Gadolinium Research Articles (Page 1)

BackgroundHigh-grade gliomas are the most common primary malignant brain tumor in adults having a median survival of only 13–16 months. This is despite the current standard of maximal safe surgical resection followed by fractionated radiotherapy and chemotherapy. Extending the tumor resection limit beyond the gadolinium (GAD)-enhancing margin (i.e., supra-marginal resection) could in principle provide an added survival benefit as it has been shown that > 80% of post-operative tumor recurrence is within a 2-cm region surrounding the original GAD-enhancing margin. However, this must be weighed against the risk of potential damage to functional brain tissue.MethodsIn this phase II pilot randomized control trial (RCT), we aim to assess the feasibility of “supra-marginal” resection extending 1 cm beyond the enhancing tumor in adults with radiographic evidence of GAD-enhancing intra-axial tumor consistent with high-grade glioma in a safe anatomical location and a Karnofsky Performance Score > 60. With six academic institutions with established neurosurgical oncology practices in participation, we aim to enroll 72 patients over 2 years. Primary outcomes include evaluating the feasibility of performing a large-scale trial with regard to recruitment, allocation, and outcome documentation as well as safety data. Secondary outcomes include determining if there is an increased survival benefit with supra-marginal resection and impact on quality of life (Modified Rankin Scale (mRS), EuroQol-5D (ED-5D), 30-day all-cause mortality).DiscussionRecent studies have revealed survival advantages comparing supra-marginal resection to standard attempt at gross total resection (GTR) with no additional perioperative surgical risk; however, the current quality of evidence is low and under-powered. Therefore, there are no current practice guidelines, and the philosophy of surgical resection is guided by individual surgeon preferences on an individual patient basis. This creates additional uncertainty and is potentially detrimental to our patients. This clinical equipoise supports the need for an adequately powered RCT to determine whether a supra-marginal resection can have a positive impact on survival for patients with HGGs. Our pilot RCT will test the feasibility of comparing the standard gross total resection of GAD-enhancing tumors and supra-marginal resection to prepare for a larger definitive multicenter RCT.Trial registrationClinicalTrials.gov, NCT04737577. Registered on February 4, 2021

Background: Magnetic resonance imaging (MRI) with gadolinium (GAD)-based contrast agents has been the imaging modality of choice for early detection and monitoring of multiple sclerosis (MS) patients. Objectives: This study aimed to assess the effect of multiple injections of linear GAD-based contrast agents on the signal intensity of the dentate nucleus (DN) in MS patients. Patients and Methods: A cohort of 122 MS patients with GAD-enhanced MRI scans and 61 healthy controls were enrolled in this study. The final standard GAD-enhanced MRI scans were acquired using 1.5T MRI systems. Non-enhanced T1-weighted MRI was performed to assess the DN hyperintensity. The signal intensity ratio (SIR) was also calculated by setting the regions of interest (ROIs) on the DN and pons and dividing the signal intensity of DN to that of pons. The patients were also divided into two subgroups, based on the total number of MRI exposures (> 4 times vs. others), and the subgroups were compared in terms of the mean SIR and hyperintensity. Results: Overall, 68% (n = 83) of the patients were exposed to a contrast agent more than four times. Of these patients, 31.3% (n = 26) showed DN hyperintensity, while no hyperintensity was found in other patients or healthy controls (P < 0.02 for both). The mean SIRs were 1.10 ± 0.07 and 1.04 ± 0.02 in the patients and healthy controls, respectively (P < 0.001). Besides, the mean SIR was 1.14 ± 0.04 in patients with DN hyperintensity and 1.09 ± 0.07 in other patients (P < 0.001). Based on the results, the mean SIR was 1.12 ± 0.7 in patients with > 4 contrast injections, while it was 1.06 ± 0.04 in patients with ≤ 4 contrast injections (P < 0.001). Conclusion: The SIR and visible DN hyperintensity increased by increasing the number of GAD injections, which could be due to the tissue deposition of GAD.

Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion (CTO) by cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT) technique. Methods: In this retrospective and observation study, patients with single CTO, who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019, were selected as case group (CTO group), and those without cardiovascular diseases defined by echocardiography, electrocardiogram (ECG) and clinical history and with normal CMR results were selected as healthy control group (control group). General clinical data including age, gender, discharge diagnosis, and the examination results of echocardiography and ECG were obtained from the electronic medical record system. Two-dimensional CMR-FT was applied to measure left ventricle (LV) global peak radial, circumferential, and longitudinal strains (GPRS, GPCS and GPLS, respectively), and the regional myocardial strain in the target vessel area of CTO was analyzed. Grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). Patients with CTOs were divided into infract size>10% group and infarct size≤10% group, and left ventricular ejection fraction (LVEF)≥50% group and LVEF<50% group, respectively. The differences between various groups were compared. Results: There were 52 patients in CTO group (34 males, age (54.1±11.7) years, body mass index (BMI) (26.2±2.5)kg/m2) and 30 patients in control group (14 males, age(51.6±12.3)years, BMI (25.6±3.3)kg/m2). There was no significant difference in age, gender, and BMI between the two groups (all P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower in CTO group than in control group (all P<0.05), left ventricular volume (LVEDV) was similar between the two groups (P>0.05). Among the patients with CTO, there were 26 patients with infarct size>10% and 26 patients with infarct size≤10%. GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEF and LVEDV were similar in CTO patients with infarct size≤10% as compared to control group (both P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEDV was similar in CTO patients with infarct size>10% (P>0.05) as compared to control group. GPRS and GPCS were significantly lower (both P<0.05), while LVEF, LVEDV and GPLS were similar in CTO patients with infarct size>10% as compared to infarct size≤10% group. There were 40 subjects in LVEF≥50% group and 12 subjects in LVEF<50% group. Compared with the control group, GPCS and GPLS of CTO patients were significantly lower in LVEF≥50% group and LVEF<50% group (all P<0.01), LVEF and LVEDV was similar in CTO patients with LVEF≥50% (both P>0.05), but LVEF was lower and LVEDV was larger in LVEF<50% group (both P<0.05). The GPRS, GPCS, GPLS and LVEF of CTO patients in LVEF ≥ 50% group were higher than those in LVEF<50% group (all P<0.0l), and the myocardial infarction size was smaller than that in LVEF reduced group (P<0.0l), but there was no significant difference in LVEDV between the two groups (P=0.07). In the CTO group, there were 21 patients with left anterior descending artery (LAD) occlusion and 126 segments supplied by the target vessels. The peak radial strain (PRS), circumferential strain (PCS) and longitudinal strain (PLS) in the blood supply area were lower than those in the control group (all P<0 01). In 7 patients with left circumflex artery (LCX) occlusion, the number of myocardial segments supplied by the target vessels was 35, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0 05). In 24 patients with right coronary artery (RCA) occlusion, the number of myocardial segments supplied by the target vessels was 120, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0.01). Among the 126 segments in 21 patients with LAD CTO, 91 (72.2%) segments had infarct size≤25%, 17 (13.5%) segments had infarct size between 26%-50%, 11 segments (8.7%) had infarct size between 51%-75%, and 7 (5.6%) segments had infarct size between 76%-100%. Among the 35 segments in 7 patients with LCX CTO, 31 (88.6%) segments had infarct size≤25%, and 4 (11.4%) segments had infarct size between 26%-75%. Among the 120 segments in 24 patients with RCA CTO, 96 (80.0%) segments had infarct size≤25%, 11 (9.2%) segments had infarct size between 26%-50%, 8 (6.7%) segments had infarct size between 51%-75%, and 5 segments (4.2%) had infarct size between 76%-100%. Conclusions: In this study with single CTO, although the LVEF is preserved in the majority of the patients, the left ventricular global and regional strain values are significantly decreased. The larger the infarct size, the greater the impact on radial and circumferential motion, reflecting the early impairment of left ventricular function in these patients.

