Deep-learning-based image quality enhancement of CT-like MR imaging in patients with suspected traumatic shoulder injury

PURPOSE

To evaluate the diagnostic performance of CT-like MR images reconstructed with an algorithm combining compressed sense (CS) with deep learning (DL) in patients with suspected osseous shoulder injury compared to conventional CS-reconstructed images.

METHODS

Thirty-two patients (12 women, mean age 46 ± 14.9 years) with suspected traumatic shoulder injury were prospectively enrolled into the study. All patients received MR imaging of the shoulder, including a CT-like 3D T1-weighted gradient-echo (T1 GRE) sequence and in case of suspected fracture a conventional CT. An automated DL-based algorithm, combining CS and DL (CS DL) was used to reconstruct images of the same k-space data as used for CS reconstructions. Two musculoskeletal radiologists assessed the images for osseous pathologies, image quality and visibility of anatomical landmarks using a 5-point Likert scale. Moreover, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.

RESULTS

Compared to CT, all acute fractures (n = 23) and osseous pathologies were detected accurately on the CS only and CS DL images with almost perfect agreement between the CS DL and CS only images (κ 0.95 (95 %confidence interval 0.82-1.00). Image quality as well as the visibility of the fracture lines, bone fragments and glenoid borders were overall rated significantly higher for the CS DL reconstructions than the CS only images (CS DL range 3.7-4.9 and CS only range 3.2-3.8, P = 0.01-0.04). Significantly higher SNR and CNR values were observed for the CS DL reconstructions (P = 0.02-0.03).

CONCLUSION

Evaluation of traumatic shoulder pathologies is feasible using a DL-based algorithm for reconstruction of high-resolution CT-like MR imaging.

Elucidation of the genetic causes of bicuspid aortic valve disease

AIMS

The present study aims to characterize the genetic risk architecture of bicuspid aortic valve (BAV) disease, the most common congenital heart defect.

METHODS AND RESULTS

We carried out a genome-wide association study (GWAS) including 2236 BAV patients and 11 604 controls. This led to the identification of a new risk locus for BAV on chromosome 3q29. The single nucleotide polymorphism rs2550262 was genome-wide significant BAV associated (P = 3.49 × 10-08) and was replicated in an independent case-control sample. The risk locus encodes a deleterious missense variant in MUC4 (p.Ala4821Ser), a gene that is involved in epithelial-to-mesenchymal transformation. Mechanistical studies in zebrafish revealed that loss of Muc4 led to a delay in cardiac valvular development suggesting that loss of MUC4 may also play a role in aortic valve malformation. The GWAS also confirmed previously reported BAV risk loci at PALMD (P = 3.97 × 10-16), GATA4 (P = 1.61 × 10-09), and TEX41 (P = 7.68 × 10-04). In addition, the genetic BAV architecture was examined beyond the single-marker level revealing that a substantial fraction of BAV heritability is polygenic and ∼20% of the observed heritability can be explained by our GWAS data. Furthermore, we used the largest human single-cell atlas for foetal gene expression and show that the transcriptome profile in endothelial cells is a major source contributing to BAV pathology.

CONCLUSION

Our study provides a deeper understanding of the genetic risk architecture of BAV formation on the single marker and polygenic level.

[Postoperative imaging of the musculoskeletal system : Clinical aspects]

BACKGROUND

Postoperative imaging in trauma surgery is an essential part of documenting optimal osteosynthetic care. A precise and goal-oriented analysis with a justifiable indication is essential. The clinical information has a great impact on the quality of imaging. An objective evaluation and structured reporting complete the postoperative imaging procedure.

