T1WI Signal Research Articles

Susceptibility-Weighted Imaging of the Pediatric Brain after Repeat Doses of Gadolinium-Based Contrast Agent.

Gadolinium complexes have paramagnetic properties; thus, we aimed to determine the susceptibility changes in the globus pallidus and dentate nucleus following administration of linear or macrocyclic gadolinium-based contrast agents in children. Thirty-three patients with linear gadolinium-based contrast agent gadopentetate dimeglumine administration, 33 age- and sex-matched patients with macrocyclic gadolinium-based contrast agent gadobutrol administration, and 33 age- and sex-matched control subjects without gadolinium exposure were enrolled in this retrospective study. The signal intensity on SWI and T1WI was determined in the dentate nucleus, middle cerebellar peduncle, globus pallidus, and pulvinar of the thalamus in an ROI-based analysis to calculate dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios. A repeated measures ANOVA was performed to compare SWIminimum, SWImean, and T1WI signal intensity ratios between gadolinium-based contrast agent groups and control subjects. Pearson correlation analysis was performed to determine any correlation between signal intensity ratios and variables. Dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios for both SWImean and SWIminimum were lower for the linear gadolinium-based contrast agent group compared with macrocyclic gadolinium-based contrast agent and control groups (P < .05). No significant difference of the SWImean and SWIminimum ratios were noted between the macrocyclic gadolinium-based contrast agent group and the control group (P > .05). Both dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios on T1WI in the linear gadolinium-based contrast agent group were higher than in the control group and the macrocyclic gadolinium-based contrast agent group (P < .05). A negative correlation was identified between SWImean and SWIminimum ratios and the number of linear gadolinium-based contrast agent administrations (dentate nucleus-to-middle cerebellar peduncle ratio: SWImean, r = -0.43, P = .005; SWIminimum, r = -0.38, P = .011; globus pallidus-to-thalamus ratio: SWImean, r = -0.39, P = .009; SWIminimum, r = -0.33, P = .017). SWI analysis of the pediatric brain demonstrated a statistically significant decrease in SWIminimum and SWImean values for the dentate nucleus and globus pallidus after administration of linear gadolinium-based contrast agents but not macrocyclic gadolinium-based contrast agents.

Evaluation of Cartilaginous Endplate Degeneration Based on Magnetic Resonance Imaging.

In order to carry out the evaluation of cartilaginous endplate degeneration based on magnetic resonance imaging (MRI), this paper retrospectively analyzed the MRI data from 120 cases of patients who were diagnosed as lumbar intervertebral disc degeneration and underwent MRI examinations in the designated hospital of this study from June 2018 to June 2020. All cases underwent conventional sagittal and transverse T1WI and T2WI scans, and some cases were added with sagittal fat-suppression T2WI scans; then, the number of degenerative cartilaginous endplates and its ratio to degenerative lumbar intervertebral discs were counted and calculated, and the T1WI and T2WI signal characteristics of each degenerative cartilage endplate and its correlation with cartilaginous endplate degeneration were summarized, compared, and analyzed to evaluate the cartilaginous endplate degeneration by those magnetic resonance information. The study results show that there were 33 cases of cartilaginous endplate degeneration, accounting for 27.50% of all those 120 patients with lumbar intervertebral disc degeneration (54 degenerative endplates in total), including 9 cases with low T1WI and high T2WI signals, 5 cases with high T1WI and low T2WI signals, 12 cases with high and low mixed T1WI and high or mixed T2WI signals, and 4 cases with both low T1WI and T2WI signals. Therefore, MRI scanning can clearly present the abnormal signals of lumbar intervertebral disc and cartilaginous endplate degeneration, accurately identity their lesion locations, and type their degenerative characteristics, which may be best inspection method for the evaluation of cartilaginous endplate degeneration in the early diagnosis of intervertebral disc degeneration. The study results of this paper provide a reference for further researches on the evaluation of cartilaginous endplate degeneration based on magnetic resonance imaging.

Analysis on the Diagnosis of Ovarian Follicular Membrane Cell Tumor by Magnetic Resonance Imaging Under Statistical Discrepancy Algorithm

