High Signal Intensity Research Articles

Predicting axillary residual disease after neoadjuvant therapy in breast cancer using baseline MRI and ultrasound.

To predict axillary node residual disease in women treated for node-positive breast cancer (BC) by neoadjuvant therapy (NAT), using breast BI-RADS MRI features and axillary ultrasound at baseline. In this single-center, retrospective study, women with node-positive BC who underwent NAT between 2016 and 2021 were included. Pre-treatment axillary US and breast MRIs were evaluated using the BI-RADS lexicon and T2 features, including Breast Edema Score. Univariate and multivariate logistic regression analyses were conducted for the prediction of axillary residual disease (ARD). A multivariable model based on logistic regression was trained and evaluated on randomly split train and test sets (7:3 ratio). Out of the 141 women, 41% had post-NAT ARD. Axillary metastasis was independently associated with luminal subtype (odds ratio (OR), 25.5; p < 0.001), anterior tumor location (OR, 14.1; p = 0.008), and cortical thickening ≥ 7 mm (OR, 6.09; p = 0.002). Intratumoral T2 high signal intensity was protective (OR, 0.16; p = 0.006), while Ki67 had a marginal association (p = 0.064). In the training and test sets, the model, which is available online, achieved AUCs of 0.860 (95% CI: 0.783-0.936) and 0.843 (95% CI: 0.714-0.971), respectively. Anterior depth location and cortical thickening greater than 7 mm were also independently associated with post-NAT axillary burden. Adjusting for BC subtype and KI-67 index, the anterior third location of BC, a cortical thickness greater than 7 mm, and the absence of intratumoral T2 hyperintensity is predictive of ARD after NAT. Question What baseline imaging-based predictive models can identify patients at risk of persistent nodal disease after neoadjuvant therapy? Findings Baseline US cortical thickness superior to 7 mm, anterior tumor location, and absence of an intratumoral high signal on T2-weighted MRI predict residual axillary disease. Clinical relevance Our predictive model, available online at: litoic.shinyapps.io/LNPred_Apps , including breast cancer subtype, Ki-67 index level, breast cancer location, intratumoral signal intensity on T2WI, and initial lymph node thickness, could guide post-NAT axillary management.

Pituitary Adenomas in Children: : Specific Imaging Features According to Hormonal Secretion.

Pituitary adenomas are much rarer in children than in adults. We aimed to analyze their imaging characteristics in this age group and to compare them according to the hormonal secretion. We conducted an observational monocentric retrospective study on clinical and imaging data. We analyzed imaging features before surgery or drug treatment of pituitary adenomas in children confirmed by histopathology or hormonal secretion. We assessed tumoral signal intensity, volume and aggressiveness, and compared it according to the hormonal secretion. We included 31 children (13 lactotroph (42%), 8corticotroph (26%), 5somatotroph (16%), 5plurihormonal adenomas (16%) including 1 non-secreting macroadenoma) with a median age of 13years (range 2-16years-old), without age or sex difference between secretion types. Lactotroph and somatotroph adenomas were larger than corticotroph adenomas (p = 0.007) and were more aggressive (p = 0.01). They also had higher signal intensity on T2-weighted images (p = 0.04). T1 signal intensity was similar between the groups on pre and post-contrast images (lower enhancement than the normal pituitary). No non-secreting micro-adenoma became clinically significant enough to lead to a pathological confirmation or specific treatment. Genetic research was conducted on 20children, finding MEN1 mutations in 80% of the patients. Pituitary adenomas in children are rare but should be considered when facing similar imaging features than in adults. Imaging characteristics may allow to suspect the hormonal secretion.

