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Ashouri H, Riyahi Alam N, Khoobi M, Haghgoo S, Rasouli Z, Gholami M. NSF evaluation of gadolinium biodistribution in renally impaired rats: Using novel metabolic Gd2O3 nanoparticles coated with β-cyclodextrin (Gd2O3@PCD) in MR molecular imaging. Magn Reson Imaging 2024; 107:120-129. [PMID: 38215955 DOI: 10.1016/j.mri.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
The use of conventional gadolinium(Gd)-based contrast agents in magnetic resonance imaging (MRI) poses a significant risk of Nephrogenic Systemic Fibrosis (NSF) syndrome in patients with impaired renal function (grades 4 and 5). To address this issue, a new study has introduced a novel metabolic Gadolinium oxide nanoparticle (Gd2O3 NPs) coated with β-cyclodextrin (βCD). The study aims to investigate NSF syndrome by quantifying tissue Gd deposition biodistribution in renal impairment rats using MR molecular imaging. This is the first study of its kind to use this approach. A group of 20 rats were divided into four groups, each containing five rats that underwent 5/6 nephrectomy. The rats received 12 intravenous injections of a novel homemade synthesized gadolinium oxide polycyclodextrin (Gd2O3@PCD) at a dose of 0.1 mmol/kg, conventional contrast agents (CAs) drugs of Omniscan (Gd-DTPA-BMA) and Dotarem (Gd-DOTA), at a dose of 2.5 mmol/kg, and 250 μl saline for two injections per week during six weeks. T1-weighted MR imaging was performed before the injections and once a week for six weeks to quantify Gd deposition in four different organs (skin, liver, heart, and lung) in rats using inductively coupled plasma mass spectrometry (ICP-MS). The relationship between Signal-to-Noise Ratio (SNR) and biodistribution of Gd deposition due to NSF-induced syndrome was also calculated. The results of the study showed that the Gd concentrations in tissues were significantly higher in the Gd2O3@PCD group compared to the other groups, without any significant histopathological changes (P < 0.05). In the Gd2O3@PCD group, Gd was mainly deposited in the skin, followed by the liver, lung, and heart, without any symptoms of thickening or hardening of the skin. The Gd concentrations in the skin, liver, lung, and heart were significantly lower in the Dotarem group than in the Omniscan group (P < 0.05). In the histopathological examinations, the Omniscan group showed increased cellularity in the dermis. A significant hyperintensity was observed in the Gd2O3@PCD-treated rats compared to the Dotarem and Omniscan groups in the liver, heart, and lung. Compared to conventional Gd-based CAs, the novel metabolically Gd2O3@PCD with increased SNR, biosafety, and a considerably lower probability of developing NSF, has potential applicability for diagnosing patients with renal diseases in clinical MR Molecular Imaging (MRMI).
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Affiliation(s)
- Hanieh Ashouri
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - Nader Riyahi Alam
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran; Concordia University, Perform Center, Montreal, Quebec, Canada; Biomaterials Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Khoobi
- Biomaterials Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran; Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Haghgoo
- Pharmaceutical Department, Food & Drug Laboratory Research Center, Ministry of Health, Tehran, Iran
| | - Zahra Rasouli
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran; Medical Imaging Center, Motahari Hospital, Jahrom University of Medical Sciences (JUMS), Jahrom, Iran
| | - Mahdi Gholami
- Department of Toxicology and Pharmacology, Toxicology and Poisoning Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Lee S, Kim YY, Shin J, Roh YH, Choi JY, Chernyak V, Sirlin CB. Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis. Eur Radiol 2024; 34:1502-1514. [PMID: 37656177 DOI: 10.1007/s00330-023-10134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/24/2023] [Accepted: 07/07/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We performed an updated meta-analysis to determine the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS, LR) 5 category for hepatocellular carcinoma (HCC) using LI-RADS version 2018 (v2018), and to evaluate differences by imaging modalities and type of MRI contrast material. METHODS The MEDLINE and Embase databases were searched for studies reporting the performance of LR-5 using v2018 for diagnosing HCC. A bivariate random-effects model was used to calculate the pooled per-observation sensitivity and specificity. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Forty-eight studies qualified for the meta-analysis, comprising 9031 patients, 10,547 observations, and 7216 HCCs. The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC were 66% (95% CI, 61-70%) and 91% (95% CI, 89-93%), respectively. In the subgroup analysis, MRI with extracellular agent (ECA-MRI) showed significantly higher pooled sensitivity (77% [95% CI, 70-82%]) than CT (66% [95% CI, 58-73%]; p = 0.023) or MRI with gadoxetate (Gx-MRI) (65% [95% CI, 60-70%]; p = 0.001), but there was no significant difference between ECA-MRI and MRI with gadobenate (gadobenate-MRI) (73% [95% CI, 61-82%]; p = 0.495). Pooled specificities were 88% (95% CI, 80-93%) for CT, 92% (95% CI, 86-95%) for ECA-MRI, 93% (95% CI, 91-95%) for Gx-MRI, and 91% (95% CI, 84-95%) for gadobenate-MRI without significant differences (p = 0.084-0.803). CONCLUSIONS LI-RADS v2018 LR-5 provides high specificity for HCC diagnosis regardless of modality or contrast material, while ECA-MRI showed higher sensitivity than CT or Gx-MRI. CLINICAL RELEVANCE STATEMENT Refinement of the criteria for improving sensitivity while maintaining high specificity of LR-5 for HCC diagnosis may be an essential future direction. KEY POINTS • The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC using LI-RADSv2018 were 66% and 91%, respectively. • ECA-MRI showed higher sensitivity than CT (77% vs 66%, p = 0.023) or Gx-MRI (77% vs 65%, p = 0.001). • LI-RADS v2018 LR-5 provides high specificity (88-93%) for HCC diagnosis regardless of modality or contrast material type.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
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Hao J, Pitrou C, Bourrinet P. A Comprehensive Overview of the Efficacy and Safety of Gadopiclenol: A New Contrast Agent for MRI of the CNS and Body. Invest Radiol 2024; 59:124-130. [PMID: 37812485 DOI: 10.1097/rli.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
ABSTRACT This review describes the pharmacokinetics, efficacy, and safety of gadopiclenol, a new macrocyclic gadolinium-based contrast agent (GBCA) recently approved by the Food and Drug Administration at the dose of 0.05 mmol/kg. Gadopiclenol is a high relaxivity contrast agent that shares similar pharmacokinetic characteristics with other macrocyclic GBCAs, including a predominant renal excretion. In pediatric patients aged 2-17 years, the pharmacokinetic parameters (assessed through a population pharmacokinetics model) were comparable to those observed in adults, indicating no need for age-based dose adjustment. For contrast-enhanced magnetic resonance imaging (MRI) of the central nervous system (CNS) and body indications, gadopiclenol at 0.05 mmol/kg was shown to be noninferior to gadobutrol at 0.1 mmol/kg in terms of 3 lesion visualization parameters (ie, lesion border delineation, internal morphology, and contrast enhancement). Moreover, for contrast-enhanced MRI of the CNS, compared with gadobenate dimeglumine at 0.1 mmol/kg, gadopiclenol exhibited superior contrast-to-noise ratio at 0.1 mmol/kg and comparable contrast-to-noise ratio at 0.05 mmol/kg. A pooled safety analysis of 1047 participants showed a favorable safety profile for gadopiclenol. Comparative studies showed that the incidence and nature of adverse drug reactions with gadopiclenol were comparable to those observed with other GBCAs. Importantly, no significant safety concerns were identified in pediatric and elderly patients, as well as in patients with renal impairment. Overall, these findings support the clinical utility and safety of gadopiclenol for MRI in adult and pediatric patients aged 2 years and older in CNS and body indications.
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Affiliation(s)
- Jing Hao
- From the Department of Clinical Development, Guerbet, Roissy CDG Cedex, France
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Robert P, Vives V, Rasschaert M, Hao J, Soares M, Lemaître M, Dencausse A, Catoen S. Detection of Brain Metastases by Contrast-Enhanced MRI: Comparison of Gadopiclenol and Gadobenate in a Mouse Model. Invest Radiol 2024; 59:131-139. [PMID: 37921777 DOI: 10.1097/rli.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the capacity of gadopiclenol, a high-relaxivity gadolinium-based contrast agent to detect brain metastases in mice as a function of dose (0.08 mmol/kg or 0.1 mmol/kg) compared with gadobenate at 0.1 mmol/kg. MATERIALS AND METHODS Brain metastases were induced by ultrasound-guided intracardiac implantation of 1.10 5 MDA-MB-231Br cells in the left ventricle of 18 anesthetized Balb/c Nude nu/nu female mice. At day 28 ± 3 after cell injection, each mouse received 2 crossover intravenous injections at 24-hour intervals, randomly selected from 2 doses of gadopiclenol (0.08 mmol/kg or 0.1 mmol/kg) and gadobenate (0.1 mmol/kg) with n = 6 mice/group (3 groups). Brain magnetic resonance imaging sessions were performed at 4 weeks on a 2.35 T magnet with a 3-dimensional T1-weighted high-resolution gradient echo sequence, before and after each injection. Images were blindly and randomly analyzed to detect enhancing lesions. Contrast-to-noise ratio between the metastases and the surrounding healthy parenchyma was calculated, based on region-of-interest signal measurements. In 2 animals per group, an early time point was added to the protocol (day 22 ± 3) to evaluate the sensitivity of detection as a function of time. After the last imaging session, the presence and location of whole-brain metastases were confirmed by histology in 4 mice. RESULTS After gadopiclenol, approximately twice as many metastases were detected compared with gadobenate, regardless of the dose. Contrast-to-noise ratios of the detected metastases were 2.3 and 3.3 times higher with gadopiclenol at 0.08 mmol/kg and 0.1 mmol/kg, respectively, compared with gadobenate at 0.1 mmol/kg ( P < 0.0001). Gadopiclenol at the dose of 0.1 mmol/kg resulted in a 1.4-fold higher contrast compared with gadopiclenol at 0.08 mmol/kg ( P < 0.02). In a subset of mice that were imaged 1 week earlier, 2 metastases were detected with gadopiclenol and not with gadobenate. CONCLUSIONS The high-relaxivity macrocyclic gadolinium-based contrast agent gadopiclenol allowed higher diagnostic performance for detecting brain enhancing metastases in terms of contrast-to-noise ratio and number of detected metastases compared with gadobenate, at both equal (0.1 mmol/kg) dose and 20% lower Gd dose (0.08 mmol/kg). Tumor detection was higher after gadopiclenol at the dose of 0.1 mmol/kg compared with 0.08 mmol/kg.
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Affiliation(s)
- Philippe Robert
- From the Research and Innovation Department, Guerbet, Roissy CDG Cedex, France
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Xin-Shuai L, Zhou JQ, Chen XF, Chen X, Feng PF. Meta-analysis of the efficacy and safety of Ginkgolide Meglumine Injection combined with Butylphthalide in the treatment of Acute Ischemic Stroke. PLoS One 2024; 19:e0296508. [PMID: 38180977 PMCID: PMC10769014 DOI: 10.1371/journal.pone.0296508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of Ginkgolide Meglumine Injection (GMI) combined with Butylphthalide in the treatment of Acute Ischemic Stroke (AIS), and provide reference for rational clinical medication. METHODS PubMed, Embase, Web of science, CNKI, Wanfang, VIP and other databases were searched for published studies on the treatment of AIS with GMI combined with Butylphthalide in both Chinese and English. The search period was from the establishment of the database to July 2023. The included studies that met the inclusion criteria were analyzed using RevMan 5.3 software for Meta-analysis. RESULTS A total of 25 studies involving 2362 patients (experimental group = 1182, control group = 1180) were included. The results of meta-analysis showed that the overall effective rate of the experimental group was significantly higher than that of the control group [RR = 1.21, 95% CI (1.16, 1.26), P< 0.00001]. In addition, compared with the control group, the experimental group showed significant improvement in NIHSS score [SMD = -1.59, % CI (-2.00-1.18), P< 0.00001] and ADL score [SMD = 2.12, 95% CI (1.52, -2.72), P<0.00001], significant decrease in CRP [SMD = -2.24, 95% CI (-3.31, -1.18), P<0.0001] and TNF-α [SMD = -2.74, 95% CI (-4.45, -1.03), P< 0.005] levels, and improvement in plasma viscosity [SMD = -0.86, 95% CI (-1.07, -0.66), P< 0.00001]. However, the influence on homocysteine level remains inconclusive. Furthermore, there was no significant difference in the incidence of adverse reactions between the two groups [SMD = 0.95, 95% CI (0.71, 1.28), P> 0.05]. CONCLUSION GMI combined with Butylphthalide shows good clinical application effects and good safety in the treatment of AIS. However, more large-sample, multicenter, randomized controlled are needed to confirm these findings.
