Vascular Distribution Pattern Research Articles

News on the imaging of large vessel vasculitis

Large vessel vasculitis, including giant cell arteritis (GCA) and Takayasu arteritis (TAK), are autoimmune diseases primarily affecting the aorta and its branches. GCA is the most common primary vasculitis. Inflammatory changes in the vessel walls can cause serious complications such as amaurosis, stroke, and aortic dissection and rupture. Imaging techniques have become an integral part for the diagnosis and monitoring of large vessel vasculitis, allowing for effective disease monitoring. GCA and TAK exhibit similar patterns of vascular distribution. However, the temporal arteries are never involved in TAK, and axillary arteritis occurs more frequently in GCA. In most centers, ultrasound of the temporal and axillary arteries has replaced temporal artery biopsy as the primary diagnostic tool for GCA. In addition to ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and [18F]-FDG (fluorodeoxyglucose) positron emission tomography-computed tomography (PET) are important, particularly for visualizing the aorta. Moreover, PET-CT is now also capable of assessing the temporal arteries, although it is not yet widely available. In polymyalgia rheumatica (PMR), ultrasound of the shoulder and hip regions is part of the ACR/EULAR classification criteria. MRI allows detailed visualization of additional inflammatory extraarticular manifestations, showing characteristic inflammatory lesions in entheses, tendons, and ligaments. [18F]-FDG-PET-CT also enables the visualization of musculoskeletal inflammation, especially in the shoulder and hip regions, as well as paravertebral areas. Ultrasound can detect subclinical GCA in up to 23% of patients with PMR, which should be treated like GCA. Technological innovations such as new radiotracers and improved MRI imaging could further enhance the diagnosis and monitoring of large vessel vasculitis and PMR, thus playing acrucial role in improving the prognosis through faster initiation of therapy.

Age-Related Macular Degeneration Choroidal Vascular Distribution Characteristics Based on Indocyanine Green Angiography.

The purpose of this study was to present our findings of the distribution pattern of choroidal arteries and large veins in patients with age-related macular degeneration (AMD) using indocyanine green angiography (ICGA). A retrospective analysis was conducted on 980 patients who underwent ICGA at The Second Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2023, including 240 patients with AMD. Secondary image processing was applied to the angiographic videos to obtain posterior distribution maps of choroidal arteries and large veins. Differences between different distribution patterns regarding age, gender, eye laterality, and circulation time were compared. We also conducted a comparison of choroidal vascular distribution characteristics between patients with AMD and patients with diabetic retinopathy (DR) and provided a summary of choroidal vascular distribution patterns in AMD. The filling patterns of choroidal arteries can be classified into the invisible trunk arteries type, the partially masked trunk arteries type, and the exposed trunk arteries type. The vascular topography of the large choroidal vein can be classified into the watershed type, the non-watershed type, and the unknown type, further divided into six subtypes. The distribution patterns of choroidal arteries and veins were significantly correlated with age (P < 0.001). Left eye, older age, and the exposed trunk arteries type were independent risk factors for non-watershed large choroidal vein (P < 0.05). The non-watershed type was the main characteristic of the venous phase in AMD. The distribution characteristics of the arterial and venous patterns in AMD suggest atrophy of the small blood vessels in the choroid and insufficient perfusion pressure of the blood flow.

Vascular Distribution and Expression Patterns of Angiogenic Factors in Caruncle during the Early Stage of Pregnancy in Goats (Capra hircus).

The placenta is a temporary maternal−fetal organ, and its maternal placenta (caruncle) is essential for fetal growth and development. The exchange function of the placenta requires vascular development (angiogenesis). However, the angiogenesis of the caruncle is poorly understood in goats during the early stage of pregnancy. Here, we investigated the vascular distribution, mRNA expression of major angiogenic factors, and the methylation levels of ANGPT2 in the goat caruncle. It showed that CAD (capillary area density), CSD (capillary surface density), and APC (area per capillary) increased gradually, while CND (capillary number density) showed an insignificant change, probably due to the variability between animals. The proportion of proliferating cells was observed to be very high (>26%) and increased (p < 0.002) approximately 2-fold from day 20 to 60 of pregnancy. Furthermore, the expression patterns of major angiogenic factors changed during the early stage of pregnancy. Interestingly, we discovered an absolute correlation between the mRNA for ANGPT2, TEK, FGF2, and vascular distribution. Subsequently, we evaluated the DNA methylation of ANGPT2, where we found that mean methylation was negatively correlated with CAD. The methylation at the CpG sites, such as CpG 4/18, CpG 9.10.11, and CpG 15, showed significant changes during the early stage of pregnancy. Thus, our findings suggest that the methylation of ANGPT2 may be involved in the regulation of caruncle angiogenesis during the early stage of pregnancy.