Analysis of immune related adverse events of pembrolizumab using FAERS database

Objective: This study aims to investigate the risk signals associated with pembrolizumab and provide references for its safe and rational clinical use. Methods: Data on adverse events (AEs) related to pembrolizumab, reported from July 2014 to September 2023, were extracted from the US FDA Adverse Event Reporting System (FAERS) database. Data mining was conducted using the Proportional Reporting Ratio (PRR) method. AEs were classified and analyzed according to the System Organ Class (SOC) and Preferred Term (PT) from the Medical Dictionary for Regulatory Activities (version 26.1). Results: A total of 37,511 AE reports related to pembrolizumab were identified, involving 5,259 PTs and 22 SOCs. Using the PRR method, 931 positive signals were detected. The top 10 risk signals for pembrolizumab were all immune-related adverse events (irAEs) and important medical events (IMEs). The five PTs with the highest signal intensity were immune-mediated hypothyroidism, immune-mediated renal disorder, immune-mediated hepatic disorder, immune-mediated gastritis, and immune-mediated hyperthyroidism. The leading SOCs involved in AE reports were general disorders and administration site conditions (8,184; 14.11%), investigations (5,333; 9.19%), gastrointestinal disorders (4,962; 8.55%), respiratory, thoracic, and mediastinal disorders (4,937; 7.57%), and injury, poisoning, and procedural complications (3,611; 6.22%). The median time to onset of AE was 25 days (IQR 6-85 days), with the Weibull distribution test indicating an early failure-type curve. Gender and age analysis revealed that women were more likely to develop hypertension, alopecia, headache, hypothyroidism, and palmar-plantar erythrodysaesthesia syndrome, whereas men were more likely to develop interstitial lung disease, renal impairment, and death. Additionally, neutropenia was more prevalent in patients under 65 years of age, while interstitial lung disease and renal impairment were more common in patients aged 65 and above. Conclusion: Significant age- and gender-related differences were observed in AE signals with pembrolizumab, particularly for irAEs. Clinical attention should be directed towards the potential occurrence of irAEs at the initial stages of drug administration, with appropriate measures implemented as necessary.

Staining Tissues with Basic Blue 7: A New Dual-Polarity Matrix for MALDI Mass Spectrometry Imaging.

Obtaining high-quality matrix-assisted laser desorption/ionization mass spectrometry (MALDI MS) images and the reproducibility of the technique depend strongly on the sample preparation protocol. The most crucial part is the application of the MALDI matrix, which often relies on expensive spraying or sublimation coaters. In this work, we present a new dual-polarity matrix for MALDI mass spectrometry imaging (MSI): Basic Blue 7 (BB7), which belongs to the group of triarylmethane dyes. Thanks to its good solubility in water, this matrix allows a quick and simple sample preparation protocol without the need for sophisticated spraying or sublimation instrumentation: dipping the glass with tissue into the dye solution. This technique closely resembles the staining methods employed in classical histopathology. The technique is demonstrated on MSI of lipids in mouse brain sections in positive and negative ion modes using a subatmospheric pressure MALDI source coupled with an orbital trap mass spectrometer. The results are compared with traditional matrices, such as 2,5-dihydroxybenzoic acid (DHB) and 1,5-diaminonaphthalene (DAN). BB7 excels, especially in negative ion mode, offering low background signals and high signal intensities of many lipid classes. Furthermore, the stained tissue can simply be inspected visually and allows basic histopathology annotation prior to MSI. Here, we demonstrate that staining offers excellent image quality, reproducible sample preparation, and the potential for automation and utilization for high spatial resolution MSI.

Computed tomography and magnetic resonance imaging features of abdominal and pelvic leiomyomatosis peritonealis disseminata: A retrospective observational study.

Leiomyomatosis peritonealis disseminata (LPD) is a rare and specific type of leiomyomatosis that is often misdiagnosed as malignant tumor with peritoneal metastasis, and accurate diagnosis is critical to treatment planning. The purpose of this study is to investigate the radiological features of LPD, analyze, and summarize its differential diagnosis and clinical features to improve the understanding of this rare disease. A retrospective analysis was conducted on clinical and radiological features from 10 patients with pathologically confirmed LPD between 2012 and 2024. The computed tomography (CT) and magnetic resonance imaging (MRI) findings were examined, focusing on parameters such as location, morphology, size, quantity, enhancement patterns, and their relationship with adjacent organs. In addition, the radiological features and the key points of differential diagnosis were summarized. All the 10 LPD patients presented with multifocal lesions in the abdomen and pelvis, and 7 of them had a history of hysteromyoma surgery. The number of lesions was all ≥2, most of them were round or quasi-circular, with clear boundaries and smooth edges, did not invade the neighboring parenchymal organs, with a length of about 1.5~16.8 cm. The lesions were located in the pelvic cavity in 6 cases, the abdominal wall in 6 cases, the intestinal wall in 3 cases, the rectouterine pouch in 1 case, the omentum in 5 cases, the abdominal cavity in 1 case, and the mesentery in 1 case. There were 7 cases with minimal pelvic fluid and 1 case with liver spread. CT showed circular solid nodules with clear boundaries. The density of small lesions was homogeneous. Cystic changes were observed in some large lesions. On MRI, T1-weighted imaging showed hypo to isointense, T2-weighted imaging (T2WI) mostly showed hypointense, and T2WI in some large lesions showed slightly high signal intensity, diffusion-weighted imaging signal intensity was not higher than that of myometrium, apparent diffusion coefficient showed isointense, and solid components of the lesions were significantly more homogeneous enhanced after enhancement, and the enhancement degree was similar to that of normal myometrium. Although the imaging findings of LPD are similar to malignant tumors with peritoneal implantation and metastasis, they have certain characteristics, which are helpful for differential diagnosis combined with the clinical history of patients.