In order to improve the early diagnosis rate of follicular cell tumor (C-Tu), reduce the occurrence of malignant tumor, make the patients receive timely treatment, and reduce the mortality, in this research, a total of 48 patients diagnosed as follicular C-Tu admitted to Chongqing Traditional Chinese Medicine Hospital from January 2017 to December 2018 were selected. Computed tomography (CT) and functional magnetic resonance imaging (MRI) images were used to obtain the image of lesion site and analyze the image characteristics. Patients were grouped and compared according to the difference of image characteristics based on statistical discrepancy algorithm (SDA). The specificity (Sp) and sensitivity (Se) of CT scan and MRI images were compared and analyzed to provide the most effective detection method for the subsequent clinical diagnosis. The results showed that most patients had unilateral disease, and most of them were round or oval, with different sizes. The SDA can effectively organize and analyze the influence characteristics of patients. Patients can be grouped according to the proportion of cystic firmness shown in the image. MRI plain scan showed moderate or low signal on T1WI and high signal on T2WI. The T2WI signal could be enhanced with the continuous cystic change of lesion site. The diagnosis efficiency (DE) of CT and MRI was compared with that of surgical pathology as the gold standard. The Se and accuracy (Ac) of MRI diagnosis were higher than that of CT diagnosis, and the comparison of kappa consistency was 0.73 (P &lt; 0.05), which showed that the imaging diagnosis of follicular membrane cell tumour by MRI could obtain higher diagnosis Ac.

Effect of Fe₃O₄ Nanomaterial-Based MRI on the Efficacy of One-Sided Butterfly Sinus Lesions in the Nose.

Fe₃O₄ materials have many crystal forms, and the morphology of their nanomaterials is more diverse. Under the influence of nano-effects, they exhibit unique physical and chemical properties. The synthesized Fe₃O₄ materials with different morphologies have different properties. They are widely used in related fields such as electromagnetics, chemical engineering, catalysis, sensors, acoustics, medicine, environmental protection and so on. Choosing the appropriate contrast agent to display the anatomical characteristics of diseased and normal tissue is an important thing before using MRI (Magnetic Resonance Imaging) technology. At present, Gd-DTPA is a commonly used magnetic contrast agent in clinical practice, but Gd-DTPA has obvious shortcomings, such as short circulation time, non-specific distribution, and high price. In comparison, the superparamagnetic iron oxide nanocrystals have a high specific distribution in living tissues, mainly concentrated in reticular endothelial cells-rich tissues and organs, such as liver, spleen, lymph nodes and bone marrow. This study analyzed the imaging characteristics of 21 patients with unilateral benign sphenoid sinus disease who were confirmed by nasal endoscopic surgery and postoperative pathology. Among the 21 patients with unilateral benign sphenoid sinus lesions, 7 cases of them had cysts. Those with altered sphenoid sinus cavity expansion may be accompanied by thinning of bone resorption. MRI manifested as long T1 and long T₂ irregular spherical signal shadows. 8 cases of them are fungal lesions. MRI showed mixed signals are in the sphenoid sinus, the flaky exudation showed a high signal, and the fungal nodule showed a low T₂WI signal. In the 3 cases of cerebrospinal fluid rhinorrhea, MRI showed a line between the high-signal shadow of the cerebrospinal fluid and the high-signal liquid shadow in the sinuses. High signal and shadow are connected, and other tissues (brain tissue, nasal mucosa) show low signal. Fe₃O₄-based MRI technology can improve imaging quality and diagnostic efficiency.

Imaging features of hemangioma in long tubular bones

BackgroundTo investigate the imaging features of hemangiomas in long tabular bones for better diagnosis.MethodsTwenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5].ResultsAmong 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI.ConclusionsThe long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.

MRI features of the normal prostatic peripheral zone: the relationship between age and signal heterogeneity on T2WI, DWI, and DCE sequences

ObjectivesTo assess the multiparametric MRI (mpMRI) appearances of normal peripheral zone (PZ) across age groups in a biopsy-naïve population, where prostate cancer (PCa) was subsequently excluded, and propose a scoring system for background PZ changes.MethodsThis retrospective study included 175 consecutive biopsy-naïve patients (40–74 years) referred with a suspicion of PCa, but with subsequent negative investigations. Patients were grouped by age into categories ≤ 54, 55–59, 60–64, and ≥ 65 years. MpMRI sequences (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC], and dynamic contrast-enhanced imaging [DCE]) were independently evaluated by two uro-radiologists on a proposed 4-point grading scale for background change on each sequence, wherein score 1 mirrored PIRADS-1 change and score 4 represented diffuse background change. Peripheral zone T2WI signal intensity and ADC values were also analyzed for trends relating to age.ResultsThere was a negative correlation between age and assigned background PZ scores for each mpMRI sequence: T2WI: r = − 0.52, DWI: r = − 0.49, DCE: r = − 0.45, p < 0.001. Patients aged ≤ 54 years had mean scores of 3.0 (T2WI), 2.7 (DWI), and 3.1 (DCE), whilst patients ≥ 65 years had significantly lower mean scores of 1.7, 1.4, and 1.9, respectively. There was moderate inter-reader agreement for all scores (range κ = 0.43–0.58). Statistically significant positive correlations were found for age versus normalized T2WI signal intensity (r = 0.2, p = 0.009) and age versus ADC values (r = 0.33, p = 0.001).ConclusionThe normal PZ in younger patients (≤ 54 years) demonstrates significantly lower T2WI signal intensity, lower ADC values, and diffuse enhancement on DCE, which may hinder diagnostic interpretation in these patients. The proposed standardized PZ background scoring system may help convey the potential for diagnostic uncertainty to clinicians.Key Points• Significant, positive correlations were found between increasing age and higher normalized T2-weighted signal intensity and mean ADC values of the prostatic peripheral zone.• Younger men exhibit lower T2-weighted imaging signal intensity, lower ADC values, and diffuse enhancement on dynamic contrast-enhanced imaging, which may hinder MRI interpretation.• A scoring system is proposed which aims towards a standardized assessment of the normal background PZ. This may help convey the potential for diagnostic uncertainty to clinicians.

