Non-active Lesions Research Articles

New Approaches in the Classification and Prognosis of Sign Clusters on Pulmonary CT Images in Patients With Multidrug-Resistant Tuberculosis.

Background: To date, radiographic sign clusters of multidrug-resistant pulmonary tuberculosis (MDR-TB) patients have not been reported. We conducted a study to investigate the classification and prognosis of sign clusters in pulmonary Computed Tomography (CT) images from patients with MDR-TB for the first time by using principal component analysis (PCA).Methods: The clinical data and pulmonary CT findings of 108 patients with MDR-TB in the Liupanshui Third Hospital were collected (from January 2018 to December 2020). PCA was used to analyze the sign clusters on pulmonary CT, and receiver operating characteristic (ROC) analysis was used to analyze the predictive value of the treatment outcome of MDR-TB patients.Results: Six cluster signs of MDR-TB were determined by PCA: nodules, infiltration, consolidation, cavities, destroyed lung and non-active lesions. Nine months after treatment, the area under the ROC curve (AUC) of MDR-TB patients with a cavity sign cluster was 0.818 (95% CI: 0.733–0.886), and the positive predictive value (PPV) and negative predictive value (NPV) of the treatment outcome were 79.6% (95% CI: 65.7–89.8%) and 72.9% (95% CI: 59.7–83.6%), respectively.Conclusion: PCA plays an important role in the classification of sign groups on pulmonary CT images of MDR-TB patients, and the sign clusters obtained from PCA are of great significance in predicting the treatment outcome.

Optical Coherence Tomography Angiography Analysis of Retinal and Choroidal Vascular Networks during Acute, Relapsing, and Quiescent Stages of Macular Toxoplasma Retinochoroiditis

Purpose To highlight the advantages of optical coherence tomography angiography (OCTA) in delineating the morphological features of the retinal and choroidal vascular network during acute, relapsing, and quiescent stages of macular toxoplasma retinochoroiditis. Methods This prospective study included patients presenting with both active and quiescent ocular toxoplasmoses. OCTA was obtained to diagnose and follow the subsequent vascular network changes at diagnosis and six months after acute presentation. Results Twenty-three eyes of 23 patients were included. In active lesions, OCTA showed extensive, well-delineated areas of intense hyposignal and perifoveal capillary arcade disruption in the parafoveal superficial capillary plexus (pSCP) and less extensive hyposignal in the parafoveal deep capillary plexus (pDCP). Signals of decreased deep capillary density and disorganization were also seen in the choroid. In nonactive lesions, OCTA demonstrated a homogenous and equally attenuated grayish hyposignal of the pSCP and pDCP and a partial restoration of the nonperfused choroidal areas. Conclusion OCTA is a useful technique for vascular network analysis in toxoplasma retinochoroiditis. It allows the visualization of the different network changes and behaviors during the different stages of the infection.

Audiovestibular symptoms in patients with multiple sclerosis: A correlation between self-reported symptomatology and MRI findings to monitor disease progression

BackgroundsThe interest about audiovestibular symptoms in patients with multiple sclerosis (MS) is recently growing. However, these symptoms can be often underestimated by patients. We aim to evaluate the presence of audiovestibular symptoms in patients with MS as reported by themselves and correlate these symptoms with the different phases of MS. Audiovestibular symptoms, if correlated with relapsing phase could be an indicator of disease progression. MethodsIn this prospective study 80 patients with MS were screened for the presence of audiovestibular symptoms, during their first neurological consultation, using a self-administered questionnaire developed by our research team. Magnetic Resonance Imaging (MRI) scans were performed within a week from the consultation and were compared with scan performed 12-month before, looking for the presence of new active lesions or enlargement of the ones already present. Data on the year of diagnosis, symptom onset, treatment history and expanded disability status scale (EDSS) were collected. Statistical analysis was performed to identify a correlation between audiovestibular symptoms and active lesions in MRI scan. Odds ratio were calculated. Results75% of patients reported audiovestibular symptoms and 37.5% of them had an active or enlarged (compared with previous MRI) lesion/s in their brain MRI scan when they referred to the symptoms’ presence. Active lesion/s in MRI were positively correlated with the presence of audiovestibular symptoms (p = 0.0009). Based on our analysis, patients with active lesions had an increased risk of developing audiovestibular symptoms compared to patients with enlarged but non-active lesions (odds ratio: 4.7). Lesions in the cortex rather than in the medulla (odds ratio: 0.6) or optic nerve (odds ratio:1.6), were more common in patients that developed audiovestibular symptoms. Patients with supratentorial active lesions were more at risk to present audiological symptoms than subjects with the infratentorial lesions (odds ratio: 1.3). ConclusionsAudio-vestibular symptoms can arise in the relapsing phases of MS and their presence may be correlated with an active lesion in the brain. The self-administered questionnaire can be useful both for patients and physicians, to early identify the presence of audiovestibular symptoms that might be related to the progression of the disease.

