High Signal Intensity Research Articles

AI-assisted Segmentation Tool for Brain Tumor MR Image Analysis.

TumorPrism3D software was developed to segment brain tumors with a straightforward and user-friendly graphical interface applied to two- and three-dimensional brain magnetic resonance (MR) images. The MR images of 185 patients (103 males, 82 females) with glioblastoma multiforme were downloaded from The Cancer Imaging Archive (TCIA) to test the tumor segmentation performance of this software. Regions of interest (ROIs) corresponding to contrast-enhancing lesions, necrotic portions, and non-enhancing T2 high signal intensity components were segmented for each tumor. TumorPrism3D demonstrated high accuracy in segmenting all three tumor components in cases of glioblastoma multiforme. They achieved a better Dice similarity coefficient (DSC) ranging from 0.83 to 0.91 than 3DSlicer with a DSC ranging from 0.80 to 0.84 for the accuracy of segmented tumors. Comparative analysis with the widely used 3DSlicer software revealed TumorPrism3D to be approximately 37.4% faster in the segmentation process from initial contour drawing to final segmentation mask determination. The semi-automated nature of TumorPrism3D facilitates reproducible tumor segmentation at a rapid pace, offering the potential for quantitative analysis of tumor characteristics and artificial intelligence-assisted segmentation in brain MR imaging.

Epidemiology, Natural History, and Growth Risk of Meningiomas

Meningiomas are the most common primary intracranial tumors. As the number of incidentally discovered meningiomas has increased with the widespread access and use of neuroimaging, treatment strategies for meningiomas have become more important. Close observation is the first choice for asymptomatic lesions; however, the natural history of meningiomas remains unclear. It is necessary to recognize the characteristics of meningiomas that are likely to grow, such as high signal intensity on MRI T2WI. It is also important to examine the growth rates and patterns using multiple neuroimaging examinations during the follow-up period. The authors suggested a relationship between the various observed growth patterns and the length of the follow-up period based on the assumed development of tumor volume. Less than 10% of patients with asymptomatic meningiomas develop symptoms and require treatment. However, it remains unclear which lesions become symptomatic, and further studies are required. Lesions with a sustained growth pattern undergo preventive treatment interventions, but the need for and appropriate timing of these interventions are continuously under debate. Further studies will help elucidate the natural history of meningiomas.

Prediction of the Natural Course of Meningioma Using CT and MR Images

The frequency of identification of asymptomatic meningiomas is increasing owing to the advancement and widespread use of CT and MRI. The first choice for asymptomatic meningiomas is observation. Approximately 70% of asymptomatic meningiomas increase in volume on long term follow-up. More than half of them reportedly exhibit a self-limiting pattern, in which growth eventually stops. Imaging findings related to increased meningioma volume include no calcification, large tumor size, high signal intensity inside the tumor on T2-weighted images, high brightness within the tumor on diffusion-weighted images, and perifocal edema. We also highlighted the presence of hypo-intensity of the surface layer on T2-weighted imaging, indicating growth arrest in a self-limiting growth pattern of meningioma. In this article, literature reports on image prediction using CT and MRI regarding the growth of asymptomatic meningiomas were reviewed, along with our report.

Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy.

The study compared the morphometric changes of the cervical spinal cord using dynamic magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and assessed the correlation with kinematic changes, cord cross-sectional area (CSA), and high signal intensity (SI) on T2-weighted imaging (T2WI). Patients with CSM were evaluated through dynamic MRI for sagittal and axial CSA changes of the cervical cord, cerebrospinal fluid (CSF) reserve ratio, degree of cord impingement, cord compression rate, range of motion (ROM), and severity of SI on T2WI. The degree of cord impingement was evaluated using the Muhle grading system. Clinical outcomes were assessed using Japanese Orthopaedic Association scoring and Nurick grade. The study included 191 patients (113 males) with a mean age of 55.34 ± 12.09 years. The lowest sagittal CSF reserve ratio and cord occupation rate were observed during extension. Cord impingement and SI change were more prevalent in extension-positioned MRI. There was no difference between ROM on dynamic radiographs and dynamic MRI. Preoperative cervical ROM was greater in patients with intensely high SI change. Dynamic MRI is useful for evaluating neck movement. Patients with high SI had greater ROM before surgery but worse outcomes after. Neck extension exacerbated cervical stenosis and cord compression compared to flexion, and cervical spinal motion contributed to the severity of CSM. Cervical spinal motion should be carefully evaluated, particularly in hyperextension, to prevent worsening of CSM.