A case of intracranial primary meningeal melanoma misdiagnosed as cortical venous infarction with hemorrhage.

Intracranial primary melanoma is a rare and highly differentiated borderline or malignant tumor. The prognosis of tumors varies significantly depending on their location and resection range. Therefore, accurate diagnosis before surgery together with complete resection of the tumor as much as possible and adjuvant chemoradiotherapy is the key to improve the prognosis of patients. Imaging is important for preoperative diagnosis. The tumor in the patients was dominated by pial meningeal lesions. It was obviously uneven after MRI enhancement, and there was no obvious low T2WI signal. It is not easy to distinguish it from cortical venous infarction with hemorrhage. Moreover, the tumor often shows different imaging manifestations due to the different melanin contents, and it is easy to be misdiagnosed before operation. The final diagnosis depends on pathological and immunohistochemical examination.

Pediatric atypical choroid plexus papilloma: Clinical features and diagnosis

ObjectiveAtypical choroid plexus papilloma (aCPP) is a newly introduced subtype of choroid plexus tumors (CPTs) defined by the World Health Organization (WHO) in 2007 and is characterized by intermediate characteristics between choroid plexus papilloma (CPP) and choroid plexus carcinoma (CPC). Currently, the available data describing the clinical features of aCPP in children are limited. MethodsWe performed a retrospective review of 24 pediatric patients with CPTs in our institute and focused on the clinical, radiological and histopathological features of 9 patients with aCPP. ResultsThe median age of aCPP patients was 12 (3−144) months, which was younger than the age of CPP patients (36 (5−132) months, P < 0.05). Of the 9 aCPPs, there were 4 cases of giant masses in the cerebral hemisphere, which was significantly higher than that in CPPs (44.4 % vs 0.0 %, P < 0.05). According to MRI analysis, cysts and necrosis (66.7 % vs 16.7 %, P < 0.05), peritumoral edema (55.6 % vs 8.3 %, P < 0.05) and blurred borders (55.6 % vs 8.3 %, P < 0.05) were more common in aCPPs than in CPPs. T1WI isointense signals were mainly observed in aCPPs and CPPs (aCPP66.7 % vs CPP58.3 %, P >0.05), while T2WI slightly low signals were more common in CPPs (CPP41.7 % vs aCPP0%, P < 0.05); moreover, the tumor volume of aCPPs was significantly larger than that of CPPs (aCPP78.3 cm3 vs 8.4 cm3, P < 0.05). For the DWI sequence scans, isointense signals were more common in aCPPs (aCPP77.8 %>CPP25.0 %, P < 0.05), while slightly low signals were more common in CPPs (CPP58.3 %>aCPP0%, P < 0.05). Both aCPPs and CPPs mainly showed homogeneously strong enhancement (aCPP66.7 % vs CPP91.7 %, P > 0.05). Interestingly, 1 aCPP showed annular enhancement. For the pathological and immunohistochemical studies, the Ki67 proliferation index was significantly higher in aCPPs than in CPPs (13 % vs 6%, P < 0.05), and the S-100(+)/Vim(+)/Syn(+) positive rate was higher in aCPPs (58.3 % vs 11.1 %, P < 0.05). ConclusionsaCPP shows some distinctive clinical features compared with CPP, such as younger age, larger tumor size, more frequent necrosis and peritumoral edema, blurred borders, slightly low signals on T2WI and isointense signals on DWI, and a higher S-100(+)/Vim(+)/Syn(+) positive rate, which may provide more valuable evidence for differential diagnosis and clinical decisions surrounding aCPP.