Purpose: The present study was aimed to assess the prevalence, location, and patterns of late gadolinium enhancement (LGE) in idiopathic dilated cardiomyopathy (DCM) on cardiac magnetic resonance (CMR) imaging and to correlate the left ventricular (LV) functions obtained by cine CMR with the values obtained by echocardiography. Methods: This was a prospective single-center study covering a 2-year study period. The authors studied the prevalence, location, and patterns of LGE in idiopathic DCM on CMR and correlated the ventricular functions obtained by CMR with those obtained by echocardiography. Results: LGE was seen in 18/40 (45%) and was absent in 22/40 (55%) of patients. With regard to location, septal enhancement was the most common, seen in 8 (20%) followed by free-wall enhancement in 4 (10%) and a concomitant septal and free-wall enhancement in 6 (15%). In terms of pattern, midwall enhancement was observed in 10 (25%), subepicardial in 2 (5%), subendocardial in 4 (10%), and focal and transmural enhancement in 1 each. The maximum correlation for calculation of LV ejection fraction (EF) was obtained between CMR and two-dimensional echocardiography (P = 0.442). Conclusion: CMR is an accurate tool to determine the phenotype of DCM by identifying the presence, location, and pattern of LGE which has a prognostic value and is used to guide management. CMR is the most accurate assessment tool for the calculation of EF and other volumetric variables in DCM.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic disease and a potentially life-threatening systemic necrotiz ing vasculitis predominantly affecting small vessels. Herein, we describe a 47-year-old man with EGPA misdiagnosed as non-ST-seg ment elevation myocardial infarction. He presented to the Emergency Department with indigestion and diarrhea. He had been di agnosed with asthma and chronic rhinosinusitis 3 years earlier and was taking antibiotics due to worsening sinusitis. In laboratory tests, peripheral blood eosinophils, serum creatinine, and serum troponin were elevated to 4,641 cells/μL, 13.40 ng/mL, and 1.26 ng/mL, respectively. Electrocardiography showed ST-segment depression on the inferior wall, and echocardiography indicated an isch emic insult in the right coronary artery territory. A non-ST-segment elevation myocardial infarction as well as antibiotic-associated diarrhea, eosinophilia and acute kidney injury was initially suspected. However, fever persisted and eosinophilia worsened despite cessation of antibiotics after admission. There was no significant stenosis of the coronary arteries on coronary angiography. Mean while, abdominal computed tomography suggested medical renal disease, and magnetic resonance imaging showed late gadolin ium enhancement at the mid wall and the subepicardial area in the left ventricle of the heart. As a workup for eosinophilia, serum anti-MPO was measured and turned out to be positive. A kidney biopsy was performed, which yielded membranous nephropathy superimposed on antineutrophil cytoplasmic antibodies-mediated crescent formation. He was diagnosed as EGPA with cardiac and renal involvement, and received systemic steroid, cyclophosphamide, and plasmapheresis. Then, peripheral eosinophil counts and renal function were normalized. He is now in clinical remission even after stopping the use of steroids and immunosuppressive agents. (Allergy Asthma Respir Dis 2021;9:50-55)

Background: Brucellosis is a highly contagious zoonosis caused by exposure to contaminated unpasteurized milk or undercooked meat, or contact with the secretions of infected animals. Although laboratory tests are the gold standard for diagnosis of brucellosis, the positive rate remains low (&lt;50%). A complication of brucellosis is lumbar brucellosis spondylitis (LBS). LBS is conventionally diagnosed using X-ray and computed tomography, however, they have low sensitivity in imaging the spine. Previous studies demonstrated that T1-weighted, T2-weighted, and gadolinium (GD)-based MRI can detect LBS. Note that diffusion-weighted MRI (DWI) is able to probe tissue microstructures quantitatively. However, the viability of DWI to diagnose LBS is unknown. Purpose: In this study, we investigated the feasibility of using DWI for diagnosing LBS, and also evaluated T1-weighted, T2-weighted, and Gd-MRI images. Materials and Methods: 79 patients (22–75 y) with brucellosis, which was confirmed by brucellosis serum agglutination test, underwent DWI as well as T1-weighted, T2-weighted, and Gd-MRI. Results: Among the 79 patients, 72.2% (57/79) showed various degrees of LBS. Relative to those without LBS, patients with LBS differed significantly with regard to maximum and minimum ADC values; maximum and minimum signal intensities of b-values= 500; and minimum signal intensities of b-value =800. The conventional MRI and Gd-MRI results were consistent with previous studies. Conclusion: Conventional MRI and Gd-MRI are able to detect LBS-induced changes, and DWI can quantitatively identify LBS. The combined use of conventional MRI, Gd-MRI, and quantitative DWI has great value for diagnosing LBS.

Alemtuzumab is a monoclonal anti-CD52 antibody prescribed to treat relapsing-remitting multiple sclerosis (RRMS). Alemtuzumab affects the balance of the immune system by depleting circulating lymphocytes, leading to the formation of a new immune repertoire less likely to induce autoimmune attack against CNS myelin. We collected real-world data of RRMS patients treated with alemtuzumab. We assessed relapse rate, disability progression, and MRI-related disease activity over a 24month period. Our study included 35 RRMS patients (19 female and 16 male) with a mean age of 37.3years (SD = 10.5). The patient cohort had a mean disease duration of 10.4years, median previous disease modifying treatments (DMTs) of 3.0, and a median expanded disability status scale (EDSS) score of 4.0 (IQR 2.5-6.0). Neurological disability remained stable during treatment and there was no statistically significant change in EDSS score. Prior to treatment, the median relapse rate was 2.0 (IQR 1.0-3.0); after treatment the median relapse rate was 0.0. This 2.0 decrease in relapse rate is statistically significant (p < 0.0001). Moreover, the treated patients exhibited a statistically significant decrease in gadolinium (GD) enhancing lesions on MRI [both in number (p < 0.005) and volume (p < 0.005)]. Thirty-three percent of patients reached NEDA-3 (no evidence of disease activity) status by the end of treatment. In a real-world setting, alemtuzumab treatment significantly decreased relapse rate and GD-enhancing lesions while preventing disability progression. Tolerability of treatment was high, with patients experiencing only minor adverse events.