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Affiliation(s)
- Li Xin-Shuai
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, Jiangsu Province, China
| | - Jia-Qi Zhou
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, Jiangsu Province, China
| | - Xiang-Fan Chen
- BioBank, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, Jiangsu Province, China
| | - Xia Chen
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, Jiangsu Province, China
| | - Pan-Feng Feng
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, Jiangsu Province, China
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Ruiz de Azcárate PH, López-Sanz C, López-Raigada A, Vega F, Jiménez-Saiz R, Blanco C. Meglumine gadoterate induces immunoglobulin-independent human mast cell activation via MRGPRX2. Allergy 2023; 78:3255-3258. [PMID: 37548384 DOI: 10.1111/all.15847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Paula H Ruiz de Azcárate
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Celia López-Sanz
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Azahara López-Raigada
- Department of Allergy, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Francisco Vega
- Department of Allergy, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Rodrigo Jiménez-Saiz
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Immunology and Oncology, Centro Nacional de Biotecnología (CNB)-CSIC, Madrid, Spain
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria (UFV), Madrid, Spain
- Department of Medicine, McMaster Immunology Research Centre (MIRC), Schroeder Allergy and Immunology Research Institute (SAIRI), McMaster University, Hamilton, Ontario, Canada
| | - Carlos Blanco
- Department of Allergy, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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van der Hoogt KJJ, Schipper RJ, Wessels R, Ter Beek LC, Beets-Tan RGH, Mann RM. Breast DWI Analyzed Before and After Gadolinium Contrast Administration-An Intrapatient Analysis on 1.5 T and 3.0 T. Invest Radiol 2023; 58:832-841. [PMID: 37389456 DOI: 10.1097/rli.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Diffusion-weighted magnetic resonance imaging (MRI) is gaining popularity as an addition to standard dynamic contrast-enhanced breast MRI. Although adding diffusion-weighted imaging (DWI) to the standard protocol design would require increased scanning-time, implementation during the contrast-enhanced phase could offer a multiparametric MRI protocol without any additional scanning time. However, gadolinium within a region of interest (ROI) might affect assessments of DWI. This study aims to determine if acquiring DWI postcontrast, incorporated in an abbreviated MRI protocol, would statistically significantly affect lesion classification. In addition, the effect of postcontrast DWI on breast parenchyma was studied. MATERIALS AND METHODS Screening or preoperative MRIs (1.5 T/3 T) were included for this study. Diffusion-weighted imaging was acquired with single-shot spin echo-echo planar imaging before and at approximately 2 minutes after gadoterate meglumine injection. Apparent diffusion coefficients (ADCs) based on 2-dimensional ROIs of fibroglandular tissue, as well as benign and malignant lesions at 1.5 T/3.0 T, were compared with a Wilcoxon signed rank test. Diffusivity levels were compared between precontrast and postcontrast DWI with weighted κ. An overall P ≤ 0.05 was considered statistically significant. RESULTS No significant changes were observed in ADC mean after contrast administration in 21 patients with 37 ROI of healthy fibroglandular tissue and in the 93 patients with 93 (malignant and benign) lesions. This effect remained after stratification on B 0 . In 18% of all lesions, a diffusion level shift was observed, with an overall weighted κ of 0.75. CONCLUSIONS This study supports incorporating DWI at 2 minutes postcontrast when ADC is calculated based on b150-b800 with 15 mL 0.5 M gadoterate meglumine in an abbreviated multiparametric MRI protocol without requiring extra scan time.
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Affiliation(s)
- Kay J J van der Hoogt
- From the Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (K.J.J.H., R.-J.S., R.W., R.G.H.B., R.M.M.); GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands (K.J.J.H., R.G.H.B.); Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands (R.-J.S.); Department of Medical Physics, the Netherlands Cancer Institute, Amsterdam, the Netherlands (L.C.B.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (R.M.M.); and Danish Colorectal Cancer Unit South, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark (R.G.H.B.)
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Yang Q, Tan T, He Q, Guo C, Chen D, Tan Y, Feng J, Song X, Gong T, Li J. Combined Amphiphilic Silybin Meglumine Nanosuspension Effective Against Hepatic Fibrosis in Mice Model. Int J Nanomedicine 2023; 18:5197-5211. [PMID: 37720597 PMCID: PMC10505037 DOI: 10.2147/ijn.s407762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Silybin (SLB) as an effective hepatoprotective phytomedicine has been limited by its hydrophobicity, poor bioavailability and accumulation at lesion sites. Additionally, present drug loading methods are impeded by their low drug loading capacity, potential hazard of materials and poor therapeutic effects. Consequently, there is a pressing need to devise an innovative approach for preparing nanosuspensions loaded with both SLB and Silybin Meglumine salt (SLB-M), as well as to investigate the therapeutic effects of SLB nanosuspensions against hepatic fibrosis. Methods The SLB nanosuspension (NS-SLB) was prepared and further modified with a hyaluronic acid-cholesterol conjugate (NS-SLB-HC) to improve the CD44 targeting proficiency of NS-SLB. To validate the accumulation of CD44 and ensure minimal cytotoxicity, cellular uptake and cytotoxicity assessments were carried out for the nanosuspensions. Western blotting was employed to evaluate the anti-hepatic fibrosis efficacy in LX-2 cells by inhibiting the secretion of collagen I. Hepatic fibrosis mouse models were used to further confirm the effectiveness of NS-SLB and NS-SLB-HC against hepatic fibrosis in vivo. Results Uniform nanosuspensions were prepared through self-assembly, achieving high drug loading rates of 89.44% and 60.67%, respectively. Both SLB nanosuspensions showed minimal cytotoxicity in cellular environments and mitigated hepatic fibrosis in vitro. NS-SLB-HC was demonstrated to target activated hepatic stellate cells by receptor-ligand interaction between HA and CD44. They can reverse hepatic fibrosis in vivo by downregulating TGF-β and inhibiting the secretion of α-SMA and collagen I. Conclusion Designed as a medical excipient analogue, SLB-M was aimed to establish an innovative nanosuspension preparation method, characterized by high drug loading capacity and a notable impact against hepatic fibrosis.
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Affiliation(s)
- Qin Yang
- School of Pharmacy, North Sichuan Medical College, Nanchong637100, People’s Republic of China
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Tiantian Tan
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Qin He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Chenqi Guo
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Dan Chen
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Yulu Tan
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Jiaxing Feng
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Xu Song
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Tao Gong
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Jia Li
- West China Hospital of Stomatology, Sichuan University, Chengdu610041, People’s Republic of China
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Simutis IS, Ratnikov VA, Scheglov AN, Nikolaeva OV, Boyarinov GA, Sapegin AA, Gaikovaya LB, Evteeva DA, Zamyatina KN. [Potential for infusion correction of COVID-19-associated endotheliopathy]. TERAPEVT ARKH 2023; 95:487-493. [PMID: 38158968 DOI: 10.26442/00403660.2023.6.202232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 01/03/2024]
Abstract
AIM To evaluate the relationship between the systemic inflammatory response and the severity of COVID-19-associated endotheliopathy and the effect of succinate-containing crystalloid solution (sodium meglumine succinate) on it in patients with severe COVID-19. MATERIALS AND METHODS Clinical and laboratory parameters of 53 intensive care unit's patients with COVID-19 complicated by community-acquired bilateral multisegmental pneumonia were analyzed. Intensive therapy complex of 27 patients (study group) included daily infusion of 1.5% solution of sodium meglumine succinate (Reamberin) in the daily dose of 10 ml/kg for at least 11 days (or during the whole stay in the unit). A similar volume of Ringer's solution was present in the control group of 26 patients. The levels of endotheliocytosis, homocysteine, and systemic inflammatory response were determined at all stages of the study. RESULTS The evaluation of endotheliopathy degree in the meglumine succinate group showed a significant reduction of initially elevated levels of endotheliemia and homocysteinemia at all study stages. The pattern of changes in the study group was highly correlated (r=0.90-0.96) with the dynamics of systemic inflammatory response parameters-fibrinogenemia, C-reactive protein and interleukin-6 levels. As normalization of the immune imbalance, we regarded the termination of lymphopenia in the Reamberin group. CONCLUSION Early inclusion of Reamberin infusion into intensive therapy of severe COVID-19, in comparison with Ringer's solution, leads to significant and stable correction of the severity of systemic inflammatory response, which in turn is naturally reflected in the severity of endothelial dysfunction, multiple organ failure, and also leads to a decrease in 28-day mortality.
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Affiliation(s)
- I S Simutis
- Sokolov North-Western District Scientific and Clinical Center
- Mechnikov North-Western State Medical University
| | - V A Ratnikov
- Sokolov North-Western District Scientific and Clinical Center
| | | | | | | | - A A Sapegin
- Sokolov North-Western District Scientific and Clinical Center
| | | | - D A Evteeva
- Mechnikov North-Western State Medical University
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10
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Peng SX, Wei C, Lei JY, Zhang T, Ding YB. [Network Meta-analysis of Chinese medicine injections for activating blood and resolving stasis in adjuvant treatment of acute ischemic stroke]. Zhongguo Zhong Yao Za Zhi 2023; 48:4215-4230. [PMID: 37802790 DOI: 10.19540/j.cnki.cjcmm.20230425.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Network Meta-analysis was employed to compare the efficacy of Chinese medicine injections for activating blood and resolving stasis combined with conventional western medicine in the treatment of acute ischemic stroke and the effects on platelet aggregation rate, fibrinogen(FIB), and hypersensitive C-reactive protein(hs-CRP), with a view to providing evidence-based medicine reference for clinical medication. CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library, and EMbase were searched for randomized controlled trial(RCT) on the treatment of acute ischemic stroke with Salvia Miltiorrhiza Ligustrazine Injection, Danhong Injection, Shuxuetong Injection, Xueshuantong Injection, Shuxuening Injection, Safflower Yellow Pigment Injection, and Ginkgo Diterpene Lactone Meglumine Injection combined with conventional western medicine. The retrieval time was from database inception to March 18, 2023. The articles were extracted by two researchers and their quality was evaluated. R 4.2.2 was used for network Meta-analysis. A total of 87 RCTs involving 8 580 patients were included. Network Meta-analysis showed that, in terms of reducing National Institutes of Health stroke scale(NIHSS) scores, the surface under the cumulative ranking curve(SUCRA) showed the order of Xueshuantong Injection + conventional western medicine(88.7%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(73.7%) > Shuxuetong Injection + conventional western medicine(69.7%) > Shuxuening Injection + conventional western medicine(51.8%) > Danhong Injection + conventional western medicine(43.7%) > Safflower Yellow Pigment Injection + conventional western medicine(36.8%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(35.3%) > conventional western medicine(1.7%). In terms of improving clinical total effective rate, SUCRA showed the order of Danhong Injection + conventional western medicine(63.0%) > Shuxuening Injection + conventional western medicine(59.0%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(58.9%) > Safflower Yellow Pigment Injection + conventional western medicine(57.1%) > Xueshuantong Injection + conventional western medicine(56.8%) > Shuxuetong Injection + conventional western medicine(54.6%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(50.5%) > conventional western medicine(0.03%). In terms of improving Barthel index, SUCRA showed the order of Danhong Injection + conventional western medicine(84.7%) > Shuxuetong Injection + conventional western medicine(72.4%) > Safflower Yellow Pigment Injection + conventional western medicine(61.6%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(44.6%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(43.2%) > Shuxuening Injection + conventional western medicine(42.2%) > conventional western medicine(1.4%). In terms of reducing platelet aggregation rate, SUCRA showed the order of Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(82.4%) > Shuxuetong Injection + conventional western medicine(81.6%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(40.7%) > Danhong Injection + conventional western medicine(37.3%) > conventional western medicine(8.0%). In terms of reducing FIB, SUCRA showed the order of Danhong Injection + conventional western medicine(81.0%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(71.9%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(70.0%) > Shuxuetong Injection + conventional western medicine(46.7%) > Xueshuantong Injection + conventional western medicine(22.6%) > conventional western medicine(8.7%). In terms of reducing hs-CRP, SUCRA showed the order of Shuxuening Injection + conventional western medicine(89.9%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(78.8%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(52.4%) > Danhong Injection + conventional western medicine(47.6%) > Xueshuantong Injection + conventional western medicine(43.5%) > Shuxuetong Injection + conventional Western medicine(35.6%) > conventional western medicine(2.3%). The results indicated that Xueshuantong Injection + conventional western medicine, Danhong Injection + conventional western medicine, and Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine ranked the top three. Xueshuantong Injection + conventional western medicine had the best effect on reducing NIHSS scores. Danhong Injection + conventional western medicine showed the best performance of improving clinical total effective rate, improving Barthel index, and reducing FIB in the blood. Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine had the best effect on reducing platelet aggregation rate in the blood. Shuxuening Injection + conventional western medicine had the best effect on reducing hs-CRP. However, more high-quality RCTs are needed for verification in the future to provide more reliable evidence-based medical reference.