Multisystemic recurrent Langerhans cell histiocytosis misdiagnosed with chronic inflammation at the first diagnosis: A case report

BACKGROUND Langerhans cell histiocytosis (LCH) is characterized by diabetes insipidus and is an uncommon occurrence. Pathological biopsies still have a certain degree of diagnostic probability. We present a case in which LCH initially affected the pituitary gland. This resulted in a misdiagnosis of chronic inflammation upon pathological examination. CASE SUMMARY A 25-year-old female exhibited symptoms of diabetes insipidus. Magnetic resonance imaging revealed an enhanced foci in the pituitary gland. After surgical resection of the pituitary lesion, the pathological diagnosis was chronic inflammation. However, the patient later experienced bone destruction in the skull and lower limb bones. After the lower limb bone lesion was compared with the initial pituitary lesion, the final diagnosis was modified to LCH. The patient was treated with multiple chemotherapy courses. However, the patient’s condition gradually worsened, and she eventually passed away at home. CONCLUSION LCH should be considered when patients exhibit diabetes insipidus and absence of high signal intensity in the pituitary gland on sagittal T1-weighted image and abnormal enhancement in the pituitary region.

Association between Neuroimaging Scores and Clinical Status in Pediatric Patients Diagnosed with Metachromatic Leukodystrophy

Purpose: Metachromatic leukodystrophy (MLD) is a lysosomal storage disease caused by arylsulfatase A deficiency, which leads to progressive demyelination in both the central and peripheral nervous systems, resulting in significant gross motor deterioration. This study aimed to analyze data concerning neuroimaging and clinical phenotypes of MLD patients, categorized by disease subtype.Methods: Patients diagnosed with MLD based on arylsulfatase A enzymatic activity, demyelination observed in brain magnetic resonance images, and/or pathogenic mutations were included in this study. The medical charts of 10 patients with confirmed MLD were retrospectively reviewed. We used a simplified magnetic resonance imaging (MRI) scoring system and clinical status, including survival. We analyzed the correlations between the scores of specific neuroimaging lesions and clinical status in two groups, categorized as late-infantile and juvenile types based on the age at symptom onset.Results: We detected a positive relationship between clinical function deterioration and MRI score (rho=0.59, P=0.002) in patients with MLD. This correlation was stronger in the late-infantile type (rho=0.700, P=0.003) than in the juvenile type (rho=0.513, P=0.029). A strong relationship was also noted in patients with high signal intensities in the pons and basal ganglia, and cerebellar atrophy, but not in those with lesions in the midbrain. MLD with a high MRI score was associated with poor clinical function. Conclusion: The identified correlations between modified MRI scores and clinical function scales may help predict the prognosis of patients with MLD, thereby aiding in the identification of treatment options and enhancing the quality of life for these patients.

Case Report - Sudden sensorineural hearing loss and vertigo due to inner ear hemorrhage

Sudden deafness is a common cause of emergency consultation in otology. Usually, despite investigations, no etiology is known. Intracochlear hemorrhage is a rare cause of sudden sensorineural hearing loss (SSNHL) and may be associated with various labyrinthine disorders. In such cases, magnetic resonance imaging (MRI) is the clef of the diagnosis. We report the case of a 70-year-old patient who was referred to our department for sudden hearing loss, tinnitus, and vertigo. Otoscopic and neurological examinations were normal, and pure-tone audiometry revealed left profound sensorineural hearing loss. Videonystagmography (VNG) revealed left vestibular deficit. MRI demonstrated a high signal intensity inside the cochlea on unenhanced T1-weighted images, and no other abnormalities were found; in particular, no enhancement after intravenous administration of gadolinium. No etiology was identified. Vertigo disappeared rapidly with corticosteroid treatment and hyperbaric oxygen therapy, but hearing did not improve. Intra-labyrinthine hemorrhage causing SSNHL is rare, and the hearing prognosis is poor.

