Near Infrared Fluorescence Imaging for early detection,monitoring and improved intervention of diseases involving the joint

Abstract

Joints consist of different tissues, such as bone, cartilage and synovium, which are at risk for multiple diseases. The current imaging modalities, such as magnetic resonance imaging, Doppler ultrasound, X-ray, computed tomography and arthroscopy, lack the ability to detect disease activity before the onset of anatomical and significant irreversible damage. Optical in vivo imaging has recently been introduced as a novel imaging tool to study the joint and has the potential to image all kinds of biological processes. This tool is already exploited in (pre)clinical studies of rheumatoid arthritis, osteoarthritis and cancer. The technique uses fluorescent dyes conjugated to targeting moieties that recognize biomarkers of the disease. This review will focus on these new imaging techniques and especially where Near Infrared (NIR) fluorescence imaging has been used to visualize diseases of the joint. NIR fluorescent imaging is a promising technique which will soon complement established radiological, ultrasound and MRI imaging in the clinical management of patients with respect to early disease detection, monitoring and improved intervention.     

High technologies in radiodiagnostics: possibilities and prospects

Diagnostic radiology includes several basic techniques such as conventional radiography, computed tomography, magnetic resonance imaging, radionuclide study, ultrasonography, and positron emission tomography as the most important methods. Radiological screening procedures or preclinical diagnostic techniques, as well as interventional radiological procedures, are being used more and more widely in clinical medicine. The integration and combination of different technologies, the introduction of digital diagnostic technologies, and the creation of radiological information systems on their basis are important factors increasing diagnostic efficiency. Improved technologies make it possible to change diagnostic tactics in the majority of diseases; the diagnostic process shortens because preference is given to most informative methods. Intensive technological development requires changes in the arrangement of radiologists' work.     

核磁共振扩散加权成像对小肝癌诊断的研究

肝癌是我国常见的恶性肿瘤之一,小肝癌的及时诊断与治疗,对改善患者预后及提高生存率至关重要。近年来,随着核磁共振扩散加权成像（DWI）技术发展迅速,其在腹部疾病诊治中广泛应用。目前MRI对小肝癌的检出率、确诊率优于CT及超声,DWI序列的联合应用对小肝癌的诊断具有重要意义。本文就 DWI成像技术在小肝癌临床诊断中的应用价值进行综述。     

Measurement of femoral neck anteversion in 3D. Part 2:3D modelling method

Femoral neck anteversion is the torsion of the femoral head with reference to the distal femur. Conventional methods that use cross-sectional computed tomography (CT), magnetic resonance or ultrasound images to estimate femoral anteversion have met with several problems owing to the complex three-dimensional (3D) structure of the femur. A 3D imaging method has been developed that virtually measures femoral anteversion on the 3D computer space with continuous CT slices; this 3D method provides more accurate and reliable results than conventional 2D CT measurements. A 3D modelling method is devised for the measurement of femoral neck anteversion. This method has advantages over the 3D imaging method, such as shorter processing time, reduced number of slices and an objective result compared with the 3D imaging method. The results of the 3D modelling method are compared with the conventional CT methods (2D CT method and 3D imaging method) using 20 dried femurs.     

Clinically low-risk prostate cancer: evaluation with transrectal doppler ultrasound and functional magnetic resonance imaging

OBJECTIVES:

To evaluate transrectal ultrasound, amplitude Doppler ultrasound, conventional T₂‐weighted magnetic resonance imaging, spectroscopy and dynamic contrast‐enhanced magnetic resonance imaging in localizing and locally staging low‐risk prostate cancer.

INTRODUCTION:

Prostate cancer has been diagnosed at earlier stages and the most accepted classification for low‐risk prostate cancer is based on clinical stage T1c or T2a, Gleason score ≤6, and prostate‐specific antigen (PSA) ≤10 ng/ml.

METHODS:

From 2005 to 2006, magnetic resonance imaging was performed in 42 patients, and transrectal ultrasound in 26 of these patients. Seven patients were excluded from the study. Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml. The examinations were analyzed for tumor identification and location in prostate sextants, detection of extracapsular extension, and seminal vesicle invasion, using surgical pathology findings as the gold standard.