Evaluation of imaging features of pelvic echinococcosis based on multimodal images

BackgroundHydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus, It is mainly prevalent in pastoral areas. Bone echinococcosis is rare, accounting for 0.5 to 4.0% of all echinococcosis. It is likely to miss the diagnosis and misdiagnose due to non-specific early symptoms and the clinical manifestations and imaging features. The clinical data of 15 patients with pelvic cystic echinococcosis were analyzed retrospectively, and the X-ray, CT, and MRI imaging features of the disease were discussed, which are reported below.MethodsAll 15 patients underwent CT scan evaluation. A total of 8 patients underwent coronal, sagittal, and three-dimensional reconstruction with 3-mm-slice thickness, and 4 patients underwent X-ray plain film examination. Five cases underwent MRI scan. Eight cases underwent MRI or CT enhanced scan.ResultsX-ray plain film is characterized by continuous cystic bone destruction, irregular low-density shadow when invading soft tissue, and sometimes calcification which can be seen on the wall or inside the cyst. The involved sacroiliac joint or hip joint may narrow or disappear. The involvement of pelvic cystic echinococcosis is relatively wide, and 80% of patients with pelvic cysts in this group had multiple lesions in the same period. Cystic expansive bone destruction was the most common. Pelvic CT revealed a lobulated hypodense lesion of varying size with internal septae, causing cortical thinning and destruction. Most of them had no periosteal reaction. The iliopsoas muscle is most easily invaded. Single cystic echinococcosis of pelvis showed intermediate or low signal intensity on T1-weighted images and hyperintensity on T2-weighted images in the involved bone and surrounding soft tissue on MRI, and the cyst wall showed linear low signal in T1WI, T2WI, and STIR sequences. The polycystic type is characterized by multiple cysts of varying signal intensity (daughter cysts) within a larger cyst is the typical MRI finding, forming “small vesicles” high signal daughter cysts. Osteosclerosis or calcification showed low signal in T1WI and T2WI.ConclusionsThe results of this study suggest that the lesions of pelvic cystic echinococcosis are mostly cystic expansive and osteolytic bone destruction, which is easy to invade the surrounding soft tissue, often accompanied with calcification; among them, multiple cystic lesions are characteristic.

Characteristics of mass lesion presentation of primary angiitis of the central nervous system: A single center 11-year retrospective case-series study

ObjectiveMass lesion presentation of primary angiitis of the central nervous system (ML-PACNS) is a special subtype of primary central nervous system vasculitis, which is difficult to be differentiated from other space-occupying disorders. We aimed to summarize our experience and improve diagnostic techniques of ML-PACNS. Patients and methodsCase records for 16 patients treated in the Department of Neurology of Six Medical Center of Chinese PLA General Hospital from December 2008 to November 2019 were examined. All patients were diagnosed with ML-PACNS by pathology. Clinical manifestations, neuroimaging results and pathological features were retrospectively analyzed. ResultsThe 16 patients with ML-PACNS in the cohort (8 males) had a median age of 32 (range 19–56 years). On T1WI and T2WI, 12 cases showed mixed signals and 4 cases showed T1WI hypointense and T2WI hyperintense. Fifteen patients showed DWI hyperintense, of which 9 cases showed hypointense in the middle of the lesion. Gadolinium enhancement of all cases was irregular. All patients had a brain biopsy (stereotactic procedure in 10 and open-wedge surgery in 6) which showed lymphocytic vasculitis in the majority of patients (15/16) and necrotizing vasculitis in one patient. ConclusionsML-PACNS is an important differential candidate for tumefactive demyelinating lesions, CNS infections and brain tumors. Mixed T1WI and T2WI signals as well as central hypointense surrounded by hyperintense lesions on DWI may be useful imaging features for the diagnosis of ML-PACNS which has implications for those who have not yet had a biopsy. ML-PACNS may have different pathological type from PACNS.

Distant metastasis prediction via a multi-feature fusion model in breast cancer.

This study aimed to develop a model that fused multiple features (multi-feature fusion model) for predicting metachronous distant metastasis (DM) in breast cancer (BC) based on clinicopathological characteristics and magnetic resonance imaging (MRI). A nomogram based on clinicopathological features (clinicopathological-feature model) and a nomogram based on the multi-feature fusion model were constructed based on BC patients with DM (n=67) and matched patients (n=134) without DM. DM was diagnosed on average (17.31±13.12) months after diagnosis. The clinicopathological-feature model included seven features: reproductive history, lymph node metastasis, estrogen receptor status, progesterone receptor status, CA153, CEA, and endocrine therapy. The multi-feature fusion model included the same features and an additional three MRI features (multiple masses, fat-saturated T2WI signal, and mass size). The multi-feature fusion model was relatively better at predicting DM. The sensitivity, specificity, diagnostic accuracy and AUC of the multi-feature fusion model were 0.746 (95% CI: 0.623-0.841), 0.806 (0.727-0.867), 0.786 (0.723-0.841), and 0.854 (0.798-0.911), respectively. Both internal and external validations suggested good generalizability of the multi-feature fusion model to the clinic. The incorporation of MRI factors significantly improved the specificity and sensitivity of the nomogram. The constructed multi-feature fusion nomogram may guide DM screening and the implementation of prophylactic treatment for BC.

