Accumulation Of Contrast Agent Research Articles

Diagnosis of some rare forms of breast cancer

Background. Breast cancer (BC) is a heterogeneous disease, in which it is crucial not only to detect the tumor, but also to determine its biological characteristics to choose an optimal treatment strategy. Herein, we review existing literature on the subject and analyze own data.Aim. To analyze clinical and morphological characteristics of rare histological types of BC.Materials and methods. In this retrospective study, we analyzed the results of instrumental examination of 180 patients with mucinous BC treated in Sverdlovsk Regional Oncology Dispensary between 2020 and 2022. The mean age of the participants was 62.5 years. All patients underwent comprehensive examination, including digital mammography using the Fujifilm Amulet Innovality system, multiparametric ultrasound breast examination using the EPIQ 5 system (Phillips, Netherlands), and 1.5 T dynamic contrast-enhanced magnetic resonance imaging with a 16-channel – dedicated breast coil (GE Healthcare, USA).Results and conclusion. The incidence of mucinous BC was 1.8 %. Other rare types of BC, such as occult, medullary, papillary, tubular, and cribriform cancer were observed in less than 1 % of cases, which is consistent with the available literature data. Mucinous tumors were primarily represented by luminal B histology (73.3 %); the Ki-67 proliferation index was usually 35 %. The most common radiological manifestation was a hyperdense formation with clear contours (85 %). Ultrasound examination usually revealed a hypoechoic formation with clear and irregular contours (92 %); however, 8 % of patients presented with isoechoic formations that can hardly be distinguished from the background. Magnetic resonance imaging showed the following patterns: mass (87.5 %) with a persistent type of contrast accumulation (56.2 %) (type I curve) or curve exhibiting a plateau (43.8 %) (type II curve). Contrast agent accumulation started from the first minutes and was >100 % in all patients. Limitation of diffusion was observed in 25 % of patients. Patients with mucinous BC were usually characterized by late manifestation; 3 patients additionally had other cancers, including colorectal cancer, mucoepidermal tumor of the salivary gland, pancreatic cancer. None of these patients had family history of cancer. Isolated findings of X-ray mammography, ultrasound, and magnetic resonance imaging suggested benign breast tumors and no cancer-specific features.A multimodal approach enabled early detection of non-specific signs of rare forms of BC characterized by a specific clinical pattern with symptoms typical of this particular cancer from.

Post-COVID-19 myocardium and coronary involvement in a young patient: differential diagnosis and comprehensive treatment

The state of the heart after a coronavirus disease 2019 (COVID-19, coronavirus disease 2019) is very diverse and in some cases requires a complex differential diagnosis. We described a 35-year-old smoking male patient who, by the end of the first month after COVID-19, developed left ventricular dysfunction with decrease in ejection fraction to 25-30% and persistent left bundle branch block (LBBB). Echocardiography also detected local contractility disorders. A significant increase in blood anticardiac antibody titers was noted. Myocardial biopsy revealed active lymphocytic myocarditis, coronavirus ribonucleic acid, while coronary angiography revealed extensive stenosis of the anterior interventricular artery. On the first day after balloon angioplasty and stenting, the disappearance of LBBB block was noted with the appearance of deep negative T waves in the precordial leads, which did not allow ruling out a previous myocardial infarction. As a result of treatment of heart failure and steroid therapy, the structural and functional cardiac parameters and the electrocardiography were completely normalized by the end of the second year of treatment. Only a transient LBBB remained at high loads. Cardiac computed tomography after 2 years showed no delayed contrast agent accumulation in the myocardium, and coronary stenosis up to 30%.The mechanisms of complex myocardial and coronary damage (including the role of coronaritis in the atherosclerosis progression) after COVID-19 are discussed.

The Difficulties of Diagnosis Giant Angiomyolipoma of the Liver: Clinical Case and Literature Review