Collateral aortic branches in the collared peccary (Pecari tajacu Linnaeus, 1758).

The determination of arterial vascular distribution patterns can contribute to more detailed knowledge on arterial systems. In this context, the aim of the present study was to describe the collateral aortic branches in the collared peccary, aiming to define a standard model for this species, providing information through comparative anatomy for analysis of some evolutionary aspects of the order Artiodactyla. Ten young male animals were employed. The vascular system was washed with a saline solution and then perfused with Neoprene 450 latex coloured with red or yellow pigment, followed by collateral aorta branch dissections and analyses. The contrasted digital radiography technique was applied to two animals, which were initially perfused with a barium sulphate solution (1 g/ml) and Neoprene 450 latex at a 1:3 ratio, and subsequently, the digital radiographic examination was performed. The aortic arch of the collared peccary emitted the brachiocephalic trunk and the left subclavian artery, while eight symmetric pairs of dorsal intercostal arteries originated from the thoracic aorta. The abdominal aorta, in turn, exhibited the celiac, cranial mesenteric, renal, caudal mesenteric, testicular, external iliac, internal iliac and sacral arteries as the collateral branches in all studied animals. Therefore, no relevant variations were observed regarding the arrangement of the arterial distribution of the aorta, thus suggesting a static standard model in the collared peccary.

Quantitative Biomarkers for Cancer Detection Using Contrast-Free Ultrasound High-Definition Microvessel Imaging: Fractal Dimension, Murray's Deviation, Bifurcation Angle & Spatial Vascularity Pattern.

A growing body of evidence indicates that there is a strong correlation between microvascular morphological features and malignant tumors. Therefore, quantification of these features might allow more accurate differentiation of benign and malignant tumors. The main objective of this research project is to improve the quantification of microvascular networks depicted in contrast-free ultrasound microvessel images. To achieve this goal, a new series of quantitative microvessel morphological parameters are introduced for differentiation of breast masses using contrast-free ultrasound-based high-definition microvessel imaging (HDMI). Using HDMI, we quantified and analyzed four new parameters: 1) microvessel fractal dimension (mvFD), a marker of tumor microvascularcomplexity; 2) Murray’sdeviation(MD), the diameter mismatch, defined as the deviation from Murray’s law; 3) bifurcation angle (BA), abnormally decreased angle; and 4) spatial vascular pattern (SVP), indicating tumor vascular distribution pattern, either intratumoral or peritumoral. The new biomarkers have been tested on 60 patients with breast masses. Validation of the feature’s extraction algorithm was performed using a synthetic data set. All the proposed parameters had the power to discriminate the breast lesion malignancy (p < 0.05), displaying BA as the most sensitive test, with a sensitivity of 90.6%, and mvFD as the most specifictest, with a specificityof 92%. The results of all four new biomarkers showed an AUC = 0.889, sensitivity of 80% and specificity of 91.4% In conclusion, the added value of the proposed quantitative morphological parameters, as new biomarkers of angiogenesis within breast masses, paves the way for more accurate breast cancer detection with higher specificity.

Dermoscopic clues of palmoplantar hyperkeratotic eczema and palmoplantar psoriasis: A prospective, comparative study of 90 patients.

