Edema-like Changes Research Articles

Shortfalls of free autologous internal limiting membrane transplantation for highly myopic refractory macular holes in a long term follow-up.

The aim of this study is to evaluate long-term anatomical and functional outcomes of autologous internal limiting membrane (ILM) transplantation in refractory highly myopic macular holes (HMMHs). Retrospective interventional analysis of 13 eyes with refractory HMMH undergoing autologous ILM transplantation with gas tamponade. Best-corrected visual acuity (BCVA, Snellen), optical coherence tomography and fundus photography were scheduled at baseline and every follow-up visit (1, 3, 6, 12, 18, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, rates of external limiting membrane (ELM)/ellipsoid zone (EZ) restoration, excessive gliosis and subfoveal retinal pigmented epithelium (RPE) atrophy were evaluated. Average AXL was 31.45 ± 2.07mm and mean follow-up was 47.2 ± 31.4 months. Anatomical success was reached in 7/13 eyes (54%), while 2 cases showed persisting HMMH, 2 cases had early recurrence and 2 cases late recurrence. BCVA went from 0.19 ± 0.18 to 0.22 ± 0.20 at final follow-up (p = 0.64), improving in 5/13 eyes (38%). One eye showed continuous ELM and EZ lines, while another eye showed an irregular ELM but no EZ. Post-operatively, 5 eyes (71%) developed progressive atrophy of the subfoveal RPE, while excessive gliosis was reported in 3 eyes (43%). Furthermore, one patient developed post-operative chronic macular edema-like changes in the perifoveal area. Autologous ILM transplantation showed controversial anatomical outcomes and and poor visual results in refractory HMMH. Moreover, progressive subfoveal patchy atrophy and excessive gliosis are possible post-operative complications.

Imaging Biomarkers of Peripheral Nerves: Focus on Magnetic Resonance Neurography and Ultrasonography.

Peripheral neuropathy is a prevalent and debilitating condition affecting millions of individuals globally. Magnetic resonance neurography (MRN) and ultrasonography (US) are noninvasive methods offering comprehensive visualization of peripheral nerves, using anatomical and functional imaging biomarkers to ensure accurate evaluation. For optimized MRN, superior and high-resolution two-dimensional and three-dimensional imaging protocols are essential. The anatomical MRN and US imaging markers include quantitative measures of nerve and fascicular size and signal, and qualitative markers of course and morphology. Among them, quantitative markers of T2-signal intensity ratio are sensitive to nerve edema-like signal changes, and the T1-mapping technique reveals nerve and muscle tissue fatty and fibrous compositional alterations.The functional markers are derived from physiologic properties of nerves, such as diffusion characteristics or blood flow. They include apparent diffusion coefficient from diffusion-weighted imaging and fractional anisotropy and tractography from diffusion tensor imaging to delve into peripheral nerve microstructure and integrity. Peripheral nerve perfusion using dynamic contrast-enhanced magnetic resonance imaging estimates perfusion parameters, offering insights into nerve health and neuropathies involving edema, inflammation, demyelination, and microvascular alterations in conditions like type 2 diabetes, linking nerve conduction pathophysiology to vascular permeability alterations.Imaging biomarkers thus play a pivotal role in the diagnosis, prognosis, and monitoring of nerve pathologies, thereby ensuring comprehensive assessment and elevating patient care. These biomarkers provide valuable insights into nerve structure, function, and pathophysiology, contributing to the accurate diagnosis and management planning for peripheral neuropathy.

The utility of chemical shift imaging and related Dixon images in evaluation of bone marrow edema-like changes in diabetic foot