Purpose: To report a clinical case demonstrating difficulties of diagnosis and successful surgical treatment of myomatous type of angiomyolipoma of the liver without simultaneous damage to the kidneys.Material and methods: A female patient, 49 years old, was admitted to the hospital in August 2023, had no specific complaints, an abdominal ultrasound revealed extraperitoneal extraorgan mass in the epigastrium and mesogastrium and masses in the right lobe of liver, most likely hemangioma. The contrast-enhanced MSCT was performed on admission. Patient was rehospitalized for a surgery in September. During the operation the tumor was removed and sent for histological examination, a further immunohistochemical study was also carried out.Results: According to the results of MSCT in S3, S4, S5 of the liver oval-shaped mass (198×104×177 mm) with heterogeneous density and solid, cystic and fat features was found. Three hypovascular hypodense inclusions sizes up to 11 mm was also identified in S7/8. There was no pathologic formation in the kidneys. The liver tumor was surgically removed, the resected material was directed to a scheduled histological examination. To confirm the diagnosis an IHC analysis was also done and it revealed the expression of melanocytic (HBM-45) and smooth muscle (SMA) markers.Discussion: In this case we encountered very sparsely described in the world literature localization of angiomyolipoma — isolated hepatic one (without kidney damage). Like other authors we encountered the similarity of muomatous tumor type to the HCC and adenoma of the liver due to the characteristic features of visualization: hypervascularity, early contrast enhancement into an arterial phase and reduced density relative to the preserved parenchyma of the liver into a delayed phase of contrast.Conclusion: This case demonstrates the difficulty of diagnosing the myomatous type of AML simulating the HCC. As one of the most informative methods of diagnosis, we single out MSCT, which allowed us to think about the possibility of a benign nature of the tumor. In our case the main features excluding HCC were the absence of rapid “washout” of contrast drug, the presence of lipomatous areas and no accumulation of contrast agent by the capsule.

Accumulation of Iron Oxide-Based Contrast Agents in Rabbit Atherosclerotic Plaques in Relation to Plaque Age and Vulnerability Features.

In this study, a detailed characterization of a rabbit model of atherosclerosis was performed to assess the optimal time frame for evaluating plaque vulnerability using superparamagnetic iron oxide nanoparticle (SPION)-enhanced magnetic resonance imaging (MRI). The progression of atherosclerosis induced by ballooning and a high-cholesterol diet was monitored using angiography, and the resulting plaques were characterized using immunohistochemistry and histology. Morphometric analyses were performed to evaluate plaque size and vulnerability features. The accumulation of SPIONs (novel dextran-coated SPIONDex and ferumoxytol) in atherosclerotic plaques was investigated by histology and MRI and correlated with plaque age and vulnerability. Toxicity of SPIONDex was evaluated in rats. Weak positive correlations were detected between plaque age and intima thickness, and total macrophage load. A strong negative correlation was observed between the minimum fibrous cap thickness and plaque age as well as the mean macrophage load. The accumulation of SPION in the atherosclerotic plaques was detected by MRI 24 h after administration and was subsequently confirmed by Prussian blue staining of histological specimens. Positive correlations between Prussian blue signal in atherosclerotic plaques, plaque age, and macrophage load were detected. Very little iron was observed in the histological sections of the heart and kidney, whereas strong staining of SPIONDex and ferumoxytol was detected in the spleen and liver. In contrast to ferumoxytol, SPIONDex administration in rabbits was well tolerated without inducing hypersensitivity. The maximum tolerated dose in rat model was higher than 100 mg Fe/kg. Older atherosclerotic plaques with vulnerable features in rabbits are a useful tool for investigating iron oxide-based contrast agents for MRI. Based on the experimental data, SPIONDex particles constitute a promising candidate for further clinical translation as a safe formulation that offers the possibility of repeated administration free from the risks associated with other types of magnetic contrast agents.

Unsupervised unpaired multiple fusion adaptation aided with self-attention generative adversarial network for scar tissues segmentation framework

Late gadolinium enhancement (LGE) is a specialized imaging technique used in cardiovascular magnetic resonance (CMR) imaging to detect and characterize areas of scar tissue or fibrosis within the heart muscle. After a heart attack, the affected region of the heart muscle becomes scarred due to insufficient blood supply. LGE CMR enhances the infarcted myocardium to appear with distinctive brightness compared to healthy tissues. It is primarily used to assess various heart conditions and can identify the extent and location of scar tissue, helping in risk stratification and guiding treatment decisions. Automated myocardium segmentation in LGE CMR poses challenges due to intensity heterogeneity caused by the accumulation of contrast agents in infarcted areas. Furthermore, LGE CMR images with gold standard labels are particularly scarce compared to other sequences, making the task even more demanding. Besides, the heart’s motion involves complex non-rigid deformations, including regional wall thickening, circumferential, and longitudinal ventricular shortening, making it challenging to model. This work presents an unsupervised unpaired domain adaptive scar tissue segmentation framework aided with the self-attention generative adversarial network. Besides, we proposed a novel segmentation architecture based on a parallel transformer for scar segmentation and compared the results with and without style transfer GAN and unpaired style self-supervised attention GAN. Besides, to model longitudinal changes in scare, we used eight days’ time points as a source and 1 month and 12 as a target and applied our proposed attention-generative network to transfer style from one-time point to another time. Experiments on four different LGE MICCAI datasets from 2019 to 2023 achieved significantly better performance than state-of-the-art segmentation methods.