Extracellular and intracellular digestion in the bivalves studied by magnetic resonance imaging with a contrast reagent.

We investigated the extracellular and intracellular digestion of bivalves employing magnetic resonance imaging (MRI). Ruditapes philippinarum clams and Mytilus galloprovincialis mussels were incubated in seawater containing a contrast reagent (GdDTPA) at 20°C. The digestive systems, from the esophagus to the rectum, were visualized at a high signal intensity by the T1-weighted MRI. The crystalline style of the clam was also identified, which turned counterclockwise when viewed from a ventral-posterior position at a rate of 16 rpm. Determined using the T1 relaxation rate, the uptake and excretion rates of the GdDTPA in the mussel's digestive glands were 2.9 and 0.25 d-1, respectively, indicating that the intracellular digestion in the gland acinar cells is slower than the extracellular digestion. These results demonstrate that MRI with contrast reagents is useful to study the activity of digestive system in the bivalves, and this technique can likely be applied to the study of other invertebrates.

Imaging characteristics and treatment of recurrent germinoma.

An MRI protocol for germinoma surveillance after complete remission has not been established. Moreover, the standard treatment for recurrent or refractory germinoma has not been determined. In this study, the authors explored the imaging characteristics of recurrent germinoma and discuss their institution's experience with multidisciplinary treatment of this malignancy. The medical records of 16 patients (14 male, 2 female) with recurrent germinoma and 62 patients (52 male, 10 female) without recurrence who were treated at the authors' institution between 1989 and 2023 were retrospectively examined. Data including diagnostic imaging, tumor markers, treatment at diagnosis and recurrence, and overall survival were collected from patients' medical records and statistically analyzed. No patients with recurrence received craniospinal irradiation (CSI) as an initial therapy, and local irradiation was a significant risk factor of recurrence (p = 0.0072). The period between the start of first-line treatment and confirmation of the first recurrence ranged from 4.2 to 272 months (median 66.8 months). Among the recurrences, 13 tumors occurred outside the radiation field, including 6 cases of spinal cord/canal recurrence. One-third of patients did not exhibit elevated tumor marker levels in the serum. Fourteen patients had contrast-enhanced recurrent lesions. In the 2 patients with non-contrast-enhanced lesions, recurrence was detected by high signal intensity on diffusion-weighted imaging (DWI) and elevated tumor marker levels in CSF. Fifteen patients received chemotherapy for the first recurrence, and 14 received radiation therapy, with 9 receiving CSI. The patients who received CSI survived without further recurrence during the study period. However, the median progression-free survival and overall survival after the first recurrence among patients who did not undergo CSI were 12.2 and 37.4 months, respectively, which were shorter than those for patients treated with CSI (both p < 0.01, log-rank test). Spinal MRI for surveillance in patients with recurrent germinoma, especially for those who do not receive CSI, is recommended. DWI might be useful for detecting recurrent germinoma. Aggressive treatment at the time of recurrence is crucial, and even if remission is achieved with chemotherapy, CSI for consolidation is important to prevent further recurrence.

A Real-World Data Analysis of Alglucosidase Alfa in the FDA Adverse Event Reporting System (FAERS) Database.

Alglucosidase alfa for injection is used as an enzyme replacement therapy for the treatment of Pompe disease. The safety profile of alglucosidase alfa-associated adverse events requires a comprehensive evaluation. In this study, we aimed to identify drug safety alert signals and investigate the real-world safety of alglucosidase alfa to guide clinical decision making and optimize the risk-benefit balance. The adverse event reports from the first quarter of 2006 to the fourth quarter of 2023 were selected by exploring the Food and Drug Administration Adverse Event Reporting System (FAERS) database. The new and unexpected potential adverse event signals were detected using a disproportionality analysis, including the reporting odds ratio, the proportional reporting ratio, the Bayesian confidence propagation neural network, and the empirical Bayes geometric mean. Then, the Medical Dictionary for Regulatory Activities was used to systematically classify the results. After analyzing 16,945,027 adverse event reports, a total of 4326 cases of adverse events related to alglucosidase alfa were identified, spanning 27 system organ classes. A total of 359 preferred terms of adverse events for glucosidase alpha were detected. Pyrexia ranked first, followed by pneumonia, dyspnea, respiratory failure, and disease progression according to occurrence frequency. The top three system organ classes were general disorders and administration-site conditions (n = 2466), respiratory, thoracic, and mediastinal disorders (n = 1749), and infections and infestations (n = 1551). In addition to adverse effects mentioned in the product label, our study also discovered rare but high signal intensity adverse events such as chronic recurrent multifocal osteomyelitis. There are many adverse events associated with the clinical use of alglucosidase alfa, which should be closely monitored in the FAERS database. As the most effective enzyme replacement therapy for Pompe disease, it is crucial to closely monitor these adverse events. Ensuring patient safety while balancing drug effectiveness is particularly important.

