Determination of acrolein in serum by high-performance liquid chromatography with fluorescence detection after pre-column fluorogenic derivatization using 1,2-diamino-4,5-dimethoxybenzene

Acrolein is a major unsaturated aldehyde that is generated during the lipid peroxidation process. The measurement of acrolein in biological samples should be useful to estimate the degree of lipid peroxidation and to evaluate the effect of hazardous properties of acrolein on human health. In this study, a highly sensitive and selective high-performance liquid chromatography with fluorescence detection method was developed for the determination of acrolein in human serum. The proposed method involves the pre-column fluorogenic derivatization of acrolein with 1,2-diamino-4,5-dimethoxybenzene (DDB) as a reagent. The fluorescent derivative of acrolein could be detected clearly without any interfering reagent blank peaks because DDB does not have intrinsic fluorescence itself, and the detection limit was 10 nM (signal-to-noise ratio = 3). The proposed method could selectively detect acrolein in human serum with a simple protein precipitation treatment.

Image quality and radiation exposure in CT of the pancreas: 320-MDCT with and without adaptive iterative dose reduction versus 64-MDCT

AIM

To compare the image quality and radiation exposure in computed tomography (CT) of the pancreas acquired using 320-multidetector (MD)CT versus 64-MDCT and to demonstrate the effects of adaptive iterative dose reduction (AIDR) on 320-MDCT.

MATERIALS AND METHODS

One hundred and fifty patients were randomized into three groups including 320-section volume imaging using AIDR (group A), 320-slice volume scan without AIDR (group B), and 64-section helical imaging without AIDR (group C). Transaxial arterial, pancreatic phase, and volume-rendered CT angiographic images were reconstructed. CT radiodensity of the abdominal aorta, pancreas, signal-to-noise ratios (SNR), dose-length products (DLPs; mGy cm), and image quality were measured.

RESULTS

No significant difference in CT radiodensity of the abdominal aorta or pancreas was noted between groups. Mean DLPs were 600.9 ± 145.8, 681.6 ± 97.5, and 1231.5 ± 271.4 in groups A, B, and C, respectively. The DLP was reduced by 51% in group A and 45% in group B compared to group C (p < 0.001). SNRs of the pancreas during the pancreatic phase were comparable between groups A and C, but were significantly lower in group B (p < 0.001). Image quality, including the depiction of some small arterial branches on the arterial and CT angiographic images and the main pancreatic duct on the pancreatic-phase images, were significantly lower in group B than in groups A and C (p = 0.008-0.038).

CONCLUSION

Radiation dose can be markedly reduced for contrast-enhanced CT imaging of the pancreas without compromising image quality using a 320-MDCT with AIDR, compared with 64-section helical CT.

Automated segmentation of recuts abdominis muscle using shape model in X-ray CT images

Our purpose in this study is to segment the rectus abdominis muscle region in X-ray CT images, and we propose a novel recognition method based on the shape model. In this method, three steps are included in the segmentation process. The first is to generate a shape model for the rectus abdominis muscle. The second is to recognize anatomical feature points corresponding to the origin and insertion of the muscle, and the third is to segment the rectus abdominis muscles based on the shape model. We generated the shape model from 20 CT cases and tested the model to recognize the muscle in 20 other CT cases. The average values for the Jaccard similarity coefficient (JSC) and true segmentation coefficient (TSC) were 0.841 and 0.863, respectively. The results suggest the validity of the model-based segmentation for the rectus abdominis muscle.

Automated recognition of the psoas major muscles on X-ray CT images

The purpose of this study is to recognize the psoas major muscle on X-ray CT images. For this purpose, we propose a novel recognition method. The recognition process in this method involves three steps: the generation of a shape model for the psoas major muscle, recognition of anatomical points such as the origin and insertion, and the recognition of the psoas major muscles by the use of the shape model. We generated the shape model using 20 CT cases and tested the model for recognition in 20 other CT cases. The average Jaccard similarity coefficient (JSC) and reproducibility rate were 0.704 and 0.783, respectively. Experimental results indicate that our method was effective for a 2-D cross-sectional area (CSA) analysis.

Automated measurement of bone-mineral-density (BMD) values of vertebral bones based on X-ray torso CT images

Bone is one of the most important anatomical structures in humans and osteoporosis is one of the major public health concerns in the world. Osteoporosis is a main target disease of bone, which can be detected by medical image techniques. The purpose of this study is to develop a fully automated computer scheme to measure bone-mineral-density (BMD) values for vertebral trabecular bones. This scheme will aid osteoporosis diagnosis performed using computer tomography (CT) images. This scheme includes the following processing steps: segmentation of the bone region, recognition of the skeletal structures and measurement of the BMD value in vertebral trabecular bone of each vertebral body. The proposed scheme was applied to 20 X-ray torso CT cases to measure the BMD values for vertebral trabecular bones. The experimental results show that the mean and standard deviation of the difference between the BMD values measured by using the proposed method and those measured using a manual segmentation method were 6.93 mg/cm(3) and 6.82 mg/cm(3) respectively. The accuracy of the proposed scheme satisfied the requirement for a computer-aided system used in osteoporosis diagnosis.