Aneurysm Wall Contrast on Magnetic Resonance Imaging: A New Predictor of Rupture of Saccular Intracranial Aneurysms

Background. Recent studies suggest that accumulation of contrast agent in the aneurysm’s wall may predict a high risk of aneurysm growth or rupture.Objective. To compare the enhancement of the aneurysm wall with other characteristics that affect at the risk of rupture.Materials and Methods. The study included 95 patients with 132 previously identified saccular aneurysms, who underwent magnetic resonance imaging (MRI) according to a specialized protocol using 3.0 Tesla MRI scanner. The presence or absence of aneurysm’s wall enhancement compared with the following characteristics: gender and age of the patient, the size and shape of the aneurysm, the presence of arterial hypertension, and the PHASES score.Results. Accumulation of contrast agent by the aneurysm’s wall was associated with the aneurysm dome size (p < 0,001, Sp = 78,1 %, Se = 72,1 %) and PHASES score (p < 0,001, Sp = 64,1 %, Se =57,1 %). No relationship between age, gender, arterial hypertension, shape, and aneurysm location and contrast enhancement was found (p > 0,05).Conclusion. Contrast enhancement of the aneurysm wall on MRI can be considered an additional risk marker of its rupture.

Quantitative MRI of Gd-DOTA Accumulation in the Mouse Brain After Intraperitoneal Administration: Validation by Mass Spectrometry.

In mice, intraperitoneal (ip) contrast agent (CA) administration is convenient for mapping microvascular parameters over a long-time window. However, continuous quantitative MRI of CA accumulation in brain over hours is still missing. To validate a quantitative time-resolved MRI technique for mapping the CA kinetics in brain upon ip administration. Prospective, animal model. 25 C57Bl/6JRj mice underwent MRI. 7-T, gradient echo sequence. Gd-DOTA concentration was monitored by MRI (25 s/repetition) over 135 minutes with (N = 15) and without (N = 10) ip mannitol challenge (5 g/kg). After the final repetition, the brains were sampled to quantify gadolinium by mass spectrometry (MS). Upon manual brain segmentation, the average gadolinium concentration was compared with the MS quantification in transcardially perfused (N = 20) and unperfused (N = 5) mice. Precontrast T1 -maps were acquired in 8 of 25 mice. One-tailed Spearman and Pearson correlation between gadolinium quantification by MRI and by MS, D'Agostino-Pearson test for normal distribution, Bland-Altman analysis to evaluate the agreement between MRI and MS. Significance was set at P-value <0.05. MRI showed that ip administered CA reached the blood compartment (>5 mM) within 10 minutes and accumulated continuously for 2 hours in cerebrospinal fluid (>1 mM) and in brain tissue. The MRI-derived concentration maps showed interindividual differences in CA accumulation (from 0.47 to 0.81 mM at 2 hours) with a consistent distribution resembling the pathways of the glymphatic system. The average in-vivo brain concentration 2 hours post-CA administration correlated significantly (r = 0.8206) with the brain gadolinium quantification by MS for N = 21 paired observations available. The presented experimental and imaging protocol may be convenient for monitoring the spatiotemporal pattern of CA uptake and clearance in the mouse brain over 2 hours. The quantification of the CA from the MRI signal in brain is corroborated by MS. N/A TECHNICAL EFFICACY: Stage 1.

A technique for assessing pulmonary perfusion in patients with previously treated COVID-19 pneumonia: clinical controlled non-randomized study