Potential of low apolipoprotein A-I as a surrogate marker of vulnerable carotid artery plaques.

Recent studies suggested that the medical control of atherogenic lipoproteins is not sufficient for stroke prevention. A low apolipoprotein A-I (apoA-I) level may play a crucial role in the anti-atherogenic effects of high-density lipoprotein (HDL-C) and may also be associated with symptomatic vulnerable plaques in carotid artery stenosis. Therefore, the present study investigated the relationship between apoA-I levels and the status of carotid artery stenosis. Ninety-one patients with carotid artery stenosis were examined. The status of carotid artery plaques was divided into symptomatic (n= 47) and asymptomatic (n= 44). We examined patient profiles, including comorbidities, and laboratory lipid data, and plaque features visualized by ultrasonography, MRI, and digital subtraction angiography. The relationships between plaque instability and risk factors for carotid artery stenosis were investigated. No significant differences were observed in the profiles of symptomatic and asymptomatic patients. Regarding plaque features, ulceration, low echo luminance, and a high signal intensity in plaques on T1-weighted images correlated with symptomatic plaques. ApoA-I, total cholesterol, and non-HDL-C levels were significantly lower in symptomatic patients than in asymptomatic patients. A multivariate logistic regression analysis identified low ApoA-I levels, ulceration, and low echo luminance as predictive factors for symptomatic carotid artery stenosis. Diagnostic accuracy for predicting symptomatic carotid stenosis was 0.84 when the following four factors were combined: ulceration, low echo luminance, a high signal intensity on T1-weighted images, and the level of apoA-I. A low apoA-I level was associated with symptomatic carotid artery stenosis. Therefore, ApoA-I levels have potential as a surrogate marker to detect unstable carotid artery plaques.

Immune checkpoint inhibitor-related diabetes mellitus associated with high signal intensity in diffusion-weighted magnetic resonance imaging of the pancreas at an early clinical stage.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but can give rise to immune-related adverse events such as ICI-related diabetes mellitus (DM). We herein present the case of a 59-year-old Japanese man with malignant melanoma who developed ICI-related DM after 18 months of nivolumab treatment. He experienced marked hyperglycemia and diabetic ketoacidosis without a personal or family history of diabetes. Laboratory findings revealed initial preservation of insulin secretion but a rapid decline in C-peptide levels in the absence of islet autoantibodies. He was therefore diagnosed with ICI-related DM. This case fulfilled the criteria for fulminant type 1 DM but lacked the typical human leukocyte antigen alleles associated with conventional type 1 diabetes. No metastasis or morphological changes were apparent on CT scans of the pancreas, and magnetic resonance cholangiopancreatography did not show dilation or interruption of the main pancreatic duct. However, diffusion-weighted magnetic resonance imaging revealed high signal intensity with low apparent diffusion coefficient values in the pancreas, likely indicative of fibrosis or infiltration of inflammatory cells. This case underscores that ICI-related DM should be considered a potential immune-related adverse event as well as pointing to the benefit of diffusion-weighted imaging for assessment of pancreatic involvement at an early stage of the disease.

Identification of Sulcal Hyperintense Vessel (Vessel Wall MR Ivy Sign) in Adult Moyamoya Disease with High-resolution Vessel Wall Imaging : A Pilot Study.