Source localization comparison and combination of OPM-MEG and fMRI to detect sensorimotor cortex responses

Background and objectives:The exploration of various neuroimaging techniques have become focal points within the field of neuroscience research. Magnetoencephalography based on optically pumped magnetometers (OPM-MEG) has shown significant potential to be the next generation of functional neuroimaging with the advantages of high signal intensity and flexible sensor arrangement. In this study, we constructed a 31-channel OPM-MEG system and performed a preliminary comparison of the temporal and spatial relationship between magnetic responses measured by OPM-MEG and blood-oxygen-level-dependent signals detected by functional magnetic resonance imaging (fMRI) during a grasping task. Methods:For OPM-MEG, the β-band (15–30 Hz) oscillatory activities can be reliably detected across multiple subjects and multiple session runs. To effectively localize the inhibitory oscillatory activities, a source power-spectrum ratio-based imaging method was proposed. This approach was compared with conventional source imaging methods, such as minimum norm-type and beamformer methods, and was applied in OPM-MEG source analysis. Subsequently, the spatial and temporal responses at the source-level between OPM-MEG and fMRI were analyzed. Results:The effectiveness of the proposed method was confirmed through simulations compared to benchmark methods. Our demonstration revealed an average spatial separation of 10.57 ± 4.41 mm between the localization results of OPM-MEG and fMRI across four subjects. Furthermore, the fMRI-constrained OPM-MEG localization results indicated a more focused imaging extent. Conclusions:Taken together, the performance exhibited by OPM-MEG positions it as a potential instrument for functional surgery assessment.

PATH-14. A CLINICAL CONUNDRUM - INFANTILE POSTERIOR FOSSA EPENDYMOMA WITH YAP1:MAML FUSION?

Abstract BACKGROUND Ependymomas of infancy (0-18months) have been reported to comprise distinct clinical, pathological and genetic entities. Young age is typically associated with posterior fossa group A (PF-A) tumours and therefore a poor prognosis. Treatment of these infants is challenging with limited therapeutic options that have significant long-term sequelae. METHOD We report a single case of a 4-month old baby girl who presented with obstructive hydrocephalus and a presumed posterior fossa mass. RESULTS Imaging demonstrated a large fairly well-defined solid lesion with multiple T1 high and corresponding T2 intermediate signal intensity foci scattered throughout the lesion and marked mass effect on the cerebellum and fourth ventricle. The lesion was inseparable from the pineal gland, habenula and tectum and only mild diffusion restriction. Whilst initially considered to be a posterior fossa tumour, the presence of a claw sign with the tectal plate, favoured a tectal origin. Histological appearances, together with immunohistochemistry findings (GFAP positive and EMA patchy perinuclear dot expression) were consistent with classic ependymoma. Grading was difficult as mitotic activity was relatively low, although focal areas of high ki67 proliferation index were noted suggesting at least focal grade 3 areas. Retained expression of tumour cells for H3K27me3 on immunohistochemistry suggested the likely posterior fossa group B (PF-B) ependymoma. Local SNP chromosome microarray found no acquired clonal abnormality; with no detection of gain chromosome 1q; loss/LOH 6q; Loss/LOH 9p21.3 [CDKN2A, CDKN2B], chromothripsis 11q [ZFTA::RELA], Loss/LOH 17p13 [TP53] or Loss/LOH 22q [NF2]. Additional NGS sequencing identified a YAP1::MAML2 fusion (confirmed with targeted RT-PCR followed by subsequent Sanger sequencing). CONCLUSION This case highlights the challenges with overlapping clinical, pathological and radiological features in an infant with ependymoma, necessitating a molecular diagnosis. After 21months, the patient remains in complete remission following surgery alone.