BackgroundMagnetic resonance imaging (MRI) is the best diagnostic tool for suspected diabetic foot osteomyelitis (DFO); adding T1-based Dixon to MR technique can identify the bone marrow edema-like signal observed in neuropathic joints and differentiate it from that observed in DFO. The aim of this study was to assess the diagnostic efficacy of chemical shift imaging (T1 in-phase and out-of-phase) and related Dixon sequence in differentiation between infectious edema-like signal found in osteomyelitis and bland edema signals observed in osteomyelitis mimickers (as neuropathic arthropathy). The study was conducted on 50 patients who were referred by surgical outpatient clinics between January 2020 and January 2022; they underwent MRI of the foot including T1-Dixon sequence.ResultsThere were variable bone and joint affection, and the most common location of bony affection in the study was the hind-foot. Forty-four out of fifty patients had bone marrow edema-like signals. Thirty-seven patients (74%) were diagnosed with osteomyelitis, whereas seven (14%) patients were diagnosed with non-infective/bland bone marrow edema signals which were related to Charcot arthropathy and/or nearby infection. Both visual and quantitative assessments of chemical shift imaging showed high sensitivity and specificity in diagnosis of DFO. The optimal cut-off point of signal intensity ratio for diagnosis of DFO was 1.005 with high sensitivity and specificity.ConclusionsChemical shift imaging and related Dixon sequence were reliable methods in diabetic foot evaluation; they could help differentiate infectious edema-like changes of osteomyelitis from and bland edema of osteomyelitis mimickers with high sensitivity and specificity especially on using quantitative analysis of their signal abnormality.

Effects of different preservation methods of human iliac veins.

With the progress of vascular anastomosis technology, the radical resection surgery of cancer combining with vascular resection and reconstruction has been focused by surgeon. As a natural substitute material for blood vessel, vascular allografts have good vascular compliance and histocompatibility. Generally, the donated veins could not be used immediately, and need to be well preserved. So, it is greatly significant to do research in the preservation effects of different preservation methods on veins. In this study, the effects of different preservative methods of human iliac veins were compared and analyzed in terms of cell viability, vascular wall structure and tension resistance. The donated human iliac veins were randomly divided into three groups: Cold Storage Group (4 °C) (CSG), Frozen Storage Group (-186 °C) (FSG)and Fresh Control Group (FCG). Six detection time-points of preservation for 1, 3, 5, 7, 14, 28days were set respectively. There are ten samples in each group and each time-point separately. Survival and apoptosis of vascular cell were evaluated by MTT assay and Tunel fluorescence staining. Tensile test was used to evaluate mechanical properties of vessels. The changes of vascular endothelial cells, smooth muscle cells, collagen fibers and elastic fibers were evaluated by HE staining, Masson staining and EVG staining. Furthermore, the changes of organelles were observed by transmission electron microscope. With the extension of preservation period, the vascular cell viability and tension resistance of two groups decreased, and the apoptotic cells increased gradually. The apoptosis index of CSG was higher than FSG at each time point (P < 0.05). In terms of cell viability, CSG was higher within 3days (P < 0.05), both groups were same between 3 and 14days, and then CSG lower than FSG after 14days (P < 0.05). In terms of tension resistance, CSG was stronger than FSG (P < 0.05) in first 7days, both groups were same in 2nd week, and then CSG was weaker in 4th week (P < 0.05). In terms of vascular wall structure, in CSG, vascular endothelial cells were damaged and shed, smooth muscle cells were edema after 14days, but the cell membrane and intercellular connection were still intact. In 4th week, endothelial cells were completely damaged and shed, the boundary of smooth muscle cell membrane was unclear, intercellular connection was damaged. Moreover, organelles were destroyed and disappeared, perinuclear condensation of chromatin was observed, and some cells had incomplete nuclear membrane or nuclear fragmentation; However, there were no obvious changes in the FSG within 28days. Finally, local exfoliation and destruction of endothelial cells and edema-like changes of organelles were observed; the collagen fibers and elastic fibers of blood vessels in the two groups had no obvious damage and change within 28days. For excised human iliac vein, cold and frozen storage can effectively preserve the cell viability, wall structure and tension resistance of blood vessels. With the extension of preservation time, the related performance of vessels declined in varying degrees. Within first week, the effect of cold storage is better than frozen storage, but frozen storage is significantly better than cold storage after 2weeks.

Autophagic vacuolar myopathy involving the phenotype of spinocerebellar ataxia type 3.