The leptomeningeal ivy sign is a distinctive finding of moyamoya disease (MMD), characterized by a linear high signal intensity along the cortical sulci on contrast-enhanced T1 magnetic resonance imaging (MRI) and fluid-attenuated inversion-recovery MRI. We recently identified a similar linear enhancement along the cortical sulci using gadolinium-enhanced vessel wall MRI (VWMR) in patients with MMD. The aim of this study was to introduce the concept of the "VWMR ivy sign (VIS)". Eighteen MMD patients underwent gadolinium-enhanced VWMR. We identified the VIS in gadolinium-enhanced VWMR, represented by a linear high intensity along the cortical sulci. The VIS was assessed by comparing pre and postcontrast T1 black blood sequences on VWMR and was investigated in the precentral, central, and postcentral sulci. "VIS scores" were calculated by the sum of VIS in the three sulci, ranged from 0 to 3. We compared the VIS scores according to different stroke presentations (non-stroke, ischemic stroke, and hemorrhagic stroke). The inter-modality agreement for identifying VIS and fluid-attenuated inversion-recovery (FLAIR)/cortical sulci on contrast-enhanced T1 MRI (CEMR) ivy sign was determined using Cohen's kappa statistics. The VIS scores were significantly different among the three groups (P = 0.004). The VIS scores in both the ischemic and hemorrhagic groups were significantly higher than those in the non-stroke group (ischemic vs. non-stroke, P = 0.009; hemorrhagic vs. non-stroke, P = 0.004). After adjusting for age and sex using the non-stroke group as a reference group, the VIS scores were significantly higher in the ischemic and hemorrhagic groups (P=0.046, OR 8.27, 95% CI 1.03-66.19 and P=0.039, OR 7.78, 95% CI 1.11-54.48, respectively). Inter-modality agreement between VIS and FLAIR ivy sign was substantial, perfect, and substantial in the precentral, central, and postcentral sulci, respectively (precentral sulcus, κ=0.609, 95% CI=0.213-1; central sulcus, κ=1; and postcentral sulcus, κ=0.769, 95% CI=0.475-1). Inter-modality agreement between the VIS and CEMR ivy sign was substantial in the precentral, central, and postcentral sulci, respectively (precentral sulcus, κ=0.727, 95% CI=0.384-1; central sulcus, κ=0.609, 95% CI=0.384-1; and postcentral sulcus, κ=0.649, 95% CI=0.310-0.998). This preliminary series introduces the concept of VIS, possibly indicating slow and retrograde flow of sulcal vessels via leptomeningeal collaterals. Future studies are needed to develop an optimal scoring system for VIS and establish its clinical correlation with stroke presentations in MMD patients.

Effect of the Surrounding Magnetic Environment of Temporal Bone on the Fluid Signal Intensity in Human Inner Ear Using a Combined T2 Preparation Pulse and Fluid Attenuated Inversion Pulse Technique

Recently, the utility of non-contrast MR endolymphatic hydrops imaging was reported, but the pitfall was indicated based on T2 preparation pulse sensitiveness to local static magnetic field (B0) inhomogeneity. The purpose of this study is to clarify the effects of surrounding magnetic environment of temporal bone to lymphatic fluid signal intensity on the T2 preparation and fluid attenuated inversion recovery pulse combination (T2prep 3D-FLAIR) technique in human inner ear study. We prepared a custom-made phantom comprising a chicken leg bone submersed in saline. To evaluate signal characteristics of saline close to bone, multiple TE gradient echoes, T2 relaxation time measurement, and T2prep 3D-FLAIR image were acquired. In the vicinity of the vestibule of a healthy volunteer, similar examinations were executed. Additionally, to investigate the influence of the magnetic environment from B0, the evaluation was performed in five head position settings relative to B0. In both the phantom case and volunteer case, together with T2 star signal intensity attenuation, T2 relaxation time shortening was observed on fluid around bone. Specifically, at the outer edge in the vestibule and cochlea of the volunteer, T2 relaxation time was shorter than that of center of vestibule and that of cochlea. In the T2prep 3D-FLAIR image, higher signal intensity was observed at the same location on the outer edge of them. These results showed that bone affects surrounding fluid magnetic environment. Also, for B0 influence, despite a large area variation ratio, there is no statistically significant difference correlated to orientation within B0. The surrounding magnetic environment of the temporal bone affects lymphatic fluid signals of the peripheral part of the human inner ear on T2prep 3D-FLAIR technique.

Lesion Location and Possible Etiology of Acute Unilateral Vestibulopathy.

Acute unilateral vestibulopathy (AUVP) is quite common in clinical practice, but lesion localization and etiological diagnosis of AUVP remain the current clinical challenges, and have always been the focus for researchers. The study aimed to explore the lesion site and possible etiology of AUVP. This study is a retrospective study. Twenty-three AUVP patients who attended the neurology outpatient clinics of our hospital from January 2020 to March 2022 were included. Clinical data of patients including baseline data, cardiovascular risk factors, immunological test results and infection indicators were collected. Vestibular function tests, including video head impulse test (vHIT), caloric testing, vestibular evoked myogenic potentials (VEMPs) and post-contrast delayed 3D-FLAIR MRI, were performed. Among 32 AUVP patients included, there were 10 males and 13 females, with a male-to-female ratio of 1:1.3, and an average age of 42.13 ± 14.57 years (range 19-76 years old). Acute persistent vertigo and relapsing-remitting vertigo accounted for 39.1% (9/23) and 60.9% (14/23) of the patients, respectively. Possible etiologies included cardiovascular risk factors (n = 11), abnormal immunological indicators (n = 8), and evidence of infection (n = 3). About 57.1% (12/21) of the patients showed abnormal vHIT (including reduced gain in horizontal canal (HC) in 14.3%, anterior canal (AC) in 4.8%, both the AC and HC in 19%, both the HC and posterior canal (PC) in 14.3%, and all three canals in 9.5% of cases). Probable entire vestibular nerve damage was found in 38.1% of the patients, only 9.5% of the patients followed the innervation pattern of the entire vestibular nerve, these patients had abnormal vHIT and VEMP results, and were considered to have definite entire vestibular nerve damage. Probable superior vestibular nerve (SVN) damage was found in 47.6% of the patients, but only 4.8% (1/21) of the patients followed the innervation pattern of SVN, with reduced VOR gains for AC and HC and abnormal oVEMP results, and were considered to have definite SVN damage. 3D-FLAIR MRI revealed high signal intensity in the SVN and vestibule in 4.8% (1/21) and 19% (4/21) of the patients, respectively. The majority of AUVP patients had a relapsing-remitting course and had vestibular function test results that did not follow the innervation pattern of the vestibular nerve. Post-contrast delayed 3D-FLAIR MRI revealed damage to the vestibule in some patients, suggesting that damage to the labyrinth itself in AUVP deserves clinical attention. The majority of the AUVP patients had cardiovascular risk factors and abnormal systemic immunological indicators, which might be the possible etiologies of AUVP.

