Assessment of first-time and repeated acute adverse reactions to gadolinium-based contrast agents in MRI: A retrospective study

PURPOSE

To identify gadolinium-based contrast agents (GBCAs)-related and patient-related risk factors for acute adverse reactions (AARs), and to examine the incidence and severity of repeated AARs.

METHODS

This study retrospectively evaluated all intravenous GBCA injections in MRI studies at a single institution from January 2012 to September 2019. First-time AARs in patients without a past history of AARs and risk factors were assessed using multivariable regression models with generalized estimating equations. For patients with a past history of AAR(s), we evaluated the incidence of repeated AARs using the Fisher's exact test, as well as the severity of these repeated AARs.

RESULTS

First-time AARs occurred in 129 of 41,827 GBCA injections (0.31 %; 0.70 % of 18,431 patients). With gadoterate meglumine as the reference, the odds ratio (OR) for allergic-like reactions to three GBCAs ranged from 3.27 to 8.03 (p = 0.012 to <0.001). For chemotoxic reactions, the OR was 3.75 (p = 0.001) for gadoteridol. Outpatients had a lower OR for chemotoxic reactions, while higher ORs were observed in head/neck and breast MRI (p < 0.05). The OR for age was 0.99 (p < 0.05). Patients with a past history of AAR(s) had a 3.6 % incidence of mild repeated AARs for all GBCA, significantly higher than the 0.31 % in first-time AARs (p < 0.001). No effectiveness was found for steroid premedication.

CONCLUSION

The occurrence of first-time AARs was related to the GBCA used and other factors. The incidence of repeated AARs was higher than first-time AARs, though all were mild in severity.

Disrupted local beta band networks in schizophrenia revealed through graph analysis: A magnetoencephalography study

AIMS

Schizophrenia (SZ) is characterized by psychotic symptoms and cognitive impairment, and is hypothesized to be a 'dysconnection' syndrome due to abnormal neural network formation. Although numerous studies have helped elucidate the pathophysiology of SZ, many aspects of the mechanism underlying psychotic symptoms remain unknown. This study used graph theory analysis to evaluate the characteristics of the resting-state network (RSN) in terms of microscale and macroscale indices, and to identify candidates as potential biomarkers of SZ. Specifically, we discriminated topological characteristics in the frequency domain and investigated them in the context of psychotic symptoms in patients with SZ.

METHODS

We performed graph theory analysis of electrophysiological RSN data using magnetoencephalography to compare topological characteristics represented by microscale (degree centrality and clustering coefficient) and macroscale (global efficiency, local efficiency, and small-worldness) indices in 29 patients with SZ and 38 healthy controls. In addition, we investigated the aberrant topological characteristics of the RSN in patients with SZ and their relationship with SZ symptoms.

RESULTS

SZ was associated with a decreased clustering coefficient, local efficiency, and small-worldness, especially in the high beta band. In addition, macroscale changes in the low beta band are closely associated with negative symptoms.

CONCLUSIONS

The local networks of patients with SZ may disintegrate at both the microscale and macroscale levels, mainly in the beta band. Adopting an electrophysiological perspective of SZ as a failure to form local networks in the beta band will provide deeper insights into the pathophysiology of SZ as a 'dysconnection' syndrome.

[Improved Neural Imaging Sequence and Comparison with Conventional Methods]

The purpose of this study was to improve the contrast between the nerves and blood by reconsidering the imaging parameters of the sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) method, and to compare it with conventional methods, including the constructive interference in steady state (CISS) and T₂-weighted SPACE (T2-SPACE) methods. In the phantom study, the repetition time (TR), echo time (TE), flip angle (FA), and turbo factor (TF) of SPACE were varied using the restore pulse. The parameters for which the nerve-blood contrast (C1) and cerebrospinal fluid-nerve contrast (C2) were equal were selected. Though multiple conditions resulted in C1 and C2 equivalence, we determined/set the TR=500 ms, TE=21 ms,  FA=120°, and  TF=30, considering the acquisition time, specific absorption rate (SAR), and artifacts. This sequence was called "short TR and short TE SPACE with restore pulse (SSSR)". In the phantom and healthy volunteer studies, the contrast between the nerves and blood in the SSSR method was statistically superior in both the physical and visual assessments compared with conventional methods. In the healthy volunteer study, C1 improved from 0.08 for CISS and 0.18 for T2-SPACE to 0.43 for SSSR. This is because the nerve signals in conventional methods were low due to the heavy T₂-weighted, while those in the SSSR method were high due to the short TE and effect of the restore pulse. In conclusion, the contrast between the nerves and blood was significantly higher in the SSSR method compared with conventional methods.