Diagnosis can be difficult in isolated palmar and plantar lesions in patients with psoriasis and eczema. The purpose of our study is to compare the dermoscopic findings in patients with palmoplantar psoriasis and palmoplantar hyperkeratotic eczema. This prospective, comparative study included 90 patients histopathologically diagnosed with eczema or psoriasis (35 psoriasis and 55 eczema). The age range was 18-75years. The most common vessel type was dot vessel in psoriasis. Red globular ring vessels were seen in five patients with psoriasis, but not in any with eczema (P=0.007). The most common vascular distribution pattern was regular in psoriasis (40%). Patchy vascular pattern was significant in eczema. The most common background color was light red in psoriasis (48.6%) (P<0.001). Brownish-orange globules were observed in 25.7% of patients with eczema and 5.7% in patients with psoriasis (P=0.02). There is only one study in the published work about dermoscopy of palmoplantar psoriasis and eczema. In our study, yellow crusts, patchy scale distribution, patchy vascular pattern, yellow scale color, dull red background color and brownish-orange globules were significant in patients with palmoplantar eczema. On the other hand, patients with psoriasis had light red background color, regular vascular distribution pattern and white scale color. We observed globule structures with a pale center and dark peripheral rim only in patients with eczema, which was not identified in previous studies. This globule structure may be a new finding in eczema.

Organogenesis and distribution of the ocular lymphatic vessels in the anterior eye.

Glaucoma surgeries, such as trabeculectomy, are performed to lower intraocular pressure to reduce risk of vision loss. These surgeries create a new passage in the eye that reroutes the aqueous humor outflow to the subconjunctival space, where the fluid is presumably absorbed by the conjunctival lymphatics. Here, we characterized the development and function of the ocular lymphatics using transgenic lymphatic reporter mice and rats. We found that the limbal and conjunctival lymphatic networks are progressively formed from a primary lymphatic vessel that grows from the nasal-side medial canthus region at birth. This primary lymphatic vessel immediately branches out, invades the limbus and conjunctiva, and bidirectionally encircles the cornea. As a result, the distribution of the ocular lymphatics is significantly polarized toward the nasal side, and the limbal lymphatics are directly connected to the conjunctival lymphatics. New lymphatic sprouts are produced mainly from the nasal-side limbal lymphatics, posing the nasal side of the eye as more responsive to fluid drainage and inflammatory stimuli. Consistent with this polarized distribution of the ocular lymphatics, a higher drainage efficiency was observed in the nasal side than the temporal side of the eye when injected with a fluorescent tracer. In contrast, blood vessels are evenly distributed at the anterior surface of the eyes. Also, we found that these distinct vascular distribution patterns were conserved in human eyes. Together, our study demonstrated that the ocular surface lymphatics are more densely present in the nasal side and uncovered the potential clinical benefits in selecting the nasal side as a glaucoma surgery site to improve fluid drainage.

Vascular plant diversity along an elevational gradient in the Central Himalayas, western Nepal

Elevational gradients are linked with different abiotic and biotic factors, which in turn influence the distribution of plant diversity. In the present study we explored the relative importance of different environmental factors in shaping species diversity and composition of vascular plant species along an elevational gradient in the Chamelia Valley, Api-Nampa Conservation Area in western Nepal. Data were collected from 2,000 to 3,800 m above sea level and analysed using a generalized linear mixed model (GLM) and non-metric multidimensional scaling (NMDS). We recorded 231 vascular plant species consisting of 158 herb species belonging to 55 families, 37 shrub species belonging to 22 families and 36 tree species belonging to 23 families. Species richness and species abundance significantly decreased with increasing elevation. However, species richness increased with the intensity of vegetation cutting. Species richness and abundance also increased with increased annual precipitation and mean annual temperature whereas species abundance decreased with grazing, soil phosphorus and nitrogen. NMDS ordination revealed that mean annual temperature and annual precipitation affect the composition of vascular plant species in opposite ways to elevation. Among the many anthropogenic disturbances, only grazing affected species composition. In conclusion, more than one environmental factor contribute to the shaping of patterns of vascular plant species distribution in western Nepal. Knowledge on species diversity, distribution and underlying factors needs to be taken into consideration when formulating and implementing conservation strategies.