Involvement of SIK2/TORC2 signaling cascade in the regulation of insulin-induced PGC-1alpha and UCP-1 gene expression in brown adipocytes

Salt-inducible kinase 2 (SIK2) is expressed abundantly in adipose tissues and represses cAMP-response element-binding protein (CREB)-mediated gene expression by phosphorylating the coactivator transducer of regulated CREB activity (TORC2). Phosphorylation at Ser(587) of SIK2 diminishes its TORC2 phosphorylation activity. In 3T3-L1 white adipocytes, SIK2 downregulates lipogenic gene in response to nutritional stresses. To investigate the impact of SIK2 on the function of brown adipose tissue (BAT), we used T37i brown adipocytes, mice with diet-induced obesity, and SIK2 mutant (S587A) transgenic mice. When T37i adipocytes were treated with insulin, the levels of peroxisome proliferator-activated receptor-coactivator-1alpha (PGC-1alpha) and uncoupling protein-1 (UCP-1) mRNA were increased, and the induction was inhibited by overexpression of SIK2 (S587A) mutant or dominant-negative CREB. Insulin enhanced SIK2 phosphorylation at Ser(587), which was accompanied by decrease in phospho-TORC2. Similarly, the decrease in the level of SIK2 phosphorylation at Ser(587) was observed in the BAT of mice with diet-induced obesity, which was negatively correlated with TORC2 phosphorylation. To confirm the negative correlation between SIK2 phosphorylation at Ser(587) and TORC2 phosphorylation in BAT, SIK2 mutant (S587A) was overexpressed in adipose tissues by using the adipocyte fatty acid-binding protein 2 promoter. The expression of recombinant SIK2 (S587A) was restricted to BAT, and the levels of phospho-TORC2 were elevated in BAT of transgenic mice. Male transgenic mice developed high-fat diet-induced obesity, and their BAT expressed low levels of PGC-1alpha and UCP-1 mRNA, suggesting that SIK2-TORC2 cascade may be important for the regulation of PGC-1alpha and UCP-1 gene expression in insulin signaling in BAT.

Fluid-fluid level formation: a rare finding of extracranial head and neck schwannomas

SUMMARY

We present 3 cases of extracranial head and neck schwannomas exhibiting fluid-fluid levels. In the described cases, CT and MR imaging showed predominantly cystic components, intermixed with cellular components. Histopathologic examinations of excised specimens revealed hemosiderin deposition, reflecting intratumoral hemorrhages, which was presumably a cause of fluid-fluid levels. Although fluid-fluid levels are nonspecific findings, schwannoma should be considered when radiologic images demonstrate marked cystic formation with fluid-fluid levels in extracranial head and neck tumors.

Carcinoma ex pleomorphic adenoma of the parotid gland: radiologic-pathologic correlation with MR imaging including diffusion-weighted imaging

We present 4 cases of carcinoma ex pleomorphic adenoma of the parotid gland. In 3 of the 4 cases, diffusion-weighted and apparent diffusion coefficient (ADC) mapping images clearly revealed carcinoma as a hypercellular area with low ADC values and pleomorphic adenoma as a hypocellular area with high ADC values. Diffusion-weighted images demonstrated well complex tissue components in carcinoma ex pleomorphic adenoma, which may be useful for the diagnosis of this disease.

Ossifying pleomorphic adenoma of the parotid gland: a case report and review

Pleomorphic adenoma is the most common parotid gland neoplasm and occasionally arises from the deep lobe of the parotid gland with extension into the parapharyngeal space. However, ossification of pleomorphic adenoma is rare, although chondroid and myxochondroid tissue formation is frequently seen histologically. We report an unusual case of ossifying pleomorphic adenoma arising from the deep lobe of the parotid gland in the parapharyngeal space.

Preliminary Study for Automated Recognition of Anatomical Structure from Torso CT images

The anatomical human structure recognition is very important and necessary during the development of computer-aided diagnosis (CAD) system. In this paper, we propose an image processing scheme that can recognize the general structure of human torso by identifying the human torso region from CT images automatically and separating it into 7 parts: skin, subcutaneous fat, muscle, bone, diaphragm, thoracic cavity and abdominal cavity based on CT number distribution and spatial relations between different organ and tissue regions. We applied this scheme to 313 patient cases of torso CT images and confirmed its usefulness from the preliminary experiment.

Dephosphorylation of TORC initiates expression of the StAR gene

Cyclic AMP responsive element (CRE) binding protein (CREB) is known to activate transcription when its Ser133 is phosphorylated. However, transducer of regulated CREB activity (TORC), a CREB specific co-activator, upregulates CREB activity in a phospho-Ser133-independent manner. Interestingly, TORC is also regulated by phosphorylation; the phospho-form is inactive, and the dephospho-form active. When PKA phosphorylates CREB, it inhibits TORC kinases simultaneously and accelerates dephosphorylation of TORC. We show in this report that staurosporine, a kinase inhibitor, induces the expression of the StAR gene in Y1 adrenocortical cells, possibly a result of an increase in the population of dephospho-TORC. The expression of the StAR gene is known to be regulated by SF-1 and CREB, and the co-activators CBP/p300 may mediate the actions of both factors. Our experiments using KG501, a disruptor of the interaction between phospho-CREB and CBP/p300, also support the importance of TORC in the regulation of StAR gene expression.

Expression of vascular endothelial growth factor in hepatocellular carcinoma and the surrounding liver: correlation with MR imaging and angiographically assisted CT

We summarize and discuss our previous research results on the correlation between findings on magnetic resonance (MR) imaging and angiographically assisted computed tomography (CT) and the intensity of vascular endothelial growth factor (VEGF) expression in hepatocellular carcinoma (HCC) and in the surrounding nontumorous liver. MR images (n = 22), CT during arterial portography (n = 20), and CT hepatic arteriography (n = 17) were retrospectively correlated quantitatively and qualitatively with VEGF expression in HCCs and in the surrounding liver assessed by western blotting. HCC-to-liver contrast-to-noise ratio correlated with VEGF expression index (VEGF(IND)) values of HCCs inversely on opposed-phase, T1-weighted, spoiled gradient recalled-echo (GRE) images, directly on T2-weighted, fast spin-echo images, and marginally and inversely on gadolinium-enhanced hepatic arterial-phase GRE images. On T2-weighted fast spin-echo images, standard deviation ratio of HCCs correlated directly with VEGF(IND) values of HCCs. By CT hepatic arteriography, the contrast-enhancement index of HCCs showed a moderate inverse correlation with VEGF(IND) values of HCCs, and the contrast-enhancement index of the liver showed marginal, moderate direct correlation with VEGF(IND) values in the liver. Heterogeneities of HCCs on images correlated directly with VEGF(IND) values of HCCs on opposed-phase T1-weighted GRE images, T2-weighted fast spin-echo images, hepatic arterial-phase GRE images, equilibrium-phase GRE images, and CT hepatic arteriogram. Our results may reflect that MR signal intensity, hepatic arterial vascularity, and heterogeneity of HCCs on CT or MR images are closely related to the intensity of VEGF expression in HCC as upregulated by hyper- or hypoxia in HCCs. Although the real effects of our results on radiologic practice are debatable at this moment, we believe that our results may help future radiologic practice in conjunction with biomolecular or genetic treatment for HCCs.