Early therapeutic efficacy of condoliase chemonucleolysis for lumbar disc herniation

BackgroundLow back pain is often caused by lumbar disc herniation (LDH). Treatment of LDH is possible using chemonucleolysis of the nucleus pulposus with condoliase injection. However, onset of the therapeutic effect varies among patients, with improvement from an early stage to 3 months post-injection. This study was performed to identify the characteristics of early responders to condoliase therapy.MethodsA retrospective cohort study was performed in 371 consecutive patients (259 males, 112 females; age, 49.9 ± 18.7 years; follow-up period, 13.1 ± 7.4 months) treated with condoliase injection for LDH between August 2018 and January 2024. Chemonucleolysis was performed with 1 mL of condoliase (1.25 U/mL) injected into the intervertebral nucleus pulposus. Clinical assessments were made before injection and 1 day, and 1, 4 and 12 weeks post-injection. Pain was measured on a visual analogue scale. Herniation parameters were evaluated on axial MRI. The herniated disc volume was measured on plain lumbar radiography. Demographic and clinical data were taken from medical charts. Multivariate logistic regression analysis was used to identify factors with independent relationships with treatment efficacy.ResultsImprovement of leg pain from baseline by ≥ 50% occurred in 21% of cases within one day after condoliase treatment. Patients with this improvement at 1 week post-injection were defined as early responders (n = 142, 38.3%). In multivariate analysis, age < 40 years (p = 0.022, odds ratio (OR): 1.71, 95% confidence interval (CI): 1.12–4.35), Pfirrmann Grade II or III at baseline (p = 0.032, OR: 1.86, 95% CI: 1.17–5.41), and a high intensity MRI signal in the herniation (p = 0.041, OR: 1.87, 95% CI: 1.06–5.27) were significantly associated with early improvement. No patients had anaphylactic shock or neurologic sequelae.ConclusionsThis study confirms the safety and efficacy of chemonucleolysis with condoliase for treating patients with painful LDH. Age, high-intensity MRI signals, and baseline Pfirrmann grade were significant factors associated with early improvement.

Magnetic resonance imaging features of uterine adenosarcoma: case series and systematic review.

To comprehensively summarize the characteristics of magnetic resonance imaging (MRI) findings of uterine adenosarcoma through a systematic review and case series analysis. A literature search was conducted in MEDLINE, Scopus, and Embase databases on June 3, 2024. In total, 25 cases from 23 articles were selected, and five cases from the authors' institution were included. Two board-certified radiologists evaluated the demographic, clinical, and radiological data. The median age at diagnosis was 48.5years (range: 9-79years). The most frequent chief complaint was abnormal bleeding (96.7%), pathological T1 stage was predominant (85.2%), and 55.2% of the patients had sarcomatous overgrowth. Locoregional/distant recurrence occurred in 36.4% of the patients. MRI findings revealed that the mean longest lesion size was 9.3cm. However, most lesions were located in the uterine body (93.1%) and primarily involved the endometrium (96.6%). Most cases (90.0%) were polypoid lesions with 80.8% protruding into the cervical canal. Cystic changes were prevalent (96.5%) and hemorrhage was observed in 84.6% of the evaluated cases. Lesions showed high (51.7%) or intermediate (48.3%) signal intensity compared with the uterine myometrium on T2-weighted imaging. Furthermore, all lesions showed heterogeneous enhancement on contrast-enhanced MRI, and the mean apparent diffusion coefficient value was 1.05 × 10-3 mm2/s. Our findings provide a comprehensive analysis of MRI features in uterine adenosarcoma cases, highlighting key characteristics that may aid in preoperative diagnosis and differentiation from other uterine malignancies.