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Affiliation(s)
- Shi-Xiong Peng
- College of Clinical Chinese Medicine, Hubei University of Chinese Medicine Wuhan 430061, China
| | - Cong Wei
- College of Clinical Chinese Medicine, Hubei University of Chinese Medicine Wuhan 430061, China
| | - Jing-Ying Lei
- College of Clinical Chinese Medicine, Hubei University of Chinese Medicine Wuhan 430061, China
| | - Teng Zhang
- Hubei Provincial Hospital of Traditional Chinese Medicine Wuhan 430060, China
| | - Yan-Bing Ding
- College of Clinical Chinese Medicine, Hubei University of Chinese Medicine Wuhan 430061, China Hubei Provincial Hospital of Traditional Chinese Medicine Wuhan 430060, China
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11
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Hua N, Minaeva O, Lupoli N, Franz ES, Liu X, Moncaster JA, Babcock KJ, Jara H, Tripodis Y, Guermazi A, Soto JA, Anderson SW, Goldstein LE. Gadolinium Deposition in the Rat Brain Measured with Quantitative MRI versus Elemental Mass Spectrometry. Radiology 2023; 306:244-251. [PMID: 36125373 PMCID: PMC9792715 DOI: 10.1148/radiol.212171] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/08/2022] [Accepted: 07/15/2022] [Indexed: 01/19/2023]
Abstract
Background T1-weighted MRI and quantitative longitudinal relaxation rate (R1) mapping have been used to evaluate gadolinium retention in the brain after gadolinium-based contrast agent (GBCA) administration. Whether MRI measures accurately reflect gadolinium regional distribution and concentration in the brain remains unclear. Purpose To compare gadolinium retention in rat forebrain measured with in vivo quantitative MRI R1 and ex vivo laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) mapping after gadobenate, gadopentetate, gadodiamide, or gadobutrol administration. Materials and Methods Adult female Sprague-Dawley rats were randomly assigned to one of five groups (eight per group) and administered gadobenate, gadopentetate, gadodiamide, gadobutrol (2.4 mmol/kg per week for 5 weeks), or saline (4.8 mL/kg per week for 5 weeks). MRI R1 mapping was performed at baseline and 1 week after the final injection to determine R1 and ΔR1. Postmortem brains from the same rats were analyzed with LA-ICP-MS elemental mapping to determine regional gadolinium concentrations. Student t tests were performed to compare results between GBCA and saline groups. Results Rats that were administered gadobenate showed gadolinium-related MRI ΔR1 in 39.5% of brain volume (ΔR1 = 0.087 second-1 ± 0.051); gadopentetate, 20.6% (ΔR1 = 0.069 second-1 ± 0.018); gadodiamide, 5.4% (ΔR1 = 0.055 second-1 ± 0.019); and gadobutrol, 2.2% (ΔR1 = 0.052 second-1 ± 0.041). Agent-specific gadolinium-related ΔR1 was detected in multiple forebrain regions (neocortex, hippocampus, dentate gyrus, thalamus, and caudate-putamen) in rats treated with gadobenate or gadopentetate, whereas rats treated with gadodiamide showed gadolinium-related ΔR1 in caudate-putamen. By contrast, LA-ICP-MS elemental mapping showed a similar regional distribution pattern of heterogeneous retained gadolinium in the forebrain of rats treated with gadobenate, gadopentetate, or gadodiamide, with the average gadolinium concentration of 0.45 μg · g-1 ± 0.07, 0.50 μg · g-1 ± 0.10, and 0.60 μg · g-1 ± 0.11, respectively. Low levels (0.01 μg · g-1 ± 0.00) of retained gadolinium were detected in the forebrain of gadobutrol-treated rats. Conclusion Differences in in vivo MRI longitudinal relaxation rate versus ex vivo elemental mass spectrometry measures of retained gadolinium in rat forebrains suggest that some forms of retained gadolinium may escape detection with MRI. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Nicola Lupoli
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Erich S. Franz
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Xiuping Liu
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Juliet A. Moncaster
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Katharine J. Babcock
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Hernán Jara
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Yorghos Tripodis
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Ali Guermazi
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Jorge A. Soto
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Stephan W. Anderson
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
| | - Lee E. Goldstein
- From the Departments of Radiology (N.H., O.M., N.L., X.L., J.A.M.,
H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (L.E.G.), Pathology &
Laboratory Medicine (L.E.G.), Anatomy & Neurobiology (K.J.B.), and
Biostatistics (Y.T.), Boston University School of Medicine, 670 Albany St, 4th
Floor, Boston, MA 02118; Boston University Alzheimer’s Disease Research
Center (N.H., O.M., J.A.M., L.E.G.), Boston, Mass; and Center for Biometallomics
(O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., S.W.A., L.E.G.),
and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston,
Mass
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12
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Colombo Serra S, Gaud E, Bano E, Bicocchi G, Bruno E, Tedoldi F. Stability testing of gadoteridol and gadobenate di meglumine formulations under exposure to high-intensity focused ultrasound. Br J Radiol 2022; 95:20220619. [PMID: 36169642 PMCID: PMC9733619 DOI: 10.1259/bjr.20220619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Contrast-enhanced MRI could be useful to guide high-intensity focused ultrasound treatment (HIFU), but the effects of HIFU on gadolinium-based agents is not known. Here, we tested in vitro the stability of gadoteridol and gadobenate dimeglumine, two widely used MR contrast agents, after exposure to HIFU at power levels typically applied in the clinical practice. METHODS 0.5 M (gadoteridol and gadobenate dimeglumine) and diluted formulations (1:10 gadoteridol in saline) were exposed to different HIFU sequences. Unexposed and exposed solutions were characterized by high-performance liquid chromatography in terms of concentration of gadolinium complex, free gadolinium and free ligand. RESULTS Gadoteridol formulation after treatment showed concentrations of the complex not significantly different from control. Free Gd and/or free ligand concentrations in the order of 0.002/0.004% w/w, were observed occasionally without significant correlation with intensity and duration of exposure to HIFU. Gadobenate dimeglumine formulation after treatment showed complex assay content values, by-products (0.24-0.26%) and free BOPTA levels (0.07%) comparable to control sample within the experimental error. CONCLUSION In the range of conditions explored, HIFU exposure did not induce significant dissociations of gadoteridol and gadobenate dimeglumine, nor a detectable increase in the concentration of free species. ADVANCES IN KNOWLEDGE Our study strengthens the hypothesis that gadolinium-based contrast agents are stable during HIFU treatment for body applications (e.g. thermal ablation of uterine fibroids).
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Affiliation(s)
- Sonia Colombo Serra
- Centro Ricerche Bracco, Bracco Imaging S.p.A., Via Ribes 5, Colleretto Giacosa (TO), Italy
| | - Emmanuel Gaud
- Bracco Suisse SA, Route de la Galaise 31, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - Esmejona Bano
- Centro Ricerche Bracco, Bracco Imaging S.p.A., Via Ribes 5, Colleretto Giacosa (TO), Italy
| | - Giacomo Bicocchi
- Centro Ricerche Bracco, Bracco Imaging S.p.A., Via Ribes 5, Colleretto Giacosa (TO), Italy
| | - Erik Bruno
- Centro Ricerche Bracco, Bracco Imaging S.p.A., Via Ribes 5, Colleretto Giacosa (TO), Italy
| | - Fabio Tedoldi
- Centro Ricerche Bracco, Bracco Imaging S.p.A., Via Ribes 5, Colleretto Giacosa (TO), Italy
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13
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Cankaya B, Ogul Y, Ogul H, Kantarci M. Development of high signal intensity within the globus pallidus and dentate nucleus following multiple administrations of gadoterate meglumine in a patient with neurotuberculosis. Acta Neurol Belg 2022; 122:781-784. [PMID: 33393069 DOI: 10.1007/s13760-020-01561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Bahar Cankaya
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Yasemin Ogul
- Department of Biochemistry, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey.
- Anesthesiology, Clinical Research Office, Ataturk University, Kazım Karabekir Mah. Terminal Cad.,Yakutiye, Erzurum, Turkey.
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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14
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Strzeminska I, Factor C, Jimenez-Lamana J, Lacomme S, Subirana MA, Le Coustumer P, Schaumlöffel D, Robert P, Szpunar J, Corot C, Lobinski R. Comprehensive Speciation Analysis of Residual Gadolinium in Deep Cerebellar Nuclei in Rats Repeatedly Administered With Gadoterate Meglumine or Gadodiamide. Invest Radiol 2022; 57:283-292. [PMID: 35066532 PMCID: PMC9855751 DOI: 10.1097/rli.0000000000000846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/14/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Several preclinical studies have reported the presence of gadolinium (Gd) in different chemical forms in the brain, depending on the class (macrocyclic versus linear) of Gd-based contrast agent (GBCA) administered. The aim of this study was to identify, with a special focus on insoluble species, the speciation of Gd retained in the deep cerebellar nuclei (DCN) of rats administered repeatedly with gadoterate or gadodiamide 4 months after the last injection. METHODS Three groups (N = 6/group) of healthy female Sprague-Dawley rats (SPF/OFA rats; Charles River, L'Arbresle, France) received a cumulated dose of 50 mmol/kg (4 daily intravenous administrations of 2.5 mmol/kg, for 5 weeks, corresponding to 80-fold the usual clinical dose if adjusted for man) of gadoterate meglumine (macrocyclic) or gadodiamide (linear) or isotonic saline for the control group (4 daily intravenous administrations of 5 mL/kg, for 5 weeks). The animals were sacrificed 4 months after the last injection. Deep cerebellar nuclei were dissected and stored at -80°C before sample preparation. To provide enough tissue for sample preparation and further analysis using multiple techniques, DCN from each group of 6 rats were pooled. Gadolinium species were extracted in 2 consecutive steps with water and urea solution. The total Gd concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS). Soluble Gd species were analyzed by size-exclusion chromatography coupled to ICP-MS. The insoluble Gd species were analyzed by single-particle (SP) ICP-MS, nanoscale secondary ion mass spectroscopy (NanoSIMS), and scanning transmission electron microscopy with energy-dispersive X-ray spectroscopy (STEM-EDX) for elemental detection. RESULTS The Gd concentrations in pooled DCN from animals treated with gadoterate or gadodiamide were 0.25 and 24.3 nmol/g, respectively. For gadoterate, the highest amount of Gd was found in the water-soluble fractions. It was present exclusively as low-molecular-weight compounds, most likely as the intact GBCA form. In the case of gadodiamide, the water-soluble fraction of DCN was composed of high-molecular-weight Gd species of approximately 440 kDa and contained only a tiny amount (less than 1%) of intact gadodiamide. Furthermore, the column recovery calculated for this fraction was incomplete, which suggested presence of labile complexes of dissociated Gd3+ with endogenous molecules. The highest amount of Gd was detected in the insoluble residue, which was demonstrated, by SP-ICP-MS, to be a particulate form of Gd. Two imaging techniques (NanoSIMS and STEM-EDX) allowed further characterization of these insoluble Gd species. Amorphous, spheroid structures of approximately 100-200 nm of sea urchin-like shape were detected. Furthermore, Gd was consistently colocalized with calcium, oxygen, and phosphorous, strongly suggesting the presence of structures composed of mixed Gd/Ca phosphates. No or occasional colocalization with iron and sulfur was observed. CONCLUSION A dedicated analytical workflow produced original data on the speciation of Gd in DCN of rats repeatedly injected with GBCAs. The addition, in comparison with previous studies of Gd speciation in brain, of SP element detection and imaging techniques allowed a comprehensive speciation analysis approach. Whereas for gadoterate the main fraction of retained Gd was present as intact GBCA form in the soluble fractions, for linear gadodiamide, less than 10% of Gd could be solubilized and characterized using size-exclusion chromatography coupled to ICP-MS. The main Gd species detected in the soluble fractions were macromolecules of 440 kDa. One of them was speculated to be a Gd complex with iron-binding protein (ferritin). However, the major fraction of residual Gd was present as insoluble particulate species, very likely composed of mixed Gd/Ca phosphates. This comprehensive Gd speciation study provided important evidence for the dechelation of linear GBCAs and offered a deeper insight into the mechanisms of Gd deposition in the brain.
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Affiliation(s)
- Izabela Strzeminska
- From the Guerbet Research and Innovation Department, Aulnay-sous-Bois
- Universite de Pau, E2S-UPPA, CNRS, Institute of Analytical and Physical Chemistry for the Environment and Materials (IPREM - UMR 5254), Pau
| | - Cecile Factor
- From the Guerbet Research and Innovation Department, Aulnay-sous-Bois
| | - Javier Jimenez-Lamana
- Universite de Pau, E2S-UPPA, CNRS, Institute of Analytical and Physical Chemistry for the Environment and Materials (IPREM - UMR 5254), Pau
| | - Sabrina Lacomme
- Bordeaux University, UMS 3420 CNRS Universite & US4 INSERM, CGFB, Bordeaux
- Bordeaux Montaigne University, INPB, EA 4592 Georessources & Environnement, Pessac, France
| | - Maria Angels Subirana
- Universite de Pau, E2S-UPPA, CNRS, Institute of Analytical and Physical Chemistry for the Environment and Materials (IPREM - UMR 5254), Pau
| | - Philippe Le Coustumer
- Bordeaux University, UMS 3420 CNRS Universite & US4 INSERM, CGFB, Bordeaux
- Bordeaux Montaigne University, INPB, EA 4592 Georessources & Environnement, Pessac, France
| | - Dirk Schaumlöffel
- Universite de Pau, E2S-UPPA, CNRS, Institute of Analytical and Physical Chemistry for the Environment and Materials (IPREM - UMR 5254), Pau
| | - Philippe Robert
- From the Guerbet Research and Innovation Department, Aulnay-sous-Bois
| | - Joanna Szpunar
- Universite de Pau, E2S-UPPA, CNRS, Institute of Analytical and Physical Chemistry for the Environment and Materials (IPREM - UMR 5254), Pau
| | - Claire Corot
- From the Guerbet Research and Innovation Department, Aulnay-sous-Bois
| | - Ryszard Lobinski
- Universite de Pau, E2S-UPPA, CNRS, Institute of Analytical and Physical Chemistry for the Environment and Materials (IPREM - UMR 5254), Pau
- Chair of Analytical Chemistry, Warsaw University of Technology, 00-664 Warsaw, Poland
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15
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Lei A, Zhang Y, Liang F, Zhang J, Cai J. Adoption of Magnetic Resonance Image Features under Segmentation Algorithm in Effect Evaluation of Ginkgo Diterpenoid Lactone Glucamine Injection in Treatment of Cerebral Infarction. Contrast Media Mol Imaging 2022; 2022:4558702. [PMID: 35510178 PMCID: PMC9033383 DOI: 10.1155/2022/4558702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging (MRI) image segmentation based on a segmentation algorithm was performed to assess neurological function in patients with acute cerebral infarction, to investigate the efficacy evaluation of Ginkgo diterpene lactones meglumine injection (GDLI) in the treatment of cerebral infarction and the efficiency of MRI image segmentation algorithm. First, the results of the fast semisupervised segmentation algorithm (algorithm group) and traditional processing (control group) were compared and analyzed. The recall rate, accuracy, recognition accuracy, and segmentation time of the two groups were compared. The control group was given conventional treatment, while the algorithm group was given GDLI based on conventional treatment. Finally, the difference in serum vascular endothelial growth factor (VEGF), hypoxia-inducible factor-la (HIF-la), angiotensin (Ang)-1, Ang-2, and interleukin (IL)-6 protein concentration was analyzed after treatment. The algorithm evaluation results showed that the accuracy and recall rate of MRI images recognized by the algorithm group fluctuate at 90%. In the control group, the accuracy and recall rate of MRI image results fluctuated at 80%, and the data were statistically different (p < 0.05). The clinical index test results showed that the serum VEGF content of the test group was higher than that of the control group, and the data was statistically different (p < 0.05). In addition, the cerebral blood flow (CBF) and cerebral blood volume (CBV) of the lesion side of the algorithm group were greatly higher than those of the control group on the 30th day, and the differences were significant (p < 0.05). There was little difference between the method presented in this study and the manual delineation by a physician. Compared with traditional manual segmentation, this method greatly reduced the time required for the segmentation of lesions. The diagnostic specificity, sensitivity, and accuracy of the images segmented by the fast semisupervised algorithm were higher than those of the conventional method, and the diagnostic accuracy of acute cerebral infarction was high. In addition, it was sensitive and accurate to detect acute cerebral infarction, which provided a reliable reference for early diagnosis and condition judgment of patients.