Elevational changes in vascular plants richness, diversity, and distribution pattern in Abune Yosef mountain range, Northern Ethiopia

The aim of this research is to investigate the patterns of vascular plant species richness, diversity, and distribution along an elevation gradient in the Abune Yosef mountain range, Ethiopia. Preferential systematic sampling was employed to collect vegetation and environmental data along the elevation gradient. We found that plant species richness declines monotonically from low to high elevations. Specifically, vascular plant species richness and diversity were lower in the Afroalpine grassland (high elevation) than in the Dry evergreen Afromontane forest and Ericaceous forest (low elevations). In contrast, endemic vascular plant richness was significantly higher in the Afroalpine grassland than in the Dry evergreen Afromontane forest and Ericaceous forest. Elevation showed a significant impact on the richness, diversity, and endemism of vascular plants. According to Sørensen's coefficient, the similarity between Dry evergreen Afromontane forest and Ericaceous forest vegetation types is higher (32%) than the similarity between Ericaceous forest and Afroalpine grassland (18%). Only 5% similarity was recorded between the Dry evergreen Afromontane forest and Afroalpine grassland. Growth forms showed different elevational richness patterns. Trees and liana increased monotonically up to 3300 m. Shrub and herb richness patterns followed a hump-shaped and inverted hump-shaped pattern along the elevation gradient. The elevation patterns of vascular plant species richness, diversity, and growth form in the present study may be attributed to differences in management intensity, spatial heterogeneity, microclimatic variations, and anthropogenic disturbances.

Vascular patterns in basal cell carcinoma: Dermoscopic, confocal and histopathological perspectives.

Basal cell carcinoma (BCC) is the most prevalent skin cancer in the Caucasian population. A variety of different phenotypic presentations of BCC are possible. Although BCCs rarely metastasize, these tumors commonly destroy underlying tissues and should therefore be treated promptly. As vascular formation and angiogenesis are indicators of tumor development and progression, the presence of blood vessels, their morphology and architecture are important markers in skin lesions, providing critical information towards pathogenesis and diagnosis. BCC commonly lacks pigmentation, therefore it is important to emphasize the usefulness of vascular feature detection, recognition, quantification and interpretation. To answer the question of whether vascular patterns observed on dermoscopy, reflectance confocal microscopy (RCM) and histopathology might reflect the biologic behavior of BCCs, we undertook this review article. Several studies have sought, by various means, to identify vascular features associated with the more aggressive BCC phenotypes. Dermoscopic vascular pattern assessment can facilitate diagnostic discrimination between BCC subtypes, more aggressive BCCs displaying less or no pink coloration and a relative absence of central tumor vessels. RCM, a novel, non-invasive imaging technique, allows for the quantification of blood vessel size, density, and flow intensity in BCCs. BCCs are distinguished on RCM chiefly by vessels that branch and intertwine between neoplastic aggregates, a pattern strongly reflecting tumor neo-angiogenesis. The analysis of these vascular morphological and distribution patterns can provide further support in the diagnosis, assessment, or monitoring of BCCs. Histopathology shows significantly higher microvessel densities in the peritumoral stroma of BCCs, when compared to normal skin or benign tumors. This angiogenic response in the stroma is associated with local aggressiveness, therefore the quantification of peritumoralmicrovessels may further assist with tumor evaluation. How dermoscopy and RCM vascular patterns in BCC correlate with histopathological subtype and thus help in discriminating aggressive subtypes definitely deserves further investigation.

Zebrafish as an early stage screening tool to study the systemic circulation of nanoparticulate drug delivery systems in vivo

Nanomedicines have gained much attention for the delivery of small molecules or nucleic acids as treatment options for many diseases. However, the transfer from experimental systems to in vivo applications remains a challenge since it is difficult to assess their circulation behavior in the body at an early stage of drug discovery. Thus, innovative and improved concepts are urgently needed to overcome this issue and to close the gap between empiric nanoparticle design, in vitro assessment, and first in vivo experiments using rodent animal models.This study was focused on the zebrafish as a vertebrate screening model to assess the circulation in blood and extravasation behavior of nanoparticulate drug delivery systems in vivo. To validate this novel approach, monodisperse preparations of fluorescently labeled liposomes with similar size and zeta potential were injected into transgenic zebrafish lines expressing green fluorescent protein in their vasculature. Phosphatidylcholine-based lipids differed by fatty acid chain length and saturation. Circulation behavior and vascular distribution pattern were evaluated qualitatively and semi-quantitatively using image analysis. Liposomes composed of lipids with lower transition temperature (<28°C) as well as PEGylated liposomes showed longer circulation times and extravasation. In contrast, liposomes composed of lipids with transition temperatures>28°C bound to venous parts of the vasculature. This circulation patterns in the zebrafish model did correlate with published and experimental pharmacokinetic data from mice and rats.Our findings indicate that the zebrafish model is a useful vertebrate screening tool for nanoparticulate drug delivery systems to predict their in vivo circulation behavior with respect to systemic circulation time and exposure.

