Signal Intensity In T2-weighted Images Research Articles

Neurobiological origin of spurious brain morphological changes: A quantitative MRI study.

The high gray‐white matter contrast and spatial resolution provided by T1‐weighted magnetic resonance imaging (MRI) has made it a widely used imaging protocol for computational anatomy studies of the brain. While the image intensity in T1‐weighted images is predominantly driven by T1, other MRI parameters affect the image contrast, and hence brain morphological measures derived from the data. Because MRI parameters are correlates of different histological properties of brain tissue, this mixed contribution hampers the neurobiological interpretation of morphometry findings, an issue which remains largely ignored in the community. We acquired quantitative maps of the MRI parameters that determine signal intensities in T1‐weighted images (R 1 (=1/T1), R 2*, and PD) in a large cohort of healthy subjects (n = 120, aged 18–87 years). Synthetic T1‐weighted images were calculated from these quantitative maps and used to extract morphometry features—gray matter volume and cortical thickness. We observed significant variations in morphometry measures obtained from synthetic images derived from different subsets of MRI parameters. We also detected a modulation of these variations by age. Our findings highlight the impact of microstructural properties of brain tissue—myelination, iron, and water content—on automated measures of brain morphology and show that microstructural tissue changes might lead to the detection of spurious morphological changes in computational anatomy studies. They motivate a review of previous morphological results obtained from standard anatomical MRI images and highlight the value of quantitative MRI data for the inference of microscopic tissue changes in the healthy and diseased brain. Hum Brain Mapp 37:1801–1815, 2016. © 2016 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc.

Scrutinizing brain magnetic resonance imaging patterns in Angelman syndrome.

Global developmental delay, lack of speech, and severe epilepsy are the characteristic hallmarks of Angelman syndrome (AS). The purpose of this study was to explore the utility of brain magnetic resonance imaging (MRI) as an ancillary tool for the diagnosis of AS. Brain MRI images of nine laboratory-confirmed patients with AS from a neurorehabilitation center in Rio de Janeiro were reviewed. Each MRI was assessed by a set of two experienced neuroradiologists following a predefined protocol. The main neuroimaging findings revealed in our study were: Thinning of the corpus callosum in five patients; enlargement of lateral ventricles in four patients; and, cerebral atrophy with frontal and temporal predominance in one patient. All patients presented with an increased signal intensity in T2-weighted images and fluid-attenuated inversion recovery (FLAIR) sequences. The lack of specific changes in the brain MRI of children with AS observed in this case series rendered brain MRI a less helpful complementary test. Thus, a definitive diagnosis of AS could only be established on molecular biology that was undertaken based on the clinical suspicion of AS.

Sarcoma uterino frente a adenocarcinoma: ¿es posible distinguirlos mediante resonancia magnética?

ObjectiveTo analyze the MRI characteristics of uterine sarcomas (mainly carcinosarcomas) and to compare them with those of adenocarcinomas to define the findings that would be useful for the differential diagnosis. Materials and methodsWe retrospectively reviewed the MRI studies of 13 patients with histologically diagnosed uterine sarcoma. We analyzed tumor size, signal in T2-weighted, unenhanced and gadolinium-enhanced T1-weighted, and diffusion-weighted sequences. We compared the data obtained with those of another series of 30 consecutive cases of adenocarcinomas studied with MRI. ResultsThe sarcomas (> 9cm in 77% of cases) were considerably larger than the adenocarcinomas (p<0.001). There were no differences in FIGO staging by MRI or surgery: both tumor types were diagnosed in early stages. The signal intensity in T2-weighted images differed significantly between the two tumor types: all the sarcomas were heterogeneous and predominantly hyperintense with respect to the myometrium in T2-weighted sequences (p<0.001). In postcontrast studies, all the sarcomas showed enhancement greater than or equal to the myometrium; this finding was significantly different from the adenocarcinomas (p<0.001). In diffusion-weighted sequences, we found no significant differences in ADC values in the areas with greatest restriction, but the ADC map was more heterogeneous in the sarcomas. ConclusionUterine sarcomas do not have specific characteristics on MRI, but some findings can indicate the diagnosis. In our study, we found significant differences between sarcomas and adenocarcinomas. Sarcomas were larger, had more hyperintense and heterogeneous signal intensity in T2-weighted sequences, and enhanced more than or at least as much as the myometrium.

Irreversible electroporation of hepatocellular carcinoma: preliminary report on the diagnostic accuracy of magnetic resonance, computer tomography, and contrast-enhanced ultrasound in evaluation of the ablated area.