Distribution of dioxins in surface soils and river-mouth sediments and their relevance to watershed properties

The dioxins toxic equivalent (TEQ) concentration in surface soils, river sediments and river-mouth sediments was measured by the CALUX assay in the Yasu and Ado River basins around Lake Biwa, Japan. In order to examine the distribution of dioxins in each watershed, we evaluated and compared the correlation between the dioxins TEQ concentration and the solid characteristics (i.e. organic carbon content and particle size distribution) of all samples. In both basins, the dioxins TEQ concentration in forest soil correspondingly showed a very good linear relationship to organic carbon content. On the other hand, the dioxins TEQ concentration in paddy field was significantly high, although organic carbon content was relatively low. Generally, the smaller particles have the higher dioxins TEQ concentrations in surface soils, and river sediments were composed of very coarse particles and had relatively low dioxins TEQ concentration. Therefore, we expected high dioxins TEQ concentration in river-mouth sediment, which was, however, not the case. Although the dioxins TEQ concentration in river-mouth sediments is low, the degree of dioxins pollution was different in each basin. The difference was considered to come from the difference of watershed properties including land use, river-slope, dam construction as well as the surface soil pollution.

Early-enhancing Non-neoplastic Lesions on Gadolinium-enhanced MRI of the Liver

AIM

To assess the frequency, cause, and significance of early-enhancing, non-neoplastic (EN) lesions on gadolinium-enhanced magnetic resonance imaging (MRI) of the liver performed for the detection of malignant hepatic tumours.

MATERIALS AND METHODS

From September 1997 to September 2000, we reviewed the images of 125 patients, suspected of having hepatic tumours, in whom (1) gadolinium-enhanced triphasic dynamic gradient-recalled-echo (GRE) imaging in addition to unenhanced T1- and T2-weighted MRI was performed, (2) conventional angiography and combination computed tomography (CT) hepatic arteriography and CT during arterial portography were performed within 2 weeks of the MRI, and (3) definitive surgery within 2 weeks of the MRI or follow-up study by means of intravenously contrast-enhanced CT or MRI in 10 months or more was performed. Angiographic studies were correlated to determine the underlying causes of the EN lesions.

RESULTS

We found 78 EN lesions in 36 patients (29%), ranging in size from 4 and 50 mm (mean, 12.2 mm). From the MR reports, our radiologists had prospectively diagnosed EN lesions as probable malignant tumours in eight (10%), possible malignant tumours in 36 (46%), and probable non-neoplastic lesion in 34 (44%). EN lesions were found in 27 of 81 (33%) cirrhotic patients and in nine of 44 (20%) non-cirrhotic patients. Fifty-one EN lesions (65%) were located along the liver edge. The shape was circular in 42 (54%), oval in 14 (18%), irregular in 12 (15%), wedge-shaped in seven (9%), and fan-shaped in three (4%). Twenty EN lesions (26%) appeared slightly hyperintense on T2-weighted images. The causes were non-neoplastic arterio-portal shunting in 48 (62%), cystic venous drainage in four (5%), rib compression in four (5%), aberrant right gastric venous drainage in two (3%), and unknown in 20 (26%).

CONCLUSION

Over half the number of EN lesions were caused by non-neoplastic arterio-portal shunting, occasionally showing slight hyperintensity on T2-weighted images. On MR images the non-neoplastic nature of the EN lesion was often ascertained. Radiologists should not overcall EN lesions as malignant as the patients involved would be inappropriately considered inoperable. In problematic cases, further investigation with angiographic CT or follow-up imaging studies should be performed.

Vector-averaged gravity regulates gene expression of receptor activator of NF-kappaB (RANK) ligand and osteoprotegerin in bone marrow stromal cells via cyclic AMP/protein kinase A pathway

Bone loss due to unloading of the skeleton may be caused by an acceleration of osteoclastic bone resorption as well as a decline of osteoblastic bone formation. Recently, two molecular species that play important roles in osteoclastogenesis were discovered: (i) the receptor activator of NF-kappaB ligand (RANKL)/osteoprotegerin (OPG) ligand/osteoclast differentiation factor induces osteoclastogenesis; and (ii) the OPG/osteoclastogenesis inhibitory factor potently inhibits osteoclastogenesis. To investigate the effects of gravity on gene expression of RANKL and OPG, a mouse bone marrow-derived stromal cell line, ST2, was cultured on a single axis clinostat, which generates a vector-averaged gravity environment. Northern blot analysis revealed that RANKL mRNA was increased, whereas that of OPG decreased. The clinostat culture also caused an increase in intracellular cyclic (cAMP) level. Both forskolin and dibutyryl-cAMP mimicked the regulation of RANKL and OPG transcription in clinostat culture. These modulations of gene expression in clinostat culture were blocked by a protein kinase A (PKA) inhibitor, H89, but not by a cyclooxygenase inhibitor, indomethacin. The enhancement of RANKL gene expression under clinostat culture and its inhibition by H89 were confirmed by a reporter assay with the murine RANKL 5'-flanking region. These results suggest that modulations of RANKL and OPG expression in stromal cells might be one of the causes of bone loss during skeletal unloading. An elevation of intracellular cAMP level caused through an as yet undetermined pathway is involved in modulation of RANKL and OPG expression during clinostat culture.