The Role of Ultrasonography for Differentiating and Management of Malignant Cervical Lymph Nodes

Objective:To investigate the value of grey scale and Doppler ultrasonography in the assessment of metastatic and lymphomatous cervical lymph nodes.Methods:One hundred and nineteen malignant cervical lymph nodes in 119 patients diagnosed as malignant according to grey scale, color Doppler and spectral Doppler ultrasonography features were included in this study. The sizes, shape, echo pattern, echogenic hilus, nodal border, cystic necrosis and coagulation necrosis, vascular distribution pattern, resistivity and pulsatility index values of lymph nodes were noted. All patients had histopathological diagnosis.Results:The final diagnosis of the 42 lymph nodes was lymphoma, and of the 77 lymph nodes was carcinoma metastasis (33 thyroid carcinoma metastasis and 44 squamous cell carcinoma metastasis). While a hyperechoic pattern and calcification were detected in the lymph nodes originating from thyroid carcinoma as 39% and 33%, respectively, a reticular pattern (26%) and low resistive and pulsatility indices were detected in lymph nodes originating from lymphoma. These criteria were statistically significant for the differential diagnosis (p<0.05). Size, shape, hypoechoic echo pattern, absence of echogenic hilus, nodal border, cystic necrosis, coagulation necrosis and vascular distribution pattern were not found to be significant for the detection of a primary tumour.Conclusion:Hyperechoic echo pattern, reticular pattern, calcification, low resistivity and pulsatility indices are useful parameters for the differential diagnosis of malignant cervical lymph nodes. These ultrasonography critaria can be used for assesment and management of unknown primary malign neck nodes.

Vascular Plant Diversity and their Distribution Pattern in Sandwip Island, Chittagong,Bangladesh

Sandwip is one of the biggest offshore island in Chittagong district of Bangladesh located at 22°22′-22°34′ N and 91°26′- 91°34′ E with an area of 762.42 sq. km. Plant species of the island are at risk because of drought, salinity, anthropological activities and continuous bank erosion in the sea. The main goal of the study is to document the plant diversity of the island before their disappear. Therefore, a study on the vascular plant diversity and their distribution pattern of the island has been conducted during March 2011 to December 2012. Vascular species diversity and distribution pattern are investigated by random quadrat method. A total of 438 vascular plant species under 319 genera and 111 families have been documented from the 48 study sites. Shannon-Wiener diversity index (H`), species richness (d) and Pielou’s evenness index (J`) have been done by using PRIMER v6 program. Plant diversity is higher in the middle part (H` 5.511, J` 0.944 and d 48.49) than the other parts of the island. Highly dominant species of the island are Centella asiatica (L.) Urban., Blumea lacera DC., Cynodon dactylon Pers., Lippia alba (Mill.) Briton et Wilson, Chenopodium album L., Alternanthera philoxeroides (Mart.) Griseb, Lemna perpusilla Torrey, Portulaca olearacea L., Chrysopogon aciculatus (Retz.) Trin and Achyranthes aspera L. respectively. Analysis of variance (ANOVA) revealed that the abundance of highly dominant species like Blumea lacera DC., Chenopodium album L., Alternanthera philoxeroides (Mart.) Griseb, Lemna perpusilla Torrey, Achyranthes aspera L. and Bryophyllum calycinum Salisb. were significantly (P<0.05) varied in different parts of the island. It can be concluded that the present study will be helpful for the planners and policy makers to plan for the better conservation and sustainable management of plant resources of Sandwip Island.