RESULTS:

Sixteen patients (45.7%) had pathologically proven organ‐confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for localizing low‐risk prostate cancer were 53.1%, 48.3%, 63.4%, 37.8% and 51.3% for transrectal ultrasound; 70.4%, 36.2%, 65.1%, 42.0% and 57.7% for amplitude Doppler ultrasound; 71.5%, 58.9%, 76.6%, 52.4% and 67.1% for magnetic resonance imaging; 70.4%, 58.7%, 78.4%, 48.2% and 66.7% for magnetic resonance spectroscopy; 67.2%, 65.7%, 79.3%, 50.6% and 66.7% for dynamic contrast‐enhanced magnetic resonance imaging, respectively.Sensitivity, specificity, PPV, NPV and accuracy values for detecting extracapsular extension were 33.3%, 92%, 14.3%, 97.2% and 89.7% for transrectal ultrasound and 50.0%, 77.6%, 13.7%, 95.6% and 75.7% for magnetic resonance imaging, respectively. For detecting seminal vesicle invasion, these values were 66.7%, 85.7%, 22.2%, 97.7% and 84.6% for transrectal ultrasound and 40.0%, 83.1%, 15.4%, 94.7% and 80.0% for magnetic resonance imaging.

CONCLUSION:

Although preliminary, our results suggest that imaging modalities have limited usefulness in localizing and locally staging clinically low‐risk prostate cancer.     

冠脉粥样硬化的断层影像检查方法及其临床应用

虽然选择性冠脉造影是诊断冠状动脉疾病的金标准,但该检查费用高,有一定的危险性。断层影像检查方法如电子束CT、多层螺旋CT、磁共振成像作为无创性的冠脉影像诊断技术,随着空间分辨率、时间分辨率的进一步提高以及各种扫描技术的进一步完善,必将成为一种有前途的诊断冠脉疾病以及其他心脏疾病的非侵袭性技术。     

Gadoxetic acid-enhanced magnetic resonance imaging significantly influences the clinical course in patients with colorectal liver metastases

Background

Gadoxetic acid (Primovist?)-enhanced magnetic resonance imaging (P-MRI) scans have higher accuracy and increased detection of small colorectal liver metastases (CRLM) compared to CT scans or conventional MRI scans. But, P-MRI scans are still inconsistently acquired in the diagnostic work up of patients with CRLM. The aim of this study was to determine the influence of P-MRI scans on treatment plan proposition and subsequently the clinical course of the patient.

Methods

Eighty-three consecutive patients with potentially resectable CRLM based on a conventional CT scan underwent P-MRI scanning prior to treatment. Treatment plans proposed by the multidisciplinary team were compared before and after P-MRI scanning and related to the final treatment and diagnosis, the accuracy for the CT scan and P-MRI scan was calculated.

Results

P-MRI scans led to a change of treatment in 15 patients (18%) and alteration of extensiveness of local therapy in another 17 patients (20%). All changes were justified leading to an accuracy of 93% for treatment proposition based on P-MRI scan, compared to an accuracy of 75% for the CT scan.

Conclusions

P-MRI scans provide additional information that can aid in proposing the most suitable treatment for patients with CRLM and might prevent short-term reintervention.

     

Imaging techniques for soft tissue sarcomas: emphasis on the role in differential diagnosis,tumour grading and monitoring therapy effects

Radiological evaluation of soft tissue sarcomas may include conventional radiography, magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US). The contribution of radiological examination from a pathologist's perspective is stressed; this includes assessment of either intra- or extraosseous tumour origin; indication of viable tumour vs tumoural or therapy-induced necrosis; differential diagnosis etc. Furthermore, this review discusses the role of different imaging modalities in initial lesion detection and identification of local recurrence. In particular, situations where MRI and plain radiography are used to narrow the differential diagnosis are outlined.     