Spinocerebellar ataxia type 3 (SCA3) is a form of autosomal dominant cerebellar ataxia with a wide range of clinical manifestations, including ataxia and pyramidal and extrapyramidal signs. A few SCA3 patients have been noticed to be predisposed to the development of inclusion body myositis. It is still unknown whether muscle can be primarily involved in the pathogenesis of SCA3. This study reported an SCA3 family in which the index patient initially presented with parkinsonism, sensory ataxia, and distal myopathy but the absence of cerebellar and pyramidal symptoms. The clinical and electrophysiological studies implied a possible combination of distal myopathy and sensory-motor neuropathy or neuronopathy. MRI muscle showed selective fat infiltration and absence of denervated edema-like changes, indicating the distal muscle weakness had a myopathic origin. Muscle pathology showed the myopathic involvement, besides neurogenic involvement, characterized by chronic myopathic changes with multiple autophagic vacuoles. Genetic screening revealed expanded CAG of 61 repeats in the ATXN3 gene, which showed co-segregation in the family. Besides the neurogenic origin, the myopathic origin may be partly attributed to the limb weakness of SCA3 patients, which expands the spectrum of the clinical manifestation of SCA3.

Multicenter retrospective study of 38 cases with fumarate hydratase deficiency uterine leiomyoma

Objective: To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma. Methods: The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results: (1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P<0.05). Conclusions: FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.

MYOTONIC DYSTROPHY: P.22Subclinical myocardial dysfunction in patients with myotonic dystrophy type 1 and type 2 detected by cardiac magnetic resonance

Myotonic dystrophies (DM) represent the most common hereditary multi-systemic muscle diseases in adults characterized by progressive skeletal muscle degeneration, muscle wasting, myotonia, and multi-organ involvement. Cardiac affection is common, and premature death often occurs due to arrhythmic events. We examined whether signs of cardiac involvement in patients without clinically evident cardiac disease can be detected by a comprehensive cardiac magnetic resonance (CMR) approach. Thirty-five DM patients (13 DM type 1 and 22 DM type 2) without cardiac symptoms and normal ECG and echocardiography findings underwent CMR. The control group consisted of 31 healthy subjects. Our CMR protocol allowed for the determination of late gadolinium enhancement (LGE), myocardial edema, T1 relaxation times, T2 relaxation times, extracellular volume (ECV) and myocardial strain. When compared with controls, DM patients showed alterations of left ventricular function as demonstrated by lower systolic longitudinal and circumferential strain values. Visible myocardial fibrosis was prevalent in 28.6% of DM patients. Markers of diffuse myocardial fibrosis were also significantly elevated (T1 relaxation, ECV). Also, T2 relaxation times indicative of edema-like changes were significantly elevated in DM patients. In conclusion, asymptomatic DM patients had a subclinical impairment of myocardial function and elevated markers of myocardial fibrosis and edema when compared to healthy controls. These findings may indicate a high burden of subclinical myocardial disease in our DM patients with normal routine heart checkup results and an unremarkable history of cardiac disease. To summarize, CMR might be a useful tool to improve cardiac monitoring and outcome in DM1 and DM2 patients especially at early disease stages.

Strength and muscle structure preserved during long-term therapy in a patient with hypokalemic periodic paralysis (Cav1.1-R1239G)

We report a young wheelchair-dependent patient with an unclear proximal myopathy and a heterozygous, de-novo Cav1.1-R1239G mutation suggesting hypokalemic periodic paralysis (HypoPP). Sonography showed a loss of the pennate pattern indicative of an edema, whereas fatty degeneration was excluded. Within 7days of therapy with spironolactone, potassium and physical therapy, muscle strength almost completely normalized, a normal pennate pattern appeared and the edema was markedly reduced. She learned to walk without aid and to do sports and has continued to do so for 11years until now. Over the years, we tested serum potassium values, muscle strength, muscle edema and muscular sodium content by 1.5 T, 3 T and 7 T 1H and 23Na magnetic resonance imaging. No fatty muscle degeneration developed. Muscular edema-like changes only occurred when she was pregnant and was set to reduced therapy. Because of the ability to do sports again, her mobility was further increased. Our observational study on this single patient may suggest that: (1) muscle imaging and molecular genetics are important diagnostic tools, (2) weakness in periodic paralysis may be reversible, and (3) continued adequate therapy may preserve muscle structure and strength on a longterm, whereas weakness due to fatty degeneration could be considered progressive and irreversible. Although HypoPP is a rare disease, it should be included in differential diagnosis not only if there is paroxysmal weakness, but also in cases of myopathy of unknown origin.