INTRODUCTION: Evaluating pulmonary lung perfusion in patients with previously treated COVID-19 infection may lead to a better understanding of long-term consequences of the disease, as well as may identify the changes determined by their symptoms. Further research is required for optimization of lung perfusion’s design parameters’ methods in order to implement those in clinical practice.OBJECTIVE: To determine the possibilities of an alternative method for evaluation of relative lung perfusion using three-dimensional ultrafast contrast-enhanced MRI on patients with previously treated COVID-19 pneumonia.MATERIALS AND METHODS: We examined 100 patients (28 male and 72 female, aged 22 to 70) who had laboratory-confirmed COVID-19 infection. The research was conducted using the three-dimensional ultrafast dynamic contrast-enhanced MRI based on 3D T1-weighted images. During the postprocessing, we received the values of rPBF (relative pulmonary blood flow), rPBV (relative pulmonary blood volume), and rMTT (relative mean transit time).Statistics. For non-linear dependence modelling we used natural spline transformation for time and interaction effect with a group. Intergroup comparison on integral measures was based on Kruskall-Wallis test (χ2), pair comparisons were based on Conover’s test (Δ). For multiple hypothesis testing correction, we used the false discovery rate (FDR). Comparisons were determined as statistically significant when p&lt;0.05.RESULTS: The differences in obtained values of lung perfusion among patient groups were confirmed both quantitatively (by rMTT, rPBV, rPBF) and qualitatively (by building the curves of contrast agent accumulation). Patients with previously treated COVID-19 demonstrate slower contrast agent transit and increased relative lung blood volume. Their accumulation curves have qualitative differences as well.DISCUSSION: We suggest a new method of evaluation of lung perfusion indicators in patients with previously treated COVID-19. We conducted an intergroup analysis based on the degree of lung damage during the acute phase of COVID-19 (with no infiltrativechanges, with minor lung damage, and major lung damage). The intergroup differences found are more significant for patients with lung damage (both minor and major) than for patients with no infiltrative lung changes during the acute phase of COVID-19.CONCLUSION: This method of evaluation of pulmonary perfusion is able to adequately characterize the functional lung conditions in patients with previously treated COVID-19 pneumonia. The chosen model is the most optimal.

Vestibular schwannomas with neuroimaging signs of spontaneous regression: frequency of continued growth after surgery

Purpose. To determine the frequency of continued growth after surgical treatment in patients with neuroimaging signs of spontaneous regression of vestibular schwannoma. Material and methods. The study included 55 patients with histologically verified vestibular schwannoma. For a comparative assessment of the results of the study, 2 groups were formed: group I included 58.2 % of patients who had no signs of spontaneous regression (gender ratio — 1:4, more often — women), group II included 41.8 % of patients with the presence of one of the MR signs of regression (gender ratio was 1:1.3). The following parameters were analyzed as the studied MR characteristics: the presence of scalloped borders, the filling of the internal auditory canal with cerebrospinal fluid, and the heterogeneity of the accumulation of contrast agent by the tumor. The retrosigmoid access was used for the patients of the studied groups. Results. The patients with these neuroimaging parameters were characterized by a prolonged asymptomatic period which led to the diagnosis of vestibular schwannoma in the late stages — KOOS 4 (𝜒2=4.8; p&lt;0.03). In the patients with MR characteristics of spontaneous regression with any size of vestibular schwannoma, a high frequency of continued growth after surgical treatment was revealed (p&lt;0.05), which demonstrates the «aggressiveness» of the course of the disease. The results obtained indicate the need for increased oncological alertness in these patients. Conclusions. A detailed study of the MR characteristics of spontaneous regression of vestibular schwannomas can improve the patients’ quality of life and treatment outcomes.

Computed tomography in the diagnosis of oncopathology in end-stage renal disease: A case report