Direct 3D Analyses Reveal Barrel-Specific Vascular Distribution and Cross-Barrel Branching in the Mouse Barrel Cortex.

Whether vascular distribution is spatially specific among cortical columns is a fundamental yet controversial question. Here, we have obtained 1-μm resolution 3D datasets that cover the whole mouse barrel cortex by combining Nissl staining with micro-optical sectioning tomography to simultaneously visualize individual cells and blood vessels, including capillaries. Pinpointing layer IV of the posteromedial barrel subfield, direct 3D reconstruction and quantitative analysis showed that (1) penetrating vessels preferentially locate in the interbarrel septa/barrel wall (75.1%) rather than the barrel hollows, (2) the branches of 70% penetrating vessels only reach the neighboring but not always all the neighboring barrels and the other 30% extend beyond the neighboring barrels and may provide cross-barrel blood supply or drainage, (3) the branches of 59.6% penetrating vessels reach all the neighboring barrels, while the rest only reach part of them, and (4) the length density of microvessels in the interbarrel septa/barrel wall is lower than that in the barrel hollows with a ratio of 0.92. These results reveal that the penetrating vessels and microvessels exhibit a barrel-specific organization, whereas the branches of penetrating vessels do not, which suggests a much more complex vascular distribution pattern among cortical columns than previously thought.

Three-dimensional power Doppler transrectal ultrasound: value in prediction of prostate cancer aggressiveness

ObjectiveThe aim of the study was to evaluate the role of three-dimensional power Doppler transrectal ultrasound in the diagnosis and prediction of aggressiveness of prostate cancer.Materials and methodsA total of 93 patients were included in the study; all patients had abnormal digital rectal examination or high serum prostate-specific antigen or both. All patients underwent two-dimensional transrectal ultrasound (2D-TRUS), three-dimensional grey-scale transrectal ultrasound (3D-GS TRUS), and three-dimensional power Doppler sonography (3D-PDS). Vascular distribution patterns were evaluated according to the following grading system: I, regular and strip-shaped flow distribution in the peripheral zone (PZ) and/or transitional zone; II, asymmetric abundant flow with vascular disorganization in the PZ; and III, diffusely increased flow with vascular disorganization in the PZ and transitional zone. Grades II and III were regarded as abnormal, and grade I was considered to be normal. Target biopsies were obtained together with 12 core systematic biopsies. Pathological results were correlated with the imaging data.ResultsFifty-six patients had prostate cancer, and 37 patients had no evidence of malignant prostatic disease. 3D-PDS had sensitivity of 76.6%, specificity 78.4%, positive predictive value of 84.3%, negative predictive value of 69%, and overall accuracy of 77.4% in differentiation between benign and malignant prostate. The vascular pattern correlated well with serum prostate-specific antigen, Gleason score, presence of metastasis, and local infiltration.Conclusion3D-PDS improves accuracy of detection, local staging, and prediction of biological behavior of prostate cancer patients compared with 2D-TRUS and 3D-TRUS.

Research for distribution of blood vessels in breast neoplasms with color Doppler flow imaging

Objective To explore the difference of normal breast artery feeding pattern between benign and malignant breast neoplasms with color Doppler flow imaging (CDFI).Methods CDFI were performed for 248 cases breast neoplasms confirmed by pathology.Spatial location were observed between normal breast arteries and breast neoplasms.The difference of breast artery feeding pattern was compared between benign and malignant breast neoplasms.Resnlts CDFI showed that penetrating vessels,branches of penetrating vessels,branches of direct vessels and central large vessels were characteristic breast cancer vascular distribution patterns,which were completely different from that of breast benign neoplasms.Conclusions The patterns of breast artery feeding breast cancer were different from that of breast benign neoplasms,that can identify both. Key words: Ultrasonography,Doppler,color ; Breast neoplasms ; Vascular distribution

Diagnostic Accuracy of Doppler Ultrasonography in Differentiation between Malignant and Benign Cervical Lymphadenopathies in Pediatric Age Group