Irreversible electroporation (IRE) is a new ablation modality. Our purpose was to describe the effectiveness and the safety of the treatment and to evaluate the magnetic resonance imaging (MRI), computed tomography (CT) and contrast-enhanced ultrasound (CEUS) diagnostic accuracy in HCC patients treated with IRE at 1-, 3-, and 6-month follow-up. In an 18-month period, we treated 24 HCC lesions in 20 patients unfit for surgery. MRI, CT and CEUS were performed before and one, 3 and 6 month after IRE. We employed the liver-specific contrast medium Primovist (gadolinium ethoxybenzyl dimeglumine) in MRI. After IRE the lesions were classified as responders or non-responders to the treatment according to the mRECIST and the complications were recorded. We evaluated the size, shape, signal intensity (T1-W, T2-W, and DWI) in MRI, dynamic contrast enhancement pattern for CEUS, CT and MRI and signal behavior during the liver-specific phase for MRI. According to mRECIST, at 1 month MRI and CEUS showed a complete response (CR) in 91.7% of cases (22/24) tumors, while there was partial response (PR) in the remaining 2/24 (8.3%) treated nodules; in CT study all ablated zone appeared as necrotic (CR 100%). The residual viable tumor in MRI and in CEUS study had similar diameter (10 mm). No new HCC were identified from MRI, CT or CEUS. At 3 months MRI and CEUS showed the same results seen after 1 month from the treatment. Twenty-two necrotic lesions, and 2 residual tumors were found (CR = 91.7% and PD = 8.3%). In MRI study the two cases of residual tumor tissue had a diameter of 11 and 12 mm each. At CEUS the diameter of residual HCC was similar to the diameter at 1 month. CT showed 23 necrotic areas and one residual viable tissue in the treated zone, with a diameter of 10 mm (CR = 95.3% and PD = 4.7%). No new foci of HCC were identified from all imaging studies. At 6 months MRI, CEUS, and CT showed 22 necrotic lesions and 2 residual tumors in ablated zone (CR = 91.7% and PD = 8.3%). At MRI the diameters of the two residual viable HCCs were 12 and 14 mm, at CEUS the diameters were 11 and 12 mm, while at CT the diameters were 10 and 10 mm. No statistical difference was evaluated between CR, PR, PD percentage values for MRI, CT and CEUS (p value > 0.05 at Chi-square test). No major vascular complication was recorded after IRE. Six out of 20 patients (30%) showed a transient hepatic intensity difference (THID) area within the normal liver parenchyma adjacent to the treated lesions. Two of the 20 patients (10%) showed an absent concentration of liver-specific contrast medium around the ablation zone. Two patients developed complications, consisting in a peripheral arteriovenous shunt and a segmental dilation of the intrahepatic biliary ducts. We found no statistically significant difference in morphology, size (variation in the largest diameter), signal intensity in T1-weighted images, in T2-weighted images, in DWI and in the related map of the apparent diffusion coefficient (ADC), presence or absence of contrast enhanced during the arterial, portal, and late phase in MRI, CT, and CEUS, and signal characteristic during the liver-specific phase in MRI of the ablation zone at 1, 3, and 6 months. IRE is a feasible, safe and efficient modality in the treatment of patients with non-resectable HCC. We had no major complication, even when the ablated lesion was adjacent to major branches of the portal vein. All images techniques showed similar accuracy during the follow-up at 1, 3, and 6 months in the assessment ablated zone.

Capsular Contracture after Calf Augmentation with Silicone Implant Insertion.

Capsular Contracture after Calf Augmentation with Silicone Implant Insertion.

The use of magnetic resonance imaging in predicting the clinical outcome of spinal arteriovenous fistula.

PurposeMagnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF.Materials and MethodsA total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS).ResultsPatients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2±3.1 vs. 1.0±1.4, p=0.001, Wilcoxon ranked test).ConclusionThe number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.

Myocardial tissue characterization in Chagas' heart disease by cardiovascular magnetic resonance.