Atypically enhancing hepatic cavernous hemangiomas: high-spatial-resolution gadolinium-enhanced triphasic dynamic gradient-recalled-echo imaging findings

We retrospectively investigated the appearance and frequency of atypically enhancing cavernous hemangiomas with high-spatial-resolution (512x224 matrix) gadolinium-enhanced triphasic dynamic gradient-recalled-echo (GRE) MR images. Images of 132 hepatic cavernous hemangiomas (ranging in size from 4 to 72 mm; mean size 17.2 mm) in 95 patients (42 men and 53 women; age range 25-85 years; mean age 54 years) were retrospectively reviewed by two independent radiologists. Forty (30%) of 132 lesions atypically enhanced. Smaller hemangiomas (< or =15 mm) more frequently (29%) showed early entire enhancement with or without arterio-portal shunting in the hepatic arterial-dominant phase ( p<0.001); most of them showed hyperintense complete fill-in in the equilibrium phase and were readily characterized. "Bright dot" or minimal peripheral enhancement in the equilibrium phase was seen in a small number of lesions (6% each). With T2-weighted images, 130 (98%) lesions showed moderately to very high signal intensity and only 2 (2%) with minimal peripheral enhancement showed hyperintensity of slight degree. The high-spatial-resolution dynamic GRE images clearly revealed minute enhancement characteristics of hemangiomas. Although moderately to very high signal intensity with T2-weighted MR images is informative for the diagnosis of most cavernous hemangiomas, when a lesion shows minimal peripheral enhancement in the equilibrium phase and hyperintensity of slight degree with T2-weighted images, further follow-up or biopsy may be warranted to discriminate hypovascular metastases.

[Current practice in MR imaging of the liver]

MR imaging, which is able to evaluate T1- and T2-relaxation time, fat, hemorrhage, metal deposition, blood flow, perfusion, diffusion, and so on, has offered more information for the diagnosis of diffuse and focal hepatic diseases than CT. The spoiled-GRE sequence with high contrast resolution and ease of the aimed contrast capture derived from the k-space property, with the use of a phased-array multicoil, have remarkably increased the value of gadolinium-enhanced dynamic MR diagnosis of the liver. In recent years, the clinical use of ferumoxide has begun, and issues concerning the superiority or inferiority and combination of contrast media are being debated. This paper describes the value, role, and clinical practice of unenhanced, gadolinium-enhanced, and ferumoxide-enhanced MR imaging of the liver based on knowledge obtained in our institution, with some reference to the literature.

Usefulness of MR imaging in the postsurgical monitoring of gallbladder cancer in a patient with bile duct cancer that developed 7 years after resection of mucinous adenocarcinoma of the gallbladder

We encountered a case of left hepatic duct cancer that developed 7 years after surgical resection of early-stage adenocarcinoma of the gallbladder. A 65-year-old woman was hospitalized with high fever and general fatigue. She also had elevated serum levels of alkaline phosphatase, gamma-glutamyltranspeptidase, and carbohydrate antigen 19-9. Seven years earlier, she had undergone extended cholecystectomy and resection of the extrahepatic bile duct for early-stage mucinous adenocarcinoma of the gallbladder. Conventional examinations did not reveal any responsible lesions. Magnetic resonance (MR) cholangiography, however, showed a tumor obstructing the left hepatic duct, and dynamic MR images revealed multiple foci of bacterial abscess in the liver. Surgically resected tissue again revealed mucinous adenocarcinoma. The present case is rare in that metachronous mucinous adenocarcinoma of the biliary system occurred after a long interval. This case suggests the usefulness of MR imaging in the postsurgical monitoring of patients with gallbladder carcinoma.

Detection of malignant hepatic tumors: comparison of gadolinium-and ferumoxide-enhanced MR imaging

OBJECTIVE

The purpose of our study was to compare how well gadolinium-enhanced and ferumoxide-enhanced MR imaging reveal malignant hepatic tumors.

SUBJECTS AND METHODS

Both gadolinium-enhanced and ferumoxide-enhanced MR imaging were separately performed in 53 patients with a total of 87 malignant hepatic tumors (57 hepatocellular carcinomas, 28 metastases, two cholangiocarcinomas). Thirty-one of the 53 patients had hepatic cirrhosis. Images were reviewed by three independent off-site observers. Observer performance was evaluated by means of sensitivity, specificity, and receiver operating characteristic curve analyses.

RESULTS

Gadolinium-enhanced MR imaging outperformed ferumoxide-enhanced MR imaging in sensitivity (81% versus 62%, p < 0.01) for malignant-tumor detection. Specificity was comparable (94%) between the two types of MR imaging. Area under receiver operating characteristic curve (A(z)) value was significantly higher with gadolinium-enhanced MR imaging than with ferumoxide-enhanced MR imaging in patients overall (A(z) = 0.896 versus 0.805, p < 0.001), in patients with cirrhosis (A(z) = 0.907 versus 0.807, p < 0.001), and in patients without cirrhosis (A(z) = 0.899 versus 0.834, p < 0.01). The superiority was enhanced in the subset of patients with cirrhosis.

CONCLUSION

Gadolinium-enhanced MR imaging outperforms ferumoxide-enhanced MR imaging in revealing malignant hepatic tumors. Gadolinium-enhanced MR imaging is recommended, particularly for patients with cirrhosis.

Mr cholangiography with volume rendering: receiver operating characteristic curve analysis in patients with choledocholithiasis

OBJECTIVE

The purpose of our study was to compare observer performances for the diagnosis of choledocholithiasis using MR cholangiography with volume-rendered, maximum-intensity-projection, and thick-section half-Fourier rapid acquisition with relaxation enhancement sequences.

MATERIALS AND METHODS

The images from three types of MR cholangiography performed on 43 patients with biliary calculi were retrospectively analyzed. Image review was conducted for two anatomic compartments (upper biliary tract and common bile duct). A total of 86 compartments, including 19 with bile duct calculi, were reviewed by three independent off-site gastrointestinal radiologists. Observer performance was determined by receiver operating characteristic curve analysis. Image quality was subjectively judged by three radiologists.