Two Cases of Ischemic Optic Neuropathy after Extracorporeal Membrane Oxygenation (ECMO)

Purpose: We report two cases of non-arteritic ischemic optic neuropathy (NAION) following extracorporeal membrane oxygenation (ECMO) treatment.Case summary: (Case 1) A 36-year-old man underwent ECMO treatment. Upon regaining consciousness, he complained of a darkened peripheral visual field and was subsequently referred to an ophthalmologist. His best-corrected visual acuity was 0.9 in the right eye and 0.8 in the left eye. The intraocular pressure measured 12 mmHg in the right eye and 10 mmHg in the left eye; color vision was normal. A visual field test demonstrated concentric visual field defects in both eyes, and a fundus examination revealed a pale optic disc. Optical coherence tomography (OCT) indicated a decrease in retinal nerve fiber layer (RNFL) thickness. (Case 2) A 48-year-old woman underwent ECMO treatment. After regaining consciousness, she reported decreased vision in her right eye. Her best-corrected visual acuity was limited to hand motion in the right eye and was 1.2 in the left eye. A relative afferent pupillary defect in the right eye was observed. Color vision in the right eye was compromised, and a fundus examination revealed a pale optic disc. A visual field test demonstrated total visual field defect in the right eye, while OCT showed decreases in both the RNFL thickness and the ganglion cell-inner plexiform layer thickness of the right eye. Magnetic resonance imaging (MRI) revealed high signal intensity and abnormal enhancement in the right retrobulbar optic nerve.Conclusions: In cases where vision loss and visual field defects are observed following ECMO treatment, differential diagnoses for ischemic optic neuropathy are warranted.

Three-dimensional cardiac magnetic resonance allows the identification of slow-conducting anatomical isthmuses in tetralogy of Fallot.

Patients with repaired tetralogy of Fallot remain at risk of life-threatening ventricular tachycardia related to slow-conducting anatomical isthmuses (SCAIs). Preventive ablation of SCAI identified by invasive electroanatomical mapping is increasingly performed. This study aimed to non-invasively identify SCAI using 3D late gadolinium enhancement cardiac magnetic resonance (3D-LGE-CMR). Consecutive tetralogy of Fallot patients who underwent right ventricular electroanatomical mapping (RV-EAM) and 3D-LGE-CMR were included. High signal intensity threshold for abnormal myocardium was determined based on direct comparison of bipolar voltages and signal intensity by co-registration of RV-EAM with 3D-LGE-CMR. The diagnostic performance of 3D-LGE-CMR to non-invasively identify SCAI was determined, validated in a second cohort, and compared with the discriminative ability of proposed risk scores. The derivation cohort consisted of 48 (34 ± 16 years) and the validation cohort of 53 patients (36 ± 18 years). In the derivation cohort, 78 of 107 anatomical isthmuses (AIs) identified by EAM were normal-conducting AI, 22 were SCAI, and 7 blocked AI. High signal intensity threshold was 42% of the maximal signal intensity. The sensitivity and specificity of 3D-LGE-CMR for identifying SCAI or blocked AI were 100% and 90%, respectively. In the validation cohort, 85 of 124 AIs were normal-conducting AI, 36 were SCAI, and 3 blocked AI. The sensitivity and specificity of 3D-LGE-CMR were 95% and 91%, respectively. All risk scores showed an at best modest performance to identify SCAI (area under the curve ≤ .68). 3D late gadolinium enhancement cardiac magnetic resonance can identify SCAI with excellent accuracy and may refine non-invasive risk stratification and patient selection for invasive EAM in tetralogy of Fallot.

Unique presentation of acute neuro-Behçet's disease involving a cytotoxic edema core surrounded by vasogenic edema.

A 53-year-old woman with recurrent stomatitis, genital ulcers, and folliculitis was admitted to our hospital after experiencing visual disturbances for the past two weeks, and a non-throbbing headache for the past three days. She had also developed numbness in her left extremities. An ophthalmological examination revealed inflammatory changes in the eye. Cerebrospinal fluid analysis showed increased cell counts, protein, and interleukin-6 levels. Brain magnetic resonance imaging revealed multiple high signal intensities on T2-weighted (T2W)/fluid-attenuated inversion recovery (FLAIR) images of the pons and occipital and parietal lobes. The T2W/FLAIR high-signal-intensity lesion in the pons was hyperintense on diffusion-weighted imaging (DWI) and hypointense on apparent diffusion coefficient mapping (ADC), suggesting cytotoxic edema. Another high-signal-intensity lesion on T2W/FLAIR was isointense to hyperintense on DWI and hyperintense on ADC, indicating vasogenic edema. The vasogenic edema in the left occipital lobe contained a small core that was hyperintense on DWI and hypointense on ADC, suggesting cytotoxic edema. The patient was diagnosed with acute neuro-Behçet's disease (neuro-BD) and responded well to high-dose glucocorticoid and colchicine treatment. The present report emphasizes that patients with acute neuro-BD may present with cytotoxic edema in the pons and cerebral spheres. Further reports of similar cases would contribute to a better understanding of the role of cytotoxic edema in the pathophysiology of neuro-BD and help elucidate the mechanisms underlying a unique presentation characterized by a central cytotoxic edema core within vasogenic edema. (233 words).