Detectability of small objects in PET/computed tomography phantom images with Bayesian penalised likelihood reconstruction.

This study investigated the subcentimetre lesion detection gains of a Bayesian penalised likelihood reconstruction (BPLR) (Q.Clear, GE Healthcare, Milwaukee, USA) in PET/computed tomography (CT) phantom images and compares observer performance with ordered subset expectation maximisation (OSEM) reconstruction images (VUE Point HD, GE Healthcare). Images were presented to three blinded experienced observers to identify lesions and assign confidence ratings. Responses were analysed using jackknife alternative free receiver operator characteristic (JAFROC) software. Phantom lesions (active and nonactive) were constructed using putty. Seventy nonactive and 93 (F) active lesions, with diameters of 3, 5 or 7 mm were suspended in active backgrounds at varying contrast ratios (2:1-32:1) within an National Electrical Manufacturers Association 2012 phantom. PET/CT images were acquired with a GE Discovery 710 and reconstructed using both BPLR (penalisation coefficient 400) and high-definition attenuation corrected (HDAC) OSEM (2 iterations, 24 subsets). Small but significant (P = 0.009) visual detection gains were seen for active lesions with BPLR [weighted JAFROC figure of merit (wJAFROC FOM) = 0.77] over OSEM (FOM = 0.74). When split by subset, these improvements were significant for 5 mm and lesion to background ratio of 8:1. No significant (P = 0.514) differences were seen for the identification of nonactive lesions of any size (BPLR FOM = 0.74 and OSEM FOM = 0.73). Significant detection gains were demonstrated for small active lesions with BPLR over OSEM. Coupled with the significant increase in contrast-to-noise ratio, these results support the use of BPLR in the imaging of small active (≤7 mm) lesions but show no improvement with BPLR in the identification of true negative lesions.

Is It Possible to Discriminate Active MS Lesions with Diffusion Weighted Imaging?

Patients with multiple sclerosis (MS) are at a risk of gadolinium deposition because of multiple control imaging. Therefore, it is important to determine biomarkers that can differentiate active and chronic lesions without using contrast agent. This study aimed to assess mean apparent diffusion coefficient (ADC) values and signal intensities (SI) on diffusion weighted imaging (DWI) values of active and nonactive lesions. We included 25 patients in this study. We measured mean ADC values and SI on DWI of the randomly selected active and nonactive lesions and normal appearing white matter (NAWM) for all patients with MS. SI on DWI and ADC values were normalized to the SI of the CSF. We compared all of the measurements between active and nonactive lesions, active lesions and NAWM, and nonactive lesions and NAWM. SI on DWI and mean ADC values of normal healthy white matter (NHWM) of control group were measured. A comparison was made between NHWM and NAWM. For patients with active lesions, the mean nADC value was 0.35±0.06 for active lesions and 0.30±0.07 for nonactive lesions (p>0.050). The mean nDWI-SI value was 3.69±0.68 for active lesions was 3.39±0.68 for nonactive lesions (p<0.050). When patients with and without active lesions were compared, both nDWI values and nADC values for active and nonactive lesions were statistically insignificant (p>0.050). In MS lesions, diffusion alternations can be quantitatively evaluated with ADC mapping. Lesions seen in patients with MS have higher mean ADC values than NAWM and NHWM.

Quantitative Analysis of Apparent Diffusion Coefficient for Disease Assessment in Paediatric Inflammatory Bowel Disease.