Effect of the field strength on the MAS NMR spectra: Comparative study between diamagnetic and paramagnetic systems

AbstractSolid‐state NMR spectroscopy has gained increasing attention as a probe to investigate structures and dynamics of various solid materials, in particular, materials for rechargeable batteries. Cathodes and anodes for rechargeable batteries contain unpaired electrons (paramagnetic), which generate localized magnetic fields at molecules. Owing to this paramagnetic interaction, it is often complicated to measure and interpret the NMR spectra of the paramagnetic systems. Thus, understanding the effect of the interaction between unpaired electrons and nuclei is important. NMR spectroscopy at higher magnetic fields has been perceived as beneficial since this can provide higher sensitivity and resolution. However, the response to the magnetic field strength varies depending on the nuclei of interest and material properties because various factors affect NMR characteristics. In this work, we performed a systematic study of the effect of the field strength on the magic angle spinning (MAS) NMR characteristics by comparing diamagnetic and paramagnetic systems at two different magnetic fields. As diamagnetic materials, LiCoO2 (LCO) and Li2O are examined. As paramagnetic materials, LiFePO4(LFP) and lithium nickel manganese cobalt oxides (LiNixMnyCo1–x–yO2) with different compositions are investigated. We have demonstrated that higher signal intensity and narrower linewidths can be obtained at higher magnetic fields for diamagnetic systems, whereas higher signal intensity and better resolution are obtained at lower magnetic fields for paramagnetic systems. Our research will provide systematic and experimental evidence about the field strength dependence of paramagnetic systems and rationalized grounds for choosing proper NMR spectrometers for each material.

Safety assessment of deutetrabenazine: real-world adverse event analysis from the FAERS database

BackgroundDeutetrabenazine is a widely used drug for the treatment of tardive dyskinesia (TD), and post-marketing testing is important. There is a lack of real-world, large-sample safety studies of deutetrabenazine. In this study, a pharmacovigilance analysis of deutetrabenazine was performed based on the FDA Adverse Event Reporting System (FAERS) database to evaluate its relevant safety signals for clinical reference.MethodsAdverse events (AEs) of FAERS with deutetrabenazine as the primary suspect drug were collected from the first quarter (Q1) of 2017 to Q1 of 2024. Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) were used to mine AEs risk signals of deutetrabenazine. AEs were standardized and classified using the System Organ Class (SOC) and Preferred Terms (PTs) from Medical Dictionary for Regulatory Activities (MedDRA) version 23.0.ResultsA total of 3,583 AEs with deutetrabenazine as the primary suspect drug were collected in this study. We found that these AEs involved 23 SOCs, and the positive signals were mainly concentrated in systemic disease and various reactions at the site of administration (n = 1816, ROR = 1.23, PRR = 1.18, IC = 0.24, EBGM = 1.18), neurological disorders (n = 1736, ROR = 3.02, PRR = 2.60, IC = 1.38, EBGM = 2.60) and psychiatric disorders (n = 1,659, ROR = 4.15, PRR = 3.52, IC = 1.82, EBGM = 3.52). We eventually identified 100 valid PTs that met the criteria of the four algorithms. Drug ineffective, dyskinesia, depression, somnolence, suicidal ideation were considered to be the common PTs of deutetrabenazine. Tongue thrust (n = 4, ROR 253.47, PRR 253.35, IC 7.88, EBGM 235.95), grunting (n = 5, ROR 78.49, PRR 78.45, IC 6.26, EBGM 76.71) and drooling (n = 17, ROR 13.21, PRR 13.19, IC 3.72, EBGM 13.14) were not mentioned in the specification, but the high signal intensity suggested that they may be the potential adverse reactions.ConclusionThe efficacy of deutetrabenazine may be accompanied by some potential adverse effects in several systems. Adverse events in psychiatric, neurologic, gastrointestinal and respiratory need to be monitored in clinical practice.

Ghost Peaks of Aromatic Metabolites Induced by Corona Discharge Artifacts in LC-ESI-MS/MS.