Detecting Stripe Artifacts in Ultrasound Images

Brain perfusion diseases such as acute ischemic stroke are detectable through computed tomography (CT)-/magnetic resonance imaging (MRI)-based methods. An alternative approach makes use of ultrasound imaging. In this low-cost bedside method, noise and artifacts degrade the imaging process. Especially stripe artifacts show a similar signal behavior compared to acute stroke or brain perfusion diseases. This document describes how stripe artifacts can be detected and eliminated in ultrasound images obtained through harmonic imaging (HI). On the basis of this new method, both proper identification of areas with critically reduced brain tissue perfusion and classification between brain perfusion defects and ultrasound stripe artifacts are made possible.     

Pulmonary vasoconstriction and changes in heart rate during asphyxia in immature foetal lambs

1. The effect of changing the composition of pulmonary arterial blood on the pulmonary vasoconstrictor response to asphyxia was studied in immature foetal lambs of ~ 90 days gestation age.

2. When normal foetal carotid arterial blood (withdrawn before asphyxia) was introduced during asphyxia, the pulmonary vasoconstriction was rapidly and wholly relieved as soon as this blood reached the lung. This did not happen when blood was used which had been withdrawn during asphyxia.

3. Conversely introduction into a pulmonary artery of a foetal lamb during recovery, of arterial blood withdrawn during asphyxia, caused an immediate return of pulmonary vasoconstriction.

4. These phenomena could not be explained by the generation of vasodilator agents such as bradykinin, acetylcholine, histamine or isoprenaline.

5. During asphyxia injection of normal foetal arterial blood into the left atrium did not cause pulmonary vasodilatation, but did elicit a large increase in heart rate.

6. Neither the pulmonary vasoconstriction during asphyxia, nor its relief by normal foetal arterial blood, nor the changes in heart rate were affected by previous bilateral vagotomy or administration of atropine or hexamethonium.

7. It was concluded that, in immature foetal lambs, the effect of asphyxia in causing pulmonary vasoconstriction was mainly, if not exclusively, by a local action within the lungs, and that the bradycardia during asphyxia was mainly due to the fall in P_O2 acting locally upon the heart.

     

A general software package for the handling of medical images

PICS (portable imaging computer software), is a software system designed for handling and processing a variety of types of medical image. It has been designed to satisfy the following criteria:

(a) the software should be portable between different items of hardware with minimal alteration:

(b) there should be a simple operator interface to enable use by inexperienced users, while avoiding the need for experienced users to be directed through tedious menu trees;

(c) the programming environment should enable simple integration of new data handling protocols.

To meet these requirements the software was written in FORTRAN using structured subroutine organization.

The software has basic image handling and processing facilities and contains a comprehensive set of nuclear medicine clinical protocols. Other facilities include alignment of images from different modalities with display of superimposed images and ability to handle, analyse and display three-dimensional data sets.

Data transfer programs have been written to capture data from gamma camera, CT, AMI, ultrasound and radiographs by converting the images to a common data format.

The system provides a hospital with a central digital image handling resource, enabling investigation of the value of digital image processing in potential clinical applications.     

The clinical and radiological evaluation of primary brain neoplasms in children, Part II: Radiological evaluation.

Data collected over the past 8 years on the radiological appearance of common pediatric primary brain neoplasms are presented. An emphasis is placed on the newer radiological imaging modality of magnetic resonance imaging (MRI). Part I of this article emphasized the clinical evaluation of these brain neoplasms. Three hundred eighty-five children with known brain neoplasms ranging in age from newborn to 18 years were evaluated with one or all of the following radiological modalities: MRI, computed tomography (CT), water-soluble myelography (WSM), WSM with CT, and angiography. Contrast-enhanced MRI and CT scans both were accurate in delineating these brain neoplasms although MRI provided better resolution and delineation than CT. Angiography provided information on the vascularity of the neoplasms and their relationship to prominent arterial and venous structures. Water-soluble myelography with CT and gadolinium-enhanced MRI of the spine were equally accurate in demonstrating metastatic spread to the spinal canal and spinal cord. Magnetic resonance imaging with gadolinium was more accurate than CT with contrast in demonstrating recurrent or residual neoplasm at the operative site and metastatic spread to the brain. Magnetic resonance imaging with gadolinium is the best radiological modality to fully evaluate pediatric brain neoplasms.     