Abstract 388: Antigen-loaded Fe3O4 nanoparticles for the stimulation and tracking of dendritic cell based vaccine

Abstract Background and purpose:Dendritic cells (DCs), as the antigen-presenting cells, play important roles in immunotherapy. The antigen uptake, cross-presentation, maturation and lymph node migration of DCs are crucial steps for immune system activation. Herein, we aim to construct a novel Fe3O4@SIINFEKL-TAT nanoparticle, which mainly consists of Fe3O4 nanosphere core and transmembrane peptide TAT on the shell, and also with the model antigen SIINFEKL peptide, a peptide of the ovalbumin (OVA) antigen. To explore the feasibility of Fe3O4@OVA-TAT to stimulate the maturation of DCs and the in vivo tracking of DCs using MRI-MPI dual-modal imaging. Methods: On the one hand, TAT peptide facilitates the uptake of the Fe3O4@OVA-TAT nanoparticles into DCs, and subsequently the OVA antigens are cross-presented to stimulate DCs maturation. On the other hand, Fe3O4 nanosphere core can function for both magnetic resonance imaging (MRI) and magnetic particle imaging (MPI) dual-modality imaging, which can realize the in vivo dynamic tracking of DCs migration to lymph nodes. Results: The laser confocal microscope experiments confirmed that Fe3O4@OVA-TAT can be taken up through the early endosome-late endosome pathway, but the fluorescent signal of the imaging probe is located outside the lysosome after 4 h, which suggested that Fe3O4@OVA-TAT could escape lysosomal uptake and cross-present. The CD80 and CD86 flow cytometry results showed that Fe3O4@OVA-TAT, LPS, and OVA can stimulate 90%, 60%, and 40% of BMDCs to mature, respectively (p &amp;lt; 0.05). After the Fe3O4@SIINFEKL-TAT labeled DCs was injected into the mouse footpad, the MRI T2WI signal decreased and the MPI signal increased in the popliteal and inguinal lymph nodes 24 h post-injection, suggesting that our DC vaccine can efficiently migrate to the lymph node. Conclusions: Our study showed that Fe3O4@SIINFEKL-TAT nanoparticles can stimulate and trace DCs in in vivo, which pave the way for further development and precision application of DC vaccine in both preclinical and clinical settings. Citation Format: Yafei Qi, Yang Du, Jie Tian, Zhengyu Jin, Yuan Li. Antigen-loaded Fe3O4 nanoparticles for the stimulation and tracking of dendritic cell based vaccine [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 388.

Correlation of prognostic factors with MRI findings in malignant breast lesions

BackgroundMagnetic resonance imaging (MRI) of the breast represents the most sensitive imaging modality in the detection of breast cancer, with a reported sensitivity between 94 and 100%. We aim to detect the correlation between MRI findings and pathologically detected prognostic factors in malignant breast lesions.Breast parenchymal density distribution, background parenchymal enhancement pattern, lesion’s morphologic features, T2WI signal characteristics, contrast enhancement, time/signal intensity curves, and lesions localizations in breast were evaluated using dynamic MRI images. Histopathological diagnosis, maximum measurements of the lesion, histological grade, presence of estrogen and/or progesterone receptors, c-erb B2, and Ki-67 parameters were noted as prognostic factors.ResultsWe cannot detect any relationship between the breast parenchymal density and prognostic factors. Mild background breast enhancement is related with ER presence, a good prognostic factor. Histopathological grade of the lesions augmented with the increase in the lesion diameters. ADC values are not related with prognostic factors.ConclusionA mild background enhancement, an intermediate signal intensity on T2WI, a high tpeak value, and absence of pathological axillary lymph node are found to be related with good prognostic factors. An irregular contour, a huge diameter, having a type III kinetic curve, a high slopei value, and presence of pathological axillary lymph node are found to be related with poor prognostic factors. MRI can be used to predict prognostic factors in breast cancer cases.