Optical Coherence Tomography Analysis of the Optic Nerve Head and Surrounding Structures in Long-Duration International Space Station Astronauts

After long-duration spaceflight, morphological changes in the optic nerve head (ONH) and surrounding tissues have been reported. To develop methods to quantify ONH and surrounding tissue changes using preflight and postflight optical coherence tomographic scans of the ONH region. Two separate analyses were done on retrospective data, with the first comparing a preflight group with a control group, followed by preflight to postflight analysis. All astronaut data were collected on the same instrument and maintained by the National Aeronautics and Space Administration (NASA) Lifetime Surveillance of Astronaut Health. Control data were all collected at the University of Houston. Participants were 15 astronauts who had previously been on an approximately 6-month long-duration mission and had associated preflight and postflight ONH scans. The control group consisted of 43 individuals with no history of ocular pathology or microgravity exposure. Development of algorithms and data analysis were performed between 2012 and 2015. The optical coherence tomography data were analyzed using custom MATLAB programs (MathWorks) in which the Bruch membrane opening (BMO) was manually delineated and used as a reference for all morphological measures. The retinal pigment epithelium (RPE) position 2 mm from the center of the BMO was used to calculate the BMO height. Global and quadrant total retinal thickness and retinal nerve fiber layer (RNFL) thickness were calculated for elliptical annular regions referenced to the BMO. The standard circumpapillary circular scan was used to quantify RNFL and choroidal thickness. Among 15 astronauts (mean [SD] age at preflight evaluation, 48.7 [4.0] years) in this retrospective study, the BMO was recessed in preflight astronauts compared with healthy controls and deepened after long-duration microgravity exposure (median change, -9.9 μm; 95% CI of difference, -16.3 to 3.7 μm; P = .03). After long-duration missions, there was an increase in total retinal thickness to 1000 μm and RNFL to 500 μm from the BMO. Circumpapillary RNFL thickness increased by a median of 2.9 μm (95% CI of difference, 1.1-4.4 μm; P < .01), and there was no change in choroidal thickness (median change, 9.3 μm; 95% CI of difference, -12.1 to 19.6 μm; P = .66). After long-duration microgravity exposure, there are disc edema-like changes in the morphology of the ONH and surrounding tissue. The methods developed to analyze the ONH and surrounding tissue can be useful for assessing longitudinal changes and countermeasures in astronauts, as well as potentially for terrestrial disc edema causes.

Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play.

Background:Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times.Hypothesis:MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP).Study Design:Retrospective cohort study.Level of Evidence:Level 4.Methods:Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors.Results:The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm3 (SD, 42.6 cm3; range, 1.1-161.3 cm3). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP.Conclusion:The extent of MRI edema in hamstring injuries does not have prognostic value.Clinical Relevance:Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.

Joint Fluid, Bone Marrow Edemalike Changes, and Ganglion Cysts in the Pediatric Wrist: Features That May Mimic Pathologic Abnormalities-Follow-Up of a Healthy Cohort.

The presence of findings at wrist MRI that may mimic disease is a diagnostic problem. The purpose of this study is to examine the occurrence of bone marrow changes resembling edema, joint fluid, and ganglion cysts over time, in a cohort of healthy children. Seventy-four of 89 healthy children included in a study of normal MRI findings of the wrists were reexamined after a period of 4 years, using the same 1.5-T MRI technique-namely, a coronal T1-weighted and a T2-weighted fat-saturated sequence. A history of handedness, diseases, and sports activity was noted. Bone marrow edema or edemalike changes were seen in 29 of 74 (39.2%) wrists in 2013 as compared with 35 of 72 (48.6%) wrists in 2009 (p = 0.153), all in different locations. Changes were found in central parts of the bone, on both sides of a joint, or near bony depressions. Fifty percent of all subjects had at least one fluid pocket greater than or equal to 2 mm. The location was unchanged in 47% of the joints. In 24% of the individuals, at least one ganglion cyst was seen. Six ganglion cysts present on the first scan were not seen on the follow-up scan, and 11 new ganglion cysts had appeared. Awareness of normal MRI appearances of the growing skeleton is crucial when interpreting MRI of children, and such findings must not be interpreted as pathologic abnormalities.