The aim of the study was to establish an apparent diffusion coefficient (ADC) cut-off value to classify active and non-active lesions in inflammatory bowel disease. We reviewed 167 paediatric magnetic resonance enterographies executed for suspected inflammatory bowel disease by using a 1.5- and 3-T scanner. We assessed the presence and activity of the disease by using morphologic and functional parameters such as the ADC. Each patient could have more than 1 examinations. Quantitative assessment of disease activity in the ADC map was measured placing 3 regions of interest in the areas of highest inflammation and the mean value was calculated, patients without sign of inflammation were assessed at 2 standardised site. Ileocolonoscopy, esophagogastroduodenoscopy, surgery, and video-capsule endoscopy were used as standards of reference. We enrolled 34 patients and 35 examinations: radiological findings of disease were identified in 29 examinations and 44 lesions were detected. Six patients had negative results and ADC assessment was taken at the terminal ileum and cecum. A total of 56 bowel segments were included in the study. Image analysis revealed 39 active lesions (69.6%) and their ADC values were lower compared to the ones of non-active segments. For each scanner a cut-off value was found (sensitivity: 0.91, specificity: 0.89 for 1.5 T and 0.81 for 3 T). Inter-rater agreement on disease activity between ADC values and magnetic resonance enterography results and between ADC values and the standard of reference were very good. ADC can provide a scanner-based quantitative measurement of disease activity.

Evaluation of the Performance of 18F-Fluorothymidine Positron Emission Tomography/Computed Tomography (18F-FLT-PET/CT) in Metastatic Brain Lesions.

18F-fluorothymidine (18F-FLT) is a radiolabeled thymidine analog that has been reported to help monitor tumor proliferation and has been studied in primary brain tumors; however, knowledge about 18F-FLT positron emission tomography/computed tomography (PET/CT) in metastatic brain lesions is limited. The purpose of this study is to evaluate the performance of 18F-FLT-PET/CT in metastatic brain lesions. A total of 20 PET/CT examinations (33 lesions) were included in the study. Semiquantitative analysis was performed: standard uptake value (SUV) with the utilization of SUVmax, tumor-to-background ratio (T/B), SUVpeak, SUV1cm3, SUV0.5cm3, SUV50%, SUV75%, PV50% (volume × SUV50%), and PV75% (volume × SUV75%) were calculated. Sensitivity, specificity, and accuracy for each parameter were calculated. Optimal cutoff values for each parameter were obtained. Using a receiver operating characteristic (ROC) curve analysis, the optimal cutoff values of SUVmax, T/B, and SUVpeak for discriminating active from non-active lesions were found to be 0.615, 4.21, and 0.425, respectively. In an ROC curve analysis, the area under the curve (AUC) is higher for SUVmax (p-value 0.017) compared to the rest of the parameters, while using optimal cutoff T/B shows the highest sensitivity and accuracy. PVs (proliferation × volumes) did not show any significance in discriminating positive from negative lesions. 18F-FLT-PET/CT can detect active metastatic brain lesions and may be used as a complementary tool. Further investigation should be performed.

Evaluation the FLAIR Sensitivity and DWI Post-inject in Comparison with Delayed Enhancement T1w for Better Detection of Active MS Lesions

Multiple sclerosis (MS) is a chronic, typically progressive and most common autoimmune disease which damaged the central nervous system. According to the reports in 2008, this disorder has affected 2 and 2.5 million people globally. While the reason is not clear, proposed causes for this include immunologic, environmental, infectious and genetic factors, and sexuality. MS can cause many symptoms, including blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, paralysis, blindness, and more. There are four distinguished illness fields in MS: relapsing-remitting MS (RRMS), primary-progressive MS (PPMS), secondary-progressive MS (SPMS), and progressive-relapsing. MRI is a great tool to identify the asymptomatic distribution of lesions in space and time. 32 patients with MS plaques were evaluated by FLAIR and DWI pre- and post-Gadolinium injection compared with 15minutes delay T1w SE. FLAIR post-inject had significantly better detection of the number and signal intensity of active MS lesions. DWI and ADC images detected active plaques different from non-active lesions without contrast. The result of this study showed that FLAIR post-inject had the highest sensitivity in detection of active MS lesions due to the CSF signal suppression in FLAIR, thus offering enough TR time recovery in active enhanced plaques.

Weekly enhanced T1-weighted MRI with Gadobutrol injections in MS patients: Is there a signal intensity increase in the dentate nucleus and the globus pallidus?