LC-ESI-MS/MS is a preferred method for detecting and identifying metabolites, including those that are unpredictable from the genome, especially in basal metazoans like Cnidaria, which diverged earlier than bilaterians and whose metabolism is poorly understood. However, the unexpected appearance of a "ghost peak" for dopamine, which exhibited the same m/z value and MS/MS product ion spectrum during an analysis of Nematostella vectensis, a model cnidarian, complicated its accurate identification. Understanding the mechanism by which "ghost peaks" appear is crucial to accurately identify the monoamine repertoire in early animals so as to avoid misassignments. Verification experiments showed that in-source oxidation of tyramine, which produced an intense signal, was responsible for this "ghost peak." This artifact commonly occurs among aromatic compounds with high signal intensities and appears at the same m/z as their respective invivo oxidized metabolites. In metabolomics, spectra contain diverse signals from complex biological mixtures, making it difficult to recognize artifact peaks. To prevent misassignments, despite +16 Da differences, adequate chromatographic separation of metabolites from their respective invivo oxidation precursors is necessary. Whereas both electrolysis and gas-phase corona discharge can cause in-source oxidation in ESI, corona discharge proved to be the dominant factor. Additionally, the presence of multiple oxygen atom sources was suggested by the voltage-dependent mass shift of +16 Da to +18 Da of the "ghost peak" when using 18O-labeled water as a solvent. Accurate metabolite identification using LC-ESI-MS/MS requires accounting for in-source products that can mimic invivo products.

Desmoplastic Small Round Cell Tumor: a study of CT, MRI, PET/CT multimodal imaging features and their correlations with pathology

PurposeExploring the computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (FDG-PET)/CT Multimodal Imaging Characteristics of Desmoplastic Small Round Cell Tumor (DSRCT) to enhance the diagnostic proficiency of this condition.MethodsA retrospective analysis was performed on clinical data and multimodal imaging manifestations (CT, MRI, FDG-PET/CT) of eight cases of DSRCT. These findings were systematically compared with pathological results to succinctly summarize imaging features and elucidate their associations with both clinical and pathological characteristics.ResultsAll eight cases within this cohort exhibited abdominal-pelvic masses, comprising six solitary masses and two instances of multiple nodules, except for one case located in the left kidney, the remaining cases lacked a clear organ source. On plain images, seven cases exhibited patchy areas of low density within the masses, four cases showed calcification within the masses. Post-contrast imaging displayed mild-to-moderate, uneven enhancement. Larger masses displayed patchy areas without significant enhancement at the center. In the four MRI examinations, T1-weighted images exhibited uneven, low signal intensity, while T2-weighted images demonstrated uneven high signal intensity. Imaging unveiled four cases of liver metastasis, four cases of ascites, seven cases of lymph node metastasis, three cases of diffuse peritoneal thickening, and one case involving left ureter invasion with obstruction. In the FDG-PET/CT examinations of seven cases, multiple abnormal FDG accumulations were observed in the abdominal cavity, retroperitoneum, pelvis, and liver. One postoperative case revealed a new metastatic focus near the colonic hepatic region. The range of maximum standardized uptake values (SUVmax) for all lesions are 6.62–11.15.ConclusionsDSRCT is commonly seen in young men, and the imaging results are mostly multiple lesions with no clear organ source. Other common findings include intratumoral calcification, liver metastasis, ascites, peritoneal metastasis, and retroperitoneal lymph node enlargement. The combined use of CT, MRI and FDG-PET/CT can improve the diagnostic accuracy and treatment evaluation of DSRCT. However, it is imperative to underscore that the definitive diagnosis remains contingent upon pathological examination.

Surface plasmon enhanced auto-fluorescence and Raman spectroscopy for low-level detection of biological pathogens.

The current culture-based bacterial detection technique is time-consuming and requires an extended sample preparation methodology. We propose the potential of surface-enhanced Raman spectroscopy (SERS) and surface plasmon-enhanced auto-fluorescence spectroscopy (SPEAS) for the label-free identification and quantification of bacterial pathogens at low concentrations collecting its unique auto-fluorescence and Raman signatures utilising highly anisotropic three-dimensional nanostructures of silver nano dendrites (Ag-NDs). The SERS data facilitates qualitative bacterial identification using the spectral features coming from the bacterial cell wall compound, and the SPEAS data was utilised to gain unique auto-fluorescence spectra present on the bacterial cell wall with enhanced quantification. The enhancement of Raman and auto-fluorescence signals of Ag-NDs were first evaluated using rhodamine 6g (R6G) as a probe molecule that exhibits a significant enhancement of 106 and limit of detection (LOD) of 10-12 M for SERS and 15 fold intensity enhancement and LOD of 10-15 M for SPEAS measurements. Further, the SERS and SPEAS measurements of bacterial pathogens, such as Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), using the Ag-NDs were recorded, and the results exhibit high auto-fluorescence and Raman signal intensity for both the samples up to 100 cfu/ml for both modalities. The significant photon count and distinct emission range in SPEAS measurements of bacteria enables accurate quantification. Therefore, the comprehensive investigation of plasmonic enhancement of Ag-NDs for SPEAS and SERS techniques provides complementary information about molecules to enable accurate and quick identification and quantification of pathogens.