Pituitary abscess is a rare but potentially life-threatening disease. Headache, visual disturbance, and hypopituitarism are the most common presenting symptoms of pituitary abscess. On magnetic resonance imaging(MRI), pituitary abscess may present as a round sellar cystic lesion, hypo- or isointense on T1 imaging and hyper- or isointense on T2 imaging with peripheral gadolinium enhancement. Diagnosis usually is made during surgical exploration when pus is found in a cystic lesion. The mainstay of treatment is transsphenoidal surgical resection in combination with antibiotic therapy, although a craniotomy approach is warranted in select conditions. Here we report 3 cases of pituitary abscess in our hospital and review the literatures. Key words: Pituitary abscess; MRI; Diagnosis; Therapy

回顾性分析2013年7月至2018年9月济宁医学院附属医院经临床诊断的13例（21耳）大前庭导水管综合征（LVAS）患者（LVAS组）和23例（23耳）听力正常者（正常组）外淋巴间隙钆成像资料。先行三维稳态构成干扰（3D-CISS）和三维液体衰减反转恢复（3D-FLAIR）序列MRI扫描，经鼓膜向鼓室内注入稀释的钆对比剂，1、2、3、6 d后分别行3D-FLAIR扫描。对两组耳蜗、前庭及半规管外淋巴间隙显示情况进行评分，评分结果比较采用Wilcoxon秩和检验。测量LVAS组内淋巴管（ED）和内淋巴囊（ES）区注射对比剂前后信号强度，计算与同层脑干的信号强度比（SIR），采用单因素方差分析比较注射前后的差异。结果显示注射对比剂前LVAS组和正常组耳蜗、前庭及半规管在3D-FLAIR上呈低信号；注射对比剂后，对比剂分布于内耳耳蜗、前庭、半规管外淋巴间隙，两组间显示情况评分差异无统计学意义（Z=-0.95，P=0.34）。正常组ED和ES均未显示，注射对比剂后亦无信号强度改变；LVAS组ED和ES区在3D-FLAIR上呈完全低信号2耳，呈分界清晰低、高信号19耳。注射对比剂后患侧ED和ES区低信号区信号强度增强，注射对比剂前后SIR值间比较差异有统计学意义（F=111.93，P <0.01）。本研究结果提示：LVAS患耳内耳（耳蜗、前庭和半规管）内淋巴积水不显著；患耳ED和ES可能与前庭外淋巴间隙相通；部分患耳的ED和ES内可能存在间隔。

Objective To analyze the effect and mechanism of gadolinium chloride on hepatic ischemia-reperfusion injury (HIRI) in Sprague Dawley (SD) rats. Methods Thirty six eight weeks special pathogen free SD rats, were included in the project. The body weight ranged from 200 to 250 g. Thirty six rats were randomly divided into sham operation group, model group and gadolinium chloride group with 12 rats/group. Model of ischemia-reperfusion injury was generated in the rats of model group; In the gadolinium chloride group, preoperative intraperitoneal injection of gadolinium chloride was performed before the model of HIRI was established; In the sham operation group, only the abdomen was opened and closed and the hilum was dissected. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected in the three groups. The relative expression of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1 β (IL-1β) mRNA were detected by Q-PCR. Western blot was used to detect the expression of markers involved in the Toll like receptor 2/myeloid differentiation factor 88 (MyD88) signaling pathway. Immunohistochemistry staining was used to detect the expression of Fas and Fas ligands in hilar bile duct epithelial cells. Results ALT and AST were (55±8) U/L, (92±22) U/L in sham operation group, lower than those in model group (1 247±62) U/L, (1 117±60) U/L, respectively, and ALT and AST in gadolinium chloride group were (622±50) U/L and (552±41) U/L, lower than those in model group (all P<0.05). Compared with the sham operation group, the relative expression of TNF-α, IL-1 β, IL-6 mRNA in the model group was significantly higher (all P<0.05), but the expression of those markers were higher than gadolinium chloride group (all P<0.05). Gadolinium chloride down-regulated the expression of Toll like receptor 2/MyD88 signaling pathway in rat with liver ischemia-reperfusion. The percentage of Fas protein positive cells in model group was (40.2±3.8)%, and the percentage of Fas ligand positive cells was (36.9±2.9)%, which was higher than those in gadolinium chloride group (29.7±2.3)% and (23.6±2.1)% with statistically significant differences (all P<0.05). Conclusion Gadolinium chloride can reduce the injury of liver function and inhibit the expression of inflammatory factors in liver tissue of SD rats with hepatic ischemia-reperfusion, which may play a protective role by down regulating the expression of relative protein in Toll like receptor 2/MyD88 signaling pathway. Key words: Reperfusion injury; Gdolinium chloride; Liver; Toll-like receptor 2; Myeloid differentiation factor 88