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Affiliation(s)
- Aidi Lei
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| | - Yanbo Zhang
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong, China
| | - Fulong Liang
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| | - Jianli Zhang
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| | - Jinle Cai
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
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16
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Glessgen CG, Breit HC, Block TK, Merkle EM, Heye T, Boll DT. Respiratory anomalies associated with gadoxetate disodium and gadoterate meglumine: compressed sensing MRI revealing physiologic phenomena during the entire injection cycle. Eur Radiol 2021; 32:346-354. [PMID: 34324024 PMCID: PMC8660712 DOI: 10.1007/s00330-021-08114-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The goal of this study was to investigate the precise timeline of respiratory events occurring after the administration of two gadolinium-based contrast agents, gadoxetate disodium and gadoterate meglumine. MATERIALS AND METHODS This retrospective study examined 497 patients subject to hepatobiliary imaging using the GRASP MRI technique (TR/TE = 4/2 ms; ST = 2.5 mm; 384 × 384 mm). Imaging was performed after administration of gadoxetate (N = 338) and gadoterate (N = 159). All GRASP datasets were reconstructed using a temporal resolution of 1 s. Four regions-of-interest (ROIs) were placed in the liver dome, the right and left cardiac ventricle, and abdominal aorta detecting liver displacement and increasing vascular signal intensities over time. Changes in hepatic intensity reflected respiratory dynamics in temporal correlation to the vascular contrast bolus. RESULTS In total, 216 (67%) and 41 (28%) patients presented with transient respiratory motion after administration of gadoxetate and gadoterate, respectively. The mean duration from start to acme of the respiratory episode was similar (p = 0.4) between gadoxetate (6.0 s) and gadoterate (5.6 s). Its mean onset in reference to contrast arrival in the right ventricle differed significantly (p < 0.001) between gadoxetate (15.3s) and gadoterate (1.8 s), analogously to peak inspiration timepoint in reference to the aortic enhancement arrival (gadoxetate: 0.9s after, gadoterate: 11.2 s before aortic enhancement, p < 0.001). CONCLUSIONS The timepoint of occurrence of transient respiratory anomalies associated with gadoxetate disodium and gadoterate meglumine differs significantly between both contrast agents while the duration of the event remains similar. KEY POINTS • Transient respiratory anomalies following the administration of gadoterate meglumine occurred during a time period usually not acquired in MR imaging. • Transient respiratory anomalies following the administration of gadoxetate disodium occurred around the initiation of arterial phase imaging. • The estimated duration of respiratory events was similar between both contrast agents.
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Affiliation(s)
| | | | - Tobias Kai Block
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, USA
| | - Elmar Max Merkle
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Tobias Heye
- Department of Radiology, University Hospital Basel, Basel, Switzerland
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17
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Stevens W, Farrow IM, Georgiou L, Hanby AM, Perren TJ, Windel LM, Wilson DJ, Sharma N, Dodwell D, Hughes TA, Dall BJG, Buckley DL. Breast tumour volume and blood flow measured by MRI after one cycle of epirubicin and cyclophosphamide-based neoadjuvant chemotherapy as predictors of pathological response. Br J Radiol 2021; 94:20201396. [PMID: 34106751 PMCID: PMC8248209 DOI: 10.1259/bjr.20201396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Better markers of early response to neoadjuvant chemotherapy (NACT) in patients with breast cancer are required to enable the timely identification of non-responders and reduce unnecessary treatment side-effects. Early functional imaging may better predict response to treatment than conventional measures of tumour size. The purpose of this study was to test the hypothesis that the change in tumour blood flow after one cycle of NACT would predict pathological response. METHODS In this prospective cohort study, dynamic contrast-enhanced MRI was performed in 35 females with breast cancer before and after one cycle of epirubicin and cyclophosphamide-based NACT (EC90). Estimates of tumour blood flow and tumour volume were compared with pathological response obtained at surgery following completion of NACT. RESULTS Tumour blood flow at baseline (mean ± SD; 0.32 ± 0.17 ml/min/ml) reduced slightly after one cycle of NACT (0.28 ± 0.18 ml/min/ml). Following treatment 15 patients were identified as pathological responders and 20 as non-responders. There were no relationships found between tumour blood flow and pathological response. Conversely, tumour volume was found to be a good predictor of pathological response (smaller tumours did better) at both baseline (area under the receiver operating characteristic curve 0.80) and after one cycle of NACT (area under the receiver operating characteristic curve 0.81). CONCLUSION & ADVANCES IN KNOWLEDGE The change in breast tumour blood flow following one cycle of EC90 did not predict pathological response. Tumour volume may be a better early marker of response with such agents.
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Affiliation(s)
| | | | | | | | | | | | - Daniel J Wilson
- Dept of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nisha Sharma
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Barbara JG Dall
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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18
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Chan AT, Dinsfriend W, Kim J, Yum B, Sultana R, Klebanoff CA, Plodkowski A, Perez Johnston R, Ginsberg MS, Liu J, Kim RJ, Steingart R, Weinsaft JW. Risk stratification of cardiac metastases using late gadolinium enhancement cardiovascular magnetic resonance: prognostic impact of hypo-enhancement evidenced tumor avascularity. J Cardiovasc Magn Reson 2021; 23:42. [PMID: 33814005 PMCID: PMC8020547 DOI: 10.1186/s12968-021-00727-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is widely used to identify cardiac neoplasms, for which diagnosis is predicated on enhancement stemming from lesion vascularity: Impact of contrast-enhancement pattern on clinical outcomes is unknown. The objective of this study was to determine whether cardiac metastasis (CMET) enhancement pattern on LGE-CMR impacts prognosis, with focus on heterogeneous lesion enhancement as a marker of tumor avascularity. METHODS Advanced (stage IV) systemic cancer patients with and without CMET matched (1:1) by cancer etiology underwent a standardized CMR protocol. CMET was identified via established LGE-CMR criteria based on lesion enhancement; enhancement pattern was further classified as heterogeneous (enhancing and non-enhancing components) or diffuse and assessed via quantitative (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR)) analyses. Embolic events and mortality were tested in relation to lesion location and contrast-enhancement pattern. RESULTS 224 patients were studied, including 112 patients with CMET and unaffected (CMET -) controls matched for systemic cancer etiology/stage. CMET enhancement pattern varied (53% heterogeneous, 47% diffuse). Quantitative analyses were consistent with lesion classification; CNR was higher and SNR lower in heterogeneously enhancing CMET (p < 0.001)-paralleled by larger size based on linear dimensions (p < 0.05). Contrast-enhancement pattern did not vary based on lesion location (p = NS). Embolic events were similar between patients with diffuse and heterogeneous lesions (p = NS) but varied by location: Patients with right-sided lesions had threefold more pulmonary emboli (20% vs. 6%, p = 0.02); those with left-sided lesions had lower rates equivalent to controls (4% vs. 5%, p = 1.00). Mortality was higher among patients with CMET (hazard ratio [HR] = 1.64 [CI 1.17-2.29], p = 0.004) compared to controls, but varied by contrast-enhancement pattern: Diffusely enhancing CMET had equivalent mortality to controls (p = 0.21) whereas prognosis was worse with heterogeneous CMET (p = 0.005) and more strongly predicted by heterogeneous enhancement (HR = 1.97 [CI 1.23-3.15], p = 0.005) than lesion size (HR = 1.11 per 10 cm [CI 0.53-2.33], p = 0.79). CONCLUSIONS Contrast-enhancement pattern and location of CMET on CMR impacts prognosis. Embolic events vary by CMET location, with likelihood of PE greatest with right-sided lesions. Heterogeneous enhancement-a marker of tumor avascularity on LGE-CMR-is a novel marker of increased mortality risk.
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Affiliation(s)
- Angel T Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Pharmacological Sciences, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - William Dinsfriend
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Brian Yum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Razia Sultana
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Andrew Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rocio Perez Johnston
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USA
| | - Richard Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Wennmacker SZ, de Savornin Lohman EAJ, de Reuver PR, Drenth JPH, van der Post RS, Nagtegaal ID, Hermans JJ, van Laarhoven CJHM. Imaging based flowchart for gallbladder polyp evaluation. J Med Imaging Radiat Sci 2021; 52:68-78. [PMID: 33422451 DOI: 10.1016/j.jmir.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preoperative differentiation between neoplastic and nonneoplastic gallbladder polyps, and the subsequent indication for cholecystectomy remains a clinical dilemma. The current 1 cm size threshold for neoplasia is unspecific. The aim of this study was to improve diagnostic work-up for gallbladder polyps using sonographic and MRI characteristics of neoplastic and nonneoplastic polyps. METHODS A prospective, exploratory study including patients undergoing cholecystectomy for gallbladder polyp(s) was conducted. Patients underwent targeted transabdominal ultrasound (TAUS) and MRI. Outcomes were sensitivity and specificity for polyp diagnosis, and the radiological characteristics of neoplastic and nonneoplastic polyp types. Histopathology after cholecystectomy was used as reference standard. RESULTS Histopathology demonstrated gallbladder polyps in 20/27 patients (74%): 14 cholesterol polyps, three adenomyomatosis, two adenomas and one gastric heterotopia. Sensitivity of polyp identification were 72% (routine TAUS) and 86% (targeted TAUS and MRI). Both adenomas were identified as neoplastic on targeted TAUS and MRI. Sonographic presentation as multiple, pedunculated polyps, either heterogeneous or with hyperechoic foci, or as single polyps containing cysts were limited to nonneoplastic polyps. On MRI hyperintense polyps on T1-weighted image were cholesterol polyps. An adenoma with high-grade dysplasia showed foci of decreased ADC values. We propose a checklist for polyp evaluation by targeted TAUS and a flowchart for radiological work-up of gallbladder polyps. CONCLUSIONS The presented checklist and flowchart could aid diagnostic work-up for gallbladder polyps compared to current routine ultrasound, by elimination of nonneoplastic polyps and ultimately improve treatment decision for patients with gallbladder polyps.
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Affiliation(s)
- Sarah Z Wennmacker
- Department of Surgery, Radboud University Medical Centre, the Netherlands.
| | | | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, the Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, the Netherlands
| | | | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, the Netherlands
| | - John J Hermans
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, the Netherlands
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20
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Kim YY, Choi JY, Kim SU, Lee M, Park MS, Chung YE, Kim MJ. MRI Ancillary Features for LI-RADS Category 3 and 4 Observations: Improved Categorization to Indicate the Risk of Hepatic Malignancy. AJR Am J Roentgenol 2020; 215:1354-1362. [PMID: 33052732 DOI: 10.2214/ajr.20.22802] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
OBJECTIVE. The purpose of this study was to investigate whether ancillary features can help stratify malignancy risk in Liver Imaging Reporting and Data System (LI-RADS) category 3 (LR-3) and 4 (LR-4) observations. MATERIALS AND METHODS. This retrospective longitudinal study included 106 LR-3 or LR-4 observations on gadolinium-enhanced MRI obtained from January 2014 to December 2015 in 80 patients who were treatment naïve and at risk (mean age, 58.0 ± 10.7 [SD] years; 60 men). The presence of major and ancillary features, the category determined using only major features, and the final category adjusted by the application of ancillary features were retrospectively analyzed. MRI features were compared using generalized estimating equations, and cumulative incidence curves for malignancy were compared using log-rank tests with a resampling extension. RESULTS. At 6-month follow-up, the cumulative incidence of observations initially categorized as LR-4, observations upgraded to LR-4, observations initially categorized as LR-3, and observations downgraded to LR-3 were 62.5%, 29.7%, 6.2%, and 0%, respectively. The cumulative incidence of malignancy did not differ between observations categorized by major feature as LR-3 and LR-4 (p = 0.12), but was higher in final observations categorized as LR-4 than in those categorized as LR-3 (p < 0.001). Among observations categorized by major feature as LR-3, the cumulative incidence of malignancy was higher in observations upgraded to LR-4 than in observations that were initially graded as LR-3 (p = 0.03), which showed differences in the frequency of restricted diffusion and mild-to-moderate T2-weighted hyperintensity (p < 0.001 for both). CONCLUSION. Final categories determined with ancillary features, instead of categories determined by major features only, can help indicate malignancy risk in LR-3 and LR-4 observations on MRI.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeongjee Lee
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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21
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Patel V, Liu CSJ, Shiroishi MS, Hurth K, Carmichael JD, Zada G, Toga AW. Ultra-high field magnetic resonance imaging for localization of corticotropin-secreting pituitary adenomas. Neuroradiology 2020; 62:1051-1054. [PMID: 32306052 DOI: 10.1007/s00234-020-02431-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
Cushing's disease manifests as symptoms of glucocorticoid excess secondary to the increased secretion of corticotropin by a corticotroph adenoma in the pituitary gland. Unfortunately, magnetic resonance imaging (MRI) performed at conventional clinical field strengths of 1.5 or 3 Tesla has limited sensitivity for the detection of these pituitary tumors, and radiologic uncertainty often necessitates more invasive workup to confirm diagnosis and guide resection. It has been postulated that higher static magnetic field strengths may increase the adenoma detection rate and thus the utility of MRI for this clinical application. In this report, we describe our initial experience using ultra-high field 7 Tesla (7 T) MRI in patients with suspected Cushing's disease and negative or equivocal imaging at conventional field strengths. We performed contrast-enhanced 7 T pituitary MRI in 10 patients with up to three different T1-weighted sequences and correlated the imaging abnormalities identified with results of histologic evaluation in patients who subsequently underwent resection. We found that 7 T MRI enabled the identification of previously undetected areas of focal pituitary hypoenhancement in 9 patients (90%), of which 7 corresponded histologically to corticotroph adenomas. These early findings suggest an important adjunctive role for ultra-high field MR imaging in the noninvasive clinical workup of suspected Cushing's disease.
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Affiliation(s)
- Vishal Patel
- Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA.
