1-mVISTA are smaller than those detected in both sequences. • Diagnostic confidence is significantly higher for lesions detected by T1-mVISTA. • Application of T1-mVISTA might be of high relevance in early stages of disease.

Mono- and dinuclear platinum(II) compounds with 5,7-dimethyl-1,2,4-triazolo[1,5-a]pyrimidine. Structure, cytotoxic activity and reaction with 5'-GMP

Mono- and dinuclear platinum(II) coordination compounds of formula cis-[PtCl(2)(NH(3))(dmtp)], 1, cis-[PtCl(2)(dmtp)(2)], 2 and {H(+)[C(28)H(32)Cl(2)N(16)Pt(2)](2+)(NO(3))(3)(H(2)O)(6)}, 3, in which dmtp is 5,7-dimethyl-1,2,4-triazolo[1,5-a]pyrimidine have been synthesized and characterized by infrared and by (1)H, (13)C, (195)Pt NMR spectroscopy. The coordination units of the cationic species of formula [Pt(2)(mu-dmtp)(2)Cl(2)(dmtp)(2)](2+) are built up by two platinum atoms in a square-planar environment. Two sites are occupied by two 5,7-dimethyl-1,2,4-triazolo[1,5-a]pyrimidine (dmtp) bridging ligands which are linked to both metal atoms through their nitrogen atoms in positions 3 and 4. The other two positions are occupied by one monodentate 5,7-dimethyl-1,2,4-triazolo[1,5-a]pyrimidine (dmtp) molecule and a coordinated chloride. This compound is the first in which the same triazolopyrimidine ligand (dmtp) coordinates to a metal ion in two different ways, i.e. bridging bidentate and non-bridging monodentate. In addition, the interaction of compounds 1 and 2 with 5'-GMP was investigated in solution by (1)H NMR spectroscopy. The cytotoxicity of all the new platinum(II) compounds were studied by using two different cell lines: T47D (breast cancer) and HCV29T (bladder cancer).

(S)-6-Methyl-∊-caprolactone

The chiral title compound, C₇H₁₂O₂, a lactone derivative, features a seven-membered ring that adopts a chair conformation. The crystal structure is stabilized by weak C—H⋯O inter­actions occurring in the (100) plane. The absolute configuration was assigned on the basis of the enantioselective synthesis.

(4aS,5R,7R,8S,8aR)-8-(1,3-Dioxolan-2-yl)-7,8-dimethyl-5-(1-methyl-ethen-yl)perhydro-naphthalen-2-one

In the chiral title compound, C(18)H(28)O(3), the two six-membered rings of the perhydronaphthalenone adopt a rigid chair-chair conformation and the five-membered dioxolanyl ring adopts an envelope conformation. The crystal structure is stabilized only by weak inter-actions.

The synthesis, chemical and biological properties of dichlorido(azpy)gold(III) chloride (azpy=2-(phenylazo)pyridine) and the gold-induced conversion of the azpy ligand to the chloride of the novel tricyclic pyrido[2,1-c][1,2,4]benzotriazin-11-ium cation

A new Au(III) coordination compound with the ligand 2-(phenylazo)pyridine has been synthesized and fully characterized by means of elemental analysis, IR, UV-visible, conductivity measurements, NMR, electrospray ionization (ESI-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES). The chemical stability of the cation in this compound, [Au(azpy)Cl(2)](+) (abbreviated: Au-azpy), was analyzed by means of several physicochemical methods. While stable in the solid state, stability studies performed with the gold compound in solution showed an unexpected and unprecedented reactivity. A cationic organic derivative of 2-(phenylazo)pyridine, (abbreviated: pyrium), was produced from the solution and has been isolated as its chloride salt and characterized by crystal structure determination, elemental analysis, NMR, ESI-MS and conductivity studies in solution. This cyclization reaction is reported for the first time in the case of gold coordination compounds. The Au adduct and the pyrium cation were investigated as potential cytotoxic and anticancer agents, and both show moderate to high cytotoxic properties in cisplatin-sensitive and cisplatin-resistant ovarian carcinoma cell lines, A2780; and cisplatin-sensitive and cisplatin-resistant murine lymphocytic leukemia cell lines, L1210. Significant anticancer activity against the cisplatin resistant cell lines was found for the pyrium salt, ruling out the occurrence of cross resistance phenomena.

Monitoring of gustatory stimulation of salivary glands by diffusion-weighted MR imaging: comparison of 1.5T and 3T

BACKGROUND AND PURPOSE

Our aim was to compare different field strengths monitoring physiologic changes due to oral stimulation of parotid glands by using diffusion-weighted (DW) echo-planar imaging (EPI).

MATERIALS AND METHODS

Twenty-seven healthy volunteers were examined with a DW-EPI sequence at 1.5T and 3T before and after oral stimulation with commercially available lemon juice. The b factors used were 0, 500, and 1000 s/mm(2). Apparent diffusion coefficient (ADC) maps were evaluated with a manually placed region of interest including the entire parotid gland. For comparison of results, a Student t test was used on the basis of the mean of the volunteer median values. To compare both field strengths, we calculated the Pearson correlation coefficient (r).