BACKGROUND: In recent years, an increasing tendency of oncopathology in patients with chronic kidney disease (CKD) was observed. Clinical data demonstrate an increased risk of malignization in patients with decreased renal function. The cohort study (2022) reported a cumulative incidence of cancer in nephrology patients ranging from 10.8% to 15.3%. A high percentage of stage IV cancers were detected in patients with CKD at the time of diagnosis. In 2022, the American Association for Cancer Research published the results of a Mendelian Randomization Study examining the causal relationship between CKD and the risk of developing 19 local cancers, including renal cell cancer, cervical cancer, leukemia, and colorectal cancer. Several studies found a direct correlation between a decreased glomerular filtration rate and the development of oncopathologies. Therefore, cancer awareness is important in the management of patients with CKD. In patients with end-stage chronic renal disease (ESRD) who are on hemodialysis, X-ray diagnosis with iodine-containing radiopaque agents is possible without additional risk of kidney damage.&#x0D; AIM: To demonstratу the role of computed tomography (CT) in the diagnosis of oncopathology in a patient with CKD to attract the attention of physicians to the importance of using advanced diagnostic techniques in patients with CKD.&#x0D; METHODS: A clinical case of a 32-year-old patient M. who was hospitalized in the Therapeutic Department of Multidisciplinary City Hospital No. 2 in Astana was presented.&#x0D; RESULTS: A patient with ESRD resulting from chronic glomerulonephritis in a hypertensive form complained of dyspnea at rest, cough with difficult sputum, right thoracic pain, general weakness, and weight loss of 8 kg in 1 month. Past medical history showed that the patient was on alternate program hemodialysis for 4 years. Deterioration occurred within 3 months. The patient was examined at the place of residence. CT scan showed signs of tuberculosis of the upper right lobe (?) and lymphadenopathy of intrathoracic and axillary lymph nodes. A neoplasm was not excluded. The patient was consulted by a phthisiatrician, GeneXpert sputum was performed, and tuberculosis was excluded. In dynamics, ultrasound was conducted due to increasing dyspnea. Fluid accumulation in the pericardial and pleural cavities was detected. A pulmonologist assessed the situation as uremic pericarditis, pleurisy on the right side, and right-sided pneumonia in the upper lobe of unclear genesis. Antibacterial therapy was prescribed. Due to a significant deterioration of the condition, the patient went to the city hospital. At admission, respiratory failure, pain syndrome in the chest area, and marked asthenization up to cachexia were observed. Ultrasound of pleural cavities showed free fluid in the pleural cavity on the right (770 ml) and left (110 ml), whereas abdominal ultrasound revealed cavernous hemangiomas of the liver (?), echogenic suspension of the gallbladder, and splenomegaly. Echocardiography showed diffuse hypokinesis of all left ventricular walls. Grade 12 pulmonary hypertension was detected. Systolic function of the left ventricle was moderately decreased. Effusion in the pericardial cavity in the volume of 430 ml and congestion in the inferior vena cava were found. A patient with ESRD was on program hemodialysis for 4 years, which allowed the use of contrast-enhanced X-ray imaging techniques without the risk of additional renal damage. Contrast-enhanced chest CT showed pronounced right-sided pleurisy. Given the presence of foci of contrast agent accumulation in the structure of the parietal pleura, malignancy was not excluded (mesothelioma?). Indolent left-sided pleurisy, segmental and subsegmental compression atelectasis of the right lung, distinct edema and thickening of interlobular septa of both lungs, and single dense foci of I/II, III segments of the left lung up to 4.2 mm in diameter were detected. In addition, chronic bronchitis, pericarditis, and lymphadenopathy of subclavian, intrathoracic, and axillary lymph nodes up to 15.0 mm in diameter (malignancy not excluded) were revealed. Osteosclerosis foci of the Th3 vertebral body measuring 4.75.1 mm was observed. Contrast-enhanced abdominal and retroperineal CT scan showed a focal mass of the IVa segment of the liver measuring 17.315.916.4 mm (malignancy not excluded), chronic calculous cholecystitis, chronic pancreatitis, lymphadenopathy of intra-abdominal para-aortic and mesenteric lymph nodes up to 18.0 mm in size (malignancy not excluded), reduced size of both kidneys (contracted kidneys), and a cystic mass in the left ovary measuring 39.442.034.5 mm (35 HU). Patient was consulted by an oncologist: pleural mesothelioma? Metastasis in the liver? Consultation with a thoracic surgeon to decide on morphological verification was recommended. A biopsy was planned at the place of residence; however, morphological verification of oncopathology was not performed due to the patients lethal outcome.&#x0D; CONCLUSIONS: This clinical case of a patient with ESRD on hemodialysis demonstrates the importance of contrast-enhanced CT to diagnose oncopathology.

Spontaneous intracranial hypotension due to CSF-venous fistula: Evaluation of renal accumulation of contrast following decubitus myelography and maintained decubitus CT to improve fistula localization.

Presented here is a strategy of sequential lateral decubitus digital subtraction myelography (LDDSM) followed closely by lateral decubitus CT (LDCT) to facilitate cerebrospinal fluid (CSF)-venous fistula (CVF) localization. This is a retrospective analysis of patients referred to our institution for evaluation of CSF leak. Patients with Type 1 and Type 2 leaks, and those not displaying MR brain stigmata of intracranial hypotension were excluded. All patients underwent consecutive LDDSM and LDCT. If the CVF was not localized on the first LDDSM-LDCT pair the patient returned for contralateral examinations. Images were reviewed for CVF and for accumulation of contrast within the renal pelvises expressed as a renal pelvis contrast score (RPCS) in Hounsfield units (HU). Twenty-two patients were included in this study. In 21 of 22 patients (95%) a CVF was identified yielding an RPCS for the LDDSM-LDCT pair ipsilateral to the CVF ranging from 71 to 423 with an average of 146 HU. An RPCS of the negative side LDDSM-LDCT pair contralateral to a CVF was available in 8 patients and averaged 51 HU. In 4 patients the initial bilateral LDDSM-LDCT pairs did not reveal the location of the CVF however in 3 of these 4 cases the CVF was revealed on a third LDDSM repeated ipsilateral to the higher RPCS. The strategy of sequential LDDSM-LDCT coupled with evaluation of renal accumulation of contrast agent appears to improve the rate of CVF localization and warrants further evaluation.