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA.
| | - Chia-Shang J Liu
- Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Mark S Shiroishi
- Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Kyle Hurth
- Keck School of Medicine, Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - John D Carmichael
- Keck School of Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gabriel Zada
- Keck School of Medicine, Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
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Kim SJ, Ratchford TL, Buchanan PM, Patel DR, Tao TY, Teckman JH, Brown JJ, Farmakis SG. Diagnostic accuracy of non-contrast magnetic resonance enterography in detecting active bowel inflammation in pediatric patients with diagnosed or suspected inflammatory bowel disease to determine necessity of gadolinium-based contrast agents. Pediatr Radiol 2019; 49:759-769. [PMID: 30899973 DOI: 10.1007/s00247-019-04369-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/14/2019] [Accepted: 02/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pediatric patients with inflammatory bowel disease (IBD) are at increased risk of gadolinium deposition given the potential need for multiple contrast-enhanced magnetic resonance enterography (MRE) exams over their lifetime. OBJECTIVE To determine whether gadolinium-based contrast agents are necessary in assessing active bowel inflammation on MRE in pediatric patients with known or suspected IBD. MATERIALS AND METHODS We conducted a retrospective study of 77 patients (7-18 years; 68.8% male) with known (n=58) or suspected (n=19) IBD and endoscopy with biopsy performed within 30 days of MRE without and with contrast evaluated bowel and non-bowel findings. During three visual analysis sessions, two radiologists reviewed pre-, post-, and pre-/post-contrast MRE images. A third radiologist independently reviewed 27 studies to assess inter-reader reliability. We used Cohen kappa (κ), Fleiss kappa, (κF), McNemar test, and sensitivity and specificity to compare MRE readings to combined endoscopic/histopathological findings (the reference standard). RESULTS The pre- and pre-/post-contrast-enhanced MRE vs. combined endoscopic/histopathological results had moderate agreement (85.7%; κ 0.713, P<0.001; P-value 0.549). Compared to combined endoscopy/histopathology, pre- vs. pre-/post-contrast sensitivity (67%, confidence interval [CI] 0.53-0.79 vs. 67%, CI 0.53-0.79) and specificity (80%, CI 0.59-0.92 vs. 68%, CI 0.46-0.84) varied little (κ 0.42, P<0.001 and κ 0.32, P=0.003, respectively). The three readers had moderate agreement (85.2%; κ 0.695, P=0.001; P-value 0.625). More penetrating complications were identified following contrast administration (P-value 0.04). CONCLUSION Use of a contrast agent does not improve the detection of active inflammation in the terminal ileum and colon compared to non-contrast MRE, although use of a contrast agent does aid in the detection of penetrating disease.
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Affiliation(s)
- Stacy J Kim
- Department of Radiology, SSM Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Ave. at Grand Boulevard, St. Louis, MO, 63110, USA
| | - Thomas L Ratchford
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA
| | - Paula M Buchanan
- Center of Health Outcomes Research, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO, 63104, USA
| | - Dhiren R Patel
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA
| | - Ting Y Tao
- Department of Radiology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA
| | - Jeffrey H Teckman
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA
| | - Jeffrey J Brown
- Department of Radiology, SSM Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Ave. at Grand Boulevard, St. Louis, MO, 63110, USA
| | - Shannon G Farmakis
- Department of Radiology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA.
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Yerly J, Becce F, van Heeswijk RB, Verdun FR, Gubian D, Meuli R, Stuber M. In vitro optimization and comparison of CT angiography versus radial cardiovascular magnetic resonance for the quantification of cross-sectional areas and coronary endothelial function. J Cardiovasc Magn Reson 2019; 21:11. [PMID: 30728035 PMCID: PMC6366062 DOI: 10.1186/s12968-019-0521-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Our objectives were first to determine the optimal coronary computed tomography angiography (CTA) protocol for the quantification and detection of simulated coronary artery cross-sectional area (CSA) differences in vitro, and secondly to quantitatively compare the performance of the optimized CTA protocol with a previously validated radial coronary cardiovascular magnetic resonance (CMR) technique. METHODS 256-multidetector CTA and radial coronary CMR were used to obtain images of a custom in vitro resolution phantom simulating a range of physiological responses of coronary arteries to stress. CSAs were automatically quantified and compared with known nominal values to determine the accuracy, precision, signal-to-noise ratio (SNR), and circularity of CSA measurements, as well as the limit of detection (LOD) of CSA differences. Various iodine concentrations, radiation dose levels, tube potentials, and iterative image reconstruction algorithms (ASiR-V) were investigated to determine the optimal CTA protocol. The performance of the optimized CTA protocol was then compared with a radial coronary CMR method previously developed for endothelial function assessment under both static and moving conditions. RESULTS The iodine concentration, dose level, tube potential, and reconstruction algorithm all had significant effects (all p < 0.001) on the accuracy, precision, LOD, SNR, and circularity of CSA measurements with CTA. The best precision, LOD, SNR, and circularity with CTA were achieved with 6% iodine, 20 mGy, 100 kVp, and 90% ASiR-V. Compared with the optimized CTA protocol under static conditions, radial coronary CMR was less accurate (- 0.91 ± 0.13 mm2 vs. -0.35 ± 0.04 mm2, p < 0.001), but more precise (0.08 ± 0.02 mm2 vs. 0.21 ± 0.02 mm2, p < 0.001), and enabled the detection of significantly smaller CSA differences (0.16 ± 0.06 mm2 vs. 0.52 ± 0.04 mm2; p < 0.001; corresponding to CSA percentage differences of 2.3 ± 0.8% vs. 7.4 ± 0.6% for a 3-mm baseline diameter). The same results held true under moving conditions as CSA measurements with CMR were less affected by motion. CONCLUSIONS Radial coronary CMR was more precise and outperformed CTA for the specific task of detecting small CSA differences in vitro, and was able to reliably identify CSA changes an order of magnitude smaller than those reported for healthy physiological vasomotor responses of proximal coronary arteries. However, CTA yielded more accurate CSA measurements, which may prove useful in other clinical scenarios, such as coronary artery stenosis assessment.
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Affiliation(s)
- Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
| | - Ruud B. van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Francis R. Verdun
- Institute of Radiation Physics, Lausanne University Hospital (CHUV and UNIL), Lausanne, Switzerland
| | - Danilo Gubian
- Direction des Constructions, Ingénierie, Technique et Sécurité (CIT-S), Lausanne University Hospital (CHUV and UNIL), Lausanne, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
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Abstract
The vast majority of intraspinal meningiomas occur in an intradural extramedullary location. A meningioma in a purely extradural location in the cervical spine as reported here is quite exceptional. Extradural meningiomas tend to show more aggressive features than intradural meningiomas and are often confused with malignant neoplasms. We report an invasive extradural meningioma in the cervical spine with multi-segmental involvement, extension through the neural foramina and encasement of the subjacent vertebral artery, mimicking malignancies such as lymphoma and sarcoma. Although rare, meningiomas may demonstrate extradural multi-segmental growth and should be considered in the differential diagnosis of such lesions.
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Affiliation(s)
- Anna Lois Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Parag Ratnakar Salkade
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | | | - Yih Yian Sitoh
- Department of Neuroradiology, National Neuroscience Institute, Singapore
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Kasalak Ö, Dammann A, Adams HJA, Overbosch J, Dierckx RAJO, Jutte PC, Kwee TC. Surveillance MRI for the detection of locally recurrent Ewing sarcoma seems futile. Skeletal Radiol 2018; 47:1517-1522. [PMID: 29752484 DOI: 10.1007/s00256-018-2966-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the frequency of locally recurrent Ewing sarcoma on surveillance MRI and the outcome of these patients. MATERIALS AND METHODS This retrospective single-center study included all patients with newly diagnosed Ewing sarcoma who underwent surveillance MRI of the primary tumor location after primary treatment between 1997 and 2016. RESULTS Thirty-two patients underwent a total of 176 local surveillance MRI scans, yielding an average of 5.5 ± 4.4 MRI scans per patient. Follow-up time of surveillance MRI after completion of primary treatment ranged between 1 and 111 months. Surveillance MRI detected five (15.6%) locally recurrent Ewing sarcomas, at 2, 4, 6, 6, and 7 months after completion of primary treatment, of whom three also had simultaneous recurrent (metastatic) disease elsewhere. Two patients had recurrent metastatic disease without any signs of locally recurrent disease on surveillance MRI. All five patients with locally recurrent disease on surveillance MRI died, at 2, 4, 5, 8, and 9 months after local recurrence detection. Patients with locally recurrent disease had a significantly worse overall survival than patients without locally recurrent disease (log-rank test, P < 0.0001). CONCLUSIONS A limited number of patients have locally recurrent Ewing sarcoma on surveillance MRI. These patients often have simultaneous recurrent (metastatic) disease elsewhere, and their outcome is poor. Moreover, some patients present without locally recurrent disease on MRI but disease recurrence elsewhere. Therefore, surveillance MRI currently seems to have little value and should be reconsidered, also given the costs and the repeated exposure of surviving patients to gadolinium-based contrast agents.
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Affiliation(s)
- Ömer Kasalak
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Amelie Dammann
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hugo J A Adams
- Department of Radiology and Nuclear Imaging, Deventer Hospital, Deventer, The Netherlands
| | - Jelle Overbosch
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Abstract
Chordoma is a rare midline malignant tumor arising from embryonic remnants of the primitive notochord. The base of the skull is the second most common site of disease after the sacrococcygeal region. Intracranial chordoma constitutes about 30-35% of chordoma cases. Metastasis from chordoma is uncommon but if occurs, it tends to spread to the lungs. Cerebrospinal fluid seeding or drop metastasis is very rare. Here we describe a case of a clival chordoma with drop metastases.
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Affiliation(s)
| | - Vijayadwaja Desai
- Department of Pathology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Lee Lian Chew
- Division of Oncologic Imaging, National Cancer Center Singapore, Singapore, Singapore
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27
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Paltrinieri S, Mangiagalli G, Ibba F. Use of urinary γ-glutamyl transferase (GGT) to monitor the pattern of proteinuria in dogs with leishmaniasis treated with N-methylglucamine antimoniate. Res Vet Sci 2018; 119:52-55. [PMID: 29857246 DOI: 10.1016/j.rvsc.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/14/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Abstract
The aim of this study was to assess if the coupled analysis of the urinary protein to creatinine (UPC) ratio and of the GGT/UC ratio (the ratio between urinary γ-glutamyl transferase activity and urinary creatinine) may be used in treated leishmaniotic dogs to differentiate dogs with transient impairment of tubular function from dogs with persistent tubular damage. To this aim, 40 urine from 10 proteinuric and leishmaniotic dogs that at the first visit had high GGT/UC ratio, consistent with tubular damage, were collected and analyzed before treatments and 2, 4 and 6 weeks after treatment with N-methylglucamine antimoniate and allopurinol. Compared with pre-treatment values, at the end of the study period the UPC ratio decreased only in 5/10 dogs, which, however, were still proteinuric or borderline proteinuric. Conversely, the GGT/CU ratio decreased in 8/10 dogs and in 3 of them the values at the end of the study period were below the threshold consistent with tubular proteinuria. The GGT/UC values at 6 weeks was significantly lower than before treatment. However, transient increases were frequent for both the analytes. These results indicate that in most of the dogs that remain proteinuric after treatment, likely due to the persistent glomerular damage, the GGT/UC ratio tends to normalize. This suggests that in these dogs tubular proteinuria at admission depends on functional impairment of tubular cells likely due to the overflow of proteins from damaged glomeruli. However, tubular proteinuria occasionally persists, suggesting that tubulointerstitial damages persist even in dogs responsive to treatments.
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Affiliation(s)
- Saverio Paltrinieri
- Department of Veterinary Medicine, University of Milan, Milan, Italy; Veterinary Teaching Hospital, University of Milan, Milan, Italy.
| | | | - Fabrizio Ibba
- Department of Veterinary Medicine, University of Milan, Milan, Italy; Veterinary Clinic Poggio dei Pini, Capoterra, Cagliari, Italy
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Budzik JF, Lefebvre G, Behal H, Verclytte S, Hardouin P, Teixeira P, Cotten A. Assessment of the zonal variation of perfusion parameters in the femoral head: a 3-T dynamic contrast-enhanced MRI pilot study. Skeletal Radiol 2018; 47:261-270. [PMID: 29143112 DOI: 10.1007/s00256-017-2802-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to describe MR perfusion characteristics of the femoral head, with a focus on the subchondral bone. MATERIALS AND METHODS This prospective monocentric study was approved by our local Ethics Committee. Written informed consent was obtained from all subjects. Dynamic contrast-enhanced MRI of the right hip was performed in 59 adults with suspected spondyloarthritis (32 women, 28 men). Mean age was 37.5 (±12.5) years. Regions of interest were drawn in the femoral head epiphysis, in the subchondral areas the most exposed to mechanical load (superolateral, anterosuperior, and posterior zones) and in areas less exposed to mechanical load (inferior subchondral zone and center of the femoral head). Semi-quantitative and pharmacokinetic parameters were calculated using the Tofts model. Statistical analysis was performed with a linear mixed model to compare the perfusion parameters in the different femoral head zones. RESULTS Extravascular extracellular volume and area under the curve were lower in the superolateral zone than in the inferior zone (p = 0.0135 and p < 0.0001 respectively) and the central zone (p = 0.007 and p = 0.0134 respectively). Extravascular extracellular volume and rate constant were lower in the anterosuperior zone than in the inferior zones (p = 0.011 and p = 0.029). In the anterosuperior zone, extravascular extracellular volume was lower, and time to peak was higher than in the central zones (p = 0.0056 and p = 0.0013 respectively). No significant differences were found for any values between other paired zones. CONCLUSION The perfusion of femoral head subchondral bone assessed with dynamic contrast-enhanced magnetic resonance imaging is not homogeneous: the areas exposed to more mechanical loading are less perfused.
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Affiliation(s)
- Jean-François Budzik
- Imaging Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France.