Magnetic Resonance Imaging Features of Solitary Hypothalamitis.

The study aimed to characterize magnetic resonance imaging (MRI) findings of solitary hypothalamitis and evaluate their clinical value in diagnosis. Magnetic resonance imaging scans, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and contrast-enhanced T1-weighted sequences, of 8 biopsy-proven hypothalamitis lesions were retrospectively analyzed along with MRI features including size, shape, signal intensity, enhancement pattern, correlation with adjacent tissues, and changes in infundibular stalk and sella turcica. Of 8 patients, 5 were diagnosed with lymphoplasmacytic proliferative inflammation, 2 with Langerhans cell histocytosis, and 1 with Rosai-Dorfman disease. Solitary hypothalamitis predominantly demonstrated mild hypointensity/isointensity in T1WI and mild hyperintensity in T2-weighted imaging. In contrast-enhanced T1WI, all lesions showed heterogeneous but primarily peripheral enhancement patterns. Seven cases showed the polygon sign. In T1WI, the normal high signal intensity of neurohypophysis was absent from all patients, with no infundibular stalk thickening. Seven patients presented with optic chiasma edema, and 5 with edema-like changes along the optic tract (OTE), but most showed no visual impairment (n = 7). Magnetic resonance imaging, particularly postcontrast MRI, is the optimal modality for assessment of hypothalamic lesions. Peripheral enhancement with polygon sign and optic tract or chiasm edema without visual impairment are highly suggestive of hypothalamitis.

Whole-body magnetic resonance imaging evaluation of facioscapulohumeral muscular dystrophy.

Facioscapulohumeral muscular dystrophy (FSHD) is a hereditary disorder that causes progressive muscle wasting. Increasing knowledge of the pathophysiology of FSHD has stimulated interest in developing biomarkers of disease severity. Two groups of MRI scans were analyzed: whole-body scans from 13 subjects with FSHD; and upper and lower extremity scans from 34 subjects with FSHD who participated in the MYO-029 clinical trial. Muscles were scored for fat infiltration and edema-like changes. Fat infiltration scores were compared with muscle strength and function. The analysis revealed a distinctive pattern of both frequent muscle involvement and frequent sparing in FSHD. Averaged fat infiltration scores for muscle groups in the legs correlated with quantitative muscle strength and 10-meter walk times. Advances in MRI technology allow for acquisition of rapid, high-quality, whole-body imaging in diffuse muscle disease. This technique offers a promising disease biomarker in FSHD and other muscle diseases.

Protective effect of naloxone injected into cisterna magna on brain tissues of rats following cardiopulmonary resuscitation