Diagnostic Value of 3.0 T Magnetic Resonance Imaging in Active Crohn's Disease.

Magnetic resonance enteroclysis (MRE) has been widely applied to diagnose Crohn's disease (CD). Magnetic resonance (MR) at 3.0 T improves signal-to-noise ratio (SNR), shortens image acquisition time, and shows more advantages. This study aimed to retrospectively analyze the diagnostic value of 3.0 T MR imaging for active CD. 48 CD patients hospitalized in our hospital from January 2021 to December 2022 were selected as the study subjects. These 48 CD patients underwent both double-balloon enteroscopy and 3.0 T MRE. All patients' arterial phase signal, venous phase signal, bowel wall, and bowel lumen of MRE were observed to identify whether they suffered from active CD. Based on the results of enteroscopy, the number of true positives, true negatives, false negatives, and false positives diagnosed by MRE were screened; next, the diagnostic accuracy, sensitivity, and specificity of MRE in assessing active CD were calculated. Of the 48 patients, 39 were diagnosed with small bowel CD by MRE, which was not significantly different from the results of enteroscopy (P>0.05). According to MRE diagnostic results, the arterial phase predominantly presented high signal intensity, and the venous phase mainly presented low signal intensity or isointensity. Small bowel CD lesions were primarily characterized by bowel wall thickening, rare pneumatosis enhancement of the bowel wall, bowel lumen pneumatosis or dilatation, and rare strictures. Besides, MRE presented an accuracy of 93.75%, sensitivity of 97.37%, and specificity of 80.00% in diagnosing CD. 3.0 T MR imaging has diagnostic value for active CD and shows certain clinical application value.</P>.

Evaluation of the extracranial “multifocal arcuate sign,” a novel MRI finding for the diagnosis of giant cell arteritis, on STIR and contrast-enhanced T1-weighted images

BackgroundWhile early diagnosis of giant cell arteritis (GCA) based on clinical criteria and contrast-enhanced MRI findings can lead to early treatment and prevention of blindness and cerebrovascular accidents, previously reported diagnostic methods which utilize contrast-enhanced whole head images are cumbersome. Diagnostic delay is common as patients may not be aware of initial symptoms and their significance. To improve current diagnostic capabilities, new MRI-based diagnostic criteria need to be established. This study aimed to evaluate the “multifocal arcuate sign” on short tau inversion recovery (STIR) and contrast-enhanced T1-weighted (CE-T1W) images as a novel extracranial finding for the diagnosis of GCA.MethodsA total of 17 consecutive patients (including five with GCA) who underwent CE-T1W and whole-brain axial STIR imaging simultaneously between June 2010 and April 2020 were enrolled. We retrospectively reviewed their MR images. The “multifocal arcuate sign” was defined as “multiple distant arcuate areas with high signal intensity in extracranial soft tissues such as subcutaneous fat, muscles, and tendons.” Extracranial abnormal high-signal-intensity areas were classified as “None,” when no lesions were detected; “Monofocal,” when lesions were detected only in one place; and “Multifocal,” when lesions were detected in multiple places. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of “Multifocal” areas were calculated using cross tabulation. Fisher’s exact test was used to compare “Multifocal” areas in five patients with GCA and those with other diseases. In addition, mean Cohen’s kappa and Fleiss’ kappa statistics were used to compare inter-reader agreement.ResultsThe sensitivity, specificity, PPV, and NPV of the “multifocal arcuate sign” in patients with GCA were 60%, 92–100%, 75–100%, and 85–86%, respectively. Significantly more patients with GCA had “Multifocal” areas compared to those with other diseases (Fisher’s exact test, p = 0.008–0.027). Mean Cohen’s kappa and Fleiss’ kappa for inter-reader agreement with respect to the five GCA patients were 0.52 and 0.49, respectively, for both STIR and CE-T1W sequences.ConclusionsThe new radiologic finding of “multifocal arcuate sign” on STIR and CE-T1W images may be used as a radiologic criterion for the diagnosis of GCA, which can make plain MRI a promising diagnostic modality.