Assessment of the Pharmacokinetics, Disposition, and Duration of Action of the Tumour-Targeting Peptide CEND-1

CEND-1 (iRGD) is a bifunctional cyclic peptide that can modulate the solid tumour microenvironment, enhancing the delivery and therapeutic index of co-administered anti-cancer agents. This study explored CEND-1's pharmacokinetic (PK) properties pre-clinically and clinically, and assessed CEND-1 distribution, tumour selectivity and duration of action in pre-clinical tumour models. Its PK properties were assessed after intravenous infusion of CEND-1 at various doses in animals (mice, rats, dogs and monkeys) and patients with metastatic pancreatic cancer. To assess tissue disposition, [3H]-CEND-1 radioligand was administered intravenously to mice bearing orthotopic 4T1 mammary carcinoma, followed by tissue measurement using quantitative whole-body autoradiography or quantitative radioactivity analysis. The duration of the tumour-penetrating effect of CEND-1 was evaluated by assessing tumour accumulation of Evans blue and gadolinium-based contrast agents in hepatocellular carcinoma (HCC) mouse models. The plasma half-life was approximately 25 min in mice and 2 h in patients following intravenous administration of CEND-1. [3H]-CEND-1 localised to the tumour and several healthy tissues shortly after administration but was cleared from most healthy tissues by 3 h. Despite the rapid systemic clearance, tumours retained significant [3H]-CEND-1 several hours post-administration. In mice with HCC, the tumour penetration activity remained elevated for at least 24 h after the injection of a single dose of CEND-1. These results indicate a favourable in vivo PK profile of CEND-1 and a specific and sustained tumour homing and tumour penetrability. Taken together, these data suggest that even single injections of CEND-1 may elicit long-lasting tumour PK improvements for co-administered anti-cancer agents.

Possibilities of MRI in the differential diagnosis of non-lactative mastitis and cancer

Non-lactational mastitis is an inflammatory process in the breast tissue that is not associated with lactation. The detection of a malignant transformation during inflammation process is often difficult, because it has similar clinical manifestations. Medical approach depends on the characteristics of the processes which are received from the data obtained from radiation diagnostic methods: whether or not there is a nodular formation or infiltrate, cystic cavities, dilatation of the ducts, how the axillary lymph nodes are changed. Diagnostic errors in inflammatory breast diseases are quite common; according to the literature, errors in the interpretation of clinical, mammographic, and ultrasound signs of cancer during inflammation account for up to 53.1% of cases. Inflammation, as well as cancer, in majority of cases is accompanied by a visually detectable increase in blood flow due to proliferation and neoangiogenesis. Magnetic resonance imaging with dynamic contrast enhancement (MRI) is highly sensitive in detecting areas with increased vascularization and makes it possible to assess their nature with a high degree of probability during any changes in the structure of the breast tissue, including edema and inflammatory infiltration. MR signs that allow to make differential diagnosis are a combination of pathological accumulation and lymphadenopathy, which are coded by the BIRADS system as category 4 and only the absence of contrast agent accumulation may suggest an inflammatory nature of the changes. According to the literature, MRI-DCE is a highly sensitive diagnostic method of identifying cancer during inflammation processes. The results of 85 MR studies with clinical manifestations of non-lactational mastitis were analyzed.The purpose of study: is to evaluate the possibilities of magnetic resonance mammography in making a differential diagnosis of non-lactational mastitis and breast cancer.

MODERN ULTRASOUND IMAGING TECHNOLOGIES IN THE DIAGNOSIS OF PAPILLARY THYROID CANCER

The aim of the study was to determine the opportunities of multiparametric ultrasound in the early detection of papillary thyroid cancer. Examination results of 258 patients with papillary thyroid cancer at the stage of preoperative preparation were analyzed. All patients underwent multiparametric ultrasound examination in grey-scale mode, in color Doppler mapping mode, in compression elastography mode and shear wave elastography, ultrasound with contrast enhancement. In papillary thyroid cancer, "cold" tones prevailed. the velocity of the shear wave was 4.61±1.33 m/s (95% CI), Young's modulus was 63.3±14.7 kPa (95% CI), the elasticity index (strain ratio) was 4.89±1.65 (95% CI) c.u. When assessing the qualitative parameters of ultrasound with contrast enhancement, it was noted that in papillary thyroid cancer, heterogeneous accumulation of ultrasound contrast agent prevailed (54.5%), there was a more pronounced intensive accumulation of ultrasound contrast agent (63.6%). when measuring TPI, the EC indicator was 20.64±4.37 s, PI – 31.08±1.65 dB, PI (DT/2) – 64.00±10.27 s. Thus, the study showed that the complex use of multiparametric ultrasound examination techniques (B-mode, color Doppler mapping, compression elastography, shear wave elastography, ultrasound with contrast enhancement) is highly informative and should be used in the differential diagnosis of papillary thyroid cancer in the preoperative assessment.