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.
| | - Guillaume Lefebvre
- Musculoskeletal Imaging Department, Centre de Consultation et d'Imagerie de l'Appareil Locomoteur, CHU Lille, University of Lille Nord de France, F-59000, Lille, France
| | - Hélène Behal
- Biostatistics Department, Lille Regional University Hospital, University of Lille Nord de France, F-59000, Lille, France
| | - Sébastien Verclytte
- Imaging Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France
| | - Pierre Hardouin
- Littoral Côte d'Opale University, Lille University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France
| | - Pedro Teixeira
- Service d'Imagerie Guilloz, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29 Ave du Maréchal de Lattre de Tassigny, F-54035, Nancy, France
| | - Anne Cotten
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France
- Musculoskeletal Imaging Department, Centre de Consultation et d'Imagerie de l'Appareil Locomoteur, CHU Lille, University of Lille Nord de France, F-59000, Lille, France
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Barth BK, Donati OF, Fischer MA, Ulbrich EJ, Karlo CA, Becker A, Seifert B, Reiner CS. Reliability, Validity, and Reader Acceptance of LI-RADS-An In-depth Analysis. Acad Radiol 2016; 23:1145-53. [PMID: 27174029 DOI: 10.1016/j.acra.2016.03.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to analyze interreader agreement and diagnostic accuracy of Liver Imaging Reporting and Data System (LI-RADS) in comparison to a nonstandardized 5-point scale and to assess reader acceptance of LI-RADS for clinical routine. MATERIALS AND METHODS Eighty-four consecutive patients at risk for hepatocellular carcinoma who underwent liver magnetic resonance imaging were included in this Health Insurance Portability and Accountability Act-compliant retrospective study. Four readers rated the likelihood of hepatocellular carcinoma for 104 liver observations using LI-RADS criteria and a 5-point Likert scale (LIKERT) based on subjective impression in two separate reading sessions. Interreader agreement was assessed using kappa statistics (κ). Diagnostic accuracy was assessed with receiver operating characteristic analysis. Reader acceptance was evaluated with a questionnaire. A sub-analysis of LI-RADS's major features (arterial phase hyper-enhancement, washout, capsule appearance, and threshold growth) and scores for lesions </>1.5 cm was performed. RESULTS LI-RADS showed similar overall interreader agreement compared to LIKERT (κ, 0.44 [95%CI: 0.37, 0.52] and 0.35 [95%CI: 0.27, 0.43]) with a tendency toward higher interreader agreement for LI-RADS. Interreader agreement (κ) was 0.51 (95%CI: 0.38, 0.65) for arterial phase hyper-enhancement, 0.52 (95%CI: 0.39, 0.65) for washout, 0.37 (95%CI: 0.23, 0.52) for capsule appearance, and 0.50 (95%CI: 0.38, 0.61) for threshold growth. Overall interreader agreement for LI-RADS categories was similar between observations <1.5 cm and observations >1.5 cm. Overall diagnostic accuracy for LIKERT and LI-RADS was comparable (area under the receiver operating characteristic curve, 0.86 and 0.87). Readers fully agreed with the statement "A short version of LI-RADS would facilitate the use in clinical routine" (median, 5.0; interquartile range, 2.25). CONCLUSIONS LI-RADS showed similar interreader agreement and diagnostic accuracy compared to nonstandardized reporting. However, further reduction of complexity and refinement of imaging features may be needed.
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Affiliation(s)
- Borna K Barth
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Olivio F Donati
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Michael A Fischer
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Erika J Ulbrich
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Christoph A Karlo
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Anton Becker
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Burkhard Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Caecilia S Reiner
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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Rousseau C, Ronot M, Vilgrain V, Zins M. Optimal visualization of focal nodular hyperplasia: quantitative and qualitative evaluation of single and multiphasic arterial phase acquisition at 1.5 T MR imaging. Abdom Radiol (NY) 2016; 41:990-1000. [PMID: 27193796 DOI: 10.1007/s00261-015-0630-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the qualitative and quantitative benefit of multiple arterial phase acquisitions for the depiction of hypervascularity in FNH explored MR imaging using an extracellular contrast agent. METHODS Between 2007 and 2014, all patients who underwent MR imaging for the exploration of FNH were included. The protocol included a single or a triple arterial phase ("single" and "triple" group, respectively). Arterial phases were visually divided into four types: (1) angiographic, (2) early, (3) late, and (4) portal. Signal intensity on arterial phase images was visually recorded as intense, moderate, or low for each lesion. Lesion-to-liver contrast (LLC) and relative lesion enhancement (RE) were calculated and compared between the two groups using the Mann-Whitney test. RESULTS Thirty-five women were included (mean 45-year old, range 20-66), with 50 FNH (mean size 30 mm). Single and triple groups included 20 patients (30 FNH) and 15 patients (20 FNH), respectively. Signal intensity was intense in all lesions in the triple group and in 22/30 (73%) in the single group (p = 0.041). Intense signals were more frequently found in the early arterial phase (p < 0.001). RE was not significantly different (1.78 ± 0.84 vs. 1.98 ± 1.81 p = 0.430, in the single and triple groups, respectively) but LLC was significantly higher in the triple group (0.32 ± 0.10 vs. 0.22 ± 0.10, p = 0.005). LLC was significantly higher in the first two arterial phases in the triple group (p < 0.001). CONCLUSION Acquisition of three arterial phases improves the visualization of hypervascularity of FNH, as lesions show high visual signal intensity and contrast. Optimal visualization is obtained in the early arterial phase.
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Affiliation(s)
- Caroline Rousseau
- Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, HUPNVS, 100, Bd du Général Leclerc, Clichy, France.
- University Paris Diderot, Sorbonne Paris Cite, Paris, France.
- INSERM U1149, CRI, 75018, Paris, France.
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, HUPNVS, 100, Bd du Général Leclerc, Clichy, France
- University Paris Diderot, Sorbonne Paris Cite, Paris, France
- INSERM U1149, CRI, 75018, Paris, France
| | - Marc Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674, Paris, France
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Shin HJ, Chae EY, Choi WJ, Ha SM, Park JY, Shin KC, Cha JH, Kim HH. Diagnostic Performance of Fused Diffusion-Weighted Imaging Using Unenhanced or Postcontrast T1-Weighted MR Imaging in Patients With Breast Cancer. Medicine (Baltimore) 2016; 95:e3502. [PMID: 27124054 PMCID: PMC4998717 DOI: 10.1097/md.0000000000003502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To evaluate the diagnostic performance of fused diffusion-weighted imaging (DWI) using either unenhanced (UFMR) or early postcontrast T1-weighted imaging (PCFMR) to detect and characterize breast lesions in patients with breast cancer.This retrospective observational study was approved by institutional review board in our hospital and informed consents were waived. We retrospectively selected 87 consecutive patients who underwent preoperative breast magnetic resonance imaging, including DWI and definitive surgery. Both UFMR and PCFMR were reviewed by 5 radiologists for detection, lesion size, Breast Imaging Reporting and Data System final assessment, the probability of malignancy, lesion conspicuity, and apparent diffusion coefficients.A total of 129 lesions were identified by at least 2 readers on UFMR or PCFMR. Of 645 potentially detected lesions, there were 528 (82%) with UFMR and 554 (86%) with PCFMR. Malignant lesions or index cancers showed significantly higher detection rates than benign or additional lesions on both UFMR and PCFMR (P < 0.05). Area under the characteristic curves (AUCs) for predicting malignancy ranged 0.927 to 0.986 for UFMR, and 0.936 to 0.993 for PCFMR, which was not significantly different. Lesion conspicuity was significantly higher on PCFMR than UFMR (8.59 ± 1.67 vs 9.19 ± 1.36, respectively; P < 0.05) across 5 readers. Mean intraclass correlation coefficients for lesion size on UFMR and PCFMR were 0.89 and 0.92, respectively.Detection rates of index malignant lesions were similar for UFMR and PCFMR. Interobserver agreement for final assessments was reliable across 5 readers. Diagnostic accuracy for predicting malignancy with UFMR versus PCFMR was similar, although lesion conspicuity was significantly greater with the latter.
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Affiliation(s)
- Hee Jung Shin
- From the Department of Radiology and Research Institute of Radiology, Biomedical Imaging Infrastructure, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
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Sousa MSC, Ramalho M, Herédia V, Matos AP, Palas J, Jeon YH, Afonso D, Semelka RC. Perilesional enhancement of liver cavernous hemangiomas in magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 39:722-30. [PMID: 24531350 DOI: 10.1007/s00261-014-0100-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate on magnetic resonance imaging (MRI) the occurrence rate of temporal perilesional parenchymal enhancement (PPE) associated with hepatic hemangiomas in a large consecutive series and to determine which aspects are associated with this observation. MATERIALS AND METHODS Institutional review board approved this retrospective study. A computerized search of the MRI database was performed for consecutive patients between January 2008 and January 2012. The study population included 513 liver hemangiomas in 224 patients (104 males and 120 females; mean age of 55.2 ± 13.5 years; age range 24-89 years). Two readers independently reviewed the frequency of PPE, size, speed of enhancement and location of each hemangioma. Marginal models with generalized estimating equation were used. Wald test was applied to verify if the model coefficients were significant. RESULTS 80/513 (15.6%) hemangiomas showed PPE. The incidence of PPE was significantly higher (p < 0.05) in hemangiomas with Type1 speed of enhancement (51/80, 63.8%) than in those with Type2 or Type3. 66/80 (82.5%) hemangiomas with PPE were subcapsular (p < 0.05). Conversely, the majority (280/433, 64.7%) of hemangiomas without PPE were deep in location (p < 0.001). Lesser proportion of hemangiomas with PPE was located in segment IVa (p < 0.05). CONCLUSION PPE is not uncommonly seen along with hepatic hemangiomas. This appearance is most frequently observed in rapidly enhancing small lesions with a subcapsular location.
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Affiliation(s)
- Marta S C Sousa
- Department of Radiology, Hospital Garcia de Orta, 2801-951, Almada, Portugal
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Hamshere S, Jones DA, Pellaton C, Longchamp D, Burchell T, Mohiddin S, Moon JC, Kastrup J, Locca D, Petersen SE, Westwood M, Mathur A. Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary? J Cardiovasc Magn Reson 2016; 18:7. [PMID: 26803468 PMCID: PMC4724400 DOI: 10.1186/s12968-016-0226-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR). METHODS CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers. RESULTS 85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21%, 95% limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs. (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001. CONCLUSIONS AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians.
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Affiliation(s)
- Stephen Hamshere
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Cyril Pellaton
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Danielle Longchamp
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Tom Burchell
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Saidi Mohiddin
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Jens Kastrup
- Department of Cardiology, Rigshopitale, University of Copenhagen, Copenhagen, Denmark.
| | - Didier Locca
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- Service de Cardiologie et Département de Médecine Interne, Centre Hospitalier Universitaire, Vaudois, Lausanne, Switzerland.
| | - Steffen E Petersen
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Mark Westwood
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Spira D, Germann T, Lehner B, Hemmer S, Akbar M, Jesser J, Weber MA, Rehnitz C. CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection. PLoS One 2016; 11:e0146399. [PMID: 26727377 PMCID: PMC4699662 DOI: 10.1371/journal.pone.0146399] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives To search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis. Methods 34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients. Results Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002). Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%. Conclusions Inflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.
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Affiliation(s)
- Daniel Spira
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
- * E-mail:
| | - Thomas Germann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Burkhard Lehner
- Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Stefan Hemmer
- Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Pöyhönen P, Hiippala A, Ollila L, Kaasalainen T, Hänninen H, Heliö T, Tallila J, Vasilescu C, Kivistö S, Ojala T, Holmström M. Cardiovascular magnetic resonance findings in patients with PRKAG2 gene mutations. J Cardiovasc Magn Reson 2015; 17:89. [PMID: 26496977 PMCID: PMC4619453 DOI: 10.1186/s12968-015-0192-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/06/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Autosomal dominantly inherited PRKAG2 cardiac syndrome is due to a unique defect of the cardiac cell metabolism and has a distinctive histopathology with excess intracellular glycogen, and prognosis different from sarcomeric hypertrophic cardiomyopathy. We aimed to define the distinct characteristics of PRKAG2 using cardiovascular magnetic resonance (CMR). METHODS CMR (1.5 T) and genetic testing were performed in two families harboring PRKAG2 mutations. On CMR, segmental analysis of left ventricular (LV) hypertrophy (LVH), function, native T1 mapping, and late gadolinium enhancement (LGE) were performed. RESULTS Six individuals (median age 23 years, range 16-48; two females) had a PRKAG2 mutation: five with an R302Q mutation (family 1), and one with a novel H344P mutation (family 2). Three of six mutation carriers had LV mass above age and gender limits (203 g/m2, 157 g/m2 and 68 g/m2) and others (with R302Q mutation) normal LV masses. All mutation carriers had LVH in at least one segment, with the median maximal wall thickness of 13 mm (range 11-37 mm). Two R302Q mutation carriers with markedly increased LV mass (203 g/m2 and 157 g/m2) showed a diffuse pattern of hypertrophy but predominantly in the interventricular septum, while other mutation carriers exhibited a non-symmetric mid-infero-lateral pattern of hypertrophy. In family 1, the mutation negative male had a mean T1 value of 963 ms, three males with the R302Q mutation, LVH and no LGE a mean value of 918 ± 11 ms, and the oldest male with the R302Q mutation, extensive hypertrophy and LGE a mean value of 973 ms. Of six mutations carriers, two with advanced disease had LGE with 11 and 22 % enhancement of total LV volume. CONCLUSIONS PRKAG2 cardiac syndrome may present with eccentric distribution of LVH, involving focal mid-infero-lateral pattern in the early disease stage, and more diffuse pattern but focusing on interventricular septum in advanced cases. In patients at earlier stages of disease, without LGE, T1 values may be reduced, while in the advanced disease stage T1 mapping may result in higher values caused by fibrosis. CMR is a valuable tool in detecting diffuse and focal myocardial abnormalities in PRKAG2 cardiomyopathy.