MATERIALS AND METHODS

Conventional x‑rays in two planes is the standard of postoperative imaging in musculoskeletal surgery. In specific anatomic structures, additional images may be necessary. The postoperative x‑ray is the simplest way to visualize a successful osteosynthesis and combines the most important points of postoperative management. Computed tomography (CT) is mostly used in emergencies, but also in the postoperative management of some elective procedures, including patients with surgery of the spine, hip or to the proximal long bones of the extremities. Furthermore, CT is useful in postoperative imaging of complicated ankle fractures. Magnetic resonance imaging (MRI) plays a modest role in postoperative imaging and is mostly used in musculoskeletal cancer surgery. Ultrasound rather plays a subordinated role in postoperative management, but it is increasingly becoming established as a tool for postoperative quality control. The great advantage is dynamic visualization in real time.

CONCLUSION

Postoperative imaging remains challenging, but can detect most issues regarding osteosynthesis, which can be then be treated or monitored. Various imaging modalities are available to make reliable statements on osteosynthetic material, bone and soft tissue.

Response comparison of PLC and SLC with magnetic resonance elastography after TACE

The aim of this study was to detect a response difference in primary (PLC) and secondary liver tumors (SLC) with magnetic resonance elastography (MRE) after TACE therapy. Thirty-one patients (25/31 male; mean age 69.6 years [range: 39-85 years]) with repeated TACE therapy of HCC were compared with twenty-seven patients (27/27 female; mean age 61.2 years [range 39-81 years]) with repeated TACE therapy of metastatic liver disease due to breast cancer. Both groups underwent either one (n = 31) or two (n = 27) repetitive magnetic resonance imaging (MRI) and MRE exams in 4- to 6-week intervals using a 1.5-T-scanner. MRE-based liver stiffness and size measurements were evaluated in tumorous lesions and in healthy liver lobe controls. PLC showed a significantly larger tumor size compared to SLC (26.4 cm2 vs. 11 cm2, p = 0.007) and a higher degree of stiffness (5.8 kPa vs. 5.1 kPa, p = 0.04). Both tumors decreased in size during the cycles (PLC: p = 0.8 and SLC: p < 0.0001) and lesions showed an increase in stiffness (PLC: p = 0.002 and SLC: p = 0.006). MRE demonstrates that PLC and SLC have similar responses to TACE therapy. PLC had a greater increase in stiffness and SLC got smaller. An increasing stiffness and decrease in size could show a good response.

MR elastography is a good response parameter for microwave ablation liver tumors

OBJECTIVES

To determine the response of hepatic tissue to percutaneous microwave ablation (MWA) of liver tumors via MR elastography in a clinical setting using MRI and MR elastography.

METHODS

51 Patients (28 m, 23f) underwent MWA of liver tumors (HCC: 20, metastasis: 31) and received MRI and MR elastography immediately before and 24 h after MWA. Retrospective analysis included pre- and post-ablative tumor extent, T1/T2 mapping and stiffness values as well as the duration and energy dose of the MWA session.

RESULTS

Total liver stiffness increased by 4.3% from 3.31 kPa to 3.45 kPa (p = 0.036). Total liver stiffness post-MWA significantly correlated with the duration of the MWA session (r = 0.369, p = 0.008). The higher the baseline tumor stiffness was, the more energy had to be applied in MWA (r = 0.391, p < 0.001) and the longer the duration of the session (r = 0.391, p = 0.007). Healthy parenchyma stiffness increased by 3.5% from 3.55 kPa to 3.68 kPa (p = 0.142) and was strongly influenced by the cumulative energy (r = 0.436, p < 0.001), the duration (r = 0.458, p < 0.001) and the energy intensity (r = 0.458, p < 0.001) of MWA. 43 patients had a technically successful ablation result (margin ≥ 5 mm). Those with successful ablation had increased ablation margin stiffness (5.3 kPa vs. 4.6 kPa, p = 0.26) and had received higher ablation intensity than those with unsuccessful ablation (5.73 kJ/min vs. 5.03 kJ/min, p = 0.002).

CONCLUSION

Additional MRE may be used before and after MWA to assess treatment response and collateral tissue damage after MWA. Baseline tumor stiffness helps finding the appropriate MWA parameters.

