Clinical implication of myocardial FDG uptake pattern in oncologic PET: retrospective comparison study with stress myocardial perfusion imaging as the reference standard

The purpose of this study was to determine the clinical implication of the myocardial FDG uptake patterns by comparing with the results of stress myocardial perfusion imaging (MPI) as the reference standard. By reviewing the medical records, 86 pairs of stress MPI and FDG PET/CT of 84 patients who underwent stress MPI and oncologic FDG PET/CT in 1 month were included in this study. The patterns of the myocardial FDG uptake were classified into five patterns such as ‘low’, ‘diffuse’, ‘basal ring’, ‘focal high’, and ‘focal defect on diffuse high’. MPI was evaluated using a 5-point scoring model ranging from 0 (normal uptake) to 4 (uptake absent) based on the 17-segment model. The summed stress score of 4 or higher was defined as ‘abnormal MPI’. Factors predictive of abnormal MPI were analyzed using a log-rank multivariate test and p < 0.05 was set as significant. Abnormal MPI was observed in only 16 of 36 (44%) patients with ‘low’ pattern, 10 of 23 (43%) patients with ‘diffuse high’ pattern, and 1 of 9 (11%) patients with ‘basal ring’ pattern, but in 8 of 9 (89%) patients with ‘focal high’ pattern, and 8 of 9 (89%) patients with ‘focal defect on diffuse high’ pattern. The log-rank multivariate test revealed that ‘focal high’ and ‘focal defect on diffuse high’ pattern were correlated with an abnormal MPI. These results indicate that further cardiac work-up might be helpful in the patients with ‘focal high’ pattern or ‘focal defect on diffuse high’ pattern of myocardial FDG at oncologic PET. A prospective study should be needed to further support this conclusion.     

All-arthroscopic AMIC procedure for repair of cartilage defects of the knee

Purpose  

Bone marrow mesenchymal stem cells were introduced into clinical practice due to their ability to differentiate into many types of cells. Autologous matrix-induced chondrogenesis (AMIC) combines the microfracture method with matrix-based techniques that utilizes a collagen membrane to serve as a scaffold for new bone marrow mesenchymal stem cells, allowing effective reconstruction of even large fragments of a damaged cartilage surface.     

Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation

Iatrogenic consequences of cardiopulmonary resuscitation (CPR) include sternal or rib fractures, pulmonary bone marrow embolisms (BME) and fat embolisms (FE). This report aimed to analyze the frequency and intensity of pulmonary BME and FE in fatal cases receiving final CPR efforts with the use of automated chest compression devices (ACCD) or manual chest compressions (mCC). The study cohort (all cardiac causes of death, no ante-mortem fractures) consisted of 15 cases for each group ‘ACCD’, ‘mCC’ and ‘no CPR’. Lung tissue samples were retrieved and stained with hematoxylin eosin (n = 4 each) and Sudan III (n = 2 each). Evaluation was conducted microscopically for any existence of BME or FE, the frequency of BME-positive vessels, vessel size for BME and the graduation according to Falzi for FE. The data were compared statistically using non-parametric analyses. All groups were matched except for CPR duration (ACCD > mCC) but this time interval was linked to the existence of pulmonary BME (p = 0.031). Both entities occur in less than 25% of all cases following unsuccessful CPR. BME was only detectable in CPR cases, but was similar between ACCD and mCC cases for BME frequency (p = 0.666), BME intensity (p = 0.857) and the size of BME-affected pulmonary vessels (p = 0.075). If any, only mild pulmonary FE (grade I) was diagnosed without differences in the CPR method (p = 0.624). There was a significant correlation between existence of BME and FE (p = 0.043). Given the frequency, intensity and size of pulmonary BME and FE following CPR, these conditions may unlikely be considered as causative for death in case of initial survival but can be found in lower frequencies in autopsy histology.     

Detection of cellular material in lip-prints

We report on the visualization of cellular material within lip-prints using Diamond™ dye (DD). The transfer of cellular material via the lips can occur in cases of contact with food or drinking items as well as cases of alleged sexual assault involving oral contact. DD can effectively detect cellular material transferred by touch. Here we investigate if lip-prints can be detected and whether there is consistency within, or variability between, a person’s propensity to shed cells within lip-prints. Ten volunteers were asked to press their lips against a glass slide with medium pressure for 15 s after not eating or drinking for at least 30 min. Both upper and lower lips were observed, and all tests were performed in five replicates, giving in total 900 observed areas. Consistency in the amount of cellular material deposited by lip-prints for each of the 10 individuals was observed, with each individual being associated with a ‘lip shedder’ status between the extremes of heavy and light. The majority of females shed more cells than the majority of males. No correlation was observed between the lip-prints shedder-status compared to deposition of cellular material from a thumb. Further, no correlation was observed between lip morphology and the ‘lip shedder’ status. Visualization of cellular material was not affected by lip-balm but was adversely affected by cosmetics such as lipstick. This technique demonstrates the visualization of deposited cells from parts of the body other than fingers and how cellular material can be visualized allowing targeted collection of DNA.     