Background and PurposeGadolinium-based contrast agents (GBCAs) administration have drastically improved the accuracy of Multiple Sclerosis (MS) diagnosis by highlighting any damage to the brain blood barrier, thereby differentiating between active and non-active lesions. Following multiple administrations of GBCAs, several MS studies have reported a signal intensity (SI) increase on unenhanced T1-weighted images in certain brain regions such as the dentate nucleus (DN) and the globus pallidus (GP). Our aim was therefore to determine the accumulation of macrocyclic GBCAs on enhanced T1-weighted images SI in the DN and the GP of MS patients injected eight times. Materials and MethodsFive MS patients underwent eight weekly consecutive MRI scans. Enhanced 3D T1-weighted images with Gadobutrol as a macrocyclic GBCA, were acquired. A ROI-based approach was applied for the evaluation of SI in the DN to middle cerebellar peduncle (DN-MCP) and GP to semi-oval white matter (GP-SOWM) ratios. An analysis of variance on repeated measures was used for the statistical analysis of each ratio. ResultsNo DN-MCP and GP-SOWM SI ratio differences were observed over the eight-weeks period using the macrocyclic GBCA. ConclusionIterative and weekly injections of macrocyclic GBCAs are not associated with T1 signal increase in the DN and GP of MS patients. These results would suggest a no gadolinium accumulation in the brain using macrocyclic GBCA even after several close injections and promote the use of a macrocylcic GBCA rather than linear agents for MS patients.

Comparison of effects of routine topical treatments in the milking parlor on digital dermatitis lesions

Digital dermatitis (DD), an infectious bacterial disease affecting the feet of dairy cattle, can cause lameness and decrease milk production, fertility, and animal welfare. Current DD treatment typically involves routine hoof trimming and topical antibiotics. Several nonantibiotic commercial topical products are used for controlling DD lesions; however, there is limited or no evidence regarding their effectiveness. The objectives of this study were to evaluate 2 commercially available topical applications on their ability to (1) clinically cure active DD lesions to nonactive lesions and (2) prevent recurrence of active DD lesions. Ten farms were visited weekly. In the milking parlor, the hind feet of lactating cattle were cleaned and scored (M-stage scoring system). Cattle with DD lesions at the first visit were randomly allocated to 1 of 4 treatment groups: positive control (tetracycline solution), HealMax (AgroChem Inc., Saratoga Springs, NY), HoofSol (Diamond Hoof Care Ltd., Intracare BV, Veghel, the Netherlands), and a negative control (saline). All products were applied to lesions using a spray bottle. Tetracycline, HealMax, and HoofSol had a higher probability of clinical cure for active lesions compared with saline 1 wk after the first treatment (wk 1), with 69, 52, and 79% clinical cure of active lesions, respectively, compared with 34% with saline. At wk 7, the probability of clinical cure for active lesions was 10, 33, 31, and 45% of lesions treated weekly with saline, tetracycline, HealMax, and HoofSol, respectively (no difference among treatments). The substantial clinical cure with saline highlighted the potential importance of cleaning feet. In wk 1, treatment with saline, tetracycline, HealMax, and HoofSol resulted in a probability of recurrence of active DD lesions of 9, 11, 11, and 8%, respectively, with no product being superior to saline. After 7 wk, the probability of recurrence of active lesions was 5, 7, 6, and 6% for saline, tetracycline, HealMax, and HoofSol respectively, with no difference among groups in wk 7. These results provide alternatives to antibiotics for treatment of DD lesions and highlight the potential importance of cleaning feet in the milking parlor.