RESULTS

Sensitivity was higher with volume-rendered MR cholangiography (58%) than with thick-section (54%, not significant) and maximum-intensity-projection MR cholangiography (47%, p < 0.07). Specificity was higher with volume-rendered MR cholangiography (92%) than with thick-section (86%, p < 0.03) and maximum-intensity-projection MR cholangiography (88%, not significant). Accuracy was higher with volume-rendered MR cholangiography (84%) than with thick-section and maximum-intensity-projection MR cholangiography (79% for both, not significant). Observer performance with volume-rendered MR cholangiography (A(z) = 0.791--0.952) was better than that with thick-section (A(z) = 0.722--0.834) and maximum-intensity-projection MR cholangiography (A(z) = 0.771--0.887). Image quality was better with maximum-intensity-projection MR cholangiography and thick-section MR cholangiography than with volume-rendered MR cholangiography (p < 0.0001).

CONCLUSION

Observer performance with volume-rendered MR cholangiography was better than that with maximum-intensity-projection and thick-section MR cholangiography for the diagnosis of choledocholithiasis. Volume rendering may be an efficient technique for the reconstruction of MR cholangiography.

Confluent hepatic fibrosis in cirrhosis: ferumoxides-enhanced MR imaging findings

We describe ferumoxides-enhanced magnetic resonance imaging findings in a 60-year-old man with confluent hepatic fibrosis in advanced cirrhosis. The extension and internal structure of confluent fibrosis were well demonstrated with ferumoxides-enhanced proton-density spin-echo magnetic resonance images, showing a wedge-shaped area of high signal intensity corresponding to the extension of fibrosis and internal focal areas of low signal intensity, presumably corresponding to residual functioning liver parenchyma. This case suggests a potential utility of ferumoxides-enhanced magnetic resonance imaging for characterizing this tumor-mimicking disorder.

Malignant hepatic tumor detection with ferumoxides-enhanced MR imaging with a 1.5-T system: comparison of four imaging pulse sequences

The purpose of our study was to compare observer performance in the detection of malignant hepatic tumors with ferumoxides-enhanced magnetic resonance (MR) images obtained with proton density-weighted spin-echo (SE), T2-weighted fast SE, T2*-weighted gradient-recalled-echo (GRE), and proton density-weighted echo-planar (EP) sequences. Ferumoxides-enhanced MR images obtained with the four sequences in 50 patients with 92 solid malignant and 64 nonsolid benign lesions were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; a total of 397 liver segments was reviewed separately for solid and nonsolid lesions by three independent readers. Observer performance was evaluated with receiver operating characteristic analysis. Lesion-to-liver contrast-to-noise ratio was higher with SE and EP than with GRE and fast SE images for solid lesions (P < 0.05), and higher with fast SE and SE than with GRE images for nonsolid lesions (P < 0.01). Proton density-weighted SE and T2-weighted fast-SE images were superior to T2*-weighted GRE and proton density-weighted EP images for detection of malignant hepatic tumors. T2-weighted fast SE images were the best for detection of nonsolid lesions. T2-weighted fast SE images that were comparable to proton density-weighted SE images for solid tumor detection, that were the best for nonsolid lesion detection, and that had an acquisition time of one third to half of that of SE imaging may be able to replace SE images for ferumoxides-enhanced liver imaging.

Pre-operative detection of malignant hepatic tumours: value of combined helical CT during arterial portography and biphasic CT during hepatic arteriography

AIMS

The purpose of our study was to evaluate the observer performance with combined helical CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the pre-operative detection of malignant hepatic tumours.

METHODS

Computed tomography images obtained in 41 patients with suspected hepatic tumours were retrospectively reviewed. In a blind fashion, three off-site, independent radiologists reviewed CTAP and early-phase CTHA combined for the first review, then late-phase CTHA was added for the second review. Statistical analysis was conducted on lesion-by-lesion and segment-by-segment bases; a total of 328 liver segments including 65 segments with 74 malignant hepatic tumours ranging in size from 5 to 100 mm (mean, 21.4 mm) were analysed.

RESULTS

Sensitivity for detection of liver segments harbouring tumours of CTAP and biphasic CTHA combined (82%) was identical to that of CTAP and early-phase CTHA combined (82%). Specificity of CTAP and biphasic CTHA combined (93%) was greater than that of CTAP and early-phase CTHA combined (90%, P < 0.005). The mean confidence level for the 74 tumours significantly increased by adding late-phase CTHA (P < 0.0005). The mean confidence level for 100-142 benign perfusion abnormalities detected with CTAP and early-phase CTHA combined significantly decreased by adding late-phase CTHA (P < 0.0005).

CONCLUSION

By combining late-phase CTHA with CTAP and early-phase CTHA information, the specificity for the detection of malignant hepatic tumours rises significantly, allowing more accurate preoperative tumour detection.

Pseudothrombosis in the portal venous system: a potential pitfall with gadolinium-enhanced dynamic gradient-recalled echo imaging of the liver

Gadolinium-enhanced dynamic magnetic resonance (MR) images in 90 patients were reviewed to assess the artifacts mimicking portal venous thrombosis. The incidence of definite signal-intensity decrease mimicking pathologic condition was higher (P < 0.01) in the right (8%) and left (9%) portal vein branches and portal trunk (6%) than in the splenic (0%) or superior mesenteric (1%) vein with equilibrium-phase images. Radiologists should remember that dynamic MR images occasionally show signal-intensity decrease mimicking portal venous thrombosis due to flow artifact.

[Usefulness of dynamic MR mammography for diagnosis of axillary lymph node status in breast cancer patient]

A retrospective study was performed to evaluate whether dynamic MR imaging is useful for the diagnosis of axillary lymph node metastases from breast cancer. Thirty-five patients with breast cancer were scanned and 147 lymph nodes were detected and compared with pathological nodal status. The parameters were the long axis dimension, the short axis dimension, the long-to-short axis (L/S) ratio, the shape, the contrast enhancement ratio (CER), the CER of lymph node-to-primary tumor (L/P) ratio. All parameters had significant differences between metastatic and normal nodes and there was a positive correlation between the CER of primary breast tumors and metastatic nodes. Multivariate analysis identified three parameters: the shape, the CER (1st phase), the L/P ratio (1st phase). ROC analysis revealed the shape and CER are superior in diagnostic performance to L/P ratio. If the shape and CER (1st phase) 60% and above are employed as criteria, the sensitivity, the specificity, the accuracy and the positive and negative predictive value were 86.0%, 78.4%, 81.0%, 67.2% and 91.6%, respectively. This method gives us useful information about the evaluation of axillary lymph node status preoperatively.