BackgroundChagas’ heart disease is an important public health problem in South America. Several aspects of the pathogenesis are not fully understood, especially in its subclinical phases. On pathology Chagas’ heart disease is characterized by chronic myocardial inflammation and extensive myocardial fibrosis. The latter has also been demonstrated by late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). In three clinical phases of this disease, we sought to investigate the presence of LGE, myocardial increase in signal intensity in T2-weighted images (T2W) and in T1-weighted myocardial early gadolinium enhancement (MEGE), previously described CMR surrogates for myocardial fibrosis, myocardial edema and hyperemia, respectively.MethodsFifty-four patients were analyzed. Sixteen patients with the indeterminate phase (IND), seventeen patients with the cardiac phase with no left ventricular systolic dysfunction (CPND), and twenty-one patients with the cardiac phase with left ventricular systolic dysfunction (CPD). All patients underwent 1.5 T CMR scan including LGE, T2W and MEGE image sequences to evaluate myocardial abnormalities.ResultsLate gadolinium enhancement was present in 72.2 % of all patients, in 12.5 % of IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). Myocardial increase in signal intensity in T2-weighted images (T2W) was present in 77.8 % of all patients, in 31.3 % of the IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). T1-weighted myocardial early gadolinium enhancement (MEGE) was present in 73.8 % of all patients, in 25.0 % of the IND, 92.3 % of the CPND and 94.1 % of the CPD (p < 0.0001). A good correlation between LGE and T2W was observed (r = 0.72, and p < 0.001).ConclusionsIncrease in T2-weighted (T2W) myocardial signal intensity and T1-weighted myocardial early gadolinium enhancement (MEGE) can be detected by CMR in patients throughout all phases of Chagas’ heart disease, including its subclinical presentation (IND). Moreover, those findings were parallel to myocardial fibrosis (LGE) in extent and location and also correlated with the degree of Chagas’ heart disease clinical severity. These findings contribute to further the knowledge on pathophysiology of Chagas’ heart disease, and might have therapeutic and prognostic usefulness in the future.

Multiparametric Magnetic Resonance Imaging Characteristics of Prostate Tuberculosis

ObjectiveTo describe the multiparametric magnetic resonance imaging (MRI) appearance of prostate tuberculosis.Materials and MethodsSix patients with prostate tuberculosis were analyzed retrospectively. The mean age of the patients was 60.5 years (range, 48-67 years). The mean prostate specific antigen concentration was 6.62 ng/mL (range, 0.54-14.57 ng/mL). All patients underwent a multiparametric MRI examination.ResultsThe histopathological results were obtained from biopsies in four men and from transurethral resection of the prostate in two men after the MRI examination. Nodular (33%, 2/6 patients) and diffuse lesions (67%, 4/6 patients) were seen on MRI. The nodular lesions were featured by extremely low signal intensity (similar to that of muscle) on T2-weighted imaging (T2WI). The T2WI signal intensity of the diffuse lesions was low but higher than that of muscle, which showed high signal intensity on diffusion weighted imaging and low signal intensity on an apparent diffusion coefficient map. MR spectroscopic imaging of this type showed a normal-like spectrum. Abscesses were found in one patient with the nodular type and in one with the diffuse type.ConclusionThe appearance of prostate tuberculosis on MRI can be separated into multiple nodular and diffuse types. Multiparametric MRI may offer useful information for diagnosing prostate tuberculosis.

Use of enhanced T2 star-weighted angiography (ESWAN) and R2* values to distinguish ovarian cysts due to endometriosis from other causes.

To evaluate the feasibility of enhanced T2 star-weighted angiography (ESWAN) in differentiating endometrial from non-endometrial cysts. Forty-nine patients with 60 histopathologically proven ovarian cystic lesions underwent pelvic MRI including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), liver acquisition with volume acceleration, and ESWAN. Ovarian cystic lesions were divided into endometrial cysts (group 1; n = 28), pyosalpinx and hydrosalpinx (group 2; n = 13), and ovarian cystic and cystic-solid tumors (group 3; n = 19). R2* (effective transverse relaxation rate) values were measured and pairwise comparison of the R2* values among the three groups was made using Kruskal-Wallis test. Receiver operating characteristic curves were used to calculate cutoff values and performance of R2* values for distinguishing among groups. T1WI signal intensity and R2* value were also compared using area under curve values. R2* values for group 1 were statistically higher than groups 2 and 3 (15.37, 1.40, and 1.79 Hz, respectively; P < 0.001). The cutoff value for R2* was 7.43 Hz with a sensitivity, specificity, PPV, NPV, and accuracy of 96.43, 87.50, 87.10, 96.55, and 91.67%, respectively. There was no significant difference between the R2* value and T1WI in diagnosing endometrial cysts. The R2* value provides an effective way to discriminate endometrial cysts from other ovarian cystic lesions.

