A simple, clinically usable whole-body MRI system of joint assessment in adolescents and young people with juvenile idiopathic arthritis

OBJECTIVES

To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice.

METHODS

The proposed system utilises post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint.

RESULTS

The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 were 80-90% and 75-90% respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive.

CONCLUSION

The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA.

Detection of inflammation by whole-body MRI in young people with juvenile idiopathic arthritis

OBJECTIVES

To assess the frequency of joint inflammation detected by whole-body MRI (WBMRI) in young people (YP) with JIA and controls, and to determine the relationship between WBMRI-detected inflammation and clinical findings.

METHODS

YP aged 14-24 years, with JIA (patients) or arthralgia without JIA (controls), recruited from one centre, underwent a WBMRI scan after formal clinical assessment. Consensus between at least two of the three independent radiologists was required to define inflammation and damage on WBMRI, according to predefined criteria. YP with JIA were deemed clinically active as per accepted definitions. The proportions of YP with positive WBMRI scans for joint inflammation (≥1 inflamed joint) as well as serum biomarkers were compared between active vs inactive JIA patients and controls.

RESULTS

Forty-seven YP with JIA (25 active and 22 inactive patients) and 13 controls were included. WBMRI detected joint inflammation in 60% (28/47) patients with JIA vs 15% (2/13) controls (difference: 44%, 95% CI 20%, 68%). More active than inactive JIA patients had WBMRI-detected inflammation [76% (19/25) vs 41% (9/22), difference: 35% (95% CI 9%, 62%)], and this was associated with a specific biomarker signature. WBMRI identified inflammation in ≥ 1 clinically inactive joint in 23/47 (49%) patients (14/25 active vs 9/22 inactive JIA patients).

CONCLUSIONS

WBMRI's validity in joint assessment was demonstrated by the higher frequency of inflammation in JIA patients vs controls, and in active vs inactive JIA patients. WBMRI found unsuspected joint inflammation in 49% YP with JIA, which needs further investigation of potential clinical implications.

Contemporary imaging of inguinal hernia and pain

Inguinal hernias are the commonest type of hernia, and are frequently encountered by general, abdominal and musculoskeletal radiologists. Such hernias may cause discomfort or pain; but many other conditions may cause pain in a similar location, meaning it is not always straightforward to determine the underlying cause of a particular patient’s symptoms. Although surgical fixation of hernia has high success rates with low recurrence, ongoing symptoms are common after apparently uncomplicated surgery. In particular, post-surgical chronic groin pain can be highly problematic in some patients. In this review, we highlight the relevant surgical and imaging anatomy, common modes of clinical presentation, contemporary surgical approaches to the repair of inguinal hernia, imaging techniques to diagnose such hernias in both unoperated and operated groins and mimics of hernia-related pain.

Transvaginal ultrasound-guided aspiration of an anterior sacral meningocele masquerading as a hydrosalpinx, resulting in abscess formation

Anterior sacral meningoceles (ASMs) have a recognized association with a number of connective tissue disorders, including Marfan’s syndrome, neurofibromatosis Type 1 and Ehlers–Danlos syndrome. We present the case of a patient with Marfan’s syndrome and ASMs who was referred to gynaecology owing to dysmenorrhoea and left-sided pelvic pain radiating to the left leg. A transvaginal ultrasound scan (TVUS) detected a left pelvic cystic tubular structure, attributed to a hydrosalpinx, which, in retrospect, likely corresponded to the ASM. The patient went on to have TVUS-guided drainage of this cystic structure, resulting in an ASM abscess. It is difficult to distinguish ASM from the vastly more common hydrosalpinx using TVUS alone, and in patients with an atypical appearing posteriorly positioned cystic pelvic lesion or in the presence of underlying conditions known to be associated with ASMs, MRI should be considered before any interventional procedure to drain the suspected hydrosalpinx transvaginally. The patient was successfully treated using a minimally invasive CT-guided posterior trans-sacral drainage technique.

Embolization of the internal iliac artery before EVAR: is it effective? Is it safe? Which technique should be used?

PURPOSE

To assess the clinical outcomes of internal iliac artery (IIA) embolization before endovascular aneurysm repair (EVAR).

METHODS

Between 2002 and 2011, 88 patients underwent IIA embolization prior to EVAR. Sixty-five patients underwent unilateral and 23 underwent bilateral IIA embolization. A total of 111 IIAs were embolized: 56 were embolized with coils, 41 with Amplatzer plugs, and 14 with a combination of embolic agents. The outcomes were assessed retrospectively by reviewing medical records and follow-up imaging.