T2-weighted MR imaging for focal hepatic lesion detection: supplementary value of breath-hold imaging with half-Fourier single-shot fast spin-echo and multishot spin-echo echoplanar sequences

The purpose of our study was to evaluate the supplementary value of breath-hold fat-suppressed T2-weighted magnetic resonance (MR) imaging with half-Fourier single-shot fast spin-echo (SE) or multishot SE echoplanar (EP) sequences combined with respiratory-triggered fat-suppressed fast SE T2-weighted MR imaging for detection and characterization of focal hepatic lesions. MR images in 42 patients with 82 solid, malignant and 77 nonsolid, benign lesions were analyzed. Image review was conducted on a segment-by-segment basis; in all, 333 liver segments were reviewed separately for solid and nonsolid lesions by three independent radiologists. For solid lesions, observer performance with receiver-operating-characteristic (ROC) analysis in one radiologist and specificity in another significantly improved after adding single-shot fast SE images. For nonsolid lesions, observer performance with ROC analysis in one radiologist and specificity in another significantly improved after adding single-shot fast SE images. Combining breath-hold half-Fourier single-shot fast SE imaging with respiratory-triggered fast SE imaging may be recommended for improved detection and characterization of focal hepatic lesions. J. Magn. Reson. Imaging 2000;12:444-452.

Prostaglandin E2 induces expression of receptor activator of nuclear factor-kappa B ligand/osteoprotegrin ligand on pre-B cells: implications for accelerated osteoclastogenesis in estrogen deficiency

Estrogen deficiency causes bone loss as a result of accelerated osteoclastic bone resorption. It also has been reported that estrogen deficiency is associated with an increase in the number of pre-B cells in mouse bone marrow. The present study was undertaken to clarify the role of altered B lymphopoiesis and of the receptor activator of nuclear factor-kappa B ligand (RANKL), a key molecule in osteoclastogenesis, in the bone loss associated with estrogen deficiency. In the presence of prostaglandin E2 (PGE2), the activity to form tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells was significantly greater in bone marrow cells derived from ovariectomized (OVX) mice than in those from sham-operated mice. Northern blot analysis revealed that PGE2 increased the amount of RANKL messenger RNA (mRNA) in bone marrow cells, not only adherent stromal cells but nonadherent hematopoietic cells; among the latter, RANKL mRNA was more abundant in OVX mice than in shamoperated mice and was localized predominantly in B220+ cells. Flow cytometry revealed that most B220+ cells in bone marrow were RANKL positive and that the percentage of RANKL-positive, B220low cells was higher in bone marrow from OVX mice than in that from sham-operated mice. The increase in the expression of RANKL and the percentage of these cells in OVX mice was abolished by the administration of indomethacin in vivo. PGE2 also markedly increased both the level of RANKL mRNA and cell surface expression of RANKL protein in the mouse pre-B cell line 70Z/3. Finally, osteoclastogenic response to PGE2 was reduced markedly by prior depletion of B220+ cells, and it was restored by adding back B220+ cells. Taken together with stimulated cyclo-oxygenase (COX)-2 activity by tumor necrosis factor alpha (TNF-alpha) and interleukin-1 (IL-1) in estrogen deficiency, these results suggest that an increase in the number of B220+ cells in bone marrow may play an important role in accelerated bone resorption in estrogen deficiency because B220+ cells exhibit RANKL on the cell surface in the presence of PGE2, thereby leading to accelerated osteoclastogenesis.

Single breath-hold T2-weighted MR imaging of the liver: value of single-shot fast spin-echo and multishot spin-echo echoplanar imaging

OBJECTIVE

The objective of our study was to evaluate the efficacy of single breath-hold T2-weighted MR imaging for detection of focal hepatic lesions.

MATERIALS AND METHODS

T2-weighted MR images were retrospectively reviewed from 51 patients with 85 solid and 59 nonsolid lesions using the following four sequences: conventional spin-echo, respiratory-triggered fast spin-echo, single-shot fast spin-echo, and multishot spin-echo echoplanar imaging. Images were reviewed on a hepatic segment-by-segment basis; T2-weighted images of a total of 408 hepatic segments were reviewed separately and independently for solid and nonsolid lesions by four radiologists. Quantitative, qualitative, and receiver operating characteristic analyses were performed.

RESULTS

For solid lesions, no significant differences were seen among the lesion-to-liver contrast-to-noise ratios with the four sequences. In terms of solid lesion detection, no significant difference was seen between the diagnostic accuracy of multishot spin-echo echoplanar (Az = 0.90) and respiratory-triggered fast spin-echo (Az = 0.91) imaging, which showed the best performance of the four sequences. For nonsolid lesion detection, respiratory-triggered fast spin-echo and single-shot fast spin-echo imaging were judged the best (Az = 0.94).

CONCLUSION

Breath-hold single-shot fast spin-echo and multishot spin-echo echoplanar sequences can be substituted for conventional spin-echo and respiratory-triggered fast spin-echo T2-weighted sequences.

Preoperative detection of malignant hepatic tumors: comparison of combined methods of MR imaging with combined methods of CT

OBJECTIVE

We compared radiologists' performance on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging with their performance on helical CT during arterial portography (CTAP) and biphasic CT during hepatic arteriography (CTHA) for the preoperative detection of malignant hepatic tumors.

SUBJECTS AND METHODS

MR images and CT scans obtained in 33 patients were retrospectively analyzed. Images of the liver were reviewed on a segment-by-segment basis; a total of 261 segments with 39 hepatocellular carcinomas and 21 metastases were independently reviewed by three radiologists who were invited from outside institutions. Unenhanced and gadolinium-enhanced MR images were reviewed first, then ferumoxides-enhanced MR images were added for combined review. CTAP images and biphasic CTHA images were reviewed together.

