Multimodality imaging for the diagnosis and treatment of constrictive pericarditis

ABSTRACT

Introduction: Constrictive pericarditis can result in debilitating congestive right heart failure and has been considered an important cause of morbidity and mortality in patients with cardiovascular disease. Multimodality imaging continues to play a fundamental role in the individual approach to diagnosis, management, and prognosis of patients with this clinical syndrome.

Areas covered: This article gives an overview of the clinical spectrum of constrictive pericardial diseases and the role of multimodality imaging in the diagnosis of constrictive pericarditis. There is a focus on the emerging role of cardiac magnetic resonance (CMR) for the diagnosis, management, and prognostication of patients with constrictive pericarditis based on more recent case series, retrospective and prospective studies, which have helped to define the role of CMR.

Expert opinion: Advanced multimodality imaging assists with identification of both overt and subclinical pericardial inflammation. This allows the pericardiologist to recognize patients with potentially reversible disease, trial medical therapy, and thereby avoid mechanical removal of the pericardium. Further, pericardial characterization by CMR has provided novel information about the natural history of these pericardial conditions, which can help tailor therapy and improve prognosis.     

Positioning ustekinumab in moderate-to-severe ulcerative colitis: new kid on the block

ABSTRACT

Introduction: Ulcerative colitis (UC) is a chronic relapsing disorder of the colonic tract. Dysregulated innate and adaptive immune pathways contribute to intestinal inflammation in IBD, and cytokines, including IL-12 and IL-23, play a key role. The blockade of both IL-12 and IL-23 may have an impact on different pathways of inflammation and could be effective for the treatment of inflammatory bowel diseases.

Ustekinumab is a fully human IgG1κ monoclonal antibody which binds to the shared p40 protein subunit of IL-12 and ?23. It is currently approved for several immune-mediated diseases such as moderate to severe plaque psoriasis, psoriatic arthritis, and Crohn’s disease, and has shown promising results in UC.

Areas covered: A review of the literature was performed to understand several aspects including the role of IL-12 and ?23 in UC, the potential therapeutic role of ustekinumab in inflammatory bowel disease, and the positioning of ustekinumab in the therapeutic algorithm of UC, based on extrapolated data from available randomized clinical trials.

Expert opinion: Ustekinumab is effective and safe in UC, and shows potential advantages compared to other drugs in moderate-to-severe UC.     

脑白质营养不良的影像学研究进展

脑白质营养不良并非一个独立的疾病,而是一组最常见于儿童的髓鞘形成或维持发生障碍的遗传性疾病的总称.随着医学影像技术的发展,对本病的认识和诊断水平明显提高.本文就脑白质营养不良的影像学研究及进展进行综述.     

Amyloid transthyretin cardiac amyloidosis: diagnosis and management

ABSTRACT

Introduction: Cardiac amyloidosis is a disorder caused by the accumulation of abnormal protein products, amyloid, in the myocardium which subsequently impairs normal heart function. Heart failure with preserved ejection fraction has been increasingly attributed to amyloidosis and the resultant restrictive cardiomyopathy it creates.

Areas covered: Amyloid transthyretin (ATTR) is one of several identified amyloid products that have been pathologically implicated in cardiac amyloidosis through advanced diagnostics. Improvements in nuclear imaging techniques, particularly scintigraphy, have enabled non-invasive diagnosis where previously endomyocardial biopsy was the only option. Despite being considered a rare disease, it is likely that ATTR cardiac amyloidosis is an underdiagnosed condition which has been supported by autopsy findings in heart failure populations. This article will review ATTR cardiac amyloidosis to provide physicians with the tools they need to establish a definitive diagnosis when there is a clinical suspicion of amyloidosis and provide the most appropriate care.

Expert commentary: Increased awareness and improved diagnostic techniques will lead to earlier diagnosis and a greater understanding of the clinical presentation. The anticipated increases in the prevalence of this disease due to increased clinical awareness will require, and in-part, facilitate the development of new therapies to manage this patient population.     

Recent advances in the use of therapeutic cancer vaccines in genitourinary malignancies

Introduction: Despite a recent increase in US FDA-approved treatments, genitourinary malignancies remain a source of significant morbidity and mortality. One focus of research is the use of therapeutic cancer vaccines in these diseases, and a significant body of clinical trial experience now exists for refining vaccine strategies to enhance antitumor efficacy and develop immune-based combination regimens.

Areas covered: In recent years, clinical data from multiple trials in genitourinary malignancies have enhanced our understanding of the potential for immunotherapy in these cancers. There are also emerging clinical strategies that combine cancer vaccines with chemotherapy, radiation, androgen-deprivation therapy and immune checkpoint inhibitors. This review is based on a search of relevant literature for data presented over the past 5 years from clinical trials of cancer vaccines in prostate, bladder and renal carcinomas.