RESULTS

DW-EPI MR imaging visualized the parotid glands of all volunteers. With 1.5T, the mean ADC before stimulation was 1.12 x 10(-3) mm(2)/s +/- 0.08 x 10(-3) mm(2)/s. After stimulation with lemon juice, the ADC increased to 1.18 x 10(-3) mm(2)/s +/- 0.09 x 10(-3) mm(2)/s. For 3T, the ADC before stimulation was 1.14 x 10(-3) mm(2)/s +/- 0.04 x 10(-3) mm(2)/s, with an increase to 1.17 x 10(-3) mm(2)/s +/- 0.05 x 10(-3) mm(2)/s after stimulation. For both field strengths, the increase in ADC after stimulation was significant (P < .001). High correlations between both field strengths were found pre- and poststimulation (r = 0.955, and 0.936, respectively).

CONCLUSION

DW-EPI MR imaging allows monitoring of physiologic changes due to oral stimulation of parotid glands by using DW imaging with high correlation between 1.5T and 3T.

Structural Elucidation of Dendritic Host–Guest Complexes by X-ray Crystallography and Molecular Dynamics Simulations

The multiple monovalent binding of adamantyl-urea poly(propyleneimine) dendrimers with carboxylic acid-urea guests was investigated using molecular dynamics simulations and X-ray crystallography to better understand the structure and behavior of the dynamic multivalent complex in solution. The results from the two methods are consistent and suggest a preferred molecular picture of this complicated aggregate of multiple components. The guest molecules can bind to the dendrimer in a variety of ways although most involve hydrogen-bonding interactions between urea groups of the dendrimer with urea and/or carboxylic acid groups of the guest. In addition, acid-base interactions between the carboxylic acid of the guest and the tertiary amine in the interior of the dendritic host are present. Our proposed structure gives important information about the predominant dynamic interactions between the host and guest and illustrates how they fit together and interact with each other.

Study on the isomerism in meso-amavadin and an amavadin analogue

An X-ray crystallographic study of 'meso-amavadin' revealed that in the crystal the negatively charged anionic species of the title compound join into infinite hydrogen-bonded chains, counterbalanced by cationic hydronium species. Along with water of crystallization a three-dimensional hydrogen-bonded network is formed. Based on NMR- and X-ray data of amavadin and 'meso-amavadin', a model was developed that accounts for the structure of amavadin-type complexes, i.e. vanadium(IV) non-oxo complexes that contain two ligands with a tridentate N-hydroxyiminodiacetate backbone. The model describes the different arrangements of the two ligands around the vanadium and it accounts for eventual symmetry in the complex. The model was used for the interpretation of NMR-data of an amavadin analogue with a benzyl group at the ligand backbone.

Novel Linear Transition Metal Clusters of a Heptadentate Bis-β-diketone Ligand

The synthesis and the structure of the new potentially heptadentate ligand 1,3-bis-(3-oxo-3-(2-hydroxyphenyl)-propionyl)-2-methoxybenzene (H5L) is described. The reaction in pyridine or DMF of this ligand with various M(AcO)2 salts (M = NiII, CoII, MnII) leads to very different products depending on the metal. Thus, the dinuclear complexes [M2(H3L)2(py)4] (M = NiII, 1; CoII, 2) or the linear zigzag tetranuclear clusters [Mn4(H2L)2(AcO)2(py)5] (3) and [Mn4(H2L)2(AcO)2(dmf)4] (4) have been synthesized and characterized crystallographically. Slow oxidation of complex 3 leads to the formation of the novel mixed-valence linear complex [Mn3(HL)2(py)6] (5), displaying an unprecedented asymmetric MnIIIMnIIIMnII topology. The coordination geometry of complexes 1 to 5 has been analyzed and discussed by means of continuous shape measures. Magnetic measurements of 3 and 5 demonstrate that the metals within these complexes weakly interact magnetically with coupling constants of J1 = -1.13 cm-1 and J2 = -0.43 cm-1 (S = 0) for complex 3 and J1 = -5.4 cm-1 and J2 = -0.4 cm-1 (S = 5/2) for complex 5 (using the H = -Sigma2JijSiSj convention). These results are consistent with X-band EPR measurements on these compounds.

A new, easily recyclable arylating agent based on a diphosphino-digold(i) complex

The synthesis of two organogold(I) complexes, [(Au(NCN))2(dppbp)] (6) and [(Au(Phebox))2(dppbp)] (9), and their application in subsequent transmetalating reactions are described. A trinuclear organogold(I) complex, [(AuCl)3(tdpppb)] (4) is also reported, which exhibits a surprisingly high solubility in dichloromethane. It was found that 6 and 9 can cleanly transfer the anionic NCN-([C(6)H(3)(CH(2)NMe(2))2-2,6]-) or Phebox-([2,6-bis(oxazolinyl)phenyl]-) moiety to Ti(IV) and Pd(II) centers, respectively. The coproduct [(AuCl)2(dppbp)] (3, dppbp is [4-Ph(2)PC(6)H(4)]2 (1)) formed during this transmetalation reaction, precipitates almost quantitatively from the reaction mixture (toluene) and can thus be separated by simple filtration. In comparison, [AuCl(PPh3)], formed as the coproduct in the transmetalation reaction of [Au(NCN)(PPh3)] with metal salts, has a higher solubility in apolar solvents and thus is more difficult to separate from the resultant organometallic complex. Digold complex 6 has been characterized by NMR spectroscopy and crystallographic analyses. These analyses show that the two gold units are essentially independent. The formation of a dimetallic transmetalating agent based on gold(I) had no effect on its transmetalating properties.