Multimodality imaging features of different properties in multifocal choroiditis

Objective To observe multimodality imaging features of different properties in multifocal choroiditis (MFC). Methods Twenty-eight patients (51 eyes) with MFC were enrolled in this study. There were 10 males and 18 females. The patients aged from 31 to 49 years, with the mean age of (41.5±0.8) years. There were 23 bilateral patients and 5 unilateral patients. All patients underwent best corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus colorized photography, infrared fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) examinations. The lesions were classified as active inflammatory lesion, inactive inflammatory lesion, active choroidal neovascularization (CNV) and inactive CNV. The multimodality imaging features of different properties in MFC was observed. Results In fundus colour photography, the boundaries of active inflammatory lesions were blurry, while inactive inflammatory lesions had relatively clear boundaries. Secondary active CNV showed mild uplift and surrounding retinal edema; Secondary active CNV lesions showed mild uplift, retinal edema around the lesion; Secondary non-active CNV had no retinal exudate edema lesions, but had lesions fibrosis and varying degrees of pigmentation. Infrared fundus examination revealed that both active and inactive inflammatory lesions showed a uniform punctate or sheet-like fluorescence. The fluorescence of CNV lesions was not uniform; there was a bright ring around the strong fluorescence. FAF found that active inflammatory lesions showed weak autofluorescence (AF), surrounded by a strong fluorescence ring; inactive inflammatory lesions showed AF loss. Secondary active CNV lesions showed strong AF with a bright ring along the edge, and obscured fluorescence for co-occurred hemorrhagic edema; secondary non-active CNV lesions were strong AF, surrounded by a weak AF ring. FFA revealed that active inflammatory lesions showed weak fluorescence in the early stage, and fluorescence gradually increased in the late stage with slight leakage. Inactive inflammatory lesions showed typical transmitted fluorescence. Fluorescein leakage secondary to active CNV was significant; lesions secondary to inactive CNV showed scar staining. In OCT, the active inflammatory lesions showed moderately weak reflex signals in the protruding lesions under the retinal pigment epithelium (RPE). The inactive inflammatory lesions showed penetrable RPE defects or choroidal scar, it also showed clear RPE uplift lesions with a strong reflection signal. Secondary active CNV showed subretinal fluid retention; secondary non-active CNV showed RPE defects and choroidal scarring. Conclusions Active inflammatory lesions in MFC have blurred boundary, retinal edema and fluorescein leakage in FFA; inactive inflammatory lesions have clear boundary and typical transmitted fluorescence in FFA, and no retinal edema. Secondary active CNV showed subretinal fluid in OCT; and secondary non-active CNV showed RPE defects and choroidal scarring. Key words: Choroiditis/diagnosis; Fluorescein angiography; Tomography, optical coherence

PET/CT Imaging of Tuberculosis with 68ga-Citrate

Objective: The impact of tuberculosis (TB) on mortality and morbidity is indisputable worldwide and even more so in countries with a high prevalence of Human Immunodeficiency Virus (HIV) co-infection. The development of a non-invasive diagnostic tool that is capable of early and accurate detection, staging and follow-up evaluation of tuberculosis is crucial in minimizing its devastating effects. We evaluated PET/CT imaging with a novel tracer, 68Ga-citrate,in this setting. Methods: Thirteen patients with tuberculosis were included in this prospective pilot study and were imaged with 68Gacitrate. A diagnosis of TB was reached with bacteriological or histopathology studies (n=8) or based on a combination of clinical data, biochemistry and imaging (n=5). PET images were acquired at 60 minutes (and 120 minutes where possible) and analyzed qualitatively (relative to the liver) and semi-quantitatively (using SUVmax and change in SUVmax). PET findings were also compared to that of CT. Results: All 13 patients demonstrated abnormal tracer accumulation in the lungs or extra-pulmonary or both. 68Ga-citrate accumulated in every lung lesion noted on CT in six cases (46%). In seven cases (54%) some of the lung lesions noted on CT were not 68Ga-citrate avid, which is suggestive of non-active tuberculosis lesions. Ten patients (77%) demonstrated extrapulmonary involvement, which included various lymph node groups, skeletal lesions, pleural-, splenicand gastro-intestinal tract involvement. More extra-pulmonary lesions were detected on PET compared to CT in eight cases (80%). The results of dual-time point imaging varied significantly amongst study participants. Conclusion: Pulmonary and extra-pulmonary tuberculosis lesions demonstrate 68Ga-citrate accumulation; with more extrapulmonary lesions detected on PET compared to CT. 68Ga-citrate PET may also provide a way of distinguishing active from inactive lesions for treatment response evaluation.

AB0708 Differences in Localization and Activity of the Entheseal Involvement between Non-Radiographic and Radiographic Axial Spondyloarthritis by the Ultrasound Assessment

BackgroundPeripheral entheseal involvement seems to be an important sign of spondyloarthritis (SpA). It may occur in patients with long-term as well as newly diagnosed disease and in those with definite...

Use of color Doppler ultrasonography for evaluating vascularity of small intestinal lesions in Crohn's disease: correlation with endoscopic and surgical macroscopic findings