CpG oligodeoxynucleotide (CpG-ODN) is a Toll-like receptor 9 (TLR9) agonist that can induce innate immune responses. In a previous study, flucloxacillin (FLUX; 100 mg/kg, gavage)-induced liver injury in mice was enhanced by co-administration of CpG-ODN (40 μg/mouse, intraperitoneally). In this study, the mechanism of CpG-ODN sensitization to FLUX-induced liver injury was further investigated in mice inhibited of Kupffer cells (KCs) function by gadolinium chloride (GdCl3; 10 mg/kg, intravenously). GdCl3-treated mice administrated with CpG-ODN and FLUX showed lower liver injury than wild-type (WT) mice treated with CpG-ODN and FLUX. Upregulation of Fas and FasL by CpG-ODN was also inhibited in GdCl3-treated mice and mitochondrial swelling in response to FLUX failed to occur regardless of pre-treatment with CpG-ODN. When FasL-mutant gld/gld mice were treated with CpG-ODN, mitochondrial swelling in response to FLUX was also inhibited. These results suggest that KCs play an essential role in liver injury induced by CpG-ODN and FLUX. CpG-ODN may activate KCs, resulting in induction of Fas/FasL-mediated apoptosis of hepatocytes. The Fas/FasL pathway may also be an upstream regulator of CpG-ODN- and FLUX-induced changes in mitochondrial permeability transition. These results enhance our understanding of the mechanism of the adjuvant effect of CpG-ODN in this mouse model of liver injury.

We propose a revised flow chart of spinal infection multidisciplinary management project (SIMP) aimed to standardize the diagnostic process and management of spinal tuberculosis (TB). We reviewed data from all TB cases with osteoarticular involvement treated at a large tertiary teaching hospital in Bologna, Northern Italy, from January 2013 to December 2017. We cross-linked notified osteoarticular TB cases with SIMP database and we analysed clinical, diagnostic, and treatment data of all cases managed by SIMP. Osteoarticular TB accounted for the 7.8% (n=40) of all TB cases notified between 2013 and 2017 (N=513). Among the identified cases, 52% (n=21/40) had spine involvement: all were enrolled and evaluated by SIMP multidisciplinary group. Females accounted for 57% (12/21) of patients, the median age was 52 years (range 24-82). In the 67% (n=14/21) of cases, the major clinical symptom of spinal TB was back pain reported for a median of 4.5 months (range 1-12 months) before hospital admission. The interferon gamma release assay was positive in 75% (n=16/21) of patients. All patients performed MRI with gadolinium, which indicated spondylodiscitis in 90%. 18F-FDG-PET/CT revealed average maximum standardized uptake value (SUV max) of 12.54 (range 5.3-22) in 17/19 (89.5%). Bacteriological confirmation of TB was obtained in 86% of cases (n=18/21). One-third of patients (7/21) underwent surgery and 95% successfully completed the anti-TB treatment. Our data reveal that a multidisciplinary approach to spine tuberculosis facilitates early and accurate diagnosis and can improve medical and surgical management of this disease.