Bone marrow dosimetry in peptide receptor radionuclide therapy with [177Lu-DOTA0,Tyr3]octreotate

Purpose  Adequate dosimetry is mandatory for effective and safe peptide receptor radionuclide therapy (PRRT). Besides the kidneys, the bone marrow is a potentially dose-limiting organ. The radiation dose to the bone marrow is usually calculated according to the MIRD scheme, where the accumulated activity in the bone marrow is calculated from the accumulated radioactivity of the radiopharmaceutical in the blood. This may underestimate the absorbed dose since stem cells express somatostatin receptors. We verified the blood-based method by comparing the activity in the blood with the radioactivity in bone marrow aspirates. Also, we evaluated the absorbed cross-dose from the source organs (liver, spleen, kidneys and blood), tumours and the so-called “remainder of the body” to the bone marrow. Methods  Bone marrow aspirates were drawn in 15 patients after treatment with [¹⁷⁷Lu-DOTA⁰,Tyr³]octreotate. Radioactivity in the bone marrow was compared with radioactivity in the blood drawn simultaneously. The nucleated cell fraction was isolated from the bone marrow aspirate and radioactivity was measured. The absorbed dose to the bone marrow was calculated. The results were correlated to the change in platelet counts 6 weeks after treatment. Results  A strong linear correlation and high agreement between the measured radioactivities in the bone marrow aspirates and in the blood was found (r=0.914, p<0.001). No correlation between the calculated absorbed dose in the bone marrow and the change in platelets was found. There was a considerable contribution from other organs and the remainder of the body to the bone marrow absorbed dose. Conclusion  (1) After PRRT with [¹⁷⁷Lu-DOTA⁰,Tyr³]octreotate, the radioactivity concentration in the bone marrow is identical to that in the blood; (2) There is no significant binding of the radiopharmaceutical to bone marrow precursor stem cells; (3) The contribution of the cross dose from source organs and tumours to the bone marrow dose is significant; and (4) There is considerable variation in bone marrow absorbed dose between patients. These findings imply that for individual dose optimization, individual calculation of the bone marrow absorbed dose is necessary.     

Extraskeletal soft tissue masses of Langerhans’ cell histiocytosis

 Typically, soft-tissue involvement with Langerhans’ cell histiocytosis (LCH) is the result of extension from adjacent bone marrow. We present a patient who developed soft-tissue masses of LCH, which did not arise as a result of extension from bone marrow, but instead produced extrinsic cortical erosion, preserving the marrow signal on MRI.     

Bone marrow involvement in diffuse large B-cell lymphoma: correlation between FDG-PET uptake and type of cellular infiltrate

Purpose  To assess, in patients with diffuse large B-cell lymphoma (DLBCL), whether the low sensitivity of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) for bone marrow assessment may be explained by histological characteristics of the cellular infiltrate. Methods  From a prospective cohort of 110 patients with newly diagnosed aggressive lymphoma, 21 patients with DLBCL had bone marrow involvement. Pretherapeutic FDG-PET images were interpreted visually and semiquantitatively, then correlated with the type of cellular infiltrate and known prognostic factors. Results  Of these 21 patients, 7 (33%) had lymphoid infiltrates with a prominent component of large transformed lymphoid cells (concordant bone marrow involvement, CBMI) and 14 (67%) had lymphoid infiltrates composed of small cells (discordant bone marrow involvement, DBMI). Only 10 patients (48%) had abnormal bone marrow FDG uptake, 6 of the 7 with CBMI and 4 of the 14 with DBMI. Therefore, FDG-PET positivity in the bone marrow was significantly associated with CBMI, while FDG-PET negativity was associated with DBMI (Fisher’s exact test, p=0.024). There were no significant differences in gender, age and overall survival between patients with CBMI and DBMI, while the international prognostic index was significantly higher in patients with CBMI. Conclusion  Our study suggests that in patients with DLBCL with bone marrow involvement bone marrow FDG uptake depends on two types of infiltrate, comprising small (DBMI) or large (CBMI) cells. This may explain the apparent low sensitivity of FDG-PET previously reported for detecting bone marrow involvement.     

Anterior cruciate ligament rupture secondary to a ‘heel hook’: a dangerous martial arts technique

The ‘heel hook’ is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a ‘heel hook’.     