Objective. Ultrasonography (US) is a simple, inexpensive and minimally invasive method. We evaluated the vascularity of small intestinal lesions in Crohn's disease using color Doppler US (CD-US) and retrospectively compared them with endoscopic and surgical macroscopic findings. Material and methods. In order to compare CD-US and endoscopic findings, 108 Crohn's disease patients who underwent examination of the terminal ileum by both colonoscopy and CD-US were included in the study. Vascularity was evaluated in CD-US using a semiquantitative method, the Limberg score. We analyzed correlations between Limberg score and simple endoscopic score for Crohn's disease (SES-CD), an index reflecting endoscopic activity. Scores of SES-CD 3 and higher were defined as endoscopically active. For comparison with surgical macroscopic findings, 22 Crohn's disease patients who received CD-US and subsequent iliectomies were included. Lesions with apparent open ulcers were defined as active, and those without as non-active. These findings were compared with the Limberg score. Results. A substantial positive correlation was observed between Limberg scores and SES-CD (ρ = 0.709 [p < 0.001]). Notably, all 27 cases with a Limberg score of 3 or 4 were classified as endoscopically active. Compared to surgical macroscopic activity, Limberg scores of active lesions were significantly higher than those of non-active lesions (p = 0.005). In particular, all 11 cases with a Limberg score of 3 or 4 were classified as active lesions. Conclusion. Vascularity of small intestinal lesions of Crohn's disease evaluated by CD-US with Limberg score is well correlated with endoscopic and surgical macroscopic findings.

Diffusion‐weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease

Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated. To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement. Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. Seventeen patients (54.8%) had active CD as defined by the MaRIA score ≥7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P = 0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6 × 10(-3) mm(2)/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (κ = 0.69, accuracy rate = 85.7%) and ADC (correlation = 0.74, P < 0.001, and concordance = 0.71, P < 0.001). DWI-MR enterography is a well-tolerated, non-time-consuming and accurate tool for detecting and assessing inflammation in small bowel Crohn's disease.

Cerebral vein changes in relapsing-remitting multiple sclerosis demonstrated by three-dimensional enhanced T 2 * -weighted angiography at 3.0 T

To investigate characteristics of the internal cerebral veins (ICVs) and their main tributaries and the deep medullary veins (DMVs) in patients with relapsing-remitting MS (RRMS) with enhanced T (2)-weighted angiography imaging (ESWAN). Fifty-three RRMS patients and 53 normal controls underwent conventional MRI and ESWAN. ESWAN venograms were created by performing minimum intensity projections of the phase images, and the resulting venograms were used to observe characteristic vascular changes, including scores of the ICVs and their main tributaries and manifestations of the DMVs. Two experienced radiologists analysed all data. Patients showed decreased mean scores of the ICVs and their main tributaries compared with controls. The mean score in acute patients was higher than in stable patients. Furthermore, the DMVs diminished and shortened in 48 patients with longer disease duration, whereas the DMVs increased and elongated in 5 patients with shorter disease duration. The penetrating veins were well defined in 30 active lesions, whereas the veins were ill defined in 69 non-active lesions. Interestingly, well-defined penetrating veins were shown in 15 non-active lesions in the stable patients. Enhanced T (2)-weighted MR angiography can detect cerebral vein characteristics in relapsing-remitting MS patients, which may provide important information on the pathogenesis of MS.

Affective psychosis, Hashimoto's thyroiditis, and brain perfusion abnormalities: case report

BackgroundIt has recently become evident that circulating thyroid antibodies are found in excess among patients suffering from mood disorders. Moreover, a manic episode associated with Hashimoto's thyroiditis has recently been reported as the first case of bipolar disorder due to Hashimoto's encephalopathy. We report a case in which Hashimoto's thyroiditis was suspected to be involved in the deteriorating course of mood disorder and discuss potential pathogenic mechanisms linking thyroid autoimmunity with psychopathology.Case presentationA 43-year-old woman, with a history of recurrent depression since the age of 31, developed manic, psychotic, and soft neurological symptoms across the last three years in concomitance with her first diagnosis of Hashimoto's thyroiditis. The patient underwent a thorough medical and neurological workup. Circulating thyroperoxidase antibodies were highly elevated but thyroid function was adequately maintained with L-thyroxine substitution. EEG was normal and no other signs of current CNS inflammation were evidenced. However, brain magnetic resonance imaging evidenced several non-active lesions in the white matter from both hemispheres, suggestive of a non-specific past vasculitis. Brain single-photon emission computed tomography showed cortical perfusion asymmetry particularly between frontal lobes.ConclusionWe hypothesize that abnormalities in cortical perfusion might represent a pathogenic link between thyroid autoimmunity and mood disorders, and that the rare cases of severe Hashimoto's encephalopathy presenting with mood disorder might be only the tip of an iceberg.