Partial deletion of the long arm of chromosome 11 [del(11)(q23.3→qter)] with abnormal white matter

A patient with partial deletion of the long arm of chromosome 11[del(11)(q23.3→qter)] had macrocephalic trigonocephaly, growth and mental retardation, congenital heart defect, and characteristic facial appearance familiar to that of 33 other reported patients with this deletion. Computed tomography (CT) and magnetic resonance imaging of this infant's brain demonstrated abnormality of the supratentorial white matter. This may represent either deficiency or delay in myelination or possibly a demyelination process. No abnormalities in white matter were described in seven of 33 previously reported patients whose brains were examined by ultrasound, CT, or autopsy.     

Simultaneous assessment of both lung morphometry and gas exchange function within a single breath‐hold by hyperpolarized 129Xe MRI

During the measurement of hyperpolarized ¹²⁹Xe magnetic resonance imaging (MRI), the diffusion‐weighted imaging (DWI) technique provides valuable information for the assessment of lung morphometry at the alveolar level, whereas the chemical shift saturation recovery (CSSR) technique can evaluate the gas exchange function of the lungs. To date, the two techniques have only been performed during separate breaths. However, the request for multiple breaths increases the cost and scanning time, limiting clinical application. Moreover, acquisition during separate breath‐holds will increase the measurement error, because of the inconsistent physiological status of the lungs. Here, we present a new method, referred to as diffusion‐weighted chemical shift saturation recovery (DWCSSR), in order to perform both DWI and CSSR within a single breath‐hold. Compared with sequential single‐breath schemes (namely the ‘CSSR + DWI’ scheme and the ‘DWI + CSSR’ scheme), the DWCSSR scheme is able to significantly shorten the breath‐hold time, as well as to obtain high signal‐to‐noise ratio (SNR) signals in both DWI and CSSR data. This scheme enables comprehensive information on lung morphometry and function to be obtained within a single breath‐hold. In vivo experimental results demonstrate that DWCSSR has great potential for the evaluation and diagnosis of pulmonary diseases.     

Hormonal actions of the heart and of lungs on the isolated kidney

1. An hormonal influence of the heart on the isolated kidney has been demonstrated by insertion of hearts into pump-oxygenator circuits during renal perfusions.

2. This hormone is a steroid which is secreted from the heart into the cardiac venous blood in response to reduction in venous input. The steroid is extractable from heart muscle.

3. The actions of the cardiac steroid resemble those of aldosterone but are of shorter latency. Renal blood flow (R.B.F.) and glomerular filtration rate (G.F.R.) rise; urine flow, Na-concentration and Na/K decrease.

4. An hormonal influence of lungs on the isolated kidney is also demonstrated. This hormone is not a steroid. It is antidiuretic and Na-retaining: the concentration of urinary Na rises: Na/K remains unchanged.

     

Evolution of picture archiving and communication systems—1989

Several areas of partial picture archiving and communication systems (PACS) applications such as teleradiology, nuclear medicine, archiving modules, and systems for handling computed tomography and magnetic resonance digital data are mentioned prior to the discussion of a fully functional PACS system. Some of the present and future social implications of PACS are reviewed. Experience to date with a pilot system called MicroRSTAR at the Massachusetts General Hospital is described.

     

Fusion of Color Doppler and Magnetic Resonance Images of the Heart

This study was designed to establish and analyze color Doppler and magnetic resonance fusion images of the heart, an approach for simultaneous testing of cardiac pathological alterations, performance, and hemodynamics. Ten volunteers were tested in this study. The echocardiographic images were produced by Philips IE33 system and the magnetic resonance images were generated from Philips 3.0-T system. The fusion application was implemented on MATLAB platform utilizing image processing technology. The fusion image was generated from the following steps: (1) color Doppler blood flow segmentation, (2) image registration of color Doppler and magnetic resonance imaging, and (3) image fusion of different image types. The fusion images of color Doppler blood flow and magnetic resonance images were implemented by MATLAB programming in our laboratory. Images and videos were displayed and saved as AVI and JPG. The present study shows that the method we have developed can be used to fuse color flow Doppler and magnetic resonance images of the heart. We believe that the method has the potential to: fill in information missing from the ultrasound or MRI alone, show structures outside the field of view of the ultrasound through MR imaging, and obtain complementary information through the fusion of the two imaging methods (structure from MRI and function from ultrasound).     