Objective To evaluate the left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy (HCM) patients by three-dimensional speckle tracking echocardiography(3D-STE) combined with cardiac magnetic resonance imaging-late gadolinium enchancemet (CMRI-LGE) sequence, and to explore the association between left ventricular global systolic function and myocardial fibrosis. Methods Thirty patients with HCM(HCM group) and 33 healthy controls(control group) were enrolled in the study. All patients underwent conventional two-dimensional echocardiography (2DE), tissue Doppler imaging (TDI), and 3D-STE. The following parameters were acquired and compared between the groups: interventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), left ventricular mass(LVM), left ventricular mass index (LVMI), left atrial volume (LAV), and left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular outflow tract pressure gradient (LVOT-PG), left ventricular outflow tract velocity time integral (LVOT-VTI), isovolumic relaxation time (IVRT), global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS). And 28 patients who met the CMRI indications underwent CMRI-LGE to obtain the LVM, and the correlation and consistency of LVM results obtained from CMRI and 3D-STE were performed.According to LGE results, HCM patients were divided into LGE(+ ) group and LGE (-) group, the differences of GLS, GRS and GCS between the two groups were analyzed. Results ①Compared with the control group, IVSD, LVPWD, LVMI, LAV, LVOT-PG, LVOT-VTI and IVRT were significantly increased in the HCM group (all P 0.05), while GLS and GRS decreased and GCS increased significantly in HCM group (P<0.05); ③The correlation between 3D-STE and CMRI in measuring measured LVM in HCM patients was good, and the results showed good concordance(r=0.807, P<0.01). ④GLS in LGE(+ ) group was lower than in LGE(-) group(P=0.004), but there was no significant difference in GCS and GRS between the two groups(P=0.597, 0.534). Conclusions ①3D-STE can detect the early damage of left ventricular global systolic function in patients with HCM; ②3D-STE combined with CMRI-LGE technology can provide an important imaging reference for the evaluation of the relationship between left ventricular global systolic function and myocardial fibrosis in patients with HCM. Key words: Echocardiography; Three-dimensional speckle tracking imaging; Cardiomyopathy, hypertrophic; Cardiac magnetic resonance imaging; Ventricular function, left; Myocardial fibrosis

Objective To investigate the quantitative evaluation efficiency of gadolinium- ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced T1 mapping in staging hepatic fibrosis caused by viral hepatitis B. Methods One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer-Ludwig scoring system. Non-enhanced and Gd-EOB-DTPA-enhanced MRI were performed in all subjects. Look-Locker sequences were performed to acquire T1 mapping of pre and post-contrast at 20 minutes after Gd-EOB-DTPA administration. The T1 value after 20 minutes of Gd-EOB-DTPA administration (T1 20 min), the reduction rate of T1 value (ΔT1 20 min%), the increase of 1/T1 value (ΔR1 20 min%) were measured and calculated. The one-way ANOVA was applied to compare the difference in T1 20 min, ΔT1 20 min%, ΔR1 20 min% of various fibrosis stages. ROC curves were used to assess the efficacy of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing ≥ S2, ≥ S3, ≥ S4. P<0.05 was considered to be statistically significant. Results The T1 20 min raised with fibrosis stage increased, ΔT1 20 min% and ΔR1 20 min% reduced with fibrosis stage increased. Areas under the curves of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing ≥ S2 were 0.844, 0.905, 0.869; and diagnosing ≥ S3 were 0.832, 0.907, 0.862; and diagnosing ≥ S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT1 20 min% was the best. Conclusion Gd-EOB-DTPA-enhanced T1 mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B. Key words: Hepatic fibrosis; Magnetic resonance imaging; Gadoxetate acid disodium; T1 mapping

Objective To evaluate the role of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer and to assess the accordance among radiologists with different experience. Methods Thirty-fifty patients underwent conventional MRI including T2 weighted (T2) sequences, gadolinium fat-suppressed T1 weighted sequences (post-contrast T1), and DWI sequences. Three radiologists with different experience determined the possibility of local recurrence (LR) on T2, T2+post-contrast T1, T2+DWI, and T2+post-contrast T1+DWI. ROC and Kappa were used. Results In total, 13 patients had LR. On T2WI, the ROC curve (AUC) achieved by the senior,intermediate and junior groups were 0.701,0.407,and 0.584, respectively.Compared with simple T2WI sequences, DWI and T1 Gd significantly improved the AUC value for the intermediate radiologist. The great difference was observed between radiologists of different experience (Kappa coefficient was from 0.227 to 0.884). Combination of multiple sequences significantly reduced the diagnostic differences between radiologists with different experience for the senior radiologists particularly. Conclusions The addition of DWI and T1 post-contrast MRI increased diagnostic ability for LR of esophagus cancer and reduced the diagnostic differences between radiologists with different experience compared to T2WI. Key words: Esophagus neoplasms; Magnetic resonance imaging; Diffusion-weighted imaging