Feasibility of a RARE-based sequence for quantitative diffusion-weighted MRI of the spine

The feasibility of a diffusion-weighted single-shot fast-spin-echo sequence for the diagnostic work-up of bone marrow diseases was assessed. Twenty healthy controls and 16 patients with various bone marrow pathologies of the spine (bone marrow edema, tumor and inflammation) were examined with a diffusion-weighted single-shot sequence based on a modified rapid acquisition with relaxation enhancement (mRARE) technique; four diffusion weightings (b-values: 50, 250, 500 and 750 s/mm²) in three orthogonal orientations were applied. Apparent diffusion coefficients (ADCs) were determined in the bone marrow and in the intervertebral discs of healthy volunteers and in diseased bone marrow. Ten of the 20 volunteers were repeatedly scanned within 30 min to examine short-time reproducibility. Spatial reproducibility was assessed by measuring ADCs in two different slices including the same lesion in 12 patients. The ADCs of the lesions exhibited significantly higher values, (1.27 ± 0.32)×10⁻³ mm²/s, compared with healthy bone marrow, (0.21 ± 0.10)×10⁻³ mm²/s. Short-time and spatial reproducibility had a mean coefficient of variation of 2.1% and 6.4%, respectively. The diffusion-weighted mRARE sequence provides a reliable tool for determining quantitative ADCs in vertebral bone marrow with adequate image quality.     

Ferumoxtran-10-enhanced MR imaging of the bone marrow before and after conditioning therapy in patients with non-Hodgkin lymphomas

To quantify permeability changes of the “blood–bone marrow barrier” (BMB) and to detect malignant bone marrow infiltrations before and after conditioning therapy for subsequent leukapheresis using ferumoxtran-10-enhanced magnetic resonance (MR) imaging. Twenty-two patients with malignant non-Hodgkin lymphomas (NHL), including 9 patients (group A) before and 13 patients (group B) after conditioning therapy, underwent MR of the spine before and after infusion of ferumoxtran-10 (0.045 mmol Fe/kg BW). Pulse sequences comprised dynamic T1-GE and pre- and post-contrast T1-SE and STIR sequences. Dynamic ΔSI-data were correlated with the quantity of mobilized CD34+ cells. In addition, the number of focal bone marrow lesions was compared before and after ferumoxtran-10 administration. Dynamic ΔSI-data were higher in group B than in group A, indicating an increased BMB permeability after conditioning therapy. However, ΔSI-data did not correlate with the quantity of mobilized CD34+ cells. Ferumoxtran-10-enhanced STIR images demonstrated a significant signal decline of the normal, non-neoplastic bone marrow and a significantly increased detection of focal neoplastic lesions compared to pre-contrast images (P<0.05). Ferumoxtran-10 depicted the bone marrow response to conditioning therapy by an increase in BMB-permeability, which, however, did not correlate with the number of mobilized CD34+ cells. Ferumoxtran-10 improved the detection of focal bone marrow lesions significantly (P<0.05).     

Diuretic renography in hydronephrosis: renal tissue tracer transit predicts functional course and thereby need for surgery

Purpose  

The recognition of those hydronephrotic kidneys which require therapy to preserve renal function remains difficult. We retrospectively compared the ‘tissue tracer transit’ (TTT) of ^99mTc-mercaptoacetyltriglycine (^99mTc-MAG₃) with ‘response to furosemide stimulation’ (RFS) and with ‘single kidney function < 40%’ (SKF < 40%) to predict functional course and thereby need for surgery.     

Evaluation of computer-aided detection and dual energy software in detection of peripheral pulmonary embolism on dual-energy pulmonary CT angiography

Purpose  

To evaluate the sensitivity of computer-aided detection(CAD) and dual-energy software(‘Lung PBV’, ‘Lung Vessels’) for detecting peripheral pulmonary embolism(PE).     

MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration

 Objective: To quantify gadolinium-related enhancement in the bone marrow of the spine in normals and in patients with homogeneous diffuse malignant bone marrow infiltration. Design and patients: The patients consisted of two groups: group 1 comprised 94 healthy adults (18–86 years) without bone marrow disease and group 2 comprised 30 patients with homogeneous diffuse malignant bone marrow infiltration due to myeloma (n=20) or breast carcinoma (n=10). All patients received intravenous gadopentetate dimeglumine (Gd-DTPA), 0.1 mmol/kg body weight. Pre- and postcontrast signal intensity (SI) on T1-weighted spin-echo (SE) images (TR/TE: 572 ms/15 ms) was measured over a region of interest (ROI) and the percentage SI increase was calculated. The results were confirmed by bone marrow biopsy (n=20) and clinical parameters (n=10). Dynamic contrast-enhanced studies using a spoiled gradient-recalled-echo (GRE) sequence (TR/TE/α: 68 ms/6 ms 75°) were performed in 10 controls with normal bone marrow. Results and conclusion: Contrast material enhancement in healthy persons can vary greatly (range 3–59%, mean 21%, SD 11%). With increasing age there is a significant decrease in contrast enhancement (Pearson’s correlation, P<0.01). The percentage SI increase in patients with intermediate-grade (biopsy 20–50 vol%) and high-grade (biopsy >50 vol%) diffuse malignant bone marrow infiltration was significantly higher than in normals (mean 67%, SD 34%, P<0.001). Low-grade (biopsy <20 vol%) diffuse malignant bone marrow infiltration can not be assessed by non-enhanced T1-weighted SE images or Gd-DTPA application. In conclusion, contrast material enhancement in healthy persons can vary greatly and is dependent on age, while intermediate-grade and high-grade diffuse malignant bone marrow infiltration can be objectively assessed with SI measurements.     