Objective To investigate the effects of naloxone injected into cisterna magna on S100βprotein and neuronspecific enolase(NSE)levels in serum and the histopathology of brain tissue of rats following cardiopulmonary resuscitation(CPR).Methods Thirty adult male SD rats were randomly divided into 3groups:Sham group,Conventional CPR group(intravenous injection of epinephrine,0.2mg/kg)and Naloxone CPR group(cisterna magna injection of naloxone,2mg/kg).Asphyxiation was used to set up rat cardiac arrest model,and corresponding drugs were given when the resuscitation was carried out.The blood samples were taken from orbital venous plexus at 0.5h,3h,6hand 24 hafter restoration of spontaneous circulation(ROSC).Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of S100βprotein and NSE.Brain tissue was taken after the last blood sampling and the pathology of brain was observed by hematoxylineosin(H-E)staining.Results Serum S100βprotein levels of the Conventional CPR group and Naloxone CPR group were significantly higher than those of the Sham group at all time points(P0.01);compared with the Conventional CPR group,S100βprotein levels in Naloxone CPR group were significantly decreased at 3h,6h,and 24 hafter ROSC(P0.05 or P0.01).Serum NSE protein level of the Conventional CPR group at all time points and Naloxone CPR group at 6hand 24 hafter ROSC were significantly higher than those of the Sham group(P0.05 or P0.01).Serum NSE protein levels were significantly decreased at 6hand 24 hafter ROSC in Naloxone CPR group compared with the Conventional CPR group(P0.05 or P0.01).Moreover,hippocampus glial cells of Conventional CPR group were scattered and decreased,with condensed eosinophilic cytoplasm,narrowed nuclues,unclear nucleolus,and swollen and deformed capillaries.However,most nerve cells of Naloxone CPR group had rich cytoplasm and the nucleolus was clear;only a few nerve cells and capillaries showed edema-like changes of different degrees.Conclusion Naloxone injected into cisterna magna has a prominent protective effect on the brain of rats following cardiopulmonary resuscitation.

Comparison of Tissue Architectural Changes between Radiofrequency Ablation and Cryospray Ablation in Barrett’s Esophagus Using Endoscopic Three-Dimensional Optical Coherence Tomography

Two main nonsurgical endoscopic approaches for ablating dysplastic and early cancer lesions in the esophagus have gained popularity, namely, radiofrequency ablation (RFA) and cryospray ablation (CSA). We report a uniquely suited endoscopic and near-microscopic imaging modality, three-dimensional (3D) optical coherence tomography (OCT), to assess and compare the esophagus immediately after RFA and CSA. The maximum depths of architectural changes were measured and compared between the two treatment groups. RFA was observed to induce 230~260 μm depth of architectural changes after each set of ablations over a particular region, while CSA was observed to induce edema-like spongiform changes to ~640 μm depth within the ablated field. The ability to obtain micron-scale depth-resolved images of tissue structural changes following different ablation therapies makes 3D-OCT an ideal tool to assess treatment efficacy. Such information could be potentially used to provide real-time feedback for treatment dosing and to identify regions that need further retreatment.

Sodium ( 23 Na) MRI detects elevated muscular sodium concentration in Duchenne muscular dystrophy

In boys with Duchenne muscular dystrophy (DMD), (1)H MRI suggested muscular edema before fatty degeneration. Using specific (23)Na MRI sequences, we tested the hypothesis that the edema is caused by an osmotic effect due to increased myoplasmic Na(+) content rather than inflammation that would lead to extracellular edema. Eleven patients with DMD (mean age, 10 ± 5 years) and 16 healthy volunteers of similar age were examined on a 3-T system with (1)H MRI and (23)Na density-adapted 3-dimensional radial MRI sequences. The muscle edema was quantified on short-tau inversion recovery images using background noise as reference. Fatty degeneration was quantified on T1-weighted images using subcutaneous fat as reference. Na(+) was quantified by a muscular tissue sodium concentration (TSC) sequence. A novel inversion recovery (IR) sequence allowed us to determine mainly the myoplasmic Na(+) by suppression of the extracellular (23)Na signal from vasogenic edema. A reference tube containing 51.3 mmol/L Na(+) with agarose gel was used for standardization. The normalized muscular signal intensity of (23)Na as assessed by the IR sequence was significantly higher for patients with DMD than for volunteers. TSC was markedly increased at 38.4 ± 6.8 mmol/L in patients with DMD compared with 25.4 ± 2.1 mmol/L in volunteers. The muscular edema-like changes were much more prominent in patients with DMD than in volunteers. In addition, the muscular fat content was significantly higher in patients with DMD than in volunteers. The elevated myoplasmic Na(+) concentration in DMD is osmotically relevant and causes a mainly intracellular muscle edema that contributes to the pathogenesis of DMD.