Cervical lymphadenopathy is a relatively common finding in pediatric age group and is caused by a wide spectrum of diseases from transient infections to malignancies especially lymphomas. The present study was aimed at evaluating the diagnostic performance of grey-scale ultrasonography, color Doppler ultrasonography and power Doppler ultrasonography in differentiation of reactively and metastatically enlarged cervical lymph nodes in pediatric age group. Fifty children with cervical lymphadenopathies were assessed by ultrasonographic methods. In each patient, the longest (L) and transverse (T) diameters, L/T ratio and presence or absence of the normal hilar pattern were checked by grey-scale ultrasonography. Spectral parameters (resistive and pulsatility indices) and vascular distribution pattern of nodes were recorded by color and power Doppler ultrasonography, respectively. Following the ultrasonographic evaluations, biopsy and/or clinical follow up was applied for six months, based on the clinical and paraclinical findings. Statistical analyses were performed by chi-square test, independent t-test and receiver operator characteristic curves. The mean age of patients was 12.42 +/- 2.42 years. Twenty eight patients (56%) had malignant enlargement of lymph nodes. The mean value of L/T ratio in malignant group was 1.70 +/- 0.22 and 2.40 +/- 0.38 in non-malignant nodes (p < 0.001). Sensitivity, specificity and accuracy of combined grey-scale and power Doppler ultrasonography were 70, 86 and 81%, respectively. Combination of grey-scale and power Doppler ultrasonography is recommended for the differentiation between the malignant and benign lymphadenopathies in children. Moreover, our findings revealed no diagnostic role of color Doppler ultrasonography in the selection of malignant cervical lymph nodes in children.

Definition of Vascular Territories on Myocardial Perfusion Images by Integration with True Coronary Anatomy: A Hybrid PET/CT Analysis

For interpretation of myocardial perfusion studies, tissue segments are usually assigned to coronary vascular territories based on general assumptions about the most frequent vascular distribution pattern. These assumptions may be inaccurate because of interindividual variability of coronary anatomy. This limitation may be overcome by hybrid imaging through the individual integration of coronary anatomy with myocardial tissue regions. We studied 71 consecutive patients who underwent (82)Rb perfusion PET/CT, including CT angiography, for work-up of coronary artery disease on a 64-slice PET/CT scanner. Coronary vessels as defined by CT were assigned to each of 17 myocardial segments for PET analysis using fusion images. Reassigned segmental maps were compared with standard assignment as proposed by the American Heart Association model, without knowledge of individual anatomy. The validity of segmental assignment was tested in 6 dogs by comparison of PET/CT with ex vivo dye staining of coronary territories. Dog studies showed excellent agreement between PET/CT-defined segments and ex vivo-stained territories (kappa, 0.80). In patients, 72% (51/71) demonstrated differences from the standard assignment in at least 1 myocardial segment; 112 of 1,207 segments were reassigned to nonstandard vascular territories. Most frequently, standard right coronary segments were reassigned to the left circumflex territory (39% of reassigned segments), standard circumflex segments were reassigned to the left anterior descending territory (30%), and standard left anterior descending segments were reassigned to either circumflex or right coronary (12% and 11%, respectively). In 27 studies with a myocardial perfusion defect, relative uptake in the vascular territory with the defect was significantly lower after CT-based reassignment and was higher in remote territories, resulting in better separation (ratio of defect to remote, 0.75 +/- 0.13 vs. 0.81 +/- 0.12 before reassignment; P = 0.0014). Standard assumptions about vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability of the coronary tree. If hybrid imaging has been used to study coronary anatomy and myocardial tissue perfusion, then localization of perfusion abnormalities should be based on CT-derived anatomy. This may bring about more accurate assignment to culprit vessels and thus improved guidance and monitoring of targeted therapy.