Evaluation of subsidence, chondrocyte survival and graft incorporation following autologous osteochondral transplantation

Purpose  

The aim of this study was to evaluate subsidence tendency, surface congruency, chondrocyte survival and plug incorporation after osteochondral transplantation in an animal model. The potential benefit of precise seating of the transplanted osteochondral plug on the recipient subchondral host bone (‘bottoming’) on these parameters was assessed in particular.     

BMP12诱导恒河猴骨髓间充质干细胞定向分化为腱细胞

目的研究骨髓间充质干细胞定向分化为腱细胞的可能性。方法通过电穿孔法将外源基因BMP12导入骨髓间充质干细胞中，诱导骨髓间充质干细胞定向分化为腱细胞；在形态学和分子生物学水平上对诱导后的细胞加以鉴定。结果光镜下，诱导后的细胞形态发生明显改变；RT-PCR结果表明，诱导后的细胞有BMP12和Collagen Ⅰ的mRNA表达，而没有Coilagen Ⅲ的mRNA表达；诱导后98.39％的细胞呈CD44^ 、HLA-DR^-。结论BMP12能够诱导骨髓间充质干细胞定向分化为腱细胞，间充质干细胞有可能成为肌腱组织工程种子细胞来源之一。     

Optical coherence tomography in forensic sciences: a review of the literature

Optical coherence tomography (OCT) is an interferometric imaging technique that has revolutionized clinical ophthalmology since the first half of the 1990’s. Despite this approach being successfully employed in ophthalmology and having great potential in forensic cases, its use in different forensic fields appears to be quite limited. In this review we reviewed the scientific literature regarding the application of OCT in forensic science and legal medicine from 1995 to 2019. Our research showed the usefulness of this approach for the study of coronary injuries, postmortem ocular changes, forensic entomology, and several other applications of specific forensic interest (the study of blood stains, fingerprints, and hair bulbs for personal identification, as well as the study of materials found in the crime scene for comparation, or anti-fraud investigation). The creation of specific ‘ad hoc’ devices and a better knowledge of this type of technology by pathologists will be a fundamental step to continue to develop the use of OCT forensic fields.     

Pitfalls in fMRI

Several different techniques allow a functional assessment of neuronal activations by magnetic resonance imaging (fMRI). The by far most influential fMRI technique is based on a local T2*-sensitive hemodynamic response to neuronal activation, also known as the blood oxygenation level dependent or BOLD effect. Consequently, the term ‘fMRI’ is often used synonymously with BOLD imaging. Because interpretations of fMRI brain activation maps often appear intuitive and compelling, the reader might be tempted not to critically question the fundamental processes and assumptions. We review some essential processes and assumptions of BOLD fMRI and discuss related confounds and pitfalls in fMRI – from the underlying physiological effect, to data acquisition, data analysis and the interpretation of the results including clinical fMRI. A background framework is provided for the systematic and critical interpretation of fMRI results.     

Correlated regions of cerebral blood flow with clinical parameters in Parkinson’s disease; comparison using ‘Anatomy’ and ‘Talairach Daemon’ software

Objectives  

We assign the anatomical names of functional activation regions in the brain, based on the probabilistic cyto-architectonic atlas by Anatomy 1.7 from an analysis of correlations between regional cerebral blood flow (rCBF) and clinical parameters of the non-demented Parkinson’s disease (PD) patients by SPM8. We evaluated Anatomy 1.7 of SPM toolbox compared to ‘Talairach Daemon’ (TD) Client 2.4.2 software.     

Correlation of the cross-over ratio of the cross-over sign on conventional pelvic radiographs with computed tomography retroversion measurements

Objective  

To find a correlation between the cross-over ratio of the cross-over sign on conventional anteroposterior (AP) pelvic radiographs and retroversion measurements (‘roof-edge angle’ and ‘equatorial-edge angle) on computed tomography (CT) scans. This would facilitate the interpretation of the cross-over sign regarding the amount of acetabular retroversion.