Evaluation of MR elastography as a response parameter for transarterial chemoembolization of colorectal liver metastases

OBJECTIVE

The aim of this study was to evaluate magnetic resonance elastography (MRE) as a response parameter in patients who received transarterial chemoembolization (TACE) for the treatment of colorectal liver metastases.

MATERIALS AND METHODS

Forty-two patients (29 male patients; mean age, 61.5 years; range, 41-84 years) with repeated TACE therapy of colorectal liver metastases underwent on average 2 repetitive magnetic resonance imaging (MRI) and MRE exams in 4- to 6-week intervals using a 1.5-T scanner. MRE-based liver stiffness measurements were performed in normal liver parenchyma and in metastatic lesions. Moreover, the size of the liver metastases was assessed during treatment and compared with the results of the MRE analysis.

RESULTS

Liver metastases showed a significantly higher degree of stiffness compared with the normal liver parenchyma (p < 0.001). However, only a weak correlation was found between the lesion size and stiffness (r = - 0.32, p = 0.1). MRE analysis revealed an increase in stiffness of the colorectal liver metastases from 4.4 to 7.1 kPa after three cycles of TACE (p < 0.001). Also, the mean size of the metastases decreased from 17.0 to 11.3 cm2 (p < 0.001). Finally, the entire liver stiffness increased from 2.9 to 3.1 kPa over the three cycles of TACE therapy.

CONCLUSION

In conclusion, MRE showed a significant change in stiffness and size of liver metastases. Therefore, MRE may provide an added value for an evaluation of treatment response in patients with colorectal liver metastases undergoing TACE.

KEY POINTS

• MRE showed an increase in stiffness of the colorectal liver metastases during TACE therapy. • Liver metastases showed a significantly higher degree of stiffness compared with the normal liver parenchyma. • However, only a weak correlation was found between the lesion size and stiffness.

Photoreactivity of a push-pull merocyanine in static electric fields: a three-state model of isomerization reactions involving conical intersections

The photochemistry of a prototype push-pull merocyanine is discussed using a simple three-state model. As a derivative of butadiene, the model focuses on two isomerization reactions around the two double bonds of the butadiene backbone. As a molecule substituted by an electron donor and electron acceptor at opposite ends, its structure as well as its photochemistry are expected to be strongly affected by the environment. In polar solvents, a zwitterion transition state for each of the isomerization reactions is stabilized, and its energy is on the same order as that of the biradical one; this leads to the symmetry allowed crossing (S(0)/S(1) conical intersection). It is shown that applying an external electric field or varying the solvent polarity changes the relative energies of the different transition states as well as that of the conical intersection, and thus different photochemical products can be obtained. In particular, the very existence of conical intersections is found to depend on these external parameters. This work provides a theoretical foundation for ideas expressed by Squillacote et al. (J. Am. Chem. Soc. 2004, 126, 1940) concerning the electrostatic control of photochemical reactions.

Photophysics of Phenylpyrrole Derivatives and Their Acetonitrile Clusters in the Gas Phase and in Argon Matrixes: Simulations of Structure and Reactivity

Recent experiments on the dual fluorescence of phenylpyrrole (PP) and pyrrolobenzonitrile (PBN) in supersonic jets and in cryogenic matrixes are analyzed. The structures of the 1:1 clusters are calculated using ab initio, density functional theory (DFT) and molecular mechanics (MM) methods. In these calculations, the structures of PP and PBN in the ground state and in two possible minima on the charge-transfer excited state are taken from a recent theoretical analysis. The structures of PP and PBN clusters with a larger number of acetonitrile molecules are also calculated using the molecular mechanics method. It is shown that the fact that small PP:AN and PBN:AN clusters do not exhibit any charge-transfer (CT) type emission, whereas for PBN:AN(n) clusters (n > or = 4) CT emission is observed, can be understood on the basis of the calculated structures. The trapping of PP and of PBN in an argon matrix (neat and doped with acetonitrile) is simulated by a molecular dynamics procedure. The observation of locally excited (LE) fluorescence only from PP in neat argon, whereas from argon-trapped PBN both CT and LE emission bands are observed, is readily understood on the basis of these simulations. Moreover, the appearance of CT emission from PP-doped argon matrixes when acetonitrile is added is also explained, as well as the relatively small spectral shift observed upon addition of acetonitrile to PBN-doped argon matrixes.