Expert opinion: In the coming years, clinical trials informed by decades of preclinical data and emerging clinical data will help to define the role of immunotherapy in genitourinary malignancies. Combination strategies that capitalize on the immune properties of standard treatments will bring greater clinical benefits, and immune-based combinations will likely be moved to the neoadjuvant setting, where they may have optimal clinical impact.     

Cardiac Metabolic Implications of Fat Depot Imaging

Purpose of Review

This article reviews recent developments in the application of positron emission tomography (PET) for personalized cardiac imaging.

Recent Findings

PET imaging has improved our understanding of various cardiovascular pathologies by probing the molecular pathways associated with specific cardiovascular diseases. The use of PET can improve disease detection and influence management strategies.

Summary

PET has improved our understanding of the pathophysiology of atherosclerosis by imaging several key features including calcification, inflammation, apoptosis, and hypoxia. Molecular imaging of myocardial inflammation and cardiac sympathetic innervation is well established and several new promising PET radiotracers have been developed. Roles for the molecular imaging of aortic valve disease and mitochondrial function are also emerging.

     

原发性肝血管肉瘤的临床及影像学特征

目的 探讨原发性肝血管肉瘤(PHA)的临床及影像学特征。方法 回顾性分析5例经病理证实的PHA患者的临床及影像学资料。结果 PHA临床表现缺乏特异性。增强CT显示PHA病灶呈不均匀强化。CEUS示PHA呈周边不规则环状增强,中心部位存在明显的无增强区域。病理检查发现无增强区内存在大量活性肿瘤组织。结论 PHA的临床表现缺乏特异性,而CEUS表现具有一定特征,对诊断有所帮助。PHA可能存在某种特殊的增强机制,初步分析考虑可能与瘤体内部血流速度过低有关。     

Severe hematuria due to vesical varices in a patient with portal hypertension: A case report

BACKGROUNDHematuria is one of the most common clinical symptoms for urologists and is typically observed in urinary system tumors, prostate hyperplasia, and urinary stone disease. Hematuria due to vesical varices is very rare, and only a few cases have been reported since 1989. We report the first case of vesical varices due to portal hypertension with aberrant development and functioning of the genitourinary system along with the complete diagnosis and treatment process.CASE SUMMARYThis patient was a 53-year-old man with a history of aberrant development of the genitourinary system and hepatitis B-associated cirrhosis. He was admitted to the emergency department with severe hematuria and bladder clot tamponade. Many abnormally dilated blood vessels were found surrounding the bladder in the pelvis by color Doppler ultrasound, contrast-enhanced computed tomography, and three-dimensional visualization technology. It was difficult to perform transurethral cystoscopy and hemostasis in this patient, so we performed open surgical bladder exploration for hemostasis and surgical devascularization around the bladder.CONCLUSIONUrologists should improve the understanding of the pathophysiology, clinical manifestations, diagnosis, and treatment of vesical varices. This case may be presented as a reference for the diagnosis and management of severe hematuria due to vesical varices.     

Radiology of the Normal S.I. Joint

Abstract

Roentgenographic and other imaging techniques are important techniques in the diagnosis and management of SI joint diseases and disorders. This paper addresses the normal radiological anatomy of the SI joint, the indications for computed tomography, magnetic resonance imaging and isotope studies.     

足踝部籽骨、副骨外伤性病变影像学表现

目的 探讨足踝部籽骨、副骨外伤性病变的影像学表现。方法 回顾性分析75例籽骨、副骨外伤性病变患者的临床及影像学资料,分析其发生机制、临床症状及影像学表现。结果 75例患者均有急或慢性损伤史。影像学表现包括籽骨、副骨骨质改变63例,周围软组织肿胀75例,周围炎性渗出积液30例,以及囊变17例,骨髓水肿10例,周围筋膜增厚5例。结论 足踝部籽骨、副骨外伤性病变与其特殊解剖与功能密切相关;影像学可为诊断足踝部籽骨、副骨外伤性病变提供重要依据。     

Donor lymphocyte infusion following allogeneic hematopoietic stem cell transplantation

Introduction: Allogeneic hematopoietic stem cell transplantation (SCT) is the treatment of choice for many malignant hematological disorders. Following recent improvements in non-relapse-related mortality rates, relapse has become the commonest cause of treatment failure. Infusion of donor lymphocytes can potentially enhance immune-mediated antitumor activity and offers a salvage option for some patients. This paper reviews the current literature on the efficacy of this therapeutic strategy.