RESULTS

Sensitivity for the detection of hepatic tumors was analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images (86%) and for combined CTAP images and biphasic CTHA images (87%). Specificity was higher with MR images (95%, p < 0.01) than with CT images (91%). Radiologists' performances were improved (Az = 0.962, p = 0.0502) by combining ferumoxides-enhanced MR images with unenhanced and gadolinium-enhanced MR images (Az = 0.950), and were analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images and for combined CTAP images and biphasic CTHA images (Az = 0.959).

CONCLUSION

Radiologists' performances on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging compared with their performances on combined helical CTAP and biphasic CTHA are analogous for the preoperative detection of malignant hepatic tumors. Such a dedicated combination of MR imaging may obviate the need for more invasive angiographically assisted helical CT for the preoperative detection of malignant hepatic tumors.

Revealing hepatic metastases from colorectal cancer: value of combined helical CT during arterial portography and CT hepatic arteriography with a unified CT and angiography system

OBJECTIVE

The purpose of our study was to evaluate the use of combined helical CT during arterial portography and CT hepatic arteriography in the preoperative assessment of hepatic metastases from colorectal cancer using a unified CT and angiography system.

MATERIALS AND METHODS

Fifty-four patients with hepatic metastases from colorectal cancer preoperatively underwent combined CT during arterial portography and CT hepatic arteriography using the unified CT and angiography system. Three radiologists independently and retrospectively reviewed the images of CT during arterial portography alone, CT hepatic arteriography alone, and combined CT during arterial portography and CT hepatic arteriography. Image review was conducted on a segment-by-segment basis; a total of 432 hepatic segments with (n = 103) 118 metastatic tumors ranging in size from 2 to 160 mm (mean, 25.8 mm) and without (n = 329) tumor were reviewed.

RESULTS

Relative sensitivity of combined CT during arterial portography and CT hepatic arteriography (87%) was higher than that of CT during arterial portography alone (80%, p < 0.0005) and CT hepatic arteriography alone (83%, p < 0.005). Relative specificity of CT hepatic arteriography alone (95%, p < 0.0005) and combined CT during arterial portography and CT hepatic arteriography (96%, p < 0.0001) was higher than that of CT during arterial portography alone (91%). Diagnostic accuracy, determined by a receiver operating characteristic curve analysis, was greater with combined CT during arterial portography and CT hepatic arteriography than with CT during arterial portography alone (p < 0.05) or CT hepatic arteriography alone (p < 0.01).

CONCLUSION

Using a unified CT and angiography system, we found that combined CT during arterial portography and CT hepatic arteriography significantly raised the detectability of hepatic metastases from colorectal cancer.

Pancreas and peripancreatic vessels: effect of imaging delay on gadolinium enhancement at dynamic gradient-recalled-echo MR imaging

PURPOSE

To investigate the effect of imaging delay on gadolinium enhancement of the pancreas and peripancreatic vessels at dynamic gradient-recalled-echo magnetic resonance (MR) imaging of the pancreas.

MATERIALS AND METHODS

Dynamic MR images were obtained after intravenous bolus injection of gadopentetate dimeglumine in 75 patients with no pancreatic malignancies. Test-bolus imaging was performed to determine aortic transit time in individual patients. Patients were randomly assigned so that the middle of k space was acquired at 5, 15, 25, 35, or 45 seconds after arrival of contrast material in the abdominal aorta. Mean signal intensities of pancreas, liver, and peripancreatic vessels were measured, and images were qualitatively assessed by two radiologists.

RESULTS

The best pancreatic enhancement occurred at a delay of 15 seconds (P <.05). The best enhancement of the liver and peripancreatic vessels occurred at 25 seconds or later (P <.05). Qualitatively, the best images of the pancreas were obtained at 15 seconds, and the best images of the liver and peripancreatic vessels were obtained at 25 seconds or later.

CONCLUSION

Biphasic imaging at 15 and 45 seconds or later after arrival of contrast material in the abdominal aorta is a practical method for acquisition of high-quality dynamic gradient-recalled-echo MR images of the pancreas.

Detection of lymph-node metastases in patients with gastric carcinoma: comparison of three MR imaging pulse sequences

BACKGROUND

To compare the diagnostic accuracy of magnetic resonance (MR) images obtained with three different pulse sequences for lymph-node metastases in patients with gastric cancer.

METHODS

T1-weighted spin-echo (SE), breath-hold T2-weighted fast SE, and triphasic gadolinium-enhanced dynamic gradient-recall-echo (GRE) MR images obtained in 16 patients with gastric carcinoma were retrospectively reviewed. Regional lymph nodes were assigned to four different groups, and image review was conducted on a lymph-node group-by-group basis; 64 lymph-node groups were reviewed by two radiologists. Relative sensitivity, specificity, and accuracy were determined based on the findings with definitive surgery and follow-up imaging. Diagnostic accuracy was determined by means of receiver-operating-characteristic (ROC) analysis.

RESULTS

Relative sensitivities for lymph-node metastases with T1-weighted SE, breath-hold T2-weighted fast SE, and dynamic GRE images were 61%, 94%, and 59%, respectively. Relative sensitivity with breath-hold T2-weighted fast SE images was significantly greater than that with T1-weighted SE (p < 0.05) and dynamic GRE (p < 0.05) images. Diagnostic accuracy determined by ROC analysis was marginally higher with breath-hold T2-weighted fast SE (area under ROC curve [Az] = 0.87) than with T1-weighted SE (Az = 0.78, p = 0.08) and dynamic GRE (Az = 0.79, p = 0.12) images.

CONCLUSION

Breath-hold T2-weighted fast SE sequence is useful in the detection of regional lymph-node metastases in patients with gastric carcinoma.