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MESH Headings
- AMP-Activated Protein Kinases/genetics
- Adolescent
- Adult
- Cardiomyopathy, Hypertrophic/enzymology
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/pathology
- Cardiomyopathy, Hypertrophic/physiopathology
- Contrast Media
- DNA Mutational Analysis
- Electrocardiography
- Female
- Fibrosis
- Genetic Predisposition to Disease
- Humans
- Hypertrophy, Left Ventricular/enzymology
- Hypertrophy, Left Ventricular/genetics
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Male
- Meglumine
- Middle Aged
- Mutation
- Myocardium/pathology
- Organometallic Compounds
- Phenotype
- Predictive Value of Tests
- Ventricular Function, Left
- Ventricular Remodeling
- Young Adult
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Affiliation(s)
- Pauli Pöyhönen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Po BOX 340, Helsinki, 00029 HUCH, Finland.
| | - Anita Hiippala
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Laura Ollila
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Po BOX 340, Helsinki, 00029 HUCH, Finland.
| | - Touko Kaasalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Helena Hänninen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Po BOX 340, Helsinki, 00029 HUCH, Finland.
| | - Tiina Heliö
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Po BOX 340, Helsinki, 00029 HUCH, Finland.
| | | | - Catalina Vasilescu
- Molecular Neurology Research Program, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.
| | - Sari Kivistö
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Tiina Ojala
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Miia Holmström
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Abstract
Acute spinal cord injury (SCI) is one of the most common causes of severe disability and mortality after trauma. Magnetic resonance imaging (MRI) can identify different levels of SCI, but sometimes unable to detect the associated soft tissue injuries. The role of MRI with contrast in patients with SCI has not been studied. This is the first study in human to compare the efficacy of MRI with and without contrast in diagnosis and prognosis evaluation of SCIs.In this cross-sectional diagnostic study, MRI with and without contrast was performed on 40 patients with acute spinal injury. In these patients, 3 different types of MRI signal patterns were detected and compared.The most common cases of spinal injuries were accident (72.5%) and the after fall (27.5%). The prevalence of lesions detected includes spine fracture (70%), spinal stenosis (32.5%), soft tissue injuries (30%), and tearing of the spinal cord (2.5%). A classification was developed using 3 patterns of SCIs. Type I, seen in 2 (5.0%) of the patients, demonstrated a decreased signal intensity consistent with acute intraspinal hemorrhage. Type II, seen in 8 (20.0%) of the patients, demonstrated a bright signal intensity consistent with acute cord edema. Type III, seen in 1 (2.5%) of the patients, demonstrated a mixed signal of hypointensity centrally and hyperintensity peripherally consistent with contusion. In the diagnosis of all injuries, MRI with contrast efficacy comparable to noncontrast MRI, except in the diagnosis of soft tissue, which was significantly higher sensitivity (P < 0.05).So given that is not significant differences between noncontrast and contrast-enhanced MRI in the diagnosis of major injuries (hematoma, edema, etc.) and contrast-enhanced MRI just better in soft tissues. We recommend to the MRI with contrast only used in cases of suspected severe soft tissue injury, which have been ignored by detection MRI without contrast.
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Affiliation(s)
- Ahmad Ghasemi
- From the Department of Radiology (AG); Department of Neurosurgery (KH); and Department of Radiology (AAS), Emam Hospital, Mazandaran University of Medical Science, Sari, Iran
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Sanguineti F, Garot P, Mana M, O'h-Ici D, Hovasse T, Unterseeh T, Louvard Y, Troussier X, Morice MC, Garot J. Cardiovascular magnetic resonance predictors of clinical outcome in patients with suspected acute myocarditis. J Cardiovasc Magn Reson 2015; 17:78. [PMID: 26318624 PMCID: PMC4553007 DOI: 10.1186/s12968-015-0185-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/17/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The natural history of acute myocarditis (AM) remains highly variable and predictors of outcome are largely unknown. The objectives were to determine the potential value of various cardiovascular magnetic resonance (CMR) parameters for the prediction of adverse long-term outcome in patients presenting with suspected AM. METHODS In a single-centre longitudinal prospective study, 203 routine consecutive patients with an initial CMR-based diagnosis of AM (typical Late Gadolinium Enhancement, LGE) were followed over a mean period of 18.9 ± 8.2 months. Various CMR parameters were evaluated as potential predictors of outcome. The primary endpoint was defined as the occurrence of at least one of the combined Major Adverse Clinical Events (MACE) (cardiac death or aborted sudden cardiac death, cardiac transplantation, sustained documented ventricular tachycardia, heart failure, recurrence of acute myocarditis, and the need for hospitalization for cardiac causes). RESULTS The vast majority of patients (N = 143,70 %) presented with chest pain, mild to moderate troponin elevation and ST-segment or T wave abnormalities. Various CMR parameters were evaluated on initial CMR performed 3 ± 2 days after acute clinical presentation (LV functional parameters, presence/extent of edema on T2 CMR, and extent of late gadolinium enhancement lesions). Out of the 203 patients, 22 experienced at least one major cardiovascular event (10.8 %) during follow-up for a total of 31 major cardiovascular events. Among all CMR parameters, the only independent CMR predictor of adverse clinical outcome by multivariate analysis was an initial alteration of LVEF (p = 0.04). CONCLUSIONS In routine consecutive patients without severe hemodynamic compromise and a CMR-based diagnosis of AM, various CMR parameters such as the presence and extent of myocardial edema and the extent of late gadolinium-enhanced LV myocardial lesions were not predictive of outcome. The only independent CMR predictor of adverse clinical outcome was an initial alteration of LVEF.
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Affiliation(s)
- Francesca Sanguineti
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Philippe Garot
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Melina Mana
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Darach O'h-Ici
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Thomas Hovasse
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Thierry Unterseeh
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Yves Louvard
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Xavier Troussier
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Marie-Claude Morice
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| | - Jérôme Garot
- The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
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Møller S, Lundemann M, Law I, Poulsen HS, Larsson HBW, Engelholm SA. Early changes in perfusion of glioblastoma during radio- and chemotherapy evaluated by T1-dynamic contrast enhanced magnetic resonance imaging. Acta Oncol 2015. [PMID: 26203926 DOI: 10.3109/0284186x.2015.1063777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The survival times of patients with glioblastoma differ widely and biomarkers that would enable individualized treatment are needed. The objective of this study was to measure changes in the vascular physiology of tumor using T1-dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in patients with glioblastoma during early stages of radio- and chemotherapy (Tx) and explore possible correlations with treatment outcomes. MATERIAL AND METHODS An exploratory prospective study was planned. Patients underwent DCE-MRI at baseline, after approximately one and six weeks of Tx and three and six months post-Tx. DCE-MRI at three Tesla generated maps of blood flow (BF), blood volume (BV), permeability (Ki) and volume of distribution (Vd) using a combination of model-free deconvolution and Patlak plots. Regions of interest in contrast enhancing tumor and in normal appearing white matter were contoured. Progression-free survival (PFS) was the primary clinical outcome. Patients with PFS > 6 months were compared with those with PFS < 6 months. Parameters of vascular physiology and changes in these during Tx were compared for these two groups at all time points using non-parametric statistics. RESULTS Eleven eligible patients were included and 46 DCE-MRI examinations were carried out. BF in tumor increased for all patients early during Tx (p = 0.005) and then fell to a level below baseline at post-Tx examinations (p = 0.016). A similar but non-significant trend was seen for tumor BV. There was no detectable difference between patients with PFS > 6 months versus PFS < 6 months with regards to baseline values or changes during and after Tx. CONCLUSIONS Although no correlations to outcomes were found, the results of this exploratory study may be hypothesis generating and will be examined in a larger patient group.
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Affiliation(s)
- Søren Møller
- a Department of Oncology , Section for Radiotherapy, Rigshospitalet, University of Copenhagen , Denmark
| | - Michael Lundemann
- a Department of Oncology , Section for Radiotherapy, Rigshospitalet, University of Copenhagen , Denmark
| | - Ian Law
- b Department of Clinical Physiology , Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen , Denmark
| | - Hans S Poulsen
- a Department of Oncology , Section for Radiotherapy, Rigshospitalet, University of Copenhagen , Denmark
- c Department of Radiation Biology , Rigshospitalet, University of Copenhagen , Denmark
| | - Henrik B W Larsson
- b Department of Clinical Physiology , Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen , Denmark
- d Functional Imaging Unit, Department of Clinical Physiology , Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen , Denmark
| | - Svend Aage Engelholm
- a Department of Oncology , Section for Radiotherapy, Rigshospitalet, University of Copenhagen , Denmark
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Mariotti E, Veronese M, Dunn JT, Southworth R, Eykyn TR. Kinetic analysis of hyperpolarized data with minimum a priori knowledge: Hybrid maximum entropy and nonlinear least squares method (MEM/NLS). Magn Reson Med 2015; 73:2332-42. [PMID: 25046363 DOI: 10.1002/mrm.25362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/11/2014] [Accepted: 06/23/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess the feasibility of using a hybrid Maximum-Entropy/Nonlinear Least Squares (MEM/NLS) method for analyzing the kinetics of hyperpolarized dynamic data with minimum a priori knowledge. THEORY AND METHODS A continuous distribution of rates obtained through the Laplace inversion of the data is used as a constraint on the NLS fitting to derive a discrete spectrum of rates. Performance of the MEM/NLS algorithm was assessed through Monte Carlo simulations and validated by fitting the longitudinal relaxation time curves of hyperpolarized [1-(13) C] pyruvate acquired at 9.4 Tesla and at three different flip angles. The method was further used to assess the kinetics of hyperpolarized pyruvate-lactate exchange acquired in vitro in whole blood and to re-analyze the previously published in vitro reaction of hyperpolarized (15) N choline with choline kinase. RESULTS The MEM/NLS method was found to be adequate for the kinetic characterization of hyperpolarized in vitro time-series. Additional insights were obtained from experimental data in blood as well as from previously published (15) N choline experimental data. CONCLUSION The proposed method informs on the compartmental model that best approximate the biological system observed using hyperpolarized (13) C MR especially when the metabolic pathway assessed is complex or a new hyperpolarized probe is used.
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Affiliation(s)
- Erika Mariotti
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom
| | - Mattia Veronese
- Institute of Psychiatry, King's College London, London, United Kingdom
| | - Joel T Dunn
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom
| | - Richard Southworth
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom
| | - Thomas R Eykyn
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom
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40
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Steeden JA, Pandya B, Tann O, Muthurangu V. Free breathing contrast-enhanced time-resolved magnetic resonance angiography in pediatric and adult congenital heart disease. J Cardiovasc Magn Reson 2015; 17:38. [PMID: 25997552 PMCID: PMC4490694 DOI: 10.1186/s12968-015-0138-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/30/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Contrast enhanced magnetic resonance angiography (MRA) is generally performed during a long breath-hold (BH), limiting its utility in infants and small children. This study proposes a free-breathing (FB) time resolved MRA (TRA) technique for use in pediatric and adult congenital heart disease (CHD). METHODS A TRA sequence was developed by combining spiral trajectories with sensitivity encoding (SENSE, x4 kx-ky and x2 kz) and partial Fourier (75% in kz). As no temporal data sharing is used, an independent 3D data set was acquired every ~1.3s, with acceptable spatial resolution (~2.3x2.3x2.3 mm). The technique was tested during FB over 50 consecutive volumes. Conventional BH-MRA and FB-TRA data was acquired in 45 adults and children with CHD. We calculated quantitative image quality for both sequences. Diagnostic accuracy was assessed in all patients from both sequences. Additionally, vessel measurements were made at the sinotubular junction (N = 43), proximal descending aorta (N = 43), descending aorta at the level of the diaphragm (N = 43), main pulmonary artery (N = 35), left pulmonary artery (N = 35) and the right pulmonary artery (N = 35). Intra and inter observer variability was assessed in a subset of 10 patients. RESULTS BH-MRA had significantly higher homogeneity in non-contrast enhancing tissue (coefficient of variance, P <0.0001), signal-to-noise ratio (P <0.0001), contrast-to-noise ratio (P <0.0001) and relative contrast (P = 0.02) compared to the FB-TRA images. However, homogeneity in the vessels was similar in both techniques (P = 0.52) and edge sharpness was significantly (P <0.0001) higher in FB-TRA compared to BH-MRA. BH-MRA provided overall diagnostic accuracy of 82%, and FB-TRA of 87%, with no statistical difference between the two sequences (P = 0.77). Vessel diameter measurements showed excellent agreement between the two techniques (r = 0.98, P <0.05), with no bias (0.0 mm, P = 0.71), and clinically acceptable limits of agreement (-2.7 to +2.8 mm). Inter and intra observer reproducibility showed good agreement of vessel diameters (r>0.988, P<0.0001), with negligible biases (between -0.2 and +0.1mm) and small limits of agreement (between -2.4 and +2.5mm). CONCLUSIONS We have described a FB-TRA technique that is shown to enable accurate diagnosis and vessel measures compared to conventional BH-MRA. This simplifies the MRA technique and will enable angiography to be performed in children and adults whom find breath-holding difficult.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Bejal Pandya
- UCL Centre for Cardiovascular Imaging, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
- The Heart Hospital, University College London Hospital Foundation Trust, London, W1G 8PH, UK.
| | - Oliver Tann
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
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Budjan J, Ong M, Riffel P, Morelli JN, Michaely HJ, Schoenberg SO, Haneder S. CAIPIRINHA-Dixon-TWIST (CDT)-volume-interpolated breath-hold examination (VIBE) for dynamic liver imaging: Comparison of gadoterate meglumine, gadobutrol and gadoxetic acid. Eur J Radiol 2014; 83:2007-12. [PMID: 25172427 DOI: 10.1016/j.ejrad.2014.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/08/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany.
| | - Melissa Ong
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Philipp Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - John N Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henrik J Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Stefan Haneder
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
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Ledger AEW, Borri M, Pope RJE, Scurr ED, Wallace T, Richardson C, Usher M, Allen S, Wilson RM, Thomas K, deSouza NM, Leach MO, Schmidt MA. Investigating the influence of flip angle and k-space sampling on dynamic contrast-enhanced MRI breast examinations. Acad Radiol 2014; 21:1394-401. [PMID: 25179563 PMCID: PMC4234081 DOI: 10.1016/j.acra.2014.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/18/2014] [Accepted: 06/27/2014] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES To retrospectively investigate the effect of flip angle (FA) and k-space sampling on the performance of dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) breast sequences. MATERIALS AND METHODS Five DCE-MRI breast sequences were evaluated (10°, 14°, and 18° FAs; radial or linear k-space sampling), with 7-10 patients in each group (n = 45). All sequences were compliant with current technical breast screening guidelines. Contrast agent (CA) uptake curves were constructed from the right mammary artery for each examination. Maximum relative enhancement, E(max), and time-to-peak enhancement, T(max), were measured and compared between protocols (analysis of variance and Mann-Whitney). For each sequence, calculated values of maximum relative enhancement, E(calc), were derived from the Bloch equations and compared to E(max). Fat suppression performance (residual bright fat and chemical shift artifact) was rated for each examination and compared between sequences (Fisher exact tests). RESULTS Significant differences were identified between DCE-MRI sequences. E(max) increased significantly at higher FAs and with linear k-space sampling (P < .0001; P = .001). Radial protocols exhibited greater T(max) than linear protocols at FAs of both 14° (P = .025) and 18° (P < .0001), suggesting artificially flattened uptake curves. Good correlation was observed between E(calc) and E(max) (r = 0.86). Fat suppression failure was more pronounced at an FA of 18° (P = .008). CONCLUSIONS This retrospective approach is validated as a tool to compare and optimize breast DCE-MRI sequences. Alterations in FA and k-space sampling result in significant differences in CA uptake curve shape which could potentially affect diagnostic interpretation. These results emphasize the need for careful parameter selection and greater standardization of breast DCE-MRI sequences.