Areas covered: The biology of adoptive cellular therapy with allogeneic immune cells to treat relapse across a spectrum of diseases in both the full intensity and reduced intensity hematopoietic SCT settings is explored. The review discusses the current limitations of the approach and reviews several new experimental strategies which aim to segregate the desired graft-versus-tumor effect from the deleterious effects of more widespread graft-versus-host reactivity.

Expert opinion: Durable responses to DLI have been noted in chronic myeloid leukemia and responses have also been described in acute leukemia, multiple myeloma and chronic lymphoproliferative disorders. The new challenge in transplantation is to optimize DLI therapy in order to further improve patient outcomes.     

Monoclonal antibodies for renal diseases: current concepts and ongoing treatments

Introduction: In recent years, technological innovations in the field of molecular biology have provided new therapeutic options. In particular, human monoclonal antibodies (mAbs), initially used in the treatment of malignancies, have become a therapeutic tool for many other diseases. Most of the application of mAbs revealed encouraging findings to treat patients with immune-mediated glomerular diseases, for whom the standard protocols based on corticosteroids and non-specific immunosuppressants with heavy side effects have for decades been the only therapies.

Area covered: Rituximab, an mAb directed against a specific antigen expressed on B lymphocytes, CD20 antigen, inducing a premature cell apoptosis became very important in the treatment of membranous glomerulonephritis, steroid-resistant nephrotic syndromes and membranoproliferative glomerulonephritis (MPGN). Another important mAb, eculizumab, is used successfully for treatment of atypical hemolytic uremic syndrome, C3 nephropathy and MPGN. Many other mAbs are now under premarketing investigation, such as adalimumab, daclizumab, fresolimumab, belimumab, tocilizumab, although some of these mAbs are already approved for different medical applications.

Expert opinion: The availability of novel mAb may therefore constitute the basis for a revolution in the treatment of immune-mediated renal diseases. However, the cost for this therapy remains very high and represents a barrier for its widespread use.     

Engineered BDNF producing cells as a potential treatment for neurologic disease

ABSTRACT

Introduction: Brain-derived neurotrophic factor (BDNF) has been implicated in wide range of neurological diseases and injury. This neurotrophic factor is vital for neuronal health, survival, and synaptic connectivity. Many therapies focus on the restoration or enhancement of BDNF following injury or disease progression.

Areas covered: The present review will focus on the mechanisms in which BDNF exerts its beneficial functioning, current BDNF therapies, issues and potential solutions for delivery of neurotrophic factors to the central nervous system, and other disease indications that may benefit from overexpression or restoration of BDNF.

Expert opinion: Due to the role of BDNF in neuronal development, maturation, and health, BDNF is implicated in numerous neurological diseases making it a prime therapeutic agent. Numerous studies have shown the therapeutic potential of BDNF in a number of neurodegenerative disease models and in acute CNS injury, however clinical translation has fallen short due to issues in delivering this molecule. The use of MSC as a delivery platform for BDNF holds great promise for clinical advancement of neurotrophic factor restoration. The ease with which MSC can be engineered opens the door to the possibility of using this cell-based delivery system to advance a BDNF therapy to the clinic.     

多层螺旋CT成像在泌尿系统疾病的应用

本文主要介绍多层螺旋CT泌尿系成像原理,图像后处理技术以及对泌尿系疾病的诊断价值。多层螺旋CT泌尿系成像适用于泌尿系疾病的患者,它具有超高速、大范围和薄层扫描的优点,可作为临床诊断的一种有效的辅助检查手段。     

Reactivation of hepatitis B virus during targeted therapies for cancer and immune-mediated disorders

ABSTRACT

Introduction: Targeted therapies have gained popularity in the treatment of several oncologic and immune-mediated diseases. Immunosuppression caused by these drugs has been associated to reactivation of hepatitis B virus (HBV) in both hepatitis B surface antigen (HBsAg) positive patients (overt infection) and HBsAg negative/anti-hepatitis B core antigen (anti-HBc) positive carriers (resolved infection), leading to premature discontinuation of therapy and potentially fatal hepatitis.

Areas covered: This review summarizes the evidence of HBV reactivation in patients with overt or resolved HBV infection undergoing targeted therapies for cancer or immune-mediated disorders, providing recommendations for the management of these patients.

Expert opinion: The risk of HBV reactivation relies on the immunosuppressive potency and duration of these therapies, the underlying disease and the virological patient’s profile. However, HBV reactivation is preventable by screening for HBV markers in all patients scheduled to receive targeted therapies, assessing the virological profile and patient’s clinical state, followed by appropriate antiviral treatment or prophylaxis in those patients at high risk of HBV reactivation. Close monitoring of HBV carriers at low risk of reactivation is warranted with the aim to start antiviral therapy as soon as HBV reactivates.     