MP7-09 DIFFUSION-WEIGHTED MRI FOR ASSESSING THE RESPONSE OF MUSCLE-INVASIVE BLADDER CANCER TO CHEMORADIOTHERAPY

You have accessJournal of UrologyImaging/Radiology II1 Apr 2014MP7-09 DIFFUSION-WEIGHTED MRI FOR ASSESSING THE RESPONSE OF MUSCLE-INVASIVE BLADDER CANCER TO CHEMORADIOTHERAPY Soichiro Yoshida, Fumitaka Koga, Hiroshi Tanaka, Shiro Satoh, Yasukazu Nakanishi, Toshiki Kijima, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Yasuhisa Fujii, and Kazunori Kihara Soichiro YoshidaSoichiro Yoshida More articles by this author , Fumitaka KogaFumitaka Koga More articles by this author , Hiroshi TanakaHiroshi Tanaka More articles by this author , Shiro SatohShiro Satoh More articles by this author , Yasukazu NakanishiYasukazu Nakanishi More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.332AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate assessment of the response to chemoradiotherapy (CRT) is an essential part of bladder-sparing therapeutic protocols against muscle-invasive bladder cancer (MIBC). However, conventional imaging studies are not useful to evaluate the therapeutic response because of the inability to distinguish residual cancer from changes secondary to the treatment. Diffusion-weighted MRI (DWI) is a functional imaging technique that derives image contrast from differences in the motion of water molecules in tissues. We prospectively investigated the ability of DWI to predict the therapeutic response to CRT for MIBC. METHODS From November 2007 to July 2012, 70 MIBC patients (T2/T3/T4a: n = 37/30/3) who underwent induction CRT comprised of radiotherapy (40 Gy) concomitant with 2 cycles of cisplatin (20 mg/day for 5 days) followed by partial (n = 41) or radical cystectomy (n = 29) were prospectively enrolled in this study. Four to 6 weeks after completion of CRT, the patients were examined using 1.5T MRI (Intera Achieva; Philips) with a 4-channel SENSE body coil including T2-weighted imaging (T2WI) and DWI. Bladder wall thickening in T2WI and high signal intensity with a b-value of 1000 mm2/s in DWI were assigned to positive findings. Two radiologists who were blinded to the clinical data independently interpreted the images. The results of each protocol were compared using the pathological results of the cystectomy specimen. RESULTS Overall, pathological examination of the cystectomy specimens revealed a pathologically complete response (pCR) in 47 patients (67%). Both reviewers predicted pCR in 41 patients (87%) using DWI, which was more accurate than that using T2WI. The sensitivity/specificity/accuracy of T2WI and DWI in detecting residual disease was 57/57/57% and 70/87/80% for reviewer 1, respectively, and 70/66/67% and 65/87/80% for reviewer 2, respectively. Despite comparable sensitivity, DWI was significantly superior in specificity and accuracy to T2WI (p = 0.003 and 0.002 for reviewer 1 and p = 0.002 and 0.023 for reviewer 2). 4 (57%) of 7 and 4 (50%) of 8 patients whose residual disease was not detected on DWI by reviewer 1 and reviewer 2, respectively, were cancers smaller than 5 mm. CONCLUSIONS DWI is superior compared to T2WI in assessing therapeutic response to CRT for MIBC. The high DWI specificity indicates that DWI is useful for accurately predicting pCR, and thus non-invasively allowing more optimal patient selection for bladder-sparing protocols. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e68-e69 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Soichiro Yoshida More articles by this author Fumitaka Koga More articles by this author Hiroshi Tanaka More articles by this author Shiro Satoh More articles by this author Yasukazu Nakanishi More articles by this author Toshiki Kijima More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Noboru Numao More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Ovarian Sertoli–Leydig cell tumors: MRI findings and pathological correlation

BackgroundTo investigate the magnetic resonance imaging (MRI) characteristics of ovarian Sertoli-Leydig cell tumors (SLCT).MethodsThe clinical, MRI and pathological findings of five cases of SLCT were reviewed retrospectively. MRI appearances of tumors including laterality, shape and size, architecture, wall, septa and vegetation, signal intensity and contrast-enhancement pattern were evaluated and correlated with pathological findings.ResultsTwo tumors were solid which appeared as low signal intensity on T1-weighted imaging (T1WI) and moderate on T2-weighted imaging (T2WI) with multiple small cysts in one of them. The remaining three SLCT were multilocular cystic with the irregularly thickened wall and septa, and with solid area and mural nodules in one of them. The cystic components had the same signal intensity as urine. All the solid components were intensely enhanced after administration of contrast medium. All five tumors were pathologically intermediate differentiation and at FIGO stage I.ConclusionsSLCT demonstrate variable MRI morphological appearances. However, the irregularly thickened wall and septa, the moderate T2WI signal intensity and obvious enhancement in the solid components are three MRI features.