Imaging Features and Floating-Ice Sign of Primary Lymphoma of the Bone

Background: The imaging presentation of primary bone lymphoma is unclear. Objectives: The present study aimed to investigate the imaging presentations of primary bone lymphoma especially a specific “floating-ice” sign. Patients and Methods: Forty one patients with primary bone lymphoma confirmed by pathology with 27 males and 14 females and an age range of 2 - 76 (mean = 40) years were enrolled. The clinical and imaging data were analyzed. Results: The tumor involved long bones in 17 cases, flat bones in 12, spine in eight and irregular bones in four cases. The imaging presentations were divided into five types: infiltrative type in nine cases (22%), osteolytic in 14 cases (34.1%), osteosclerotic in four cases (9.8%), mixed in 11 cases (26.8%) including four cases with a “floating-ice” sign and cystic in three cases (7.3%). In plain radiography, only three of four long bone lesions in children had a varying degree of periosteal reaction. Among 20 cases with CT scanning, sixteen had soft tissue masses, seventeen had ill-defined margins, and three had well-defined margins with sclerotic rims. Among twelve patients with MRI, ten had soft tissue masses with well-defined margins. MRI demonstrated a greater extent of lesion than CT. In MRI T1 weighted image (T1 WI), isointense signal was seen in three cases, hypointense signal in five and mixed signal in four. In T2 WI, isointense and hypointense signal was detected in five cases, hyperintense signal in three and mixed hyperintense signal in four. Conclusion: Primary bone lymphoma occurs most frequently in long and flat bones as infiltrative osteolytic destruction, and combined plain radiographs, CT and MRI help obtain a correct diagnosis.

An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province, China

To investigate the incidence of severe neonatal hyperbilirubinemia and the management on the treatment and follow-up of this disease in Jiangsu Province, China. The neonates with severe hyperbilirubinemia who were admitted to 13 hospitals in Jiangsu Province from January to December, 2018, were enrolled as subjects. A retrospective analysis was performed on their mediacal data and follow-up data. In 2018, 740 neonates with severe hyperbilirubinemia were reported from the 13 hospitals in Jiangsu Province, accounting for 2.70% (740/27 386) of the total number of neonates admitted to the department of neonatology. Among these neonates, 620 (83.8%) had severe hyperbilirubinemia, 106 (14.3%) had extremely severe hyperbilirubinemia, and 14 (1.9%) had hazardous hyperbilirubinemia. Four neonates (0.5%) were diagnosed with acute bilirubin encephalopathy. A total of 484 neonates (65.4%) were readmitted due to severe hyperbilirubinemia after discharge from the delivery institution, with a median age of 7 days, among whom 214 (44.2%) were followed up for jaundice at the outpatient service before readmission, with a median age of 6 days at the first time of outpatient examination. During hospitalization, 211 neonates (28.5%) underwent cranial MRI examinations, among whom 85 (40.3%) had high T1WI signal in the bilateral basal ganglia and the globus pallidus; 238 neonates (32.2%) underwent brainstem auditory evoked potential examinations, among whom 14 (5.9%) passed only at one side and 7 (2.9%) failed at both sides. The 17 neonates with acute bilirubin encephalopathy or hazardous hyperbilirubinemia were followed up. Except one neonate was lost to follow-up, and there were no abnormal neurological symptoms in the other neonates. Neonates with severe hyperbilirubinemia account for a relatively high proportion of the total number of neonates in the department of neonatology. Jaundice monitoring and management after discharge from delivery institutions need to be strengthened. For neonates with severe hyperbilirubinemia, relevant examinations should be carried out more comprehensively during hospitalization and these neonates should be followed up comprehensively and systematically after discharge.

Affibody-Modified Gd@C-Dots with Efficient Renal Clearance for Enhanced MRI of EGFR Expression in Non-Small-Cell Lung Cancer.

PurposeGd-encapsulated carbonaceous dots (Gd@C-dots) have excellent stability and magnetic properties without free Gd leakage, therefore they can be considered as a safe alternative T1 contrast agent to commonly used Gd complexes. To improve their potential for cancer diagnosis and treatment, affibody-modified Gd@C-dots targeting non-small-cell lung cancer (NSCLC) EGFR-positive tumors with enhanced renal clearance were developed and synthesized.Materials and MethodsGd@C-dots were developed and modified with Ac-Cys-ZEGFR:1907 through EDC/NHS. The size, morphology, and optical properties of the Gd@C-dots and Gd@C-dots-Cys-ZEGFR:1907 were characterized. Targeting ability was evaluated by in vitro and in vivo experiments, respectively. Residual gadolinium concentration in major organs was detected with confocal imaging and inductively coupled plasma mass spectrometry (ICP-MS) ex vivo. H&E staining was used to assess the morphology of these organs.ResultsGd@C-dots with nearly 20 nm in diameter were developed and modified with Ac-Cys-ZEGFR:1907. EGFR expression in HCC827 cells was higher than NCI-H520. In cell uptake assays, EGFR-expressing HCC827 cells exhibited significant MR T1WI signal enhancement when compared to NCI-H520 cells. Cellular uptake of Gd@C-dots-Cys-ZEGFR:1907 was reduced, when Ac-Cys-ZEGFR:1907 was added. In vivo targeting experiments showed that the probe signal was significantly higher in HCC827 than NCI-H520 xenografts at 1 h after injection. In contrast to Gd@C-dots, Gd@C-dots-Cys-ZEGFR:1907 nanoparticles can be efficiently excreted through renal clearance. No morphological changes were observed by H&E staining in the major organs after injection of Gd@C-dots-Cys-ZEGFR:1907.ConclusionGd@C-dots-Cys-ZEGFR:1907 is a high-affinity EGFR-targeting probe with efficient renal clearance and is therefore a promising contrast agent for clinical applications such as diagnosis and treatment of NSCLC EGFR-positive malignant tumors.