Ophthalmic features of systemic diseases

Abstract

The eye is intricately integrated with the functions of the body. Ocular changes may precede or run concurrently with various systemic conditions and often represent important prognostic indicators of disease progression. In addition to a thorough diagnostic evaluation and treatment of underlying processes, individuals with systemic diseases and concurrent ocular changes may need comprehensive ophthalmic examination to reduce the risk of visual impairment and morbidity. In this review the authors highlight the clinically relevant ocular signs that occur parallel with systemic conditions. In particular, the study focuses on the varied clinical presentations that can lead to rapid diagnosis to improve management of eye disorders that accompany systemic diseases.     

Imaging and clinical features of xanthogranulomatous pancreatitis: an analysis of 10 cases at a single institution

Purpose

The purpose of the study was to investigate the imaging and clinical features of xanthogranulomatous pancreatitis (XGP).

Methods

This retrospective series study included 10 patients with pathology-proven XGP. Two radiologists reviewed the computed tomography (CT) and magnetic resonance imaging (MRI) in consensus to determine the morphological features of XGP. The lesion enhancement pattern on dynamic contrast-enhanced scans and the MR signal intensity were also evaluated. Clinical data including symptoms, underlying pancreatic disease, and laboratory findings were reviewed.

Results

Two XGP cases were of a solid type; six were of cystic type, and two were mixed type. XGP usually showed a lobulated contour (90%) and heterogeneous enhancement (100%), with lesion size varying from 2 to 11 cm. Perilesional infiltration was common (90%), but pancreatic duct dilatation was less frequent (30%). Cystic type XGP mostly had an irregular thick wall (83%). On dynamic contrast-enhanced CT/MRI, XGP enhanced progressively from arterial to portal or delayed phases. Lesions appeared hypointense on T1-weighted images (89%) and hyperintense on T2-weighted images (100%). All lesions appeared hyperintense on diffusion-weighted images, with the majority (78%) showing diffusion restriction on apparent diffusion coefficient maps. The patients often had abdominal pain (80%) and underlying pancreatic disease (80%), but mostly had normal or clinically insignificant laboratory findings.

Conclusions

XGP typically manifests as a clinically silent lobulated heterogeneous mass, with a progressive enhancement pattern and/or irregular thick wall, and diffusion restriction on CT/MRI. Awareness of the imaging and clinical features of XGP may help differentiate it from pancreatic neoplasms, thereby reducing unnecessary surgery.

     

In vivo stem cell tracking in neurodegenerative therapies

Introduction: Cell transplants to replace cells lost due to injury or degenerative diseases, for which there are currently no cures, are being pursued in a wide range of experimental models. Thus, the application of stem cell-based therapies to treat neurodegenerative and traumatic injuries is now a clinical reality. However, the monitoring of cellular grafts, non-invasively, is an important aspect of the ongoing efficacy and safety assessment of cell-based therapies. Hence, there is a need for non-invasive imaging techniques to ensure that transplants are not only administered to the relevant site, but also allow the monitoring of inappropriate cellular migration to improve our understanding of stem cell migration in the context of the whole organism.

Areas covered: This review provides an up to date overview of molecular imaging approaches that have been used for visualizing and tracking transplanted stem cells, in vivo.

Expert opinion: It's important to emphasize that the application of molecular imaging to interrogate transplanted cells may require one or even two imaging modalities to provide a reasonable assessment of transplanted cells in specific organs.     

重视儿童造血干细胞移植(HSCT)术后并发症影像学表现

造血干细胞移植（HSCT）在治疗各种儿科难治性良性疾病和恶性肿瘤中具有越来越重要的作用,而诊断和干预HSCT术后并发症影响疗效和预后。目前针对HSCT术后并发症虽已取得可喜成果,但仍面临着不能尽早准确诊断并及时治疗的困境。医学影像学的发展为此提供了助力。HSCT术后常见中枢神经系统感染和可逆性后循环脑病、肺部感染、累及胃肠道和肺部移植物抗宿主疾病以及少见的移植后淋巴增殖性疾病等均具有某些影像学特征性表现,有助于诊断和鉴别并为临床提供重要帮助。     

Alcoholic heart disease

PREVIEW

Although essential tremor is common, its various presentations may be confused with other movement disorders, such as Parkinson's disease and dystonic tremor. In this article, Dr Evidente describes classify cation of tremor, the clinical features of essential tremor, and the differential diagnostic considerations. He also discusses the extensive list of medications used to treat the disorder and the surgical options for severe, drug-resistant cases.