Objective To investigate the effect and mechanism of gadolinium chloride alleviates partial warm ischemia-reperfusion injury of liver by suppressing kupffer cell function in mice. Methods Forty-eight male C57BL/6 mice were randomly divided into sham-operated group (Sham), Hepatic ischemia-reperfusion injury (HIRI) group, gdolinium chloride groups (Gd+ IRI), and cobalt protoporphyrin (CoPP+ IRI) group (n=12). The rats were injected with the same dose of normal saline in Sham group and IRI group. Gd+ IRI group were intraperitoneally injected with GdCl3 (20 mg/kg) 24 hours before operation. At the same time, CoPP+ IRI group were intraperitoneally injected with CoPP (5 mg/kg). Except for Sham group, an 70% volume HIRI model was established by means of 60 minutes ischemia and then 6 hours reperfusion in the other groups. The levels of serum aspartate transaminase (AST) and alanine aminotransferase (ALT) in each group were compared. Enzyme-linked immunosorbent assay were used to test the levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) in the liver tissue. The level of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, heme oxygenase-1 (HO-1), and protective factor IL-10 mRNA level were detected by real time quantitative polymerase Chain Reaction (RT-PCR). Immunohistochemical staining was used to measure Fas, FasL protein expression level of extrahepatic biliary epithelial cells. Results Respectively, the serum ALT level in the HIRI, Gd+ IRI and CoPP+ IRI groups was (1 236.7±62.4), (638.9±50.9), (740.3±53.1) U/L, and the AST level was (1 107.8±68.3), (568.5±42.7), (679.1±49.9) U/L, the serum level of ALT and AST in Gd+ IRI and CoPP+ IRI groups was lower than IRI group (t=6.721, P<0.01; t=4.732, P<0.05; t=5.984, P<0.01; t=2.691, P<0.05). Compared with IRI group, the activity of SOD and GSH-Px was promoted (t=7.301, P<0.01; t=1.937, P<0.05), whereas the levels of MDA was reduced (t=9.519, P<0.01; t=8.635, P<0.01). Simultaneously, the TNF-α, IL-1β and IL-6 mRNA level in Gd+ IRI and CoPP+ IRI groups were decreased (t=6.721, P<0.01; t=2.316, P<0.05), and the levels of IL-10 and HO-1 mRNA were increased (t=2.973, P<0.05; t=7.921, P<0.01). After hepatic artery reflow 6 h, the Fas expression levels on bile ducts epithelial cells in Gd+ IRI and CoPP+ IRI groups respectively was 22.4%, 29.7%, which was lower than IRI group (38.9%) (χ2=6.561, P<0.01; χ2=2.547, P<0.05). The FasL expression levels in Gd+ IRI and CoPP+ IRI groups respectively was 21.2%, 25.1%, which was lower than IRI group (36.5%) (χ2=5.982, P<0.05; χ2=3.188, P<0.05). Conclusion Gdolinium chloride shows an protective function aganist liver ischemia-reperfusion iniury in mice by Oxidative stress, inhibiting inflammation and cell apoptosis. The up-regulation of HO-1 by gdolinium chloride may be the possible mechanism. The up-regulation of HO-1 and inhibiting the Fas/FasL protein expression by gdolinium chloride may be the possible mechanism. Key words: Gdolinium chloride; Liver; Ischemia-reperfusion injury; Heme oxygenase-l

Background: Multiple sclerosis (MS) is a neurologic disorder with a considerable global burden. During the last decades, some pharmaceutical treatments have been approved for patients with MS. Dimethyl fumarate (DMF) is one of these drugs which has been reported to have early promising results in recent studies, but the efficacy of this drug in patients with MS is still being studied in different parts of the world. In the present study, we evaluated the effectiveness of DMF therapy on reducing relapses, lesions, and disability in Iranian patients with MS.Methods: The present single-arm before-after study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran [Iranian Registry of Clinical Trial (IRCT) code: IRCT20190121042439N1]. Every patient who was diagnosed with relapsing MS was considered eligible to enroll in the present clinical trial. Before receiving DMF therapy, the baseline liver function tests and complete blood count were obtained from all individuals. Also, a baseline brain magnetic resonance imaging (MRI) was obtained and Expanded Disability Status Scale (EDSS) was documented from all patients. After receiving 240 mg DMF twice daily for 12 months, the laboratory and imaging measurements as well as EDSS were repeated. Furthermore, the total number of relapses within the study period was recorded. Satisfaction with DMF treatment was determined by answering a yes-no question.Results: A total number of 50 patients enrolled in the study and most of them were female (80%). There was a significant decrease in EDSS score and gadolinium (GD)-enhancing lesions after the study period (P < 0.001 for each). Moreover, the attacks significantly dropped after the study period (P < 0.001) and 86% of patients were satisfied with their treatment.Conclusion: The findings of this study showed that 240 mg DMF administered twice daily can effectively reduce disability and provide satisfaction within the first year of therapy in patients with MS.