Prognostic significance of whole-body MRI in patients with monoclonal gammopathy of undetermined significance

Radiological skeletal survey or computed tomography are currently applied to assess bone diseases in patients with monoclonal plasma cell disorders. Whole-body magnetic resonance imaging (whole-body MRI) allows detecting the infiltration of clonal cells in nearly the whole bone marrow compartment even before bone destruction has occurred. Those MRI results (i.e., patterns of bone marrow infiltration) have been demonstrated to be of prognostic significance in patients with symptomatic as well as asymptomatic multiple myeloma. We have therefore analyzed the findings of whole-body MRI in 137 consecutive individuals with monoclonal gammopathy of undetermined significance (MGUS). A focal infiltration pattern was detected in 23.4% of patients. Presence and number of focal lesions as well as value of M-Protein were of independent prognostic significance for progression into a symptomatic disease requiring systemic treatment (P=0.02; P<0.0001 and P=0.0005, respectively). Lower homogeneous signal intensities in T1-weighted images were related to a physiologically higher bone marrow cellularity in younger individuals (P=0.002). We conclude that whole-body MRI identifies patients with focal accumulations of presumably monoclonal cells in bone marrow with prognostic impact concerning the risk of progression into symptomatic disease.

Quantitative MRI and ultrastructural examination of the cuprizone mouse model of demyelination

The cuprizone mouse model of demyelination was used to investigate the influence that white matter changes have on different magnetic resonance imaging results. In vivo T2 -weighted and magnetization transfer images (MTIs) were acquired weekly in control (n = 5) and cuprizone-fed (n = 5) mice, with significant increases in signal intensity in T2 -weighted images (p < 0.001) and lower magnetization transfer ratio (p < 0.001) in the corpus callosum of the cuprizone-fed mice starting at 3 weeks and peaking at 4 and 5 weeks, respectively. Diffusion tensor imaging (DTI), quantitative MTI (qMTI), and T1/T2 measurements were used to analyze freshly excised tissue after 6 weeks of cuprizone administration. In multicomponent T2 analysis with 10 ms echo spacing, there was no visible myelin water component associated with the short T2 value. Quantitative MTI metrics showed significant differences in the corpus callosum and external capsule of the cuprizone-fed mice, similar to previous studies of multiple sclerosis in humans and animal models of demyelination. Fractional anisotropy was significantly lower and mean, axial, and radial diffusivity were significantly higher in the cuprizone-fed mice. Cellular distributions measured in electron micrographs of the corpus callosum correlated strongly to several different quantitative MRI metrics. The largest Spearman correlation coefficient varied depending on cellular type: T1 versus the myelinated axon fraction (ρ = -0.90), the bound pool fraction (ƒ) versus the myelin sheath fraction (ρ = 0.93), and axial diffusivity versus the non-myelinated cell fraction (ρ = 0.92). Using Pearson's correlation coefficient, ƒ was strongly correlated to the myelin sheath fraction (r = 0.98) with a linear equation predicting myelin content (5.37ƒ - 0.25). Of the calculated MRI metrics, ƒ was the strongest indicator of myelin content, while longitudinal relaxation rates and diffusivity measurements were the strongest indicators of changes in tissue structure.

Characteristic MRI findings of sarcomatoid renal cell carcinoma dedifferentiated from clear cell renal carcinoma: radiological–pathological correlation

PurposeTo evaluate MRI findings of sarcomatoid renal cell carcinoma (SRCC). Material and MethodsEleven patients with pathologically proven SRCC dedifferentiated from clear cell renal carcinoma (CCRC) underwent preoperative renal MRI. The MRI findings were compared with histological findings. On MRI, the following findings were evaluated: the presence and distribution of areas showing heterogeneous iso to high signal intensity (SI) on T2-weighted images (T2HIA) and conspicuously low SI areas (T2LIA) compared to normal renal cortex, areas showing high SI on T1-weighted images and unenhanced areas on dynamic contrast-enhanced images, disruption of pseudocapsule, and the SIs of T2HIA and T2LIA on diffusion-weighted imaging (DWI). The apparent diffusion coefficient (ADC) values and SI ratios to muscle on dynamic contrast-enhanced imaging (DCE) were compared between T2HIA and T2LIA using the t test. ResultsThe distribution of T2HIA and T2LIA was as follows: a mixed pattern alone in five, nodular T2LIA pattern alone in one, both mixed and nodular T2LIA patterns in four, and a separated pattern in one. Disruption of the pseudocapsule was seen in all cases. The imaging findings suggesting intratumoral hemorrhage and necrosis were seen in 18% and 63%, respectively. The SIs of T2HIA and T2LIA were low intermediate and high on DWI, respectively. T2LIA and T2HIA corresponded to the components of SRCC with abundant fibrosis and CCRC, respectively. T2LIA showed significantly lower enhancement at all DCE phases and a lower ADC value than T2HIA. ConclusionThe presence of T2LIA corresponding to the area showing a hypovascular nature and markedly restricted diffusion might be characteristic findings of SRCC. Intratumoral hemorrhage and necrosis were seen, but they were not specific findings.