Frequency-Specific Resting Connectome in Bipolar Disorder: An MEG Study

BACKGROUND

Bipolar disorder (BD) is a serious psychiatric disorder that is associated with a high suicide rate, and for which no clinical biomarker has yet been identified. To address this issue, we investigated the use of magnetoencephalography (MEG) as a new prospective tool. MEG has been used to evaluate frequency-specific connectivity between brain regions; however, no previous study has investigated the frequency-specific resting-state connectome in patients with BD. This resting-state MEG study explored the oscillatory representations of clinical symptoms of BD via graph analysis.

METHODS

In this prospective case-control study, 17 patients with BD and 22 healthy controls (HCs) underwent resting-state MEG and evaluations for depressive and manic symptoms. After estimating the source current distribution, orthogonalized envelope correlations between multiple brain regions were evaluated for each frequency band. We separated regions-of-interest into seven left and right network modules, including the frontoparietal network (FPN), limbic network (LM), salience network (SAL), and default mode network (DMN), to compare the intra- and inter-community edges between the two groups.

RESULTS

In the BD group, we found significantly increased inter-community edges of the right LM-right DMN at the gamma band, and decreased inter-community edges of the right SAL-right FPN at the delta band and the left SAL-right SAL at the theta band. Intra-community edges in the left LM at the high beta band were significantly higher in the BD group than in the HC group. The number of connections in the left LM at the high beta band showed positive correlations with the subjective and objective depressive symptoms in the BD group.

CONCLUSION

We introduced graph theory into resting-state MEG studies to investigate the functional connectivity in patients with BD. To the best of our knowledge, this is a novel approach that may be beneficial in the diagnosis of BD. This study describes the spontaneous oscillatory brain networks that compensate for the time-domain issues associated with functional magnetic resonance imaging. These findings suggest that the connectivity of the LM at the beta band may be a good objective biological biomarker of the depressive symptoms associated with BD.

[Comparison of Analytical Values in Diffusion Kurtosis Imaging among Different MRI Units]

Diffusion kurtosis imaging (DKI) is a method of analyzing restricted diffusion. Mean kurtosis (MK) is obtained from DKI. It is not known how different MRI scanners and coil systems will change MK when the same imaging parameters are used. The purpose of this study is to identify tendencies in MK when using various MRI scanners and coil systems. A total of 27 healthy volunteers were enrolled in this study. DKI was performed on the brain for each volunteer on five MRI scanner/coil system combinations using the same scan parameters. MK of 10 anatomical areas of the brain were compared, and the signal-noise ratios (SNRs) of b-2000 s/mm² images were measured in identical areas. There were no significant differences among MKs from multi transmit (MT) MRI systems, but MK was significantly lower on the single transmit MRI system because of pepper artifact caused by low SNR. In conclusion, we found no significant differences in MK among MT systems, and MK was significantly lower without MT.

MTF Measurement of MR Blurring in Liver Dynamic MRI with Gd-EOB-DTPA

During the arterial phase acquisition of Gd-EOB-DTPA examinations, use of a small volume of the Gd-EOB-DTPA may make it difficult the encoding center of the k-space, and produce blurring. The previous studies revealed the encoding technique of the k-space was one of the most important reasons. However, there is no report to discuss the reasons with quantitative evaluations. The purpose of this study was to quantitatively evaluate the characteristics of the artifacts using different k-space encoding techniques (centric-view ordering (CVO) and sequential-view ordering (SVO)) for liver dynamic MRI in computer simulation study. This simulation study consists of the following steps. First of all, the creation of a time intensity curve, and original simulation images at certain points among the one phase dynamic scanning. Secondly, creation-simulated MR echo data from the created original images using FFT, and encoding simulated k-space using the simulated MR echo data. Finally, a reconstruction of simulated dynamic MR images from the simulated k-space, and to evaluate each simulated MR images, we measured modulation transfer functions (MTFs) from the bar patterns of the reconstructed images. The results of the CVO simulation indicated that the bar patterns were blurring compared to the images encoded by the SVO. The results of the SVO simulation indicated that the bar patterns were not enhanced at late scan timings. In addition, the results of MTFs indicated that there was no edge enhancement at all scan timings and both encoding techniques. In conclusion, it is possible to quantitatively evaluate the characteristics of artifacts using MTF, which was measured by the bar patterns, in liver dynamic MRI.