Detection of hepatocellular carcinoma: comparison of low- and high-spatial-resolution dynamic MR images

OBJECTIVE

The purpose of our study was to compare the diagnostic performance of low- and high-spatial-resolution gadolinium chelate-enhanced triphasic dynamic gradient-recalled echo (GRE) MR images in the detection of hepatocellular carcinoma.

MATERIALS AND METHODS

Triphasic dynamic MR images obtained with low (256 x 128) and high (512 x 224) image matrices in 28 patients with 65 hepatocellular carcinomas (HCCs) were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; a total of 215 liver segments, including 56 segments with tumor burden, were reviewed for the presence of HCC by three independent radiologists. Detectability was evaluated with relative sensitivity, specificity, and receiver operating characteristic (ROC) analysis. Image quality was evaluated with rank order analysis.

RESULTS

Relative sensitivity was statistically significantly better with high-spatial-resolution images than with low-spatial-resolution images (p < .005). Relative specificity was statistically significantly better with low-spatial-resolution images than with high-spatial-resolution images (p < .001). Diagnostic accuracy determined by ROC curve analysis was marginally higher with high-spatial-resolution (area under ROC curve [Az] = .97) than with low-spatial-resolution (Az = .94, p < .09) images. Image quality was statistically significantly better with high-spatial-resolution images (p < .005).

CONCLUSION

High-spatial-resolution dynamic GRE images were superior to low-spatial-resolution images in sensitivity of detecting HCC and in image quality. Triphasic dynamic GRE imaging in the screening and follow-up programs of patients with suspected HCC should be performed using high image matrices.

Potential utility of magnetic resonance cholangiography in the management of endoscopic biliary drainage tubes

An 80-yr-old woman with advanced hilar cholangiocarcinoma underwent a placement of endoscopic biliary drainage (EBD) tube from the common hepatic to common bile duct through the stricture. Magnetic resonance cholangiography clearly demonstrated the later dislocation and obstruction of the EBD tube. The present case suggests that magnetic resonance cholangiography may be a potentially useful tool in the management of EBD tubes.

Fat-suppressed T2-weighted MR imaging of hepatocellular carcinoma and metastases: comparison of conventional spin-echo, fast spin-echo, and echoplanar pulse sequences

The purpose of our study was to compare the diagnostic accuracy of fat-suppressed T2-weighted magnetic resonance (MR) images obtained with conventional spin-echo (SE), respiratory-triggered fast SE, and breath-hold multishot SE echoplanar (EP) sequences for the detection of hepatocellular carcinoma and metastases. Images obtained with the three sequences in 17 patients (15 with cirrhosis) with 31 hepatocellular carcinomas and 14 patients with 45 metastases were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; in all, 248 liver segments were reviewed separately and independently for detection of solid, malignant lesions. Diagnostic accuracy was evaluated with receiver-operating-characteristic (ROC) curve analysis. Diagnostic accuracy for hepatocellular carcinoma as determined by ROC curve analysis was better by a statistically significant amount for conventional SE (Az = 0.95) images when compared with respiratory-triggered fast SE (Az = 0.83, P < 0.05) and breath-hold multishot SE EP (Az = 0.80, P < 0.05) images. Conventional SE MR sequences should not be replaced with respiratory-triggered fast SE or breath-hold multishot SE EP sequences for T2-weighted MR imaging of patients with hepatocellular carcinoma in cirrhosis, unless sufficient contrast-enhanced dynamic MR imaging is subsequently performed.

Focal hepatic lesion detection: comparison of four fat-suppressed T2-weighted MR imaging pulse sequences

PURPOSE

To evaluate fat-suppressed T2-weighted magnetic resonance (MR) imaging with conventional spin-echo (SE), breath-hold fast SE, respiratory-triggered fast SE, and breath-hold multishot SE echo-planar sequences for the detection of focal hepatic lesions.

MATERIALS AND METHODS

Fat-suppressed T2-weighted MR images obtained with the four sequences in 55 patients with 81 solid and 129 nonsolid lesions were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; a total of 440 liver segments were reviewed separately for solid and nonsolid lesions by three independent radiologists. Diagnostic accuracy was evaluated with receiver operating characteristic analysis.

RESULTS

The mean lesion-to-liver contrast-to-noise ratio was highest on the multishot SE echo-planar images of both solid and nonsolid lesions. Fat-suppressed respiratory-triggered fast SE images had significantly better (P < .05) or comparative detectability of both solid and nonsolid lesions compared with the other types of images. Image quality was best on the respiratory-triggered fast SE images.

CONCLUSION

Fat-suppressed respiratory-triggered fast SE imaging should replace fat-suppressed conventional SE imaging as a standard T2-weighted imaging examination in the detection of focal hepatic lesions.

Small hepatic nodules in cirrhosis: ultrasonographic, CT, and MR imaging findings

PURPOSE

The purpose of this study was to assess the imaging findings of pathologically-proved small hepatic nodules 2 cm in size or smaller detected with ultrasonography in cirrhotic patients with suspected hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

We evaluated sonographically detected 32 small hepatic nodules which were pathologically confirmed in 23 consecutive cirrhotic patients who were suspected of having HCC. Twenty-six lesions were confirmed with ultrasonographically-guided aspiration needle-core biopsy, and six with definitive surgery. Ultrasonographic examination records were retrospectively reviewed. CT, and MR images obtained with various imaging techniques were retrospectively reviewed by two radiologists in a blind fashion.

RESULTS

The 32 hepatic nodules were comprised of seven focal fatty changes, two large regenerative nodules, three low-grade dysplastic nodules, five high-grade dysplastic nodules, and fifteen HCCs. Ultrasonography showed various echogenicity for the hepatic nodules. The signal-intensity characteristics with T1-weighted spin-echo, in-phase gradient-recalled-echo, and dynamic MR imagings may be useful in distinguishing HCC from nonHCC nodules.

CONCLUSIONS

Nearly half of small hepatic nodules detected with ultrasonography were nonHCC nodules. Ultrasonographic findings may not be reliable in characterizing small hepatic nodules in cirrhosis. CT and MR imaging obtained with the various techniques are still insensitive to these hepatic nodules.