Background: The proton therapy is a form of particle radiation therapy that dose enhancement to improve therapeutic ratio (TR) is obtained by high-Z materials. This study evaluated the physical properties of dose enhancement and the resulting changes in the secondary particle production using the spread-out Bragg peak (SOBP). Methods: Monte Carlo simulations were performed using the Geant4 software and the medical internal radiation dose head phantom. Gold and gadolinium were applied as enhancement materials at concentrations of 10, 20, and 30 mg/g in the tumor volume, and the composition of soft tissue was varied in parallel. The ratio of changes in the reaction caused by the interaction of the initial particles with the enhancement materials was calculated. Results: Among the physical interaction processes, inelastic Coulomb scattering by electrical action occurred with the highest frequency of 99.02%, and elastic collisions, nuclear inelastic collisions, and multiple Coulomb scatterings appeared with low frequencies of 0.633%, 0.334%, and 0.006%, respectively. The use of gold as the enhancement material increased the frequency of interactions by a factor of 1.14–1.18 for inelastic Coulomb scattering, 1.05–1.30 for elastic collision, and 1.03–1.37 for nuclear inelastic collision. Furthermore, the use of gadolinium as the enhancement material increased the frequency of interactions by a factor of 1.08–1.14 for inelastic Coulomb scattering, 1.03–1.25 for elastic collision, and 1.01–1.34 for nuclear inelastic collision. Regarding the dose by the production of secondary particles, the equivalent dose increased by a factor of 1.032–1.070 for alpha particles, 1.133–1.860 for neutrons, and 1.030–1.053 for deuterons when gold was used as the enhancement material. When gadolinium was used as the enhancement material, the equivalent dose increased by a factor of 1.015–1.043 for alpha particles, 1.075–1.478 for neutrons, and 1.021–1.036 for deuterons. Conclusions: Based on this study’s findings, the dose enhancement simulations correspond to the physical characteristics of energy transmission. The study’s results can be used as basic data for in vivo and in vitro experiments investigating the effects of dose enhancement.

Objective To explore the role of radiotherapy in the treatment of primary central nervous system lymphoma. Methods Clinical data of 60 patients diagnosed with primary central nervous system lymphoma from September 2010 to December 2017 were retrospectively analyzed. Among them, 50 cases were diagnosed by histopathological examination after stereotactic biopsy or tumor resection and 10 patients were diagnosed by gadolinium enhanced magnetic resonance imaging (MRI). Fifty-two patients underwent chemotherapy, and 45 of them received methotrexate-based chemotherapy, 25 received rituximab-based regimen. Twenty-seven patients were given with planned whole brain radiotherapy, while 33 patients were not. Salvage radiotherapy was delivered in 9 patients after treatment failure. Results The median follow-up time was 28 months (5-70 months). The median overall survival time and median progression-free survival time of the whole patients was 22 months (5-65 months) and 13 months (5-55 months), respectively. The 4-year overall survival rate and progression-free survival rate were 61% and 33%, respectively. The 4-year overall survival rates between patients with and without planned whole brain radiotherapy were 68% and 54%(P=0.083). The 4-year progression-free survival rates between patients with and without planned whole brain radiotherapy were 47% and 20%(P=0.014), respectively. Patients with and without salvage whole brain radiotherapy had a 4-year overall survival of 49% and 68%, respectively (P=0.398). Among patients who received whole brain radiotherapy, patients with a lower dose of ≤36 Gy had a similar overall survival compared with those with a higher dose of>36 Gy (80% vs. 45%, P=0.136). Conclusions Radiotherapy is part of the comprehensive treatment of primary central nervous system lymphoma. Planned radiotherapy may bring clinical benefits to patients during the comprehensive therapy. However, the irradiation dose to the whole brain should not be too high because of neurotoxicity. Key words: Primary central nervous system lymphoma/radiotherapy; Primary central nervous system lymphoma/chemotherapy; Prognosis

MR钆对比剂在MRI增强检查中发挥了重要作用，应用范围广泛。出于安全性使用方面的考虑，以及在钆对比剂的临床安全性应用方面不断有新的发现和证据，中华医学会放射学分会磁共振学组和质量控制与安全工作委员会共同发布了《钆对比剂临床安全性应用中国专家建议》，旨在向我国广大临床医师提供符合我国国情的、具有可操作性的专家建议，让放射科医师了解钆对比剂的不良反应、对比剂不良反应发生的高危因素和预防策略，更加重视其安全性应用，以保障患者的安全。