Magnetic Resonance Imaging Reveals Edema-like Changes Not Only Subcutaneously, But Also in Muscle Tissue After Femoropopliteal Bypass Surgery

The pathophysiological mechanisms that induce postrevascularization edema after femoropopliteal bypass surgery are not completely understood. Reperfusion-associated injury to revascularized tissue and damage to lymphatic structures are both likely to play a role. Aim of this study was to study edema formation after peripheral bypass surgery with magnetic resonance imaging. Nine patients suffering from severe peripheral arterial occlusive disease were subjected to magnetic resonance imaging scans before and 1 week after autologous femoropopliteal or femorocrural bypass surgery. A 12% increase in volume of the upper legs and an 11% increase in volume of the lower legs were measured in patients postoperatively. The increase of volume was largely due to expansion of the subcutaneous compartments: a 35% increase in the upper legs and a 41% increase in the lower legs. Edema in the upper legs was predominantly located medially at the site of the surgical wound. In contrast, edema in the lower legs was homogenously distributed around the entire leg circumference. The muscle compartment showed no significant change of volume. However, in the majority of patients, edema-like changes were seen in selected muscles as well after a peripheral bypass reconstruction. Swelling of the subcutaneous compartments is mainly responsible for the volume increases in upper and lower legs similar to lymphatic edema. In addition, in a majority of patients, edema-like changes in selected muscles were seen especially in the upper legs. Reperfusion-associated injury as a cause of these changes cannot be ruled out.

Klinisch unklare schmerzhafte Schwellung des Oberarms

In contrast to the intramedullary (80%) and intracortical (14%) subtypes, the subperiostal subtype of aneurysmatic bone cysts (sABC) is relatively rare (6%). Females are affected more frequently than males, whereby the diaphysis is predominantly affected and less frequently the metaphysis of long bones as well as the vertebral column. Especially in conventional radiography sABCs can mimic aggressive lesions. Cross-sectional imaging can potentially reduce the wide range of differential diagnoses. Due to typical imaging features magnetic resonance imaging (MRI) is the most valuable modality to reduce the range of possible differential diagnoses. MRI usually presents a multicystic appearance with a hypointense rim of the lesion, contrast-enhancing cyst walls, fluid levels and edema-like changes in the adjacent tissue. In sABCs with solid components the diagnosis cannot be made with confidence and the suspicion must be confirmed by biopsy. The therapy of primary lesions consists of curettage or the complete excision of the sABC and the defects are subsequently filled with spongiosa or bone cement depending on the size of the lesion.

Ultrasound in the Inflammatory Myopathies

Dermato- or polymyositis must be diagnosed or ruled out early because early immunosuppressive therapy prevents irreversible muscle degeneration. Acute poly- and dermatomyositis are accompanied by normal or increased size, low echogenicity, and elevated perfusion of affected muscles, whereas in chronic poly- and dermatomyositis, the size and perfusion of affected muscles are reduced and echogenicity is increased. Although magnetic resonance imaging is more sensitive in detecting edema-like muscular changes and thereby acute myositis, contrast-enhanced ultrasound with its capability of measuring perfusion has become a useful diagnostic tool in diagnosing acute inflammation in poly- and dermatomyositis.

Bone marrow changes on STIR MR images of asymptomatic feet and ankles

The purpose of this study was to evaluate the prevalence, pattern and size of bone marrow changes on short-tau inversion recovery (STIR) magnetic resonance (MR) images of asymptomatic feet and ankles. In 78 asymptomatic volunteers (41 women, 37 men; median age 47 years; range 23-83 years) sagittal STIR MR images of hindfoot and midfoot were reviewed for various patterns of high signal changes in bone marrow. The size of these bone marrow changes was measured, and signal intensity was rated semi-quantitatively using a scale from 0 (=normal) to 10 (=fluid-like). Fifty percent (39/78) of all volunteers had at least one bone marrow change. Thirty-six percent (28/78) of all volunteers had edema-like changes, 26% (20/78) had necrosis-like changes, and 5% (4/78) had cyst-like changes. The long diameters of all changes varied between 4 mm and 16 mm (median 7.5 mm). The median signal intensity for all changes was 5.0 (range 1-10). Bone marrow changes on STIR MR images are commonly detected in asymptomatic feet and ankles. However, such changes tend to be small (<1 cm) or subtle.