极度非均匀磁场下的低场核磁共振成像技术研究进展

传统的磁共振成像设备系统庞大笨重、价格昂贵、检查噪声大、摆位困难等,因此限制其普及应用,而低场可移动式磁共振成像设备可以克服这些缺点。传统核磁共振成像采取大磁体包围小样品的模式,对高度均匀磁场环境(<5×10^-6/40 mm DSV)中的样品进行成像,相应的硬件设计和许可技术相对都比较成熟和完善。开放式核磁共振成像系统基于极度不均匀的磁场条件(>1 000×10^-6/mm DSV),相关的硬件设计、成像技术与传统的核磁共振成像系统差距很大,难度也急剧增加。全面论述低场开放式磁共振成像技术的起源、发展、关键技术,包括磁体、射频线圈、梯度线圈等硬件和射频脉冲设计、成像序列、图像后处理等方法,旨在为可移动式核磁共振成像设备的研发抛砖引玉。     

β-mannosyl linkages inhibit CAWS arteritis by negatively regulating dectin-2-dependent signaling in spleen and dendritic cells

Abstract

Aims: CAWS, Candida albicans water-soluble fraction, is an extracellular mannoprotein produced by C. albicans NBRC1385. It is a ligand of dectin-2, the C-type lectin receptor for innate immunity, and has strong potency for induction of vasculitis in DBA/2 mice. The structure of this mannoprotein is known to be modulated by the culture conditions. To clarify the structure required for vasculitis, CAWSs were prepared in the two culture conditions with or without pH control, and biological properties were compared.

Methods: CAWSs prepared by the standard protocol and pH controlled at 7.0 were designated as CAWS and CAWS727, respectively. The antigenicity was detected by the anti-Candida mannan IgG. These chemical structures were assessed by nuclear magnetic resonance analysis and the lectin array system. The in vitro activity of CAWSs was tested by tumor necrosis factor-α (TNF-α) induction using bone marrow-derived dendritic cells and spleen cell cultures.

Results: The antigenicity of CAWS727 was similar to CAWS but the nuclear magnetic resonance analysis showed a higher ratio of β-mannosyl linkages were detected in CAWS727. The lectin array showed relative affinities of CAWS727 to α-mannosyl specific lectins were weaker than those of CAWS. CAWS induced severe vasculitis in DBA/2 mice while CAWS727 did not. CAWS significantly induced TNF-α but CAWS727 did slightly. In addition, CAWS-induced TNF-α production was inhibited by mixing with CAWS727 in a concentration dependent manner.

Conclusion: The α-mannosyl linkages of Candida mannan is a key molecule for the immunotoxicity. CAWS727, which conatins β-mannosyl linkages, competitively bound to lectin receptors, and resulted in reductions in the inflammatory response.     

Mild emphysema: a novel method using formalin-fixed lungs for computed tomography and pathological analyses

We evaluated a novel method of computed tomography (CT) analysis using formalin-fixed lungs of autopsy cases with mild emphysema. Eight formalin-inflated lungs (FILs) obtained at autopsy were examined using CT after draining off the formalin and air inflation with an air pump, and subjected to pathological study including pathological scoring of emphysema and microscopic image analysis (MIA). Satisfactory CT examination was carried out within 5 h of lung fixation. The mean alveolar area determined by MIA correlated highly with the lung volume (r=0.845) and CT score (r=0.722). This method is simple compared with conventional polyethylene glycol fixation for CT and enables CT examination of resected lungs without anxiety about biohazards. Mild emphysema can be detected by MIA.