Inguinal lymphangioma in an adult patient mimicking an irreducible inguinal hernia: A case report

IntroductionLymphangiomas are rare benign vascular malformations of the lymphatic system. They are usually located in the head, neck, and axilla and are typically present during the first two years of life. A few cases of inguinal lymphangioma have been reported in adults. Case presentationWe report a 35-year-old male who presented with left groin swelling for a one-year duration associated with on and off pain. On examination, he had soft, irreducible left inguinal swelling with positive cough impulse and no tenderness on palpation. Ultrasound (US) and magnetic resonance imaging (MRI) were done for him, showing a well-defined lobulated cystic lesion located between subcutaneous and deep fascia measuring around 6.5 × 4.2 × 8.1 cm with multiple internal septations. The lesion shows Low signal intensity in the T1 weighted image and high signal intensity in the T2 weighted image. 97 % alcohol was injected under US guidance and aspirated after 30 min. The swelling significantly decreased in size clinically and radiologically during the follow-up. Clinical discussionLymphangioma rarely occurs in the inguinal region, presenting a diagnostic challenge as it mimics various inguinal conditions. Differential diagnoses include inguinal hernia, hydrocele of the cord, lymphadenopathy, or hematoma. Imaging is used to determine the size, invasion, relation to surrounding structures, and extension to the abdominal cavity. MRI is the diagnostic modality of choice in non-emergency settings. Complete surgical excision is the gold standard for the management with the lowest risk of recurrence. Alternative non-surgical treatment options have been used successfully in poor surgical candidates. Different sclerosing agents have been used with low complications and rates of recurrence. Ethanol is a widely available sclerosing agent, and it was used with no recurrence or side effects during the follow-up period. ConclusionSurgeons should have a high index of suspicion when investigating any inguinal mass, considering such a rare presentation as part of the differential. Sclerotherapy is an effective treatment for lymphangioma and should be considered as an alternative modality in non-surgical candidates.

Asprosin as a potential new paracrine regulator in the heart

Abstract Funding Acknowledgements None. Background Asprosin was recently described as a novel hormone that is released by white adipose tissue upon fasting. However, a functional role of asprosin in human cardiovascular tissues has not been yet investigated at the tissue level. Asprosin is the C-terminal propeptide of the extracellular matrix (ECM) glycoprotein fibrillin-1 and is cleaved off from the pro-fibrillin-1 precursor by the endopeptidase furin. Fibrillin-1 is expressed in the heart and aorta, and FBN1 mutations are causative for aortic aneurysm formation and cardiomyopathy. Whether asprosin is also present in cardiac tissues and utilized by cardiac resident cells remains unknown. Purpose In the present study, we investigated the localization and distribution of asprosin protein in human atrial and ventricular heart tissue. Methods Human heart tissue was obtained from patients undergoing aortic valve replacement. In addition, we used ventricular tissue from mice. Cryosections from human (n=8) and mouse (n=8) heart samples were analysed by immunohistochemistry. The anti-asprosin antibodies were raised against human or mouse asprosin respectively and applied in combination with anti-CD31/PECAM, an endothelial cell marker, or anti-sarcomeric alpha-actinin, a Z-line marker. The immunofluorescence of incubated specimens was examined by confocal microscopy. Results Our data suggest that asprosin is localized in myocardium in different cell types: cardiomyocytes (Figure 1 a-d), arterial smooth muscle cells (Figure 1 a), micro- and vascular endothelial cells (Figure 1 d), and with the lowest intensity, in periarterial located epicardial adipocytes (Figure 1 e). In cardiomyocytes, incubation with anti-asprosin resulted in a high signal intensity. Asprosin immunoreactivity was observed: in intercalary discs (Figure 1 b-d), as striated pattern in the sarcoplasm, and as weak signal in the perinuclear area (Figure 1 b, c). In human tissue, the anti-asprosin signal was about four times higher in intercalated discs than in the sarcoplasm. The distribution pattern in ventricular cardiomyocytes of mice were similar. Conclusion Our results show that in human myocardium, asprosin localises mainly intracellular. Asprosin accumulations were found in intercalary discs. In short, asprosin was found at locations that are known to be crucial for regulation of cardiac function. Intracellular presence of asprosin may indicate cellular utilization by uptake from extracellular asprosin pools. Whether these pools are replenished exclusively by resident cells or by other tissues such as WAT is currently unknown. However, further research is needed to prove this hypothesis. Figure. 1. Confocal microscopy of asprosin localization in human myocardium. Cryosections incubated with anti-asprosin (red) or combined with anti-alpha actinin (sarcomeric) or anti-CD31/PECAM (green) antibodies and DAPI (blue, nuclei). SM: vascular smooth muscle cells, BV: blood vessels, Arrowheads: Intercalated disks.