Charge-Transfer-Type Fluorescence of 4-(1H-Pyrrol-1-yl)benzonitrile (PBN) and N-Phenylpyrrole (PP) in Cryogenic Matrixes: Evidence for Direct Excitation of the CT Band

The fluorescence spectrum of PBN in a neat argon matrix is excitation-wavelength-dependent: at short excitation wavelengths, it consists of dual emission assigned to a charge-transfer (CT) state and a much weaker band assigned to the locally excited (LE) state. The CT emission is broad and almost completely devoid of vibrational structure, whereas the LE band is characterized by vibrationally resolved emission. At long excitation wavelengths, only CT emission is observed, indicating that the CT state is populated directly by light absorption and not via the LE state. Comparison with jet-cooled spectra of the bare molecule allows the unambiguous assignment of the LE spectrum and the location of the 0,0 band. The matrix LE emission spectrum is blue-shifted with respect to that of the gas phase, showing that the dipole moment of the LE state is smaller than that of the ground state. The fluorescence spectrum of PBN in an argon matrix does not change appreciably when acetonitrile (AN) is added to the matrix, in contrast to the case of N-phenylpyrrol (PP) (Schweke, D.; Haas, Y. J. Phys. Chem. A 2003, 107, 9554), for which addition of AN results in the appearance of two well separated emission bands. The different photophysical behaviors of PP and PBN in an argon matrix (and in supersonic jets) are analyzed by a simple model that considers the restriction of large-amplitude motions in the matrix. The implications of these low-temperature studies for understanding the properties of these systems in liquid solution are discussed.

Molecular and functional characterization of GnRH receptors cloned from rat pituitary and a mouse pituitary tumor cell line

A cDNA for a GnRH receptor (mtGnRH-R) was obtained from a mouse gonadotropic pituitary cell line (alpha T3-1) by expression cloning. This full-length cDNA was subsequently used as a probe to clone a rat pituitary GnRH receptor (rGnRH-R). The two receptors differ by 13 amino acids and are 100% identical to those recently reported. The analysis of the cloned receptors by photoaffinity-labeling followed by SDS-PAGE reveals a major band of approximately 70 kDa. This is in contrast to the native rat pituitary and mouse alpha T3-1 receptors whose major labeled species migrate with an apparent size of approximately 45 kDa. Functional studies reveal that both receptors, when transiently expressed in COSM6 cells, can bind GnRH with high affinity and transduce the stimulation of IP3 accumulation in response to GnRH.

The gonadotropin-releasing hormone pituitary receptor interacts with a guanosine triphosphate-binding protein: differential effects of guanyl nucleotides on agonist and antagonist binding

Binding of the GnRH agonist [DAla6,NMe-Leu7,Pro9Net]GnRH to bovine anterior pituitary membranes is inhibited by guanyl nucleotides. The effect of guanyl nucleotides is temperature dependent, in that significant binding inhibition is observed when the receptor-hormone interaction is measured at 37 C, and no inhibition is seen at 4 C. Micromolar concentrations of the nonhydrolyzable GTP analog 5'-guanylylimidodiphosphate [Gpp(NH)p] displace the bound agonist in a dose-dependent manner, with half-maximal displacement occurring in a concentration range of 0.1-0.5 microM, and maximum displacement occurring at a concentration of 50 microM Gpp(NH)p. At a concentration of 50 microM, the other nucleotides GTP and GDP inhibit binding to a lesser extent, while GMP, cGMP, 5'-adenylylimidodiphosphate [App(NH)p], ATP, and cAMP have no effect on the binding. At 37 C, Gpp(NH)p reduces the affinity of the agonist by a factor of 6 and increases its dissociation rate. In the presence of Gpp(NH)p at 37 C, there is also a 2-fold increase in the total number of binding sites. Under the same conditions as those used for the agonist, there is no displacement of the bound antagonist [Ac-D2Nal1,4ClDPhe2,D3Pal3,DLys6,Lys8,D Ala10]-GnRH by doses up to 50 microM Gpp(NH)p. The modulation of the binding of the agonist, but not that of the antagonist, by guanyl nucleotides is characteristic of receptors that are coupled to GTP-binding proteins. Thus, the GnRH receptor appears to be coupled to a GTP-binding protein that may play a role in the mechanism of action of GnRH at the pituitary.