Placental markers of twin-to-twin transfusion syndrome in diamniotic–monochorionic twins: A morphometric analysis of deep artery-to-vein anastomoses

Twin-to-twin transfusion syndrome (TTTS) is a multifactorial disorder that develops in 9–15% of diamniotic–monochorionic twin gestations. While the pathogenesis of TTTS remains poorly understood, unbalanced deep artery-to-vein (AV) anastomoses have traditionally been implicated in the gradual shift of blood from donor to recipient. The aim of this study was to define the placental markers of twin-to-twin transfusion syndrome, with special emphasis on the deep AV anastomoses. A prospective cohort of 284 consecutive diamniotic/monochorionic twin placentas was examined at Women and Infants Hospital between 2001 and 2008. Following exclusion of monoamniotic, multiple, disrupted and laser-treated placentas, 218 twin placentas (21 TTTS and 197 non-TTTS controls) formed the subject of this study. Placentas were injected with color-coded dyes. Anatomic characteristics and choriovascular anastomotic patterns of TTTS placentas were compared with non-TTTS controls. The TTTS placentas showed significantly higher frequencies of velamentous cord insertion, magistral vascular distribution patterns, uneven placental sharing, absence of AA anastomoses and presence of VV anastomoses. Deep AV anastomoses were identified in ≥95% of TTTS and non-TTTS placentas and were overall more abundant than previously reported. The total and net numbers of AV anastomoses were similar in both groups. However, the net cross-sectional area of AV anastomoses, which also takes into account the caliber of the vessels, was significantly smaller in TTTS placentas. There was no correlation between the direction of the AV imbalance and the twin donor/recipient status. In conclusion, TTTS has distinct placental characteristics, warranting their routine inclusion in the diamniotic–monochorionic placental pathology report. Our findings suggest imbalance of AV anastomoses is not required for the development for TTTS, although their presence, whether balanced or unbalanced, may contribute to the creation or perpetuation of the syndrome. Elucidation of the role of the various placental determinants in diamniotic–monochorionic twin gestations may lead to further refinement of therapeutic strategies.

The correlation of tumor vascularity as imaged by near-infrared technology with tissue distribution of angiogenic and growth promoters.

Abstract Abstract #907 Background: Angiogenesis is necessary for solid tumors to grow. Rapidly growing tissues, increased metabolic demands as well as the presence of hypoxia and ischemia promote angiogenesis by stimulation of factors like vascular endothelial cell growth factor (VEGF), a key angiogenic factor. Many studies have found that angiogenesis is an independent prognostic factor in both node positive and node negative breast cancer. We have developed a novel technique, ultrasound guided optical tomography in the near-infrared wavelength (NIR-US), that accurately localizes tumor lesion with ultrasound and then images tumor angiogenesis. We have now collected images and tissue from 12 patients treated with preoperative chemotherapy. These tumors are large and heterogeneous with respect to vascular images. We have begun to correlate the tissue expression of a variety of pro-angiogenic proteins with the extent, distribution and pattern of vascularity demonstrated by our NIR-US. Methods: Using NIR-US images, the quantification of vascular content was performed by measuring the total hemoglobin content X volume of distribution of that hemoglobin content. This measure is termed the Blood Volume Index (BVI). In 12 patients studied, the level of tumor vascularity as measured by the initial BVI did not correlate with tumor grade, mitotic index, or estrogen receptor status or most importantly with response to treatment. We analyzed tissue specimens already collected with known patterns of vascular distribution on NIR-US and with known MVD to understand what might be driving the vascular response. Histologic sections were prepared and stained for; endothelial adhesion marker PECAM/CD31, VEGF, the activated stress response kinase P-AMPK, the cell proliferation marker Ki67, and SMA (smooth muscle actin) a marker of vasculature support cells and glucose transporter-1. Each case was quantified using at least 5 40X fields and pixel-by-pixel summation using Image Pro Plus software (Media cybernetics, Inc.) represented as average +/- SD. Results: The tumor BVI as defined by NIR-US did not correlate with either CD31 or SMA expression and was inversely correlated with VEGF levels. The higher VEGF, the lower the BVI. Of particular interest, the highest CD31 signals correlated with high VEGF levels in two, HER-2 positive patients, but not with BVI. Proliferation rate (Ki67), glucose transporter-1 and P-AMPK expression did not correlate with vascular content as measured by NIR-US.&amp;#x2028; Conclusion: Study of the above growth promoters in tissue imaged by NIR-US did not reveal an association between their expression and the vascular content of the tissue. Of interest, VEGF expression varied greatly within the tumor specimens and showed no correlation to BVI.&amp;#x2028; Financial support provided by a Research Grant from the CT Breast Health Initiative. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 907.