Magnetic resonance imaging features for predicting axillary lymph node metastasis in patients with breast cancer

PurposeThe purpose of this study was to assess the clinical value of conventional magnetic resonance imaging (MRI) and intravoxel incoherent motion (IVIM) features for predicting the risk of axillary lymph node (ALN) metastasis in patients with breast cancer. MethodsThis retrospective study involved 265 patients with breast cancer who underwent 3.0 T breast magnetic resonance imaging examinations prior to surgery and other treatment. Of these, 119 underwent IVIM examination. The features of MRI and IVIM and postoperative pathologic results were collected. The association of MRI features of breast cancer with ALN metastasis were determined by univariate and multivariate analyses. Comparison of IVIM parameters between breast cancer patients with and without ALN metastasis was performed using the Mann–Whitney U test. ResultsAmong the 265 patients, 144 (54.3%) had ALN metastasis, and 121 (45.7%) did not. The size and shape of the tumours, T2WI signal, inhomogeneous enhancement, washout intensity–time curves and the values of slow ADC, fast ADC and fraction of fast ADC parameters were significantly associated with ALN metastasis. The AUC of conventional MRI for diagnosing axillary lymph node metastasis was 0.722. The AUC of MRI combined with slow ADC, fast ADC and fraction of fast ADC parameters that were used to diagnose breast cancer with ALN metastasis were 0.814, 0.803 and 0.900, respectively. ConclusionsThe features of IVIM parameters and conventional MRI can be used to predict the ALN metastasis in patients with breast cancer. MRI combined with fraction of fast ADC showed higher diagnostic efficiency for ALN metastasis in breast cancer than MRI did.

MON-337 Peripheral Neurological Complications in Pregnancy- Is Idiopathic Transient Osteoporosis of Pregnancy Concerning?

Idiopathic transient osteoporosis of pregnancy (ITOP) is a rare and under-reported condition that has affected healthy pregnancies. ITOP usually presents in the final trimester of a normal pregnancy. Radiographic studies detect drastic loss of bone mass, elevated rates of turnover in the bone, and edema in the affected portion.We present a 26-year-old previously healthy woman, who was admitted at 39 weeks of gestation with severe left hip pain and inability to walk for one month.The pain was constant, progressive, involving left lower limb, and associated with numbness and weakness. Neurological exam revealed diminished power in the left hip (motor power was 2/5), and inability to stand and walk due to pain in the left hip. She was unable to stand by herself. Investigations revealed anemia, low vitamin B12, low vitamin D and magnesium. Bilateral hip MRI showed increased T2WI signal in the left femoral head consistent with idiopathic transient osteoporosis of the left hip (ITOP). DXA scan showed bone mass density (BMD) below expected for age.The patient had induced vaginal labor without complication. The left hip pain improved after delivery. She was treated conservatively with Calcium, Magnesium and vitamin D. The patient symptoms completely resolved in 3 months post-delivery. DXA scan and Hip MRI at 1 year interval showed normal BMD and complete resolution of previous bone marrow edema and changes seen in MRI hip.This case report serves to highlight the effect of pregnancy on bone mass during third trimester which may result in transient osteoporosis of pregnancy leading to weakness and gait disturbance. Clinical symptoms can be misdiagnosed as a peripheral neurological complications instead of bone metabolism changes of pregnancy.