Hour-Long, Kilohertz Sampling Rate Three-Dimensional Single-Virus Tracking in Live Cells Enabled by StayGold Fluorescent Protein Fusions.

A viral infection process covers a large range of spatiotemporal scales. Tracking the viral infection process with fluorescent labels over long durations while maintaining a fast sampling rate requires bright and highly photostable labels. StayGold is a recently identified green fluorescent protein that has a greater photostability and higher signal intensity under identical illumination conditions compared to existing fluorescence protein variants. Here, StayGold protein fusions were used to generate virus-like particles (StayGold-VLPs) to achieve hour-long 3D single-virus tracking (SVT) with 1000 localizations per second (kHz sampling rate) in live cells. The expanded photon budget from StayGold protein fusions prolonged the tracking duration, facilitating a comprehensive study of viral trafficking dynamics with high temporal resolution over long time scales. The development of StayGold-VLPs presents a simple and general VLP labeling strategy for better performance in SVT, enabling exponentially more information to be collected from single trajectories and allowing for the future possibility of observing the entire life cycle of a single virus.

Evaluation of left atrial function and tissue after pulmonary vein isolation - initial results of The EVALUATE-PVI STUDY

Abstract Background Pulmonary vein (PV) isolation (PVI) by catheter ablation is a well-established treatment for atrial fibrillation (AF). Currently, the direct and long-term impact of ablation injury on left atrial (LA) function and tissue is poorly understood. Purpose The aim of this study is to evaluate the acute and long-term impact of radiofrequency (RF) PVI ablation on LA function and corresponding tissue changes as assessed with cardiac magnetic resonance imaging (CMR). Methods Seventeen patients (76.5% male, 60.8±9.7 years) with AF who underwent primo RF PVI as part of the EVALUATE-PVI STUDY underwent three sequential CMR scans prior to PVI, and &amp;lt;72 hours and 3 months after PVI ablation. T2-weighted turbo spin echo imaging was applied to assess post-ablation edema. High-resolution three-dimensional (3D) late gadolinium-enhancement (LGE) images were acquired to study acute LA wall injury and chronic fibrosis formation. LA volume and function were derived from two-chamber and four-chamber SSFP cine images. Maximum and minimal LA volume was indexed to body surface area to compute LAVimax and LAVimin. Longitudinal LA strain was calculated using feature tracking, and subdivided into reservoir, conduit, and contractile strain. Results Acutely post-PVI, T2w images showed increased signal intensity and thickening throughout the entire LA wall. LGE images showed diffuse increased signal intensity, without distinct focal high signal intensity areas (Fig. 1). Functional assessment at this stage showed significantly reduced LA emptying fraction (EF), LA reservoir, and contractile strain compared to pre-PVI (54.8±11.1% vs. 48.5±7.9%, p=0.01; 18.6±5.6% vs. 14.6±2.0%, p&amp;lt;0.01; 8.5±3.5% vs. 5.2±1.8%, p&amp;lt;0.001, respectively), while LA conduit strain, LAVimin, and LAVimax did not differ significantly (Fig. 2). The LGE images acquired at 3 months, displayed clear, focal, high signal intensity areas surrounding the PVs. At this stage post-PVI, a significant increase in LA strain was observed (LA reservoir strain 14.6±2.0% vs. 16.9±3.5%, p&amp;lt;0.01; and contractile strain 5.2±1.8% vs. 6.7±2.9%, p&amp;lt;0.01; respectively). LAVimax was significantly reduced at 3 months compared to acutely post-PVI (Fig. 2). LAVimin and LA conduit strain did not differ between the pre- and post-PVI stages. Conclusion PVI ablation resulted in temporary reduced LA function acutely post-PVI, likely due to edema and thickening of the LA wall. At three months, LGE images revealed clearly visible increased signal intensity in the ablated segments. At this stage, LA function improved, though full recovery did not occur as evidenced by the persistent slightly reduced contractile strain, possibly due to the ablation-induced loss of LA myocardium and formation of fibrosis. The decrease in LAVimax indicates reverse remodeling as a result of the ablation.