Corticotropin-releasing factor binding to the anterior pituitary receptor is modulated by divalent cations and guanyl nucleotides

The binding of ovine CRF to bovine anterior pituitary membranes was characterized with the radioligand [Nle21, m-125I Tyr32]ovine CRF. The specific binding of CRF was increased by millimolar concentrations of the divalent cations Mg2+, Ca2+, and Mn2+, but was unaffected by the monovalent cations Na+, Ki+, and Li+. The increase in specific binding was not caused by a change in the affinity, but resulted from an apparent increased number of high affinity binding sites. In the presence of 10 mM Mg2+, CRF binding was saturable, specific, and of high affinity. At room temperature, under optimum conditions, binding reached equilibrium within 70 min, remained stable for at least 4 h, was reversible by excess unlabeled peptide, and was characterized by a Kd of 1.3 nM (0.74-2.4) and a total number of sites, R degree, of 90 fmol/mg protein (55-145). The affinity for the bovine membranes was the same as that for rat anterior pituitary membrane homogenates, and the concentrations of sites were similar. The relative binding affinities for the CRF receptor of selected agonists and antagonists in the bovine and rat systems were similar, and both showed good correlation with the relative in vitro potencies at stimulating or antagonizing, respectively, ACTH release from cultured rat anterior pituitary cells. The nonhydrolyzable GTP analog 5'-guanylylimidodiphosphate [Gpp(NH)p], caused a dose-dependent inhibition of bound radioligand, with an EC50 of about 0.5 microM. In the presence of 1 microM Gpp(NH)p, the number of high affinity CRF-binding sites was reduced, but the affinity was unchanged. In the presence of 5 microM Gpp(NH)p, there was no detectable high affinity binding, and the rate of dissociation of previously bound radioligand was increased. The other guanyl nucleotides, GTP and GDP, inhibited binding but to a lesser extent, whereas GMP and (Bu)2cGMP were ineffective. The inhibition was specific for guanyl nucleotides. In view of the established effects of guanyl nucleotides and divalent cations on adenylate cyclase-linked receptors, these data support the involvement of the adenylate cyclase system in the mechanism of action of CRF on the anterior pituitary.

Solubilization of the gonadotropin-releasing hormone receptor from bovine pituitary plasma membranes

The plasma membrane receptor for GnRH in bovine anterior pituitaries has been solubilized with the cholic acid derivative detergent 3([3-cholamidopropyl)dimethylammonio]propane sulfonate. The soluble receptor in the supernatant from a 100,000 x g x 90 min centrifugation displays high affinity, saturability and specific binding to the agonist, [DA1a6,N alpha MeLeu7, Pro9-NEt]-GnRH. The dissociation constant, KD, for the soluble receptor is 0.56 +/- 0.07 nM (mean +/- SEM) and the number of sites, Ro, is 85 +/- 17 fmols/mg protein. For the membrane-bound receptor the KD is 0.50 +/- 0.04 nM and Ro is 300 +/- 18 fmols/mg protein. The relative potencies of GnRH and the potent antagonist, [Ac-delta 3Pro1,pFDPhe2, DTrp3,6]-GnRH are similar for both the soluble and membrane-bound receptor.