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Affiliation(s)
- Araminta E W Ledger
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | - Marco Borri
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | - Romney J E Pope
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Erica D Scurr
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Toni Wallace
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Cheryl Richardson
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Marianne Usher
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Steven Allen
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Robin M Wilson
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Karen Thomas
- Clinical Research and Development, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Nandita M deSouza
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | - Martin O Leach
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom.
| | - Maria A Schmidt
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
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Weir-McCall JR, Khan F, Lambert MA, Adamson CL, Gardner M, Gandy SJ, Ramkumar PG, Belch JJF, Struthers AD, Rauchhaus P, Morris AD, Houston JG. Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden: a cross sectional study using whole body magnetic resonance angiography. PLoS One 2014; 9:e99190. [PMID: 24933122 PMCID: PMC4059661 DOI: 10.1371/journal.pone.0099190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA). Methods 50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50–70%, 3 = 70–99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated. Results The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β −0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β −0.45 p = 0.005). Conclusion ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to a strong correlation with ilio-femoral atheroma burden.
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Affiliation(s)
- Jonathan R. Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
- * E-mail:
| | - Faisel Khan
- Vascular & Inflammatory Diseases Research Unit, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Matthew A. Lambert
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Carly L. Adamson
- University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Michael Gardner
- University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Stephen J. Gandy
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, United Kingdom
| | | | - Jill J. F. Belch
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Allan D. Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Petra Rauchhaus
- Dundee epidemiological and biostatistics unit, University of Dundee, Dundee, United Kingdom
| | - Andrew D. Morris
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - J. Graeme Houston
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
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Hansmann J, Michaely HJ, Morelli JN, Luckscheiter A, Schoenberg SO, Attenberger UI. Enhancement characteristics and impact on image quality of two gadolinium chelates at equimolar doses for time-resolved 3-Tesla MR-angiography of the calf station. PLoS One 2014; 9:e99079. [PMID: 24893292 PMCID: PMC4043962 DOI: 10.1371/journal.pone.0099079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/10/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare enhancement characteristics and image quality of two macrocyclic gadolinium chelates, gadoterate meglumine and gadobutrol, in low-dose, time-resolved MRA of the calf station. MATERIALS AND METHODS 100 consecutive patients with peripheral arterial disease (stages II-IV) were retrospectively analysed. Fifty patients were included in each group - 32 men and 18 women for gadobutrol (mean age 67 years) and 34 men, 16 women for gadoterate meglumine (mean age 64 years). 0.03 mmol/kg bw of either gadobutrol or gadoterate meglumine was injected. Gadobutrol was diluted 1 ∶ 1 with normal saline (0.9% NaCl) to provide similar injection volume and bolus geometry compared to the undiluted 0.5 M dose of gadoterate meglumine. Signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR) and image quality were analysed and compared between the two groups. RESULTS Mean SNR ranged from 83.0 ± 46.7 (peroneal artery) to 96.4 ± 64.5 (anterior tibial artery) for gadobutrol, and from 37.6 ± 13.8 (peroneal artery) to 45.3 ± 16.4 (anterior tibial artery) for the gadoterate meglumine group (p<0.0001). CNR values ranged from 30.1 ± 20.1 (peroneal artery) to 37.6 ± 26.0 (anterior tibial artery) for gadobutrol and from 14.9 ± 8.0 (peroneal artery) to 18.6 ± 16.4 (anterior tibial artery) for gadoterate meglumine (p<0.0001). No significant difference in image quality was found except for the peroneal arteries (p = 0.006 and p = 0.04). Interreader agreement was excellent (kappa 0.87-0.93). CONCLUSION The significantly better enhancement as assessed by SNR and CNR provided by gadobutrol compared to gadoterate meglumine does not translate into substantial differences in image quality in an equimolar, low-dose, time-resolved MRA protocol of the calves.
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Affiliation(s)
- Jan Hansmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - Henrik J. Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - John N. Morelli
- The Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - André Luckscheiter
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
| | - Ulrike I. Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany
- * E-mail:
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Hermens JAJM, van Es J, von Birgelen C, Op den Akker JW, Wagenaar LJ. Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries. Int J Cardiovasc Imaging 2014; 30:1097-103. [PMID: 24794293 DOI: 10.1007/s10554-014-0435-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/26/2014] [Indexed: 11/26/2022]
Abstract
Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14%) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44-187) with median peak creatinine phosphokinase of 485 U/l (IQR 234-618). Echocardiographic wall motion abnormalities were detected in 8/11 (73%) patients; in 75% of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36%) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization.
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Affiliation(s)
- Jeannine A J M Hermens
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands,
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Barone-Rochette G, Augier C, Rodière M, Quesada JL, Foote A, Bouvaist H, Marlière S, Fagret D, Baguet JP, Vanzetto G. Potentially simple score of late gadolinium enhancement cardiac MR in acute myocarditis outcome. J Magn Reson Imaging 2013; 40:1347-54. [PMID: 24293405 DOI: 10.1002/jmri.24504] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 10/14/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To determine the value of cardiac MRI for the monitoring and the prognosis of patients with acute myocarditis. Cardiac MRI plays an increasingly important role in the diagnosis of acute myocarditis. However, it is less established as a prognostic tool, which requires specific postprocessing of images. MATERIALS AND METHODS In a prospective pilot study, we assessed the prognostic value of the evolution in a simplified visual quantitative score (SQS) of late gadolinium enhancement (LGE) between initial hospitalization and 3 months later. The prognostic value was assessed at 1 year using a combination of death, heart transplant, and confirmed recurrence as main outcome. RESULTS Twenty-eight patients were included in this study. A significant correlation was found between LGE measured by SQS and planimetry (r = 0.95, P < 0.001). Intraobserver and interobserver reproducibilities were good for SQS (ICC = 0.95 [95% CI: 0.86 to 0.98], and 0.94 [95% CI: 0.84 to 0.98], respectively). At initial hospitalization, patient characteristics between the two groups were similar. Patients with stable or increased SQS suffered more frequently from clinical outcome events than patients with a decrease in SQS (P = 0.02). CONCLUSION Monitoring of the evolution of LGE using a simple visual score is of interest to identify patients at risk of pejorative prognosis after acute myocarditis.
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Affiliation(s)
- Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble, France; INSERM U 1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
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Potet J, Rahmouni A, Mayer J, Vignaud A, Lim P, Luciani A, Dubois-Randé JL, Kobeiter H, Deux JF. Detection of myocardial edema with low-b-value diffusion-weighted echo-planar imaging sequence in patients with acute myocarditis. Radiology 2013; 269:362-369. [PMID: 23696680 DOI: 10.1148/radiology.13121811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To evaluate the performance of a low-b-value diffusion-weighted (DW) echo-planar (EP) imaging sequence for detection of regional and diffuse myocardial edema in patients with acute myocarditis. MATERIALS AND METHODS This study was approved by the institutional review board, and informed consent was obtained from all subjects. Thirteen patients with acute myocarditis and a control group of seven healthy adults underwent low-b-value (50 sec/mm(2)) DW cardiac magnetic resonance imaging. DW EP images were acquired in the four-chamber long-axis section and analyzed qualitatively and quantitatively. Short inversion time inversion-recovery (STIR) T2-weighted and late gadolinium chelate enhancement images were acquired in the same plane and analyzed. Late gadolinium chelate enhancement was used as the reference standard. Statistical analyses were performed with a receiver operating characteristic analysis and a nonparametric Wilcoxon test. RESULTS Qualitative analysis showed myocardial high-signal-intensity areas in 100% (13 of 13) of patients on DW EP, 38% (five of 13) on STIR T2-weighted, and 100% (13 of 13) on late gadolinium chelate enhancement images. In eight patients (61%), high-signal-intensity areas were exhibited on DW EP images that were not detected on STIR T2-weighted images, but were colocalized with lesions detected on late gadolinium chelate enhancement images. Similar results were obtained by using an automatic analysis with dedicated cardiac software. The global myocardial signal intensity ratio was significantly higher (P = .03) in patients than in controls for DW EP (2.2 ± 0.4 [standard deviation] vs 1.1 ± 0.4, respectively), and exhibited no significant difference (P = .14) for STIR T2-weighted (1.7 ± 0.6 vs 1.4 ± 0.1, respectively) images. Sensitivity and diagnostic accuracy were higher for DW EP images than for STIR T2-weighted images (92% vs 54%, and 95% vs 70%, respectively), and specificity was the same (100% vs 100%). CONCLUSION A low-b-value DW EP imaging sequence is a feasible alternative to the standard STIR T2-weighted sequence for detection of regional and global myocardium edema in patients with acute myocarditis. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121811/-/DC1.
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Affiliation(s)
- Julien Potet
- Departments of Radiology and Cardiology, Henri Mondor Hospital, University Paris Est Creteil, Assistance Publique-Hôpitaux de Paris, 51 av Mal de Lattre de Tassigny, 94000 Creteil, France; Siemens Healthcare, Saint Denis, France
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48
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Weiß M. [Non-ionic contrast agent gadobutrol preference clarified]. ROFO-FORTSCHR RONTG 2013; 185:690. [PMID: 24058985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Punwani S, Cheung KK, Skipper N, Bell N, Bainbridge A, Taylor SA, Groves AM, Hain SF, Ben-Haim S, Shankar A, Daw S, Halligan S, Humphries PD. Dynamic contrast-enhanced MRI improves accuracy for detecting focal splenic involvement in children and adolescents with Hodgkin disease. Pediatr Radiol 2013; 43:941-9. [PMID: 23377561 DOI: 10.1007/s00247-012-2616-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 12/02/2012] [Accepted: 12/17/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate assessment of splenic disease is important for staging Hodgkin lymphoma. OBJECTIVE The purpose of this study was to assess T2-weighted imaging with and without dynamic contrast-enhanced (DCE) MRI for evaluation of splenic Hodgkin disease. MATERIALS AND METHODS Thirty-one children with Hodgkin lymphoma underwent whole-body T2-weighted MRI with supplementary DCE splenic imaging, and whole-body PET-CT before and following chemotherapy. Two experienced nuclear medicine physicians derived a PET-CT reference standard for splenic disease, augmented by follow-up imaging. Unaware of the PET-CT, two experienced radiologists independently evaluated MRI exercising a locked sequential read paradigm (T2-weighted then DCE review) and recorded the presence/absence of splenic disease at each stage. Performance of each radiologist was determined prior to and following review of DCE-MRI. Incorrect MRI findings were ascribed to reader (lesion present on MRI but missed by reader) or technical (lesion not present on MRI) error. RESULTS Seven children had splenic disease. Sensitivity/specificity of both radiologists for the detection of splenic involvement using T2-weighted images alone was 57%/100% and increased to 100%/100% with DCE-MRI. There were three instances of technical error on T2-weighted imaging; all lesions were visible on DCE-MRI. CONCLUSIONS T2-weighted imaging when complemented by DCE-MRI imaging may improve evaluation of Hodgkin disease splenic involvement.
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Affiliation(s)
- Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK, NW1 2PG.
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Ng AWH, Griffith JF, Taljanovic MS, Li A, Tse WL, Ho PC. Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union? Skeletal Radiol 2013; 42:983-92. [PMID: 23653220 DOI: 10.1007/s00256-013-1627-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) as a measure of vascularity in scaphoid delayed-union or non-union. MATERIALS AND METHODS Thirty-five patients (34 male, one female; mean age, 27.4 ± 9.4 years; range, 16-51 years) with scaphoid delayed-union and non-union who underwent DCE MRI of the scaphoid between September 2002 and October 2012 were retrospectively reviewed. Proximal fragment vascularity was classified as good, fair, or poor on unenhanced MRI, contrast-enhanced MRI, and DCE MRI. For DCE MRI, enhancement slope, Eslope comparison of proximal and distal fragments was used to classify the proximal fragment as good, fair, or poor vascularity. Proximal fragment vascularity was similarly graded at surgery in all patients. Paired t test and McNemar test were used for data comparison. Kappa value was used to assess level of agreement between MRI findings and surgical findings. RESULTS Twenty-five (71 %) of 35 patients had good vascularity, four (11 %) had fair vascularity, and six (17 %) had poor vascularity of the proximal scaphoid fragment at surgery. DCE MRI parameters had the highest correlation with surgical findings (kappa = 0.57). Proximal scaphoid fragments with surgical poor vascularity had a significantly lower Emax and Eslope than those with good vascularity (p = 0.0043 and 0.027). The sensitivity, specificity, positive and negative predictive value and accuracy of DCE MRI in predicting impaired vascularity was 67, 86, 67, 86, and 80 %, respectively, which was better than that seen with unenhanced and post-contrast MRI. Flattened time intensity curves in both proximal and distal fragments were a feature of protracted non-union with a mean time interval of 101.6 ± 95.5 months between injury and MRI. CONCLUSIONS DCE MRI has a higher diagnostic accuracy than either non-enhanced MRI or contrast enhanced MRI for assessing proximal fragment vascularity in scaphoid delayed-union and non-union. For proper interpretation of contrast-enhanced studies in scaphoid vascularity, one needs to incorporate the time frame between injury and MRI.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong, SAR, People's Republic of China.
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