Relationship of γ-aminobutyric acid and glutamate+glutamine concentrations in the perigenual anterior cingulate cortex with performance of Cambridge Gambling Task

The anterior cingulate cortex (ACC), consisting of the perigenual ACC (pgACC) and mid-ACC (i.e., affective and cognitive areas, respectively), plays a significant role in the performance of gambling tasks, which are used to measure decision-making behavior under conditions of risk. Although recent neuroimaging studies have suggested that the γ-aminobutyric acid (GABA) concentration in the pgACC is associated with decision-making behavior, knowledge regarding the relationship of GABA concentrations in subdivisions of the ACC with gambling task performance is still limited. The aim of our magnetic resonance spectroscopy study is to investigate in 20 healthy males the relationship of concentrations of GABA and glutamate+glutamine (Glx) in the pgACC, mid-ACC, and occipital cortex (OC) with multiple indexes of decision-making behavior under conditions of risk, using the Cambridge Gambling Task (CGT). The GABA/creatine (Cr) ratio in the pgACC negatively correlated with delay aversion score, which corresponds to the impulsivity index. The Glx/Cr ratio in the pgACC negatively correlated with risk adjustment score, which is reported to reflect the ability to change the amount of the bet depending on the probability of winning or losing. The scores of CGT did not significantly correlate with the GABA/Cr or Glx/Cr ratio in the mid-ACC or OC. Results of this study suggest that in the pgACC, but not in the mid-ACC or OC, GABA and Glx concentrations play a distinct role in regulating impulsiveness and risk probability during decision-making behavior under conditions of risk, respectively.

Characterization of antiviral activity of a sesquiterpene, triptofordin C-2

The activities of 13 sesquiterpenes isolated from Tripterygium wilfordii Hook fil. var. regelii Makino were studied against herpes simplex virus type 1 (HSV-1) in vitro. Among these compounds, only triptofordin C-2 showed a selectivity index of more than 10. The compound, which could also inhibit the replication of human cytomegalovirus (HCMV), did not affect either adsorption or penetration of HSV-1 to host cells, but showed moderate virucidal activity against several enveloped viruses including HSV-1, HCMV, measles virus and influenza A virus. Triptofordin C-2 suppressed viral protein synthesis of infected cells when added at early steps of HSV-1 replication and exerted inhibition of translation of the transcripts of the immediate early genes. When acyclovir and triptofordin C-2 were evaluated in combination for antiviral activity against HSV-1 replication, additive antiviral effects were observed for this virus.

Inhibitory effects of triptogelin A-1 on 12-O-tetradecanoylphorbol-13- acetate-induced skin tumor promotion

Dihydroagarofuran sesquiterpenes, which were isolated from Tripterygium wilfordii Hook fil. var. regelii Makino and Euonymus sieboldianus Blume, showed inhibitory effects on Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA). Triptogelin A-1, one of the active dihydroagarofuran sesquiterpenes, exhibited remarkable inhibitory effects on mouse skin tumor promotion in an in vivo two-stage carcinogenesis test. Interestingly, triptogelin A-1 was more effective when applied after TPA-treatment (post-treatment) than before TPA-treatment (pretreatment). The findings indicate that these dihydroagarofuran sesquiterpenes might be valuable antitumor promoters.

Inhibitory effects of dihydroagarofuran sesquiterpenes on Epstein-Barr virus activation

To search for possible antitumor promoters, we carried out a primary screening of thirty-seven dihydroagarofuran sesquiterpenes from Tripterygium wilfordii Hook fil. var. regelii Makino and Euonymus sieboldianus Blume, using their possible inhibitory effects on the Epstein-Barr virus early antigen (EBV-EA) activation which is induced by 12-O-tetradecanoylphorbol-13-acetate (TPA) in Raji cells. Some of these sesquiterpenes, triptofordin F-2 (Takaishi et al., 1988), 1,2,6,8,15-pentaacetoxy-9-benzoyloxy-4-hydroxy-beta-dihydroagarofuran and triptogelin A-1 (Takaishi et al., 1990) were observed to significantly inhibit the EBV-EA activation at low doses. Based on the results, the structural requirements for the activity of these compounds were discussed [corrected].