Operator's Influence on Contrast Agent Intravasation During Hysterosalpingo-Contrast Sonography: Explanation Based on a Physics Model.

ObjectiveTo analyze the risk factors of the operators on contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy).MethodsWe retrospectively collected 399 infertile women who underwent HyCoSy by the same sonographer. These patients were divided into two groups according to the way how the assistants connected the syringe to the uterus radiography catheter to inject the contrast agent. We analyzed whether the use of different contrast bolus injection methods had any influence on the incidence of intravasation during HyCoSy.ResultsThere was no significant difference between the two groups with different cross-sectional areas of the syringe outflow tract in the risk variables for intravasation, but the intravasation rates of the two groups were different, 26.4% in group A and 17.1% in group B, P <0.05. The primary manifestation was that when both fallopian tubes were unobstructed, the intravasation rate of group B with smaller cross-sectional area of the outflow tract of the syringe was lower, and the difference was statistically significant. The inferences drawn from our physics model were also in line with the clinical results.ConclusionThe influence of different operators on the contrast agent intravasation rate of HyCoSy cannot be ignored. The assistants of HyCoSy examination should inject the contrast agent slowly and steady, and a needle can be used as a flow restrictor to control the flow into the uterine cavity per unit time, slow down the rising speed of intrauterine pressure, and avoid the accumulation of contrast agent in the uterine cavity, so as to reduce the intravasation caused by operator factors.

Functional biomarkers derived from computed tomography and magnetic resonance imaging differentiate PDAC subgroups and reveal gemcitabine-induced hypo-vascularization

PurposePancreatic ductal adenocarcinoma (PDAC) is a molecularly heterogeneous tumor entity with no clinically established imaging biomarkers. We hypothesize that tumor morphology and physiology, including vascularity and perfusion, show variations that can be detected by differences in contrast agent (CA) accumulation measured non-invasively. This work seeks to establish imaging biomarkers for tumor stratification and therapy response monitoring in PDAC, based on this hypothesis.Methods and materialsRegional CA accumulation in PDAC was correlated with tumor vascularization, stroma content, and tumor cellularity in murine and human subjects. Changes in CA distribution in response to gemcitabine (GEM) were monitored longitudinally with computed tomography (CT) Hounsfield Units ratio (HUr) of tumor to the aorta or with magnetic resonance imaging (MRI) ΔR1 area under the curve at 60 s tumor-to-muscle ratio (AUC60r). Tissue analyses were performed on co-registered samples, including endothelial cell proliferation and cisplatin tissue deposition as a surrogate of chemotherapy delivery.ResultsTumor cell poor, stroma-rich regions exhibited high CA accumulation both in human (meanHUr 0.64 vs. 0.34, p < 0.001) and mouse PDAC (meanAUC60r 2.0 vs. 1.1, p < 0.001). Compared to the baseline, in vivo CA accumulation decreased specifically in response to GEM treatment in a subset of human (HUr −18%) and mouse (AUC60r −36%) tumors. Ex vivo analyses of mPDAC showed reduced cisplatin delivery (GEM: 0.92 ± 0.5 mg/g, vs. vehicle: 3.1 ± 1.5 mg/g, p = 0.004) and diminished endothelial cell proliferation (GEM: 22.3% vs. vehicle: 30.9%, p = 0.002) upon GEM administration.ConclusionIn PDAC, CA accumulation, which is related to tumor vascularization and perfusion, inversely correlates with tumor cellularity. The standard of care GEM treatment results in decreased CA accumulation, which impedes drug delivery. Further investigation is warranted into potentially detrimental effects of GEM in combinatorial therapy regimens.

Long-term cardiac pathology in individuals with mild initial COVID-19 illness

Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77–177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274–383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.

Possibilities of using contrast-enhanced ultrasound in formation of virtual dynamic nephroscintigraphy protocol in patients with type II diabetes mellitus