Hypopituitarism with secondary adrenocortical insufficiency and arginine vasopressin deficiency due to hypophysitis after COVID-19 vaccination: a case report

BackgroundAlthough vaccination against coronavirus disease (COVID-19) has several side effects, hypopituitarism due to hypophysitis has rarely been reported.Case presentationAn 83-year-old healthy woman, who had received her fourth COVID-19 vaccine dose 2 days before admission, presented to the emergency department with difficulty moving. On examination, impaired consciousness (Glasgow Coma Scale: 14) and fever were observed. Computed tomography and magnetic resonance imaging of the head revealed swelling from the sella turcica to the suprasellar region. Her morning serum cortisol level was low (4.4 μg/dL) and adrenocorticotropic hormone level was normal (21.6 pg/mL). Central hypothyroidism was also suspected (thyroid stimulating hormone, 0.46 μIU/mL; free triiodothyronine, 1.86 pg/mL; free thyroxine, 0.48 ng/dL). Secondary adrenocortical insufficiency, growth hormone deficiency, delayed gonadotropin response, and elevated prolactin levels were also observed. After administration of prednisolone and levothyroxine, her consciousness recovered. On the 7th day of admission, the patient developed polyuria, and arginine vasopressin deficiency was diagnosed using a hypertonic saline test. On the 15th day, the posterior pituitary gland showed a loss of high signal intensity and the polyuria resolved spontaneously. On the 134th day, the corticotropin-releasing hormone loading test showed a normal response; however, the thyrotropin-releasing hormone stimulation test showed a low response. The patient’s disease course was stable with continued thyroid and adrenal corticosteroid supplementation.ConclusionsHerein, we report a rare case of anterior hypopituitarism and arginine vasopressin deficiency secondary to hypophysitis following COVID-19 vaccination.

Laparoscopic transabdominal approach for resection of presacral epidermoid cyst in an obese man: a case report

BackgroundComplete resection of presacral epidermoid cysts is recommended due to the potential for infection or malignancy. Transsacral and transabdominal approaches have been used to treat presacral tumors. However, there are no standard surgical approaches to resection. We present the case of a presacral epidermoid cyst in an obese male patient who underwent laparoscopic transabdominal resection.Case presentationA 44-year-old man was referred to our hospital for treatment of a cystic tumor on the pelvic floor. Contrast-enhanced computed tomography revealed a 45 × 40-mm tumor on the left ventral side of the rectum, right side of the ischial spine, dorsal side of the seminal vesicles, and in front of the 5th sacrum. Enhanced magnetic resonance imaging revealed a multilocular cystic tumor with high and low signal intensities on T2-weighted images. The tumor was diagnosed as an epidermoid cyst. We considered the transsacral or laparoscopic approach and decided to perform a laparoscopic-assisted transabdominal resection since the tumor was in front of away from the sacrum, and a transsacral approach would result in a larger scar due to poor visibility from the thickness of the buttocks. The entire tumor was safely resected under laparoscopic guidance, because the laparoscopic transabdominal approach can provide a good and magnified field of view even in a narrow pelvic cavity with small skin incisions, allowing safe resection of the pelvic organs, vessels, and nerves while observing the tumor contour.ConclusionsThe laparoscopic transabdominal approach is an effective method for treating presacral tumors in obese patients.