RESULTS

IIA embolization was technically successful in 95.7% of cases. Type 2 endoleak from previously embolized IIAs was seen in 4 cases, and in 1 case this was significant necessitating re-intervention. Buttock claudication was reported in 38% of cases, whereas new onset erectile dysfunction occurred in 10% of cases. No severe ischemic complications, such as spinal cord ischaemia or buttock necrosis, were reported. Analysis comparing unilateral versus bilateral embolization, simultaneous versus sequential embolization, and the type of embolic material used showed no statistical significance.

CONCLUSION

IIA embolization is technically successful and effective in preventing significant type 2 endoleak in the majority of cases. It is a relatively safe procedure without major complications, but the incidence of buttock claudication and erectile dysfunction remain relatively high, and patients should be consented appropriately. There is no significant benefit for adopting a particular embolization technique, but there is a tendency towards reduced pelvic ischaemia with proximal embolization. Four cases of type II endoleak occurring after technically successful IIA embolization supports the school of thought that IIA should be embolized prior to coverage and extension of the distal landing zone.

Different models for evaluation of growth traits and Kleiber ratio in an experimental flock of Iranian fat-tailed Afshari sheep

Records for Afshari sheep were retrieved from data collected between 2000 and 2005 at the Zanjan University experimental flock, at Zanjan, Iran. (Co)variance components and corresponding genetic parameters for birth weight (BW), weaning weight (WW), 6-month weight (W6), average daily gain from birth to weaning (ADGa), from birth to 6 months (ADGb), from weaning to 6 months (ADGc), Kleiber ratio at weaning (WWKR) and Kleiber ratio at 6 months of age (W6KR) were estimated using univariate and bivariate analyses by the DFREML procedure. The Kleiber ratio, defined as growth rate/metabolic weight, has been suggested to be a useful indicator of growth efficiency and an indirect selection criterion for feed conversion. Estimates of direct heritability (h(2)) were 0.23, 0.27, 0.11, 0.22, 0.07, 0.01, 0.13 and 0.06 for BW, WW, W6, ADGa, ADGb, ADGc, WWKR and W6KR, respectively. Maternal genetic effects represented a relatively large proportion of the total phenotypic variance for BW (m(2) = 0.22), whereas maternal permanent environmental effects were significant for W6 (c(2) = 0.15), ADGb (c(2) = 0.16), ADGc (c(2) = 0.14) and W6KR (c(2) = 0.16). Results of bivariate analyses indicated the variable genetic correlations between traits. The largest positive genetic relationships were between adjacent measurements. The moderate estimates of h(2) for early growth traits indicate that in Afshari sheep faster genetic improvement through selection is possible for these traits. In order to increase the efficiency of feed conversion, use of Kleiber ratio in selection programmes was recommended.

Kinetics studies on the lignan class of natural compounds that inhibits alpha-chymotrypsin

The mechanism of inhibition of the alpha-chymotrypsin enzyme by two lignans of the fused bistetrahydrofuran series, epiexcelsin (1) and 5'-demethoxyepiexcelsin (2), which were isolated from the Commiphora mukul Engl., was investigated. Lineweaver-Burk and Dixon plots and their secondary replots showed that these compounds were noncompetitive inhibitors of the enzyme. K(i) values for 1 and 2 were found to be 22.29 +/- 0.015 and 336.30 +/- 0.053 microM, respectively.

An investigation of the kinetic and anti-angiogenic properties of plant glycoside inhibitors of thymidine phosphorylase

We investigated the potential of symplocomoside (1) and symponoside (2), glycosides isolated from the bark of Symplocos racemosa to inhibit thymidine phosphorylase (TP) activity and associated angiogenesis. Compound 1 was a reversible, noncompetitive inhibitor of deoxythymidine binding to TP (IC(50) = 65.45 +/- 5.08 microM; K(i) = 62.83 +/- 2.10 microM) and 2 was a reversible, uncompetitive inhibitor (IC(50) = 94.17 +/- 4.05 microM; K(i) = 101.95 +/- 1.65 microM). Molecular modeling analysis indicated that both compounds bound at the active site of the enzyme but not solely to amino acid residues involved in catalysis. Both compounds were active in in vitro angiogenic assays inhibiting endothelial cell migration and invasion in Matrigel, but did not inhibit growth factor-induced proliferation and were not cytotoxic. Compound 1 may have potential as an anti-angiogenic and anti-tumor agent.

New salirepin derivatives from Symplocos racemosa

The phytochemical investigation of the n-butanol soluble fraction of the bark of stem of Symplocos racemosa Roxb. yielded two new phenolic glycosides of salirepin series, symplocuronic acid (1) and sympocemoside (2), while salirepin (3) was isolated for the first time from this plant. The structures of the new compounds were identified by 1D and 2D NMR techniques along with other spectral evidences and by comparison with the published data of closely related compounds.