Objective. To evaluate the effectiveness of contrast-enhanced ultrasound in the formation of the protocol of virtual dynamic nephroscintigraphy in patients with type 2 diabetes mellitus. Materials and methods. All patients were examined according to a single diagnostic algorithm, which included four stages: 1) multiparametric ultrasound examination of the kidneys in the In-mode; 2) Doppler assessment of the state of intrarenal blood flow in this group of patients; 3) carrying out CEUS of the kidneys in accordance with European recommendations for clinical practice on contrast-enhanced ultrasound examination followed by the calculation of virtual dynamic nephroscintigraphy; 4) carrying out dynamic nephroscintigraphy according to standard the methodology as a reference method. Results. In the course of the study, patients (n = 32) with a clinical diagnosis of type 2 diabetes mellitus of varying severity were examined. All patients were divided into 2 groups of 16 people each, depending on the results of glomerular filtration rate (GFR). The time of maximum accumulation of contrast agent in group 1 (patients with type 2 diabetes and GFR greater than 60 ml/min/1.73 m2) is quantitatively less than in group 2 (patients with type 2 diabetes and GFR 30–44 ml/min/1.73 m2). The half-life of the contrast agent in groups 1 and 2 does not change significantly. When performing virtual dynamic nephroscintigraphy in patients of the 1st and 2nd groups, the results correlating with the reference method – dynamic nephroscintigraphy were obtained. Conclusion. The method of using contrast-enhanced ultrasound in the formation of the protocol of virtual dynamic nephroscintigraphy in patients with type 2 diabetes mellitus allows us to obtain quantitative indicators of dynamic nephroscintigraphy for subsequent medical conclusions, as well as the possibility of dynamic monitoring of the course of the disease without the use of ionizing research methods.

The system for assessing liver function according to magnetic resonance imaging with gadoxetic acid

Purpose. To develop a system for assessing liver function in patients with liver cirrhosis according to magnetic resonance imaging (MRI) with gadoxetic acid.Material and Methods. Data from studies of 74 patients who underwent abdominal MRI with intravenous gadoxetic acid (GA) enhancement were analyzed. For statistical analysis of the data, two groups were formed: group 1 (n = 22) comprised patients with unchanged liver parenchyma, normal liver function, and benign tumors; group 2 (n = 52) comprised patients with liver cirrhosis, with the presence of regenerative and/or dysplastic nodes, and hepatocellular carcinoma (HCC). The following quantitative parameters were studied to assess liver function in patients of two groups: relative enhancement (RE), contrast enhancement index (CEI), liver/skeletal muscle (SM) index, liver/spleen index, liver/kidney index, analysis of histograms (AH), and liver function imaging scale (FLIS).Results. The criteria for a functional deficiency of liver function based on calculated data of contrast agent transport and accumulation were a decrease in FLIS total score to 4 and below, RE values below 0.85, and CEI values below 1.38 with sensitivity and specificity of 100 and 75%, the values of liver/SM and liver/kidney indices below 0.350, liver/spleen index below 0.750 with sensitivity and specificity of 100 and 81%, respectively, in patients with cirrhosis.Conclusion. The developed system for assessing liver function using FLIS, intensity matching analysis (IMA), and AH according to MRI with GC in comparison with METAVIR allowed for liver function assessment in patients with cirrhosis with a sensitivity and specificity of 100% and 80%, respectively.

CT and MRI diagnostics of desmoid fibroids in familial colon adenomatosis

Objective: to study the features of CT and MRI diagnostics of desmoid fibroids (DF) in familial colon adenomatosis (SATC). Patients and methods: the study included 35 patients with desmoid fibroids (DF) in familial colon adenomatosis (SATC). All patients were examined using computed tomography (CT) and magnetic resonance imaging (MRI) with intravenous contrast. Localization, size, growth pattern, prevalence of DF, features of contrast and intensity of the MR signal on T2-VI and post-contrast T1-VI were evaluated. Twenty-five (71.4%) patients were observed in dynamics, including during systemic therapy. Results: in 21 (60.0 %) patients, a lesion of only one anatomical area was detected, and in 14 (40.0%) cases, a combined lesion of different anatomical zones was noted. In the majority of observations (33/35, 94.4 %) desmoid fibroids were detected in the mesentery and mesentery root of the small intestine, including with a combined lesion. The majority of patients (24/35, 68.6%) were diagnosed with a diffuse nodular form of growth; 13 (37.1%) had a nodular form and 6 (17.1%) had a diffuse form. Twenty-five patients (25/35, 71.4%) were repeatedly re-examined using CT (13/35, 37.1%) and MRI (12/35, 34.3%), in particular during systemic therapy. Conclusion: CT and MRI are the basic methods for detecting DF in SATC, allowing to determine the nature of tumor growth, to assess the prevalence of the tumor process and the degree of involvement of adjacent organs and structures. In dynamic observation and evaluation of the response of a desmoid tumor to systemic therapy, MRI has greater diagnostic capabilities compared to CT, since it takes into account not only the size of the desmoid, but also the intensity of the MR signal on T2-VI and the nature of the accumulation of contrast agent on post-contrast T1-VI with fat suppression.