Platinum-catalyzed hydroformylation of terminal and internal octenes

A brief historic overview of Pt/Sn-catalyzed hydroformylation as well as recent advances in the hydroformylation of internal alkenes is provided. This serves as background for the results obtained with the [Pt(Sixantphos)Cl(2)] system, for which the molecular structure and the spectroscopic data are described. Insitu UV/Vis-spectroscopic studies have revealed rapid formation of the corresponding Pt-stannate complex upon reaction with SnCl(2), whereas high-pressure insitu IR-spectroscopy showed formation of a Pt-CO species and a short-lived Pt-H species under syngas, as well as rapid evolution of aldehyde product upon addition of 1-octene to the preformed catalyst in the IR autoclave. The hydroformylation of 1-octene and the i-octenes has been performed. For the internal alkenes, selective tandem isomerization/hydroformylation towards n-nonanal is observed with this catalyst system.

Bis[bis(2-pyridylcarbonyl)aminato]iron(III) perchlorate acetonitrile disolvate

The title compound, [Fe(C12H8N3O2)2]ClO4.2C2H3N, contains Fe(III) in a distorted octahedral coordination environment, with the Fe-N(pyridine) bonds significantly longer than the Fe-N(amine) bonds. The crystal packing involves a bifurcated C-H...(O,O) contact that is also found in all other [M(C12H8N3O2)2] complexes reported previously.

High-Nuclearity Manganese and Iron Complexes with the Anionic Ligand Methyl Salicylimidate

The three novel clusters [Mn6O4(OMe)2(OAc)4(Mesalim)4] (3), [Mn8O2(OH)2(OMe)12(OAc)2(Mesalim)4] (4), and [Fe10O4(OMe)14Cl2(Mesalim)6] (5) have been synthesized from a simple bidentate ligand HMesalim (HMesalim = methyl salicylimidate). Starting from the mononuclear complex [Mn(Mesalim)2(OAc)(MeOH)].MeOH (1), either the hexanuclear complex 3 or the octanuclear complex 4 is obtained after recrystallization, depending upon the reaction conditions and solvents used. Similarly, starting from the purple-colored mononuclear complex [Fe(Mesalim)2Cl] (2), the orange-colored decanuclear iron(III) cluster 5 has been obtained upon recrystallization from methanol. Complex 3, which could also be prepared directly from manganese acetate and the ligand, has a face-sharing double-cubane [Mn6O6] core, unique in transition metal chemistry. Compounds 4 and 5 are composed of [M3O4] partial cubanes. All complexes belong to a class of oxo-bridged cubic close-packed molecular clusters resembling the metal oxide/hydroxide ores. Complex 4 exhibits intramolecular ferromagnetic interactions, as evidenced from dc magnetic susceptibility studies (1.8-300 K), resulting in a high-spin ground state, probably with S(T) = 8. Complex 4 displays single molecule magnet behavior as indicated by frequency and temperature dependences of its ac susceptibility. An Arrhenius plot gave relatively large experimental activation energy of 36.0 K. The magnetic properties of complexes 3 and 5 are dominated by antiferromagnetic interactions leading to zero-spin ground states.

The use of a surgical sealant (CoSeal) in cardiac and vascular reconstructive surgery: an economic analysis

AIM

We designed a study to estimate the economic impact of CoSeal Surgical Sealant for the prevention of anastomotic bleeding in cardiac and vascular surgery. We also explored the potential economic value of CoSeal as a means of inhibiting the formation of pericardial tissue adhesions.

METHODS

A Delphi panel of 6 expert vascular and cardiac surgeons provided the assumptions and estimates needed to develop a decision analysis model to assess the impact of sealant on the costs associated with low- and high-risk forms of cardiac (valve replacement/reconstruction) and vascular (abdominal aortic aneurysm [AAA] repair, femoral bypass grafting) surgery. The primary outcome was incremental cost per patient.

RESULTS

For valve repair/replacement surgery, sealant was expected to confer cost-savings in high-risk but not low-risk procedures. Predicted cost savings for high-risk AAA repairs were substantial, but minimal in the overall AAA group. Cost-savings were predicted for sealant use in all femoral-popliteal ePTFE bypass grafts, but in high-risk femoral-femoral ePTFE bypass grafts only.

CONCLUSIONS

According to our decision analysis model, routine use of surgical sealant in select subgroups may confer considerable economic benefits to health service budgets. Future research should aim at testing this model in a real-world hospital setting. Assessment of the value of CoSeal in the prevention of postsurgical adhesions showed that expert surgeons see a need for effective prophylaxis. Further research into the clinical and economic benefit of this intervention is required.