Resveratrol Has Anabolic Effects on Disc Degeneration in a Rabbit Model

This study was done to evaluate whether injections of resveratrol, a natural compound found in the skin of grapes, had anabolic effects on degenerated intervertebral discs in a rabbit model. Two non-continuous lumbar discs were punctured in rabbits to induce disc degeneration. Four weeks and 6 weeks after puncture, the rabbits were treated by injections with dimethylsulfoxide (DMSO) or resveratrol. At 4, 8, and 16 weeks after initial injection, rabbits were sacrificed and the spine was extracted for magnetic resonance image (MRI), mRNA expression, and histological staining. Resveratrol treatment resulted in stronger signal intensity in T2-weighted images. MRI grade showed significantly lower in the resveratrol group than the DMSO group (P = 0.039). In the resveratrol group, aggrecan gene expression was significantly increased than that in the DMSO group at 16 weeks after injection (P = 0.027). MMP-13 mRNA levels in the resveratrol group were significantly decreased than those in the DMSO group at 8 and 16 weeks (P = 0.006 and P = 0.048, respectively). In hematoxylin and eosin stain, resveratrol-treated discs showed the features of regeneration. Histologic grade revealed improvement in resveratrol-treated discs, compared with DMSO-treated discs (P = 0.024). These anabolic effects on degenerated discs indicate that resveratrol is a promising candidate for treatment of degenerative disc disease.

A Case of Sjögren's Syndrome Associated with Neuromyelitis Optica

Neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating disease, characterized by optic neuritis and myelitis. NMO is a very uncommon and serious neurologic manifestation of Sjogren's syndrome. We report on a 32-year-old female with NMO as central nerve system involvement of Sjogren’s syndrome. She had a transverse myelitis ten years ago and did not have symptoms for a long period of time. She visited the emergency center because of worsening weakness of both limbs. She had an appendectomy three days ago before hospitalization. Cervical spinal magnetic resonance imaging showed increased signal intensity in T2-weighted images from the cervical (C2) to the upper thoracic (T4) spinal cord. As serum NMO-IgG was positive, we diagnosed neuromyelitis optica and treated with high dose steroid, but failed. Therefore, we treated with plasmapheresis and the patient was discharged without any neurological deficits.

Acute hydrocephalus following heroin induced leukoencephalopathy

Heroin-induced leukoencephalopathy is a rare complication of heroin intoxication, and always presents as hypoxic ischemic leukoencephalopathy with periventricular white matter edema and spongiform leukoencephalopathy in cerebral and cerebellar white matter [1, 2]. Acute hydrocephalus following toxic leukoencephalopathy has been reported in carbon monoxide and methadone intoxication [3, 4]. However, acute hydrocephalus following heroininduced leukoencephalopathy has not been previously reported. On 14 April 2011, a 37-year-old man found in a hotel presented to our hospital after 1 day of unconsciousness. The rubbish can in the man’s hotel room contained an empty syringe, and there were several needle holes in his forearm. Physical examination showed neck rigidity. Glasgow score on admission was 7/15 (E = 1/4, V = 3/5, M = 3/6). His personal and family history was negative for diabetes, seizure disorders, alcohol abuse, and vascular risk factors. There was no evidence of carbon monoxide poisoning. Hematological and biochemical examinations including hepatitis B, C virus and HIV serology were normal except for high levels of blood creatine kinase (847.24 U/L) and myoglobin (193 lg/L). Drug screening in urine showed positive for heroin. Lumbar puncture showed mildly increased intracranial pressure of 200 mmH2O, and cerebrospinal fluid routine test and biochemistry were negative. A magnetic resonance imaging (MRI) of the brain revealed abnormally low signal intensity in T1-weighted and high signal intensity in T2-weighted images in bilateral cerebellar hemispheres (Fig. 1a). No abnormality was found in the cerebral magnetic resonance angiography. Toxic leukoencephalopathy was suspected. Mannitol and dexamethasone were administered, and the man became confused on the second day. Surprisingly, a repeat MRI of the brain on the fifth day revealed enlarged lesions in the bilateral cerebellar hemispheres and compression in the fourth ventricle (Fig. 1b), and diffusion weighted image (DWI) showed a high signal intensity in the bilateral cerebellar hemispheres (Fig. 1c). The man fell into a coma accompanied by dyspnea on the seventh day of admission. A computed tomography (CT) of the brain showed hypodense lesions in bilateral cerebellar hemispheres, the fourth ventricle vanishing, and dilatation of the lateral and third ventricles, indicating acute obstructive hydrocephalus (Fig. 1d). Tracheotomy and surgical external drainage of the hydrocephalus were applied, the consciousness and respiration recovered on the twentieth day while the ataxia and pyramidal signs remained. A brain CT showed that the hydrocephalus was improved (Fig. 1e). The man admitted to 1 year of heroin abuse by intranasal and intravenous administration about 1–3 g a day and confirmed that he had injected an extensive quantity of heroin on the day of onset. This pattern confirmed the diagnosis of acute heroin intoxication accompanied with leukoencephalopathy and acute hydrocephalus. Following a month of treatment, his symptoms were resolved and the imaged lesions were absorbed (Fig. 1f). To the best of our knowledge, this report is the first description of acute hydrocephalus in heroin-induced H. Long J. Zhou X. Zhou Y. Xie B. Xiao (&) Neurology Department, Xiangya Hospital Central-south University, Changsha 410008, China e-mail: csulhy@yahoo.cn