Comparison of the Imaging and Pathological Features of Telangiectatic Osteosarcoma and Aneurysmal Bone Cyst of Long Tubular Bones

Background: The clinical, imaging and pathological features of telangiectatic osteosarcoma (TOS) in long bones are helpful for differentiation from aneurysmal bone cysts (ABC). Objectives: To investigate the clinical, imaging and pathological features of TOS in comparison with ABC in long bones. Patients and Methods: Seventeen patients with TOS and 17 patients with ABC in our hospital were analyzed in the clinical, imaging and pathological features for proper diagnosis. Results: For plain radiographs in 17 TOS cases, a soft tissue mass was detected in 14 cases, lytic bone destruction in 13, ill-defined border in 12, periosteal reaction in eight, formation of the Codman triangle in five, pathological fracture in three, and calcification in one. In 17 cases with ABC, an ill-defined border was found in fifteen cases, lytic and expansile destruction in eleven, thinned sclerotic rim in twelve, eccentrically location in ten, coarse septations in eight, a soft tissue mass in three, pathological fracture in three, periosteal reaction in two, and ill-defined border in two cases. In CT imaging of TOS, multiple cysts were in twelve cases, and fluid-fluid levels in three. In ABC, multiple cysts were in eleven cases while fluid-fluid levels in four. In MRI presentations of TOS, low and medium signal was present in the T1-weighted imaging (T1WI), whereas mixed (9/12) or high signal (3/12) was presented in the T2 WI with inhomogeneous signal. Four cases had multiple cysts and fluid-fluid levels in the bone destruction and soft tissues. The cysts had long T1 and long T2 signal with isointense signal in the septations (5/12). Fat inhibition sequence showed clear cystic changes. In ABC, low complete or incomplete signal was demonstrated in all lesions with a higher incidence of fluid-fluid levels (8/11). The lesion was of low and medium inhomogeneous signal in the T1 WI but mixed signal in T2 WI (6/11) including hyperintense signal in the upper part but mixed signal in the lower part in four cases or hyperintense signal (1/11) in T2 WI. The histopathological features of TOS were bleeding inside the lesion, highly atypia tumor cells of malignancy in the septa and tumorous bone tissue. The septa of ABC were composed of proliferative fibroblasts with dispersed polykaryocytes, reactive woven bone but no atypical cells. Conclusion: The clinical, imaging and pathological characteristics should be combined to make a correct differential diagnosis between telangiectatic osteosarcoma and aneurysmal bone cyst.

Value of MRI in the differential diagnosis of uveal melanoma and other intraocular masses in adults

Objective To compare MRI findings of uveal melanomas and other intraocular masses in adults and to evaluate the optimal MRI features for the differential diagnosis. Methods The MRI data of 254 patients with intraocular masses confirmed by histopathologic or clinical follow-up results from March 2005 to December 2015 in Beijing Tongren Hospital, Capital Medical University was analyzed retrospectively. A total of 128 patients with uveal melanoma and 126 patients with other intraocular masses were enrolled. MRI findings of the masses including the location, shape, margin, signal intensity on T1WI and T2WI compared to the gray matter and vitreous body, homogeneity and degree of enhancement of the mass, secondary retinal detachment, height, and ratio of basal diameter to height were compared between uveal melanoma and other intraocular masses by χ2 test or independent t test. The logistic regression analysis was performed to identify the most discriminating MRI features. The diagnostic performance of different predictive models was analyzed by receiver operating characteristic (ROC) curve. The model of multiple parameters was established by logistic analysis, and the diagnostic efficacy was evaluated. Results The location, shape, margin, signal intensity on T1WI and T2WI compared to the gray matter and vitreous body, homogeneity and degree of enhancement of the mass, secondary retinal detachment, height and ratio of basal diameter to height were significantly different between the uveal melanoma and other intraocular masses (all P<0.05). The results of logistic regression analysis showed that the signal intensity on T1WI and T2WI compared to the gray matter, height, shape, location, degree of enhancement of the mass, and secondary retinal detachment were associated with higher likelihood of uveal melanoma. The mass with hypointense on T2WI (compared with gray matter) was the best MRI feature in the differential diagnosis of uveal melanoma and other intraocular masses (odds ratio 12.237), with the accuracy of 86.2%. The diagnostic accuracy of low signal on T2WI and high signal on T1WI (compared with gray matter) was significantly higher than those of vitreous (Delong test, P<0.001). The sensitivity, specificity and accuracy of the combination of height, degree of enhancement, T1WI and T2WI signal compared to the gray matter were 90.6%, 92.1% and 96.1%, respectively. The diagnostic performance of combination features was higher than that of each single sign (P<0.001). Conclusion MRI features including the signal intensity on T1WI and T2WI compared to the gray matter, height, shape, degree of enhancement of the mass, and secondary retinal detachment are helpful in the differential diagnosis between uveal melanoma and other intraocular masses. In addition, the gray matter as the reference is superior to the vitreous body in the evaluation of the signal intensity of intraocular masses. Key words: Melanoma; Eye neoplasms; Magnetic resonance imaging; Diagnosis, differential