Usefulness of Fractional Flow Reserve in Multivessel Coronary Artery Disease with Intermediate Lesions

Calculation of myocardial fractional flow reserve (FFR) enables coronary stenoses to be evaluated. We determined the usefulness of measuring the FFR in multivessel coronary artery disease, reflected in changes in the therapeutic options for patients with moderate coronary stenosis. We studied 38 patients (30 men, 8 women; mean age: 59.8+/-10 years) with multivessel coronary artery disease with 41 moderate lesions. Indications for coronary angiography were unstable angina in 24 patients (60%), acute myocardial infarction in 10 (27%), and stable angina in 4 (13%). We studied the FFR (in nonactive lesions) in the left anterior descending artery in 23 patients (56%), the left coronary trunk in 8 (19.5%), the circumflex artery in 5 (12.2%), the right coronary artery in 3 (7.3%), and the left internal mammary artery and diagonal branch in 1 patient each. Twelve patients had a positive FFR, which resulted in no change in the mode of revascularization; 26 patients had a negative FFR, in 20 (77%) of whom the revascularization approach was changed, especially those with moderate lesions of the left coronary trunk or anterior descending artery. No differences were detected in the angiographic characteristics of the lesions examined. Cardiac events during follow-up were few. The results of FFR may influence the decision-making process after diagnostic coronary angiography in multivessel coronary artery disease with moderate lesions, especially in patients with a negative FFR in nonculprit lesions of the left trunk or left anterior descending artery.

Endothelin-1 and endothelin converting enzyme-1 in human atherosclerosis--novel targets for pharmacotherapy in atherosclerosis.

The role of chronic inflammation in the pathogenesis of the acute coronary syndromes has received increasing attention since active plaques rich in macrophages (Mphi's) are more prone to rupture whereas plaques rich in myofibroblasts are considered to be stable. Functionally, active plaques show a locally enhanced vasoreactivity. Endothelin-1 (ET-1) a potent vasoconstrictor acts in a paracrine fashion to regulate vascular tone. ET-1 is also produced by inflammatory cells suggesting a role for ET-1 in inflammation. Additionally, ET-1 is a mitogen. Endothelin converting enzyme-1 (ECE-1) activates ET-1 and may thus contribute to the regulation of vascular tone and cell growth during atherosclerosis. We evaluated the presence of ECE-1 and big ET-1/ET-1 and the activity of ECE-1 in different plaque types. Together with ET-1, ECE-1 is present in endothelial cells (ECs), vascular smooth muscle cells (VSMCs) and Mphi's. ECE-1 activity and ET-1-immunoreactivity (IR) both are upregulated during the progression of atherosclerosis from a non-inflammatory to an inflammatory stage. Thus, enhanced production of active ET-1 may contribute to cell growth and regulation of vascular tone in advanced plaques and also in very early stages of atherosclerosis. Furthermore, we examined the presence of ET-1 in coronary plaque tissue obtained by directional coronary atherectomy. ET-1 IR localized to plaque components indicative of chronic inflammation. Semiquantitative analysis of ET-1 IR revealed significantly higher staining grades in active coronary lesions compared with nonactive lesions. The increased ET-1 content in active coronary lesions may be beneficial to the stabilization of the vessel wall after plaque rupture and disadvantageous because it may lead to vasospasm and to the progression of atherosclerosis.

Distinct patterns of active and non-active plaques using texture analysis on brain NMR images in multiple sclerosis patients: preliminary results

The benefits of texture analysis of magnetic resonance images have been assessed in multiple sclerosis (MS) patients. Out of thirty-two lesions identified in eight MS patients, nine were considered active, judging from their gadolinium uptake. Texture analysis allowed to obtain forty-two characterizing parameters for each lesion. Using discriminant analysis as a statistical method allowed to classify the lesions into two groups: active or non-active. An attempt to classify their level of activity by using only co-occurrence matrices was unsuccessful. Alternately, the same type of analysis performed on runlength analysis criteria allowed the accurate classification of 88% of active lesions and 96% of non-active lesions. Using incremental discriminate analysis can reduce the number of useful parameters. This method showed that among the 42 parameters, 8 only were highly significant and permitted an accurate classification. Five of these parameters are runlength parameters, and three others are more directly related to the global distribution. The main interest of runlength parameters is that they allowed to demonstrate that the lesion structure was different in active and non-active plaques. This preliminary work suggests that using texture analysis could be of interest in the follow-up of MS patients because it provides an opportunity to identify active lesions without frequent gadolinium injections.