Huge Atypical Cyst Arising From the Pancreas

Question: A 68-year-old man who had no specific abdominal symptoms was found to have a huge pancreatic cyst on a screening computed tomography (CT) and was referred to our department for a diagnostic workup. On presentation, the patient seemed to be well-nourished and in good health. He was mildly diabetic, but had no history of alcohol abuse or pancreatitis. Abdominal CT showed a multicystic lesion measuring 8 cm located in the body of the pancreas. The lesion protruded craniad and was compressing the pancreatic parenchyma, main pancreatic duct, and surrounding anatomic structures including the common hepatic artery, the portal vein, the stomach, and the left lobe of the liver (Figure A). However, there was no evidence of invasion or regional lymph node swelling. CT revealed that the wall of the cyst was relatively thick and clearly enhanced, and the contents of the cysts were slightly denser than water. On magnetic resonance imaging, the contents of the cysts were slightly higher signal intensity than water on the T1-weighted images and slightly lower signal intensity in T2-weighted images (Figures B and C). Magnetic resonance cholangiopancreatography did not show any clear connection between the cysts and the pancreatic duct (Figure D). Abdominal ultrasonography showed a floating echo pattern within the cysts and a nodular structure suggesting an intracystic lesion was seen on the wall of the cyst (Figure E, arrow). The laboratory data showed a markedly elevated serum CA19-9 level (450 U/mL; reference range, <37) and s-pancreas-1 antigen (SPan-1) level (100.3 U/mL; reference range, <30). Other blood and blood chemistry data were unremarkable. What is the most likely diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Palpation of the lesion at laparotomy revealed an elastic hard mass with thick capsule that was mobile in relation to the surrounding structures (Figure F), and it could be enucleated with a very small portion of the pancreas from which the lesion seemed to have originated. Examination of the surgical specimen revealed a multicystic tumor filled with yellowish atheroma-like debris (Figure G). The concentrations of CA19-9 and SPan-1 in the cyst fluid were extremely high−34,123,900 U/mL and 353.6 U/mL, respectively. Microscopically, the inner surface of the cysts was lined by stratified squamous cells and well-developed lymphatic tissue was observed within the wall of the cysts (Figure H). The serum CA19-9 and SPan-1 levels had decreased dramatically to 54.4 and 25.1 U/mL, respectively, at 1 month after surgery. Lymphoepithelial cysts (LECs) are rare, non-neoplastic, benign pancreatic tumors first described in 1985.1Luchtrath H. Schriefers K.H. A pancreatic cyst with features of a so-called branchiogenic cyst.Pathologe. 1985; 6: 217-219PubMed Google Scholar Typically, LECs appear on CT as a multi- or unilocular, well-encapsulated, hypodense cystic lesion with an enhancing wall, and they often extend outside the pancreas.2Katz M.H.G. Mortenson M.M. Wang H. et al.Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach.J Am Coll Surg. 2008; 207: 106-120Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar The clinical significance of tumor markers, such as CA19-9, in LECs has not been established. However, the findings in the present case suggested a clear association between the serum tumor markers and the tumor markers in the cyst. If a definitive diagnosis has been made, resection of LECs is not always necessary because of its benign nature. Endoscopic fine needle aspiration and cytology3Policarpio-Nicolas M.L. Shami V.M. Kahaleh M. et al.Fine needle aspiration cytology of pancreatic lymphoepithelial cysts.Cancer. 2006; 108: 501e6Crossref Scopus (39) Google Scholar may be an alternative means of selecting patients for invasive treatment. Surgical resection is considered only for symptomatic LECs or when malignancy cannot be ruled out because of the size of the tumor or the tumor marker levels. However, aggressive resection, including major pancreatectomy should be avoided when LEC is suspected preoperatively.

Effects of 1-3-n-Butylphthalide on the blood-brain barrier following whole brain irradiation in rats

Objective To investigate the effects of 1-3-n-Butylphthalide on the blood-brain barrier (BBB) following whole brain irradiation in rats.Methods 144 male Sprague Dawley rats were randomly divided into sham-irradiation group,irradiation group,1-3-n-Butylphthalide group,and irradiation plus 1-3-n-Butylphthalide group.Whole-brain irradiation was given as a single-dose of 10 Gy using 4 MV X-ray.The rats were injected intraperitoneally with 1-3-n-Butylphthalide at 0.3 mg/kg,1.0 mg/kg,3.0 mg/kg once per day.The changes of the BBB were assessed by Evans blue (EB) assay.The expression of vascular endothelial growth factor (VEGF) in the brain tissue was determined by immunohistochemistry. The circulating endothelial cells (CECs) isolated from right ventricular blood were counted.MRI was evaluated with the T1-weighted images,T2-weighted images and MRI enhancement images induced by Gd-DTPA.The data were compared among the groups through Student-Newman-Keuls test.Results Compared with the sham-irradiation group,the EB content,the expression of VEGF in the brain tissue and the CECs were significantly increased in the irradiation group (2.81∶ 7.82,P =0.002;5.83∶ 10.26,P=0.003;3.16∶6.14,P =0.002).The signal intensity of T1-weighted images was significantly decreased while T2-weighted images and the enhancement rate significantly increased in the irradiation group (P =0.004 -0.018 ).Compared with irradiation group,the EB content,the expression of VEGF and the CECs were decreased significantly in the irradiation plus 1-3-n-Butylphthalide group ( 7.80∶ 3.86,P =0.007 ; 10.83 ∶ 5.26,P =0.008 ;6.36∶ 3.64,P =0.009 ).However,the changes in the MRI were significantly attenuated ( P =0.008-0.026,and 0.006 -0.038,respectively).Conclusions Following whole brain irradiation,1-3-n-Butylphthalide can decrease the permeability of the BBB in rats via decreasing VEGF expression and decreasing the CECs. Key words: Blood-brain barrier; Radiation protection; 1-3-n-Butylphthalide

A case of polyarteritis nodosa limited to the right calf muscles, fascia, and skin: a case report

IntroductionLimited polyarteritis nodosa is a rare benign disease that usually responds well to systemic corticosteroid treatment. We report a case limited to calf muscles, fascia, and skin treated with local corticosteroid therapy directed to the affected areas by ultrasound guidance.Case presentationA 36-year-old Caucasian woman presented with a 10-month history of progressive right calf pain and swelling, which were unresponsive to treatment with non-steroidal anti-inflammatory drugs and physiotherapy. An examination revealed a swollen tender right calf with indurated overlying skin. Laboratory investigations showed an erythrocyte sedimentation rate of 24 mm/hour and a C-reactive protein of 15 mg/dl. Full blood count, renal profile, and creatinine kinase level were normal. A full autoantibody screen and hepatitis B and C serology results were negative. A chest X-ray was unremarkable. Magnetic resonance imaging of the right leg revealed increased signal intensity in T2-weighted images and this was suggestive of extensive inflammatory changes of the gastrocnemius muscle and, to a lesser extent, the soleus muscle. There were marked inflammatory changes throughout the gastrocnemius muscle and the subcutaneous tissue circumferentially around the right lower leg. A biopsy of affected skin, muscle, and fascia showed histopathological features consistent with polyarteritis nodosa, including small-vessel vasculitis with fibrinoid changes in the vessel wall and intense perivascular and focal mural chronic inflammatory changes. Our patient declined treatment with oral steroids. She received a course of ultrasound-guided injections of steroid (Depo-Medrone, methylprednisolone) in the involved muscle area and commenced maintenance azathioprine with a good response.ConclusionsLimited polyarteritis nodosa is rare and affects middle-aged individuals. In most cases, treatment with moderate- to high-dose corticosteroids gives symptomatic relief within one week. Resistant cases require treatment with cytotoxics or intravenous immunoglobulins. This case demonstrates response to local targeted steroid therapy as an alternative to systemic steroids.